[Multiple synchronous intrathoracic neurilemmomas who had a past history of neurilemmoma on the abdominal wall; report of a case].

A 66-year-old female, who had received a surgery of the neurilemmoma on the abdominal wall 6 years ago, was referred to our hospital because of a chest X-ray abnormality. Chest computed tomography (CT) revealed 3 tumors in the left chest wall. One tumor arised from the 7th intercostal nerve and 2 tumors from 8th nerve. These tumors were surgically removed by video-assisted thoracic surgery. These tumors are histopathologically diagnosed as neurilemmoma and have the same characteristics with previously resected abdominal wall tumor.

[Experience with invasive thymoma presenting pleural dissemination].

A 61-year-old man was admitted to Showa University Hospital because of a myasthenia gravis. Chest computed tomography revealed a mediastinal invasive tumor. During surgery, invasion to the pericardium and dissemination on the left visceral pleura and the left diaphragm were observed. Extended thymo-thymectomy and partial resection of the pericardium, left lung, and diaphragm were performed. Incomplete resection was achieved because of the dissemination on the diaphragm. Chemotherapy using ADOC and radiotherapy for mediastinum and left diaphragm were done. Four years after surgery, neither recurrence of the tumor nor myasthenia gravis was observed.

[Incomplete resection for primary non-small cell lung cancer].

A superior outcome is observed for cases of complete resection compared with that of incomplete resection. The reason and the countermeasure of the incomplete resection for lung cancer were analyzed. During 12 years, 274 patients with primary non-small cell lung cancer were surgically treated. Two hundred and forty-eight patients underwent complete resection and 26 incomplete resection. Three-year survival was 62% for patients with complete resection and 17% for patients with incomplete resection. Survival rates were not different between the paroative reduction surgery and the exploratory thoracotomy. Tiny but multiple pleural dissemination or small amount of the malignant pleurfal effusion was not able to detect preoperatively. In these cases, preoperative thoracoscopic observation may useful for avoiding the meaningless thoracotomy. Postoperative radiochemotherapy may improve the prognosis if the therapy is effective. Chemotherapy on the basis of the sensitivity assay is warranted.

Post radiation inflammatory malignant fibrous histiocytoma arising from the chest wall.

A 59-year-old man who underwent radiation therapy (41 Gy) to the mediastinum through the anterior chest for Hodgkin's disease presented with a painful anterior chest wall tumor 18 years later. The tumor originated from the left parasternal region and was excised with the sternum. Chest wall reconstruction was performed. The tumor measured 45 x 45 mm and invaded the sternum. The pathologic diagnosis was malignant fibrous histiocytoma. Early and complete excision of the tumor is indicated.

Glucose lowers CRP* levels resulting in repression of the lac operon in cells lacking cAMP.

CRP-cAMP-dependent operons of Escherichia coli can be expressed in cells lacking functional adenylate cyclase when they carry a second-site mutation in the crp gene (crp*). It is known that the expression of these operons is repressed by glucose, but the molecular mechanism underlying this cAMP-independent catabolite repression has been a long-standing mystery. Here we address the question of how glucose inhibits the expression of beta-galactosidase in the absence of cAMP. We have isolated several mutations in the crp gene that confer a CRP* phenotype. The expression of beta-galactosidase is reduced by glucose in cells carrying these mutations. Using Western blotting and/or SDS-PAGE analysis, we demonstrate that glucose lowers the cellular concentration of CRP* through a reduction in crp* mRNA levels. The level of CRP* protein correlates with beta-galactosidase activity. When the crp promoter is replaced with the bla promoter, the inhibitory effect of glucose on crp* expression is virtually abolished. These data strongly suggest that the lowered level of CRP* caused by glucose mediates catabolite repression in cya- crp* cells and that the autoregulatory circuit of the crp gene is involved in the down-regulation of CRP* expression by glucose.

[Clinicopathological features and diagnostic points of uncommon pancreatic tumors].

Clinicopathological features of uncommon pancreatic tumors including solid cystic tumor (SCT), acinar cell carcinoma and pancreatoblastoma are described, based upon a literature survey and own experiences. They are often discovered by US and CT as asymptomatic pseudocystic tumor. SCTs almost always occur in young female and Pancreatoblastoma, in children less than five years old. The prognosis is very favorable in SCT, and relatively good in acinar cell carcinoma and pancreatoblastoma. Pancreatoblastoma is often associated with the elevation of serum AFP levels. Characteristic histological features and immunocytochemical features are also described, all of which are very different from those of usual pancreatic ductal carcinoma. Molecular biological features including the results of k-ras and p53 point mutation are also discussed. In addition to the clinicopathological features, these uncommon tumors are very different from usual ductal carcinoma in the molecular biological features.

A lowered concentration of cAMP receptor protein caused by glucose is an important determinant for catabolite repression in Escherichia coli.

A decreased intracellular concentration of cAMP is insufficient to account for catabolite repression in Escherichia coli. We show that glucose lowers the amount of cAMP receptor protein (CRP) in cells. A correlation exists between CRP and beta-galactosidase levels in cells growing under various conditions. Exogenous cAMP completely eliminates catabolite repression in CRP-overproducing cells, while it does not fully reverse the effect of glucose on beta-galactosidase expression in wild-type cells. When the CRP concentration is reduced by manipulating the crp gene, beta-galactosidase expression decreases in proportion to the concentration of CRP. These findings indicate that the lowered concentration of CRP caused by glucose is one of the major factors for catabolite repression. We propose that glucose causes catabolite repression by lowering the intracellular levels of both CRP and cAMP.

[Histological evaluation of intra-arterial infusion and systemic chemotherapy of pancreatic carcinomas].

Histological analyses of 16 autopsies of pancreatic carcinoma [9 cases after intra-arterial infusion chemotherapy (IAC), and 7 cases of systemic chemotherapy (SC)] were performed. Histological effects of chemotherapy (Shimosato) were seen in 15 cases, but less than 5 Grade II a. cases of IAC and 4 cases of SC showed Grade IIa, 3 cases of IAC and 3 cases of SC showed Grade I. The ratio of Grade IIa was almost the same in IAC and SC. But histologically, anaplastic change, sarcomatous change and Bizarre cells, immunohistologically positive to anti-EMA and Vimentin antibody, were dominant in IAC. And clinically, serum tumor markers (CEA, CA19-9) were fewer in almost all the cases in IAC. These results may suggest that the anti-tumor effect of IAC was greater than the histological appearance.

Epidermoid cyst derived from an accessory spleen in the pancreas. A case report with literature survey.

A rare case of splenic epidermoid cyst (SEC) of the pancreas discovered in a 32-year-old Japanese female is reported. The lesion, 5 x 6 cm in size including caseous material and serous fluid in the lumen, was discovered by ultrasonography and computed tomography at the tail of the pancreas and was easily removed. Histopathologically, the cystic wall consisted of three components: the inside was lined by mature squamous epithelium with keratinization, the middle layer consisted of splenic pulp with a sinus structure, and the peripheral layer was dense fibrous connective tissue in which some involutional pancreatic ducts and islets were recognized. The literature about SEC of the pancreas is discussed in comparison with other types of epidermoid cyst including lymphoepithelial cyst and dermoid cyst in the pancreas.

Multiple carcinomata associated with anomalous arrangement of the biliary and pancreatic duct system. A report of two cases with a literature survey.

Two rare cases of multiple neoplasms occurring in association with anomalous arrangement of the pancreatobiliary duct system (PBD) are reported. Ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography revealed cholecystic tumor in the first case, and multiple choledochocholecystic tumors in the second case. In the first case, pancreatic tumor was discovered two years after cholecystectomy. In the second case, a pancreatic tumor was discovered incidentally in the removed pancreatic head after the operation. The histology of all of these biliary and pancreatic tumors revealed papillary adenocarcinoma in both patients, and additionally small pancreatic endocrine tumors were found in the first case. Postoperative prognosis was comfortably favorable in both patients. In a literature survey, two other cases of double carcinomata associated with anomalous PBD were found, in which the tumors showed the same histology of papillary adenocarcinoma and the postoperative prognoses were also good. These mutual clinicopathological features appear to suggest that this abnormal condition acts as a carcinogenetic risk factor in the pancreatic duct and the biliary duct system, and may finally cause multiple carcinomata in the PBD.