Carcinomas of the biliary tract are known to be more common in East Asia than in Western countries, but their exact histopathological characteristics and tumorigenesis are not well elucidated. To examine the histological and immunohistochemical characteristics of the biliary tract carcinomas according to their anatomical sites and to elucidate their tumorigenesis, we performed histological review and immunohistochemical study in a total of 135 cases of biliary tract carcinomas; 24 intrahepatic bile duct, 34 gallbladder, 51 common bile duct, and 26 periampullary carcinomas. Precancerous lesions were associated with 5 (20.8%) cases of intrahepatic duct carcinomas (dysplasia 5), 7 (20.6%) cases of gallbladder carcinomas (adenoma 5, dysplasia 2), 10 (19.6%) cases of common bile duct carcinomas (adenoma 7, dysplasia 3), and 2(7.7%)cases of periampullary carcinomas (adenoma 2). Immunohistochemically, c-erbB-2 expression in gallbladder carcinoma (21/34, 62%) was significantly higher than that of intrahepatic (8/24, 33%). Ki-67 indices were higher in common bile duct carcinomas (19%) than those of intrahepatic bile duct (14%) or periampullary carcinomas (12%). Overexpression of p53 gene product in the periampullary carcinomas (20/22, 77%) was higher than that of intrahepatic (12/24, 50%) or common bile duct carcinoma (26/51, 51%). In the precancerous lesions the c-erbB-2 expression was present in 29% of the gallbladder, 20% of the intrahepatic, 10% of the common bile duct precancerous lesions and none of the 2 cases of adenomas in the periampullary region. The p53 overexpression in the precancerous lesions was frequent, ranging from 43% to 60%. These results suggest that a mechanism involving p53 gene mutation and c-erbB-2 gene activation is present in the tumorigenesis in a significant number of the biliary tract carcinomas and they may be the early events in the tumorigenesis of the biliary tract carcinomas.
Adenoma ; Bile Ducts, Intrahepatic ; Biliary Tract* ; Carcinogenesis ; Common Bile Duct ; Far East ; Gallbladder ; Genes, erbB-2 ; Genes, p53

To evaluate the correlation between the histologic grade and DNA ploidy or proliferation index/S phase fraction (SPF) of gastrointestinal stromal tumors, we performed the DNA analysis using the flow cytometry. Paraffin embedded tissue samples of 57 gastrointestinal stromal tumors were used. The sites of the tumors were: stomach (28), small intestine (23), and large intestine(6). DNA index, proliferative index, and SPF by the flow cytomery were compared with histologic grade. The histologic grade of the gastric tumors were benign (12), borderline (10), and malignant (6). Those of the small intestinal timors were benign (2), borderline (13), and malignant(8). The large intestine were borderline (2), and malignant (4). In stomach, aneuploidy was found in 25.0% of benign, 40.0% of borderline, and 100% of malignant. And there was statistically significant correlation between the histologic grade and ploidy (p < 0.05). By contrast, small and large intestinal tumors showed more frequent aneuploidy in benign than in malignant. The proliferative index was correlated with the histologic grade in gastric tumors (p<0.05), but the SPF was not. In conclusion, the ploidy and proliferative index of gastric tumors are closely correlated to the histologic grade. However, aneuploidy in tumors of the small and large intestine were difficult to predict the malignancy.
Aneuploidy ; DNA* ; Flow Cytometry ; Gastrointestinal Stromal Tumors ; Indonesia ; Intestine, Large ; Intestine, Small ; Paraffin ; Ploidies ; Stomach

The cytologic findings in fine needle aspiration of a case of myxoid liposarcoma of the mediastinum are described. The smear and cell block of the aspirate revealed solid clusters with background of amorphous material and scattered single tumor cells. The clusters were moderately cellular and consisted of atypical lipoblasts in varying stages of differentiation and delicate plexiform capillaries. Good correlation was found between the histologic and cytologic findings in the fine needle aspirates. The differential diagnosis between myxoid liposarcoma and other myxoid soft tissue tumors is discussed.
Biopsy, Fine-Needle* ; Capillaries ; Diagnosis, Differential ; Liposarcoma, Myxoid* ; Mediastinum* ; Needles

Segmental dilatation of small intestine is a rare form of the congenital intestinal anomaly. Many other congenital anomalies have been reported in these patients, but to our knowledge, the association with colonic duplication has not been reported in literatures. Herein we report a case of segmental dilatation of distal ileum associated with colonic duplication. The main clinical and pathogenic aspects are discussed, and the literatures were reviewed.
Colon* ; Dilatation* ; Humans ; Ileum* ; Intestinal Obstruction ; Intestine, Small

We have experienced a case of pseudocyst of transverse mesocolon in 3-year-old male child. Operative findings showed that the pseudocyst was originated from the transverse mesocolon, and was not connected to the pancreas. A colonic duplication has been also found incidentally near the pseudocyst. On microscopic examination of specimen, ectopic pancreatic tissue was noted in transverse mesocolon. We think that this pseudocyst may be originated from the ectopic pancreas of the transverse mesocolon. To our knowledge, this is the first case of pseudocyst originated from ectopic pancreas associated with colonic duplication, and the pathogenesis is discussed.
Child ; Child, Preschool ; Colon* ; Humans ; Male ; Mesocolon* ; Pancreas*

It is generally believed that the anomalous pancreaticobiliary duct union (APBDU) might be involved in the formation of choledochal cyst and malignancies of hepatopancreaticobiliary system. The purpose of this study is to make an animal model of APBDU similar to that of human. One to two-month-old Mongrel dogs (n=12) were divided into two groups; the control group (n=2) in which sham operation was performed, and the experimental group (n=10) in which the end of distal common bile duct (CBD) was anastomosed to the side of dorsal pancreatic duct to produce APBDU. Serum was obtained for chemical analysis at the 10th postoperative day. The dogs were sacrificed at the 5th week (n=3), the 6th week (n=3), the 7th week (n=2), the 8th week (n=2) and the 6th month (n=2) after the operative intervention. At the day when the experimental animals were sacrificed, operative cholangiogram was taken, and bile juice was obtained for chemical analysis and bacterial culture. The en-bloc specimens of hepatopancreaticobiliary system were obtained for microscopic examination. Serum and bile juice amylase levels were elevated in the experimental group (n=10), but not in the control group (n=2). On operative cholangiogram, there was no evidence of bile duct dilatation in control group (n=2). On the other hand, bile duct in the experimental group was markedly dilated without any evidence of stenosis in all (n=10). Histologic examination of the hepatopancreaticobiliary system in the experimental group resembled the findings of choledochal cyst in human. The APBDU of this animal model can produce bile duct dilatation by pancreaticobiliary reflux. We think that this animal model can be potentially promising for the research about the APBDU associated hepatopancreaticobiliary diseases.
Amylases ; Animals ; Bile ; Bile Ducts ; Choledochal Cyst ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Dogs ; Hand ; Humans ; Models, Animal* ; Pancreatic Ducts

Although the required extent of lymph node dissection remains controversial, surgery is the cornerstone of the treatment of advanced gastric cancer. However, only approximately 30% of patients are diagnosed as operable, and an R0 resection will be achieved in only 40~60% of these. Since R0 resection and the treatment response of the primary cancer or resected specimen are significant prognostic factors in locally advanced gastric cancer, various preoperative treatment modalities have been attempted to induce downstaging and improve complete nodal resection. Several recent studies revealed that preoperative chemoradiation therapy can prolong patient survival by improving the R0 resection rate and treatment response. Here, we present an advanced gastric cancer patient with serosal penetration involving multiple perigastric and celiac lymph nodes who underwent radical surgery and entered complete remission after S1 and cisplatin-based concurrent chemoradiation therapy. Pathology revealed total necrosis of the tumor cells, and fibrous nodules in 2 out of 47 resected lymph nodes indicated dead cancer cells due to chemoradiation therapy. Subsequently, the patient received an additional six rounds of postoperative adjuvant chemotherapy with uracil/tegafur (UFT) and cisplatin. Follow-up imaging showed no evidence of tumor recurrence.
Chemotherapy, Adjuvant ; Cisplatin ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Necrosis ; Recurrence ; Stomach Neoplasms

PURPOSE: Most cases of primary hyperparathyroidism are due to either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We undertook a retrospective study in 4 patients with functioning parathyroid carcinoma, with the aim of conveying experience from management of this rare cause of kyperparathyroidism. METHODS: Clinical simptoms, biochemical laboratory, radiologic, and intraoperative findings, extent of surgical resection. histologic findings, local recurrence and distant metastasis were analysed in 4 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 1998. RESULTS: Mean age was 46.7 years (33~51 years) and male to female ratio was 1:3. Neck mass was found in 3 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidsm in all the cases, mean serum calcium level was 11.1 mg/dl (10.5~12.0 mg/ dl), slightly elevated. Laboratory values after surgery were within the normal range in 3 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 2 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During followup period, any local or systemic recurrence were not evident in all the cases. CONCLUSION: Although functioning parathyroid carcinoma is a rare disease and its preoperative diagnosis, in general, cannot easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important fo the management of the parathyroid cancer.
Calcium ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperplasia ; Kidney Failure, Chronic ; Male ; Muscles ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Parathyroid Neoplasms* ; Rare Diseases ; Recurrence ; Recurrent Laryngeal Nerve ; Reference Values ; Retrospective Studies ; Thyroid Neoplasms

PURPOSE: Most cases of primary hyperparathyroidism are due to either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We undertook a retrospective study in 4 patients with functioning parathyroid carcinoma, with the aim of conveying experience from management of this rare cause of kyperparathyroidism. METHODS: Clinical simptoms, biochemical laboratory, radiologic, and intraoperative findings, extent of surgical resection. histologic findings, local recurrence and distant metastasis were analysed in 4 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 1998. RESULTS: Mean age was 46.7 years (33~51 years) and male to female ratio was 1:3. Neck mass was found in 3 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidsm in all the cases, mean serum calcium level was 11.1 mg/dl (10.5~12.0 mg/ dl), slightly elevated. Laboratory values after surgery were within the normal range in 3 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 2 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During followup period, any local or systemic recurrence were not evident in all the cases. CONCLUSION: Although functioning parathyroid carcinoma is a rare disease and its preoperative diagnosis, in general, cannot easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important fo the management of the parathyroid cancer.
Calcium ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperplasia ; Kidney Failure, Chronic ; Male ; Muscles ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Parathyroid Neoplasms* ; Rare Diseases ; Recurrence ; Recurrent Laryngeal Nerve ; Reference Values ; Retrospective Studies ; Thyroid Neoplasms

PURPOSE: The purpose of this study was to investigate the reliability and the clinical applicability of the adenosine-triphosphate-based chemotherapy response assay (ATP-CRA) as a method of determining in vitro chemosensitivity in patients with gastric cancer. MATERIALS AND METHODS: A total of 243 gastric cancer tissue samples were obtained from gastrectomies performed between February 2007 and January 2010. We evaluated the effectiveness of the ATP-CRA assay in determining the chemosensitivity of gastric cancer specimens using eleven chemotherapeutic agents - etoposide, doxorubicin, epirubicin, mytomicin, 5-fluorouracil, oxaliplatin, irinotecan, docetaxel, paclitaxel, methotraxate, and cisplatin - for chemosensitivity studies using ATP-CRA. We assessed the failure rate, the cell death rate, and the chemosensitivity index. RESULTS: The failure rate of ATP-CRA was 1.6% (4/243). The mean coefficient of variation for triplicate ATP measurements was 6.5%. Etoposide showed the highest cell death rate (35.9%) while methotrexate showed the lowest (16.6%). The most active chemotherapeutic agent was etoposide, which most frequently ranked highest in the chemosensitivity test: 31.9% (51/160). Oxaliplatin was more active against early gastric cancers than advanced gastric cancers, whereas docetaxel was more active against advanced cancers. The lymph node negative group showed a significantly higher cell death rate than the lymph node positive group when treated with doxorubicin, epirubicin, and mitomycin. CONCLUSIONS: ATP-CRA is a stable and clinically applicable in vitro chemosensitivity test with a low failure rate. The clinical usefulness of ATP-CRA should be evaluated by prospective studies comparing the regimen guided by ATP-CRA with an empirical regimen.
Adenosine ; Adenosine Triphosphate ; Camptothecin ; Cell Death ; Cisplatin ; Doxorubicin ; Epirubicin ; Etoposide ; Fluorouracil ; Gastrectomy ; Humans ; Lymph Nodes ; Methotrexate ; Organoplatinum Compounds ; Paclitaxel ; Polyphosphates ; Stomach Neoplasms ; Taxoids