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Background and Aim: Hepatocellular carcinoma (HCC) is a hypervascular tumor, and angiogenesis plays an important role in its development. Previously, we demonstrated that des-gamma-carboxyl prothrombin (DCP) promotes both cell proliferation and migration of human umbilical vein endothelial cells (HUVECs) by inducing the autophosphorylation of kinase insert domain receptor (KDR). In the present study, DCP-associated tumor angiogenesis was assessed by comparing hypovascular and common hypervascular HCC. Methods: The solitary HCCs of 827 patients were classified into two groups according to the tumor density at the arterial phase of a dynamic computed tomography scan; the initial clinical data of patients with the hyper- and hypovascular types were compared. The HCC tissues from 95 tumors were analyzed by immunohistochemical staining for DCP and phosphorylated KDR, and intratumoral microvessel density (MVD) was analyzed to evaluate microvessel angiogenesis. Results: The serum DCP levels (320 +/- 3532 mAU/mL) and tumor size (18.4 +/- 9.0 mm) of patients with hypervascular HCC were significantly greater than those with hypovascular HCC (38.7 +/- 80 mAU/mL and 14.6 +/- 5.2 mm, P < 0.001). Immunohistochemical analysis revealed that the expressions of DCP and phospho-KDR were significantly greater in hypervascular HCC (71.4% and 31.0%, respectively) than in hypovascular HCC (7.6% and 5.7%, respectively). Intratumoral MVD was significantly correlated with DCP (r = 0.48, P < 0.0001). Conclusions: des-gamma-carboxyl prothrombin production is associated with tumor angiogenesis in HCC.

BACKGROUND: Assessment of hepatic functional reserve is important in hepatic resection. The aim of this study was to evaluate the role of hepatic asialoglycoprotein receptor (ASGP-R) analysis in the preoperative estimation of remnant liver function in liver surgery. METHODS: One hundred and one patients undergoing hepatic resection for liver tumours were studied. Seventeen patients had preoperative percutaneous transhepatic portal vein embolization (PTPE). Function of the hepatic remnant was estimated before surgery using radioactivity in fusion images of both liver single-photon emission computed tomography and computed tomography scans using (99m)Tc-labelled diethylene triamine penta-acetate-galactosyl-human serum albumin. RESULTS: All three patients with an ASGP-R concentration below 400 nmol/l and preoperative total amount of receptor in the future remnant liver (R0-remnant) of less than 53.0 nmol per liver died. Two patients with chronic hepatitis and R0-remnant values between 53.0 and 65.0 nmol per liver and a receptor concentration lower than 600 nmol/l developed liver dysfunction. The incidence of liver failure decreased inversely with increasing R0-remnant value. CONCLUSION: A combination of receptor concentration and the amount of hepatic receptor in the future liver remnant as detected on fusion images is useful in evaluating the risk of postoperative liver failure.

application/pdf, We have investigated complex perovskite oxide ceramics with nominal composition of (Ba1-xCax)(Scv2Nbv2)03 (0.35 < X < 0.50). It has been confirmed that solid solutions could be prepared with whole range of x by continuous change in cubic lattice constant with x. However, impurities are easy to be included in the ceramic samples and it is very difficult to prepare single phase samples. Contrast of back scattered electron image reflects homogeneity for distribution of chemical composition. The back scattered electron images were observed for selected ceramic samples with the composition to obtain knowledge for phase generations in the samples. An interesting micro structure occurred suddenly at x = 0.47 and another interesting structure occurred at x = 0.475 with increasing x.

後腹膜原発の軟部組織肉腫3例を報告した.症例1は30歳男性, 症例2は31歳女性で, 左胸痛, 腹部膨満感を自覚した.CTで腫瘍を認め, 腫瘍摘出術を行った.腫瘍と左腎, 脾臓との癒着は強固であった.摘除標本の重量は症例1:3000g, 症例2:2000gで, 病理組織学的に後腹膜原発のfibrosarcoma, undifferential sarcomaと診断された.2例とも腫瘍断端陽性を一部に認め, その後再発した.症例1は再腫瘍摘出術を行ったが, 初回手術から約1年半後に, 症例2は術後約2ヵ月半後に死亡した.尚, 症例1は, 再腫瘍摘出術の病理組織像も原発巣と同様であった.症例3は73歳女性で, 心不全フォロー中に腫瘍を指摘され, 腫瘍摘出術を行った.重量は2420gで, 病理組織学的にwell-differentiated liposarcomaが一部で脱分化したものと診断された.一部に腫瘍細胞を認めた.術後1年2ヵ月後に局所再発が出現し, 2回目の腫瘍摘除術を行った.病理組織診断は初回同様differentiated liposarcomaであった, Soft tissue sarcomas (STS) are rare tumors that comprise only 1% of all malignancies. The retroperitoneum is an uncommon site of origin for them, accounting for about 10% of all STS. In case 1, a 30-year-old man complaining of chest pain was found to have a retroperitoneal tumor around the left kidney by computed tomography (CT). The tumor was removed along with the left kidney. Histologically, it was fibrosarcoma 3, 000 g in weight. In case 2, a 31-year-old woman complaining of abdominal distension was found to have a retroperitoneal tumor by CT. The tumor was removed in the same way. It was undifferentiated sarcoma 2, 000 g in weight. In case 3, a 73-year-old woman, who had no complaint was found to have mass in the left lateral region during follow up for cardiac failure. She was referred to our department for treatment of retroperitoneal tumor revealed by ultrasound and CT. The tumor was dedifferentiated liposarcoma 2, 420 g in weight. All three patients had local recurrences, and two of them underwent a second surgical procedure.

57歳男性.患者は頻尿を主訴に近医を受診, 直腸診にて前立腺腫瘤を指摘され, 著者らの施設へ紹介となった.入院時, 血清PSAの軽度上昇を認め, 経直腸エコーでは前立腺背側に精嚢へ突出する28×23×18mm大の内部不均一な腫瘤を認めた.経直腸エコーガイド下前立腺針生検の結果, leiomyosarcomaと診断し, 前立腺全摘術を施行したところ, 病理組織学的には前立腺原発のP-STUMPと診断され, 術後11ヵ月経過現在, 再発・転移は認められず, 経過も良好である, Sarcomas and related proliferative lesions of specialized prostatic stroma are rare. Lesions have been classified into prostatic stromal tumor of uncertain malignant potential (P-STUMP) and prostatic stromal sarcoma based on the degree of stromal cellularity, presence of mitotic figures, necrosis, and stromal overgrowth. STUMPs are considered neoplastic, based on the observations that they may diffusely infiltrate the prostate gland and extend into adjacent tissues, and often recur. Although most cases of STUMPs do not behave in an aggressive fashion, occasional cases have been documented to recur rapidly after resection and a minority have progressed to stromal sarcoma. Here we describe a case of P-STUMP. A 57-year-old male went to his family doctor because of pollakisuria. Digital examination revealed abnormal findings in the prostate, then he was referred to our medical center. The mass was palpable in the left lobe of the prostate; it was elastic hard, surface smooth, about 2 cm in diameter. Serum PSA was elevated slightly (5.42 mg /dl). We diagnosed firstly leiomyosarcoma by transrectal ultra sound guided needle biopsy of the prostate. Then we performed radical prostatectomy. Finally we made the pathological diagnosis of P-STUMP. After 11 months, there is no sign of metastasis or recurrence.

57歳女.2年前に右尿管癌を発症し摘出術を施行した.そのさい術前に尿管狭窄に対して一時的に右腎瘻を留置した.今回, 右腰背部皮下に腫瘤が出現し, 尿管癌の転移を疑い腫瘤切除術を施行した.切除標本の病理組織像は尿管癌と酷似しており, 腫瘍の部位が2年前の腎瘻穿刺ライン上にあることから尿管癌のneedle tract implantationと診断した, Malignant metastasis along the needle tract, called "needle tract implantation" (NTI), has been demonstrated for numerous carcinomas, including prostate, colon and liver. We report a case of NTI of ureteral carcinoma following percutaneous nephrostomy tube replacement. A 57-year-old woman was found to have a subcutaneous mass at the site of nephrostomy. She had a past history of right nephroureterectomy for ureteral carcinoma about one year earlier, and a nephrostomy tube had been inserted before diagnosis postoperatively. We resected the subcutaneous mass. Pathological diagnosis was urothelial carcinoma closely resembling right ureteral carcinoma. To our knowledge, this is the seventh reported case of NTI of upper urinary tract urothelial carcinoma. Percutaneous manipulation carries a potential risk of local tumor spillage and NTI in the nephrostomy tract.

50歳男.主訴は左腰背部痛.CT・MRI検査で左後腹膜腔に辺縁石灰化を伴う嚢胞性の巨大腫瘤を認め, また右腎は腎盂尿管移行部狭窄による水腎症を認めた.左後腹膜腫瘍の診断で, 後腹膜腫瘍摘除術および下行結腸合併切除術を施行した.病理組織学的診断は水腎症が長期存在していた左腎実質から発生した腎悪性末梢神経鞘腫瘍(MPNST)であった.術後3ヵ月, 左下肺野多発性転移のため死亡した, We report a case of malignant peripheral nerve sheath tumor (MPNST) of the kidney. A 50-year-old man was referred to our hospital because of left back pain. Computed tomographic scan and magnetic resonance imaging revealed a huge left retroperitoneal tumor (30 x 13 x 11 cm), which consisted of a solid tumor with calcification surrounding the cystic component. He underwent resection of the retroperitoneal tumor and additional descending colectomy. Histopathological examination revealed MPNST arising from severely atrophic renal parenchyma of giant hydronephrosis. He died of tumor metastasis to the lungs 3 months after the operation. To our knowledge, this is the fourth case of MPNST of the kidney, moreover the third case arising from the renal parenchyma to be reported in Japan.

原発性上皮小体機能亢進症により上皮小体腫瘍摘出術を行い病理組織が確認された18例を対象とした.術後反回神経麻痺等の重篤な合併症を併発した症例は認めなかった.病理組織は全例単発の腺腫で過形成, 癌腫は認めなかった.なお全例術後に血清カルシウム及び上皮小体ホルモンの正常化を認めた.摘出した腺は全部で24腺で腺腫が18腺, 正常上皮小体が6腺であった.局在診断成績は腺腫18腺中17腺が91mTc-methoxy-isobutyl-isonitrile(MIBI)シンチグラフィーで描出された.sensitivityは94.4%, positive predictive value (PPV)は94.4%であった.超音波断層検査ではsensitivityは52.9%, PPVは81.8%であり, MRI検査ではsensitivityは80.0%, PPVは92.3%であった, We evaluated the usefulness of 99mTc-methoxy-isobutyl-isonitrile (MIBI) dual phase scintigraphy for detecting hyperfunctioning parathyroid adenoma. We retrospectively reviewed 18 hyperparathyroid patients who received MIBI prior to neck exploration and compared the radiological findings of MIBI with ultrasonography (US) and magnetic resonance imaging (MRI). Fifteen patients were studied with MRI, and 17 patients were examined with US. All patients were found to have a solitary parathyroid adenoma histopathologically. MIBI correctly revealed the location of 17 adenomas among 18 confirmed tumors. In our series, there was one false-positive case that was found to have thyroid adenoma. The diagnostic sensitivity of MIBI MRI and US was 94.4%, 80% and 52.5%, respectively. The positive predictive value (PPV) was 94.4% for MIBI, 81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and accurate for the preoperative localization of adenoma in primary hyperparathyroidism.