Microsatellite instability (MSI) is known to be associated with defective DNA mismatch repair in various human malignancies, and is regarded as a major factor in tumorigenesis. To establish an assay system where more precise and objective assessments are made feasible, we made use of fluorescence-labeled polymerase chain reaction (PCR) and laser scanning. Secondly, we cotntroled Taq polymerase-dependent modification of the amplified microsatellite sequences, by enzymatic modification with T4 DNA polymerase. Thirdly, we developed a dual fluorescence co-electrophoresis system, in which both samples derived from cancer and normal tissues are electrophoresed in the same lane, in order to minimize migration errors. These improvements remarkably facilitate precise and objective assessments of microsatellite instability. Using this new system, High Resolution Fluorescent Microsatellite Analysis (HRFMA), we examined MSI in various human malignancies. Intriguingly, patterns of microsatellite changes observed can be classified into two distinct subtypes; one showing relatively small changes within 6 base pairs (type A) and the other exhibiting drastic changes over 8 base pairs (type B). In gastric and colorectal cancer, Type A and Type B was observed in 20-25% and 3-10%, respectively. Although MSI has been uniformly connected to high risk for cancer, only type B microsatellite instability correlated with family history in gastric cancer. The risk for secondary malignancies and that for a familial predisposition may be independent, even in the same diseases.

急性腹症診療ガイドライン2015が発刊され実臨床への応用が開始された。有意義なガイドラインとするためにこれを広く周知する必要があるが，その実態を把握する目的で当院の常勤医師38名にアンケート調査を行った（回答率100%）。本ガイドラインを知っている5名（13%），知らない33名（87%）であった。また発刊から2ヵ月が経過した時点では2名が知っており，院内講演会で本ガイドラインの概要を解説したところ3名が増加していた。本ガイドライン策定に携わった日本腹部救急医学会，日本医学放射線学会，日本プライマリ・ケア連合学会，日本産科婦人科学会，日本血管外科学会の5学会へ所属しているのはこの5名中2名で，院内全体では6名が所属していた。本ガイドラインの周知が進んでおらず，広く恩恵を受ける段階に至っていない。学会側からの啓発活動を推進していただきたい。また院内での勉強会も反復する必要性があると考えた。5学会の会員数も多くはなく，より構成人員の多い学会と連携して本ガイドラインを策定・啓発していくことも一手段である。

今回われわれは乳癌と直腸癌の同時性重複癌の１例を経験した．症例は67歳女性，約１年前より左乳房内の小硬結を自覚していたが，血便で当院内科を受診した．肛門縁より約２cmの部位に２型病変が認められ組織診にてgroup3であった．MMG，USで左乳房D領域に約３cm大の腫瘤が認められ，針生検にて硬癌であった．PET/CTで左内腸骨動脈周囲や直腸左背側のリンパ節に腫大と異常集積があり，直腸癌の主リンパ節への転移が疑われた．以上より左乳癌：T2N0M0；StageⅡA，直腸癌：T2（MP）?T3（A）N3M0?1；c StageⅢb?Ⅳと術前診断され，Bp+SLN＋S状結腸人工肛門造設術を施行した．術後SOX３コースと骨盤腔へRT50Gyを行い治療効果はPRであった．その４週間後に直腸切断術＋D3郭清施行した．以後左残存乳房へのRT50Gyを行った後，３コースのSOXを追加した．さらにその後DTX+ハーセプチンを投与中であるが，再発はなく健在である．同時性重複癌においては各癌腫の進行度，患者のQOLやADL，手術時期，各抗癌剤の副作用などに配慮し，効率良く各癌腫の根治を行う必要がある．

The patient was a 42-year-old woman with Bloom syndrome and a history of malignant lymphoma, who presented with left central facial nerve paralysis.

Examination revealed deafness, and obstruction of the left external auditory meatus. CT revealed a soft tissue shadow with destruction of the left apex in the petrous area, and cholesteatoma was suspected. It was Bloom syndrome and considered the merger of the malignant tumor and photographed PET-CT, and a tumor with the accumulation of FDG was indicated at parapharyngeal space. Since it was considered difficult to perform radical excision, a craniotomy operation was performed together with neuro surgeon team of our hospital. A frozen-section examination revealed the diagnosis of squamous cell carcinoma.

Bloom syndrome is a hereditary autosomal recessive disease characterized by a distinctive facial appearance, low body weight, immunodeficiency, primary amenorrhea, sunlight-hypersensitive erythema. In addition, it is known even that I have a high cancer-causing percentage to be associated with a high incidence of cancer.

In this study, an Au sensor surface of surface plasmon resonance was developed for detection of catecholamine metabolites such as homovanilic acid (HVA) in urine samples. The sensor surface was modified with mixed self-assembled monolayer containing oligo (ethylene glycol) chain for reducing nonspecific adsorption. An indirect competitive assay using anti-HVA-concholepas concholepas hemocyanin (CCH) polyclonal antibody and HVA in model of urine solution was carried out. HVA concentrations of human urine samples were estimated from SPR sensor responses by referring the response curve. As the results, the detection limit of HVA in model of urine was obtained 15 ppb. The rank of estimated concentration in five human urine samples was matched with that of the quantified concentration by high performance liquid chromatography-mass spectrometry.

We propose a computer-aided diagnostic (CAD) system that uses time-intensity curves to distinguish between benign and malignant mammary tumors. Many malignant tumors show a washout pattern in time-intensity curves. Therefore, we designed a program that automatically detects the position with the strongest washout effect using the technique, such as the subtraction technique, which extracts only the washout area in the tumor, and by scanning data in 2×2 pixel region of interest (ROI). Operation of this independently developed program was verified using a phantom system that simulated tumors. In three cases of malignant tumors, the washout pattern detection rate in images with manually set ROI was ≤6%, whereas the detection rate with our novel method was 100%. In one case of a benign tumor, when the same method was used, we checked that there was no washout effect and detected the persistent pattern. Thus, the distinction between benign and malignant tumors using our method was completely consistent with the pathological diagnoses made. Our novel method is therefore effective for differentiating between benign and malignant mammary tumors in dynamic magnetic resonance images.

当科で経験した大腸癌を非重複大腸癌（C群），乳癌重複大腸癌（B群），他癌重複大腸癌（O群）の3群に分類し，重複大腸癌の臨床病理学的特徴を明らかにした．男性での重複癌の臓器は主に胃，前立腺，肺，女性では乳腺，胃，肺であった．大腸癌発症までの平均期間はB群で7年，O群で12年であった．B群はCEA高値で発見され右側結腸癌の頻度が高く，予後は大腸癌のpStageが影響した．一方，O群は高齢で，予後は他癌の悪性度が影響しB群と異なっていた．3群のpStageIVの患者はすべて大腸癌で死亡した．pStage0-IIの大腸癌患者は術後5年以降に二次癌に罹患することが多かった．多変量解析による癌死の独立危険因子はO群，大腸癌のpStageII，IIIであった．重複癌の早期発見，予後改善には二次癌を念頭に置いた適切なサーベイランスが必要である．