Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Evaluation of human epidermal growth factor receptor 2 (HER2) overexpression caused by erb-b2 receptor tyrosine kinase 2 (ERBB2) amplification (AMP) by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) is essential for treating unresectable metastatic gastric cancer (GC). A targeted tumour sequencing test enables comprehensive assessment of alterations in cancer-related genes, including ERBB2. This study aimed to evaluate the concordance between the targeted tumour sequencing test and IHC/FISH for detecting HER2-positive GC and to clarify the significance of ERBB2 AMP and concomitant genetic alterations in HER2 downstream pathways (DPs) in anti-HER2 therapy for unresectable metastatic GC patients. METHODS: ERBB2 copy number alteration (CNA) was examined via a targeted tumour sequencing test in 152 formalin-fixed paraffin-embedded (FFPE) GC tissues. ERBB2 CNA was compared to HER2 status evaluated by IHC/FISH in FFPE block sections, which were identical to those subjected to the targeted tumour sequencing test. Treatment outcomes of anti-HER2 therapy in 11 patients with unresectable metastatic GC was evaluated. RESULTS: ERBB2 AMP (≥ 2.5-fold change) was detected by the targeted tumour sequencing test in 15 patients (9.9%), and HER2 positivity (IHC 3 + or IHC 2+/FISH positive) was detected in 21 patients (13.8%). The overall percent agreement, positive percent agreement, negative percent agreement and Cohen's kappa between ERBB2 CNA and HER2 status were 94.7%, 66.7%, 99.2% and 0.75, respectively. Progression-free survival for trastuzumab therapy in patients with ERBB2 AMP was significantly longer than that in patients with no ERBB2 AMP detected by the targeted tumour sequencing test (median 14 months vs. 4 months, P = 0.007). Treatment response to trastuzumab therapy was reduced in patients with ERBB2 AMP and concomitant CNAs of genes in HER2 DPs. One patient with ERBB2 AMP and concomitant CNAs of genes in HER2 DPs achieved a durable response to trastuzumab deruxtecan as fourth-line therapy. CONCLUSIONS: A targeted tumour sequencing test is a reliable modality for identifying HER2-positive GC. ERBB2 AMP and concomitant genetic alterations detected through the targeted tumour sequencing test are potential indicators of treatment response to trastuzumab therapy. The targeted tumour sequencing test has emerged as a plausible candidate for companion diagnostics to determine indications for anti-HER2 therapy in the era of precision medicine for GC.

DOI： 10.1186/s12885-024-12482-5

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BACKGROUND/AIM: NAD(P)H dehydrogenase [quinone] 1 (NQO1), an antioxidant enzyme, confers resistance to anticancer agents. NQO1 C609T is a single-nucleotide polymorphism associated with reduced protein expression in the non-neoplastic esophageal squamous epithelium (ESE). This study aimed to investigate immunohistochemical NQO1 expression in non-neoplastic ESE and to elucidate its prognostic significance in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant therapy followed by esophagectomy. MATERIALS AND METHODS: NQO1 expression in non-neoplastic ESE was determined in surgical specimens from 83 patients with ESCC using immunohistochemistry. The association between NQO1 expression and clinicopathological factors, and the prognostic significance of NQO1 expression for relapse-free survival (RFS) were statistically evaluated. RESULTS: Patients with complete loss or weak NQO1 expression and patients with moderate or strong NQO1 expression were classified into the NQO1-negative (n=29) and NQO1-positive (n=54) groups, respectively. The downstaging of T classification status after neoadjuvant therapy was significantly more frequent in the NQO1-negative group than in the NQO1-positive group (59% vs. 33%; p=0.036). The NQO1-negative group had significantly more favorable RFS than the NQO1-positive group (p=0.035). Multivariate survival analysis demonstrated that NQO1 negative expression had a favorable prognostic impact on RFS (HR=0.332; 95%CI=0.136-0.812; p=0.016). CONCLUSION: Immunohistochemical evaluation of NQO1 expression in non-neoplastic ESE has clinical utility for predicting patient prognosis after neoadjuvant therapy followed by esophagectomy and might be helpful for selecting candidates for adjuvant therapy to treat ESCC.

DOI： 10.21873/anticanres.16993

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

An 87-year-old woman with a gradually enlarging mass in her left breast, diagnosed as having left-sided breast cancer with skin invasion by a local practitioner, was referred to our hospital. Computed tomography revealed ascending colon cancer with abdominal wall invasion and a thoracic aortic aneurysm(Stanford type B), in addition to breast cancer with skin invasion. A thoracic endovascular aortic repair and bypass surgery between the subclavian arteries were both performed for the thoracic aortic aneurysm. After 6 days, a right hemicolectomy and D2 lymphadenectomy were performed for the ascending colon cancer. A postoperative pathological diagnosis of pT3N0M0, pStage Ⅱa, was made. A total left mastectomy with a full-thickness skin graft for left breast cancer was performed after 2 months following the ascending colon cancer surgery. The postoperative pathological diagnosis was pT3N0M0, pStage ⅡB. No evidence of local recurrence or distant metastasis of the ascending colon cancer has been observed at 20 months postoperatively, or of the breast cancer after 18 months following surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 57-year-old man was diagnosed as having resectable advanced esophageal carcinoma adjacent to the trachea(Ut, cT3N0M0)and received preoperative docetaxel, cisplatin, and 5-fluorouracil therapy. Due to tracheal tumor invasion and upstaging to cT4bN0M0 after 1 course of chemotherapy, the treatment was converted to definitive chemoradiotherapy (CRT). A remarkable response with no evidence of tracheal invasion was observed on computed tomography following definitive CRT. He underwent successful curative resection with salvage esophagectomy, and the resected tumor was staged as pT1bN0M0. No adjuvant therapy was administered, and the patient was alive with no evidence of disease at the 5-year postoperative follow-up. The response to preoperative treatment should be meticulously assessed and appropriate treatment modalities used to avoid overlooking the potential for cure, even if the response to preoperative treatment with docetaxel, cisplatin, and 5-fluorouracil is poor.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は87歳,女性。左乳房腫瘤が徐々に増大したため近医を受診した。皮膚浸潤を伴う左乳癌と診断され,当科を受診した。精査の結果,左乳癌に加え,上行結腸癌と胸部大動脈瘤を認めた。上行結腸癌(cT4bN1bM0,cStage IIIc,大腸癌取扱い規約第9版),左乳癌(cT3N0M0,cStage IIB,乳癌取扱い規約第18版),胸部大動脈瘤(Stanford B型)と診断した。まず,胸部大動脈瘤に対して胸部大動脈ステント内挿術,両側鎖骨下動脈バイパス術を施行した。その6日後,上行結腸癌に対して結腸右半切除術,D2郭清を施行した。病理組織診断の結果,pT3N0M0,pStage IIaであった。上行結腸癌手術の2ヵ月後に左乳癌に対して左乳房全切除術,全層植皮術を施行した。病理組織診断の結果,pT3N0M0,pStage IIBであった。上行結腸癌術後20ヵ月,左乳癌術後18ヵ月無再発生存中である。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320011&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F011%2F1393-1395%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F011%2F1393-1395%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は57歳,男性。嚥下困難と嘔吐の精査で進行食道扁平上皮癌(Ut,cT3N0M0)と診断した。経鼻栄養チューブによる栄養管理を行いながら,術前docetaxel,cisplatin,5-fluorouracil併用(DCF)療法を実施した。1コース終了後に気管浸潤を認めた(cT4bN0M0)。根治的化学放射線療法(CF療法併用,照射60Gy)を実施し,気管浸潤の解除を認めた(cT3N0M0)。生検では癌の検出はなかったが,肉眼的に遺残が疑われ狭窄の悪化も認められた。安全に根治切除が可能と判断し,右開胸食道切除術(D0),胸骨後経路胃管再建を行った。病理診断ではpT1bN0M0であった。術後補助治療は実施せず,術後5年が経過して無再発生存中である。術前治療中の注意深い治療効果判定と適切な治療選択により,術前DCF療法不応例であっても根治の可能性を逃さないことが重要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320029&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F029%2F1447-1449%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F029%2F1447-1449%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Ceramide and sphingosine-1-phosphate (S1P) play opposing roles in cell death and survival, and maintain a dynamic balance called the sphingolipid rheostat. Glucosylceramide is a substrate to generate ceramide but its effect on breast cancer by oral administration was never tested. The purpose of this study was to reveal the anticancer activity of glucosylceramide and its potential as a new therapeutic agent in breast cancer. METHODS: E0771 cells were inoculated into the breast tissue of female C57BL/6NJcl mice. Glucosylceramide was administered orally to the mice for nine consecutive days. The concentrations of sphingolipid mediators including ceramide, glucosylceramide, and S1P in tumor tissues and serum were determined by mass spectrometry. RESULTS: Oral administration of glucosylceramide significantly suppressed E0771 tumor growth compared with the control group (P = 0.006). There were no significant differences in the serum concentrations of sphingolipid mediators including ceramide and S1P between the mice treated with glucosylceramide and control-treated mice. The ceramide concentration was significantly lower in tumor tissues (P = 0.026), and the S1P concentration was significantly higher than that in paired non-tumor tissues (P = 0.009). The S1P concentration in tumor tissues was significantly lower in mice treated with glucosylceramide than in control-treated mice (P = 0.001). The ceramide-to-S1P concentration ratio in tumor tissues was significantly higher in mice treated with glucosylceramide than in control-treated mice (P = 0.034). CONCLUSIONS: Breast tumors could enhance their survival by increasing S1P conversion from ceramide. Oral administration of glucosylceramide suppressed tumor growth by affecting the ceramide/S1P balance. Oral administration of glucosylceramide is a promising basis for a new therapeutic approach.

DOI： 10.14740/wjon1656

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Language：English   Publisher：(一社)日本癌学会  

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BACKGROUND/AIM: Sphingosine-1-phosphate (S1P) is a pleiotropic, bioactive, lipid mediator, produced by sphingosine kinase 1 (SphK1). In this study, we evaluated the expression of phosphorylated SphK1 (pSphK1) in patients with pancreatic ductal adenocarcinoma (PDAC) and investigated its clinical significance. MATERIALS AND METHODS: A total of 111 patients who underwent curative-intent resection for PDAC were enrolled. We investigated pSphK1 (Ser-225) expression in surgically resected specimens of PDAC using immunohistochemistry. The patients were divided into two groups according to pSphK1 immunoreactive expression: a pSphK1-high group (n=63) and a pSphK1-low group (n=48). RESULTS: Logistic regression analyses revealed that lymphatic invasion (p=0.007) was a significantly independent factor associated with high pSphK1 immunoreactive expression. The pSphK1-high group showed significantly worse disease-specific survival (DSS) than the pSphK1-low group (5-year DSS rate, 19.6% vs. 58.7%; p=0.001). High pSphK1 immunoreactive expression (hazard ratio=2.547; 95% confidence interval= 1.434-4.527; p=0.001) was an independent prognostic factor for DSS. CONCLUSION: High pSphK1 expression is independently associated with lymphatic invasion and unfavorable prognosis in PDAC patients. Thus, the SphK1-S1P axis may be important in mechanisms of tumor progression, such as lymphatic invasion, in PDAC patients.

DOI： 10.21873/anticanres.16584

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Next-generation sequencing (NGS) has enabled comprehensive genomic profiling to identify gene alterations that play important roles in cancer biology. However, the clinical significance of these genomic alterations in triple-negative breast cancer (TNBC) patients has not yet been fully elucidated. The aim of this study was to clarify the clinical significance of genomic profiling data, including copy number alterations (CNA) and tumor mutation burden (TMB), in TNBC patients. METHODS: A total of 47 patients with Stage I-III TNBC with genomic profiling of 435 known cancer genes by NGS were enrolled in this study. Disease-free survival (DFS) and overall survival (OS) were evaluated for their association to gene profiling data. RESULTS: CNA-high patients showed significantly worse DFS and OS than CNA-low patients (p = 0.0009, p = 0.0041, respectively). TMB was not associated with DFS or OS in TNBC patients. Patients with TP53 alterations showed a tendency of worse DFS (p = 0.0953) and significantly worse OS (p = 0.0338) compared with patients without TP53 alterations. Multivariable analysis including CNA and other clinicopathological parameters revealed that CNA was an independent prognostic factor for DFS (p = 0.0104) and OS (p = 0.0306). Finally, multivariable analysis also revealed the combination of CNA-high and TP53 alterations is an independent prognostic factor for DFS (p = 0.0005) and OS (p = 0.0023). CONCLUSIONS: We revealed that CNA, but not TMB, is significantly associated with DFS and OS in TNBC patients. The combination of CNA-high and TP53 alterations may be a promising biomarker that can inform beyond standard clinicopathologic factors to identify a subgroup of TNBC patients with significantly worse prognosis.

DOI： 10.1007/s12282-023-01449-2

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00990&link_issn=&doc_id=20240528040003&doc_link_id=%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Elmer Press, Inc.  

DOI： 10.14740/wjon1530

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Although numerous experiments revealed an essential role of a lipid mediator, sphingosine-1-phosphate (S1P), in breast cancer (BC) progression, the clinical significance of S1P remains unclear due to the difficulty of measuring lipids in patients. The aim of this study was to determine the plasma concentration of S1P in estrogen receptor (ER)-positive BC patients, as well as to investigate its clinical significance. We further explored the possibility of a treatment strategy targeting S1P in ER-positive BC patients by examining the effect of FTY720, a functional antagonist of S1P receptors, on hormone therapy-resistant cells. Plasma S1P levels were significantly higher in patients negative for progesterone receptor (PgR) expression than in those positive for expression (p = 0.003). Plasma S1P levels were also significantly higher in patients with larger tumor size (p = 0.012), lymph node metastasis (p = 0.014), and advanced cancer stage (p = 0.003), suggesting that higher levels of plasma S1P are associated with cancer progression. FTY720 suppressed the viability of not only wildtype MCF-7 cells, but also hormone therapy-resistant MCF-7 cells. Targeting S1P signaling in ER-positive BC appears to be a possible new treatment strategy, even for hormone therapy-resistant patients.

DOI： 10.3390/ijms222413367

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 70-year-old female with liver metastases from gastrointestinal stromal tumor(GIST)that were found 3 months after partial gastrectomy for the primary GIST underwent Auchincloss operation for left breast cancer with ipsilateral axillary lymph node metastases. The diagnosis was microinvasive ductal cancer that was pT1miN1M0, pStage ⅡA, hormone receptor negative, and HER2 positive. Given the impact of this cancer on the prognosis of liver metastases of GIST, imatinib therapy, but not adjuvant chemotherapy, was started promptly for breast cancer after surgery. Four months after the surgery, left subclavian lymph node recurrence of breast cancer was found. Since the liver metastases of GIST had been stable, imatinib was discontinued, and paclitaxel and anti-HER2 therapy were administered. After confirming tolerability, imatinib was carefully added in combination. Because the lymph nodes shrank and liver metastases of GIST were stable, both anti-HER2 therapy and imatinib were continued. There are few reports of combined chemotherapy for synchronous double cancer, and we report our experience in which careful treatment was required.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、女性。胃GIST術後3ヵ月目に左乳癌、腋窩リンパ節転移、GIST肝転移を認め、左乳癌に対し手術を施行した。病理組織学的結果はHER2陽性乳癌、pT1miN1M0、pStage IIAであった。予後規定因子はGIST肝転移と考え、イマチニブを開始した。乳癌術後4ヵ月目に乳癌左鎖骨下リンパ節再発を認めた。GIST肝転移の病勢は安定していたためイマチニブをいったん休薬し、パクリタキセル、抗HER2療法を開始した。忍容性を確認した後、慎重にイマチニブを併用した。リンパ節は著明に縮小し肝転移も増大を認めず、パクリタキセルを7コースで終了した。現在は抗HER2療法、イマチニブを継続中である。転移性の重複癌において両者に対する薬物療法を同時併用した報告は少なく、若干の考察を加えて報告する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20220117600064&doc_link_id=%2Fab8gtkrc%2F2021%2F004813%2F064%2F1725b1727%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004813%2F064%2F1725b1727%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は48歳、女性。左腋窩副乳原発の浸潤性小葉癌(invasive lobular carcinoma:ILC)と診断され、当科を受診した。MRI検査では49×43mm大のILC病変と乳管内進展を含む70mm大の広がりを認めた。手術は左腋窩部広範切除、左腋窩リンパ節郭清を施行し、上肢の可動域制限を避けるために広背筋皮弁で腋窩を再建した。病理組織学的検査では副乳原発ILC、浸潤径80×50mm、リンパ節転移陽性、切除検体の外下方の皮膚側断端で浸潤癌陽性であった。局在の特殊性およびILCの浸潤様式の特徴を考慮した画像診断と、外科治療戦略が必要であると考えられた。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

症例は76歳,女性.7年前に慢性リンパ性白血病(chronic lymphocytic leukemia,以下CLL)と診断され,無症状のため経過観察していたが,白血球数およびリンパ球割合の上昇と全身の腫大リンパ節の増大を認め,化学療法の導入が検討されていた.マンモグラフィー検診で右乳房に局所的非対称性陰影を指摘され,当科を受診した.超音波検査では右乳房C領域に22mm大の地図状の低エコー領域を認め,非浸潤性乳管癌が疑われた.腋窩リンパ節は両側とも腫大していたが,リンパ門は保たれていた.針生検ではリンパ球浸潤を認め,表面マーカー解析でCD20陽性,CD5陽性,CD23陽性であり,CLLの乳房内浸潤の診断に至った.CLLの病勢進行に対して化学療法が開始され,治療開始3ヵ月後には白血球数およびリンパ球割合の低下とともに乳房内病変の消失を認めた.造血器悪性腫瘍を背景に持つ患者の乳房内に病変を認めた際には,髄外浸潤も鑑別に挙げることが重要である.(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 48-year-old female discovered a mass in her left axilla. A thorough examination resulted in a diagnosis of left invasive lobular carcinoma(ILC)of the accessory mammary gland with wide ductal spread. Considering the wide ductal spread, massive resection of the left axilla mass, left lymph node dissection, and a latissimus dorsi musculocutaneous flap procedure were performed. However, histological analysis revealed ILC measuring 80×50 mm with lymph node metastases(5/23)and extensive cancer spread, resulting in a positive surgical margin. It is important to recognize the characteristics of ILC, axillary accessory breast cancer, and the axilla in a treatment strategy.

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Here, we report about a woman in her 30s who had peritoneal dissemination and multiple colon cancer with high-frequency microsatellite instability(MSI-H). Her father, paternal grandfather, and maternal grandmother had a history of colorectal cancer treatment. Thus, Lynch syndrome was suspected. We performed R0 resection for peritoneal dissemination and subsequent peritoneal dissemination. A 435-gene panel testing using a next-generation sequencer identified MSH2 and other mutations in the tumor. Hence, we speculated that she could have a germline mutation of MSH2, which causes Lynch syndrome. In the future, if she wishes to receive genetic counseling and undergo germline testing for variants to confirm the diagnosis of Lynch syndrome, we will perform them after receiving informed consent.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は30歳代、女性。家族歴は父、父方祖父、母方祖母が大腸癌である。高頻度マイクロサテライト不安定性(high-frequency microsatellite instability:MSI-H)Stage II大腸癌の術後経過観察中に、腹膜播種再発および多発大腸癌を指摘された。現病歴および家族歴からリンチ症候群が疑われたため、当院を紹介された。当院では腹膜播種再発と、その後の腹膜播種再々発に対して2回のR0切除術を施行した。腹膜播種再発の癌組織を用いて、次世代シークエンサーを用いた遺伝子パネル検査を施行したところ、MSH2変異(c.A2211-2G)を認めた。本症例では、生殖細胞系列におけるMSH2変異がリンチ症候群の原因遺伝子変異となり、MSI-H大腸癌の発生に関与している可能性がある。今後は、必要に応じて遺伝カウンセリングや生殖細胞系列の遺伝子変異検査を実施する予定である。(著者抄録)

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BACKGROUND: Adenomyoepithelioma (AME) of the breast is a very rare tumor and is generally considered to be benign. However, some show malignant transformation, which results in local recurrences or distant metastases. The morphological features of AME that might predict malignant potential have not been elucidated. Moreover, there is also no established multidisciplinary treatment for malignant AME aside from complete excision at an early stage. CASE PRESENTATION: A 64-year-old female diagnosed with AME of the left breast underwent lumpectomy. The surgical margins were negative. Six months after the operation, however, malignant AME recurred locally in the left breast. MRI showed multiple masses, which invaded the skin. A left mastectomy with axillary lymph node dissection was performed. Additional areas of AME were found in about one third of the entire breast. Eight months after the mastectomy, lung metastases were detected. She underwent chemotherapy with fluorouracil, epirubicin, and cyclophosphamide (FEC) for 9 cycles with little response. Lung metastasectomy was performed. Nine months after lung metastasectomy, the metastases were widespread to the brain, heart, and kidney; she subsequently died 2 months later. CONCLUSIONS: Malignant AME has various morphological features, and in this report, we characterize new findings from both imaging and pathology/autopsy. Malignant potency is related to the tumor size, tumor appearance, and mitoses, even if only a few. Given that ductal spread is one of the morphological features of malignant AME, it is of paramount importance to assess the surgical margins.

DOI： 10.1186/s40792-020-00881-2

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BACKGROUND: The cystic duct has been included in the staging classification scheme for gallbladder cancer since the 2010 publication of the AJCC Cancer Staging Manual (7th edition). To our knowledge, only seven other cases of adenocarcinoma arising in the remnant cystic duct following cholecystectomy have been reported in the English-language literature, and none has been reported as primary early-stage T1b remnant cystic duct cancer (CDC). We report, herein, a case of primary adenocarcinoma arising in the remnant cystic duct in a patient with history of laparoscopic cholecystectomy for gallstone disease. CASE PRESENTATION: An 81-year-old female presented with abdominal pain. Her medical history included a laparoscopic cholecystectomy for cholecystolithiasis two years prior. Jaundice was observed; imaging studies suggested that this was caused by choledocholithiasis. Blood chemistry findings showed severe liver dysfunction. Endoscopic retrograde cholangiography revealed haemobilia from the common bile duct with no evidence of choledocholithiasis. A bile sample showed Papanicolaou class IV cytology. As the extent of tumour spread was undetermined by abdominal ultrasonography and endoscopic ultrasonography, peroral cholangioscopy (POCS) was performed, which revealed tiny papillary lesions within the confluence of cystic duct, and fine granular lesions in the centre of bile ducts, signifying early-stage remnant CDC. Extrahepatic bile duct resection with regional lymphadenectomy was done. Histopathological findings revealed a 42-mm tubular adenocarcinoma originating from the remnant cystic duct with the considerable shallow spread across the extrahepatic bile ducts. It invaded the fibromuscular layer, with no lymphovascular or perineural invasion, no lymph node metastasis (13 nodes examined), and uninvolved surgical resection margin (R0 resection), and was staged as pT1bN0M0, Stage I. CONCLUSIONS: Primary early-stage T1b remnant CDC is an uncommon condition for which early diagnosis is challenging; if intraoperatively recognized, it can complicate surgery. Our experience of this case and an overview of the English literature suggest that POCS is an efficient tool to diagnosis this tumour and assess its spread along the extrahepatic bile ducts.

DOI： 10.1186/s12893-019-0647-9

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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DOI： 10.1007/s12282-019-00953-8

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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BACKGROUND: Neurofibromatosis type 1 (NF1) is an autosomal dominant disease of the skin and soft tissue. Aneurysms associated with NF1 can occur, but a secondary aneurysm rupture is very rare, with very few cases reported in literature. CASE PRESENTATION: We describe the case of a 67-year-old female with NF1 who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) rupture. She developed a type Ib endoleak requiring a redo-EVAR. Eighteen days after her primary operation, she was found to have two new left colic artery aneurysms. She required emergency surgery consisting of a left hemicolectomy and transverse colon colostomy. Pathology showed neurofibromatous changes to the peri-vasculature tissue, consistent with her underlying disease. CONCLUSIONS: Although rare, secondary aneurysms can occur following AAA repair. Patients with soft tissue connective tissue disorders, like NF1, may be at an increased risk for development of these secondary aneurysms. Endovascular repair appears to be a safe approach for NF1 patients with AAA, but endovascular management can be challenging in the setting of NF1. Surgeons should be ready to convert to open surgery if the patient displays persistent signs of bleeding or structural changes related to connective tissue disorders like NF1.

DOI： 10.1186/s40792-019-0570-4

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 68-year-old woman who had leftbreastcancer (cT2N0M0, cStage ⅡA)underwentbreast -conserving therapy and sentinel lymph node biopsy. Pathological diagnosis of the resected specimen revealed a 60mm cancer lesion including a 50 mm invasive ductal carcinoma with surrounding ductal carcinoma in situ, although the pre-operative MRI suggested a 30mm invasive cancer. The surgical margin was positive with the exposure of ductal carcinoma in situ. Additional resection was performed with a resection margin of 20mm from the head-side stump of the previous surgery. Pathological diagnosis of the additionally resected specimen revealed a 6mm invasive carcinoma with its exposure on the surface of the specimen around the new surgical stump distant from the initial surgical margin, where no remnant cancer was noted. She underwent left mastectomy. Pathological diagnosis further revealed 7mm and 2mm invasive carcinomas in the remnant breast. The preoperative imaging was reviewed retrospectively, and it was found that identifying the nodules in the remnant breast was quite difficult based on the images, including MRI. We report a case of breast cancer with metastatic nodules in additionally resected specimens.

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A 33-year-old woman underwent resection of a right breast mass, which was diagnosed as a fibroadenoma 15 years ago. Ten years later, a right breast mass appeared again, and it was diagnosed as a fibroadenoma based on core needle biopsy. After observation for a while, the mass increased in size, and she underwent resection of the tumor, which was diagnosed as a borderline-malignant phyllodes tumor. A mass appeared again in the right breast and rapidly expanded. A malignant phyllodes tumor was suspected, and right mastectomy was performed. The pathological diagnosis revealed a benign phyllodes tumor. Four years ago, a left breast mass was also detected. Because the mass was suspected to be a fibroadenoma, it has been observed for a few years. The mass has increased in size since 1 year ago, and another mass emerged 2 months ago. Core needle biopsy of the 2 masses revealed that both were phyllodes tumors. She underwent left mastectomy, and the pathological examination revealed that both masses were benign phyllodes tumors. We report this rare case of metachronal phyllodes tumors that presented bilaterally.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は68歳、女性。左乳癌、cT2N0M0、cStage IIAに対して、左乳房部分切除術、センチネルリンパ節生検を施行した。術前MRI検査で浸潤癌の長径は30mmと診断されていたが、術後病理組織診断では浸潤癌は長径50mmで周囲に非浸潤性乳管癌を伴い、病変全体の範囲は60mmに及び、頭側断端に非浸潤性乳管癌の露出を認めた。追加切除を希望し、前回手術の頭側断端より20mmの切除範囲で、乳房追加部分切除術を施行した。病理組織診断では前回手術断端周囲に癌の遺残は認めなかったが、その頭側に6mm大の浸潤癌を認め、体表側断端に癌が露出していたため左残存乳房に対して全摘術を行った。病理組織診断では7mmと2mmの浸潤癌をさらに認めた。術前画像の見直しを行ったが、乳房内転移と一致する結節の同定はできなかった。追加切除した乳房内に転移結節を認めた1例を報告する。(著者抄録)

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症例は33歳、女性。15年前に右乳房の腫瘤摘出術を施行され、線維腺腫と診断された。5年前に再度右乳房に腫瘤を認め、針生検で線維腺腫と診断され経過観察となったが、その後増大を認め4年前に腫瘤摘出術が施行された。病理診断は境界悪性葉状腫瘍で、切除断端は陰性であった。2年前に右乳房に再度腫瘤を認め、針生検で葉状腫瘍と診断された。急速な増大を認めたため悪性化を疑い、右乳房切除術を施行された。病理診断は良性葉状腫瘍であった。また、左乳房には4年前より腫瘤を指摘されていたが、線維腺腫の疑いで経過観察されていた。1年前より腫瘤の増大を認め、2ヵ月前よりさらに新たに腫瘤が出現し増大を認めた。針生検でいずれの腫瘤も葉状腫瘍と診断され、左乳房切除術を施行した。病理診断はいずれも良性葉状腫瘍であった。両側に異時性に多発した葉状腫瘍の1例を経験したので報告する。(著者抄録)

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Impact Journals LLC  

Sphingolipids have emerged as key regulatory molecules in cancer cell survival and death. Although important roles of sphingolipids in breast cancer progression have been reported in experimental models, their roles in human patients are yet to be revealed. The aim of this study was to investigate the ceramide levels and its biosynthesis pathways in human breast cancer patients. Breast cancer, peri-tumor and normal breast tissue samples were collected from surgical specimens from a series of 44 patients with breast cancer. The amount of sphingolipid metabolites in the tissue were determined by mass spectrometry. The Cancer Genome Atlas was used to analyze gene expression related to the sphingolipid metabolism. Ceramide levels were higher in breast cancer tissue compared to both normal and peri-tumor breast tissue. Substrates and enzymes that generate ceramide were significantly increased in all three ceramide biosynthesis pathways in cancer. Further, higher levels of ceramide in breast cancer were associated with less aggressive cancer biology presented by Ki-67 index and nuclear grade of the cancer. Interestingly, patients with higher gene expressions of enzymes in the three major ceramide synthesis pathways showed significantly worse prognosis. This is the first study to reveal the clinical relevance of ceramide metabolism in breast cancer patients. We demonstrated that ceramide levels in breast cancer tissue were significantly higher than those in normal tissue, with activation of the three ceramide biosynthesis pathways. We also identified that ceramide levels have a significant association with aggressive phenotype and its enzymes have prognostic impact on breast cancer patients.

DOI： 10.18632/oncotarget.24903

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BACKGROUND: A gastric adenosquamous carcinoma (ASC) that produces granulocyte-colony stimulating factor (G-CSF) is an uncommon malignancy with a poor prognosis. Due to the rarity of this lesion, a standard treatment for the disease has not been established. CASE PRESENTATION: We describe a case of a 66-year-old male with a G-CSF-producing gastric ASC who presented with severe anemia and leukocytosis. A radical resection was performed, followed by a course of adjuvant chemotherapy. Histopathologic examination revealed that the tumor consisted of areas of both squamous cell carcinoma and adenocarcinoma. Immunohistochemical staining with an anti-G-CSF antibody was also positive. He was started on adjuvant capecitabine and oxaliplatin (CapeOX) 6 weeks after surgery. The patient stopped treatment after 3 months due to his own preference. Eight months following surgery, the patient was found to have diffuse lymph node, liver, and peritoneal metastases. CONCLUSIONS: G-CSF-producing gastric ASC is a rare and aggressive tumor. Because patients are usually diagnosed at an advanced stage, multidisciplinary evaluation and innovative treatments are needed. The rarity of this disease, with its aggressive features, poses a significant challenge in its treatment. In this brief case report, we summarize the management and outcomes of G-CSF-producing gastric ASC.

DOI： 10.1186/s40792-017-0338-7

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 59-year-old woman attended a previous hospital complaining of a nodule of the right axilla. Although ultrasonography had shown no evidenceof malignancy, a growth of thenodulewas found on follow-up. Excisional biopsy revealed a primary accessory breast cancer. Because the resected margins were involved, she was referred to our hospital for additional treatment. Based on imaging, both bilateral mammary glands and axillary lymph nodes were reported normal, and distant metastasis was not observed. We performed additional resection of the right axillary tissue around the biopsy site and the right axillary lymph nodedisse ction. Histo-pathological examination revealed the residual invasive ductal carcinoma in the resected specimen. Both the new surgical margins and the lymph nodes were free of disease. Accessory breast cancer is relatively rare, with the incidence being less than 1% of all breast cancers. It is most frequent in the axillary region. Local extensive resection with sufficient surgical margin and axillary lymph node dissection are generally required. This case report presents our clinical experience of accessory breast cancer with some discussion of the literature.

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BACKGROUND: Bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. In contrast, diagnosis of a Bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm. Even more rare is the diagnosis of a right-sided Bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases. CASE PRESENTATION: We describe a case of an 89-year-old female who presented with abdominal pain. An abdominal computed tomography (CT) scan showed decreased intravenous contrast uptake and thickening of the wall of herniated small intestine through the right side of the diaphragm, which led to the diagnosis of a strangulated diaphragmatic hernia. The patient underwent emergent laparotomy and required a partial resection of the necrotic ileum and a hernia repair with direct closure. Interestingly, in this case, organ malformation was not observed. The patient was discharged approximately 2 weeks after surgery without complication. CONCLUSIONS: Adult right-sided Bochdalek hernia with strangulation in the absence of hepatic atrophy is a rare entity. Considering the severity of this condition, accurate diagnosis and proper treatment are needed. A tailored operative approach is required on an individual case basis.

DOI： 10.1186/s40792-017-0385-0

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BACKGROUND: A prospective randomized study was performed to investigate the validity of intravenous carnitine administration during postoperative parenteral nutrition (PN) with lipid emulsion. METHODS: Patients undergoing surgery for gastric or colorectal cancer were enrolled in the study and were randomly divided into two groups (n = 8 in each group): 1) group L, who received a peripheral PN (PPN) solution of 7.5% glucose, 30% amino acid, and 20% lipid emulsion; and 2) group LC, who received the same PPN solution, as well as carnitine intravenously. PPN was performed from postoperative day (POD) 1 to POD4. Clinical and laboratory parameters were compared between the two groups; statistical significance was set at P < 0.05. RESULTS: Serum carnitine concentrations were significantly higher in group LC on POD3 (P < 0.01) and POD7 (P = 0.01). Postoperative changes in laboratory parameters and morbidity were comparable between the two groups. However, the decrease in C-reactive protein from POD3 to POD7 was significantly greater in group LC than in group L (P = 0.011). CONCLUSION: The results show that intravenous carnitine administration in addition to PN is safe and may be beneficial for recovery from postoperative inflammatory reactions.

DOI： 10.14740/jocmr3113w

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BACKGROUND: Benign esophageal tumors are uncommon, comprising approximately 2% of esophageal tumors. Esophageal schwannomas constitute an even rarer entity, with few cases reported in the literature. CASE PRESENTATION: We present a 66-year-old male who was referred for dysphagia. A computed tomography scan showed a well-demarcated, enhancing, and homogenous esophageal tumor measuring 50 mm. The tumor was hypermetabolic on positron emission tomography, and an endoscopic ultrasound-guided fine needle aspiration demonstrated the presence of benign spindle cells. We performed an uncomplicated, simple, tumor enucleation through a cervical approach. Histology revealed spindle-shaped cells in a fasciculated, disarrayed pattern. Immunohistochemistry demonstrated positive staining for S-100 protein and negative staining for KIT, CD34, desmin, and α-smooth muscle actin. These findings were consistent with a benign esophageal schwannoma. CONCLUSIONS: We report our experience with esophageal schwannoma, a rare but benign diagnosis of the esophagus.

DOI： 10.1186/s40792-017-0369-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

Background and aims: Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery.
Methods: A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak.
Results: Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P &lt; 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P &lt; 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F.
Conclusions: Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak. (C) 2016 The Authors. Published by Elsevier Ltd.

DOI： 10.1016/j.clnu.2016.03.018

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Although ductal carcinoma in situ(DCIS)is generally cured by surgical resection, it has been suggested that resection is over-treatment for some patients with DCIS. The aim of this study was to reconsider operative indications for patients with DCIS by examining clinicopathological features of 23 patients who underwent surgical resection for DCIS in our institute over a single year. Postoperative histological examination revealed that there were Luminal and HER2-positive subtypes, but no triple negative cancers. We found coincidental invasive ductal carcinoma(IDC)in 5 patients, and in all 5 the tumor size exceeded 60 mm. There was no coincidence of IDC in patients with a Ki-67 index ≤5%. Positive surgical margins were observed in 7 patients, all of which were histologically diagnosed as DCIS. Only 1 of the 7 patients underwent additional surgical resection; the 6 remaining patients, including 2 patients who received no treatment, did not undergo additional resection. All patients including those with positive surgical margins have had a 5-year relapse-free survival. Our findings imply that the subgroup of DCIS patients without IDC could be followed up without surgery.

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Language：English   Publisher：SPRINGER  

Patients with unresectable hepatocellular carcinoma (HCC) cannot generally be cured by systemic chemotherapy or radiotherapy due to their poor response to conventional therapeutic agents. The development of novel and efficient targeted therapies to increase their treatment options depends on the elucidation of the molecular mechanisms that underlie the pathogenesis of HCC. The DNA damage response (DDR) is a network of cell-signaling events that are triggered by DNA damage. Its dysregulation is thought to be one of the key mechanisms underlying the generation of HCC. Sphingosine-1-phosphate (S1P), a lipid mediator, has emerged as an important signaling molecule that has been found to be involved in many cellular functions. In the liver, the alteration of S1P signaling potentially affects the DDR pathways. In this review, we explore the role of the DDR in hepatocarcinogenesis of various etiologies, including hepatitis B and C infection and non-alcoholic steatohepatitis. Furthermore, we discuss the metabolism and functions of S1P that may affect the hepatic DDR. The elucidation of the pathogenic role of S1P may create new avenues of research into therapeutic strategies for patients with HCC.

DOI： 10.1007/s00595-015-1270-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Background: Sphingosine-1-phosphate (S1P), a pleiotropic bioactive lipid mediator, has been implicated as a key regulatory molecule in cancer through its ability to promote cell proliferation, migration, angiogenesis, and lymphangiogenesis. Previous studies suggested that S1P produced by sphingosine kinase 1 (SphK1) in breast cancer plays important roles in progression of disease and metastasis. However, the associations between S1P and clinical parameters in human breast cancer have not been well investigated to date.
Materials and methods: We determined levels of S1P and other sphingolipids in breast cancer tissue by electrospray ionization-tandem mass spectrometry. Associations between S1P levels and clinicopathologic features of the tumors were analyzed. Expression of phospho-SphK1 (pSphK1) in breast cancer tissues was determined by immunohistochemical scoring.
Results: Levels of S1P in breast cancer tissues were significantly higher in patients with high white blood cell count in the blood than those patients without. S1P levels were lower in patients with human epidermal growth factor receptor 2 overexpression and/or amplification than those patients without. Furthermore, cancer tissues with high pSphK1 expression showed significantly higher levels of S1P than cancer tissues without. Finally, patients with lymph node metastasis showed significantly higher levels of S1P in tumor tissues than the patients with negative nodes.
Conclusions: To our knowledge, this is the first study to demonstrate that high expression of pSphK1 is associated with higher levels of S1P, which in turn is associated with lymphatic metastasis in breast cancer. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2016.06.022

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Background: Sphingolipids, including sphingosine-1-phosphate (S1P) and ceramide, have emerged as key regulatory molecules that control various aspects of cell growth and proliferation in cancer. Although important roles of sphingolipids in breast cancer progression have been reported in experimental models, their roles in human patients have yet to be determined. The aims of this study were to determine the levels of sphingolipids including S1P, ceramides, and other sphingolipids, in breast cancer and normal breast tissue and to compare the difference in levels of each sphingolipid between the two tissues.
Materials and methods: Tumor and noncancerous breast tissue were obtained from 12 patients with breast cancer. Sphingolipids including S1P, ceramides, and their metabolites of sphingosine, sphingomyelin, and monohexosylceramide were measured by liquid chromatography-electrospray ionization-tandem mass spectrometry.
Results: The levels of S1P, ceramides, and other sphingolipids in the tumor were significantly higher than those in normal breast tissue. There was a relatively strong correlation in the levels of S1P between the tumor and those of normal breast tissue from the same person. On the other hand, there was no correlation in the levels of most of the ceramide species between the tumor and those of normal breast tissue from the same person.
Conclusions: To our knowledge, this is the first study to reveal that levels of sphingolipids in cancer tissue are generally higher than those of normal breast tissue in patients with breast cancer. The correlation of S1P levels in these tissues implicates the role of S1P in interaction between cancer and the tumor microenvironment. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2016.05.022

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Language：English   Publisher：BAISHIDENG PUBLISHING GROUP INC  

Inflammation is a central process in several disorders and contributes to cancer progression. Inflammation involves a complex cascade of pro-inflammatory and anti-inflammatory signaling events with protein and lipid mediators. Recent advances in lipid detection have revealed the importance of lipid mediators in inflammation. Omega three polyunsaturated fatty acids (omega-3 PUFA) are found naturally in fish oil and have been extensively studied in multiple inflammatory diseases with improved outcomes. Resolvins are thought to be the active metabolites of omega-3 PUFA, and are responsible for facilitating the resolving phase of acute inflammation. Clinically, resolvins have been associated with resolution of acute kidney injury and acute lung injury, micro and macro vascular response to injury, and inhibition of microglia-activated inflammation in neurodegenerative disorders. In addition to inflammatory diseases, omega-3 PUFA and resolvins appear to modulate cancer progression. omega-3 PUFA intake has been associated with reduced inflammation in colorectal cancer, and favorable phenotype in breast cancer. Resolvins offer promising therapeutic potential as they may modulate inflammation with minimal side-effects, in contrast to currently available anti-inflammatory medications. This review describes the roles of omega-3 PUFA and resolvins in the inflammatory cascade, various inflammatory diseases, and specific cancers. Additionally, it will discuss the clinical therapeutic potential of resolvins as targets in inflammatory diseases and cancers.

DOI： 10.12998/wjcc.v4.i7.155

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Language：English   Publisher：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2016.34.15_suppl.e15103

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A 63-year-old woman was found to have a mass in her right breast and visited our hospital to undergo a detailed examination. A histopathological examination by using ultrasound-guided core needle biopsy revealed ductal carcinoma in situ. A partial mastectomy with sentinel lymph node biopsy was performed for the cancer of the right breast. The postoperative histopathological examination indicated apocrine carcinoma with a predominantly intraductal component without lymph node metastasis. The discrimination between ductal adenoma and apocrine carcinoma sometimes becomes a problem in making decisions about treatment. We need to take care when making a diagnosis.

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A 64-year-old woman discovered a mass in her left breast and visited our hospital. A thorough examination resulted in a diagnosis of left, locally advanced breast cancer (cT4bN3, M0, cStage Ⅲc) with muscle invasion and Level Ⅲ lymph node metastases. Because of drug-induced lung disease following 4 courses of adriamycin and cyclophosphamide, the chemotherapy had to be stopped. Halsted's operation and postoperative radiotherapy (50 Gy) were performed. The patient was alive with no evidence of recurrence 9 months after surgery. Although multidisciplinary therapy is recommended in locally advanced breast cancer, chemotherapy sometimes cannot be performed due to factors such as age and physical status. Halsted's operation could be considered as a treatment of choice in patients with locally advanced breast cancer. It is important to choose the treatment strategy based on the condition of the patient.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. METHODS: Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. RESULTS: A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. CONCLUSIONS: Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.

DOI： 10.14740/jocmr2195w

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(NPO)日本乳腺甲状腺超音波医学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(NPO)日本乳腺甲状腺超音波医学会  

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Language：Japanese   Publisher：新潟県立がんセンター新潟病院  

乳癌は女性のがんのなかで最も多いがんであり、罹患率、死亡率ともに増加の一途をたどっている。近年、個人のゲノム(遺伝子)情報に基づき、個人ごとの違いを考慮したゲノム医療への期待が高まる中、2017年10月24日に「第3期がん対策推進基本計画」が閣議決定され、がんゲノム医療等を推進していくことが個別目標として掲げられた。乳癌診療においても個人のゲノム情報が利用され、治療の個別化やさらなる治療成績の向上が試みられている。今回、乳癌診療におけるゲノム医療の現状を概説する。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本乳腺甲状腺超音波医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は59歳、女性。右腋窩に腫瘤を自覚し、前医を受診した。超音波検査で明らかな悪性所見を認めず経過観察されていたが、腫瘤が増大したため摘出術を施行された。病理組織診断で副乳癌と診断され、切除断端が陽性であったため、治療目的に当院へ紹介された。画像上、両側乳腺、腋窩リンパ節に異常を認めず、遠隔転移を認めなかった。切除部周囲組織の追加切除および右腋窩リンパ節郭清を施行した。術後病理組織診断では切除した組織内に浸潤癌の遺残を認めたが、追加切除断端は陰性で、リンパ節転移を認めなかった。副乳癌は副乳に発生した癌を指し、乳癌全体の1%未満と比較的まれな疾患である。発生部位としては腋窩が最も多く、手術は局所広範切除と腋窩リンパ節郭清が第一選択となる。今回われわれは、右腋窩に発生した副乳癌の1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：English   Publisher：日本癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

非浸潤性乳管癌(ductal carcinoma in situ:DCIS)は、切除により治癒が期待できるが、一部の患者ではover treatmentとなる可能性が示唆されている。今回われわれは、自施設で単年に手術を施行したDCIS 23例の臨床病理学的検討から、手術適応について再考した。術後病理では、サブタイプ分類でLuminalとHER2のみが認められ、triple negativeは認められなかった。5例に浸潤癌の併存を認めたが、浸潤癌症例は腫瘍径が60mm以上と大きい傾向にあった。またKi-67 index≦5%の症例では、浸潤癌の併存は認めなかった。切除断端陽性例は7例あり、すべてDCISでの断端陽性であった。追加切除は1例に行われた。無治療経過観察の2例を含む6例では追加切除を行わなかったが、術後5年が経過し全例無再発生存中である。DCISには浸潤癌の合併がなければ、経過観察できるサブグループが存在すると考えられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00296&link_issn=&doc_id=20161222480042&doc_link_id=%2Fab8gtkrc%2F2016%2F004312%2F042%2F1544-1546%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2016%2F004312%2F042%2F1544-1546%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：新潟医学会  

頸部鈍的外傷により甲状腺損傷および頸部血腫が出現するも、保存的に軽快した1例を経験したので報告する。症例は28歳、女性。直進中の普通乗用車の助手席に乗っていた際、右折してきた乗用車に衝突され、自家用車は横転し炎上寸前のところを救助され、救急車にて当院救急外来に搬送された。来院時、意識は清明であったが、事故直後のことは記憶になかった。血圧129/81mmHg、脈拍95/分と循環動態は安定していたが、前頸部の腫脹および皮下出血を認めた。右前胸部の軽度圧痛を認める以外は、ほかに明らかな異常所見は認めなかった。血液生化学所見では、白血球数の軽度増多と、トランスアミナーゼの軽度上昇を認めたが、明らかな貧血は認めなかった。TSH 0.42μIU/ml、FT3 11.7pg/ml、FT4 2.7ng/dlと甲状腺機能亢進を認めた。CT検査では、甲状腺右葉下極の腫大と前頸部から上縦隔に至る血腫を認め、気管損傷は認めなかったが気管は軽度左側に圧排されていた。呼吸苦・呼吸困難の所見は認めなかったが、血腫増大による気道狭窄が出現してくる危険もあったため、入院の上、保存的に経過観察を行った。翌日、血腫は縮小傾向となり、血液所見でも貧血の進行を認めず、CT検査では血腫は縮小しており、水分摂取・食事を開始した。入院後3日目の採血では、FT3 6.4pg/ml、FT4 2.8ng/dlと甲状腺機能亢進は改善し全身状態も良好であったため、入院後4日目に退院となった。退院2週間後の外来受診時、前頸部腫脹は消失しており、血液生化学検査では貧血を認めず、TSH 0.07μIU/ml、FT3 3.6pg/ml、FT4 1.4ng/dlと甲状腺機能もほぼ正常となっていた。鈍的外傷による頸部甲状腺損傷の報告は文献的にも少ないが、甲状腺血腫が増大せず、気道狭窄を伴わない状態であれば、まず保存的治療を試みることが勧められる。また、本症例のように、甲状腺外傷に伴い甲状腺機能亢進を認めた例も報告されており、全身管理にも注意が必要である。(著者抄録)

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Other Link： http://hdl.handle.net/10191/45622

Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は63歳、女性。検診で右乳房腫瘤を指摘され、当科を受診した。精査で非浸潤性乳管癌と診断され、右乳房部分切除術、センチネルリンパ節生検を施行した。術後病理組織学的検査では診断に苦慮したが、最終的に乳管腺腫を背景に発生した微小浸潤アポクリン癌と診断した。乳管腺腫とアポクリン癌の鑑別は難しく病理診断上しばしば問題となる。本症例のように乳管腺腫を背景としてアポクリン癌を合併することもあり、良悪性の判別には注意を要する。乳管腺腫とアポクリン癌の鑑別が困難な場合は診断を兼ねた完全切除が望ましいと考えられる。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は64歳、女性。左乳房腫瘤を自覚し当科を受診した。精査の結果、左乳癌cT4bN3(左腋窩、胸筋間、左鎖骨上リンパ節転移陽性)、M0、cStage IIIcと診断され、針生検診断は浸潤性乳管癌、サブタイプはトリプルネガティブであった。術前化学療法としてadriamycin+cyclophosphamide(AC)療法4コースを施行したが、grade 2の薬剤性肺障害が出現したため継続を断念した。遠隔転移を認めなかったことから、局所制御に重点を置いた治療方針の下、ハルステッド手術、術後放射線療法を施行した。9ヵ月経過した現在も再発を認めていない。化学療法有害事象発生例においては、患者の状態に合わせ施行可能な治療法を選択することが重要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00296&link_issn=&doc_id=20151224470119&doc_link_id=%2Fab8gtkrc%2F2015%2F004212%2F119%2F1803-1805%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2015%2F004212%2F119%2F1803-1805%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：新潟医学会  

症例は35歳男性。検診腹部エコーで脾門部に2cm大の腫瘤を指摘された。2年後検診で腫瘤の増大傾向を認め、腹部造影CT検査で膵尾部に44mm大の多房性分葉状腫瘤を認めた。血算・生化学・凝固系、腫瘍マーカー、各種ホルモン値は正常範囲内であった。SPIO造影MRIを施行したが、腫瘍より尾側におけるT2強調画像信号低下を確認したのみで、確定診断を下すことができなかった。腹腔鏡下膵尾部切除を施行し、術後病理診断で膵内副脾に生じた類上皮嚢胞と診断された。診断に苦渋した1例を報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00990&link_issn=&doc_id=20160108140009&doc_link_id=%2Fdg3nigta%2F2015%2F012907%2F009%2F0401-0407%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2015%2F012907%2F009%2F0401-0407%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：新潟医学会  

甲状腺腫瘍に対し甲状腺全摘術施行後に濾胞腺腫と診断され、その3年後に骨転移が出現し、初回の摘出腫瘍が濾胞癌であったことが判明した1例を経験したので報告する。症例は61歳、男性。他院で甲状腺腫瘍に対し甲状腺全摘術が施行され、術中迅速診断および永久病理診断で腺腫と診断されていた。しかし、術後3年目頃から腰痛・下肢痛が出現、その後、下肢麻痺を認めたため当院整形外科で第5腰椎切除が行われ、術後病理診断では甲状腺濾胞癌の骨転移の診断であった。経過から初回甲状腺腫瘍が濾胞癌であったと考えられた。甲状腺濾胞癌は細胞異型がほとんど認められないため術前細胞診での診断は困難とされている。濾胞腺腫を疑った場合でもサイログロブリン高値等の場合は濾胞癌の可能性を考慮して治療やフォローアップを行っていく必要がある。(著者抄録)

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Other Link： http://hdl.handle.net/10191/44091

Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：新潟医学会  

近年、マンモグラフィー検診の普及に伴い、非触知乳癌の発見率が上昇してきている。非触知乳癌の中には、石灰化病変のみで発見される非浸潤性乳管癌(Ductal carcinoma in situ:DCIS)も多く含まれるが、石灰化病変を超音波検査で描出することは困難なことがあり、手術に際し切除範囲の設定には苦慮することも多い。臨床上、実際に十分切除できているのか否かを術中に判断することは、その後の局所再発を防ぐ上で極めて重要である。今回、石灰化病変のみで発見された乳癌症例に対し、術中に切除標本のマンモグラフィーを撮影し、石灰化病変が切除できていることを確認できた症例を経験した。症例は51歳、女性。検診マンモグラフィーで右乳房の石灰化を指摘され、ステレオガイド下マンモトーム生検を施行し乳癌と診断された。超音波検査では石灰化病変の描出は困難であったが、マンモトーム生検時に留置したクリップ部位をマーキングし、乳房温存手術を施行した。術中に切除標本マンモグラフィーを施行し、ターゲットとした石灰化病変が切除できていることを確認して手術を終了した。術後病理診断でも術前に予測した石灰化病変が完全に切除できていることを確認できた。切除標本マンモグラフィーは、簡便に石灰化病変の切除範囲の確認が可能な方法として有用であり、文献的考察を加えて報告する。(著者抄録)

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Other Link： http://hdl.handle.net/10191/44092

Language：Japanese   Publisher：新潟医学会  

センチネルリンパ節生検(sentinel node biopsy:SNB)は術前評価で原発巣T1-T2、かつ臨床的N0症例では標準手技となっている。センチネルリンパ節転移が陽性であった場合は、センチネルリンパ節以外の腋窩リンパ節(非センチネルリンパ節)にも転移の危険があるため、腋窩郭清を行うことが一般的な治療指針とされてきた。しかし近年、欧米の大規模な前向き臨床試験の結果により、センチネルリンパ節転移個数が2個以下の場合や、センチネルリンパ節転移巣が2mm以下の微小転移の場合では腋窩郭清を省略しても、郭清を行った場合と比較して予後に影響を与えないことから、今後は腋窩郭清を省略する方向に向かうことが予想される。しかし、センチネルリンパ節転移個数が2個以下の場合に、センチネルリンパ節以外の腋窩リンパ節である非センチネルリンパ節に転移が無いのか、あるいは転移の危険が少ないのか、については完全に明らかにされてはいない。したがって、センチネルリンパ節転移個数が2個以下での腋窩郭清の省略の安全性も確実ではないと考えられる。今回我々は、乳癌センチネルリンパ節転移陽性例における、さまざまな臨床病理学的因子と非センチネルリンパ節転移の有無との関連について調べ、また、乳癌センチネルリンパ節転移個数が非センチネルリンパ節転移を予測するのに有用であるか否かを検討した。2010年〜2013年の期間に当科でセンチネルリンパ節生検を行った浸潤性乳管癌症例のうち、センチネルリンパ節転移が陽性で腋窩郭清が施行され、年齢、腫瘍浸潤径、核異型度、脈管侵襲の有無、ホルモン受容体発現、Her2受容体発現、Ki-67標識率などの臨床病理学的因子の検索が全て施行されている症例を検討の対象とした。非センチネルリンパ節転移と年齢、腫瘍浸潤径、核異型度、脈管侵襲の有無、ホルモン受容体発現、Her2受容体発現、subtype分類、Ki-67標識率などの臨床病理学的因子との関連を調べた。また、センチネルリンパ節摘出個数、センチネルリンパ節転移個数と非センチネルリンパ節転移との関連についても検討を行った。統計学的解析はMann-Whitney U検定、カイ2乗検定、およびロジスティック回帰モデルによる多変量解析を用いた。統計学的判定はP&lt;0.05を有意とした。該当期間のセンチネルリンパ節生検施行症例は310例であり、そのうち309例でセンチネルリンパ節を同定することができた(同定率99.7%)。センチネルリンパ節同定症例のうち46例(14.9%)がセンチネルリンパ節転移陽性であった。腫瘍浸潤径の平均は、全体で27.5±21.3mmであり、非センチネルリンパ節転移陽性例では転移陰性例に比し有意差はないものの腫瘍径が大きい傾向があった(34.5±26.3mm vs 21.5±13.8mm;P=0.0603)。非センチネルリンパ節転移の有無は脈管侵襲(リンパ管侵襲・静脈侵襲)と有意な関連を認めたが(P=0.0274)、年齢、核異型度、ホルモン受容体発現、Her2発現、subtype分類、Ki-67標識率との関連は認められなかった。摘出されたセンチネルリンパ節個数は2.9±1.7個(中央値3個)であり、転移陽性センチネルリンパ節個数は1.5±0.8個(中央値1個)であった。センチネルリンパ節転移陽性46例の全例で腋窩リンパ節郭清が施行されたが、非センチネルリンパ節転移陽性は21例、転移陰性が25例であった。また、郭清された非センチネルリンパ節個数は全体で13.3±2.2個(中央値12個)であり、非センチネルリンパ節転移個数は3.2±5.2個(中央値1個)であった。摘出されたセンチネルリンパ節個数は非センチネルリンパ節転移陰性例と陽性例で差を認めなかったが(2.8±1.7個vs3.0±1.0個;P=0.5571)、転移陽性センチネルリンパ節個数は非センチネルリンパ節転移陰性例に比し陽性例で有意に多かった(1.2±0.5個:中央値1個vs1.8±1.7個:中央値2例;P=0.0086)。さらにセンチネルリンパ節転移個数2個以下と3個以上の2群について、非センチネルリンパ節転移との関連を検討したが、有意な関連は認めなかった。しかし、センチネルリンパ節転移個数1個以下と2個以上の2群で検討したところ、センチネルリンパ節転移個数が2個以上では有意に非センチネルリンパ節転移の割合が高かった。単変量解析でセンチネルリンパ節転移の有無と有意な関連を認めた脈管侵襲、およびセンチネルリンパ節転移個数について、ロジスティック回帰モデルによる多変量解析を行った。センチネルリンパ節転移のリスクは、脈管侵襲(LVI)では脈管侵襲ありが脈管侵襲なしに対しハザード比3.868(P=0.068、95%信頼区間0.905-16.531)であった。一方、センチネルリンパ節転移個数ではセンチネルリンパ節転移個数2個以上では、1個以下に対しハザード比4.845(P=0.030、95%信頼区間1.164-20.167)であり、センチネルリンパ節転移個数は非センチネルリンパ節転移の独立した予測因子であることが示された。乳癌センチネルリンパ節生検において、脈管侵襲とセンチネルリンパ節転移個数は非センチネルリンパ節転移の危険性を予測する因子であり、センチネルリンパ節転移陽性例では腋窩郭清を行うべきである。(著者抄録)

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Other Link： http://hdl.handle.net/10191/44071

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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