[Double extrahepatic bile duct with pancreaticobiliary maljunction:a case report].

A 76-year-old woman with a suspected double extrahepatic bile duct was referred to our hospital. MRCP revealed that the left hepatic and posterior ducts combined to form the ventral bile duct and that the anterior duct formed the dorsal bile duct. ERCP demonstrated that the ventral bile duct was linked with the Wirsung duct. Amylase levels in the bile were unusually high. Based on these findings, we diagnosed a double extrahepatic bile duct with pancreaticobiliary maljunction and choledocholithiasis. Duplicate bile duct resection and bile duct jejunal anastomosis were performed considering the risk of biliary cancer due to pancreaticobiliary maljunction. The resected bile duct epithelium demonstrated no atypia or hyperplastic changes.

Clinical Impact of Histological Heterogeneity in the Metastatic Lymph Nodes of Patients with Colorectal Cancer.

AIM: The purpose of this study was to evaluate the clinical impact of histological heterogeneity in patients with node-positive colorectal cancer (CRC). PATIENTS AND METHODS: One hundred and twenty-nine patients who underwent curative surgical resection for histological node-positive CRC were enrolled. Patients were divided according to the histological heterogeneity in the primary lesion into p-hetero and p-homo groups. The p-hetero group was further divided according to histological heterogeneity in the metastatic lymph nodes into n-hetero and n-homo groups. RESULTS: There were no significant differences between p-homo and p-hetero groups and between n-homo and n-hetero groups in prognosis. However, the recurrence-free survival rate of the n-homo group was significantly lower than that of the n-hetero group in the N2 category. CONCLUSION: Histological heterogeneity in metastatic lymph nodes may be useful for predicting prognosis, and prognosis in those with histological heterogeneity in a metastatic lymph node is not necessarily poor, even in those of the N2 category.

[Case of main duct-intraductal papillary mucinous carcinoma (pancreatobiliary type) causing 4-mm dilatation of the pancreatic duct].

A 77-year-old woman with mild dilatation (4mm) of the main pancreatic duct was referred to our hospital. Contrast-enhanced computed tomography revealed segmental dilatation of the main pancreatic duct in the pancreatic tail, but no mass was noted in the pancreas. Endoscopic ultrasonography showed low papillary lesions in the dilated pancreatic duct. Cytological analysis of the pancreatic juice revealed adenocarcinoma. Distal pancreatectomy was performed for a diagnosis of main duct-intraductal papillary mucinous cancer (MD-IPMC) of the pancreatic tail. Histological findings indicated pancreatobiliary (PB)-type non-invasive IPMC. Although the patient did not meet the diagnostic criteria for intraductal papillary mucinous neoplasms (IPMNs), her final diagnosis was PB-type non-invasive IPMC. Because PB-type IPMNs display poor mucin production, pancreatic duct dilatation is sometimes mild and requires careful assessment for accurate diagnosis.

Characteristic alteration of monocytes with increased intracellular IL-10 and IL-12 in patients with advanced-stage gastric cancer.

BACKGROUND: It was previously reported that monocytes/macrophages play an important role in mediating T cell dysfunction in tumor-bearing hosts, in which monocytes/macrophages were found to induce the loss of T cell functions concomitantly with induction of defects in T cell signaling molecules. These observations encouraged us to investigate monocytes status in cancer-bearing hosts. MATERIALS AND METHODS: We characterized peripheral blood monocytes in gastric cancer patients with advanced disease (n = 14), in those with early disease (n = 17), and in healthy individuals (n = 14), based on surface marker, oxygen-burst capacity, and intracellular cytokine status (IL-10 and IL-12). RESULTS: Intracellular IL-10 and IL-12 status on monocytes in advanced disease was significantly increased in comparison with those in early disease or healthy individuals, while there were no differences in the surface marker or oxygen-burst capacity of monocytes. To clarify which mediators induced the characteristic differences of monocytes in cancer-bearing hosts, healthy donor-derived monocytes were coincubated with the patient's plasma. The plasma from the patients with advanced disease could induce healthy monocytes to increased intracellular IL-10 and IL-12 status. The phenomenon was significantly inhibited with neutralizing mAbs specific for VEGF. Furthermore, the contents of VEGF in the patient's plasma correlated with their capacity to induce healthy monocytes to increased intracellular IL-10. In addition, the treatment of healthy monocytes with exogenous VEGF resulted in increased intracellular IL-10. CONCLUSIONS: Monocytes in gastric cancer patients with advanced disease showed different characteristics in comparison with those with early disease or healthy individuals, which might be potentially induced by circulating VEGF in the patients.