Clinical investigation of hepatectomies for hepatocellular carcinoma--significance of extended hepatectomy for advanced hepatocellular carcinoma

Although the diagnostic methods for hepatocellular carcinoma (HCC) are now being improved, there are still many cases detected at advanced stage. We, based on the Redox theory and using a technique of vascular surgery and liver transplantation, made it possible to perform the extended hepatectomy more actively even in the advanced cases which were previously considered to be in-operable. We report these extended hepatectomies in this paper. From January 1985 to August 1989, we performed 263 hepatectomies for HCC. Out of these 263 cases, we examined 208 cases which had an interval more than three months from the time of the operation and had exact follow-up data at the end of August 1989. There are 57 extended hepatectomies and they consist of 4 groups as follows. 1) Multiple group (14 cases): the operation for the cases with multiple daughter nodules in both lobes besides the main tumor. 2) Thrombus group (30 cases): the operation for the cases with portal tumor thrombus in the first branch or the main trunk of portal vein. 3) IVC group (4 cases): the operation adding resection and reconstruction of IVC because tumor was hardly fixed to the wall of IVC. 4) Recurrence group (9 cases): the operation for hepatic recurrence. Six cases of the Multiple group survived more than one year and one case is still alive more than two years after surgery. The 6-months, 1-year and 2-year cumulative survival rates of the Multiple group are 50.5%, 38.3%, and 8.5% respectively and these results are better than other reports. Forty-three hepatic recurrences were observed in 138 cases whose tumor was completely resected macroscopically.(ABSTRACT TRUNCATED AT 250 WORDS)     

Recurrent intracranial germinoma outside the initial radiation field: a single-institution study

Between 1975 and 2005, we treated 52 newly diagnosed germinoma patients. Until 1991, patients with pure germinomas or germinomas with syncytiotrophoblastic giant cells (STGCs) received whole-brain radiotherapy only. Of the 52 patients, 30 were treated with a reduced radiation volume and combined chemotherapy; seven of these received local irradiation with 24 Gy, two received whole-brain (30 Gy) plus local irradiation (20 Gy), 16 received extended local irradiation delivered to the whole ventricles (30 Gy) plus local (20 Gy) irradiation, and five received extended local irradiation (24 Gy). Of the 30 patients treated with a reduced radiation volume and combined chemotherapy, four experienced tumor recurrence; three patients had been treated with 24 Gy of local radiotherapy and one had received extended local (30 Gy) plus local (20 Gy) irradiation in addition to chemotherapy. In these patients, the delivered radiotherapy was inadequate and the origin of the recurrent tumors was outside the radiation field. None of the patients who had received at least 24 Gy of whole ventricle radiotherapy combined with chemotherapy experienced tumor recurrence. In combination with chemotherapy, the delivery of irradiation covering the ventricles effectively reduced the incidence of tumor recurrence in patients with germinomas or germinomas with STGCs.     

The association of thyrotoxicosis and chronic lymphoproliferative disorders

We diagnosed thyrotoxicosis (Tx) and chronic lymphoproliferative disease (LPD) in nine cases; seven had chronic lymphocytic leukemia (CLL), one had hairy cell leukemia (HCL) and one had non-Hodgkin's lymphoma (NHL). In a literature review, we found only one reported case with Tx and CLL and documentation of an higher incidence of Tx in the relatives of CLL patients. We report these nine cases here and discuss this interesting association.     

Multimodal treatment including intraoperative irradiation for advanced pancreatic cancer with extended metastasis]

From January 1987 to December 1999, we treated 11 advanced pancreatic cancer patients with extended metastasis with multimodal treatment. Two patients received external radiation therapy (ERT) and systemic chemotherapy, 1 received intraoperative radiation therapy (IORT) and ERT and arterial infusion chemotherapy (AIC), 2 received IORT and AIC, 4 received only IORT, 2 received only AIC, and 15 did not receive any of these treatments. There was a significant difference in the survival rate between treatment and no treatment cases (median survival of 177 days and 109 days, respectively) (p = 0.04). A significant difference in the survival rate was also observed between IORT cases and no treatment cases (median survival of 212 days and 109 days, respectively) (p = 0.02). However, there was no significant difference in the survival rate between AIC cases and no treatment cases (median survival of 177 days and 109 days, respectively) (p = 0.10). Therefore, our experience suggests that multimodal treatment including intraoperative irradiation is effective for advanced pancreatic cancer patients with extended metastasis.     

Leiomyosarcoma of the zygoma : Report of a case and review of literature

Leiomyisarcomas are rarely encounter ed in otolaryngological practice and primary lesions of the bone are rarer still. Until 1982 only 20 documented cases of primary leiomyosarcoma of bone had been reported (Kratochvil, 1982). In eight of these cases the tumour occurred in the mandible or maxilla. Orbital involvement is extremely uncommon, only five cases having been reported so far (Wojno et al, 1983). In the English literature available to date we have been unable to find any case of primary leiomyosarcoma of the zygoma, additionally involving the orbit. Our experience with such a case is being reported.     

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIII: Meningiomas

Twelve cases of meningiomas involving the nasal cavity and paranasal sinuses are reported. Meningiomas only rarely involve the upper respiratory tract; these 12 cases were found among the 566,000 surgical pathology cases that have been studied in this laboratory. In this series, five meningiomas probably arose in the cranial cavity and secondarily extended into the nasal cavity and paranasal sinuses. Because radiographs demonstrated hyperostosis or bone destruction, three other tumors could have involved the cranial cavity, but this was never proven. In two other cases, the meningiomas appeared to involve only extracranial tissues and thus probably were primary extracranial lesions. (The data available in two other cases were insufficient to assess the possibility of intracranial involvement). These patients clinically had nonspecific signs and symptoms similar to those produced by other types of neoplasms growing in the upper respiratory tract. The tumor involved the sphenoid area in seven cases, the nasal cavity in six, the maxilla in five, the ethmoid sinus in four, and the frontal sinus in one. The diagnosis was first established when biopsy material was examined, although in several cases the presence of meningioma was first suggested on radiographic examination. Treatment depended upon the size and location of the tumor. In some cases, surgical resection appeared to control the lesion. These tumors did not appear to respond well to radiotherapy. The histologic differential diagnosis is discussed.     

Detailed deletion mapping at chromosome 9p21 in non-small cell lung cancer by microsatellite analysis and fluorescence in situ hybridization

We examined 82 cases of primary non-small cell lung cancer (NSCLC) for loss of heterozygosity (LOH) at the chromosome 9p21-24 region using 16 microsatellite markers. A total of 52 tumors (63%) displayed LOH, and 25 of these cases displayed LOH for all markers. Two cases had small hemizygous losses confined to the p16 gene and more distal markers, whereas 3 cases had loss proximal to p16 and extended through marker D9S126. This latter region has recently been described as another minimal region of loss at 9p21 in lung cancer. However, homozygous deletion of the p16 gene was observed in 18 of 85 cases, with only 5 cases having large deletions extended into the D9S126 region. Furthermore, we did not observe homozygous deletion at the 9p21 region that excluded the p16 gene. Fluorescence in situ hybridization (FISH) analysis using genomic probes spanning either the p16 or Hel-N1 (located at D9S126) gene was performed in 14 tumors. The results from FISH correlated with the chromosomal mapping data, suggesting that the p16 region is the major target of deletion at chromosome 9p21 in primary NSCLC. Int. J. Cancer 74:588–592, 1997.© 1997 Wiley-Liss, Inc.     

Papillary renal cell carcinoma in a young adult: serial changes in diagnostic images

In renal tumors, we often encounter cases in which accurate diagnosis before surgery is difficult. The serial changes in various diagnostic images were studied in a case of renal cell carcinoma in which definitive diagnosis could not be made by various imaging examinations and biopsies. We report on a case of renal cell carcinoma in a young adult. A 19-year old man complained of left flank pain and pyrexia. Computerized tomography (CT) scan and urography revealed a solid mass in the left kidney. Angiography revealed no abnormality, and CT scan after 3 months showed that the mass was decreasing in size, which suggested an inflammatory mass. CT scan and retorograde pyelography 12 months later showed that the tumor had enlarged and that much of the tumor had extended into the renal pelvis. Left nephrectomy was performed and histological examination revealed that the tumor was papillary renal cell carcinoma. When imaging results and clinical symptoms are atypical, pre-surgery diagnosis of renal cell carcinoma is extremely difficult. In such cases, we found that it was effective to observe the changes in various diagnostic images and to make an overall judgment based on these results.     

Human papillomavirus, cytomegalovirus and herpes simplex virus infections for cervical cancer in Taiwan

Previously, we had reviewed 43 cases of invasive cancers, adenosquamous cell carcinoma and adenocarcinoma for HPV type infections. With the same cases we extended the investigation to cytomegalovirus (CMV) and herpes simplex virus (HSV) infections. Results show that the prevalence of CMV and HSV infections from these cases of cervical carcinoma was 67 and 76%, respectively, by polymerase chain reaction. The results of the analysis of the association of HPV, CMV and HSV with various clinical characteristics of cervical cancer patients indicated that the correlation between HSV infections and clinical stages of squamous carcinoma was marginally significant (P=0.068). HSV infections seemed to have a higher association with cell keratinization pattern as compared with the other two viral infections.     

Second non-germ cell malignancies after radiotherapy of testicular cancer with or without chemotherapy

The incidence of a new primary non-germ cell malignancy was determined in 876 patients with testicular cancer treated at the Norwegian Radium Hospital from 1956 to 1977. Sixty-five patients developed a second cancer leading to a statistically significant increased relative risk (RR = 1.58), especially if extended radiotherapy had been given (RR = 4.13). The excess risks of developing lung cancer and malignant melanoma were 2.03 and 3.89, respectively. Increased RR for these two cancer types were seen both after extended radiotherapy and after radiotherapy combined with chemotherapy. Studies of the time between treatment and secondary lung cancer indicated that the development of the new lung cancer could be partly treatment related, whereas the raised incidence of malignant melanoma may be related to the frequent health checks performed in patients with testicular cancer. Patients who had received extended radiotherapy were also at an increased risk of developing cancer of the stomach and of the colon. Three cases of acute leukaemia were observed more than 5 years after treatment, all of them in patients who had received abdominal radiotherapy only. It is concluded that patients apparently cured of a testicular cancer have an increased risk of developing a new treatment related non-germ cell malignancy, in particular lung cancer. The application of the extended radiotherapy or the combination of radiotherapy and chemotherapy containing alkylating drugs should be avoided in order to reduce this excess risk.     

Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type,depth of wall invasion,and lymph node metastasis

Background Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy for early tumors should therefore be based on a complete cure, and limited surgery must thus have clear indications. Methods D2 gastric resection was performed in 278 early gastric adenocarcinomas, and a retrospective histological review of the specimens was made. The extended indications for EMR or ESD, according to the Japanese Gastric Cancer Association Treatment guidelines for gastric cancer in Japan, were also assessed. Results Of the 278 early gastric cancers, 115 were mucosal (M) cancers without ulcer. No lymph node metastases were seen in these specimens. Six of the 41 specimens of M cancer with ulcers had lymph node metastases at the N1 level only. One of these had lymph node metastases from a tumor measuring less than 3 cm in size. Twenty-eight of 122 submucosal cancers had lymph node metastases (23%). Twenty of these were SM1 tumors and 5 had lymph node metastases; 4 of these 5 had lymph node metastases despite the absence of vascular invasion. Conclusion Three cases had lymph node metastases that met the extended criteria for EMR/ESD. EMR and/or ESD should be limited to M cancers without ulcer or differentiated-type M cancer with ulcers smaller than 2 cm. When the depth of tumor invasion is deeper than M, then a gastric resection with lymph node dissection is necessary.     

High frequency of chromosome 9 deletion in ovarian cancer: evidence for three tumour-suppressor loci.

We have screened 33 ovarian tumours of various grades and stages for the loss of heterozygosity (LOH) of markers on chromosome 9. LOH was detected in 26 cases (79%). Eleven tumours (33%) showed LOH of all informative markers. The remaining 15 cases had partial deletions. Of these, six (18%) had losses on 9p only, three (9%) had LOH confined to 9q and six (18%) had losses on both chromosome arms, four of which had a retention of hetereozygosity in between. There was no association between tumour grade stage or histopathology and any losses. High-density deletion mapping was carried out in 12 selected cases that had partial deletions of 9p and/or 9q. The deleted region on 9p included the cyclin-dependent kinase inhibitor 2 (CDKN2) locus and one tumour was found to have a homozygous deletion of CDKN2. LOH on 9q extended over a larger region. We found evidence for two regions of deletion on 9q, one at 9q34 and the other encompassing the nevoid basal cell carcinoma (Gorlin) syndrome locus on proximal 9q.     

电视纵隔镜在胸部疾病诊断和治疗中的价值

目的：探讨电视纵隔镜在胸部疾病诊断和治疗中的价值。方法：回顾性总结2002年10月～2004年6月纵隔镜诊疗患者58例，其中纵隔镜诊断术组48例，纵隔镜治疗术组10例。纵隔镜诊断术组有40例患者行标准的纵隔镜检查术，8例行扩大的纵隔镜检查术。纵隔镜治疗术组有9例手汗症患者行胸交感神经切断术，1例行心包脂肪瘤切除。结果：纵隔镜诊断术组47例获得病理诊断(97．9％)，发生并发症4例(8．3％)：纵隔镜治疗术组无并发症发生，所有患者痊愈出院。结论：电视纵隔镜手术不仅是肺癌诊断、分期和纵隔肿瘤诊断的重要手段，而且也可以用于治疗手汗症、心包脂肪瘤和囊肿等部分胸部疾病。     

Observational study on candidaemia at a university hospital in southern Italy from 1998 to 2004

In an observational study on candidaemia in hospitalised patients, conducted in a southern Italy hospital during 1998-2004, 155 cases were noted. Candida albicans (CA) was isolated in 71 (45.8%) cases involving mainly patients recovered in ICU, General Surgery and Neonatology. Candida non-albicans (CnA) species were isolated by 84 (54.2%) candidaemic patients, and in particular, Candida parapsilosis was the most frequent species isolated in Pediatric Oncology. 91.6% of the patients had a central venous catheter and only 46.4% were receiving antifungal prophylaxis. Among these patients, 87.5% (63) developed CnA infections; in particular, 41 patients had a C. parapsilosis bloodstream infection. During our study, we observed a variable drift from 1998 to 2003; we registered an evident increment of CnA candidaemia (76.9%) and a decrease of CA cases (23%) only in 2004. The mortality was 26.7%, and we observed that CA was associated with the highest rate of mortality (53.6%). Although Candida infections are correlated primarily with risk factors, their resolution depends on timely diagnosis and early therapy.     

The significance of low-grade prostate cancer on needle biopsy. A radical prostatectomy study of tumor grade, volume, and stage of the biopsied and multifocal tumor.

Twenty-one cases showing only low Gleason grade prostate carcinoma on needle biopsy were identified. In 15 cases radical prostatectomy was performed with the entire prostate embedded for thorough evaluation of grade, volume, and stage of tumor at the needle biopsy site as well as of multifocal tumor. Eight specimens had solitary low grade and low volume tumor, with only one of these cases showing minimal capsular penetration and the others confined to the prostate. Four cases had low-grade tumor at the biopsy site, yet multifocal higher grade tumor. All of these tumor nodules were low volume and confined to the prostate. In three cases there was both low-grade and high-grade tumor in the nodule sampled by needle biopsy. In two of these cases the tumor was large and in the third it was small but mostly higher grade, with two of these cases showing capsular penetration. Although transrectal ultrasound and repeat needle biopsy would most likely have identified either the tumors' large size or high-grade component in these latter three cases, it is unlikely that these techniques would have identified the cases of multifocal higher grade tumor because of their relatively small size. Furthermore, preoperative serum prostate specific antigen levels and clinical stage failed to distinguish those cases with higher grade tumor. Because of the difficulty in identifying these areas of high-grade tumor preoperatively, it is uncertain whether expectant therapy could be recommended even for patients with very low-grade cancer on needle biopsy.     

The availability of digital subtraction angiography using continuous intra-arterial infusion tubes founded various malignancy

DSA was employed using continuous intraarterial infusion tubes for various malignancies (73 cases) which were examined a total of 135 times. In head and neck malignancy (50 cases), the general position of the infusion tube had been determined beforehand by dye infusion, but DSA from the tube showed that the tubes in 24 cases (48%) were located in the wrong position, especially in tongue cancer (21 cases) where many tubes were discovered to be in an erroneous position (71%) such as the common carotid artery. We were unable to determine the effect of chemotherapy and radiation using DSA only. In 9 cases of breast cancer for which fixation of the tube was not attempted under X-ray fluoroscopy, 7 (78%) showed an unusual tube position such as the intraaortic arch. In 5 cases of abdominal malignancy, only the tube position for sigmoid colon cancer was unusual. We were able to observe the effect of chemotherapy by DSA in 2 cases. For DSA in one out of 3 hepatomas using a Port-A-Cath, we observed that infusion of anticancer drug with degradable starch microspheres caused a reduction in tumor size. However, in the two remaining cases, we were unable to observe any effect of infusion of these drugs by DSA for various mechanical reasons. DSA from an infusion tube revealed not only the location of the tube accurately and promptly, but also the effect of chemotherapy.     

扩大部分喉切除颈前肌皮瓣喉重建术临床观察

目的　探讨颈阔肌双蒂转门肌皮瓣在喉重建术中的临床应用价值。方法　对 38例喉癌行扩大部分喉切除术 ,包括扩大垂直喉切除术 2 7例 ,扩大额侧喉切除术 7例 ,次全喉切除术 4例 ,应用颈阔肌双蒂转门肌皮瓣同期进行缺损喉腔重建 ,结果　本组病例术后气管套管拔除率为 92 1% ( 35 /38) ,全部患者恢复了发音功能 ,语言响亮清晰者 95 0 % ( 36/38) ,吞咽防护功能全部恢复 ,局部复发率 7 9% ( 3/38) ,3年生存率 89 5 % ( 3/38)。结论　中晚期喉癌选择性地施行功能保全性喉手术是可行的 ,应用转门肌皮瓣进行缺损喉腔重建可获得满意的喉功能恢复效果     

Squamous cell carcinoma of the oral cavity rarely harbours oncogenic human papillomavirus

Although it is now well established that a significant proportion of oropharyngeal squamous cell carcinomas (SCC) harbour oncogenic human papillomavirus (HPV) sequences, the frequency with which these sequences are detected in oral SCC (excluding oropharyngeal subsites) is highly variable. In an attempt to establish the true prevalence of HPV-16 and HPV-18 subtypes in oral SCC, we screened 142 consecutive cases from a UK cohort using both conventional PCR with consensus primers and type-specific quantitative PCR (Q-PCR), while at the same time employing a rigorous protocol to avoid sample contamination. Q-PCR revealed HPV sequences in five cases; two contained HPV-16 alone, two HPV-18 alone, and one sample carried both genotypes. However, only two of these cases (both HPV-16-positive) had moderate viral loads (51 and 91 viral copies per 100 cells respectively) and were positive for HPV DNA by conventional PCR. Both cases contained HPV DNA in tumour cells as shown by Q-PCR analysis of micro-dissected tissue and by in situ hybridisation. The remaining three cases had only very low viral loads (between 3 and 7 viral copies per 100 cells), were negative by conventional PCR and lacked HPV DNA in tumour cells. Our data provide strong evidence that oncogenic HPV is uncommon in oral SCC and that routine HPV testing of these tumours cannot be advocated.     

Expression of cdc25A and cdc25B phosphatase in breast carcinoma

BACKGROUND: Previous studies have indicated that cdc25B and cdc25A phosphatase stimulate cell cycle progression and also play a role in malignant transformation of cells. In this study, we investigated the expression of these phosphatases in breast carcinoma to elucidate their significance. METHODS: We immunohistochemically examined cdc25B and cdc25A expression in 46 cases of breast carcinoma. RESULTS: Cdc25B and cdc25A were negative or only equivocally expressed in glandular epithelial cells. In breast carcinoma, 56.5% of cases had high levels of cdc25B expression. Interestingly, the expression of cdc25B was significantly lower in cases with biologically aggressive phenotypes. The cdc25A level was high in 69.6% of cases, but we could not find any relationship between cdc25A expression and clinicopathological parameters. CONCLUSION: These results suggest that cdc25B is important especially in the early phase of breast carcinoma progression.     

The frequency and risk factor of herpes zoster infection in non-Hodgkin's lymphoma patients

The chemotherapy treatment of non-Hodgkin's lymphoma(NHL)is associated with an increased risk of infection because of the intensity of the treatment. We examined the frequency of herpes zoster infections in 170 non-Hodgkin's lymphoma patients who had completed a chemotherapy course. Furthermore, we examined the risk factors contributing to these infections. This study took place in the Department of Hematology at Ogaki Municipal Hospital. Of the 170 patients treated in our facility, 25 developed herpes zoster(14. 7%), 19 of whom developed symptoms within 30 days of starting the chemotherapy treatment. Significant risk factors for the development of herpes zoster were post-autologous peripheral blood stem cell transplantation, relapsing patients, ten or more total treatments and the use of two or more regimens. In these cases the average interval of the treatments had to be extended from 6. 6 days to 14. 2 days due to the infection(comparing post - infection to pre-infection). We recommend the prophylactic use of low-dose acyclovir in patients with a higher risk of herpes zoster infection. We also recommend further monitoring of other opportunistic infections associated with chemotherapy usage.