[A Case of Intestinal Lymphoma with Two Perforation in a Short Period Time].

An 86 years old man was diagnosed with jejunum tumor by detail examination of anemia. Eight days after endoscopy he developed abdominal pain, an emergency surgery was performed by a diagnosis of gastrointestinal perforation. They detected perforation in jejunum and performed jejunum resection, small intestinal lymphoma was diagnosed by histopathological examination. We were talked about chemotherapy against lymphoma, he was transferred at our hospital. The first chemotherapy was provided, abdominal pain appeared at 2 days after chemotherapy. Computed tomography revealed air bubbles out of intestinal tract, we performed emergency operation. A perforation of jejunum in the part where is different from the last time was existed, we performed jejunum resection. Chemotherapy was performed postoperatively, resulted in successful progress. Lymphoma of gastrointestinal tract often causes intestinal perforations, but reports that perforations heterochrony in separate parts multiple tumors of intestine is rare. We report a case of intestinal lymphoma with 2 perforations in a short period time.

[Suggesting the Significance of Pericardial Fat Pad in Bronchial Stump Fistula].

Bronchial stump fistula is a post-operative complication with poor outcome after pulmonary lobectomy. In order to prevent this complication, the bronchial stump is covered with pericardial fat tissue in our hospital. The case was 58 year old male who received adjuvant chemotherapy after sigmoidectomy for sigmoid colon cancer. As he developed multiple pulmonary metastases, 48 courses of chemotherapy were performed. The lesions had been localized at the right lower lobe, and neither increase in the size of these lesions nor development of other lesions were observed. Hence, an operation was performed. After right lower lobectomy, the bronchial stump was covered with the pericardial fat tissue. Three months after the operation, he developed pneumothorax, and bubbles were detected inside the fat. The pneumothorax was cured conservatively, and the bubbles disappeared spontaneously after 10 months. It is rare that the patient with bubbles in the covering tissue observed for a long time is cured conservatively, suggesting the significance of the stump pad.

Epithelioid myofibroblastoma of the breast: A case report and review of the literature.

INTRODUCTION: Mammary myofibroblastoma (MFB) is a rare tumour. Its clinical and pathologic characteristics have been only sporadically described. A case of epithelioid variant of MFB is reported with the diagnostic tips, the differential diagnoses, and a discussion on the possible pathogenesis. PRESENTATION OF CASE: A 74 year-old woman presented with a painless nodule in the left breast. Core needle biopsy (CNB) revealed a tumour primarily composed of epithelioid cells. Despite epithelioid appearance of the tumour cells, ductal/lobular components were absent within the tumour. As cell lineage of the epithelioid cells could not be determined with CNB, lumpectomy was performed to obtain definitive diagnosis and, at the same time, to remove the lesion. Histologically, the tumour consisted of multiple epithelioid cell nests that were spread over fibrous stroma infiltrated with adipose tissue. Spindle cells were also present, but they were fewer than epithelioid cell clusters. Occasionally, the tumour cells showed nuclear atypia. It was difficult to determine whether this tumour was benign or malignant solely with Hematoxylin-eosin stain. However, with the aid of immunohistochemical analyses, we could make a histodiagnosis of epithelioid subtype of myofibroblastoma. DISCUSSION: The differential diagnoses of epithelioid MFB include ductal, lobular, metaplastic carcinomas and mesenchymal tumours. Comprehensive knowledge of classic and variant MFB is necessary for the correct diagnosis. CONCLUSION: Pathologic diagnosis of epithelioid variant of MFB requires careful evaluation of histology and the use of a panel of immunohistochemistry. Female phenotype of breast stroma may play a role in the pathogenesis of MFB.

Pathological complete response induced by the combination therapy of S-1 and 24-h infusion of cisplatin in two cases initially diagnosed as inoperable advanced gastric cancer.

We report on two patients, successfully treated by the combination therapy of S-1 and 24-h infusion of cisplatin (CDDP), who were initially diagnosed with unresectable stage 4 advanced gastric cancer. Each patient had a very good clinical response and underwent curative gastrectomy after completion of 14 and 10 courses of S-1/CDDP chemotherapy, respectively. A microscopically detailed examination of surgically obtained specimens showed the complete disappearance of malignant cells in the two cases. S-1/CDDP combination therapy can, therefore, be highly active in incurable advanced gastric carcinoma.

Aberrant methylation is frequently observed in advanced esophageal squamous cell carcinoma.

The combined methylation status of the p16, helicase-like transcription factor (HLTF) and T-cadherin, H-cadherin (CDH13) genes in 35 resected primary esophageal squamous cell carcinoma (ESCC) was examined using methylation-specific PCR. To examine whether the methylation status could be a marker for the malignancy of ESCC, the methylation status was correlated with the clinicopathological features of the affected patients. Aberrant methylation of the p16, HLTF and CDH13 genes was detected in 28 (80%), one (3%) and five (14%) out of 35 ESCC specimens, respectively. ESCC with methylation-positive genes showed a trend towards larger tumor size and deeper invasion (p = 0.139 and p = 0.0664, respectively). Thus, the methylation of the p16, HLTF and CDH13 genes is a high malignancy factor in ESCC.

Expression level of thymidylate synthase is a good predictor of chemosensitivity to 5-fluorouracil in colorectal cancer.

BACKGROUND: It is important to seek the appropriate chemotherapy drugs to effectively eliminate colorectal cancers. To avoid unnecessary medication and uncomfortable side effects, it is important to estimate the chemosensitivity of cancers to 5-fluorouracil (5-FU) before chemotherapy. METHODS: We examined thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) gene expressions in 23 colorectal cancers, using quantitative reverse transcription-polymerase chain reaction (RT-PCR). We then evaluated the relationship between TS and DPD gene expression levels and the sensitivity of colorectal cancers to 5-FU, as determined by histoculture drug response assay (HDRA). RESULTS: A significant increase in the TS expression score was observed in 5-FU-sensitive colorectal cancers (0.57 +/- 0.19) compared to 5-FU-resistant ones (1.16 +/- 0.98; P = 0.029), whereas no significant differences in DPD expression scores were observed in 5-FU-sensitive colorectal cancers (0.86 +/- 1.19) compared to 5-FU-resistant ones (0.56 +/- 1.05; P = 0.603). CONCLUSIONS: TS mRNA may be useful as a predictor of the 5-FU chemosensitivity of colorectal cancers.