論文 - 河上 洋
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Nakanishi Y., Zen Y., Hirano S., Tanaka E., Takahashi O., Yonemori A., Doumen H., Kawakami H., Itoh T., Nakanuma Y., Kondo S.
Journal of Hepato-Biliary-Pancreatic Surgery 16 ( 6 ) 869 - 873 2009年11月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Hepato-Biliary-Pancreatic Surgery
We report herein the first case of intraductal oncocytic papillary neoplasm of the bile duct arising from a peribiliary gland of the left hepatic duct. The patient was a 63-year-old Japanese man. Radiological and cholangioscopic examinations revealed intraductal tumor of the left hepatic duct. After pathological diagnosis of adenocarcinoma by cholangioscopic biopsy, a surgical hepatobiliary resection was performed. Pathological examination revealed papillary tumor in the left hepatic duct. Histologically, the tumor was identified as papillary neoplasm comprising oncocytic cells and delicate fibrovascular cores. Interestingly, this tumor originated from the cystic space in the bile duct wall. This cystic space was histologically identified as a cystically dilated peribiliary gland. Carcinoma in situ was observed in this cystic peribiliary gland at the bottom of the tumor, but not on any areas of biliary epithelium. This case suggests that intraductal papillary neoplasm can arise from both biliary epithelium and peribiliary glands. © 2009 Springer.
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Kawakami H., Maguchi H., Hayashi T., Yanagawa N., Chiba A., Hisai H., Amizuka H.
Journal of Gastroenterology 44 ( 11 ) 1140 - 1146 2009年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Gastroenterology
Background: In duodenoscopy, during endoscopic retrograde cholangiopancreatography (ERCP), a backward-oblique angle duodenoscope (BOAD) is generally used. In Japan, 15° BOAD are mainly used, but in Western countries, 5° BOAD are mostly used. In bile duct cannulation associated with ERCP, a catheter for contrast imaging is used in Japan, but wire-guided cannulation (WGC) using a papillotome is standard in Western countries. We conducted a randomized controlled multicenter trial to evaluate the contributions of different duodenoscopes using WGC to selective common bile duct cannulation. Methods: Subjects comprised 179 consecutive patients who underwent ERCP. Patients were randomized into the 15° BOAD group (15° group, n = 90) or the 5° BOAD group (5° group, n = 89). Results: The duodenal papilla could not be accessed endoscopically in two cases from each group. Success rates for bile duct cannulation by WGC without bow-up for the 15° and 5° groups were 85.6 and 56.2%, respectively (P < 0.01). Success rates for bile duct cannulation by WGC with bow-up for the 15° and 5° groups were 88.9 and 78.7%, respectively. Total rates of bile duct cannulation for the 15° and 5° groups were 94.4 and 92.1%, respectively. As for accidents, incidences of acute pancreatitis for the 15° and 5° groups were 5.6 and 9.0%, respectively, with no significant difference seen. Conclusions: With 15° BOAD, bile duct cannulation was favorable without papillotome bow-up. With 5° BOAD, the success rate of WGC may be improved by adjusting the angle based on papillotome bow-up. © 2009 Springer.
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Kuwatani M., Kawakami H., Eto K., Haba S., Shiga T., Tamaki N., Asaka M.
Internal Medicine 48 ( 11 ) 867 - 875 2009年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
Objective: It has recently been reported that 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for estimation of the chemotherapy effect. Thus, we examined the value of FDG-PET in assessing the efficacy of chemotherapy in advanced pancreatic cancer, and compared this modality with tumor markers (TMs) and CT. Patients and Methods: Nineteen patients with unresectable pancreatic adenocarcinoma were enrolled. All patients received chemotherapy with gemcitabine and S-1, an oral derivative of 5-fluorouracil, and underwent FDG-PET, CT, and serological examination for TMs before and after chemotherapy. Results: Standardized uptake value in FDG-PET before treatment and survival time were not correlated. A good prognosis was seen after 1 course of chemotherapy in patients whose tumors were in partial or complete remission as assessed by FDG-PET [median of survival time (MST), 12.5 months] or TMs (MST, 13.5 months), but not in CT responders (MST, 10.3 months). Furthermore, patient prognosis correlated with PET and TM assessment of the best tumor response through all courses. Namely, both PET and TM were useful for the prediction of survival or chemotherapy sensitivity of the patients. Conclusion: FDG-PET and TMs can each play an adjunct role to CT for estimating the effect of chemotherapy and predicting survival by distinguishing between responders and non-responders among patients with advanced pancreatic cancer. © 2009 The Japanese Society of Internal Medicine.
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Pancreatic carcinoma associated with portal vein tumor thrombus: Three case reports
Yamato H., Kawakami H., Kuwatani M., Shinada K., Kondo S., Kubota K., Asaka M.
Internal Medicine 48 ( 3 ) 143 - 150 2009年3月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
Pancreatic carcinoma associated with portal vein tumor thrombus (PVTT) is rare. Here, we report three cases of resected pancreatic carcinoma associated with PVTT. In all three cases, preoperative images obtained using computed tomography and endoscopic ultrasonography revealed a tumor thrombus in the portal vein, which was connected to an irregular mass in the pancreas. All cases underwent surgical resection of the primary lesion and the PVTT. The pathological diagnoses of the tumors were two cases of tubular adenocarcinoma and one case of nonfunctioning endocrine carcinoma. We also retrospectively examined other patients who underwent surgical excision with portal vein resection. © 2009 The Japanese Society of Internal Medicine.
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Kuwatani M., Kawakami H., Yamato H., Shinada K., Tanaka E., Hirano S., Kondoh S., Itoh T., Asaka M.
Japanese Journal of Gastroenterology 105 ( 7 ) 1061 - 1069 2008年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Japanese Journal of Gastroenterology
We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonograghy revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.
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Kuwatani M., Kawakami H., Asaka M., Marukawa K., Matsuno Y., Hosaka M.
Diagnostic Cytopathology 36 ( 11 ) 840 - 842 2008年11月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1002/dc.20924
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Autoimmune pancreatitis associated with hemorrhagic pseudocysts: A case report and literature review
Kawakami H., Kuwatani M., Shinada K., Yamato H., Hirano S., Kondo S., Yonemori A., Itoh T., Matsuno Y., Asaka M.
Internal Medicine 47 ( 7 ) 603 - 608 2008年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
Autoimmune pancreatitis (AIP) is a new category of pancreatic diseases. AIP associated with pseudocysts is rare; only 8 cases have been reported in the literature. A 63-year-old man was admitted to our department because of upper left abdominal pain and back pain. Various imaging studies demonstrated swelling of the tail of the pancreas with hemorrhagic pseudocysts. The patient underwent a surgical operation. A pancreatogram of the specimen revealed total occlusion of the main pancreatic duct in the tail of the pancreas. Histopathological examination revealed that it was AIP with hemorrhagic pseudocysts. © 2008 The Japanese Society of Internal Medicine.
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Nakanishi Y., Zen Y., Kawakami H., Kubota K., Itoh T., Hirano S., Tanaka E., Nakanuma Y., Kondo S.
Modern Pathology 21 ( 7 ) 807 - 816 2008年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Modern Pathology
Extrahepatic bile duct carcinoma occasionally presents with intraepithelial spread for a considerable area around the main tumor. In this study, we compared clinicopathological features of extrahepatic bile duct carcinoma with and without extensive intraepithelial spread (≥20 mm from the main tumor). Out of 117 cases of extrahepatic bile duct carcinoma, 21 (18%) were found to have extensive intraepithelial spread. Those cases were pathologically characterized by a papillary or nodular main tumor, a more differentiated histological grade, less deep invasion, and infrequent portal vein or hepatic invasion in comparison with cases without intraepithelial spread. Areas of intraepithelial spread his tologically consisted of low-papillary growth (17 cases, 81%) and completely flat growth (4 cases, 19%) of carcinoma cells. The former histology corresponded to a macroscopic granular mucosa, whereas the latter growth was hardly detected by gross examination. Immunohistochemically, in 16 of 21 cases (76%), at least one of p53, CEA, and MUC1 was expressed in both the main tumor and the spreading area. Interestingly, patients with intraepithelial spread had a better postoperative prognosis than those without intraepithelial spread (P=0.009). However, three patients had anastomotic recurrence 54-130 months after surgery. In conclusion, intraepithelial-spreading bile duct carcinoma is characterized by papillary or nodular main lesions, a more differentiated histological grade, and less invasiveness. The presence of intraepithelial spread was not an indicator of a poor prognosis, but carcinoma in situ at the bile duct stump could cause late anastomotic recurrence after surgery. © 2008 USCAP, Inc All rights reserved.
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A rare complication with extraction of proximally migrated biliary stent by using a basket catheter
Kawakami H., Uebayashi M., Konishi K., Kuwatani M., Shinada K., Yamato H., Asaka M.
Gastrointestinal Endoscopy 67 ( 7 ) 1170 - 1172 2008年6月
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Pancreatic metastasis from renal cell carcinoma with intraportal tumor thrombus
Kawakami H., Kuwatani M., Yamato H., Shinada K., Hirano S., Kondo S., Yonemori A., Matsuno Y., Asaka M.
Internal Medicine 47 ( 22 ) 1967 - 1970 2008年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
A 68-year-old woman with a history of renal cell carcinoma (RCC) resected curatively 12 years previously was admitted to our department for scrutiny of pancreatic tumors. Various unaging studies demonstrated heterogeneously well-enhanced masses in the head and tail of the pancreas. The well-enhanced mass in the head of the pancreas was connected with the tumor thrombus in the portal vein. To differentially diagnose the multiple pancreatic lesions, we performed endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). Histopathologic findings of the EUS-FNAB specimens were similar to those of the renal clear cell carcinoma previously resected. The patient underwent a surgical operation with segmental resection of the portal vein with the preoperative diagnosis of RCC metastasis to the pancreas with intraportal growth. Histopathological examination of the resected specimen revealed that the masses in the pancreas were multiple pancreatic metastases with intraportal tumor thrombus of RCC. The pancreas is a rare target for metastasis. This is a rare case of pancreatic metastasis from RCC with intraportal extension, and is the first preoperatively definitely diagnosed case using EUS-FNAB. © 2008 The Japanese Society of Internal Medicine.
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Villous adenoma arising in choledochocele 査読あり
Kawakami H., Kuwatani M., Onodera M., Asaka M., Hirano S., Kondo S.
Gastrointestinal Endoscopy 66 ( 6 ) 1231 - 1232 2007年12月
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Kuwatani M., Kawakami H., Makiyama H., Onodera M., Matsumoto K., Karasawa G., Asaka M.
Internal Medicine 46 ( 18 ) 1557 - 1564 2007年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
A 58-year-old male had been diagnosed as having autoimmune pancreatitis (AIP) from the results of serological examinations and image findings. He was treated with prednisolone (PSL) for 3.5 months. Fifteen months later, follow-up CT revealed the main pancreatic duct (MPD) dilatation in the pancreas body to tail and right hydronephrosis caused by complicated retroperitoneal mass. We diagnosed him as having recurrent AIP with retroperitoneal fibrosis, and restarted PSL treatment. After one month, Examinations indicated amelioration of the MPD dilatation and right hydronephrosis, but not the right renal failure. This case indicates the importance of maintenance of PSL treatment. © 2007 The Japanese Society of Internal Medicine.
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Kawakami H., Kuwatani M., Onodera M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Internal Medicine 46 ( 15 ) 1191 - 1195 2007年8月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
Hepatolithiasis associated with cholangiocellular carcinoma is occasionally a calcium bilirubinate stone. Primary cholesterol hepatolithiasis associated with cholangiocellular carcinoma is rare; only 6 cases have been reported in the literature. A 55-year-old man was admitted to our hospital because of an elevated level of carbohydrate antigen 19-9. Various imaging studies demonstrated a mass in the segment VII of the liver. The patient underwent a curative surgical operation. Histopathological examination revealed that it was cholangiocellular carcinoma located in the periphery of the liver. A cholesterol stone was present, encircled by the cholangiocellular carcinoma. Minor inflammatory changes were observed around the stone. © 2007 The Japanese Society of Internal Medicine.
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Nakanishi Y., Ito T., Kubota K., Takeda H., Yonemori A., Kawakami H., Zen Y., Kondo S.
Surgery Today 37 ( 8 ) 708 - 712 2007年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Surgery Today
Spindle cell-type undifferentiated carcinoma arising from the extrahepatic bile duct is extremely rare. We herein report a case of this type of carcinoma in the common bile duct of the hepatic hilus. A 59-year-old man was admitted to our hospital complaining of jaundice. The laboratory data revealed an elevation of the serum carbohydrate antigen 19-9 level. Cholangiography revealed a complete obliteration of the left hepatic bile duct and stenosis of the bile duct from the superior to the right hepatic bile duct. Computed tomography showed the tumor to measure 15 × 12 mm in the hepatic hilus, with the obliteration of the right to main trunk of the portal vein and a swollen lymph node in the hepato-duodenum ligament. Arteriography revealed a kink of the right hepatic artery; therefore an encasement of the right hepatic artery was suspected. We preoperatively diagnosed hilus bile duct carcinoma and scheduled a right trisection hepatectomy. Intraoperative frozen sections taken from the tumor and tissues around the hepatic arteries showed spindle and inflammatory cells; therefore an inflammatory pseudotumor was diagnosed intraoperatively. As the right hepatic bile duct was occluded, a right lobe hepatectomy was performed. However, a permanent section revealed both spindle cells and poorly differentiated tubular adenocarcinoma cells positive for CAM5.2, AE1/AE3, and vimentin. On the basis of these findings, the tumor was finally diagnosed to be spindle cell-type undifferentiated carcinoma. Unfortunately, the patient died of pulmonary infarction 11 days after the operation. © 2007 Springer-Verlag.
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Primary acinar cell carcinoma of the ampulla of Vater
Kawakami H., Kuwatani M., Onodera M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Journal of Gastroenterology 42 ( 8 ) 694 - 697 2007年8月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Gastroenterology
Acinar cell carcinoma of the pancreatobiliary system is a relatively rare malignant neoplasm arising usually in the pancreatic parenchyma. We experienced a 68-year-old woman who presented with obstructive jaundice due to an ampullary mass 1.0 cm in diameter, detected by abdominal computed tomography and endoscopic examination. The patient underwent a curative surgical operation, and histopathological examination revealed that the tumor was confined to the ampulla of Vater with no continuity to the pancreatic parenchyma. The tumor cells showed acinar or tubular arrangement with eosinophilic to basophilic granular cytoplasm, findings identical to those of acinar cell carcinoma of the pancreas. Immunohistochemically, the tumor cells were positive for lipase. From these findings, we concluded that the tumor was primary acinar cell carcinoma arising in the ampulla of Vater, probably originating from heterotopic pancreatic tissue. This is the first reported case of primary acinar cell carcinoma in the ampulla of Vater. © Springer-Verlag Tokyo 2007.
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Kitagami H., Kondo S., Hirano S., Kawakami H., Egawa S., Tanaka M.
Pancreas 35 ( 1 ) 42 - 46 2007年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Pancreas
OBJECTIVES: Acinar cell carcinoma (ACC) of the pancreas is a rare tumor, and many aspects remain unclear because no large-scale clinical studies have been conducted. METHODS: The present study investigated the clinical characteristics, treatment, and therapeutic outcomes of 115 patients registered in the Pancreatic Cancer Registry of the Japan Pancreas Society, and therapeutic plans were reviewed. RESULTS: Although ACC has been associated with advanced stage and poor prognosis, this tumor was resectable in 76.5% of the patients, and the 5-year survival rate after resection was favorable, being 43.9%. CONCLUSIONS: Confirming the diagnosis of ACC preoperatively is difficult, but this diagnosis should be kept in mind while planning surgery for ordinary pancreatic cancer. Once the diagnosis has been confirmed, a possibility of surgical resection should be pursued to achieve better prognosis. If ACC is unresectable or recurrent, chemotherapy is likely to prove useful. Multidisciplinary therapy centering on the role of surgery will need to be established. © 2007 Lippincott Williams & Wilkins, Inc.
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膵漿液性嚢胞腺腫solid-variant typeと考えられた１例—自験例と報告例の画像所見の検討— 査読あり
Kuwatani M., Kawakami H., Onodera M., Hirano S., Kondo S., Itoh T., Koshiyama T., Kawakami A., Asaka M.
Gastroenterological Endoscopy 49 ( 5 ) 1303 - 1309 2007年5月
担当区分：責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Gastroenterological Endoscopy
A 70-year-old female was admitted to our hospital for workup and treatment of a 23 X 16mm mass in the pancreas head. Ultrasonography showed a hypoechoic solid lesion, whereas, abdominal CT revealed a hypervascular tumor with clear boundaries. Endoscopic ultrasonography demonstrated a hypoechoic mass with lateral shadow and a tiny anechoic lesion. According to these findings, we diagnosed it as endocrine tumor of the pancreas head and performed subtotal stomach preserving pancreatoduodenectomy. The final diagnosis was 'solid-variant type of serous cystadenoma'. When we diagnose a hypervascular and well-demarcated tumor, we need to notice sporadic hyperechoic spots in US, acoustic enhancement in EUS and high-intensity area in MRCP, which seem to represent solid-variant type of SCA.
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Kawakami H., Kuwatani M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Internal Medicine 46 ( 6 ) 273 - 277 2007年3月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
Pancreatic endocrine tumors are rare tumors classified into "functioning" and "nonfunctioning" tumors. A 68-year-old man was admitted to our hospital with the chief compliant of abdominal pain. Various imaging studies demonstrated a mass in the head of the pancreas with intraductal growth into the main pancreatic duct and an intraportal mass. The patient underwent a curative surgical operation. Histopathological examination revealed that it was nonfunctioning endocrine carcinoma of the pancreas. This is the first reported case of a pancreatic endocrine tumor with intraductal growth into the main pancreatic duct and tumor thrombus within the portal vein. © 2007 The Japanese Society of Internal Medicine.
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G-CSF産生膵管癌の1例 査読あり
河上 洋，桑谷将城，藤谷好弘，上林 実，小西康平，牧山裕顯，橋野 聡，久保田佳奈子，伊藤智雄，浅香正博
日本消化器病学会雑誌 104 ( 2 ) 233 - 238 2007年2月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Japanese Journal of Gastroenterology
We report a case of pancreatic ductal adenocarcinoma producing granulocyte-colony stimulating factor (G-CSF). A 56-year-old Japanese man was admitted to our hospital with back pain and high fever. An abdominal CT scan revealed masses in the pancreatic body to the tail, and both lobes of the liver. A biopsy specimen of the hepatic tumor demonstrated metastatic poorly differentiated adenocarcinoma We administered oral S-1 in combination with gemcitabine. However, his general condition gradually worsened, and a high serum level of G-CSF persisted. He died 135 days after admission. The diagnosis of autopsy was pancreatic ductal adenocarcinoma. Immunohistochemical staining showed the presence of G-CSF in tumor cells. The final diagnosis was G-CSF-producing pancreatic carcinoma.
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Miseki T., Kawakami H., Natsuizaka M., Darmanin S., Cui H., Chen J., Fu Q., Okada F., Shindo M., Higashino F., Asaka M., Hamuro J., Kobayashi M.
Cancer Gene Therapy 14 ( 1 ) 39 - 44 2007年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Cancer Gene Therapy
We have recently reported that the intra-tumoral injection of adrenomedullin (AM) antagonist (AMA; AM (22-52)) peptides significantly reduced the in vivo growth of a pancreatic cancer cell line in severely combined immunodeficient (SCID) mice. In the present study, we examined the effects of intra-tumoral and intra-muscular transfers of naked DNA encoding AMA on the in vivo growth of cancer cell lines. We demonstrate that these treatments induce the regression of a pancreatic cancer cell line and a breast cancer cell line inoculated in SCID mice. Furthermore, CD31-positive cells disappear completely from tumor tissues, following treatment, indicating that neo-vascularization is entirely inhibited. These results suggest that the intra-tumoral or intra-muscular transfer of naked DNA encoding AMA might be a promising alternative modality for treating human cancers. © 2007 Nature Publishing Group All rights reserved.