Extrauterine endometrial stromal sarcoma with JAZF1/JJAZ1 fusion confirmed by RT-PCR and interphase FISH presenting as an inguinal tumor.

Endometrial stromal sarcomas are rare malignant mesenchymal tumors that usually develop in the uterine corpus and occasionally arise at various extrauterine sites. This report describes the first case of primary extrauterine endometrial stromal sarcoma arising in the extraperitoneal portion of the round ligament presenting as a solitary inguinal mass in a 46-year-old woman. The patient presented gradually growing tumor in the right inguinal region. Local tumor resection was performed and no recurrence or metastasis was found at 15 months after the operation. Histological examination revealed that the tumor comprised uniform, spindle-shaped cells with blunt nuclear figure and scattered small arteries, and infiltrated into adjacent tissue. No endometriosis was morphologically identified in the lesion. Immunohistochemically, the tumor cells were positive for CD10, estrogen receptor, progesterone receptor, alpha-smooth muscle actin, and calponin. We confirmed JAZF1/JJAZ1 fusion by reverse transcription-polymerase chain reaction and the corresponding chromosomal translocation by interphase fluorescence in situ hybridization on paraffin sections. It is essential that the inguinal region should be recognized as a possible primary site of endometrial stromal sarcoma, and the detection of a JAZF1/JJAZ1 fusion can be useful when the diagnosis is not confirmed by microscopic observation or immunohistochemistry for the tumor arising in extrauterine sites.

Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases.

BACKGROUND/AIMS: More than 20% of patients with advanced gastric cancer show paraaortic lymph node metastasis. However, whether extensive paraaortic lymphadenectomy is beneficial remains controversial. We performed a prospective study of paraaortic lymphadenectomy for patients with advanced gastric cancer. METHODOLOGY: From January 1991 to March 2004, 244 consecutive patients with advanced gastric cancer underwent gastrectomy with paraaortic lymphadenectomy with curative intent. The patients were divided into 3 groups according to the period: Group 1 (1991-1995), Group 2 (1996-1999), and Group 3 (2000-2004). RESULTS: Overall mortality rate was 2.4%, and it fell rapidly from 7.1% in Group 1 to 0% in Group 3. Postoperative complications occurred in 35.6%. High age and postoperative complications were significant predictive factors for operative death. Preoperative comorbidity, positive distal margin, and pancreatectomy were significant predictive factors of postoperative complications. Depth of cancer invasion was correlated with paraaortic node metastasis. Ten patients with paraaortic node metastases survived for more than 5 years. Operative curability and postoperative complications were significant prognostic factors for patients who underwent this procedure. CONCLUSIONS: Paraaortic lymph node dissection for gastric cancer should be performed in patients with tumors deeper than the serosa. Pancreatectomy should be avoided, with careful management required in cases of unavoidable pancreatectomy.

Effects of thymidine phosphorylase levels in cancer, background mucosa, and regional lymph nodes on survival of advanced gastric cancer patients receiving postoperative fluoropyrimidine therapy.

Due to the contradictory roles that thymidine phosphorylase (TP) plays in both tumor aggressiveness and fluoropyrimidine activation, its impact on drug responses has yet to be clearly established. Therefore, the present study was performed to clarify the effects of TP levels on the prognosis of gastric cancer patients treated postoperatively with different fluoropyrimidines. A total of 52 gastric cancer patients who underwent gastrectomy from January 1997 to March 1998 were enrolled in the present study. The TP levels in the specimens were assayed by enzyme-linked immunosorbent assay (ELISA). Survival was significantly poorer for the 27 patients with high normal tissue TP activity than for the 25 with low normal tissue TP activity. Normal tissue TP level showed different effects on survival according to the chemotherapy regimen used. While the survival rate was significantly poorer in patients with high normal TP level than in those with low normal TP in the 5-FU group, the rate was almost the same in the 5'-DFUR group. Cox's proportional hazard model revealed that tumor TP was an independent prognostic factor in gastric cancer patients. Since activating and catabolizing enzymes for fluoropyrimidines differ from each other, alterations in gene expression of these enzymes should be useful predictive factors.