Prognostic significance of Ki-67 and p53 antigen expression in carcinomas of bile duct and gallbladder

Ki-67 and p53 protein expression was evaluated immunohistochemically in 32 patients with intrahepatic, extrahepatic bile duct and gallbladder carcinomas, who underwent surgery at First Department of Surgery, The University of Tokushima School of Medicine. p53 expression was found more in the well differentiated group than poorly differentiated group (p=0.007). MIB1 labelling index (MIB1 LI) was higher in EHC than in GBC (p=0.0061). MIB1 LI (T), (MIB1 LI in tumor) was higher in cases with lymph node metastasis than in those without lymph node metastasis (p=0.0189). Moreover, MIB1LI (L) (MIB1 LI in metastasized lymph node) was higher in poorly differentiated than in well differentiated carcinoma (p=0.0404). Prognostically, patients with high MIB1 LI (T) (>56.93) had a worse prognosis after surgery than those with low MIB1 LI (T) (p<0.05). There was no association between p53 positive tumors and MIB1 expression. These results suggest that cancer cell proliferative activity was markedly increased in cases with EHC compared to those with GBC and the poorly differentiated and lymph node metastasis group. MIB1 LI in tumor was found to be a good prognostic indicator whereas there was no association of p53 positive tumor with MIB1 expression and prognosis of the patients

Ventralex オ モチイタ フクヘキ ハンコン ヘルニア シュウフクジュツ ノ 1 レイ

A 78-year-old woman underwent cystectomy of left ovary 1 year ago. She came to our hospital with the chief complaint of bulging of the abdominal scar before 2 months. The bulging of 3×3 cm was recognized in the operation scar in a standing position. CT scan of the abdomen revealed incisional hernia in upper part of operation wound. The hernia orifice was 2.5×2.5 cm. A radical operation was therefore performed. Under local anesthesia, Ventralex was fixed by insertion, and the hernia was repaired. The adhesion between the omentum and the caudal part of operation scar was dissected. In the condition patch was inserted and made to adhere to abdominal wall, strap was fixed in the rectus sheath. The postoperative course was good. Repair of incisional hernia using Ventralex seemed to be useful operative method, which could enforce the tension free operation in the minimum invasion

Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia

An 85-year-old woman was admitted to our hospital because of vomiting. An upper gastrointestinal series what showed a large esophageal hiatus hernia, suggesting an association with extrinsic pressure in the middle portion of the stomach. An upper gastrointestinal endoscopic examination showed severe esophagitis and a prominent narrowing in the middle portion of the stomach, however, it showed normal gastric mucosa findings. CT and MRI revealed a large tumor extending from the region of the lower chest to the upper abdomen. From these findings, the tumor was diagnosed as gastrointestinal stromal tumor(GIST), which arose from the gastric wall and complicated with an esophageal hiatus hernia. We performed a laparotomy, however, the tumor showed severe invasion to the circumferential organs. Therefore, we abandoned the excision of the tumor. Histologically, the tumor was composed of spindle shaped cells with marked nuclear atypia and prominent mitosis. The tumor cells were strongly positive for CD34 and c-kit by immunohistochemical examination. From these findings, the tumor was definitely diagnosed as a malignant GIST. As palliative treatment, we implanted a self-expandable metallic stent in the narrow segment of the stomach. The patient could eat solid food and was discharged. In the treatment of esophageal hiatus hernia, the rare association of GIST should be considered