Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy

Pancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches. In the sealing group, fibrin glue was sprayed over the closed pancreatic stump and sutures. Alternatively, in the sandwich group fibrin glue was sprayed so as to cover and join the cut surface of the pancreatic remnant, which was then held closed with sutures. Altogether 111 patients were included in the study (90 with gastric cancer, 10 with esophageal cancer, and 11 with pancreatic cancer). Patients were nonrandomly assigned to the sandwich or the sealing group. Morbidity was 21.8% for the patients in the sandwich group versus 33.9% in the sealing group. Pancreatic fistulas occurred in 9.0% of the sandwich group versus 26.8% of the sealing group. The incidence of fistula was thus significantly lower in the sandwich group. The incidence of fistula was also significantly lower in the sandwich group for gastric malignancy patients undergoing extended radical lymphadenectomy down to the paraaortic lymph nodes combined with left adrenalectomy. Of the patients with gastric malignancy, pancreatic fistulas occurred in 9.3% of the sandwich group versus 25.5% of the sealing group. The fibrin glue sandwich technique is simple and reliable and should be valuable for complementing other prophylactic methods of preventing pancreatic fistula.

[A case of huge abscess extended from anterior neck to left lung and lateral chest wall]

62-year-old woman admitted our hospital with pain of left upper extremity from the left chest and dysphasia. Chest X-ray showed the huge mass shadow in the left lung field. Diabetes mellitus and inflammatory reaction such as high fervor, leukocytosis, CRP and ESR accentuation were recognized. Conservative therapy was done at first, but mass shadow on X-ray increased, and swelling appeared from the neck to the left lateral chest wall. And the same site appeared like subcutaneous emphysema. Computed Tomography showed mass shadow which was enlarged and spread in lung parenchyma and left chest wall with bubble image. Incision and open drainage was performed for the left chest wall but origin bacteria was detected in neither anaerobic nor aerobic culture of pus. Inflammation and mass shadow of left upper lung field have decreased gradually. The patient discharged without bronchoalveolar fistula. Abscess extending from the neck or chest wall with diabetes mellitus is very rare.

Pitted keratolysis: clinical manifestations in 53 cases

Pitted keratolysis (PK) has been reported to be more common among bare-footed people living in tropical regions. It is now known that the disease is not limited to the tropics but has a world-wide distribution. However, no study has previously been performed analysing the clinical manifestations of the disease in temperate countries. A survey of 53 patients revealed several distinctive clinical features. Hyperhidrosis is the most frequently observed symptom of this condition. Malodour and sliminess of the skin are also distinctive features, evident in 88.7% and 69.8% of the cases, respectively. The most common sites of onset of PK are the pressure-bearing areas, such as the ventral aspect of the toe, the ball of the foot and the heel. The next most common site is a friction area, the interface of the toes. Lesions are rarely seen on the non-pressure-bearing locations. Some of the primary lesions originate as a small defect along the plantar furrow, which gradually grows into the characteristics crateriform pit. Several clinical features are helpful in diagnosing PK.

Effects of 5'-DFUR and OK-432 on cytokines and thymidine phosphorylase in tumor tissue of gastric cancer patients

BACKGROUND

The purpose of the study was to verify whether OK-432 in combination with 5'-DFUR induced thymidine phosphorylase (TdR Pase) and cytokines in gastric cancer patients as well as in vitro.

MATERIALS AND METHODS

Fifty patients with invasive gastric cancer were randomly assigned, upon admission using by a closed-envelope technique, to either a group receiving 5'DFUR or OK-432 alone, to a group receiving both 5'DFUR and OK-432, or to a non- treated group up. Surgical specimens of the tumor and normal tissues were taken soon after gastrectomy to evaluate TdR Pase activity, IL-1 alpha and TNF-production.

RESULTS

TdR Pase activities were several times higher in tumor than in normal tissues. In normal tissues, TdR Pase activities in the 5'-DFUR + OK-432 group were significantly higher than in the OK-432 group. TdR Pase activity in tumors, however, showed no significant difference between treated group. In the 5'-DFUR + OK-432 group, the level of IL-1 alpha production in tumor was significantly higher compared to the control group. In the 5'-DFUR + OK-432 group, the level of TNF alpha production in tumor was significantly higher than in normal tissue. TNF alpha production in tumor showed no significant difference in each treated group compared to the control. There was a significant correlation between TdR Pase activity and IL-1 alpha production levels in tumor.

CONCLUSIONS

TdR Pase was induced by IL-1 alpha in tumor tissues of gastric cancer patients. OK-432 in combination with 5'-DFUR, however, did not induce TNF alpha and IL-1 alpha, and increase TdR Pase activity in gastric cancer tumors.

[A case of pleural metastasis of invasive thymoma with pulmonary metastasis responding to chemotherapy with cyclophosphamide and prednisolone]

The patient, a 48-year old male, was seen with hoarseness in December 1990. A chest radiograph and chest CT scan showed an anterior mediastinal mass. Median sternotomy revealed epithelial thymoma with involved partial lung and pericardium. After surgery, he received external radiation to the mediastinum. One year later he was given another 40 Gy external radiation in the cervical and mediastinal recurrence region. In May 1994, a chest CT scan revealed an extrapleural and bilateral lung mass. Histological examination revealed recurrent epithelial thymoma in the left cervical muscle biopsy, so treatment with cyclophosphamide and prednisolone were begun. A dose of 100 mg/body/day of cyclophosphamide and a dose of 10 mg/body/day of prednisolone were administered every 2 week. Complete remission was induced with four cycles of this treatment of cyclophosphamide and prednisolone. The chemotherapy was thus continued for 20 cycles in 14 months. This chemotherapy with cyclophosphamide and prednisolone appeared to be useful and safe for recurrent thymoma at the outpatient clinic level.

Linear focal elastosis: a review of three cases in young Japanese men

Linear focal elastosis in three young Japanese men is described. The lesions are asymptomatic palpable yellow strialike bands extending horizontally across the middle and lower parts of the back. They are histologically composed of many fine wavy bundles of elastic fibers separating the dermal collagen bundles. Electron microscopy demonstrates numerous elongated and fragmented elastic fibers.

[Video-assisted right pneumonectomy for small cell carcinoma]

We presented a case of video-assisted right pneumonectomy for small cell carcinoma. A 54-year-old male was admitted because of an abnormal shadow on a chest rentogenogram occasionally. The bronchoscopic biopsy revealed squamous cell carcinoma at the right intermediate bronchus. His magnetic resonance imaging demonstrated a 5-cm right hilar mass involving with right pulmonary artery. The operation was carried out by video-assisted thoracotomy with small lateral thoracotomy. Pathological findings revealed oat cell carcinoma with a subcarinal node involvement postoperatively. His postoperative course was uneventful. He received adjuvant chemotherapy and 60 Gy radiation in the mediastinum. He is alive 12 months after surgery without any evidence of recurrence. The advantages of the video-assisted thoracotomy were reported less postoperative pain and discharged earlier than the standard thoracotomy. Video-assisted pneumonectomy had not disturbed him in the adjuvant therapy for oat cell carcinoma.

Localization of mouse Rad51 and Lim15 proteins on meiotic chromosomes at late stages of prophase 1

BACKGROUND

In meiosis, eukaryotic chromosomes show a series of morphological changes, during which chromosomes synapse and recombine. To understand the mechanisms of the morphological changes and recombination of chromosomes, we examined stage-specific localization of the Rad51 and Lim15 proteins on the chromosomes in meiotic prophase 1. These proteins are homologous with the RecA protein and have general properties of searching and pairing of homologous DNA sequences. We used mouse chromosomes whose small sizes allow us to identify the locations of these proteins on the entire structures of the chromosomes.

RESULTS

In the leptotene and zygotene stages, the Rad51 protein was present on chromatin loops of mouse testis chromosomes then the protein left the loops. In the pachytene stage, the Rad51 protein was present almost exclusively along the core of the synaptonemal complexes (SC). When the stage proceeded to diplotene, the protein was present in the synaptic regions of chromosomes, in particular, in the chiasma regions. The protein was not present on separated homologous SC cores. On the other hand, the Lim15 protein that was found on chromatin loops in early prophase 1, was present almost exclusively at both ends of the SC cores throughout the late stages of prophase 1.

CONCLUSION

The Rad51 and Lim15 proteins are present in chromatin loops when chromosomes form SC. The proteins may promote pairing of homologous DNA sequences that would lead formation of SC. The Rad51 protein in the SC cores may be involved in chiasma formation in late stages. The Lim15 protein, instead, may be involved in recombination in the telomeric region or in cohesion of sister chromatids for segregation.

Effect of the hydroxyl radical on fibroblast-mediated collagen remodelling in vitro

1. It has been reported that free radicals prevent wound healing. However, the mechanism of this effect is not yet clear. We attempted to clarify the influence of hydroxyl radicals on wound healing in vitro. 2. We used an ascorbate-copper ion system (ACS) to produce hydroxyl radicals in accordance with variables of time elapsed and concentration of copper ion. The effects of hydroxyl radical on fibroblast-mediated collagen remodelling, cell viability, the functions of fibroblasts and collagen fibrils were studied. 3. With a copper ion concentration of 100 mumol/L ACS significantly reduced contraction, while 10 mumol/L stimulated contraction. Hydrogen peroxide (H2O2) was employed in observing these findings. ACS did not influence cell viability, the expression of alpha 2 beta 1 integrin and cellular fibronectin, or the cytoskeletal organization of fibroblasts involving actin until 3 h. A concentration of ACS at 10 mumol/L of copper ion induced the polymerization of collagen after 30 min, while ACS at 100 mumol/L induced collagen degradation; this finding was also established by using H2O2. Collagen reduced the amount of formaldehyde produced by trapping hydroxyl radical with dimethyl sulfoxide. 4. Our findings suggest that collagen is denatured by scavenging the hydroxyl radical before fibroblasts are damaged, so that the radical may influence the remodelling of collagen.

Expression of heat shock protein 72 on peripheral blood mononuclear cells from patients with pustulosis palmaris et plantaris

The expression of heat shock protein (HSP) 72 on peripheral blood mononuclear cells (PBMC) from patients with pustulosis palmaris et plantaris (PPP) was studied. PBMC isolated freshly from patients with PPP expressed HSP72, while those from psoriasis patients did not. PBMC from patients with PPP continued to express it in in vitro cultures at 37 degrees C. This expression was further augmented by in vitro heat stimulation at 43 degrees C. Immunofluorescence studies showed that approximately 20% of PBMC from patients with PPP were stained positively with anti-HSP72 antibody. HSP72 was expressed on both nonadherent and adherent cells of PBMC. These findings suggest that PBMC from patients with PPP may produce HSP72 spontaneously through their in vivo exposure to stressful agents.

Expression of Lewis Y (Le(y)) antigen in human anagen hair follicles

Lewis Y (Le(y)) antigen, a difucosylated tetrasaccharide found on type 2 blood group oligosaccharides of glycolipids and glycoproteins, is thought to be a phenotypic marker predictive of cell differentiation. The distribution of this antigen in human anagen hair follicles was examined by immunohistochemical staining using a monoclonal antibody (AH-6) to Le(y). In the bulbar and suprabulbar portion of anagen hair follicles, Le(y) antigen was detected in the three layers of the inner root sheath. Subsequently, the positive staining became translocated to the innermost layer of the outer root sheath in the middle part of the hair follicles. In the upper portion of the hair follicles, Le(y) antigen was found in the outer cells of the outer root sheath. These findings suggested that the expression of Le(y) antigen in the anagen hair follicles was correlated with the processes of keratinization or terminal differentiation.

Left-sided gallbladder with anomalies of the intrahepatic portal vein and anomalous junction of the pancreaticobiliary ductal system: a case report

A 66-year-old man was admitted for an early cancer in the gastric corpus. At laparotomy, the gallbladder was located on the left side of the round ligament and attached to the lateral segment of the liver. This finding was compatible with a left-sided gallbladder. Postoperative ultrasonograms and portograms demonstrated anomalies of the intrahepatic portal vein as follows; The left umbilical portion and the posterior point of the portal branch were lacking. The posterior point was seen as an umbilical portion. An endoscopic retrograde cholangiopancreaticogram showed the cystic duct entering into the right side of the common bile duct confluent to the accessory pancreatic duct. A left-sided gallbladder unassociated with visceral inversion is a rare congenital anomaly. Forty-one cases have been reported in Japan, five with anomalies of the intrahepatic portal vein and two with anomalous junction of the pancreaticobiliary ductal system. To our knowledge, our patient is the only case of the left-sided gallbladder which both congenital anomalies.

[Video-assisted lobectomy for primary lung cancer]

We had performed video-assisted lobectomy for six primary lung cancer cases. This report is presented our method of video-assisted lobectomy with a typical case. This case had a complain of positive sputum cytology at the regular examination. His chest rentogenogram was almost normal and the bronchoscopic appearance was revealed polypoid lesion at left B 3 orifice. His sputum cytology examined 3 years ago was positive. At that time we could not find the malignant site at the left B 3 orifice. So further examination was performed, but we did not find other metastatic site and mediastinal nodes involvement by chest computed tomography. Left upper lobectomy and lymph node dissection was performed by video-assisted thoracotomy with small lateral incision of about 8 centimeters on the fifth intercostal space and other two thoracotomy ports. This operation method was followed as same fashion as the standard lobectomy with double knotted pulmonary vein and artery without the usage of the automatic anastomotic device. His postoperative pathological study was revealed intramural bronchial cancer at B 3 orifice without node involvement. His postoperative course was uneventful. He had discharged at 18 postoperative day.

Lichen planus pemphigoides: identification of 180 kd hemidesmosome antigen

We describe a man with lichen planus pemphigoides. Direct immunofluorescence studies of peribullous skin showed linear deposition of IgG and C3 in the basement membrane zone. Indirect immunofluorescence studies disclosed circulating anti-basement membrane zone antibodies. Immunoelectron microscopy demonstrated binding of antibodies to the hemidesmosomes and lamina lucida. The patient's serum defined only the minor bullous pemphigoid antigen with a molecular weight of 180 kd. These findings suggest the coexistence of lichen planus and bullous pemphigoid in lichen planus pemphigoides.

Expression of transglutaminase I in human anagen hair follicles

The expression of the transglutaminase I in human anagen hair follicles was studied by an immunohistochemical staining. In the bulbar and suprabulbar portions of anagen hair follicles, transglutaminase I was detected on the hair cuticle and the three layers of the inner root sheath. Subsequently, the positive staining became translocated to the inner site of the outer root sheath in the middle part of the hair follicle. In the upper portion of the hair follicle transglutaminase I was detected in the internal part of the outer root sheath and the surface epidermis. Therefore, it was suggested that the expression of transglutaminase I might be closely associated with the terminal keratinization in the anagen hair follicles.

Pemphigoid nodularis: a case with 230 kDa hemidesmosomes antigen associated with bullous pemphigoid antigen

We report a 73-year-old woman with typical clinical, histological and immunofluorescence features of pemphigoid nodularis. Direct immunofluorescence studies of prurigo nodularis-like lesions and peribullous skin showed the linear deposition of IgG and C3 at the basement membrane zone. Circulating IgG against the basement membrane was also detected by indirect immunofluorescence. The serum from the patient was shown to contain the autoantibody against 230 kDa hemidesmosomal antigen associated with bullous pemphigoid antigen.

A species-specific interaction of rad51 and rad52 proteins in eukaryotes

The structures and properties of the Rad51 and Rad52 proteins in eukaryotes are described. Both proteins form a complex and are responsible for recombination and repair reactions. The N-terminal region of the Rad51 protein interacts with the C-terminal region of the Rad52 protein. Species-specific interaction is probably essential for the functioning of these genes.

Identification of programmed cell death in normal human skin tissues by using specific labelling of fragmented DNA

Programmed cell death (PCD) in normal human skin tissues was studied by using in situ specific labelling of fragmented DNA. This labelling method clearly stained the nuclei of Henle's layer in the bulb of the anagen hair follicle in serial sections, and the nuclei of the inner root sheath cuticle cells and Huxley's layer cells showed positive staining in the upper part of the hair follicles. This staining pattern was consistent with the sequence of keratinization in the three layers. The nuclei of differentiated cells located at the centre of the sebaceous glands, and those of the granular keratinocyte layer, were also stained. These findings suggest that PCD might play a key role in the terminal differentiation of the epidermis and epidermal appendages.

Diagnostic approach to autoimmune blistering diseases using immunoblotting with chemiluminescence

Autoantibodies in sera from patients with autoimmune blistering diseases were detected by immunoblotting with chemiluminescence. This method provided the high sensitivity in the detection of autoantibodies against human epidermal extract. It was useful for detecting low titers of autoantibodies, and identifying small amounts of autoantigens in antigen extracts.

A chimeric RecA protein exhibits altered double-stranded DNA binding

RecAc38 protein, a chimeric RecA protein of Escherichia coli and Pseudomonas aeruginosa, is proficient in the renaturation from complementary single strands. However, RecAc38 protein showed a significant deficiency in promoting homologous pairing of single-stranded DNA and double-stranded DNA. RecAc38 protein was able to remove the secondary structure of single-stranded DNA, the first step of homologous pairing, at a slightly reduced rate. RecAc38 protein-single-stranded DNA-complex (presynaptic complex) was found to be deficient in the sequence-independent binding to double-stranded DNA which is a step in the search for the homology. On the other hand, once unwinding was initiated, RecAc38 protein was able to propagate the unwinding of the double helix at the same extent as wild-type RecA protein. These defects and the proficiency of RecAc38 protein are explained by a model showing that RecA protein has three distinct DNA strand-binding sites (a site for the primary binding to single-stranded DNA, a site for the binding to a strand of second single- or double-stranded DNA, and a site required for the binding to the other strand of the double-stranded DNA) and that RecAc38 protein has a defect in the third site.

[Hospital infection and our policy to control]

Since we organized the committee to control hospital infection in April 1980, we have adopted various investigations and strategies. When wide spread of infection caused by Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa was recognized in 1981 our strategies were set up of water faucets with footpedal, frequent to wash of hands and use of disposable paper towels. Investigation of HBV markers revealed that the positive rate of HBV antibody was 21% in scrub and ward nurse group. Vaccination was performed to our HVB antibody negative members to protect them from the infection of HBV antigen. After HBV antigen positive patients were operated, we sterilized the operating room using our ultraviolet ray irradiation apparatus. In 1990, 50 cases infected with MRSA were detected bacteriologically, which occupied 68.5% of all those infected with Staphylococcus aureus. Therefore, we cultured MRSA from nose swabs and investigated numbers of bacteria in the air which were gathered with air sampler in the operating rooms and wards.

Acrosyringeal adenomatosis (eccrine syringofibroadenoma of Mascaro). A case report and review of the literature

The case of a 63-year-old man with acrosyringeal adenomatosis (eccrine syringofibroadenoma of Mascaro) is reported. Asymptomatic papular lesions had appeared on the dorsum of both of his feet 30 years earlier, then extended gradually and symmetrically to his hands, arms, legs, trunk, and auriculae. Although his hair, teeth, and nails were normal, he had glaucoma, chronic sinusitis, chronic otitis media, chronic pancreatitis, and gastrointestinal polyposis. No similar symptoms were found in the family history. Histopathologically, proliferations of pale epithelial cells extended from acrosyringia into the dermis, forming interconnected epithelial cords, within some of which were ductal structures. A syringoma and syringoma-like structures were closely associated with these lesions. Enzyme-histochemical, immunohistochemical, and ultrastructural studies supported the concept that this case represents a benign tumor derived from the acrosyringium, which is different from eccrine poroma. Acrosyringeal adenomatosis seems to be a more appropriate name for such a lesion than does eccrine syringofibroadenoma (Mascaro).

Immunogenetic study of three Japanese families with neonatal lupus erythematosus

We encountered three Japanese families with neonatal lupus erythematosus. None of the three fathers showed any signs of collagen disease. The three mothers were found to suffer from Sjögren's syndrome; they all tested positive for anti-SSA and SSB antibodies and had lymphocyte infiltration into the small salivary gland. In two families, one child had neonatal lupus erythematosus while a sibling was normal; in the third family, both children had neonatal lupus erythematosus. Thus, a mother with positive anti-SSA and SSB antibodies can give birth to one infant with and one infant without or have two infants with neonatal lupus erythematosus. We conducted HLA typing of all 12 members of the three families in order to clarify the immunologic factors involved. We found no increased frequency of any HLA phenotype in the three mothers and their four children with neonatal lupus erythematosus; however, HLA-DR4 was present in three of the children with neonatal lupus erythematosus.

Dysplastic nevus syndrome among Japanese. A case study and review of the Japanese literature

Three Japanese families with dysplastic nevus syndrome (DNS) are reported. Each family had at least two members with multiple dysplastic nevi (DN). Family members with DN or multiple moles had paler skin than average Japanese, usually sunburned, and tanned less than average, whereas members with darker skin almost never had DN. Each of two families had one cutaneous malignant melanoma (CMM) patient associated with multiple DN. Both CMMs were on the leg. In Japanese DNS, skin color and sun sensitivity seem to be closely related to DN. The locations of CMMs associated with DNS were unique: No CMMs were found on acral areas where they most frequently occur in Japanese.

Significance of tubuloreticular structures in infants with neonatal lupus erythematosus and their mothers with Sjögren's syndrome

Four infants with neonatal lupus erythematosus who had annular erythema on the trunk and face reacted positively to tests for anti-Ro(SS-A)/La(SS-B) antibodies. Electron microscopic examination of vascular endothelial cells in the annular erythema revealed the presence of tubuloreticular structures. Once anti-Ro(SS-A)/La(SS-B) antibodies had turned negative, these tubuloreticular structures were no longer evident in the vascular endothelial cells in the same area where annular erythema had been present. Mothers of these 4 infants reacted positively to anti-Ro(SS-A)/La(SS-B) antibodies, but had no sicca syndrome. A biopsy taken from the minor salivary gland of the lip of each mother revealed marked periductal mononuclear cell infiltration. Primary subclinical Sjögren's syndrome was confirmed. Tubuloreticular structures were also observed in the vascular endothelial cells in the region of the minor salivary gland. These findings suggest that the presence of tubuloreticular structures may be related to anti-Ro(SS-A)/La (SS-B) antibodies.

[A case of smoldering ATLL in high risk family and familial double infection of HTLV-1 and HBV]

A 35-year-old male from Kagoshima prefecture developed nodules with asymptomatic erythema on both upper eyelids, both hands and upper right leg in April 1986. On April 10, 1987, biopsy of skin lesions revealed numerous atypical CD4 positive lymphocytes which had invaded the dermis around the vessels. Analysis of serum showed positive antibody titer (X40) against the human T lymphotropic virus type I (HTLV-I) with some flower cells evident in peripheral blood; however, no infiltration into bone marrow or lymph nodes could be seen. Lymphocytes from peripheral blood and from the skin lesion of the right leg showed monoclonal integration of HTLV-I proviral DNA. Chronic active hepatitis B virus (HBV) was also a complicating factor. Familial study revealed all three family members to be infected with HTLV-1 as well as HBV. Proviral integration of HTLV-I was the intermediate type in two out of the three. From the results, a diagnosis of smoldering adult T cell leukemia-lymphoma (ATLL) was made in this patient with high risk to family members. Herein we discuss the development of ATLL in this case and infection among family members.

Right hepatic lobectomy for primary lymphoma: a case report and literature review

Primary lymphoma of the liver is an extremely rare entity; only eight cases have been reported in the literature. We treated a 34-year-old man with primary hepatic lymphoma by right hepatic lobectomy, including right hemicolectomy the nephrectomy. The histological diagnosis was a small cell diffuse histiocytic lymphoma. Details of this case plus that of others in the literature are described in this report.

[5-FU concentration in tissues of gastric cancer patients with preoperative administration of UFT--especially in comparison with FT-207]

FT-207 or UFT was administered preoperatively to 74 patients with gastric cancer. The 5-FU and FT-207 concentrations in the serum and various tissues were investigated. The 5-FU concentration in various tissues was higher than in the serum after the administration of FT-207 or UFT. Especially it showed that 5-FU concentration in tumor was highest in other normal tissues. The 5-FU concentration in the tumor for the UFT group was higher than for the FT-207 group. There was a significant difference between the UFT and FT-207 groups (P less than 0.05). Levamisole had no influence on the concentration of 5-FU.

Acquired hypertrichosis lanuginosa

Acquired hypertrichosis lanuginosa occurred in a man with lung cancer. Fine lanugo-like hair covered his face, trunk, and extremities, and there were marked pigmentation of oral mucous membrane and a painful red tongue. Our study revealed a high concentration of carcinoembryonic antigen (CEA) in the serum of the patient. We considered that CEA might be an important etiological factor of this disease.