岡山医学会雑誌
Online ISSN : 1882-4528
Print ISSN : 0030-1558
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126 巻, 1 号
選択された号の論文の15件中1～15を表示しています
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平成24年度岡山医学会賞
総説
原著
  • 早期乳癌におけるOne-step Nucleic Acid Amplification(OSNA)法によるセンチネルリンパ節転移診断の検討
    溝尾 妙子, 枝園 忠彦, 伊藤 麻衣子, 野上 智弘, 岩本 高行, 元木 崇之, 平 成人, 松岡 順治, 土井原 博義
    2014 年 126 巻 1 号 p. 25-30
    発行日: 2014/04/01
    公開日: 2014/05/01
    DOIhttps://doi.org/10.4044/joma.126.25
    ジャーナル フリー
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    　Introduction: The one-step nucleic acid amplification (OSNA) assay is a new method to detect sentinel lymph node (SLN) metastases using cytokeratin 19 (CK19) mRNA in early breast cancer. Here we retrospectively analyzed the advantages and disadvantages of the OSNA assay.
    　Methods: In a trial period, SLNs were divided into two sections, and we examined one side using the OSNA assay. The other side was examined by pathologists. After this period, we examined whole SLNs using only the OSNA assay. The patients with positive nodes by OSNA assay and/or pathology required axillary dissection.
    　Results: We examined 27 primary breast cancer patients (36 SLNs) during the trial period. The overall concordance rate between the OSNA assay and pathology results was 91%. In the later period, 157 patients (217 SLNs) were examined. The CK19-positive rate obtained by the OSNA assay was 16.5% (macrometastases OSNA (++) : 7.2%, micrometastases OSNA (+) : 9.2%). The non-SLN positive rate among the CK19-positivecases was 23%. The OSNA assay's false negative was one case in which the expression of CK-19 on the primary tumor and lymph node was not detected.
    　Conclusions: Our OSNA assay results were comparable to those obtained using a conventional pathological technique. Pathologists and laboratory technicians could save time and effort by using the OSNA assay when seeking the precise diagnosis during surgery.
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症例報告
  • 著明な貧血と血小板減少と末梢血の異常細胞で発見された転移性乳癌の１例
    太田 誠介, 笠原 明宣, 水野 翔馬, 深津 遥香, 木下 修, 野口 敏生, 岸本 信康, 松村 正
    2014 年 126 巻 1 号 p. 31-34
    発行日: 2014/04/01
    公開日: 2014/05/01
    DOIhttps://doi.org/10.4044/joma.126.31
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    　Worldwide, breast cancer accounts for 22.9% of all cancers excluding non-melanoma skin cancers in women. More than 80% of breast cancer cases are discovered when a woman discovers a lump that feels different from the rest of the breast tissue. We report the case of a 60-year-old woman who had been treated for one year at a psychiatric hospital for suspected schizophrenia, and was referred to our hospital on March 23, 2011 for consultation regarding complete blood count abnormalities: hemoglobin, 4.8g/dl ; Plt, 1.9×104/μl ; WBC, 12,700/μl with 18.5% abnormal cells. Computed tomography revealed an enhanced, irregular mass in her right breast as well as right axillary lymph node swelling, suggestive of breast cancer. BM biopsy confirmed the presence of abnormal, keratin-positive cells, suggesting metastasis to the bone. CA15-3 was 300U/ml (normal range ＜25). The patient died on April 11, 2011, post-admission day 20. We found a rare case of terminal breast cancer that presented with peripheral blood abnormality. Breast cancer in patients who do not notice breast abnormality can present with peripheral blood abnormality.
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  • 腸重積で発症した結腸脂肪腫の１例
    二宮 卓之, 小島 康知, 原野 雅生, 大野 聡, 塩崎 滋弘, 二宮 基樹
    2014 年 126 巻 1 号 p. 35-38
    発行日: 2014/04/01
    公開日: 2014/05/01
    DOIhttps://doi.org/10.4044/joma.126.35
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    An 84-year-old man, who had been found to have a submucosal tumor in the ascending colon two years before, was admitted to our hospital for right lower quadrant abdominal pain and melena. An abdominal computed tomography (CT) scan showed intussusception in the ascending colon, resulting from a fat-density tumor. The intussusception was located by colonoscopy. Since the colonic tumor was enlarged in comparison with two years ago and had an ulcer at the top of the tumor, there was the possibility of malignancy and recurrence of intussusception. He underwent a laparoscopy-assisted right colectomy with lymph node dissection. Pathologically, the tumor of the ascending colon was a benign lipoma.
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  • 術前DCF療法が著効した食道原発内分泌細胞癌の１切除例
    前田 直見, 白川 靖博, 國府島 健, 大原 利章, 田邊 俊輔, 野間 和広, 櫻間 教文, 藤原 俊義
    2014 年 126 巻 1 号 p. 39-43
    発行日: 2014/04/01
    公開日: 2014/05/01
    DOIhttps://doi.org/10.4044/joma.126.39
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    　Esophageal endocrine cell carcinoma is extremely rare. We report a case of esophageal endocrine cell carcinoma showing histological complete response to neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil (DCF). A 66-year-old man had been experiencing epigastralgia, and a type 2 tumor in the thoracic part of esophagus was detected by upper endoscopy. The biopsy showed endocrine cell carcinoma. PET/CT, endoscopy and an esophagogram showed that the patient had a 70-mm scaled type 2 tumor in the middle thoracic esophagus, and they also revealed lymph node metastases (no. 106recR). We diagnosed a cT3cN1cM0 cStage III tumor. With two courses of DCF treatment, both the primary tumor and lymph node metastases showed a partial response. We performed a subtotal esophagectomy with three-field lymph node dissection. The pathological examination of the resected specimens revealed no malignant cells in the esophagus or lymph nodes, and we concluded that the pathological effect of the DCF treatment was Grade 3.
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  • 食道原発悪性黒色腫の１切除例
    前田 直見, 白川 靖博, 國府島 健, 大原 利章, 田邊 俊輔, 野間 和広, 櫻間 教文, 藤原 俊義
    2014 年 126 巻 1 号 p. 45-48
    発行日: 2014/04/01
    公開日: 2014/05/01
    DOIhttps://doi.org/10.4044/joma.126.45
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    　We report the case of a 61-old-man with a primary malignant melanoma of the esophagus, an extremely rare and highly aggressive malignancy. He presented with dysphagia, and we performed an upper gastrointestinal endoscopy that detected a tumor in the thoracic part of the esophagus. The biopsy showed malignant melanoma. PET/CT, endoscopy and an esophagogram showed that a 70-mm scaled type 2+1 tumor in the thoracic esophagus and no metastases. We diagnosed a cT3cN0cM0 cStage II tumor. We then performed a subtotal esophagectomy with two-field lymph node dissection and esophagogastrostomy via a retrosternal route. The pathological examination of the resected specimens confirmed that the type 2+1 tumor was PMME (pT2N0M0 pStage II). We administered six courses of postoperative adjuvant chemotherapy with dacarbazine, and the patient has had no recurrence for 17 months after the surgery.
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