Preoperative Hyperthermia Combined with Chemotherapy and Irradiation for the Treatment of Patients with Esophageal Carcinoma

Aims and Background

The purpose of this study was to investigate the combined effects of hyperthermia, chemotherapy and irradiation on esophageal cancer.

Methods and material

Since 1978, we have clinically applied hyperthermia combined with chemotherapy and irradiation (HCR therapy), to patients with carcinoma of the esophagus. The clinical results of 136 patients receiving preoperative HCR therapy were then compared with those of 107 cases undergoing preoperative chemo-radiotherapy (CR).

Results

A histological examination of the resected esophagus after preoperative treatment revealed that 65.4% and 50.5% of the patients responded markedly (no viable cancer cells) and moderately (more than two thirds of all cancer cells destroyed) to HCR and CR therapies, respectively (p <0.05). The five-year survival rates were 22.3% and 13.7% in the HCR and CR groups, respectively, and the difference was statistically significant (p <0.01). In particular, for the patients classified as TNM Stages III and IV, a significantly longer survival period was obtained with HCR therapy (p <0.05). In addition, no severe side effects were encountered in the patients given just hyperthermia.

Conclusion

Our clinical results suggest that preoperative hyperthermo-chemo-radiotherapy shows great promise for treatment of patients with advanced carcinoma of the esophagus.

Gap-junction-mediated Communication in Human Periodontal Ligament Cells

Periodontal tissue homeostasis depends on a complex cellular network that conveys cell-cell communication. Gap junctions (GJs), one of the intercellular communication systems, are found between adjacent human periodontal ligament (hPDL) cells; however, the functional GJ coupling between hPDL cells has not yet been elucidated. In this study, we investigated functional gap-junction-mediated intercellular communication in isolated primary hPDL cells. SEM images indicated that the cells were in contact with each other via dendritic processes, and also showed high anti-connexin43 (Cx43) immunoreactivity on these processes. Gap-junctional intercellular communication (GJIC) among hPDL cells was assessed by fluorescence recovery after a photobleaching (FRAP) analysis, which exhibited dye coupling between hPDL cells, and was remarkably down-regulated when the cells were treated with a GJ blocker. Additionally, we examined GJs under hypoxic stress. The fluorescence recovery and expression levels of Cx43 decreased time-dependently under the hypoxic condition. Exposure to GJ inhibitor or hypoxia increased RANKL expression, and decreased OPG expression. This study shows that GJIC is responsible for hPDL cells and that its activity is reduced under hypoxia. This is consistent with the possible role of hPDL cells in regulating the biochemical reactions in response to changes in the hypoxic environment.

Tau Expression and Efficacy of Paclitaxel Treatment in Metastatic Breast Cancer

Purpose: Paclitaxel is widely used for the treatment of patients with metastatic breast cancer (MBC), such as in anthracycline-based combinations as a first-line chemotherapy. Although several mechanisms of paclitaxel resistance have been demonstrated, useful markers of paclitaxel resistance have not been available in clinical practice. A recent study revealed that low tau expression in cases of early breast cancer can predict susceptibility to paclitaxel administration in neoadjuvant therapy.Methods: In this study, the clinical significance of tau expression in MBC cases was established by identifying candidates with paclitaxel administration. Tissue specimens obtained from 35 patients who had received neither chemotherapy nor radiotherapy before surgery were examined. Status of tau expression was determined by immunohistochemistry.Results: Based on a previously reported classification scheme, 15 cases were classified as tau-negative (0, 1+) and 20 cases were classified as tau-positive (2+, 3+).Nine (60%) of 15 cases with tau-negative expression showed favorable response. Conversely, 17 (85%) of 20 cases with tau-positive expression showed progressive or stable disease after paclitaxel administration.Table 1 Relationship between tau expression and response to paclitaxel  nNumber of responses (%)PTaunegative159 (60%)  positive203 (15%)0.01 Time to disease progression in tau-negative and tau-positive groups was 9.4 ± 6.6 months and 6.0 ± 3.7 months, respectively. Although no significant differences were apparent, this period tended to be longer in the tau-negative group.Discussion: Patients with tau-positive expression may derive less benefit than tau-negative from paclitaxel therapy in MBC. This suggests that tau expression could be used at diagnosis to select patients for whom paclitaxel treatment is likely to be of most benefit. However, this study has some clear limitations in terms of the modest sample size and the heterogeneity of eligible patients (e.g., different numbers and regimens for adjuvant and MBC chemotherapy). Many more cases must be examined before tau expression can be applied to practical clinical treatment.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1138.

Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy - a case series

Detection of early gastric tube cancers (GTCs) has increased with more detailed surveillance endoscopy using indigo carmine dye following esophagectomy. This retrospective study clarified the clinicopathological features and application of endoscopic submucosal dissection (ESD) for GTCs. Data collected for eight GTCs treated by ESD included clinical and pathological features and outcomes following ESD. Overall, eight GTCs were identified in seven (6.3 %) of 112 patients who underwent esophagectomy and gastric tube reconstruction. Almost all lesions were macroscopically type 0-IIa with mucosal to submucosal invasion, and seven GTCs were successfully resected en bloc by ESD. Submucosal invasion to > 500 microm was observed in one case with associated delayed perforation that was treated conservatively. No local recurrences of GTCs were observed. Detailed surveillance endoscopy using indigo carmine dye appears useful for diagnosing early-stage GTC. Furthermore ESD represents a feasible alternative to conventional endoscopic mucosal resection as a minimally invasive therapy for early-stage GTC.

Evaluation of combined docetaxel and nedaplatin chemotherapy for recurrent esophageal cancer compared with conventional chemotherapy using cisplatin and 5-fluorouracil: a retrospective study

This retrospective study evaluated the safety and efficacy of combination chemotherapy using docetaxel and nedaplatin in an outpatient setting compared with those of chemotherapy using cisplatin (CDDP) and 5-Fu under hospitalization. Subjects comprised 21 patients who had been diagnosed with recurrent esophageal squamous cell carcinoma (ESCC), with 10 patients receiving combination chemotherapy comprising CDDP and 5-fluorouracil (5-Fu) under hospitalization (FP group; n = 10), and 11 patients receiving combination chemotherapy comprising docetaxel and nedaplatin in an outpatient setting (Doc/Ned group; n = 11). In the Doc/Ned group, patients received 30 mg/m(2) of docetaxel over a 1-h infusion on day 1, followed by 40 mg/m(2) of nedaplatin over a 2-h infusion on day 1 in an outpatient setting. In the Doc/Ned group, complete response was observed in two patients (18.1%), one with liver metastasis and one with abdominal lymph node metastasis, and two (18.1%) achieved partial response. In contrast, no complete responses were obtained in the FP group, and partial response was observed in only one patient (10.0%) with local recurrence. Response rates were thus 36.3% for the Doc/Ned group and 10.0% for the FP group. With a median follow-up of 234 days in the Doc/Ned group and 279 days in the FP group, median survival time (MST) was 234 days in the Doc/Ned group and 378 days in the FP group. No significant differences in MST were identified between groups. Thus regimen based on docetaxel and nedaplatin allows administration on an outpatient basis and appears feasible for recurrent ESCC as a second-line chemotherapy.

Protein microarray analysis identifies human cellular prion protein interactors

AIMS

To obtain an insight into the function of cellular prion protein (PrPC), we studied PrPC-interacting proteins (PrPIPs) by analysing a protein microarray.

METHODS

We identified 47 novel PrPIPs by probing an array of 5000 human proteins with recombinant human PrPC spanning amino acid residues 23-231 named PR209.

RESULTS

The great majority of 47 PrPIPs were annotated as proteins involved in the recognition of nucleic acids. Coimmunoprecipitation and cell imaging in a transient expression system validated the interaction of PR209 with neuronal PrPIPs, such as FAM64A, HOXA1, PLK3 and MPG. However, the interaction did not generate proteinase K-resistant proteins. KeyMolnet, a bioinformatics tool for analysing molecular interaction on the curated knowledge database, revealed that the complex molecular network of PrPC and PrPIPs has a significant relationship with AKT, JNK and MAPK signalling pathways.

CONCLUSIONS

Protein microarray is a useful tool for systematic screening and comprehensive profiling of the human PrPC interactome. Because the network of PrPC and interactors involves signalling pathways essential for regulation of cell survival, differentiation, proliferation and apoptosis, these observations suggest a logical hypothesis that dysregulation of the PrPC interactome might induce extensive neurodegeneration in prion diseases.

Neutrino signals from the formation of a black hole: A probe of the equation of state of dense matter

The gravitational collapse of a nonrotating, black-hole-forming massive star is studied by nu-radiation-hydrodynamical simulations for two different sets of realistic equation of state of dense matter. We show that the event will produce as many neutrinos as the ordinary supernova, but with distinctive characteristics in luminosities and spectra that will be an unmistakable indication of black hole formation. More importantly, the neutrino signals are quite sensitive to the difference of equation of state and can be used as a useful probe into the properties of dense matter. The event will be unique in that they will be shining only by neutrinos (and, possibly, gravitational waves) but not by photons, and hence they should be an important target of neutrino astronomy.

Efficacy and safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal bleeding: a prospective study

BACKGROUND AND STUDY AIMS

Recent studies have documented the safety of propofol sedation for endoscopic procedures, but many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects. The aim of this study was to demonstrate the safety and efficacy of nurse-administered propofol sedation during emergency upper endoscopy for patients with gastrointestinal bleeding.

PATIENTS AND METHODS

Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a registered nurse. Among these, 15 patients were classified into American Society of Anesthesiologists (ASA) class IV, 84 were ASA class III, and 21 were ASA class II. Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and ASA class, served as controls.

RESULTS

Endoscopic hemostasis was achieved in 98.3 % of patients, and 97.5 % were satisfied with the procedure. In patients with gastrointestinal bleeding, the rates of hypotension (systolic blood pressure < 90 mmHg) and hypoxemia (peripheral oxygen saturation < 90 %) were 8.3 % and 6.7 % respectively, values higher than those in the control group. However, neither mask ventilation nor endotracheal intubation was necessary. Although two patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure, they recovered within 5 days of treatment. There were no sedation-associated severe complications or mortalities.

CONCLUSION

Using a strict protocol designed to protect the patient's airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.

Pressure-pain threshold of oral mucosa and its region-specific modulation by pre-loading

Once subjected to denture wearing, oral mucosa has to withstand mechanical loads of various levels and durations. However, how this load affects oral mucosal sensitivity is unknown. This study investigated the pressure-pain threshold (PPT) of oral mucosa with or without pre-loading. An electric pressure algometer was developed specifically for measuring the PPT of oral mucosa. Measurements of 10 dentulous maxillae showed that the baseline PPT (BPPT) of the palatal site was 4.9- and 3.7-fold greater than that of the labial or buccal sites, respectively. The PPT of the labial site decreased significantly compared with its BPPT after 2 s-100% BPPT and 5 s-100% BPPT pre-loading. The PPT of the palatal site increased after 5 s-50% BPPT and 5 s-80% BPPT and 0.2 s-100% BPPT and 2 s-100% BPPT pre-loading. The PPT of the buccal site did not change after all levels and durations of pre-loadings tested. These results indicated the disproportionate modulation of oral mucosal PPT following various loads, suggesting that oral mucosa possesses region-specific psychophysical tolerance to mechanical stimuli.

Smads regulate collagen gel contraction by human dermal fibroblasts

BACKGROUND

Transforming growth factor (TGF)-beta induces fibroblast contraction that is implicated in efficient wound healing. The Smad family of proteins mediates signal transduction of the TGF-beta superfamily. However, its role in fibroblast contraction remains unclear.

OBJECTIVES

To determine whether Smad proteins regulate fibroblast contraction.

METHODS

We used an in vitro type I collagen gel contraction assay with human dermal fibroblasts infected with adenoviruses carrying Smads.

RESULTS

Overexpression of Smad3, a major signal transducer in the Smad family, enhanced collagen gel contraction by fibroblasts when compared with fibroblasts overexpressing a control lacZ. Addition of a very low concentration of TGF-beta1 that did not affect the collagen gel contraction by itself enhanced the contraction by fibroblasts overexpressing Smad3. In contrast, TGF-beta1-mediated collagen gel contraction was suppressed by overexpression of Smad7, a major inhibitory regulator in the Smad family, in fibroblasts. In addition, inhibitors of the Erk and p38 pathways, PD98059 and SB203580, did not affect TGF-beta1-mediated collagen gel contraction by dermal fibroblasts.

CONCLUSIONS

Modulation of Smad3 or Smad7 expression in dermal fibroblasts affected their contraction of collagen gels possibly by regulating TGF-beta signalling in fibroblasts.

The effect of whole-body hyperthermia combined with 'metronomic' chemotherapy on rat mammary adenocarcinoma metastases

Many women diagnosed with invasive breast cancer have undetected occult metastases at the time of their primary tumour diagnosis. The development and growth of these micro-metastases relies heavily on angiogenesis. Therefore, administering an angiogenesis-blocking treatment from the time of diagnosis could reduce the incidence of metastasis and, ultimately, increase patient survival. It is hypothesized that an antiangiogenesis strategy combining fever-range whole-body hyperthermia (FR-WBH) and metronomic chemotherapy could inhibit the development of metastatic disease with minimal toxicity. To test this theory, a low, daily dose of the topoisomerase-I inhibitor irinotecan hydrochloride (CPT-11) was administered over a prolonged period of time to rats bearing the highly metastatic MTLn3 mammary adenocarcinoma primary tumour surgically excised on day 12 after implantation. The metronomic CPT-11 was combined with long-duration, low-temperature, fever-range whole body hyperthermia (FR-WBH). This systemic hyperthermia enhances chemotherapy-induced cytotoxicity as well as immunological activity. Both the group treated with FR-WBH alone and the combined FR-WBH + CPT-11 group had delayed onset and reduced incidence of axillary lymph node metastases compared to control (p < 0.05). Combination therapy of FR-WBH + CPT-11 resulted in a significantly greater inhibition of axillary lymph node metastasis volume compared to both control and CPT-11 alone (p < 0.02) at day 16. Interestingly, none of the therapies significantly affected inguinal lymph node metastases. Lung metastases were decreased by 36% at the time of death in rats treated with FR-WBH + CPT-11, by 25% in the CPT-11 alone group and by 14% in the FR-WBH alone group. Rats treated with FR-WBH, + CPT-11 survived significantly longer (35%) than control animals (p < 0.04). Neither significant body weight loss nor gastrointestinal toxicity was observed in any group. These data suggest that, after excision of the primary tumour, FR-WBH and metronomic CPT-11 can be safely combined to reduce distant lymph node and lung metastases and, thus, to increase survival.

Pressure-pain threshold determination in the oral mucosa: validity and reliability

Fundamental knowledge of pain in the oral mucosa is lacking. We determined the validity and reliability of the pressure-pain threshold (PPT) measurement in the oral mucosa using a newly developed hand-held pressure algometer. Ten dentulous subjects were recruited, and the PPT was measured at the bilateral buccal (on the attached gingiva apical to the midline of the upper first premolars, 3 mm from the mucogingival junction) and the palatal sites (mid-point between the bilateral upper first molars). The PPT linearly increased with an increase in load-rate (P < 0.0001). The PPT yielded a high intra-individual stability both for the same-day consecutive trials and weekly sessions. The palatal site revealed a 4- to 4.65-fold greater PPT than the buccal sites (Bonferroni, P < 0.0001), whereas no difference was found between the bilateral buccal sites (P=0.663). Despite a great interindividual variation in the PPT, significant intra-individual correlations were found among the measurement sites. This suggested differences in individual sensitivity to pain in the oral mucosa, which may determine overall pain sensation specific to an individual. A pressure algometer described herein reliably assessed the PPT in the oral mucosa and sensitively discriminated PPT differences at different sites and at different load-rates, suggesting the reliability and validity of PPT measurements in the oral mucosa for clinical and research investigations.

Transforming growth factor-beta1 suppresses atopic dermatitis-like skin lesions in NC/Nga mice

BACKGROUND

Atopic dermatitis is a chronic, relapsing inflammatory disorder characterized by pruritic and eczematous skin lesions. Transforming growth factor (TGF)-beta1 has been implicated in the suppression of inflammatory responses.

OBJECTIVE

The purpose of this study is to determine whether TGF-beta1 suppresses skin lesions in a mouse model of atopic dermatitis.

METHODS

We used the NC/Nga strain of mice as an in vivo model of atopic dermatitis. The effects of exogenous TGF-beta1 on atopic dermatitis-like skin lesions in NC/Nga mice were evaluated clinically, histologically and immunologically.

RESULTS

Subcutaneous injection of recombinant TGF-beta1 macroscopically suppressed eczematous skin lesions in NC/Nga mice associated with reduced serum immunoglobulin E (IgE) levels. Histological analysis showed that TGF-beta1 significantly inhibited the infiltration of inflammatory cells such as mast cells and eosinophils into the skin of NC/Nga mice. Spontaneous interferon (IFN)-gamma production from splenocytes of NC/Nga mice was down-regulated by the treatment with TGF-beta1 and neutralizing antibody against IFN-gamma inhibited skin lesions in NC/Nga mice. The inhibitory effect of TGF-beta1 on the skin lesions lasted at least 1 week after cessation of the treatment.

CONCLUSION

These findings indicate that TGF-beta1 suppressed atopic dermatitis-like skin lesions in NC/Nga mice at least in part through down-regulation of IFN-gamma. These results suggest that TGF-beta1 may have a therapeutic potential for atopic dermatitis.

Pathogenesis of esophageal squamous cell carcinoma with lymphoid stroma

BACKGROUND/AIMS

Lymphocyte infiltration in esophageal cancer, especially when beneath intraepithelial carcinoma, is frequently seen. However, cases of esophageal cancer with a dense stromal infiltration of lymphocytes are rare and the pathogenesis of such cases has yet to be clearly demonstrated. The objective of this study is to clarify its pathogenesis.

METHODOLOGY

Four cases of esophageal squamous cell carcinoma with lymphoid stroma were investigated by immunohistochemical staining for the detection of Epstein-Barr virus, human papillomavirus, human leukocyte antigen-DR, as well as T and B cells in cancer tissue.

RESULTS

In these four cases, neither positive staining of Epstein-Barr virus nor human papillomavirus infection was detected. On the other hand, the expression of human leukocyte antigen-DR antigen was evident in all cases with dense T-cell infiltration in the tumor tissue and moderate B-cell infiltration around the tumor.

CONCLUSIONS

The expression of human leukocyte antigen-DR antigen without Epstein-Barr virus or human papillomavirus infection could thus be one possible pathogenesis of patients demonstrating esophageal squamous cell carcinoma with a lymphoid stroma.

Cerebral blood flow measurement of severely head-injured patients during mild hypothermia

In 14 patients with severe head injury, the cerebral blood flow (CBF) during mild hypothermia therapy was measured. Their Glasgow Coma Scale scores on admission were 8 or less and the intracranial pressures were greater than 20 mmHg despite conventional therapy. The CBF was measured with two-level stable xenon CT techniques. And in 11 patients, the cerebral metabolic rates for oxygen (CMRO2) was also calculated. All cases were divided into two groups according to the outcome at discharge by using the Glasgow Outcome Scale, good outcome group in 6 and poor outcome one in 8. The values of mean CBF and CMRO2 of each group were 25.6 +/- 6.6 vs 24.4 +/- 6.4 ml/100 g/min and 1.26 +/- 0.45 vs 0.79 +/- 0.31 ml/100 g/ml, respectively. There were no statistically significant differences between both groups. Single CBF measurement during this therapy may not be helpful as a factor of prognosis evaluation in patients with severe head injury.

Pancreatic Schwannoma: report of a case

We present herein a case of solitary schwannoma of the pancreas and also review 26 previously reported cases from the English and Japanese literature. Primary schwannoma of the pancreas is a rare tumor. A 50-year-old female was discovered to have a large mass in the upper abdomen on ultrasonography. An examination by computed tomography (CT) scan, magnetic resonance imaging (MRI), and ultrasonography revealed a solid and cystic tumor in the left upper quadrant of the abdomen. A distal pancreatectomy with a splenectomy was performed to remove this tumor. A microscopic examination identified the tumor to be situated in the pancreas while it was composed of cells that originated from Schwann cells. Only 26 cases of pancreatic schwannoma have previously been reported in the English and Japanese literature. We describe in detail the characteristic findings based on image analyses, including CT scan, MRI, ultrasonography, and angiography, in these 26 cases.

[Arterial infusion therapy with implantable port for inoperable hepatobiliary tumors]

PURPOSE

To assess the clinical utility of arterial infusion therapy with implantable port for inoperable malignant hepatobiliary tumors.

MATERIALS AND METHODS

Twenty-seven patients with advanced hepatobiliary tumors (M:F = 14:13, mean age 63.6, 11 cases with metastases from colon cancer, 4 cases from gastric cancer, 5 cases with gallbladder cancer, 3 cases with cholangiocarcinoma, 2 cases with cholangiocellularcarcinoma, 1 case with hepatocellular carcinoma and 1 with pancreatic cancer) were treated with arterial infusion ports which were placed via left subclavian artery or femoral artery. The regimens used were FEM for 5 cases, EEP for 2 cases and FP for 20 cases.

RESULTS

Overall mean survival date was 241.8 days. The numbers of cases with CR, PR, NC and PD were 1, 6, 10 and 10, respectively, and the effective rate was 25.9%. Mean survivals of cases with cholangiocellularcarcinoma, metastases from gastric cancer and colon cancer were 715 days, 324.3 days and 245.9 days, respectively. Severe gastrointestinal side effects (> grade 3) were not observed. Serious bone marrow suppressions were frequently observed with FEM and EEP, but were rare with FP (10%).

DISCUSSION

Arterial infusion therapy with implantable port is clinically useful for advanced cholangiocancer and metastases from the gastrointestinal system. This system contributes to the quality of life of patients, since the infusion procedure is simple and can be archived in the outpatient clinics.

HLA-DR antigen expression in squamous epithelial dysplasia and squamous cell carcinoma of the esophagus: an immunohistochemical study

To clarify the biologic significance of esophageal squamous epithelial dysplasia, especially the similarity to carcinoma in situ, immunohistochemical investigation of HLA-DR antigen expression and lymphocyte infiltration was performed. HLA-DR antigen was expressed in 12 of the 35 invasive carcinomas (34.4%), 23 of the 38 intraepithelial carcinomas (60.5%), 21 of the 50 areas of dysplasia (42.0%) and only 2 of the 625 specimens of non-cancerous squamous epithelium (0.3%). The HLA-DR-positive rate of dysplasia localized continuous to HLA-DR-positive carcinoma was 68.4%, which was significantly higher than that for HLA-DR positive dysplasia localized continuous to HLA-DR negative cancer (11.1%) (p<0.05). In areas of dysplasia and intraepithelial carcinoma, T cell infiltration was significantly increased at the sites of HLA-DR antigen expression (P<0.01). B cell infiltration was also more common in areas of positive expression. These results suggest that HLA-DR antigen is associated with the local immune response to squamous epithelial dysplasia, and that HLA-DR antigen expression may prevent tumor invasion similarly to its role in intraepithelial carcinoma.

Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer

OBJECTIVE

To find out if strict assessment of organ function preoperatively predicted morbidity and mortality in patients being operated on for oesophageal carcinoma.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Japan.

SUBJECTS

178 patients operated on for oesophageal cancer 1989-1993.

INTERVENTIONS

Oesophagectomy and reconstruction (using either stomach or colon) in one stage by a right thoracoabdominal approach in 173, and transhiatal resection in 5 with either poor pulmonary reserve or early lesions.

MAIN OUTCOME MEASURES

Correlation between preoperative assessment of organ function and postoperative development of complications.

RESULT

79 patients (44%) developed complications and 6 died (3%). Pulmonary dysfunction preoperatively was significantly associated with the development of all complications (p=0.001) and of postoperative pulmonary complications (p=0.04). No other preoperative assessment correlated significantly with the development of postoperative complications.

CONCLUSION

Accurate preoperative assessment of pulmonary function is a valuable indicator of postoperative morbidity.

Adenosquamous carcinoma of the pancreas: report of two cases

Adenosquamous carcinoma of the pancreas is a rare variant of pancreatic exocrine carcinoma. We herein report two patients with this entity. One patient was a 60-yr-old Japanese man complaining of a palpable mass, 5.5 cm in the greatest diameter, in the epigastrium. Serum CA 19-9 was increased (2010 U/ml). Ultrasonography and computed tomography showed a mass in the pancreatic tail with central necrosis and invading the posterior wall of the stomach. Angiography showed an encasement of the splenic artery and complete obstruction of the splenic vein. Distal pancreatectomy, splenectomy, and partial resection of the stomach were done. The patient died of uncontrolled bleeding from the duodenal ulcer four months after operation. The other patient was a 73-yr-old man who presented with jaundice. The CA 19-9 was also elevated (354.8 U/ml). Ultrasonography showed a pancreatic head mass of heterogeneous echogeneity and computed tomography demonstrated a cystic mass with an enhanced rim, indicating necrosis in the tumor center. Angiography showed a hypervascular mass in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy was done, but the patient died of multiple liver metastases 10 months after the operation. From our experience with the two patients, the presence of central necrosis in an infiltrative huge pancreatic tumor seems to be suggestive of the diagnosis of adenosquamous carcinoma of the pancreas.

Difference in the mechanism of balancing-side disclusion between 1st and 2nd molars

This study investigates the cusp angle and movement variables related to balancing-side disclusion and compares the characteristics between the 1st and 2nd molar regions. Fifty-six normal young adults were divided into two groups according to balancing-side contact: a disclusion group consisting of 40 subjects (80 excursions), and a non-disclusion group consisting of 16 subjects (20 excursions). Lateral excursions were measured in six-degrees of freedom, and the inclinations of the frontal paths were calculated on the working-side canine, balancing-side 1st and 2nd molars and balancing-side condylar point. The cusp angle was measured using a three-dimensional digitizer. While there were no differences between disclusion and non-disclusion groups in the inclination of the balancing-side condylar path, significant differences were found in the cusp angle and the inclination of the working-side canine path. In the non-disclusion group, the cusp angle of the 2nd molar was markedly greater than that of the 1st molar. It was concluded that the inclination of the anterior guidance and the cusp angle of related teeth have a great effect on the occurrence of balancing-side disclusion and that the mechanism of high frequent balancing-side contacts at the 2nd molar was characterized by its greater cusp angle compared to the 1st molar.

Laparoscopic repair of a paraesophageal hiatal hernia with gastric volvulus

We report the case of a massive paraesophageal hiatal hernia with gastric volvulus which presented with the symptom of a precordial sense of pressure for over two years, which was successfully treated with laparoscopic surgery. The patient is presently in good condition, without any recurrence of either the hiatal hernia or other symptoms one year after surgery. This approach is considered to be a safe and effective procedure, and it also provides for rapid recovery from the operation.

Tumor invasion and angiogenesis in early esophageal squamous cell carcinoma

BACKGROUND AND OBJECTIVES

Although the relationship between angiogenesis and tumor proliferation or malignant potential has been previously demonstrated in several studies, early stage of cancer invasion and angiogenesis has seldom been investigated.

METHODS

From the esophageal specimens of eight recently resected cases with esophageal squamous cell carcinoma, 25 areas of carcinoma-in-situ or microinvasive carcinoma were selected, and then a serial histologic investigation and immunohistochemical staining for the detection of Factor VIII-related antigen to investigate microvessels in the lamina propria mucosae beneath the lesions as a measure of angiogeneses and staining for laminin to visualize basement membrane was performed. Lymphocyte infiltration below the lesions were also estimated. In view of early cancerous invasion, histologic patterns of the growth of the lesions were divided into "flat," "expansive," and "downgrowth" patterns.

RESULTS

Although downgrowth patterns are thought to be more invasive, relationships between the histologic patterns, and basement membrane staining patterns, and lymphocyte infiltration patterns were not demonstrated. However, the angiogenetic ratio (the number of vessels/cm under the lesions divided by that under normal epithelium) was observed to be significantly and closely related to tumor invasion patterns (P < 0.01), although it was not related to the destruction of the basement membrane or lymphocyte infiltration below the lesions.

CONCLUSIONS

The angiogenesis of esophageal squamous cell carcinoma is closely correlated to the tumor invasion patterns in early esophageal cancerous lesions.

Biosynthesis and secretion of MHC class III gene products (complement C4 and factor B) in the exocrine pancreas

We recently found that complement C3 is locally synthesized and secreted into the exocrine pancreas. In the present study, we attempted to demonstrate the secretion of complement C4 and factor B in the exocrine pancreas. In five samples of pancreatic fluid, both C4 and factor B proteins were detected by enzyme-linked immunosorbent assay (ELISA). Immunoblot analysis revealed the C4 and factor B molecules in pancreatic fluid to be identical with these molecules in serum. Reverse transcriptase (RT)-polymerase chain reaction (PCR) analysis in pancreatic carcinoma cell lines suggested ductal epithelial cells to be the local production sites of these proteins in the pancreas. The secretion of C4 and factor B in ductal cell lines (PANC-1 and MIA PaCa-2) was independently regulated by interleukin (IL)-1 beta, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma; C4 secretion was induced by IFN-gamma, whereas factor B secretion was induced by IL-1 beta, TNF-alpha, or IFN-gamma. These observations indicate that: (a) complement C4 and factor B are secreted into the exocrine pancreas, (b) ductal epithelial cells appear to be the site of C4 and factor B biosynthesis, and (c) local secretion of C4 and factor B in the pancreas is differentially regulated by IL-1 beta, TNF-alpha, and IFN-gamma.

Characterization of complement C3, C4, and factor B molecules in human bile

We performed molecular analysis of complement components (C3, C4, and factor B) in human bile by sodium dodecyl sulfate-polyarylamide gel electrophoresis (SDS-PAGE) and immunoblotting. Complement C3 was detected as a molecule composed of a 115-kDa alpha-chain linked to a 70-kDa beta-chain by disulfide bonds, and C3 levels ranged from 45 to 650 micrograms/ml (n = 15). C4 was detected as a triple chain (98-kDa alpha-chain, 73-kDa beta-chain, and 33-kDa gamma-chain) molecule linked by disulfide bonds, and C4 levels ranged from 2.5 to 60 micrograms/ml. Factor B, a component of the alternative pathway, was also detected, as an intact form. Factor B levels ranged from 0.3 to 8.0 micrograms/ml. The sizes and subunit structures of complement components in human bile were compatible with those reported in human serum. The results of a hemolytic assay indicated that complement molecules in human bile were functionally active. These molecules may participate in local immune and inflammatory responses in the biliary tract.

Effect of occlusal splint on masticatory movement in healthy individuals

To investigate the effects of wearing an occlusal splint on masticatory movements in healthy individuals, twelve healthy individuals were examined. A full maxillary stabilization splint made of heat-cured acrylic resin was fabricated for, and worn by, each individual for 24 hours. Masticatory movement was measured before and after the 24-hour period using a 3-D mandibular movement analyzing system. While the duration of a masticatory cycle+ did not change, the occlusal time significantly decreased after use of the splint. The lateral displacement of the opening phase to the balancing-side area also decreased after use of the splint, showing a vertical pattern of the opening path. Measurement in more healthy individuals and patients should help clarify the therapeutic mechanism of the splint in the treatment of temporomandibular disorders.

Tumour necrosis factor-alpha up-regulates decay-accelerating factor gene expression in human intestinal epithelial cells

The increased expression of decay-accelerating factor (DAF) has been detected in intestinal epithelial cells at the inflamed mucosa. In this study, we examined the effects of tumour necrosis factor (TNF)-alpha on DAF expression in three intestinal epithelial cell lines. DAF mRNA expression was evaluated by Northern blot analysis, and DAF protein expression was analysed by biotin labelling and immunoprecipitation. TNF-alpha induced a marked increase in DAF mRNA and protein expression in HT-29, T84 and Caco-2 cells. In HT-29 cells, the effects of TNF-a on DAF mRNA accumulation were observed in a dose-dependent manner; DAF mRNA accumulation reached a maximum at 3-6 hr, and then gradually decreased. These effects of TNF-alpha required de novo protein synthesis. Messenger RNA stability studies suggested that TNF-alpha partially regulated DAF gene expression by a posttranscriptional mechanism. Moreover, the combination of TNF-alpha and interleukin (IL)-4 induced an additive increase in DAF mRNA accumulation in HT-29 and T84 cells. In human intestinal epithelial cells, TNF-alpha acts as a potent inducer of DAF mRNA expression, indicating an important role for TNF-alpha in the regulation of DAF expression at the inflamed mucosa.

Expression of p53 protein in glandular differentiation admixed with squamous cell carcinoma of the esophagus

BACKGROUND

Glandular differentiation in squamous cell carcinoma of the esophagus is occasionally recognized by serial histologic investigations. We previously performed histopathologic investigations of such tumors and suggested the possibility of field carcinogenesis in esophageal cancer.

MATERIALS AND METHODS

In the current study, we performed an immunohistochemistry analysis for p53 protein in such cases to investigate the mode of carcinogenesis from the view point of genetic changes. p53 protein expression in both ordinary squamous cell carcinoma and glandular differentiation of nine cases to demonstrate the coexistence of these components.

RESULTS

The expression of p53 in the areas of squamous cell carcinoma was diffusely detected in three and focally in two (five in all, 55.6%) and, in these five cases, p53 was also positive in the areas of glandular differentiation in four cases. On the other hand, the expression of p53 in the glandular components was negative in all four tumors with p53 negative squamous cell carcinoma.

CONCLUSIONS

The process of carcinogenesis within the tumor was thought to be similar in almost all cases even in the different histopathologic components.

The clinical and histopathological contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy for the patients with esophageal cancer

BACKGROUND/AIMS

The effectiveness of hyperthermic treatment combined with irradiation and chemotherapy for patients with esophageal cancer on local response as well as on long-time survival has been reported. In order to investigate the contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy (HCR therapy), this study was performed.

MATERIALS AND METHODS

One hundred nineteen patients with esophageal cancer who underwent preoperative HCR therapy followed by esophagectomy were reviewed in this retrospective study. The rate of effectiveness of preoperative HCR therapy was then compared in resected tissue specimens with regard to such factors as age, sex, the location of the tumor, the longitudinal diameter of the esophagogram, the radiographic type of tumor, the histological type and the histological depth of invasion using univariate and multivariate analyses.

RESULTS

Both univariate and multivariate analyses showed that the clinical and histopathological factors which had the greatest effect on preoperative HCR therapy were well differentiated squamous cell carcinoma regarding the histological type and tumorous type regarding the radiographic types.

CONCLUSION

We thus conclude that preoperative HCR therapy shows great promise for the treatment of patients with esophageal cancer, especially in instances of well differentiated and radiographic tumorous type squamous cell carcinoma.

Interleukin 4 acts as an inducer of decay-accelerating factor gene expression in human intestinal epithelial cells

BACKGROUND & AIMS

Decay-accelerating factor (DAF) protects host tissues from the attack of autologous complement activation. In this study, we attempted to define the cytokine regulation of DAF messenger RNA (mRNA) expression in human intestinal epithelial cells.

METHODS

The effects of cytokines on DAF mRNA accumulation were evaluated by Northern blot analysis. The DAF protein expression was analyzed by both immunoprecipitation and immunoblotting.

RESULTS

Interleukin (IL)-4 induced a marked increase in DAF mRNA accumulation in HT-29 cells. In this line, IL-1 beta evoked only weak induction, and IL-6, IL-8, IL-10, and interferon gamma had no effect. The effect of IL-4 was observed in a dose-dependent manner and confirmed at the protein level. The increase in DAF mRNA accumulation reached a maximum at 3-6 hours and then gradually decreased. These effects of IL-4 on DAF mRNA and protein expression were also observed in T84 cells. The mRNA stability studies suggested that IL-4 regulates DAF gene expression mainly at the transcriptional level.

CONCLUSIONS

In human intestinal epithelial cells, IL-4 acts as a potent inducer of DAF mRNA expression, suggesting a cytoprotective role for IL-4 against autologous complement activation.

Oesophageal cancer coexisting with colorectal lesions

OBJECTIVE

To investigate the incidence of colorectal lesions in patients who present with oesophageal cancer.

DESIGN

Prospective open study.

SETTING

University hospital, Japan.

SUBJECTS

135 of 218 patients who presented with squamous cell carcinoma of the oesophagus during the seven year period 1988-1994 were randomly allocated to have a barium enema examination.

INTERVENTIONS

Barium enema examinations, and if colorectal lesions were found, colonoscopy and biopsy.

MAIN OUTCOME MEASURE

Incidence of coexistent colorectal lesions.

RESULTS

No abnormal findings were found in 52 (39%), diverticula were present on 37 (27%), benign polypoid lesions in 51 (38%), and malignant lesions in 6 (4%). We examined the clinical and histopathological details of all patients to see if it was possible to distinguish the patients at high risk of developing oesophageal and colorectal cancer but could find no differences among the groups.

CONCLUSION

Asymptomatic colorectal lesions are relatively common in patients with squamous cell carcinoma of the oesophagus in Japan.

Regulation of complement C3 synthesis by interleukin-1 and transforming growth factor-beta in rat non-transformed intestinal epithelial cell line, IEC-6

Intestinal epithelial cells are an important source of many biologically active molecules that modulate immune responses in the mucosa. The purpose of this study was to demonstrate the synthesis of complement C3 component in the rat non-transformed crypt-like intestinal epithelial cell line, IEC-6. Unstimulated IEC-6 cells secreted a low level of C3 protein and showed weak expression of C3 mRNA. The addition of interleukin (IL)-1 beta induced a dose- and time-dependent increase in C3 production. These effects of IL-1 beta were observed at a concentration as low as 0.01 ng/ml and reached a plateau at a concentration of 5 ng/ml. The effects were observed at the mRNA level as early as 6 h after the beginning of incubation. Transforming growth factor (TGF)-beta alone had no effect. However, TGF-beta at low concentrations (0.001-1 ng/ml) enhanced the effect of IL-1 beta in increasing C3 production; this enhancement was not observed at high concentrations (5-10 ng/ml). These effects of TGF-beta were also observed at the mRNA level. The present findings indicate that intestinal epithelial cells are indeed capable of synthesizing complement C3 in response to IL-1 beta and TGF-beta.

Local secretion of complement C3 in the exocrine pancreas: ductal epithelial cells as a possible biosynthetic site

BACKGROUND & AIMS

The complement system participates in the local immune system in various tissues. In this study, we investigated the local secretion of complement C3 into the pancreatic fluid and attempted to determine a possible biosynthetic site.

METHODS

C3 protein in human pancreatic fluid was analyzed by, immunoblotting. The C3 messenger RNA (mRNA) expression in several pancreatic carcinoma cell lines was analyzed by the polymerase chain reaction and/or Northern blotting. The secretion of C3 by these pancreatic carcinoma cells was assessed by metabolic labeling and immunoprecipitation experiments.

RESULTS

In five samples of human pancreatic fluid, C3 was detected as a molecule composed of alpha and beta chains. C3 mRNA expression was observed in the ductal cell carcinoma lines (PANC-1 and MIA PaCa-2) but not in the acinar cell line (HPC-YO and AR-42J). C3 production in these cells was enhanced by interleukin 1 beta and tumor necrosis factor alpha at both the protein and the mRNA levels.

CONCLUSIONS

(1) Complement C3 is secreted into the exocrine fluids of the pancreas. (2) Ductal epithelial cells are possible biosynthetic sites for C3. (3) The proinflammatory cytokines, interleukin 1 beta and tumor necrosis factor alpha are effective stimulators of local C3 production in the pancreas.

Prognostic significance of immunological parameters in patients with esophageal cancer

BACKGROUND

The role of immunosurveillance in the fight against cancer is well known. In addition, cancer patients have been reported to have an impaired immune function. In patients with esophageal cancer, however, the relationship between the immunological parameters of the host and their survival has not yet been evaluated fully.

MATERIALS AND METHODS

Of 103 patients with esophageal cancer who underwent esophagectomy, lymphocyte subsets (CD4+ and CD8+), the PHA response, and natural killer cell (NK) activity were all assessed in relation to clinicopathological features and the prognostic significance was evaluated using both a univariate and multivariate analysis.

RESULTS

The CD4+/CD8+ ratio in 58 (56%) patients was higher than the mean of the control, while the PHA response and NK activity in 74 (72%) and 70 (68%) patients, respectively, were lower than 1 SD below the mean of the control. None of these three parameters demonstrated a low value in 5 patients, while 1, 2 and 3 parameters showed a low value in 28, 49 and 21 patients, respectively. The survival rate of the patients with low values in all of three of these parameters was significantly worse than that for the patients in whom the number of low parameters was less than two. A multivariate analysis revealed that tumor invasion and the number of low values in these parameters were independently significant prognostic factors.

CONCLUSIONS

This survival analysis revealed that low values in the CD4+/CD8+ ratio, the PHA response, and the NK activity will help predict a poor prognosis in patients with esophageal cancer.

What is the earliest malignant lesion in the esophagus?

BACKGROUND

The incidence of early esophageal cancer is definitely increasing due to recent advances in diagnostics. When we discuss early carcinoma of the esophagus, however, there is still controversy as to whether dysplasia is either benign or the earliest malignant lesion.

METHODS

Nineteen resected esophaguses with both cancer and dysplasia (including 19 cancers concomitant with 26 dysplastic lesions) were studied for expression of p53 protein.

RESULTS

Immunohistochemical overexpression of p53 protein in esophageal dysplasia is almost the same as that in cancer.

CONCLUSIONS

Esophageal dysplasia should be recognized as the earliest malignant lesion which already demonstrates cancerous features although it is not immediately critical. A routine endoscopic Lugol's solution test is very useful for both detection and following-up of the early nests in the esophagus. These lesions are good candidates for endoscopic mucosal resection for the purpose of accurate diagnosis or curative treatment.

[Reevaluation of precancerous lesion of squamous cell carcinoma]

One hundred fifty-nine cases of esophageal carcinoma were reviewed retrospectively. There were 75 dysplastic lesions in 32 cases (20.1%). Although the continuity of dysplastic lesions to the areas of carcinoma was not so frequent (48.0%), it was more often encountered in severe rather than in moderate or mild dysplasia, which suggested some relationship between the severity of dysplasia and carcinoma. Using a silver colloid staining technique, nucleolar organizer region-associated proteins (NOR) were studied in paraffin sections of 22 normal epithelia, 22 dysplasias, 17 carcinomas in situ (CIS), and 14 invasive carcinomas. The mean numbers of NOR in the nucleus were 1.77 +/- 0.14 (mean +/- SD) in normal epithelium, 2.16 +/- 0.30 in dysplasia, 2.78 +/- 0.51 in CIS, and 3.67 +/- 0.85 in invasive carcinoma. On the other hand, the NOR number in the atypical layer of the dysplasia was 2.60 +/- 0.39, which was almost the same level as that of CIS. These results suggest that atypical layers in esophageal dysplasia already have the same level of proliferative activity judging from the NOR numbers. Immunohistochemical staining for P53 protein revealed that, in the 13 cases with positive staining of the cancer tissue, 79.1% of dysplastic lesions were also positively stained. These results suggested that, although dysplasia was not carcinoma because of the restriction in the mucosa without invasion, the biological nature of dysplasia might be considered as serious a lesion as carcinoma itself.

Histological suggestions of 'paratransformation' in oesophageal squamous cell carcinoma

We have postulated that oesophageal squamous cell carcinoma arises from multifocal areas and not from one cell, and we present the circumstantial evidence for field carcinogenesis in oesophageal cancer. Among 290 cases examined with oesophageal squamous cell carcinoma, lymphatic permeation or intramural metastasis was evident in 110 cases. Of these carcinomatous transformation of the epithelium adjacent to either lymphatic vessel permeation or intramural metastasis of the squamous cell carcinoma was recognized in six cases. It is considered that the cancer tissue either in the lymphatic vessel or intramural metastasis promotes a malignant transformation of the squamous epithelium over these foci. 'Paratransformation' is therefore thought to be one of the potential models of origin for oesophageal squamous cell carcinoma.