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Orbital metastasis from breast cancer is relatively uncommon and is not the dominant prognosis. While it can reduce a patient's QOL through symptoms such as diplopia, visual impairment, and exophthalmos, evidence suggests that radiotherapy might improve these symptoms in a relatively short period. We report 3 cases of orbital metastasis from breast cancer treated with radiotherapy. All 3 patients were diagnosed with stage Ⅳ breast cancer and underwent chemotherapy and endocrine therapy for several years. When they were diagnosed with orbital metastasis, their life expectancy was only a few months with debilitating illness. They received radiotherapy, which caused slight side effects including skin disorders. The cancer symptoms rapidly improved in 2 patients, suggesting that radiotherapy can be an efficacious choice for improving the QOL for patients with orbital metastasis from breast cancer, especially for patients in terminal status.

Fibroadenoma with remarkable cystic change is very unusual. Opinions differ as to the interpretation of this lesion. Furthermore, there have been few reports focusing on its macroscopic view. We herein report a case of fibroadenoma in a 43-year-old woman. The patient presented herself to a medical doctor’s office due to a rapidly growing breast tumor. Based on a core needle biopsy, a benign lesion was suspected, and the tumor was surgically resected. On a macroscopic study, the cut surface of the tumor revealed a remarkably cystic and well-circumscribed lesion with an intracystic polypoid component. Microscopically, a variety of findings of epithelial and stromal proliferation were observed. This is an interesting case not only because a fibroadenoma with prominent cystic change is unusual but also because the breast tumor showed a characteristically cystic appearance on its macroscopic view.

Endobronchialmetastasis(EBM)is a rare complication in breast cancer patients. Herein, we report 2 cases of EBM in breast cancer patients. Patient 1 had pulmonary metastases that were treated with hormone therapy and showed long survival after achieving a CR, while patient 2 had multi-organ metastases and died 42 months after the diagnosis of EBM. If bronchial obstruction is observed in a breast cancer patient, early diagnosis of EBM via a bronchoscopic examination is recommended. EBM may not indicate a poor prognosis, and appropriate anti-cancer therapy with palliative intrabronchial therapies can prolong the survival in selected EBM patients.

Leptomeningeal metastasis(LM)is a rare complication in patients with breast cancer. We report 3 cases of LMs in patients with breast cancer who were treated with intrathecal methotrexate via an Ommaya reservoir. In 2 patients, a significant neurological improvement was observed, whereas in 1 patient there was no response. The overall survivals for the patients who experienced improvements were 22 and 9 months. Although we have no evidence for the efficacy of intrathecal chemotherapy for LMs in patients with breast cancer, its effects for some patients could be promising, after reservoir management and drug selection establishment.

While skull base metastases from breast cancer are not uncommon, there are relatively few reported cases in the literature. We report a case of skull base metastasis of breast cancer that resulted in dysphasia, odynophagia, and dysarthria. The case involved a woman in her 50 s who was diagnosed with cancer of the right breast(cT4N1M0, cStage III B)at another medical institution 9 years previously and who underwent a partial mastectomy and an axillary lymph node dissection following neoadjuvant chemotherapy. She began experiencing neck pain 6 months previously, followed by dysphasia, odynophagia, and dysarthria 1 month previously. The patient was referred to our hospital for detailed examination and treatment. PET-CT and cranial MRI was conducted and detected metastatic lesion from the skull base to the upper cervical vertebrae. An orthopedic surgeon performed a posterior decompression and fusion surgery on the occipital bone, cervical vertebra, and thoracic vertebra. A histological examination of bone tissue extracted during surgery revealed that the breast cancer had metastasized. We then performed irradiation of the cervical vertebra from the cranial base and initiated treatment with zoledronic acid and anastrozole. Symptoms such as dysphasia, odynophagia and dysarthria lessened, and the patient is currently being followedupas an outpatient.

症例1:35歳,男性. 主訴:特になし. 現病歴:平成16年1月,人間ドックの腹部エコー検査にて 膵頭部に嚢胞性病変を指摘された.3月精査目的で当科紹 介となった. 既往歴:7歳 脾門リンパ節炎,14歳 十二指腸潰瘍,24歳 気管支喘息. 現症:腹部は平坦,軟. 入院時検査所見:血液,生化学検査では異常を認めなかっ た.腫瘍マーカーにおいては,CEA 1.1ヘ/ml DUPAN-2 25未満U/mlで正常であったが,Span-1が58U/ml,CA19-9 が139.2U/mlと上昇を認めた. 腹部US所見:膵頭部~体部に直径47.6mm大の多房性の嚢 胞性腫瘍を認め,一部は壁在結節様であった. EUS 所見:膵頭部の腫瘍は44×49mm大で隔壁を持つ嚢胞 性病変として描出された.内部は不均一であった. 腹部CT所見:膵体部頭側に突出して5×5cm大の多房性 嚢胞性病変を認めた.比較的厚い被膜,隔壁を有している が,内部に明らかな充実部分は認めなかった.Dynamic study にて隔壁に早期濃染を認めた(図1a). MRI(MRCP)所見:膵体部の頭側に径46mm大の分葉状の 腫瘤性病変を認めた.T1強調像にてやや高信号,T2強 調像にてやや低信号を呈していた.信号強度から嚢胞内の 性状は比較的粘稠度が高いと考えられた.主膵管との連続 性は指摘できず,主膵管の拡張も見られなかった. 血管造影:腫瘍濃染などの異常は認めなかった. 膵リンパ上皮嚢胞の2例 濱 野 亮 輔*,稲 垣 優,木 村 裕 司,磯 田 健 太, 北 田 浩 二 ,西 江 学,野 村 長 久,徳 永 尚 之, 高 橋 健 司 ,宮 宗 秀 明,常 光 洋 輔,大 塚 眞 哉, 三 好 和 也 ,岩 川 和 秀,高 橋 正 彦,岩 垣 博 巳

A 58-year-old man was diagnosed as having descending colon cancer and underwent a left colectomy with D3 node dissection and end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5 (POD5), and nausea and vomiting appeared on POD10. An upper gastrointestinal series revealed to-and-fro peristalsis in the third portion of the duodenum and dilatation of the proximal duodenum. Abdominal CT showed that the second portion of the duodenum was markedly dilated and the third portion was compressed by the superior mesenteric artery (SMA). As a result, he was diagnosed with post-operative superior mesenteric artery syndrome (SMAS) and treated with conservative therapy. The symptoms improved with a nasogastric tube, and he started to eat after POD26, followed by a successful outcome.

患者は67歳女性. 主訴は呼吸困難. C型肝硬変症にて当院内科にて治療中, 胸腹水貯留にて入院. 胸水に対し胸腔ドレーンを挿入したが, 1.5l/dayの胸水を認め, ドレーンクランプにて呼吸困難を生じ, 胸水コントロールのため, 当科紹介となった. Child-Pugh score9点Bであった. CTにて右胸腔内に著明な胸水貯留を認め, 肺実質は虚脱していたが, 腹水は少量であった. 以上より, 胸腔静脈シャントの手術を行った. 手術は腹腔静脈シャント用のDenver shuntシステムを用いた. 術後経過は当初300回/dayでポンプを押していたが, 胸水の改善が見られず, 回数を増やすと共に胸水穿刺を適時行うことにより, 胸腔内で肺の再膨張が見られるようになり, 患者の呼吸状態も改善し, 現在ポンプのみにて平衡状態が保たれている. 末期肝硬変患者で腹水が少量で, 難治性胸水を認める症例では積極的に胸腔静脈シャントを留置することにより, 患者の状態が改善できると考えられた.

症例は81歳,女性,直腸癌にて腹会陰式直腸切断術の既往あり.血便を主訴にて紹介され,横行結腸と盲腸の多重癌の診断にて,横行結腸切除術および回盲部切除術を施行した.術後2日目より頻回な嘔吐出現し,上部消化管造影にて十二指腸水平部に辺縁明瞭な狭窄像を認めた.また腹部CTにて上腸間膜動脈の右側に造影剤の溜まりを認め,上腸間膜動脈と大動脈による十二指腸水平部の圧迫を認めた. SMA症候群と診断して十二指腸授動術とTreitz靱帯切離術を施行した.消化管再建に伴う上腸間膜根部の過進展と小骨盤内への小腸の癒着による腸間膜の牽引が原因であった.術後胃内容停滞を認め,胃内減圧と消化管運動賦活剤の投与を行ったが,改善せず,モチリン受容体のアゴニストであるエリスロマイシン500mg×2回/日を再手術後22日目より5日間投与して軽快した.術後にSMA症候群をきたした症例であるが,手術を中心にした集学的治療が有効であった.

Background: Although many clinical data regarding breast-conserving treatment have already been reported from European and North American countries, few clinical data with long-term follow-up have been reported from Japan. Method: We collected information on therapeutic and possible or developed prognostic factors and follow-up data for Japanese women who had received breast-conserving treatment consisting of wide excision of the primary tumor, axillary dissection and radiotherapy for unilateral breast cancer considered suitable for breast-conserving treatment from 18 Japanese major breast cancer treating hospitals; 1561 patients were registered. Results: The median follow-up period was 77 months. Five-year disease-free and overall survival rates were 89.4 and 95.9%, respectively. The 5-year local recurrence-free rate was 96.3%. The patients with histologically positive margins (P < 0.0001) or estrogen receptor negative tumor (P = 0.0340) or younger than 40 years old (P < 0.0001) developed statistically significantly more local recurrences. Adjuvant endocrine therapy was essential for the estrogen receptor positive patients to have a lower local recurrence rate. Endocrine therapy did not change the local recurrence rate among estrogen receptor negative patients at all. Multivariate analysis showed histological margin status and the combination of estrogen receptor status and endocrine therapy were independent prognostic factors for local recurrence. Conclusion: The 5-year local recurrence rate of Japanese breast cancer patients who were treated with breast-conserving treatment using radiotherapy was 3.7%. Independent prognostic factors for local recurrence were histological margin status and the combination of estrogen receptor status and adjuvant endocrine therapy.

腹腔内出血で発症した直腸inflammatory myofibroblastic tumor (IMT) の手術治験例を報告する. 症例は26歳の男性. 急激な腹痛を訴えて受診し, 腹部超音波検査にて腹腔内に大量の液体の貯留を認めた. 緊急開腹術を行ったところ, 腹腔内には1,400gの出血があり, 出血源となった2個の結節性病変をふくめて上部直腸を切除した. 術後経過は良好であった. 病理所見では, 好酸性の胞体と明瞭な核小体を有する紡錐形の腫瘍細胞が直腸の粘膜下から漿膜下に増殖していた. 炎症細胞浸潤をともない, 核分裂像と組織内出血を認めた. 腹腔内臓器に原発するIMTでは, 腫瘤, 発熱, 成長障害などの症状を示すことが多いとされるが, 腹腔内出血で発症したという報告例を検索しえなかったので, 文献的考察を加えた.

症例は76歳,女性.約半年前から下血,貧血を繰り返し,精査するも出血部位不明にて紹介入院となる.上下部消化管内視鏡検査および上部消化管透視にて出血部位を同定できないため,腹部血管造影を施行した.上腸管膜動脈造影にて第1空腸動脈枝の末梢に動脈相早期から静脈相まで造影される拡張した静脈が確認され,小腸内視鏡にてTreitz靱帯から約30cmの空腸に粘膜下腫瘍様の発赤を伴った隆起性病変を認めた.以上から,空腸の動静脈奇形と診断した.手術は腹腔鏡下にて行った.小腸漿膜側より全く病変部位が不明のため,術中小腸内視鏡にて病変部位を確認し,小切開を加え,腹腔外にて病変部位を含む約10cmの小腸を切除した.術後経過は良好で現在まで下血を認めていない.小腸内視鏡併用の腹腔鏡下手術は有効な治療法と考えられた.

We evaluated the effect of using the cooling method on pain at the site of luteinizing hormone-releasing hormone(LH-RH) agonist injection in 181 prostate cancer or premenopausal breast cancer patients by using a numerical rating scale(NRS)and a questionnaire survey with open-ended questions. According to the NRS, 38.1% of the patients experienced a reduction in pain, 37.5% experienced no change, and 24.4% experienced an increase in pain. Therefore, use of the cooling method did not have a statistically significant effect in terms of pain reduction(p=0.123). However, on analyzing pain reduction according to the answers in the questionnaire survey, 53.2% of the patients experienced a reduction in pain, 38.5% experienced no change, and 8.3% experienced an increase in pain. These findings were different from those obtained on using the NRS. In addition, irrespective of using the cooling method, needle thickness and patient obesity strongly influenced the pain experienced. The skin icing method was effective in reducing pain at the site of LH-RH agonist injection. This method is simple, inexpensive, and safe, and is hence recommended.

Background. Jejunal pouch reconstruction after total gastrectomy has been demonstrated to ameliorate postgastrectomy symptoms, with the process of adaptation taking several months. In contrast to the short-term effects of pouch reconstruction, there are few reports about the long-term consequences (more than 2 years after surgery). Methods. In this study, 22 patients with jejunal pouch (PRY group) and 12 patients without jejunal pouch (RY group) who survived for more than 2 years without any recurrence and were available for follow-up were compared. Patients in the two groups were compared 2 years after surgery in terms of postgastrectomy symptoms, and improvements in body weight and nutritional parameters. Results. Eating capacity at a single meal compared with that in the pre-illness state was significantly better in the PRY group than in the RY group. The total score on the gastrointestinal symptom rating scale (GSRS) in the PRY group was less than that in the RY group (3.17 vs 5.25). The GSRS score for reflux syndrome in the PRY group was significantly better than that in the RY group. Assessment according to Cuschieri's gradings revealed that the total score in the PRY group was lower than that in the RY group (2.73 vs 5.92). Among the various symptoms examined, the incidence of dietary restriction and that of heartburn were significantly lower in the PRY group. Conclusion. We conclude that, 2 years after total gastrectomy, the pouch reconstruction had alleviated postgastrectomy symptoms to a greater extent than simple Roux-en-Y reconstruction, but the effectiveness could be improved. The long-term effects of pouch reconstruction should be examined more precisely with an adequate and valid scoring system for determining quality of life.

胃全摘術後に空腸pouchを用いた再建を行い, 機能評価を行った. 同時期の48例の胃全摘術症例について, pouch and Roux-en-Y法 (以下, PRY)(N=23), pouch and interposition法 (以下, PI)(N=12), またはpouchを用いない従来のRoux-en-Y法 (以下, RY)(N=13) で再建を行った. 各症例の自覚症状, 1回食餌摂取量, 体重の変化, 血液生化学的検査値の推移, および消化管しんちぐらむによるRI停滞率について検討した. PRY-PI群では, RY群に比べ, 術後12か月における1回食餌摂取量が有意にすぐれていた (p

We report a case of suture line recurrence in a jejunal pouch, diagnosed 4 months after total gastrectomy for advanced gastric cancer. The jejunal pouch was made with a linear stapler, without intraluminal irrigation being carried out before anastomosis, and was replaced in an interposition fashion. We propose that the recurrence was caused by the implantation of exfoliated cancer cells in either the intraluminal mucus or on a contaminated stapling device.

Medullary carcinoma of the breast is a rare specific type breast cancer. It has peculiar clinical features including favorable prognosis. In a series of 373 cases of breast cancer operated on at the hospital from 1990 to the end of 1997, eight (2.1%) cases were initially diagnosed as medullary carcinoma of the breast by postoperative pathological study. In this study, the specimens from the eight tumors were re-evaluated according to the pathological criteria given by Ridolfi and his coworkers. Five tumors were classified as typical medullary carcinoma (TMC), and three tumors as atypical medullary carcinoma (AMC). Ultrasonography images revealed well-circumscribed, hypoechoic nodules. On mammography the tumors were unclassified masses with indistinct or circumscribed borders. Enhanced magnetic resonance imaging revealed homogeneously enhancing masses with well-defined borders. Although AMC is similar to TMC in pathological findings, AMC lacks in clinical characters of medullary carcinoma, and hence it is important to distinguish TMC from AMC. Any diagnostic modalities could not reliably help to distinguish TMC from AMC.

1992年から1994年末までの3年間に, 20年以上の長期にわたり抗精神病薬の内服治療を受けてきた8例の精神分裂病患者について消化器外科手術を経験した.手術の対象となった疾患は胆石症2例, 急性胆嚢炎2例, 虫垂炎の穿孔による汎発性腹膜炎2例, 肝内結石症と横行結腸癌が各1例であった. 術後の合併症は胆管空腸吻合の縫合不全と麻痺性イレウスを各1例に認めたのみで, 突然死例はなかった. 横行結腸癌で閉塞性イレウスをきたした1例を除いて, 抗精神病薬は手術の前日まで減量せずに継続した.手術の翌日から抗精神病薬の就眠前の非経口投与を開始し, 食餌開始にあわせて術前の経口剤を再開した. 4例に精神症状が見られたが, いずれも軽症で外科的管理上問題にならなかった. 精神分裂病患者の安全な周術期管理のためには精神科医の協力による精神的ケアが重要であった.

門脈ガス血症は, さまざまな疾患に伴ってみられる比較的まれな病態であり, 一般に予後不良の徴候とされている. 特に, 本症を伴う急性上腸間膜動脈閉塞症の予後はきわめて不良であることが知られ, 過去にわずか4例の救命例が報告されているにすぎない.症例はBuerger病の既往を有する64歳の男性で, 突然発症した腹部の疝痛を主訴に来院した. 腹部X線検査では, 右上腹部に拡張した小腸ガス像を認めたが, 門脈内のガス像は描出されなかった. 腹部computed tomographyでは, 肝内門脈内に樹枝状に広がるガス像を認めた. 発症後13時間にて開腹したところ, 回腸の一部が壊死に陥っていたため, 壊死腸管を40cmにわたり切除し, 端々吻合にて再建した. 術後経過は良好であった.

A 68-year-old woman was admitted to the hospital because of a hard tumor on the right anteriorthoracic wall. Chest CT revealed an expansively growing tumor attached to the 5th rib. Ga scintigraphydemonstrated a high uptake lesion at the tumor. Histological diagnosis could not be made with theincisional biopsy performed prior to the radical operation. The whole thoracic wall containing the tumorwas resected sufficiently apart from the tumor margin. Malignant fibrous histiocytoma (MFH) showinga striform-pleomorphic pattern was recognized histologically with the resected specimen. MFH commonly arises in the soft tissues of the extremities, but rarely in those of the chest. This paper also presentsa review of 22 reported cases of MFH originated from the thoracic soft tissues in Japan.

The present study examined long‐term efficacy outcomes in a subgroup of postmenopausal, estrogen receptor‐positive Japanese breast cancer patients from the Pre‐Operative “Arimidex” Compared with Tamoxifen trial, following pre‐operative (3 months) and post‐operative (5 years) adjuvant treatment with either anastrozole or tamoxifen. Patients with large, potentially operable, locally‐advanced breast cancer were randomized to receive anastrozole (1 mg/day) plus tamoxifen placebo or tamoxifen (20 mg/day) plus anastrozole placebo pre‐operatively. After surgery at 3 months, patients continued on the same study medication as adjuvant therapy for up to 5 years or until recurrence, intolerable toxicity or withdrawal of patient consent. Recurrence‐free survival and overall survival were measured from the date of randomization to the date of recurrence or death, whichever occurred first. Patients were monitored for adverse events throughout the study period and up to 30 days following administration of the last study medication. During post‐operative adjuvant therapy, 4/48 (8%) anastrozole and 25/49 (51%) tamoxifen patients experienced recurrence. There was a significant difference in recurrence‐free survival between the two groups (hazard ratio 0.14; 95% confidence interval 0.05–0.41; P = 0.0003). There was a significant increase in overall survival with anastrozole (0.21; 0.05–0.96; P = 0.0436) and there were 2/48 (4%) and 10/49 (20%) deaths with anastrozole and tamoxifen, respectively. Most patients responding to pre‐operative therapy remained recurrence‐free. Sequential pre‐operative/post‐operative treatment with anastrozole resulted in lower recurrence and death rates, compared with tamoxifen. (Cancer Sci 2012; 103: 491–496)

This paper reports a case of coecocutaneus fistula developed fifty years after appendectomy. An 82-year-old man was seen at the hospital in 1992 because of a 10-day history of inflammation of the skin around the old appendectomy wound which was performed in 1942. Plain abdominal radiographs and CT scan revealed an abscess containing abnormal gas and much pus was released through a small skin incision. There was no malignant possibility nor association of Crohn disease, and conservative treatments with drainage and chemotherapy were started. The abscess disappeared and the fistura was spontaneously closed. Coecocutaneus fistula is known as a surgical complication of appendectomy occuring within months after the operation. The delayed presentation of such a fistula many years after appendectomy is rare.

二次性副甲状腺機能亢進症による腎性骨異栄養症 (ROD) に対して上皮小体全摘一部自家移植術 (PTX-AT) が行われているが, 術後3年以上の遠隔期における骨代謝, 骨所見に関する報告は少ない. 過去8年で38例に, PTX-ATを施行した. このうち術後3年以上経過した27症例について骨代謝の生化学的指標と, 全身骨X線所見について検討した. 透析歴は120-235か月 (平均181.1±30.7か月), PTX-AT後36-89か月 (平均61.9±11.9か月) を経過していた. C-PTHは術直後より減少し, 術後3年で5ng/ml以下のものは22例で, 残り5例中4例は術後もほとんど減少せず, その後の検査で残存副甲状腺を確認した. 骨新生の指標となるオステオカルシンを, 術後症例 (PTX-AT群) とC-PTH 10ng/ml以上の二次性副甲状腺機能亢進症例 (2°HPT群) で比較検討すると, PTX-AT群 (n=26) は平均106.9±98.7ng/ml, 2°HPT群 (n=27) は平均230.9±157.9ng/mlで, 有意にPTX-AT群が低値を示した (p

透析歴8年の48歳女性に肺癌術後1か月してミオクローヌス様不随意運動, 四肢麻痺, 言語障害, 健忘, 錯乱, 昏睡などの多彩な精神神経症状が出現した. 発病早期に脳波にて広汎な徐波を認めたが,当初脳CT検査では軽い脳萎縮のみであった. 血清アルミニウム (AI) 濃度は8-2μg/dlで, 透析患者の平均血清AI濃度よりやや高値であったが, 透析液は逆浸透処理の上, AI製剤の内服歴もないため, AI脳症は否定的であった. 髄液検査にて蛋白細胞解離が存在し, 発病2か月後の脳CT検査にてびまん性白質浮腫を認めた. 病勢の極期に病因であるJCウイルス (パポバウイルス群) 抗原を髄液細胞から, JCウイルス抗体を髄液から検出し, 進行性多巣性白質脳症 (Progressive multifocal leucoencephalopathy; PML) と診断した. 経過中経口摂取が不可能な時期は, IVHによる栄養管理を行ったが, 5か月の経過で自然治癒した. PMLは悪性腫瘍などの低免疫状態に合併するスローウイルス感染で, 予後不良の疾患とされているが, 本例は肺癌の根治手術が施行された直後に発症しており, 幸いにも救命し得た. 透析患者に合併したPMLの報告は極めて少ないが, 臨床上では特にAI蓄積による透析脳症との鑑別が重要と考えられる.

A 25-year-old man with RS rectal cancer received a radical resection of the original tumor and lymph node dissection. Oral tegafur/uracil (UFT)/Leucovorin (LV) therapy has been used for adjuvant chemotherapy, as the pathological Stage was T3N1M0, Stage IIIa. After 10 months from operation, multiple liver metastases were recognized and not resectable. So a systemic chemotherapy by mFOLFOX6+bevacizumab was begun via CV port. After 5 courses of mFOLFOX6+bevacizumab, abdominal CT revealed liver metastases showed remarkable reduction in size. Hepatic resection of S6 segment was enforced, and the patient uneventfully discharged. Pathological findings of S6 segment revealed no residual cancer cells, indicating the histological effect of mFOLFOX6+bevacizumab was Grade 3. And no liver damage was recognized.

A 41-year-old man with multiple liver metastases from sigmoid colon cancer received a radical resection of the original tumor and 16 courses of weekly high-dose 5-FU(WHF)chemotherapy via hepatic arterial reservoir. The metastatic lesions showed stable disease(SD), and systemic chemotherapy by mFOLFOX6 was begun via CV port. After 14 courses of mFOLFOX4, abdominal CT revealed liver metastases were remarkably reduced in size. Hepatic resection of lateral segment and radio frequency ablation(RFA)for S6 were enforced, and the patient was uneventfully discharged. Pathological findings of lateral segment revealed no residual cancer cells, indicating that the histological effect of mFOLFOX6 was Grade 3.

Metastasis to the breast from extramammary malignancies is rare. There are especially few reports of metastasis from esophageal cancer. We report the pathological and autopsy findings of a 44-year-old man with advanced esophageal cancer and a left breast tumor. Squamous cell carcinoma invading the mammary glands was demonstrated histologically. Immunostains for ER, PgR, and ErbB-2 were negative. At autopsy, metastatic lesions were found in lung, liver, diaphragm, peritoneum, spine, and mediastinal lymph nodes, with no evidence of metastasis to the skin. While metastatic breast tumors are rarely the initial sign of malignancy, it is important to distinguish a metastasis from primary breast cancer to avoid unnecessary conflicting treatments.

保存的療法に抵抗を示すROD症例に対して上皮小体摘除術が広く行われている. その術式の中でも上皮小体全摘一部自家移植術 (PTX-AT) は極めて合理的な手術法であり, 我々もROD症例に対し本法を施行してきた. 今回はPTX-AT後の骨病変の経過を中心にその遠隔成績および問題点について検討した. 1984年より1988年にPTX-ATを受けた透析患者31例を対象とした. その男女比は20:11, 手術時の平均年齢は45.6±8.7歳, 平均透析年数は10.0±2.4年であった. PTX-AT後, 血清Ca値は活性型ビタミンDやCa製剤にてほぼ一定に維持された. 一方, 血清P値は術後低下したのち, 約1年後には術前のレベルにまで上昇した. PTH値は全例で術直後より激減したが, その後7例に再上昇 (PTH>5ng/ml) が認められ, うち1例は移植上皮小体による上皮小体機能亢進症の再発にて移植腺摘出を行い, 4例で残存腺の腫大を認めた. 全身骨レ線像をPTX-AT前後で比較してみると, 頭蓋骨 (salt & pepper像) や手指骨 (tuft resorption) では著明な改善を示し, 骨所見が陽性から陰性に転じた症例はそれぞれ67%, 74%に認められた. 腰椎 (rugger jersey spine) でも改善傾向を示したが, 陰性転化例は43%に留まった. Metacarpal indexは47.1%から51.1%に有意に増加し, PTX-AT後の骨量の増加を示唆した. その一方で末梢血管への石灰沈着が著明に認められた症例ではその改善はほとんど認められず, 中には悪化する症例も認められた. PTXはRODに対して有効であるが, 血管系の著明な石灰化病変には効果が期待できず, 今後検討を要する問題と考えられた.

We report a rare case of spontaneous biloma with a cancer of the common bile duct. A 71-year-old man was admitted to the hospital for further examination of fever up and obstructive jaundise. Abdominal computed tomography and ultrasonography revealed dilatated bile duct and ascites locarized in only left side of the abdomen which was from anterior wall of S3 area of the liver. Cholangiography at surgery showed complete obstruction at the lower common bile duct. Serum level of a tumor marker (CA19-9) was vary high. It was thought that the common bile duct cancer caused complete obstruction of the common bile duct to increase the pressure in the biliary tract which resulted in rupture and perforation of the intrahepatic bile duct causing spontaneous biloma. Drainage where PTCD tube was inserted into the perforated site and a T tube into the common bile duct was conducted. In Japan, only 24 cases of biloma have been reported until 1996. Biloma with malignancy is very rare among of them.

We examined clinicopathological characteristics and prognoses of seventy advanced colorectal cancer cases by measuring pyrimidine nucleoside phosphorylase (PyNPase) and dihydropyrimidine dehydrogenase (DPD) in tumor and normal tissue. PyNPase activities in cancerous tissue obtained from resected were 82.7 +/- 41.9 U/mg protein, which were significantly higher than 37.2 +/- 24.0 U/mg protein in normal tissue (p0.001). On the other hand, DPD activities in cancerous tissue were significantly lower in normal tissue (p0.05). In cases with lymphnode metastases, PyNPase activities of cancerous tissue were significantly higher than that of no lymphnode metastases cases (p0.05). In cases with grade 2 side-effects or higher by oral adjuvant chemotherapy, DPD activities in normal tissue were significantly lower than that of other cases (p0.05). With regard to Dukes' B and C cases that were resected curatively, PyNPase activities of cancerous tissue of higher group's prognosis were worse than that of the lower group. In the group received 5'-DFUR as adjuvant chemotherapy, non-recurrent survival rate of the group exhibiting higher PyNPase activities was better than that of the lower group.

For metastatic breast cancer patients who have hormone receptor-positive tumors, hormonal therapy aiming at optimal palliation and prolongation of life is the initial treatment of choice. To enhance the effect of hormonal monotherapy, a combination therapy with Anastrozole 1 mg po and 5'-DFUR 800 mg po daily was given to 11 patients with metastatic breast cancer. At a median follow-up period of 15 months, the overall response rate was 45.5%. The median duration of response in responders was 25 months. The overall median survival for the entire series was 15 months after the start of treatment. No patients complained of adverse events of grade 2 and over. This combination therapy with good response and little side effects is useful for metastatic breast cancer patients.

We performed radiofrequency ablation (RFA) therapy combined with intrahepatic arterial infusion chemotherapy for 7 patients with liver metastasis from colorectal cancer. Synchronous metastasis accounted for 5 cases and metachronous for 2 cases. Two cases were H1, 2 cases H2, and 3 cases H3. Following the resection of colorectal primary lesion, we performed RFA for liver metastasis, using a Cool-tip electrode purchased from Radionics (Burlington, MA, USA). The mean number of sessions per patient was 5.1 (1-10). Ablation time of each session was changed according to tumor size, as follows: less than 1 cm in diameter: 2 min, 2 cm: 5 min, 2.5 cm: 10 min. By using intra-operative catheterization, weekly intrahepatic arterial infusion chemotherapy was performed for liver metastasis. Excellent ablation was achieved in all cases by CT evaluation and no significant side-effect was observed. Average observation period was 15 months (maximal survival period was 31 months) and 6 patients are alive. RFA therapy combined with intrahepatic arterial infusion chemotherapy achieved excellent therapeutic effect, and maintained good quality of life in patients.

In the following study, we investigated whether ex vivo perfusion of canine pancreaticoduodenal allografts prior to transplantation using a class-II-specific monoclonal antibody (MoAb) OKIa1) could prevent acute rejection. Untreated grafts were rejected within 6 days after transplantation, and all of these recipients suffered severe hyperglycemia. In contrast, in recipients who received grafts which underwent ex vivo class-II-specific MoAb perfusion treatment, the mean urinary amylase levels were sustained significantly higher (11733 ±4493 vs. 3274 ± 2108 U/L on day 7, P < 0.005), and mean fasting blood glucose (FBG) levels remained within the normal range (13.4 ± 5.8 vs. 23.4 ± 3.9 mM on day 7, P < 0.0005). Low doses of cyclosporin A (CsA) were necessary in order to maintain lower FBG levels. Histopathology analysis on day 7 after transplantation showed that endotheliitis and necrosis were much less prominent in the MoAb-treated grafts. In the light of our results, we conclude that ex vivo perfusion of canine pancreaticoduodenal allografts using a class-II-specific MoAb is effective in delaying the onset of acute rejection, and low doses of CsA could extend this effect.