To assist in the evaluation of inflammatory changes of the affected bowel, we classified the transabdominal ultrasonographic findings into types A-C. We compared the in vivo and in vitro sonographic images to the histopathologic findings of resected specimens. A total of 22 bowel specimens (five normal, 12 with Crohn's disease, five with ulcerative colitis) were examined sonographically with a 3.75-MHz curved and a 7.5-MHz linear array scanner; histologic examination of the same area of tissue was performed afterwards. These three examinations corresponded well to each other. Our classification scheme is useful in quantifying the severity of inflammatory changes in the affected bowel.

Colitis, Ulcerative↗

PubMedDate not supplied

Diagnostic ability of high-frequency ultrasound probe sonography in staging early gastric cancer, especially for submucosal invasion.

BACKGROUND: Advances in gastrointestinal endoscopy have resulted in endoscopic mucosal resection becoming the main therapy for many early gastric cancers confined to the mucosa and, in some cases, of minimal submucosal invasion. Thus, preoperative determination of the depth of the cancer is important. We compared the results of high-frequency ultrasound probe sonography with those of histologic study to clarify the usefulness of identifying of submucosal invasion and determining the depth of early gastric cancer. METHODS: Subjects were 295 patients diagnosed with early gastric cancer who had undergone endoscopic mucosal or surgical resection. High-frequency ultrasound probe sonographic findings were compared with histologic findings. RESULTS: The muscularis mucosae was visualized in 63% of cases of early gastric cancer. By construction on receiver operator characteristics curve, we determined that submucosal invasive cancer could be diagnosed by high-frequency ultrasound probe sonography to a depth of about 600 microm. There was no case in which invasion deeper than 1000 microm was diagnosed as a hypoechoic area limited to the mucosal layer or a fan-shaped hypoechoic area in the submucosal layer. The depth of early gastric cancer was accurately determined in 90% of cases. CONCLUSIONS: High-frequency ultrasound probe is a useful tool for accurately determining the depth of invasion of early gastric cancer when its limitations are understood.

Adult↗

PubMedDate not supplied

The Ishikawa classification of cavernous sinus lesions by clinico-anatomical findings.

PURPOSE: The Jefferson classification has been used to localize cavernous sinus lesions. However, this classification occasionally showed dissociation between identified localization and clinical findings. We investigated the clinical applicability of the newly proposed Ishikawa classification based on serial topographic sections of human cavernous sinus and the clinical findings. METHODS: In the Ishikawa classification, the cavernous sinus is divided into three portions, that is, anterior, middle, and posterior, demarcated by the location of the intracranial orifice of the optic canal and the entry of the maxillary nerve into the cavernous sinus. A total of 162 patients with cavernous sinus lesions were classified using both the Jefferson and the Ishikawa classifications and the clinical applicability of these two classifications was studied. Characteristics of the localization of lesions were also examined in each etiological type. RESULTS: By the Jefferson classification, 11% of the 162 patients had the anterior type of lesion, 12% the middle, 8% the posterior type, and 69% the unclassifiable type. However, by the Ishikawa classification, 35% had the anterior type, 10% the middle type, 22% the posterior type, 5% the whole type, and 28% the unclassifiable type of lesion. Furthermore, the Ishikawa classification revealed that the etiology of the anterior type was mainly inflammation, and that the etiology of the posterior and whole types was tumors. CONCLUSION: The Ishikawa classification is clinically useful to identify and classify the localization of cavernous sinus lesions.

Carotid Artery, Internal↗

PubMedDate not supplied

Immunoreactive MUC1 expression at the deepest invasive portion correlates with prognosis of colorectal cancer.

This study sought to examine the relationship between MUC1 expression at the deepest invasive portion, invasive/metastatic potential, and prognosis of colorectal cancer in relation to cellular proliferation. MUC1 expression was detected immunohistochemically using KL-6 antibody (anti-MUC1 monoclonal antibody) in 100 surgically resected specimens of advanced colorectal cancer. Distinct staining of the luminal surfaces, defined as positive immunoreactive (IR)-MUC1 expression, was seen in more than 30% of the tumor cells at the deepest invasive portion. The proliferating cell nuclear antigen labeling index (PCNA-LI) was also examined in the same areas. IR-MUC1 expression was detected in 71 (71%) of 100 lesions. Lesions with lymphatic or venous invasion showed a significantly higher incidence of IR-MUC1 expression than those without lymphatic or venous invasion (80 vs. 42% and 82 vs. 61%, respectively). Lesions with lymph node metastasis showed a significantly higher incidence of IR-MUC1 expression than those without lymph node metastasis (88 vs. 53%). Lesions with liver metastasis showed a significantly higher incidence of IR-MUC1 expression than those without liver metastasis (92 vs. 59%). Dukes' stage was also significantly correlated with IR-MUC1 expression. The incidence of IR-MUC1 expression did not significantly differ with regard to histologic subclassification and depth of invasion. There was no significant correlation between IR-MUC1 expression and the PCNA-LI. IR-MUC1 expression at the deepest invasive portion revealed a significant correlation with prognosis; furthermore, in patients with better differentiated lesions, in those with lesions confined to muscularis propria or subserosa (subadventitial) invasion, in those with Dukes' B and C, or in those undergoing curative resection, IR-MUC1 expression significantly correlated with prognosis. Patients with high PCNA-LI lesions showed a significantly poorer prognosis than those with low PCNA-LI lesions. Only in patients undergoing curative resection, patients with IR-MUC1-positive and high PCNA-LI lesions showed a significantly poorer prognosis than those with IR-MUC1-negative and low PCNA-LI lesions. The significant risk factors in the order of poorer prognosis in patients undergoing curative resection by the multivariate analysis were the histologic grade (moderately-poorly, poorly or mucinous adenocarcinomas), IR-MUC1 expression, and lymph node metastasis. These results indicate that IR-MUC1 expression is an important predictor of the metastatic potential and the prognosis of colorectal cancer, independent of histologic grade, depth of invasion or cellular proliferative activity. Combined analysis of IR-MUC1 and histologic grade, and combined expression of IR-MUC1 and PCNA at the deepest invasive portion are especially useful in predicting colorectal cancer prognosis.

Aged↗

PubMedDate not supplied

Combined expression of HLA-DR antigen and proliferating cell nuclear antigen correlate with colorectal cancer prognosis.

HLA-DR antigen expression and the proliferating cell nuclear antigen labeling index (PCNA-LI) were examined immmunohistochemically in 59 surgically resected advanced colorectal cancers to clarify the clinicopathologic significance of the HLA-DR antigen. HLA-DR antigen expression was detected in 33 (56%) of the 59 lesions, which showed less frequent liver metastasis than lesions without HLA-DR antigen expression (40 vs. 68%; p < 0.05). Five-year survival rates of patients with and without HLA-DR antigen expression were 50 and 19%, respectively. Lesions combining HLA-DR antigen expression and a relatively low PCNA-LI had the best prognosis. These results indicate that HLA-DR antigen expression, particularly combined with a low PCNA-LI, is an important outcome predictor in colorectal cancer.

Aged↗

PubMedDate not supplied

The clinical significance of the histologic subclassification of colorectal carcinoma.

According to the histologic features at the deepest level of tumor invasion (the tumor apex), we classified colorectal carcinomas as follows: well differentiated (W), moderately differentiated (M), and mucinous (Muc). By assessing its glandular configuration and cellular arrangement, the M type was further subdivided in to two different groups: moderately well differentiated (Mw) and moderately poorly differentiated (Mp) carcinomas. In our sample there were 56 W, 53 Mw, 20 Mp and 13 Muc tumors. The malignant potential of each tumor was evaluated by examining for the presence or absence of lymphatic invasion, venous invasion, lymph node metastases and liver metastases. In comparison with the other tumors, the Mp tumors proved to harbor the highest malignant potential, exhibiting a higher incidence of lymphatic invasion (95%, 19/20 of the cases), venous invasion (75%, 15/20 of the cases), lymph node metastases (80%, 16/20 of the cases), and liver metastases (40%, 8/20 of the cases). Colorectal carcinomas are composed of multiple cell populations with different biological and malignant properties, and through the histologic subclassification we could identify that Mp tumors have the highest potential to invade normal tissue and metastasize.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Carcinoembryonic antigen staining patterns at the invasive tumor margin predict the malignant potential of colorectal carcinoma.

Immunohistochemical carcinoembryonic antigen (CEA) staining patterns at the invasive tumor margin were correlated with malignant potential in 64 advanced colorectal carcinomas. Twenty-two (34%) carcinomas showed an apical and 42 (66%) a cytoplasmic staining pattern. Carcinomas with a cytoplasmic pattern had a higher incidence of lymph node (71 versus 41%; p < 0.05) and liver (50 versus 23%; p < 0.05) metastasis and higher levels of serum CEA (p < 0.01) than those with an apical staining pattern. Nine of 11 recurrent tumors had a cytoplasmic pattern and 2 had an apical pattern (p < 0.05). Among carcinomas having the same degree of differentiation, those with a cytoplasmic CEA staining pattern were more aggressive. Six (55%) well-differentiated carcinomas with a cytoplasmic pattern metastasized to the liver while none with an apical pattern did (p < 0.05). Moderately differentiated carcinomas with a cytoplasmic pattern had a significantly higher incidence of lymph node metastasis than those with an apical pattern (77 versus 46%; p < 0.05). When colorectal carcinomas are examined at the invasive tumor margin, an evaluation of the CEA staining pattern is useful in recognizing carcinomas having a higher potential to metastasize and recur after curative surgery.

Adenocarcinoma↗

PubMedDate not supplied

Proliferating cell nuclear antigen expression correlates with the metastatic potential of submucosal invasive colorectal carcinoma.

To examine the malignant potential of submucosal invasive colorectal carcinoma, the relationship between proliferating cell nuclear antigen (PCNA) expression and clinicopathologic risk factors for lymph node metastasis was studied in 149 patients with submucosal invasive colorectal carcinoma. The depth of submucosal invasion was classified as scanty or massive. Histologic subclassification at the submucosal deepest invasive portion was done as follows: well differentiated (W), moderately well differentiated (Mw), moderately poorly differentiated (Mp) or poorly differentiated (Por). Tumor growth was divided into polypoid growth and nonpolypoid growth. The PCNA expression (labeling index, LI) was examined at the submucosal deepest invasive portion. The PCNA-LI of tumors showing lymph node metastasis (mean, 56.5 +/- 19.0%) was significantly higher than that of tumors without lymph node metastasis (mean, 41.5 +/- 19.3%; p < 0.01). The PCNA-LI of Mp tumors (mean, 57.7 +/- 16.5%) was significantly higher than that of W (mean, 38.5 +/- 19.0%; p < 0.05) and Mw (mean, 43.7 +/- 19.1%; p < 0.05) tumors. The PCNA-LI of tumors without adenomatous features (mean, 47.9 +/- 20.5%) was significantly higher than that of tumors with such features (mean, 37.1 +/- 17.1%; p < 0.05). The PCNA-LI was not correlated with other risk factors for lymph node metastasis, such as lymphatic invasion, depth of submucosal invasion, macroscopic type, and growth pattern. These results indicate that the PCNA-LI may be useful marker for predicting the potential metastases to lymph nodes in submucosal invasive colorectal carcinoma, while the proliferative activity of cancer cells correlates with the degree of the differentiation in the area of deepest invasion.

Antibodies, Monoclonal↗

PubMedDate not supplied

Histologic grade and cellular proliferation at the deepest invasive portion correlate with the high malignancy of submucosal invasive gastric carcinoma.

To establish appropriate indications for endoscopic treatment of submucosal invasive gastric carcinoma, we investigated clinicopathologic features and proliferating cell nuclear antigen (PCNA) expression at the deepest invasive portion of 192 differentiated submucosal invasive gastric carcinomas that had been surgically resected. Lymph node metastasis was demonstrated in 30 (15.6%) of 192 lesions. Histologic heterogeneity (based on differentiation at the deepest invasive portion) was demonstrated in 36 (18.8%) of the 192 lesions. In 159 lesions, excluding 33 undifferentiated lesions at the deepest invasive portion, the depth of invasion, histologic grade, lymph vessel involvement, infiltrative growth pattern (INF) and existence of an ulceration were all significantly correlated with the incidence of lymph node metastasis. The lesions with both well-differentiated adenocarcinoma (WELL) and minimal submucosal invasion (sm1) showed no lymph node metastasis. PCNA expression was estimated in 59 good stained lesions. The mean PCNA labeling index (LI) was 50.9 +/- 7.2% in lesions with lymph node metastasis and 43.7 +/- 9.3% in those without lymph node metastasis (p < 0.05). In addition, PCNA-LI also correlated significantly with the histologic grade, depth of invasion, INF and lymph vessel involvement. These results indicate that the submucosal invasive gastric carcinoma with both WELL and sm1, which shows no other risk factors, can be considered as the appropriate indication for curative endoscopic treatment. The PCNA-LI at the deepest invasive portion is useful in understanding the biology of lymph node metastasis in submucosal invasive gastric carcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Growth of human gastric carcinomas and expression of epidermal growth factor, transforming growth factor-alpha, epidermal growth factor receptor and p185c-erbB-2.

We examined the expression of epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha), epidermal growth factor receptor (EGFR) and p185c-erbB-2 immunohistochemically and correlated the expression with growth in 66 cases of human gastric carcinoma. To evaluate growth, we used the bromodeoxyuridine (BrdU) labeling index in 51 cases and the radiographic growth rate in 15 cases. Expression of EGF was detected in 41 cases (62.1%), TGF-alpha in 42 cases (63.6%), EGFR in 34 cases (51.5%), and p185c-erbB-2 in 37 cases (56.1%). The BrdU labeling index ranged from 1.5 to 32.0%. The BrdU labeling index was higher in tumors that coexpressed EGF and EGFR or TGF-alpha and EGFR than in tumors without expression or in tumors that expressed growth factors or the receptors (p < 0.01). The BrdU labeling index was also significantly higher in tumors with the expression of EGFR and/or p185c-erbB-2. Tumors with simultaneous expression of EGF, TGF-alpha, EGFR and p185c-erbB-2 had an association with a high BrdU labeling index. Moreover, all of these growth factors and receptors were expressed simultaneously in gastric carcinomas with rapid growth. These results suggest that the expressions of EGF, TGF-alpha, EGFR and p185c-erbB-2 are closely related and then play an important role in the growth of human gastric carcinomas.

Adult↗

PubMedDate not supplied

Flat-elevated colorectal neoplasms exhibit a high malignant potential.

The potential of flat-elevated colorectal adenomas to undergo rapid malignant transformation and progression to invasive carcinoma is still under discussion. Therefore, a total of 130 colorectal neoplastic lesions > or = 1 cm in diameter were examined after endoscopic or surgical resection. Lesions were macroscopically classified into three categories: (1) flat elevation (22 lesions), superficially elevated lesion with a smooth surface; (2) granular laterally spreading tumor (GLST; 26 lesions), laterally spreading aggregates of nodules forming a lesion with granular surface, and (3) polypoid (82 lesions), pedunculated, subpedunculated and sessile polyps. The adenomatous component showed a tubulovillous architecture in 9/26 (35%) of GLST and 18/82 (22%) of polypoid lesions, however none of the flat-elevated lesions had a villous component (p <0.01; p <0.05). Carcinoma was present in 17/22 (77%) flat elevations, 37/82 (45%) polypoid lesions and 11/26 (42%) GLST (p <0.05). None of the carcinomas arising in GLST and only 1/37 (3%) of those developing in polypoid lesions were invasive carcinomas, but 4/17 (24%) carcinomas arising in flat elevations showed submucosal invasion. Moreover, while all 5 noncancerous flat elevations showed severe atypia, 17/82 (21%) polypoid lesions and 5/26 (19%) GLST showed moderate atypia. In conclusion, flat-elevated colorectal neoplasms have a high malignant potential and the role of these lesions as precursors of colorectal carcinomas deserves greater emphasis.

Adenoma↗

PubMedDate not supplied

Influence of cigarette smoking on recurrence of duodenal ulcer.

The aim of this study of 225 duodenal ulcer patients was to determine the association of cigarette smoking to ulcer recurrence. In this study, smokers were mostly men whose smoking habit was positively associated with a past history of duodenal ulcer, stress and alcohol consumption. These characteristics are regarded to favor ulcer recurrence. In 161 patients not on maintenance therapy, smokers had a higher recurrence rate than nonsmokers, even when foregoing patients characteristics were taken into consideration. No difference in recurrence rates could be observed between nonsmokers and smokers in 64 patients under maintenance therapy. In conclusion, our findings suggest that smoking plays a major role on recurrence of duodenal ulcer and that maintenance therapy can overcome the adverse effect of cigarette smoking on ulcer recurrence.

Adult↗

PubMedDate not supplied

Predictive value of cathepsin D and Ki-67 expression at the deepest penetration site for lymph node metastases in gastric cancer.

To search for reliable predictors for lymph node metastasis, we immunohistochemically analyzed surgically resected gastric cancer specimens that showed invasion of submucosa (sm) and muscularis propria (mp) of the tumor. The analysis investigated cathepsin D and Ki-67 expression in 136 specimens that were divided into an sm1/sm2 group and an sm3/mp group. In sm1/sm2 group, the incidence of lymph node metastases was significantly higher in tumors with high Ki-67 labeling index (LI) (44%) than in those with low Ki-67 LI (0%). In sm3/mp group, the incidence of lymph node metastases was significantly higher in cathepsin D-positive (56%) and high Ki-67 LI tumors (64%) than in cathepsin D-negative (33%) and low Ki-67 LI (33%). Combined analysis of cathesin D expression and Ki-67 LI correlated strongly with lymph node metastases. No lesions with cathepsin D-negative expression and low Ki-67 LI had lymph node metastases in either group. Cathepsin D and Ki-67 expression may be useful predictors for lymph node metastases in gastric cancer with sm and mp invasion. As predictors, they can identify lesions without lymph node metastases and indicate lesions not needing additional treatment after endoscopic mucosal resection and laparoscopic gastrectomy.

Adult↗

PubMedDate not supplied

Conditions of curability after endoscopic resection for colorectal carcinoma with submucosally massive invasion.

The deepest invasive portion of colorectal carcinoma (CRC) is considered to be the part, which ultimately will invade, spread locally and give metastasis. We have previously reported that histologic differentiation at the deepest invasive portion of CRC closely correlate with metastatic potential and is useful in understanding the curability of endoscopic mucosal resection (EMR). The aim of this study is to clarify the conditions of curative EMR for CRC with submucosally (sm) massive invasion. A total of 521 cases with sm invasive CRC (Group A, 470 surgically resected cases; Group B, 51 followed-up cases after EMR) were studied. The depth of sm invasion was defined as the practically measured distance from muscularis mucosae. Histologic subclassification was performed at the deepest invasive tumor margin as: well-differentiated (W), moderately differentiated (M) and poorly differentiated (Por). By assessing glandular configuration and cellular arrangement, M type was further subdivided into two different groups; moderately-well differentiated (Mw) and moderately-poorly differentiated (Mp). In group A, lymph node (LN) metastasis was detected in 45 (9.6%) of 470 cases. W or Mw lesions showed LN metastasis in 4.9% (19/388). Mp or Por lesions showed LN metastasis in 37.3% (25/67) (W/Mw vs Mp/Por; p<0.01). Of 45 cases with LN metastasis that could be measured the practical distance of sm invasion, W or Mw lesions showed no LN metastasis in cases within 1,500 micrometer invasion. However, Mp or Por lesions showed LN metastasis in cases within 1,500 micrometer invasion (5/15, 33.3%, minimum 400 micrometer invasion; so-called scanty invasion). In group B, none of 51 cases died of LN metastasis and showed no other metastasis, although 17 cases (33.3%) showed an sm invasion more than 1,500 micrometer. These results indicated that CRC even with sm massive invasion can be cured by complete EMR on conditions that the depth of sm invasion is within 1,500 micrometer and histologic grade at the deepest invasive portion is W or Mw, if there are no vessel involvement. However, cases with Mp or Por grade were not curative by EMR, even if they showed an sm scanty invasion.

Colorectal Neoplasms↗