[Clinicopathological Examination of 81 Cases Added Gastrectomy for Early Gastric Cancer after ESD].

As a general rule, our department has performed additional gastrectomy with lymph node dissection(radical surgery: RS) for non-curative endoscopic submucosal dissection(ESD)cases. This time, we performed a clinicopathological study on 81 patients who underwent RS after ESD for 10 years from May 2009 to April 2019. Lymph node metastasis(LNM)was observed in 5 cases and local cancer residue(LCR)was observed in 8 cases. Examination of the presence or absence of LNM and LCR by clinicopathological factors(histopathological type, tumor size, lymphatic invasion[ly], venous invasion[v], horizontal margin[HM], vertical margin[VM], submucosal invasion, ulceration[scar])revealed no significant risk factor for LNM, however, tumor size and HM were significant risk factors for LCR. The relationship between the eCura system and the case rate associated with LNM in our hospital was similar to that in the original report. Regarding the prognosis, there was one local recurrence and no death from the primary disease.

[A Case of Primary Gastric Adenocarcinoma with Enteroblastic Differentiation(GAED)].

Gastric adenocarcinoma with enteroblastic differentiation(GAED)is a rare disease that is classified as a special type in the 15th edition Japanese Classification of Gastric Carcinoma. GAED is considered to have a poor prognosis. We report about a 76-year-old man with GAED who presented with complaints of poor appetite and weight loss. He was suspected of having gastric cancer based on ultrasonography and computed tomography findings and was referred to our hospital by his home doctor. Upper gastrointestinal endoscopy revealed a gastric cancer in the lesser curvature of the gastric antrum. Distal gastrectomy was performed. Histopathology showed a moderately differentiated adenocarcinoma with a clear cytoplasm. Immunostaining was positive for Sal-like protein 4(SALL4)and negative for α-fetoprotein(AFP). The patient was diagnosed as having GAED. Vascular and lymphatic invasion were not observed. He was discharged on the 9th day after surgery. At 5 months postoperatively, he was treated with adjuvant chemotherapy, and no recurrence was noted. GAED is a rare disease with a poor prognosis. We report this case and discuss relevant literature.

[Efficacy of Palliative Radiotherapy for Unresectable Advanced Gastric Cancer with Bleeding].

Bleeding and obstruction negativelyimpact qualityof life for patients with unresectable advanced gastric cancer. There are several choices against bleeding and obstruction such as surgery, endoscopic therapy, radiotherapy and interventional radiology. We report on an 85-year-old woman with StageIV gastric cancer with tumor bleeding. Radiation therapyof 30 Gyin 10 fractions was performed. Anyadverse events were not confirmed. Bleeding or obstruction did not occur for 7 months after radiation therapy. Palliative radiation therapy to gastric cancer can be a reasonable option for patients with unsuitable general conditions for surgical intervention.

[A Case of Laparoscopic Cholecystectomy(TANKO)for Gallbladder Cancer with Torsion].

Gallbladder torsion is comparatively rare. Gallbladder cancer is found in 1.5% of cases of acute cholecystitis. We report a case of laparoscopic cholecystectomy(TANKO)for gallbladder cancer with torsion. CASE: A 54-year-old woman with epigastric pain underwent enhanced computed tomography. Gallbladder torsion and a tumor at the gallbladder neck were suspected, and ascites was observed. She was diagnosed with gallbladder torsion, and surgery was performed the same day. Intraoperative findings: The gallbladder was movable, minimally attached to the liver bed, rotated 360°around the cystic duct and cystic artery, and appeared necrotic. The torsion was relieved and laparoscopic cholecystectomy(TANKO)was performed. We accidentally perforated the gallbladder and bile leaked out. COURSE: The patient did well postoperatively. Pathological diagnosis revealed gallbladder cancer. DISCUSSION: Gallbladder cancer with torsion has been reported in 14 cases, not including ours. Among these, none were performed using laparoscopic cholecystectomy(TANKO). We believe that laparoscopic cholecystectomy is appropriate for such cases, but the approach must be carefully considered because of the risk of perforation.

Treatment with antibodies against primary group A streptococcal peritonitis: A case report and a review of the literature.

RATIONALE: Several reports describe severe group A streptococcal (GAS) infections causing septic shock, soft-tissue necrosis, and multiple organ failure known as streptococcal toxic shock syndrome (STSS). However, primary peritonitis with GAS is rare and most of them were undertaken surgical procedure. PATIENT CONCERNS: We herein reported the case of 26-year-old healthy woman with sudden severe abdominal pain and hypotension. Computed tomography (CT) showed that large amount of free fluid in the peritoneal cavity consist with peritonitis, and no free air. DIAGNOSES: Primary peritonitis with GAS. INTERVENTIONS: Proper antibiotic therapy according to blood culture results. OUTCOMES: After antibiotic therapy, the patient recovered well without complications. LESSONS: An appropriate diagnostic approach and prompt antibiotic therapy is essential in GAS primary peritonitis.

[A Case of Gemcitabine and Nab-Paclitaxel Therapy for Multiple Metastatic Pancreatic Cancer].

Pancreatic cancer is one of the leading causes of cancer-related death in Japan. Nab-paclitaxel(nab-PTX)and gemcitabine( GEM)combination chemotherapysignificantlyimproved overall survival in a phase III trial(MPACT). This combination chemotherapyhas become one of the first-line treatments for patients with metastatic pancreatic cancer since December 2014. We report a case of a patient who underwent this chemotherapyfor recurrence of pancreatic head cancer. A 64-yearold man, who underwent curative resection of pancreatic cancer 2 years ago, relapsed with multiple lung metastases and a para-aortic nodal metastasis. The patient was treated with combination chemotherapyof nab-PTX 125mg/m2 plus GEM 1,000mg/m2. He died from carcinomatous pleurisy1 9 months after starting the chemotherapy. The patient skipped scheduled chemotherapyonly3 times due to Grade 3 neutropenia during his clinical course over 19 months. The combination regimen of nab-paclitaxel and gemcitabine is thought to be a well-tolerated and standard treatment for metastatic pancreatic cancer.

[A Case of Giant Liver Metastasis from Gastric Cancer after Surgery for Which Transcatheter Arterial Embolization and Chemotherapy Made Hepatic Resection Possible].

The prognosis of liver metastasis from gastric cancer, which often exhibits incurable factors, is dismal, and no effective therapy exists. We report a case of giant liver metastasis from gastric cancer after surgery, for which transcatheter arterial embolism and chemotherapy(G-SOX)made it possible to perform hepatic resection. The patient was a 78-year-old woman who underwent distal gastrectomy combined with D2 lymphadenectomy at our department in August 2014. She complained of abdominal distension, and a liver metastasis measuring more than 16 cm in diameter was found on computed tomography in April 2015. Transcatheter arterial embolization was performed followed by chemotherapy(9 courses of G-SOX were administered). These therapies were effective, enabling partial hepatic resection to be performed. The patient remains alive and free from recurrence 4 months after surgery. Although no effective therapy exists for liver metastasis from gastric cancer, intensive therapies may enable curative resection.

Carbonic Anhydrase XII as an Independent Prognostic Factor in Advanced Esophageal Squamous Cell Carcinoma.

BACKGROUND: Although recent studies described important roles for carbonic anhydrase (CA) XII in epithelial carcinogenesis and tumor behavior, a consensus has not yet been reached regarding its clinicopathological significance in esophageal squamous cell carcinoma (ESCC). In the present study, we investigated its prognostic significance in ESCC. MATERIALS AND METHODS: An immunohistochemical analysis was performed on 70 primary tumor samples obtained from ESCC patients who underwent esophagectomy, and the relationships between the expression of CA XII and various clinicopathological features or prognosis were analyzed. RESULTS: Immunohistochemical staining showed that CA XII was primarily found in the cell membranes of carcinoma cells. Although the expression of CA XII was related to the pT category, it had no prognostic impact. We then examined the expression of CA XII according to the pT category. In pT2-3 ESCC, the 3-year survival rate of patients with the high grade expression of CA XII (29.1 %) was significantly lower than that of patients with the low grade expression of CA XII (70.3 %). Furthermore, a multivariate analysis demonstrated that the expression of CA XII was one of the most important independent prognostic factors following radical esophagectomy in pT2-3 ESCC. CONCLUSION: These results suggest that the expression of CA XII may be a valuable prognostic factor for patients with advanced ESCC. The results of the present study provide an insight into the role of CA XII as a biomarker in ESCC.