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We describe herein the case of a 68-year-old man who experienced leptomeningitis after esophagectomy from an esophageal basaloid carcinoma. Although the patient had a good operative course for the first 10 days after surgery, he suddenly had general convulsions with unconsciousness. He was placed on mechanical ventilation in an intensive care unit. Computed tomography and magnetic imaging resonance did not reveal any abnormal findings. No abnormal data in the cerebrospinal fluid were found by biochemical, virological, and cytological examination. The positive expression of carcinoembryonic antigen messenger ribonucleic acid in cerebrospinal fluid was detected by a quantitative reverse transcription-polymerase chain reaction method. Immunohistochemical staining using an anticytokeratin antibody confirmed the presence of tumor cells in the cerebrospinal fluid. Spontaneous breathing was recovered after treatment with systemic chemotherapy. Six months after surgery, computed tomography revealed multiple brain metastases. This case demonstrates that the quantitative reverse transcription-polymerase chain reaction method of analyzing carcinoembryonic antigen messenger ribonucleic acid may be a sensitive and useful method for determining leptomeningeal metastasis before the detection of tumors by cytological and imaging examinations in patients with cancer.

Background. There are few studies of flow cytometric analysis for DNA heterogeneity of patients with superficial carcinoma of the esophagus limited to the epithelium or superficially invading the lamina propria or submucosa. Methods. Flow cytometric analysis of cellular DNA content was performed on superficial carcinomas of the esophagus using paraffin embedded blocks of the surgically resected specimens from 56 patients. To evaluate the intratumoral DNA heterogeneity, a total of 141 samples of the 56 tumors were analyzed, depending upon the tumor size. Results. One or two of the samples was available from 18 of 19 patients with tumors 2 cm or less in greatest dimension, whereas more than three of the samples were available from 22 of 37 patients with tumors 2.1 cm or greater in dimension (P < 0.003). Of 56 tumors, 40 (71.4%) exhibited DNA aneuploidy ; DNA heterogeneity was found in 26 tumors (46.4%). The remaining 16 tumors exhibited DNA diploidy. Two of the five tumors that were limited to the epithelium had DNA heterogeneity. The mean dimension of the tumors with DNA heterogeneity was significantly greater (5.8 ± 2.8 cm) than those exhibiting DNA diploidy (2.3 ± 1.1 cm) and DNA aneuploidy without heterogeneity (2.9 ± 2.4 cm). Recurrences after esophagectomy were detected in 6 of the 56 patients ; the DNA ploidy pattern of these six patients exhibited DNA heterogeneity. Conclusion. The incidence of DNA heterogeneity increases as tumor size increases and is associated with an increased risk of tumor recurrence after esophagectomy in patients with superficial carcinoma of the esophagus. Cancer 1995 ; 75 :914-9.

胆嚢癌と下部胆管癌の同時性重複癌の1切除例を経験した.症例は63歳の男性.主訴は黄疸で, 腹部エコーによって膵頭部の腫瘤と胆嚢壁の肥厚をみとめた.経皮経肝胆管ドレナージによる減黄後, 全胃・幽門輪温存膵頭十二指腸切除術を施行し, 膵胃吻合およびBillroth I法形式による消化管再建を行った.切除標本において総胆管に結節型で径2.2×1.2cm大の腫瘍, 胆嚢底部に結節型で径1.8×0.7cm大の腫瘍が認められた.病理組織学的診断は両者とも高分化型腺癌で, 脈管侵襲像や両腫瘍の連続性は指摘されなかった.Carcinoembryonic antigenの免疫組織学的染色では胆管癌が弱陽性であったのに対し, 胆嚢癌が強陽性を示した.また, 核DNAploidypattemでは胆管癌はdiploid, 胆嚢癌はaneuploidを示し, 両腫瘍の生物学的性状に差が認められた.以上より同時性胆嚢・下部胆管重複癌と診断した.本症例は本邦34例目の同時性胆道系重複癌と思われる.

A 56-year-old-man complained of abdominal pain, and was diagnosed as having advanced rectal cancer with synchronous multiple metastatic liver cancer (H 3) in July 1999. He underwent low anterior resection and hepatic partial resection (S 1, S 2+S 3, S 5, S 6, S 8) in August 1999. In addition, he underwent hepatic arterial infusion chemotherapy (HAI) 6 times at ADM 30 mg+5-FU 1,000 mg+MMC 16 mg between October 1999 and July 2000 for recurrent metastatic liver cancer. He has survived more than 6 years after the initial surgery. Multidisciplinary treatment with hepatic resection may well be a strategy for patients with multiple colorectal liver cancer, even though H 3 type of metastasis.

Adenosquamous carcinoma of the esophagus is an uncommon type of esophageal tumor. In the present case, a 54-year-old man without symptoms was diagnosed with esophageal squamous cell carcinoma, based on endoscopic examination of a biopsy specimen. Endoscopy and barium roentgenography revealed a superficial plateau-type lesion, 2 cm in length, in the lower esophagus. Esophagectomy with lymphadenectomy was performed via a right thoraco-abdominal approach. The histological diagnosis was adenosquamous carcinoma with no lymph node metastasis. Three years after the surgery, multiple liver metastases were detected by computed tomography. The patient was treated with a combination of low-dose 5-fluorouracil(350 mg/body/day) and low-dose cisplatin (7 mg/body/day). Because the first course of chemotherapy was very effective and the number of liver metastases was reduced,a further 6 courses were administered. After 6 courses of chemotherapy, no liver metastases were detected. Based on the present findings, we recommend low-dose 5-fluorouracil/cisplatin therapy for liver metastasis from esophageal adenosquamous carcinoma.

Intestinal malrotation is a rare anomaly of rotation and fixation of the midgut. Left-sided appendicitis occurs in association with two types of congenital anomalies, situs inversus and intestinal malrotation. We describe a rare case of left-sided acute appendicitis with intestinal malrotation in a 14-year-old boy, in which computed tomography (CT) was useful for a preoperative diagnosis.

Six cases of carcinosarcoma of the esophagus were studied clinicopathologically, immunohistochemically and with DNA flow cytometry. Transitional areas with morphology intermediate between carcinoma and sarcoma were found microscopically in all cases. Immunohistochemically, the carcinomatous areas contained keratin-positive cell components in all cases while vimentin-positive cells were found in sarcomatous areas in 5 cases. By DNA flow analysis of microdissection, the sarcomatous components of the tumors showed an aneuploid pattern with one exception, in contrast the carcinomatous components were diploid in all cases. In these few cases, PCNA, S-phase fraction and the mitotic rate were extremely high, apparently indicating a correlation with malignant behavior. Accordingly, examination by immunohistochemistry and DNA ploidy is useful for the analysis of biological properties in the so-called carcinosarcoma of the esophagus.