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(Objective) We investigated the prognostic significance of intraductal carcinoma of the prostate (IDC-P) in radical prostatectomy specimens. (Materials and methods) We evaluated 441 patients treated with radical prostatectomy and analyzed data on IDC-P, lymph node metastases, Gleason score, seminal vesicle invasion, extraprostatic extension, surgical margin, total cancer volume, and zonal origin of dominant cancer focus in radical prostatectomy specimens. The median follow-up was 50 months (range 6-164 months). (Results) We identified IDC-P in 112 cases (25.4%). The five-year biochemical progression-free survival rate in patients with IDC-P was significantly lower than for those without IDC-P (35.8% vs 69.6%; p<0.0001). In a univariate analysis, IDC-P (p<0.0001), lymph node metastases (p=0.0022), Gleason score (p<0.0001), seminal vesicle invasion (p<0.0001), extraprostatic extension (p<0.0001), surgical margin (p<0.0001) and total cancer volume (p<0.0001) were significantly associated with the biochemical progression-free survival. In a multivariate analysis, Gleason score (p<0.0001), IDC-P (p=0.0002), seminal vesicle invasion (p=0.0011), extraprostatic extension (p=0.0012), surgical margin (p=0.0019) and lymph node metastases (p=0.0402) were significantly associated with biochemical progression-free survival. (Conclusions) The presence of IDC-P is an independent factor of biochemical recurrence in prostate cancer patients treated with radical prostatectomy. We therefore recommend that the presence of IDC-P in radical prostatectomy specimens be reported.

A 26-year-old woman, who developed ALL when she was eighteen years old, achieved remission after chemotherapy. Her ALL relapsed when she was twenty-two years old. After re-induction therapy, she underwent cord blood transplantation. Her bone marrow examination on the 42nd day revealed a lymphoblast count of 16%. She was observed without any therapy, but her bone marrow blast count continued to be around 6% for three years without any symptoms. The bone marrow blast fraction originated from the cord blood. Surface marker analysis of the blast fraction initially revealed a pattern of hematogones that was CD10 and CD19 positive, but then showed a myeloblast pattern that was CD13 and CD33 positive. AML developed as donor cell leukemia. When blasts appear in the early phase after transplantation and persist, an observation period is necessary with molecular chimerism, morphology, and surface marker analysis of the blast fraction to consider relapse, hematogones, or donor cell leukemia.

We reviewed risk factors of recurrence in resected pathological stage I non-small cell lung cancer (I NSCLC). Objective is 229 complete resected I NSCLC in our department. Risk factors of recurrence were carcinoembryonic antigen (CEA), histology, differentiation, lymphatic invasion, blood vessel invasion, pleural invasion and tumor size. By univariate analysis, lymphatic invasion (p=0.009), blood vessel invasion (p=0.008), pleural invasion, p1 (p=0.013), p2 (p=0.001), and tumor size (value of cut off was 2 cm) were significant risk factors of recurrence. By multivariate analysis, blood vessel invasion (p=0.004), pleural invasion (p1 or p2) [p=0.001], were significantly risk factors of recurrence. It was suggested that I NSCLC presenting pathological blood vessel invasion and/or pleural invasion should be recognized as cases with a high risk of recurrence, and a strict follow-up and adjuvant therapy should be in consideration.

The long-term results of a multi-institutional study were analyzed in 101 cases (27 with stage III and 74 with stage IV) with advanced head and neck squamous cell carcinoma (HNSCC) given S-1 administration for 6 months after definitive treatments. The 3-year disease-free survival rate was 66.3% in cases overall. In terms of the survival rates in two groups with different administration methods, i.e., 2-week administration followed by 1-week rest or 4-week administration followed by 2-week rest, there was no significant difference. The risk factors of relapse were examined by multivariate analysis. The relapse rate increased according to the advancement of N staging and the higher risk of distant metastasis in cases with laryngeal (especially, supraglottic type) or hypopharyngeal carcinomas. Now, the efficacy of S-1 administration as adjuvant chemotherapy after definitive treatments for advanced HNSCC is under investigation,and the adequate administration period of S-1 should be evaluated in a controlled randomized study in future.

A 66-year-old man visited our hospital complaining of a high prostate-specific antigen (PSA) (6.9 ng/ml) and dysuria. Prostatic needle biopsies revealed no malignancy in January 1998 and February 1999 (PSA 8.0 ng/ml). Transurethral resection of prostate (TURP) was performed in March 1999. Although none of the TURP specimen showed any malignancy, the PSA level remained high (3.7 ng/ml 1 year after the TURP), and gradually increased. About 3 years later, re-biopsy was done (PSA 13.2 ng/ml) and pathological finding was moderately differentiated adenocarcinoma (Gleason score 3 + 3 = 6). After 9-month MAB, radical prostatectomy (RP) was performed in January 2003 (PSA 4.2 ng/ml). Though the RP specimen showed moderately differentiated adenocarcinoma with negative capsule penetration and negative surgical margins, PSA decreased to 2.5 ng/ml and gradually increased. Computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy showed neither distant metastasis nor local recurrence. Review of the RP specimen revealed ductal carcinoma with positive capsular penetration and suspicion of positive surgical margins. Although the patient was treated with maximum androgen blockade, diethylstilbestrol diphosphate, and tegafururacil, PSA gradually increased and was kept at a high level (5-6 ng/ml). In December 2005, the patient complained of anal pain and MRI showed a 4.8 x 2.3 cm tumor in the prostatic bed. Needle biopsy of the tumor revealed ductal carcinoma (PSA 6.39 ng/ml). In January 2006 (PSA 11.9 ng/ml), we initiated a treatment with 66 Gy of intensity modulated radiation therapy. In November 2006, PSA decreased to 0.279 ng/ml, and the tumor reduced (3.8 x 1.0 cm) on MRI.

A 46-year-old man had undergone radical high orchiectomy because of a tumor of the right spermatic cord. Pathological diagnosis was atypical lipomatous tumor. Six years later, he had asymptomatic swelling in his right groin. Local recurrence was suspected, and surgical resection of the tumor with a sufficient surgical margin was performed. Pathological diagnosis was well-differentiated liposarcoma, sclerosing type. Ten cases of recurrent spermatic cord liposarcoma, including the present case, have been reported in Japan. Because of the possibility of local recurrence, spermatic cord liposarcoma needs strict and long-term follow up.

A Phase I study of docetaxel (DOC) and cisplatin (CDDP) combination therapy was conducted as second-line treatment for advanced squamous cell carcinoma of the head and neck in order to determine the maximum tolerated dose (MTD), the dose-limiting toxicity (DLT) of DOC, and the recommended dose (RD) for this combination therapy. Twenty patients with recurrence for whom failed first-line chemotherapy with CDDP and 5-FU proved in-effective (17 male, 3 female; age range 38-74 years; performance status 0=7, 1 =8, 2=5) were included in this study. DOC at dose level I (40 mg/m2), level II (50 mg/m2), level III (60 mg/m2) and level IV (70 mg/m2) was used, followed by CDDP administration at a fixed dose of 80 mg/m2. Originally, chemotherapy was repeated every 3 weeks. In level I, grade 4 hypokalemia occurred in one patient. No DLT occurred at level II. At level III, one patient experienced grade 4 vomiting. At level IV, grade 2 creatinine clearance decrease occurred in a total of two patients. The maximum tolerated dose in this combination therapy was DOC 70 mg/m2, and CDDP 80 mg/m2. The recommended dose for this combination therapy is DOC 60 mg/m2, and CDDP 80 mg/ m2. A multicenter cooperative phase II study in this RD is recommended.

About 70% of bladder cancers are superficial at the initial state. If diagnosed at an early stage, the tumor may be resected completely and easily. However, recurrence is seen in many cases. Prognostic factors of recurrence were investigated in 55 cases of bladder cancer newly diagnosed (excluding carcinoma in situ) between 1995 and 2003, and in which complete resection by transurethral resection (TUR) was possible at first recurrence after initial TUR. One- and three-year postoperative non-recurrence rates were 51.9% and 36.3%, respectively. None of the factors studied, i.e., stage, grade, tumor multiplicity (at initial and at first recurrence), change of stage and grade at first recurrence compared with that of initial TUR, duration to recurrence and adjuvant therapy after TUR, were found to influence the prognosis after recurrence. Similar results were obtained for third TUR. Recurred pTa, grade 1 or solitary cancer at initial or at recurrence had the same prognosis as pT1, grade 2-3 or multiple cancers, and careful follow-up is needed.

We report a case of recurring middle ear adenoma with bone formation that was histologically difficult to differentiate from adenocarcinoma. The patient was a 31-year-old female. Preoperative clinical and CT findings in the 31-years-old woman examined suggested benign tumor of the middle ear. Although intraoperative pathological examination indicated adenocarcinoma, tympanoplasty in canal reconstruction was done. Malignancy was not considered because the tumor had not increased in size for 1 year and no bone erosion had occurred in the ossicles or middle ear cleft. The definitive pathological diagnosis was middle ear adenoma. The tumor repeatedly recurred thereafter, closely resembling normal middle ear mucosa and making it difficult to remove completely. When middle ear adenoma is suspected, surgical procedures should be determined carefully based on radiological and intraoperative findings in tumor expansion.

From 1985 to 2002, 22 patients with local recurrence after radical mastectomy have been treated in our hospital. Resection was possible in 9 patients. We evaluated long-term prognosis of the 9 patients. The observation interval from first recurrence was 17-207 months (median 91.5 months). Five of the 9 experienced recurrence again. Opposite axillary lymph node metastasis was observed in 2, bone metastasis in 1, liver metastasis in 1, and lung metastasis in 1. Disease free interval (DFI) until the first recurrence of patients with a second recurrence was 69-100 months (median 90 months). The interval from first recurrence to second recurrence was 46-108 months (median 60 months). Each second recurrence occurred within double the DFI until the first recurrence. For all of the patients in which a second recurrence was not observed, the observed interval was shorter than the DFI until first recurrence. Local recurrence should be considered systemic disease. Many of the patients who underwent resection of the local recurrence experienced a second recurrence after longer observation. We believe that patients with local recurrence should be observed for a period of about double the DFI.

We report the effects and toxicities of intravenous administration of cisplatin, 5-FU and high-dose leucovorin for advanced esophageal cancer. Eight patients were registered and sixteen lesions were measurable. Of these sixteen lesions, thirteen were primary or synchronous metastatic lesions, and the response was 69%. Three were recurrence lesions, and the response rate for them was 0%. Including seven neoadjuvant cases, ten patients had oral mucositis, and seven patients had appetite loss. Other toxicities were diarrhea, myelosuppression, renal dysfunction, and alopecia. All were reversible after administration. It is suggested that this treatment regimen is a superior neoadjuvant chemotherapy with low toxicity.

Androgen-deprivation therapy is often the first choice of several therapeutic procedures for advanced prostate cancer. However, despite an initial response to androgen-deprivation therapy, the cancer eventually progresses from an androgen-dependent to an androgen-independent phenotype. Molecular mechanism of development to androgen-independence and recurrence during androgen-deprivation therapy remain unclear. The observation that heterogeneity of AR expression in prostate cancer correlates with malignancy suggests that androgen responsiveness plays an important key role in the progression of prostate cancer. Therefore, it is very important to consider the role of AR and mechanisms of relapse when we treat androgen-independent prostate cancer.

A 40-year-old female was referred to our hospital for dysphagia. A hemangioma measuring 5 x 2.5 x 2.5 cm was revealed as a round defect by esophagography and was partially cystic on CT and MRI. Through a neck incision, the esophageal wall on the tumor side was initially opened. The tumor partially adhered to the esophageal wall, but was dissected from the esophageal wall and then resected easily. Microscopic examination of tumor revealed cavernous hemagioma. Thirty days after the initial surgery, the recurrent tumor was detected in the pharynx and increased rapidly. Then a second operation was performed. The tumor was completely resected by mucosectomy including normal esophageal mucosa. Recurrence was caused by residual cystic wall of the hemangioma adhering to the esophageal mucosa after the first procedure.

We report a 3-year-old boy with acute myelogenous leukemia, who relapsed very early after peripheral blood stem cell transplantation (PBSCT). He was admitted with a tumor in maxillar sinus and hemorrhagic diathesis and was diagnosed as having acute myelogenous leukemia with t(8;21). He achieved complete remission with etoposide, cytosine arabinoside and mitoxantrone. After 8 courses of consolidation therapy and marrow ablative chemotherapy, he received PBSCT. G-CSF was given from day 0 because of severe infection. WBC and platelete counts rapidly increased, however, from day 20 platelet count spontaneously decreased. Concomitantly bone marrow examination revealed the presence of blastic cells. RT-PCR showed that the presence of AML 1/MTG 8 chimera mRNA in the cryopreserved PBSC samples. In vitro analysis also revealed that leukemic cells had G-CSF receptors and increased 3H-thymidine uptake in the presence of G-CSF. These findings strongly suggest that the reinfusion of leukemic cells in PBSC and the administration of G-CSF after PBSCT might be relevant to early relapse in this patient.

A total of 205 patients with primary superficial bladder cancer (Ta, T1) followed more than 3 years were retrospectively analyzed for factors related to recurrence of tumors after transurethral resection. Patients age were 25 to 90 years old, average 61 years old, and there were 160 males and 45 females. Initial tumor grades were G0 in 4 patients, G1 in 48, G2 in 134 and G3 in 19. Seventy four patients had Ta tumor and 131 had T1. Initial treatments were transurethral resection (TUR) alone in 137 patients. TUR with intravesical chemotherapy in 64, with BCG therapy in 7 and others in 7. Factors examined included age, sex, chief complaint, shape, size, and number of tumors, tumor distribution (single area or multiple area), histological grade, stage and intravesical chemotherapy. Overall non-recurrent rate were 81.7% at 1 year, 60.7% at 3 year, 53. 8% at 5 year and 44.2% at 8 year. Five-year non-recurrent rate according tumor factors, showed significant difference regarding tumor size (< 1 cm or 1 cm <: P = 0.027), tumor number (single or multiple: P = 0.004), tumor distribution (single area or multiple area: p = 0.002), histological grade (< G1 or G2 < : p = 0.001) and stage (Ta or T1: p = 0001). However, there were no significant difference regarding factors of age, sex, chief complaint, tumor figure and presence or absence of intravesical chemotherapy. This results suggested that the tumor factors of size, number, tumor distribution, grade and stage were highly related to intravesical tumor recurrence of superficial bladder cancer.

Ninety-eight patients with advanced gastric cancers underwent gastrectomy from Jan. 1989 to Dec. 1991. For these patients, preoperative intra-arterial injection therapy using EAP-II (etoposide 100 mg, epirubicin 20 mg, carboplatin 100 mg) was given to 24 patients. In this report, the recurrence and survival rate of these patients were investigated. After curative resection, the survival rate of patients with EAP-II 36 months after operation was 76.9%, while that of patients without EAP-II was 78.6%. There were no significant differences between these two groups. Two peritoneal carcinomatoses and two liver metastases were seen in patients with EAP-II (recurrence rate, 30.7%). Eight recurrences were observed in patients without preoperative injection therapy (peritoneal dissemination, 4; local recurrence, 3; lymph node recurrence, 1). Previously, we reported that drugs were remarkably accumulated in gastric cancer tissue and regional lymph nodes after EAP-II intra-arterial injection therapy. This high accumulation might cause no local or lymph node recurrence was seen in patient with EAP-II. Thus, it was concluded that preoperative EAP-II intra-arterial injection may prevent local and lymph node recurrences, and that further study of the combination and dose of anti-cancer drug needed to improve the postoperative survival rate in advanced gastric cancer patients.

More than 80% of malignant gliomas have been reported to recur locally after conventional chemoradiation therapy. This regional pattern of recurrence has encouraged the introduction of new treatments for local tumors. Since 1987 interstitial brachytherapy using Iridium-192 seeds has been carried out in our department for malignant brain tumors. The present study was designed to evaluate the patterns of recurrence following interstitial brachytherapy and to assess how this recurrence differs from that observed in patients treated by conventional means. Ten patients who satisfied the following criteria were selected among 41 patients treated with brachytherapy. The criteria were; 1) histologically diagnosed to be malignant glioma (astrocytoma grade III or glioblastoma), 2) followed up with MRI every month after the brachytherapy, 3) follow-up period was more than 6 months, and 4) the time of recurrence was confirmed. The patients were classified into 3 groups according to the patterns of tumor recurrence as follows; 1. Local recurrence group: The tumor recurred near the pretreatment tumor site. 2. Necrotomy group: Reoperation was performed because of neurological deterioration and radiographic evidence of increasing mass effect with surrounding edema. Neurological symptoms were unchanged or improving during the 6 months after the reoperation. 3. CSF seeding group: Primary tumor was well controlled, but seeding via cerebrospinal fluid was recognized on MRI. Local recurrence occurred in three patients, necrotomy was carried out in three patients, and CSF metastases were defined by both MRI and clinical symptoms in four patients. Median radiation does was 33 Gy in the local recurrence group, 57.6 Gy in the necrotomy group, and 43.2Gy in the CSF seeding group.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of duodenogastric reflex on the development of residual stomach cancer and cell proliferation kinetics were investigated in Wistar rats. Billroth II resection (B-II group) was performed on 24 rats and Billroth I resection (B-I group) was performed on 22 rats. The incidence of cancer in the B-II group was 20.8%, though no cancer was noted in the B-I group. The incidences of the pseudopyloric gland, dilated gland and gastritis cystica profunda in the B-II group were significantly higher than those in the B-I group. The degree of mucosal atrophy was greater in the B-II group than in the B-I group. The stomal area in the B-II group had expansion of proliferative zone as well as increased S-phase duration and turn over time, compared with those in the B-I group. The sequence of histological and proliferative events associated with duodenogastric reflux suggests that the residual stomach in the B-II group is susceptible to the development of cancer.

In order to prevent local recurrence, intra-operative pelvic hyperthermochemotherapy (IOPHC) combined with surgery for rectal cancer has been performed. In this study, we evaluated the clinical effect of IOPHC in 20 patients who were given IOPHC, compared with 13 patients who underwent curative surgery without IOPHC (control group). The IOPHC procedure was as follows: After rectal amputation, the pelvic cavity was filled with a physiological saline containing 40 micrograms/ml of MMC. Then, the physiological saline was warmed and maintained by the apparatus (heater) we devised at 45 degrees C for 90 minutes. Local recurrence occurred in 2 cases of IOPHC group (2/20:10.0%), and in 3 cases in the control group (3/13:23.1%). On the other hand, distant metastases developed approximately at the same rate in the IOPHC group (4/20:20.0%) and control group (2/13:15.4%). Thus, IOPHC is a feasible approach to reduce local recurrence of rectal cancer.

Benign Mesenchymoma of the chest wall is very rare neoplasm. We report a case of the tumor. The patient is a 64 year-old male, whose tumor was removed on 1978. Histologically, the tumor was diagnosed as benign mesenchymoma. However, 8 years after the last operation, the tumor recurred in the right chest wall. The tumor was 4.5 X 4.0 cm in size and was removed smoothly n Nov. 1986. It was composed of fat tissue, blood vessels and smooth muscles. One year and two months later, the patient is alive without recurrence.

Between 1962 and 1982, 273 patients underwent sphincter saving resection for rectal cancer in my hospital. In 30 of these patients, local anastomotic recurrence was observed (11%). Computer analysis of 64 variables was undertaken to identify factors contributing to the anastomotic recurrence, especially in reference to the resecting line from the tumor, safety margin (AW). The present study shows no positive relationship between the length of normal bowel resected below the tumor, if it overs 2cm in advanced case, and anastomotic recurrence. We advocated the principle that "safety margin should be 4 or 5 cm in the advanced case". But this principle must now be changed. There appears every justification to carry out a curative sphincter saving procedure, resecting a shorter length of rectum -3cm (in vivo)- below the tumor in order to spare the patient a permanent colostomy. But, Borrmann 3 type, annular growth, severe serosal invasion, and undifferentiated or mucinous feature of cancer are the predominant factors associated with anastomotic recurrence and demand the longer length of safety margin as well as extended Miles operation. The causes of anastomotic recurrence in 30 patients have been investigated and searched for respectively. The recurrence in 9 of them seemed to be very unexpectedly and implantation might, therefore, be responsible for it.

Clinical data from 131 patients who underwent primary radical operation for breast cancer at the Second Department of Surgery, Shinshu University Hospital during five-years from January 1976 to the end of December 1980 were analyzed to investigate for the relationship between biopsy and prognosis. The incisional biopsy group had a significant higher recurrence rate as compared with the no biopsy group, cytology group and the cancer negative group after excisional biopsy. Although the puncture aspiration cytology group did not show significant difference in recurrence rate, an any more than 3 weeks of interval between puncture aspiration cytology and radical surgery associated with a significant high recurrence rate. This suggests that the interval also exerts an unfavorable influence upon prognosis. Puncture aspiration cytology was recognized to be apt to result in distant metastasis than any other biopsy methods and also it is tended to have a higher recurrence rate in scirrhous and mucinous carcinoma of the breast.