A case of endocrine ductal carcinoma of the breast.

A case of endocrine ductal carcinoma of the breast is presented. A 65-year-old woman was admitted with complaints of left breast mass and pain. Physical examination, mammography, ultrasonography, and computed tomography showed a mass 5 cm in diameter in the left breast suggestive of breast cancer, and incisional biopsy confirmed ductal carcinoma. Auchincloss's mastectomy was performed. The tumor, 4.0 x 3.8 cm in size, consisted of a relatively uniform proliferation of tumor cells with round nuclei and abundant eosinophilic cytoplasm. Immunohistochemically, tumors cells were positive for chromogranin A, synaptophysin, and neuron-specific enolase. Endocrine ductal carcinoma with invasion was diagnosed. No lymph node metastasis was observed, and estrogen and progesterone receptors were positive.

Laparoscopic ligation of an aneurysm of the left gastric artery.

We describe the laparoscopic ligation of an aneurysm of the left gastric artery. The patient was admitted to the hospital with epigastric pain, and computed tomography showed a retroperitoneal hemorrhage. Celiac angiography showed a fusiform-type aneurysm 1.0 cm in diameter at the trunk of the left gastric artery. The left gastric artery was ligated at sites proximal and distal to the aneurysm under laparoscopy, and the patient's postoperative course was uneventful. Laparoscopic surgery appears useful for elective surgery of an aneurysm in the left gastric artery.

Laparoscopic resection for ectopic gastric mucosa of the duodenum: report of a case.

We report herein the case of a 53-year-old man in whom ectopic gastric mucosa was successfully resected laparoscopically. Radiography and endoscopy showed a well-demarcated and sessile polypoid lesion measuring 2.0 cm in diameter in the second part of the duodenum. Under the diagnosis of a submucosal tumor of the duodenum, a wedge resection of the duodenum was performed laparoscopically. Subsequent histological examination revealed that the tumor was ectopic gastric mucosa of the duodenum.

[DNA stemline heterogeneity as preoperative prognostic factor in esophageal cancer].

Flow cytometric nuclear DNA analysis was performed on 36 preoperative endoscopic biopsy specimens and 89 surgically resected specimens of esophageal carcinomas without preoperative radiotherapy. Carcinomas with aneuploid or DNA stem-line heterogeneity had a higher frequency of lymph node metastasis (p < 0.01). The correspondence rate of nuclear DNA ploidy patterns was 97% between biopsy and resected specimens, and that of heterogeneity was 72%. Though only six cases showed heterogeneity in biopsy specimens out of 12 cases which showed heterogeneity in resected specimens, preoperative detection of heterogeneity was supposed to be more accurate by an increase of biopsy specimens. DNA analysis of biopsy specimens may be a possible indicator of the malignant potential of esophageal carcinoma.

DNA stem line heterogeneity in esophageal cancer accurately identified by flow cytometric analysis.

BACKGROUND: This study was designed to evaluate the importance of DNA stem line heterogeneity in determining the malignant potential of esophageal cancer. METHODS: Flow cytometric analysis of intratumor heterogeneity of DNA contents was performed on step-sectioned slices of 57 resected esophageal carcinomas. RESULTS: DNA stem line heterogeneity, as assessed by DNA content measurements, was present in 25 (44%) tumors; 6 (11%) were a combination of diploid and aneuploid DNA pattern, and 19 (33%) had two or more aneuploid peaks with different DNA contents (multiploid). Of the remaining 32 homogeneous tumors, 4 showed only a diploid DNA pattern in all samples examined, whereas 28 tumors had only the aneuploid pattern. Tumors with the heterogeneous DNA pattern had a significantly higher frequency of lymph node metastasis than did those with the homogeneous DNA pattern (P < 0.05). CONCLUSIONS: For evaluation of the highly malignant potential of esophageal carcinoma by nuclear DNA contents, it is important to identify accurately intratumoral heterogeneity. Because different DNA stem lines were evident in different areas of the lesion, evaluation of multiple specimens from a wide area of each lesion is needed to determine with accuracy the degree of intratumor DNA stem line heterogeneity.

Stemline heterogeneity of nuclear DNA in hepatocellular carcinoma.

Flow cytometric analysis of intratumoral DNA stemline heterogeneity was carried out in 48 patients who underwent liver resection for hepatocellular carcinoma (HCC). The nuclear DNA content was determined in specimens cut into one centimeter square pieces; all specimens had been taken from the largest section of the tumor. Of the 48 tumors twelve (25%) were diploid (group D), 11 (22.9%) had both diploid and aneuploid patterns (group DA), and the remaining 25 (52.1%) were aneuploid (group A). Out of 25 group A tumors, eleven had two or more different aneuploid peaks (multiple aneuploid). Thus, DNA stemline heterogeneity was present in 22 tumors (45.7%). With respect to survival, patients with group A tumors had a significantly poorer prognosis than did those with group D tumors, irrespective of tumor size. In group DA patients, the outcome was influenced by the "poor" prognostic nature of the positive DNA aneuploidy. Thus, HCC has a higher incidence of intratumoral DNA heterogeneity than previously considered, and the prognosis for patients with a positive aneuploidy pattern is poor.

[Preoperative evaluation of malignant potential in esophageal carcinoma by nuclear DNA contents].

Employing surgically resected specimens from patients without preoperative radiation therapy, we measured the nuclear DNA contents in order to evaluate the malignant potential of esophageal carcinoma. The association of the DNA index (DI) > or = 1.7 and the intratumoral DNA heterogeneity of biopsy specimens from patients with or without preoperative radiotherapy was also analyzed in relation to problems related to preoperative evaluation of nuclear DNA contents using biopsy specimens and the influence of irradiation on nuclear DNA contents. Esophageal carcinomas in 128 cases were studied. Nuclear DNA content was measured for biopsy specimens as well as surgically resected tumors by flow cytometry according to the method of Hedley and colleagues. HET was found in 42% of surgically resected specimens, but in only 18% of biopsy specimens. In 90% of cases, dominant DI of the resected tumor was also found in the biopsy specimens. Cases of DI > or = 1.7 showed a poorer prognosis than those with DI < 1.7 in cases with preoperative radiotherapy (p < 0.05) as well as in those without it. These results indicated that DI can be an indicator for highly malignant potential of esophageal carcinoma when measuring nuclear DNA contents using not only biopsy specimens but also specimens from irradiated cases.

[The intensity of hst-1 gene amplification and malignant potential of esophageal carcinoma in relation to intratumoral heterogeneity].

Amplification of hst-1 gene is associated with poor prognosis in patients with esophageal carcinoma. Since there is a high frequency of DNA stem-line heterogeneity, we studied intratumoral heterogeneity of hst-1 amplification, and evaluated whether or not the intensity of hst-1 amplification is associated with the malignant potential of esophageal carcinoma. A total of 73 patients with esophageal carcinoma who had undergone esophagectomy were studied. Intratumoral heterogeneity of hst-1 amplification was examined in two to four sections of tumour specimens which showed mainly DNA heterogeneity in 27 of these patients. The judgement of hst-1 amplification in the same tumor was identical in all of the 27 patients, although its intensity was not identical in some cases. And in 73 patients, postoperative recurrence in organs showed a high incidence (78%) in the hst-1 amplification group with a high intensity (over 7-fold). Therefore, hst-1 amplification exceeding 7-fold can serve as an indicator to predict the high grade of malignant potential of esophageal carcinoma.

Sacral chordoma developing two years after low anterior resection for rectal cancer.

A 43-year-old male with sacral chordoma associated with rectal cancer is herein reported. A presacral tumor with extensive destruction of S4 and S5 was found 2.5 years after a low anterior resection for advanced rectal mucinous carcinoma. Under the preoperative diagnosis of a solitary sacral metastasis of rectal cancer, the lower sacral segments together with the tumor were removed by amputation at S3. Histologically, the tumor was a chordoma composed of polyhedral cells with an abundant eosinophilic cytoplasm mixed with typical vacuolated physaliferous cells within a myxoid matrix. Colorectal cancer associated with an extracolic primary malignant neoplasm is not uncommon; however, this is only the second case of colorectal cancer associated with chordoma to the best of our knowledge.

Primary anorectal malignant melanoma.

A case of primary anorectal malignant melanoma seen in a 46 year old woman is presented herein. Her most marked symptoms were bloody stools and anal pain. Endoscopic examination indicated a tumor with ulceration but without pigmentation in the anorectal region. Histologic examination of the biopsied specimens showed spindle-shaped cells with atypia proliferating in a bandlike arrangement, as in leiomyosarcoma. An abdominoperineal resection was done and detailed histological examination of the tumor confirmed the nature of the tumor to be malignant melanoma. The postoperative immunochemotherapy consisted of Dimetyl-Triazeno-Imidasole-Carboxamide (DTIC), Amino-Methyl-Pyrimidinyl-Methyl-Chlorethyl-Nitrosourea-Hydrochlori de (ACNU), Vincristine (VCR) and OK-432. The patient has been well without recurrence for fifteen months following her operation through the continuous administration of these agents.

Adenoma of the nipple.

We report herein a case of a 42 year old woman with adenoma of the nipple of her left breast. The diseased nipple was enlarged, reddened and a hard elastic mass was palpable within its substance. There was an area of eczematoid erosion on the surface. Incisional biopsy revealed a picture of adenoma and therefore the nipple was excised. Five years postoperatively, there has been no recurrence of the disease. To our knowledge, only thirteen cases of adenoma of the nipple have been reported in the Japanese literature. Some clinical features and treatments are discussed in a review following the case report. Although rare, adenoma of the nipple should be borne in mind to avoid a misdiagnosis of malignancy and unnecessarily extensive surgery.

Clinical significance of ras p21 overexpression for patients with an advanced colorectal cancer.

The expression of ras oncogene product p21 was examined in 45 paraffin-embedded sections of primary advanced colorectal cancers, using the anti-v-H-ras p21 monoclonal antibody Y13-259. Fourteen of these specimens (31 percent) were stained positively. The incidence of lymphatic vessel invasion of cancer cells and lymph node metastasis correlated statistically with the overexpression of ras p21. The depth of invasion and incidence of liver metastasis in the p21-positive group were more prominent than in the p21-negative group. Statistically significant differences were evident in operative curability and clinical stage at initial surgery and in the long-term survival rate between these groups (P less than 0.05). We propose that ras p21 overexpression may serve as a marker to predict the prognosis of colorectal cancer.

Preoperative assessment of cervical lymph node involvement in esophageal cancer.

Lymphoscintigraphy (LS) and computed tomography (CT) were used preoperatively to assess nodal involvement in 23 patients with esophageal cancer. LS predicted nodal involvement with a high sensitivity and low specificity since false positives were frequent while in contrast, CT predicted it with high specificity and low sensitivity. The combination of LS and CT improved sensitivity by up to 87 per cent but not specificity. The positive image of nodes in LS was associated with malignant cell involvement and/or reactive changes in the nodes, especially sinus histiocytosis and germinal center hyperplasia. When cervical nodes were involved, bilateral images of lymph flows were often lost and by using the images of lymph flow as well as those of the nodes, the combination predicted cervical nodal involvement with a sensitivity of 83 per cent and a specificity of 86 per cent. Thus, the combination of LS and CT is beneficial for preoperatively estimating cervical nodal involvement in esophageal cancer.

[Two stages three fields lymph node dissection in esophageal cancer].

In order to indicate the three fields lymph node dissection method to wider ranges of patients with esophageal cancer, the two stages technique was applied to those with moderate disturbance of general physical conditions. Fifty eight patients with esophageal cancer admitted to our clinic from January 1986 to December 1988 and 38, in whom those with cervical esophageal cancer were excluded, employed esophagectomy. Of them, 26 patients (68%) received the three fields dissection method, 13 being due to the one stage technique and the remaining 12 being due to the one stage technique and the remaining 13 being due to the two stages technique. The three fields dissection method was indicated to patients who were younger than 75 years of age, were expected to receive curative resections or had no, mild and moderate disturbances of the physical conditions. The one stage technique was applied to patients with no and mild disturbances of the physical conditions while the two stages technique was to those with moderate disturbance. The general physical conditions were evaluated with the past history, underlying diseases, functions of the main organs and the ability of host defense. In the first operation of the two stage technique, subtotal esophagectomy and dissection of the regional lymph nodes including the paratracheal ones were performed. After approximately one month, esophageal reconstruction with the gastric tube and dissection of the regional nodes of the abdomen and neck were done in the second operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of multiple cytomegalovirus strains from a patient with adult T cell leukemia.

A 66-year-old male with adult T cell leukemia had an ulcer on the left medial thigh. The biopsy of the skin lesion revealed enlarged endothelial cells with acidophilic intranuclear inclusion bodies, suggesting cytomegalovirus (CMV) infection. At autopsy, CMV was isolated from a nodular skin lesion of the scrotum. The urine constantly tested positive for CMV. Restriction endonuclease cleavage analysis of DNA of the isolates from the skin and urine indicated that this patient was infected with two different strains of CMV.

The beneficial effect of cyclosporine on liver ischemia in rats.

The effect of pretreatment with cyclosporine on normothermic liver ischemia was studied in rats. The rats were divided into two groups. In group I, the animals were subjected to 60 min of warm liver ischemia. In group II, CsA (10 mg/kg, p.o.) was given daily for 4 days before induction of liver ischemia. The survival rates, serum biochemical parameters, and extent of necrosis (% liver necrosis), mitotic activities, and histology of the livers were investigated from days 1 to 7 following the release of hepatic vascular occlusion. CsA pretreatment significantly improved the survival of the animals (75.8%) in comparison with the control (42.5%). The highest levels of serum transaminases in group II had a tendency to be lower than in group I. The extent of liver necrosis reached a maximum in both groups one day postsurgery when the transaminases rose highest; however, the peak value of percentage of liver necrosis was significantly ameliorated by CsA treatment (27.1%) as compared with the control (48.3%). Furthermore, mitosis of hepatocytes in the group treated with CsA was substantially increased at day 3. Histological alterations of the livers coincided with the changes in other parameters. Our results demonstrate that CsA is capable of protecting the liver from ischemic insult. The mechanisms by which CsA exerts its beneficial effect on normothermic liver ischemia are discussed.

Flow cytometric analysis of nuclear DNA content in esophageal cancer. Aneuploidy as an index for highly malignant potential.

Flow cytometric analysis of nuclear DNA content was performed on excised malignant tissue of the esophagus. The DNA ploidy pattern was compared with a variety of histologic parameters and the subsequent clinical course to determine whether or not this pattern is associated with the mode of malignant potentiality. Of the 31 patients, eight had the diploidy DNA pattern and 23 the aneuploid DNA pattern. Tumors with the aneuploidy DNA pattern had a significantly higher frequency of lymph node metastasis than did those with the diploidy DNA pattern (P less than 0.01). Mitotic rates in the aneuploid tumors were significantly higher than was the case in diploid tumors (P less than 0.0005). The incidence of recurrence within 12 months after surgery was higher in patients with aneuploid tumors (83.3%) than in those with diploid ones (16.7%), with a statistical difference (P less than 0.05). Thus, the DNA aneuploidy based on flow cytometry closely correlates with the high frequency of nodal involvement and high mitotic rates, factors generally indicative of the aggressive behavior of the malignant tumors. DNA aneuploidy based on flow cytometric analysis is a pertinent index for determining the highly malignant potential in esophageal carcinoma.

Immunohistochemistry of vascular lesion in thrombotic thrombocytopenic purpura, with special reference to factor VIII related antigen.

We collected 23 autopsied cases of thrombotic thrombocytopenic purpura (TTP) and examined them immunohistochemically and electronmicroscopically to elucidate the nature of thrombi and subendothelial deposits. The findings were compared with those of 10 cases of disseminated intravascular coagulation (DIC) and 3 cases of polyarteritis nodosa (PN). Intravascular thrombi and subendothelial hyaline deposits in TTP stained weakly for fibrinogen/fibrin by the PAP technique, while they stained strongly for factor VIII related antigen (FVIIIR: Ag). Electronmicroscopically, thrombi in TTP were composed of numerous, variably degranulated and altered platelets, and a small amount of amorphous materials. Thrombi in DIC were strongly positive for fibrinogen/fibrin, while they were weakly positive for FVIIIR:Ag. Electronmicroscopically they were composed of polymerized fibrin. Fibrinoid necrotic lesions in PN were strongly positive for fibrinogen/fibrin but negative for FVIII R:Ag. Based on these findings, we concluded that thrombi in TTP are essentially platelet thrombi and that subendothelial hyaline deposits may not be a result of increased vascular permeability but may be platelet thrombi incorporated into the arterial wall and covered with newly formed endothelial cells.