Sarcoid-like reaction in the regional lymph nodes and spleen in gastric carcinoma: a clinicopathologic study of five cases.

To clarify the occurrence of sarcoid-like reaction in the spleen of the gastric carcinoma patients, 100 consecutive specimens from gastrosplenectomy were examined. Sarcoid-like reaction was observed in the lymph nodes of 13 cases (13%) and the spleen of five cases (5%). All cases of the latter group were included in the former one. None of them showed any symptoms or signs indicative of systemic sarcoidosis. It seems that the cases with sarcoid-like reaction in the spleen ocurred more frequently in an advanced stage of the gastric cancer than those without this phenomenon. Epithelioid cell granulomas (EPGs) appeared to arise in the periarteriolar lymphoid sheaths of the spleen histologically, but were never found in red pulp or germinal centers. They were composed of groups of epithelioid cells and accompanied by the small lymphocytes and plasma cells. In three cases, scattered eosinophils were also observed among the epithelioid cells. Immunohistochemically, the majority of the intragranulomatous small lymphocytes had T-cell phenotype, while B-cells formed only the minor cellular population. None of the 13 cases contained EPGs in the primary tumor. Our study indicates that sarcoid-like reaction in the spleen is possibly not such a rare phenomenon in the gastric cancer as previously considered and more frequently seen in the advanced stage of the gastric cancer. Sarcoid-like reactions of the regional lymph nodes were more frequently seen in the patients with EPGs in the spleen than in those without. We also suggest that the incidence of sarcoid-like reactions in the spleen is closely related to those in pancreaticosplenic nodes and/or nodes of the hilus of the spleen.

Experimental and clinical studies on the intraperitoneal administration of cis-diamminedichloroplatinum (II) for peritoneal carcinomatosis caused by gastric cancers.

The effectiveness of the intraperitoneal administration of cis-diamminedichloroplatinum (II) (DDP) on peritoneal carcinomatosis caused by gastric cancers was evaluated. Seventeen patients were treated with one of three protocols, consisting of the intraperitoneal injection (ip) of DDP at doses of 70 and 110 mg/m2, with or without sodium thiosulfate (STS) rescue. The area under the curve (AUC) of DDP for sufficient anticancer activities against cultured human cell lines in vitro was estimated at 240 micrograms h/ml, which was equivalent to the AUC gained by 110 mg/m2 ip DDP in the clinical studies. The cytotoxic activity of DDP was reduced by approximately 50% with 100-fold STS in the AUC in the experimental studies. However, this was achieved only in urine, and not in either the peritoneal cavity or in plasma in the clinical studies. Three cases of a partial response against peritoneal carcinomatosis were seen from a total of four evaluable cases treated with 110 mg/m2 DDP, and no renal toxicities were observed in those treated with the STS rescue. The results of this study led us to conclude that high-dose ip DDP treatment combined with the STS rescue would be useful chemotherapy against peritoneal carcinomatosis caused by gastric cancers.

[Study of DDS to the lymph node-metastases of the gastric cancer by the endoscopic injection of Lip-ADM].

We studied the drug delivery and anti-tumor effect of the endoscopic injection of liposomal adriamycin (Lip-ADM) in the submucosa of stomach by rabbit model. Concerning the drug delivery to regional lymphnode, the lymphnode ADM concentration of Lip-ADM injection group was higher than that of free ADM group (p less than 0.05). We also studied the lymphnodes pathohistologically. The lymphnodes of the rabbits injected with Lip-ADM indicated massive necrosis, whereas those of the rabbits injected with free ADM indicated residual tumor. Among clinical cases, patients injected Lip-ADM had paraaortic lymphnodes in which the adriamycin remained 10 days. The endoscopic injection of Lip-ADM into the submucosa of the stomach appeared to be an effective drug delivery system.

[Intraperitoneal administration of anti-cancer drug with cisplatinum (CDDP)].

Six patients were administered cisplatinum (CDDP) i.p. There were four cases with peritoneal dissemination of gastric cancer after gastrectomy and the other two, for whom prophylactic intraperitoneal administration of CDDP had been attempted to prevent peritoneal metastasis. The dose of CDDP was 75-140 mg/body (58-90 mg/m2). The results were 1 PR, 2 NC and 1 PD. The PR case was given intraperitoneal CDDP combined with RF thermotherapy. Liver dysfunctions, renal dysfunctions, bone marrow suppressions, and GI tract disturbances were observed as toxic reactions. The degrees of side effects after i.p. administration were less severe than after i.v. administration. However the indication of CDDP i.p. administration should be decided after case conferences. On pharmacokinetics, non-protein bound platinum was detected at 24 hours after i.p. administration, in ascites and plasma. The concentration of platinum in ascites was about three-fold than in plasma. It was considered that CDDP absorption from ascites into plasma depended on the state of peritoneal dissemination of cancer.

[Modified operation for early gastric cancer; rationale, technic and results].

During 1964 to 1976, standard operation, which consisted of subtotal or total gastric resection, extended dissection of lymph node and omentobursectomy, was performed for early gastric cancer. The result was satisfactory, i.e., 5 year relative survival rate was 95.2 per cent. But there were very few lymph-node metastases, which localized almost perigastric, no marked infiltration into the esophagus in cases of early cancer in the cardiac region. Macroscopic determination about the margin of the cancer was well compatible with microscopic one. The recurrent cases seemed to be due to hematogenous metastasis. These suggest that an extended lymph-node dissection, omentobursectomy and thoracotomy are not necessary for the early cancer. Proximal gastric resection and pylorus preserving gastric resection were indicated in some cases. In addition, the diagnosis of the early cancer, especially about the depth of invasion into the gastric wall, was accurate except for the early cancers which contained ulcerous lesion. Since 1977 modified operation for the early cancer has been applied. At this operation, lymph-node dissection was limited to perigastric region, omentobursectomy was omitted and the pancreas and spleen preserved. Through this method the operative time and blood unit have been much spared and the 5 year postoperative relative survival rate has improved, i.e., 100 per cent. It is concluded that the modified operation should be performed for the early gastric cancer.

Paraneoplastic cortical cerebellar degeneration. A neuropathological study of an autopsy case in comparison with cortical cerebellar degeneration in alcoholics.

A case is described of paraneoplastic cortical cerebellar degeneration in a patient with a small cell carcinoma of the lung. Following therapy, clinical improvement of cerebellar ataxia had been observed. The most severe degeneration was found in the superior aspects of the vermis and in the anterior and simple lobes as well as in the inferior aspects of the hemisphere. In addition to this distribution of degenerative lesions, uneven loss of Purkinje cells was apparent. Such distribution patterns in this case were apparently compatible with those of alcoholic cortical cerebellar degeneration (ACD), although the lesions were less severe than in ACD. Furthermore, dendritic changes in the Purkinje cells including loss of the spiny branchlets, focal swelling of the dendrites, and disappearance of secondary and tertiary branches were remarkable. It is noteworthy that these cells showed various stages of degeneration before cell loss occurred. These data suggest that the degree of vulnerability varies among Purkinje cells, and that this could be related to the uneven loss of these cells. It is proposed that, although this case and cases of ACD have both similarities and differences in their neuropathological aspects, it is apparent that both conditions have some common morphopathogenetic factor.