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症例は2歳8ヵ月の男児で, 咳嗽, 呼吸困難のために当院に入院.胸部X線, CTで左上葉の過膨脹を認めた・全身麻酔下の気管支鏡検査で左上葉支のチェックバルブ状の狭窄を認め先天性肺葉性肺気腫と診断した.治療は左上葉切除を行い, 術後経過は順調であった.病理検査では左上葉気管支壁に異常は認めず, 原因不明であった.手術時の体重は正常下限であったが, 術後1年4ヵ月には体重は平均値にまで増加し, 先天性肺葉性肺気腫が患児の正常な成長に障害となっていた可能性が示唆された.

Controversy exists regarding the relationship of the degree of c-erbB-2 amplification to other prognostic factors in breast cancer. To determine the degree of amplification of c-erbB-2 exactly, a sensitive and quantitative method is required. We have developed a competitive PCR method to quantitatively determine the amplification of the c-erbB-2 oncogene. Using this method, we evaluated DNA from 27 breast cancer tissue specimens and DNA from peripheral blood leukocytes from a normal individual. Regarding the relationship between the degree of c-erbB-2 amplification and clinicopathological factors, we found a greater degree of amplification of the c-erbB-2 oncogene in estrogen receptor- negative or progesterone receptor-negative specimens than in positive ones and in lymph node metastasis-positive specimens than in negative specimens, in stages II, III, and IV of disease compared with stage I disease, and in samples with positive lymphatic vessel invasion than with no lymphatic vessel invasion. Generally, these factors were seen in the group of patients who had a bad prognosis. By univariate analysis and multivariate analysis, reverse correlation was observed between amplification of c-erbB-2 and overall survival. Regarding disease-free survival, these relationships were observed only with univariate analysis in our group of patients.

症例は53歳男性, 嚥下障害を主訴に近医受診, 食道癌の疑いで紹介入院となった.全身検索の結果, 原発性食道癌, 原発性肺腺癌及び転移性脳腫瘍と診断されたが症状緩和のため食道癌の切除を計画, 同一術野にて肺切除も可能と判断し食道亜全摘術及び左下葉切除術を施行した.術後病理検査により肺の腫瘍は原発性低分化型腺癌, 食道の腫瘍は肺からの転移と診断された.原発性肺癌の食道転移は剖検例においては比較的稀ではないとされているが, 手術報告例は少なく自験例を含め3例にすぎない.また一期的手術施行例は1例のみで自験例が2例目であった.

一時的バイパス設置下に切除し得た大動脈漫潤肺癌2例を経験した.症例1は64歳男性, 左上葉大細胞癌。腫瘍は下行大動脈に浸潤しており, 左鎖骨下動脈一下行大動脈間にバイパスを設置し大動脈の外膜のみを剥離して, 左上葉切除によって摘出した.症例2は48歳男性, 左下葉腺癌.腫瘍は下行大動脈に浸潤しており, 腫瘍を挟み下行一下行大動脈間にバイパスを設置して大動脈環状切除を行い, 左下葉切除によって摘出した.肺癌の大動脈浸潤例に対する一時的バイパスの設置は補助循環を使用する事なく簡便でかつ安全な方法であると考えられた.

We conducted a phase II study to determine the availability and safety of combination chemotherapy with weekly paclitaxel and doxifluridine (a capecitabine metabolite) in the treatment of advanced or recurrent breast cancer. Patients were treated with a combination chemotherapy regimen: doxifluridine was orally administered at 800 mg/day for 14 days, followed by a 7-day washout period. Paclitaxel was given intravenously on days 1 and 8 at 80 mg/m2 for 1 h, followed by a 1-week washout period. This 3-week cycle of therapy was repeated as long as possible (at least eight cycles) until the progression of the tumor and drug-related adverse effects were no longer observed. From May 2003 to December 2005, 26 patients were enrolled in the study. The overall response rate was 53.8% (95% confidence interval, 33.4-73.4%). The clinical benefit rate, including long-term no change, was 65.4% (95% confidence interval, 44.3-82.8%). Time to progression and survival time were 297 and 1182 days, respectively, for the 26 enrolled patients. No severe toxicities were observed. Grade 3/4 leucopenia in three patients, neutropenia in five patients, increased serum creatinine in three patients, hypercalemia in one patient, hypocalcemia in one patient, nausea/vomiting in two patients, and diarrhea in one patient. The good response rate and long time to progression and overall survival time of this doxifluridine combined with weekly paclitaxel therapy indicate its potential as a first-line or second-line treatment for advanced or recurrent breast cancer patients.

Sonodynamically induced antitumor effect of a gallium porphyrin complex, ATX-70 was evaluated on a chemically induced mammary tumor in Sprague-Dawley rats. The timing of 24 h after the administration of ATX-70 was chosen for ultrasonic exposure, based on pharmacokinetic analysis of ATX-70 concentrations in the tumor, plasma, skin, and muscle. At an ATX-70 dose not less than 2.5 mg/kg and at a free-field ultrasonic intensity not less than 3 W/cm(2), the synergistic effect between ATX-70 administration and ultrasonic exposure on the tumor growth inhibition was significant. These results suggest that ATX-70 is a potential sonosensitizer for sonodynamic treatment of spontaneous mammary tumors.

The sonodynamically induced antitumor effect of porfimer sodium (PF) was evaluated on a chemically induced mammary tumor in Sprague-Dawley rats. The timing of 24 h after the administration of PF was chosen for the ultrasonic exposure, based on pharmacokinetic analysis of the PF concentrations in the tumor, plasma, skin and muscle. At a PF dose not less than 2.5 mg/kg and at a free-field ultrasonic intensity not less than 3 W/cm2, the synergistic effect between PF administration and ultrasonic exposure on the tumor growth inhibition was significant. The ultrasonic intensity showed a relatively sharp threshold for the synergistic antitumor effect, which is typical of an ultrasonic effect mediated by acoustic cavitation. These results suggest that PF is a potentially useful as a sonosensitizer for sonodynamic treatment of chemically induced tumors.

Fundamental studies have confirmed that combination chemotherapy with docetaxel and doxifluridine (a capecitabine metabolite) is very useful in the treatment of breast cancer. This study investigated the usefulness and tolerability of a combination chemotherapy consisting of docetaxel administration on day 8 of doxifluridine therapy in 40 advanced/recurrent breast cancer patients. The overall response rate was 41.0% in 39 eligible patients. The median time to progression (TTP) for all patients was 295 days. Many responders had lung metastasis, soft tissue metastasis or a good performance status, whereas the clinical response showed no correlations with the estrogen receptor status or prior treatment with an anthracycline. The most common hematological toxicities were leukopenia and neutropenia, but dose reduction or delay of administration of either drug was unnecessary.The good response rate and long TTP of this doxifluridine plus docetaxel regimen indicate its potential as a first- or second-line treatment for advanced/recurrent breast cancer patients.

The formation of microvessels in tumors by angiogenesis is considered to be an important prognostic factor, and closely correlates with lymph node metastasis. We used color Doppler ultrasound to examine the relationship between the amount of blood vessels in tumors and pulsatility index (PI), and tumor size in breast cancers, with and without regional lymph node metastasis. Doppler ultrasound was performed on 80 patients with breast cancer prior to surgery. The concentration of vascular endothelial growth factor (VEGF) within the tumors was measured following surgery in 42 cases chosen at random. In the negative metastatic nodes group, the number of vessels in the tumor correlated positively with tumor diameter. In the positive metastatic nodes group, however, the number of blood vessels in the tumor did not correlate with tumor diameter. Differences in tumor vascularity between node positive and negative groups were useful in determining the status of node metastasis in subsequent analysis. Fifteen of 17 cases of tumors that measured20 mm, and in which there were no blood vessels, were node-negative. There were no node-negative tumors measuring20 mm in diameter (p=0.003). Conversely, in nodes with positive metastasis, blood vessels were observed in 5 of 7 tumors that measured15 mm in diameter (p=0.019). These findings may be useful in estimating the likelihood of metastasis to regional lymph nodes. PI was directly proportional to tumor size in the negative nodes group (r=0.47). There was no such correlation in the positive nodes group. There was no correlation between VEGF concentration in the tumor and the number of blood vessels in that tumor. In conclusion color Doppler analysis of blood vessels appears to be useful in predicting lymph node metastasis, especially for small tumors.

In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 years, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours after operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cancer. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancer if there are no metastatic lesions in other organs.

A 74-year-old woman complained of a small nodule in the outer lower quadrant of her left breast. On physical examination, a 0.9 x 0.8 cm, round-shaped and firmly elastic nodule was palpated. Excisional biopsy was performed. Histologically, the tumor was separated into, with a bicellular pattern, containing both numerous glandular structures and numerous spindle-shaped cells. Immunohistochemical staining for EMA and cytokeratin showed strongly positive immunoreactivity for epithelial cells. Staining foraipha;-SMA showed strongly positive immunoreactivity for myoepithelial components. Staining for keratin and S-100 protein showed weakly positive immunoreactivity for myoepithelial cells. Microscopically, the tumor was diagnosed as adenomyoepithelioma of the breast. Immunohistochemical examination is needed to distinguish epithelial cell proliferation from myoepithelial cell proliferation. Immunohistochemical examination using antibodies against EMA, alpha-SMA, Keratin, cytokeratin and S-100 protein, is indispensable.

Two cases of occult breast cancer that we encountered are reported inaddition to the discussion on the literature. Case 1 was a 57-year-old woman who visited our department because she moted masses in the left axillary and supraclavicular fossae. When the mass in the left axillary fossa was examined via biopsy, it was diagnosed as metastatic adenocarcinoma. Because a mammogram showed very small calcification, but a possible malignant tumor in other organs was clinically denied, she was diagnosed as breast occult cancer. This patient underwent extended radical mastectomy of the left breast; the tumor was defined as T0, N3, M0 and stage IIIb. Case 2 was a 64-year-old woman who visited our department with the main complaint of an egg-sized painless mass in the left axillary fossa. Because the mass was diagnosed as metastatic adenocarcinoma via biopsy, her whole body was examined, a nd a mass, measuring about 2cm in diameter, was detected in the left thyroid lobe. While we were thinking of a possibility of breast occult cancer, we undetook operation based on suspected thyroid adenocarcinoma. Because that tumor was found to be benign goiter during operation, total mastectomy was performed at the same time. Her breast tumor was histopathologically defined as medullary tubular carcinoma with infiltration to a very limited extent.

膵癌, 慢性膵炎, 急性膵炎の超音波像の同じ所見における出現率を比較検討した. 対象は膵癌15症例, 慢性膵炎14症例, 急性膵炎9症例である. 膵癌に高頻度に現れる所見は辺縁の不整, 腫瘤部の低エコー, 総胆管拡張, 限局性腫大, 腫瘤部エコースポットの不均一性, 肝管, 膵管の拡張であった. 出現頻度は少ないが, 他の膵疾患にない膵周囲血管, リンパ節の異常, 膵後方エコーの減弱も重要な所見と考える. 慢性膵炎に高頻度に現れる所見はspotty echo (不均一な点状, 斑状エコーの増強), 辺縁の不整, 低エコーであり, 出現頻度は少ないが膵の萎縮, 膵石エコーも重要な所見と考える. 軽症例においては必ずしも種々の異常所見を呈さないことがわかった. 急性膵炎に高頻度に現れる所見は, びまん性腫大, 低エコー, エコースポットの不均一性であった.