Yoshiro Matsumoto

Overexpression of Lymphangiogenic Growth Factor VEGF-C in Human Pancreatic Cancer

Vascular endothelial growth factor C (VEGF-C) is a lymphangiogenic polypeptide that has been implicated in cancer growth. In this study, we characterized VEGF-C expression in cultured human pancreatic cancer cell lines and determined whether the presence of VEGF-C in human pancreatic cancers is associated with clinicopathologic characteristics. VEGF-C mRNA transcripts were present in all five tested cell lines (Capan-1, MIA-PaCa-2, PANC-1, COLO-357, and T3M4). Immunoblotting with a highly specific anti-VEGF-C antibody revealed the presence of VEGF-C protein in all the cell lines. Northern blot analysis of total RNA revealed an approximately 2.2-fold increase in VEGF-C mRNA transcript in the cancer samples compared with the normal pancreas. Immunohistochemical analysis confirmed the expression of VEGF-C and its receptor flt-4 in the cancer cells within the tumor mass. Immunohistochemical analysis of 51 pancreatic cancer tissues revealed the presence of strong VEGF-C immunoreactivity in the cancer cells in 80.4% of the cancer tissues. The presence of VEGF-C in these cells was associated with increased lymphatic vessels invasion and lymph node metastasis, but not with decreased patient survival. These findings indicate that VEGF-C and its receptor are commonly overexpressed in human pancreatic cancers and that this factor may contribute to the lymphangiogenic process and metastasis in this disorder.

Anomalous Lesions of the Pancreatic Head and Vaterian System, Related to Their Structures

There are a variety of anomalous lesions that can arise in the pancreaticobiliary system. nPancreaticobiliary maljunction (PBM), in which the junction of the bile duct and the pancreatic nduct is exte

A Case of Extrahepatic-Growing Hepatocellular Carcinoma who Survived More than 5 Years without Recurrence, after Resection of Solitary Intrahepatic Metastasis which was Detected 18 Months after the Primary Resection.

症例は57歳の女性. 1992年7月14日, 肝外発育型肝細胞癌の診断で肝外側区域切除を施行した. 腫瘍は細い茎で肝外側区域と連続し, 最大径6.5cmの有茎型腫瘍で, 肝内に腫瘤性病変は認めなかった. 腫瘍は病理組織学的に中～低分化型肝細胞癌で, 茎の部分で腫瘍の脈管侵襲を認めた. 術後18か月目, 内側区域に径1.5cmの腫瘤を認め, 再切除術を実施した. 再発腫瘍は組織学的に初回切除腫瘍の組織型に類似した中分化肝細胞癌であり, 肝内転移再発と考えた. その後は5年以上無再発で生存中である. 肝外発育型肝細胞癌は有茎型であっても肝内転移を考慮した系統的肝切除術を選択する必要があることを示唆する症例である.

Effect of Splenectomy on Prognosis in Immunochemotherapy After Total Gastrectomy for Gastric Cancer

This retrospective study was undertaken to gain insight into the relationship between spleen and immunochemotherapy after total gastrectomy. The patients were stratified into two groups in stage II and III: a splenectomized group and a spleen preserved group. Furthermore the patients in each group were divided into immunotherapy and non-immunotherapy group. Survivals of splenectomized group was lower than spleen preserving group. The 5-year survival rate of spleen preserved group with immunotherapy in stage III was 41.7%. It was significantly higher level compared with 0% of splenectomized group with non-immunotherapy in stage III. These results suggest that the spleen is necessary for effective immunotherapy.

Expression of the Antimetastatic Gene nm23 in Human Hepatocellular Carcinomas

Expression of nm23 messenger RNA was investigated by primer extension-reverse transcription and polymerase chain reaction method (RT-PCR) in patients with hepatocellular carcinomas (HCC). Relative density units (RDU) of the expression of nm23 (Mean ± S.D.) in non-cirrhotic liver, cirrhotic liver and HCC were 0.86 ± 0.26, 0.84 ± 0.24 and 0.56 ± 0.38, respectively. RDU in solitary HCCs less than 5 cm in diameter with no portal thrombus or capsular infiltration and multinodular HCCs in the whole liver were 0.74 ± 0.51 and 0.38 ± 0.26 (p<0.05). Two years after gross resection of solitary HCCs, RDU in recurrent cases and in recurrence-free cases were 0.95 ± 0.57 and 0.49 ± 0.30, respectively (p<0.05). These results suggest that the expression of nm23 decreases during progression of HCC. It may be a useful factor for predicting the risk of intrahepatic metastasis from HCC in individual cases at the time of initial surgical treatment.

A Case Report of Synchronous Early Esophageal Cancer and Early Gastric Cancer.

食道癌は頭頸部癌, 胃癌など他臓器癌を併存することは知られているが, 食道, 胃の同時性早期癌は比較的まれであり, 本邦において過去に19例の報告があるだけである. 今回われわれが経験した症例は, 66歳の男性で, 胸やけを主訴に来院した. 上部消化管検査の結果, 胸部中部食道のIIa+IIb型早期癌と胃角部のIIc型早期癌と診断された. 食道, 胃同時性早期重複癌として, 胸部食道全摘術, 幽門側胃亜全摘術, 左側結腸による胸骨後再建術施行し, 結腸胃吻合には器械吻合器を用いた.胃中部または胃下部の早期癌と食道との同時性早期重複癌の術式は, 文献的にはほとんどの症例で胃全摘術がなされており, 本例のように胃亜全摘術が施行されたのは本例を含めて2例のみであり, 手術術式に重点をおいて文献的考察を加え報告する.

Differential diagnosis for the cystic lesion of the pancreas with a special references to analysis of intracystic fluids.

過去20年間の自験膵嚢胞性疾患20例中, 仮性嚢胞は9例, 真性嚢胞は11例であった. 腹痛は仮性嚢胞の全例にみられたのに対し, 真性嚢胞では6例が腹痛を伴わない腹部腫瘤を主訴とした. 血清アミラーゼ値は仮性嚢胞の9例中8例が229～1,580IU/lと高値を示した. 嚢胞の存在診断にはCTおよび超音波検査が有用であったが, 質的診断には不十分であった. 嚢胞内容液のアミラーゼ値は真性嚢胞が4.398±9.1311U/lであるのに対して仮性嚢胞では199, 360±135,58IIU/lと著しく高値であった. また, 細胞診では悪性例6例中4例がclass IV, またはclass Vであった. 内容液のCEA値は, 悪性例では50,278±83,948ng/mlで, 良性例の256±141ng/mlと比べ有意に高値を示した. 以上より, 嚢胞内容液のアミラーゼ値, 細胞診, CEA値は膵嚢胞性疾患の質的診断に有用と考えられた.

Clinical aspects and surgical treatments in patients with anomalous arrangement of the pancreatico-biliary ductal system.

胆管と膵管の合流点が十二指腸壁外に認められる先天性総胆管拡張症ならびに正常な胆管の内腔例103例について共通する臨床症状および治療法を検討した. これらに共通する臨床像は上腹部痛ならびに背部痛であり, 発作時の臨床化学的検査で急性膵障害および胆汁うっ滞型の急性肝障害が大部分の症例に, 同時に認められることである. これは胆管と膵管の「共通の導管」が膵管であろうと考えられるところから, この部分に胆汁の通過などによる後天的な通過障害が生じ, 胆汁, 膵液の膵管内および胆管内への振子様移行現象が起り臨床症状が発生するものと考えられる. したがって胆汁をこの共通の導管部を通さない目的でのbiliary diversionが最も良好な成績であった.