Biliary carcinoembryonic antigen levels can predict metachronous liver metastasis of colorectal cancer.

We set out to determine whether carcinoembryonic antigen (CEA) levels in gallbladder bile and serum can predict metachronous liver metastasis of colorectal cancer. At the time of surgery, gallbladder bile and serum were sampled for enzyme immunoassays of CEA. Upper limit (mean +/- 2SD) of the normal range for CEA in bile was established from samples at surgery for nonneoplastic gallbladder disease. In 11 patients with synchronous liver metastases, biliary CEA levels correlated with the size of hepatic lesions. In 49 patients without evident liver metastases at the time of surgery, elevated biliary CEA levels predicted subsequent emergence of metachronous liver metastases with 75% sensitivity, 85% specificity, and 84% accuracy; serum CEA levels were not a reliable predictor. In conclusion, determination of biliary CEA level at the time of colorectal resection shows promise as a way to identify patients at high risk for hepatic recurrence.

[A case of Borrmann type 4 gastric cancer successfully treated with MTX and 5-FU therapy through the hepatic artery].

A 73-year-old male was diagnosed as having a Borrmann type 4 gastric cancer with multiple liver metastases. Total gastrectomy (D2) with hepatic arterial cannulation was performed. Hepatic arterial infusion therapy of MTX (50 mg or 100 mg/body) and 5-FU (500 mg or 750 mg/body) was started postoperatively. A total dose of 1,150 mg of MTX and 6,250 mg of 5-FU caused a marked decrease in the volume of liver metastases and the effect remained for 8 months (partial response). Regarding drug concentrations, serum MTX levels rapidly decreased after bolus injection through hepatic artery and corresponded to those of intravenous injection as reported elsewhere. Serum 5-FU levels were maintained as low as 1.2 micrograms/ml during 2-hr continuous infusion and rapidly decreased after the end of the infusion. These results indicate that hepatic arterial infusion therapy of MTX and 5-FU may be safe and feasible for multiple liver metastases of Borrmann type 4 gastric cancer.

Increased number of Epstein-Barr virus latently infected B-cells in T-cell non-Hodgkin's lymphoma tissues.

Epstein-Barr virus (EBV) is a causative agent of malignant lymphomas occurring in immunocompromised hosts. Similar lymphoid tumors can be induced in mice with severe combined immunodeficiency (SCID mice) by transplanting human B-cells with latently infected EBV. We have previously observed that when apparently EBV-negative lymphomas were engrafted into SCID mice, 11 of 18 T-cell non-Hodgkin's lymphomas (NHLs) produced EBV associated lymphomas, but only 2 of 30 engrafted with B-NHLs. Previous studies suggested that EBV-infected cell inducing lymphomas in SCID mice may preferentially exist in T-cell NHL tissues. To prove this assumption, in situ hybridization (ISH) using oligonucleotide probes for EBV-encoded small RNAs 1 (EBER1) was used in this study to demonstrate EBV-bearing lymphocytes in NHL tissues. It was found that EBV-bearing cells existe in 9 of the 10 T-cell NHL surgical specimens. By contrast, in B cell NHLs, only 2 of 10 carried EBV-bearing cells. Further semi-quantitative analysis demonstrated that apparently significantly more EBV-bearing cells were present in T-cell NHL tissues than in B-cell NHLs. Moreover, these EBV-bearing cells in lymphoma tissues were shown to be of B-cell lineage, by the combinated analysis of immunostaining with CD20 and ISH with EBER1. These results indicated the increase of EBV-bearing B-cells in T-cell NHL tissues, suggesting the activation of B-cells with latently infected EBV by neoplastic T-cells.

Rearrangement of bcl-2 is detectable in Hodgkin's disease by polymerase chain reaction.

The authors examined the occurrence of the t(14;18) chromosomal translocation in 44 cases of Hodgkin's disease (HD) using the polymerase chain reaction and Southern blot hybridization with non-radioactive oligonucleotide probes. DNAs were extracted from unfixed, fresh-frozen and formalin-fixed, paraffin-embedded biopsy specimens. Southern blot hybridization of the amplification product showed that, of 44 HD DNAs, three had a detectable t(14;18) breakpoint at the mbr (major breakpoint region), while none had a detectable t(14;18) breakpoint at the mcr (minor cluster region). Of the three cases positive for a t(14;18) breakpoint at the mbr, two were of lymphocyte predominance type, and the other was of mixed cellularity type.

[A case of AFP (alpha-fetoprotein) producing gastric cancer successfully treated with EAP (etoposide, adriamycin, cisplatin) therapy].

A case of AFP producing gastric cancer successfully treated with EAP therapy is reported with a review of the literature. A 56-year-old male was admitted complaining of epigastralgia and back pain. He was diagnosed as having a gastric cancer with multiple liver metastases by endoscopy and computed tomography. Serum AFP level was 2,791,000 ng/ml and biopsy specimen showed AFP-positive tumor cells by PAP (peroxidase-antiperoxidase) method in hepatoid structure. Preoperative combination chemotherapy with etoposide, adriamycin and cisplatin resulted in a remarkable decrease in serum AFP level. Subtotal gastrectomy (R3) with hepatic artery cannulation was performed. The therapeutic effect by histological examination showed Grade 3 in the primary site and Grade 2 in both resional lymph nodes and liver metastasis.

Expression of Lyn protein on human malignant lymphomas.

BACKGROUND: lyn is one of the src family genes encoding protein-tyrosine kinases, expressed preferentially in B lymphocytes and monocytes/macrophages. Its gene product, Lyn protein, is thought to participate in cell membrane-associated signal transduction on B lymphocytes by associating physically and functionally with membrane-bound IgM. EXPERIMENTAL DESIGN: To investigate the expression of Lyn on human malignant lymphomas (MLs), 50 ML biopsies, 12 ML samples maintained in mice with severe combined immunodeficiency, and 4 African Burkitt type cell lines were studied with the use of immunohistology, immunochemistry, and Southern blot analysis. RESULTS: Among biopsy specimens, 27 of 27 B-MLs, 5 of 21 T-MLs, and 2 of 2 null-MLs were stained. In severe combined immunodeficiency mouse-maintained B-MLs, unlike biopsied B-MLs, 4 of 11 were found to be unstained. Further analysis disclosed that all 4 of these unstained B-MLs were the Epstein Barr virus transformed B cells proliferating in severe combined immunodeficiency mice and not the original ML cells, suggesting the presence of a specific mechanism down-regulating the Lyn protein in this group. One IgA+ IgM- B-ML and one IgG+ IgM- B-ML were stained by the antibody, indicating the possible existence of molecular mechanisms other than membrane-bound IgM that facilitate Lyn protein expression. Decrease of Lyn expression was also noted in 3 of 4 Epstein-Barr virus-positive African Burkitt's ML lines. Complementary Western blot analysis of 8 immunostained and 4 unstained MLs confirmed the immunohistologic findings. However Southern blot analysis showed that the lyn gene in Lyn-positive and -negative cases were apparently unchanged. CONCLUSIONS: The level of Lyn expression in MLs reflects mainly their normal counterpart, whereas it can be expressed somewhat differently in some cases, especially in Epstein Barr virus-transformed MLs that occur in immunocompromised hosts, on which it is often down-regulated. This is the first report of Lyn expression on human MLs.

Engraftment of human non-Hodgkin lymphomas in mice with severe combined immunodeficiency.

BACKGROUND: Malignant non-Hodgkin lymphoma (NHL) is one of the most difficult neoplasms to transplant into nude mice. Mice with severe combined immunodeficiency (SCID) accept various human cancers much more efficiently than do nude mice. The authors investigated whether SCID mice could be used as convenient hosts in which to grow human NHL in vivo. METHODS: Fifty NHL specimens were engrafted into SCID mice. The original specimens and the tumors that developed in SCID mice were studied immunohistologically and by Southern blot analysis to clarify their clonal identity and to determine if they were Epstein-Barr virus (EBV)-transformed B cell proliferations. RESULTS: SCID tumors developed from 23 of 50 NHL specimens. Ten tumors were identical immunophenotypically and, partly, genotypically to the original NHL, showing that the original NHL grew in the SCID mice. B-cell NHL rather than T-cell NHL and high-grade rather than low-grade malignancy groups were much more easily heterotransplanted. Most of the heterotransplanted NHL were maintained by successive transplantation. In two other SCID tumors, the original NHL clones and a newly developed B-cell clone coexisted. The remaining 11 SCID tumors were composed of newly developed clones. The latter 13 tumors were shown to be human cells of B-cell lineage bearing EBV latent proteins--latent membrane protein 1 and EB nuclear antigen 2--suggesting that they originated from EBV-infected B-cells that were present in the original tumor tissues. CONCLUSION: SCID mice accept human NHL far more efficiently than do nude mice. However, frequent occurrence of spontaneous EBV-associated B-cell proliferation must be kept in mind.

[Measurement of bile CEA levels in patients with colorectal cancer: is it of value for diagnosis of occult liver metastases aiming at prophylactic regional hepatic chemotherapy?].

A preliminary study was conducted to determine whether the measurement of CEA levels in gallbladder bile would be of value for diagnosis of occult liver metastases aiming at prophylactic regional hepatic chemotherapy in patients with colorectal cancer. Forty-fold dilution by normal human sera was necessary to measure CEA levels of gallbladder bile by the enzyme immunoassay (EIA). Bile CEA levels were 27.2 +/- 30.4 (M +/- SD) ng/ml in patients with benign biliary diseases (control), 248.5 +/- 426.3 ng/ml (p < 0.05, vs. control) in Dukes B, C patients, and 3,331.5 +/- 4,473.3 ng/ml (p < 0.01 vs. control, p < 0.05 vs. Dukes B, C) in patients with hepatic metastases from colorectal cancer, respectively. Bile CEA tended to demonstrate the existence of hepatic metastases more accurately than serum CEA. Our results obtained from a small number of patients suggest that patients with either elevation of bile CEA level or with a high ratio of bile CEA/serum CEA may be candidates for hepatic recurrence that requires prophylactic hepatic chemotherapy. However, it may be difficult to determine the bile CEA level at which occult liver metastases are demonstrated.

Jejunal perforation caused by blunt abdominal trauma in a patient with Crohn's disease: report of a case.

We report herein the case of a 23-year-old man with Crohn's disease who was found to have a perforated small bowel following blunt abdominal trauma sustained in a traffic accident. The general findings of diffuse peritonitis were identified by physical examination, and a plain X-ray film showed free air in the abdominal cavity. An emergency laparotomy was performed which revealed three perforated ulcers in the affected intestine. An abrupt increase in intraluminal pressure due to the striking force of the steering wheel to the abdomen was assumed to have been the cause of these perforations.

An experimental study on intestinal vascular lesions: a comparison between the effects of arterial and venous occlusion in the acute phase.

In order to clarify what early ischemic changes are produced by venous interruption in the intestine, intestinal vascular lesions caused by peripheral venous ligation were compared with those caused by arterial ligation in rabbits. With less than 30 min ligation, there were only 4 specimens from a total 13 without injury following venous ligation, whereas there were 7 from a total 11 without injury following arterial ligation. After 30 min venous ligation, both the mucosal and submucosal layers of all 10 specimens were affected, while following arterial ligation, 3 of the 11 specimens showed no histological changes. Moreover, in 3 of the remaining 8 specimens from the latter group, the injury was confined to within the mucosal layer. Thus, in cases of venous interruption, intestinal injury might be evoked earlier with more severe damage than in cases of arterial interruption.

Enterocolitis due to methicillin-resistant Staphylococcus aureus--report of two cases.

Two cases of postoperative enterocolitis due to methicillin-resistant Staphylococcus aureus (MRSA) after gastrectomy were experienced. Case 1: A 59-year-old male underwent subtotal gastrectomy for advanced gastric cancer. Diffuse peritonitis progressed after the first operation, so reoperation for drainage was required. Two days after the second operation, a profuse watery diarrhea developed. Case 2: A 46-year-old male underwent total gastrectomy for early gastric cancer. On the fourth postoperative day, frequent vomiting and cholera-like diarrhea started, followed by profound shock several hours later. Both cases were treated successfully by the administration of vancomycin. Stool cultures of both cases revealed MRSA and it had the same minimal inhibitory concentration, coagulase type and enterotoxin type, so that nosocomial infection was indicated.