Appropriate liver resection type for patients with the American joint committee on cancer classification T1 and T2 hepatocellular carcinoma.

SYNOPSIS: Major liver resection prevents intrahepatic tumor recurrence in T2 hepatocellular carcinoma patients with microvascular invasion or daughter nodules. BACKGROUND AND OBJECTIVES: There is no consensus on whether major or minor hepatectomy is better for hepatocellular carcinoma (HCC) patients. We investigated the outcomes of liver resection type in resectable HCC patients. METHODS: Two hundred sixty-three HCC patients with Child-Pugh class A liver function who underwent curative hepatectomy were enrolled. Among them, 186 patients had pathologic stage T1 HCC and 77 had stage T2 HCC. Patients were also classed according to the type of resection (major or minor). Clinicopathologic characteristics and outcomes were compared. RESULTS: Patients with T1 HCC who underwent major resection had a higher rate of blood transfusion than those who underwent minor resection (P < 0.001). The disease-free survival rate of T2 patients who underwent major resection was better than that of patients who underwent minor resection (P = 0.004). The overall survival rates of T1 and T2 HCC patients did not differ significantly between those with major or minor resection. CONCLUSIONS: Major liver resection is recommended for T2 HCC patients with adequate remnant liver function because it results in a better disease-free survival rate than does minor resection in these patients. Minor liver resection is suggested for T1 HCC patients, except for those with a tumor sitting close to vessels, because it is associated with a low incidence of blood transfusion and a good survival rate.

Stages of mammography adoption in Asian American women.

Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.

Perforated appendicitis: urgency or interval surgery?

BACKGROUND: The purpose of this study was to report how conservative treatment with interval appendectomy (IA) of ruptured appendicitis with localized abscess or phlegmon affects the outcome of patients. PATIENTS AND METHODS: From January 2001 to December 2005, 121 patients with ruptured appendicitis with localized abscess or phlegmon were treated in our hospital. 104 patients underwent appendectomy (Group A); 17 patients underwent antibiotic treatment with interval appendectomy (Group B). The clinical characteristics (age and sex), laboratory data, mean time to surgery, operative time, complications, hospital days and cost of hospitalization were recorded. RESULTS: The sex, age, white blood cell count (WBC), body temperature, operation time, length of stay after surgery, first flatus, oral feeding, passage of stools, cost and overall complications (including wound infection, wound disruption, intra-abdominal abscess and enterocutaneous fistula) were not significantly different between the two groups. However, the length of stay after diagnosis established of group B was significantly longer in group B than in group A. CONCLUSION: Conservative treatment with IA is a safe and effective method to treat perforated appendicitis with localized abscess and phlegmon, but the recovery time may be longer and also the hospital stay (since diagnosis established). Thus this method is not cost-saving.

Guidewire assisted cephalic vein cutdown for insertion of totally implantable access ports.

BACKGROUND: Totally implantable access ports (TIAP) placed by the cephalic vein cutdown technique have high failure rates. METHODS: We describe a guidewire assisted technique of the cephalic vein cutdown for TIAP placement that can be easily introduced catheter when difficulties in insertion of the catheter. The key point of the presented technique is the use of J guidewire to go beyond the stenosis and advancement of catheter through the guidewire into the superior vena cava. RESULTS: We used this technique for introducing the catheter in six patients without failure or complication. CONCLUSION: The presented technique is easy and simple. It can be used where there are difficulties in insertion of the catheter by cephalic vein cutdown method.

An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases.

AIM: The aim of the present study was to report our experience of totally implantable central venous access devices (TICVAD) implantation using two techniques and attempt to define the better technique. MATERIALS AND METHODS: From January 1998 to September 2003, 1131 patients were reviewed and divided into two groups with implantation by cephalic vein cut-down (group A) done by general surgeons and subclavian vein puncture with the Seldinger technique (group B) done by vascular surgeons. The operative time, early and late complications of these two groups were compared. Data were analysed by Student's t-test. RESULTS: The average of operative time was 43 min in group A (35-70 min) and 40 min in group B (35-60 min) (P>0.05). No post-operative pneumothorax, hemothorax and fragmentation occurred in group A; the incidence of peri-operative complication was higher in group B. The overall and early complications of group A were significantly lower than that of group B (P<0.0001). CONCLUSION: This retrospective study showed that the cephalic vein cut-down approach for TICVAD placement avoided the risks of pneumothorax, hemothorax and catheter fragmentation.

Prediction of the risk of hepatic failure in patients with portal vein invasion hepatoma after hepatic resection.

AIM: Hepatic failure can develop after curative hepatectomy in patients with a hepatocellular carcinoma (HCC) invading the portal vein, because of cirrhosis and excessive tissue loss. This study aimed to identify the risk factors for hepatic failure in such patients. METHOD: Forty patients with an HCC invading the portal vein underwent curative hepatectomy from January 1995 to June 2003. Eight patients developed hepatic failure and died within 3 months. Possible risk factors for this were analysed using univariate and multivariate regression. These included the liver function index, surgical blood loss, tumour pattern, portal hypertension, estimated residual liver volume measured by computed tomography (ERLV(CT)) and estimated residual liver volume using the indocyanine green (ICG) retention rate at 15 min (ERLV(ICG15)). RESULTS: The ERLV(CT) smaller than the ERLV(ICG15) and presence of portal hypertension were independent risk factors for post-hepatectomy hepatic failure. CONCLUSION: Having portal vein invasion HCC with portal hypertension or an ERLV(CT) less than an ERLV(ICG15) are significant predictors of post-hepatectomy hepatic failure. These factors are important considerations for patients with portal vein invasion HCC who could undergo curative hepatic resection.

Telomerase activity in human hepatocellular carcinoma: parallel correlation with human telomerase reverse transcriptase (hTERT) mRNA isoform expression but not with cell cycle modulators or c-Myc expression.

BACKGROUND: To explore the possible regulatory mechanisms of telomerase, we examined the telomerase activity (TA), expression of human telomerase RNA (hTR), human telomerase reverse transcriptase (hTERT) mRNA isoforms and cell cycle modulators in human hepatocellular carcinoma (HCC) cell lines (J5, J7) and a normal human immortalized hepatic epithelial cell line (Chang-liver). METHODS: The cell lines were chemically synchronized in either G1, G1/S, G2/M or M phases. TA was measured by polymerase chain reaction (PCR)-based telomerase repeat amplification protocol assay. The hTR and hTERT mRNA levels were analyzed by reverse transcriptase-polymerase chain reaction. Western blotting and immunocytochemistry were used to assay the cell cycle modulators. RESULTS: The TA of J5, J7 and Chang-liver cell lines tested was highest in M phase. The expression level of hTERT mRNA associated with the highest TA detected in the M phase of HCC cell lines. Chang-liver expressed markedly less TA and hTERT mRNA than J5 or J7. The elevated TA and expression of hTERT mRNA isoforms in M phase of HCC cell lines did not significantly correlate with that of the cell cycle modulators and c-Myc. CONCLUSIONS: The results implicate that regulation of TA is related to hTERT mRNA isoform expression, and that regulation is different between the cell immortalization and tumorigenesis.

CD34, CD117, and actin expression in phyllodes tumor of the breast.

BACKGROUND: This study investigated the immunophenotypic patterns of CD34, CD117 (a product of the c-kit proto-oncogene), and actin (HHF35) in benign and malignant phyllodes tumors (PTs). We correlated the expression of CD34, CD117, and actin with histopathological grade. MATERIALS AND RESULTS: We analyzed 19 cases (7 benign and 12 malignant cases) of PTs using immunohistochemical analysis. Six of 7 benign PT stromal lesions stained positively for CD34, while only 3 of 12 cases of malignant PT were focally CD34 positive (P = 0.0106). Only 1 of the 7 benign PTs stromal lesions expressed CD117. Nine of the malignant PTs were composed CD117-positive fibroblasts. This result demonstrated that CD117 expression is associated with the malignant potential of PTs (P = 0. 0106). Actin (HHF-35) expression was found in 8 of 12 cases of malignant PTs (P = 0.027), but in only 1 of 7 cases of benign PTs. Actin expression was significantly (P = 0.04) correlated to frequent mitotic activity (>5 mitoses per 10 high-power fields). The immunophenotypic markers were not related to tumor size. Additionally, we sequenced part of the juxtamembrane region of the c-kit proto-oncogene and found point mutations in two malignant PTs. CONCLUSION: Our results demonstrated that expression of CD34 was associated with benign PTs, while CD117 and actin were preferentially expressed in malignant PTs. Our results implied that these immunohistological markers might be used for the histopathological grading of PTs.

Microsatellite alterations on human chromosome 11 in in situ and invasive breast cancer: a microdissection microsatellite analysis and correlation with p53, ER (estrogen receptor), and PR (progesterone receptor) protein immunoreactivity.

BACKGROUND AND OBJECTIVES: Microsatellite instability (MSI) has been documented in a subset of sporadic tumors. Loss of heterozygosity (LOH) on chromosome 11 loci in breast cancer is a frequent event. The purpose of the present study is to examine the incidence of microsatellite alterations in in situ and invasive human breast carcinoma and to clarify their significance in regulating the dynamics of cancer progression. METHODS: Four highly polymorphic (CA)n repeat microsatellites were used to determine microsatellite alterations in ten ductal carcinoma in situ (DCIS) and 19 invasive ductal carcinoma (IDC). To investigate the expression of p53, ER (estrogen receptor), and PR (progesterone receptor) association with MSI, immunohistochemistry staining was applied. RESULTS: MSI were detected in 20% (2/10) of DCIS and in 47.4% (9/19) of IDC. The frequency of MSI in IDC was significantly higher than that in DCIS (P < 0.001). Also, the MSI seemed to correlate with clinical stage (P = 0.0001) and tumor size (P = 0.004) but not histological grade or age. In addition, we found that 27% of the tumors showed LOH at 11q23.3-24 region between loci D11S934 and D11S912. Seven of nine MSI cases demonstrated low or no expression of p53. However, there was significantly reduced expression of PR, but not ER in MSI cases. CONCLUSIONS: Our results suggest that breast cancer acquires the RER phenotype (replication-error phenotype) in the relatively late stages, and that the RER phenotype is associated with aggressiveness of IDC (infiltrative duct carcinoma). The result also implicated that mismatch repair failure can alter the expression of PR but not ER and p53.

Telomerase activity correlates with cell cycle regulators in human hepatocellular carcinoma.

AIMS/BACKGROUND: Mutation in cell cycle genes is the most common genetic change in malignant tumor cells. Telomerase activation, considered as essential in the immortality of cancer cells, is found in most cancers, where there may be an association with an active cell cycle. METHODS: In this study study we used the TRAP assay to determine telomerase activity in liver tumor specimens from 25 cases of hepatocellular carcinoma (HCCs) as well as in corresponding non-cancerous liver tissue in each patient. The expression of cyclin D1, cdk2, and cdk4 protein was also examined by Western blot. RESULTS: Twenty-one of the 25 cases of HCC were found to have increased telomerase activity, whereas only five out of the 25 non-cancerous liver samples were found to have weak telomerase activity. Telomerase activity was not found to be related to tumor size, HBsAg, HBeAg, anti-HCV, transaminase, or alpha-fetoprotein serum titer. Furthermore, three out of the 25 cases of HCC showed cyclin D1 overexpression, whereas 15 of the 23 cases of HCC showed decreased cyclin D1 expression. Down regulation of cyclin D1, cdk2, cdk4 protein correlated with telomerase activity (p<0.004, p<0.013, and p<0.001 respectively). CONCLUSION: The results indicate that genetic defects in HCC facilitate the reactivation of telomerase activity, a process which may be dependent on cyclin D1 with its cyclin dependent kinase (cdk) partner defect.

Molecular studies into the role of CD44 variants in metastasis in gastric cancer.

CD44, an integral membrane glycoprotein expressed by many cell types, serves as the principal transmembrane hyaluronate receptor and might be a determinant of metastatic and invasive behaviour in carcinomas. The generation of CD44 splice variants might be linked closely with gastric carcinoma tumorigenesis and differentiation. Some studies have reported that the magnitude of CD44 variant synthesis at the protein level correlates with lymph node metastasis. A number of studies have examined the possible mechanism of involvement of the CD44 variant in tumour metastasis. Most studies have reported that the regulation of CD44 binding to hyaluronate results from glycosylation of variably spliced exons. Direct hyaluronate binding studies of CD44 V4-V7 isoforms transfected into the human gastric carcinoma cell line, SC-M1, have indicated that the V4-V7 isoforms themselves, in addition to glycosylation, can alter hyaluronate binding.

Apoptosis in nasopharyngeal carcinoma as related to histopathological characteristics and clinical stage.

AIMS: We investigated the significance of apoptosis, using the terminal deoxynucleotidyl transferase mediated dUTP-digoxigenin nick end-labelling method, in nasopharyngeal carcinoma biopsy samples. METHODS AND RESULTS: The apoptotic index (AI) in 50 nasopharyngeal carcinomas was compared with various histopathological features and clinical stage. Also, the AI was correlated with p53, bcl-2 and Ki67 expression by immunohistochemistry. In histopathological studies, the AI was significantly higher in mixed cellular type (MC) than in keratizing squamous cell type (KS) and spindle cell type (SC) (P < 0.001) which worsens prognosis. In tumour stage analyses, AI was higher in early stage (stage 2 and 3) than in high stage (stage 4). In addition, there was a significant correlation between the AI and p53 expression (P < 0.001) but not with proliferative activity (P = 0.15). In NPC containing p53 protein positive tumour cells, there was a significantly higher apoptotic rate. CONCLUSIONS: These findings indicate that apoptosis is related to type and stage of nasopharyngeal carcinoma. They also confirm the role of p53 in regulating tumour apoptosis.

Carcinoid tumor localized in the liver--two cases report: immunohistochemical and ultrastructural studies.

Two cases of carcinoid tumors, considered to be probably hepatic in origin, occurring in a 53-year-old man and a 69-year-old woman are reported. In both cases no endocrine syndrome appeared, and an alternative primary source of the tumor was not found in case two, despite an intensive search at operation. The neoplasms in both cases were soft, firm, brown-pink and well-encapsulated. They were composed of small uniform cells, that had distinct borders and grew in insular, nests, trabeculae and strands that were separated by a delicate fibrous stroma. Stains of argentaffin and argyrophil showed strong positivity in both cases. The immunohistochemical and ultrastructural studies all demonstrated characteristics of a carcinoid. The postoperative recovery was good. They have remained well 5 years later in case 1 and 3 years in case 2 after surgical treatment. Literature concerning this rare condition is also reviewed.

Cytogenetic studies of gastric adenocarcinoma.

Cytogenetic analyses were performed on a short-term culture of a primary tumor and an established cell line of gastric adenocarcinoma (SC-M1). The former case was near-diploid, and the latter was near-triploid. No common numerical and structural change or breakpoint was found in these cells. Review of the 13 cases of gastric carcinomas so far reported showed that only trisomies 8 and 9 were consistent findings. The Y chromosome, although lost in all the near-triploid cases, was preserved in all of the near-diploid cases. No consistent structural abnormality and breakpoint were identified in this and other studies.