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Toshiaki Kunimura

Publications and source records attributed to Toshiaki Kunimura.

17 recordsLinked to original sources
PubMed2006

Right pleural effusion in Fitz-Hugh-Curtis syndrome.

Right pleural effusion was diagnosed in a 36-year-old woman with right upper quadrant pain and fever. Enhanced pelvic computed tomography performed because of irregular genital bleeding revealed the pelvic inflammatory disease. Upon further questioning, the patient confirmed that she had recently undergone therapy for Chlamydia trachomatis infection. Therefore she was given an injection of tetracycline because we suspected Fitz-Hugh-Curtis syndrome (FHCS), a pelvic inflammatory disease characterized by perihepatitis associated with chlamydial infection. A remarkable clinical response to antibiotics was noted. The right upper quadrant pain was due to perihepatitis, and the final diagnosis was FHCS. Right pleural effusion may be caused by inflammation of the diaphragm associated with perihepatitis. Once chlamydial infection reaches the subphrenic liver, conditions in the closed space between the liver and diaphragm due to inflammatory adhesion may be conductive to chlamydial proliferation. The possibility of FHCS should be considered in patients and carefully distinguished from other abdominal diseases.

Adult↗
PubMed2005

Outcome following surgery for primary lung cancer with interlobar pleural invasion.

PURPOSE: To determine whether interlobar pleural invasion into the adjacent lobe (interlobar P3) should be assessed as T3 according to the tumor-node metastasis classification. METHODS: Surgically treated patients with primary lung cancer (n = 322) were analyzed. RESULTS: Tumors with interlobar P3 had a significantly lower incidence of mass screening detection, a higher occurrence rate of squamous cell carcinoma, and a larger tumor diameter than tumors without interlobar P3. The lymph node metastatic rate did not differ between the patients with and without interlobar P3. The 5-year survival rate of patients with interlobar P3 was 63% and the rates of other patients were 56% with T1 disease, 57% with T2, 31% with T3, and 19% with T4. The survival rate for patients with interlobar P3 was higher than for those with T3 without interlobar P3 (P < 0.05). The 5-year survival rate of the patients with interlobar P3 was lower in adenocarcinoma (39%) than in squamous cell carcinoma (69%, P < 0.01). The results were similar when the analysis was restricted to patients without lymph node metastasis. In adenocarcinoma, the survival rate for interlobar P3 was between the rates for T2 (53%) and T3 (13%) without interlobar P3, whereas in squamous cell carcinoma, the survival rate for interlobar P3 was between the rates for T1 (88%) and T2 (54%) without interlobar P3. CONCLUSION: Tumors with interlobar P3 should be classified as T2 only in squamous cell carcinoma.

Aged↗
PubMed2005

Osteopontin expression in proliferated bile ductules: the correlation with liver damage in fulminant hepatitis.

There have been many reports about the severity of hepatic necrosis caused by fulminant hepatitis; however, the relation between proliferated bile ductules and osteopontin (OPN) expression in inflamed areas in each of the clinical forms of fulminant hepatitis has not been described. To analyze the mechanism in the onset of fulminant hepatitis, we classified not only 16 autopsy cases of fulminant hepatitis into two clinical forms--acute and subacute--but also 3 autopsy cases of late-onset hepatic failure (LOHF) associated with fulminant hepatitis, and examined liver specimens by light microscopy and immunohistochemistry and also serum transaminase levels. Histopathologic study revealed that some of the proliferated bile ductules were associated directly with deteriorating hepatocytes and that bile plugs were present in the proliferated bile ductules. The value of the proliferative cell nuclear antigen labeling index (PCNA-L I) for proliferated bile ductules was very high during the acute form of fulminant hepatitis. Immunohistochemical analysis revealed that OPN expression was higher in the proliferated bile ductules of acute-form fulminant hepatitis than in cirrhotic and normal liver bile ducts. Transaminase levels in acute-form fulminant hepatitis were significantly elevated in comparison with levels in the other forms of the disease. Comparison of acute form fulminant hepatitis with the subacute form and LOHF showed OPN expression in proliferated bile ductules and serum aspartate aminotransferase (ALT)max to be decreased in the subacute form of fulminant hepatitis. OPN expression is an important marker of the degree of liver inflammation, and its regulation mechanism is very important to understanding the pathophysiology of fulminant hepatitis.

Acute Disease↗
PubMed2005

Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation.

OBJECTIVES: Intraductal neoplasms of the pancreas are generally referred to as intraductal papillary mucin-producing neoplasms (IPMNs), according to the WHO classification system. Herein, we report that morphologic and immunohistochemical features of intraductal tubular carcinoma (ITC) are quite different from those of intraductal papillary mucinous carcinoma (IPMC). METHODS: We analyzed histogenesis and differentiation of ITC by light microscopy and immunohistochemistry. RESULTS: Histologically, ITC was characterized as an intraductal nodular appearances with a monotonous tubular growth pattern without papillary projection. ITC showed de novo-like appearance without sequential progression usually observed in IPMC, suggesting that ITC is a homogeneous neoplasm. Cuboidal tumor cells in ITC resembled normal pancreatic duct epithelia, and the characteristic growth pattern of ITC replaced that of normal pancreatic duct epithelium. Immunohistochemically, ITC cells were positive for MUC-1 on the apical side of the cell membrane. In contrast to ITC cells, IPMC cells were negative for MUC-1, and ductal adenocarcinoma cells were strongly positive for MUC-1, as was the stroma around the cancer. The immunohistochemical staining pattern of DUPAN-2 resembled that of MUC-1. Interestingly, localization of MUC-1 and DUPAN-2 staining in ITC cells was similar to that in normal pancreatic ductules. ITC cells were negative for MUC-2 and MUC-5AC. In contrast, most IPMC cells were positive for MUC-2 and MUC-5AC. CONCLUSION: Based on our histologic and immunohistochemical findings, the intraductal pancreatic neoplasm (IPN) can be classified into 2 groups: IPN with gastrointestinal differentiation and IPN with pancreatic duct differentiation. Our present data indicated that ITC cells may arise directly from duct epithelia without progression and possessed pancreatic duct differentiation. On the basis of our data, we suggest that classification of pancreatic neoplasms in the WHO and The Armed Forces Institute of Pathology (AFIP) systems should be reconsidered.

Adenocarcinoma↗
PubMed2004

Mucinous cystadenoma of the pancreas 17 years after excision of gallbladder because of a choledochal cyst.

A 56-year-old woman who had undergone excision of the gallbladder because of a choledochal cyst had a tumorous lesion of the pancreas identified by upper abdominal ultrasonography, but an operation was not carried out, because there was no apparent increase in the cystic mass and no elevation of serum tumor markers. In October 2001, she was admitted to our hospital to check for malignancy because of elevated levels of the tumor marker Dupan-2. Abdominal enhanced computed tomography and upper abdominal ultrasonography revealed a large multilocular cystic mass in the body to tail of the pancreas. Endoscopic retrograde cholangiopancreatography showed elongation of the common duct that communicates with the common bile duct and the main pancreatic duct, indicating an anomalous arrangement of the biliary and pancreatic duct system. No apparent communications between the cystic mass and the main pancreatic duct were observed. In January 2002, the patient underwent a spleen-preserving distal pancreatectomy, and histopathological and immunohistochemical examinations led to the diagnosis of pancreatic mucinous cystadenoma with ovarian-like stroma. The mucinous cystadenoma was detected 17 years after the operation for the choledochal cyst. To the best of our knowledge, no documented case reports of mucinous cystadenoma of the pancreas associated with a choledocal cyst have been reported to date. We present here the first case report of pancreatic mucinous cystadenoma occurring in the body to tail of the pancreas, associated with a choledocal cyst.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2004

Histologic and immunohistochemical comparison of intraductal tubular carcinoma, intraductal papillary-mucinous carcinoma, and ductal adenocarcinoma of the pancreas.

OBJECTIVE: To analyze the differences between intraductal tubular carcinoma (ITC) and intraductal papillary-mucinous carcinoma (IPMC), we performed light microscopic and immunohistochemical analysis of 4 cases of ITC, 6 cases of IPMC, and 9 cases of ductal adenocarcinoma of the pancreas. METHODS AND RESULTS: Light microscopic examination showed no hyperplasia or adenoma around the carcinoma in ITC, and immunohistochemical analysis showed that the apical side of the cell membrane was positive for MUC-1 in almost all ITC cells. In contrast to ITC cells, all IPMC cells were negative for MUC-1 and ductal adenocarcinoma cells were strongly positive for MUC-1 in the cytoplasm and cell membrane. Immunohistochemical staining patterns of DUPAN-2 in ITC resembled those of MUC-1 in these cancers. ITC and IPMC cells were negative for carcinoembryonic antigen, but ductal adenocarcinoma cells were positive. There were no apparent differences in proliferative activity between ITC and IPMC, but ductal adenocarcinoma showed significantly greater activity than either ITC or IPMC. CONCLUSION: The PCNA-L.I of IPMC and ITC was lower and the cell atypia of them was more mild compared with those of ductal carcinoma, indicating that IPMC possess low-grade malignant potentials. However, we observed differences of growth patterns and mucous secretion between ITC and IPMC of the pancreas.

Adenocarcinoma↗
PubMed2003

Tumor dimension and prognosis in surgically treated lung cancer: for intentional limited resection.

Tumors with a maximum dimension of 3 cm are categorized as T1, whereas those greater than 3 cm are T2 by TNM classification. Some physicians suggest that early-stage peripheral lung cancer should have a maximum tumor diameter of 2 cm and that limited surgery (segmentectomy without lymph node dissection) is acceptable for the patients. In this study, the relationship between the tumor dimension and prognosis was analyzed in 207 patients with surgically treated primary non-small-cell lung cancer (SCLC). The 5-year survival rate of those with tumors 3 cm or less and without lymph node (LN) metastases was 86%, which was significantly higher than that of those with tumors more than 3 cm and without hilar and mediastinal LN metastases (65%) (p < 0.05). However, 33% of the patients with tumors 3 cm or less had LN metastases, and the 5-year survival rate did not differ between those with tumors 3 cm or less (60%) and those with tumors more than 3 cm (54%). Twenty-eight percent of patients with tumors 2 cm or less had LN metastases, and the 5-year survival rate of the patients with tumors 2 cm or less was 62%. The 5-year survival rate of those with tumors 2 cm or less and without LN metastases was 88%. Forty-six patients with tumors 2 cm or less included 5 cases with an intrapulmonary metastasis in the same lobe (11%). In conclusion, a size of 3 cm is an appropriate boundary as the T factor. Because those with tumors 2 cm or less have a relatively high percentage of LN metastases, intraoperative frozen sections of LN should be considered for those undergoing limited surgery for primary non-SCLCs 2 cm or less. Intrapulmonary metastases also should be considered for those undergoing limited surgery even if the maximum dimension of the primary tumor is less than 2 cm.

Adult↗
PubMed2003

Immunohistochemical evaluation of tissue-specific proteolytic enzymes in adenomas containing foci of early carcinoma: correlations with cathepsin D expression and other malignant features.

BACKGROUND: Cathepsin D (CD) is an aspartyl lysosomal protease, and the prognostic value of CD expression has been studied in a variety of tumors, however, its role in early adenocarcinomas remains unclear. AIM OF THE STUDY: We evaluated the expression of CD in a series of colorectal adenomas with severe dysplasia containing foci of early carcinoma and compared the results to several histopathological and immunohistochemical features. METHODS: Adenomas were obtained by endoscopic polypectomy from 33 patients. Twenty-four of the 33 adenomas contained well-differentiated adenocarcinomas and nine adenomas contained moderately differentiated adenocarcinomas. RESULTS: Positive CD expressions were observed in 25% of well-differentiated adenocarcinomas and in 66.7% of moderately differentiated adenocarcinomas (p < 0.05). Of the 12 adenocarcinomas with positive CD expression, four had positive CD expression in their adenomas (p < 0.01), 6 showed positive Ki-67 expression in their adenomas (NS), and 10 had positive p53 expression in their adenomas (p < 0.05). No significant association was seen between the level of CD expression and adenoma size. CONCLUSIONS: The expression of CD in adenocarcinoma correlated significantly with differentiation, and with the levels of CD and p53 expression in the adenomas of the polyp.

Adenocarcinoma↗
PubMed2002

Resection of thymic carcinoma in a patient with thoracic aortic aneurysm.

A 72-year-old man with a history of brain infarction presented with left sided anterior chest pain secondary to a thymic carcinoma. He received induction radiotherapy, 45 Gy. Preoperative computed tomography showed the tumor was adherent to a thoracic aortic aneurysm (TAA) which had extensive mural thrombus and calcification. To obtain adequate exposure without exerting tension on the fragile aneurysmal wall, ribs were resected to allow us to separate the tumor from the TAA, after which median sternotomy was performed uneventfully, creating generous exposure. The tumor had invaded the sternum, ribs, innominate vein, phrenic and recurrent laryngeal nerves, and lung. The tumor was removed en bloc, and the chest wall was reconstructed. Intra- and post-operative brain infarction and rupture of the TAA were avoided. The patient is alive and well without recurrence 10 months after surgery.

Aged↗
PubMedDate not supplied

Cyopathologic and histologic features of biphasic pulmonary blastoma: a case report.

BACKGROUND: Biphasic pulmonary blastoma is a rare malignant neoplasm of debatable histogenesis. Although well described histologically, it is scarcely mentioned in the cytologic literature. CASE: A 78-year-old man reporting intermittent hemoptysis was admitted to the hospital. Chest radiography revealed a right-sided pulmonary mass. Cytologic examination of tumor specimens revealed 2 types of malignant cells. The smears were highly cellular, with a necrotic background. The stromal cells had predominantly round to ovoid or spindle-shaped nuclei and scant cytoplasm, and the nucleoli had slightly irregular borders with coarsely aggregated chromatin. The epithelial cells were arranged in sheets and glandular configurations. The cytoplasm of these cells was finely vacuolated or foamy, with indistinct cellular boundaries; eccentrically located nuclei were hyperchromatic and had irregularly shaped nucleoli. The cell block preparation showed a distinctly biphasic malignant tumor with the classic morphologic features of pulmonary blastoma. CONCLUSION: A preoperative diagnosis ofpulmonary blastoma is difficult to obtain by cytopathologic methods. A diagnosis of biphasic pulmonary blastoma should be considered whenever epithelial cells and a separate population of stromal cells are seen in a pulmonary exfoliative cytology specimen.

Aged↗
PubMedDate not supplied

Sequential progression and intraductal spread of invasive ductal adenocarcinoma of the pancreas arising from around the main pancreatic duct.

A 76-year-old woman was admitted to our hospital after increased transaminase, hepato-biliary enzyme levels, and tumor markers were found. Abdominal contrast computed tomography revealed a mass (20 x 18 mm) in the uncus of the pancreas. Magnetic resonance cholangiopancreatography showed an abrupt narrowing with the dilatation of the peripheral main pancreatic duct (MPD) in the pancreatic head. Endoscopic retrograde cholangiopancreatography showed only dilatation of the lower bile duct; insertion of the cannula was not seen because the MPD was obstructed. The patient underwent a Whipple-pancreatoduodenectomy. Histopathological and immunohistochemical examinations led to a diagnosis of sequential progression and intraductal spread of invasive ductal adenocarcinoma of the pancreas arising from around the main pancreaticduct. Interestingly, the intraductal spread was approximately 20 mm to the point where the carcinoma began to infiltrate. To the best of our knowledge, there have been no other reported cases of such broad intraductal spread, indicating that noninvasive lesions that replace the normal epithelia can be broader than those reported previously.

Aged↗