Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case.

We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

CD40-CD40 ligand (CD154) engagement is required but not sufficient for modulating MHC class I, ICAM-1 and Fas expression and proliferation of human non-small cell lung tumors.

To determine the possible functional significance of CD40 expression on human non-small cell lung carcinomas and to assess the potential of CD40 as a therapeutic target, 18 lung tumor cell lines were established from biopsy tissues and were monitored for phenotypic changes on the cell surface and alterations in tumor cell proliferation after the ligation of CD40 with a trimeric fusion protein complex of CD40 ligand (CD40Lt). CD40 cross-linking resulted in up to a 6-fold increase in the surface expression of major histocompatibility complex (MHC) class I, Fas and intracellular adhesion molecule (ICAM)-1 in a subset of tumors expressing the highest levels of CD40. Suppression of tumor proliferation was seen after the ligation of CD40 on CD40Lt-responsive cell lines. The suppression was dose dependent, reversible and resulted from a delay of the tumor cells entering S-phase. No change in the cell phenotype or in proliferation were observed in CD40-negative tumors or in tumors expressing moderate-to-low levels of CD40 after incubation with CD40Lt. CD40-negative tumors transfected with the CD40 gene expressed high levels of CD40 on their surface, but were also unresponsive to CD40Lt cross-linking of CD40. Our data establish that CD40 is required (but not sufficient) for transducing a signal that results in phenotypic changes in human lung tumors and suppression in their proliferation. We conclude that CD40 on non-small cell lung tumors may represent a potential therapeutic target, but only on a subset of the CD40+ tumors.

Prophylactic perioperative treatment in a patient with colon carcinoma complicated by polycythemia vera.

A patient with colon carcinoma complicated by polycythemia vera (PV) who underwent a partial colectomy concomitant with prophylactic perioperative treatment resulting in successful outcome is herein described. Seven weeks after the cessation of the latest exacerbation of PV, a partial colectomy was performed. In order to prevent the development of disseminated intravascular coagulation and thrombotic complications, the following perioperative treatment was performed: administration of gabexate mesilate (2,000 mg/day), fresh frozen plasma (300 ml/day), heparin (5,000 IU/day) for 7 days and anti-thrombin-III for 4 days, and a potent antibiotic therapy for 12 days and graded elastic bandages around the bilateral lower extremities for 14 days. As a result, an uneventful postoperative course was achieved. The present case suggests that these treatments are useful in the perioperative management of PV patients.

[A study on the relationship between clinicopathological findings of gastric cancer and its biological behavior such as DNA ploidy pattern and immunohistochemical staining of PCNA, laminin, p53 and nm 23].

UNLABELLED: The quantity of DNA ploidy and the expression of PCNA, laminin, p53 and nm23 by immunohistochemical stain were investigated using paraffin-embedded specimens obtained from 135 gastric cancer patients, and were compared with clinicopathological findings. RESULTS: (1) The incidence of DNA high ploidy (HP) was significantly higher in such a case with infiltrating type (INF) and positive lymph node metastasis (p+) compared with that of negative cases. (2) The high level of PCNA labeling index (HLI), negative expression of laminin (NEL) and nm23 (NE23) were more frequently observed in INF; large tumor size, deep invasion and p+, while positive p 53 was noted only in p+ cases. (3) The survival curve of HP, HLI, NEL, and NE 23 was significantly lower than that of the cases showing the reverse findings. As a conclusion, it is suggested that the investigation of the DNA ploidy, PCNA, laminin, p53 and nm23 might be useful as a parameter of biological behavior for gastric cancer and the prognosis of gastrectomized patients.

[Two cases of primary, diffusely infiltrating carcinoma (linitis plastica) of the colon].

Two rare cases of a primary, diffusely infiltrating carcinoma (linitis plastica) of the colon are reported. Case 1: In a 54-year-old male complaining of constipation and bloody stool, stenosis in the lower rectum was detected. He was diagnosed as having rectal cancer and rectal amputation with R3 lymphadenectomy was performed. The histological diagnosis was a signet ring cell carcinoma (a2, n2(+), Ho, Po stage IV). The patient died of multiple metastasis on the 318th postoperative day. Case 2: In a 29-year-old male complaining of a lower left abdominal pain, a circular stenosis of 7.5 cm in length in the descending colon, with Schnitzler's metastasis, was found. In spite of the advanced stage, a palliative colectomy was performed. A circular thickness of the wall was noted macroscopically, and the histological diagnosis was signet ring cell carcinoma, (s, n4(+), Ho, Po, stage V). The patient died of multiple metastasis on the 25th postoperative day.