The ATP-hydrolyzing ectoenzyme E-NTPD8 attenuates colitis through modulation of P2X4 receptor-dependent metabolism in myeloid cells.

Extracellular adenosine triphosphate (ATP) released by mucosal immune cells and by microbiota in the intestinal lumen elicits diverse immune responses that mediate the intestinal homeostasis via P2 purinergic receptors, while overactivation of ATP signaling leads to mucosal immune system disruption, which leads to pathogenesis of intestinal inflammation. In the small intestine, hydrolysis of luminal ATP by ectonucleoside triphosphate diphosphohydrolase (E-NTPD)7 in epithelial cells is essential for control of the number of T helper 17 (Th17) cells. However, the molecular mechanism by which microbiota-derived ATP in the colon is regulated remains poorly understood. Here, we show that E-NTPD8 is highly expressed in large-intestinal epithelial cells and hydrolyzes microbiota-derived luminal ATP. Compared with wild-type mice, Entpd8-/- mice develop more severe dextran sodium sulfate-induced colitis, which can be ameliorated by either the depletion of neutrophils and monocytes by injecting with anti-Gr-1 antibody or the introduction of P2rx4 deficiency into hematopoietic cells. An increased level of luminal ATP in the colon of Entpd8-/- mice promotes glycolysis in neutrophils through P2x4 receptor-dependent Ca2+ influx, which is linked to prolonged survival and elevated reactive oxygen species production in these cells. Thus, E-NTPD8 limits intestinal inflammation by controlling metabolic alteration toward glycolysis via the P2X4 receptor in myeloid cells.

[A Case of Locally Advanced Gastric Cancer Treated with Chemoradiotherapy before Surgical Resection].

A 70-year-old woman presented to our hospital because of stomach pain. She was diagnosed as having clinical Stage ⅢC gastric cancer with invasion into the pancreas and treated with S-1+oxaliplatin(SOX)as neoadjuvant therapy, after palliative radiotherapy for tumor bleeding. After 4 courses of SOX therapy and 7 courses of S-1 therapy, the tumor size reduce and the invasion into the pancreas disappeared. Subsequently, she underwent distal gastrectomy. The pathological diagnosis was ypStage ⅢB, with no findings of tumor invasion into the pancreas. As of 1 year 9 months after the surgery, no metastasis or recurrence was observed.

[A Case of Small-Sized Acinar Cell Carcinoma of the Pancreas Resected by Laparoscopic Distal Pancreatectomy].

A 81-year-old woman was referred to our hospital for a stomach pain. Abdominal enhanced CT scan showed a pancreatic hypovascular tumor 10mm in size. Abnormal FDG uptake was found on the tumor at FDG/PET-CT examination. The tumor was identified also at endoscopic ultrasonography, and the endoscopic ultrasound-guided fine needle aspiration biopsy of this tumor gave the diagnosis of pancreatic adenocarcinoma. Under the preoperative diagnosis, laparoscopic distal pancreatectomy was performed. There were no postoperative complications. Histopathological examination of the resected tumor revealed acinar cell carcinoma of the pancreas, not pancreatic adenocarcinoma. The patient is alive without any postoperative recurrences 1 year after the pancreatectomy.

[Afferent Loop Syndrome after Hepatobiliary and Pancreatic Surgery Successfully Treated with Percutaneous Drainage].

We report 2 cases where afferent loop syndrome after hepatobiliary and pancreatic surgery was successfully treated with percutaneous drainage. Case 1: A 74-year-old man who had undergone pancreaticoduodenectomy for pancreatic cancer presented with cholangitis, obstructive jaundice, and dilatation of the elevated jejunum. These conditions were attributed to obstruction of the elevated jejunum on the anal side due to peritoneal dissemination. Subsequently, percutaneous transhepatic biliary drainage was performed, and the dilated jejunum was drained through the approach route. Case 2: A 71-year-old woman who had undergone left hepatectomy for hilar bile duct cancer presented with peritoneal dissemination. Owing to the dissemination, the elevated jejunum was obstructed, resulting in its dilatation on the oral side. Percutaneous drainage of the dilated jejunum was directly performed. Percutaneous drainage was effective in both the abovementioned cases, and no symptoms related to the obstruction were observed until the death of the patients because of primary cancer. This suggested that percutaneous drainage may be an effective treatment option for afferent loop syndrome after hepatobiliary and pancreatic surgery.

Endometrioid adenocarcinoma arising from inguinal endometriosis during follow-up for gastric cancer surgery: a case report and literature review.

Malignant transformation of inguinal endometriosis is rare. A 56-year-old woman underwent surgery for advanced gastric cancer 5 years ago and received postoperative adjuvant chemotherapy. She had no recurrence since then. However, 5 years after surgery, contrast-enhanced computed tomography (CT) showed a mass in the right inguinal region suspected to be a hydrocele of the canal of Nuck, with a blood test showing a slightly elevated CA19-9 level (63.0 U/mL). Six months later, CT showed an enlarged mass in the right inguinal region and inflammation in the surrounding area. In addition, both inguinal lymph nodes and those in the right iliac artery area were enlarged, suggesting the possibility of malignancy. For diagnostic purposes, a right inguinal mass was excised. Histopathological examination revealed that it was endometrioid adenocarcinoma with ectopic endometriois as the origin. The differential diagnoses for inguinal masses in women include an inguinal hernia, hydrocele of the canal of Nuck, ectopic endometriosis, lymphoma, and metastatic malignancy. The presence of a primary malignancy in the inguinal region is sporadic but must be differentiated. This is the first case of malignant transformation of inguinal endometriosis developed during postoperative follow-up of another cancer.

The Validity of a New Edition of Classification for Ovarian Metastasis from Colorectal Cancer.

OBJECTIVES: In the 9th edition of the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (JCCRC), ovarian metastasis is classified as distant metastasis. We assessed the significance of resection of ovarian metastases and the validity of this 9th edition of JCCRC for ovarian metastases from colorectal cancer (CRC). METHODS: We retrospectively analyzed the clinicopathological factors and overall survival of 17 patients with ovarian metastases from CRC who underwent resection and 110 female CRC patients with Stage IV (M1a) disease. RESULTS: The patients with only ovarian metastases who underwent resection had a longer median survival time than patients with both ovarian and peritoneal metastases who underwent resection (45.4 months vs. 9.3 months, P = 0.029). The 5-year overall survival of the patients with only ovarian metastases who underwent R0 resection was as long as that of the female Stage IV (M1a) CRC patients after R0 resection (50% vs. 48%, P = 0.334). CONCLUSIONS: We found that, after resection, patients with only ovarian metastases had significantly better prognoses than patients with ovarian and peritoneal metastases. R0 resection of ovarian metastasis indicated as good prognosis as R0 resection of metastasis to one distant organ without ovaries. So the 9th edition of JCCRC, which classifies ovarian metastasis from CRC as distant metastasis, is appropriate.

Feasibility of laparoscopic cholecystectomy in patients with cerebrospinal fluid shunt.

INTRODUCTION: Previous reports of laparoscopic surgery in patients with cerebrospinal fluid (CSF) shunts for intracranial hypertension described shunt-related complications. Thus, the shunts have been considered a contraindication for laparoscopic procedures. However, with the implementation of recent improvements in surgical techniques, perioperative management, and shunt technology, laparoscopic surgery may now be safe in cases with shunts. The aim of the present study was to examine the safety of such procedures based on our own experiences with laparoscopic surgery in patients with CSF shunts. METHODS: A total of 582 patients underwent laparoscopic cholecystectomy for gallbladder disease at our institute during the study period. Among these patients, four (0.7%) had a CSF shunt at the time of laparoscopic cholecystectomy. We retrospectively investigated the clinical characteristics of these four cases. RESULTS: Two patients had ventriculoperitoneal shunts, and two patients had lumboperitoneal shunts. Based on the advice of consulted neurosurgeons, the shunt catheter was clamped during pneumoperitoneum in three of the four cases, and the catheter was left unclamped in the remaining case because it was judged to be occluded. Laparoscopic cholecystectomy was performed under pneumoperitoneum pressure of 8 mmHg. All four cases experienced an uneventful postoperative course, with no shunt-associated complications. CONCLUSION: Analysis of our current cases suggests the safety of laparoscopic cholecystectomy in cases with CSF shunts.