Yasuo Ohtani

Visualization, quantification and therapeutic evaluation of angiogenic vessels in cancer by synchrotron microangiography

The usefulness of a synchrotron microangiography system for depicting, quantitating and therapeutically evaluating angiogenic vessels in cancer is illustrated. In 20 mice transplanted with murine colon cancer, sequential changes in the angiogenic vessels were determined by using synchrotron microangiography, using changes in tumor volume for reference. This system allowed the depiction and quantification of angiogenic vessels in the period from one to four weeks after transplantation. The effects of antiangiogenic therapy were evaluated by using a neutralizing antibody against vascular endothelial growth factor. The neutralizing antibody partially suppressed angiogenesis and tumor growth. Synchrotron microangiography is shown to be useful for the depiction, quantification and evaluation of angiogenic vessels in cancer.

Clinical significance of wall invasion pattern of subserosa-invasive gallbladder carcinoma.

We have previously classified wall invasion patterns of gallbladder carcinoma (GBC) cases into two groups, i.e., the infiltrative growth type (IG type) and destructive growth type (DG type). The DG type was significantly associated with poor differentiation, aggressive infiltration and decreased postoperative survival in terms of its histological differentiation, lymphatic invasion, venous invasion, lymph node status, neural invasion and mode of subserosal infiltration. In the present study, we analyzed 42 surgically-resected subserosal invasive gallbladder adenocarcinomas, invading the perimuscular connective tissue (pT2). The cumulative 5-year survival rate in the series was 48.7%. Lymphatic invasion (p=0.021), venous invasion (p=0.020), mode of subserosal infiltration (p<0.001), histological differentiation (p=0.030) and biliary infiltration (p=0.007) were noted, respectively, at a significantly higher incidence in more aggressive infiltration or poor differentiation in the DG type. The cumulative 5-year survival rate of curative resection cases was lower in patients with the DG type than in those with the IG type (68.9 versus 20.2%, respectively, p=0.006, log-rank test). On Cox’s proportional hazard regression modeling, the low degree of venous/perineural invasion and IG type of wall invasion pattern were associated with a significant improvement in overall survival. Our data suggest that the wall invasion pattern is an independent predictor of survival in subserosal invasive GBC. Regarding the clinical application of our concept, on the classification of patients with subserosal invasive GBC based on a combination of the wall invasion pattern and lymph node status, the overall survival rate in patients with the DG type and/or N2 metastasis (n=21) was lower than in patients with the IG type and N0, 1 metastasis (n=21) (p=0.0023, log-rank test). The wall invasion pattern could contribute to decision-making concerning curative resection for subserosal invasive GBC.

Gallbladder adenocarcinoma with human chorionic gonadotropin: a case report and review of literature

BackgroundThe case of adenocarcinoma with human chorionic gonadtropin (HCG), primary in the male gallbladder, is extremely rare. A Medline search has shown only a few similar cases reported.MethodsWe herein describe a case of primary gallbladder adenocarcinoma associated by ectopic HCG positive tumor cells in a 79-year-old male.ResultsPathological examination showed a mixture of moderately and poorly differentiated adenocarcinoma with ectopic HCG and placental alkaline phosphatase (PlAP) in tumor cells, though the increase of serum or urinary HCG secretion was not confirmed. The literatures were also reviewed.ConclusionsA case of gallbladder cancer with ectopic HCG production is quite rare in the literature, though many similar cases in other site, especially in GI tract, are reported. Embryological consideration suggests the increased frequency of similar cases more than being thought now.

Nonfunctioning pancreatic endocrine tumor with extension into the main pancreatic duct: Report of a case

Pancreatic endocrine tumors (PETs) rarely involve the main pancreatic duct. We report a case of malignant nonfunctioning pancreatic endocrine tumor (NFPET) with prevalent intraductal growth. A 47-year-old woman was referred to us after ultrasonography at a routine health check showed diffuse swelling of the pancreas. Preoperative imaging showed a solid mass in the tail of the pancreas and a bulging intraductal mass in the main pancreatic duct. We performed total pancreatectomy because the tumor occupied almost the entire lumen of the main pancreatic duct. Histological examination confirmed well-differentiated endocrine carcinoma. We review reported cases of the intraductal growth of NFPETs and discuss the pathogenesis of these unusual tumors.

DUPLICATE GALLBLADDER DIAGNOSED WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND TREATED WITH LAPAROSCOPIC CHOLECYSTECTOMY

A 44‐year‐old man was admitted to hospital because of sudden severe postprandial right epigastric pain. Abdominal echography showed multiple calculi in the gallbladder and evidence of a probable septum at the neck. Based on the results, tentative diagnoses were made of gallbladder calculosis with associated gallbladder curvature or malformation, and gallbladder adenomyomatosis. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) revealed a duplicate gallbladder consisting of two cystic ducts with two connected gallbladders. Laparoscopic cholecystectomy (Lap‐C) was performed. Inflammation of the Calots triangle was mild. The two cystic ducts with one common bile duct were identified, and the cystic ducts separated by individual clipping. Duplicate gallbladder, a malformation of the gallbladder, has been reported to occur at an incidence of 0.02%. To date, a total of 60 cases have been reported in Japan, and recent cases have been treated with Lap‐C. In the present case, the surgery could be safely performed because the bifurcation of the cystic ducts could be identified by preoperative ERCP.

A Case of Post-Laparoscopic Cholecystectomy Bile Leakage from the Cystic Duct Treated by Endoscopic Nasobiliary Drainage without EST

Abstract: The patient was a 45 year old female with cholelithiasis who had undergone laparoscopic cholecystectomy. Bile leakage was detected from the site of Penrose drain insertion immediately after the operation. As no improvement of bile leakage was subsequently observed, ERCP (endoscopic retrograde cholangiopancreatography) was performed on the third postoperative day. Neither choledocholithiasis nor choledochal stricture was found and the diagnosis of bile leakage from the cystic duct stump was made. A 5Fr ENBD (endoscopic nasobiliary drainage)‐tube without EST (endoscopic sphincterotomy) was inserted into the common bile duct, and bile leakage disappeared completely on the third day after insertion of the ENBD tube. Additional laparotomy, EST or biliary stenting was thereby avoided. Choledo‐chography, via the ENBD‐tube, showed no leakage of contrast material, the ENBD‐tube was removed and the patient was discharged. ENBD should be considered as a method of treatment for management of bile leaks from the cystic duct stump.

2 Long Term Survival Cases of Small Pancreatic Cancers Performed Middle Pancreatectomy

われわれは, 膵中央切除術を施行し5年生存が得られた小膵癌2例を経験した. 症例1: 72歳の女性で, 心窩部痛で来院し超音波検査で膵体部腫瘤が指摘された. 精査の結果, 小膵癌と診断, 膵中央切除術を施行. 病理診断は中分化型管状腺癌, stage Iであった. 術後5年7か月無再発生存中である. 症例2: 68歳の男性で, 無症状にて検診超音波検査で膵管拡張と膵腫瘍が指摘され来院した. 精査の結果. 膵体部小膵癌と診断, 膵中央切除術を施行, 病理診断は中分化型管状腺癌, stage IV aであったが術後5年3か月無再発生存中である. 従来, 予後不良な膵管癌では, 脈管侵襲, 膵外進展および転移率の高さから, 小膵癌でも拡大手術を求める傾向があるが, 縮小手術でも長期生存する症例もある. TSP-1, EGFRなどの癌増殖転移関連因子の発現の有無を検討することは, 拡大手術を避け, 縮小手術の可能性を示唆するものと考えられた.