Toshimitsu Matsusaka

Evaluation of extensive lymph node dissection for carcinoma of the stomach.

We compared the results of curative resection for carcinoma of the stomach in 254 patients who underwent simple resection (SR) and 454 patients who underwent extensive regional lymph node dissection (ELD). The 5-year survival rates of the 2 procedures were significantly different in carcinoma involving the serosa of the stomach; it was 45% in the ELD group and 18% in the SR group (p<0.001). In patients with regional lymph node metastasis we obtained a 5-year survival rates of 39% and 18% by ELD and SR, respectively (p<0.001). The incidence of metastasis to the secondary lymph nodes, removable only by ELD, was higher in cases with carcinomatous invasion of the deeper layers of the gastric wall, and this may have been the reason why ELD proved to be more effective than SR. ELD is discussed in relation to the site of the primary carcinoma and the extent of lymph node metastasis.

Pseudosarcoma and carcinosarcoma of the esophagus.

Two cases of polypoid carcinoma with pseudosarcoma and one of so‐called carcinosarcoma of the esophagus are presented. The clinical and morphologic characteristics of these tumors are described and the literature is reviewed. It is postulated that pseudosarcomas and so‐called carcinosarcomas belong essentially to the same pathologic entity because of their similar morphologic and biologic aspects. The histogenesis of the sarcoma‐like elements of these tumors support the theory of epithelial origin on the basis of the sarcoma‐like transformation of squamous cell carcinoma and of the presence of epithelial elements in the “sarcomatous” areas.

Anaplastic carcinoma of the esophagus. Report of three cases and their histogenetic consideration.

The autopsies of three cases of esophageal anaplastic carcinoma with an oat cell pattern are presented. Grossly, each case revealed a fungating growth and showed extensive metastases all over the body. The histology bears a striking resemblance to that of oat cell carcinoma of the lung, occasionally showing rosette formation, mucin secretion, and intracytoplasmic argyrophil granules in each case. These peculiar carcinomas most probably were derived from the esophageal submucosal glands. They were composed of both a cell group of argyrophil variety and a group of mucus‐secreting variety which may have originated from the more primitive cells capable of differentiation into either variety.

Recurrence in early gastric cancer. A pathologic evaluation

The cause of death in 26 of 220 cases of early gastric carcinoma was studied, particularly in relation to the mode of recurrence. Of the 26, 7 patients died of disease related causes and gross appearance revealed that 4 cases were IIa predominant, 2 were IIc (or +I), and 1 was IIc predominant. Histologic examination indicated that all 7 cases were differentiated‐type adenocarcinomas. Two of 7 recurring carcinomas were due to residual carcinoma in the resected stumps and 5 patients had hematogenous metastases, particularly in the liver. Eighteen of the 26 patients died of other causes, in 1 case of unknown causes, and it is interesting that in 5 of the 18 cases, simultaneous or nonsimultaneous double carcinomas at sites other than the stomach were noted. In order to prevent recurrence in early gastric carcinoma, it is important that no carcinoma be left in the resected stump or remnant, and that the prophylaxis be achieved through the administration of adequate amounts of anticancer chemotherapy, in order to prevent hematogenous metastasis, particularly to the liver. Cancer 46:168–172, 1980.

Carcinomas of the stomach in the young adults

The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.

Malignant Adenomyoepithelioma of the Breast:A Case with Distant Metastases.

Adenomyoepithelioma is thought to be a low-grade malignancy, and cases showing malignant behavior are rare.A massive breast tumor with skin invasion in a 60-year-old woman was diagnosed as malignant adenomyoepithelioma. Despite the tumor size and skin invasion, no axillary lymph node metastases were detected. Light microscopy showed proliferation of tubular structures composed of atypical epithelial and myoepithelial cells and occasional anaplastic cells with mitotic figures extending to the epidermis of the skin.Twenty-four months after the surgery the patient complained of dull pain in the right thigh, and was found to have bone, lung and mediastinal lymph node metastases. There was neither local recurrence nor axillary lymph node metastasis. Subsequent femur fracture was treated by osteotomy. Despite additional chemoradiotherapy, the patient died 43 months after the first operation.Our case and literature review indicated that this tumor tends to show hematogenous metastasis.

Clinicopathologic evaluation of recurrence in early gastric cancer

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.

Long-term outcome of S-1 and cisplatin combination therapy in patients with advanced or recurrent gastric cancer.

BackgroundAlthough combination therapy of S-1 and cisplatin (CDDP) has excellent efficacy against gastric cancer, the effect of the treatment on survival has been unclear. The aim of this study was to evaluate the long-term outcome of this combination therapy.MethodsSixty-three patients with advanced or recurrent gastric cancer were treated with S-1, with or without CDDP, as first-line chemotherapy, and the clinical results were compared retrospectively. S-1 was administered orally at a standard dose of 80 mg/m2. In the treatment of the S-1 group, S-1 was given for 28 consecutive days, followed by a 14-day rest. In the treatment of the S-1/CDDP group, S-1 was given for 21 consecutive days, followed by a 14-day rest, and CDDP, at 60 mg/m2, was infused on day 8.ResultsThe incidence of adverse reactions of more than grade 3 was 22.5% in the S-1 group and 43.5% in the S-1/CDDP group, and the treatment compliance was better in the S-1 group. The overall response rate was 25.9% in the S-1 group, and 36.8% in the S-1/CDDP group. The combination of S-1 with CDDP had better effects on the primary lesion and on differentiated-type carcinoma than S-1 alone. However, there was no difference in survival between the two patient groups. The median survival time after the initiation of treatment in the S-1 group was 322 days, and that in the S-1/CDDP group was 319 days.ConclusionsOur results suggest that the combination of CDDP with S-1 does not improve the long-term outcome of S-1 therapy.

Primary Non-Hodgkin's Lymphoma of the Breast: A Report of Two Cases

Background: Primary non-Hodgkin’s lymphoma of the breast (PBNHL) is a rare neoplasm and PBNHL occuring in a man is extremely rare.Method: We report herein two cases of PBNHL and discuss methods of diagnosis and treatment.Results: The first patient was a 35-year-old woman who presented with an elastic-hard mass in her left breast and adenopathy in her left axillary fossa. Mammography and ultrasonography suggested left breast cancer. Frozen sections demonstrated PBNHL histologically. Quadrantectomy of the breast was performed followed by chemotherapy. The second patient was a 65-year-old man with an elastic-hard mass in his left breast and left axillary lymphadenopathy. Mammography and ultrasonography suggested breast cancer or a soft tissue tumor. Intraoperative histological examination revealed a diagnosis of non-Hodgkin’s lymphoma (NHL). A simple mastectomy and postoperative chemotherapy were performed and the patient had a good prognosis.Conclusion: A multidisciplinary approach including surgery, chemotherapy, and radiotherapy is indispensable in treating PBNHL, after diagnosis by excisional biopsy or aspiration cytology.

Direct Hypogastric Artery Reconstruction for Threatened Lower Limb Ischemia: Report of a Case

Abstract The hypogastric artery is one of the major collateral arteries in aortoiliac occlusive disease. This report describes a case of limb-threatening ischemia caused by acute arterial thrombosis of the right hypogastric artery. The external iliac and distal arteries were obstructed and the hypogastric artery was a major collateral artery. A diagnostic arteriogram taken after intra-arterial thrombolytic therapy revealed a stenotic lesion in the orifice of the hypogastric artery. Open thromboendarterectomy of the hypogastric artery and patch angioplasty, using an expanded polytetrafluoroethylene graft, were performed to salvage the limb. The hypogastric artery was successfully revascularized and ischemic rest pain was relieved.