Transurethral resection for botryoid bladder rhabdomyosarcoma

The outcome of multimodal therapy for localized bladder rhabdomyosarcoma is quite good in terms of morbidity, and conservative surgery is generally recommended. However, in cases originating in the bladder neck, tumorectomy or partial cystectomy has adverse effects on bladder function. A 2-year-old girl underwent transurethral resection of a bladder tumor (TUR-BT), chemotherapy consisting of vincristine, actinomycin-D, and cyclophosphamide, and radiotherapy. She was in remission for 3 years when frequent urination became evident. Her bladder capacity and compliance were low; however, her urinary symptom was controlled using anticholinergic medication. Accordingly, TUR-BT could be an optional approach for bladder rhabdomyosarcoma

Calcium sparks enhance the tissue fluidity within epithelial layers and promote apical extrusion of transformed cells

In vertebrates, newly emerging transformed cells are often apically extruded from epithelial layers through cell competition with surrounding normal epithelial cells. However, the underlying molecular mechanism remains elusive. Here, using phospho-SILAC screening, we show that phosphorylation of AHNAK2 is elevated in normal cells neighboring RasV12 cells soon after the induction of RasV12 expression, which is mediated by calcium-dependent protein kinase C. In addition, transient upsurges of intracellular calcium, which we call calcium sparks, frequently occur in normal cells neighboring RasV12 cells, which are mediated by mechanosensitive calcium channel TRPC1 upon membrane stretching. Calcium sparks then enhance cell movements of both normal and RasV12 cells through phosphorylation of AHNAK2 and promote apical extrusion. Moreover, comparable calcium sparks positively regulate apical extrusion of RasV12-transformed cells in zebrafish larvae as well. Hence, calcium sparks play a crucial role in the elimination of transformed cells at the early phase of cell competition

Recurrent giant longitudinal duodenal ulcer with massive hemorrhage in a Helicobacter pylori-negative patient

A 67-year-old man, in whom a linear ulcer running from the duodenal bulb to the descending part had been noted 3 years previously, was admitted to our hospital because of abdominal pain and melena. Duodenoscopy revealed a bleeding giant longitudinal ulcer, which was more extensive than before. Tests for Helicobacter pylori (Hp) were negative. The ulcer was cured by endoscopic hemostasis and repeated blood transfusions. Attention must be paid to Hp-negative post-bulbar duodenal ulcers because of the frequent complications including hemorrhage

通常型膵癌進展におけるFibroblast activation protein α 発現に関する臨床病理学的検討

通常型膵癌(以下膵癌)は極めて予後不良な癌であり,病理学的には癌周囲に豊富な間質を伴う。固形癌の間質は癌の増殖,浸潤,転移や抗癌剤に対する抵抗性獲得に重要な役割を果たし,なかでも癌関連線維芽細胞(Carcinoma associated fibroblast:CAF)と呼ばれる癌間質の活性化線維芽細胞は癌進展に深く関与している.今回我々は膵癌組織のCAFに発現するFibroblast activation protein α(以下FAP)の臨床病理学的な意義について検討した.対象は2006年4月から2010年4月の間に当院で切除した膵癌症例30例である.抗FAP抗体を用いて免疫組織学的検討を行った.FAPは主として癌周囲の間質に検出され,一部には膵癌細胞にも認められたが,今回の検討ではFAP陽性の線維芽細胞をCAFとみなし,線維芽細胞のFAP発現強度と臨床病理学的因子を比較検討した.FAP陽性線維芽細胞は28/30例(93%)に認められた.FAP発現強度の内訳は,1+:8例,2+:16 例,3+:4例であった.陰性/弱陽性群(陰性・1+)と強陽性群(2+・3+)での生存率を比較したところ,それぞれの全生存日数の中央値は862日と352日であり強陽性群の生存率は有意に低かった(P<0.05).またFAPの発現強度と膵癌細胞の分化度は有意な関連性を示し,FAPの発現が強いほど有意に低分化であった.さらに多変量解析ではFAPの強陽性は膵癌患者の予後を規定する独立因子の一つであった.以上の成績から膵癌組織の線維芽細胞におけるFAPの発現は膵癌患者の予後を規定する重要なバイオマーカーであることが明らかとなり,膵癌細胞の分化度と相関することを初めて明らかにした.Pancreatic cancer is associated with an extremely poor prognosis, and pathologically shows abundant stroma surrounding cancer cells. The stroma of solid cancer plays an important role in cancer growth, invasion, metastasis, and the acquisition of resistance to anticancer drugs. In particular, activated fibroblasts in the cancer stroma called carcinomaassociated fibroblasts (CAFs) are closely involved in cancer progression. In this study, we evaluated the clinicopathological importance of fibroblast activation proteinα (FAP) that is expressed in CAFs in pancreatic cancer tissue. The subjects consisted of 30 patients with pancreatic cancer who underwent resection in our hospital between April 2006 and April 2010.Immunohistological evaluation was performed using the anti-FAP antibody.FAP was detected mainly in the stroma surrounding pancreatic cancer cells and partly in cancer cells. In this study, FAP-positive fibroblasts were regarded as CAFs, and the associations between the FAP expression level in fibroblasts and clinicopathological factors were evaluated. FAP-positive fibroblasts were observed in 28(93%) of the 30 patients. The FAP expression level was 1+ in 8 patients, 2+ in 16, and 3+ in 4. The survival rate was compared between the negative/weakly positive group (negative, 1+) and strongly positive group (2+, 3+). The medians of all survival periods were 862 and 352 days in the negative/weakly positive and strongly positive groups, respectively, and the survival rate was significantly lower in the latter (p<0.05). In addition, the FAP expression level was significantly correlated with the differentiation level of pancreatic cancer cells; when the FAP expression level was higher, differentiation was significantly poorer. Multivariate analysis revealed strongly FAP-positive fibroblasts to be an independent prognostic factor in patients with pancreatic cancer. These results show that FAP expression in fibroblasts in pancreatic cancer tissue is an important prognostic biomarker in patients with pancreatic cancer and correlated with the differentiation level of pancreatic cancer cells

A case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery

　症例は74歳男性．膵体部癌を指摘され当院消化器外科にて201X 年に膵体尾部切除施行．術後半年間テガフール・ギメラシル・オテラシルカリウム内服． ３ヶ月ごとの computed Tomography（CT）と腫瘍マーカーで当院消化器外科にて経過観察していた．術後４年に腹痛で当院消化器外科外来を受診．CT で新たに胃大弯側から横行結腸にかけて内部壊死を疑う造影不良域を伴った腫瘤性病変を認めた．膵癌の大網播種を疑われ，abdominal ultrasonography（AUS）でも同様に腹膜播種が疑われた．消化器内科で化学療法の方針となり病理学エビデンス取得目的で endoscopic ultrasound-guided fine-needle aspiration（EUSFNA）を施行したが EUSFNA では明らかな腫瘍細胞を認めず，壊死様の蛋白様物質とともに多数の細菌を認めた．採血で炎症反応高値であったことから，膵癌の腹膜播種ではなく腹腔内膿瘍を疑い抗生剤で治療を開始．治療後の画像検査では膿瘍の縮小を認めた．今回膵癌術後４年目に発症した腹腔内膿瘍の一例を経験したため若干の文献的考察を加えて報告する．　We report the case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery, with a review of the literature. A 74-year-old man was diagnosed with cancer of the pancreatic body and underwent pancreatic tail resection in 201X at the department of gastrointestinal surgery of our hospital. Oral Tegafur, Gimeracil, and Oteracil Potassium chemotherapy was administered for 6 months postoperatively. The patient was followed-up at the department of gastrointestinal surgery, and computed Tomography (CT) and tumor marker assessment were performed every 3 months. Four years after surgery, the patient visited the outpatient clinic of the department of gastrointestinal surgery with a complaint of abdominal pain. CT showed a new mass lesion with poor contrast, and internal necrosis of the transverse colon approximating the gastric curvature was suspected. abdominal ultrasonography (AUS) examination suggested omental and peritoneal dissemination of pancreatic cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) biopsy, which was performed for obtaining pathological evidence for chemotherapy as per the policy of the department of gastroenterology, revealed a large number of bacteria along with necrotic-like protein-like substances, but no obvious tumor cells were found. Since hematological examination revealed a strong inflammatory reaction, an intraperitoneal abscess was suspected instead of peritoneal dissemination of pancreatic cancer, and treatment with antibiotics was initiated. Post-treatment imaging showed shrinkage of the abscess