A phase II study of vindesine in the treatment of esophageal carcinoma. Japanese Esophageal Oncology Group

A phase II study of Vindesine for esophageal carcinoma was carried out cooperatively by 10 Japanese institutions. Fifty patients were enrolled in the study over a year and ten months. Four patients could not be evaluated because less than 4 weeks had elapsed since their preceding therapy. There were one complete remission and five partial remissions among the 46 remaining patients, a response rate of 13.0%. The patient experiencing the complete remission is still alive more than 24 months after treatment. The main side effects were depilation, anorexia, stomatitis and leukopenia. Thrombocytopenia and elevations of blood urea nitrogen and creatinine were not marked. There was no mortality connected with the administration of Vindesine. It was concluded that Vindesine is useful in the treatment of esophageal carcinoma as a single agent.

An unusual case of bronchial carcinoid predominantly consisting of large cells

A 58-year-old woman presented an unusual variant of bronchial carcinoid. A tumor measuring 20 x 25 mm was recognized upon gross examination in the upper lobe of the right lung. Microscopically, the tumor consisted of large polyhedral cells with a pseudoglandular arrangement similar to pheochromocytoma cells. Immunohistochemically, the tumor cells contained serotonin, S-100 protein and neuron-specific enolase. Thus, we consider this neoplasm to be a large cell variant of bronchial carcinoid which, to our knowledge, has not been described in the literature.

[Clinical usefulness of bleomycin combined with preoperative irradiation in cancer of the esophagus]

The clinical usefulness of bleomycin combined with irradiation was evaluated using 154 preoperatively treated cases with cancer of the esophagus. With the appearance rate Ef-3 (highly effective: no viable tumor cell in the esophageal specimen resected after preoperative treatment) the radiation effect was observed, in comparison with those three groups (30 Gy alone, 40 Gy alone and 30 Gy + 67.5 mg of bleomycin). Dose modifying actor (DMF) of bleomycin for the preoperatively irradiated esophageal cancer was 1.2-1.3. As a serious interstitial pneumonitis was sometimes caused by the administration of bleomycin, it was concluded that the usage of bleomycin combined with preoperative irradiation for cancer of the esophagus, is less useful than that for cancer of the uterine cervix and the head and neck region.

[Postoperative therapy of recurrent esophageal squamous cell carcinoma]

Some 218 resected cases and 43 autopsied cases after resection during the last 13 years were analyzed with regard to the mode of recurrence and survival. Several factors were investigated with the following results. 1) Extensive clearance of upper mediastinal lymph nodes during radical surgery may reduce the incidence of tumor recurrence. It is preferable to remove the cervical lymph node, however, after positive metastasis to cervical lymph node. 2) Beginning in 1981, interstitial brachytherapy of 192Ir seed assemblies using afterloading techniques was administered to two patients with esophageal carcinoma infiltrating the aorta and four patients infiltrating the trachea and main bronchus which were not completely resected in either case due to invasion of adjacent organs. No significant difference in life-prolongation was observed, but it may have been effective for prevention of localized recurrence in cases with aortic infiltration and with infiltration of the trachea and bronchus. 3) From 1984, eleven patients with recurrent squamous cell esophageal carcinoma were treated with combination chemotherapy sandwiched with irradiation (CDDP/5FU-RT-CDDP/5FU). Eight patients (73%) had complete or partial response, and six patients survived over one year after combination chemotherapy sandwiched with irradiation. Combination chemotherapy sandwiched with irradiation appears to be effective in the treatment of patients with recurrent squamous cell carcinoma of the esophagus. Toxic effects are moderate and manageable.

Preoperative radioactive therapy for esophageal carcinoma. Randomized evaluation trial in eight institutions

A cooperative, prospective, randomized study to evaluate the effectiveness of preoperative irradiation in curatively resected esophageal carcinoma was performed in 364 cases in eight institutions from August 1982 to November, 1983. Based on the survival curves, postoperative irradiation alone was superior to preoperative plus postoperative irradiation. Because of the progression of the disease and complications after operation, there were many inevaluable cases in this study. However, analysis revealed there was no bias caused by a greater number of unfavorable patients being selectively included in inevaluable cases in the postoperative irradiation only group. Our data question the value of preoperative irradiation being performed in addition to resection plus postoperative irradiation.

[A case of a male gastric choriocarcinoma with massive mesenteric tumor and review of the literature on male choriocarcinoma]

A 32-year-old man was admitted to our hospital, complaining of an abdominal mass. An operation disclosed a large tumor, the size of a child's head, in the mesenterium of the transverse colon, with a multiple liver metastasis. A tumor resection was performed and, histologically, the tumor was diagnosed as being a choriocarcinoma. Gynecomastia was not observed. The patient died 2 months after this operation in spite of chemotherapy. An autopsy disclosed metastatic choriocarcinomas in the lungs, the liver, the peritoneum, the stomach, the adrenal glands and in the lymph nodes. The testis was found to be normal by a serial histological examination. Primary advanced adenocarcinoma, which is histologically similar to a choriocarcinoma, was found in the stomach. This case was finally diagnosed as being a gastric adenocarcinoma which showed choriocarcinomatous differentiation at various metastatic sites.

Intramural giant gallstone: report of a rare case

We report a case of intramural giant gallstone. Cholangiography revealed narrowing of the neck of the gallbladder due to a hemispherical prominence. At cholecystectomy, a giant gallstone 2.1 cm in diameter which was located in the submucosa of a hemispherical prominence at the neck of the gallbladder, was found. Although the usual sizes of intramural gallstones mentioned in previous reports have ranged from 2 to 5 mm in diameter, the stone found in our case is, as far as we know, the largest intramural gallstone yet reported.

Hemorrhagic necrosis of pheochromocytoma associated with reversible renal artery stenosis

An unusual case of pheochromocytoma associated with renal artery stenosis is described. Despite the removal of bilateral adrenal pheochromocytoma, laboratory findings suggested the presence of residual pheochromocytoma and abdominal aortography revealed more pronounced stenosis of the right renal artery. Two months later, the undetected residual pheochromocytoma underwent hemorrhagic necrosis with acute cessation of catecholamine release. Thereafter, the patient's blood pressure decreased to a normal level with marked improvement in hypertensive symptoms. No remaining stenosis was demonstrated on follow up renal angiography. Our case suggests that constant local secretion of catecholamines may be responsible for the development of renal artery stenosis.

Nonfunctioning adrenocortical carcinoma in a young girl

A 9 year old Japanese girl was admitted complaining of left hypochondrial pain and a large upper left abdominal tumor. There were no clinical or laboratory signs of hormonal abnormality. Intravenous pyelography showed marked compression and deformity of the kidney by a tumor. This tumor was excised together with the left kidney. The pathological diagnosis was adrenocortical carcinoma. Postoperatively, the child was given neither irradiation nor chemotherapy. Twenty-one months after the surgery, there was a hepatic metastasis, and she died 40 months after surgery from a combination of hepatic metastases and local tumor recurrence.

Relationship between the radiologic features of esophageal cancer and the local control by radiation therapy

In order to predict the possibility of local control of esophageal cancer by radiation therapy, the relationship between the x-ray findings before and after irradiation and the histologic radiation effect obtained from the surgically resected esophagus was analyzed in 130 cases irradiated preoperatively during the period 1971 through 1980. In the superficial or proliferative type in x-ray image before treatment, the local control was obtained in 46.5% of the cases with the dose of 40 Gy, whereas in the ulcerative or infiltrative type, in 21.8%. The barium examination performed after irradiation was more useful to evaluate the radiation effect than that before treatment. In cases with a marked radiation effect after irradiation, the frequency of local control reached 76.9%. On the other hand, the local control remained 11.9% in cases with no or poor radiation effect. The results obtained by the preoperatively irradiated cases were applied to the analysis of 119 cases irradiated radically during the period 1965 to 1980. Almost the same results were also acquired in radically irradiated cases. The degree of radiologic and histologic radiation effect on the primary tumor was closely related to the long-term survival rate of the patient.

A morphological study of the ultimobranchial body in the grass parakeet

As parafollicular cells can be stained by Grimelius' silver impregnation and by lead-hematoxylin, the ultimobranchial body cells, homologous to them, seem to also react positively to these methods. In the present study of the ultimobranchial body of the grass parakeet, mirror-image sections were stained by both methods and compared. While about 50% of the cells reacted positively to both Grimelius' silver impregnation and lead-hematoxylin staining, only about 20% were positive to the former and about 30% were positive to the latter only. This result indicating heterogeneity among the cells of the ultimobranchial body of the grass parakeet suggests a possible occurrence of cells secreting substances other than calcitonin.