A Case of Intraductal Papillary Neoplasm of the Bile Duct with Stromal Invasion

Intraductal papillary neoplasm of the bile duct (IPNB) represents biliary papillary tumors mainly growing and is considered to be of relatively low-grade malignancy. Here we report a case of IPNB in whom the poorly differentiated component deeply infiltrated the bile duct wall. A 77-year-old male had an invasive carcinoma of the bile duct 3 cm in size. He underwent right hemihepatectomy with combined resection of the extrahepatic bile duct. Papillary growing tumor was observed in the common bile duct and the right posterior Glisson's pedicle was invaded. Histologic finding showed papillary adenocarcinoma in the surface layer superficially extending to the epithelium of the surrounding bile duct. In the subserosal layer, the tumor represented poorly differentiated adenocarcinoma. The tumor was diagnosed as invasive bile duct carcinoma arising from IPNB

Treatment of concomitant gastric varices in patients with hepatocellular carcinoma at a single Japanese Institute

Hepatocellular carcinoma (HCC) patients often have esophagogastric varices due to portal hypertension by chronic hepatitis or cirrhosis. Surgical treatment for gastric varices is necessary when the patient undergoes hepatic resection for HCC, simultaneously. We examined the clinical demographics, surgical records and outcome in 7 patients undergoing both hepatectomy and Hassab\u27s operation (=decongestion of upper gastric veins and splenectomy) between 1994 and 2007. All patients had HCC, including chronic injured liver diseases. Preoperative liver functions were well preserved in all patients. Right hepatectomy was performed in two patients and limited resections in 5. Three patients had postoperative complications and the in-hospital death by hepatic failure was observed in one. Four patients had tumor recurrence within one year and 3 were dead, while, two patients had long-term survival with or without recurrence of HCC. Following Hassab\u27s operation, gastric varices dramatically disappeared. Portal hypertension and hypersplenism were significantly improved. Simultaneous operation with Hassab\u27s procedure and hepatectomy is useful and can be safely performed in HCC patients with gastric varices

Clinical Significance of Microvessel Count in Patients with Metastatic Liver Cancer Originating from Colorectal Carcinoma.

BACKGROUND: Microvessel count (MVC) has been correlated with patient prognosis in hepatocellular carcinoma. We investigated whether MVC assessed by staining with CD34 antibody was associated with disease-free and overall survival in patients with metastatic liver cancer (MLC). METHODS: We examined relationships between MVC and clinicopathologic factors or postoperative outcomes in 139 MLC patients who underwent hepatectomy between 1990 and 2006. CD34 expression was analyzed by the immunohistochemical method. RESULTS: MVC was associated with fibrous pseudocapsular formation on histological examination. By means of the modern Japanese classification of liver metastasis, poorer survival was associated with higher score, poorly differentiated adenocarcinoma, higher preoperative carcinoembryonic antigen (CEA) level, fibrous pseudocapsular formation, and smaller surgical margin. Shorter disease-free survival was associated with higher score when the Japanese classification of liver metastasis was used, multiple or bilobar tumor, regional lymph node metastasis in primary colon carcinoma, preoperative CEA level, fibrous pseudocapsular formation, and smaller surgical margin (/=406/mm(2)) was associated with decreased disease-free and overall survival by univariate analysis (P = .034 and P = .021, respectively), and higher MVC represented an independently poor prognostic factor in overall survival by Cox multivariate analysis (risk ratio, 2.71; P = .023) in addition to histological differentiation. CONCLUSIONS: Tumor MVC seems to be a useful prognostic marker of MLC patient survival

Relationship between microvessel count and post-hepatectomy survival in patients with hepatocellular carcinoma

AIM: To elucidate the relationship between the microvessel count (MVC) by CD34 analyzed by immunohistochemical method and prognosis in hepatocellular carcinoma (HCC) patients who underwent hepatectomy based on our preliminary study

Relationship between Microvessel Count and Clinicopathological Characteristics and Postoperative Survival in Patients with Pancreatic Carcinoma

Background/Aims: The present study aimed to elucidate the relationship between microvessel count (MVC) according to CD34 expression and clinicopathological characteristics or prognosis in pancreatic carcinoma (PC) patients who underwent hepatectomy. Methodology: CD34 expression was analyzed using immunohistochemical methods. Mean MVC in 5 areas per specimen and clinicopathological factors were consecutively examined in 42 PC patients. Results: Median MVC for PC patients was 123/mm2, which was applied as a cut-off value. Higher MVC was significantly associated with the advanced Japanese tumor-node-metastasis stage IVa and IVb (p=0.034). Univariate survival analysis identified higher carcinoembryonic antigen (CEA) and CA19-9 level, infiltrative type on macroscopic examination, invasive ductal carcinoma, node metastasis and higher tumor-node-metastasis classification were significantly associated with poor survival. The 5-year overall survival rate in the higher MVC group tended to be lower than that in the higher MVC group (37 vs. 55%), but not statistically significant (p=0.15). Conclusions: Tumor MVC might be a candidate prognostic marker of PC patient survival after pancreatectomy and further investigation in a larger series is warranted to clarify the significance of this marker

Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

Objective Serum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association.Design This cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression.Results Rates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found.Conclusion In Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH

The albumin to globulin ratio is associated with clinical outcome in Japanese patients with ulcerative colitis

Purpose The albumin to globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. Methods The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). Results The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52–14.18 and adjusted OR, 4.97; 95% CI, 2.14–12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56–11.51 and adjusted OR, 5.22; 95% CI, 1.97–14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06–21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Conclusion Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH