Association between thyroid cancer of cribriform variant and familial adenomatous polyposis.

A case of a 20 year old Japanese woman who developed thyroid cancer exhibiting unusual cribriform structures while being followed up for familial adenomatous polyposis/Gardner's syndrome is reported. The patient presented with osteomas, pigmented retinal lesions, and adenomas of the duodenum and the papilla of Vater, in addition to numerous adenomatous polyps in the colorectum. On ultrasonography, the thyroid cancer was localised to the right lobe and was identified as an irregular, internal echo tumour with a peripheral hypoechoic zone, measuring 1.8 cm in diameter. Histological examination of the resected tumour showed a concomitance of papillary proliferation and cribriform structures with follicles of varying sizes. These features can be distinguished from sporadic thyroid cancer.

Complete ten-year postgastrectomy follow-up of early gastric cancer.

The postoperative courses of 109 patients with early gastric carcinoma treated from 1970 through 1976 were followed for 10 years. The cumulative 5-year survival rate was 96 percent and the 10-year survival rate was 92 percent. In this series, there was no significant difference in the survival rates between the mucosal cancer and submucosal invasion groups or between patients with and without lymph node metastasis. Five patients died from the recurrent cancer. The other causes of death were metachronous primary cancer in eight patients, synchronous primary cancer of sigmoid colon or rectum in two, cerebrovascular accident in six, heart disease in six, other causes in four, and unknown causes in four. Although the prognosis of early gastric cancer is remarkably good, patients should be carefully followed over a long period for late recurrence of the primary cancer and possible metachronous cancer of the other organs.

Comparison of blood flow assessment between laser Doppler velocimetry and the hydrogen gas clearance method in ischemic intestine in dogs.

Blood flow of the colon and the ileum was measured before and after intestinal devascularization by laser Doppler velocimetry and the hydrogen gas clearance technique in 10 dogs in order to evaluate the clinical usefulness of laser Doppler velocimetry. The submucosal blood flow of the colon and the ileum measured by the hydrogen gas clearance method was significantly decreased, as was the subserosal blood flow of both sites measured by laser Doppler velocimetry. There was a linear relationship between the flow values using the two methods both in the colon (r = 0.7192, p less than 0.001) and in the ileum (r = 0.7646, p less than 0.001). These data suggested laser Doppler velocimetry may be a useful method to assess the degree of intestinal ischemia because of its noninvasiveness and good correlation with submucosal blood flow by the hydrogen gas clearance technique.

Rapidly and infiltratively growing Crohn's carcinoma of the small bowel: serial radiologic findings and a review of the literature.

We carried out a retrospective evaluation of serial changes in the small bowel radiographs of a patient with small bowel cancer accompanied by long-standing Crohn's disease. During the 8 months before diagnosis, marked morphological changes were noted. A solitary and irregular protrusion, and rapidly growing stricture under careful medical management of the underlying disease may indicate the development of cancer.

Effect of a new prostacyclin analogue on anastomosis of ischemic colon in dogs.

The effect of a new prostacyclin analogue OP-41483 on ischemic colonic anastomosis was investigated in dogs. Colonic ischemia was produced by devascularization of the marginal vessels in the left colon and graded into three degrees by measuring colonic blood flow with a hydrogen gas clearance method. The agent was administered intravenously after devascularization using a continuous infusion pump. The parameters studied were colonic blood flow in the submucosal layer, rate of anastomotic leakage, beta-glucuronidase activity and protein content of the colonic mucosa, and histologic changes. After administration of the agent, blood flow increased significantly and beta-glucuronidase activity at the anastomotic site was well preserved at a relatively high level in spite of ischemic change. The anastomotic leakage rate was significantly decreased. The present study proved that administration of this new prostacyclin analogue minimizes ischemic damage, and may be of considerable importance in ischemic colonic anastomoses.

Treatment of desmoid tumors in Gardner's syndrome. Report of a case.

Aggressive desmoid tumors present difficult problems among patients with Gardner's syndrome. Recently, attention has been directed toward metabolic or hormonal manipulation of these tumors. A 21-year-old woman with Gardner's syndrome was admitted because of recurrent abdominal wall tumors. She was treated with nonsteroidal anti-inflammatory drugs, tamoxifen, and ascorbate for seven months. During this therapy, CT scan showed a gradual increase in size of the tumors. Subsequent resection of the abdominal tumors and the colon was performed. Although these three types of drugs were administered to prevent postoperative recurrence, an abdominal wall desmoid tumor that invaded the mesentery developed within nine months. The known treatments, that is, chemotherapy, irradiation, and surgical resection are discussed in view of this experience.

Regression of an aggressive abdominal desmoid tumor in a patient with familial adenomatous polyposis by hyperthermoradiotherapy.

A case of huge desmoid tumor successfully treated by hyperthermoradiotherapy is described. A 23-year-old man with familial adenomatous polyposis was operated upon for a desmoid tumor in the mesenterium involving the right kidney and small intestine in 1988. In 1990, the tumor recurred and could not be resected because of the involvement of the vena cava. The tumor grew larger and larger, and occupied two-thirds of the right lower quadrant. Several therapies using sulindac, tamoxifen, prednisolone, indomethacin, luteinizing hormone-releasing hormone analogue, and ascorbate were all ineffective. Finally, the combination of radiation and hyperthermia was used over a 6-month period. At the end of the hyperthermoradiotherapy, the tumor in the abdominal wall was markedly reduced in size, and the protruded abdominal wall became flat. To our best knowledge, this is the first report of the successful treatment of a huge desmoid tumor by hyperthermoradiotherapy.

Correlation between macroscopic morphologic features and malignant potential of colorectal sessile adenomas.

PURPOSE AND METHODS: To clarify malignant potential of colorectal sessile adenomas, we investigated 46 colorectal sessile adenomas surgically resected from 44 patients. Lesions were divided into three types according to their macroscopic morphologic features: nodular-type (19 adenomas), villous-type (7), and creeping-type (20). Clinicopathologic features were investigated and compared among these three types. RESULTS: Frequency of focal carcinoma in the nodular-type, villous-type, and creeping-type adenoma was 37, 29, and 55 percent, respectively. Frequency of submucosal invasion in these three types were 11, 14, and 20 percent, respectively. Irrespective of the type, large lesions (> 3 cm) tended to have a higher frequency of submucosal invasion than did smaller ones (60 vs. 20 percent; P = 0.063). Large creeping-type adenomas (> 3 cm) had a definitely higher frequency of submucosal invasion than smaller ones (36 vs. 0 percent; P < 0.05). Lymphatic or vascular invasion of carcinoma was present only in the lesion with submucosal invasion: 5 percent in the nodular-type; 14 percent in the villous-type; 20 percent in the creeping-type. Lymph node metastasis was present only in the creeping-type lesion. CONCLUSIONS: The large creeping-type adenomas (> 3 cm) have a definitely high frequency of submucosal invasive carcinoma. Endoscopic polypectomy or local resection may be adequate for most sessile adenomas. However, we recommend segmental resection of the colon with regional lymph node dissection for a creeping-type adenoma that is larger than 3 cm because of increased risk of submucosal carcinomatous invasion and lymph node involvement.

Change in colonic motility after extrinsic autonomic denervation in dogs.

Changes in colonic motility were compared in dogs undergoing autonomic denervation of the paraaortic and presacral (group A), paraaortic (group B), or mesocolonic region (group C), and sham operation (group D). Five bipolar recording electrodes were placed into the seromuscular layer of the colon and rectum. The numbers of continuous electrical response activity and contractile electrical complex after an intragastric olive oil injection were smaller in group A than in the other groups (P < 0.05) from three weeks through six months after denervation. This difference was significant even in the proximal colon. These data suggest that the pelvic plexus may play an important role in colonic motility including the proximal colon. The damage to the plexus did not recover for at least six months after denevation. Pelvic plexus injury may thus be one of possible explanations for the prolonged change in bowel habit after anterior resection of the rectum.

Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA stapler for rectal cancer.

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.

The possible presence of a separate disease entity in nonfamilial polyposis of the large intestine.

Familial adenomatosis coli (FAC) traditionally has been diagnosed as the presence of more than 100 colonic adenomas, even if no familial occurrence is present. In the present communication, clinical features of FAC have been compared in detail to detect differences between familial and nonfamilial cases with regard to colonic and extracolonic lesions and to discover whether they constitute the same disease entities. No significant difference was found in the incidence of extracolonic lesions. The average number of colonic polyps in the nonfamilial cases of patients over 30 years old was 1128, the number of polyps was significantly higher in the familial cases (3154). When three patients with approximately 100 polyps were excluded, the mean number of colonic polyps in nonfamilial cases became 2608. This was similar to that of familial cases. Furthermore, the occurrence of approximately 100 polyps was extremely rare in familial patients who were over 30 years old. Therefore, most of the nonfamilial cases can be considered to be familial probands of FAC, but some, such as the three cases in the present study, may be a different disease entity, such as recessive adenomatous polyposis or multiple colonic adenomas.

Terminal ileal transposition procedure in ileoanal anastomosis following proctocolectomy.

We introduced a terminal ileal transposition procedure (TITP) in ileal pouch-anal anastomosis, in which a 50 to 70 cm isolated ileal segment 20 to 40 cm from the ileocecal valve was interposed between the terminal ileum and the anus. Twelve patients underwent this procedure in two or three-staged operations. Mean stool frequency per 24 hours was 4.4 +/- 1.7, and stool consistency was formed and soft in all patients at the mean of 13 months after TITP. We observed neither surgical technique-related complications nor metabolic disorders, except for iron deficiency anemia, during and after the operations. The serum level of vitamin B12 significantly increased after the operation in eight patients (P < 0.05). TITP has advantages such as preventing the terminal ileum from metabolic dysfunction due to pouchitis, avoiding sacrifice of the terminal ileum in the two-staged operation, and obviating the need for reconstruction of ileostomy in the three-staged operation. It may also promote intestinal absorption and reduce late metabolic complications.