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Biomedical subjects

H Kuwano

Publications and source records attributed to H Kuwano.

At least 127 records · Page 7Linked to original sources
PubMed1995

Hyperthermochemoradiotherapy is effective for small cell carcinoma of the esophagus.

Esophageal small cell carcinoma is a highly aggressive disease, and no effective treatment has yet been reported. We present here two cases of esophageal small cell carcinoma preoperatively treated with a combination of hyperthermia, irradiation, and an intravenous infusion of cis-diammine-dichloroplatinum (CDDP). The first case concerned a 67-year-old Japanese woman. Hyperthermochemoradiotherapy (HCR) was performed before surgical treatment. A histopathologic study of the resected specimen showed no residual viable cancer cells either in the esophagus or in the dissected lymph node. The second case involved a 59-year-old Japanese man who received HCR therapy before surgical treatment. This patient survived for 33 months, the longest known period of survival for small cell carcinoma of the esophagus. These cases indicate that preoperative hyperthermochemoradiotherapy may be considered one promising adjuvant therapy alternative for this aggressive disease.

Aged↗
PubMed1995

Esophageal squamous cell carcinoma occurring in the surface epithelium over a benign tumor.

The coexistence of a benign tumor and carcinoma in the same esophagus is uncommon, while the occurrence of carcinoma in the surface epithelium over a benign tumor is considered to be extremely rare. Among 587 patients with surgically resected esophageal cancer, the cases with carcinoma located over a benign tumor of the esophagus were histopathologically investigated and the carcinogenesis of such cases was discussed. Only three cases were found to have esophageal squamous cell carcinoma located over benign tumors (two were leiomyomas and one was a lipoma). All three benign tumors protruded to the esophageal surface, and the carcinoma was located just over such tumors without coexisting epithelial dysplasia. Moreover, the epithelium, except for portions around these tumors, was intact in all three cases. From these findings it was suggested that chronic stimulation of the epithelium covering the benign tumors might have induced the carcinoma.

Aged↗
PubMed1995

Prospective randomized study of hyperthermia combined with chemoradiotherapy for esophageal carcinoma.

From January 1988 to June 1992, 66 patients with resectable squamous cell carcinoma of the thoracic esophagus underwent preoperative adjuvant therapy. These patients were prospectively divided into two treatment groups; 32 were treated with radiofrequency wave local hyperthermia combined with chemoradiotherapy (hyperthermochemoradiotherapy; HCR), while the remaining 34 patients were treated with chemoradiotherapy alone (CR). There were no procedural complications in either group and the postoperative mortality was zero. In the HCR group, no viable cancer cells were found within the entire 5 mm-width slices of the resected specimen in eight patients (25%), while only two (5.9%) in the CR group (P < 0.05) demonstrate no viable cancer cells. The cumulative 3-year survival rate was 50.4% in the HCR group and 24.2% in the CR group. The present prospective trial demonstrated that the addition of hyperthermia to chemoradiotherapy resulted in a better local control and an improved long-term survival when treating patients with advanced esophageal carcinoma.

Adult↗
PubMed1995

Effect of dietary vitamin A on forestomach tumorigenesis during the total and postinitiation stages in mice treated with high- or low-dose benzo(a)pyrene.

The effects of dietary vitamin A on forestomach tumorigenesis during the total stage of the initiation and postinitiation periods and during the postinitiation stage were evaluated in ICR/Jcl mice treated with either high or low doses of benzo(a)pyrene (B(a)P). In experiment 1, the animals were initiated with a high carcinogenic dose of B(a)P to a total of 20 mg, while in experiment 2 the animals were treated with a low dose of B(a)P to a total of 2 mg. A control group of animals received no carcinogens. Five different dietary levels of vitamin A supplements were used in each experiment and in the control study. In experiment 1, a high incidence of tumorigenesis was observed in every group, with 74% to 96% developing papilloma and 19% to 46% developing carcinoma. In experiment 2, the incidence of tumorigenesis in the high-dose vitamin A groups, including those given during the total and postinitiation stages, was found to be significantly reduced at 7.4%, compared with that in the low-dose vitamin A group of 57.7% (P < 0.05). These results suggest that a high dietary level of vitamin A can reduce the incidence of tumorigenesis when low carcinogenic dose levels of B(a)P are given in both the total and postinitiation stages.

Animals↗
PubMed1995

Mastopathy of the accessory breast in the bilateral axillary regions occurring concurrently with advanced breast cancer.

We herein report a 41-year-old Japanese woman who demonstrated advanced cancer in the left breast occurring concurrently with mastopathy of the accessory breast tissue in the bilateral axillary regions, which appeared to be metastatic lymphadenopathy. A preoperative examination, including a mammogram, US, and CT, did not provide us with a definite diagnosis of the axillary masses: it was essential to diagnose the masses preoperatively since a bilateral mastectomy with nodal dissection is called for if the right axillary masses are metastatic from a cancer in the right breast. An intraoperative cytological examination from the bilateral axillary masses revealed adenosis with fibrocystic changes in the accessory breast tissue. We therefore performed a modified radical mastectomy only on the left side. The patient was thus saved from an unnecessary mastectomy of the right breast. Based on our experience, we wish to emphasize that the accessory breast tissue should be considered for a differential diagnosis when evaluating the axillary masses in order to avoid over-surgery, especially when a patient has been diagnosed to have massive breast cancer. An intraoperative cytological examination is strongly recommended to reach a final diagnosis in such confusing cases.

Adult↗
PubMed1995

The prognostic significance of the cytophotometric DNA content and its relationship with the argyrophilic nucleolar organizer regions (AgNOR) and proliferating cell nuclear antigen (PCNA) in oesophageal cancer.

We examined the DNA pattern, AgNOR number and PCNA-positive ratio (PCNA ratio) from biopsy specimens of oesophageal carcinoma, and attempted to identify any prognostic factors for oesophageal carcinoma. DNA analysis: the cell nuclear DNA content was measured and the distribution pattern of the DNA content was grouped into four types according to the ploidy pattern (n = 182). The survival rate of patients with high-ploidy tumours (type III and IV) was shorter than that for low-ploidy tumours (type II), (P < 0.05). AgNOR number (n = 99) and PCNA ratio (n = 41): the AgNOR number and PCNA ratio were measured from 100 cancer cells in each specimen. Both the high-AgNOR-number patients (> or = 5) and the high-PCNA-ratio patients (> or = 35) demonstrated poorer prognoses than the low-rate patients (P < 0.05). These results suggest that the DNA pattern, AgNOR number and PCNA ratio may thus reflect the proliferative activity of tumours and therefore also offer the possibility of interdependence among these three factors.

Aged↗
PubMed1995

The long-term results of pre-operative hyperthermo-chemo-radiotherapy for oesophageal carcinoma--a comparison with preoperative radiation therapy alone.

The long-term results of patients with oesophageal carcinoma treated with pre-operative hyperthermo-chemo-radiotherapy (HCR) and pre-operative radiation therapy alone were compared. Twenty-six patients treated with pre-operative hyperthermo-chemo-radiotherapy (HCR Group) and 25 treated with radiation therapy alone (R Group), which demonstrated histopathologically marked effective results (Grade 3), were entered into the study. The 3-year survival rates after oesophagectomy in the HCR Group and the R Group were 67.4% and 41.8%, respectively, while the 5-year survival rates were 50.5% and 34.9%, respectively. Thus post-operative prognosis in the HCR Group was significantly more favourable than that in the R Group (P < 0.05). The local recurrence and distant metastasis rate in the HCR Group was significantly less than in the R Group (P < 0.01). This significant difference in prognosis was thought to be due to the reinforced effects of local regulation by hyperthermia and the systemic control of micrometastasis by chemotherapy in addition to radiation. Our data suggest that for carcinoma of oesophagus, pre-operative hyperthermo-chemo-radiotherapy contributes to prolonged post-operative survival while reducing both local recurrence and micrometastasis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Histological suggestions of 'paratransformation' in oesophageal squamous cell carcinoma.

We have postulated that oesophageal squamous cell carcinoma arises from multifocal areas and not from one cell, and we present the circumstantial evidence for field carcinogenesis in oesophageal cancer. Among 290 cases examined with oesophageal squamous cell carcinoma, lymphatic permeation or intramural metastasis was evident in 110 cases. Of these carcinomatous transformation of the epithelium adjacent to either lymphatic vessel permeation or intramural metastasis of the squamous cell carcinoma was recognized in six cases. It is considered that the cancer tissue either in the lymphatic vessel or intramural metastasis promotes a malignant transformation of the squamous epithelium over these foci. 'Paratransformation' is therefore thought to be one of the potential models of origin for oesophageal squamous cell carcinoma.

Aged↗
PubMed1995

Development of esophageal cancer after endoscopic injection sclerotherapy for esophageal varices: three case reports.

We report here three cases of squamous-cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. All three patients were men and cigarette smokers, with a mean age of 58.3 +/- 5.0 years. Hepatitis B and C virus infection tests were negative, and alcoholic cirrhosis was present in each patient. The interval between sclerotherapy and the development of carcinoma was 9, 10, and 33 months, in the respective cases. The sclerosant used was 5% ethanolamine oleate with a mean total volume of 51.0 +/- 18.9 ml. While we have no evidence of a direct relationship between sclerotherapy and esophageal cancer, in patients with alcoholic cirrhosis who have risk factors for esophageal cancer there may be an acceleration of the potential malignancy, as a result of the chronic inflammation related to sclerotherapy. Such patients should be closely followed, using endoscopy.

Carcinoma, Squamous Cell↗
PubMed1995

Resection margin for squamous cell carcinoma of the esophagus.

OBJECTIVE: The safe resection margin in esophagectomy for esophageal squamous cell carcinoma (SCC) was determined based on the extent of epithelial and subepithelial accessory lesions from the main lesions of esophageal SCC. BACKGROUND: There have been many reports on the high incidence of a positive resection margin for esophageal cancer. Although there were some studies on the relationships of the proximal clearance to postoperative local recurrence, no pathologic study on the resection margin has been reported. METHODS: Four hundred twenty specimens of a whole resected esophagus were examined histopathologically and the longitudinal length from the main lesion to the five types of accessory lesions was measured on microscopic slides. RESULTS: Contiguous intraepithelial carcinoma existed in 69 (46%) of 150 sites of main lesions restricted to the mucosa or submucosa and subepithelial lesions existed in 131 (54%) of 245 sites and 82 (55%) of 150 sites of main lesions invading an adventitia and into neighboring structures, respectively. The risk of a positive resection margin due to subepithelial lesions was below 5% at 10 mm in the main lesion, restricted to the submucosa or the muscularis propria, and at 30 mm in the main lesion, invading the adventitia in the potentially curative operation cases. CONCLUSION: These clearances of the resection margin, in which the risk of a positive resection margin is below 5%, are acceptable, although these clearances should only be accepted after the extent of epithelial accessory lesions is accurately determined by the Lugol's stain method.

Adult↗
PubMed1995

Successful simultaneous resection and reconstruction of abdominal aortic aneurysm and esophageal cancer.

A simultaneous resection and reconstruction of abdominal aortic aneurysm (AAA) and esophageal cancer was performed on an eighty-year-old Japanese man. In spite of his advanced age, preoperative assessments revealed that the general functions of the patient were quite satisfactory. An esophagram, endoscopy and CT scan all demonstrated the esophageal cancer to be in a relatively early stage without any lymph node metastasis, while the CT scan demonstrated an infrarenal type of fusiform abdominal aortic aneurysm with a maximum transverse diameter of 7.0 cm. A simultaneous resection and reconstruction of both the AAA and esophageal cancer was performed on August 8, 1991. First, the operation for AAA was done through a retroperitoneal approach, and next, a resection and reconstruction of the esophageal cancer was performed with a right thoracotomy and laparotomy using the gastric tube as an esophageal substitute. The postoperative course was uneventful except for a temporary purulent discharge through the mediastinal drain. The patient was discharged on the 56th postoperative day. Therefore, when the general conditions are considered to be tolerable for operation, such a simultaneous operation may be indicated even inpatients of advanced age by utilizing isolated approaches and taking great care.

Aged↗
PubMed1995

Extensive spreading carcinoma of the esophagus with invasion restricted to the submucosa.

OBJECTIVES: The aim of this study was to examine the clinicopathological features of extensive spreading type of squamous cell carcinoma (SCC) of the esophagus with invasion restricted to the submucosa. METHODS: Thirty-eight submucosal SCC were studied histopathologically, and five of these 38 submucosal SCC, which demonstrated an extensive spreading-type SCC in which the size of the SCC was over 5 cm in longitudinal length while extending entirely across the esophageal lumen in a circumferential spread, are described in detail. RESULTS: The extent of SCC depended mainly on the extent of intraepithelial carcinoma (IEC) and ranged from 50 to 135 mm in longitudinal length. IEC existed continuously in four cases, and multiple IEC existed separately in one case. An epithelium showing dysplasia was present in all cases, and the involvement of the glands and ducts by IEC was present in two cases. There was only one invasive part of SCC observed in one case, and three to 10 invasive parts of SCC were observed in the other four cases; various features of invasion, including an invasive SCC from the esophageal glands and ducts, were also present. CONCLUSIONS: The extensive spreading-type SCC of the esophagus, which was considered to result from the widespread or multiple carcinomatous changes of the esophageal epithelium, was found to not be as rare as generally thought. The multiple and various features of the invasive parts of SCC suggested the simultaneous development of a downward invasion of SCC at different areas in extensive IEC.

Adult↗
PubMed1995

[Reevaluation of precancerous lesion of squamous cell carcinoma].

One hundred fifty-nine cases of esophageal carcinoma were reviewed retrospectively. There were 75 dysplastic lesions in 32 cases (20.1%). Although the continuity of dysplastic lesions to the areas of carcinoma was not so frequent (48.0%), it was more often encountered in severe rather than in moderate or mild dysplasia, which suggested some relationship between the severity of dysplasia and carcinoma. Using a silver colloid staining technique, nucleolar organizer region-associated proteins (NOR) were studied in paraffin sections of 22 normal epithelia, 22 dysplasias, 17 carcinomas in situ (CIS), and 14 invasive carcinomas. The mean numbers of NOR in the nucleus were 1.77 +/- 0.14 (mean +/- SD) in normal epithelium, 2.16 +/- 0.30 in dysplasia, 2.78 +/- 0.51 in CIS, and 3.67 +/- 0.85 in invasive carcinoma. On the other hand, the NOR number in the atypical layer of the dysplasia was 2.60 +/- 0.39, which was almost the same level as that of CIS. These results suggest that atypical layers in esophageal dysplasia already have the same level of proliferative activity judging from the NOR numbers. Immunohistochemical staining for P53 protein revealed that, in the 13 cases with positive staining of the cancer tissue, 79.1% of dysplastic lesions were also positively stained. These results suggested that, although dysplasia was not carcinoma because of the restriction in the mucosa without invasion, the biological nature of dysplasia might be considered as serious a lesion as carcinoma itself.

Carcinoma, Squamous Cell↗
PubMed1994

The multicentric occurrence of squamous epithelial dysplasia and squamous cell carcinoma in the esophagus.

BACKGROUND: The biologic significance of esophageal dysplasia has not yet been completely elucidated, especially regarding the process of multiple occurrences of squamous cell carcinoma. METHODS: The multiplicity of dysplasia in 73 patients with solitary carcinoma of the esophagus (Group I) and 21 with multiple carcinomas (Group II) was compared in surgically resected specimens. RESULTS: Thirty-nine second carcinomas were identified in 13 patients of Group II, and all were superficial. The incidences of five or more isolated dysplasias in cases without continuity to a carcinomatous lesion, was 6.8% and 66.7% in Groups I and II, respectively (P < 0.01). In a case with three or more carcinomas, the incidence increased to 84.6%. The coexistence of all grades of isolated dysplasias was observed in 10 patients (47.6%) in Group II but in only 6 patients (8.2%) in Group I (P < 0.01). CONCLUSIONS: These findings suggest that various degrees of evolving biologically related lesions, such as dysplasia and carcinoma, can occur multicentrically in the same esophagus.

Carcinoma in Situ↗
PubMed1994

Local immune response to tumor invasion in esophageal squamous cell carcinoma. The expression of human leukocyte antigen-DR and lymphocyte infiltration.

BACKGROUND: The purpose of this study was to investigate the local immune response to tumor invasion in esophageal squamous cell carcinoma by using an immunohistochemical examination of the expression of human leukocyte antigen- (HLA) DR and lymphocyte infiltration. METHODS: The paraffin embedded sections from 108 patients with esophageal squamous cell carcinoma were studied immunohistochemically, using the streptavidin biotin peroxidase method with monoclonal antibody (HLA-DR, T-cell, and B-cell) in the 68 noninvasive sites of cancer (intraepithelial carcinoma) and the 108 invasive sites of cancer. RESULTS: The expression of HLA-DR antigen was detected in 49 of 108 cases (45%) of esophageal cancer. The expression of this antigen was more predominant in intraepithelial carcinoma than at the invasive sites of cancer (60% versus 22%, P < 0.01). Among the 40 cases with positive staining for HLA-DR antigen in intraepithelial carcinoma, negative staining of the invasion portion was shown in 27 (67.5%) cases. On the other hand, in the 28 cases with negative staining in intraepithelial carcinoma, 27 cases (96.4%) were also negative at the invasive sites. T-cell infiltration was significantly recognized at the area of HLA-DR antigen expression at the sites of both intraepithelial carcinoma and tumor invasion. However, no significant relationship was observed between the HLA-DR antigen expression and long term survival at this time. CONCLUSIONS: These results suggest that the local immune response to the HLA-DR may prevent tumor invasion, whereas the negative expression of HLA-DR antigen is a significant factor facilitating tumor invasion in esophageal squamous cell carcinoma.

Adult↗
PubMed1994

Multiple occurrence of carcinoma in the upper aerodigestive tract associated with esophageal cancer: reference to smoking, drinking and family history.

Smoking and drinking habits as well as family history were examined in 143 men with esophageal cancer, including 30 who had associated second cancers of the upper aerodigestive tract (UADT) and 113 who did not. The risk of second cancers of UADT associated with the main lesions of the esophagus was evaluated, using odds ratios (ORs). As a result, the ORs of second cancers for current smoking and drinking were 5.3 and 7.6 respectively. The ORs significantly increased to 12.7 and 14.7 in heavy smokers and in heavy drinkers respectively. Furthermore, the risk of second cancer also significantly increased (8-fold) in patients who had close relatives with UADT cancer, compared to those without family history of any cancer. However, there were no differences in smoking or drinking habits regardless of family history. Our data thus suggest that a family history of UADT cancer as well as heavy smoking and drinking are clearly associated with multiple occurrence of UADT cancer. Therefore, careful and frequent examination for appearance of any second lesions are required for patients in these high-risk groups.

Aged↗