A Case of Minute Duodenal Carcinoma Resected by Endoscopy

Abstract: A 61-year-old man who had experienced epigastric pain for a year underwent an esophagogas. troduodenoscopy (EGD) which revealed a tiny, lobular and uneven-surfaced protrusion (approximately 4 mm in diameter), well demarcated at the base and normal in color, in the duodenal bulb. A biopsy revealed a well differentiated adenocarcinoma. After admission, an endoscopic mucosal resection was performzed for this lesion. The resected tissue was 19 ×14 mm in size and contained a carcinoma measuring 4×3 mm in diameter. Histopathologically, it was a well differentiated tubular adenocarcinoma limited to the mucosa; the lesion had been completely resected. In Japan, 133 cases of early primary duodenal carcinoma have been reported in the literature. However, the so-called minute cancer measuring less than 5 mm in diameter has never been reported before. Dzagnosis, anatomical distribution, and treatment of the reported cases of early duodenal carcinoma were analyzed in this paper.     

A Case of Adult T-cell Leukemia Associated With Hypercalcemia

This case study concerns a 56-year-old man who exhibited hypercalcemiadue to T-cell leukemia. The leukemic cell was identified tobe of T-cell origin by the method of routine T- and B-cell markers(E rosette and EAC rosette formation). Hypercalcemic crisisoccurred in conjunction with an increase in leukemic cells.X-ray studies revealed no apparent skeletal bone destructionsby metastasis of leukemic cells, but showed cortical erosionof the phalanges of the hands. Hypophosphatemia and decreasedtubular reabsorption of phosphates were also observed. However,immunoreactive parathyroid hormone (iPTH) in his serum was notdetected. The serum calcium concentration returned to its normallevel in the coincidental improvement of the leukemia afterresponding to chemotherapy. In order to test whether the leukemiccells produce an active substance or not, studies were carriedout in vitro, that is, culture mediums were obtained from leukemiccells incubated for 24 hours and injected into chicks, and theirserum calcium concentrations were measured. Significant elevationsin the calcium level were found when compared with controls.No iPTH was detectable in the culture medium. It was concludedthat the hypercalcemia in this patient could be due to a humoralfactor (or factors) other than iPTH, which was produced by T-leukemiccells.     

Serum Carcinoembryonic Antigen Levels in Patients with Apudoma

Previous reports of elevated carcinoembryonic antigen (CEA)levels in sera from patients with medullary carcinoma of thethyroid (MCT) prompted us to determine whether or not tumorsnow recognized as apudomas, other than MCT, can produce theantigen, because of the common origin tumors, the neural crest. Together with sera from patients with sporadic MCT (2) and Sipple'ssyndrome (4), we collected sera from patients with other typesof apudomas—pheochromocytoma (11), neuroblastoma (5),pancreatic islet-cell tumor (2) and parathyroid adenoma (2)—andmeasured CEA by radioimmunoassay. Like previous investigators,we found increased levels of CEA in patients with MCT, eithersporadic or Sipple's syndrome. However, other apudoma patientsshowed normal or only slightly increased CEA levels. Our findingsindicate that CEA production is not a feature common to allapudomas. The specificity of CEA is not affected and its assayis a valuable procedure for the diagnosis and follow-up of MCT.     

中国湖北汉族人群HLA-DRB1基因多态性研究

目的:调查湖北汉族人群人类白细胞抗原(HLA)-DRB1基因多态性,获得完整准确的遗传学数据。方法:应用序列特异性引物聚合酶链反应(PCR-SSP)方法对213名随机选取无亲缘关系的湖北籍汉族健康体检者或健康献血员进行HLA-PDRB1基因型检测。结果:在213名正常个体中,发现基因频率(GF)较高的有DRB1*1501-1502(GF=11.0%)、*1101-1105(GF=8.5%)、*0901(GF=6.8%)、*1301-1302(GF=6.6%)、DRB4*0101(GF=19.0%)、DRB5*0101(GF=16.9%),低频率等位基因是DRB1*04、*1001和*0101-0103。结论:从基因水平分析了HLA-DRB1基因在湖北汉族群体中的分布特征,提供了一套比较完整准确的DRB1基因频率,为人类学和疾病相关性等研究提供了重要的参考数据。     

Tachycardia and Apparent Sino-Atrial Block Due to Concealed Sinus Node Re-entry

The role of the middle intercavaJ area ("internodal pathway") in the genesis of atrial re-entry was studied using microelectrode techniques and the extra-stimulus method in the rabbit heart. Following surgical interruption of the anterior and posterior internodal tracts, two patterns of re-entry were observed using the middle internodaJ pathway manifesting alternatively as tachy- and brody-arrhythmias. Re-entry which was produced by critically timed extrastimulation at the septal branch of the crista terminalis (CT) caused tachycardia reciprocating between the sinus node (SN) and intercaval area. Spontaneous re-entrant impulses were also observed, particularly following the addition of cedilanid (0.04 mg/L). In addition, in association with critical prolongation of conduction in the sino-septal area, premature discharge of the dominant pacemaker fibers was observed and resulted in the appearance of bradyarrhythmias. These were commonly manifest as bigeminy and trigeminy on the surface septal electrogram. Hence concealed sinus node re-entry could manifest itself as apparent sino-atrial block or sino-atrial re-entry tachycardia.     

A Case of Recurrent Medullary Thyroid Carcinoma with Extensive Metastasis 11 Years after Partial Thyroidectomy

A case of recurrent medullary thyroid carcinoma (MTC) with extensivemetastasis in a 55-year-old female II years after partial thyroidectomyis reported. In 1969, at the age of 44, she underwent partialthyroidectomy for MTC. Subsequently, bilateral adrenal pheochrornocytomaswere found and removed. Her youngest sister also had Sipple'ssyndrome associated with adeno matous hyperplasia of the parathyroidgland. The patient was well for 10 years after these operations,but then diarrhea developed and more recently a small tumorin the left side of her neck was noted. Metastatic lesions ofrecurrent MTC were found in the cervical lymph nodes, mediastinumand liver. Her serum calcitonin and carcinoembryonic antigen(CEA) levels were significantly elevated. A recurrence of pheochromocytomawas excluded, since urinary catecholamines and their metaboliteswere all within normal limits. These observations suggest thattotal thyroidectomy should be performed even in an early stageof MTC and regular measurements of serum calcitonin and CEAmight be of great help for detection of recurrent or metastaticMTC after thyroidectomy.     

Present Status of Early Colorectal Cancer in Japan

We examined and clinicopathologically analyzed 422 patients with early colorectal cancer that we encountered, and discussed the problems typical of early colorectal cancers in Japan. In Japan we define early colorectal cancer as consisting of intramucosal cancer and cancer with submucosal invasion. Because histopathologists subjectively diagnose patients with intramucosal cancer, their diagnoses for the same specimen often differ from each other. The only way to avoid such confusion caused by diagnostic differences and to reach a consensus on the diagnosis of intramucosal cancer is to make a diagnosis of intramucosal cancer only in those patients who clearly show the structural atypia and/or the cellular atypia, that are typical of cancer. No one will deny the importance of the depressed type early cancer, the number of cases of which have recently been increasing in Japan. However, it is also important to assert that endoscopically-discovered depressed neoplastic lesions are not always cancer. In the depressed neoplastic lesions discovered in our patients, the number of adenoma was almost three times that of cancer. Forty percent of the patients with depressed type early cancer also had an adenoma component. Therefore, at this moment we cannot conclude that early cancer with a depression is de-novo-genetic colorectal cancer. Eighty percent of early colorectal cancers are discovered to be the protruded type of early cancer. Twenty-six percent of early cancers with submucosal invasion, including early cancers with massively submucosal invasion, are 6 to 10 mm in diameter and 76% of these are protruded early cancers. These facts indicate that colorectal tumors, protruded or depressed, which are more than 6 to 10 mm in diameter should be endoscopically removed to prevent them from becoming advanced cancers.