Among patients undergoing surgical resection for extrahepatic cholangiocarcinoma, invasive carcinoma at the ductal resection margins appears to have a significant relation to local recurrence and also a significant negative impact on survival, whereas residual carcinoma in situ does not. Discrimination whether carcinoma in situ or invasive carcinoma is present is important in clinical setting in which the resection margin at the ductal stump is positive.

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MIB-1, and the argyrophilic nucleolar organizer regions (AgNOR) and examined the relationships among them in carcinoma of the extrahepatic bile duct (EHBD). Shin-ichi RESULTS. MIB-1 and AgNOR were closely associated with lymph node metastasisIwate Medical University, Morioka, Japan.(P õ 0.01). The cumulative survival rate for patients with a low MIB-1 labeling index (LI) (õ29%) was significantly better than that for patients with a high MIB-2 Division of Pathology, Central Clinical Laboratory, School of Medicine, Iwate Medical Univer-1 LI (¢29%) in cases of EHBD carcinoma (P õ 0.05), but MIB-1 was not an indepensity, Morioka, Japan. dent prognostic factor in multivariate analysis. The results indicated that AgNOR and p53 overexpression had no prognostic value. The authors detected p53 in 24 of the 54 EHBD carcinomas (44.4%). There was a significant correlation between MIB-1 and AgNOR (P õ 0.01). The authors found that neither MIB-1 nor AgNOR correlated with p53 overexpression. CONCLUSIONS. MIB-1 and

DNA heterogeneity of colorectal carcinomas has been investigated by flow cytometry, most studies have focused on the clinical usefulness of DNA ploidy analysis. Since cancers consist of predominant subclones with proliferative advantage due to clonal expansion, we attempted to analyse the clonal expansion of colorectal carcinomas within a tumour by measuring DNA ploidy. The DNA ploidy and heterogeneity of multiple fresh samples obtained from 164 colorectal adenocarcinomas were analysed by flow cytometry. Each tumour was divided into an average of six specimens, which were analysed separately. For 146 of the tumours (89%) at least one DNA aneuploid population was found within the cancer tissue examined. DNA multiploidy was detected in 26 cases (17.8%) among the cancers with aneuploidy. Based on the DNA index (DI), hypertriploid aneuploidy (1.7

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas-preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.