Clinicopathological Study of Anal Canal Cancer

On the basis of a result of clinical experience with the treatment for patients with anal canal cancer, a clinicopathological study of anal canal cancer was performed in comparison with that of colon cancer. Anal canal cancer has a complex histologic types and a tendency toward deep invasion outside the adventitia when compared with colon cancer. Therefore, nodal involvement was in proportion to the depth of cancer infiltration. As a result, the survival time had become worst in patients with Dukes C of anal canal cancer. The anal canal has been defined that as a canal from the level of the attachment of puborectal muscle to the anal verge. It is mainly covered with smooth striated squamous epithelia except for the upper portion which is covered with specialized columnar epithelia, lasting to the rectal epithelium. The structure of the anal canal is complex with the composition of ecto-and endodermal tissues. Anal canal cancer is particular in gross appearance, histologic types and the modes of cancer extension in comparison with rectal cancer. This study defined the clinicopathological specificity of anal canal cancer on the basis of our clinical experience

Distribution and Localization of Endocrine Cells in the Human Gastro-intestinal Tract -In Relation to Histogenesis of Rectal Carcinoid-

The distribution of endocrine cells in the human intestine was studied by immunostaining using the labeled avidinbiotin technique. The total number of endocrine cells was abundant in the proximal portion of the small intestine and the distal portion of the large intestine. Gastrin, cholecystokinin, and motilin immunoreactive cells were localized in the proximal portion of the small intestine. Peptide YY, serotonin, and glucagon/glicentin immunoreactive cells were distributed more abundantly in the lower large intestine. The serotonin and somatostatin concentrations in the colonic mucosa determined by high-performance liquid chromatography and radioimmunoassay were higher in the distal than proximal portion of the large intestine, being in correlation with the distribution of serotonin and somatostatin immunoreactive cells estimated by immunostaining. Therefore, the regional differences in the number of endocrine cells and the mucosal concentrations of the hormones probably reflect differences in the physiological functions of different regions of the gut. Not many endocrine cells with unknown peptides and animes and immature endocrine cells were present in the lower large intestine. Therefore, the frequent occurrence of carcinoids in the rectum is difficult to explain by the quantitative dominance of endocrine cells alone in the rectal mucosa, and other factors are considered to need evaluation

Nuclear DNA Analysis in Hepatocelular Carcinoma in Comparison with Clinicopathologic Factors

Nuclear DNA patterns were analyzed in the 33 patients with primary hepatocellular carcinoma on the basis of clinicopathologic standpoint. It is concluded that biologic behavior of hepatocellular cancer cells in patients with DNA aneuploidy pattern displayed highly malignant potential, indicating severe atypism, rapid growth of rupturing, the presence of cancer invasion into the wall of portal vein and distant metastasis. Furthermore, the survival time in patients with DNA aneuploidy pattern in hepatocellular carcinoma was shorter than that in patients with diploidy one

Surgical Treatment for Liver Cyst

We assess surgical treatment for seven patients with hepatic cyst on the basis of our clinical experience. It is emphasized to infer that surgical treatment is necessary for carcinoma arising from a cyst or suspcious one. It is also recommended that incidentally detected cysts should be treated with ethanol infusion under direct vision, if necessary, by using echoguided method. The operation method of deroofing except for complete resection is not necessarily guaranteed for large sized cysts

Free Perforation in Crohn\u27s Disease

Rare complication of free perforation in Crohn\u27s disease was clinically reviewed on the basis of surgical experiences with Crohn\u27s diseases. 1) Free perforation occurred in younger patients with steroid therapy. 2) There are no close correlation with the time duration of the disease affection. 3) The fortuitous locations of free perforation were the ileum and the ascending colon with multiple perforations. 4) One expired with postoperative sepsis on 55 days after surgery because of delay in diagnosis and treatment, although the other one was very well one year and one month following surgery. It was emphaseized that physicians should be aware of rare complication of free perforation in the follow-up of younger patients with Crohn\u27 disease in the use of steroid

Expressions of Vascular Endothelial Growth Factor (VEGF)-D and VEGF Receptor-3 in Colorectal Cancer: Relationship to Lymph Node Metastasis

Angiogenic factors play a major role in tumor growth and metastasis. Vascular endothelial growth factor (VEGF)- D is a ligand for VEGF receptor-3 (VEGFR-3/Flt-4), which mainly expressed on the lymphatic endothelium. Recent experimental studies have shown that VEGF-D induces tumor lymphangiogenesis and promote metastatic spread of tumor cells via lymphatic vessels. However, the contribution of VEGFD to lymph node metastasis in human colorectal cancer is less understood. We therefore examined VEGF-D and VEGFR-3 expression in patients with colorectal cancer. Sections of formalin-fixed and paraffin-embedded specimens from 76 colorectal cancers were immunohistochemically stained for VEGF-D and VEGFR-3. Staining for VEGF-D was positive in the cytoplasm of tumor cells in 43 of 76 examined tumors (56.6%). Staining for VEGFR-3 was positive in endothelial cells in 38 (50.0%) tumors. Univariate analysis showed that both VEGF-D and VEGFR-3 expressions correlated significantly with lymph node metastasis, histological type and depth of tumor invasion. However, logistic regression analysis indicated that VEGF-D expression, but not that of VEGFR-3, was an independent predictor for lymph node metastasis. Our data suggest that VEGF-D plays an important role in lymph node metastasis in colorectal cancer

Treatment of Surgical Site Infection with Aqua Oxidation Water: Comparison with Povidone Iodine

Aqua oxidation water is a new disinfectant with a bactericidal activity based on high oxidation-reduction potential and acidity. We compared the effectiveness of aqua oxidation water and povidone iodine against the surgical site infection (SSI). The bacteriological effect against several organisms and the efficacy of both disinfectants were almost similar. However, the duration of treatment with aqua oxidation water was shorter than that with the povidone iodine in healed wounds (p<0.05) and the number of patients treated with aqua oxidation water who reported pain was smaller than that with povidone iodine (p<0.05). Our results indicated that aqua oxidation water useful and effective for the treatment of incurable SSI

Retrospective Comparison of Minilaparotomy (\u27moving window method\u27) and Laparoscopic-assisted Approaches for Colon Cancer Resection

Aims: Outcome in minilaparotomy and laparoscopic-assisted approaches to colon cancer resection was compared retrospectively. Methods: The \u27minilaparotomy approach\u27, defined as a complete resection performed through a skin incision of 7cm or shorter (\u27moving window method\u27), was achieved in 47 patients with colon cancers (Tis/T1/T2/T3/T4) between 1997 and 1998 (minilaparotomy group). A laparoscopic-assisted approach was used in 30 patients with colon cancers (Tis/T1) between 1994 and 1996 (laparoscopic-assisted group). Results: Age, gender, prior laparotomy, tumor location, weight, height, body mass index, operation time, blood loss, and type of colectomies and anastomosis were similar in both groups. Median incision lengths in the minilaparotomy group were longer than in the laparoscopic-assisted group (7.0 versus 6.0cm). Maximal tumor diameter, number of lymph nodes removed, and proximal and distal margins in the minilaparotomy group were larger than in the laparoscopicassisted group. The minilaparotomy group had more advanced staged tumors; however, times until initial walking, flatus, fluid and solid food, time with urinary catheter, analgesic usage, postoperative hospital stay, and postoperative complication frequencies were similar. In neither group was there tumor recurrence at the laparotomy wound or port sites. Conclusion: Minilaparotomy and laparoscopic-assisted approaches to colon cancer resection were similar in terms of early return of function and discharge

Cancer Specific Long-term Survival After Surgery for Carcinoma of the Splenic Flexure

Purpose: Carcinoma of the splenic flexure is uncommon and it is associated with a high risk of obstruction. However, survival after resection of this tumor is controversial. The aim of this study was to evaluate cancer specific long-term survival after surgery for splenic flexure cancers compared to survival for the colon cancer at other sites. Patients and Methods: Of 500 patients undergoing surgery for colon cancer, 16 (3.2%) had cancers of the splenic flexure. Clinicopathological features and cancer specific longterm survival after curative resection were evaluated. Results: Splenic flexure carcinomas were found to be associated with a high risk of obstruction (4 out of 16; 25.0%) and a high risk of penetration/perforation (1 out of 16; 6.2%) compared with colon cancers at other sites (P <0.0001 and P=0.0128, respectively). Operative mortality rate for patients with carcinomas of splenic flexure was significantly higher than that of other sites (6.3% versus 0.8%; P=0.0319). However, resection for splenic flexure tumors was usually possible, and there was no difference in cancer specific long-term survival after surgery between the patients with splenic flexure cancers and the other site colon cancers (P=0.3505). Conclusions: Carcinoma of the splenic flexure has a similar prognosis to colon cancer at other sites

Numerical Chromosome Aberrations In A Recurrent Malignant Fibrous Histiocytoma of the Retroperitoneum

Malignant fibrous histiocytoma (MFH) of the retroperitoneum is relatively rare in Japan. MFHs often recurs even if the tumor is resected completely. We describe a case with recurrent MFH of the retroperitoneum. A 49-year-old male was-admitted to our hospital for a palpable mass in the right lower abdomen. Ultrasonography and computed tomography demonstrated a solid mass with cystic compartment in the lower pole of the right kidney. The tumor was resected completely, and histological examination showed it was MFH, storiform-pleomorphic type. Thirty-three months later, a local recurrence developed and a second operation was performed. The resected tumor was 4.5 ﾃ・3.9 ﾃ・3.1 cm in size and histological diagnosis was recurrent MFH. We also examined the cytological characteristics of the tumor, using DNA flow cytometric quantification and fluorescence in situ hybridization (FISH) with a set of 14 chromosomespecific DNA probes. DNA contents showed a DNA diploid pattern, however, FISH analysis showed various aberrations of chromosome number such as +1, +2, +7, +8, -10, +11, +12, -16, -17, -18, and +20. These results suggested that chromosomal aberrations may reflect a higher biologic aggressiveness of recurrent MFH