To improve survival rate and to decrease local recurrence after operation of advanced rectal cancer, preoperative irradiation therapy with total dose of 42.6 Gy. has been performed in our department. In this study, we examined relationship between the histological effects and the roentogenographic changes in cases of rectal cancer treated with preoperative irradiation therapy. In fourty-one patients barium enema examination was performed before and after irradiation therpy, and the reduction rate of tumor diameter was measured on roentogenogram. Cancer gland ratio (CGR) and fibrosis ratio (FR), which were defined as the ratio of cancer glands and fibrosis to the tumor on histological section respectively, were measured by image analizer system. Histologically, 19 patients showed minor response (non-effective group), and the remaining 22 patients showed moderate to marked effects (effective group) for the radiation therapy. As a result, the tumor reduction rate on barium enema was 18.7 % on the average of all patients. According to histolgical effects, the tumor reduction rate on barium enema was 15.6 % ±6.7 % in non-effective group, and 21.7 % ±8.4 % in effective group, respectively. The difference was stastically significant (p < 0.01). There was significant correlation between CGR and the tumor reduction rate on barium enema (p < 0.01).
But FR has no correlation with the tumor reduction rate on barium enema. It is suggested that tumor reduction was due to the decrease of the cancer glands, and tumor reduction rate on barium enema was a good clinical parameter of radiation effects.

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The purpose of our study is to examine the relationship between intratumoral DNA heterogeneity in colon cancer and clinicopathological findings and prognosis.
A series of 31 patients with colon cancer was studied. Four samples from the different sites of each tumor were subjected to DNA measurement by static cytofluorometry. When there were multiple peaks in one tumor which varied by more than 10% in DNA index the tumors were defined as heterogeneity.
Seventeen (54.8 %) of 31 patients were found to have heterogeneity tumors. As compared with homogeneity, heterogeneity tumors showed a tendency for deeper invasion, liver metastasis and more advanced staging. The patients with heterogeneity tumors had poorer prognosis than the those with homogeneity tumors. And this tendency was remarkable in stage III-V cases.
These data might suggest that the intratumoral DNA heterogeneity is possible to be an indicator of liver metastasis and prognosis in patients with colon cancer.

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During the 6 years period from 1985 to December 1990, we had done curative resection in 31 patients with Dukes' C, lower rectal cancer.
Of 31, fifteen patients were perscribed intraoperative pelvic hyperthermochemotherapy (IOPHC) as an adjuvant therapy to prevent local recurrence, and effects of IOPHC on preventing local recurrence and distant metastasis were evaluated, comparing with 16 patients undergoing surgery alone (control group).
The procedure of IOPHC was as follows : After removal of the rectum, the pelvic cavity was filled with pre-warmed physiological saline, contaning mitomycin C of 40 μg/ml, and the saline was warmed at 45°C for 90 minutes by an apparatus we devised for IOPHC. The local recurrence has developed in 7 cases of control group (7/16: 43.8 %), and in 2 cases (2/15: 13.3 %) of IOPHC group. On the other hand, distant metastasis occured at the approximately same rate, 4 cases in each group.
IOPHC is a safe and feasible adjuvant therapy for preventing local recurrence of curatively resected Dukes' C, lower rectal cancer.

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One hundred sixteen patients underwent radical operation for carcinoma of the right colon from 1979 to 1990. Lymph node metastases were seen in 49 patients (42.2%). Neither paracolic nor epicolic lymph node metastasis were found more than 5 cm distance from the edge of primary tumor.
Cumulative five year survival rates of Dukes' A, Dukes' B, and Dukes' C were 81.8% 84.3%, and 74.9%, respectively. According to the general rules for clinical and pathological studies on cancer of the colon, rectum, and anus by the Japanese Research Society, a five year survival rate of absolute curative resection was 81.6% and relative curative resection was 72.8 % (P=0.06) . But the survival rate of relative non-curative resection cases due to insufficient colon resection was 75.0%, which was almost the same as that of curative resection.
The case with lymph node metastasis caused an increase in the incidence of recurrence, and also the case with invasion to serosa and the cases whose histological diagnosis was mode-rately or poorly differentiated adenocarcinoma also caused recurrence.
If colon is resected 5 cm away from the edge of the primary tumor, almost all cases are expected to be curative.

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The prognosis of colonic cancer in 201 resected cases was analyzed according to the number of metastatic lymph nodes.
The metastatic rate to the lymph nodes was 40.3 %. We divided node-positive patients into one to two, three to five, and over five groups. The 5 year survival rate was 94.2 % in the no metastatic group, 89.3 % in the one to two group, 47 % in the three to five group and 16 % in the over five group. The number of positive nodes was related inversely to prognosis, and there was a recognized difference in the survival rate between the one to two node-positive group and three to five or over five group. No significant difference was found between the no metastatic group and the one to two node-positive group. It is concluded that the number of metastatic lymph nodes is important determinants in the prognosis of colonic cancer, and seems to be an indicator of lymphatic invasion in colonic cancer. Also, the number of metastatic lymph nodes clarifies the difference of prognosis not recognized in the stage classification decided by the Japanease Reseach Society for Cancer of Colon and Rectum.

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In our department, 491 cases of colorectal cancer have been surgically treated in the past 11 years. Twenty-seven (5.5 %) of those 491 cases were histologically confirmed mucinous carcinoma. Clinicopathological variables and nuclear DMA ploidy pattern of these 27cases (mucinous group) were compared with those of the remaining 464 cases (non-mucinous group).
Mucinous carcinoma occurred more frequently in the right colon (48.1 %), and was larger in size (mean: 8.3cm) than in non-mucinous group. In macroscopic typing of the cancer, type 1, protuberant type, had a higher incidence (22 %) in the mucinous group. Lymph nodal metastasis, depth of cancer invasion, hepatic metastasis and Dukes' stage did not differ between the two groups. The incidence of peritoneal dissemination was higher in the mucinous group (15 %). Cumulative Five-year survival rate for the mucinous group (70 %) did not differ from that for the non-mucinous group (56 %). The survival rate for patient after curative resection was higher in the mucinous group (92 %) than non-mucinous group (68 %). Analysis of nuclear DNA ploidy patterns revealed a higher incidence of the diploid pattern in the mucinous group (57 %) than in non-mucinous group (41 %).
These results indicate that the prognosis of colorectal mucinous carcinoma can be favorable if curative resection is carried out wherever possible.

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A clinicopathological study was done on 13 cases of diffusely infiltrating carcinoma of the large bowel. They were classfied into 2 groups based on their infiltration pattern as follows:
1) Stromal type; the tops of infiltration of the cancer cells were shown in stroma.
2) Lymph vessel type; the tops of infiltration of the cancer cells were only found in the lymph vessels.
It is suggested that in the former type the lesion grows by the stromal infiltration and in the latter type lymph vessels infiltration.
Comparing the 2 types, the stromal type is more frequently found in young women and its histological type was mucocellular adenocarcinoma, while the lymph vessel type is found more in older men and its histological type was poorly differentiated adenocarcinoma and muconodular adenocarcinoma. Macroscopically, the stromal type showed severe shrinkage and thickening of the wall, while the lympy vessel type showed weak shrinkage and its longitudinal diameter was longer. Lymph node metastasis of the lymph vessel type was marked and its prognosis was poor. By classifying diffusely infiltrafing carcinoma into 2 types, different clincopathological features were found, and the classification may be useful as the sub-typing of the diffusely infiltrating carcinoma of the large bowel.

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Labeling index (LI) of Ki-67, a nuclear antigen present in proliferating cells, was determined in 56 colorectal cancer by an immunohistochemical technique, and was correlated with recurrence of the disease and survival of patients.
The LI did not correlate with clinical stages of the disease, recurrence rate after curative resection, or survival of the patients.
A potential proliferative activity of tumor cells can be easily determined by measuring Ki-67 labeling index.
The proliferative activity of tumor cells thus determined, however, has little prognostic value for colorectal cancer patients.

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Colorectal cancer is diagnosed histologically in many cases as well differentiated adenocarcinoma because of histological predominance. However, there are not a few histological findings of well differentiated adenocarcinoma combined with moderately or poorly differentiated adenocarcinoma or mucinous carcinoma. Thus, the significance of histomorphological heterogeneity was examined pathologically and clinically in 640 cases of well differentiated colorectal carcinoma, and the following results were obtained.
(1) The heterogeneity was observed in 32% (203 cases) of the total cases and related to tumor extent (depth, lymph node metastasis and stage), vascular invasion (lymphatic permeation, venous invasion and perineural invasion) and proliferation by local infiltration.(2) The heterogeneity was considered to be a factor having effects on prognosis (recurrence and survival rates).(3) It was demonstrated that cancer cells showing poorly or mucinous differentiation metastasize even if they are not predominant.(4) Well differentiated adenocarcinoma combined with heterogeneity should be treated separately from that without heterogeneity.

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Recently, cases of colorectal carcinoma associated with Shistosomisis Japonica are very rare. However, the relationship between the Ova and carainogenesis very interesting. We report a case of an early metachronous colon carcinoma associated with Ova of Shistosoma Japonicum.
The patient was a 76-year-old man who had undergone sigmoidectomy for sigmoid colon carcinoma 7 years before. We found a IIa+IIc type early carcinoma in the ascending colon by a periodic colonofiber examinations. Ileocecal resection was carried out. The lesion of the carcinoma mesured macroscopically 0.7×0.6×0.2cm in size. The carcinoma slightly invaded into submucosal layer, and we found Ova of Shistosoma Japonicum in close proximity of the carcinoma. W e re-examined sections which were removed in initial operation, and found Ova in normal submucosal layer but no Ova was found in carcinomatous tissues.
These findings sugested that the Ova might drop out with necrotic carcinoma tissue by cancer-growing.

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A 35 year-old man, who had ulcerative colitis (total colitis, remitting and relapsing type) since the age of 17, was reexamined by colonoscopy because of tenesumus and loss of body weight. The endoscopic examination revealed an advanced carcinoma in the rectum. Total colectomy with ileo-rectal anastomosis was performed. Eight months after the operation he died of extensive metastasis in the bones. Histological exmination showed that the tumor was partly poorly differentiated adenocarcinoma and partly signet-ring cell carcinoma, and that colonic mucosa was mostly in a remission stage. A detailed histopathological examination of the resected specimen showed 2 patchy flat lesions of low grade dysplasia in the sigmoid colon apart from the rectal cancer.
The stainings by high iron-diamin alcian blue (HID-AB) appeared to be an appreciable help for detecting dysplasia.
104 cases have been accumulated and analysed in the review of the Japanese literature of the colorectal cancer assosiated with ulcerative colitis.

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Colon cancers, particularly caecal cancers, often invade the abdominal wall by a direct extention. We reported here a 53-year-old woman with a caecal cancer forming a huge mass extended through the abdominal wall via an old scar for a appendectomy. After resection of the mass, together with adjacent abdominal wall, the defect of the abdominal wall was repaired using a myocutaneous flap graft of the free latissimus dorsi muscle. Postoperative course was satisfactory and the patient had no evidence of local reccurence one year after the opera tion.

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A 50-year-old woman was admitted to the hospital with a year's history of perianal eczema. Raised irregular, scaly, browish-white plaques with eczematoid features 5.3 × 2.6 cm and 3.7 × 3.4cm in diameter respectively were observed in the anterior and posterior regions of the anus. Lesions extended to the lavia, the vagina, and the perianus, but not to the anal canal. Wide local excision and lymphadenectomy of the inguinal nodes were performed. Histological findings showed invasive well differentiated squamous cell carcinoma (3.5mm in the deepest) with Bowen's disease. The lesion didn't extend to the muscle. No lymph node involvement was confirmed. Wide local excision is suggested to be the option even for concomitant invasive carcinoma with Bowen's disease. Depth of invasion and histological differentiation of the carcinoma with Bowen's disease, regardless of diameter of the lesion, is thought to be the factors for the decision of operative methods unlike usual anal and bulbar carcinoma from the literature.

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A 62-year-old male was admitted to our Hospital on Dec. 20, 1991, complaining of right lower abdominal pain. Barium enema demonstrated subpedunculated polypoid lesions in the transverse and sigmoid colons. Colonoscope showed a Yamada type III like polyp with round shape and smooth surface covered with grossly normal colonic mucosa at transverse colon and a Yamada type IV polyp at sigmoid colon. The both polyps were resected successfully by colonoscopic polypectomy, and found to be 8×8×8 mm sized solid tumor covered with normal colonic mucosa from the transverse colon and 13×10×7 mm sized polyp from the sigmoid colon. The histopathological examination of the former revealed leiomyoma of the colon. The 29 cases of colon leiomyoma resected by colonoscopic polypectomy were also discussed from the references in Japan.

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A 61-year-old man underwent colonoscopy. A submucosal tumor, 0.8 cm in size, with an irregular surface was observed in the cecum. The submucosal tumor, 0.5 cm in size, had a smooth surface eight months ago. Colonoscopic polypectomy was performed because the size and shape of tumor had changed. By studying the polypectomized specimen, it was found that the tumor was in the submucosa with clear margin measuring 0.8×0.4 cm and was completely removed. Histological examination showed that the tumor was a Antoni type A neuroma. Only 33 cases of neuromas of the colo-rectum have been reported to date in Japan, none of which was resected endoscopically. Our present case was the first one in Japan, which was resected endoscopically.

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Thirty patients with villous tumor were clinico-pathologically studied. They were 22 men and 8 women, whode highest incidence was in the 60th decade.
The lesions were predominantly located in the rectum (61.3%) and the most frequent symptoms were rectal bleeding (76.7%) and mucoid diarrhea. All the lesions but one pedunculated were sessile or flat in shape, measuring an average size of 5.6 cm. The incidence of malignant change was as high as 56.7%. Twelve of 14 rectal tumors were locally resected by transsphincteric. traissacral and or anal approach. The remainder underwent appropriate radical bowel and regional lymah node resection.
None of the patients had any lymph node metastasis nor died from the original tumor during the follow up period with a mean of 5.2 years. It is condidered, from our findings, that the villous tumor may be benign in biological behavior and low in malignant quality.

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