[A Case of Adenocarcinoma Arising from Ectopic Gastric Mucosa in Meckel's Diverticulum with Abdominal Wall Abscess]

A 47-year-old woman visited a neighboring hospital because of lower abdominal pain and high fever. She was diagnosed with acute pyelonephritis and administered(oral)antibiotics. However, there was no sign of improvement. She was referred to our hospital for closer examination. Computed tomography revealed an 8 cm abdominal wall abscess spreading from the prevesical space to the rectus abdominis. Incisional drainage was performed under local anesthesia. She developed rectus abdominis muscle diastasis, and a laparotomy was performed 2 months later. Intraoperative findings showed that her Meckel's diverticulum was continuous with the abdominal wall abscess. Diagnosed with Meckel's diverticulitis with abdominal wall abscess, the patient underwent surgery(excision)for these. Histopathological findings showed adenocarcinoma cells in the abscess tissue and were continuous with gastric pyloric gland-like tissue in Meckel's diverticulum. Based on these findings, the patient was diagnosed with adenocarcinoma arising from ectopic gastric mucosa in the Meckel's diverticulum. The patient received postoperative adjuvant chemotherapy for a year. The patient is currently alive and has not experienced recurrence for 2 years since surgery. It is difficult to diagnose carcinoma of Meckel's diverticulum preoperatively due to late onset of symptoms. The diagnosis is often made at the advanced stage, when the prognosis is poor. This case is rare due to the incidental finding of an abdominal abscess and the absence of recurrence 2 years after surgery.

[Clinical Experience with 13 Cases of Primary Small Bowel Adenocarcinoma]

Between 2003 and 2017, 13 patients with primary small bowel adenocarcinoma(SBA)were treated at our hospital. Tumors developed in the duodenum in 6 patients and in the jejunum in 7 patients. The median age of the patients was 62 (range: 31-83)years and male/female ratio was 10/3. Initial symptoms were obstruction in 5 patients, bleeding in 3 patients, and abdominal pain in 1 patient. The median diameter of tumor was 50(range: 23-100)mm. Concerning surgical margin, R0 resection was in 8 patients, R1 resection in 3 patients, and R2 resection in 2 patients. The number of patients with stage 0 disease was 1, stage Ⅱ was 2, stage Ⅲ was 6, and stage Ⅳ was 4. Chemotherapy was provided to 8 patients. The median survival time was 31.6(range: 1-118)months and 5-year survival rate were 26.9%. Four patients survived longer than 4 years without recurrence. Although there is no treatment established for SBA, it was thought that proactive resection and chemotherapy can be anticipated in these patients to bring about an improved survival.

Role of a TRIM72 ADP-ribosylation cycle in myocardial injury and membrane repair

Mono-ADP-ribosylation of an (arginine) protein catalyzed by ADP-ribosyltransferase 1 (ART1) - i.e., transfer of ADP-ribose from NAD to arginine - is reversed by ADP-ribosylarginine hydrolase 1 (ARH1) cleavage of the ADP-ribose-arginine bond. ARH1-deficient mice developed cardiomyopathy with myocardial fibrosis, decreased myocardial function under dobutamine stress, and increased susceptibility to ischemia/reperfusion injury. The membrane repair protein TRIM72 was identified as a substrate for ART1 and ARH1; ADP-ribosylated TRIM72 levels were greater in ARH1-deficient mice following ischemia/reperfusion injury. To understand better the role of TRIM72 and ADP-ribosylation, we used C2C12 myocytes. ARH1 knockdown in C2C12 myocytes increased ADP-ribosylation of TRIM72 and delayed wound healing in a scratch assay. Mutant TRIM72 (R207K, R260K) that is not ADP-ribosylated interfered with assembly of TRIM72 repair complexes at a site of laser-induced injury. The regulatory enzymes ART1 and ARH1 and their substrate TRIM72 were found in multiple complexes, which were coimmunoprecipitated from mouse heart lysates. In addition, the mono-ADP-ribosylation inhibitors vitamin K1 and novobiocin inhibited oligomerization of TRIM72, the mechanism by which TRIM72 is recruited to the site of injury. We propose that a mono-ADP-ribosylation cycle involving recruitment of TRIM72 and other regulatory factors to sites of membrane damage is critical for membrane repair and wound healing following myocardial injury.

[A case of huge advanced hepatocellular carcinoma resected after hepatic arterial infusion therapy of 5-FU/LV/CDDP]

A 58-year-old man was referred to our hospital for a huge tumor occupying the entire right lobe of the liver. An imaging method revealed a 15 cm-sized hepatocellular carcinoma in the right lobe which extended to the internal segment across the middle hepatic vein. The serum AFP level was 15.3 ng/mL, and the level of protein induced by vitamin K absence or antagonist II was 4,340 mAU/mL. We judged it unresectable, then arterial infusion chemotherapy using 5-fluorouracil, cisplatin, and Leucovorin was performed. After 4 courses, the tumor was markedly reduced to 56 mm. We performed an extended right lobectomy. In the operative finding, although the tumor partially reached the internal segment, the middle hepatic vein was preserved. Nine months after operation, no sign of recurrence was found. It is suggested that hepatic arterial infusion therapy is useful for pre-operative therapy of far-advanced hepatocellular carcinoma as a part of combined modality therapy.

A case report of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas and literature review

Osteoclast-like giant cell tumors rarely arise in the pancreas. Here we report the case of a 78-year-old woman who was diagnosed with a well-defined 3 cm multilocular mass in the pancreatic body by the use of ultrasonography, computed tomography and magnetic resonance imaging. The rim and the septa of the tumor were well enhanced. The distal pancreas was removed with the spleen and the peripancreatic lymph nodes. Macroscopically, the mass was composed predominantly of a multilocular cystic tumor filled with hemorrhagic necrosis, and partly composed of solid components. A histopathological study showed a proliferation of multinucleated osteoclast-like giant cells and spindle cells. Although the predominant tumor cells were strongly positive for vimentin and CD68 and negative for epithelial markers, there were some sparsely scattered cytokeratin-positive neoplastic glands. Seventeen months after surgery, the patient is still alive and has had no recurrence. Below we review 32 cases of osteoclast-like giant cell tumor of the pancreas that have been reported in English literature since 2000.

Relationship between pancreatic secretory trypsin inhibitor and early recurrence of intrahepatic cholangiocarcinoma following surgical resection

OBJECTIVES

The extremely unfavorable prognosis of intrahepatic cholangiocarcinoma (ICC), even after surgical resection, is mainly attributed to a high rate of recurrence. The aim of this study was to identify the molecules associated with early recurrence of ICC following resection.

METHODS

Between December 1984 and July 2003, 46 patients with ICC underwent surgical resection. The clinical outcome of these patients was evaluated in view of the time of recurrence. Consequently, we categorized ICC patients into subgroups, based on the clinical results, and screened differentially expressed genes by DNA microarray analysis. Furthermore, the obtained results were validated in an independent sample set by quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR). Immunohistochemistry was performed to assess the expressed genes at the protein level.

RESULTS

The survival of patients with early recurrence, occurring within a year after surgical resection, was significantly poor after surgery and even after recurrence, as compared to that of patients whose recurrence occurred beyond a year after surgery. By the DNA microarray analysis, 13 differentially expressed genes were picked up, and quantitative RT-PCR reaction identified the pancreatic secretory trypsin inhibitor (PSTI) as a candidate gene associated with early recurrence of ICC after resection. This observation was confirmed through examination of an independent set of samples, in which the patients with higher levels of PSTI mRNA expression had significantly shorter recurrence-free survival. Immunohistochemically, PSTI was expressed in the cytoplasm of cancer cells.

CONCLUSIONS

PSTI might be a potential marker for identifying ICC patients with an increased risk of early recurrence after surgical resection.

[A case of metastatic submandibular lymphnode treated successfully with palliative oral (5-FU + PSK) chemotherapy in the elderly]

The patient was a 87-year-old woman diagnosed as type 2 advanced colon cancer in the ascending colon. The patient underwent right hemicolectomy. The pathological diagnosis showed poorly-differentiated adenocarcinoma, si, ly2, v1, n0 (0/41) and Stage IIIa. The postoperative course was uneventful, and she was discharged on POD 23. But a left submandibular lymph node enlarged rapidly within two months after the operation. Aspiration cytology of the lymph node indicated poorly-differentiated adenocarcinoma, and she was diagnosed as recurrent colon cancer. Combined chemotherapy of 5-FU (200 mg/day/po) and PSK (3.0 g/day/po) was started as palliative chemotherapy. The metastatic lymph nodes were reduced in size within two months after the treatment. Oral administration of 5-FU+PSK succeeded without serious adverse effects or worsening of quality of life. Ten months later, no recurrence was detected on physical examination or computed tomography. We conclude that palliative oral (5-FU+PSK) chemotherapy is useful for recurrent colon cancer in the elderly because of its excellent safety and effectiveness.

[Creative activities in home care for terminally-ill cancer patients at a rural municipal hospital]

Karuizawa Hospital is a rural, small town municipal hospital with 60 beds, located in Nagano Prefecture in central Japan. The terminal stages of patients who were treated in our department of surgery but later died of cancer are reviewed. In the five year period extending from April, 1994 through March, 1999 sixty patients died from cancer. Of them, 34 people died in their own home and 26 in our hospital. The annual ratio of patients who died at home to those who died in the hospital are analyzed, as well as whether these ratios differed according to the location of the patient's cancer. The identity of the patients' main home caregiver was sought, as well as how many days the patients resided at home until they passed away, and how frequently doctors or nurses visited their home. Some of the doctors' attempts to gain informed consent are described. Based on the findings, the authors recommend an end to the practice of first revealing the name and details of a patient's disease to his/her family. It was also found that documented information is useful in order to promote smooth relationships among patients, family members, and the doctor.

Hsl7p, a negative regulator of Ste20p protein kinase in the Saccharomyces cerevisiae filamentous growth-signaling pathway

In the budding yeast, Saccharomyces cerevisiae, protein kinases Ste20p (p21(Cdc42p/Rac)-activated kinase), Ste11p [mitogen-activated protein kinase (MAPK) kinase kinase], Ste7p (MAPK kinase), Fus3p, and Kss1p (MAPKs) are utilized for haploid mating, invasive growth, and diploid filamentous growth. Members of the highly conserved Ste20p/p65(PAK) protein kinase family regulate MAPK signal transduction pathways from yeast to man. We describe here a potent negative regulator of Ste20p in the yeast filamentous growth-signaling pathway. We identified a mutant, hsl7, that exhibits filamentous growth on rich medium. Hsl7p belongs to a highly conserved protein family in eukaryotes. Hsl7p associates with the noncatalytic region within the amino-terminal half of Ste20p as well as Cdc42p. Deletions of HSL7 in haploid and diploid strains led to cell elongation and enhancement of both haploid invasive growth and diploid pseudohyphal growth. However, deletions of STE20 in haploid and diploid greatly diminished these hsl7-associated phenotypes. In addition, overexpression of HSL7 inhibited pseudohyphal growth. Thus, Hsl7p may inhibit the activity of Ste20p in the S. cerevisiae filamentous growth-signaling pathway. Our genetic analyses suggest the possibility that Cdc42p and Hsl7p compete for binding to Ste20p for pseudohyphal development when starved for nitrogen.

Insulin-stimulated polypeptide chain elongation in the soleus muscle of mice

The effect of insulin on polypeptide chain elongation was examined in soleus muscles isolated from 18 hour-fasted mice. Treatment with insulin for 1 hour increased the elongation rate, which was estimated by the half-transit time. This suggests that insulin stimulated protein synthesis by modifying the elongation rate in addition to the initiation rate.

A yeast gene necessary for bud-site selection encodes a protein similar to insulin-degrading enzymes

Cells of the yeast Saccharomyces cerevisiae choose bud sites in a non-random spatial pattern that depends on mating type: axial for haploid cells and bipolar for a/alpha diploid cells. We identified a mutant yeast, axl 1, in which the budding pattern is altered from axial to bipolar. Expression of the AXL1 gene is repressed in a/alpha diploid cells. With the ectopic expression of AXL1, a/alpha cells exhibited an axial budding pattern, thus AXL1 is a key morphological determinant that distinguishes the budding pattern of haploid cells from that of a/alpha diploid cells. AXL1 encodes a protein similar in sequence of the human and Drosophila insulin-degrading enzymes and to the Escherichia coli ptr gene product. The axial budding pattern might result from degradation of a target protein by the putative Axl1 protease.

Molecular cloning of the gene encoding a highly expressed protein in SFL1 gene-disrupted flocculating yeast

We identified a yeast gene encoding Flocculent Specific Protein (FSP) produced excessively in the SFL1 gene-disrupted flocculent strain. The sequenced gene encodes a 430 amino acid protein and is mainly composed of multiple repeats of Ser-Asn-Asn-X-Asp-Ser-Tyr-Gly. The FSP gene disruption of the flocculent strain decreased the degree of flocculation, so FSP may be one factor concerned with yeast flocculation. A gene database search indicated that the FSP gene is identical with the DDR48 gene.