Signet-Ring Cell-Like Amphicrine Cell Carcinoma of the Stomach

A poorly differentiated adenocarcinoma containing diverse components, tubular, signet-ring cell and neuroendocrine elements, in a 79-year-old man is described. Endoscopy examination revealed a Borrmann type IV tumor in the antrum. Histologically, scattered foci of tubular and signet-ring cells and a greater number of neuroendocrine elements were observed. The tumor cells were positive for chromogranin A, neuron specific enolase (NSE) and carcinoembryonic antigen (CEA). Furthermore, about one third of the tumor cells were demonstrated as amphicrine differentiation by double staining with chromogranin A and periodic acid-Schiff (PAS). Amphicrine cell carcinomas with exocrine and endocrine differentiation in the stomach is rare and poor prognosis. The present case suggests that amphicrine cell carcinomas can occur in signet-ring cell morphogenesis, and that a multipotential stem cell is an origin of this unusual variant of neuroendocrine carcinoma

Brown Adipose Tissue in Amyotrophic Lateral Sclerosis

The prevalence of brown adipose tissue (BAT) in the periadrenal adipose tissue was studied in 20 autopsy cases of amyotrophic lateral sclerosis (ALS). In 19 of 20 cases, the periadrenal BAT in focal or diffuse distribution was observed. Histometry of BAT revealed average occupancy rates of 21.6% and 4.2% in ALS and age-matched control cases, respectively (p<0.01). Since emaciation and chronic hypoxia in those ALS patients were most likely related to severe muscle wasting and respiratory involvement, it is speculated that an increase in BAT occupancy rates may be secondary to altered thermogenesis which was augmented by chronic hypoxia

Immunohistochemical Study of p53 Overexpression in Radiation-Induced Colon Cancers

The expressions of p53 and proliferating cell nuclear antigen (PCNA) were studied immunohistochemically from paraffin sections of 7 cases (9 lesions) of radiation-induced colon cancer and 42 cases of spontaneous colon cancer. Age distribution of radiation-induced and spontaneous colon cancer were 68.1 years (range, 56 to 77 years) and 67.4 years (range, 31 to 85 years), respectively. Among the radiation-induced colon cancers, there were 3 lesions of mucinous carcinoma (33%), a much higher than found for spontaneous mucinous cancer. Immunohistochemically, p53 protein expression was detected in 7/9 (78%) of radiation-induced cancers and in 23/42(55%) of spontaneous colon cancers. χ^2 analysis found no significant differences between radiation-induced and spontaneous colon cancers in age distribution or p53-positive staining for frequency, histopathology, or Dukes\u27 classification. In radiation colitis around the cancers including aberrant crypts, spotted p53 staining and abnormal and scattered PCNA-positive staining were observed. In histologically normal cells, p53 staining was almost absent and PCNA-positive staining was regularly observed in the lower half of the crypt. In radiation colitis including aberrant glands, cellular proliferation increased and spotted p53 expression was observed. This study suggests that radiation colitis and aberrant glands might possess malignant potential and deeply associate with carcinogenesis of radiation-induced colon cancer

A Retrograde Tube-Gastrostomy Technique for Management of Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

Delayed gastric emptying (DGE) is one of the most frequent and unpleasant postoperative discomforts in patients who were given pylorus-preserving pancreatoduodenectomy (PPPD). To prevent DGE after PPPD with the modified version of Traverso\u27s reconstruction procedure, we have used retrograde tube-gastrostomy technique. In our method, a 16-Fr gastrostomy tube with several pores was inserted in the retrograde direction from the jejunal stump into the gastric fundus, by leading the catheter tip through the jejuno-jejunal anastomosis, the efferent jejunum and the pylorus. Between January 1996 and September 2003, 51 patients underwent PPPD for periampullary malignancy in our department. DGE after PPPD was observed in 12 patients (23.5%); 2 of the 19 patients (10.5%) with retrograde tube-gastrostomy technique and 10 of the 32 patients (31.3%) with conventional tube-gastrostomies. Because of effective internal drainage of gastric juice to the efferent jejunum by this method, the external gastric drainage from the gastrostomy tube was extremely small when compared to conventional tube-gastrostomies, resulting in reduction of postoperative venous infusion and hypochloremia. Oral intake was also started earlier after surgery, and the postoperative hospital stay was shortened. In conclusion, the retrograde tube-gastrostomy technique was found easy to perform and beneficial to the patients undergoing PPPD

Postoperative Management of Living Donor Liver Transplantation for Extrahepatic Biliary Atresia with Intrapulmonary Shunting: Report of A Case

A six-year-old girl with biliary atresia underwent a living donor liver transplantation because of deteriorating intrapulmonary shunting related to portal hypertension. Following transplantation, the patient\u27s oxygenation improved after the tenth postoperative day and returned to normal within thirty days. The important points of early post-transplantation management for intrapulmonary shunting are as follows: 1) coping with large volume of sputum and thus, if necessary, a prompt tracheotomy should be performed; 2) when dealing with persistent hypoxemia, it is essential to maintain the preoperative oxygenation levels and avoid any outflow disturbance of the graft liver; and 3) the prevention of the fatal vascular thrombosis. Phlebotomy to correct the presence of underlying polycythemia is also required