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We report a case of granulocyte-colony stimulating factor(G-CSF)producing breast cancer in a 54-year-old woman. Eight months after surgery, multiple liver and pulmonary metastases appeared. They progressed rapidly in 2 weeks and she had a high fever of 38 degrees. Serum G-CSF was high, and positive cells were found by immunostaining of the primary tumor. Chemotherapy was initially successful but she died 4 months after relapse.

A general one-pot method for the enantioselective synthesis of β,β-disubstituted allylic alcohols has been developed starting from readily available terminal alkynes and aldehydes. Trisubstituted (E)-vinylaluminium reagents, generated regio- and stereoselectively by the Zr-catalyzed carboalumination of the alkynes with Me3Al, was used in subsequent enantioselective addition reactions with aldehydes using a DPP-H8-BINOL-derived titanium catalyst system at low catalyst loading (5 mol-%).

A general one-pot method for the enantioselective synthesis of β,β-disubstituted allylic alcohols has been developed starting from readily available terminal alkynes and aldehydes. Trisubstituted (E)-vinylaluminium reagents, generated regio- and stereoselectively by the Zr-catalyzed carboalumination of the alkynes with Me3Al, was used in subsequent enantioselective addition reactions with aldehydes using a DPP-H8-BINOL-derived titanium catalyst system at low catalyst loading (5 mol-%).

Eosinophilic gastroenteritis (EG) is an inflammation of the digestive tract that is characterized by eosinophilic infiltration. There are no specific symptoms, and are related to the layer in which eosinophilic infiltration is observed. A 69-year-old Japanese man presented to our hospital with a history of general malaise, diarrhea, and dysgeusia. Esophagogastroduodenoscopy showed reddish elevated lesions that were edematous all over the gastric mucosa. In addition, three tumors were also observed. The biopsies of the reddish elevated mucosa revealed eosinophilic infiltration and tubular adenocarcinoma from the tumors. Colonoscopy showed abnormal reddish elevated mucosa. The biopsies from the reddish elevated mucosa showed eosinophilic infiltration. From the abdominal contrast computed tomography scan, tumor stain was seen in the anterior wall of the gastric body. No ascites, intestinal wall thickening, or lymph node swelling were found. A slight elevation in the serum immunoglobulin E (IgE), 480 IU/ml, was found from the laboratory test results; other laboratory results were within normal limits including the number of peripheral eosinophils. No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative. He was diagnosed with EG associated with gastric cancer and underwent total gastrectomy, regional lymph node dissection with reconstruction by a Roux-en-Y method. He was prescribed prednisolone after the operation and showed a good clinical response. There are many case reports on EG, but none of them were associated with cancer. We encountered a case of EG associated with multiple gastric cancer; the patient underwent total gastrectomy.

症例は74歳，女性．当院婦人科定期受診中，CEA高値を認め精査にて右腎背側に腫瘍を指摘されたため，外科紹介受診となった．腹部超音波，CT，MRI検査で後腹膜腫瘍と診断し，FDG-PETで腫瘍に一致して集積亢進（SUVmax:4.9）を認め，悪性腫瘍の可能性を否定できないため，腫瘍摘出術を施行した．腫瘍の大きさは8.0×4.5×4.5cmで，病理組織学的にはAntoni A，B混合型を呈する神経鞘腫であった．近年，FDG-PETは様々な腫瘍において，良悪性診断や転移検索の目的に利用される機会が増加している．後腹膜神経鞘腫は，FDG-PETの集積亢進を示すことが多い良性腫瘍の1つであり，後腹膜腫瘍ではFDG-PETによる悪性腫瘍の鑑別診断として念頭に置く必要があると思われた．

症例は49歳の女性で，近医で肝機能異常とCA19-9の高値を認め腹部CT施行，胆嚢腫瘍と左卵巣腫瘍を指摘され精査加療目的に当科紹介された．腹部CT, MRIで胆嚢に不整な壁肥厚と乳頭状隆起を認め，骨盤腔内に14 cm大の多房性嚢胞を認めた．胆嚢と卵巣の重複癌の診断にて開腹手術を施行したが，胆嚢癌は腹膜転移を伴っており総肝動脈幹リンパ節のサンプリングと両側附属器切除のみを施行した．手術時に採取したリンパ節と左卵巣腫瘍はともに腺癌で，免疫組織染色検査にていずれもCA19-9陽性，cytokeratin 7陽性，cytokeratin 20陽性，p53陽性であり，一元的に胆嚢癌のリンパ節転移，卵巣転移と診断した．消化管腫瘍の卵巣転移のうち，胆嚢癌由来はまれである．本例はジェムシタビン，TS-1による化学療法を行い，術後21か月生存した．

A 69-year-old man diagnosed as having gallbladder cancer with liver invasion and metastasis to Couinaud's hepatic segment 8 (S8) was referred to our hospital. Because of the presence of liver metastasis, gemcitabine administration was chosen. Although gemcitabine was effective for the liver metastasis, his serum carcinoembryonic antigen (CEA) level had gradually increased after 12 cycles of gemcitabine administration. There was no distant metastasis other than the liver metastasis (manageable with gemcitabine) on detailed radiological examination. Therefore, we performed surgery for the primary lesion, after obtaining informed consent. Pathological examination demonstrated viable cancer cells with necrosis and fibrosis in the gallbladder, and fibrosis without viable cancer cells in the induration in liver S8. Gemcitabine was re-administered as postoperative adjuvant chemotherapy. Twenty months after the surgery, there was no sign of recurrence. In selected patients, gemcitabine treatment may be effective against gallbladder cancer with metastasis.

69歳，女性．黄疸を主訴に近医受診し肝門部胆管癌と診断され，精査加療目的にて当科紹介入院となったが，肝転移を認めたため手術適応外と判断し，gemcitabine（GEM）を投与開始し外来継続投与を行った．投与開始後148日目に下肢脱力感を訴え，両側下肢近位筋の軽度筋力低下を認めたが，血液検査で異常なく経過観察となった．しかし，両下肢疼痛・筋力低下が進み，投与開始後162日目に両下肢疼痛・近位筋筋力低下，発熱，乏尿を主訴に当院救急外来受診となった．血液検査で炎症反応，筋原性逸脱酵素の上昇を認め，急性腎不全の所見で入院となったが，安静，輸液にてcreatine kinase（CK）は低下を示し，利尿を得た．疼痛，筋力低下は徐々に改善し入院後13日目からリハビリテーションを開始し，症状発現後約2カ月で症状消失した．原因精査の結果，GEMによる横紋筋融解症が最も強く推測された．

Background and Objectives The presence of lymph node (LN) metastases is an important prognostic factor in patients with biliary cancers. The aim of this study was to characterize systematically the morphological features of metastatic LNs in biliary cancers. Methods Four hundred ninety-six LNs (including 112 para-aortic LNs) dissected from 47 patients with biliary cancer were examined. The diameter of the long axis (size) and the percent metastatic area relative to whole-node area were measured from histologic specimens. Results The average size of metastatic LNs (9.5 mm) was significantly larger than those without metastasis (6.5 mm; P 7.5 mm, but the sensitivity of this predictor of metastasis was low (60.8%). In general, metastatic area correlated significantly with the size of metastatic LNs (P = 0.023). Para-aortic LNs contained metastasis in 7.1% of cases, and only 25% of para-aortic LNs with a high ratio of metastatic area could be evaluated from preoperative CT scans. Although large LNs are highly suggestive of metastasis, poor detection of many small LNs with a low percentage of metastatic area can increase risk in patients with biliary tract cancer. J. Surg. Oncol. 2008;97:423–427. © 2008 Wiley-Liss, Inc. Although large LNs are highly suggestive of metastasis, poor detection of many small LNs with a low percentage of metastatic area can increase risk in patients with biliary tract cancer. J. Surg. Oncol. © 2008 Wiley-Liss, Inc.

Lack of effective adjuvant therapy against advanced extrahepatic biliary tract carcinoma (BTC) requires that new therapeutic methods, such as molecular targeted therapy, be developed. The mitogen-activated protein kinase (MAPK) and Akt signaling pathways, which activate cell proliferation and suppress apoptosis, respectively, may function as important targets for such therapies. The aim of this study was to examine the expression patterns of phosphorylated MAPK (p-MAPK) and phosphorylated Akt (p-Akt) proteins in BTC cell lines and clinical specimens. Expression of p-MAPK and p-Akt proteins in four human BTC cell lines and in frozen sections of 20 advanced extrahepatic BTC specimens was analyzed by Western blotting. Thirty formalin-fixed BTC specimens were immunohistochemically stained for p-MAPK and p-Akt using labeled streptavidin–biotin conjugates. Expression of p-MAPK was observed in three of four (75%) BTC cell lines, whereas no expression of p-Akt was observed. Twenty-three of 30 formalin-fixed specimens stained positive for p-MAPK (77%), whereas only 47% stained positively for p-Akt. Expression of p-MAPK relative to that of p-Akt was also seen more frequently in the frozen specimens. The results of this study suggest that MAPK is activated more frequently than Akt in extrahepatic biliary tract carcinoma.

今回,われわれは尋常性乾癬に伴った消化器癌の3例を経験したので報告する.症例1は71歳,男性で,直腸癌に対して根治術を施行した後,皮疹は軽快した.症例2は63歳,男性で,胃癌と直腸癌の同時性重複癌に対して一期的に根治術を施行した.術後,皮疹は軽快したが,術前より投与したステロイド外用剤が奏効したものと考えられた.症例3は52歳,男性で,胃癌に対して根治術を施行したが,術後,皮疹は軽快せず,また再発時も増悪しなかった.本邦における尋常性乾癬に伴った内臓癌の報告例は自験例3例を含め18例あり,癌と皮疹の関係について検討した結果,内臓癌が乾癬の発症,増悪因子の1つである可能性が高いと考えられた.

症例は36歳,女性.下腹部違和感を主訴にて来院,直腸診で肛門縁から4～5 cmの下部直腸右側に,弾性軟,表面平滑な腫瘤を触知した.骨盤部超音波, CT, MRI検査により前仙骨部嚢胞性腫瘤と診断し,経腹的腫瘤摘出術を施行した.摘出標本は, 7.7×6.8×6.8cm大,表面平滑で弾性軟の単胞性嚢胞であり,内容物は黄白色の粥状物であった.病理組織学的には,嚢胞壁は重層扁平上皮に被われ,皮膚付属器を認めず, epidermoid cystと診断した.仙骨前epidermoid cystの本邦報告例は36例あり,自験例を含めた37例を集計し,検討を加えた.

Background. Although bacterial translocation is a sig- nifi cant problem in patients with obstructive jaundice, how translocation is promoted in this situation is not clearly understood. We previously reported the recov- ery of gut mucosal T-lymphocyte numbers in jaundiced rats following internal biliary drainage. This suggests that bile in the intestinal lumen promotes T-lymphocyte redistribution into the gut mucosa. To test this hypoth- esis, we have examined the expression patterns of che- mokines that play an important role in lymphocyte recruitment into the small intestine. Methods. Four groups of rats receiving one of the following surgical procedures were studied: a sham operation (SHAM), common bile duct ligation (CBDL), CBDL followed by external drainage, or CBDL followed by internal drain- age. Expression levels of intestinal mRNAs encoding TECK, MECK, and LARC chemokines were assessed using real-time polymerase chain reaction. Distribution of chemokine mRNA in the rat ileum was examined using in situ hybridization (ISH). Results. Following surgery, the expression levels of TECK mRNA decreased signifi cantly in the CBDL group compared with in the SHAM group. While TECK expression did not recover after external drainage, it recovered to a near-normal level after internal drainage. Expression levels of MECK and LARC mRNAs were similar among all groups. ISH confi rmed strong expression of TECK mRNA in the epithelial cells of the small intes- tine. Conclusions. These results indicate that bile may contribute to high expression levels of TECK/CCL25 mRNA in the small intestine. Bile may also have a role in regulating the distribution of gut mucosal T lympho- cytes by promoting TECK production from epithelial cells.