Comprehensive Cancer Genomic Profiling of Liver Metastasis Led to the Unexpected Identification of Colorectal Cancer.

Comprehensive genomic profiling (CGP) of a metastatic liver tumor biopsy specimen suggested that the patient, who was initially diagnosed with cholangiocarcinoma, had colorectal cancer. The identification of both FBXW7 and APC mutations is deemed characteristic of colorectal cancer. Indeed, subsequent colonoscopy revealed sigmoid colon carcinoma that led to tumor resection followed by systemic chemotherapy. CGP is principally used to identify agents that might potentially benefit the patient. However, results must be interpreted carefully to ensure consistency with the initial diagnosis.

Highly Advanced Colorectal Liver Metastases Successfully Treated With Fluorouracil Plus Leucovorin Monotherapy and Microwave Ablation.

BACKGROUND: Fluorouracil plus leucovorin (5-FU/LV) is a less toxic but mild chemotherapy. CASE REPORT: A 63-year-old male patient with rectal cancer and multiple colorectal liver metastases (CRLM, total volume of 1,826 ml) was hospitalized. He had several poor prognostic factors, including elevated levels of tumor markers, with carcinoembryonic antigen and carbohydrate antigen 19-9 levels of 17,119 ng/ml and 7,617 U/ml, respectively. Additionally, the patient had a low body mass index, poor performance status, and a history of apparent weight loss. After capecitabine and oxaliplatin for four cycles, 5-FU/LV has been lasting for nine months. Interestingly, tumor marker levels returned close to normal limits, and the total CRLM volume decreased to 154 ml without any enhancements. The patient's general condition clearly improved after a year of chemotherapy. CONCLUSION: Chemotherapy with 5-FU/LV and percutaneous microwave ablation is beneficial to achieve tumor control in patients with highly advanced liver-only CRLM and poor general condition.

Extensor Tendon Dislocation at the Metacarpophalangeal Joint of Both Ring Fingers Caused by a Specific Hand Posture in a Shiatsu Therapist.

A 43-year-old female shiatsu therapist complained of sudden snapping of the metacarpophalangeal joints (MCPjs) of both ring fingers during a specific hand posture. The extensor tendon of the ring finger was dislocated ulnarly when the MCPj of the ring finger was flexed and deviated ulnarly and the MCPj of the middle finger was extended. Surgical exploration revealed an attenuated radial sagittal band. We plicated the juncturae tendinum of the extensor digitorum communis between the middle and ring fingers and released the ulnar sagittal band partially to centralise the extensor tendon excursion. Twenty-six months postoperatively, the patient regained full active and passive range of motion of all fingers without extensor tendon dislocation or snapping in either hand during work.

Risk of recurrence after surgical resection of small-sized invasive lung adenocarcinoma: analysis based on apoptotic index.

OBJECTIVE: It has been reported that small-sized invasive lung adenocarcinomas, i.e., those classified as type C through type F according to Noguchi's classification, may also recur even after complete resection. We evaluated the prognostic value of molecular biologic markers (apoptosis, Ki-67, p53, epidermal growth factor) and clinicopathological factors in patients with small-sized invasive lung adenocarcinomas. METHODS: The clinical records of all patients who had had a peripheral adenocarcinoma surgically resected between 1996 and 2002, and histologically diagnosed as type C through type F according to Noguchi's classification were retrospectively reviewed. The apoptotic index (AI) was determined by the triphosphate biotin nick end-labeling method and the expression of Ki-67, aberrant p53 protein and epidermal growth factor receptor was determined by immunohistochemical staining. RESULTS: Data from 28 patients who had been followed up for a mean period of 41.8 months (range: 16 to 89 months) were evaluated. During the follow-up period, recurrence was seen in 6 patients. The log-rank test showed that AI was a significant predictor of cancer recurrence. The 5-year disease-free survival rate of the 10 patients in the high AI group (AI > 0.3%) was 100%; while that of the 18 patients in the low AI group (AI < or = 0.3%) was 50.5% (p = 0.036). None of the other molecular biologic markers or clinicopathological factors were found to be a significant predictor of cancer recurrence. CONCLUSION: Peripheral small-sized invasive lung adenocarcinomas with a low AI carry an increased risk of distant metastases, indicating that adjuvant chemotherapy after complete resection might be needed.

Enhanced induction of apoptosis in lung adenocarcinoma after preoperative chemotherapy with tegafur and uracil (UFT).

PURPOSE: To determine if the preoperative administration of tegafur and uracil (UFT) to patients with lung adenocarcinoma could induce apoptosis. METHODS: We conducted a randomized prospective study on 30 patients with lung adenocarcinoma, divided into two groups of 15 patients each. One group received UFT 600 mg/day preoperatively for 7 consecutive days and a control group received no chemotherapy or radiotherapy. The apoptotic index (AI) was determined by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end-labeling (TUNEL) method. Expression of Ki-67 was examined by immunohistochemical staining. The concentration of 5-fluorouracil (5-FU) in tumor tissue was measured by chemical assay. RESULTS: The AI of lung adenocarcinoma cells increased significantly in the UFT-treated group but not in the control group. A significant positive correlation was seen between the AI and the 5-FU concentrations in the tumor tissue. CONCLUSIONS: The continuous oral administration of UFT for 7 days preoperatively resulted in enhanced apoptosis and a significant positive correlation between the AI and 5-FU concentrations in lung adenocarcinoma. Therefore, it may be possible to evaluate the effects of adjuvant chemotherapy based on the AI.