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Inokuchi, Masafumi ; 井口, 雅史
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取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1611号, 学位授与年月日 : 平成15年12月31日, 学位授与大学 : 金沢大学
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Tajima, Hidehiro ; Takamura, Hiroyuki ; Kitagawa, Hirohisa ; Nakayama, Akira ; Shoji, Masatoshi ; Watanabe, Toshifumi ; Tsukada, Tomoya ; Nakanuma, Shinichi ; Okamoto, Koichi ; Sakai, Seisho ; Kinoshita, Jun ; Makino, Isamu ; Nakamura, Keishi ; Hayashi, Hironori ; Oyama, Katsunobu ; Inokuchi, Masafumi ; Nakagawara, Hisatoshi ; Miyashita, Tomoharu ; Ninomiya, Itasu ; Fushida, Sachio ; Fujimura, Takashi ; Wakayama, Tomohiko ; Iseki, Shoichi ; Ikeda, Hiroko ; Ohta, Tetsuo ; 田島, 秀浩 ; 高村, 博之 ; 北川, 裕久 ; 中村, 信一 ; 岡本, 浩一 ; 木下, 淳 ; 牧野, 勇 ; 中村, 慶史 ; 林, 泰寛 ; 尾山, 勝信 ; 井口, 雅史 ; 中川原, 寿俊 ; 宮下, 知治 ; 二宮, 致 ; 若山, 友彦 ; 藤村, 隆 ; 井関, 尚一 ; 池田, 博子 ; 太田, 哲生
概要:
金沢大学医薬保健研究域医学系<br />A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and mult
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iple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success. © 2015, Spandidos Publications. All Rights Reserved.<br />Embargo Period 6 months
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Yoshimoto, Katsuhiro ; Tajima, Hidehiro ; Ohta, Tetsuo ; Okamoto, Koichi ; Sakai, Seisho ; Kinoshita, Jun ; Furukawa, Hiroyuki ; Makino, Isamu ; Hayashi, Hironori ; Nakamura, Keishi ; Oyama, Katsunobu ; Inokuchi, Masafumi ; Nakagawara, Hisatoshi ; Itoh, Hiroshi ; Fujita, Hideto ; Takamura, Hiroyuki ; Ninomiya, Itasu ; Kitagawa, Hirohisa ; Fushida, Sachio ; Fujimura, Takashi ; Wakayama, Tomohiko ; Iseki, Shoichi ; Shimizu, Koichi ; 田島, 秀浩 ; 太田, 哲生 ; 岡本, 浩一 ; 木下, 淳 ; 古川, 裕之 ; 牧野, 勇 ; 林, 泰寛 ; 中村, 慶史 ; 尾山, 勝信 ; 井口, 雅史 ; 中川原, 寿俊 ; 藤田, 秀人 ; 高村, 博之 ; 二宮, 致 ; 藤村, 隆 ; 若山, 友彦 ; 井関, 尚一 ; 清水, 康一
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金沢大学医薬保健研究域医学系<br />Several recent studies have reported that selectins are produced during ischemia-reperfusion injury,
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and that selectin ligands play an important role in cell binding to the endothelium and in liver metastasis. Portal clamping during pancreaticoduodenectomy with vessel resection for pancreatic head cancer causes hepatic ischemia-reperfusion injury, which might promote liver metastasis. We investigated the liver colonization of pancreatic cancer cells under hepatic ischemia-reperfusion and examined the involvement of E-selectin and its ligands. A human pancreatic cancer cell line (Capan-1) was injected into the spleen of mice after hepatic ischemia-reperfusion (I/R group). In addition, to investigate the effect of an anti-E-selectin antibody on liver colonization in the IR group, mice received an intraperitoneal injection of the anti-E-selectin antibody following hepatic ischemia-reperfusion and tumor inoculation (IR+Ab group). Four weeks later, mice were sacrificed and the number of tumor nodules on the liver was compared to mice without hepatic ischemia-reperfusion (control group). The incidence of liver metastasis in the I/R group was significantly higher (16 of 20, 80%) than that in the control group (6 of 20, 30%) (P<0.01). Moreover, mice in the I/R group had significantly more tumor nodules compared to those in the control group (median, 9.9 vs. 2.7 nodules) (P<0.01). In the I/R+Ab group, only 2 of 5 (40%) mice developed liver metastases. RT-PCR and southern blotting of the liver extracts showed that the expression of IL-1 and E-selectin mRNA after hepatic ischemia-reperfusion was significantly higher than the basal levels. Hepatic ischemia-reperfusion increases liver metastases and E-selectin expression in pancreatic cancer. These results suggest that E-selectin produced due to hepatic ischemia-reperfusion is involved in liver metastasis.<br />Embargo Period 6 months
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川島, 博子 ; 井口, 雅史
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[学会開催報告]
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井口, 雅史 ; 太田, 哲生 ; 北川, 裕久 ; 谷, 卓 ; 西村, 元一 ; 萱原, 正都 ; 清水, 康一 ; 三輪, 晃一 ; 松井, 修
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米田, 由美 ; 守山, 成則 ; 八幡, 徹太郎 ; 井口, 雅史 ; 野口, 昌邦 ; 立野, 勝彦
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金沢大学附属病院乳腺科 特任教授
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齋藤, 裕人 ; 尾山, 勝信 ; 伏田, 幸夫 ; 柄田, 智也 ; 岡本, 浩一 ; 中沼, 伸一 ; 木下, 淳 ; 牧野, 勇 ; 中村, 慶史 ; 林, 泰寛 ; 井口, 雅史 ; 中川原, 寿俊 ; 宮下, 知治 ; 藤田, 秀人 ; 田島, 秀浩 ; 高村, 博之 ; 二宮, 致 ; 北川, 裕久 ; 藤村, 隆 ; 太田, 哲生
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We report a case of gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor (G-CSF). A 60-year-o
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ld man was admitted to our hospital complaining of upper abdominal pain. Endoscopic examination revealed a large type 5 advanced gastric cancer with bleeding from the low body of stomach to the antrum, accompanied with para-aortic and mesenteric lymph node metastasis. He had marked leukocytosis, and serum levels of G-CSF were elevated. Histological diag-nosis of the biopsy specimen was adenosquamous carcinoma producing G-CSF. We attempted combination chemotherapy with docetaxel, cisplatin and S-1 (DCS). After 1 course of treatment, the primary lesion was reduced in size. However, the size of the metastatic lymph node was larger. Chemotherapy was not effective enough, and the patient died 3 months after ending chemotherapy. 症例は60歳、男性。上腹部痛を主訴に受診。上部消化管内視鏡で胃体下部から前庭部の小弯後壁に易出血性の5型胃癌を認め、画像所見で傍大動脈・腸間膜リンパ節転移を認めた。生検にて腺癌成分と扁平上皮癌成分の混在を認めた。来院時より白血球数が著明に増多し、血清G-CSF高値、生検組織の免疫組織染色で腫瘍組織のG-CSF発現を認めた。以上よりG-CSF産生胃腺扁平上皮癌と診断し、化学療法（DCS (docetaxel/ cisplatin/ S-1併用)療法）を1コース行ったところ原発巣の縮小を認めたが、転移リンパ節の増大を認めた。急激な病状悪化により3ヶ月の経過で死亡した。
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寺川, 裕史 ; 尾山, 勝信 ; 渡邉, 利史 ; 柄田, 智也 ; 岡本, 浩一 ; 木下, 淳 ; 古河, 浩之 ; 牧野, 勇 ; 中村, 慶史 ; 林, 泰寛 ; 井口, 雅史 ; 中川原, 寿俊 ; 宮下, 知治 ; 田島, 秀浩 ; 高村, 博之 ; 二宮, 致 ; 北川, 裕久 ; 伏田, 幸夫 ; 藤村, 隆 ; 太田, 哲生
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An 83-year-old woman was diagnosed as having advanced gastric cancer with multiple lymph node and hepatic metastases. Hi
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stopathological examination revealed that the tissue was human epidermal growth factor receptor 2 (HER2) positive. The patient underwent gastrojejunostomy to improve stomach obstruction. Thereafter, S-1 and trastuzumab combination chemotherapy was administered as first-line treatment; irinotecan (CPT-11), cisplatin, and trastuzumab combination chemotherapy, as second-line treatment; and docetaxel plus trastuzumab combination chemotherapy, as third-line treatment. Although both primary and metastatic lesions decreased in size temporarily, their size increased again, and the patient died 1 year and 7 months later. The level of serum HER2-extracellular domain (ECD) was a valuable indicator of response to chemotherapy. Thus, serum HER2-ECD could be a useful biomarker for HER2-positive gastric cancer.症例は83歳, 女性. 多発リンパ節転移, 多発肝転移を伴う進行胃癌を指摘された. 生検検体のHER2判定は陽性であった. 通過障害改善目的の胃空腸バイパス術後に化学療法を開始した. first-lineにS-1+trastuzumab, second-lineとしてirinotecan(CPT-11)+cisplatin+trastuzumab, third-lineとしてdocetaxel+trastuzumabを行った. いずれも一時的には治療効果が得られたが不応となり, 1年7か月後に永眠された. 経過中, 血清HER2-ECD値の増減と治療効果に相関を認めた. 血清HER2-ECD値はHER2陽性胃癌の治療効果を反映するバイオマーカーとなる可能性が示唆された.
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寺川, 裕史 ; 尾山, 勝信 ; 渡邉, 利史 ; 柄田, 智也 ; 岡本, 浩一 ; 木下, 淳 ; 古河, 浩之 ; 牧野, 勇 ; 中村, 慶史 ; 林, 泰寛 ; 井口, 雅史 ; 中川原, 寿俊 ; 宮下, 知治 ; 田島, 秀浩 ; 高村, 博之 ; 二宮, 致 ; 北川, 裕久 ; 伏田, 幸夫 ; 藤村, 隆 ; 太田, 哲生
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症例は59歳, 男性. 進行胃癌に対し, 胃全摘術(D2郭清, 脾合切)を施行した. 病理診断は多発胃癌で病変は2か所あり, ML, AntLess, type 3, por, pT3, ly1, v0およびM, Post, 0-IIc,
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tub1, pT1b2, ly0, v0, pN2M0P0H0, pStage IIIAであった. 術後3年6か月目に, 顔面, 頸部, 体幹, 上肢に小結節が多数出現した. 皮膚結節の生検では胃癌の転移に矛盾しない所見であり, 胃癌多発皮膚転移と診断した. さらに多発骨転移・リンパ節転移を認め, 化学療法を行っている. 胃癌の皮膚転移部位は, 臍部, いわゆるSister Mary Joseph's noduleが最多であるが, それ以外の部位に多発する症例はまれである. 「はじめに」 内臓悪性腫瘍の皮膚転移は一般的にはまれとされ, その頻度は3～10%程度と報告されている1, 2). A 59-year-old man with gastric cancer underwent a total gastrectomy with splenectomy and D2 lymph node dissection. Pathological findings after the first operation were as follows: ML, AntLess, type 3, por, pT3, ly1, v0, and M, Post, 0-II c, tub1, pT1b2, ly0, v0, pN2M0P0H0, pStage IIIA. At 3 years and 6 months after the operation, multiple small nodules were noted on the skin of his face, neck, body, and arms. Biopsy of a skin lesion indicated that it was a metastatic skin cancer resulting from an adenocarcinoma. Thus, we diagnosed the lesions as skin metastases originating from an adenocarcinoma of the stomach. We also detected the presence of multiple metastases to the bone and lymph nodes, and we have treated the patient with chemotherapy. Metastases to the umbilicus from gastric cancer are termed as Sister Mary Joseph's nodules (SMJN). Although cases of SMJN are often reported, cases of multiple metastases from gastric cancer, without invasion to the umbilicus, are rare.
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井口, 雅史 ; Inokuchi, Masashi
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金沢大学附属病院<br />本研究では、血小板が癌の浸潤や転移を促進する癌微小環境の一因であることに着目し、乳癌における血小板の存在、上皮間葉転換(EMT)や化学療法の効果との関連を検討した。術前化学療法を行った原発性乳癌の生検標本を用いて
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免疫組織化学検査にて、検討した結果、血小板(CD42b発現)は59%に認め、腫瘍浸潤先進部や血管周辺の腫瘍細胞周囲に多く観察され、EMT様形態変化を認めた。またCD42b陽性例は、病理学的完全奏功(pCR)との間にも有意な相関を認めた。以上より、乳癌における癌細胞周囲の血管外血小板の存在とEMTとの関連性が明らかとなり、癌治療のターゲットとして臨床応用が期待される研究となった。<br />We investigated the presence of platelets around breast cancer primary tumor cells, and the associations among platelets, tumor cells, chemoresistance, and epithelial-mesenchymal transition (EMT). We retrospectively analyzed data from patients with breast cancer who underwent neo-adjuvant chemotherapy. The presence of platelets(CD42b) was observed in 59% breast cancer biopsy pecimens. Platelet positive tumor cells showed EMT-like morphological changes and EMT marker expression. Primary tumor cells associated with platelets were less esponsive to neo-adjuvant chemotherapy. Platelets were an independent predictor of the response to chemotherapy upon multivariable analysis. In conclusion, platelets surrounding primary tumor cells were significantly associated with the chemotherapeutic response in breast cancer, and it may represent novel predictors of chemotherapeutic responses.<br />研究課題/領域番号:26461943, 研究期間(年度):2014-04-01 - 2017-03-31
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