Fluorescence diagnosis of metastatic lymph nodes using 5-aminolevulinic acid (5-ALA) in a mouse model of colon cancer.

[Background]Lymph node metastasis is one of the most critical prognostic factors in patients with colorectal cancer. Although regional lymph nodes should be surgically resected and pathologically examined, techniques for the intraoperative diagnosis of lymph node metastasis remain to be well established. Fluorescence diagnosis using 5-aminolevulinic acid (5-ALA) is a promising technique for evaluating various malignancies. After exogenous administration of 5-ALA, protoporphyrin IX (PPIX) accumulates in malignant cells and can be detected as red fluorescence. In this study, we investigated the usefulness of fluorescence diagnosis using 5-ALA for the detection of lymph node metastasis in a mouse model of colon cancer. [Materials and Methods]An orthotopic colon cancer model was prepared by inoculating the cecal wall of nude mice with HCA7, a human colon adenocarcinoma cell line. After 3 wk, 40 mg/kg of 5-ALA was administered intraperitoneally (IP) or orally (PO). Fluorescence diagnosis with a D-Light System (Karl Storz) was then performed after 3 or 6 h. [Results]In the IP group, PPIX fluorescence was detected in metastatic lymph nodes as well as in other malignant lesions, including primary tumors and abdominal implantations, while non-metastatic nodes were fluorescence-negative. In contrast, no obvious fluorescence was detected in cancerous tissues in the PO group. [Conclusions]PPIX fluorescence induced by intraperitoneal injection of 5-ALA allows metastatic lymph nodes to be accurately diagnosed in this mouse model. This technique may facilitate the intraoperative diagnosis of lymph node metastases from colon cancer in a clinical setting

Systemic Lymphadenectomy Cannot Be Recommended for Low-Risk Corpus Cancer

Objective. The objective of this study is to ascertain whether omission of lymphadenectomy could be possible when uterine corpus cancer is considered low-risk based on intraoperative pathologic indicators. Patient and Methods. Between 1998 and 2007, a total of 83 patients with low risk corpus cancer (endometrioid type, grade 1 or 2, myometrial invasion ≦50%, and no intraoperative evidence of macroscopic extrauterine spread, including pelvic and paraaortic lymph node swelling and adnexal metastasis) underwent the total abdominal hysterectomy and bilateral salpingo-oophorectomy without lymphadenectomy. A retrospective review of the medical records was performed, and the disease-free survival (DFS), overall survival (OS), peri- and postoperative morbidities and complications were evaluated. Results. The 5-year DFS rates and the 5-year OS rates were 97.6% and 98.8%, respectively. No patient presented postoperative leg lymphedema and deep venous thrombosis. Conclusion. Omission of lymphadenectomy did not worsen the DFS or OS. The present findings suggest that systemic lymphadenectomy could be omitted in low-risk endometrial carcinoma

三角線維軟骨複合体損傷における尺側手根伸筋腱と遠位橈尺関節のMRI画像分析

BACKGROUND: We compared the incidence of extensor carpi ulnaris (ECU) tendon and distal radioulnar joint (DRUJ) abnormalities using magnetic resonance imaging (MRI) between patients with triangular fibrocartilage complex (TFCC) tears and subjects without ulnar wrist pain. Additionally, we aimed to identify potential predictors of these MRI lesions. METHODS: The TFCC group comprised 70 consecutive patients with TFCC tears. The control group comprised 70 age- and sex-matched subjects without ulnar wrist pain. We evaluated the presence or absence of fluid collection in the DRUJ and ECU peritendinous area and longitudinal ECU tendon splitting. Dimensions of the fluid collection area around the ECU tendon were measured to evaluate the severity. The incidences of these abnormal MRI findings were compared between the two groups. We analyzed the correlation between the presence of ECU tendon and DRUJ lesions and variables including age, magnitude of ulnar variance, and type of TFCC tear. RESULTS: Significant differences were found between the two groups in the incidence of fluid collection of the DRUJ and ECU peritendinous area, and longitudinal ECU tendon splitting. Among the 70 patients with TFCC tears, age and the magnitude of ulnar variance were significantly correlated with the severity of fluid collection around the ECU tendon. The magnitude of ulnar variance in patients with DRUJ fluid collection was significantly larger than that in patients without fluid collection. There was a significant correlation between the presence of disc tears and DRUJ fluid collection. CONCLUSION: We found a higher incidence of accompanying abnormal MRI findings of the ECU tendon and DRUJ in patients with TFCC tears than in the control group. The presence of disc tears, the magnitude of ulnar variance, and age may be risk factors for these MRI lesions associated with TFCC tears.博士（医学）・甲第690号・平成30年11月30日Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved