Author(s) Miura, Toshio; Kawaguchi, Akio; Ogawa, Toshiyuki; Ohishi, Tetsuya; Inoue, Kenichiro; Kajiwara, Keiji; Ishikawa, Hiroshi; Yamaguchi, Eiichiro; Yasutaka, Tohru; Shimizu, Teruhisa; Kosei, Miyashita; Hiroyuki, Kusano; Tohru, Nakagoe; Takatoshi, Shimoyama; Ayaba, Hiroyoshi; Tomita, Masao Citation Acta Medica Nagasakiensia. 1992, 37(1-4), p.195-200 Issue Date 1992-12-25 URL http://hdl.handle.net/10069/17588 Right NAOSITE: Nagasaki University's Academic Output SITE

Title Numerical Chromosome Aberrations In A Recurrent Malignant Fibrous Histiocytoma of the Retroperitoneum Author(s) Sawai, Terumitsu; Tsuji, Takashi; Yamaguchi, Eiichiro; Nanashima, Atsushi; Jibiki, Masaaki; Yamaguchi, Hiroyuki; Yasutake, Toru; Nakagoe, Tohru; Ayabe, Hiroyoshi; Tagawa, Yutaka Citation Acta medica Nagasakiensia. 1998, 43(3-4), p.88-91 Issue Date 1998-12-16 URL http://hdl.handle.net/10069/16123 Right NAOSITE: Nagasaki University's Academic Output SITE

症例は63歳，女性．10歳頃から臍ヘルニアを自覚するも放置していたが，50歳頃から臍ヘルニア膨隆増大傾向となり，63歳時に手術目的で近医より当科紹介となった．精査にて臍ヘルニアの増大原因は，常染色体優性遺伝性多発性嚢胞腎（Autosomal Dominant Polycystic Kidney Disease;以下ADPKDと略記する）と判明した．本症例ではヘルニアの大きさは4cm大で，嵌頓歴は認められなかった．しかし難治性であるADPKDは進行性疾患のため，今後のヘルニアの大きさの増大と嵌頓出現を危惧し臍ヘルニア根治術を施行した．術後経過は良好であった．しかしADPKDには腎臓をはじめ，その他の様々な臓器にも障害が生じる遺伝疾患であり，退院後も経過観察が重要と考えられた．ADPKDが原因となった臍ヘルニアの症例報告例は存在しなかったため，本症を報告し理解しておく必要性があると思われた．

The proto-oncogene Ets-1 is a transcription factor that is known to regulate certain matrix metalloproteinases and plasminogen activator, which have been associated with malignant behaviors in solid carcinomas. We hypothesized that Ets-1 expression is also associated with tumor progression and a worse prognosis in lung carcinoma patients. To clarify the role of the Ets-1 proto-oncogene, the expression of Ets-1 in non-small cell lung carcinomas using 156 paraffin-embedded specimens was determined in surgically resected tissue samples. Immunohistochemical staining showed Ets-1 expression in 82 cases of 156 carcinomas (53%): 36 of 52 (69%) squamous cell carcinomas, 41 of 96 (43%) adenocarcinomas, and 5 of 8 (63%) other carcinomas. In adenocarcinomas, a higher proportion of acinar type expressed Ets-1 compared to papillary or alveolar type (p < 0.05). The proportion of adenocarcinoma that expressed Ets-1 increased with poorer histologic differentiation of the adenocarcinoma (p < 0.05). Ets-1 positive adenocarcinomas had a larger mean size than Ets-1 negative adenocarcinomas (p < 0.01). In adenocarcinoma patients, expression of Ets-1 was associated with disease-free (p = 0.09) and overall survivals (p < 0.05) after lung resection. Such relationship was not observed among squamous cell carcinoma patients. Our findings indicate that Ets-1 expression is related to histopathological differentiation, morphogenesis, and tumor progression of lung adenocarcinomas. Ets-1 appears to be a useful predictor of poor prognosis after surgical resection in lung adenocarcinoma patients. Ets-1 expression could be used to evaluate the malignant behaviors of lung adenocarcinomas.

疫学的に日本住血吸虫症患者に肝細胞癌が発生することが報告されているが,実際に経験することは稀である.今回われわれは病理組織学的に日本住血吸虫の虫卵結節を確認することのできたB型C型肝炎ウイルス感染のない肝細胞癌の1例を経験した.症例は80歳,男性.右季肋部痛を主訴に近医を受診.腹部エコーで肝腫瘍を指摘され,加療目的で紹介された.精査の結果,肝内に計5個の腫瘍を認めた.肝細胞癌の診断で肝右葉切除術,ラジオ波焼灼療法を施行した.病理組織学的に腫瘍部は中分化型肝細胞癌であった.非腫瘍部は肝硬変像を呈し,グリソン鞘内の門脈枝内に多数の虫卵結節を認めた.

症例は45歳の男性.検診で便潜血反応陽性であったため精査目的で外来を受診した.大腸内視鏡検査で横行結腸に粘膜下腫瘍を認め,腹腔鏡補助下結腸楔状切除術を施行した.病理組織検査では紡錘形細胞が線維束状に増殖しており,免疫染色でc-kit, vimentin, S-100, NSE (neuron specific enorase)が陽性, CD34, desmin, α-SMA (smooth muscle actin), NF (neurofilament)が陰性であった.横行結腸gastrointestinal stromal tumorのneural typeと診断した.術後10カ月経過した現在,無再発生存中である.

十二指腸側胆管への著明な表層拡大進展を認めた肝門部胆管癌の2例を経験したので報告する. 症例1: 46歳の男性. 肝門部胆管癌 (Blrcs) の診断で拡大肝左葉切除術, 尾状葉切除術を施行した. 十二指腸側胆管は膵内胆管で切離した. 術中病理検査で癌細胞の表層拡大進展を認めたため, 膵頭十二指腸切除術を追加した. 症例2: 66歳の男性. 肝門部胆管癌 (Brcsm) の診断で拡大肝右葉切除術, 尾状葉切除術を施行した. 十二指腸側胆管は膵内胆管で切離した.術後病理検査で十二指腸側胆管断端まで癌細胞の表層拡大進展を認めたため, 二期的に膵頭十二指腸切術を施行した. ともに肉眼的形態は平坦浸潤型で, 組織型は高分化型管状腺癌であった. 肝臓側胆管への表層拡大進展を認めた報告例は散見されるが, 十二指腸側胆管への表層拡大進展はまれである.

Background: The aim of this study was to clarify the prognostic value of distal intramural spread of tumor for survival and recurrence in patients with rectal cancer.Methods: Microscopic distal intramural spread was examined in 134 consecutive specimens of resected rectal cancer. Correlations among distal intramural spread, established clinicopathologic factors, and patients' prognoses were examined by univariate and multivariate analyses. American Joint Committee on Cancer classification and stage groupings were used for tumor assessment.Results: Thirty-three patients (24.6%) had distal intramural spread. Multivariate logistical regression analysis revealed that T3/T4 and M1 were independent predictive variables for the presence of distal intramural spread. Patients with distal intramural spread had a shorter disease-specific or disease-free survival time after curative surgery than those without distal intramural spread (P = .0003 and P = .0006, respectively). Most patients with distal intramural spread developed distant recurrence. Cox's regression with multiple covariates showed that distal intramural spread is an independent factor in predicting distant recurrence and worse outcomes after curative surgery in patients with rectal cancer.Conclusions: Distal intramural spread is an independent risk factor for distant metastasis and poor prognosis in patients with rectal cancer.

The present study was designed to provide a systemic analysis of prognosis in 62 patients who underwent hepatic resection for colorectal liver metastasis. The analyzed factors included microvessel counts stained by CD34 and expression of two adhesion molecules, E-cadherin and CD44 variant exon 6-(v6) in these tumors. No significant factors related to recurrence were identified and only negative expression of CD44v6 tended to correlate with recurrence (P = 0.075). A short disease-free period to recurrence was noted in patients with high CEA levels (>10 ng/ml) and H2/3 classification. A short surgical margin, H2/3 classification, high microvessel counts (>60/field, ×200), and negative expression of CD44v6 and E-cadherin tended to be associated with poor prognosis. A high microvessel count was the most significant prognostic factor by multivariate Cox proportional hazards regression model. Hepatic resection without tumor exposure and a careful follow-up in cases identified with poor prognostic factors are necessary.

A 65-year-old man visited our hospital complaining of a 4×4cm soft and round mass in the right lower quadrant of the abdomen. Abdominal CT and MRI examinations disclosed an abdominal wall tumor originating from the abdominal wall muscle. In Jauary 1999, the mass became slightly enlarged, but disappeared with the patient in the supine position. A second abdominal CT examination revealed a Spigelian hernia that passed through the Spigelian fascia from the abdominal cavity. Operative findings confirmed a Spigelian hernia. The hernia sac with preperitoneal fat had penetrated the external oblique aponeurosis through the Spigelian fascia. The transverse oblique and internal oblique aponeurosis were sutured to the lateral side and anterior sheath of the rectus abdominis muscle in layers. Posterior repair of the spermatic cord using Marlex mesh was performed. His postoperative course was uneventful and he is now symptom free.

Title Numerical Chromosome Aberrations In A Recurrent Malignant Fibrous Histiocytoma of the Retroperitoneum Author(s) Sawai, Terumitsu; Tsuji, Takashi; Yamaguchi, Eiichiro; Nanashima, Atsushi; Jibiki, Masaaki; Yamaguchi, Hiroyuki; Yasutake, Toru; Nakagoe, Tohru; Ayabe, Hiroyoshi; Tagawa, Yutaka Citation Acta medica Nagasakiensia. 1998, 43(3-4), p.88-91 Issue Date 1998-12-16 URL http://hdl.handle.net/10069/16123 Right NAOSITE: Nagasaki University's Academic Output SITE

Malignant fibrous histiocytoma (MFH) of the retroperito- neum is relatively rare in Japan. MFHs often recurs even if the tumor is resected completely. We describe a case with recurrent MFH of the retroperitoneum. A 49-year-old male was-admitted to our hospital for a palpable mass in the right lower abdomen. Ultrasonography and computed tomography demonstrated a solid mass with cystic compart- ment in the lower pole of the right kidney. The tumor was resected completely, and histological examination showed it was MFH, storiform-pleomorphic type. Thirty-three months later, a local recurrence developed and a second operation was　 performed.　 The　 resected　 tumor　 was　 4.5　× 3.9　× 3.1　 cm　 in size and histological diagnosis was recurrent MFH. We also examined the cytological characteristics of the tumor, using DNA flow cytometric quantification and fluorescence in situ hybridization (FISH) with a set of 14 chromosome- specific DNA probes. DNA contents showed a DNA diploid pattern, however, FISH analysis showed various aberrations of chromosome number such as +1, +2, +7, +8, -10, +11, +12, -16, -17, -18, and +20. These results suggested that chromosomal aberrations may reflect a higher biologic aggressiveness of recurrent MFH.

胃癌において術前にリンパ管侵襲の有無を推測できるか否かを臨床病理学的, 細胞・分子生物学的に検討した.臨床病理学的には1,129例, 細胞・分子生物学的には100例の胃癌を対象とした.腫瘍径はリンパ管侵襲陽性 (ly (+)) 例で平均71mm, 陰性 (ly (-)) 例で43mmとly (+) 例で有意に腫瘍径が長かった (p<0.001).また, 蛍光免疫細胞化学fluorescence in situ hybridization (FISH) 同時染色法を用いてproliferating cell nuclear antigen (PCNA) 染色性と17番染色体数を同時に検討した.PCNA陽性で17番染色体数的異常を認める細胞の比率はly (+) 例で平均15.3%, ly (-) 例で9.0%とly (+) 例で有意に高かった (p=0.0001).これらの方法は, 生検標本で十分に施行可能であった.以上より, 腫瘍径が長い症例, PCNA陽性かつ17番染色体数的異常陽性細胞を多く認める症例はly (+) の頻度が高く注意を要すると考えられた.

The prevalence of brown adipose tissue (BAT) in the periadrenal adipose tissue wasstudied in 20 autopsy cases of amyotrophic lateral sclerosis (ALS). In 19 of 20 cases, the periadrenal BAT in focal or diffuse distribution was observed. Histometry of BAT revealed average occupancy rates of 21.6% and 4.2% in ALS and age-matched control cases, respectively (p<0.01). Since emaciation and chronic hypoxia in those ALS patients were most likely related to severe muscle wasting and respiratory involvement, it is speculated that an increase in BAT occupancy rates may be secondary to altered thermogenesis which was augmented by chronic hypoxia.

We experienced a patient with primary hyperparathyroidism presenting with unconsciousness due to hypercalcemia who was surgically treated with a successful outcome. Hyperparathyroidism was suspected from clinical symptoms and high serum level of parathyroid hormone, but its location could not be confirmed by imagings such as CT and echography. Conservative Cawash out therapy was insufficient. Then operation was performed and a tumor which was in the thyroid partially was found out. It was chief cell adenoma of the parathyroid, microscopically. Hypercalcemia was corrected 2 days after the operation, and the patient was discharged on the 21st POD. This case showed the availability of surgical treatment for primary hyperparathyroidism.

Author(s) Miura, Toshio; Kawaguchi, Akio; Ogawa, Toshiyuki; Ohishi, Tetsuya; Inoue, Kenichiro; Kajiwara, Keiji; Ishikawa, Hiroshi; Yamaguchi, Eiichiro; Yasutaka, Tohru; Shimizu, Teruhisa; Kosei, Miyashita; Hiroyuki, Kusano; Tohru, Nakagoe; Takatoshi, Shimoyama; Ayaba, Hiroyoshi; Tomita, Masao Citation Acta Medica Nagasakiensia. 1992, 37(1-4), p.195-200 Issue Date 1992-12-25 URL http://hdl.handle.net/10069/17588 Right NAOSITE: Nagasaki University's Academic Output SITE