Primary Neoplasm in a Vesical Diverticulum: Analysis by Step-Sectioning

A primary neoplasm arising in a vesical diverticulum was cystectomizedand analyzed by step-sectioning of the whole bladder in an attemptto determine the carcinogenic process. Serial sections of thecystectomy specimen revealed a small area of mild dysplasiain the mucosa of the bladder and the diverticulum without atumor. Most of the mucosal cells in the tumor-bearing diverticulumwere desquamated, but a small area of dysplasia in the remainingcells was also observed.     

A Case of Hepatocellular Carcinoma Developed on Polycystic Disease of the Liver with Cirrhosis

A case of hepatocellular carcinoma associated with polycysticdisease of the liver and posthepatitic cirrhosis in a 56-year-oldKorean woman was described. She was first admitted because ofepigastralgia, irradiated back pain and general fatigue. Onthe liver scan a relative cold area was demonstrated. The celiacangiography revealed multiple avascular areas indicating cysticlesions. The exploratory laparotomy confirmed the presence ofpolycystic disease of the liver with cirrhosis. Four years afterthe first admission, she underwent an appendectomy. At the timeof operation, the surgeon suspected the presence of hepatocellularcarcinoma, and she was admitted for the second time to our hospital.The minimal elevation of serum -fetoprotein was observed. Thedevelopment of hepatocellular carcinoma was confirmed by theceliac angio graphy, and a partial lobectomy of the liver wasperformed. Four months after the operation she died of hepaticfailure. Of the four reported cases of hepatocellular carcinoma associatedwith polycystic disease of the liver including this case, allhad liver cirrhosis, and serum HBs-Ag was positive in all ofthe three cases examined.     

Morphometry of Bladder Cancer Cells in Tissue Sections According to Histological Grade of Malignancy

Morphometrical analysis was performed on cells of bladder carcinomastaken from patients who had undergone surgery at the NationalCancer Center Hospital. Ten cases each of the following groupswere compared as to the nuclear area, standard deviation ofnuclear areas, cytoplasmic area, and nuclear/cytoplasmic ratio:normal mucosa and grade I transitional cell carcinoma obtainedby transurethral resection (TUR), and normal mucosa, grade II,III and in situ transitional cell carcinomas obtained by totalcystectomy. There were significant differences in both nuclear area andnuclear/cytoplasmic ratio between normal epithelium obtainedby TUR and grade I carcinoma. There were also significant differencesin nuclear area and nuclear/cytoplasmic ratio among the fourtotal cystectomy groups. In this cytomorphometrical analysis, cells of carcinoma in situhad the characteristics of grade II or grade III carcinoma cells.The morphometrical features of the two advanced cases of gradeII carcinoma revealed that the nuclear area, the standard deviationof the nuclear area and the cytoplasmic area were rather small,whereas the nuclear/cytoplasmic ratio was almost average forthe grade II group. The results of this analysis, especially those for the nuclear/cytoplasmicratio, corresponded well with the histological grading of bladdercarcinoma.     

Diagnosis of Small Carcinoma of the Pancreas: Importance of Ultrasound Scanning and Endoscopic Retrograde Cholangiopancreatography (ERCP)

Diagnostic aspects of 23 patients with carcinoma of the pancreaswere analyzed and four cases of small cancer (less than 2 cm)were presented. These tumors were resected between January 1975and Dcember 1982 in the National Cancer Center Hospital, Tokyo. Initial signs and symptoms were generally vague and none ofthem were specific for pancreatic cancer. The most importantclues to the detection of the tumor were jaundice in the casesof pancreas head cancer, and extragastric compression demonstratedby x-ray examination in cases of cancer of the pancreas bodyand tail. In those cases without jaundice, elevated levels ofamylase and glucose in the serum and urine were important findings.In regard to imaging diagnosis, endoscopic retrograde cholangiopancreatographyand ultra-sonography were the most helpful means of diagnosisof small pancreatic carcinoma.     

A Case of Hepatoblastoma in Adult

A rare case of hepatoblastoma in a 60-year-old man is reported.The first sign of his illness was metastasis found as a tumoron the left fifth rib. There were no laboratory or angiographicfindings that might differentiate hepatoblastoma from hepatocellularcarcinoma. In this case, the diagnosis was made by histologicalexamination at autopsy, which revealed mesenchymal tumor tissuesin addition to the epithelial ones. The incidence of hepatoblastomain people over 15 years old is 0.056% of that of hepatocellularcarcinoma in Japan.     

Distribution of Alpha-Fetoprotein and Immunoreactive Carcinoembryonic Antigen in Human Hepatocellular Carcinoma and Hepatoblastoma

The distribution of alpha-tetoprotein (AFP) and immunoreactivecarcinoembryonic antigen (CEA) in 62 hepatocellular carcinomas(HCC) and five hepatoblastomas (HBL) all surgically removedwas studied by an immuno-histochemical method, and the resultswere compared with the levels of the antigens in the patients'serum. AFP was present as coarse granules in the cytoplasm of immaturetumor cells. AFP-positive tumor cells were detected in 34/43cases (79.1%) with serum AFP levels higher than 400 ng/ml andin 1/24 (4.2%) of the remaining cases. They were present in8/32 (25%) cases of relatively well-differentiated HCC (Edmondson'sgrade I or II), 22/32 (68.8%) of relatively poorly differentiatedHCC (Edmondson's grade III or IV), and 5/5 of HBL. An antigen immunoreactive with a conventional rabbit anti-CEAim-munoglobulin (DAKO) but not with a murine monoclonal anti-CEAantibody (Hybritech) was present on the surface of bile canaliculiof both non-neo-plastic and neoplastic hepatocytes. This CEAcross-reactive differentiation antigen was more often foundin relatively well-differentiated tumors, and the presence ofthis antigen in tumors did not correlate with patients' serumCEA levels. In conclusion, CEA of an oncofetal nature was notproduced by either HCC or HBL.     

Lymph Node Dissection in Radical Resection for Carcinoma of the Head of the Pancreas and Periampullary Region

Resected specimens from 41 cases of carcinoma of the head ofthe pancreas or the periampullary region and autopsy specimensfrom 16 patients with recurrence were examined for lymph nodemetastasis. Evidence demonstrating the need for dissection andremoval of specific lymph node groups in pancreatoduodenectomyor total pancreatectomy was discussed. These include the commonhepatic and celiac groups, the superior mesenteric group, thejejunal group located in the mesentery of the proximal portionof the jejunum, and the retropancreatic group located behindthe uncinate process. Metastasis to these groups was found evenin cases where the carcinoma was considered small. In carcinomaof the head of the pancreas, metastasis to the peripancreaticlymph nodes was seen more widely. Therefore, total pancreatectomywith lymph node dissection is desirable for this disease.     

Ultrasonographic Diagnosis of Malignant Hepatic Tumors

Forty-two patients with liver malignancies were examined withthe U.I. Octoson ultrasonographic scanner. The cases were dividedinto four groups according to the ultrasonographic patterns.About 71% (5/7) of the metastatic tumors of colonic cancer and91% (10/11) of those of gastric cancer were of the homogeneoushyperechoic pattern (Group A), while all cases of hepato-cellularcarcinoma were of the hypoechoic pattern with nodular echogenicity(Group B) or hypoechoic pattern with granular and reticularechogenicity (Group C). These results indicate that ultrasonography is useful methodfor differentiating hepatocellular carcinoma from metastatictumors to the liver, especially those of adenocarcinomas ofthe stomach and colon.     

Dysplasia of the Uterine Cervix

In order to evaluate the significance of dysplasia lesions ofthe uterine cervix, 6,587 cervical biopsies in the five yearsfrom 1974 to 1978 were reviewed. The average age at the timeof diagnosis was: dysplasia, 44.4 years; carcinoma in situ,48.7 years; microinvasive carcinoma, 50.9 years; invasive carcinoma,56.6 years. This group consisted of 653 cases of dysplasia,194 of carcinoma in situ, 75 of microinvasive carcinoma, and536 of invasive carcinoma. On the basis of follow-up studiesof 166 dysplasia patients, the lesions of nine (5.4%) of thesepatients progressed to in situ carcinoma. These nine patientswere kept under observation for periods varying between 12 and41 months. These findings, in addition to the similar distributionof dysplasia and carcinoma in situ on the cervix, suggest thatdysplasia is a stepping stone to carcinoma.     

Two Cases of Bladder Carcinoma with Similar Initial Features That Exhibited Completely Different Clinical Courses

Two cases of bladder carcinoma are described. The patients wereof similar age, were both smokers and were treated for the sameperiod, but exhibited completely different later clinical courses.Initially, both had a single, papillary, pedunculate tumor,identified as a transitional cell carcinoma, grade 2. pTa. Onepatient, six years later, had multiple papillary tumors coveringalmost all the mucosal surface and underwent simple cystectomy.Histologically the tumors were identified as transitional cellcarcinomas, grade 2, pT1. The other patient, nine years later,had a single nodular invasive tumor with a concomitant, verytiny papillary tumor and underwent radical cystectomy. Histologicallythe tumor was transitional cell carcinoma, grade 2>3, pT4.Many of the questions raised by these cases are unanswered,but comparison of such cases should provide sonic cities tothe natural history of bladder carcinoma.