Yoichi Kasai

Alveolar echinococcosis of the liver; studies on 60 operated cases.

During the years 1936 through 1978, 60 cases received surgical intervention for alveolar echinococcosis of the liver. The re-sectability and operative mortality rate were 64.0% (16/25) and 43.8% (7/16) before 1968, but 54.3% (19/35) and zero (0/19) thereafter. Establishment of clinical staging and criteria for justifying radical resection of a given lesion, combined with systematic evaluation of all hepatic vasculatures, contributed to improvement of the result. The long-term prognosis of the disease, unless resected, has been exclusively poor. A mass screening program, which became possible by the development of serologic tests, has covered a population of over 140,000 in the endemic area and been of value in detecting the disease in its early developmental stage. The disease should be recognized even in currently unaffected areas since the cestode has a fairly wide geographic distribution including the United States.

PRIMARY YOLK SAC TUMOR OF THE LIVER

An autopsy case of yolk sac tumor of the liver in a 29‐year‐old female was reported. The tumor was found originally in the right anterior segment of the liver on the first operation. The autopsy disclosed that the liver was almost entirely replaced by multiple, round tumor nodules. The tumor masses continuously extended to the peritoneum and to the subcutaneous tissue. There were no tumors in other organs including the ovaries, gut, stomach, lung, uterus, and kidneys, indicating that the tumor originated in the liver. Microscopically, the tumor showed typical characteristics of the yolk sac tumor. An immunohistochemical study showed that AFP was distributed fine granularly in the cytoplasm of tumor cells. Electron microscopic observation disclosed large amounts of electron‐dense material being closely related to basement membrane.

Carcinoma arising in the cyst of the liver--report of three cases--.

A generally recognized concept dictates that surgical intervention for non-parasitic cysts of the liver is mostly palliative such as aspiration of the content, suture and closure, internal or external drainage, marsupialization, and unroofing of the cyst, while total excision of the entire cyst, which sometimes necessitates hepatic resection, is not usually recommended.3, 6, 9 The results of these lesser procedures have been acceptable, favoring those conservative procedures.This paper presents three cases with carcinoma arising in the cysts of the liver. Review of the present cases with five comparable cases appearing in the literature revealed that young female population and left lobe of the liver are frequently involved. Hence the general trend for palliative procedures should be reassessed. Possible malignancy should be considered when a patient belongs to this category, the cystic content is not clear, or the cystic wall presents irregular texture with nodules. The carcinomatous changes would have been of higher incidence than reported if the entire cysts had been more carefully examined.

Stage IVS neuroblastoma.

This is a review of the findings in 10 cases of stage IVS neuroblastoma, that have been observed in the First Surgical Department of Hokkaido University Hospital. The patients under the age of 1 yr in stage IVS neuroblastoma have a favorable prognosis; the survival rate was 70%. The regressions were histologically confirmed as maturation of the neuroblastoma cells to ganglioma cells. The lymphocyte counts and T-cell function were well maintained in the surviving patients but both were markedly reduced in the patients who later died. The treatment should be conservative so that immune mechanisms are not inhibited and should be withheld until respiratory failure or progressive signs toward stage IV are identified.

Revision of porto-enterostomy in congenital biliary atresia

For the patients with insufficient bile flow following porto-enterostomy for congenital biliary atresia, removal or resection of granulation or scar tissue at the porta hepatis has been performed. Of 11 reoperations, constant bile excretion was obtained in four. Sufficient resection of scar tissue at the porta hepatis was most important for revision of porto-enterostomy. For resection of scar tissue, a special scissors devised by us was used.

Establishment of an experimental model of human hepatoblastoma

Establishment of xenografts or cell culture lines in which the α‐fetoprotein (AFP) characteristic of clinical hepatoblastoma persists have been difficult. The serially transplantable strain (HB‐3) of highly AFP‐producing hepatoblastoma was successfully established in nude mice. And a highly AFP producing cell line (c‐HB‐3) is easily obtained by HB‐3. This strain and line give us an ideal experimental model of hepatoblastoma in vivo and in vitro. Cancer 50:97–101, 1982.

Operative treatment of alveolar echinococcosis of the liver

This study is based on the experience with 51 cases of hepatic alveolar echinococcosis underwent operative treatment up to the end of 1976. Hepatic resection was carried out in 28 cases with overall operative mortality of 25 per cent, but no death occurred in the last 10 years period during which 12 cases were subjected to the procedure. This apparent improvement of the result is ascribed to the establishment of the strict criteria for operative intervention, i.e., when less than three segments are involved, the hepatic hilum is not highly involved, and the inferior vena cava is not invaded. Marsupialization is employed when hepatic resection is not indicated and the lesion shows liquefaction. Ten cases underwent the procedure with one operative death. Biliary tract reconstruction was carried out in two cases with hilar involvement, but the prognosis was poor. Eleven cases were only with celiotomy. The follow-up studies indicated that the hepatic resection offers the best hope for cure followed by marsupialization.Unlike unilocular echinococcosis in which a cyst grows expansively, the alveolar echinococcosis should be considered clinically malignant, in that it grows invasively and often shows metastatic lesions. Surgical intervention at its early developmental stage is the only definitive way of the treatment. Only recent advances in diagnostic procedures and development of type specific serological studies made it possible to bring the disease under control.

Clinical evaluation of palliative therapy for unresectable primary liver cancer

Ninety‐nine patients with unresectable primary liver cancer were treated with ligation of the hepatic artery (LHA), intra‐arterial infusion chemotherapy (IAIC) or transcatheter arterial embolization (TAE) between 1960 and 1983. A statistical study was made of therapeutic effects and prognosis. The results are as follows: (1) The mean survival time of 14 patients treated with LHA was about 5 months. (2) The survival time of the LHA + IAIC with mitomycin C group was not prolonged as compared with that of the LHA group, but LHA + IAIC with Adriamycin (doxorubicin) group showed a significant prolongation of survival time over the LHA group. (3) In the LHA + IAIC with Adriamycin group, the mean survival time was 12.8 months and the 1‐year survival rate was 37.5%. (4) Factors including age, presence of liver cirrhosis, number of involved segments, and degree of anaplasia graded on Edmondsons criteria did not influence survival time. Cancer 58:329–331, 1986.

Thyroid cancer in childhood

Thyroid cancer in childhood is a relatively rare condition. Often is shows biological characteristics different from those seen in adults. Based upon 10 cases in our clinic and 57 cases collected from the Japanese literatures, clinical features, pathology, treatment and prognosis of thyroid cancer in childhood are discussed. Pathogenesis is most likely to be related to hormonal changes during adolescence and previous radiation of the neck region. Cervical lymph nodes swelling was the chief complaint in 84.6 per cent of the cases. On the other hand, pulmonary metastases were recognized in the early stages in 33.5 per cent of the cases. Radical excision of the tumor with modified radical neck dissection is the treatment most frequently employed even in the presence of lung metastases. However, hypoparathyroidism and recurrent nerve injuries should be avoided at all cost in view of long life expectancy and the difficulty in treating them satisfactorily. Prognosis could be as good for children as it is for adults except in cases with early lung metastases.

Effect of anti-α-fetoprotein serum on human hepatoblastoma

There is no definitive treatment of hepatoblastoma. Except for radical resection, the prognosis of unresectable cases remains pessimistic. Therfore, the development of new anticancer drugs for this tumor is urgently needed. Using the human hepatoblastoma cell line (c-HB-3) we demonstrated that horse anti-α-fetoprotein containing serum suppressed proliferation of the hepatoblastoma cells. This effect was dependent on the duration of exposure and the concentration of anti-α-fetoprotein serum.