Periductal infiltrating type of intrahepatic cholangiocarcinoma: a rare macroscopic type without any apparent mass

Purpose

This study was undertaken to elucidate the clinicopathological characteristics and surgical outcome of the periductal infiltrating (PI) type of intrahepatic cholangiocarcinoma (ICC), which is a distinct macroscopic type of ICC arising from the second-order of the intrahepatic bile ducts without apparent invasion of the surrounding liver parenchyma.

Methods

All patients with the PI type of ICC were identified from a database of patients with intrahepatic cholangiocellular carcinoma that underwent surgical resection between 1983 and 2009. The clinicopathological data of these patients were analyzed retrospectively.

Results

Sixteen of 203 patients (7.9%) had the PI type of ICC. The median survival was 7.7?years with 5-year survival rate of 62.1%. The PI type of ICC showed a significantly better survival than the mass-forming (MF) type (P?=?0.0293) or MF plus PI type of ICC (P?=?0.0001). Microscopic examinations showed intrahepatic metastasis to be absent in all the patients with PI type ICC. The incidence of intrahepatic metastases in patients with PI type was significantly lower in comparison to that of patients with MF type (P?=?0.0030) and MF plus PI type (P?=?0.0533), respectively.

Conclusion

Surgery could therefore provide a favorable outcome in patients with the PI type of ICC, probably due to its lower incidence of intrahepatic metastases.     

Serum hepatocyte growth factor and cancer mortality in an apparently healthy Japanese population

Background: In patients with cancer, hepatocyte growth factor (HGF) is elevated and is a predictor of prognosis. We investigated whether serum HGF was a predictive marker for cancer death in a population of community-dwelling Japanese.Methods: We studied 1492 apparently healthy Japanese adults who underwent health examinations in 1999. Those who reported a history of liver disease or malignancy on a baseline questionnaire were excluded, and plasma HGF was measured in the remaining 1470 participants, who were followed periodically for 10 years. Multivariate proportional hazards regression was used to estimate cancer mortality.Results: A total of 169 participants died during follow-up (61 from cancer, 32 from cerebrocardiovascular disease, and 76 from other diseases). Mean HGF at baseline was significantly higher among decedents than among survivors (0.26 ± 0.11 vs 0.23 ± 0.09 ng/ml, respectively; P < 0.01). The Cox proportional hazards model showed that age, systolic blood pressure, HGF (hazard ratio, 1.27; 95% CI, 1.06-1.52; P = 0.009), albumin level, smoking status, and creatinine were independent predictors of all-cause death. Age, HGF (hazard ratio, 1.31; 95% CI, 1.04-1.65; P = 0.02), and total cholesterol were independent predictive markers for cancer death.Conclusions: Serum HGF was a predictor of cancer death in an apparently healthy population of community-dwelling Japanese.     

Clinicopathological characteristics of left ventricular myocardium with transient asynergy: report of three cases

The aim of the present retrospective study was to clarify the histopathologic substrates of left ventricular myocardium with transient asynergy due to acute ischemic insult in man. Three patients who had had prolonged chest pain, new abnormal Q waves and new ST segment elevation were studied. There was no significant elevation of serum creatine phosphokinase activity in two of the three patients. Echocardiograms on admission or the next day showed severe hypokinetic or akinetic motion and thinning of the anteroseptal and apical portions of the left ventricle and regional dilatation of the same portions. Disappearance of the abnormal Q waves, ST segment elevation resolution, and early T wave inversion were observed later. Complete improvement of the echocardiographic abnormalities was confirmed after a few weeks in all patients. Manifest ischemic lesions of subendocardial scars of the anteroseptal region of the left ventricle were detected in only one of the three cases by gross examination. However, on microscopic examination, islands of necrotic myocytes were interspersed with islands of viable cells throughout the jeopardized region in one case, although the scattered necrotic foci were restricted to the subendocardium and the trabeculae. Normal myocardium and subendocardial scars were observed in the other two cases. In conclusion, left ventricular myocardium with transient asynergy. detected clinically during acute ischemic attack, consists of normal myocardium or small ischemic lesions primarily in the subendocardium.     

Effect of the non-steroidal anti-inflammatory drug sulindac on colorectal adenomas of uncolectomized familial adenomatous polyposis

Background: The aim of the present study was to elucidate the effect of sulindac on uncolectomized familial adenomatous polyposis (FAP). Methods: Seven FAP patients (SU group) without proctocolectomy were given sulindac 300 mg/day orally for 12 months. Six FAP patients without sulindac (non‐SU group) served as controls. Colorectal lesions were assessed by protrusion index (no. radiolucent areas/cm²; PI) under barium enema examination and non‐polypoid lesion were assessed under chromoscopy prior to and at the end of the observation period. In the SU group, germline adenomatous polyposis coli (APC) mutation was determined by protein truncation test. Results: In the SU group, PI decreased significantly in the distal colon (from 3.0 ± 1.1 to 1.1 ± 0.8/cm², P < 0.02) and in the proximal colon (from 3.4 ± 2.4 to 0.9 ± 1.3/cm², P < 0.02). The PI in the non‐SU group slightly but significantly increased in the distal colon (from 1.0 ± 0.8 to 1.2 ± 0.9/cm²; P < 0.05) and it remained unchanged in the proximal colon (from 0.6 ± 0.3 to 0.7 ± 0.3/cm²; P > 0.05). Chromoscopy at the end of observation identified non‐polypoid lesions in five patients in the SU group, whereas such lesions were not found in the non‐SU group (71% vs 0%, P = 0.016). Decrease in PI was not different among distal APC mutation (exons 1–9), proximal APC mutation (exons 10–15) and negative mutation. Conclusion: Sulindac reduces colorectal adenomas of protruding type in uncolectomized FAP. The effect of sulindac may be unrelated to genotype of FAP.     

Efficient cardiomyogenic differentiation of embryonic stem cell by fibroblast growth factor 2 and bone morphogenetic protein 2.

BACKGROUND: Despite the pluripotency of embryonic stem (ES) cells, the specific control of their cardiomyogenic differentiation remains difficult. The aim of the present study was to investigate whether growth factors may efficiently enhance the in vitro cardiac differentiation of ES cells. METHODS AND RESULTS: Recombinant growth factors at various concentrations or their inhibitors were added according to various schedules during the cardiomyogenic differentiation of ES cells. Cardiomyogenic differentiation was assessed by mRNA and protein expressions of several cardiomyocyte-specific genes. Basic fibroblast growth factor-2 (FGF-2) and/or bone morphogenetic protein-2 (BMP-2) efficiently enhanced the cardiomyogenic differentiation, but only when they were added at the optimal concentration (1.0 ng/ml in FGF-2 and 0.2 ng/ml in BMP-2; relatively lower than expected in both cases) for the first 3 days. Inhibition of FGF-2 and/or BMP-2 drastically suppressed the cardiomyogenic differentiation. CONCLUSION: FGF-2 and BMP-2 play a crucial role in early cardiomyogenesis. The achievement of efficient cardiac differentiation using both growth factors may facilitate ES cell-derived cell therapy for heart diseases as well as contribute to developmental studies of the heart.     

Performance of antegrade double-balloon enteroscopy: comparison with push enteroscopy

BACKGROUND: Double-balloon enteroscopy (DBE) is a novel procedure for the diagnosis of small-bowel pathology. The aim of this retrospective study was to compare the performance and the diagnostic value of antegrade DBE with those of push enteroscopy (PE). METHODS: We reviewed endoscopic and histologic findings in 118 patients examined by PE or antegrade DBE during a period 1980 to 2004. The maximal length of insertion under plain radiograph was compared between patients examined by PE and those examined by antegrade DBE. Diagnostic yield was compared among patients stratified by indication for enteroscopy and the duodenal pathology. RESULTS: Ninety-one patients were examined by PE and 27 patients by antegrade DBE. Length of insertion from the ligament of Treitz was significantly greater in antegrade DBE (median, 92 cm; range, 40-144 cm) than in PE (median, 22 cm; range, 0-98 cm; p < 0.0001). In 90 nonbleeding patients with inflammatory or miscellaneous diseases or polyposis, the diagnostic yield was not different between PE and antegrade DBE (64% vs. 82%, p = 0.13). However, it was higher in antegrade DBE (79%) than in PE (31%, p = 0.012) in nonbleeding patients without duodenal pathology. In bleeding patients, the diagnostic yield was 40% in antegrade DBE and 36% in PE (p = 0.61). CONCLUSIONS: Antegrade DBE is superior to PE in exploration of the small intestine and in diagnostic yield for small-intestinal pathology.