Biomedical subjects

Taichi Shuto

Publications and source records attributed to Taichi Shuto.

79 records · Page 5Linked to original sources

PubMedDate not supplied

A mixed hepatocellular carcinoma and cholangiocarcinoma: dual expression of biliary-type cytokeratin and hepatocyte specific marker.

A 5-cm lesion in the right hepatic lobe was detected in a 61-year-old man with chronic hepatitis C by ultrasonography. Contrast-enhanced computed tomography showed a low-density lesion with wide peripheral enhancement. Hepatic angiography revealed that the tumor had partial hypervascularity. Although serum concentrations of alpha-fetoprotein and carcinoembryonic antigen were within normal limits, an elevated concentration of carcinohydrate antigen 19-9 was detected in serum. A definitive diagnosis was not made although we strongly suspected mixed hepatocellular carcinoma and cholangiocarcinoma. Since intraoperative frozen-section examination revealed adenocarcinoma, a right hepatic lobectomy with regional lymph node dissection was performed. A histologic diagnosis of mixed hepatocellular carcinoma and cholangiocarcinoma was made because the hepatic tumor consisted of components of both hepatocellular carcinoma and cholangiocellular carcinoma, with a transitional area. Additionally, immunohistochemical examination revealed that some tumor cells in the transitional area were immunoreactive for both cytokeratin 19 and hepatocyte paraffin 1.

Bile Duct Neoplasms↗

PubMedDate not supplied

Limitation of portal vein embolization for extension of hepatectomy indication in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Although percutaneous trans-hepatic portal vein embolization (PTPE) expands the candidate pool for hepatectomy in patients with hepatobiliary malignancies, the role of PTPE in patients with active hepatitis or cirrhosis has yet to be determined. METHODOLOGY: Records of patients who underwent PTPE of the right portal vein between 1984 and April 2001 were reviewed retrospectively. To determine the indication for PTPE and subsequent hepatectomy, clinical variables, including serum concentrations of hyaluronic acid (HA), procollagen type III peptide (P-III-P), and the 7S domain of type IV collagen (7S-IV), were compared between patients who underwent right hepatectomy (group A; n=44) and the other patients (group B; n=17). RESULTS: The scores for prediction of postoperative liver failure (prediction score) and serum HA and P-III-P concentrations were different in the two groups. Thirteen of 30 patients (43%) whose prediction score was more than 50, the limit of the hepatectomy without PTPE, successfully underwent right hepatectomy following PTPE. The resectability ratios increased to 75% and 100%, when the HA concentration was < or = 100mg/L and the P-III-P concentration < or = 0.7/mL. CONCLUSIONS: Serum HA and P-III-P concentrations are useful guidelines for identifying candidates for right hepatectomy following PTPE.

Aged↗

PubMedDate not supplied

CD44 and VEGF expression in extrahepatic metastasis of human hepatocellular carcinoma.

BACKGROUND/AIMS: We investigated the correlation between vascular endothelial growth factor (VEGF) and CD44 expression in hepatocellular carcinoma (HCC) and the frequency of extrahepatic metastasis, in order to evaluate the influence of vascular growth and adhesion molecules in facilitation of distant metastasis. METHODOLOGY: We obtained materials from primary lesions of HCC with no extrahepatic metastasis (control group) and primary lesions and metastatic lesions with extrahepatic metastasis (metastasis group). Immunohistochemical staining was performed using anti-human CD44v3 monoclonal antibodies and anti-human VEGF ab-3 monoclonal antibodies. Although pathological parameters such as tumor size, differentiation, capsule formation, and vascular invasion were analyzed, there was no marked difference among the groups. RESULTS: Percentages of nodules with VEGF-positive tumor and sinusoidal cells were low in primary lesions of the control and metastasis groups, while high in metastatic lesions in the metastasis group. On the other hand, percentages of nodules with CD44-positive tumor and sinusoidal cells were low in primary lesions of the control group, while high in primary lesions and metastatic lesions of the metastasis group. CONCLUSIONS: The present study demonstrated that CD44 expression in primary lesions is related to a higher frequency of extrahepatic metastasis, suggesting that this is a clinicopathologically useful parameter in predicting the occurrence of distant metastasis.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Curative resection of a huge bile duct cancer without pancreatoduodenectomy.

A 71-year-old woman was admitted to our hospital with obstructive jaundice. Magnetic resonance cholangiography revealed a 9-cm spindle-shaped tumor in the common bile duct. Laboratory examination noted a high concentration of total serum bilirubin. Although the serum concentration of carcinoembryonic antigen was within normal limits, the serum concentration of carbohydrate antigen 19-9 was elevated. We diagnosed the lesion as an extrahepatic bile duct cancer and performed a laparotomy. The anterior wall of the common bile duct was incised, and the tumor was found to have a small base in only the posterior wall of the duct, and spread within the duct was from the common hepatic duct to the intrapancreatic bile duct. Bile duct resection, cholecystectomy with lymphadenectomy and hepaticojejunostomy were performed. Frozen sections of the proximal and distal surgical margins of the bile duct were free of cancer. Macroscopically, the lesion was an expansive polypoid tumor measuring 9x3cm in diameter arising from a 5-mm base. Histologic examination revealed that the tumor was a well-differentiated tubular adenocarcinoma that had infiltrated the fibromuscular layer at its base. Longitudinal spread was more extensive hepatopetally than hepatofugally. The patient is alive and well without any complaints 8 months after surgery.

Adenocarcinoma↗

PubMedDate not supplied

Postoperative survival in intrahepatic cholangiocarcinoma showing intraductal growth.

Clinicopathologic variables favoring recurrence after hepatic resection for intrahepatic cholangiocarcinoma showing intraductal growth remain unclear. We investigated various clinicopathologic features in three patients who underwent resection for this type of intrahepatic cholangiocarcinoma. All underwent extended left hepatectomy plus resection of the caudate lobe and lymph node dissection. Lymph nodes showed no pathologic involvement. Although no cancer cells were seen in the mucosal layer by intraoperative pathologic examination at the bile duct stump in any patient, pathologic examination of resected specimens showed cancer cells invading beyond the mucosal layer in connective tissues surrounding the bile duct stump (interstitial invasion) of the Glisson's sheath in 2 patients. One of them died of cancer recurrence near the bile duct stump, while the third patient, without interstitial invasion, has survived for 10.6 years. In the intraductal growth type of intrahepatic cholangiocarcinoma, absence of cancer cells should be confirmed by intraoperative pathologic examination of not only the mucosal layer of the bile duct but also the connective tissue surrounding the bile duct, since interstitial invasion may be a risk factor for cancer recurrence.

Bile Ducts↗

PubMedDate not supplied

Two cases of intrahepatic cholangiocarcinoma detected after interferon therapy for chronic hepatitis C.

Recently, it has been suggested that hepatitis C virus infection plays a role in the pathogenesis of some intrahepatic cholangiocarcinomas (ICC). We describe two patients with small ICC detected after interferon therapy for chronic hepatitis C. Case 1 was diagnosed with ICC by preoperative biopsy and underwent anterior segmentectomy of the liver, while Case 2 was diagnosed with hepatocellular carcinoma preoperatively and the tumor was diagnosed as ICC after biopsy and microwave coagulonecrotic therapy. Both patients are in good health six months and five months, respectively, after operation. It is important to monitor carefully for ICC as well as hepatocellular carcinoma in patients with chronic hepatitis C, even when interferon therapy has been carried out, since the outcome of treatment for small ICC is favorable.

Aged↗

PubMedDate not supplied

Bowel injury associated with liver surgery for hepatocellular carcinoma.

BACKGROUND/AIMS: Bowel injury associated liver surgery is rare but can be fatal if not adequately treated. The contribution of underlying liver disease and previous hepatectomy to bowel injury in hepatectomy for hepatocellular carcinoma is unknown. METHODOLOGY: Clinical records of 531 patients who underwent hepatic resection without combined resection of the biliary tract or intestine for hepatocellular carcinoma during 13 years were reviewed. Differences in incidence of bowel injury according to presence or absence of liver cirrhosis, technique of hepatectomy, and history of hepatectomy were investigated. Outcome after treatment also was reviewed. RESULTS: Bowel injury occurred in 5 patients (0.9%). Previous hepatectomy history was associated with an increased incidence of bowel injury [repeat hepatectomy, 3/91 (3.3%), and first hepatectomy, 2/440 (0.5%), p = 0.038]. Injury was recognized intraoperatively in two patients and postoperatively in three. In the former two patients, the injured bowel was repaired immediately but a fistula still developed in one patient. One patient with a fistula eventually required temporary fecal diversion and eventually limited colectomy. The other three patients were treated by continuous external drainage, but two of them required debridement or colic sleeve resection. CONCLUSIONS: Previous hepatectomy increases the risk for bowel injury during hepatectomy. Care must be taken to prevent adhesion to the hepatic cut surface. Careful use of electrocautery to prevent burn injury also should be taken.

Adolescent↗