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Lymphatic metastasis to the regional lymph nodes through the lymphatic vessels is an important indicator of poor prognosis in many types of malignant tumors. Recently, much attention has been paid to lymphangiogenesis for its possible role on tumor progression in various carcinomas. However, morphological evidence that lymphatic vessels actively proliferate in colorectal carcinoma has not been reported. Here, we first devised a triple immunostaining method to detect proliferating lymphatic vessels utilizing antibody to Ki-67 antigen as a marker of cell proliferation, antibody to cytokeratin as an epithelial cell marker, and antibody to podoplanin as a lymphatic vessel-specific marker. Ki-67/podoplanin-immunoreactivity enabled us to identify proliferating lymphatic vessels, while cytokeratin immunoreactivity allowed us to distinguish proliferating lymphatic vessels from Ki-67/cytokeratin-positive carcinoma cells in lymphatic lumens. Analyzing 64 colorectal carcinoma patients' samples using this technique, we showed that both lymphatic vessel density and proliferating activity of lymphatic vessels were significantly increased in colorectal carcinoma tissues compared with their normal counterparts. We then examined the correlation between the degree of lymphangiogenesis and patients' prognosis or clinicopathological variables, but no statistically significant differences were obtained in these analyses. Thus, these results combined together indicate that extensive lymphangiogenesis occurs in colorectal carcinoma, but that the degree of lymphangiogenesis alone is not an independent prognostic factor for this disease.

N-acetylgalactosamine 4-sulfate 6-O-sulfotransferase (GalNAc4S-6ST) is a sulfotransferase responsible for biosynthesis of chondroitin sulfate E (CS-E). CS-E plays important roles in numerous biological events, such as neurite outgrowth. However, the role of GalNAc4S-6ST in tumor progression remains unknown. In the present study, we analyzed expression of GalNAc4S-6ST mRNA in colorectal cancer by combining real-time RT-PCR with in situ hybridization (ISH) using archived formalin-fixed and paraffin-embedded tissue sections. In 57.5% of 40 patients, expression of GalNAc4S-6ST mRNA was increased in cancer tissues compared with paired normal mucosa. ISH using an RNA probe specific for GalNAc4S-6ST revealed that it was expressed in colorectal cancer cells. Analysis of the relationship between expression of GalNAc4S-6ST as determined by real-time RT-PCR assay and various clinicopathological variables revealed that GalNAc4S-6ST was associated with vessel invasion, although a statistically significant difference was not seen (P=0.125 for lymphatic vessel invasion and P=0.242 for venous invasion). Taken together, we show that real-time RT-PCR combined with ISH is useful to investigate quantitatively GalNAc4S-6ST mRNA expression in formalin-fixed and paraffin-embedded tissue sections, and that GalNAc4S-6ST expressed by colorectal cancer cells plays a minor role in tumor progression.

We describe a case of obstruction of the cervical oesophagus in which ultrasonography and computed tomography revealed characteristic dislocation of the cervical oesophagus and food impaction in a segmental canal. Although the patient presented with complete obstruction initially, spontaneous recovery of passage was achieved with conservative therapy. One recurrent episode was noted during her remaining life span. To our knowledge, no similar case has been described previously.