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Yuhei Kitasato,
Yusuke Ishida,
Yoshinobu Okabe,
Osamu Tsuruta,
Munehiro Yoshitomi,
Gen Akasu,
Kazuhiro Mikagi,
Yousuke Oka,
Yuichirou Maruyama,
Ryuichi Kawahara,
Hisamune Sakai,
Hiroto Ishikawa,
Toru Hisaka, Masafumi Yasunaga,
Hiroyuki Horiuchi,
Yoshito Akagi,
Koji Okuda,
Hisafumi Kinoshita,
Kazuo Shirouzu,
Hiroyuki Tanaka
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ABSTRACT: The success of biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice influences its prognosis greatly. In this study, we report a retrospective evaluation of endoscopic retrograde biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice. Materials and methods: From April 2004 to December 2011, 9 patients with liver metastases from colorectal cancer and obstructive jaundice who underwent endoscopic biliary drainage were evaluated retrospectively. Results: The mean serum levels of total bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase improved significantly after biliary drainage. The median survival time after biliary drainage was 133 days. Only 4 cases were able to resume chemotherapy after biliary drainage, and their prognosis was significantly better than patients who were not able to resume chemotherapy(p=0.014). Discussion: Endoscopic biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice was effective, led to the resumption of chemotherapy, and improved prognosis. However, sufficient consideration of the patient's prognosis and performance status is required in order to perform biliary drainage.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1860-2.
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Yoshiki Naito,
Hironori Kusano,
Osamu Nakashima,
Eiji Sadashima,
Satoshi Hattori,
Tomoki Taira,
Akihiko Kawahara,
Yoshinobu Okabe,
Kazuhide Shimamatsu,
Jun Taguchi, [......],
Koichi Higaki,
Munehiro Yoshitomi, Masafumi Yasunaga,
Koji Okuda,
Hisafumi Kinoshita,
Masamichi Nakayama,
Makiko Yasumoto,
Jun Akiba,
Masayoshi Kage,
Hirohisa Yano
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ABSTRACT: To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB).
Clinicopathological features of 24 cases of INihB, which were previously diagnosed as biliary papillomatosis or intraductal growth of intrahepatic biliary neoplasm, were reviewed. Mucin immunohistochemistry was performed for mucin (MUC)1, MUC2, MUC5AC and MUC6. Ki-67, P53 and β-catenin immunoreactivity were also examined. We categorized each tumor as adenoma (low grade), borderline (intermediate grade), and malignant (carcinoma in situ, high grade including tumors with microinvasion).
Among 24 cases of INihB, we identified 24 tumors. Twenty of 24 tumors (83%) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB). In contrast, the remaining four tumors (17%) showed both tubular and papillary structures. In three of the four tumors (75%), macroscopic mucin secretion was limited but microscopic intracellular mucin was evident. Histologically, 16 tumors (67%) were malignant, three (12%) were borderline, and five (21%) were adenoma. Microinvasion was found in four cases (17%). Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P = 0.0095). Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2 ± 15.5 vs 7.5 ± 6.3, P < 0.01). In the 16 malignant cases, expression of MUC5AC showed borderline significant association with high Ki-67 LI (P = 0.0622). Nuclear expression of β-catenin was observed in two (8%) of the 24 tumors, and these two tumors also showed MUC1 expression. P53 was negative in all tumors.
Some cases of INihB have a tubular structure, and are subcategorized as IPNB with tubular structure. MUC1 expression in INihB correlates positively with degree of malignancy.
World Journal of Gastroenterology 07/2012; 18(28):3673-80. · 2.47 Impact Factor
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ABSTRACT: BACKGROUND/PURPOSE: Mastering the technique of pancreaticoduodenectomy (PD) is a major theme in hepato-biliary-pancreatic surgery, and education for PD has not been established even in each institution. With the progression of disease, the difficulty of PD increases due to cases requiring resection of multiple organs and borderline resectable cases, and complications affecting survival also often occur. To help to improve the education of young surgeons, we clarified the institutions' principles and the status of operations performed by young surgeons. METHODS: We sent questionnaires to institutions as members of the Japanese Society of Pancreatic Surgery about the institutions' educational principles in 2010 and surgeons who performed PD and patients treated by PD between January and December 2007. The PD operators were classified into two groups: postgraduate year ≤10 or ≥11, and each institution's principles, and pre-, intra-, and postoperative factors were evaluated. RESULTS: PD was performed by surgeons at postgraduate year ≤10 in 29 (40.6%) institutions. Education programs were using 29 (41.4%) institutions. High-volume centers, where the surgeons performing PD tend to be at postgraduate year ≤10, can provide more training. Preoperative risks were not included in the criteria for selecting cases for operations by young surgeons, and young surgeons tended to perform PD in patients with less advanced stages. The incidence of pancreatic fistula classified as International Study Group of Pancreatic Surgery Grade B or C was significantly higher (P = 0.010) in the operator group at postgraduate year ≤10 (24.6%, 32 patients) than that at postgraduate year ≥11 (17.6%, 177 patients). Cumulative survival rate of pancreatic cancer or extrahepatic bile duct cancer did not significantly differ between the two operator groups. CONCLUSION: The present questionnaire showed increased opportunities of performing operations by young surgeons. Although the incidence of Grade B/C fistula is higher for postgraduate year ≤10, postoperative outcome is acceptable. It is acceptable for the pancreaticoduodenectomy performed by young surgeons, when young surgeons receive high-level education under the guidance of supervisory doctor. Prognosis did not differ between two operator groups at postgraduate year ≤10 and ≥11 in this study. Based on these findings, operations by surgeons at postgraduate year ≤10 present can be recommended.
Journal of hepato-biliary-pancreatic sciences. 03/2012;
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Yuhei Kitasato,
Masamichi Nakayama,
Gen Akasu,
Munehiro Yoshitomi,
Kazuhiro Mikagi,
Yuichiro Maruyama,
Ryuichi Kawahara,
Hiroto Ishikawa,
Toru Hisaka, Masafumi Yasunaga,
Hiroyuki Horiuchi,
Naoyuki Saito,
Shinzo Takamori,
Yoshinobu Okabe,
Masayoshi Kage,
Hisafumi Kinoshita,
Hiroyuki Tanaka
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ABSTRACT: For the majority of patients, ductal adenocarcinoma of the pancreas remains a lethal disease. Currently, surgical extirpation for localized disease offers the only chance for long-term survival.
We report a patient who underwent successful resection of isolated lung metastasis occurring 13 years after pancreatic cancer resection. A 59-year-old woman underwent distal pancreatectomy for pancreatic cancer 13 years previously, followed by adjuvant chemotherapy, and was followed-up at the outpatient clinic of a local hospital. From around June 2010, she noticed bloody sputum, so she visited a local hospital. Since her chest X-ray and CT revealed a 1.5 cm mass shadow in the segment 10 of her right lung and she was referred to the Respiratory Disease Center of our hospital. As a result of through examinations, she was strongly suspected of having lung metastasis of pancreatic cancer, and underwent partial pneumonectomy. Postoperative histopathological examination of the resected specimen was consistent with lung metastasis of pancreatic cancer. She is still alive and currently receives third line of chemotherapy.
Patients who have achieved long-term survival after pancreatic cancer resection and can tolerate surgery may benefit from resection of a lung metastasis of pancreatic cancer in terms of survival, if it controls the metastasis.
JOP: Journal of the pancreas 01/2012; 13(3):296-300.
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Yuhei Kitasato, Masafumi Yasunaga,
Masamichi Nakayama,
Gen Akasu,
Munehiro Yoshitomi,
Kazuhiro Mikagi,
Ryuichi Kawahara,
Hiroto Ishikawa,
Toru Hisaka,
Hiroyuki Horiuchi,
Hisafumi Kinoshita,
Yoshinobu Okabe
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ABSTRACT: The patient was a 62-year-old man who underwent distal pancreatectomy and partial resection of transverse colon with diagnosis of cystic tumor of pancreas tail in July 2006. In histology, the tumor was an invasive carcinoma derived from intraductal tumor. So, Chemotherapy using gemcitabine (GEM) was administered. Eleven months after the operation, abdominal contrast-enhanced CT showed a cystic tumor in the subdiaphragm and CEA increased to 15 .2 ng/mL. Combination chemotherapy using GEM and S-1 was administered under the diagnosis of peritoneal recurrence. CEA decreased to a normal level, but 19 months after the operation, CA19-9 increased to 187 .7 U/mL. Then, radiotherapy (a total of 40 Gy) was performed. Twenty two months after the radiotherapy, though chemotherapy using S-1 was continued, CA19-9 re- increased to 134 .2 U/mL. Abdominal contrast-enhanced CT and PET detected no other recurrent lesion. A tumor resection was performed in January 2010. In immunostaining MUC1(+), MUC2(-), MUC5AC(+), MUC6(+) and mucus expression forms as well as with previous specimen, and was diagnosed as recurrence of the invasive carcinoma derived from intraductal tumor.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2161-4.
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ABSTRACT: Malignant transformation of a mature cystic teratoma of the ovary is rare, occurring in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Much less frequently, the malignant transformation is represented by sarcomas. Dedifferentiated chondrosarcoma usually develops in bone. There has been no case of a dedifferentiated chondrosarcoma arising in mature cystic teratoma of the ovary since the establishment of this diagnostic entity. This is a report of a definitive dedifferentiated chondrosarcoma arising in a mature cystic teratoma of the ovary, presenting clinicopathologic features.
International Journal of Gynecological Pathology 06/2011; 30(4):391–394. · 1.45 Impact Factor
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ABSTRACT: Ovarian mucinous neoplasms of gastro-intestinal type (GI-type) are known to be a heterogeneous tumor composed of benign, borderline and non-invasive and invasive malignant lesions. The presence of infiltrative invasion is also known to be an important prognostic factor of this neoplasm. Laminin γ 2 chain, known to stimulate tumor cell invasion and migration, has not been sufficiently investigated in ovarian mucinous neoplasms. The purpose of this study was thus to clarify the role of laminin γ 2 in ovarian mucinous neoplasms of GI-type. We selected each morphological phase of tumor development from 61 cases of mucinous neoplasms of the GI-type: 55 adenoma lesions, 60 borderline lesions, 20 microinvasive lesions, 17 intraepithelial carcinoma lesions, 38 expansile invasive carcinoma lesions, 19 infiltrative invasive carcinoma lesions and 5 mural nodules lesions; and evaluated the localization of laminin γ 2 in the lesions using immunohistochemical method. The staining pattern was classified into i) basement membranous (BM), ii) cytoplasmic (CYT) and iii) stromal (S) pattern. The BM pattern was characteristic in adenoma, borderline, and interaepithelial and expansile invasive carcinoma lesions. The CYT and S patterns were characteristic in infiltrative invasive lesions. The staining pattern of mural nodules was similar to that of infiltrative invasion. The infiltrative invasion of GI-type ovarian mucinous neoplasms may be promoted by cytoplasmic and/or stromal expression of laminin γ 2 chain.
Oncology Reports 12/2010; 24(6):1569-76. · 1.84 Impact Factor
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ABSTRACT: This study was designed to analyze the subcellular localization of E-cadherin and β-catenin both of which play a critical role in cell-cell adhesion in uterine carcinosarcoma (UCS). We performed an immunohistochemical reaction analysis of the subcellular localization of E-cadherin and β-catenin proteins in 46 cases of UCSs consisting of 28 UCSs with heterologous sarcoma and 18 UCSs with homologous sarcoma and compared their clinicopathological features. In most UCSs, membranous expression of E-cadherin and β-catenin was completely lost in sarcomatous components, but it was preserved in carcinomatous components. Nuclear β-catenin expression was observed significantly more frequently in sarcomatous components (31/46, 67.4%) than in carcinomatous components (22/46, 47.8%; P = 0.0025). In sarcomatous components, nuclear β-catenin expression was found significantly more frequently in heterologous sarcoma (23/28, 82.1%) than in homologous sarcoma (8/18, 44.4%; P = 0.0279). The stage was the only independent prognostic significant factor. These results suggest that reduced membranous expression of E-cadherin and β-catenin may contribute to the biphasic morphology of UCS. Furthermore, although the precise mechanism is unclear, nuclear β-catenin expression in sarcomatous components may also be associated with biphasic morphology and heterologous sarcomatous differentiation.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 11/2010; 458(1):85-94. · 2.49 Impact Factor
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Yuhei Kitasato, Masafumi Yasunaga,
Yuichi Goto,
Tomohiro Sato,
Gen Akasu,
Koji Shiota,
Hisamune Sakai,
Toshiro Ogata,
Koji Okuda,
Hisafumi Kinoshita,
Kazuo Shirouzu,
Shigeaki Aoyagi
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ABSTRACT: We examined the case of laparoscopic radiofrequency ablation (L-RFA) to hepatocellular carcinoma (HCC), and then the method of this treatment was considered in terms of selection and adjustment. Between January 2008 and May 2010, L-RFC was performed on 18 cases (27 tumors). A total operation time was 203 minutes (± 85.5). The median survival time was 562 days (± 197 day). The amount of blood was 21.0 g (± 68.4), and 3 postoperative complications (pleural effusion) were observed. The average length of hospital stay after the operation was 8 days. There was no vestigial remnant in all cases after the operation. The prognosis of death due to a liver failure was one case on the 516th day after the operation. All other 17 cases were survived. If the tumors were identified by the naked eye and ultrasonography, and considering the position in relation to the main vas, the ablation would be possible for the troublesome part in case of the percutaneous approach. Therefore, we thought the application of RFA to HCC would be more expandable.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2662-3.
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ABSTRACT: Hobnail-like cells, which suggest a diagnosis of clear cell carcinoma, are also focally observed in serous borderline tumor of the ovary, causing diagnostic confusion. However, the precise nature of hobnail-like cells in serous borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not hobnail-like cells in serous borderline tumor represent concomitant incipient clear cell neoplasms. First, we carefully reviewed hematoxylin and eosin slides taken from 115 ovarian tumors diagnosed as clear cell carcinoma (73 cases), mixed adenocarcinoma containing clear cell carcinoma (5 cases), and serous borderline tumor (37 cases) to clarify the frequency of coexistence of typical clear cell carcinoma and serous borderline tumor. Through the hematoxylin and eosin review, we paid special attention to the cytologic features of hobnail-like cells in serous borderline tumor and serous borderline tumor-like papillary areas in clear cell carcinoma. Second, we selected 19 serous borderline tumors and 16 clear cell carcinomas, in which hobnail-like cells were easily recognizable, and investigated the immunohistochemical expression of estrogen receptor and Wilms tumor gene protein. No coexistence of clear cell carcinoma and serous borderline tumor was evident in any of the above 115 ovarian tumors. Hobnail-like cells were focally positive for estrogen receptor and Wilms tumor gene protein in nearly all serous borderline tumors. Hobnail-like cells in all clear cell carcinomas were completely negative for estrogen receptor and Wilms tumor gene protein, although estrogen receptor expression was very focally observed (less than 5% area) in non-hobnail cells of only one clear cell carcinoma. In conclusion, hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms because (1) clear cell carcinoma and serous borderline tumor do not coexist and (2) hobnail-like cells in clear cell carcinoma and serous borderline tumor are immunophenotypically distinct. Recognition of our conclusion may protect a patient with "conspicuous hobnail-like cells in serous borderline tumor" from an erroneous overdiagnosis of "concomitant clear cell carcinoma admixed with serous borderline tumor."
Human pathology 05/2009; 40(8):1168-75. · 3.03 Impact Factor
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Masafumi Yasunaga,
Yoshihiro Ohishi,
Yoshinao Oda,
Munechika Misumi,
Atsuko Iwasa,
Shuichi Kurihara,
Izumi Nishimura,
Emi Okuma,
Hiroaki Kobayashi,
Norio Wake,
Masazumi Tsuneyoshi
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ABSTRACT: Mullerian mucinous borderline tumor and gastrointestinal mucinous borderline tumor are considered mucinous tumor subtypes. However, it has been reported that mullerian mucinous borderline tumor shares many clinicopathologic features with serous borderline tumor. Furthermore, some investigators have explained the histogenesis of mullerian mucinous borderline tumor by metaplastic and hyperplastic transformation of endometriosis (Fukunaga M, Ushigome S. Epithelial metaplastic changes in ovarian endometriosis. Mod Pathol. 1998;11:784-788). The purpose of this study is to substantiate the concept that mullerian mucinous borderline tumor is histogenetically closer to serous borderline tumor or low-grade endometrioid tumor than to gastrointestinal mucinous borderline tumor by directly comparing their immunophenotype. A total of 80 cases of low-grade ovarian tumors composed of 20 mullerian mucinous borderline tumors, 20 gastrointestinal mucinous borderline tumors, 20 serous borderline tumors, and 20 low-grade endometrioid tumors were immunohistochemically evaluated for the expression of estrogen receptor, progesterone receptor, vimentin, WT-1, beta-catenin, and PTEN. Almost all cases of mullerian mucinous borderline tumor, serous borderline tumor, and low-grade endometrioid tumor showed diffuse and strong nuclear expression of estrogen receptor and progesterone receptor. In addition, about half of the mullerian mucinous borderline tumor, serous borderline tumor, and low-grade endometrioid tumor cases showed focal but strong vimentin cytoplasmic expression. In contrast, gastrointestinal mucinous borderline tumor showed no expression of estrogen receptor, progesterone receptor, or vimentin, except for 1 case in which estrogen receptor expression was very focally and weakly observed. WT-1 nuclear expression was observed in most serous borderline tumors and only 15% of low-grade endometrioid tumor, but mullerian and gastrointestinal mucinous borderline tumor cases were completely negative. beta-Catenin nuclear expression was significantly more frequent in low-grade endometrioid tumor than in mullerian mucinous borderline tumor, gastrointestinal mucinous borderline tumor, or serous borderline tumor. PTEN expression was significantly lower in low-grade endometrioid tumor than in mullerian mucinous borderline tumor, gastrointestinal mucinous borderline tumor, and serous borderline tumor. Multiple comparisons of quantitative immunoreactivities of estrogen receptor, progesterone receptor, and vimentin revealed that the gastrointestinal mucinous borderline tumor expression profiles were significantly different from those of mullerian mucinous borderline tumors, serous borderline tumors, and low-grade endometrioid tumors. The immunohistochemical expression profiles of estrogen receptor, progesterone receptor, and vimentin substantiate the concept that the histogenesis of mullerian mucinous borderline tumor is closer to those of serous borderline tumor and low-grade endometrioid tumor than to that of gastrointestinal mucinous borderline tumor. However, aberrant beta-catenin and PTEN protein expression, both of which are known to contribute to the tumorigenesis of low-grade endometrioid tumor, appeared to be less important for the tumorigenesis of mullerian mucinous borderline tumor.
Human pathology 04/2009; 40(7):965-74. · 3.03 Impact Factor
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ABSTRACT: We report a case of spontaneous splenic rupture (SSR) caused by a Bacillus species (sp.) infection. A 36-year-old man on warfarin therapy since an aortic valve replacement at the age of 13 was admitted to our hospital with a 3-week history of a high fever. He had been asymptomatic until 4 months previously, when he suffered a cerebral embolism despite adequate oral anticoagulation. Abdominal computed tomography revealed splenic infarctions, which resulted in splenic rupture 2 days later. After embolization of the splenic artery, splenectomy was successfully performed. Pathologic examination revealed splenic infarction, resulting from septic emboli, with associated rupture of the splenic capsule, but no abscess was found. Bacillus sp. was isolated from cultures of arterial blood preoperatively, and the excised splenic specimens, postoperatively. In addition to rupture of the suppurating intrasplenic vessels with hematoma formation, the anticoagulant therapy possibly contributed to distension of the intrasplenic hematoma.
Surgery Today 02/2009; 39(8):733-7. · 1.22 Impact Factor
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ABSTRACT: Ovarian mature cystic teratomas (MCT) uncommonly undergo malignant transformation to squamous cell carcinoma (SCC). While alterations in the p53 tumor suppressor gene and protein have been shown, few studies have analyzed other molecular changes leading to this malignant conversion. The purpose of the present study was to investigate 21 samples of SCC arising in MCT for altered expression in known p53- and p16/Rb-dependent cell cycle regulatory proteins, and the association between their expression and cellular proliferation and histological features. Overexpression of the p53 protein was observed in 14 SCC (67%), while four (19%) had point mutations in the p53 gene. Reduced expression of the p16 protein was observed in 18 SCC (86%), while p16 gene alterations (hypermethylation (29%) and point mutation (33%)) were found in 11 (52%). Furthermore, a statistically significant correlation was observed between p53 and Rb overexpression (P=0.0010), and the overexpression of both p53 and Rb was respectively significantly correlated with increased cellular proliferation. The results indicate that alterations in both the p53 and p16-Rb pathways are associated with SCC arising in MCT.
Pathology International 01/2009; 58(12):757-64. · 1.62 Impact Factor
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Masafumi Yasunaga,
Yoshihiro Ohishi,
Izumi Nishimura,
Sadafumi Tamiya,
Atsuko Iwasa,
Emi Takagi,
Takafumi Inoue,
Hideaki Yahata,
Hiroaki Kobayashi,
Norio Wake,
Masazumi Tsuneyoshi
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ABSTRACT: Giant cell carcinoma (GCC) is a highly aggressive variant of sarcomatoid carcinoma of the lung. To date, however, there have been no reported cases of ovarian carcinoma mainly composed of GCC. Herein is reported the case of a 54-year-old Japanese woman with an undifferentiated ovarian carcinoma producing granulocyte colony-stimulating factor (G-CSF) and an inflammatory cytokine. Histologically, the tumor was composed of cohesive nests or discohesive pleomorphic mononucleated or multinucleated tumor giant cells, accompanied by inflammatory cell infiltration and emperipolesis. Immunohistochemically, the tumor cells were focally positive for epithelial membrane antigen and cytokeratin 7. Clinically, after the initial surgery, the tumor had rapid regrowth along with the production of G-CSF and an inflammatory cytokine. Adjuvant chemotherapy was administered but induced severe heart failure and severe neutropenia, probably due to the presence of hypercytokinemia and excess G-CSF. Upon the appearance of these fatal side-effects the chemotherapy was immediately discontinued and replaced with radiotherapy. The recognition of this type of ovarian tumor is important for clinical management, because adjuvant chemotherapy is the standard treatment for clinical management of epithelial ovarian cancer.
Pathology International 05/2008; 58(4):244-8. · 1.62 Impact Factor
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ABSTRACT: Acinar cell carcinoma (ACC) of the pancreas is relatively rare, accounting for only approximately 1% of all exocrine pancreatic tumors. A 69-year-old man was found to have a mass lesion measuring approximately 4 cm in diameter in the pancreatic head on ultrasound, abdominal dynamic CT, and percutaneous transhepatic cholangiography. Magnetic resonance cholangiopancreatography showed defect of the lower common bile duct (CBD) due to obstruction by the tumor cast. Histopathologically, the pancreatic head tumor invaded the main pancreatic duct (MPD) and CBD with extension into the CBD in a form of tumor cast. The tumor cells consisted of a solid proliferation with abundant eosinophilic cytoplasm and round nuclei in an acinar and trabecular fashion. A 55-year-old man with upper abdominal pain and nausea, had a cystic lesion approximately 3 cm in size in the pancreatic tail on CT. Histopathologically, the tumor was encapsulated by fibrous capsule and had extensive central necrosis with solid areas in the tumor periphery, and invaded with extension into the MPD in a form of tumor cast. The tumor cells resembled acinar cells in solid growths. Two resected cases of ACC with unusual tumor extension into the CBD and the MPD, respectively, are reported.
Pathology International 11/2006; 56(10):633-7. · 1.62 Impact Factor
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ABSTRACT: Although an accurate anatomical understanding of the hepatic arteries is the most and essential step in living-related liver transplantation (LRLT), the need to reduce the burden place on the donor should be considered in imaging diagnosis. The present study examined the reliability of intravenously enhanced three-dimensional (3D) angiography from multidetector-row computed tomography (MDCT) in evaluating the anatomical configuration of the hepatic arteries comparing with those from conventional angiography by Seldinger method. A total of 109 patients underwent MDCT and 3D images were reconstructed on arterial phase using the volume rendering (VR) method. In the case of 3D angiography, at an infusion rate of 4 ml/s, the extrahepatic hepatic arteries were visualized successfully in all cases (the right, left and middle hepatic artery). The aberrant hepatic arteries were successfully visualized in 23 of 24 cases. The 3D angiography is a reliable method of visualizing the extrahepatic and aberrant hepatic arteries. This minimally invasive examination procedure is useful in individual operative planning and is help to increase the safety of surgery.
Transplant International 06/2005; 18(5):499-505. · 2.92 Impact Factor
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Hisafumi Kinoshita,
Jun Nagashima,
Mitsuo Hashimoto,
Kazunori Nishimura,
Takahito Kodama,
Hideki Matsuo,
Shigeru Hamada, Masafumi Yasunaga,
Masaharu Odo,
Shuichi Fukuda,
Masao Hara,
Koji Okuda,
Mamoru Hiraki,
Kazuo Shirouzu,
Shigeaki Aoyagi
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ABSTRACT: We report a patient with benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma. A 66-year-old woman consulted a local physician because of general fatigue. Blood biochemical tests showed increased levels of biliary tract enzymes. Abdominal ultrasonography (US) revealed tapering and blockage of the midportion of the bile duct and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) demonstrated obstruction of the midportion of the bile duct. Later, because a marked increase in biliary tract enzymes and jaundice appeared, percutaneous transhepatic biliary drainage (PTBD) was performed. Post-PTBD cytological examination of bile was negative for cancer. A third biopsy showed slight hyperplasia with no malignant findings. Recholangiography, performed through PTBD, suggested gradual improvement of bile duct stricture, but could not completely exclude the possibility of malignancy; thus, resection of the bile duct including the stricture site was performed, and the resected specimen was submitted for intraoperative frozen section examination. Histopathological diagnosis did not reveal malignant findings. After cholecystectomy and bile duct resection, hepaticojejunostomy (Roux-en-Y) was performed. Because only erosion and desquamation of the mucosal epithelium and mild submucosal inflammatory cell infiltration and fibrosis were observed, chronic cholangitis was diagnosed histopathologically. Surgical resection of the bile duct should be considered for potentially malignant stricture of the bile duct.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2004; 11(1):64-8. · 1.60 Impact Factor
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Hiroyuki Horiuchi,
Hiroto Ishikawa,
Katsumi Hayashi,
Shinji Uchida,
Takahito Kodama,
Kazunori Nishimura,
Toshirou Ogata, Masafumi Yasunaga,
Masaharu Ohdo,
Msao Hara,
Kouji Okuda,
Hisahumi Kinoshita,
Shigeaki Aoyagi,
Kazuo Shirouzu
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ABSTRACT: Pancreatic cancer is a malignant tumor with a poor prognosis. It frequently presents with locally advanced and distant metastasis at the time of diagnosis. Favorable results were obtained by performing intraoperative radiation therapy (IORT) and chemotherapy (administration of GEM) for the treatment of inoperable pancreatic cancer. A study was conducted on its efficacy as an adjuvant therapy for inoperable and advanced pancreatic cancer.
Between May 1998 and December 2002, 40 patients with stage IV pancreatic cancer were treated at our institution. The study comprised background factors, adjuvant therapy and survival rate.
According to the treatment modality, the study population was classified into four groups: group A, consisting of 3 patients with localized unresectable tumors who had been treated with IORT: group B, 5 patients who underwent curative resection of primary tumor combined with IORT: group C, 6 patients who were administered GEM combined with IORT: group D, 26 patients not falling into groups A, B or C. The mean survival for group A, B, C and D was 10.3 months, 6.7 months, 16.8 months and 9.4 months, respectively. The 1-year survival rates were 0%, 0%, 80.0% and 19.3%, respectively. The mean survival and the 1-year survival rate were significantly better in group C than in the other groups. In group C, the tumor decreased in size, invasion of large vessels and pancreatic posterior evolution was suppressed, and 4 patients survived for 17 months or more.
Prolongation of the survival period was shown by concomitant IORT and administration of GEM for inoperable advanced pancreatic cancer. Thus, attempting to combine chemotherapy with IORT and giving additional consideration to the administration method was shown to provide adjuvant therapy that can be expected to be effective against stage IV inoperable pancreatic cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2003; 30(11):1571-4.
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Hisafumi Kinoshita,
Masao Hara,
Kazunori Nishimura,
Takahito Kodama,
Hideki Matsuo,
Ryuichi Kawahara, Masafumi Yasunaga,
Hisamune Sakai,
Masaharu Odo,
Koji Okuda,
Kazuo Shirouzu,
Shigeaki Aoyagi
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ABSTRACT: We evaluated the resection of the papilla of Vater performed in patients with cancer in the papilla of Vater. The subjects were 6 patients who underwent resection of the papilla of Vater between January 1969 and December 2001. The patients aged 57-87 years consisted of 3 males and 3 females. The maximal diameter of the tumors was 0.5 cm in 1 patient, 1.5 cm in 3 patients, and 2.0 cm in 2 patients. Macroscopically, the tumors were of the protruded type (exposed) in 3 patients, of the mixed type (predominant protruded type) in 2 patients, and of the ulcerative type in 1 patient. The histological depth of the tumors was up to the mucosa in 1 patient, up to the oddi in 1 patient, up to the panc0, du1 in 1 patient, up to the panc1, du2 in 1 patient, and unknown in 2 patients. Histologically, the tumors were papillotubular adenocarcinoma (pap-tub) in 4 patients and tubular adenocarcinoma of the well-differentiated type (tub1) in 2 patients. Resection of the papilla of Vater was chosen because of high risk factors such as advanced age in 2 patients, complicated severe cirrhosis and confinement to bed due to poor systemic conditions after intracerebral hemorrhage in 3 patients, and hepatic metastasis observed during surgery in 1 patient. Residual cancer cells around the excised region were positive in 4 patients and unknown in the remaining 2 patients. Of the 6 patients, 5 died within 2 years after surgery, but 1 is alive without symptoms of recurrence 7 years after surgery. The death causes were the primary disease in 3 of the 5 patients. From the viewpoint of radical treatment, resection of the papilla of Vater cannot be chosen as a reduced surgery for cancer in the papilla of Vater. However, resection of the papilla of Vater can be applied to very elderly patients and patients under poor systemic conditions, for whom pancreatoduodenectomy (PD) is considered excessively invasive due to a small diameter of tumor.
The Kurume Medical Journal 02/2003; 50(1-2):17-9.
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Hiroyuki Horiuchi,
Hiroto Ishikawa,
Mamoru Hiraki,
Shinji Uchida, Masafumi Yasunaga,
Masaharu Ohdo,
Tsuyoshi Tamae,
Shuichi Fukuda,
Masao Hara,
Kohji Okuda,
Hisafumi Kinoshita,
Shigeaki Aoyagi,
Kazuo Shirouzu,
Masamichi Koganemaru
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ABSTRACT: Most patients with pancreatic cancer are unresectable because of local invasion and liver metastasis at the time of diagnosis. To date, no treatment has had a significant impact on this disease. To deliver a high concentration of drug to the cancer, intra-arterial chemotherapy with GEM was performed in two patients with unresectable advanced cancer.
One patient, a 70-year-old man with liver metastasis, was treated with arterial infusion of GEM 1,000 mg/body. Another patient, a 55-year-old woman with local invasion and distant metastatic lymphadenopathy, was given intra-arterial infusion of GEM 400 mg and intra-venous infusion of GEM 1,000 mg/body. The patients were given GEM weekly for 3 weeks followed by a week of rest.
In the first patient, the pain went away and CEA was decreased for 6 months. After that, the patient died due to intra-abdominal dissemination within 4 months. In the other patient, the pain went away. Tumor markers, such as CEA and CA19-9, were normalized and primary pancreatic cancer was reduced locally. The patient currently has a metastatic liver tumor, but she has had a significant improvement in performance status.
Intra-arterial chemotherapy with GEM may be tolerated in patients with unresectable pancreatic cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2002; 29(12):2065-9.
