Early sigmoid colon carcinoma developed from a pedunculated polyp

A 60‐year‐old man underwent routine colonoscopy, and was noted to have a pedunculated polyp in the sigmoid colon. The pathologic diagnosis was adenoma, and due to patient’s personal circumstances, the lesion was left untreated. The colonoscopic examination was repeated 4 years and 11 months later, to find that the polyp had transformed into an elevated lesion with irregularly depressed surface. The patient was diagnosed as having early sigmoid cancer, and underwent sigmoidectomy. The histologic examination of the excised specimen revealed well‐differentiated adenocarcinoma with invasion into the submucosal layer. Through studying the natural course of colon cancer, it has become known that the advanced cancers commonly develop from polyps with short pedicles (sessile polyps). This case represents an early sigmoid cancer developed from a pedunculated polyp, which differs from the current mainstream concept of ‘polyp‐cancer sequence of colon cancer.’     

Gastrin-Enhanced Tumor Growth of a Xenotransplantable Human Gastric Carcinoma in Nude Mice

A human tumor line serially transplantable in nude mice, originatingfrom a well-differentiated papillo-tubular adenocarcinoma ofthe stomach, was established. The growth of this tumor was enhancedby daily injection of C-terminal tetrapeptide gastrin into themice. Although there was little difference in histology, thegastrin-stimulated tumor had larger glandular spaces filledwith mucin-like substance than the control tumor. ³H-thymidine uptake of the gastrin stimulated tumor was higherthan that of control, as shown by microradiography and countingof radioactivity in tissue homogenates. The plasma membrane fraction of the tumor revealed positivebinding for gastrin and the cytosol fraction contained cyclicAMP dependent- and independent protein kinases. Incubation oftumor slices with gastrin caused a conformational change inthe enzymes. Therefore we conclude that this G4 tumor line xenotransplantablein nude mice is sensitive to gastrin in its trophic and secretorymechanisms.     

Usefulness of the [13C]-urea breath test for detection of Helicobacter pylori infection in fasting patients

Most of the reported [¹³C]-urea breath test procedures use a test meal, which is believed to assist in the spread of the [¹³C]-urea solution into the entire stomach, as results without a test meal may mainly reflect urease activity in the antrum. Yet, procedures for the [¹³C]-urea breath test and interpretation of the obtained ¹³C excess value have not been well established. We carried out the present study to validate the usefulness of the [¹³C]-urea breath test in fasting subjects and to establish cut-off values. [¹³C]-Urea breath tests were performed on 258 Helicobacter pylori-positive and 151 -negative subjects (247 H. pylori positive and 26 negative prior to any H. pylori cure treatment and 125 H. pylori negative and 11 positive after undergoing H. pylori cure treatment). The breath test procedure was performed under the following conditions: an 8 h fast, mouth washing before and after dosing, administration of 100 mg [¹³C]-urea, collection of breath sample in a plastic bag, a baseline and a 20 min sampling point and subject in a sitting position. Delta-¹³C at the 20 min sampling point in H. pylori-positive and -negative subjects was 31.0 ± 1.25 and 1.6 ± 0.11%o, respectively. Although the mean Δ¹³C value was greatest in duodenal ulcer or ulcer scar patients, there were no significant differences among mean Δ¹³C values in the various diseases. From Receiver Operator Characteristic curves and calculation of accuracy of the test, a cut-off value of 5.0%o is considered to be appropriate for diagnosis of H. pylori infection, which provides 96.7% specificity and 96.5% sensitivity, suggesting that the [¹³C]-urea breath test in the fasting state is as effective in detecting the presence of H. pylori as other reported methods.     

Diagnosis of gastric adenoma versus early gastric cancer by Bromodeoxyuridine immunohistochemistry from gastric biopsy specimen

Differentiation between gastric adenomas and type IIa early gastric cancer by macroscopic and histologic examinations is often difficult. This study has shown that there are differences in the distribution of S-phase cells in these two types of tumour, and these differences can be exploited to differentiate between them. The distribution of S-phase cells was assessed by Bromodeoxyuridine (BrdU) immunohistochemistry using an in vitro BrdU-labelling method. Biopsy specimens were obtained from 27 lesions (12 adenomas and 15 type IIa early gastric cancers), and the distributions of BrdU-labelled cells in the tumour thickness as well as in the superficial layer of the tumour were determined. Significant difference was seen in the labelling of the two tumour types with regard to both these parameters. Using the criteria of BrdU immunohistochemisty, the accuracy of differentiation between gastric adenomas and cancers was 88.9%. Therefore, it is concluded in this study that in vitro BrdU labelling is a useful method of diagnosing gastric adenomas and cancers.     

Factors Influencing Transfused Platelet Recovery and Survival, With Special Reference to Antiplatelet Antibody

Factors influencing platelet increment, recovery and survivalwere analyzed in 103 transfusions given to 33 thrombocytopenicpatients, with special reference to the antiplatelet antibodywhich was examined by the mixed passive hemoagglutination methodrecently developed by Shibata et al., (1976). The results demonstratedthat platelet increment, recovery and survival were significantlyreduced in the patients with post-transfusion fever or antiplateletantibody. Platelet recovery seemed to decrease with the increasein the number of HLA mismatched antigens, but the changes inpercent recovery among every HLA mismatched grades were notstatistically significant. The presence of the antiplateletantibody rather than the lymphocytotoxic antibody, HLA mismatchedgrades or post-transfusion fever established the presence ofthe poorer platelet recovery and survival and the more refractorystate. Post-transfusion fever was significantly associated withthe presence of antibodies against platelets and/or lymphocytes.Hemorrhage was arrested after transfusion in 81.1% out of the33 patients that had clinical hemorrhage prior to transfusion,but not in six cases (18.2%), all which had poor platelet recoveryand post-transfusion fever. The detection of antiplatelet antibodyand platelet cross-match test using the mixed passive hemoagglutinationmethod was of primary importance for selecting the adequatedonor for platelet transfusion. Platelet typing must be donein the near future.     

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.     

Interferon therapy for patients more than 60 years of age with chronic hepatitis C

Abstract Nineteen patients aged > 60 years with chronic hepatitis C (CHC) received interferon (IFN) therapy and a complete response (CR) was achieved by five of them (26%). The incidence of CH with severe fibrosis in this elderly group was significantly higher than in another 52 patients with CHC who were < 60 years of age (the younger group; P < 0.05). There was no significant difference in the hepatitis C virus (HCV) genotype distribution between the elderly group and the younger group. However, the HCV-RNA titre was significantly higher in the elderly group than in the younger group ( P < 0.05). There was no significant difference in the efficacy rate of IFN in the elderly and younger groups after standardization of the background factors. In the elderly group, the HCV-RNA titre was significantly lower in the patients achieving CR than in those with no response ( P < 0.05). These data suggest that elderly patients with a low HCV-RNA titre can still respond well to IFN therapy.     

A Case of Pancreatic Cancer With Liver Metastasis Which Responded to Chemotherapy

A case of pancreatic cancer with liver metastasis is reported,in which chemotherapy had a marked effect, with the responsesclearly documented. The patient was a 59-year-old male who experienced epigastricpain in February 1985, upper gastrointestinal X-ray examinationrevealing extragastric compression by the pancreas. He visitedthe National Cancer Center Hospital, Tokyo, in April 1985 andthe diagnosis of pancreatic cancer with liver metastasis wasmade using the imaging procedures of ultrasonography, computedtomograph scanning and endoscopic retrograde cholangiopancreatographyas well as by biochemical and serological tests. At the timea 5 cm tumor was palpable in the middle upper abdomen. The patient was treated with Cis-diaminedichloro platinum, tegafur,and 5-fluorouracil, successively, and the abdominal tumor graduallydiminished, finally becoming impalpable. The response was evaluatedas one of partial responses (PR) by ultrasonography, and theimprovement substantiated by computed tomography and tumor markers.