Recently, various examinations for histological detection of the proliferative activity have been reported. Nucleolar organizer regions (NORs) are loops of ribosomal DNA (rDNA) which occur in nucleoli and ultimately direct to ribosome and protein formation. NOR-associated protein and NORs themselves have been visualized using simple AgNORs staining technique. And the number of AgNORs has been used to characterize and grade various types of malignant cells in cytological preparations and paraffin sections.
Authors report the recent concepts and practical points on the AgNORs-studies, and our AgNORs studies on the hepatocellular carcinoma are presented.

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We studied the correlation between the expression of HLA-DR antigen in primary colorectal adenocarcinoma and that in synchronous hepatic metastatic tumor.5 cases treated in our hospital without preoperative treatment such as chemotherapy or radiation were examined as the subject of the study. Tissue specimens were fixed in 10% neutrally buffer formalin solution, embedded in paraffin and stained with HLA-DR using the indirect immunoperoxidase technique. We classified the expression of HLA-DR antigen into 4 gradings, according to its intracellular staining pattern and the percentage of positive cancer cells in carcioma tissne. The following results were obtained. The expression of HLA-DR antigen in both primary colorectal adenocarcinoma and hepatic metastatic tumor was much lower than that in other colorectal adenocarcinoma. Also HLA-DR staining grade of each hepatic metastatic tumor was similar to that of primary colorectal adenocarcinoma. From these results, we speculated that HLA-DR antigen on cancer cells is correlated with their metastatic potentiality in colorectal carcinoma tissue.

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The expression of glycoconjugates in 35 primary breast carcinomas with lymph node metastases and 20breast carcinomas without metastases was studied by the use of lectin histochemistry. Paraffin sections of primary tumors as well as axillary lymph node metastases were stained with a panel of six biotinylated lectin with defined sugar specificities. There was a considarable variation in staining patterns among primary tumors. In addition, the lectin reactivity was heterogeneous in their respective tumors. The positivity of Helix Pomatia(HPA) in primary breast carcinomas with metastases was 77% and that in carcinomas without metastases was 25%. However, the positivities of 5 other lectins(UEA-1, GS-1, PNA, SBA, DBA ) showed no difference between with or without metastases, or primary and metastatic foci. There was a strong association between HPA binding and the presence of lymph node metastases. The positivity of HPA in metastatic lymph nodes was 48%. This finding indicates that there is intratumoral heterogeneity in the primary carcinomas, and the pesence of HPA binding in primary tumors correlated with lymph node involvement. Whereas, selected malignant cells without HPA-binding seems to give rise to metastases.

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Immunoreactivity in 16 cases of prostatic adenocarcinoma and 5 normal/hyperplastic prostates were investigated in methacarn-fixed, paraffin-embedded sections using anti-laminin monoclonal antibody (MAB1920, chemicon).
In normal/hyperplastic prostates, laminin Immunoreactivity showed distinct continuous basement membrane around the prostatic ducts/acini and the stroma (capillary, small blood vessel, smooth muscle and nerve).
In prostatic carcinomas, the structural pattern of basement membrane formation dependended on the histological differentiation. The well differentiated adenocarcinoma showed continuous basement membrane comparable to normal glands. The poorly differentiated adenocarcinomas usually had widespread absence of laminin immunoreactivity. The prostatic acinar laminin reactivity was inversely proportioned to the degree of dedifferentiation.
In our investigation no correlation between laminin reactivity on prostatic carcinomas and bone metastasis was found.

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Metastatic tumor of the small bowel from extraabdominal sites are rare. Lung and jejunum metastasis from malignant cystosarcoma phyllodes of the breast is reported in this paper. The patient is a 61 year old woman. She had modified radical mastectomy for the left breast when malignant cystosarcoma phyllodes of the breast was found in September,1986. She was admitted to the Department of Surgery in September 10,1991. with vomitting, upper abdominal pain and bloody stool. Emergency operation was performed immediately. At the exploration of the peritoneal cavity, intussusception of the jejunum was observed, so we performed partial jejunectomy. Many polyps have been observed in the resected jejunum. Small bowel obstruction was caused by intussusception from the polyp as the lead point.

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We describe a case of perforated metastatic tumor of the small intestine from carcinoma of urinary bladder which was eventually found to be inoperable because of metastasis to the lung. The patient was a 60-year-old male who had received chemotherapy for transitional cell carcinoma in urinary bladder. After 8 weeks of the chemotherapy, he was lapalotomized because of abdominal pain and free air on abdominal X-P, and three metastatic tumors were observed in jejunum. Most distal tumor formed an invagination and middle tumor was perforated. The jejunum was resected and histological examination revealed metastasis of transitional cell carcinoma. To our knowledge this isthe first case of intestinal metastasis from urinary bladder carcinoma.

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The clinical outcomes and pathological data of 22 patients with nasopharyngeal carcinoma treated between 1985 and 1992 were reviewed. Patients consisted of 19 male and 3 female, ranging 23 to 77 years with a median age of 53 years.20 out of 22 patients(91%) were found as advanced stage(stage III and IV) according to stage classification(UICC). Pathological data by classification of nasopharyngeal(UICC) showed 2 keratinizing squamous cell carcinomas,9 non-keratinizing carcinomas,11 undifferentiated carcinomas.10 out of 22patients(45%) demonstrated recurrence, which were 2 local recurrence and 7 cervical lymphnode/distant metastases. The overall 3-year and 5-year survival rates determined by Kaplan-Meyer analysis were 46% and 11%, respectively. No significant improvement to survival rate by the combined chemotherapy with radiation therapy was observed in comparsion with radiation therapy alone.

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We investigated nine metastatic cystic brain tumors. The major sources of metastatic cystic brain tumor were carcinoma of the lung (7cases), and histologically 5 cases were ademoma.
Enhanced CT showed that 8 cases were enhanced ring-like shape. Six cases showed moderately change of the ventricle on CT scan. The ratio of the cyst to perifocal low density was 1 to 1.41. This ratio suggests that perifocal edema was smoller than what we had expected.
We inserted Ommaya tube in 7 cases, and made subtotal removal of the cyst in 3 cases. We treated 6 cases with radiotherapy,5 cases with chemotherapy.
Two cases were alive more than 12 months and 3 cases were dead in several weeks.
We investigated doses of immuno glb, CEA, and AFP in the cysts. There was no relationship between these doses and prognosis of the patients.

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45 cases of hepatic tumors (HCC cases: 23 cases, Metastic liver cancer: 22 cases) were treated by local hyperthermia combined with intraarterial chemotherapy. Hyperthermia was performed by 8 MHz RF capacitive heating device. Intra-arterial chemotherapy or chemoemblolization using DSM (Degradable Starch Micropheres) and lipiodol was combined with hyperthermia. Chemoterapeutic agents were 5-FU, ADM, MMC and/or CDDP. The mean Tmax was lower in the HCC group than in the metastatic group. However, even HCC cases, remarkable increases in tumor temperatures were obtained, when hyperthermia was combined with embolization materials. The risings of the temperature were greater in the cases with portal vein obstruction than wiothout it. The effective rates were 31.1% in all case,30.4% in HCC group, and 31.8% in metastatic tumor group. The response rate was fairly higher in the high tumor temperature group(over 42°C) than in the low termperature group(under 42°C). Toxities were not severe. This treatment was useful for advanced hepatic tumors.

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Surgical techniques have been well standardized in gastroesophageal surgery. But surgical treatment of advanced esophageal carcinoma still have many problems to be answerd, because of the esophagus localets in complicated anatomical position in the thorax and has longitudinal lymphatic flows closely related to regional lymphonodus metastasis even in early phase. Recently, neoadjuvant theraphy for advanced esophageal carcinoma has been established, and the number of resectable case is increasing after an effective adjuvant theraphies. We have experienced 90 cases of esophageal carcinoma last five years from 1987 to 1991. Twenty seven cases of them have been shown to have extraesophageal invasion. In some advanced cases, we used an adjuvant theraphy preoperatively and made resectable. In this review, our treatment for advanced esophageal carcinoma is discussed. We are trying to find and use an more effective neoadjuvant theraphy in order to resect the advanced esophageal carcinoma successfuly.

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We encountered a case of a female child (1 year old) with diffuse calcified and undifferentiated brain tumor.
She first lost her consciousness and conplainted nausea. We find a calcified cystic tumor in right cerebral hemi-sphere on CT scan.
Pathology of the tumor have many undifferentiated cells and a few glial fiber with differentiates to glia and therefore, the tumor was diagnosed PNET.
PNET is very malignant, but we performed surgical treatmant, irradiation, and chemotherapy. The clinical course of this case was very good without neurological deicit.

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In the cells fixed in 50% ethanol, the antigenicith of PCNA was well preserved, allowing simple flowcytometric evaluation. The study using double staining of propidium iodide (PI) and fluorescein isothiocyanatelabeled anti-PCNA antibody showed that PCNA-postitive cells were widely distributed from the Go to the M phase by fixation with 50% ethanol.
Contrary to this, it is considered that G0 phase, but G1 to M phase if DNA synthesis is ceased under some condition. In comparison with convertional porliferating index determined by flow cytometry using P1, PCNA is a potential sensitive indicator of cell growth.

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