Yasuo Sannohe

Oat cell carcinoma (apudoma) of the esophagus. A case report

An oat cell carcinoma occurring in the esophagus of a 62‐year‐old man is described. A strong argyrophilia of the oat cells together with the presence electron microscopically of neurosecretory type granules in their cytoplasm suggests a derivation of this tumor from the cells of the APUD series, and the tumor is diagnosed as apudoma. An aberrant columnar epithelium on the esophageal surface is presumed to be the source of its origin. A rapid postoperative course of the patient despite a rather circumscribed growth pattern of the primary tumor appears to characterize the clinical aspect of this case. An apparent accumulation of the cases with esophageal apudoma in Japan is discussed.

Lymph node metastases in cancer of the thoracic esophagus

Curettage of lymph nodes in 36 patients with cancer of the thoracic esophagus was performed in the bilateral supraclavicular, right intrathoracic and abdominal regions. The overall metastatic ratio in lymph nodes was 52.8 percent (19 of 36). It was particularly high in the right supraclavicular nodes (26.7 percent), the paracardial (27.8 percent) nodes, and nodes of the arch of the left gastric artery (19.4 percent) and the celiac axis (16.7 percent). Metastatic lesions were limited to the intrathoracic lymph nodes in 1 of 19 patients with positive nodal metastasis and were accompanied by metastases of the supraclavicular or abdominal nodes in the other 18 patients. In eight (88.9 percent) of nine patients in whom intrathoracic nodal metastases were confirmed, the supraclavicular or abdominal lymph nodes were involved by metastatic lesions. On the other hand, jumping metastasis to the neck or the abdominal lymph nodes without intrathoracic involvement was observed in 27.8 percent.

Single layer suture by manual or mechanical stapling technique in esophagojejunostomy after total gastrectomy

Manual single layer suturing procedures were used for esophagojejunostomy in end-to-side fashion after total gastrectomy in 30 patients with upper gastric carcinoma involving the esophagus. Only one minor suture line leak was observed in spite of the anastomosis without any other seromuscular reinforcing sutures. Transabdominal, highly placed intramediastinal esophagojejunostomy was made by mechanical suturing; the instrument proved simple to use and produced a reliable closure of good quality in 14 patients with esophgogastric cancer. Suture line leak was seen in two patients in whom this one layer inverting stapling suture technique was used. Post-operative barium roentgenography of the anastomosis by these two methods showed a stoma wide enough to pass any kind of food without stenosis in all successful cases.

Clinico-pathological significance of the dna histogram patterns in cancer cell nuclei of the stomach and the esophagus

SummaryCytofluorometric analysis of nuclear DNA content was performed in carcinoma cells of the stomach and the esophagus and the exclusive four types of the DNA histogram patterns were established. In 33 patients with carcinoma of the stomach 7 (87.5%) out of 8 with Type I and 3 (50%) out of 6 with Type II in the DNA histogram pattern were the superficial spreading types of carcinoma. Eighteen (81.8%) out of 22 patients with advanced gastric carcinoma belonged to Type III or IV in the DNA histogram pattern and there was only one of the superficial spreading carcinoma seen in these Types. The superficial spreading carcinoma (Stout10)) is generally reported to take more favorable clinical course than the usual advanced ones and the above data were supported that the DNA histogram pattern was associated with prognostic important property of invasive growth.In 34 patients with carcinoma of the esophagus 4 out of 7 with Type I in the DNA histogram pattern have been living more than 3 years following surgery with poor lymphatic permeation (14.3%) around the tumor. While, 6 out of 9 with Type IV had an early recurrence of cancer causing postoperative death within a year after surgery with high incidence of lymphatic permeation (77.8%) around the tumor. Thus, the DNA histogram pattern in the cytofluorometric DNA analysis of the tumor cells seems to give valuable information about the malignancy degree of the individual tumor, which is not possible to obtain only from the cytomorphological features.

A new trial in endoscopic diagnosis for stomach cancer: Intra-arterial dye (IAD) method

Forty gastric cancers were examined by endoscopy before and after the injection of Evans blue or indigo carmine dye into the celiac artery. Seventeen of these lesions were also examined after injection of vasomotor drugs. The authors conclude that these techniques permitted more precise endoscopic deliniation of the size and extent of cancerous lesions, particularly those otherwise obscured by overlying, intact epithelium.

Fatal interstitial pneumonitis induced by low dosage of bleomycin in an esophageal cancer patient

One-shot intratumor injection of 60 mg oil-bleomycin prior to subtotal esophagectomy induced fatal, acute interstitial pneumonitis in a 53 year-old esophageal carcinoma patient. The progression of bleomycin-induced pneumonitis was rapid and the patient succumbed to respiratory insufficiency 41 days after surgery (58 days after bleomycin administration). Autopsy revealed bilaterally increased lung weight and the organ was of rubbery consistency and anthracotic. Histology showed advanced interstitial fibrosis, numerous lymphocytes in alveolar septi and fibrinous exudate, macrophages and desquamative cells within the alveolar spaces.In the present case, pneumonitis was due not to patient age or dosage level of bleomycin, but rather to the administration method.

Onlay fundic patch method applied in spontaneous rupture of the esophagus: a case report.

A successful attempt using the onlay fundic patch method for treatment of spontaneous rupture of the esophagus (SRE) was reported. A 38-year old male presented with left chest pain and a preoperative diagnosis of SRE was made. Surgery was performed 16 hours after the onset of symptoms and a 3 cm esophageal tear just above the level of the diaphragmatic hiatus was noted. The esophageal tear was repaired by the onlay fundic patch method through left thoracotomy and the postoperative course was uneventful and recovery was complete.A search of the literature has yielded only one case of SRE that was improved with onlay fundic patch by Thal and Hatafuku (1964) and this method is useful for the immediate and late repair of rupture of the esophagus.

Mechanical suture methods in esophago-gastrointestinal anastomosis

Mechanical suturing procedures have been performed in 10 patients for total gastrectomy, 6 for proximal partial gastrectomy and 7 for esophageal transection. The instrument (SPTU all-round type made in Russia) proved simple to use and produced reliable good quality closures without any other inforcement. There was one minor suture leak in 10 patients with intramediastinal esophagojejunostomy and in 6 with proximal partial gastrectomy respectively, but neither leak nor other problem has been arisen in esophageal transection for varices.It is believed that this staple suturing methods used SPTU all-round type apparatus are safe from anastomotic failure and useful for secure intramediastinal anastomosis in high level, and they represent a significant advance in the technique of thoraco-abdominal surgery.