Metastasis of adenoid cystic carcinoma of the mandible to the Gasserian ganglion.

A case of adenoid cystic carcinoma of the mandible in a 47-year-old woman metastasized to the Gasserian ganglion probably through the perineural space of the inferior alveolar nerve. The patient was treated by irradiation after excision of the tumor from the ganglion. She is currently an outpatient in the oral and maxillofacial surgery department; two years and seven months after the first examination, there is no sign of recurrence or metastasis of adenoid cystic carcinoma.     

Randomized controlled study of gemcitabine plus S-1 combination chemotherapy versus gemcitabine for unresectable pancreatic cancer

Purpose

The aim of this study was to evaluate efficacy and safety of gemcitabine plus S-1 (GS) combination chemotherapy in patients with unresectable pancreatic cancer.

Methods

Patients were randomly assigned to receive GS (oral S-1 60 mg/m² daily on days 1–15 every 3 weeks and gemcitabine 1,000 mg/m² on days 8 and 15) or gemcitabine (1,000 mg/m² on days 1, 8, and 15 every 4 weeks). The primary endpoint was progression-free survival (PFS).

Results

One hundred and one patients were randomly assigned. PFS was significantly longer in the GS arm with an estimated hazard ratio (HR) of 0.65 (95 % CI 0.43–0.98; P = 0.039; median 5.3 vs 3.8 months). Objective response rate (ORR) was also better in the GS arm (21.6 vs 6 %, P = 0.048). Median survival was 8.6 months for GS and 8.6 months for GEM (HR 0.93; 95 % CI 0.61–1.41; P = 0.714). Grade 3–4 neutropenia (44 vs 19.6 %, P = 0.011) and thrombocytopenia (26 vs 8.7 %, P = 0.051) were more frequent in the GS arm.

Conclusions

GS therapy improved PFS and ORR with acceptable toxicity profile in patients with unresectable pancreatic cancer.     

Mediastinal lipoma: Report of a case

We experienced a case of mediastinal lipoma, which is considered to be a relatively rare disease. A 3-year-old girl was referred to Gifu University hospital because of fever and an abnormal shadow on her chest X-ray. The chest X-ray clearly showed a well-delineated tumor shadow which seemed to oppress the diaphragm and the right atrium in the right lower lung area. A computed tomogram (CT) of the chest showed a homogeneous mass localized on the right diaphragm and adjoining the right anterior chest wall and heart. The mass showed a fat density measuring about-100 HU. Magnetic resonance imaging (MRI) showed a high-intensity mass which was almost the same level as the subcutaneous fat on both the T₁-weighted and T₂-weighted images. Thoracotomy was performed and a fatty tumor was found. It arose from the right side of the pericardium and adjoined the diaphragm, the anterior chest wall, and the thymus. There was no adhesion between the tumor and the surrounding organs. It was resected easily and its contents were yellowish and homogeneous. The patient made an uneventful recovery and was discharged 10 days after the operation. Light microscopy showed a lipoma consisting of mature adipose tissue and no malignancy was found.     

HEPATIC METASTASIS 17 YEARS FOLLOWING RESECTION OF LOW-GRADE LEIOMYOSARCOMA OF THE RECTUM

A case of histologically low-grade leiomyosarcoma of the rectum showing an unusually late appearance of hepatic metastasis is reported. This was found at autopsy 17 years after a curative resection of the primary rectal tumor that had been diagnosed initially as a leiomyoma.     

Specific expression of tenascin in human colonic neoplasms.

Tenascin, a novel six-armed extracellular matrix glycoprotein, was immunohistochemically examined in the human normal adult colon, and colonic neoplasms such as tubular adenomas, primary and metastatic adenocarcinomas. In contrast to previous reports, tenascin was hardly detectable in the normal adult colons, being predominantly localised in the fibrous stroma surrounding the glandular epithelia of the neoplastic lesions. The neoplastic cells themselves were totally negative for tenascin expression. Both the tubular adenoma tissues and the superficial layer of well-differentiated adenocarcinomas in general were intensely reactive to tenascin antibody, and the staining intensity increased as the adenoma became more atypical in cases of tubular adenomas. By pretreatment of the paraffin-embedded tissue sections with pepsin, the distribution of tenascin was often intensified considerably and distinct localisation was more clearly demonstrated in the colonic tumour tissues. Tenascin was also biochemically purified from human invasive colonic carcinomas, and this cancerous tissue tenascin was compared with that extracted from a human umbilical cord fibroblast cell line in terms of molecular heterogeneity. Two major isoforms of the purified tenascin from colonic cancer tissues were found to have relative molecular masses of 250 kD and 190 kD, which were almost identical to those of human foetal fibroblast tenascin glycoproteins. In addition, several lower molecular weight isoforms were frequently detectable in the cancerous tissues, which might represent immuno-reactive tenascin isoforms proteolytically digested in human colonic carcinomas in vivo.     

Fibrinolytic activity in cystic lesions of jaw bones.

The fibrinolytic activity in the tissues of cystic lesions of jaw bones was investigated by the semiquantitative method of Astrup. The specimens examined were ameloblastoma (9 cases), follicular cyst (8 cases) and radicular cyst (14 cases). High fibrinolytic activity was observed in ameloblastoma, while in radicular cyst the activity was variable. It is suggested that in radicular cyst inflammatory episodes play an important role in activating local fibrinolysis, while in ameloblastoma the tissue itself has a great capacity to induce locally activated plasmin.     

A case of lupus erythematosus profundus followed by systemic lupus erythematosus presenting with severe intestinal involvement]

A 52-year-old female visited the outpatient department of Sapporo Medical University hospital in 1984 due to a refractory rash on the skin of the trunk. Histological findings of a skin biopsy specimen indicated a diagnosis of lupus erythematosus profundus (LEP). The eruption remained quiescent with moderate doses of prednisolone. In October 2003, she was suddenly admitted to our hospital with abdominal pain, fever and bloody stool. Lupus enteritis was diagnosed based on an elevated level of anti-DNA antibody, low complementemia and diffuse edematous change of the intestinal walls on CT scans. Although high doses of corticosteroids resulted in transient improvement, melena developed again on the 24th hospital day. Colonoscopy revealed deep ulceration at the rectum and a gastrografin enema indicated perforation. Accordingly, the involved rectum was resected and an artificial anus was constructed on the 50th hospital day. Examination of the resected specimen by microscopy showed that the ulceration approached at the depth of the subserosal layer with intense infiltration of inflammatory cells around the vessels. The pathogenesis of the rectal lesion might have been due to vasculitis associated with systemic lupus erythematosus (SLE). The disease did not recur under the administration of 10 mg of prednisolone daily until November 2004. Colonic function made a remarkably untroubled recovery after the artificial anus was closed in February 2005. The LEP was generally accompanied by a mild form of SLE. This case seemed to be rare in that SLE was associated with severe lupus enteritis and a refractory rectal ulcer developed from LEP. Patients with SLE and intestinal involvement should be carefully monitored in cooperation with a surgeon.