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WAKASA Tomoko

    Kindai University Nara Hospital　Professor/General Manager
Last Updated :2024/04/19

Researcher Information

J-Global ID

Research Interests

  • 妊娠高血圧症候群   Maternal death   Surgical Pathology   Pathology of liver   Gynecological Pathology   

Research Areas

  • Life sciences / Human pathology

Academic & Professional Experience

  • 2021/04 - Today  Kindai University奈良病院病理診断科Professor

Education

  •        - 1991  Osaka University  Faculty of Medicine  Medical School
  •        - 1991  Osaka University  Faculty of Medicine

Association Memberships

  • 日本婦人科腫瘍学会   日本肝臓学会   日本臨床細胞学会   日本思春期学会   日本癌学会   日本産科婦人科学会   日本病理学会   

Published Papers

  • 非典型的な画像所見を呈したIPMCの1例
    水野 成人; 橋本 和彦; 福田 泰也; 若狹 朋子
    膵臓 (一社)日本膵臓学会 38 (3) A489 - A489 0913-0071 2023/07
  • 額原 敦; 石川 原; 寺下 大補; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 橋本 和彦; 肥田 仁一; 若狭 朋子; 木村 豊
    癌と化学療法 (株)癌と化学療法社 50 (3) 378 - 380 0385-0684 2023/03 
    症例:症例は76歳,男性。検診で異常を指摘され,精査目的に当院紹介受診となった。上部消化管内視鏡検査で,十二指腸下行脚～水平脚に凹凸不整を伴う全周性の平坦な病変を認めた。生検で乳頭腺癌と診断された。腹部造影CTではリンパ節腫大や遠隔転移を認めなかった。内視鏡的深達度はM癌と推定されたが,大きさは約60mmで全周性,Vater乳頭近傍に位置していた。そのため,内視鏡的切除は困難と判断した。亜全胃温存膵頭十二指腸切除術を施行した。術後病理診断で0-IIa型,tub1>pap,pTis,Ly0,V0,80×50mm,BD1,Ex0,Pn0,pPM0,pDM0,pN0,pStage 0であった。その後,再発なく経過している。側方発育型の十二指腸癌はまれな疾患であり,内視鏡的切除や縮小手術,膵頭十二指腸切除などが報告されている。広範な側方発育型十二指腸癌の1切除例を経験したため,文献的考察を加えて報告する。(著者抄録)
  • Atsushi Gakuhara; Hajime Ishikawa; Daisuke Terashita; Hideo Tomihara; Shuichi Fukuda; Masahisa Otsuka; Kotarou Kitani; Kazuhiko Hashimoto; Jinnichi Hida; Tomoko Wakasa; Yutaka Kimura
    Gan to kagaku ryoho. Cancer & chemotherapy 50 (3) 378 - 380 0385-0684 2023/03 
    A 76-year-old man came to our hospital for a close examination after an abnormal finding during a medical checkup. Upper gastrointestinal endoscopy revealed a circumferential flat lesion with irregularity in the second to third portions of the duodenum. Biopsy diagnosed papillary adenocarcinoma. Contrast-enhanced CT of the abdomen showed no evidence of lymph node enlargement and distant metastasis. Endoscopic depth of the lesion was estimated to be intramucosal carcinoma, but it was approximately 60 mm in size, circumferential, and located near the papilla Vater. Therefore, endoscopic resection was deemed difficult. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Postoperative pathological examination revealed type 0-Ⅱa, tub1>pap, pTis, Ly0, V0, 80×50 mm, BD1, Ex0, Pn0, pPM0, pDM0, pN0, pStage 0. There has been no recurrence since then. Lateral spreading duodenal carcinoma is a rare disease, and endoscopic resection, local resection, and pancreaticoduodenectomy have been reported as treatment options. We report a case of resection of a large lateral spreading duodenal carcinoma with a review of the literature.
  • 豊留宗一郎; 家根旦有; 上田吉生; 二川晃一; 若狭朋子; 渡瀬謙仁; 岩本展子; 根本直人; 長井聖武; 長田哲次
    medical journal of kindai university 近畿大学医学会 47 (3・4) 73 - 81 0385-8367 2022/12 [Refereed]
     
    type:Departmental Bulletin Paper 原発性顎骨中心性扁平上皮癌は顎骨中心性に発生し，初期には口腔粘膜と連続性がなく，かつ他臓器からの転移ではない扁平上皮癌であると定義されている．発生頻度は口腔領域悪性腫瘍の１％以下と稀であるが，臨床症状が乏しく進行してから発見されることが多い．今回われわれは，歯牙動揺を契機に発見され，後に口腔多発癌の経過を辿ったと考えられた原発性下顎骨中心性扁平上皮癌患者を経験したためその概要を報告する．患者は64歳女性，右側舌下面の白斑を主訴に来院した．５年前に他院にて左側舌縁部の上皮内癌切除術を実施し，経過観察を受けていた．初診時に右側下顎第１大臼歯の動揺を認め，X線画像にて右側下顎骨の辺縁不整な骨吸収像を認めた．右側下顎第１大臼歯を抜歯し抜歯窩より生検を行ったところ，扁平上皮癌との診断を得たため，右側下顎骨区域切除術を実施した．その後，術後１ヶ月にて左側下顎第１大臼歯舌側歯肉，術後１年10ヶ月にて左側舌根部にそれぞれ扁平上皮癌を生じ，外科的切除を行った．現在，定期的に経過観察を行っているが，再発所見は認めず経過している．顎骨中心性癌は無症状に経過し発見が遅れることが多いが，可及的早期に診断するために，複数の検査を速やかに実施し多角的に判断することが重要と考えられた．また，口腔領域の悪性腫瘍では口腔多発癌を発症する可能性があり，原発性下顎骨中心性扁平上皮癌でも注意を要することが示唆された．
  • 胃癌術後経過観察中に発症した鼠径部子宮内膜症を背景とした類内膜腺癌の1例
    松元 哲也; 額原 敦; 寺下 大補; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 若狹 朋子; 木村 豊
    日本臨床外科学会雑誌 日本臨床外科学会 83 (増刊) S541 - S541 1345-2843 2022/10
  • 橋口 康弘; 山本 皇之祐; 岸本 佐知子; 西岡 和弘; 若狭 朋子; 大井 豪一
    産婦人科の進歩 「産婦人科の進歩」編集室 74 (2) 287 - 287 0370-8446 2022/05
  • Hideo Tomihara; Kazuhiko Hashimoto; Hajime Ishikawa; Daisuke Terashita; Atsushi Gakuhara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Jin-Ichi Hida; Tomoko Wakasa; Yutaka Kimura
    Surgical case reports 8 (1) 79 - 79 2022/04 
    BACKGROUND: Undifferentiated carcinoma is a very rare histologic subtype, representing only 0.8% to 5.7% of all pancreatic exocrine neoplasms. Additionally, spontaneous abdominal hemorrhage is a particularly rare, life-threatening cause. CASE PRESENTATION: A 68-year-old man was taken by ambulance to our hospital because of sudden-onset abdominal pain. Contrast-enhanced abdominal computed tomography revealed a huge mass measuring 99 × 70 mm in the pancreatic tail with enhanced rim staining in the peripheral area. Imaging also showed extravasation and fluid collection beside the tumor. Hence, spontaneous rupture of the pancreatic tumor and intra-abdominal bleeding were diagnosed. Emergency laparotomy was performed because of acute abdominal pain with peritoneal signs. With an intraoperative diagnosis of rupture of the pancreatic tumor, distal pancreatectomy was successfully performed. Histologically, hematoxylin and eosin staining showed round to spindle-shaped, highly pleomorphic mononuclear cells and multinucleated giant cells as well as a component of ductal adenocarcinoma. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, whereas the non-neoplastic osteoclast-like giant cells were positive for CD68. Taken together, these results led to a diagnosis of undifferentiated carcinoma with osteoclast-like giant cells. The patient's postoperative course was uneventful. CONCLUSION: We experienced an extremely rare case of spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells presenting as intra-abdominal bleeding. Obtaining a correct preoperative diagnosis is quite difficult at the first evaluation. Undifferentiated carcinoma should be considered as a differential diagnosis in the case with spontaneous rupture of a pancreatic tumor.
  • ルゴール液で発熱、イソジンで粘膜びらんを呈し、多数の薬剤アレルギー歴を持ったバセドウ病患者の一例
    岸谷 讓; 末吉 功治; 西川 大祐; 森川 大樹; 衛藤 克幸; 家根 旦有; 大谷 知之; 若狭 朋子; 覚道 健一
    日本内分泌学会雑誌 (一社)日本内分泌学会 98 (1) 349 - 349 0029-0661 2022/04
  • 胃癌と原発性右副腎リンパ腫が併存した1例(A case of synchronous gastric cancer and primary lymphoma of right adrenal gland)
    福田 周一; 額原 敦; 若狹 朋子; 花本 仁; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 (一社)日本胃癌学会 94回 489 - 489 2022/03
  • 潰瘍を伴う粘膜下腫瘍様の内視鏡像を呈した壁外発育型胃肝様腺癌の1例(Extraluminal growth type gastric hepatoid adenocarcinoma with submucosal tumor-like appearance)
    福田 周一; 額原 敦; 若狹 朋子; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 (一社)日本胃癌学会 94回 495 - 495 2022/03
  • 妊娠期に急速に増大した子宮腟部尖圭コンジローマの1例
    西岡 和弘; 山本 皇之祐; 橋口 康弘; 岸本 佐知子; 若狭 朋子; 大井 豪一
    日本産科婦人科学会雑誌 (公社)日本産科婦人科学会 74 (臨増) S - 398 0300-9165 2022/02
  • EUS-FNAにより診断が可能であった、後腹膜DLBCLの1例
    大丸 直哉; 松原 卓哉; 今村 瑞貴; 田中 秀和; 半田 康平; 河野 辰哉; 木下 大輔; 川崎 俊彦; 水野 成人; 若狭 朋子; 大谷 知之; 山田 薫; 花本 仁; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 116回 113 - 113 2022/02
  • Takahiro Kimura; Takayuki Takahama; Tomoko Wakasa; Shiori Adachi; Yusaku Akashi; Takao Tamura; Katsunari Yane
    Molecular and clinical oncology 16 (1) 2 - 2 2022/01 [Refereed]
     
    Immune checkpoint inhibitors (ICIs) have markedly changed the treatment landscape for melanoma; however, their efficacy and applications are currently limited and medical requirements remain unmet. The present case study reports on a 85-year-old female patient who visited our outpatient clinic with a 1-month history of a buccal mucosa mass and was diagnosed with locally advanced mucosal melanoma of the head and neck. The patient's tumor progressed right after the administration of nivolumab, compromising oral intake. Palliative debulking surgery was performed. Subsequently, the other part of the melanoma on the hard palate slightly decreased in size without forming new lesions for more than one year after surgery. The present case exemplifies that tumor volume reduction surgery may increase the response to ICI and may prolong the duration of response. This combination therapy may be more effective in patients whose tumors increase in size after administration of ICIs or whose tumor is already large at the beginning of treatment. The combination of ICIs and debulking surgery may become an important treatment option in the future for locally advanced mucosal melanoma.
  • 小腸ポリープからの出血によると思われる黒色便の1例
    大丸 直哉; 松原 卓哉; 今村 瑞貴; 河野 辰哉; 半田 康平; 田中 秀和; 木下 大輔; 川崎 俊彦; 水野 成人; 若狭 朋子; 大谷 知之; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 107回 108 - 108 2021/12
  • 西岡 和弘; 松岡 基樹; 福井 寛子; 岸本 佐知子; 若狭 朋子; 金山 清二; 大井 豪一
    産婦人科の進歩 「産婦人科の進歩」編集室 73 (4) 396 - 397 0370-8446 2021/10 
    70歳以上の高齢子宮体癌患者に対する治療法を、70歳未満との比較から明らかにすることを目的に、当科(大学病院産婦人科)で2015年1月〜2019年12月に治療を行った子宮体癌80症例を、70歳以上の10例(B群)と70歳未満の70例(A群)に分け、両群を比較検討した。その結果、B群はA群より、手術療法の縮小、化学療法の省略、基礎疾患、術後せん妄の4項目の件数が有意に多かった。
  • 穿刺吸引細胞診より悪性を疑うも診断に苦慮した筋上皮癌の一例
    田口 直樹; 福森 恭代; 浦 雅彦; 大谷 知之; 若狹 朋子; 長尾 俊孝
    日本臨床細胞学会雑誌 (公社)日本臨床細胞学会 60 (Suppl.2) 489 - 489 0387-1193 2021/10
  • 穿刺吸引細胞診より悪性を疑うも診断に苦慮した筋上皮癌の一例
    田口 直樹; 福森 恭代; 浦 雅彦; 大谷 知之; 若狹 朋子; 長尾 俊孝
    日本臨床細胞学会雑誌 (公社)日本臨床細胞学会 60 (Suppl.2) 489 - 489 0387-1193 2021/10
  • Hideo Tomihara; Kazuhiko Hashimoto; Hajime Ishikawa; Daisuke Terashita; Atsushi Gakuhara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Jin-Ichi Hida; Tomoko Wakasa; Yutaka Kimura
    Clinical journal of gastroenterology 14 (5) 1544 - 1549 2021/10 [Refereed]
     
    Hepatocellular adenoma (HCA) is a rare benign liver tumor that has been reported to occur particularly more often in women who use contraceptives. A 72-year-old woman with no history of using contraceptives presented to our hospital for further examination of a liver tumor. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed a huge solitary hepatic tumor measuring 83 × 76 mm in segments 4, 5, and 8. The differential diagnoses were cholangiocarcinoma and mixed-type hepatocellular carcinoma. Percutaneous needle biopsies were performed twice, and no malignant components were found. Central bi-segmentectomy of the liver was successfully performed. Immunohistochemical staining showed that β-catenin was positive in the membrane of the tumor cells, while fatty acid-binding protein, glutamine synthetase, and amyloid A were negative. These results led to a diagnosis of HCA, hepatocyte nuclear factor-1α-inactivated subtype. The patient's postoperative course was uneventful, and she developed no recurrence for 10 months after surgery. We experienced a rare case of benign HCA. Obtaining a correct preoperative diagnosis is sometimes difficult at the first evaluation. HCA should be considered as a differential diagnosis of liver tumors.
  • Shuichi Fukuda; Tomoko Wakasa; Hitoshi Hanamoto; Taichi Koyama; Yoshio Ohta; Masatoshi Inoue; Daisuke Terashita; Atsushi Gakuhara; Hideo Tomihara; Katsuya Ohta; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jin-Ichi Hida; Yutaka Kimura
    Clinical journal of gastroenterology 14 (5) 1350 - 1357 2021/10 [Refereed]
     
    This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient's request. The patient died 2 months after surgery.
  • Yuichiro Hamamoto; Yoji Kukita; Masanori Kitamura; Masako Kurashige; Hiroaki Masaie; Shigeo Fuji; Jun Ishikawa; Keiichiro Honma; Tomoko Wakasa; Hitoshi Hanamoto; Mitsuyoshi Hirokawa; Ayana Suzuki; Eiichi Morii; Shin-Ichi Nakatsuka
    Histopathology 79 (4) 521 - 532 2021/10 [Refereed]
     
    AIMS: Follicular lymphoma (FL), comprising a minor subset of primary thyroid lymphomas, is divided into two groups based on Bcl-2 expression and IGH-BCL2 translocation. The clinicopathological features exhibited by Bcl-2-negative IGH-BCL2 translocation-negative FL of the thyroid (Bcl-2- /IGH-BCL2- tFL) are different from those of conventional FL; however, its lymphomagenesis remains unclear. Here, we collected samples from seven patients with Bcl-2- /IGH-BCL2- tFL to investigate their epigenetic and genetic aberrations. METHODS AND RESULTS: The immunohistochemical profiles of epigenetic modifiers and the methylation status of histones were examined, including EZH2, MLL2/KMT2D, CBP/CREBBP, EP300, H3K27me3 and H3K4me3, in Bcl-2- /IGH-BCL2- tFL and Bcl-2-positive IGH-BCL2 translocation-positive FL of the thyroid (Bcl-2+ /IGH-BCL2+ tFL). Most Bcl-2- /IGH-BCL2- tFLs retained the positivity of epigenetic modifiers and lower expression of H3K27me3, although Bcl-2+ /IGH-BCL2+ tFLs exhibited aberrant immunohistochemical patterns of EZH2 and CBP/CREBBP and overexpression of H3K27me3. Samples from seven cases were further analysed using targeted sequencing, focusing on the exons of 409 key tumour suppressor genes and oncogenes. Bcl-2- /IGH-BCL2- tFLs do not have pathogenic mutations of epigenetic modifiers, such as EZH2, MLL2/KMT2D, MLL3/KMT2C, EP300 and ARID1A, which have been reported in FLs in the literature, whereas Bcl-2+ /IGH-BCL2+ tFLs are probably pathogenic/pathogenic missense mutations or frameshift mutations of these genes. Additionally, novel mutations in TET2 and EP400 were detected in Bcl-2- /IGH-BCL2- tFLs. CONCLUSIONS: Different genetic and epigenetic abnormalities might be involved in the oncogenesis of Bcl-2- /IGH-BCL2- tFLs from Bcl-2+ /IGH-BCL2+ tFLs and other FLs.
  • 右卵巣腫瘍茎捻転と鑑別が問題となった回腸線維脂肪腫によるイレウスの1例
    西岡 和弘; 木谷 光太郎; 山本 皇之祐; 橋口 康弘; 岸本 佐知子; 若狭 朋子; 大井 豪一
    日本産科婦人科内視鏡学会雑誌 (一社)日本産科婦人科内視鏡学会 37 (Suppl.I) 301 - 301 1884-9938 2021/09
  • 術後10年以上無再発生存中の食道癌肉腫の1切除例
    額原 敦; 福田 周一; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 若狭 朋子; 太田 善夫; 湯川 真生
    日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 75回 153 - 153 2021/09
  • 術後10年以上無再発生存中の食道癌肉腫の1切除例
    額原 敦; 福田 周一; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 若狭 朋子; 太田 善夫; 湯川 真生
    日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 75回 153 - 153 2021/09
  • 松岡 基樹; 鹿庭 寛子; 岸本 佐知子; 西岡 和弘; 金山 清二; 若狭 朋子; 大井 豪一
    産婦人科の進歩 「産婦人科の進歩」編集室 73 (3) 257 - 264 0370-8446 2021/08 
    子宮内膜症の癌化は,卵巣に発生する卵巣子宮内膜症性嚢胞が癌化したものが多く報告されているが,腸管子宮内膜症が癌化した症例は本邦での報告例は少なくまれのため報告する.症例は81歳女性,骨盤内腫瘤と不正出血を認め,近医より精査目的で当科紹介となった.初診時の骨盤内MRIで骨盤内に5cm大の不整形の腫瘤を認め,内部は隔壁と不規則な信号で辺縁優位の不均一な濃染を示し,S状結腸への浸潤を疑った.血中CA125 1850U/mlと異常高値を示した.卵巣癌の疑いで骨盤内腫瘤に対して腹式単純子宮全摘術,両側付属器切除および大網切除の方針とした.腫瘍はS状結腸と広間膜と強固に癒着しており,S状結腸を15cm部分切除し摘出した.両側卵巣は正常で腫瘍と連続性はなかったが,腫瘍は子宮と癒着しており,予定どおり手術を行った.腹腔内には明らかな播種や内膜症所見を認めなかった.切除標本では,子宮と両側卵巣には形態学的,病理学的に異常はなかった.病理結果ではS状結腸に内膜腺上皮類似の腫瘍細胞の増殖を認め,免疫染色ではCK7(+),CK20(-),CDX(-),PAX8(+)であり,結腸由来でなくMueller管由来の類内膜癌G1と診断した.腫瘍は結腸の粘膜下層まで浸潤するが粘膜上皮と連続性はなく,腸管子宮内膜症から発生した類内膜癌と考えた.他に子宮や両側付属器には内膜を疑う所見は見られなかった.術後後療法を呈示すると,高齢のため希望されなかった.術後CA125は上昇なく経過観察されていたが,術後5ヵ月目に腫瘍マーカーCA125の上昇とCT画像から再発と診断し,現在,Paclitaxel+Carboplatin(TC)療法を行っている.腸管に限局した子宮内膜症が閉経から30年後に癌化した症例を経験したので報告する.(著者抄録)
  • 田中 秀和; 水野 成人; 橋本 和彦; 大谷 知之; 若狹 朋子; 福永 朋洋; 工藤 正俊
    胆道 (一社)日本胆道学会 35 (3) 425 - 425 0914-0077 2021/08
  • X線透視下胆管擦過細胞診・胆管生検の診断能についての検討
    田中 秀和; 水野 成人; 橋本 和彦; 大谷 知之; 若狹 朋子; 福永 朋洋; 工藤 正俊
    胆道 日本胆道学会 35 (3) 425 - 425 0914-0077 2021/08
  • 子宮頸癌肺転移に対するアバスチン維持療法直後に発症した緊張性気胸の一例
    西岡 和弘; 山本 皇之祐; 橋口 康弘; 岸本 佐知子; 若狭 朋子; 大井 豪一
    日本婦人科腫瘍学会学術講演会プログラム・抄録集 (公社)日本婦人科腫瘍学会 63回 323 - 323 2021/07
  • 性風俗産業従事者にみられた舌腫瘤を契機に発見された第2期梅毒の1例
    岩本 展子; 豊留 宗一郎; 鈴木 晴也; 根本 直人; 長田 哲次; 若狭 朋子; 太田 善夫
    日本口腔科学会雑誌 (NPO)日本口腔科学会 70 (2) 183 - 183 0029-0297 2021/07
  • Shuichi Fukuda; Kaoru Okajima; Kaoru Okada; Kohei Fukuda; Tomoko Wakasa; Tomoyuki Tsujimoto; Atsushi Gakuhara; Hideo Tomihara; Katsuya Ohta; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jin-Ichi Hida; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Molecular and clinical oncology Spandidos Publications 15 (1) 130 - 130 2049-9450 2021/07 [Refereed]
     
    Treatment strategies for distant organ metastasis have changed markedly since the concept of oligometastasis was introduced. The perception that distant organ metastasis is a systemic disease and not eligible for local therapy is now a thing of the past. Therefore, the present report details a case of postoperative solitary liver metastasis from esophageal squamous cell carcinoma (ESCC), which achieved a clinical complete response to chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by stereotactic body radiotherapy (SBRT). A 76-year-old male patient underwent esophagectomy for lower thoracic ESCC. At 7 months after surgery, abdominal CT revealed a solitary hypovascular mass, 28 mm in size, in segment 7 of the liver. After three courses of chemotherapy with cisplatin and 5-FU, abdominal CT revealed that the liver mass had shrunk to 7 mm in size. SBRT was then administered with a 6 MV X-ray beam generated by a linear accelerator. A total dose of 50 Gy was given in 5 fractions of 10 Gy to the liver mass. At 1 month after SBRT, abdominal CT revealed that the liver mass had disappeared. The patient received no further adjuvant chemotherapy and had no recurrence at 18 months after diagnosis of liver metastasis and 13 months after SBRT.
  • Tomoko Wakasa; Hatsue Ishibashi-Ueda; Makoto Takeuchi
    Pathology international 71 (4) 223 - 231 2021/04 [Refereed][Invited]
     
    The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.
  • Von-Hippel-Lindau病合併妊娠の1症例
    松岡 基樹; 鹿庭 寛子; 岸本 佐知子; 西岡 和弘; 金山 清二; 若狭 朋子; 大井 豪一
    日本産科婦人科学会雑誌 (公社)日本産科婦人科学会 73 (臨増) S - 598 0300-9165 2021/03
  • Tomomi Isono; Tomoko Wakasa; Hidenori Kusumoto; Keiji Shimada; Takafumi Ogawa; Hiroyuki Shiono
    Medicine 100 (5) e24491 - e24491. 2021/02 [Refereed]
     
    RATIONALE: The relationship between thymic tumors and Sjögren syndrome (SjS) is unknown, and surgical resection has not been optimized. Especially, thymic carcinoma with autoimmune disease is rare. Analysis of SS-A52, germinal centers, plasma cells, and Foxp3+ Treg in thymic carcinoma has never been reported, and their pathological roles in causing SjS have not been studied. PATIENT CONCERNS: A 78-year-old man presented with sputum production and xerostomia while asleep. Chest computed tomography showed a homogeneous and hypodense mass in the anterosuperior mediastinum. Serum levels of the antinuclear antibody, antibody to SS-A, and antibody to SS-B were positive. DIAGNOSES: Thymic carcinoma (squamous cell carcinoma) and SjS. INTERVENTIONS: Video-assisted thoracoscopic resection of the mediastinal tumor and postoperative radiation therapy was performed. OUTCOMES: The histological diagnosis was thymic squamous cell carcinoma. Histologically, the squamous carcinomatous cells were arranged in nests and cords in the fibrohyaline stroma with capsular invasion. In the stroma, dense lymphoid tissues containing large reactive germinal centers and many plasma cells were also noted. In the involuted thymus, CD20-positive mature lymphocytes infiltrated, and germinal centers were noted. Double immunohistochemical staining revealed that SS-A52 antigen was positive in both the carcinoma component and CD20-positive mature B cells. Postoperatively, the xerostomia persisted, and serum SS-A and SS-B remained positive. No evidence of carcinoma recurrence with chest computed tomography scan was observed at 18-months follow-up. LESSONS: In the surgical treatment of thymic tumors with SjS, extended thymectomy might be worth considering to stop the progressive destruction of the targets of SjS-specific autoantibodies. However, the postoperative symptoms may not dramatically improve because the target organs might have changed irreversibly, and memory B cells might persist. This is the first report that demonstrated the SS-A52 antigen presentation in a thymic tumor to the best of our knowledge.
  • Shinji Katsuragi; Hiroaki Tanaka; Junichi Hasegawa; Naohiro Kanayama; Masahiko Nakata; Takeshi Murakoshi; Kazuhiro Osato; Masamitsu Nakamura; Kayo Tanaka; Akihiko Sekizawa; Isamu Ishiwata; Yoshiko Yamamoto; Tomoko Wakasa; Makoto Takeuchi; Jun Yoshimatsu; Tomoaki Ikeda
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 34 (3) 432 - 438 2021/02 [Refereed]
     
    OBJECTIVE: We reviewed malignancy related maternal deaths in Japan to ascertain if there were avoidable factors. METHODS: Malignancy-related maternal death in Japan reported to the Maternal Death Exploratory Committee, from 2010 to 2016 inclusive. RESULTS: There were 12 cases of maternal death caused by malignancy. There were four gastric cancers (two poorly differentiated adenocarcinoma, one signet ring cell carcinoma with adenocarcinoma, one histology not available), 3 leukemia (two acute myeloid leukemia, one aggressive NK cell leukemia), two ureteral cancers (histology not available), one malignant lymphoma (diffuse large B-cell lymphoma with translocation), one brain tumor (gliomatosis cerebri), and one cervical cancer (glassy cell carcinoma). Two gastric cancer patients had chronic gastric pain before conception. In two cases the physicians commented that they had avoided computed tomography and the brain biopsy needed for diagnosis because the patient was pregnant. At diagnosis, the clinical stages were II-IV in 9, and the performance status was 3-5 in 8. Indication for delivery was exacerbated maternal condition in 5, for treatment in 3, spontaneous labor in 3, and one patient declined elective delivery. Median [interquartile rage] (range) gestational weeks of delivery was 29 [24-30] (19-40). One cervical cancer patient had a radical hysterectomy and chemotherapy for 10 months. However, three leukemia and one gastric cancer patients had chemotherapy within 10 d because they deteriorated rapidly. Another seven cases did not have any treatment because of poor general condition or because they remained undiagnosed. In all cases, the Committee considered that there was no evidence of substandard care. CONCLUSION: In these cases, both the clinical stages and biological degree of malignancy were high. In two-thirds of cases, early termination of the pregnancy was indicated because of deteriorating maternal condition. Chemotherapy was not effective because of short available time for therapy and the advanced stage of the cancers when diagnosed. Encouraging women to have a thorough medical assessment before conception, and early diagnosis and treatment before pregnancy, appears to be the only practical way to reduce deaths from malignancy while a woman is pregnant.
  • 乳癌術後アロマターゼ阻害薬内服中に発見された著しい扁平上皮化生を伴う子宮体癌の一例
    若狹 朋子; 松岡 基樹; 西岡 和弘; 鹿庭 寛子; 金山 清二; 張 波; 太田 善男; 大井 豪一
    日本婦人科腫瘍学会雑誌 (公社)日本婦人科腫瘍学会 39 (1) 381 - 381 1347-8559 2021/01
  • 異状死と医療関連死の定義と問題点を見直す：病理医の立場から
    若狹朋子
    病理と臨床 39 883 - 888 2021 [Refereed]
  • 救急で死亡確認され、臨床医から剖検を依頼されたときの対応は？警察の検視が必要かどうかの判断は？
    若狹朋子
    病理と臨床 39 904 - 904 2021 [Refereed]
  • Tomoyuki Tsujimoto; Atsushi Gakuhara; Hideo Tomihara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jinichi Hida; Tomoko Wakasa; Yoshio Ohta; Masao Yukawa
    Gan to kagaku ryoho. Cancer & chemotherapy 47 (13) 1936 - 1938 0385-0684 2020/12 [Refereed]
     
    A 74-year-old woman visited her local doctor with stomach ache and weight loss. Abdominal ultrasonography showed a mass in the hepatic flexure of the transverse colon. She was referred to our hospital. Colonoscopy revealed transverse colon cancer in the hepatic flexure. Upper endoscopy showed redness of the mucosa and stenosis in the descending portion of the duodenum. Therefore, duodenal invasion was suspected. The CT scan showed a regional lymph node metastasis, but there were no obvious signs of distant metastases. From the aforementioned findings, we diagnosed the patient with duodenal invasion of transverse colon cancer(cT4b, N1, M0, cStage Ⅲ). There was no intraoperative peritoneal dissemination or liver metastasis, and we performed right hemicolectomy and pancreatoduodenectomy for transverse colon cancer. On histopathological examination, we diagnosed pT4b(Duo, Pan), N1b(3/35), M0, pStage Ⅲb. The patient had delayed gastric emptying after surgery. She recovered conservatively and was discharged on POD 37. She underwent adjuvant chemotherapy( capecitabine therapy)and has been alive without recurrence 8 months after surgery. In some cases of colon cancer invasion of other organs, long-term survival can be achieved if R0 resection is possible, and we should consider extended resection.
  • Rie Mizumoto; Kazuhiko Hashimoto; Tomoko Wakasa; Tomoyuki Tsujimoto; Atsushi Gakuhara; Shuichi Fukuda; Kotaro Kitani; Hajime Ishikawa; Jinichi Hida; Ryuichiro Ashikaga; Toshihiko Kawasaki; Yoshio Ohta; Masao Yukawa; Masatoshi Inoue
    Gan to kagaku ryoho. Cancer & chemotherapy 47 (13) 1845 - 1847 0385-0684 2020/12 [Refereed]
     
    A 42-year-old man complaining of left back pain was admitted to our hospital. The hepatis B and C surface antigens were negative. The serum levels of tumor markers were within the reference ranges. Abdominal ultrasound revealed an 8 cm-sized, primarily round and hyperechoic mass in the left lateral segment. Contrast-echo showed non-uniform enhancement in the arterial phase and uniform enhancement in the portal phase. This mass did not indicate"wash-out"on contrast- enhanced CT. It showed hypointensity in the hepatobiliary phase on MRI. The definitive diagnosis could not be obtained, and the patient was suspected with malignancy, such as hepatocellular carcinoma(HCC). Therefore, left hemi-hepatectomy was performed for the diagnostic treatment. Based on the immunochemical staining results, he was diagnosed with angiomyolipoma( AML). AML is composed of fat, blood vessels, and smooth muscles. It is regarded as a tumor of perivascular epithelioid cell tumor(PEComa). Early venous return and adipose tissues in the tumor were the distinctive features of this tumor. The preoperative diagnosis of AML without any fatty component as in this case is very difficult.
  • Kazuhiko Hashimoto; Tomoko Wakasa; Toshihiko Kawasaki; Tomoyuki Tsujimoto; Atsushi Gakuhara; Hideo Tomihara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Hajime Ishikawa; Jinichi Hida; Yoshio Ohta; Masao Yukawa; Masatoshi Inoue
    Gan to kagaku ryoho. Cancer & chemotherapy 47 (13) 1893 - 1895 0385-0684 2020/12 [Refereed]
     
    A 69-year-old woman with a hepatocellular carcinoma(HCC)was followed-up for type B chronic hepatitis and underwent partial hepatectomy(S6)at our hospital. Afterwards, she underwent radiofrequency ablation(RFA)therapy twice because of intrahepatic recurrence. Seven months after the first hepatectomy, a left adrenalectomy was performed for a left adrenal metastasis. Seventeen months after the first hepatectomy, a splenectomy was performed for a splenic metastasis. Forty-three months after the first hepatectomy, a second hepatectomy was performed for intrahepatic recurrence, and a right adrenalectomy was performed for an adrenal metastasis. Sixty-eight months after the first hepatectomy, an abdominal CT revealed a growing solitary lesion in the ascending colon, which was diagnosed as a peritoneal metastasis. The peritoneal dissemination was removed because there were no other extrahepatic or intrahepatic recurrences. Histologically, the resected specimen was diagnosed as a peritoneal metastasis from a HCC. The patient survived, and there were no recurrences for 6 months after the operation. We report this case of a peritoneal metastasis from a HCC after surgery with a review of the literature.
  • Atsushi Gakuhara; Shuichi Fukuda; Tomoyuki Tsujimoto; Hideo Tomihara; Katsuya Ota; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jinichi Hida; Tomoko Wakasa; Yoshio Ota; Masao Yukawa
    Gan to kagaku ryoho. Cancer & chemotherapy 47 (13) 2156 - 2158 0385-0684 2020/12 [Refereed]
     
    A 67-year-old man visited his doctor because of anorexia and was diagnosed with gastric cancer based on endoscopic findings. Endoscopy revealed a 0-Ⅰ type tumor, 6 cm in size, at the gastric angle. Preoperative CT showed no apparent lymph node or distant metastases. Distal gastrectomy was performed for gastric cancer with Billroth Ⅰ reconstruction. He had no complications and was discharged on postoperative day 11. The pathological Stage was pT2N0M0, pStage ⅠB, and he underwent no adjuvant chemotherapy. Four months postoperatively, serum CA19-9, AFP, and PIVKA-Ⅱ were elevated, and CT revealed multiple liver tumors. A liver biopsy was performed for the definitive diagnosis. The patient was diagnosed with liver metastases from gastric cancer. It is considered that AFP and PIVKA-Ⅱ were produced by the liver metastasis from gastric cancer. He received chemotherapy for liver metastasis and died 1 year after the recurrence.
  • Hideo Tomihara; Kazuhiko Hashimoto; Tomoko Wakasa; Hajime Ishikawa; Tomoyuki Tsujimoto; Atsushi Gakuhara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Jin-Ichi Hida; Yoshio Ohta; Masao Yukawa
    Surgical case reports 6 (1) 274 - 274 2020/10 [Refereed]
     
    BACKGROUND: Gallbladder neuroendocrine tumors (GB-NETs) are extremely rare, representing only 0.5% of all NETs because no neuroectodermal cells are present in the gallbladder. In 2019, the World Health Organization updated the classification of NETs based on their molecular differences. The mutation status of DAXX and ATRX has been added to the criteria for well-differentiated NETs. CASE PRESENTATION: A 50-year-old man presented to our hospital for further examination of a gallbladder polyp. He had no right quadrant pain, fever, jaundice, weight loss, or carcinoid syndrome-related symptoms. The patient hoped to avoid cholecystectomy. During the 3-year observation period, the polyp gradually increased in size from 8.3 to 9.9 mm. He decided to undergo surgery, and whole cholecystectomy was successfully performed. Immunohistochemical staining revealed positivity for chromogranin A, synaptophysin, and CD56. The Ki-67 index was < 3%. Taken together, these results led to a diagnosis of a grade 1 GB-NET. We also performed immunohistochemical staining of DAXX and ATRX, which revealed that DAXX protein expression was negative. The patient's postoperative course was uneventful, and he developed no recurrence for 8 years after surgery. CONCLUSION: We experienced a very rare case of GB-NET. Obtaining a correct preoperative diagnosis is quite difficult at the first evaluation. A GB-NET should be considered as a differential diagnosis of gallbladder tumors.
  • 膵神経内分泌腫瘍治癒切除後の肝転移再発を認め切除された一例
    杉崎 俊亮; 川崎 俊彦; 福永 朋洋; 野村 健司; 米澤 真衣; 半田 康平; 河野 辰也; 橋本 有人; 木下 大輔; 水野 成人; 若狭 朋子; 太田 善夫; 辻本 智之; 橋本 和彦; 石川 原; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 113回 83 - 83 2020/10
  • 対側乳腺のマンモグラフィー微細石灰化で発見された対側乳腺リンパ管転移の1例
    湯川 真生; 岡嶋 馨; 橋本 和彦; 井上 雅智; 若狭 朋子; 太田 善夫
    日本乳癌学会総会プログラム抄録集 (一社)日本乳癌学会 28回 325 - 325 2020/10
  • Shuichi Fukuda; Taichi Koyama; Tomoko Wakasa; Hitoshi Hanamoto; Tomoyuki Tsujimoto; Atsushi Gakuhara; Hideo Tomihara; Katsuya Ohta; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jin-Ichi Hida; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Surgical case reports 6 (1) 232 - 232 2020/09 [Refereed]
     
    BACKGROUND: Regional lymphadenopathy is more commonly noted in gastric schwannomas than in other gastric submucosal tumors. Most of the swollen lymph nodes associated with gastric schwannomas are non-metastatic lymphadenopathy. CASE PRESENTATION: A 69-year-old Japanese woman was referred to our hospital with a chief complaint of abdominal discomfort. Contrast-enhanced computed tomography (CT) of the abdomen revealed an extraluminal tumor with heterogeneous enhancement at the middle stomach on the lesser curve, accompanied with one swollen lymph node approximately 10 mm in size and several small lymph nodes in the perigastric region. These lymph nodes were flat; therefore, we considered them to be non-metastatic. The main tumor was removed via wedge resection. Soft and slightly swollen lymph nodes, which were compatible with the lymph nodes noted in the preoperative CT, were found near the main tumor in the fatty tissue at the lesser curvature of the stomach. An excisional biopsy of the largest lymph node was performed for the diagnosis. Based on pathological findings, a diagnosis of gastric schwannoma and follicular lymphoma (FL) was confirmed. The patient is doing well without recurrence of either the gastric schwannoma or FL 28 months postsurgery. CONCLUSIONS: The present report detailed an extremely rare case of FL coincidentally discovered in the swollen regional lymph node of gastric schwannoma.
  • 橋本 和彦; 水野 成人; 若狭 朋子; 辻本 智之; 額原 敦; 富原 英生; 福田 周一; 太田 勝也; 木谷 光太郎; 石川 原; 肥田 仁一; 太田 善夫; 湯川 真生
    胆道 日本胆道学会 34 (3) 568 - 568 0914-0077 2020/08 [Refereed]
  • 腸管子宮内膜症に発生した類内膜腺癌の1例
    松岡 基樹; 鹿庭 寛子; 張 波; 西岡 和弘; 金山 清二; 若狭 朋子; 大井 豪一
    産婦人科の進歩 「産婦人科の進歩」編集室 72 (2) 172 - 172 0370-8446 2020/05
  • 妊娠中期に発症した胎児巨大リンパ管腫の1症例
    松岡 基樹; 鹿庭 寛子; 張 波; 西岡 和弘; 金山 清二; 若狭 朋子; 大井 豪一
    日本産科婦人科学会雑誌 (公社)日本産科婦人科学会 72 (臨増) S - 663 0300-9165 2020/03
  • 覚道 健一; 若狭 朋子; 太田 善夫
    病理と臨床 (株)文光堂 38 (2) 124 - 129 0287-3745 2020/02 [Refereed][Invited]
  • 術前診断が困難であった肝多血性腫瘍の1例
    大丸 直哉; 川崎 俊彦; 高田 隆太郎; 福永 朋洋; 橋本 有人; 秦 康倫; 木下 大輔; 水野 成人; 橋本 和彦; 石川 原; 若狭 朋子; 太田 善夫; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 112回 93 - 93 2020/02
  • Rie Mizumoto; Masanori Tsujie; Tomoko Wakasa; Kotaro Kitani; Hironobu Manabe; Shuichi Fukuda; Kaoru Okada; Shumpei Satoi; Hajime Ishikawa; Toshihiko Kawasaki; Hitoshi Hanamoto; Masao Yukawa; Masatoshi Inoue
    Surgical case reports 6 (1) 2 - 2 2020/01 [Refereed]
     
    BACKGROUND: Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow. CASE PRESENTATION: We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction. CONCLUSIONS: Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.
  • Unno H, Mabuchi S, Arai I, Wakasa T, Yamamasu S.
    development of lymphangiosarcoma after pelvic radiation therapy for uterine cervical cancer: A case report and literature review
    Eur J Gynaecol. Oncol. doi: 10.31083/j-ejgo.2020.03.5082 2020
  • 根本 直人, 豊留 宗一郎, 若狭 朋子, 太田 善夫, 鈴木 晴也, 岩本 展子, 長田 哲次
    近畿大学医学雑誌 近畿大学医学会 45 (3-4) 69 - 74 0385-8367 2020 [Refereed]
     
    歯牙腫は、2017年のWHOの歯原性腫瘍の分類において、良性上皮間葉混合性歯原性腫瘍に分類され、複雑性と集合性に大別される。また、長径30mmを超えるものはまれであるとされている。今回われわれは、右側上顎臼歯部から右側上顎洞にかけて突出した大きな歯牙腫の1例を経験したのでその概要について報告する。患者は19歳、女性。歯科治療目的に近歯科を受診。パノラマX線画像にて、右側上顎洞に不透過像を認めたため、精査加療目的に当科紹介となった。口腔内所見にて、右側上顎第二大臼歯は完全埋伏しており、右側上顎第一大臼歯の遠心部から右側上顎結節にかけて無痛性で骨様硬の膨隆を認めた。パノラマX線及びCT画像にて、右側上顎洞内に、境界明瞭な塊状の不透過像を認め、右側上顎第二大臼歯はその上方に圧排され、深部埋伏を認めた。右側上顎骨腫瘍の臨床診断の下、全身麻酔下にて右側上顎顎骨腫瘍摘出術、右側上顎第二大臼歯抜歯術を施行。摘出標本は31×26×22mm大で、病理組織学的診断は複雑性歯牙腫であった。現在、上顎洞底部に骨再生を認め、上顎洞穿孔は認めていない。術後感染や再発所見、機能的な問題は認めず経過良好である。(著者抄録)
  • 水元 理絵, 橋本 和彦, 若狭 朋子, 辻本 智之, 額原 敦, 福田 周一, 木谷 光太郎, 石川 原, 肥田 仁一, 足利 竜一朗, 川崎 俊彦, 太田 善夫, 湯川 真生, 井上 雅智
    癌と化学療法 (株)癌と化学療法社 47 (13) 1845 - 1847 0385-0684 2020 [Refereed]
     
    症例は42歳、男性。左背部痛を主訴に近医を受診し、腹部CT検査で肝腫瘍を指摘され当院紹介受診となった。血液検査では肝障害を認めず、肝炎ウイルス、腫瘍マーカーは陰性であった。腹部エコー検査で肝左葉外側区域に血流豊富な8cm大の類円形高エコー腫瘤を認めた。腫瘤は造影エコー検査の動脈相で全体に不均一に、門脈相で全体に均一に染影され、胸腹部造影CT検査ではwash outは認めなかった。EOB-MRI検査では肝細胞相で低信号を示した。以上より、悪性の可能性を否定しきれず有症状であったため肝左葉切除術を施行し、肝血管筋脂肪腫(AML)と診断した。肝AMLは成熟脂肪細胞、血管内皮細胞、平滑筋細胞から構成されるperivascular epithelioid cell tumor(PEComa)の一種である。画像診断においては、血管成分と脂肪成分の証明や流出路血管が肝静脈である所見が鑑別に用いられる。脂肪成分が豊富な場合は画像所見で診断可能であるが、自験例は脂肪成分をほとんど含まず術前診断に難渋したものと考えられた。(著者抄録)
  • 橋本 和彦, 若狭 朋子, 川崎 俊彦, 辻本 智之, 額原 敦, 富原 英生, 福田 周一, 太田 勝也, 木谷 光太郎, 石川 原, 肥田 仁一, 太田 善夫, 湯川 真生, 井上 雅智
    癌と化学療法 (株)癌と化学療法社 47 (13) 1893 - 1895 0385-0684 2020 [Refereed]
     
    症例は69歳、女性。当院でB型慢性肝炎の加療中に肝細胞癌(S6、単発)を発症し、肝切除術を施行した。その後、肝内再発を認めRFA治療を2回施行した。肝切除術から7ヵ月後に左副腎転移を切除した。肝切除術から1年5ヵ月後に脾臓転移を切除し、さらに肝切除術から3年7ヵ月後に肝内再発に対して2回目の肝切除術と右副腎転移を切除した。初回肝切除術から5年8ヵ月後に腹部造影CTで上行結腸近傍に増大傾向を示す結節病変を認めた。腹膜播種再発と診断したが、その他に肝内再発や肝外転移を認めなかったため腹膜播種摘出術を施行した。病理組織学的所見は肝細胞癌の腹膜播種と診断した。術後6ヵ月経過現在、当院外来通院中であるが無再発生存中である。本症例のように肝内病巣の制御が良好であれば、切除する適応はあると考えられる。今回、肝細胞癌術後腹膜播種の1切除例を経験したので文献的考察を加えて報告する。(著者抄録)
  • 辻本 智之; 額原 敦; 富原 英生; 福田 周一; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 若狹 朋子; 太田 善夫; 湯川 真生
    癌と化学療法 (株)癌と化学療法社 47 (13) 1936 - 1938 0385-0684 2020 [Refereed]
     
    症例は74歳、女性。腹痛、体重減少を主訴に近医を受診した。腹部エコーにて横行結腸肝彎曲部に腫瘤を認め、当院紹介受診となった。下部消化管内視鏡検査にて肝彎曲部に横行結腸癌を認めた。上部消化管内視鏡検査にて十二指腸下行脚に粘膜の発赤、狭窄を認め、十二指腸浸潤が疑われた。CTで所属リンパ節転移を認めたが、明らかな遠隔転移は認めなかった。以上から、横行結腸癌、十二指腸浸潤(cT4b、N1、M0、cStage III)と診断した。術中に腹膜播種や肝転移を認めずR0手術が可能と判断し、結腸右半切除術・膵頭十二指腸切除術を施行した。病理組織学的所見にてpT4b(Duo、Pan)、N1b(3/35)M0、Stage IIIbと診断した。術後胃排泄遅延となったが保存的に治療を行い、第37病日に退院となった。外来にて術後補助化学療法(capecitabine単独療法)施行中であり、術後8ヵ月現在無再発生存中である。結腸癌の他臓器浸潤例ではR0切除ができれば長期生存が得られるという報告もあり、拡大切除を積極的に検討すべきと考えられた。(著者抄録)
  • 額原 敦, 福田 周一, 辻本 智之, 富原 英生, 太田 勝也, 木谷 光太郎, 橋本 和彦, 石川 原, 肥田 仁一, 若狭 朋子, 太田 善夫, 湯川 真生
    癌と化学療法 (株)癌と化学療法社 47 (13) 2156 - 2158 0385-0684 2020 [Refereed]
     
    症例は67歳、男性。食欲不振を主訴に前医を受診し、内視鏡検査で胃癌を指摘され紹介となった。内視鏡検査では胃角部に6cm大の0-I型の腫瘍を認めた。造影CT検査では明らかな所属リンパ節転移や遠隔転移は認めなかった。幽門側胃切除術、Billroth I再建を行った。経過は良好で術後11日目に退院された。術後病理組織学的診断はpT2N0M0、pStage IBで、術後経過観察の方針となった。術後4ヵ月の採血でCA19-9、AFP、PIVKA-II高値、CTで多発肝腫瘍を認めた。原発性肝癌の可能性を鑑別にあげ、肝生検が行われた。肝生検の結果、胃癌の肝転移と診断された。化学療法が開始されたが、最終的に門脈腫瘍塞栓、腹水貯留を認め、再発後1年で原病死された。AFPおよびPIVKA-II産生胃癌は、進行・切除不能症例が多いとされている。AFPおよびPIVKA-II産生胃癌について若干の文献的考察を加えて報告する。(著者抄録)
  • Development of lymphangiosarcoma after pelvic radiation therapy for uterine cervical cancer: A case report and literature review
    Unno H, Mabuchi S, Arai I, Wakasa T, Yamamasu S.
    Eur J Gynaecol. Oncol. doi: 10.31083/j-ejgo.2020.03.5082 - doi: 10.31083/j-ejgo.2020.03.5082 2020 [Refereed]
  • Masanori Tsujie; Soichi Fumita; Tomoko Wakasa; Shigeto Mizuno; Hajime Ishikawa; Kotaro Kitani; Shumpei Satoi; Kaoru Okada; Keisuke Inoue; Shuichi Fukuda; Hironobu Manabe; Noriko Ichimura; Shinya Ueda; Takao Tamura; Toshihiko Kawasaki; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    International journal of surgery case reports 72 471 - 476 2020 [Refereed]
     
    INTRODUCTION: We report a case of conversion surgery for pancreatic ductal adenocarcinoma (PDAC) with synchronous distant metastases showing pathological complete response (pCR) after FOLFIRINOX therapy. PRESENTATION OF CASE: A 46-year-old woman with obstructive jaundice was referred to our hospital. A CT scan revealed a hypo-vascular mass in the head of the pancreas with multiple para-aortic lymph nodes and a Virchow's node swollen. The serum CA 19-9 level was 71795.1 U/mL. The result of tumor biopsy from the biliary stenotic site was concordant with adenocarcinoma. She was diagnosed with PDAC with distant metastases. After 10 courses of FOLFIRINOX followed by 4 courses of FOLFIRI, a CT scan showed that distant lymph node swellings disappeared, and CA19-9 level became almost normal. She underwent pancreaticoduodenectomy with dissection of para-aortic lymph nodes 8 months after the initiation of chemotherapy. Pathologically, no evidence of residual adenocarcinoma was observed in neither pancreas nor lymph nodes. Adjuvant chemotherapy using S-1 was administered for 6 months, and no recurrence has been observed 4 years after surgery. BRCA1/2 mutations were not detected in patient's DNA. DISCUSSION: With the induction of intensive chemotherapies such as FOLFIRINOX, an increasing number of patients with synchronous distant metastases could become suitable candidates for surgery of the primary lesion because of the potential complete response of metastatic lesions. CONCLUSION: This case presented a rare occurrence of pCR in a patient with unresectable PDAC with distant metastases who received FOLFIRINOX. The feasibility and benefits of conversion surgery in such patients must be investigated in future trials.
  • Hiroki Akaba; Noriko Fujita; Gerhard Stauch; Yasuyo Matsumoto; Tomoko Wakasa; Kunimitsu Kawahara; Motoji Sawabe; Toshiaki Kawai
    Global health & medicine 1 (2) 110 - 113 2019/12 [Refereed]
     
    Rapid economic growth and a changing disease burden have increased the demand for pathology services in Cambodia. This paper describes the status of pathological services and international support for pathology professionals in Cambodia, and discusses future needs for strengthening pathology services. In 2016, there were only four pathologists and 18 pathology technologists in Cambodia. A postgraduate course in pathology was created in 2015, and five residents became certified in 2018. Besides multinational support with lectures and practice for pathologists, the Japanese team provides on-the-job training for pathology technologists to improve slide preparation for diagnosis. A clinicopathological conference was introduced to strengthen the communication among pathologists, pathology technologists, and gynecologists. Although there is a long way to go to reach high quality pathological services, coordination among international partners needs to continue, as does the balance between human resource development for pathology professionals, to provide a higher level of care to local citizens.
  • 肝細胞腺腫の1例
    山根 雅智; 秦 康倫; 松村 まり子; 福永 朋洋; 高田 隆太郎; 河野 匡志; 木下 大輔; 奥田 英之; 川崎 俊彦; 水野 成人; 日向 聖; 石川 原; 井上 雅智; 若狭 朋子; 太田 善夫; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 111回 76 - 76 2019/10
  • Masanori Tsujie; Soichi Fumita; Hajime Ishikawa; Kotaro Kitani; Shumpei Satoi; Shuichi Fukuda; Hironobu Manabe; Yusaku Akashi; Tomoko Wakasa; Hiroyuki Shiono; Takao Tamura; Masao Yukawa; Masatoshi Inoue
    Gan to kagaku ryoho. Cancer & chemotherapy 46 (8) 1259 - 1263 0385-0684 2019/08 [Refereed]
     
    We retrospectively analyzed adverse effects(AEs), overall survival(OS), and progression-free survival(PFS)in 15 consecutive patients treated with FOLFIRINOX as the first-line treatment for recurrent or unresectable pancreatic ductal adenocarcinoma( PDAC)between February 2014 and December 2017 in our hospital. Eleven patients were treated for unresectable PDAC with distant metastases(UR-M), and 4 were treated for locally advanced unresectable PDAC(UR-LA). The median age was 56(range: 40-75)years. Nine patients were male, and 6 were female. The performance status was 0 or 1 in all patients. Tumors were located in the pancreas head in 8 cases and in the body-tail in 7 cases. Grade 5 AEs were observed in 1 case in which liver abscess causing sepsis resulted in mortality. The response rate was 20.0%, and the disease control rate was 66.7%. Two patients underwent conversion surgery after FOLFIRINOX treatment. Seven patients received a nab-paclitaxel plus gemcitabine regimen as second-line treatment. The median OS and PFS were 17.0 and 8.4 months, respectively, and the 1-year survival rate was 66.7%. FOLFIRINOX for recurrent and unresectable PDAC showed relatively good tumor control. However, strict attention is required for severe AEs. Conversion surgery might be effective in patients who are good responders even if they have metastatic disease.
  • 子宮頸がん検診のための病理技術者育成と体制整備事業(カンボジア)における病理標本の質向上2018
    廣井 禎之; 小松 京子; 沢辺 元司; 副島 友莉恵; 片山 博徳; 布引 治; 河合 俊明; 若狭 朋子
    日本病理学会会誌 (一社)日本病理学会 108 (1) 443 - 443 0300-9181 2019/04
  • 【食道の炎症を視る】薬剤性・中毒性・物理的傷害性 放射線食道炎 長期経過まで含めた内視鏡像と病理像
    岡嶋 馨; 若狭 朋子
    消化器内視鏡 31 1231 - 1235 2019 [Refereed]
  • 若狹 朋子; 植田 初江; 竹内 真
    病理と臨床 (株)文光堂 37 (10) 976 - 981 0287-3745 2019 [Refereed]
  • 若狹 朋子
    産婦人科の実際 金原出版(株) 68 (13) 1519 - 1523 0558-4728 2019 [Refereed]
     
    ＜文献概要＞妊娠・分娩の仕組みはいまだ解明されていない点が多い。妊婦には侵襲的な検査ができない場合も多いことから,妊娠・分娩に関連した病態の研究は進んでいない。このため,異常妊娠・異常分娩の病態の理解のためには,事後のデータではあるが,病理解剖が多くの情報を提供する。妊産婦死亡登録事業に登録された解剖症例42例について検討したところ,15例36%の症例では剖検診断と臨床診断に不一致があった。現在,死後画像(Ai)の活用が模索されているが,妊産婦死亡症例については画像だけでは確定診断できない疾患が多いことから,妊産婦死亡が発生したときにはAiと病理解剖の併用が望ましいと考える。
  • 当院における再発・切除不能膵癌に対する一次化学療法としてのFOLFIRINOX療法の治療成績
    辻江 正徳; 文田 壮一; 石川 原; 木谷 光太郎; 里井 俊平; 福田 周一; 眞鍋 弘暢; 明石 雄策; 若狭 朋子; 塩野 裕之; 田村 孝雄; 湯川 真生; 井上 雅智
    癌と化学療法 46 1259 - 1263 2019 [Refereed]
  • Naoki Shimizu; Yusaku Akashi; Tomomi Fujii; Hiroyuki Shiono; Katsunari Yane; Tadashi Kitahara; Yoshio Ohta; Kennichi Kakudo; Tomoko Wakasa
    Anticancer research 39 (1) 413 - 420 2019/01 [Refereed]
     
    BACKGROUND: Patients with adenocarcinoma of the lung are routinely screened for anaplastic lymphoma kinase (ALK) rearrangement because they can be treated by ALK-specific targeted therapy. The clinical and molecular characteristics of large-cell neuroendocrine carcinoma (LCNEC) associated with ALK rearrangement are still unclear. Herein, we assessed the ALK status in a series of patients with LCNEC by testing methods commonly used for adenocarcinoma. MATERIALS AND METHODS: ALK expression was first examined by immunohistochemistry. For a positively stained tumor, molecular analyses were then conducted. The ALK fusion partner found in a patient with ALK rearrangement was further identified by direct DNA sequencing. Patient clinicopathological features were also analyzed, focusing on the ALK rearrangement-positive case. RESULTS: Immunohistochemistry of seven patients identified strong ALK expression in one case of stage IV LCNEC. Molecular analysis identified a novel rearranged gene resulting from the fusion of kinesin family member 5B (KIF5B) exon 17 to ALK exon 20. The patient was treated with ALK-specific inhibitors, crizotinib and later, alectinib, and has remained alive for more than 24 months without disease progression. Three of the remaining six patients without ALK rearrangement had stage IV cancer and received cytotoxic chemotherapies. Their average overall survival was 5.4 months. CONCLUSION: To our knowledge, this is the first report of a KIF5B-ALK fusion gene in LCNEC. The patient was successfully treated with ALK inhibitors, suggesting that sensitivity to ALK inhibitor may define a specific LCNEC subtype. We propose that screening for ALK rearrangement in patients with LCNEC may assist in selecting potential candidates for targeted therapy.
  • Masanori Tsujie; Tomoko Wakasa; Shigeto Mizuno; Hajime Ishikawa; Hironobu Manabe; Taichi Koyama; Kotaro Kitani; Shumpei Satoi; Keisuke Inoue; Shuichi Fukuda; Toshihiko Kawasaki; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    International journal of surgery case reports 55 136 - 139 2019 [Refereed]
     
    INTRODUCTION: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm, affecting primarily young females. Because SPNs are of low-malignancy, they rarely obstruct the main pancreatic duct (MPD) and cause atrophy of the distal pancreas even if their tumor sizes are large. PRESENTATION OF CASE: A 35-year-old female was referred to our hospital due to pancreatic tumor. Imaging findings showed the presence of well-defined round tumor in the body of the pancreas with 25-mm in diameter. The pancreas parenchyma distal to the tumor was markedly atrophic, and MPD dilatation was not observed. The lesion was diagnosed as SPN by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and central pancreatectomy was performed. Intraoperative frozen section of the distal atrophic pancreas showed no evidence of acinar cells, indicating exocrine dysfunction. Therefore, we closed distal pancreas stump instead of reconstruction. In the distal atrophic parenchyma, scattered foci of islets of Langerhans and the vestige of dilated MPD were observed. She has shown neither endocrine nor exocrine insufficiency after surgery. DISCUSSION: SPNs are usually found without atrophic change of distal pancreas. To the best of our knowledge, this is the first report of SPN in which exocrine dysfunction of atrophic pancreas was demonstrated pathologically and central pancreatectomy without anastomosis of distal pancreas was chosen for the surgical treatment. CONCLUSION: We reported a very rare case of SPN with marked distal parenchymal atrophy. We successfully performed central pancreatectomy without reconstruction.
  • 口腔粘膜擦過細胞診で診断が可能であった尋常性天疱瘡の1例
    浦 雅彦; 森 真俊; 福森 恭代; 寺口 皓; 河合 邦恵; 宇都宮 孝治; 若狭 朋子; 太田 善夫; 藤井 智美
    奈良県臨床細胞学会雑誌 奈良県臨床細胞学会 (19) 34 - 35 2434-7248 2018/12 [Refereed]
  • 絨毛癌と小細胞癌の胃衝突癌の1例
    福田 周一; 藤原 由規; 若狭 朋子; 濱田 隆介; 小原 秀太; 井上 啓介; 木谷 光太郎; 石川 原; 辻江 正徳; 湯川 真生; 太田 善夫; 井上 雅智
    奈良県医師会医学会年報 (一社)奈良県医師会 31 (1) 76 - 77 1343-2257 2018/08 [Refereed]
  • Teiko Sakurai; Hidenori Kusumoto; Tomoko Wakasa; Yoshio Ohta; Eiichi Konishi; Hiroyuki Shiono
    Surgical case reports 4 (1) 77 - 77 2018/07 [Refereed]
     
    BACKGROUND: Epithelioid sarcoma (ES) is a rare variant of soft tissue sarcoma. The proximal type of ES occurs in various locations. We present a resected case with proximal-type ES that occurred in the chest wall and discuss the relevant literature. CASE PRESENTATION: A 47-year-old woman was referred for a 6-month history of a right anterior chest mass with tenderness. Chest computed tomography showed an invasive chest wall mass with calcification surrounding the third rib. Aspiration biopsy cytology suggested malignancy. We performed wide resection, including the middle part of the pectoralis major muscle, the pectoralis minor muscle, the third and fourth ribs, and reconstruction of the chest wall, using a 2-mm polytetrafluoroethylene patch. Severe deformation of the chest wall was avoided. Postoperative physical therapy of the shoulder was effective for the continuous pain and weakness of the arm. She has remained alive for 1 year and 10 months without recurrence. Our literature review showed five previously reported cases of ES in the chest wall, and all of these were surgically resected. Two of these patients suffered from frequent local recurrence and died of disease. CONCLUSIONS: ES in the chest wall is rare. Previous reports have indicated that surgical resection with tumor-free margins is essential for treatment. We performed complete resection of the tumor in our case, and a polytetrafluoroethylene patch was effective for reconstructing the deficit in the chest wall.
  • Hiroshi Takeyama; Tomoko Wakasa; Keisuke Inoue; Kotaro Kitani; Masanori Tsujie; Takafumi Ogawa; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Molecular and clinical oncology 9 (1) 3 - 10 2018/07 [Refereed]
     
    In patients with colorectal liver metastases (CRLM), predictive markers for response to preoperative chemotherapy are lacking. The aim of the present study was to evaluate the expression of thymidylate synthase (TS) and excision repair cross-complementation group 1 (ERCC1) as predictive markers in CRLM. A total of 24 patients with CRLM were included in this study. Tumor response was evaluated using the tumor regression grade (TRG) and Response Evaluation Criteria in Solid Tumors (RECIST) methods. TS and ERCC1 expression in paired CRLM and primary lesions were assessed by immunohistochemistry. We analyzed correlations between i) the response to preoperative chemotherapy evaluated by TRG and RECIST, ii) TS and ERCC1 expression and the response evaluated by TRG and RESICT, and iii) TS and ERCC1 expression in matched pairs of primary tumor and CRLM. The preoperative chemotherapy response evaluated by TRG and RECIST was significantly associated (P=0.0005). The response based on RECIST criteria and TRG was significantly associated with TS expression in the primary tumor (P=0.0272, and P=0.0137, respectively). No correlations were detected between marker expression in the primary tumor and in CRLM for either TS or ERCC1 (P=0.371 and P=1.00, respectively). Our data suggested that TS expression in the primary tumor is a predictive marker of preoperative chemotherapy response in CRLM based on both TRG and RECIST methods.
  • 鹿庭 寛子; 冨本 雅子; 張 波; 西岡 和弘; 金山 清二; 若狭 朋子; 大井 豪一
    産婦人科の進歩 「産婦人科の進歩」編集室 70 (2) 256 - 256 0370-8446 2018/05
  • Junichi Hasegawa; Tomoko Wakasa; Hiroshi Matsumoto; Makoto Takeuchi; Naohiro Kanayama; Hiroaki Tanaka; Shinji Katsuragi; Masahiko Nakata; Takeshi Murakoshi; Kazuhiro Osato; Masamitsu Nakamura; Akihiko Sekizawa; Isamu Ishiwata; Tomoaki Ikeda
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 31 (3) 333 - 338 2018/02 [Refereed]
     
    OBJECTIVE: To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan. METHODS: Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed. RESULTS: Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy. CONCLUSION: Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.
  • Sumire SUGIMOTO; Tomoko WAKASA; Masahiko URA; Yasuyo HUKUMORI; Masatoshi MORI; Yoshio OTA; Masako NAKAMURA; Seiji KANAYAMA
    The Journal of the Japanese Society of Clinical Cytology The Japanese Society of Clinical Cytology 57 (5) 245 - 250 0387-1193 2018 [Refereed]
  • 大谷 知之; 若狹 朋子; 大林 千穂; 金山 清二; 大井 豪一; 太田 善夫
    診断病理 (一社)日本病理学会 35 (1) 47 - 53 1345-6431 2018 [Refereed]
     
    40代女性。腹部膨満を主訴とし、骨盤内腫瘍・血清AFP高値を指摘され、当院で切除術が施行された。病変は肉眼的に出血壊死を伴う白色充実性腫瘍であり、組織学的に淡明な細胞質を有する腫瘍細胞が網状・小嚢胞状、充実状、乳頭状など多彩なパターンを呈していた。免疫組織化学染色でSALL4陽性、AFP一部陽性であった。同時にPAX8一部陽性、HNF1β陽性であり、患者年齢・発生部位・組織形態を併せ明細胞癌との鑑別が問題となったが、核形態や多彩な組織像、CK7陰性、EMA陰性の所見も参考にし、最終的に後腹膜原発卵黄嚢腫瘍と診断した。40歳以上の患者に発生する卵黄嚢腫瘍は明細胞癌と慎重に鑑別される必要がある。(著者抄録)
  • 腹水細胞診から診断に至った卵管上皮内病変の一症例
    森岡佐知子 金山清二 若狹朋子 大井豪一
    日本婦人科腫瘍学会雑誌 36 30 - 35 2018 [Refereed]
  • 卵巣過剰刺激症候群に卵巣茎捻転を合併した一例
    中村雅子; 張 波; 生駒直子; 金山清二; 若狹朋子; 大井豪一
    奈良県産婦人科医会誌 61 73 - 73 2018 [Refereed]
  • 赤穂宗一郎; 喜多竜一; 井口恵里子; 越川頼光; 若狹朋子; 中島収
    肝臓 (一社)日本肝臓学会 59 (3) 187 - 193 0451-4203 2018 [Refereed]
     
    症例は60歳代・女性。健診にて腹部MRIを施行し、肝S6に腫瘤を指摘され精査目的に紹介となる。当院の腹部超音波にて肝S6に36mm大の境界のやや不明瞭で均一な高エコー腫瘤として認め、内部には小嚢胞を数個有していた。dynamic study CTでは動脈相で血管と同程度の強い濃染を呈し、門脈相まで造影効果は遷延した。血管造影検査を行いCTHA1相目で境界明瞭に腫瘍実質が均一に濃染し2相目ではcoronaは認めず造影効果が残存していた。single level dynamic CTHAでは腫瘍内部に点状の血管影が出現した後に腫瘍全体が徐々に濃染した。腫瘍内の毛細血管へ造影剤が流入する像であると考えられ毛細血管性血管腫を疑った。超音波下肝生検にてCD34およびFactor VIII陽性の毛細血管集簇巣を認めた。以上より肝毛細血管性血管腫と診断し経過観察となった。肝毛細血管性血管腫は稀な良性腫瘍であり、画像検査での診断が困難なため手術を施行された例を散見する。今回、single level dynamic CTHAにて特徴的な像を捉えた症例を経験し報告する。(著者抄録)
  • 水野 成人; 辻江 正徳; 若狭 朋子; 太田 善夫
    胆道 日本胆道学会 32 (4) 763 - 767 0914-0077 2018 [Refereed]
     
    胆道出血による肝胆道系酵素上昇が診断の契機となった胆嚢管癌の1例を経験した。症例は77歳男性、上腹部痛を訴え救急外来を受診した。肝胆道系酵素の上昇を認め、単純CTで総胆管・胆嚢管結石と診断した。抗血栓薬2剤を内服中であり、初回のERCでは胆管ステントを留置した。5日後のERC再検時、総胆管に明らかな結石は認めなかった。胆嚢管が造影されないため胆嚢管内の結石と判断し、手術を予定して一旦退院した。2ヵ月後に腹痛で再度救急受診した。単純CTで総胆管内に高吸収域を認め、胆道出血と診断した。ERCでは胆管口からの出血と胆管内に凝血塊を認めた。造影CTで胆嚢管に造影される腫瘤があり、胆嚢管癌を疑った。同部の擦過細胞診で腺癌と診断され、肝外胆管切除術が施行された。抗血栓療法中の患者が肝障害を認めた場合には、肝胆道系腫瘍からの出血の可能性を考慮する必要がある。(著者抄録)
  • 浦 雅彦; 森 真俊; 福森 恭代; 寺口 皓; 宇都宮 孝治; 河合 那恵; 覚道 健一; 若狹 朋子; 太田 善夫; 藤井 智美; 一木 澄香
    奈良県臨床細胞学会雑誌 奈良県臨床細胞学会 19 (19) 24 - 27 2434-7248 2018 [Refereed]
     
    口腔歯肉粘膜の擦過細胞診で診断が可能であった、尋常性天疱瘡のl例を経験したので報告する。症例は60歳代女性で、右上臼歯歯肉のびらんを主訴とし、3ヶ月後も改善しないため当院を受診、精査目的で口腔擦過細胞診がおこなわれた。Papanicolaou染色標本で、尋常性天疱瘡に特徴的なTzanck細胞が散在性から敷石状に認められた。2核から4核の多核細胞や、異型角化細胞を疑うような細胞も散見された。そのため、修復細胞(再生上皮)、ヘルベス感染細胞、扁平上皮癌細胞との鑑別を要したが、Tzanck細胞にはクロマチンの増加は認めず、細胞質はやや厚みをもち単染性から両染性であるため鑑別は可能であった。
  • Akira Watanabe; Kinya Nakanishi; Kazuo Kataoka; Tomoko Wakasa; Yoshio Ohta
    Surgical neurology international 9 (243) 243 - 243 2018 [Refereed]
     
    Background: Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are clinically rare, nonneoplastic, noninflammatory-calcified lesions of the central nervous system. Resection of a lesion usually indicates good prognosis without recurrence. However, we experienced a unique case of CAPNON that repeatedly recurred after resection. Case Description: A 52-year-old woman with recurrence of an undiagnosed brain tumor, which was resected 12 years ago, was admitted to our institution. Three calcifying lesions along with perifocal edema were detected in the frontal interhemispheric fissure. We performed the second surgery for total removal of the lesions. The patient was diagnosed with CAPNON on the basis of the clinical features of the lesions and medical examination results. However, 14 months after the second surgery, recurrence occurred, and the patient has been followed up conservatively thereafter. Conclusion: CAPNONs may indicate healing process associated with an unidentified agent. Maximum resection, including an unidentified agent, is necessary to prevent recurrence.
  • 若狹 朋子
    奈良県臨床細胞学会雑誌 奈良県臨床細胞学会 (18) 22 - 23 2434-7248 2017/12
  • オトガイ部および下唇知覚異常を契機に発見されたびまん性大細胞型B細胞性リンパ腫(diffuse large B cell lymphoma:DLBCL)の1例
    田中 里枝; 岩本 展子; 古田 治彦; 山口 万枝; 太田 善夫; 若狭 朋子
    日本口腔科学会雑誌 (NPO)日本口腔科学会 66 (2) 122 - 123 0029-0297 2017/07 [Refereed]
  • 竹山 廣志; 木谷 光太郎; 若狭 朋子; 辻江 正徳; 藤原 由規; 水野 成人; 湯川 真生; 太田 善夫; 井上 雅智
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 59 (6) 1444 - 1453 0387-1207 2017/06 [Refereed]
     
    【背景と目的】閉塞性大腸癌症例における術前減圧法としての大腸ステント(self-expanding metallic stent:SEMS)の有用性を経肛門イレウス管(transanal drainage tube:TDT)および減圧不成功により緊急手術となった症例(emergency surgery after failure of decompression:ESFD)と、病理組織学的変化を含めて比較検討した。【対象と方法】2010年1月から2015年6月までの術前減圧処置を試みた閉塞性大腸癌患者39例のデータを解析した。留置成功率、臨床的減圧成功率、切除標本の病理組織学所見について解析した。浮腫の程度については病理組織学的に評価を行った。【結果】留置成功率はSEMS群で100%、TDT群で78.9%であった。臨床的な減圧成功率はSEMS群で100%、TDT群で80.0%であった。術後腸閉塞はSEMS群でTDT群より有意に少なかった(P=0.014)。病理組織学的な浮腫の程度はSEMS群でTDT群より有意に改善していた(P<0.0001)。TDT群において、浮腫の程度は減圧期間と相関を認めなかった(P=0.629)、一方SEMS群はすべての症例で浮腫は軽度であった(浮腫grade 0-2)。人工肛門造設率は浮腫の程度が強い群(浮腫grade 3)において低浮腫群(浮腫grade 0-2)よりも高かった(P=0.003)。病理組織学的に穿孔を認めた症例は認めなかった。【結論】SEMSはTDTと比較して病理組織学的に有意に浮腫を改善させていた。この結果はSEMSがTDTと比較して、臨床的に良好な成績を得ている一因を示唆していると考えられる。(著者抄録)
  • Hiroshi Takeyama; Tsutomu Sakiyama; Tomoko Wakasa; Kotaro Kitani; Keisuke Inoue; Hiroaki Kato; Shinya Ueda; Masanori Tsujie; Yoshinori Fujiwara; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Oncology letters 13 (6) 4290 - 4294 2017/06 [Refereed]
     
    Disseminated carcinomatosis of the bone marrow (DCBM) is a condition in which bone marrow (BM) metastases diffusely invade the BM, and is frequently accompanied by disseminated intravascular coagulation (DIC). While prostate, lung, breast and stomach malignancies, in addition to neuroblastoma, are the most prevalent non-hematological malignancies to metastasize frequently to the BM, colorectal cancer is a malignancy that rarely metastasizes to the BM. The present case describes a 65-year-old male patient treated by resection and one course adjuvant chemotherapy for stage IIIC rectal cancer who presented with nasal bleeding at 8 months post-surgery. A blood test exhibited DIC. A BM biopsy was performed and the definitive diagnosis was DCBM with DIC. Promptly, anti-DIC treatment and chemotherapy with a modified FOLFOX6 (folinic acid, leucovorin (LV), 5-fluorouracil (5-FU) and oxaplatin) regimen was started. Following 1 cycle of chemotherapy, DIC was improved and subsequent to 2 cycles of modified FOLFOX6 the patient was discharged. The patient was alive 263 days subsequent to the diagnosis of DIC, but succumbed to carcinomatous meningitis as a result of disease progression. To the best of our knowledge, this is the first report of DCBM with DIC of curatively resected rectal cancer as the first presentation of relapse that was successfully treated with aggressive therapy, including chemotherapy.
  • Keiichi Takahashi; Tomoko Wakasa; Masayuki Shintaku
    Asian journal of surgery 40 (3) 243 - 247 2017/05 [Refereed]
     
    Primary squamous cell carcinoma of the breast (SCCB) is a rare disease, with a worldwide incidence <0.1%. In many cases, it is clinically characterized by rapid growth. Cyst formation due to central necrosis of the tumor accompanies its growth of the tumor in approximately 60-80% of all cases. Furthermore, it is considered difficult to diagnose SCCB solely on the basis of findings from diagnostic imaging. For large intracystic tumors, mammotome biopsy or core needle biopsy (CNB) is rarely performed. Instead, fine-needle aspiration (FNA) targeted at the tumor inside the cyst is often performed. The accurate diagnosis rate of SCCB using FNA is lower than that for ordinary-type breast cancer. If the cyst is large, the solid tumor shadow outside the cyst behind or around the cyst may be masked or hidden by the large cyst, which can sometimes yield an unclear view of the tumor shadow or make it impossible to visualize the shadow. In the present case, the contents within the cyst were completely aspirated and collected during the first step (FNA), thereby yielding a clearer, complete view of the solid tumor located outside the cyst. Thus, the subsequent step (CNB) was able to be performed in a more accurate and reliable manner. The combined use of FNA and CNB proved to be useful in making a preoperative diagnosis of SSCB accompanying a cyst.
  • Shuichi Fukuda; Yoshinori Fujiwara; Hiroshi Mishima; Tomoko Wakasa; Hitoshi Hanamoto; Keisuke Inoue; Kotaro Kitani; Hajime Ishikawa; Masanori Tsujie; Masao Yukawa; Kaoru Okajima; Yoshio Ohta; Masatoshi Inoue
    Clinical case reports 5 (4) 419 - 424 2017/04 [Refereed]
     
    Granulocyte colony-stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma (ESCC) is rare. Esophageal cancer is a highly aggressive disease and often spreads hematogenously; however, choroidal metastases are rarely seen. This report detailed an extremely rare case of G-CSF-producing ESCC with choroidal metastasis.
  • Shuichi Fukuda; Yoshinori Fujiwara; Tomoko Wakasa; Kotaro Kitani; Masanori Tsujie; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Journal of medical case reports 11 (1) 33 - 33 2017/02 [Refereed]
     
    BACKGROUND: At the time of diagnosis, giant gastric gastrointestinal stromal tumors are sometimes associated with severe peritoneal dissemination. Unresectable gastrointestinal stromal tumors are considered a systemic disease; therefore, imatinib therapy is currently the primary treatment option in these cases. CASE PRESENTATION: A 49-year-old Japanese woman was referred to our hospital with symptoms of anorexia, abdominal discomfort, and a palpable abdominal mass. Contrast-enhanced computed tomography revealed a huge mass with an irregular wall, approximately 22 cm in size, located between the posterior gastric wall and her pancreas. The tumor grew rapidly, and her abdominal symptoms worsened; therefore, a semi-urgent laparotomy was performed. The tumor had arisen from her upper stomach and was removed by wedge resection of her stomach. In addition, widely distributed multiple white nodules were noted, which were resected as far as possible. Immunohistochemical staining of the resected specimen was positive for KIT and CD34. The resected white nodules contained the same cells as the primary tumor. Based on these pathological findings, a final diagnosis of a gastric gastrointestinal stromal tumor with peritoneal dissemination was made. Imatinib was administered at 400 mg per day from 1 month postoperatively. The disease progression of the residual disseminated lesions was favorably controlled, and our patient is now doing well, 12 months after surgery. CONCLUSIONS: Imatinib therapy following debulking surgery can show dramatic effectiveness in giant gastric gastrointestinal stromal tumors with severe peritoneal dissemination.
  • 副腎に発生した平滑筋肉腫の1例
    高橋 一肇; 松浦 知弘; 長谷川 博一; 藤原 一央; 岡嶋 馨; 若狭 朋子; 上島 成也
    Japanese Journal of Radiology (公社)日本医学放射線学会 35 (Suppl.) 43 - 43 1867-1071 2017/02
  • NAKAMURA Masako; ZHANG Bo; SUGIMOTO Sumire; IKOMA Naoko; WAKASA Tomoko; KANAYAMA Seiji; OI Hidekazu
    ADVANCES IN OBSTETRICS AND GYNECOLOGY THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN 69 (2) 131 - 137 0370-8446 2017 [Refereed]
     

    Genital tuberculosis sometimes progresses to tuberculous peritonitis. It may show same findings as peritoneal metastasis and nodes of malignant tumor. We report a case of genital tuberculosis with tuberculous peritonitis hard to be diagnosed before operation. The patient was a 68-year-old woman, gravida 3, para 2. She visited another hospital complaining of abdominal distention continuous for two months. Ultrasonography indicated a moderate volume of ascitic fluid. Magnetic resonance imaging showed peritoneal metastasis. Her serum CA125 level was 139 U/ml. Upper gastrointestinal endoscopy and colonoscopy did not show any abnormal findings. Cytological findings were normal in ascites, uterine cervix and endometrium. The possibility of peritoneal cancer could not be excluded. Hence, she was referred to our hospital. The level of adenosine deaminase (ADA) in her ascites was high, although acid-fast bacilli were not detected. We performed a surgical biopsy with N95 mask. Rapid perioperative histopathological analysis of the peritoneum and omentum revealed an epithelioid granuloma with Langhans' giant cells. Thus, we strongly suspected tuberculous peritonitis. We performed a total hysterectomy and bilateral salpingo-oophorectomy. After the operation, T-SPOT and PCR for tubercle bacilli, on the fluid retained in the uterus, were positive. Tubercle bacilli were cultured from the ascites. Histopathological diagnosis was genital tuberculosis and tuberculous peritonitis. Therefore, treatment with anti-tuberculosis drugs was started. In the cases suspected carcinomatous peritonitis, particularly high levels of ascites ADA without malignant cells, it appears important to include tuberculous peritonitis as a differential diagnosis.[Adv Obstet Gynecol, 69 (2) : 131-137, 2017 (H29.5)]

  • 高山 政樹; 大原 裕士郎; 秦 康倫; 木下 大輔; 奥田 英之; 川崎 俊彦; 水野 成人; 若狭 朋子; 太田 善夫; 工藤 正俊
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 59 (4) 450 - 455 0387-1207 2017 [Refereed]
     
    症例は89歳、男性。2015年3月より悪性黒色腫に対しニボルマブ投与が開始され、今回8回目の投与目的で入院となった。投与後より腹痛・下痢・下血を認め、当科に紹介された。下部消化管内視鏡検査にて潰瘍性大腸炎類似の所見を認めたため、ニボルマブによる免疫有害事象と判断し、ステロイド治療を開始した。その後臨床症状、内視鏡所見は著明に改善した。ニボルマブによる免疫有害事象による腸炎は、注目すべき病態と考える。(著者抄録)
  • 河合 賢二; 中室 誠; 大久保 遊平; 近藤 禎晃; 若狭 朋子; 太田 善夫
    日本臨床外科学会雑誌 日本臨床外科学会 78 (4) 830 - 835 1345-2843 2017 [Refereed]
     
    症例は63歳,女性.他院にて21年前に膵solid pseudopapillary neoplasm(SPN)に対して膵体尾切除術を施行された.術後の定期フォローは再発なく終了し,糖尿病・高血圧症で当院内科に定期通院中であった.食思不振を訴え,精査のため撮影したCT・MRI検査で肝左葉に10cm以上の多房性腫瘤を認めた.SPNの肝転移再発,その他の腫瘍の可能性を考慮され,診断・治療目的で拡大肝左葉切除術を施行された.切除された肝腫瘍は初回手術時のSPNと類似した組織像であり,vimentin強陽性,CD10びまん性に陽性,CD56弱陽性,progesteron receptor弱陽性,β-catenin陽性でSPNの肝転移再発として矛盾しない所見であった.原発巣切除から20年以上経過して肝転移再発したSPNの症例の報告はなく,非常にまれであると考えられたため若干の文献的考察を加えて報告する.(著者抄録)
  • 坂本 鉄基; 櫻井 禎子; 井上 啓介; 若狭 朋子; 太田 善夫; 塩野 裕之
    日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 31 (4) 494 - 500 0919-0945 2017 [Refereed]
     
    肺癌の大腸転移はまれであり、自覚症状に伴い発見されることが多い。肺癌術後の無症状経過中にPET-CTで病変を指摘し得た症例を経験したので報告する。症例は69歳、男性。右上葉肺癌(acinar adenocarcinoma、pT1aN0M0、pStage IA)に対して右肺上葉切除+ND2a-1施行後、外来経過観察中であった。自覚症状はなく、術後2年目の胸腹部CTにて左肺門リンパ節腫大および盲腸周囲リンパ節腫大を認めた。PET-CTで回盲部に集積を認め、下部消化管内視鏡検査を施行した。生検の結果Group5、腺癌を認め、大腸癌と診断し手術を施行した。病理組織学的検査結果にて肺癌盲腸転移と診断した。根治切除が行われた早期肺癌でも大腸転移を起こすことがあり、PET-CTでの全身検索の検討の余地がある。(著者抄録)
  • A case of rare primary cystic-type squamous cell carcinoma of the breast that could be preoperatively diagnosed./ /2017;40
    Takahashi K, Wakasa T, Shintaku M
    Asian J Surg. 40 (243) 247  2017 [Refereed]
  • Teiko Sakurai; Tetsuki Sakamoto; Tomoko Wakasa; Yoshio Ohta; Hiroyuki Shiono
    International journal of surgery case reports 30 (186) 186 - 189 2017 [Refereed]
     
    BACKGROUND: A thymoma, an epithelial neoplasm of the thymus, mainly occurs in the anterior mediastinum, while few are seen in the middle mediastinum. CASE PRESENTATION: An 83-year-old male was referred for an incidental mass in the middle mediastinum. He had severe dementia and denied symptoms. Our follow-up computed tomography (CT) examinations had revealed the progress of tracheal compression along with tumor enlargement for 2 years. At 85 years old, we performed a thymomectomy via a median sternotomy to avoid complete trachea obstruction. The pathological diagnosis was WHO type A thymoma, Masaoka stage II. One year after surgery, the patient was free of disease. DISCUSSION: Thymomas occurring in the middle mediastinum are rare. In our review of 13 such cases, none were Masaoka stage III or IV, while the majority (9/13, 69.2%) were WHO type A or AB. CONCLUSION: We encountered a thymoma in the middle mediastinum that showed enlargement over a 2-year period, inducing severe tracheal compression. Thymomas can occur widely in pharyngeal pouch-derived locations and should be considered in differential diagnosis of a middle mediastinum tumor.
  • Shuichi Fukuda; Yoshinori Fujiwara; Tomoko Wakasa; Keisuke Inoue; Kotaro Kitani; Hajime Ishikawa; Masanori Tsujie; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    International journal of surgery case reports 36 (64) 64 - 68 2017 [Refereed]
     
    INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are clinically asymptomatic until they reach a significant size; therefore, GISTs that are 2cm or less are typically asymptomatic. Patients with symptomatic GISTs typically present with abdominal pain, gastrointestinal bleeding, or a palpable mass but rarely present with hemoperitoneum. PRESENTATION OF CASE: A 72-year-old Japanese man presented to us with acute onset abdominal pain. Physical examination showed peritoneal irritation in the lower abdomen. Findings of abdominal computed tomography were suggestive of hemoperitoneum; therefore, urgent surgery was performed. Approximately 1500ml of blood in the abdominal cavity was removed. A small, ruptured mass was found in the middle of the small intestine, and partial resection of the small intestine, including the mass, was performed. The resected tumor was 2cm in size and exhibited an exophytic growth pattern. Immunohistochemical staining revealed that the tumor was positive for KIT and CD34; therefore, a final diagnosis of GIST was made. Treatment with imatinib at 400mg per day was started from postoperative month 1. The patient is doing well without recurrence 5 months after surgery. DISCUSSION: Even small GISTs in the small intestine can spontaneously rupture and cause hemoperitoneum. Moreover, when a patient presents with sudden abdominal pain and hemoperitoneum without an evident mass on imaging, clinicians should be aware of the possibility of bleeding from a small GIST in the small intestine. CONCLUSION: We present an extremely rare case of a patient with a small, spontaneously ruptured GIST in the small intestine, resulting in hemoperitoneum.
  • Shuichi Fukuda; Yoshinori Fujiwara; Tomoko Wakasa; Keisuke Inoue; Kotaro Kitani; Hajime Ishikawa; Masanori Tsujie; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    International journal of surgery case reports 37 (216) 216 - 220 2017 [Refereed]
     
    INTRODUCTION: Both gastric choriocarcinoma and small cell carcinoma are extremely rare, both accounting for approximately 0.1% of all gastric cancers. Therefore, simultaneous occurrence of gastric choriocarcinoma and small cell carcinoma is even rarer. PRESENTATION OF CASE: An 84-year-old Japanese man was referred to our hospital with the chief complaint of dysphagia. Laboratory data showed iron deficiency anemia. Contrast-enhanced computed tomography of the abdomen revealed thickened wall of the stomach at the fundus and several enlarged abdominal lymph nodes. Upper gastrointestinal endoscopy showed a friable gastric tumor with necrosis in the gastric cardia extending to the abdominal esophagus. Small cell carcinoma was diagnosed based on pathological examination of biopsy specimens. The anemia, which was probably because of tumor bleeding, progressed despite repeated transfusion; therefore, a semi-urgent laparotomy was performed to control hemorrhage. Finally, total gastrectomy and lymph node resection were performed. Based on pathological findings, a diagnosis of collision tumor of choriocarcinoma and small cell carcinoma of the stomach was confirmed. DISCUSSION: When encountering large tumors with necrosis or hemorrhage in the stomach, the possibility of choriocarcinoma component should be considered. Moreover, when small cell carcinoma is morphologically suspected, even if slightly, additional immunohistochemical staining must be performed. CONCLUSION: This report detailed an extremely rare case of collision tumor of choriocarcinoma and small cell carcinoma of the stomach.
  • 井上 啓介; 藤原 由規; 古形 修平; 金泉 博文; 福田 周一; 竹山 廣志; 木谷 光太郎; 辻江 正徳; 湯川 真生; 若狭 朋子; 太田 善夫; 井上 雅智
    癌と化学療法 (株)癌と化学療法社 43 (12) 1869 - 1871 0385-0684 2016/11 [Refereed]
     
    症例は71歳、男性。主訴は貧血、体重減少、食欲低下。超音波検査で胃の壁肥厚を指摘され、上部消化管内視鏡検査で胃体部大彎に3型病変を認めた。胃全摘+横行結腸部分切除術+Roux-en-Y再建術を施行した。術後病理結果でadenocarcinoma、tub2とdiffuse large B cell lymphomaの衝突所見が認められた。現在、悪性リンパ腫に対して化学療法を行っており、再発なく経過している。(著者抄録)
  • Keisuke Inoue; Yoshiyuki Fujiwara; Shuhei Kogata; Hirofumi Kanaizumi; Shuichi Fukuda; Hiroshi Takeyama; Kotaro Kitani; Masanori Tsujie; Masao Yukawa; Tomoko Wakasa; Yoshio Ohta; Masatoshi Inoue
    Gan to kagaku ryoho. Cancer & chemotherapy 43 (12) 1869 - 1871 0385-0684 2016/11 
    A 71-year-old man with anemia, weight loss, and loss of appetite was admitted. Ultrasound examination found thickening of the wall of the stomach. A type 3 gastric tumor was detected in the greater curvature of the gastric corpus via upper gastrointestinal endoscopy. Total gastrectomy, transverse colon resection, and Roux-en-Y anastomosis reconstruction was performed. In the postoperative pathological results, adenocarcinoma, tub2, and diffuse large B cell lymphoma collision was found. The patient underwent chemotherapy for malignant lymphoma and although it was a relatively advanced neoplasia, he is alive without a recurrence.
  • 西川 侑輝; 御勢 久也; 和田 翔大; 澤口 博千代; 村木 正人; 若狭 朋子; 太田 善夫; 寺嶋 応顕; 上田 眞也; 明石 雄策; 塩野 裕之; 東田 有智
    気管支学 (NPO)日本呼吸器内視鏡学会 38 (5) 449 - 449 0287-2137 2016/09
  • 閉塞性大腸癌に対する術前大腸ステントは経肛門ドレナージチューブより病理組織学的な腸管の浮腫を改善する
    竹山 廣志; 木谷 光太郎; 井上 啓介; 福田 周一; 辻江 正徳; 若狭 朋子; 藤原 由規; 湯川 真生; 太田 善夫; 井上 雅智
    日本消化器外科学会総会 (一社)日本消化器外科学会 71回 P2 - 3 2016/07 [Refereed]
  • Hiroshi Takeyama; Kotaro Kitani; Tomoko Wakasa; Masanori Tsujie; Yoshinori Fujiwara; Shigeto Mizuno; Masao Yukawa; Yoshio Ohta; Masatoshi Inoue
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 28 (4) 456 - 464 2016/05 [Refereed]
     
    AIMS: To compare the usefulness of the self-expanding metallic stent (SEMS) with that of the transanal drainage tube (TDT) and emergency surgery after failure of decompression (ESFD) in patients with malignant colonic obstruction (MCO), and to evaluate post-decompression histopathologic changes. METHODS: From January 2010 to June 2015, 39 patients with MCO received SEMS, TDT, and ESFD. We evaluated the outcomes including success rates of placement, clinical outcomes after decompression, and histopathologic findings of the resected specimens. RESULTS: Technical success rates were 100% for SEMS and 78.9% for TDT. Clinical success rates were 100% for SEMS and 80.0% for TDT. Postoperative ileus was significantly less frequent after SEMS than after TDT (p = 0.014). Histopathologic edema grade was significantly lower for SEMS than for TDT and ESFD (p < 0.0001). There was no significant difference between edema grade and duration of decompression in the TDT group (p = 0.629), while all patients with SEMS were classified in a low edema grade (grade 0-2). The rate of stoma creation was significantly higher in patients with a high edema grade (grade 3) than in those with a low edema grade (grade 0-2) (p = 0.003). There was no microscopic perforation in any group. CONCLUSION: Significantly greater resolution of histopathologic edema was achieved after placement of SEMS than after placement of TDT. These findings provide an indication of favorable clinical outcomes of SEMS in comparison with TDT and ESFD. This article is protected by copyright. All rights reserved.
  • 櫻井 禎子; 竹山 廣志; 木谷 光太郎; 井上 啓介; 辻江 正徳; 若狭 朋子; 太田 善夫; 井上 雅智
    日本臨床外科学会雑誌 日本臨床外科学会 77 (4) 904 - 908 1345-2843 2016/04 [Refereed]
     
    症例は83歳,女性.肝嚢胞のフォローアップ中,腹部造影CTで結腸肝彎曲部に壁肥厚を認めた.下部消化管内視鏡で上行結腸肝彎曲部に隆起性病変を認め,生検より神経内分泌癌(neuroendocrine carcinoma;NEC)と診断され手術目的で当科紹介となった.腹腔鏡下結腸右半切除術を施行し,大細胞型神経内分泌癌(large cell neuroendocrine carcinoma;LCNEC)の診断となった.本症例では,診断時に遠隔転移を認めず腹腔鏡下に治癒切除を施行しえた.術後6ヵ月が経過し再発は認めていない.大腸LCNECは消化管悪性腫瘍の中ではまれで,検索しえた範囲では9編の症例報告に留まった.非常にまれな症例を経験したので報告する.(著者抄録)
  • Hiroaki Kato; Masanori Tsujie; Tomoko Wakasa; Shuhei Kogata; Hirofumi Kanaizumi; Hiroshi Takeyama; Johji Hara; Kotaro Kitani; Yoshinori Fujiwara; Shigeto Mizuno; Toshihiko Kawasaki; Yoshio Ohta; Masao Yukawa; Masatoshi Inoue
    International cancer conference journal 5 (2) 107 - 112 2016/04 [Refereed]
     
    We report a rare case of a diffuse large B-cell lymphoma (DLBCL) arising from the common bile duct (CBD). A 77-year old man presented with general fatigue and obstructive jaundice. Abdominal computed tomography revealed a well-circumscribed enhancing mass in the midportion of the CBD with proximal bile duct dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) also showed a midportion of the CBD stricture. Direct peroral cholangioscopy revealed smooth mass in the midportion of the CBD, and narrow-band imaging (NBI) showed irregular tortuous microvessels. The brushing cytology of the CBD was performed, and it was diagnosed as suspicious for poorly differentiated adenocarcinoma or malignant lymphoma. We performed extrahepatic bile duct resection for accurate diagnosis. Histological and immunohistochemical examination of the resected specimen revealed DLBCL. Although systemic chemotherapy is the mainstay of treatment for DLBCL, he refused scheduled subsequent chemotherapy, and died of multiple liver metastases 6 months after surgery.
  • Ichiro Ohashi; Isao Arai; Chieko Tamura; Nobuyasu Hayashi; Shigeharu Inoue; Tomoko Wakasa
    Gan to kagaku ryoho. Cancer & chemotherapy 42 (12) 2103 - 5 0385-0684 2015/11 [Refereed]
     
    We report here a rare case of gastric metastasis after resection ofa transverse colon cancer in which eating ability was restored following mFOLFOX6 (folinic acid plus fluorouracil plus oxaliplatin) plus cetuximab (Cet) chemotherapy. A 56-year-old man with chief complaints of constipation and abdominal fullness was referred to our hospital. In February 2013, he was diagnosed with transverse colon cancer via enema and colonoscopy. We performed transverse colon cancer resection followed by a 6-month course of capecitabine chemotherapy. In July 2014, the patient's serum carcinoembryonic antigen level increased, in October, he was again referred to our hospital with complaints of appetite loss and vomiting. He was diagnosed with multiple lymph node and gastric metastases via ultrasonography, computed tomography, and endoscopy, as well as multiple lung metastases via computed tomography. As the gastric metastases and vomiting rendered him unable to eat, a nasogastric tube was inserted and was administered mFOLFOX6 plus Cet chemotherapy. After 2 courses of chemotherapy his ability to eat was restored. As of March 2015, the patient remains alive following 12 courses of chemotherapy.
  • 森下 祐次; 米倉 竹夫; 山内 勝治; 大割 貢; 神山 雅史; 石井 智浩; 太田 善夫; 若狭 朋子
    日本小児外科学会雑誌 (NPO)日本小児外科学会 51 (4) 818 - 822 0288-609X 2015/06 [Refereed]
     
    症例は9歳男児。下腹部痛を主訴に近医受診し腸炎と診断された。しかし症状は改善せず、血液検査で強い炎症所見を認めたため精査加療目的にて当院へ紹介となった。腹部CT検査ではS状結腸に接した約5cmの腫瘤を認め、感染を伴う腫瘤病変を疑い抗生剤治療を行ったが、炎症所見は改善しなかった。MRI検査にて血腫成分を伴う腫瘍病変も疑い、単孔式腹腔鏡下手術を施行した。腫瘍は骨盤腔内に存在し、大網、腸間膜、膀胱、腹壁に軽度癒着を認めていたが、鈍的剥離のみで腫瘍を摘出した。腫瘤は5.5×5.0×3.5cmの充実性腫瘍で、特殊染色検査および遺伝子検索からepithelioid inflammatory myofibroblastic sarcoma(EIMS)と診断された。EIMSは再発に対する補助療法の効果が少ないため、外科的治療が重要とされる腫瘍である。本症例では術後補助療法を施行せず2年が経過しているが、再発を認めていない。今後もさらなる経過観察は必要と思われる。(著者抄録)
  • 覚道 健一; 若狭 朋子; 太田 善夫
    内分泌・糖尿病・代謝内科 = Endocrinology, diabetology & metabolism 科学評論社 40 (5) 362 - 366 1884-2917 2015/05 [Refereed][Invited]
  • SHINTAKU Masayuki; WADA Kyosuke; WAKASA Tomoko; MISE Yuka
    J. Jpn. Soc. Clin. Cytol. The Japanese Society of Clinical Cytology 54 (2) 164 - 169 0387-1193 2015 
    Background : Small cell carcinoma of the ovary of the hypercalcemic type (SCCO-H) is a rare tumor which predominantly affects young women and shows an aggressive biological behavior. Early and accurate pathological diagnosis is highly desirable for the therapy and management of patients. Only a few previous reports have described the cytological findings of this tumor. We report the intraoperative cytological findings of an additional case.
    Case : A 39-year-old woman presented with a large left ovarian tumor accompanied by peritoneal dissemination and ascites. Intraoperative cytological examination of ascitic fluid and imprint smears of the cut surface of the extirpated ovarian tumor demonstrated sheet-like clusters of small to medium-sized cells with atypical nuclei and scant cytoplasm. Large polygonal cells with abundant cytoplasm were also admixed. The histopathology of the ovarian tumor demonstrated typical features of SCCO-H.
    Conclusion : The cytological findings of SCCO-H are largely non-specific and need to be differentiated from various other ovarian tumors. The distinction from desmoplastic small round cell tumor, a rare soft tissue tumor that occasionally involves the ovary, is particularly difficult and requires adjunct immunohistochemical studies.
  • Takaaki Murakami; Masato Taki; Takuo Nambu; Tomoko Wakasa; Tomoko Kato; Yuki Matsuda; Shin Yonemitsu; Seiji Muro; Shogo Oki
    Internal medicine (Tokyo, Japan) JAPAN SOC INTERNAL MEDICINE 54 (7) 807 - 12 0918-2918 2015 [Refereed]
     
    A 55-year-old man presented with a rapidly enlarging thyroid. He had been diagnosed with lung adenocarcinoma nine months earlier. Computed tomography (CT) and ultrasound (US) detected reticular cord-like structures, but no nodules, in the thyroid. A fine-needle aspiration biopsy (FNAB) of the thyroid revealed thyroglobulin-negative adenocarcinoma cells, thus establishing the diagnosis of diffuse thyroid metastases of lung cancer. Moreover, the fluid demonstrated milky chyliform effusion. This case suggests that the presence of reticular cord-like structures on US and CT may be a key imaging finding for the clinical diagnosis of diffuse thyroid metastases and that chyliform effusion may contribute to rapid goiter formation.
  • Kennichi Kakudo; Tomoko Wakasa; Yoshio Ohta; Katsunari Yane; Yasuhiro Ito; Hiroyuki Yamashita
    Endocrine journal JAPAN ENDOCRINE SOC 62 (1) 1 - 12 0918-8959 2015 [Refereed]
     
    This review emphasizes that the so-called high-risk thyroid carcinoma is not a distinct tumor entity, but a group of tumors with different histologies. High-grade histological features, such as tumor necrosis, increased mitoses, and nuclear pleomorphism, together with high Ki-67 labeling index (more than 10%), are good indicators of high-risk thyroid carcinoma and suggest a possible risk for anaplastic transformation. This review proposes the stratification of patients with thyroid carcinoma into low-, moderate-, and high-risk groups based on Ki-67 labeling index, which should be useful for the clinical management of patients, even after initial surgery. Currently, both the aggressive variant of papillary carcinoma and poorly differentiated carcinoma are aggressively treated by a completion of total thyroidectomy with prophylactic lymph node dissection followed by radioactive iodine treatment. Therefore, patients with moderate-risk or high-risk thyroid carcinoma based on Ki-67 labeling index should also be considered candidates for this treatment strategy.
  • Takashi Kanesaka; Akira Sekikawa; Takehiko Tsumura; Takanori Maruo; Yukio Osaki; Tomoko Wakasa; Masayuki Shintaku; Kenshi Yao
    Gastrointestinal endoscopy 80 (6) 1194 - 1198 2014/12 [Refereed]
  • Tomoko Wakasa; Yaqiong Li; Yanhua Bai; Zhiyan Liu; Takashi Ozaki; Ichiro Mori; Akira Miyauchi; Kennichi Kakudo; Misa Nakamura
    Pathology, research and practice 210 (11) 733 - 8 2014/11 [Refereed]
     
    The aim of the present study is to investigate the relationship between urinary-type plasminogen activator (uPA) expression and clinicopathological features in papillary thyroid carcinoma (PTC) and to determine the signal transduction of PTC cells in vitro. PTC tissues from 42 patients were analyzed for the expression of uPA and the BRAF(V600E) mutation. BCPAP, a PTC cell line harboring the BRAF(V600E) mutation, was used to study MAPK signaling. PCR and direct sequencing were applied to analyze BRAF(V600E) mutation status. uPA mRNA expression was measured using a quantitative RT-PCR method, and uPA protein was localized using an immunohistochemical method. The ERK protein status was detected by Western blot analysis. uPA gene expression was significantly increased in PTC tissues as compared to the corresponding non-tumor tissues. Furthermore, the up-regulation of uPA mRNAs was correlated with high-risk clinicopathological features, including extrathyroid invasion, loss of cellular polarity/cohesiveness, and the BRAF(V600E) mutation. Marked dephosphorylation of ERK1/2 and down-regulation of uPA expression were detected when BCPAP was treated with a MEK inhibitor, U0126. MEK inhibitors might be a potential treatment strategy for aggressive PTC with BRAF(V600E) through inhibition of uPA expression.
  • Ichiro Ohashi; Isao Arai; Chieko Tamura; Nobuyasu Hayashi; Shigeharu Inoue; Tomoko Wakasa
    Gan to kagaku ryoho. Cancer & chemotherapy 41 (12) 1758 - 60 0385-0684 2014/11 [Refereed]
     
    We report a rare case of long -term survival after laparoscopic resection of sigmoid colon cancer with multiple liver metastases, followed by 5-fluorouracil Leucovorin irinotecan with bevacizumab (FOLFIRI+Bev) chemotherapy. A 61-year-old woman was referred to our hospital with a principal complaint of bloody stools. She was diagnosed with sigmoid colon cancer by colonoscopy and multiple liver metastases by ultrasonography. In October 2008, we performed laparoscopic resection of the sigmoid colon cancer with multiple liver metastases, followed by 4 courses of modified 5-fluorouracil Leucovorin oxaliplatin ( mFOLFOX6) chemotherapy. In February 2009, abdominal ultrasonography showed progressive disease, and as a result the patient was administered 73 courses of FOLFIRI +Bev chemotherapy. As of March 2014, the patient has survived for more than 5 years following treatment, but still has liver metastases. The possibility of resecting multiple liver metastases from colorectal cancer should be considered, and in some cases, chemotherapy may enhance survival.
  • 肺羊水塞栓症による心肺停止後に蘇生後脳症となり47日後に死亡した1剖検例
    関 駿介; 太田 聡; 岩本 雅美; 若狭 朋子; 尾本 暁子; 清川 貴子; 生水 真紀夫; 中谷 行雄
    日本病理学会会誌 (一社)日本病理学会 103 (2) 66 - 66 0300-9181 2014/09
  • 喜多 竜一; 坂本 梓; 井口 恵里子; 竹田 治彦; 大原 芳章; 西島 規浩; 斎藤 澄夫; 那須 章洋; 西川 浩樹; 木村 達; 大崎 往夫; 若狭 朋子; 中沼 安二; 松井 修
    日本消化器病学会雑誌 (一財)日本消化器病学会 111 (5) 940 - 947 0446-6586 2014/05 [Refereed]
     
    Gd-EOB-DTPA造影MRIの肝細胞相において、異なる信号強度をもつ腫瘍が併存する肝細胞癌について3例の切除例を検討した。すべての症例において、取り込み系トランスポーターであるOATP8の発現強度は肝細胞相の信号強度に良く相関した。一方、排泄系トランスポーターであるMRP2やMRP3の発現は、症例によりOATP8の発現多寡と同様の挙動を示す場合と、異なる挙動を示す場合が見られた。(著者抄録)
  • Ryuichi Kita; Azusa Sakamoto; Eriko Iguchi; Haruhiko Takeda; Yoshiaki Oohara; Norihiro Nishijima; Sumio Saito; Akihiro Nasu; Hiroki Nishikawa; Toru Kimura; Yukio Osaki; Tomoko Wakasa; Yasuni Nakanuma; Osamu Matsui
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 111 (5) 940 - 7 0446-6586 2014/05 
    We report three cases of resected hepatocellular carcinomas with nodules showing different signal intensities in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI). One case involved a nodule-in-nodule type hepatocellular carcinoma that showed high signal intensity for the outer tumor and low intensity for the inner tumor in the hepatobiliary phase of EOB-MRI. The inner tumor was more dedifferentiated than the outer. The other two cases involved similar nodules, which showed different signal intensities in the hepatobiliary phase of EOB-MRI. In all three cases, the expression of OATP8 showed good correlation with high signal intensity in the hepatobiliary phase of EOB-MRI, whereas MRP2, MRP3, or both were also highly expressed. However, in the two nodules showing low intensities, the expression of one excreting transporter was independently high even though that of OATP8 was not high. The expression of excreting transporters is usually characterized by passive correspondence to OATP8 expression levels; nevertheless, it sometimes shows expression independent of OATP8.
  • 村上 隆亮; 多木 誠人; 松田 優樹; 松尾 浩司; 南部 拓央; 米光 新; 若狭 朋子; 武呂 誠司; 隠岐 尚吾
    日本内分泌学会雑誌 (一社)日本内分泌学会 90 (1) 371 - 371 0029-0661 2014/04 [Refereed]
  • Takashi Kanesaka; Akira Sekikawa; Takehiko Tsumura; Takanori Maruo; Yukio Osaki; Tomoko Wakasa; Masayuki Shintaku; Kenshi Yao
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 26 (1) 57 - 62 2014/01 [Refereed]
     
    BACKGROUND: Magnifying endoscopy with narrow-band imaging (ME-NBI) can visualize crypt openings (CO) as slit-like structures in gastric epithelial neoplasia. Visualization of numerous CO is characteristic of low-grade adenoma (LGA). The aim of the present study was to investigate whether visualization of CO by ME-NBI is useful for discriminating between LGA and early gastric cancer (EGC). PATIENTS AND METHODS: Fifty-one superficial elevated-type gastric neoplasias (10 LGA and 41 EGC) were retrospectively evaluated. The presence of CO and the number of CO were evaluated in endoscopic photos obtained at high-power endoscopic magnification by ME-NBI. The optimal cut-off value for the number of CO visualized to discriminate between LGA and EGC was determined by receiver operating characteristic curve analysis. RESULTS: The mean number of CO visualized was significantly larger in the LGA group than in the EGC group (31.2, 95% confidence interval [CI] 16.3-46.1 vs 6.3, 95% CI 3.6-9.0; P < 0.001). When the cut-off for the number of CO visualized was set at 20, the sensitivity, specificity, and accuracy of dense-type CO for discriminating between LGA and EGC were 90.0%, 87.8%, and 88.2%, respectively. CONCLUSION: Determining the number of CO visualized in superficial elevated-type gastric neoplasias by ME-NBI appears to be a useful method for discriminating between LGA and EGC.
  • Sumio Saito; Takehiko Tsumura; Hiroki Nishikawa; Haruhiko Takeda; Jun Nakajima; Takashi Kanesaka; Fumihiro Matsuda; Azusa Sakamoto; Shinichiro Henmi; Keiichi Hatamaru; Akira Sekikawa; Ryuichi Kita; Takanori Maruo; Yoshihiro Okabe; Toru Kimura; Tomoko Wakasa; Yukio Osaki
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 26 (1) 69 - 76 2014/01 [Refereed]
     
    BACKGROUND: The relationship between the thickness of subepithelial collagen bands (CB) and the development of linear ulcerations (LU) in collagenous colitis (CC) remains unclear. The aim of the present study was to compare the clinical and pathological features, including the thickness of CB, in CC patients with and without LU. PATIENTS AND METHODS: Twenty-five patients with CC diagnosed by pathological examination of biopsy specimens were analyzed. Eleven patients with LU (LU group) and 14 patients without LU (non-LU group) were compared. RESULTS: Ten patients in the LU group and seven in the non-LU group were taking lansoprazole (P = 0.038). Seven patients in the LU group and one in the non-LU group were taking non-steroidal anti-inflammatory drugs (NSAIDs) (P = 0.004). All LU were locatedin the transverse or left colon. Patients in the LU group were older than those in the non-LU group (P = 0.015). CB were significantly thicker in the LU group than in the non-LU group (mean ± SD, 40 ± 21 μm vs 20 ± 11 μm, P = 0.004). Multivariate analysis showed that NSAIDs use (odds ratio, 19.236; 95% confidence interval, 1.341-275.869) and CB thickness (odds ratio, 0.893; 95% confidence interval, 0.804-0.999) were independently associated with the development of LU. CONCLUSION: Use of lansoprazole and NSAIDs, thick CB, and advanced age are associated with the development of LU in CC patients.
  • Haruhiko Takeda; Hiroki Nishikawa; Takehiko Tsumura; Akira Sekikawa; Takanori Maruo; Yoshihiro Okabe; Toru Kimura; Tomoko Wakasa; Yukio Osaki
    Internal medicine (Tokyo, Japan) 53 (6) 563 - 9 2014 [Refereed]
     
    A 78-year-old woman was admitted to our hospital complaining of anorexia and purpura of the extremities. She presented with prominent peripheral eosinophilia and disseminated intravascular coagulation (DIC). Despite receiving intensive therapy for DIC, her illness worsened. Esophagogastroduodenoscopy revealed advanced gastric cancer (AGC), and a bone marrow biopsy led to a diagnosis of disseminated carcinomatosis of the bone marrow caused by AGC. We initiated combination chemotherapy with S-1 and cisplatin, which lead to a significant improvement of the DIC and eosinophilia, and the patient was finally discharged. The primary symptoms of DIC and eosinophilia were both considered to be caused by AGC, and we successfully treated the patient's critical condition.
  • Tomoko Wakasa; Kumiko Inayama; Tomoko Honda; Masayuki Shintaku; Yoshihiro Okabe; Kennichi Kakudo
    Acta cytologica 58 (4) 398 - 405 2014 [Refereed]
     
    OBJECTIVES: To improve the diagnostic accuracy of bile smear cytology, we assessed two cell-yielding procedures. STUDY DESIGN: One hundred and forty-one patients with biliary stricture underwent endoscopic retrograde cholangiopancreatography (ERCP) and conventional brush sampling. The cytologist cut the brush head off the support wire, centrifuged it directly in tissue culture medium for 1 min at 3,000 rpm, centrifuged the medium again and then smeared the cell pellet onto slides. The remaining sheath tube was then cut into 12-cm segments, which were centrifuged in a centrifuge tube for 1 min at 3,000 rpm, collected and submitted for cytospin preparation. RESULTS: The final histopathological diagnoses based on surgery, biopsy or clinical progression were evaluated for sensitivity, specificity and accuracy. Using conventional smears alone, the sensitivity, specificity and accuracy in patients with biliary stricture were 66.1, 80.7 and 68.8%, respectively. For conventional smears, brush washing and sheath tube contents together, the sensitivity improved to 73.9%, specificity to 100% and accuracy to 78.7%. In the patients with bile duct carcinoma, the sensitivity, specificity and accuracy were 87.3, 100 and 90.7%, respectively. CONCLUSION: Superior diagnostic accuracy was achieved when conventional smear procedures were combined with the two new procedures.
  • Tomoko Wakasa; Misa Nakamura; Tomoko Kagiya; Emiko Taniguchi; Takeo Sakurai; Kennichi Kakudo
    Acta cytologica 58 (1) 89 - 95 2014 [Refereed]
     
    OBJECTIVE: We analyzed smears by fine needle aspiration (FNA) from 37 cases that displayed numerous dissociated cells and correlated the results with histological findings. STUDY DESIGN: Between 1996 and 2005, 1,583 patients underwent breast FNA and resection. Loss of cellular cohesion was observed in 37 of these cases. RESULTS: From the cytological findings, we classified cases into 3 groups according to cell size and shape. Type A: numerous isolated spindle cells with a necrotic background. Four cases were classified into this group (3 cases of intraductal papilloma and 1 case of adenomyoepithelioma). Type B: lymphocytes and large isolated cells such as medullary carcinoma. Five cases were classified into this group [1 case of classic medullary carcinoma, 1 case of ductal carcinoma in situ (DCIS) and 3 cases of invasive carcinoma of no special type (NST)]. Type C: numerous uniform small round cells. Twenty-eight cases were classified into this group (2 cases of lobular carcinoma, 1 case of DCIS, 22 cases of invasive carcinoma NST, and 3 cases of solid papillary carcinoma). CONCLUSION: Numerous isolated cells are sometimes seen in both benign and malignant cytology.
  • Gd-EOB-DTPA造影MRI肝細胞相において高信号を呈する肝細胞癌におけるglutamine synthethaseの発現についての検討
    喜多 竜一; 井口 恵里子; 竹田 治彦; 坂本 梓; 大原 芳章; 斎藤 澄夫; 西島 規浩; 那須 章洋; 西川 浩樹; 木村 達; 大崎 往夫; 若狭 朋子
    肝臓 (一社)日本肝臓学会 54 (Suppl.3) A731 - A731 0451-4203 2013/11
  • Rika Onishi; Sayoko Ohno; Tomoko Wakasa; Yuji Horiguchi
    International journal of dermatology 52 (11) 1456 - 8 2013/11 [Refereed]
  • 竹田 治彦; 喜多 竜一; 金坂 卓; 中島 潤; 松田 史博; 坂本 梓; 幡丸 景一; 齋藤 澄夫; 那須 章洋; 西川 浩樹; 米門 秀行; 関川 昭; 津村 剛彦; 圓尾 隆典; 岡部 純弘; 木村 達; 大崎 往夫; 若狭 朋子; 中島 収
    日本消化器病学会雑誌 (一財)日本消化器病学会 110 (9) 1625 - 1632 0446-6586 2013/09 [Refereed]
     
    症例は85歳男性。主訴は心窩部痛。胃噴門部隆起病変および壊死をともなう多発肝腫瘍を認め、CEA、CA19-9、AFP、PIVKAII高値、精査中肝腫瘍破裂を認め肝動脈塞栓術(TAE)にて止血したが、早期に癌死した。剖検で胃hepatoid adenocarcinoma(HAC)肝転移と診断した。HAC肝転移は多血性で増大速度が速く破裂に至ったと考えたが、緊急時の対処としてTAEも選択肢の一つと考える。(著者抄録)
  • Haruhiko Takeda; Ryuichi Kita; Takashi Kanesaka; Jun Nakajima; Fumihiro Matsuda; Azusa Sakamoto; Keiichi Hatamaru; Sumio Saito; Akihiro Nasu; Hiroki Nishikawa; Hideyuki Komekado; Akira Sekikawa; Takehiko Tsumura; Takanori Maruo; Yoshihiro Okabe; Toru Kimura; Yukio Osaki; Tomoko Wakasa; Osamu Nakashima
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 110 (9) 1625 - 32 0446-6586 2013/09 [Refereed]
     
    An 85-year-old man with epigastric pain and anorexia was admitted to our hospital. His serum α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were markedly elevated. Gastrointestinal endoscopy revealed a large mass near the fundus, and computed tomography revealed multiple liver tumors. Intraperitoneal bleeding followed rupture of a liver tumor and was successfully stopped by transarterial embolization; however, regrowth of multiple tumors followed, resulting in liver failure and death within a short period. Autopsy revealed hepatoid adenocarcinomas originating in the stomach that had metastasized to the liver. Hepatoid adenocarcinomas are hypervascular, rapidly growing tumors that may result in the spontaneous rupture of metastatic liver lesions. Transarterial embolization may be a feasible option for the treatment of these ruptured tumors.
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    European journal of gastroenterology & hepatology LIPPINCOTT WILLIAMS & WILKINS 25 (8) 912 - 9 0954-691X 2013/08 [Refereed]
     
    OBJECTIVES: The aim of this study was to compare the clinical outcomes and safety of surgical resection for hepatocellular carcinoma between patients older than 75 years of age (elderly group) and those younger than 75 years (control group). METHODS: A total of 92 patients were included in the elderly group and 206 patients were included in the control group. Clinical outcomes including overall survival, recurrence-free survival, and safety were compared between these two groups after initial surgery. RESULTS: The mean (±SD) observation periods were 2.5 ± 1.8 years in the elderly group and 3.1 ± 2.2 years in the control group. The 1, 3, and 5-year overall survival rates after surgery were 90.0, 73.3, and 43.0%, respectively, in the elderly group and 91.0, 77.5, and 64.4%, respectively, in the control group (P=0.188). The corresponding recurrence-free survival rates were 66.3, 38.8, and 26.2%, respectively, in the elderly group and 66.3, 38.8, and 22.2%, respectively, in the control group (P=0.634). Multivariate analysis identified a total bilirubin level greater than 1.0 mg/dl (P=0.003), a serum albumin level greater than 4.0 g/dl (P=0.005), an α-fetoprotein level greater than 100 ng/ml (P<0.001), and microvascular invasion (P<0.001) as significant factors linked to overall survival, and tumor number (P=0.014) and microvascular invasion (P=0.008) were significant factors associated with recurrence-free survival. There was no significant difference between the two groups in terms of surgery-related serious adverse events (P>0.999). CONCLUSION: Surgical resection appears to be a safe and feasible procedure for the treatment of hepatocellular carcinoma in elderly patients.
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    Oncology reports SPANDIDOS PUBL LTD 30 (1) 91 - 8 1021-335X 2013/07 [Refereed]
     
    The impact of antibodies to hepatitis B core antigen (anti-HBc) on survival after curative surgical resection (SR) for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) remains unclear. The aim of the present study was to examine the relationship between anti-HBc positivity and survival of HCV-related HCC patients who underwent curative SR. A total of 222 patients with HCV-related, hepatitis B surface antigen (HBsAg)-negative HCC who underwent curative SR were analyzed. They included 119 anti-HBc-positive patients (53.6%) and 103 anti-HBc-negative patients (46.4%). Overall survival (OS) and recurrence-free survival (RFS) rates were compared between the two groups. The median follow-up periods in the anti-HBc-positive and anti-HBc-negative groups were 3.4 years (range, 0.3-10.9 years) and 3.2 years (range, 0.5-10.9 years), respectively. The 1-, 3- and 5-year cumulative OS rates were 88.8, 70.2 and 50.0%, respectively, in the anti-HBc-positive group and 95.8, 77.1 and 61.7% in the anti-HBc-negative group (P=0.300). The corresponding RFS rates were 68.7, 33.0 and 20.0%, respectively, in the anti-HBc-positive group and 74.4, 38.5 and 16.5% in the anti-HBc-negative group (P=0.482). Multivariate analyses identified serum albumin ≥3.8 g/dl (P=0.005) and the presence of microvascular invasion (P<0.001) as independent factors linked to OS, and interferon therapy after surgery (P=0.011), α-fetoprotein ≥40 ng/ml (P=0.030) and the presence of microvascular invasion (P<0.001) were significant predictors linked to RFS. In subgroup analyses according to maximum tumor size and background liver disease in terms of OS and RFS, no significant difference between the anti-HBc-positive and anti-HBc-negative groups was observed except in patients with non-cirrhotic liver in terms of RFS. In conclusion, anti-HBc-positivity is not a useful predictor for survival of patients with HCV-related HCC after curative SR.
  • 覚道 健一; 李 亜琼; 若狭 朋子
    日本甲状腺学会雑誌 日本甲状腺学会 4 (1) 23 - 26 2185-3126 2013/05 [Refereed][Invited]
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    Anticancer research INT INST ANTICANCER RESEARCH 33 (3) 1181 - 8 0250-7005 2013/03 [Refereed]
     
    BACKGROUND AND AIMS: We examined the prognostic value of pre-treatment C-reactive protein (CRP) after surgical resection (SR) for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: A total of 298 patients with HCC who underwent SR were analyzed. They were categorized into a CRP-positive group (group A: CRP >0.2 mg/dl, n=130) and a CRP-negative group (group B: CRP <0.2 mg/dl, n=168). Overall survival (OS) and recurrence-free survival (RFS) were compared. RESULTS: The 1- and 3-year cumulative OS rates were 87.0% and 68.3% in group A and 95.9% and 81.1% in group B (p=0.194). The corresponding RFS rates were 61.6% and 30.3% in group A and 77.2% and 44.9% in group B (p=0.004). In multivariate analysis, the pre-treatment CRP level was a significant prognostic factor linked to RFS (p=0.046). CONCLUSION: Pre-treatment CRP levels may be a useful predictor of recurrence after SR for HCC.
  • HATANO Yuko; RAI Yukako; KAWAHARA Shunsuke; SUNADA Masumi; MISE Yuka; NAGANO Fusaka; KAWASHIMA Naotoshi; NISHIKAWA Takeshi; YOSHIOKA Shinya; YAMASHITA Yui; WAKASA Tomoko
    ADVANCES IN OBSTETRICS AND GYNECOLOGY THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN 65 (2) 126 - 132 0370-8446 2013 
    Cushing syndrome, one of the causes of secondary hypertension, is a condition caused by excessive cortisol secretion because of adrenal hyperfunction. Hypercortisolism induces characteristic symptoms such as central obesity, moon face, and buffalo hump. Cushing syndrome rarely occurs in pregnant women because of menstrual disturbances ; furthermore, most women suffering from hypercortisolism also suffer from infertility. A diagnosis of Cushing syndrome during pregnancy is often difficult because some symptoms and signs of this condition are considered normal during pregnancy. Cushing syndrome in pregnancy is associated with a high frequency of maternal and fetal complications such as miscarriage, stillbirth, and maternal congestive heart failures. Some maternal deaths have also been reported. Here we present the case of a 34-year-old Japanese woman (gravida 0, para 0) who was diagnosed with Cushing syndrome during pregnancy but delivered a healthy infant via cesarean section. The patient who had conceived naturally was transferred to our hospital at 22 weeks of gestation because of hypertension since the first trimester, which worsened despite medications. Her blood pressure remained elevated at 158/100 mmHg despite intravenous hydralazine administration on admission. Blood and urine analyses to detect the cause of hypertension revealed low plasma adrenocorticotropic hormone levels, high plasma and urine cortisol levels, and hypokalemia. Abdominal magnetic resonance imaging revealed a round mass, approximately 4 cm in diameter, in the left adrenal gland. A diagnosis of Cushing syndrome secondary to adrenal adenoma was made, and left adrenalectomy was performed at 24 weeks of gestation. Histopathological examination of the resected specimen confirmed benign adrenal adenoma. After surgery, her blood pressure returned to normal ; however, it elevated again soon after. Furthermore, fetal growth restriction was observed from 31weeks of gestation. We diagnosed preeclampsia superimposed on chronic hypertension and performed an emergency cesarean section at 33 weeks of gestation. She delivered a female baby who weighed 1834 g with Apgar scores of 8/9 at 1/5 minutes. Histopathological findings of her placenta were indicative of pregnancy-induced hypertension. Both mother and child remained in good health after delivery. [Adv Obstet Gynecol, 65(2) : 126 - 132, 2013 (H25.5)]
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    International journal of oncology 42 (1) 151 - 60 2013/01 [Refereed]
     
    The aim of the present study was to evaluate the influence of preoperative transcatheter arterial chemoembolization (TACE) on survival after surgical resection (SR) for hepatocellular carcinoma (HCC). Two hundred and thirty-five HCC patients who underwent SR with curative intent were analyzed. Overall survival (OS), recurrence-free survival (RFS) and complication rates were compared between the TACE (n=110) and control groups (n=125). Moreover, TACE subjects were classified into TACE responders (n=85) and TACE non-responders (n=25), according to the therapeutic efficacy of pretreatment TACE, and the factors contributing to OS and RFS after SR were analyzed using univariate and multivariate analyses. The 1-, 3- and 5-year OS rates were 87.4, 76.0 and 62.5%, respectively, in the TACE group and 94.9, 79.0 and 57.8%, respectively, in the control group (P=0.674). The corresponding RFS rates at 1, 3 and 5 years were 73.3, 48.9 and 33.2%, respectively, in the TACE group and 73.3, 29.4 and 16.3%, respectively, in the control group (P=0.062). No TACE-related serious adverse events (SAEs) were observed. There were no significant differences between the groups in terms of surgery-related SAEs (P=0.714), operation time (P=0.881), blood loss during surgery (P=0.334) and hospitalization period (P=0.447). Multivariate analyses identified TACE responder, TACE non-responder, total bilirubin ≥1 mg/dl, serum albumin ≥4 g/dl, pretreatment α-fetoprotein (AFP) level ≥100 ng/ml and microscopic vascular invasion as significant prognostic factors linked to OS. TACE non-responder, tumor number (multiple) and pretreatment AFP level ≥100 ng/ml were significant adverse prognostic factors linked to RFS. In conclusion, TACE is a safe procedure in patients with HCC, and the efficacy of TACE prior to surgery may be associated with clinical outcomes after SR.
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    Gastroenterology research and practice 2013 430438 - 430438 2013 [Refereed]
     
    Background and Aims. We aimed to investigate the relationship between obesity and survival in hepatitis C virus-(HCV-) related hepatocellular carcinoma (HCC) patients who underwent curative surgical resection (SR). Methods. A total of 233 patients with HCV-related HCC who underwent curative SR were included. They included 60 patients (25.8%) with a body mass index (BMI) of > 25 kg/m(2) (obesity group) and 173 patients with a BMI of < 25 kg/m(2) (control group). Overall survival (OS) and recurrence-free survival (RFS) rates were compared. Results. The median follow-up periods were 3.6 years in the obesity group and 3.1 years in the control group. The 1-, 3-, and 5-year cumulative OS rates were 98.3%, 81.0%, and 63.9% in the obesity group and 90.0%, 70.5%, and 50.3% in the control group (P = 0.818). The corresponding RFS rates were 70.1%, 27.0%, and 12.0% in the obesity group and 70.1%, 39.0%, and 21.7% in the control group (P = 0.124). There were no significant differences between the obesity group and the control group in terms of blood loss during surgery (P = 0.899) and surgery-related serious adverse events (P = 0.813). Conclusions. Obesity itself did not affect survival in patients with HCV-related HCC after curative SR.
  • Eriko Iguchi; Takehiko Tsumura; Akira Sekikawa; Tomoko Wakasa; Takanori Maruo; Yoshihiro Okabe; Toru Kimura; Yukio Osaki
    Internal medicine (Tokyo, Japan) 52 (19) 2215 - 8 2013 [Refereed]
     
    We herein report the case of a 43-year-old man with distinct gastropathy and hypoproteinemia treated with H. pylori eradication therapy. Most reported cases of protein-losing gastropathy are divided into Ménétrier's disease (MD) and diffuse varioliform gastritis (DVG). Our patient presented with leg edema due to marked hypoalbuminemia, which we ascribed to distinct gastropathy with novel endoscopic findings resembling cap polyposis in the colon, apparently different from both MD and DVG. H. pylori eradication therapy promptly induced the normalization of laboratory data and mucosal healing. Our case together with two previously published similar cases may contribute to establishing an association between cap-polyposis-like-gastropathy with hypoproteinemia and H. pylori.
  • Hiroki Nishikawa; Akira Arimoto; Tomoko Wakasa; Ryuichi Kita; Toru Kimura; Yukio Osaki
    Journal of Cancer IVYSPRING INT PUBL 4 (6) 502 - 13 1837-9664 2013 [Refereed]
     
    BACKGROUND AND AIMS: We compared clinicopathologic data and long-term clinical outcomes among patients with non-B and non-C hepatocellular carcinoma (NBNC-HCC) who underwent curative resection (group A, n=129), those with hepatitis B virus-related HCC (group B, n=62) and those with hepatitis C virus-related HCC (group C, n=284). METHODS: Clinicopathologic characteristics and cumulative overall survival (OS) and recurrence-free survival (RFS) after curative resection were compared among the three groups. RESULTS: The proportion of patients with non-liver cirrhosis (LC) or diabetes mellitus in group A was significantly higher than that in group B or group C. The mean maximum tumor size in group A was significantly larger than that of group B or group C. Cumulative 3-year OS rates after resection were 76% in group A, 79% in group B and 72% in group C (A vs. B, P=0.638; A vs. C, P=0.090; B vs. C, P=0.091; overall significance, P=0.088). The corresponding RFS rates after resection were 38% in group A, 36% in group B and 36% in group C (A vs. B, P=0.528; A vs. C, P=0.281; B vs. C, P=0.944; overall significance, P=0.557). In subgroup analyses in patients with LC, in those without LC and in those who satisfied the Milan criteria, similar results were obtained, i.e., the difference among the three groups did not reach significance in terms of OS and RFS. CONCLUSION: Long-term clinical outcomes in patients NBNC-HCC after curative resection were comparable to those in patients with hepatitis virus-related HCC after curative resection.
  • Masato Taki; Shinya Inada; Ryo Ariyasu; Yoshinobu Konishi; Natsumi Okamoto; Masanori Yoshida; Hiroaki Nagano; Kenji Hanaoka; Kazuhiko Nakagawa; Yasukiyo Nakamura; Chie Yoshimura; Toshiaki Wakayama; Yasuo Nishizaka; Tomoko Wakasa; Mitsuru Tsudo; Ryoichi Amitani
    Internal medicine (Tokyo, Japan) JAPAN SOC INTERNAL MEDICINE 52 (23) 2645 - 51 0918-2918 2013 [Refereed]
     
    Fibrosing mediastinitis is rare. One type of this disease is idiopathic fibrosing mediastinitis. It is necessary to rule out malignancy in order to accurately diagnose fibrosing mediastinitis. We herein report a case of anaplastic large cell lymphoma diagnosed three months after a preliminary diagnosis of fibrosing mediastinitis. Glucocorticoid therapy was not successful in controlling disease progression. Immediately after initiating chemotherapy for lymphoma, the patient's symptoms improved dramatically and the mediastinal lesion decreased in size. Although few similar cases have been reported, hidden malignancy may present as fibrosing mediastinitis. Therefore, physicians should consider the probability of malignancy in patients with fibrosing mediastinitis because treatments may vary accordingly.
  • Soichiro Ako; Takehiko Tsumura; Yoshihiro Okabe; Akira Sekikawa; Takashi Kanesaka; Tomoko Wakasa; Masayuki Shintaku; Takanori Maruo; Toru Kimura; Yukio Osaki
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 109 (11) 1910 - 9 2012/11 [Refereed]
     
    A 66-year-old man with giant gastric folds had been followed up since February 2000. In March 2010, a submucosal tumor of 35mm was identified with endoscopy and a low echoic mass was identified with endoscopic ultrasonography. After histologic diagnosis by endosonography-guided fine needle aspiration biopsy, he underwent a total gastrectomy. Histologic examination of the resected specimen revealed a tumor 20mm in diameter consisting of well-to-moderately differentiated tubular adenocarcinoma in the thickened wall of the gastric greater curvature, which contained small cystic lesions in the lamina propria. Immunohistochemical staining showed thick gastric wall consisting of not only multiple cysts but also smooth muscle, elastic and collagen fibers. The histologic diagnosis was advanced gastric cancer accompanied by diffuse cystic malformation (DCM). Although it is a rare condition, DCM should be considered in the differential diagnosis of giant gastric folds and as a pre-cancerous lesion.
  • INUZUKA Tadashi; OSAKI Yukio; MATSUDA Fumihiro; SAKAMOTO Azusa; HATAMARU Keiichi; HENMI Shinichiro; ISHIKAWA Tetsuro; SAITO Sumio; NISHIKAWA Hiroki; KITA Ryuichi; OKABE Yoshihiro; KIMURA Toru; WAKASA Tomoko; HAGIWARA Satoru; KUDO Masatoshi
    Kanzo 一般社団法人 日本肝臓学会 53 (1) 42 - 47 0451-4203 2012/01 [Refereed]
     
    A 65-year-old Japanese male with chronic hepatitis B (CH-B) diagnosed in December 2008 was referred to our department in July 2009. He started combination therapy with peginterferon alfa-2b (80 μg/week) and entecavir (0.5 mg/day) for 48 weeks from December 2009. At the initiation of therapy, his significant laboratory test results were as follows: alanine aminotransferase (ALT) 55 IU/l, aspartate aminotransferase (AST) 37 IU/l, hepatitis B surface antigen (HBsAg) positive, hepatitis B e antigen (HBeAg) positive, hepatitis B virus (HBV) DNA levels 7.9 Log copies/ml. HBV DNA, HBsAg and HBeAg levels decreased progressively with therapy. After 36 weeks, HBV DNA, AST and ALT levels flared up, but after 44 weeks, HBV DNA levels decreased below 2.1 Log copies/ml and HBeAg seroconversion and HBsAg seroclearance were achieved. After 72 weeks he maintained HBsAg seroclearance and achieved a sustained viral response. Cases of spontaneous HBsAg seroclearance have been reported previously, but HBsAg seroclearance caused by combination therapy with peginterferon alfa-2b and entecavir has not been reported. Pre- and post-treatment cccDNA load in liver tissue, hepatitis B virus core-related antigen (HBcrAg) concentration in serum and expression of hepatitis B core antigen (HBcAg) in hepatocyte were compared, and it was found that all were drastically decreased. The present study suggests that these reduction appeared to contribute to the successful outcome of this therapy.
  • Takaaki Murakami; Hiroki Nishikawa; Yorimitsu Koshikawa; Yoshihiro Okabe; Tomoko Wakasa; Yukio Osaki
    Internal medicine (Tokyo, Japan) JAPAN SOC INTERNAL MEDICINE 51 (17) 2329 - 35 0918-2918 2012 [Refereed]
     
    We herein present a rare case of myocardial metastases from intrahepatic cholangiocarcinoma. The patient was a 68-year-old man diagnosed with stage IVb intrahepatic cholangiocarcinoma. Growing low-density nodules at the cardiac interventricular septum and the left lateral wall were found on contrast enhanced computed tomography (CECT). He died and an autopsy was performed. Intrahepatic cholangiocarcinoma was found to have metastasized to the myocardium, and these myocardial metastases conformed to the low-density nodules detected on CECT. A hilar nodule in the lung was revealed to be lung squamous cell carcinoma. This was a rare case of intrahepatic cholangiocarcinoma with myocardial metastases and lung squamous cell carcinoma.
  • Ichiro Ohashi; Mikio Miyata; Chieko Tamura; Shigeharu Inoue; Kouji Takami; Tomoko Wakasa
    Gan to kagaku ryoho. Cancer & chemotherapy 38 (12) 2420 - 2 0385-0684 2011/11 [Refereed]
     
    We report a rare case of esophageal cancer resection in which lung metastases was resected after chemotherapy with paclitaxel. A 59-year-old man with epigastralgia as a chief concern was referred to our hospital and was diagnosed with esophageal cancer by gastrointestinal fiber. In June 2007, the cancer was resected and followed by 3 courses of weekly chemotherapy with paclitaxel. In January 2009, chest computed tomography showed lung nodules (Rt-S1 and Rt-S5), and positron emission tomography (PET) showed uptake (Rt-S1); a final diagnosis of multiple lung metastases was made. Thereafter, the patient underwent 8 courses of weekly chemotherapy with paclitaxel. In December 2009, the growing Rt-S1 nodule was detected but no other lesion. The patient underwent a resection of lung metastases followed by 5 courses of weekly chemotherapy with paclitaxel. As of June 2011, the patient was alive and disease free. In conclusion, the resection of solitary lung metastases derived from esophageal cancer should be considered because it may improve survival.
  • Haruka Minato; Norito Ishii; Shunpei Fukuda; Tomoko Wakasa; Ken'ichi Wakasa; Ryosuke Sogame; Takashi Hashimoto; Yuji Horiguchi
    The Journal of dermatology 38 (9) 887 - 92 2011/09 [Refereed]
     
    An otherwise healthy 31-year-old man presented with multiple, vesicular, subepidermal blistering on the head, face, chest and oral cavity, leaving shallow scar formation, typical of Brunsting-Perry type pemphigoid. Direct immunofluorescence showed linear deposition of immunoglobulin (Ig)G and C3 along the basement membrane zone (BMZ), and indirect showed anti-BMZ autoantibodies (IgG, >40×) reacting with the dermal side under the salt-split study. Immunofluorescence staining for type IV collagen and laminins, as well as routine electron microscopy, demonstrated that the cleavage level of the blister was intra-lamina lucida. The immunoperoxidase method applied to lesional skin demonstrated IgG deposits along the lamina densa. The post-embedding immunogold method demonstrated that the autoantibodies against BMZ reacted with the lamina densa and the dermis just beneath it. Immunoblot studies demonstrated that the autoantibodies reacted with the 290-kD polypeptide (suggesting type VII collagen) when dermal extract was used as the substrate. The patient was treated with combination therapy consisting of 30 mg prednisolone, 900 mg nicotinamide and 750 mg tetracycline, and the number of newly forming blisters decreased. We concluded that Brunsting-Perry type pemphigoid, a rare autoimmune blistering disease, includes cases showing characteristics of epidermolysis bullosa acquisita as well as bullous pemphigoid. This case showed discrepancy between the blistering level (intra-lamina lucida) and location of antigen (lamina densa and sub-lamina densa areas).
  • Niansong Qian; Takayuki Ueno; Nobuko Kawaguchi-Sakita; Masahiro Kawashima; Noriyuki Yoshida; Yoshiki Mikami; Tomoko Wakasa; Masayuki Shintaku; Shigeru Tsuyuki; Takashi Inamoto; Masakazu Toi
    Cancer science 102 (8) 1590 - 6 2011/08 [Refereed]
     
    Caveolin-1 (Cav-1) has been extensively characterized in cancer biological research. However, the role of Cav-1 in the interaction between tumor and stromal cells remains unclear. In the present study, we examined Cav-1 expression in tumor cells and stromal cells in breast cancer tissue by immunohistochemical analysis and evaluated its prognostic value in a training cohort. Immunohistochemical analysis of Cav-1 expression was scored as (++), (+) or (-) according to the proportion of positively stained tumor cells (T) and stromal cells (S). Correlation analysis between tumor/stromal Cav-1 expression and clinicopathological parameters revealed that only T(++) Cav-1 status was positively associated with tumor size and histological nodal status (P = 0.019 and 0.021, respectively). Univariate analysis revealed that combined T(++)/S(-) status was significantly correlated with unfavorable prognostic outcomes (P < 0.001). Multivariate analysis demonstrated that this combined status is an independent prognostic factor for primary breast cancer (P = 0.002). Clinical outcomes in different subgroups of breast cancer patients were also strictly dependent on this combined status (P < 0.05). The prognostic value of T(++)/S(-) Cav-1 status was also validated in the testing cohort. Collectively, our data indicate that high Cav-1 expression in tumor cells and lack of this expression in stromal cells could help identify a particular subgroup of breast cancer patients with potentially poor survival. Further studies are required to understand the regulatory mechanism of Cav-1 in the tumor microenvironment.
  • 松田 史博; 岡部 純弘; 赤穂 宗一郎; 越川 頼光; 竹田 治彦; 犬塚 義; 中島 潤; 金坂 卓; 恵荘 裕嗣; 坂本 梓; 邊見 慎一郎; 金 秀基; 石川 哲朗; 齊藤 澄夫; 波多野 貴昭; 西川 浩樹; 関川 昭; 津村 剛彦; 喜多 竜一; 圓尾 隆典; 木村 達; 大崎 往夫; 若狭 朋子
    肝胆膵画像 (株)医学書院 13 (3) 318 - 321 1882-5087 2011/05 [Refereed]
     
    66歳女。検診で肝腫瘤を指摘され当科紹介となった。腹部USで肝左様に境界明瞭、辺縁に帯状の高エコー像、内部に不整形の低エコー領域を有し一部石灰化を伴う腫瘍を認め、ソナゾイド造影では辺縁高エコー部位にのみ流入を認めた。腹部CTでは肝S4に造影で濃染される乳頭状隆起を伴う嚢胞性腫瘍を認め、胆管外側枝は拡張していた。腹部MRIではT2強調像でS4に内部に不均一な低信号と高信号が混在する腫瘍を認めた。ERCPで乳頭開口部は軽度開大しており、通常の胆管造影では左肝管付近に陰影欠損を認め、末梢は描出されず、バルーン造影では拡張した内側枝を認め、IDUSでは腫瘍内に高エコーで丈の高い乳頭状隆起がみられた。S4を主体とする粘液産生胆管内乳頭状腫瘍と診断し、一部がS8まで進展していたため拡大肝左葉切除術、右後枝-小腸吻合、Roux-en Y再建術を施行した。病理学的所見で胆管内に乳頭状に発育する腫瘍を認め、腫瘍細胞の形態は膵胆管上皮型、低異型度の乳頭状腺癌であった。MUC染色ではMUC1陽性、MUC2、MUC5ACは陰性で、MIB-index 4.3%であった。
  • Noriko Sugino; Chishiho Nakamura; Sumie Fujii; Yusuke Matsui; Hitomi Kaneko; Mitsumasa Watanabe; Yasuo Miura; Tomoko Wakasa; Mitsuru Tsudo
    [Rinsho ketsueki] The Japanese journal of clinical hematology 52 (3) 129 - 35 0485-1439 2011/03 [Refereed]
     
    Age-related EBV-associated B-cell lymphoproliferative disorder is a highly aggressive lymphoma, and a standard therapy for this disease has not yet been established. A 58-year-old male was admitted to our hospital because of fever and lymphadenopathy across the whole body. Neck lymph node biopsy showed hemorrhagic and geographic necrosis with Hodgkin-like large cells against a background of small lymphocytes. The large cells were positive for CD30 and EBER. The patient was diagnosed as having age-related EBV-associated B-cell lymphoproliferative disorder. Although there was no response to CHOP therapy, he obtained partial response after 3 courses of DeVIC therapy. Because his lymphoma was highly aggressive and chemotherapy-resistant, he underwent autologous stem cell transplantation with a conditioning regimen including ranimustine, etoposide, cytarabine, and melphalan. After stem cell transplantation and subsequent radiotherapy to the residual lesion, the patient achieved complete remission. This is the first report of successful autologous stem cell transplantation for a patient with age-related EBV-associated B-cell lymphoproliferative disorder.
  • Masayuki Shintaku; Kyosuke Wada; Tomoko Wakasa; Maho Ueda
    Acta cytologica 55 (5) 467 - 72 2011 [Refereed]
     
    BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a heterogeneous group of neoplasms that shows divergent differentiation potential, and the cytological findings are largely nonspecific. There are no previous reports specifically alluding to the cytological findings of MPNST showing fibroblastic differentiation (fibroblastic MPNST). CASE: A 59-year-old woman with neurofibromatosis type 1 developed a rapidly enlarging tumor on the scalp. A metastatic lesion in the ileum was examined cytologically. Irregularly shaped clusters of spindle cells with wavy or buckled nuclei and fibrillary cytoplasm were found as well as many similar isolated cells. Histopathologically, the tumor showed a spindle cell sarcomatous appearance typical of MPNST. Immunohistochemically, the tumor cells were negative for S-100 protein and epithelial membrane antigen but immunoreactive for vimentin, CD10 and CD34. Ultrastructurally, the tumor cells were not invested by the basal lamina and had abundant rough-surfaced endoplasmic reticulum and a subplasmalemmal accumulation of microfilaments with dense patches. These immunohistochemical and ultrastructural findings were consistent with fibroblastic or myofibroblastic differentiation. CONCLUSION: Although there are no cytological findings specific for fibroblastic MPNST, the wide spectrum of differentiation in MPNST should be kept in mind during cytological examination of soft tissue sarcomas.
  • Makiko Maeda-Taniguchi; Yutaka Ueda; Takahito Miyake; Takashi Miyatake; Toshihiro Kimura; Kiyoshi Yoshino; Masami Fujita; Tomoko Wakasa; Hiroshi Ohashi; Eiichi Morii; Takayuki Enomoto; Tadashi Kimura
    Gynecologic and obstetric investigation KARGER 72 (3) 196 - 202 0378-7346 2011 [Refereed]
     
    BACKGROUND/AIMS: An intraoperative diagnosis in cases with primary and metastatic ovarian carcinomas is important for adequate treatment. The aim of the present study was to find a reliable method to discriminate primary from metastatic mucinous adenocarcinomas (MACs) of the ovary intraoperatively. METHODS: Clinical features of all primary and metastatic mucinous ovarian carcinomas diagnosed from 1994 to 2008 at the Osaka University and Osaka Rosai Hospitals, Osaka, Japan, were reviewed retrospectively. RESULTS: Among the 73 MACs, 51 (70%) and 22 cases (30%) were diagnosed as primary and metastatic ovarian carcinomas, respectively. The distributions of tumor size, patient age, and serum CA125 level were significantly different between primary and metastatic cases. Our algorithm that categorizes patients ≥50 years whose tumor size was <10 cm into metastatic cases, and patients <50 years, or the ones whose tumor size was ≥10 cm, into primary tumors, provided an 84% accuracy in our population. CONCLUSIONS: A more reliable method to discriminate primary from metastatic MACs of the ovary by patient age and serum tumor markers was derived from our study population.
  • Kaoru Abiko; Masaki Mandai; Junzo Hamanishi; Noriomi Matsumura; Tsukasa Baba; Akiko Horiuchi; Yoshiki Mikami; Shinya Yoshioka; Tomoko Wakasa; Tanri Shiozawa; Ikuo Konishi
    The American journal of surgical pathology 34 (12) 1842 - 8 2010/12 [Refereed]
     
    Immature teratoma of the ovary is an uncommon tumor comprising 1% of ovarian malignancies. The amount of immature neuroepithelium in the teratoma is an important prognostic factor. Although the current grading system based on this criterion is widely accepted, the biological significance of immature neuroepithelium is poorly understood. In this study, we used immunohistochemistry to evaluate the expression of Oct4 (also known as Oct3 or POU5F1), a transcription factor expressed in primordial germ cells and embryonic stem cells, along with that of PAX6, a transcription factor contributing to neurogenesis, and CD56, a known marker for tumors of neural origin, in 18 cases of pure immature teratoma of the ovary. Oct4 was expressed in the immature neuroepithelium of all 7 grade-3 cases and 2 grade-2 cases. It was not expressed in 4 grade-2 cases and all 5 grade-1 cases. These tumor cells lacked CD30 or α-fetoprotein expression, which supported the diagnosis of pure immature teratoma. PAX6 was expressed in the immature neuroepithelium of all immature teratomas, but not in Oct4-positive cells. CD56 was expressed in neural components of various maturities including PAX6-positive immature neuroepithelium, but not in Oct4-positive cells. These data suggest that the expression of these markers probably reflects the differentiation status of neural tissue in immature teratomas. The finding that Oct4 expression was exclusively detected in immature neuroepithelium of high-grade immature teratomas indicates that Oct4 might serve as a promising biomarker for the diagnosis of highly malignant cases of immature teratoma.
  • Shiori Itoh; Asako Masatsugu; Atsushi Hinoue; Miyuki Ohta; Tomoko Wakasa; Masayuki Shintaku; Tatsuya Fukumoto; Tetsunori Kimura; Yuji Horiguchi
    The Journal of dermatology 37 (7) 685 - 8 2010/07 [Refereed]
  • 卵巣粘液性腺癌において転移性癌を術前・術中に如何に鑑別するか
    谷口 真紀子; 上田 豊; 三宅 貴仁; 榎本 隆之; 松崎 慎哉; 宮武 崇; 高田 友美; 横山 拓平; 三好 ゆかり; 宇垣 弘美; 木村 敏啓; 吉野 潔; 藤田 征巳; 木村 正; 若狭 朋子
    日本婦人科腫瘍学会雑誌 (公社)日本婦人科腫瘍学会 28 (3) 305 - 305 1347-8559 2010/06
  • Shiori Itoh; Noriko Okada; Tomoko Wakasa; Mitsuru Tsudo; Masayuki Shintaku; Tetsunori Kimura; Yuji Horiguchi
    International journal of dermatology 49 (3) 339 - 41 2010/03 [Refereed]
  • Endo Kosuke; Matsukawa Yasuhiro; Yoshitoshi Yukie Elena; Wakasa Tomoko
    Journal of the Japanese Society of Pediatric Surgeons The Japanese Society of Pediatric Surgeons 46 (6) 962 - 965 0288-609X 2010 
    An 8-year-old boy was referred to our hospital for treatment of the ileus. He was refractory to conservative therapy and an emergent operation was done. Strangulation was the cause of the ileus and it was released. Apart from the obstruction, we found an elastic hard tumor in the ileum. It was well circumscribed, and 2cm in diameter. Partial resection of the ileum was performed. Histopathological examination revealed that it was a 15×8mm subserosal tumor with prominent eosinophilic infiltration. Immunohistochemically, the lesion was positive for CD1a and S-100. We finally diagnosed it as Langerhans cell histiocytosis (LCH). The post-operative course was uneventful and he was discharged on POD 7. Further examination revealed no other lesions, so we finally diagnosed it as the single organ-single site type. As far as we know, this was the first case diagnosed as the SS type of LCH by immunohistochemical examination. The prognosis of multiple organ-multiple site LCH involving the digestive tract is very poor, so a detailed whole body retrieval is necessary.
  • Matsukawa Yasuhiro; Yoshitoshi Elena Yukie; Wakasa Tomoko
    Journal of the Japanese Society of Pediatric Surgeons The Japanese Society of Pediatric Surgeons 46 (6) 935 - 940 0288-609X 2010 
    Purpose: Umbilical polyps are believed to be rare and difficult to distinguish from umbilical granuloma, a common disease in infancy. We checked our cases and discussed their clinical features and differential diagnosis. Methods: In seven years, 78 infants with umbilical tumors resistant to medical therapy were referred to our hospital. Their ages, treatments, appearances of tumor and other clinical features were checked. Fifty-three cases of umbilical polyps in the Japanese literature were also discussed. Results: In 78 cases, 10 were umbilical polyps, 3 were suspected polyps and 65 were umbilical granulomas. They showed male predominance. Umbilical tumors were noticed immediately after separation of the cords. Granulomas were referred within two months after birth, responded well to treatments, and showed complete cure within three months after birth, while the average referral of polyps was 2.2 years after long periods of ineffective medical therapy. Granulomas were rough-surfaced dull-pink tumors, while polyps were smooth-surfaced and bright-red. Differential diagnosis was easy with these typical features even in the neonatal period. Nine polyps were surgically resected, and one was ligated. All were cured. Pathology revealed intestinal mucosa localized within the surface of the polypoid protrusion. Conclusions: Umbilical polyp is one of the common diseases in early infancy. An umbilical tumor which persists beyond the age of 3 months after birth has a high probability of being an umbilical polyp. Differential diagnosis is easy by its typical bright-red appearance even in the neonatal period. Proper diagnosis at the initial visit is important to avoid ineffective medical treatments.
  • MAEDA Makiko; MATSUZAKI Shinya; MIYATAKE Takashi; UEDA Yutaka; FUJITA Masami; ENOMOTO Takayuki; KIMURA Tadashi; WAKASA Tomoko
    ADVANCES IN OBSTETRICS AND GYNECOLOGY THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN 62 (1) 39 - 41 0370-8446 2010
  • WAKASA Kenichi; WAKASA Tomoko; OHSAWA Masahiko
    ADVANCES IN OBSTETRICS AND GYNECOLOGY THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN 62 (1) 17 - 19 0370-8446 2010
  • Sayaka Tanaka; Natsuhiko Kameda; Yuki Kubo; Naoko Obatake; Tomoko Wakasa; Masahiko Ohsawa; Kenichi Wakasa
    Pathology international WILEY-BLACKWELL PUBLISHING, INC 59 (8) 598 - 600 1320-5463 2009/08 [Refereed]
  • 当科における原発性および転移性卵巣粘液性腺癌症例の検討
    前田 真紀子; 松崎 慎哉; 宮武 崇; 上田 豊; 藤田 征巳; 榎本 隆之; 木村 正; 若狭 朋子
    産婦人科の進歩 「産婦人科の進歩」編集室 61 (2) 200 - 200 0370-8446 2009/05
  • Yoshiki Mikami; Takako Kiyokawa; Yuko Sasajima; Norihiro Teramoto; Tomoko Wakasa; Kenichi Wakasa; Sakae Hata
    Histopathology WILEY-BLACKWELL PUBLISHING, INC 54 (2) 184 - 91 0309-0167 2009/01 [Refereed]
     
    AIMS: To describe the gastric phenotype of synchronous mucinous metaplasia and neoplasms of the female genital tract (SMMN-FGT). METHODS AND RESULTS: Six patients (mean age 57 years, range 39-83 years) were diagnosed with SMMN-FGT. All six patients had mucinous metaplasia of endometrium, which showed features of lobular endocervical glandular hyperplasia (LEGH)/pyloric gland metaplasia (PGM) in five and was associated with mucinous adenocarcinoma in three. Five patients had mucinous metaplasia of the fallopian tubes, of which three showed borderline features. Two patients had mucinous borderline tumour of the ovary. Five patients had cervical lesions including LEGH/PGM associated with either adenocarcinoma in situ or minimal deviation adenocarcinoma of the cervix. All mucinous lesions were positive for HIK1083 and/or MUC6. One patient with minimal deviation adenocarcinoma involving the vagina died of her disease, whereas five patients, including three with microinvasion and three with positive peritoneal cytology or mucinous ascites, were alive without recurrence after a mean follow-up of 46 months (range 13-102 months). CONCLUSIONS: There is a close association between SMMN-FGT and LEGH/PGM. Microinvasion and positive peritoneal cytology may not have an influence on outcome.
  • Tomoko Wakasa; Kenichi Wakasa; Masahiro Nakayama; Yuko Kuwae; Keiko Matsuoka; Makoto Takeuchi; Noriyuki Suehara; Tadashi Kimura
    Gynecologic and obstetric investigation KARGER 67 (2) 137 - 44 0378-7346 2009 [Refereed]
     
    BACKGROUND: The histological changes in uterine blood vessels during pregnancy have been well investigated, but there have been few reports focusing on the changes in blood vessels during the involution process, especially within the first 24 h. We observed the process of uterine involution, focusing on the vessels of the resected uterus. METHODS: Paraffin-embedded uterine samples from 15 patients who underwent hysterectomy because of severe cervical laceration and uterine rupture were examined. The time between delivery and hysterectomy ranged from 15 min to 456 h. The specimens were stained with hematoxylin-eosin, elastica-van Gieson and an antioxytocin receptor antibody. RESULTS: Changes in the uterine vessels varied substantially based on their location. The intima in arteries of the endometrial side thickened within 5 h after delivery. On the serosal side, phlebosclerosis was demonstrated 6 weeks postpartum. Immunoreactivity for the oxytocin receptor (OTR) appeared in the muscular medias of arteries 5 h after delivery although it was not expressed before this period. CONCLUSION: Remodeling of uterine vessels involved thickening of the arterial intima and OTR expression in vessel walls during the first 5 h postpartum; the parameters normalized within 6 weeks. However, phlebosclerosis persisted for a long time on the serosal side.
  • Minori Kato; Hiroaki Nakamura; Eisuke Suzuki; Hidetomi Terai; Kenichi Wakasa; Tomoko Wakasa; Kunio Takaoka
    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 15 (7) 827 - 30 2008/07 [Refereed]
     
    There are many reports of extradural ependymal cysts in the literature; however, reports of intradural ependymal cysts are very rare and there has been no prior mention of an ependymal cyst originating from the filum terminale. In this report we present the case of a 31-year-old woman with an ependymal cyst that caused cauda equina compression, and discuss the clinical profile of the case in terms of symptoms, diagnostic images, pathohistological findings, and surgical procedures. To our knowledge, this is the first report of an ependymal cyst that caused cauda equina compression. The cyst was successfully treated by excision of the cyst during careful intraoperative monitoring to prevent neurological damage to the conus medullaris and cauda equina.
  • Kenji Tezuka; Naoyoshi Onoda; Tsutomu Takashima; Tetsuro Ishikawa; Tomoko Wakasa; Kenichi Wakasa; Kosei Hirakawa
    Oncology reports SPANDIDOS PUBL LTD 20 (1) 25 - 32 1021-335X 2008/07 [Refereed]
     
    The lymphatic system is known as one of the most important pathways in the disease progression of breast cancer. In this study, we investigated lymphatic systems intra-tumorally, and found a unique structure displaying lymphoendothelial immunoreactivity. These incomplete vessel-like structures that formed sinusoids and specifically reacted with the D2-40 antibody, were found in the tumor stroma and were often infiltrated by cancer cells. To show the clinical significance of these intra-tumoral sinusoidal structures (ISS), we examined 113 specimens of surgically resected breast cancer. In multivariate logistic regression analysis, lymph node status (p=0.024) and disease recurrence (p=0.008) were the independent factors that correlated with the existence of ISS. Positive ISS detection in the tumor correlated more strongly with lymph node metastases than positive lymphovascular invasion by cancer cells. Furthermore, a significant correlation with frequent recurrence and poorer survival were recognized in patients with ISS (p<0.001, log-rank test). The evaluation of ISS by needle-biopsied specimens was as accurate as that with surgical specimens, and a significant correlation between the positive ISS evaluated by biopsy and positive lymph node status (p=0.020) was found. In conclusion, ISS are unique structures which play a crucial role in disease progression through lymphatic systems in breast cancer. In a clinical setting, the detection of ISS by biopsy specimen should be considered as a method for determining prognosis instead of a whole tumor examination.
  • MABUCHI Yasushi; FURUKAWA Kenichi; WAKASA Tomoko
    ADVANCES IN OBSTETRICS AND GYNECOLOGY THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN 60 (2) 65 - 69 0370-8446 2008 [Refereed]
     
    Ectopic ovary is a rare gynecologic condition that is classified into two subtypes, supernumerary ovary and accessory ovary. Herein, we report a case of mature cystic teratoma originating in an ectopic ovary. A 38-year-old woman (gravida 2, para 2) visited a physician with a complaint of constipation. Computed tomography showed a round cystic mass with a diameter of 4.5cm and a calcified surface, adjacent to the uterus. She was referred to our hospital because the mass had been considered to be an ovarian tumor. On pelvic examination, a hard right adnexal tumor was palpated, although the uterus was normal sized and the left adnexa was not palpable. Ultrasound examination revealed similar findings to those of CT. Magnetic resonance imaging revealed a cystic lesion adjacent to the uterus, with high T1 and T2 intensities. Fat saturated image showed a mass with low intensity. Laboratory data were within normal ranges. The preoperative diagnosis was suspected a right ovarian mature cystic teratoma, and laparoscopic surgery was performed. At the operation, a tumor, 4 cm in size, was noted in her cul de sac, which was firmly adherent to the uterus and uterosacral ligament. The bilateral ovaries were normal in appearance and were in the proper position. The tumor was isolated from both ovaries and was completely resected. Intraoperative bleeding was extremely small and the feeding vessel to the tumor was not evident. The wall of the tumor was hard with calcification and it contained hair, adipose tissue and calcification. Spindle-shaped theca cells were noted in the capsule of the tumor, although a primordial follicle was absent. In conclusion, the tumor was diagnosed as a mature cystic teratoma originating in an ectopic supernumerary ovary. [Adv Obstet Gynecol, 60(2) : 65-69, 2008 (H20.5)]
  • Kennichi Kakudo; Yanhua Bai; Yaqiong Li; Tomoko Wakasa; Ichiro Mori
    Nihon rinsho. Japanese journal of clinical medicine 65 (11) 1979 - 84 0047-1852 2007/11 [Refereed]
     
    The poorly differentiated carcinoma was first added as a new member in the lists of classification of thyroid carcinomas in the WHO 2004 edition. However its histological criteria include necrosis and increased mitoses in addition to the original definition by Sakamoto's proposal, solid, trabecular and schirrhous growth. This modification creates a significant change in the incidence and prognosis of this carcinoma. This carcinoma, defined by the new WHO classification, is about 1-5% of all thyroid malignancy and has more aggressive outcome than the previous definition.
  • 三上 芳喜; 清川 貴子; 笹島 ゆう子; 寺本 典弘; 若狭 朋子; 若狭 研一
    日本婦人科腫瘍学会雑誌 (公社)日本婦人科腫瘍学会 25 (3) 238 - 238 1347-8559 2007/06 [Refereed]
  • Kenji Tezuka; Naoyoshi Onoda; Tsutomu Takashima; Keiichi Takagaki; Tetsuro Ishikawa; Tomoko Wakasa; Kenichi Wakasa; Kosei Hirakawa
    Oncology reports PROFESSOR D A SPANDIDOS 17 (5) 997 - 1003 1021-335X 2007/05 [Refereed]
     
    Prognostic factors for breast cancer include axillary lymph node status, tumor size, histology, nuclear grade, presence of estrogen and progesterone receptors, HER2/neu status, and mean microvessel density (MVD). In this study, we evaluated the usefulness of a new marker, D2-40, by investigating lymph vascular invasion of the tumor immunohistochemically in 132 patients with breast cancer and compared it with those of well-known prognostic indicators. Positive immunostaining of lymphatic endothelium with D2-40 outlining tumor emboli in the lumen of lymphatics was defined as D2-LVI, and lymphatic invasion following conventional hematoxylin and eosin staining was defined as HE-LVI. Significant correlation was observed between HE-LVI and D2-LVI (p<0.001), between lymph node status and HE-LVI (p=0.005), and between recurrent status and D2-LVI (p=0.008) by univariate analysis. Based on multivariate analysis, lymph node status (p<0.001, OR=6.993), tumor size (p=0.005, OR=5.504), D2-LVI (p=0.006, OR=4.740), and MVD (p=0.002, OR=4.484) were independent prognostic factors of disease recurrence. A significant difference in disease-free survival was also found between patients with and without D2-LVI (p=0.0067), but not with or without HE-LVI. Even in node-positive cases, D2-LVI had prognostic meaning. D2-LVI may play a crucial role for predicting recurrence of breast cancers much more than expected. Our data identifying D2-LVI expression in tumors of patients with a poor disease-free survival prognosis provides an easier and more accurate prognostic method than identifying HE-LVI.
  • Takashi Miyatake; Yutaka Ueda; Kiyoshi Yoshino; Kenneth R Shroyer; Hiroyuki Kanao; Hongbo Sun; Ryuichi Nakashima; Toshihiro Kimura; Tomoko Wakasa; Takayuki Enomoto
    International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 26 (2) 180 - 7 0277-1691 2007/04 [Refereed]
     
    Atypical immature squamous metaplasia (ISM) of the uterine cervix often has histological features that overlap with the histological characteristics of high-grade cervical intraepithelial neoplasia. To identify the cellular basis and clinical significance of atypical immature metaplasia (AIM), 10 cases of AIM were analyzed for the clonal status, and the presence of human papillomavirus (HPV) infection. The physical status of HPV was also evaluated in HPV type 16 (HPV-16)-positive cases. Squamous metaplasias with no nuclear atypia (29 mature squamous metaplasias [SMs]) and a single case of ISM were analyzed as a control. Nine AIMs, 20 SMs, and a single case of ISM were informative for clonal analysis. Monoclonal composition of the lesion was demonstrated in 8 (89%) of 9 AIMs, but only in 2 (10%) of 21 cases of SM without atypia (AIM vs SM + ISM, 8/9 vs 2/21; P < 0.0001). High-risk HPV was detected in 6 (60%) of 10 AIMs, all were HPV-16, but only in 3 (13%) of 24 SMs with no atypia (2/23 SM and 1/1 ISM). The frequency of high-risk HPV infection was also significant between AIMs and SM with no atypia (6/10 vs 3/24; P < 0.001). Among the cases, which were informative for clonal analysis, all 5 AIMs positive for high-risk HPV were monoclonal in composition. Physical status of HPV was examined in HPV-16-positive cases. Human papillomavirus type 16 was present as a mixture of episomal form and integrated form in 4 of 6 AIMs. These observations imply that unlike SMs with no atypia, which arises as a result of reactive or inflammatory process, lesions with the histological characteristics of AIM may be indeed true precursors of cervical carcinoma.
  • Tomoko Wakasa; Kenichi Wakasa; Taichi Shutou; Seikan Hai; Shoji Kubo; Kazuhiro Hirohashi; Koji Umeshita; Morito Monden
    Hepato-gastroenterology H G E UPDATE MEDICAL PUBLISHING S A 54 (74) 508 - 13 0172-6390 2007/03 [Refereed]
     
    BACKGROUND/AIMS: Combined hepatocellular and cholangiocarcinoma of the liver is relatively infrequent, and its pathogenesis remains obscure. The aim of this study is to investigate its clinical and pathological features and proliferative activity. METHODOLOGY: In this study, we investigated the histopathological features, Ki-67 labeling index, and p53 immunohistochemistry of 18 surgically resected cases of combined hepatocellular and cholangiocarcinoma among 1102 consecutive cases of surgically resected primary liver cancers. All tumors were compatible with the WHO definition of this tumor. Microscopically, we classified the cases into the following three categories according to the arrangement of the hepatocellular carcinoma and cholangiocarcinoma components; (1) Type I in which hepatocellular carcinoma and cholangiocarcinoma formed nodules that could easily be distinguished from each other, (2) Type II in which the both components were finely mixed, so that the two components were almost indistinguishable, and (3) Type III in which the tumors had lobular structures with hepatocellular carcinomas existing centrally and cholangiocarcinomas existing peripherally. RESULTS: Microscopically, the tumors were classified into type I 7 tumors, type II 5 tumors, and type III 6 tumors. In one case of type I, well differentiated hepatocellular carcinoma demonstrated cholangiocarcinoma in "nodules-in-nodules" fashion. The average of Ki-67 labeling index of hepatocellular carcinoma component of combined hepatocellular and cholangiocarcinoma was 4.4 +/- 3.4% and the index of cholangiocarcinoma component was 11.0 +/- 8.5%, which is significantly higher than that of the hepatocellular carcinoma component. On p53 immunohistochemistry, 5 of 18 cases (29.4%) were positive. In one case, the cholangiocarcinoma component was positive for p53, but the hepatocellular carcinoma component was negative. In the other 4 cases, both the hepatocellular carcinoma and cholangiocarcinoma components were positive. CONCLUSIONS: Microscopically, type III seems to be a feature of metaplasia or proliferation of bipotential progenitor cells. Metaplasia of hepatocellular carcinoma to intrahepatic cholangiocarcinoma is assumed to be one of the pathogenic pathways of combined hepatocellular and cholangiocarcinoma.
  • Yoshimasa Hamazawa; Koichi Koyama; Terue Okamura; Yasuhiro Wada; Tomoko Wakasa; Tomohisa Okuma; Yasuyoshi Watanabe; Yuichi Inoue
    Annals of nuclear medicine 21 (1) 47 - 55 0914-7187 2007/01 [Refereed]
     
    PURPOSE: We investigated the optimum time for the differentiation tumor from inflammation using dynamic FDG-microPET scans obtained by a MicroPET P4 scanner in animal models. MATERIALS AND METHODS: Forty-six rabbits with 92 inflammatory lesions that were induced 2, 5, 7, 14, 30 and 60 days after 0.2 ml (Group 1) or 1.0 ml (Group 2) of turpentine oil injection were used as inflammatory models. Five rabbits with 10 VX2 tumors were used as the tumor model. Helical CT scans were performed before the PET studies. In the PET study, after 4 hours fasting, and following transmission scans and dynamic emission data acquisitions were performed until 2 hours after intravenous FDG injection. Images were reconstructed every 10 minutes using a filtered-back projection method. PET images were analyzed visually referring to CT images. For quantitative analysis, the inflammation-to-muscle (I/M) ratio and tumor-to-muscle (T/M) ratio were calculated after regions of interest were set in tumors and muscles referring to CT images and the time-I/M ratio and time-T/M ratio curves (TRCs) were prepared to show the change over time in these ratios. The histological appearance of both inflammatory lesions and tumor lesions were examined and compared with the CT and FDG-microPET images. RESULTS: In visual and quantitative analysis, All the I/M ratios and the T/M ratios increased over time except that Day 60 of Group 1 showed an almost flat curve. The TRC of the T/M ratio showed a linear increasing curve over time, while that of the I/M ratios showed a parabolic increasing over time at the most. FDG uptake in the inflammatory lesions reflected the histological findings. For differentiating tumors from inflammatory lesions with the early image acquired at 40 min for dual-time imaging, the delayed image must be acquired 30 min after the early image, while imaging at 90 min or later after intravenous FDG injection was necessary in single-time-point imaging. CONCLUSION: Our results suggest the possibility of shortening the overall testing time in clinical practice by adopting dual-time-point imaging rather than single-time-point imaging.
  • Tatsuya Nishida; Noritoshi Nishiyama; Kiyotoshi Inoue; Yasuhiro Kawata; Tsuyoshi Ichikawa; Takuma Tsukioka; Tomoko Wakasa; Kenichi Wakasa; Shigefumi Suehiro
    Osaka city medical journal 52 (2) 87 - 92 0030-6096 2006/12 [Refereed]
     
    A 25-year-old man was referred to our hospital in June 2000 for treatment of massive enlargement of residual pulmonary metastases from a nonseminomatous germ cell testicular tumor. He had undergone right orchiectomy followed by cisplatin-based combination chemotherapy 7 years ago. Chest radiography and computed tomography showed complete opacification of the left hemithorax with mediastinal shift to the right, and two smaller nodules in the right lung. After salvage chemotherapy, elevated serum alpha-fetoprotein concentrations decreased to the normal range. Considering this response, we successfully resected the metastases via median sternotomy. Postoperative pathologic examination disclosed metastatic germ cell tumors composed of mature teratoma. The patient recovered uneventfully and has been alive for 6 years since residual metastasectomy. When technically possible, resection of even massive pulmonary metastases after a favorable response to chemotherapy for a nonseminomatous germ cell tumor, can provide pathologic assessment of the response and offer patients a chance of long-term survival.
  • TENDO Masashige; ONODA Naoyoshi; NISHINO Hiroji; NISHIHARA Tamahiro; WAKASA Tomoko; WAKASA Kenichi; HIRAKAWA Kosei
    The journal of the Japanese Practical Surgeon Society Japan Surgical Association 67 (10) 2453 - 2456 1345-2843 2006/10 
    Lymphangiomyoma (LAM) is a rare entity occurring mainly in women in the reproductive generations, and is often accompanied with multiple lesions in the lower retroperitoneum and/or lethal spread to the lung and mediastinum. On the other hand, there have been only few reports of LAM confined within the retroperitoneum. We present a case of LAM of the retroperitoneum located on the posterior surface of the pancreas which is the ninth case, together with a review of the reported cases in Japan.
    A 40-year-old woman was admitted to the hospital because of a retroperitoneal tumor on the posterior surface of the pancreas. Examinations revealed a polycystic mass located between the descending aorta and the inferior vena cava, with clear borders from adjacent organs. A diagnosis of retroperitoneal tumor was made and laparotomy was performed. The cystic tumor, filled with lymphatic fluid, did not invaded the surrounding tissues and was dissected enbloc easily. LAM was diagnosed with histological examinations postoperatively. The patient has been well without recurrence for 48 months after the operation.
  • H Wada; H Nagano; H Yamamoto; YB Yang; M Kondo; H Ota; M Nakamura; S Yoshioka; H Kato; B Damdinsuren; D Tang; S Marubashi; A Miyamoto; Y Takeda; K Umeshita; S Nakamori; M Sakon; K Dono; K Wakasa; M Monden
    LIVER INTERNATIONAL BLACKWELL PUBLISHING 26 (4) 414 - 423 1478-3223 2006/05 [Refereed]
     
    Background: Hepatocellular carcinoma (HCC) is a hypervascular tumor and angiogenesis plays an important role in its progression. Angiogenesis is regulated by a balance between pro and antiangiogenic molecules. The aim of this study was to investigate the expressions of angiogenic factors and elucidate their roles in angiogenesis in HCC. Methods: We investigated immunohistochemical expression of vascular endothelial growth factor (VEGF), angiopoietins (Ang-1 and Ang-2), hypoxia-induced factor-1 alpha (HIF-1 alpha) and thrombospondin-1 (TSP-1) in 60 specimens of surgically resected HCC. We investigated the relationship between their expressions and clinicopathological factors or prognosis. Results: Ang-2 staining had a significant correlation with the grade of differentiation of HCC cells (P=0.0082). VEGF and Ang-2 expression correlated positively with microvessel density (MVD) (P=0.0061 and 0.0374, respectively). MVD of well-differentiated HCC were significantly lower than those of moderately and poorly differentiated HCC. The disease-free survival time of patients with high Ang-2 and/or HIF-1 alpha expression was significantly shorter than that of the low expression group (P=0.0278 and 0.0374, respectively).Conclusions: Our study showed that the expression of VEGF and Ang-2 correlated with MVD. Strong Ang-2 expression and/or high nuclear expression of HIF-1 alpha is a significant predictive factor for recurrence after curative resection in HCC patients.
  • Ping Zhang; Hui Zuo; Yasushi Nakamura; Misa Nakamura; Tomoko Wakasa; Kennichi Kakudo
    Pathology international 56 (5) 240 - 5 1320-5463 2006/05 [Refereed]
     
    Thyroid transcription factor 1 (TTF1), thyroid transcription factor 2 (TTF2) and paired box gene 8 (Pax8) are demonstrated to play a crucial role for the differentiation and organogenesis of thyroid follicular cells. Their roles in thyroid carcinogenesis are not very clear. Because dedifferentiation is a common process in thyroid carcinogenesis, thyroid-specific transcription factors seem also to be involving in thyroid carcinogenesis. The purpose of the present paper was to investigate their expression in a broad spectrum of follicular cell tumors in different degrees of differentiation, from well-differentiated benign follicular adenoma to anaplastic carcinoma. Medullary (C cell) carcinoma was also included in the investigation. Results of immunohistochemical staining showed that nuclear localization of these transcription factors was gradually decreased corresponding to the progressive dedifferentiation of thyroid tumors. Also, abnormal cytoplasmic accumulation of TTF2 and Pax8 was detected in many tumors samples, which may indicate a subtle regulation mechanism on the function of these transcription factors. In conclusion, abnormal expression of TTF1, TTF2 and Pax8 was closely related to thyroid tumorigenesis.
  • Y Nobuhara; N Onoda; K Fukai; N Hosomi; M Jshii; K Wakasa; T Nishihara; T Ishikawa; K Hirakawa
    SURGERY TODAY SPRINGER 36 (3) 283 - 286 0941-1291 2006/03 [Refereed]
     
    Abdominal lymphangioma is a rare tumor III adults. The most common location is the mesentery, but this tumor occasionally develops in the pancreas. We report a case of pancreatic lymphangioma associated with blue rubber-bleb nevus syndrome (BRBNS) in a Japanese woman. The pancreatic lymphangioma spread extensively throughout the retroperitoneum without causing ally symptoms for more than 4 years after its histological diagnosis by laparoscopic biopsy. Multiple hemangiomas were also seen in the mucous membranes and oil the skin. The hemangiomatosis was segregated in the dominant fashion in her family, and a germ-line gain-of-function Mutation (Arg849Trp) in TIE2 gene was confirmed. To our knowledge, this is the first report of pancreatic lymphangioma occurring in association with BRBNS in a patient with genetic alteration. We describe the clinical features of this case and discuss a possible correlation between these two uncommon conditions.
  • H Ota; H Nagano; M Sakon; H Eguchi; M Kondo; T Yamamoto; M Nakamura; B Damdinsuren; H Wada; S Marubashi; A Miyamoto; K Dono; K Umeshita; S Nakamori; K Wakasa; M Monden
    BRITISH JOURNAL OF CANCER NATURE PUBLISHING GROUP 93 (5) 557 - 564 0007-0920 2005/09 
    We previously reported the beneficial effects of combination therapy of interferon (IFN)-alpha/5-fluorouracil (FU) for advanced hepatocellular carcinoma (HCC) with tumour thrombi in the major portal branches. This report describes the results of longer follow-up and includes more than double the number of patients relative to the original report, and evaluates the role of IFN-alpha/type 2 interferon receptor (IFNAR2) expression on the response to the combination therapy. The study subjects were 55 patients with advanced HCC and tumour thrombi in the major branches of the portal vein (Vp3 or 4). They were treated with at least two courses of IFN-alpha/5-FU without major complication. In the 55 patients, 24 (43.6%) showed objective response ( eight (14.5%) showed complete response, 16 (29.1%) partial response), four (7.3%) showed no response, and 27 (49.1%) showed progressive disease. Immunohistochemically, IFNAR2 expression was detected in nine out of 13 (69.2%) patients. There was significant difference in the time-to-progression survival ( P = 0.0002) and the overall survival (P<0.0001) between IFNAR2-positive and - negative cases. There was a significant correlation between IFNAR2 expression and response to IFN-alpha/5-FU combination therapy in univariate analysis ( P = 0.0070). IFN-alpha/5-FU combination therapy is a promising modality for advanced HCC with tumour thrombi in the major portal branches and could significantly depend on IFNAR2 expression.
  • B Damdinsuren; H Nagano; M Kondo; H Yamamoto; N Hiraoka; T Yamamoto; S Marubashi; A Miyamoto; K Umeshita; K Dono; S Nakamori; K Wakasa; M Sakon; M Monden
    INTERNATIONAL JOURNAL OF ONCOLOGY PROFESSOR D A SPANDIDOS 26 (2) 319 - 327 1019-6439 2005/02 [Refereed]
     
    Several studies reported that Id (Inhibitor of DNA binding or Differentiation) proteins, helix-loop-helix transcription factors, have important roles in differentiation, cell cycle and angiogenesis in various cells. However. the role of Id proteins in hepatocellular carcinoma (HCC) remains unclear. We examined the immunohistochemical expression of Id1, Id2 and Id3 proteins in 54 surgically resected HCCs with surrounding HCV or HBV-related chronic hepatitis (n=30) and liver cirrhosis (n=24). All non-cancerous livers exhibited immunoreactivity for Id proteins and the expression increased from chronic hepatitis to cirrhosis. In HCCs (n=45), well-differentiated tumors mostly exhibited strong or moderate immunostaining for all Id proteins, while proportion of the samples with weak or no expression increased with tumor dedifferentiation and frequently observed in poorly (66.7, 93.3 and 93.3% respectively for Id1, 2, 3) or undifferentiated (100% for all Ids) HCCs. Clinicopathological survey demonstrated a significant correlation between Id 1, 2 and 3 expression and differentiation of carcinoma (p=0.0044, 0.0014 and 0.0014, respectively) although univariate analysis indicated that high expression of Id1 was significant predictive factor for longer disease-free survival of the patients (p=0.047). A similar tendency was also observed with Id2 and Id3. The present study demonstrate high expression of Id1, 2 and 3 in well-differentiated HCC and low expression in advanced dedifferentiated HCC, in contrast to its continuous expression during breast, prostate and colon carcinogenesis. These findings suggested that Id1. 2 and 3 might play a role in the early stages of hepatocarcinogenesis. but not in the development of advanced carcinoma. and might consequently be related to HCC dedifferentiation.
  • Yutaka Ueda; Takayuki Enomoto; Takashi Miyatake; Kenneth R Shroyer; Tatsuo Yoshizaki; Hiroyuki Kanao; Yuko Ueno; Hongbo Sun; Ryuichi Nakashima; Kiyoshi Yoshino; Toshihiro Kimura; Tomoko Haba; Kenichi Wakasa; Yuji Murata
    American journal of clinical pathology 122 (2) 266 - 74 0002-9173 2004/08 [Refereed]
     
    To elucidate the pathogenesis of vulvar carcinomas, we studied clonality and human papillomavirus (HPV) infection in vulvar epithelial diseases. Monoclonal composition was demonstrated in all 9 invasive tumors (squamous cell carcinoma [SCC], 6; basal cell carcinoma, 1; malignant melanoma, 2), 15 of 20 cases of vulvar intraepithelial neoplasia (VIN), 7 of 9 cases of Paget disease, 2 of 6 cases of lichen sclerosus (LS), and 2 of 3 cases of squamous cell hyperplasia (SCH); high-risk type HPV was revealed in 5 of 6 SCCs and 17 of 20 VINs. These observations might imply that a subset of cases of LS and SCH result from a neoplastic proliferation, similar to VINs but not related to infection with high-risk type HPV. In 1 case of SCC with concurrent VIN 3 in an adjacent lesion, both lesions showed the same pattern of X chromosome inactivation and the presence of HPV-16 in episomal and integrated forms, suggesting that monoclonal expansion triggered by high-risk type HPV integration is an early event for carcinogenesis of HPV-associated SCC.
  • Z Xiang; N Onoda; M Ohira; T Yukawa; T Uchida; T Arakawa; K Wakasa; KHYS Chung
    HEPATO-GASTROENTEROLOGY H G E UPDATE MEDICAL PUBLISHING S A 51 (57) 732 - 735 0172-6390 2004/05 [Refereed]
     
    We present a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the duodenum treated with surgical resection. A 64-year-old woman underwent upper gastrointestinal endoscopy because of melena. Examinations revealed an ulcer-forming lesion at the second portion of the duodenum that was diagnosed histologically as low-grade MALT lymphoma. We attempted Helicobaeter pylori eradication therapy, although all the tests revealed negative results for its infection. No sign of remission was observed and we performed surgical resection. The patient has shown no sign of recurrence at present, 39 months after the operation. Duodenal MALT lymphoma is a rare entity. Only 17 cases have been reported in the English literature. We summarized the characteristics of the disease and tried to figure out differences in comparison with those in the stomach, including the involvement of the Helicobaeter pylori infection.
  • T Takashima; N Onoda; T Ishikawa; T Koyama; M Inaba; Y Nishizawa; T Nakatani; K Wakasa; K Hirakawa
    SURGERY TODAY SPRINGER-VERLAG 34 (4) 374 - 378 0941-1291 2004/04 [Refereed]
     
    Idiopathic retroperitoneal fibrosis (IRF) is characterized by the progressive proliferation of connective tissue, but it rarely results in the formation of a mass. Herein, we report a rare case of tumor-forming IRF. A 76-year-old woman was referred to our hospital after a tumor in the right retroperitoneum was found by ultrasonography and computed tomography. Magnetic resonance imaging showed a 5 x 8 x 5-cm irregularly shaped tumor, lying adjacent to the right kidney, with a high-intensity T1-weighted image and a high-intensity T2-weighted image. Hormonal levels were within normal limits. Surgery was performed because of the possibility of an adrenal cancer. The tumor was firm, measured 7 x 8 x 4 cm, and weighed 115 g. The pathological diagnosis was retroperitoneal fibrosis. It is very difficult to distinguish tumor-forming IRF from malignancy. Several examinations, including needle aspiration cytology and biopsy, are necessary for the diagnosis and treatment of this disease.
  • Hiroto Iwasaki; Ken Morimoto; Masae Koh; Terue Okamura; Kenichi Wakasa; Tomoko Wakasa; Hiroaki Kinoshita
    Magnetic resonance imaging 22 (2) 285 - 90 0730-725X 2004/02 [Refereed]
     
    A 63-year-old woman was found to have a left breast mass after quadrantectomy and radiation for bilateral breast cancer on postoperative cyclic examination. Intramammary recurrence could not be excluded by physical examination, mammography, or ultrasound examination. MR imaging with fat suppression technique revealed an oil-containing lesion, indicating fat necrosis. It was confirmed histologically that the mass-forming lesion included no cancer tissue. MR imaging with fat suppression technique appears to be a promising method for identification of postoperative mass lesions of the breast.
  • H Kawajiri; N Onoda; M Ohira; T Nakatani; K Wakasa; T Ishikawa; K Hirakawa
    SURGERY TODAY SPRINGER-VERLAG 34 (1) 86 - 89 0941-1291 2004/01 [Refereed]
     
    Carcinoid tumors are known to occur frequently in the gastrointestinal tract and they can develop in nearly every organ system. However, a carcinoid tumor of the kidney is an extremely rare entity and only 38 cases have been reported in the English literature. We herein describe the 39th case of primary renal carcinoid tumor, found in a young Japanese woman 2 months after delivery. The pathologic similarities of our case with those of previously reported cases are briefly reviewed together with some aspects of clinical features and prognostic factors of this rare disease.
  • J Shimizu; H Oka; K Dono; M Sakon; M Takamura; T Murakami; S Hayashi; H Nagano; S Nakamori; K Umeshita; S Sase; M Gotoh; K Wakasa; H Nakamura; M Monden
    DIGESTIVE DISEASES AND SCIENCES KLUWER ACADEMIC/PLENUM PUBL 48 (8) 1510 - 1516 0163-2116 2003/08 [Refereed]
     
    The aim of this study was to quantitatively measure tissue blood flow (TBF) in hepatocellular carcinoma (HCC) by a noninvasive method using xenon (Xe) inhalation/CT scans and to correlate the measured TBF with histological features. TBF was measured in HCC with xenon-enhanced CT (xenon/CT) in 20 patients. In 15 patients with HCC diagnosed as hypervascular tumors by conventional CT, TBF of the tumors was significantly higher than that of noncancerous liver tissue (151.1 +/- 20 vs 42.6 +/- 20 ml/min/100 g). Histologically, these tumors were diagnosed as moderately-to-poorly differentiated HCC. In contrast, in five patients with hypovascular HCC, TBF of HCC was almost comparable to that of the noncancerous regions (45.3 +/- 6 vs 48.3 +/- 6 ml/min/100 g). All these tumors were well-differentiated HCC. In conclusions, the measured values of TBF correlate with the clinicopathologic features of liver tumors and nontumorous liver tissue in patients with HCC.
  • Akira Hagiwara; Yuichi Inoue; Kenichi Wakasa; Tomoko Haba; Takahiko Tashiro; Takeshi Miyamoto
    Radiology 228 (2) 533 - 8 0033-8419 2003/08 [Refereed]
     
    PURPOSE: To identify characteristic features of growth hormone (GH)-producing pituitary adenomas. MATERIALS AND METHODS: A total of 174 pathologically proven pituitary adenomas were evaluated retrospectively on magnetic resonance (MR) images to determine the signal intensity (on T2-weighted images), maximum diameter, and amount of suprasellar and infrasellar extension. For microadenomas, sellar depth was also measured. GH-producing adenomas were classified at histologic evaluation as densely or sparsely granulated. Specimens from 38 adenomas were stained to assess the amounts of fibrous tissue, iron, and amyloid they contained. Results were correlated with the size and hormonal activity of adenomas by using the chi2, unpaired t, and Mann-Whitney U tests. RESULTS: Among 174 pituitary adenomas, 42 were GH-producing adenomas. Of these, 16 were densely granulated, and 24 were sparsely granulated (two histologic specimens were lost). Signal intensity was evaluated among 153 adenomas. On T2-weighted MR images, hypointensity was seen more commonly in adenomas that produced GH (16 of 40 cases [40%]; P <.001) than in those that did not; hypointensity was nearly exclusive to densely granulated GH-producing adenomas. The amounts of amyloid, fibrous tissue, and iron contained in adenomas demonstrated little relationship with signal intensity. Average suprasellar extension was significantly smaller in adenomas that produced GH (-0.8 mm) than in those that did not (5.3 mm) (P <.001). GH-producing adenomas tended to demonstrate infrasellar extension rather than suprasellar extension. Average sellar depth associated with GH-producing microadenomas (13.3 mm) was significantly greater than for non-GH-producing microadenomas (9.7 mm; P <.001). CONCLUSION: Characteristic features regarding growth direction and T2 signal intensity can be identified for GH-producing adenomas.
  • M Kondo; H Nagano; M Sakon; S Hayashi; J Okami; K Dono; K Umeshita; S Nakamori; K Wakasa; M Monden
    HEPATO-GASTROENTEROLOGY H G E UPDATE MEDICAL PUBLISHING S A 50 (50) 504 - 506 0172-6390 2003/03 [Refereed]
     
    Background/Aims: Intractable ascites is one of the serious complications after hepatectomy. Only little is known about their effect on postoperative ascites in patients with liver cirrhosis although beta-blockers have been used for cirrhotic complications including ascites. Methodology: Here, we report five cases of intractable ascites after hepatectomy, which were treated by propranolol (1mg/kg/body). Results: In three patients, plasma renin activity and aldosterone concentrations were markedly increased before propranolol administration, but fell to normal levels thereafter. Ascites subsided in all subjects except one, who developed cardiac dysfunction. Conclusions: Beta-blockers might be a promising drug for intractable ascites in cirrhotic patients undergoing hepatectomy.
  • Well-differentiated papillary mesothelioma in the pelvic cavity. A case report.
    Tomoko Haba, Kenichi Wakasa, Masaomi Sasaki
    Acta cytologica 47 (1) 88 - 92 2003
  • Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma.
    Takahiro Uenishi, Kazuhiro Hirohashi, Tomoko Haba, Kenichi Wakasa, Shoji Kubo, Taichi Shuto, Hiromu Tanaka, Takatsugu Yamamoto, Shogo Tanaka, Hiroaki Kinoshita
    Hepato-gastroenterology 50 1140 - 1142 2003
  • Masamichi IMAKITA; Katuyosi NOSE; Hitosi SAKAGAMI; Yutaka NISIDA; Yasuhiro MISIMA; Keigo KISIMOTO; Tomoko HABA; Kenichi WAKASA
    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) Japanese College of Surgeons 28 (2) 299 - 302 0385-7883 2003 [Refereed]
  • 田 海; 八幡朋子; 若狹 研一; 佐々木 政臣
    大阪市医学会雑誌 51 (3-4) 115 - 118 2002/12 [Refereed]
  • 八幡 朋子; 若狭 研一
    病理と臨床 20 (11) 1125 - 1129 2002/11 [Refereed][Invited]
  • M Kondo; K Dono; M Sakon; J Shimizu; H Nagano; S Nakamori; K Umeshita; K Wakasa; M Monden
    HEPATO-GASTROENTEROLOGY H G E UPDATE MEDICAL PUBLISHING S A 49 (47) 1230 - 1234 0172-6390 2002/09 [Refereed]
     
    Background/Aims: Adenosquamous carcinoma of the gallbladder is relatively rare. Its biological behavior and optimal surgical procedure are still controversial. Methodology: Clinicopathological factors and proliferating cell nuclear antigen expression were studied in four stage IV adenosquamous carcinoma patients who underwent curative surgery between June 1987 and April 2000, comparing those of 14, stage IV adenocarcinoma patients at the same period. Results: Preoperative radiological evaluation disclosed a mass invading to the adjacent organs in all cases (liver in 3 cases, and liver and stomach in one case). Three patients (case 1, 2 and 3: well-differentiated adenosquamous carcinomas) were all alive without recurrence in 10, 7, and 2 years after surgery. In contrast, the remaining patient (case 4: moderately differentiated adenosquamous carcinoma) with positive pathologic factors (lymph node metastasis, vascular invasion, etc) deceased one year after surgery due to peritoneal dissemination. When survival rate of adenosquamous carcinoma was compared, the prognosis of adenosquamous carcinoma was significantly better than that of adenocarcinoma (P=0.0103). Comparison of pathological factors revealed that the frequency of lymph node metastasis was significantly higher in adenocarcinoma than in adenosquamous carcinoma (P=0.004). Consistent with these findings,- the positivity rate of proliferating cell nuclear antigen labeling was significantly lower in squamous carcinoma component, compared with adenosquamous component (P<0.0001) or adenocarcinoma (P<0.0001). Conclusions: Even in patients with stage IV adenosquamous carcinoma of the gallbladder, a long-term survival may be obtained by curative surgery if the squamous component is predominant.
  • 被嚢性腹膜硬化症(EPS)の剖検2例
    大年 辰幸; 奥野 仙二; 出雲谷 剛; 植田 美佐子; 中村 順一; 山本 忠司; 金 昌雄; 八幡 朋子; 若狭 研一
    腎と透析 53巻別冊 腹膜透析2002 53 (suppl) 233 - 236 2002/09 [Refereed]
  • Naoki Kawamura; Tomoyuki Ichimura; Fumihiro Ito; Sachiko Shibata; Kumiyo Takahashi; Akemi Tsujimura; Osamu Ishiko; Tomoko Haba; Kenichi Wakasa; Sachio Ogita
    Cancer 94 (6) 1713 - 20 0008-543X 2002/03 [Refereed]
     
    BACKGROUND: The clinical differential diagnosis between uterine sarcoma and benign leiomyoma is difficult even with magnetic resonance imaging (MRI). Therefore, a considerable number of patients have undergone hysterectomies due to an indication of "suspected malignancy" based on tumor size alone. However, approximately 80% of these hysterectomies have been judged to have been recommended inappropriately. In such situations, reliable preoperative diagnostic tests are required. The authors have evaluated the accuracy of needle biopsy for uterine myoma-like tumors, a procedure that to the authors' knowledge has been performed infrequently. METHODS: Transcervical needle biopsy was performed in 435 patients with uterine myoma-like tumors. The biopsy specimens were scored for degree of malignancy according to the histopathologic criteria proposed by Bell et al. Histopathologic evaluation of surgical specimens and clinical outcome after 2 years of follow-up were used as the reference standards. RESULTS: Of 435 patients, 7 had uterine sarcomas, 4 of which were scored as > or = 4 points and were diagnosed as "sarcoma" by needle biopsy alone. No sarcoma cases were included in the group of patients with a score of 0. The cutoff score combining the highest sensitivity and specificity with respect to distinguishing uterine leiomyosarcoma from uterine leiomyoma was 2; sensitivity, specificity, and positive and negative predictive values were 100%, 98.6%, 58%, and 100.0%, respectively. CONCLUSIONS: Transcervical needle biopsy using histopathologic scoring is a reliable diagnostic test for the differential diagnosis between uterine sarcoma and leiomyoma. This diagnostic method, combined with MRI screening, could reduce the number of patients currently undergoing unnecessary surgery.
  • Cytologic diagnosis of estrogen and progesterone receptors in breast imprints.
    Masaomi Sasaki, Ken Morimoto, Masae Koh, Kenichi Wakasa, Tomoko Haba, Hiroaki Kinoshita
    Acta cytologica 46 (6) 1056 - 1060 2002
  • Norihiro Ohba; Daisuke Tsuruta; Michinari Muraoka; Tomoko Haba; Masamitsu Ishii
    International journal of dermatology 41 (1) 48 - 9 0011-9059 2002/01 [Refereed]
  • S Kubo; A Tamori; K Ohba; T Shuto; T Yamamoto; H Tanaka; S Nishiguchi; K Wakasa; K Hirohashi; H Kinoshita
    DIGESTIVE DISEASES AND SCIENCES KLUWER ACADEMIC/PLENUM PUBL 46 (11) 2408 - 2414 0163-2116 2001/11 [Refereed]
     
    We investigated the role of hepatitis B virus infection in development of hepatocellular carcinoma in hepatitis C virus-infected patients without hepatic fibrosis. Of 253 patients, 8 lacked hepatic fibrosis (group 1); group 2 included the remaining 245 patients. Clinicopathologic findings were compared between the groups. Hepatitis B x gene wits sought ill cancers and adjoining noncancerous liver. Group 1 showed better liver function parameters and milder active hepatitis than group 2. The proportion of patients with anti-hepatitis B virus antibody tended to be higher in group 1 than in group 2. The proportion of patients with hepatitis B x RNA in cancers was significantly higher in group 1 than in group 2. All group 1 patients had previous or occult hepatitis B virus infection. Previous or occult hepatitis B virus infection may be critical in development of hepatocellular carcinomas in hepatitis C virus-infected patients without hepatic fibrosis.
  • M Morimura; O Ishiko; K Honda; T Sumi; N Kawamura; K Wakasa; T Haba; S Ogita
    INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE PROFESSOR D A SPANDIDOS 8 (3) 319 - 321 1107-3756 2001/09 [Refereed]
     
    Endocervical epithelium from women treated with gonadotropin releasing hormone agonist (GnRH agonist) were compared with those from untreated women, using metachromatic stain with toluidine blue and immunohistochemistry, for estrogen and progesterone receptors. Smaller endocervical epithelium with lower intraepithelial mucus and more prominent nuclear distribution of estrogen receptors were seen in a woman who was treated for twelve months with GnRH agonists, as compared with those from an untreated premenopausal woman.
  • T Okuda; K Wakasa; S Kubo; T Hamada; M Fujita; T Enomoto; T Haba; K Hirohashi; H Kinoshita
    Cancer letters 164 (1) 91 - 96 2001/05 [Refereed]
  • 上田 豊; 和田 弘子; 尾崎 圭一郎; 中嶋 康雄; 倉垣 千恵; 藤田 征巳; 金尾 祐之; 上野 裕子; 国重 陽子; 中村 隆文; 上田 外幸; 村田 雄二; 榎本 隆之; 八幡 朋子; 若狭 研一
    産婦人科の進歩 近畿産科婦人科学会 53 (1) 65 - 66 0370-8446 2001 [Refereed]
  • Y Matsumoto; O Ishiko; M Deguchi; S Ogita; T Haba; K Wakasa
    ONCOLOGY REPORTS PROFESSOR D A SPANDIDOS 8 (1) 93 - 97 1021-335X 2001/01 [Refereed]
     
    The purpose of this study was to determine whether intratumor expression of platelet-derived endothelial cell growth factor (PD-ECGF) is a prognostic factor. We examined specimens from 61 cases of carcinoma of uterine cervix (Ca-Cx). Specimens were stained with periodic acid-Schiff preparation with diastase (d-PAS) and alcian blue (pH 2.5) to identify the presence of intracellular mucin. PD-ECGF expression and microvessel count (MVC) were assessed by immunohistochemical staining. Twenty specimens stained positive for mucin. MVC correlated with clinical stage (p<0.01). There was a correlation between PD-ECGF expression and survival time (p<0.05), but no correlation was seen between mucin staining positivity, MVC, and PD-ECGF expression and survival time by the Cox proportional hazard model. Intratumor PD-ECGF expression was not a prognostic factor in keratinizing-type squamous cell carcinoma of the uterine cervix.
  • Y Ogawa; Y Kato; K Ikeda; M Aya; K Ogisawa; K Kitani; N Onoda; T Ishikawa; T Haba; H Wakasa; K Hirakawa
    SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY SPRINGER-VERLAG 31 (2) 97 - 101 0941-1291 2001 [Refereed]
     
    This study was conducted to assess the diagnostic potential and pitfalls of performing fine-needle aspiration cytology (FNAC) for thyroid nodules. We retrospectively analyzed 1012 aspirated samples obtained from 806 thyroid nodules by the ultrasound (US)-guided method. Of these 806 nodules, 226 (31%) had been surgically treated, 152 (67%) of which were histologically diagnosed as malignant. The rate of sufficient aspirate was 82%, being lower in nodules with a diameter of less than 5 mm (73%, P = 0.10); either calcified (77%, P = 0.043) or benign (72%, P = 0.0002). The accuracy of FNAC was 75%, the rate of indeterminate diagnosis was 16%, the false negative rate was 13%, and the positive malignancy rate was 99%. The rate of indeterminate diagnosis was higher in adenomatous goiter, follicular carcinoma, and malignant lymphoma, at P = 0.015, P = 0.0008, and P = 0.035, respectively. The accuracy was lower in follicular carcinoma and malignant lymphoma (both at P = 0.013). Sufficient aspirate was finally obtained from 701 (87%) of the 806 nodules by repeated aspiration. Of 152 malignant nodules, 28 (18%) were diagnosed after two or more aspirations, and the accuracy was improved to 81% by repeating the procedure. These findings indicated that repeated aspiration may be a simple and effective method of improving the diagnostic potential of FNAC.
  • Y Matsumoto; O Ishiko; S Nishimura; S Ogita; K Kubota; T Haba; K Wakasa
    ONCOLOGY REPORTS PROFESSOR D A SPANDIDOS 7 (5) 1079 - 1082 1021-335X 2000/09 [Refereed]
     
    A 65-year old woman operated on for verrucous carcinoma of the uterine cervix 13 years previously was found to have multiple small recurrent tumors in the retroperitoneal space. Tumor cell expression of vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) was investigated at the second operation. Expression of VEGF was strongly positive in the tumor cells and expression of PD-ECGF was strongly positive in both the tumor cells and the interstitial cells.
  • Y Matsumoto; O Ishiko; M Deguchi; K Ueda; S Ogita; T Haba; K Wakasa
    ONCOLOGY REPORTS PROFESSOR D A SPANDIDOS 7 (4) 867 - 869 1021-335X 2000/07 [Refereed]
     
    Tumor tissue from 57 cases of keratinizing-type squamous cell carcinoma of the uterine cervix that had been stored in the archives of Osaka City University Hospital between May 1986 and October 1994 were stained with periodic acid-Schiff (PAS) reagent following amylase and alcian blue to identify the presence of intracellular mucin and to assess the value and significance of demonstrating the presence of mucin, Nineteen specimens (33.3%) stained positive for mucin with alcian blue or PAS following diastase. The results of mucin staining were not significant in terms of survival by Kaplan-Meier's analysis.
  • 腟・外陰の悪性腫瘍の診断と治療 クロナリティー解析による外陰部病変の腫瘍性の検討
    上田 豊; 榎本 隆之; 和田 弘子; 尾崎 圭一郎; 倉垣 千恵; 藤田 征巳; 八幡 朋子; 若狭 研一; 孫 紅波; 村田 雄二
    日本婦人科腫瘍学会雑誌 (公社)日本婦人科腫瘍学会 18 (1) 26 - 26 1347-8559 2000/06
  • T Uenishi; K Hirohashi; S Kubo; H Hamba; T Ikebe; T Yamamoto; H Tanaka; K Wakasa; T Haba; H Kinoshita
    INTERNATIONAL JOURNAL OF PANCREATOLOGY HUMANA PRESS INC 26 (3) 201 - 204 0169-4197 1999/12 [Refereed]
     
    A 56-yr-old man with complaint of abdominal pain and body weight loss was admitted to our hospital. Contrast-enhanced computed tomography on admission revealed a pancreatic tumor. Contrast-enhanced computed tomography 1 mo after admission revealed rapid growth of this tumor. We performed exploratory laparotomy with only a needle biopsy of the unresectable tumor because of extensive spread, including liver metastases, Further histological and immunohistochemical examination revealed that both the pancreatic tumor and the hepatic metastases featured malignant spindle-shaped cells. Despite radiotherapy, the patient died 40 d after laparotomy.
  • 腟原発色素嫌性悪性黒色腫(amelanotic malignant melanoma)の1例
    上田 豊; 榎本 隆之; 尾崎 圭一郎; 中村 隆文; 上田 外幸; 森重 健一郎; 村田 雄二; 八幡 朋子; 若狭 研一
    日本婦人科腫瘍学会雑誌 (公社)日本婦人科腫瘍学会 17 (1) 34 - 34 1347-8559 1999/06
  • R Nakashima; M Fujita; T Enomoto; T Haba; K Yoshino; H Wada; H Kurachi; N Sasaki; K Wakasa; M Inoue; G Buzard; Y Murata
    BRITISH JOURNAL OF CANCER CHURCHILL LIVINGSTONE 80 (3-4) 458 - 467 0007-0920 1999/05 [Refereed]
     
    The roles of the p16 and p15 inhibitor of cyclin-dependent kinase tumour suppressor genes were examined in human uterine cervical and endometrial cancers. p16 mRNA, examined by reverse transcription polymerase chain reaction (RT-PCR), was significantly reduced in five of 19 (26%) cervical and four of 25 (16%) endometrial tumours. Reduced expression of p16 protein, detected by immunohistochemistry, occurred even more frequently, in nine of 33 (27%) cervical and seven of 37 (19%) endometrial tumours. Hypermethylation of a site within the 5'-CpG island of the p16 gene was detected in only one of 32 (3%) cervical tumours and none of 26 endometrial tumours. Homozygous p16gene deletion, evaluated by differential PCR analysis, was found in four of 40 (10%) cervical tumours and one of 38 (3%) endometrial tumours. Homozygous deletion of p15 was found in three of 40 (846) cervical tumours and one of 38 (3%) endometrial tumours. PCR-SSCP (single-strand conformation polymorphism) analysis detected point mutations in the p16 gene in six (8%) of 78 uterine tumours (four of 40 (10%) cervical tumours and two of 38 (5%) endometrial tumours). Three were mis-sense mutations, one in codon 74 (CTG-->ATG) and one in codon 129 (ACC-->ATC), both in cervical carcinomas, and the other was in codon 127 (GGG-->GAG) in an endometrial carcinoma. There was one non-sense mutation, in codon 50 (CGA-->TGA), in an endometrial carcinoma. The remaining two were silent somatic cell mutations, both in cervical carcinomas, resulting in no amino acid change. These observations suggest that inactivation of the p16 gene, either by homologous deletion, mutation or loss of expression, occurs in a subset of uterine tumours.
  • H Tanaka; K Hirohashi; S Kubo; T Ikebe; T Tsukamoto; H Hamba; T Shuto; K Wakasa; H Kinoshita
    JOURNAL OF GASTROENTEROLOGY SPRINGER VERLAG 34 (1) 100 - 104 0944-1174 1999/02 [Refereed]
     
    Percutaneous transhepatic portal vein embolization (PTPE) produces regenerative hypertrophy in the nonembolized part of the liver. but the regenerative capacity after PTPE in patients with chronic hepatitis is unknown. We studied 34 patients with hepatocellular carcinoma and chronic hepatitis who underwent PTPE at the right portal vein. Hepatic lobular volumes were calculated by computed tomography before and 2 weeks after PTPE. The increase in left lobular volume was analyzed using a stepwise multiple regression method incorporating 11 factors: age portal venous pressure: proportional volume of the right lobe; indocyanine green retention test; platelet count: serum levels of aspartate transaminase. alanine transaminase, total bilirubin, and albumin: and histological inflammatory grade and stage of fibrosis, according to the criteria of the International Association for the Study of the Liver recommended at their 1994 meeting. The median volume of the left lobe had increased from 405 to 554 cm(3) (P < 0.0001) by 2 weeks after PTPE. Inflammatory grade was the only independent factor predicting regenerative hypertrophy (regeneration ratio (%) = 80.3 - 20.1 x grade: standard correlation coefficient = -0.566; P = 0.0014). Histological inflammatory activity was the essential factor regulating liver regeneration after PTPE in patients with chronic hepatitis.
  • K Wakasa; T Haba; M Sasaki; M Sakurai; T Ikebe; T Shuto; K Hirohashi; H Kinoshita
    PATHOLOGY INTERNATIONAL BLACKWELL SCIENCE 48 (1) 29 - 32 1320-5463 1998/01 [Refereed]
     
    In the cirrhotic and precirrhotic liver, there may be small foci with increased cellularity and amphophilic cytoplasm. These are microscopic lesions that do not form macroscopically detectable nodules, which differ from the macroscopically apparent nodules of dysplastic nodules. In the present study, we assessed the proliferating activity of 12 hyperplastic foci in 11 patients with cirrhosis or chronic hepatitis, by staining for agyrophilic nucleolar organizing regions (AgNOR). The mean AgNOR count per nucleus in the hyperplastic foci ranged from 0.96 to 1.36 (mean, 1.13; SD 0.12), and from 0.81 to 1.06 (mean, 0.94; SD 0.08) in the controls. The AgNOR count in the hyperplastic foci was significantly higher than that in the controls (P < 0.01). Small hyperplastic foci show increased proliferative activity. Further study on these foci is required to clarify their relation to hepatocarcinogenesis.
  • H Wada; T Enomoto; M Fujita; K Yoshino; R Nakashima; H Kurachi; T Haba; K Wakasa; KR Shroyer; M Tsujimoto; T Hongyo; T Nomura; Y Murata
    CANCER RESEARCH AMER ASSOC CANCER RESEARCH 57 (23) 5379 - 5385 0008-5472 1997/12 [Refereed]
     
    The pathogenesis of carcinosarcoma is still a subject of controversy, In the present study, molecular techniques were applied to determine the pathogenesis of uterine carcinosarcomas, The patterns of chromosome X inactivation were analyzed, targeting a portion of exon 1 of the human androgen receptor (HUMARA) in malignant epithelial and mesenchymal components, The presence of p53 and K-ras mutations were al(io analyzed, H&E-stained sections of paraffin-embedded, formalin-fixed tissues were microdissected to obtain both epithelial and nonepithelial lesions from 25 carcinosarcomas, and DNAs were extracted by proteinase 1( digestion, Following treatment with methylation-sensitive restriction endonuclease (HhaI or HpaII), PCR amplification was performed using nested primers targeted to the HUMARA locus, Mutations in the p53 gene and K-ras gene were found in eight (32%) and six (24%) tumors, respectively, The patterns of chromosome X inactivation were different between the carcinomatous and sarcomatous components of three carcinosarcomas, indicating that these three tumors represent collision tumors, By contrast, he patterns of chromosome X inactivation, K-ras sequence, and p53 sequence were identical in both carcinomatous and sarcomatous components in 21 carcinosarcomas, indicating that these 21 tumors represent combination tumors, One case produced equivocal results that precluded determination of whether it represented a collision or combination tumor, These observations show that although most carcinosarcomas are combination tumors, some develop as collision tumors, The determination of histogenesis in individual cases of carcinosarcoma using molecular markers may be worthwhile, because the result could help predict the prognosis of individual cases and help guide clinical management.
  • T Enomoto; T Haba; M Fujita; T Hamada; K Yoshino; R Nakashima; H Wada; H Kurachi; K Wakasa; M Sakurai; Y Murata; KR Shroyer
    INTERNATIONAL JOURNAL OF CANCER WILEY-LISS 73 (3) 339 - 344 0020-7136 1997/11 [Refereed]
     
    We previously reported that invasive squamous cell carcinomas of the uterine cervix are of monoclonal composition. In the current study, we extended our previous work to determine the clonal composition of cases of high-grade squamous intra-epithelial lesion (HSIL). Clonal analysis targeting the HUMARA locus was performed on cervical tissue from 9 cases, 8 showing heterozygosity at the HUMARA locus and being, therefore, informative for clonality analysis. Uterine cervices were cut into IZ blocks, fixed with formalin and embedded in paraffin, and DNA was extracted from targeted lesions of each block. A total of 30 samples of cervical intra-epithelial neoplasia 3 (CIN3) (14 samples of carcinoma in situ and 16 samples of severe dysplasia) and I sample of CIN2 (moderate dysplasia) were analyzed. Monoclonal composition of the lesions was demonstrated in 30/30 cases of CIN3. Polyclonal composition was seen in the single case of CIN2. In 6 uterine cervices, in which dysplastic lesions were present in move than 3 blocks, the pattern of X-chromosome inactivation was the same in all lesions, suggesting that these individual lesions were derived from a single cell, with intraepithelial extension within the cervical mucosa. By contrast, one uterus contained 2 discontinuous dysplastic foci with different patterns of X-chromosome inactivation, indicating that the 2 lesions developed independently from each other. Our results demonstrate that (i) lesions of CIN3 (severe dysplasia and carcinoma in site) are composed of a clonal neoplastic population of cells and (ii) most cases of HSIL are unifocal in origin. (C) 1997 Wiley-Liss, Inc.
  • M Fujita; T Enomoto; T Haba; R Nakashima; M Sasaki; K Yoshino; H Wada; GS Buzard; N Matsuzaki; K Wakasa; Y Murata
    INTERNATIONAL JOURNAL OF CANCER WILEY-LISS 74 (2) 148 - 155 0020-7136 1997/04 [Refereed]
     
    We have examined the roles of 2 putative tumor-suppressor genes, the p16 and p15 inhibitor-of-cyclin-dependent-kinase genes, in the most commonly occurring epithelial tumors of the human ovary. Expression of p16 mRNA, examined by RT-PCR, was significantly reduced in 15 of the 48 tumors. Aberrant expression of p16 protein, detected by immunohistochemistry, occurred in 22 of 60 tumors, more frequently in low-grade tumors, and had significant correlation with low p16 mRNA expression. Hypermethylation of a site within the 5'-CpG island of the p16 gene was significantly associated with loss of p16 mRNA and protein expression. Homozygous gene deletion, evaluated by differential PCR analysis, was found in 2 tumors for the p16 gene and in 1 tumor for the p15 gene among 70 ovarian tumors examined. PCR-SSCP analysis detected point mutations in p16 in 4 tumors and in p15 in 1 tumor. One was a 38-bp deletion, from codons 48 to 60, in a mucinous tumor of low malignant potential; another was a non-sense mutation in codon 60 in a mucinous adenocarcinoma. The remaining 2 mutations were mis-sense mutations, one in codon 58 and the other in codon 60, in 2 endometrioid adenocarcinomas. We conclude that inactivation of p16 by loss of p16 mRNA and protein expression as a consequence of hypermethylation of the 5'-CpG island, rather than by gene deletion or point mutation, may play an important role in the genesis of human ovarian epithelial tumors. (C) 1997 Wiley-Liss, Inc.
  • K Wakasa; T Haba; T Hamada; M Sasaki; M Sakurai
    PATHOLOGY INTERNATIONAL BLACKWELL SCIENCE 47 (1) 54 - 59 1320-5463 1997/01 [Refereed]
     
    The pathological features of 11 nodules of early hepatocellular carcinoma (EHCC) were studied. Their macroscopic features resembled those of adenomatous hyperplasia and differed from those of advanced hepatocellular carcinomas (AHCC). The EHCC extended along the hepatic lobular structure and lacked expansive growth. The endothelial cells in the sinusoids of EHCC did not react to Ulex europaeus agglutinin 1 (UEA1) like adenomatous hyperplasia or other liver parenchyma, whereas the endothelial cells in the AHCC did react to UEA1. Immunohistochemically, CD66-positive Kupffer cells were noted in the sinusoids of EHCC, whereas in the AHCC Kupffer cells were not seen. Tumor emboli in the portal vein and intrahepatic metastases were not identified in EHCC, which seemed to be carcinoma-in-situ or a microinvasive stage of hepatocarcinogenesis.
  • 八幡朋子; 榎本隆之; 藤田征巳
    日本婦人科病理・コルポスコピー学会雑誌 14 (1) 47  1996 [Refereed]
  • The Journal of the Japan society of gynecologic pathology and colposcopy 14 (1) 47  1996 [Refereed]
  • 思春期女子の骨塩量についての検討
    八幡朋子; 甲村弘子; 三宅侃
    オステオポローシス ジャパン 2 (1) 142  1994 [Refereed]
  • 八幡朋子; 甲村弘子; 三宅侃
    思春期学 11 (1) 34 - 34 1993 [Refereed]

Books etc

  • Saving mothers lives in Japan 日本の妊産婦を救うために2020
    (Contributor基本編 妊産婦死亡の病理解剖)若狹朋子 東京医学社 東京 2020 67-70
  • Nursing Communication 看護技術のための英語
    (Joint work)Noguchi J, Asano M, Wakasa T, Matsuda N Pearson 東京 2019 1-86
  • 産科グリーンノート
    (Contributor3. 胎児異常 8) 胎児死亡)若狹朋子 中外医学社 2019 199-200
  • 一冊でわかる婦人科腫瘍・疾患
    (Contributor妊娠高血圧症候群（HDP))若狹朋子 文光堂 東京 2017 144-145
  • 一冊でわかる婦人科腫瘍・疾患
    (Contributor自然流産)若狹朋子 文光堂 東京 2017 142-143
  • 一冊でわかる婦人科腫瘍・疾患
    (Contributor多胎妊娠)若狹朋子 文光堂 東京 2017 140-141
  • 一冊でわかる婦人科腫瘍・疾患
    (Contributor異所性妊娠)若狹朋子 文光堂 東京 2017 138-139
  • 一冊でわかる婦人科腫瘍・疾患
    (Contributor自然流産)若狹朋子 文光堂 東京 2017 1-86
  • 妊産婦死亡剖検マニュアル 改訂版
    (Joint work)金山 尚裕、植田初江、竹内真、田村直顕、松田義雄、松本博志、吉松 淳、若狹朋子、池田智明 妊産婦死亡時の剖検と病理検査の指針作成委員会厚生労働省科学研究費補助金地域医療基盤開発推進研究事業 2016 1月23日
  • 卵巣・卵管腫瘍病理アトラス 改訂・改題第二版・
    (Contributor機能性間質をもつ卵巣腫瘍)若狹朋子 文光堂 東京 2016 92-96
  • Saving mothers lives in Japan 日本の妊産婦を救うために2015
    (Contributor基本編 妊産婦死亡発生時の日本産婦人科医会への届け出と病理解剖)若狹朋子 東京医学社 東京 2015 50-53
  • 細胞診ガイドライン ５ 消化器 2015年版 口腔／唾液腺／消化管／肝胆道系／膵臓 膵臓
    (Contributor各論 E. 膵管内乳頭粘液性腫瘍(intraductal papillary mucinous neoplasm; IPMN))若狹朋子 金原出版株式会社 2015 283-288
  • 腫瘍病理鑑別診断アトラス 胆道癌・膵癌
    (Contributor第4部 臨床との連携 Ⅶ 病理診断報告書の記載 Ⅱ細胞診)若狹朋子 文光堂 東京 2015 318-321
  • 腫瘍病理鑑別診断アトラス 胆道癌・膵癌
    (Contributor第3部 鑑別ポイント Ⅶ 胆汁、膵液FNAを含めた細胞診における鑑別診断)若狹朋子 文光堂 東京 2015 239-244
  • 腫瘍病理鑑別診断アトラス「肝臓」
    (ContributorⅠ 肝細胞系腫瘍 ３ 微小肝細胞性異型病変（肝細胞性ディスプラジア）)若狹朋子 文光堂 東京 2010 36-39
  • 妊産婦死亡剖検マニュアル
    (Joint work)金山 尚裕、吉松 淳、竹内真、植田初江、木村聡、中山雅弘、松田 義雄、若狹朋子、池田智明 厚生労働省科学研究費補助金成育疾患克服等次世代育成基盤研究事業 2010 1月11日

Conference Activities & Talks

  • Histological findings of the uterine blood vessels during the early postpartum course  [Not invited]
    Tomoko Wakasa; Kenichi Wakasa; Naoko Obatake; Masahiko Nakayama
    MODERN PATHOLOGY  2006/09  NATURE PUBLISHING GROUP
  • Mixed tumor of soft tissue with pulmonary metastasis  [Not invited]
    Kenichi Wakasa; Tomoko Wakasa; Naoko Obatake; Makoto Ieguchi
    MODERN PATHOLOGY  2006/09  NATURE PUBLISHING GROUP
  • T Enomoto; T Haba; M Fujita; T Hamada; K Yoshino; R Nakashima; H Wada; H Kurachi; K Wakasa; M Sakurai; Y Murata; KR Shroyer
    INTERNATIONAL JOURNAL OF CANCER  1997/11  WILEY-LISS
     
    We previously reported that invasive squamous cell carcinomas of the uterine cervix are of monoclonal composition. In the current study, we extended our previous work to determine the clonal composition of cases of high-grade squamous intra-epithelial lesion (HSIL). Clonal analysis targeting the HUMARA locus was performed on cervical tissue from 9 cases, 8 showing heterozygosity at the HUMARA locus and being, therefore, informative for clonality analysis. Uterine cervices were cut into IZ blocks, fixed with formalin and embedded in paraffin, and DNA was extracted from targeted lesions of each block. A total of 30 samples of cervical intra-epithelial neoplasia 3 (CIN3) (14 samples of carcinoma in situ and 16 samples of severe dysplasia) and I sample of CIN2 (moderate dysplasia) were analyzed. Monoclonal composition of the lesions was demonstrated in 30/30 cases of CIN3. Polyclonal composition was seen in the single case of CIN2. In 6 uterine cervices, in which dysplastic lesions were present in move than 3 blocks, the pattern of X-chromosome inactivation was the same in all lesions, suggesting that these individual lesions were derived from a single cell, with intraepithelial extension within the cervical mucosa. By contrast, one uterus contained 2 discontinuous dysplastic foci with different patterns of X-chromosome inactivation, indicating that the 2 lesions developed independently from each other. Our results demonstrate that (i) lesions of CIN3 (severe dysplasia and carcinoma in site) are composed of a clonal neoplastic population of cells and (ii) most cases of HSIL are unifocal in origin. (C) 1997 Wiley-Liss, Inc.
  • M Fujita; T Enomoto; T Haba; R Nakashima; M Sasaki; K Yoshino; H Wada; GS Buzard; N Matsuzaki; K Wakasa; Y Murata
    INTERNATIONAL JOURNAL OF CANCER  1997/04  WILEY-LISS
     
    We have examined the roles of 2 putative tumor-suppressor genes, the p16 and p15 inhibitor-of-cyclin-dependent-kinase genes, in the most commonly occurring epithelial tumors of the human ovary. Expression of p16 mRNA, examined by RT-PCR, was significantly reduced in 15 of the 48 tumors. Aberrant expression of p16 protein, detected by immunohistochemistry, occurred in 22 of 60 tumors, more frequently in low-grade tumors, and had significant correlation with low p16 mRNA expression. Hypermethylation of a site within the 5'-CpG island of the p16 gene was significantly associated with loss of p16 mRNA and protein expression. Homozygous gene deletion, evaluated by differential PCR analysis, was found in 2 tumors for the p16 gene and in 1 tumor for the p15 gene among 70 ovarian tumors examined. PCR-SSCP analysis detected point mutations in p16 in 4 tumors and in p15 in 1 tumor. One was a 38-bp deletion, from codons 48 to 60, in a mucinous tumor of low malignant potential; another was a non-sense mutation in codon 60 in a mucinous adenocarcinoma. The remaining 2 mutations were mis-sense mutations, one in codon 58 and the other in codon 60, in 2 endometrioid adenocarcinomas. We conclude that inactivation of p16 by loss of p16 mRNA and protein expression as a consequence of hypermethylation of the 5'-CpG island, rather than by gene deletion or point mutation, may play an important role in the genesis of human ovarian epithelial tumors. (C) 1997 Wiley-Liss, Inc.
  • K Wakasa; T Haba; T Hamada; M Sasaki; M Sakurai
    PATHOLOGY INTERNATIONAL  1997/01  BLACKWELL SCIENCE
     
    The pathological features of 11 nodules of early hepatocellular carcinoma (EHCC) were studied. Their macroscopic features resembled those of adenomatous hyperplasia and differed from those of advanced hepatocellular carcinomas (AHCC). The EHCC extended along the hepatic lobular structure and lacked expansive growth. The endothelial cells in the sinusoids of EHCC did not react to Ulex europaeus agglutinin 1 (UEA1) like adenomatous hyperplasia or other liver parenchyma, whereas the endothelial cells in the AHCC did react to UEA1. Immunohistochemically, CD66-positive Kupffer cells were noted in the sinusoids of EHCC, whereas in the AHCC Kupffer cells were not seen. Tumor emboli in the portal vein and intrahepatic metastases were not identified in EHCC, which seemed to be carcinoma-in-situ or a microinvasive stage of hepatocarcinogenesis.
  • Tomoko Haba; Kenichi Wakasa; Masami Sakurai; Souji Kaneshiro; Noriko Naitoh; Akihiro Tamori; Syuuhei Nishiguchi; Tetuo Kuroki; Kennzou Kobayashi
    Acta Hepatologica Japonica  1997  Japan Society of Hepatology

Works

  • 子宮頚部前癌病変のクロナリティー解析
    1995 -1996
  • Clonality analysis of precancerous lesion of uterine cervix
    1995 -1996
  • 悪性腫瘍の臨床病理学的研究
    1995

MISC

Awards & Honors

  • 2018/11 Japanese Society of Pathololgy Award of Case Study
     日本の母体死亡 解剖が行われた妊産婦死亡例79例の検討 
    受賞者: WAKASA Tomoko

Research Grants & Projects

  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research
    Date (from‐to) : 2023/04 -2027/03 
    Author : 浅野 元子; 野口 ジュディー津多江; 若狹 朋子; 宮崎 佳典; 松田 紀子
  • 日本学術振興会：科学研究費助成事業
    Date (from‐to) : 2022/04 -2025/03 
    Author : 阿萬 紫; 小田 智昭; 魏 峻洸; 若狭 朋子; 山下 篤
  • 日本学術振興会：科学研究費助成事業
    Date (from‐to) : 2004 -2005 
    Author : 若狭 朋子
     
    本年度の検索で我々は大阪の産科後送施設からインフォームド・コンセントの得られた15例の子宮破裂及び重度頸管裂傷症例を集めることができた。(出産時母体年齢;29歳から39歳(平均33.7歳)胎児娩出後子宮摘出までの時間;30分から19日) 摘出された子宮体部の動静脈についてss-DNA、Ki-67、オキシトシンレセプター(2F8)等を染色し娩出後の時間に沿って検討した。比較対象として子宮頚部上皮内癌のために摘出された未経産婦の子宮と、分娩後60日と7年の子宮とを用いた。 オキシトシンレセプターについては胎児娩出直後の子宮では子宮筋層中層の筋細胞束にオキシトシンレセプターは発現しているが、動脈及び静脈周囲の血管壁の平滑筋は発現していなかった。しかし娩出後5時間の子宮では筋細胞束のみならず、血管壁の平滑筋もレセプターが発現した。その後オキシトシンレセプターは持続的に発現していたが、産褥60日目の子宮では染色されなかった。 さらにKi-67染色ではいずれの症例においても陽性細胞はほとんど認められなかった。しかしsingle stranded DNA染色では分娩後30分で血管内皮細胞で陽性となり5時間では細動脈の血管平滑筋細胞に陽性となった。さらに分娩後16時間で子宮体部平滑筋細胞が陽性となった。 昨年度までの研究で分娩三期の子宮の血管は形態学的に循環不全の臓器で起こるものと同様の変化を示し漿膜側の血管では静脈瘤等で起こるものと同様の血管壁の変化を示すことがわかっていた。 本年度の研究では、分娩後子宮血管はアポトーシスが増加し退行性変化を起こしていることがわかった。さらに形態的に見られる血管内皮の肥厚も血管内皮細胞そのものの増殖ではなく、子宮収縮による相対的な細胞密度の増加によるものであることが裏付けられた。 また血管壁の平滑筋のオキシトシンレセプターの発現は分娩後5時間を要することが分かり、分娩直後の止血ではオキシトシンと麦角アルカロイドなどの血管収縮剤は作用部位が異なっていることが示された。
  • 科学研究費補助金
    Date (from‐to) : 2004
  • 日本学術振興会：科学研究費助成事業
    Date (from‐to) : 2002 -2003 
    Author : 若狹 朋子
     
    混合型肝癌の外科切除例はその後増加し合計21例となった。症例ごとにDNAを抽出するに適した部分(炎症細胞浸潤が少なく、間質との境界が容易に判別できる部分)を決定しDNAを抽出した。抽出したDNAをアンドロゲンレセプター遺伝子に対するprimarでPCRを用いて増幅した。現在増幅させたDNAを解析し混合型肝癌の肝細胞癌の成分と胆管細胞癌の成分、各々のクロナリティーを解析中である。また腫瘍の由来を解析するクロナリティー解析とは別に腫瘍の生物学的悪性度を決定する増殖能の検討も行うため、混合型肝癌の各々の成分についてKi-67 labeling indexを検討した。その結果、Ki-67 labeling indexはいずれの症例においても胆管細胞癌の部分は肝細胞癌の部分より高いことが判明した。さらにKi-67 labeling indexの分布と肉眼形を比較したところ肝細胞癌の部分のKi-67 labeling indexは症例によって差は少なかったが胆管細胞癌については、肝細胞癌を取り囲むように存在するものでは比較的底値で、胆管細胞癌の成分が大きく境界が明瞭なものでは高値を示す傾向があった。腫瘍をアポトーシスに誘導するFas抗原についても免疫染色法を用いて個々の症例おける発現形式を検討した。肝細胞癌の部分では全例でFas抗原は発現していたが、胆管細胞癌の成分の部分ではFas抗原は発現していなかった。同一の腫瘍の移行部においては肝細胞癌の部分が陽性であっても、形態学的に腺腔構造を形成し胆管細胞癌に変化すると陰性化していた。このことから肝細胞癌はアポトーシスが起こる可能性が残っているか胆管細胞癌は悪性度がさらに高くなっていることが推測される。
  • 科学研究費補助金
    Date (from‐to) : 1999
  • 悪性腺腫の遺伝子解析
    その他の研究制度
    Date (from‐to) : 1997
  • 共同研究
    Date (from‐to) : 1997
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research
    Date (from‐to) : 1995 -1996 
    Author : WAKASA Kenichi; HABA Tomoko
     
    Before treatment of multiple hepatocellular carcinomas (HCCs), identification of the origin of the tumors as either intrahepatic metastases or multicentric occurrences is important. Pathological findings have been used for tentative discrimination. Recently, a polymorphic short tandem repeat was identified at the HUMARA locus of exon 1 of the human androgen receptor gene, which is linked with the X-chromosome. This sequence, consisting of the trinucleotide [CAG]n, is heterozygous in more than 90% of the general population. In this study, we amplify this locus of DNA or mRNA obtained from frozen surgical samples and analyze the clonal origin and multicentricity of HCCs and adenomatous hyperplasia (AH) that seems to be a precancerous lesion by the patterns of X-chromosome inactivation by methylation. Amplification of templates from noncancerous tissues showed that 14 (93%) of the 15 patients were heterozygous at this locus and their tumors could, therefore, be analyzed for clonal origin. All 17 of the HCCs investigated here were monoclonal and both specimens of AH also were monoclonal. Our results suggested that at least some AH is monoclonal in origin and if so, should be monitored carefully or treated. Four patients had multiple HCCs, and the clonal origin of these multiple lesions could be examined. Two patients had lesions of multicentric occurrence and the other two patients seemed to have metastatic lesions. Analysis of the methylation pattern of an X-chromosome-linked locus ; HUMARA must be useful to identify tumors of multicentric occurrence although this method is available in only women.
  • パラフィン包埋材料からのモノクロナリティー解析
    その他の研究制度
  • The Other Research Programs
  • Pathology of combined hepatocellular and cholangiocarcinoma.
    The Other Research Programs
  • The Other Research Programs
  • The Other Research Programs

Committee Membership

  • 2001 -2017   Japanese Society of Clinical Cytology   councilor

Other link

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