Stromal-type Nephroblastoma with or without Anaplasia in Two Hedgehogs (Atelerix albiventris).

We describe the clinical and histological characteristics of stromal-type nephroblastomas that developed in two hedgehogs (Atelerix albiventris). In case 1, the tumour was composed of a proliferation of anaplastic stromal cells with ductal structures resembling the epithelium of nephroblastoma. In case 2, spindle-shaped cells that were somewhat larger than nephroblasts were frequently seen surrounding the cell cluster, and there was proliferation of stromal cells with collagen fibres at the periphery. Immunohistochemically, the tumour cells labelled weakly to strongly for the nephroblast marker Wilms' tumour-1 and were positive for Ki67 with rates of 5% and 10% for cases 1 and 2, respectively. Based on the above, the diagnosis was of stromal-type nephroblastoma with anaplasia in case 1 and without anaplasia in case 2. Our findings suggest that stromal-type nephroblastomas arise in adult hedgehogs and are clinically benign, and that histological anaplasia does not affect the prognosis.

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sagittal split osteotomy.

BACKGROUND: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. MATERIAL AND METHODS: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). RESULTS: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. CONCLUSION: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO.

How to assess tonsilloliths and styloid chain ossifications on cone beam computed tomography images.

OBJECTIVE: The aim of this study was to establish an anatomical guideline in cone beam computed tomography (CBCT) images to discriminate soft-tissue calcifications, specifically, tonsilloliths, and styloid chain ossification (SCO) in the multiplanar reconstruction screen of the i-CAT Vision. MATERIALS AND METHODS: We analyzed 100 pairs of CBCT images and panoramic digital radiographies regarding the presence or absence of tonsilloliths and SCO. The intraobserver agreement varied from excellent to good. The statistical analyses included Mann-Whitney test, chi-square test, Spearman test, Student's t-test, and Wilcoxon test. The analyses were repeated without the guideline to verify its effectiveness. RESULTS: A total of 25 tonsilloliths were found in panoramic images while CBCT images revealed 60. Panoramic and CBCT images showed 42% and 63% of patients positive to SCO, respectively. We found a statistically significant difference when comparing the presence of tonsilloliths and SCO between panoramic and CBCT images (Wilcoxon test P < 0.05). The analyses without the guideline showed that the observer tended to diagnoses more false-positive SCO. CONCLUSION: Based on the results, we can suggest that CBCT images are more suitable to differentiate tonsilloliths and SCO than panoramic images. The guideline was more important to diagnosis SCO than tonsilloliths. SCO was misclassified in 34% without the guideline.

Clinical outcomes in older or younger patients with papillary thyroid carcinoma: impact of lymphadenopathy and patient age.

AIMS: To examine lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC) according to clinicopathological features and outcomes associated with the nodal status. METHODS: We reviewed 231 patients with PTC (> or =1.0cm) who underwent initial thyroidectomy with modified neck dissection. LNM was examined in the central and lateral compartment and risk factors for disease-free survival (DFS) were evaluated. Nodal status and outcomes were further evaluated in four subgroups, 19 older patients (> or =45years old) with palpable lymphadenopathy (PLA) and 134 without PLA, and 11 younger patients (<45years old) with PLA and 67 without PLA, because multivariate analysis revealed that age (p<0.05, Hazard ratio (HR) 3.51) and PLA (p<0.0001, HR 14.9) were risk factors for DFS. RESULTS: Central and lateral LNM were found in 176 and 151 patients. Seventeen exhibited skip metastasis. Recurrence and disease death occurred in 23 and 5. In analysis of the four subgroups, recurrence was significantly frequent in older patients with PLA than in younger patients with PLA or older patients without PLA (8/19 vs. 3/11 or 12/134). Younger patients without PLA did not exhibit recurrence. CONCLUSIONS: Prognosis is worse in older patients with PLA. Such patients should be treated carefully with a considerable treatment strategy.

Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy.

BACKGROUND: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. METHODS: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. RESULTS: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). CONCLUSION: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

[Clinical outcome of the operation using deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest in thoracoabdominal aortic aneurysm].

Deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest has been used for protection of the spinal cord during operations for thoracoabdominal aortic aneurysm (TAAA) in our hospital. We examined the effect of this adjunct this time. We studied 15 patients who were operated using deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest among 19 patients with the TAAA who we performed the operations from 1995 through 2003. The patients ranged in age from 21 to 80 (an average of 65 +/- 14 SD) years. We used deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest between 16 and 20 degrees C for the adjunct but did not use a monitor of evoked spinal cord potentials or cerebrospinal fluid drainage. Operation time was an average of 805 +/- 168 minutes. Cardiopulmonary bypass time was an average of 403 +/- 73 minutes. Deep hypothermic cardiopulmonary bypass time was an average of 215 +/- 67.5 SD minutes. Duration of spinal cord ischemia to the intercostal arteries were reconstructed was from 25 to 104 (50.5 +/- 24) minutes. We recognized nerve disorder in 6 cases in progress after operation, and respiratory organs management period and a hospitalization period became long, but the hospitalization death was 3 cases, and, as for the paraplegia was no case, 12 patients were discharged in good condition. The deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest was regarded as a useful adjunct for prevention of the paraplegia.

Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax.

BACKGROUND: Thoracoscopic simple bullectomy for primary spontaneous pneumothorax (PSP) has a relatively high postoperative recurrence rate and sometimes results in postoperative air leakage. One of the reasons for postoperative recurrence is the regrowth of bullae around the staple line. Therefore, reinforcement of the visceral pleura around the staple line is a reasonable way to prevent postoperative air leaks and recurrence. This study was done to determine the efficacy in preventing postoperative air leak and recurrent pneumothorax of widely covering the staple line with absorbable mesh after thoracoscopic bullectomy. METHODS: Wide coverage of the staple line with absorbable mesh was performed on 114 patients with PSP. These patients were retrospectively compared with 126 patients who underwent thoracoscopic simple bullectomy alone. RESULTS: The postoperative duration of chest drainage in the coverage group (mean, 1 day; range, 0-5) was significantly shorter than that in the simple bullectomy group (mean, 3 days; range 0-20). A prolonged air leak (>7 days) occurred in six patients in the simple bullectomy group, but there were no such leaks in the coverage group. Recurrent pneumothorax occurred in three patients (2.6%) in the coverage group and 12 patients (9.5%) in the simple bullectomy group. CONCLUSION: Wide coverage of the staple line with absorbable mesh is effective in preventing postoperative air leak and in decreasing the recurrence rates of PSP.

Effect of sodium valproate on neuromagnetic responses to chromatic flicker: implication for photosensitivity.

The effect of oral administration of sodium valproate in normal subjects was evaluated using whole-scalp magnetoencephalography, with results compared to the effect of sodium valproate in photosensitive children. Neuromagnetic responses to 10 Hz equiluminant red-green and red-blue flicker were measured before and after 5 days of sodium valproate administration. For the red-green flicker, relative power spectra at the stimulus frequency (10 Hz) were attenuated with medication in most brain regions. However, for the red-blue flicker, the 10-Hz power in the occipital region was enhanced with medication, while it was reduced in other regions. These results qualitatively resembled those in photosensitive children. The present findings suggest that (1) combinational chromatic sensitivity can be a critical factor for cortical excitability, that (2) the effect of sodium valproate is qualitatively similar in normal and photosensitive subjects, and that (3) the effect of sodium valproate on cortical excitability is not simply to suppress the stimulus-synchronized occipital activity, but rather to inhibit the spread of cortical activity from the occipital region to other regions.

Pancreatic necrosis and ventricular erosion in adenovirus-associated hydropericardium syndrome of broilers.

Seven 19-day-old broiler chickens affected with hydropericardium syndrome (HPS) with pancreatic necrosis and gizzard erosions were investigated pathologically and virologically. Mortality increased after 13 days of age in a flock on a broiler farm. The mortality rate of the flock reached 10% by 19 days of age. Macroscopically, the chickens had hydropericardium (the characteristic gross change of HPS), pinpoint white foci in the pancreas, and ventricular erosions. Histologically, the chickens had multifocal hepatic necrosis with intranuclear inclusions in hepatocytes, a marked increase of macrophages in the spleen and lung, mild epicardial edema, multifocal necrosis of pancreatic acinar cells with intranuclear inclusions, focal necrosis of the ventricular koilin layer, and degeneration of the ventricular glandular epithelium with intranuclear inclusions. Immunohistochemically, intranuclear inclusions in the liver, pancreas, and ventriculi were stained positively against group I avian adenovirus (GIAAV) antigens. Ultrastructurally, 67-nm diameter viral particles were present in intranuclear inclusions. Virologically, serotype 4 of GIAAV was isolated from the liver, heart, and kidney of affected chickens. The pathologic changes of the present cases differ from previous cases of HPS; therefore, the present strain of GIAAV may have different pathogenicity for chickens than the previous virus strain of HPS.

Complete, long-lasting protection against lethal infectious bursal disease virus challenge by a single vaccination with an avian herpesvirus vector expressing VP2 antigens.

Marek's disease herpesvirus is a vaccine vector of great promise for chickens; however, complete protection against foreign infectious diseases has not been achieved. In this study, two herpesvirus of turkey recombinants (rHVTs) expressing large amounts of infectious bursal disease virus (IBDV) VP2 antigen under the control of a human cytomegalovirus (CMV) promoter or CMV/beta-actin chimera promoter (Pec promoter) (rHVT-cmvVP2 and rHVT-pecVP2) were constructed. rHVT-pecVP2, which expressed the VP2 antigen approximately four times more than did rHVT-cmvVP2 in vitro, induced complete protection against a lethal IBDV challenge in chickens, whereas rHVT-cmvVP2 induced 58% protection. All of the chickens vaccinated with rHVT-pecVP2 had a protective level of antibodies to the VP2 antigen at the time of challenge, whereas only 42 and 67% of chickens vaccinated with rHVT-cmvVP2 or the conventional live IBDV vaccine, respectively, had the antibodies. The antibody level of chickens vaccinated with rHVT-pecVP2 increased for 16 weeks, and the peak antibody level persisted throughout the experiment. The serum antibody titer at 30 weeks of age was about 20 or 65 times higher than that of chickens vaccinated with rHVT-cmvVP2 or the conventional live vaccine, respectively. rHVT-pecVP2, isolated consistently for 30 weeks from the vaccinated chickens, expressed the VP2 antigen after cultivation, and neither nucleotide mutations nor deletion in the VP2 gene was found. These results demonstrate that the amount of VP2 antigen expressed in the HVT vector was correlated with the vaccine efficacy against lethal IBDV challenge, and complete protective immunity that is likely to persist for the life of the chickens was induced.

Gizzard nematodiasis in Japanese mountain hawk eagle (Spizaetus nipalensis).

In this paper, we report spontaneous gizzard nematodiasis in an adult Japanese mountain hawk eagle (Spizaetus nipalensis). Grossly, the gizzard had a black mucoid substance attached to the surface mucous membrane, and the heart was dilated. Histologically, immature larvae with yellow pigments invaded crypts of the mucous membrane. More developed larvae invaded the lamina propria and muscular layers and serosa of the gizzard, with pressure atrophy and cellular reaction (infiltration of heterophils and macrophages and proliferation of fibrous connective tissue). Moderate bronchopneumonia due to larvae invasion was also seen in the lung. The morphology suggests that the parasites may be nematodes, but the species of nematode could not be confirmed. The bird may have died from malabsorption and respiratory damage as a result of the gizzard and lung lesions.

Role of nitric oxide in human gastric cancer cells treated with 5-fluorouracil.

We examined whether 5-fluorouracil (5-FU) induces nitric oxide (NO) production and evaluated the role of NO in antitumor activity in human gastric cancer cells. MKN-1 gastric cancer cells were treated with the IC50 of 5-FU in the presence of interferon-gamma (IFN-gamma). In addition, s-methylisothiourea (an antagonist of inducible nitric oxide synthase) or anti-TNF-alpha antibody was added to the culture medium. Production of NO was measured by nitrite assay, TNF-alpha was measured by enzyme-linked immunoabsorbent assay, antitumor activity was evaluated by 3-[4,5-dimethylethiazol-2-yl]-2,5-dipheniltetrasolium bromide (MTT) assay. After 5-FU treatment in the presence of IFN-gamma, NO and TNF-alpha were produced and anti-tumor activity was enhanced. In contrast, s-methylisothiourea abolished the antitumor activity of 5-FU treatment. Anti-TNF-alpha antibody inhibited NO production and decreased the antitumor activity. 5-FU induces NO production by gastric cancer cells, and NO participates in antitumor activity in gastric cancer cells. These effects may be mediated by TNF-alpha production.

Angiogenesis in hepatocellular carcinoma as evaluated by alpha smooth muscle actin immunohistochemistry.

BACKGROUND/AIMS: Angiogenesis has been known to be associated with tumor development. In this study, neovascularization in small hepatocellular carcinoma was investigated by evaluation of intratumoral arteriole counts, using alpha smooth muscle actin antibody immunohistochemistry. METHODOLOGY: Surgical specimens from 38 patients with small hepatocellular carcinoma were immunostained for alpha smooth muscle actin and proliferating cell nuclear antigen. The correlation between intratumoral arteriole density and clinicopathological factors including angiographic findings, proliferative activity, and patient prognosis were analyzed. RESULTS: Significant difference in intratumoral arteriole density were observed between well-differentiated hepatocellular carcinoma and poorly differentiated hepatocellular carcinoma (P = 0.004) or moderately differentiated hepatocellular carcinoma and poorly differentiated hepatocellular carcinoma (P = 0.011). The mean intratumoral arteriole count in the tumors showing angiographic hypervascularity was significantly higher than that in the tumors without angiographic hypervascularity (P = 0.011). A significant and positive correlation was found between proliferating cell nuclear antigen labeling index and intratumoral arteriole density (r = 0.5232, P = 0.001). A high intratumoral arteriole density in tumor was significantly correlated with shorter patients survival (P = 0.018). Cox's multivariate regression analysis showed that the intratumoral arteriole density was independent prognostic factors (P = 0.0306). CONCLUSIONS: Intratumoral arteriole density was found to be significantly associated with histological grade, proliferative activity, and patient survival. It also reflected the angiographic findings. Alpha smooth muscle actin antibody immunohistochemistry would provide a simple and biologically significant method which is usable to screen neovascularization and arterial blood supply in hepatocellular carcinoma, and may have predicting utility for patients outcome. This technique is applicable to routine paraffin sections, and may be useful as an adjunct to surgical pathology of hepatocellular carcinoma.

Laparoscopic surgery using a newly designed suction lifter.

The authors describe a simple and available abdominal wall-lift technique for endoscopic surgery that involves a new suction lifter that they designed for laparoscopic surgery. Since July 1998, the authors have used this technique successfully in eight patients with appendicitis, in one patient with a perforated duodenal ulcer, and in one patient with an adenoma of the ascending colon.

Imported parakeets harbor H9N2 influenza A viruses that are genetically closely related to those transmitted to humans in Hong Kong.

In 1997 and 1998, H9N2 influenza A viruses were isolated from the respiratory organs of Indian ring-necked parakeets (Psittacula Krameri manillensis) that had been imported from Pakistan to Japan. The two isolates were closely related to each other (>99% as determined by nucleotide analysis of eight RNA segments), indicating that H9N2 viruses of the same lineage were maintained in these birds for at least 1 year. The hemagglutinins and neuraminidases of both isolates showed >97% nucleotide identity with those of H9N2 viruses isolated from humans in Hong Kong in 1999, while the six genes encoding internal proteins were >99% identical to the corresponding genes of H5N1 viruses recovered during the 1997 outbreak in Hong Kong. These results suggest that the H9N2 parakeet viruses originating in Pakistan share an immediate ancestor with the H9N2 human viruses. Thus, influenza A viruses with the potential to be transmitted directly to humans may be circulating in captive birds worldwide.

[Combined 5-FU and CDDP in a gastric cancer patient undergoing hemodialysis--pharmacokinetics of 5-FU and CDDP].

The pharmacokinetics of 5-FU and CDDP was examined in a gastric cancer patient receiving regular hemodialysis (HD) for renal failure. The patient received combination chemotherapy of 5-FU and CDDP, then on the day of HD we measured the plasma concentration of 5-FU, total platinum, and non-protein-bound platinum of the patient. In the present case, the 5-FU concentration was kept at an almost even level during HD. Non-protein-bound platinum disappeared after being maintained in blood for a certain time when HD was started 30 minutes after the end of CDDP administration. From these findings, we conclude that combined 5-FU and low-dose CDDP therapy should be done by decreasing the dose of 5-FU, administrating CDDP only on the day the patient undergoes HD, and starting HD 30 minutes after the end of CDDP administration.

The efficacy of 1 alpha hydroxy vitamin D3 treatment of the metabolic bone disorder in patients who underwent gastrectomy for gastric cancer.

BACKGROUND/AIMS: The aim of this study was to elucidate the efficacy of 1 alpha hydroxy vitamin D3 for treatment of metabolic bone disorder after gastrectomy. METHODOLOGY: MD-MS method was performed in 16 patients who underwent gastrectomy to evaluate the metabolic bone disorder and compared before and after 1 alpha hydroxy vitamin D3 treatment. The symp-toms related to the metabolic bone disorder were also analyzed through patient interview. RESULTS: The severity of the metabolic bone disorder analyzed by the MD-MS method improved after 1 alpha hydroxy vitamin D3 treatment in 56.3% of patients. The deviation degree of the cortical bone density was also significantly improved. The symptoms related to metabolic bone disorder disappeared in 80% of patients after treatment. CONCLUSIONS: The administration of 1 alpha hydroxy vitamin D3 may be useful for the metabolic bone disorder in the treatment of patients after gastrectomy.

Clinicopathologic differences between early gastric remnant cancer and early primary gastric cancer in the upper third of the stomach.

BACKGROUND/AIMS: This study was designed to clarify the clinicopathologic characteristics and survival in early gastric remnant cancer and compare with early primary cancer in the upper third of the stomach. METHODOLOGY: Twenty-five patients with early gastric remnant cancer, who underwent resection at Kanagawa Cancer Center and First Department of Surgery, Yokohama City University between 1974 and 1996 were evaluated in this study. Various clinicopathologic characteristics, such as age, sex, symptoms, size of tumor, depth of invasion, lymph node metastasis, cell differentiation, and survival were investigated and early gastric remnant cancer was compared with early primary cancer in the upper third of the stomach. RESULTS: According to the macroscopic type, protruded type such as I or II type accounted for a great majority in early gastric remnant cancer, while II c depressed type was common in early primary cancer in the upper third of the stomach, comprising 64.2% of all cases. Pathological examination disclosed that well-differentiated carcinoma and mucosal carcinoma were more frequently observed in early gastric remnant cancer than in early primary cancer in the upper-third of the stomach. The 5-year survival rate was 83.5% for early primary cancer in the upper-third of the stomach. In contrast, no patients experienced recurrence after operation for early gastric remnant cancer. CONCLUSIONS: From the view point of clinicopathological evaluation, gastric remnant cancer is a special from of gastric cancer. A follow-up program is important in order to detect early gastric remnant cancer. A low incidence of lymph node metastasis suggests that endoscopic mucosal resection of the tumor or limited operation could be performed under strict indication.

Avian nephritis virus (ANV) as a new member of the family Astroviridae and construction of infectious ANV cDNA.

The complete RNA genome of the avian nephritis virus (ANV) associated with acute nephritis in chickens has been molecularly cloned and sequenced. Excluding the poly(A) tail, the genome comprises 6,927 nucleotides and contains three sequential open reading frames (ORFs). The first ORF (ORF 1a) contains a sequence encoding a serine protease motif, and the second ORF (ORF 1b) has a sequence encoding an RNA-dependent RNA polymerase. ORF 1a may be linked to the second ORF by a ribosomal frameshifting mechanism. The third ORF (ORF 2) may encode the virion structural proteins as a polyprotein precursor. Two RNAs, probably genonic and subgenonic RNA (7.5 and 3.0 kb), were detected in the cytoplasm of ANV-infected cells. ANV and human astroviruses have the same genonic organization, and both are characterized by the presence of two RNA bands. The amino acid homologies of the products of ORF 1a, 1b, and 2 were 20.3, 41.9, and 25.8% to products of the corresponding ORFs of human astrovirus serotype 1 (A/88 Newcastle strain). We have constructed a genonic-length cDNA clone of ANV to test whether the in vitro transcript is infectious. When a chicken kidney cell culture was transfected with RNA transcribed in vitro and the cDNA clone, infectious virus was produced with cytopathic effects in the absence of trypsin. These observations suggested that the ANV (G-4260 strain) is a new genus of the family Astroviridae.

Prognostic significance of the carcinoma area in the thickest part of the lymph node.

BACKGROUND/AIMS: The carcinoma volume in each metastatic lymph node varies widely. Our aim was to define the meaning of carcinoma volume in lymph nodes as a prognostic factor. METHODOLOGY: One hundred and five patients with preoperatively untreated esophageal carcinoma who underwent surgery were enrolled as subjects. In the present study, the carcinoma area within lymph nodes at their thickest level was substituted for carcinoma volume in lymph nodes for measurement and analysis. A total of 3,703 lymph nodes were isolated and the area of the carcinoma in the thickest part of the lymph node (CALN) was measured. Univariate and multivariate analysis of prognostic significance were made for the factors age, sex, cancer location, cell differentiation, pT, conventional classification of lymph nodes for surgical dissection (n), number of metastatic lymph nodes (MLN number), and CALN. RESULTS: In all 105 cases, n was the best prognostic factor and CALN was more useful than MLN number. In the cases in which absolute curative resection was successful, CALN was the best prognostic factor. CONCLUSIONS: The carcinoma area in the thickest part of the lymph node is a meaningful prognostic factor.