Malignant schwannoma of the esophagus with lymph node metastasis: literature review of schwannoma of the esophagus.

An extremely rare case of malignant schwannoma of the esophagus with lymph node metastasis is reported. A 49-year-old woman was found to have an abnormal shadow on a chest X-ray film taken during an annual checkup. Upper gastrointestinal series showed extrinsic pressure on the middle thoracic esophagus, without a mucosal lesion. An exploratory operation was performed, with a tentative diagnosis of esophageal leiomyoma. The tumor was enucleated with part of the esophageal mucosa, and a few enlarged lymph nodes around the tumor were dissected. The resected tumor was an elastic firm mass, measuring 8.2 x 5.8 x 3.7 cm, and had a smooth surface. Histological examination of the tumor revealed the proliferation of spindle-shaped cells with chromatin-rich nuclei. The nuclei were variable in size and showed remarkable atypia. A paraesophageal lymph node had same findings as the main tumor. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein and neuron-specific enolase. The pathological diagnosis of this tumor was malignant esophageal schwannoma with lymph node metastasis. Esophageal schwannoma is extremely rare. We reviewed the literature on 19 cases of esophageal schwannoma, including that in our patient. The majority of the tumors were benign. Only three cases of schwannoma were malignant, and this is the first reported case of malignant schwannoma with lymph node metastasis.

Effects of portal-systemic shunt following 90% partial hepatectomy in rats.

We studied the effects of portal-systemic shunt after massive hepatectomy. Male Wistar rats were divided into two groups: one group underwent laparotomy alone (C group) and in the other group a portal-systemic shunt was placed through laparotomy (S group). After 90% hepatectomy was performed, 3-day and 1-week survival rates and histopathology were examined, and hepatic hemodynamics during the early stage after hepatectomy were measured using dye-containing microspheres. The 3-day survival rate in the S group was significantly higher, and the 1-week survival rate was slightly higher, than those in C group. Sinusoidal dilation 7 days after hepatectomy in the S group was significantly milder than that in the C group. Fatty degeneration of hepatocytes in the S group was significantly milder than that in the C group. With respect to hepatic hemodynamics during the early stage after hepatectomy, the rate of shunt (26.3%) in the S group was significantly higher than that (9.5%) in the C group. Portal pressure, total hepatic blood flow, and total hepatic blood flow per gram of liver in the S group were significantly lower than those in the C group. These results suggest that approximately 26% shunt after 90% hepatectomy in rats increases the early survival rate and improves histological changes in surviving rats 7 days after resection.

Effect of portal hypertension caused by chronic high venous pressure on small-intestinal sugar absorption.

The effect of portal hypertension and chronic high venous pressure on the absorption of the small intestine was examined by constricting the suprahepatic and subdiaphragmatic inferior vena cava in rats. A group of rats with the constricted suprahepatic and subdiaphragmatic inferior vena cava comprised group 1 (n = 9) and another group of rats with only laparotomy comprised group 2 (n = 9). Two months after the operation, sugar absorption and other parameters were measured. The blood pressures of the infrahepatic inferior vena cava and the portal vein 8 wk after the operation in group 1 were significantly higher than those in group 2. The results of D-xylose absorption tests showed that the amount of excreted D-xylose in urine in group 1 was significantly lower than that of group 2, but the D-xylose everted sac test showed no significant differences between the two groups. The glucose everted sac test showed that the amount of glucose absorption in group 1 was significantly lower than that in group 2. These findings suggest that chronic high venous pressure caused by constriction of suprahepatic inferior vena cava may lead to sugar malabsorption. We conclude that portal hypertension with high venous pressure below the diaphragm can lead to sugar malabsorption in the intestine.

Influence of intermittent ischemia on thioacetamide-induced rat liver cirrhosis.

We studied the influence of intermittent ischemic injury on thioacetamide-induced liver cirrhosis in rats. Wistar rats were divided into group A, intermittent ischemic injury to liver cirrhosis, and group B, continuous ischemic injury to liver cirrhosis. Total ischemic time was 60 min in both groups. In group A, ischemic injury consisted of a repetition 4 times of 15 min ischemia and 5 min reperfusion. The ATP level of the liver was measured before ischemia, before reperfusion, and 60 min after reperfusion. Bile was collected to determine bile flow rate. The ATP level in the liver tissue 60 min after reperfusion was significantly (p < 0.05) higher in group A than in group B. The ATP level immediately before reperfusion was also significantly (p < 0.05) higher in group A than in group B. The survival rate 1 week after ischemic injury and bile flow rate 60 min after reperfusion were significantly (p < 0.01) higher in group A compared with those in group B. The energy level was much higher in intermittent ischemic injury than in continuous ischemic injury immediately before reperfusion and after reperfusion. Survival rate and bile flow rate were higher in intermittent ischemic injury than in continuous ischemic injury. Therefore it suggests that the viability of the liver was maintained better in intermittent ischemic injury than in continuous ischemic injury.

Congenital multiple arterioportal fistula: a case report treated with portocaval shunt.

A case of 48-year-old man, with diffuse arterioportal fistula (APF) considered congenital in origin, is described. The patient presented with recurring intractable variceal hemorrhage which was treated by endoscopic ligation or sclerotherapy. In this case, gastroduodenal artery and branches of mesenterial artery were diffusely involved, so these lesions could not be resected. Portocaval shunt between the superior mesenteric vein and the right iliac vein was successfully performed. Follow-up endoscopic examination one year later revealed no evidence of esophageal and gastric varices. To our knowledge, this is the second case in which a patient underwent portocaval shunt successfully for congenital APF.

[A case of esophageal leiomyoma found as mediastinal tumor, diagnosed with endoscopic ultrasonography].

A 20 year-old female was admitted to our department because of an abnormal shadow in chest roentgenogram on a physical check-up. The barium swallowing study revealed an oppression of the middle of the esophagus. Endoscopy, chest CT and MRI failed to distinguish submucosal tumor from mediastinal tumor. Endoscopic ultrasonography showed the mass originated from the esophagus and a diagnosis of esophageal smooth muscle tumor was obtained. The tumor was tried to resect by thoracoscopic surgery but was failed because of its shape like a tortoise shell. The tumor was resected through the right thoracotomy and the diagnosis was confirmed histopathologically.

Evidence of direct recognition subset in xeno-reactive helper T cells.

There are two functional subsets of alloreactive helper T cells: one recognizes the alloantigens on self-antigen-presenting cells (APCs), and the other recognizes the alloantigens on allo-APCs. In this study, we analyzed which specific Th cells have a possible effect on concordant-xenograft rejection responses and how Th cells recognize xeno-antigens. In the proliferative response stimulated with spleen cells obtained from rats (r-SPC), mouse T cells (m-Tc) were not inhibited by GK1.5 (CD4) or 2.43 (CD8) antibodies. In a xeno-mixed lymphocyte reaction, m-Tc that included APC (APC(+)) proliferated when stimulated with r-SPC APC(+) or APC(-). In contrast, B6 T cell APC(-) proliferated only when stimulated with r-APC(+)SPC but not when stimulated with APC(-). The m-Tc lines responded to F344 SPC APC(+) but not to SPC APC(-); however, the m-Tc line did not respond to SPC from another rat strain. We hypothesize that both CD4+ Th and CD8+ Th are included in the concordant xeno-reactive Th; there are both xeno-APC-restricted Th and self-APC-restricted Th; and xeno-APC-restricted Th recognizes xeno-major histocompatibility complexes.

[Association of Epstein-Barr virus with primary malignant lymphomas of the digestive tract].

The association of Epstein-Barr virus (EBV) with 85 non-Hodgkin lymphomas of the digestive tract in nonimmunocompromised cases was investigated, using in situ hybridization technique to detect EBV encoded small RNAs in paraffin sections. 85 cases (83 B-cell type and 2 T-cell type) included 3 gingivas, 1 tongue, 3 palates, 10 tonsils, 43 stomachs, 2 jejunums, 12 ileums, 3 ileo-cecal regions, 5 colons and 3 rectums. Out of 85 cases, 4 (4.7%) were EBV-positive, comprising 1 B-cell lymphoma of the tonsil, 2 B-cell lymphomas of the stomach, and 1 T-cell lymphoma of the rectum. On the other hand, EBV-positive rate in nasal/nasopharyngeal lymphomas examined for comparison was very high, 81.8% (9 out of 11). These results show that EBV is associated with only a small proportion of lymphomas of the digestive tract in nonimmunocompromised case, suggesting the existence of the other oncogenetic factors in the pathogenesis of this group of lymphomas.

Influence of CO2 tension on hepatic hemodynamics during portal arterialization.

We investigated the effect of portal arterialization (PA) on hepatic energy metabolism and hepatic hemodynamics. Portal perfusion flow rate with arterial blood was 25% of the preperfusion portal flow. During PA up to 120 min, hepatic energy metabolism was maintained from the aspects of ATP, energy charge, and arterial ketone body ratio. However, during this PA, carbon dioxide tension (25-35 mm Hg) in arterial blood was lower than that in normal portal vein blood and portal vein resistance (PVR) was significantly increased during perfusion compared with that at preperfusion. When carbon dioxide tension (50-63 mm Hg) in arterial blood was made equivalent to that in normal portal vein blood by controlling the respiratory conditions, PVR was not increased during PA up to 120 min. It was suggested that PCO2 in perfusion blood should change PVR, while it should not change hepatic energy metabolism when portal perfusion flow rate with arterial blood was 25% of the preperfusion portal flow.

Rapid growth of hepatocellular carcinoma after or during interferon treatment of chronic hepatitis C: report of three cases.

We report herein the cases of three patients in whom marked rapid growth of hepatocellular carcinoma (HCC) became evident after or during interferon (IFN) treatment for chronic hepatitis C. The HCC tumors were 10, 4.7, and 3.1 cm in size, and were found 7 months, 10 weeks, and 10 weeks after the initiation of IFN, respectively, in cases 1, 2, and 3. The clinical courses of these three patients suggest that the progression of HCC was more rapid during the IFN treatment period. Thus, we propose that abdominal ultrasonic (US) examination should be performed monthly in patients with chronic hepatitis who undergo IFN treatment.

Clinical study on hepatocellular carcinoma with extrahepatic malignancies.

In a consecutive series of 146 patients with hepatocellular carcinoma (HCC), 10 patients (6.8%) were found to have one or two extrahepatic malignancies (EHM). Of these, eight had double cancers and two, triple cancers. The associated malignancies included eight cases of gastric cancer and four cases of colon cancer. Among the 12 lesions, eight were in the early stage. All the 10 patients were hepatitis B surface antigen negative. The incidence of coexisting liver cirrhosis and the retention rate of indocyanin green in 15 minutes among HCCs with EHM were significantly lower than those among HCC alone. These results suggest that the etiology of HCC with EHM is different from the etiology of HCC alone in Japan.

[A case of ruptured hepatocellular carcinoma with rapid growth after the interferon therapy in chronic hepatitis].

A 75-year-old man who had had a long history of chronic hepatitis C virus liver disease underwent interferon (IFN) therapy for three months. After three months of the last IFN injection, he presented with a sudden attack of epigastralgia. Abdominal US and CT revealed a tumor about 9 x 10 cm in the right lobe of the liver. Serum AFP level was 8,499 ng/ml. Spontaneous hemoperitoneum due to ruptured hepatocellular carcinoma (HCC) was suspected. Hepatectomy was carried out on 35 days postembolization. Pathological examination revealed HCC of trabecular type. Although the relation between the rapid growth and IFN is not clear, US examination should be performed once a month for the patient.

[Changes in high energy phosphates and tissue blood flow in ischemia and reperfusion of jaundiced rat liver--effect of intermittent brief ischemia].

This study was focused on the changes of high energy phosphates and tissue blood flow (TBF) in ischemia and reperfusion, of jaundiced rat liver. We ligated and cut the bile duct of male Wistar rats to induce jaundice. The rats were divided into two groups, BDL-4W which had ligation four weeks before examination and control which had no ligation. Two studies were performed; In study A, ischemia was induced by clamping portal vein and hepatic artery for 60 minutes. In study B, 15 minutes of ischemia was repeated four times with intervals of 10 minutes of reperfusion. A: 1) In BDL-4W, ATP was significantly lower than that in control at pre-ischemia and reperfusion. Recovery ratios (RR) of ATP in BDL-4W were significantly lower than those in control. 2) RR or TBF in BDL-4W were significantly lower than those in control. 3) In BDL-4W, xanthine was significantly higher than that in control at reperfusion. B: 4) There were no significant differences in the RR of ATP after reperfusion between two groups. 5) There were no significant differences in the RR of TBF between two groups. 6) There were no significant differences in xanthine after reperfusion between two groups. We concluded that intermittent brief ischemia was useful when 60 minutes of ischemia was required for the operation of jaundiced liver.

Two cases of endoscopically identified esophageal cancer of the superficial-slightly depressed type.

We experienced two cases of superficial type esophageal cancer. Case 1 was a 72-year-old man in whom endoscopic examination revealed a slightly protruded, partially reddened and faded area of irregular shape corresponding to 0-IIa + IIc (slightly depressed type) of the endoscopic classification of esophageal cancers. Macroscopically, it was a superficial, ill-defined and non-cicatrized solitary tumor measuring 2.5 x 2.4 cm in size. Histologically it was a monofocal semidifferentiated squamous cell carcinoma of a swelling type of stage 0. Case 2 was 55-year-old man. Endoscopic examination disclosed an almost roundish, smooth-surfaced, flat and dull red area corresponding to IIc (slightly depressed type). Macroscopically it was a superficial, semidefined and non-cicatrized solitary tumor measuring 1.0 x 1.0 cm in size. Histologically it was a monofocal, semidifferentiated squamous cell carcinoma of stage 0. To detect esophageal cancer at an early stage, the endoscopist needs to inspect the mucosa carefully. In case of males aged over 50, the endoscopist would be well advised to employ the dye-spraying method (Lugol staining method) at the endoscopic examination.