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Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.

Immunohistochemical staining for epithelial (E)-cadherin and alpha-catenin was performed using frozen sections taken from fresh operative specimens, by the avidin-biotin-peroxidase complex method. Tumors were classified into three types according to the expression modality. Cancer cells with expression at the cell-cell boundaries were defined as normal; when the expression was positive, but not concentrated at the cell-cell boundaries, they were defined as cytoplasmic; and when the tumor showed no staining, they were defined as lost. The relationship between these three expression types and the clinicopathological features of colorectal cancer was investigated. In all 50 normal mucosa samples, E-cadherin and alpha-catenin were coexpressed normally. The expression type of E-cadherin and alpha-catenin was normal in 11 and 13 of the cancer tissue specimens, respectively, cytoplasmic in 26 and 29, respectively, and lost in 13 and 8, respectively. Cytoplasmic or lost expression was observed in cancer demonstrating an advanced clinical stage (E-cadherin, P = 0.0065; alpha-catenin, P = 0.0069), advanced tumor penetration (P = 0.0003, P = 0.0001), undifferentiated tumor histology (P = 0.0196, P = 0.0343), widespread lymph node involvement (P = 0.0204, P = 0.0340), and liver metastasis (P = 0.0063, P = 0.0299). In conclusion, the expression type of E-cadherin is significantly correlated to that of alpha-catenin, and the loss of their expression indicates the metastatic potentiality of colorectal cancer.

A case of microcystic disease of the pancreas which was clearly demonstrated by magnetic resonance cholangiopancreatography (MRCP) is reported herein. Cystic dilatation of the pancreatic duct was recognized by computed tomography scanning and endoscopic retrograde cholangiopancreatography (ERCP). Furthermore, the existence of microcystic clusters surrounding the dilated pancreatic duct were clearly visualized by MRCP. These microcystic clusters were strongly suspected preoperatively of having caused dilatation of the major pancreatic duct. Based on these findings, a distal pancreatectomy was performed. The operative specimen showed no accumulation of mucin and no evident lesions in the dilated pancreatic duct, being inconsistent with the entity of a mucus-producing tumor. Pathological examination revealed that the inner parts of microcysts constituted columnar epithelium with mucus production and papillary growth. Thus, a final histological diagnosis of intraductal papillary adenoma with idiopathic pancreatic duct ectasia was confirmed. In conclusion, MRCP, being a less aggressive diagnostic procedure than ERCP, proved extremely useful for obtaining precise information on cystic lesions of the pancreas in this patient.

DNA flow cytometry was performed on paraffin-embedded tissue blocks made from 230 surgically resected colorectal cancers, 109 (47.4%) of which were diploid tumors, and 121 (52.6%) aneuploid tumors. The DNA index (DI) was calculated as the ratio of the G0/G1 channel number of tumor cells to the G0/G1 channel number of stromal cells. There was no significant difference in survival between patients with diploid tumors and those with aneuploid tumors (P = 0.322), although the survival rate was significantly lower in patients with a high DI (or = 1.5) than in those with a low DI (1.5) (P = 0.004). A multivariate analysis of prognostic factors using Cox's proportional hazard model showed that Dukes' staging was the strongest predictor of survival, followed by the DI of tumor cells, then histological differentiation. In conclusion, it is suggested that the DI of tumor cells is instructive for predicting the survival of patients with colorectal cancer.

The serum levels of intercellular adhesion molecule-1 (sICAM-1) and endothelial leukocyte adhesion molecule-1 (sELAM-1) were determined in 40 patients with colorectal cancer. The sICAM-1 and sELAM-1 levels in the drainage venous blood adjacent to a tumor were significantly correlated with those in the peripheral venous blood in patients without evident hematogenous dissemination of tumor cells. The sICAM-1 levels in peripheral venous blood were significantly higher in patients with hepatic metastases, while the sELAM-1 levels were significantly higher in those with pulmonary metastases. An immunohistochemical study of metastatic sites in the liver revealed that ICAM-1 was expressed in cancer stroma, but not in the cancer cells. In conclusion, the sICAM-1 and sELAM-1 levels in the peripheral venous blood in colorectal cancer patients without any distant metastasis are likely to reflect the topical production of these cell adhesion molecules, and appear to be instructive in predicting hematogenous dissemination in patients with colorectal cancer.

Electrochemotherapy is a novel antitumor treatment involving the systemic administration of bleomycin followed by the delivery of electrical pulses to the tumor. The present study investigates the effects of electrochemotherapy on the growth of colon 26 cells inoculated subcutaneously into the backs of BALB/c mice. The mice were divided into the following four experimental groups: 20 that received no further treatment after the inoculation of colon 26 cells (control group); 20 that received 500 micrograms of bleomycin intraperitoneally 7 and 9 days after the inoculation (BLM group); 20 that received electric pulses to the tumor 7 and 9 days after the inoculation (EP group); and 30 that received electrochemotherapy 7 and 9 days after the inoculation (ECT group). During 28 days of observation, no deaths due to tumor progression occurred in the ECT group, but there were 18 in the control group, 11 in the BLM group, and 18 in the EP group. While weight loss was observed in all groups, it was most remarkable in the control group. Tumor growth was significantly inhibited in the ECT group, compared to the other experimental groups (P0.01). The results of this study demonstrated that electrochemotherapy significantly inhibited the growth of colon 26 tumors in mice, without causing any remarkable adverse effects.

Immunohistochemical staining of p53 was performed using an anti-p53 mouse monoclonal antibody, Pab1801, on 67 colorectal adenocarcinoma specimens to determine the prognostic value of p53 in colorectal cancer patients. Of a total of 67 tumors examined, p53 was detected in 34, but the rate of positive staining for p53 did not correlate with the clinical stage of disease. In 59 patients undergoing curative resection of the tumor, there was no significant difference in the recurrence rate (P = 0.137) or the disease-free survival rate between 28 patients with p53 positive tumors and 31 with p53 negative tumors (P = 0.135).

The bromodeoxyuridine (BrdU) labeling index was determined in 40 primary colorectal carcinomas by DNA flow cytometry using a BrdU-specific monoclonal antibody. The labeling index, or the fraction of cells in the S-phase of the cell cycle, ranged from 12% to 52%, with a mean of 28% (SEM, 2%). The labeling index in 19 patients was over 30%, which was termed a higher labeling index. There was no significant difference in the labeling index based on the clinical stage of the disease. During the 5-year follow-up after the apparently curative resection, 14 patients died of the disease, 1 died of an unrelated cause, 1 is alive with a recurrence of the disease, and 24 are alive without the disease. The higher labeling index was thus associated with a significantly poorer patient survival (P = 0.03 based on the generalized Wilcoxon test). The present study therefore disclosed that the S-phase fraction of tumor cells thus determined had prognostic significance in primary colorectal carcinoma.

This article presents a case of advanced cancer of the transverse colon seen in an 18-year-old woman who underwent a potentially curative resection. The histological type of cancer was well-differentiated adenocarcinoma. After reviewing the clinicopathological features of 110 colorectal cancer cases in patients younger than 20 years of age compiled from the Japanese literature, the high incidence of poorly differentiated carcinoma (51.5% for poorly differentiated adeno-carcinoma, signet-ring cell carcinoma, mucinous carcinoma, and undifferentiated carcinoma) and of more advanced stages (67.1% for clinical stages IIIb and IV) were found to be characteristic for patients with colorectal cancer younger than 20 years of age. The presence of more advanced disease and the high incidence of poorly differentiated carcinoma thus seem to be related to the low postoperative survival rates. The 2-year survival rate was 19.8% and the 5-year survival rate was 8.8% in colorectal cancer patients younger than 20 years of age.

DNA ploidy and expression of the c-myc oncoprotein p62 and the v-H-ras oncoprotein p21 were examined in 54 colorectal carcinomas. DNA ploidy, determined by DNA flow cytometry, was diploid in 19 samples and aneuploid in 35. Expression of the p62 oncoprotein, determined by immunohistochemical staining, was intensely positive in 18 samples while that of the p21 oncoprotein, also determined by immunohistochemical staining, was positive in 29. There was no correlation between DNA ploidy and expression of the p62 oncoprotein, and DNA ploidy did not correlate with expression of the p21 oncoprotein. There was, however, a close correlation between expression of the p62 oncoprotein and that of the p21 oncoprotein being P

The serum levels of NCC-ST-439, a monoclonal antibody raised against a human gastric cancer xenograft (ST-439), were determined in 28 patients who had undergone a curative resection of Dukes’ C colorectal carcinoma. The preoperative mean levels of NCC-ST-439 were 14.4 U/ml (range 1.0–280.0) and positive (>7.0 U/ml for women under the age of 49, >4.5 U/ml for women over the age of 50, and ment at any age) in 6 patients. Recurrence of the disease after a curative resection was encountered in 7 patients (serum NCC-ST-439 was positive in 5 and negative in 2 patients). The positive serum NCC-ST-439 was associated with a significantly poorer disease-free survival time (P

The DNA index (DI), defined as the ratio of the G0/G1 channel number of tumor cells to the G0/G1 channel number of stromal cells, was analyzed in 121 aneuploid colorectal cancers. In patients with aneuploid tumors, a high DI significantly correlated with tumor penetration beyond the proper muscle layer, positive vascular invasion, and the presence of liver metastasis. This observation led us to conclude that a high DI is likely to be associated with hematogenous dissemination in aneuploid colorectal cancer.