A Case of Early Rectal Cancer (Mucosal Cancer) with Pulmonary Metastasis Detected by Postoperative Rise of Carcinoembryonic Antigen

Polypectomy was conducted under rectoscopic observation fora patient with a small rectal polypoid cancer (mucosal cancer)on an outpatient treatment basis. The serum carcinoembryonicantigen (CEA) level, which had been high before the polypectomy,was reduced and complete cure seemed to have been attained.However, the postoperative serum CEA level at the patient'speriodical check-up proved to be abnormally high, and a closerexamination revealed a small pulmonary metastasis. Eight monthsafter the polypectomy, the metastatic focus in the lung wasresected curatively and the serum CEA level returned to normal.It was verified by immunofluorescence that the tissues in themetastatic focus were CEA-productive. As the pulmonary metastasis, which is extremely rare in thecases of early cancers, could be detected at its early stageby the periodical check of the serum CEA level, and as the serumCEA level could be returned to normal by resection of the metastaticfocus, it was thought that the resection was curative.     

Development of hepatocellular carcinoma in a man with auto-immune chronic active hepatitis

A 57 year old man with auto-immune chronic active hepatitis, regularly treated with immunosuppressive therapy, had hepatocellular carcinoma (HCC) 10 years after diagnosis of the hepatitis. Assays of the hepatitis C virus antibodies against capsid and non-structural proteins revealed seronegativity in serial serum samples of this patient stored in the previous 10 years during follow up. The seronegative hepatitis C antibodies excluded hepatitis C virus as the cause of the HCC. The occurrence of HCC in this case suggests the necessity of surveillance for early detection of liver cancer in patients with auto-immune chronic active hepatitis undergoing long-term immunosuppressive therapy.     

Circular dichroic and 1 H-NMR studies on the aged form of bovine plasma albumin

Bovine plasma albumin (BPA) has 17 disulfide bonds and approximately one SH group at Cys-34 which catalyzes the intramolecular SH, S-S exchange reaction in the alkaline region at low ionic strength, resulting in the formation of the aged form (A-form). 1) Fractions of α-helix (f_α) and β-form (f_β) of iodoacetamide-blocked non-aged BPA (IA-BPA) at pH 6.5 (the N-form) and 9.0 (the B-form) in the absence of added salt were 0.70, 0.12 and 0.62, 0.18, respectively (Era et al. (1990)). However, there were no changes in f_α and f_β of the iodoacetamide-blocked A-form (IA-A-form) over the pH range from 5.5 to 9.1 in the absence of added salt or in 0.10 m KCl(f_α～ 0.60, f_β～ 0.20), indicating that the secondary structure of the IA-A-form might be similar to that of non-aged IA-BPA at pH 9.0 (B-form) in the absence of added salt, that is, the frozen B-form, stabilized covalently by the repairing of disulfide bonds. 2) The rigidity of the A- and IA-A-forms, as monitored by cross-relaxation times between irradiated and observed protein protons, was similar to or slightly higher than that of non-aged IA-BPA or BMA. However, spin-echo ¹H-NMR spectra indicated that side chains of the IA-A-form, such as ?-CH₂ of Lys, -CH₃, in the absence of added salt are more mobile than those of non-aged IA-BPA. 3) The ratio of the hydrodynamic volume of the A-form to that of non-aged BPA at pH5.5 was approximately 1.1.     

The Differential Diagnosis of Malignant Lymphoma and Reactive Lymphoreticular Hyperplasia of the Stomach Using Endoscopic Ultrasonography

Abstract: It is difficult to differentiate between reactive lymphoreticular hyperplasia (RLH) and malignant lymphoma (ML) even with an endoscopic biopsy. We performed endoscopic ultrasonography (EUS) examination on 25 cases histologically diagnosed as being RLH or ML. We classified their EUS findings into three types; protruding, wall-thickening and superficial types, and examined their ultrasonographic findings. Of the four cases classified as being the protruding type (ML 3, RLH 1), disruption of the third layer was seen in the cases of ML, while it was preserved in the case of RLH. All nine cases of the wall-thickening type were ML. Twelve cases were classified as being the superficial type (ML 6, RLH 6). Of the five cases of this type without ulcerative changes, thickening of the second layer of the low echoic homogeneous pattern (“Loss of original mucosal structure: OMS”) was seen in all two cases of ML, while the second layer was dotted with low echoic granular particles and looked grossly heterogeneous (“Granular pattern”) in all three cases of RLH. In the other seven cases the lesion looked like an advanced tumor due to ulcerative changes. From observations of the surrounding nonulcerative area, “Loss of OMS” was seen in three of four cases of ML, while a “Granular pattern” was seen in all three cases of RLH. Six of seven cases with only the “Granular pattern” were RLH, and all 16 cases with only the “Tumorous pattern” were ML. Of the two cases with the “Combined pattern” which had the “Tumorous pattern” in the central area and “Granular pattern” in the peripheral area, one was ML and the other was RLH. EUS is thought to be a useful diagnostic technique which provides us with important information to differentiate between ML and RLH.     

Resolution of human mercapt- and nonmercaptalbumin by high-performance liquid chromatography

Gel-exclusion high-performance liquid chromatographic (HPLC) analysis of human serum albumin (HSA) on PGP 2000 column (0.10 M sodium phosphate buffer, 0.30 M NaCl, pH 6.86) showed at least two peaks, the principal component corresponding to human mercaptalbumin (HMA) and the second one to human nonmercaptalbumin (HNA). Mechanism for the separation of HMA and HNA might be due to weak resin-HSA interaction. HPLC analysis of bovine plasma albumin (BPA) showed a single peak on PGP 2000 column. The elution volume of HSA was larger than that of BPA, resulting in a clear resolution of HSA and BPA.     

Radiation-Induced Colo-rectal Carcinoma -- A Report of Seven Cases --

Seven cases of colo-rectal carcinoma which were considered tohave developed secondarily to radiation injuries are reported.The incidence in our series was 0.8% (seven out of 880 primarycolo-rectal carcinomas). Initial diseases, the targets of radiotherapy,were five carcinomas of the uterine cervix, one of the cecum,and one of the vulva. The latent period, the interval between the initiation of irradiationand the detection of colo-rectal carcinoma, varied from 16 to21 years with an average of 18 years. Late radiation injuries were confirmed histologically in thesegments of the resected bowel involved in all cases. Postoperativecomplications were highly related to the radiation injuriesof the urinary bladder, macrohematuria in two and vesical fistulain three. Among the seven patients, four died within five years and threemonths, two of postoperative complications and two of recurrenceof the disease; the other three are alive and well without evidenceof disease, for three years and seven months, three years andthree months, and 11 months, respectively.     

Investigation of melena and hematochezia as the chief complaint of gastrointestinal bleeding in pediatric surgical patients

The causes of melena or hematochezia in 48 pediatric patients were examined. Malrotation with volvulus was an important cause of hemorrhage during the newborn period, and intussusception was very typical in patients aged from 1 month to 1 year. Polyps of the rectum and colon were the most common causes of melena or hematochezia in patients older than 1 year. No cause of melena or hematochezia could be identified in 11 children. Ten patients have remained in good health with no further episodes of melena or hematochezia. Localized multiple polyps of the rectum with focal carcinoma were detected in only one patient. In general, although no further investigation is required after detection of the cause of bleeding and its successful treatment, it should be kept in mind that gastrointestinal malignancy can occur in children.     

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.     

Six Cases of Carcinosarcoma of the Esophagus

Clinical aspects of six cases of esophageal carcinosarcoma werereported. They were all male in their sixties. Although almostall cases of carcinosarcoma of the esophagus reported in theliteratures had polypoid lesions, two of our cases showed ulcerativeappearance and were not considered to be carcinosarcoma by macroscopicobservations. Recently, preoperative irradiation has been adoptedfor the treatment of esophageal carcinoma in many hospitalsand it may be possible that some of sarcomatous component hasdisappeared at the time of operation. Therefore, more casesof esophageal carcinosarcoma could be present among those whohad been diagnosed as esophageal carcinoma.     

Immunological responses against an autologous human hepatocellular carcinoma cell line

We performed a detailed analysis of immune responses in a hepatocellular carcinoma (HCC) cell line and effector cells obtained from a patient with HCC. We examined the cytotoxic activity of natural killer (NK) cells, lymphokine-activated killer (LAK) cells and cytotoxic T lymphocytes (CTL) against an autologous tumour cell line (SUHC-1) to investigate the immune mechanism of human lymphocytes against HCC cells. Cytotoxic T lymphocytes were induced by co-culturing of peripheral blood lymphocytes (PBL) and SUHC-1 cells, mixed lymphocyte and tumour cell culture (MLTC). The susceptibility of SUHC-1 to NK and LAK cells was similar to that of other allogeneic cell lines, such as K562, PLC/PRF/5 and Mahlavu. Effector cells induced in the primary MLTC had high cytotoxic acitivity but were not specific for SUHC-1. Cytotoxic T lymphocytes with specific activity against SUHC-1 were induced after PBL were stimulated five times at 7–10 day intervals with SUHC-1 and low-dose recombinant interleukin-2 (rIL-2), suggesting that as the culture progressed, broadly reactive effector cells disappeared and specific effector cells survived. The specific effector cells were identified as CD3⁺/CD4⁺ and CD⁺/CD8⁺ T-lymphocyte subsets. The recognition mechanisms of CD3⁺/CD4⁺ CTL remain unresolved because the cytotoxicities were not inhibited by anti-CD4 and anti-major histocompatibility complex (MHC) class II monoclonal antibodies (MoAb). Treatment of cells with anti-CD3, anti-CD8 and anti-MHC class I MoAb partially inhibited lysis. These results demonstrated that the T-cell receptor (TCR)/CD3 complex appeared to be involved in SUHC-1 specific antigen recognition and antigen recognition of CD3⁺/CD8⁺ CTL was MHC class I restricted.