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Clinicopathologic data on 201 patients who underwent surgical resection of esophageal squamous cell carcinoma, with or without intramural metastasis (IM), were analyzed to determine the significance of IM for patient prognosis and survival. In 24 (11.9%) patients IM was observed. There was one (1.4%) in 74 cases in Stage 0, I, or II, and 23 (18.1%) in 127 cases in Stage III or IV, based on the new pTNM classification. There was a statistically significant Cox-Mantel test difference in the percentage survival curves of the patients, both in all stages (P less than 0.01) and in only Stages III and IV (P less than 0.05), as a function of the presence or absence of IM. Lymph node metastasis and distant organ metastasis were observed in 22 (91.7%) and seven (29.2%) of the 24 patients, respectively, with IM and in 111 (62.7%) and 13 (7.3%) of the 177 patients without IM. For both types of metastasis, the incidence was significantly lower in the patients without IM (P less than 0.01). Seventy percent of IM on the proximal side was detected during preoperative clinical examination. These data indicate that the presence of IM is an important factor for preoperative and postoperative evaluation of the prognosis of patients with esophageal squamous cell carcinoma.

A 71 year old Japanese man with basaloid‐squamous carcinoma of the esophagus is reported. The carcinoma contained basaloid cells, a few small cornified foci, and a large amount of eosinophilic hyaline substance, which reacted positively upon periodic acid Schiff, type IV collagen, and laminin staining. Ultrastructural examination revealed markedly replicated basement membranes (BM). The morphological findings suggested that this tumor secreted abundant BM substance. Small nests of cancer cells were attached to the dysplastic esophageal epithelium. The tumor cells exhibited negative staining for mucin, secretory component, lactoferrin, and carcinoembryonic antigen. These findings, as well as the observed keratini‐zation and attachment between the carcinoma nests and mucosal epithelium, indicate that the tumor originated in the mucosal epithelium of the esophagus. Acta Pathol Jpn 41: 59–64, 1991.

Study Design: Prospective cross-sectional study. Objectives: To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies. Setting: Spinal Cord Injury Center in Hokkaido, Japan. Methods: Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant. Results: DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5 ± 2.2 days. The mean D-dimer level upon DVT detection was 14.6 ± 11.8 μg ml − 1 , with no significant differences between those who developed DVT and those who did not at any of the time points. Conclusion: These results suggest that DVT can develop at the very-acute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury. INTRODUCTIONDeep vein thrombosis (DVT) is one of the most dangerous complications of a spinal cord injury. DVT has a high incidence in patients with spinal cord injury as compared with patients with other diseases 1 with a high mortality rate if complicated by pulmonary embolism. 2 Although prevention, early detection and timely treatment of DVT are important during the management of patients with spinal cord injury, the timing of DVT onset secondary to a spinal cord injury has not yet been determined. In order to clarify these problems, this study aimed to investigate the timing of DVT onset by prospectively analyzing the patients immediately after a spinal cord injury.