Search

白線ヘルニアは白線の腱膜繊維の間隙より発生するヘルニアで,本邦においては比較的稀な疾患とされる.今回われわれは外傷を契機として発生したと考えられた高齢者白線ヘルニアの1例を経験したので報告する.症例は87歳の男性. 1997年に転落事故にて左肋骨骨折を起こしていた. 1998年より上腹部腫瘤を自覚していたが放置していた.腫瘤の増大と違和感を認めたため, 2005年2月,当科を受診した.腹部超音波およびX線CT検査にて白線ヘルニアが疑われた.外科的治療が施行されたが,白線に約15×10mmの欠損を認めた.腹膜前脂肪織とヘルニア嚢の脱出を認め,腹膜前脂肪織は絞拒されていた.ヘルニア門は小さく,単純閉鎖した. 70歳以上の白線ヘルニアは本邦では自験例を含め, 15例しか報告されていない.その中では,嵌頓もしくは絞据症例が7例 (47%) と約半数にみられ,高齢発症例では嵌頓もしくは絞扼の可能性を念頭に置き対処が必要であると考えられた.

1997年4月から2005年3月までの8年間に当科で外科的治療が行われた原発性上皮小体機能亢進症35症例の臨床的検討を行ったので報告する.男性は4例,女性は31例で全体の平均年齢は61.7歳であった.発見の契機は健診での無症候性高カルシウム血症が19例(54.3%)と最も多かった.臨床型別では,化学型が22例(62.9%),腎・骨型が13例(37.1%)であったが,両者間で生化学検査所見の有意差は認められなかった.病理組織診断では腺腫,過形成はそれぞれ28例(80%), 7例(20%)であった.画像診断での術前局在診断は, X線CT検査,超音波検査, RI検査それぞれ全体で91.4%, 51.4%, 57.1%であった.腫瘍の局在部位は右下,左下が多かった.腫瘍の最大径は,腺腫に比べ過形成の方が小さい傾向にあった.外科治療の成績は,腺腫の2例,過形成症例の3例で術後血清カルシウム・上皮小体ホルモンの高値が持続していた.合併甲状腺疾患で,乳頭癌を1例認めた.

乳腺葉状腫瘍は全乳腺腫瘍中0.3～0.9%とされるが,悪性葉状腫瘍は乳腺悪性腫瘍の中の0.24%と比較的稀とされる.今回,われわれは再発を繰り返すうちに悪性化したと考えられた巨大乳腺葉状腫瘍の1例を経験したので報告する.症例は56歳,女性. 1983～2002年までの19年間に,いずれも同側の乳腺線維腺腫の診断で腫瘍摘出術が3回行われていた. 2005年4月に同側の巨大乳腺腫瘍を主訴に来院した.腫瘍は大きさ12×10cmであり,右乳腺全体を占めるほどであった.穿刺吸引細胞診にてclass III, 乳腺線維腺腫の疑いであったが悪性腫瘍の合併も否定できなかったため,非定型的乳房切除術が施行された.病理組織学的所見での診断はlow grade malignantの乳腺葉状腫瘍であったが,リンパ節転移は認めなかった.本疾患は,線維腺腫との鑑別診断が穿刺吸引細胞診,病理組織診断でも難しい場合がある.本症例も線維腺腫の診断で核出術を施行したが,結果的には葉状腫瘍が再発を繰り返すうちに悪性化したと考えられ,診断・治療が難しかった1例であった.

Oxidative DNA damage caused by reactive oxygen species (ROS) generated by Helicobacter pylori (H. pylori) infection or smoking may be a cause of gastric cancer development. 8-Hydroxydeoxyguanine (8-OHdG) formation is one of the most common types of oxidative DNA damage, while human oxoguanine glycosylase 1 (hOGGl) is responsible for repairing 8-OHdG lesions. Among several hOGGl gene polymorphisms, the SerCys polymorphism at position 326 is related to biological function. To investigate the association between Ser326Cys hOGGl polymorphism and gastric cancer in relation to the potential risk factors of gastric cancer and antioxidant dietary or nutrient intakes, we conducted a case-control study with 142 histologically-confirmed gastric cancer cases and 271 age, sex-matched healthy controls in Japanese populations. Overall, neither the hOGG1 Ser/Cys nor the Cys/Cys genotype was associated with risk of gastric cancer, compared with the Ser/Ser genotype. A significant interaction was observed between hOGGl Ser/Cys or Cys/Cys genotype and atrophic gastritis (P for interaction =0.03). No significant interaction was found between hOGGl genotype and antioxidant dietary or nutrient intakes. The results of the present study suggest that patients with atrophic gastritis in conjunction with the hOGGl Cys allele might have a higher susceptibility to gastric cancer.

Although Helicobacter pylori infection is a major risk factor for gastric cancer, it does not explain the full picture of stomach carcinogenesis. There have been few epidemiological studies, however, which examined both H. pylori and environmental factors simultaneously. The aims of this study were to estimate the association of environmental factors (smoking and dietary factors) with gastric cancer in consideration of H. pylori infection, and to investigate the effects of the interaction between environmental factors and H. pylori infection.A multicenter, hospital-based, case-control study of gastric cancer was conducted at four hospitals in Nagano prefecture, Japan, between October 1998 and March 2002. For 153 newly diagnosed gastric cancer cases, two controls matched by age (within 3 years), sex, and residence area were randomly selected from the participants of a health check-up program during the same period in the same hospitals. We conducted a questionnaire survey and obtained blood samples. Consequently, 122 non-cardia gastric cancer cases and 235 controls were available for this analysis.Results. H. pylori infection was strongly associated with non-cardia gastric cancer after adjustment for possible confounding factors (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.7-18.2). Cigarette smoking (OR, 2.8; 95% CI, 1.2-6.5) and frequent intake of miso (fermented soy bean) soup (OR, 2.1; 95% CI, 0.9-5.1) and rice (OR, 2.5; 95% CI, 1.0-6.1) were determined to be risk factors even after adjusting for possible confounding factors, including H. pylori infection. However, no statistically significant interaction between environmental factors and H. pylori infection was detected.This finding suggests that although H. pylori infection is clearly an important risk factor for gastric cancer, smoking cessation and dietary modification may be practical strategies for the prevention of non-cardia gastric cancer among both H. pylori-positive and -negative subjects in Japan.

乳癌は発見時の腫瘍の大きさ,所属リンパ節転移数などにより,外科治療後の予後が大きく左右されるため,早期発見,早期治療が重要である.今回われわれは1997年4月から2003年9月までの6.5年間の当院人間ドックでの視触診による乳癌検診の成績および外科治療を含めた臨床的検討を行った.総受診者数は15,683人で,平均年齢は51.4歳であった.要精検者数は543人(3.46%),乳癌発見数は15人(0.10%),陽性反応的中率は2.76%であった.最大腫瘍径が2 cm以下の乳癌は13例(87%)であった. 15例の組織型は硬癌が7例(46%),乳頭腺管癌が3例(20%),充実腺管癌が2例(13%),粘液癌,髄様癌,小葉癌がそれぞれ1例(7%)と,低分化の硬癌が最も多かったが,リンパ節転移では12例(80%)が陰性であり,早期の乳癌が多かったことを裏づける結果であった.予後はn1βの1例が再発死亡した以外,現在無再発生存中である.発見乳癌に占める最大腫瘍径2 cm以下の乳癌の割合が87%と高率であったことは乳癌からの救命という乳癌検診の目的と合致しており,当院の乳癌検診の状況は妥当なものであると考えられた.

甲状腺乳頭癌初回手術後35年目に上腹部皮下に単発の転移性腫瘍をきたした1例を経験したので報告する.症例は73歳の女性.甲状腺乳頭癌で35年前に甲状腺全摘術および頸部リンパ節郭清術が行われた.上腹部皮下の腫瘍は15×15mm大で,比較的軟らかく,可動性良好であった.穿刺吸引細胞診ではclass V,甲状腺乳頭癌からの転移が疑われた.頸部リンパ節,骨,肺転移を認めなかったため,腫瘍が摘出された.低分化の甲状腺乳頭癌であり,サイログロブリンの免疫染色にて陽性所見であった.甲状腺乳頭癌の血行性遠隔転移は舌,皮膚,脳などの報告が散見されるが,稀であり,本症例も血行性転移が推測された.

乳腺原発内分泌細胞癌は稀な腫瘍であるが,われわれはその1例を経験したので報告する.症例は66歳女性で主訴は右乳腺腫瘤であった.超音波検査所見,マンモグラフィ検査所見では境界明瞭で良性腫瘍が考えられた.穿刺吸引細胞診検査では血性内容液が見られ, class IIあるいはIIIであったため,確定診断の目的で腫瘍摘出術が施行された. HE染色による病理組織学的所見およびクロモグラニンA染色の陽性所見に加えて,戻し電顕検査にてdense core-granuleが確認されたため乳腺原発内分泌細胞癌と診断された.

We assessed the possible association of gastrointestinal cancers with cruciferous vegetables and mushrooms in a multicenter, hospital-based case-control study in an agricultural area of Japan. One hundred forty-nine cases and 287 controls for stomach cancer and 115 cases and 230 controls for colorectal cancer were matched by age, sex, and residential area. In stomach cancer, the protective effect of vegetables (consumption of total vegetable) was obscure, but it became clearer when we examined specific kinds of vegetables. Marginal associations were observed in the group of the highest consumption of Chinese cabbage (odds ratio [OR] = 0.61; 95% confidence interval [CI] = 0.35-1.07), broccoli (OR = 0.60; 95% CI = 0.34-1.08), Hypsizigus marmoreus (Bunashimeji) (OR = 0.57; 95% CI = 0.31-1.04) and Pholita nameko (Nameko) (OR = 0.56; 95% CI = 0.30-1.06). In colorectal cancer, we observed decreased risks from the highest tertile of total vegetables (OR = 0.22; 95% CI = 0.08-0.66) and low-carotene-containing vegetables (OR = 0.28; 95% CI = 0.08-0.77), and inverse associations were observed in the group of the highest consumption of broccoli (OR = 0.18; 95% CI = 0.06-0.58). Although the sample size was limited, subgroup analyses showed that the associations differed with the histopathological subtype. These findings suggest that cruciferous vegetables decrease the risk of both stomach and colorectal cancer, and that mushrooms are associated with a decreased risk of stomach cancer.

症例は60歳,男性. 2001年9月,発熱,腹痛を主訴に当院入院.精査にて下部胆管癌と診断され2001年11月膵頭十二指腸切除術が施行された.切除標本にて胆管癌と別に胆嚢底部に25×20mm大の平坦浸潤型腫瘍を認めた.病理組織検査にて胆管癌は結節浸潤型腺癌,胆嚢病変は小細胞癌で,免疫染色ではグレメリウス,クロモグラニン, NSEが陽性であった.術後にCPT-11+CDDPの補助化学療法を施行し,無再発生存中である.胆嚢原発小細胞癌は稀な疾患であるが,切除後早期に再発をきたすため化学療法の併用を必要とする意見が多いが一定の見解は得られていない.また胆嚢小細胞癌報告例のなかでも胆管腺癌との同時性重複癌症例はなく,極めて稀な症例と考えられ報告する.

Nodal marginal zone B-cell lymphoma (NMZBL) occasionally represents prominent plasma cell differentiation. Recently, primary lymph node plasmacytoma has been suggested to represent an extremely plasmacytic differentiation of NMZBL. We here report a case of NMZBL showing histological features resembling plasmacytoma arising from a plasma cell variant of localized Castleman's disease (PCLCD). The patient was a 69-year-old Japanese female with a 20-year history of a right inguinal mass. Histologically, a prominent proliferation of plasma cells occupied the interfollicular area of the central portion of the lymph node, whereas centrocyte-like (CCL) cells were the main cellular component in the peripheral portion of the lymph node. Although most of the plasma cells were mature 'Marshalko-type', occasional atypical forms with enlarged nuclei were also present. The majority of the lymphoid follicles had atrophic or regressive germinal centers. A few lymphoid follicles were colonized by CCL cells. Immunohistochemistry study revealed that both plasma cells and some CCL cells had a monotypic intracytoplasmic lambda light chain. When monoclonal plasma cell infiltration is observed in PCLCD, the light chains are mostly restricted to the lambda chain. This case suggests that some plasma cell-containing tumors arising from PCLCD may represent a variant of NMZBL.

膵solid cystic tumorは若年女性に好発する比較的稀な疾患である.今回われわれはTurner症候群に併存した膵solid cystic tumorの1例を経験したので報告する.症例は35歳の女性で, 1999年8月健診での腹部超音波にて膵腫瘍を指摘され,当院受診.腹部CT, MRIから膵尾部solid cystic tumorと診断された.また低身長,原発性無月経があり染色体分析が行われたが46, X, i(q10)/45Xの性染色体異常を示し, Turner症候群と診断された. 2000年7月膵尾部切除が行われた.腫瘍は病理組織学的に膵solid cystic tumorであった.組織エストロゲンレセプター,プロゲステロンレセプターは陰性であり,本症例では膵solid cystic tumorの発現あるいは発育における女性ホルモンの関与は否定的であった. Turner症候群に合併する膵腫瘍は極めて稀とされるが文献的考察を加えて報告する.

甲状腺癌のほとんどを占める乳頭癌は分化度の高いものが多く,早期発見および適切な外科治療により治癒が期待できる.今回われわれは, 1997年4月から2002年3月までの5年間の当院人間ドックにおける触診での甲状腺癌検診の成績および外科治療を含めた臨床的検討を行った.発見率は総受診者25,139人中58人(0.23%)で,男性は17,443人中11人(0.06%),女性は7,696人中47人(0.61%)であった.最大腫瘍径が1cm以下のいわゆる微小癌は25例(43%)であった.組織型は乳頭癌は56例(96%)で,濾胞癌,髄様癌はそれぞれ1例(2%)であった.リンパ節転移陽性は27例(47%)に認められた.いずれも手術時合併症はなく現在再発を認めていない.人間ドックでの早期発見により侵襲,合併症が少ない治療が可能で患者のQOLは向上することが期待され,検診の意義は十分にあると考えられる.

症例は88歳,女性. 2001年6月腹痛を主訴に来院.右側腹部から右下腹部に圧痛,筋性防御を認めた.胸部・腹部単純X線写真ではfree airを認めなかったが,腹部造影CT検査にて右側後腹膜に広範な低吸収域を認めた.汎発性腹膜炎として開腹手術が行われた.十二指腸下行部外側に径3cm大の憩室とその穿孔を認め,憩室切除,縫合閉鎖およびドレナージが行われた.病理組織学的には切除された憩室は層構造が破壊され好中球浸潤とフィブリンの析出が著明であった.術後経過は良好であった. 十二指腸憩室は日常臨床上よく見られる疾患であるが外科的治療の対象となるものは稀である.興味深いCT所見を呈した十二指腸憩室穿孔の1例を経験したので若干の文献的考察を加えて報告する.

症例は75歳,男性. 1999年3月横行結腸癌に対して横行結腸切除(D2郭清)が施行された.病理組織学的に中分化腺癌, se, ly1, v0, n (-)であった. 2000年11月腹部CTで脾上極に径10mm大の低吸収域を認めた. 2001年4月脾腫瘍の増大と血清中CEA値の上昇を認めたため大腸癌孤立性脾転移と診断され, 2001年5月脾摘出術が行われた.病理組織学的に高分化腺癌で大腸癌の脾転移と診断された.術後CEA値は正常化したが,再手術3ヵ月後に肝両葉に多発転移を, 10ヵ月後に胸腔内転移を認めた.化学療法を施行しているが脾摘手術後14ヵ月経過した現在,坦癌生存中である.稀な大腸癌の孤立性脾転移の1例を経験したので文献的考察を加えて報告する.

While the global methylation level of leukocyte DNA may be a suitable biomarker for cancer risk, the level may be influenced by multiple factors, both environmental and host-related, one of which is exposure to environmental pollutants. To date, three epidemiologic studies have examined associations between serum organochlorine levels and global DNA methylation level, but their findings are not fully consistent, and the associations thus require confirmation in other well-characterized populations. We tested the association between organochlorine exposure and the global DNA methylation level of leukocytes in Japanese women. We conducted a cross-sectional study using the control group of a breast cancer case-control study in Japan. Subjects were 403 Japanese women who provided blood samples. Serum polychlorinated biphenyls (PCBs) and nine pesticide-related organochlorines were measured by gas chromatography isotope-dilution high-resolution mass spectrometry. Further, global methylation level of peripheral leukocyte DNA among 399 women was measured by luminometric methylation assay. Linear trends in the association between methylation and quartile levels of organochlorines were evaluated by regression coefficients in a multivariable linear regression model. We found significant inverse associations between the global methylation level in leukocyte DNA and many of the organochlorine levels measured. Global methylation level was significantly decreased by 0.33-0.83% per quartile category for serum o,p'-dichlorodiphenyltrichloroethane (o,p'-DDT), p,p'-DDT, p,p'-dichlorodiphenyldichloroethylene, trans-nonachlor, oxychlordane, hexachlorobenzene, β-hexachlorocyclohexane, PCB17, PCB52/69, PCB74, PCB114, and PCB183. Serum organochlorine levels were inversely associated with the global methylation level of leukocyte DNA in a relatively large sample of Japanese women.

The 'Clinical Guidelines for Obstetrical Practice, 2011 edition' were revised and published as a 2014 edition (in Japanese) in April 2014 by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction of burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. The number of Clinical Questions and Answers items increased from 87 in the 2011 edition to 104 in the 2014 edition. The Japanese 2014 version included a Discussion, a List of References, and some Tables and Figures following the Answers to the 104 Clinical Questions; these additional sections covered common problems and questions encountered in obstetrical practice, helping Japanese readers to achieve a comprehensive understanding. Each answer with a recommendation level of A, B or C was prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' was weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 104 Clinical Questions and Answers items, with the omission of the Discussion, List of References, and Tables and Figures, are presented herein to promote a better understanding among English readers of the current standard care practices for pregnant women in Japan.

54歳の女性で,平成9年9月5日に胃下部から上部に及ぶ全周性の4型の癌に対して膵体尾部脾合併切除を伴う胃全摘術 (D3), 胆嚢摘除術, Roux-en Y吻合を施行した.総合および病理組織学的所見は, LMU, Circ, 4, T4 (膵被膜), N1, H0, P0, CY0, M0, PM (-), DM (-), porl, sci, INFγ, ly2, v1, stage IIIb, 根治度Bであった.補助化学療法としてMTX-5Fu交代療法を施行後,外来でUFT-Eの経口投与を行っていたが,平成10年7月頃より頻尿,尿失禁の症状が出現した.膀胱壁はびまん性に肥厚し,コンプライアンスが低下し,萎縮性膀胱炎の様相を呈していたが,膀胱鏡下の生検で胃癌からの膀胱転移と診断された.胃癌からの膀胱転移は比較的稀で,播種によるものが多いとされる.手術後血尿や頻尿,尿失禁などの膀胱症状を認めるときは,膀胱への転移も念頭に置き,経過観察を行う必要がある.

Papillary carcinoma of the thyroid is a common thyroid malignancy with a relatively good prognosis. However, distant metastases may develop and become threatening, particularly to older patients, in a more aggressive manner. We report herein the clinical, radiological, and pathological findings of a patient with papillary thyroid carcinoma who had a solitary cerebral metastasis. The patient had been suffering from depression and had already undergone a hemithyroidectomy for primary thyroid carcinoma, and was known to have metastatic thyroid carcinoma of the lungs and bone. After the removal of the remnant thyroid gland prior to radioiodine (131I) therapy, he developed additional problems related to depression. Electroencephalography played an important role in identifying suspected brain metastasis and computed tomography demonstrated a space-occupying lesion in the left cerebral hemisphere. Consequently, an early removal of intracranial mass could be performed without any further life-threatening complications. Moreover, after removal of the brain mass the patient's depression improved immediately without the use of any antidepressants. This case report indicates the possibility that a patient's depression might be associated with brain metastasis from papillary thyroid carcinoma, and also suggests that an early diagnosis with the appropriate surgical management of a brain metastasis followed by radioiodine therapy could be valuable for achieving a prolonged disease-free period.

The concentration of thyroglobulin (Tg) measured by radioimmunoassay (RIA) or enzyme-linked immunosorbent assay (ELISA) is greatly affected by the presence of anti-Tg autoantibodies in sera. We developed a new assay for detecting Tg in the presence of high concentrations of anti-Tg autoantibodies. A 48-kDa fragment was purified from Tg after treatment with V8 protease. This fragment did not appear to bind to two types of monoclonal antibodies (57Ab and 28D3) against a peptide in the C-terminus (amino acids 2735-2748) of Tg and intact Tg, respectively, by ELISA and Western blot analysis. In contrast, anti-Tg autoantibody or anti-Tg polyclonal antibody reacted well with this fragment. Our new ELISA used 57Ab as a solid phase antibody and 28D3 as a antibody conjugated to horseradish peroxidase. Buffer containing purified 48-kDa fragment was used to neutralize autoantibodies against Tg. With this assay, the recovery of Tg was 84.0-89.6% in normal healthy donors (n=5) in the presence of immunoglobulin G (IgG) purified from sera positive for anti-Tg autoantibody, and 76.2-104.4% in patient sera Grave's disease (n=15). Furthermore, the Tg concentrations in sera from patients with Grave's disease (n=20) ranged from 25 to 526 ng/ml, even though the Tg concentration, as measured by a commercial RIA did not exceed 55 ng/ml. There was good agreement between Tg concentrations measured by new Tg-ELISA and commercial Tg-RIA in sera that were negative for anti-Tg autoantibody. Overall, our new ELISA containing a Tg fragment to neutralize the presence of autoantibodies, showed good sensitivity and precision, and may be useful for routine use. Further investigations with the new assay should allow wider assessment of the prevalence and pattern of thyroid autoimmunity or thyroid neoplasms.

Objective: To find out which factors predict recurrence of cancer in the remnant after unilateral thyroid lobectomy for patients with papillary cancer. Design: Retrospective study. Setting: Teaching hospital, Japan. Subjects: One hundred thirty-three patients with a clinically solitary papillary thyroid cancer who had unilateral lobectomy for the primary disease between 1966 and 1990 and were followed up for more than 60 months. Twelve patients had developed recurrences in the remnant gland by the time of the second operation and 121 patients had not as judged by a second operation, an ultrasound examination, or by palpation. Result: The primary tumour size in those who developed recurrences was significantly larger than in those who did not (p < 0.0001), and clinical signs of regional lymph node involvement or distant metastases were also significantly more common (p = 0.006). No patient died of their cancer. Conclusion: Size of the primary tumour is an important prognostic factor for recurrence of solitary papillary thyroid cancer in the remnant after unilateral lobectomy. Such recurrences are unlikely to be lethal.

A kindred with five members with papillary thyroid carcinoma is reported. The patients were three females and two males. The index patient was a 21-year-old man, whose mother had undergone a surgical therapy for papillary thyroid carcinoma in other hospital 8 years before his admission. In addition his elder brother with papillary thyroid carcinoma visited the hospital. Because of the family history, a screening study for thyroid disease was performed on other six members of the family and revealed that there were two patients with papillary thyroid carcinoma. One was a 49-year-old aunt of index patient and the other was a 79-year-old grand mother. The surgical treatments were performed for four out of these five patients in the hospital. It is believed that total thyroidectomy seems to be the choice of operation for papillary thyroid carcinoma with a familial occurrence. In these cases, however, we employed near total thyroidectomy to prevent from postoperative complications. A family screening study which may permit early detection of the disease should be continued strictly.

A chondromyxoid fibroma of the chest wall is a rare occurrence. A case study of a 40-year-old woman diagnosed with this tumor in the left chest wall is presented. The lesion was removed by video-assisted thoracic surgery (VATS), and the final pathology examination confirmed a chondromyxoid fibroma. At present, this patient has continued to visit our outpatient unit regularly and has shown no recurrence during the past 1 year.

A 45-year-old woman was seen at the hospital because of an antetior neck nodule pointed out at a recent medical checkup. The nodule was diagnosed as intrathoracic goiter by neck CT and MRI. She was also pointed out an abnormal shadow on a chest X-ray film. Chest CT demonstrated a huge lipodensity mass pressing the right middle lobe of the lung in the anterioinferior mediastinum. The clinical diagnosis was lipoma or thymolipoma arising from the mediastinum. Right lobectomy including intrathoracic part of the thyroid and an extirpation of the huge mediastinal tumor were performed. Histologically, the specimen of anterior neck tumor (256g) was adenomatous goiter and the specimen of the huge tumor (2000g) of the mediastinum was thymolipoma. Thymolipoma associated with intrathoracic goiter is very rare and this is the first case report as far as we could review.

We studied the expression of both fibroblast growth factor-2 (FGF-2) and FGF receptor-1 (FGFR-1) in various histological types of human thyroid neoplastic and hyperplastic tissues to clarify the biological behavior of FGF-2. A total of 37 malignant tumors (24 papillary carcinomas, 10 follicular carcinomas, 3 anaplastic carcinomas), 8 follicular adenomas, and 12 adenomatous goiters were examined by immunohistochemical methods. With immunohistochemical staining, both FGF-2 and FGFR-1 were frequently detected in human thyroid carcinoma (79.2 to 100% and 80 to 100%, respectively). In thyroid hyperplastic lesions such as adenomatous goiter, the FGF-2 immunoreactivity in follicular cells was detected in 2 of 12 adenomatous goiters (16.7%). In contrast, FGFR-1 immunoreactivity was detected in 66.7% of cases of this disease. The endothelial cells of microvessels in the stroma adjacent to the neoplasms and hyperplastic lesions also showed cytoplasmic FGF-2 immunoreactivity. The difference between FGF-2 and FGFR-1 expression in adenomatous goiters was statistically significant (P

In our therapeutic guidelines for anaplastic carcinoma of the thyroid, we first conduct either excision of the tumor (surgery) or open biopsy with radiation as local control to avoid asphyxy due to the increasing tumor, followed by chemotherapy. This study was designed to compare the therapeutic results retrospectively between the surgery group and open biopsy with radiation group. Subjects were 21 (3.1%) evaluable patients with anaplastic carcinoma from a series of 668 cases of primary thyroid carcinoma treated at the hospital in a recent 16-years from January 1980 to December 1995. Of these 21 cases, 10 cases underwent surgery (Group S) and 11 cases open biopsy with radiation (Group B). There was no significant difference between Group S and Group B in clinical factors such as age, tumor size, tumor extent, distant metastases, and treatments except for surgery. One year survival rate was 10.0% in Group S and 27.3% in Group B. Although there was no significant difference in the survival rate, Group B outnumbered Group S4 to 2 in long survival patients who survived more than one year. Moreover, though no significant difference was noted in local recurrence, a better influence on the patients' quality of life in Group B was evident. Therefore, the most effective strategy for anaplastic carcinoma of the thyroid at present is to perform open biopsy with radiotherapy followed by chemotherapy as soon as possible after diagnosis. Surgery should be permitted in only operable cases without resecting the surrounding organs.

We encountered a very rarc case of occult breast cancer associated with paraneoplastic sensory polyneuropathy. A 59-year-old woman was admitted to our hospital complaining of numbness in all extremities, ataxia of left extremities and a tumor in the left axilla. From the neurological findings, a malignant tumor was suspected. The immunohistochemical analysis of the axillar swollen lymph node revealed metastasis from breast cancer and confirmed the primary lesion. On a preoperative diagnosis of suspected occult breast cancer, left mastectomy and resection of left axillar lymph nodes were performed. Furthermore, immunohistochemical staining of sural nerves and Western blot analysis of the serum of this patient showed the loss of axons and the presence of antineural antibody in the seurm. Immunological response was considered to be the remote effector system between the breast cancer and sensory polyneuropathy in this disorder.

Phyllodes tumors are relatively rare neoplasms, accounting for less than 1% of all breast tumors and most of them are diagnosed as benign tumors on histological examination. We report a case of giant phyllodes tumor of the left breast which revealed high tumor marker lebel (CA15-3, CEA, BCA225) in serum. A 44-year-old woman was admitted to the hospital because of a giant tumor of the left breast. Blood examination showed elevated lebels of CA15-3, CEA and BCA225. Besides these elevated levels there were no malignant findings, with a diagnosis of phyllodes tumor the patient underwent a simple mastectomy. The excised tumor was 2838g in weight. Histologically, the most part of the tumor was benign, however a small part was malignant. Furthermore, an atypical epithelium resembling papillotubular carcinoma was shown in some part.

We report herein rare cases who developed hyperthyroid Graves' disease after surgical treatments for thyroid nodules. We have seen only 4 such cases in the course of 1680 consective cases (0.24%) of thyroidectomies in which partial thyroidectomy was carried out from 1966 to 1993. It is of interest that because 2 of these three cases (67%) were associated with positive TGHA and/or MCHA at the time of surgery, the presence of autoimmune thyroiditis may predispose to Graves' disease, but surgical treatment of the thyroid glands may not be related to the development of Graves' disease, because the hyperthyroid symptoms appeared 2 to 27 years (mean: 12 years) after the surgery.

This investigation was undertaken to clarify the effectiveness of endogenous TSH-suppression therapy with thyroxin (T4) for adenomatous goiter (AG) employing ultrasonography. Seventeen AG patients treated with T4 (50-100μg daily) during the past 7 years were enrolled in the present study. Serum TSH level of the all patients were continuously suppressed under 0.2μU/ml. Sixteen patients with AG only being followed-up periodically without suppression therapy during the same period, were served as control for the purpose of comparison. Ultrasonographical examination was carried out every 3-6 months. According to the change in the size of main thyroid nodule, all these patients were classified into 3 types as follows: D; apparent decrease more than 5mm in diameter of the nodule, I; increase of the nodule size more than 5mm, and NC; no significant change in diameter of the nodule. In the 17 patients having the TSH-suppression therapy with T4, D-type, I-type and NC type were noted in 3, 4 and 10 patients, respectively. Meanwhile, in the 16 control patients, three types were found in 3, 6, and 7 patients, respectively. There exist no significant differences in change of the main nodule size between the two groups. This clinical study indicates that endogenous TSH-suppression therapy for AG would not be effective.

Eight cases of pheochromocytoma experienced at the department in a recent 8-year period were subjected to a study on their clinical features. Plasma and urinary free catecholamines and urinary vanillylmandelic acid were estimated for biochemical diagnosis. Impaired glucose tolerance was found in 7 cases, and fasting insulin secretion was low only in the patients wih high level of urinary noradrenaline. The main modalities utilized for localization of the tumors were ultrasonography and computed tomography. All patients were treated with an α1-blocking agent for operative preparation. Patients with hypertension and tachycardia were treated with a combination of α1-blocking agent, β-blocking agent and calcium antagonist. The transabdominal approach was performed for surgical incision, and no complications were observed during and immediately after the operation. One patient with histopathologically diagnosed malignant pheochromocytoma, however, is still having high level of urinary catecholamines, of which probable causes are in study.

We report herein a case of hyperthyroid Graves' disease developed from asymptomatic autoimmune thyroiditis (AAT). A 25-year-old single female with AAT was followed up for over 3 years. Thereafter her condition progressed to hyperthyroidism with both positive TSH receptor antibodies (TRAb) and an increase in antithyroidal antibodies. It is possible that there was continuous destruction of thyroid epithelial cells without a hyperthyroid state, followed by production of TRAb, although Graves' disease very rarely develops from destructive thyroiditis including AAT.

症例は76歳男性, 血痰を主訴として来院し, 術前の喀痰細胞診から肺癌と診断し, 壁側胸膜, 心嚢合併切除を含む左肺下葉切除を施行した. 切除標本から腫瘍は肺原発の大細胞癌と診断した. 術後3年目に同側前胸壁に巨大腫瘤が出現し, 穿刺細胞診等を施行したが, 組織学的確定診断は得られなかった. 剖検から, 胸壁の腫瘍は病理組織学的には悪性リンパ腫であり, また免疫組織化学的染色からKi-1リンパ腫と診断した. 大細胞癌と診断した切除標本についても再検討したところ, 病理組織学的には悪性リンパ腫であり, 免疫組織化学的染色からKi-1リンパ腫と診断し, また臨床経過から原発部位は胸壁ではないかと推察された

Background Although global hypomethylation of leukocyte DNA has been associated with an increased risk of several sites of cancer, including breast cancer, determinants of global methylation level among healthy individuals remain largely unexplored. Here, we examined whether postmenopausal endogenous sex hormones were associated with the global methylation level of leukocyte DNA. Methods A cross-sectional study was conducted using the control group of a breast cancer case–control study in Nagano, Japan. Subjects were postmenopausal women aged 55 years or over who provided blood samples. We measured global methylation level of peripheral blood leukocyte DNA by luminometric methylation assay; estradiol, estrone, androstenedione, dehydroepiandrosterone sulfate, testosterone and free testosterone by radioimmunoassay; bioavailable estradiol by the ammonium sulfate precipitation method; and sex-hormone binding globulin by immunoradiometric assay. A linear trend of association between methylation and hormone levels was evaluated by regression coefficients in a multivariable liner regression model. A total of 185 women were included in the analyses. Results Mean global methylation level (standard deviation) was 70.3% (3.1) and range was from 60.3% to 79.2%. Global methylation level decreased 0.27% per quartile category for estradiol and 0.39% per quartile category for estrone while it increased 0.41% per quartile category for bioavailable estradiol. However, we found no statistically significant association of any sex hormone level measured in the present study with global methylation level of leukocyte DNA. Conclusions Our findings suggest that endogenous sex hormones are not major determinants of the global methylation level of leukocyte DNA.

Although approximately 20 common genetic susceptibility loci have been identified for breast cancer risk through genome-wide association studies (GWASs), genetic risk variants reported to date explain only a small fraction of heritability for this common cancer. We conducted a four-stage GWAS including 17 153 cases and 16 943 controls among East-Asian women to search for new genetic risk factors for breast cancer. After analyzing 684 457 SNPs in 2062 cases and 2066 controls (Stage I), we selected for replication among 5969 Chinese women (4146 cases and 1823 controls) the top 49 SNPs that had neither been reported previously nor were in strong linkage disequilibrium with reported SNPs (Stage II). Three SNPs were further evaluated in up to 13 152 Chinese and Japanese women (6436 cases and 6716 controls) (Stage III). Finally, two SNPs were evaluated in 10 847 Korean women (4509 cases and 6338 controls) (Stage IV). SNP rs10822013 on chromosome 10q21.2, located in the zinc finger protein 365 (ZNF365) gene, showed a consistent association with breast cancer risk in all four stages with a combined per-risk allele odds ratio of 1.10 (95% CI: 1.07-1.14) (P-value for trend = 5.87 × 10(-9)). In vitro electrophoretic mobility shift assays demonstrated the potential functional significance of rs10822013. Our results strongly implicate rs10822013 at 10q21.2 as a genetic risk variant for breast cancer among East-Asian women.

We evaluated the generalizability of a single nucleotide polymorphism (SNP), rs2046210 (A/G allele), associated with breast cancer risk that was initially identified at 6q25.1 in a genome-wide association study conducted among Chinese women. In a pooled analysis of more than 31,000 women of East-Asian, European, and African ancestry, we found a positive association for rs2046210 and breast cancer risk in Chinesewomen [ORs (95% CI) = 1.30 (1.22-1.38) and 1.64 (1.50-1.80) for the AG and AA genotypes, respectively, P for trend = 1.54 × 10 -30], Japanese women [ORs (95% CI) = 1.31 (1.13-1.52) and 1.37 (1.06-1.76), P for trend = 2.51 × 10 -4], and European-ancestry American women [ORs (95% CI) = 1.07 (0.99-1.16) and 1.18 (1.04-1.34), P for trend = 0.0069]. No association with this SNP, however, was observed in African American women [ORs (95% CI) = 0.81 (0.63-1.06) and 0.85 (0.65-1.11) for the AG and AA genotypes, respectively, P for trend = 0.4027]. In vitro functional genomic studies identified a putative functional variant, rs6913578. This SNP is 1,440 bp downstream of rs2046210 and is in high linkage disequilibrium with rs2046210 in Chinese (r 2 = 0.91) and European-ancestry (r 2 = 0.83) populations, but not in Africans (r 2 = 0.57). SNP rs6913578 was found to be associated with breast cancer risk in Chinese and European-ancestry American women. After adjusting for rs2046210, the association of rs6913578 with breast cancer risk in African Americans approached borderline significance. Results from this large consortium study confirmed the association of rs2046210 with breast cancer risk among women of Chinese, Japanese, and European ancestry. This association may be explained in part by a putatively functional variant (rs6913578) identified in the region. ©2011 AACR., link_to_OA_fulltext

Recent experience with a rare case of acinic cell carcinoma originating from the minor salivary gland, which metastasized to the lymph node in the submandibular region following repeated recurrence after the initial operation 30 years before, is reported here. The patient was a 66-year-old man. There were histories of undergoing the initial operation for a tumor in the right oral vestibule at elsewhere about 30 years before and the second operation for a tumor in the same region 5 years before, of which details were unknown. Recently the patient visited the hospital because of tumors of the submandibular region and minor salivary gland. Aspiration biopsy cytology of both tumors showed class IIIb. The right submandibular gland with the tumor and the tumor of minor salivary gland were therefore removed. The final histological examination showed the lymphnode metastasis in the submandibular region from the acinic cell carcinoma originating from the minor salivary gland. It is generally known that the acinic cell carcinoma of the salivary gland is relatively low grade malignant, although the recurrence rate isn't low. In this case reoperation for the radicality was not performed, because the patient and his family never hoped, where long-term follow up would be mandatory.

We observed a patient manifesting spontaneous hypothyroidism with thyroid stimulation blocking antibody (TSBAb) long after treatment with antithyroid drugs (ATDs) for hyperthyroid Graves' disease. A 19-year-old female with Graves' disease was treated with ATDs for approximately 2 years; after cessation of ATDs, hyperthyroidism did not recur. Nine years later, she was again seen in our hospital because of symptoms indicative of hypothyroidism. Thyroid hormone replacement was commenced after laboratory confirmation of hypothyroidism. TSH-binding inhibitor immunoglobulin and TSBAb were both positive, while thyroid stimulating antibody (TSAb) was negative, at the time of diagnosis of hypothyroidism. These results indicated that the alterations in thyroid function in this patient appeared to relate to the presumed decline in the activity of TSAb and the appearance of TSBAb years after ATDs administration had been discontinued.

症例は78歳,男性.食欲不振を主訴に当院入院となった.入院2週間後から腹痛,嘔吐が出現し腹部CTで内ヘルニアによるイレウスが疑われ開腹手術が行われた.開腹するとTreitz靱帯から130cmの位置で空腸が約30cmにわたり,横行結腸間膜に生じた径3cmの異常裂孔から網嚢内に嵌入していた.用手整復後,横行結腸間膜異常裂孔の縫合閉鎖が行われた.術後経過は良好であった.

Estrogen has been indicated to play an etiological role in the development of lung adenocarcinoma (ADC), particularly bronchioloalveolar carcinoma (BAC), a type of ADC that develops from a benign adenomatous lesion, atypical adenomatous hyperplasia (AAH). Polymorphisms in the CYP19A1 gene cause interindividual differences in estrogen levels. Here, 13 CYP19A1 single-nucleotide polymorphisms (SNPs) were examined for associations with lung AAH risk. AAH is detected as ground-glass opacity (GGO) by computed tomography (CT) examination, and this study consisted of 100 individuals diagnosed with GGO in their lungs among 3088 CT-based cancer screening examinees and 424 without. Minor allele carriers for the rs3764221 SNP showed an elevated risk for GGO [odds ratio (OR) = 1.72, P = 0.017]. Associations of this SNP with risks for lung AAH and BAC in the lungs were next examined using 359 ADC cases whose resected lung lobes were subjected to a histological examination for AAH accompaniment and the presence of BAC components and 330 controls without cancer. The ORs were also increased for lung ADC accompanied by AAH (OR = 1.74, P = 0.029) as well as lung ADC with BAC components (OR = 1.41, P = 0.091). The minor allele was associated with an increased circulating estradiol level (P = 0.079) in a population of 363 postmenopausal women without cancer. These results indicate that CYP19A1 polymorphisms are involved in the risk for lung AAH and BAC in the lungs by causing differences in estrogen levels.

A 72-year-old man underwent total gastrectomy for gastric carcinoma. Postoperative staging was Stage IA. One year after operation, abdominal CT revealed a metastatic tumor in the left lateral posterior segment of the liver. He was given S-1/ CDDP combination chemotherapy(S-1 120mg/body, day 1-21, CDDP 95mg/body, day 8)every 5weeks as first-line treatment. After 2 courses of the treatment, the liver tumor was not detected by PET-CT. The clinical response was assessed to be complete response. After total 5 courses of the treatment, we changed to a single administration of S-1(120mg/body, day 1- 14)every 3 or 4 weeks as second-line chemotherapy. The effect has been continued for 18 months after the initial metastasis. S-1/CDDP and S-1 chemotherapy are effective for metachronous liver metastasis from gastric carcinoma, although prognosis of the disease is poor.

Previous studies showing the presence of antibodies against tumor-associated antigens in healthy individuals suggest that antibody-dependent cell cytotoxicity (ADCC) might play a role in the development of breast cancer. We hypothesized that functional polymorphisms in fragment c gamma receptor (FcgR) genes were associated with breast cancer risk. We conducted hospital-based case-control studies of patients aged 20-74 years with invasive breast cancer, and matched controls from medical checkup examinees in Nagano, Japan and from cancer-free patients in Sao Paulo, Brazil. A total of 869 pairs (403 Japanese, 80 Japanese Brazilians and 386 non-Japanese Brazilians) were genotyped for two single nucleotide polymorphisms (SNPs): a histidine (H)/arginine (R) polymorphism at position 131 of FcgRIIa (FcgRIIa H131R) and a valine (V)/phenylalanine (F) polymorphism at position 158 of FcgRIIIa (FcgRIIIa F158V). We found no statistically significant association between either of the two SNPs and breast cancer risk regardless of population. In analyses of the three populations combined, adjusted odds ratio (OR) was 0.93 [95% confidence interval (CI) 0.66-1.32] for women with the R/R versus H/H genotype of the FcgRIIa H131R polymorphism and 1.04 (95% CI 0.69-1.57) for the V/V versus F/F genotype of the FcgRIIIa F158V polymorphism. On combination of the two SNPs, compared to women with both the R/R genotype of the FcgRIIa H131R polymorphism and F/F genotype of the FcgRIIIa F158V polymorphism, the adjusted OR for women with both the H/H and V/V genotype was 0.68 (95% CI 0.37-1.27). In conclusion, our findings suggest that ADCC might not play a major role in the etiology of breast cancer.

Genetic factors play an important role in the etiology of breast cancer. We carried out a multi-stage genome-wide association (GWA) study in over 28,000 cases and controls recruited from 12 studies conducted in Asian and European American women to identify genetic susceptibility loci for breast cancer. After analyzing 684,457 SNPs in 2,073 cases and 2,084 controls in Chinese women, we evaluated 53 SNPs for fast-track replication in an independent set of 4,425 cases and 1,915 controls of Chinese origin. Four replicated SNPs were further investigated in an independent set of 6,173 cases and 6,340 controls from seven other studies conducted in Asian women. SNP rs4784227 was consistently associated with breast cancer risk across all studies with adjusted odds ratios (95% confidence intervals) of 1.25 (1.20-1.31) per allele (P = 3.2 x 10(-25)) in the pooled analysis of samples from all Asian samples. This SNP was also associated with breast cancer risk among European Americans (per allele OR = 1.19, 95% CI = 1.09-1.31, P = 1.3 x 10(-4), 2,797 cases and 2,662 controls). SNP rs4784227 is located at 16q12.1, a region identified previously for breast cancer risk among Europeans. The association of this SNP with breast cancer risk remained highly statistically significant in Asians after adjusting for previously-reported SNPs in this region. In vitro experiments using both luciferase reporter and electrophoretic mobility shift assays demonstrated functional significance of this SNP. These results provide strong evidence implicating rs4784227 as a functional causal variant for breast cancer in the locus 16q12.1 and demonstrate the utility of conducting genetic association studies in populations with different genetic architectures., published_or_final_version

Physical activity may decrease breast cancer risk. However, it is unclear what intensity of exercise and during which life periods this effect on decreasing risk is efficiently expressed, and whether the associations differ by the estrogen-/progesterone- receptor (ER/PR) status of tumors. We investigated associations between age- and intensity-specific leisure-time physical activity and ER/PR-defined breast cancer risk.We conducted a hospital-based case-control study in Nagano, Japan. Subjects were 405 cases newly diagnosed (99% known ER/PR) from 2001 to 2005, who were age-/area-matched with 405 controls. Activity was assessed with a self-reported questionnaire which considered intensity level (moderate and/or strenuous) at different ages (at 12 and 20 years, and in the previous 5 years). Odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression.Strenuous but not moderate physical activity at age 12 was inversely associated with pre- and postmenopausal breast cancer risk across ER/PR subtypes [overall OR(≥ 5 days/week vs. none) = 0.24 (0.14-0.43)]. Moderate physical activity in the previous 5 years was significantly associated with a decrease in risk for postmenopausal ER + PR + tumors only [OR(≥ 1 day/week vs. none) = 0.35 (0.18-0.67)].Strenuous activity in teens and moderate activity after menopause may contribute to a reduction in breast cancer risk.

We investigated associations among intake of folate, vitamin B2, vitamin B6, vitamin B12, and polymorphisms of 5,10-methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) genes and breast cancer risk in a Japanese population. A hospital based, case-control study was conducted in Nagano Prefecture, Japan, in 388 pairs of patients with histologically confirmed invasive breast cancer and age- and area-matched controls selected from medical checkup examinees. Energy-adjusted intakes of folate and other B vitamins were derived from a validated food frequency questionnaire. Genotyping was completed for MTHFR (C677T and A1298T) and MTR (A2756G). Odds ratios and 95% confidence intervals were calculated by the conditional logistical regression model. Median dietary folate intake (microg/day) in the control group was 438.2 (interquartile range: 354.9-542.9). Neither dietary intake of folate, vitamin B2, vitamin B6, or vitamin B12 nor polymorphisms of MTHFR or MTR genes were significantly associated with breast cancer risk. Further, no significant interaction was found among nutrients, polymorphisms, and breast cancer risk. Associations of nutrients with breast cancer risk did not differ by hormone receptors status. We conclude that dietary intake of folate and related B vitamins and genotypes of MTHFR or MTR have no overall association with breast cancer risk in Japanese women.

Although associations between dietary HCA intake and colorectal cancer risk have been investigated, results have been suggestive but inconsistent. The aim of this hospital-based case-control study was to examine the impact of heterocyclic amine (HCA) intake on colorectal cancer risk. A further objective was to investigate the possible effect of genetic polymorphisms of NAT2, CYP1A1, and CYP1A2 on colorectal cancer.HCA exposure data were assessed using a self-administered food frequency questionnaire, and estimated HCA intake was verified by measuring the PhIP value in human hair. A total of 117 cases and 238 controls were included in these analyses. Odds ratios (ORs) were calculated using conditional logistic regression analysis to compare intake levels between the first and third tertiles.No statistically significant increase in the risk of colorectal cancer with respect to total HCA intake was shown by analysis (OR = 0.99, 95% CI = 0.21-4.81). Furthermore, no association with risk was seen for individual HCAs, including PhIP, MeIQ, and MeIQx. Although variant alleles of CYP1A2 were associated with colorectal cancer (OR = 0.27; 95% CI = 0.07-0.99), genetic polymorphisms of NAT2, CYP1A1, and CYP1A2 did not influence the association of HCA intake with colorectal cancer.In the present study in subjects with low HCA exposure and with a limited sample size, no association was found between HCA intake and colorectal cancer, or any evidence of influence by genetic polymorphisms of NAT2, CYP1A1, and CYP1A2.