Thyroid adenoma with extensive extracellular mucin deposition: report of a case.

A thyroid tumor with extensive extracellular mucin deposition is extremely rare. We herein describe a case of a thyroid adenoma with prominent myxoid stroma. A 63-year-old man presented with a mass in his right anterior neck. Radiological examinations showed this mass to be a thyroid tumor with a cystic component. The histopathological findings showed the stroma of this tumor to consist of abundant myxoid materials which stained gray-bluish for hematoxylin-eosin. The myxoid material was positive for alcian blue, whereas periodic acid-Schiff did not stain this material. No intracytoplasmic mucin was identified. In an immunohistochemical study, the tumor cells were negative for cytokeratin 19. Furthermore, positive staining was observed for thyroglobulin while a negative finding was seen for calcitonin.

Serum levels of interleukin-12 in Graves' disease and their dynamic changes after surgery.

PURPOSE: To investigate the role of interleukin-12 (IL-12) in Graves' disease, we measured the pre- and postoperative levels of serum IL-12 in patients undergoing surgery for Graves' disease. METHODS: The subjects of this study were 73 patients with Graves' disease, admitted for surgical treatment after taking antithyroid drugs for various durations. We collected blood from 11 of these patients, 1, 3, and 6 months postoperatively, to measure the serum IL-12 levels using a Human IL-12 +p40 Immunoassay Kit. RESULTS: The preoperative levels of serum IL-12 were higher in patients with Graves' disease than in healthy controls. Based on the preoperative data, there was a significant relationship between the levels of serum IL-12 and free T3. An analysis of the postoperative time course of these 11 patients showed that the levels of serum IL-12 decreased gradually from 1 month to 6 months, postoperatively. There was also a significant correlation between the levels of serum IL-12 and soluble IL-2R, and a significant negative correlation between the levels of serum IL-12 and thyroid-stimulating hormone receptor antibody. CONCLUSION: Measurement of the levels of serum IL-12 may be a valuable immunological marker in the time course of treatment for Graves' disease.

Serum interleukin-12 levels in patients with gastric cancer.

PURPOSE: To evaluate the immunological status of patients with gastric cancer before surgery, we investigated the relationship between serum interleukin-12 (IL-12) levels and clinicopathological factors. METHODS: We measured serum IL-12 levels in 127 patients with gastric cancer and 35 healthy controls, by a sandwich enzyme-linked immunosorbent assay using the Human IL-12 +p40 Immunoassay kit. RESULTS: The serum IL-12 levels in the patients with gastric cancer were significantly higher than those of the healthy controls (P < 0.05). There were no significant differences in disease stage or gross appearance among the cancer groups, but the serum IL-12 levels in patients with T4 disease were significantly lower than those in patients with T1, T2, or T3 (P < 0.01). There were no significant differences in serum IL-12 levels between patients with and those without lymph node, liver, or peritoneal metastasis. The serum IL-12 levels in patients with distant metastasis were significantly lower than those in patients without distant metastasis (P < 0.02). There were no significant differences in the serum IL-12 levels according to classification by histopathological findings. Analysis with the linear correlation coefficient showed no significant correlation between serum IL-12 and serum carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, CA 72-4, alpha-fetoprotein, or immunosuppressive acidic protein. However, there was a significant relationship between serum IL-12 levels and soluble IL-2 receptor levels (r = 0.53, P < 0.01). CONCLUSION: Serum IL-12 levels in patients with far-advanced gastric cancer were significantly lower than those in patients with less-advanced gastric cancer. This is because macrophages in patients with far-advanced cancer would be hectic and unable to produce sufficient IL-12.

Soluble interleukin-2 receptor in cancer.

Levels of serum sIL-2R (soluble interleukin-2 receptor) reflect the total amount of activated T lymphocytes in tumor infiltrating lymphocytes of cancer tissues and metastatic organs, because a part of alpha-chain of IL-2R is released into the bloodstream on the attachment of IL-2 (interleukin-2) to its specific IL-2R membrane. In most malignant diseases, elevated levels of serum sIL-2R are found, compare to normal control. Serum sIL-2R is a useful parameter for evaluating the disease stage and monitoring the disease progression during the post-treatment follow-up, though it is not an organ-specific parameter.

Churg-Strauss syndrome manifesting as perforation of the small intestine: report of a case.

We report a case of Churg-Strauss syndrome (CSS) causing perforation of the small intestine. A 51-year-old woman was admitted with an asthma attack and paralysis of both legs. Intravenous predonisolone (40 mg) was given to relieve her asthma. Laboratory data on admission showed leukocytosis with hypereosinophilia and a high level of serum IgE. Neurological examination also revealed mononeurutis multiplex. Based on these findings, we diagnosed CSS, and oral corticosteroids were continued. On the 20th day after admission, she suffered sudden abdominal pain. Abdominal X-ray showed free air in the abdomen, suggesting perforation of the gastrointestinal tract. Emergency laparotomy revealed generalized peritonitis caused by a perforated ulcer of the ileum. The resected specimens contained a perforation and multiple nonperforated ulcers with an irregular shape on the mucosal surface. Histopathological examinations revealed angiitis of the small vessels surrounded by eosinophilic infiltration and granuloma, consistent with CSS. Considering the high risk of perforation of the gastrointestinal tract, including the small intestine, during corticosteroid treatment in patients with CSS, any abdominal pain or discomfort must be investigated carefully.

Changes in liver enzymes after surgery in anti-hepatitis C virus-positive patients.

The aim of this study was to assess the influence of surgical intervention on changes in liver enzymes in patients with antibodies to hepatitis C virus (HCV). Of 623 patients who underwent laparotomy in our department during the 2 years between January 2000 and December 2001, a group of 39 (6.3%) who were positive for the HCV antibody were enrolled in this study. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and cholinesterase (ChE) were the standard liver tests performed. The antibody to HCV was measured in serum using an ELISA kit that can detect antibodies against the combined epitopes. The postoperative elevated values of AST and ALP in the anti-HCV-positive group were significantly higher than those in the anti-HCV-negative group ( p < 0.05). The postoperative decreased values of ChE in the anti-HCV-positive group were significantly greater than those in the anti-HCV-negative group ( p < 0.02). The postoperatively decreased ratios of ChE in the anti-HCV positive group were significantly greater than those in the anti-HCV negative group ( p < 0.0001). Using multivariate logistic regression modeling, testing positive for the antibody to HCV was independently and significantly associated with abnormal levels of ALT and ALP ( p = 0.035 and 0.018, respectively). Monitoring liver enzymes such as ChE, ALT, and ALP might be effective for evaluating liver function after surgery in anti-HCV-positive patients.

Situs inversus totalis with malignant lymphoma of the stomach: report of a case.

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A followup CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy.

Changes in the levels of serum-soluble interleukin-2 receptor after surgical stress.

PURPOSE: Surgical stress induces alterations in numerous physiological functions, including the cell-mediated immune response. It is known that interleukin-2 receptor (IL-2R) is released from its specific affinity membrane receptor on activated T lymphocytes and then is detected as a form of the alpha-chain of the IL-2R in the bloodstream. The levels of serum-soluble IL-2R (sIL-2R) reflect the quantity of activated T lymphocytes. This study investigated the changes in the serum sIL-2R levels and the relationship of such changes with other cytokines and the number of lymphocytes after abdominal surgery. METHODS: Twenty-four patients who were scheduled to undergo abdominal operations were enrolled in this study. Blood samples of these cases were collected before surgery, and on postoperative days (POD) 1, 3, 7, and 14. The levels of serum sIL-2R were measured by an enzyme-linked immunosorbent assay. RESULTS: The levels of serum sIL-2R achieved the maximal values on POD 1, and gradually decreased until POD 14. The levels of serum sIL-2R on POD 1, 3, and 7 were significantly higher than the preoperative levels. There was a significant and positive correlation between the levels of serum sIL-2R and serum IL-6. There were significant and positive correlations between the levels of sIL-2R and the number of white blood cells and neutrophils. Conversely, there was a significantly negative correlation between the levels of serum sIL-2R and the number of lymphocytes. CONCLUSIONS: As high levels of serum sIL-2R were recognized after abdominal operations, the proliferation of T lymphocytes might still be highly activated in a state of surgical stress, though it is popularly acceptable that surgical stress induces a suppression of cell-mediated immunity.

Adrenal metastasis from rectal cancer: report of a case.

We report a case of heterochronic adrenal metastasis from colorectal carcinoma in a 51-year-old woman. A left adrenal metastasis was found by computed tomography and magnetic resonance imaging 8 months after an anterior resection for advanced rectal carcinoma, and a left hepatectomy for a solitary liver metastasis. The level of serum carcinoembryonic antigen was still within the normal range. A left adrenalectomy was performed, and histopathological examination revealed adenocarcinoma, compatible with the rectal carcinoma resected 8 months earlier. The patient died of lung metastases 6 months after the adrenalectomy. A review of autopsy series in the world literature revealed that adrenal metastasis from colorectal cancer is not rare. Therefore, the possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though the liver and lung are the main metastatic sites.

Serum soluble interleukin-2 receptor (IL-2R) and immunohistochemical staining of IL-2R/Tac antigen in colorectal cancer.

BACKGROUND: In the present study, we investigated the significance of serum soluble interleukin-2 receptor (IL-2R) as a tumor marker, and examined the existence and localization of cells positive for IL-2R/Tac antigen in colorectal cancer tissues and their regional lymph nodes. METHODS: The study included 155 patients with colorectal cancer. Levels of serum soluble IL-2R were measured by an enzyme-linked immunosorbent assay. In the tissues obtained from 18 patients, immunohistochemical staining was performed, with the use of the avidin-biotin-peroxidase complex technique, in which mouse anti-human IL-2R antibody was used. RESULTS: The preoperative levels of serum soluble IL-2R in patients with colorectal cancer were significantly higher than those of normal controls ( P = 0.0065). The levels of serum soluble IL-2R in patients with metastatic lymph nodes were also significantly higher than the levels in those without metastatic lymph nodes ( P = 0.0258). Concerning tumor markers, there were significant differences in serum soluble IL-2R levels between patients who were positive and those who were negative for carcinoembryonic antigen (CEA) and between these who were positive and those who were negative for immunosuppressive acidic protein (IAP). In the immunohistochemical staining of IL-2R, 16 of the 18 patients (88.8%) showed IL-2R-positive cells in the colorectal cancer tissues. In regard to the metastatic lymph nodes, all of 5 patients (100%) showed IL-2R-positive cells. On the other hand, IL-2R-positive cells were not recognized in normal colorectal tissues and non-metastatic lymph nodes. CONCLUSION: These results suggest that activated T lymphocytes infiltrating into cancer tissues to play an antitumor role may release a large amount of the alpha-chain of IL-2R, resulting in the high levels of serum soluble IL-2R in patients with colorectal cancer.

Human colorectal malignancy and oral UFT.

Thymidylate synthase (EC 2.1.1.45) and thymidine kinase (EC 2.71.21) are key enzymes involved in de novo and salvage pathways for pyrimidine nucleotide synthesis. Both enzyme activities are increased in rapidly proliferating normal, fetal and neoplastic tissues. In a previous study, the activities of thymidylate synthase and thymidine kinase were relatively predominant in the poorly-and well-differentiated types of a gastric cancer. In the present study of patients with colorectal cancer, the serum thymidine kinase activities are elevated in cases at a clinically late stage, and in cases with a recurrence and a distant metastasis associated with abundant blood supply, i.e. metastasis to the liver, lung and bone. Well-differentiated colorectal cancer shows higher thymidine kinase activity than moderately-well-differentiated type as was previously shown in gastric cancer patients. Furthermore, neoadjuvant chemotherapy using the 5-fluorouracil derivative UFT demonstrates a stronger suppression of increased activities of thymidylate synthase in the tumorous tissues than in the non-tumorous mucosa.

Serum soluble interleukin-2 receptor as a predictor of lymph node metastasis in early gastric cancer.

BACKGROUND: In the present study, we investigated the clinical significance of serum soluble IL-2R as a predictor of lymph node metastasis in patients with early gastric cancer. PATIENTS AND METHODS: Seventy-four patients with early gastric cancer were enrolled in this study. Levels of serum soluble IL-2R were measured by an enzyme-linked immunosorbent assay. RESULT: Significant differences in serum soluble IL-2R between the control group and cases of T1 were not recognized. On the other hand, levels of serum soluble IL-2R in 74 patients with early gastric cancer (T1) were significantly lower than those of T2, T3, and T4 (p < 0.05). There were no significant differences in serum soluble IL-2R between cases of mucosal and submucosal invasion (379 +/- 42 vs. 382 +/- 35 U/ml). Six of 35 patients with submucosal invasion (17.1%) had lymph node metastasis, but none of the 39 patients with mucosal invasion. In the 6 cases showing lymph node metastasis, the macroscopic types were IIc + Ul(+) in 4, and IIc + IIa and IIc + IIb in 1, respectively. Histopathologically, there were 5 poorly and 1 moderately differentiated adenocarcinomas. In 6 cases with lymph node metastasis, serum soluble IL-2R levels were significantly higher than in those without lymph node metastasis (556.8 +/- 73 vs. 329 +/- 22 U/ml, respectively, mean +/- SEM, p < 0.05). Five of these 6 cases demonstrated statistically significantly increased levels of serum soluble IL-2R (sensitivity 83%, specificity 63%), suggesting serum soluble IL-2R as a predictor of lymph node metastasis in early gastric cancer (p < 0.05). CONCLUSION: According to these data, in patients of early gastric cancer with increased levels of serum soluble IL-2R, endoscopic mucosal resection or minimal invasive gastrectomy without dissection of regional lymph nodes should be avoided, since there is a high risk of lymph node metastasis.