[A case report-neoadjuvant chemoradiotherapy with combination of S-1 and gemcitabine in a patient with locally advanced pancreatic cancer].

A 63-year-old woman was pointed out pancreatic tumor by a follow up CT after operation for the corpus uteri cancer. She was diagnosed as having locally advanced pancreatic cancer which involved the superior mesenteric vein (SMV). She was treated with radiation (1.8 Gyx28 Fr) and the combination chemotherapy of S-1 plus gemcitabine (S-1: 80 mg/m2/dayx28 days, gemcitabine 200 mg/m2/dayx6 fr, 1 fr a week). Indeed, grade 3 leukopenia and neutropenia were occurred by this treatment, she could be treated on schedule. Four weeks later from completion date, a reduction of the tumor size and an improvement of involving SMV were observed by diagnostic imaging. Subsequently, pylorus-preserving pancreatoduodenectomy (PpPD) with a partial resection of SMV and intraoperative radiation were undergone. She was discharged 19 days after the operation without any surgical complications, and is undergoing adjuvant chemotherapy.

[A case of submucosal invasive cancer of the sigmoid colon, recurring as multiple liver metastases one year after the surgery].

A 55-year-old woman underwent colonoscopy due to a positive fecal occult blood test during a mass screening examination, and a 0-Ip type early cancer in the sigmoid colon was found. Endoscopic mucosal resection was performed for this lesion. Histological examination of the endoscopic resected specimen showed a well-differentiated adenocarcinoma invading submucosal layer (depth of invasion, 6,000 microm), positive lymph vessel invasion, and cut end negative. The patient was referred to our hospital, and an additional sigmoidectomy with lymphadenectomy was conducted. Histological examination revealed no residual cancer and no lymph node metastasis. One year after the surgery, an abdominal CT scan showed liver metastases in the segment 4 and 7. The patient underwent a medial segmentectomy and partial resection of the segment 7 of the liver. After the surgery, 8 courses of oral UFT/LV therapy as adjuvant chemotherapy were administered. The patient remains free of recurrence 2 years and 7 months after the first surgery.

[A case of advanced esophageal cancer with large liver metastasis successfully treated with FAP therapy].

A 70-year-old man with dysphagia was diagnosed as advanced esophageal cancer by a primary doctor, and he was admitted to our hospital for treatment in February, 2004. The pretreatment diagnosis was basaloid squamous carcinoma, Mt area, T4 (aorta) , N2 (No. 107) , M1 (liver), Stage IVb performed systemic chemotherapy by FAP (5-fluorouracil ( 5-FU)+doxorubicin (DXR)+cisplatin (CDDP) ) from March, 2004. After 4 courses, the local tumor almost entirely disappeared, and the liver metastasis was obviously reduced. We continued chemotherapy afterwards. As of March 31, 2007, he had local lesion CR and metastatic lesion PR. It is very important to perform FAP repeatedly, for local and metastatic lesion of esophageal cancer while maintaining the patient's general condition and avoiding adverse events.

[Acute necrotizing tubulointerstitial nephritis due to adenoviral infection following hematopoietic stem cell transplantation: clinical findings obtained from 4 autopsy cases].

Once adenovirus infection extends to the kidney from the bladder in the immunosuppressive state after hematopoietic stem cell transplantation, most patients develop acute renal failure due to adenovirus-associated necrotizing tubulointerstitial nephritis. In the 6 years from 2000 to 2006, we retrospectively investigated the characteristics of adenovirus infection in 402 patients who had received a hematopoietic stem cell transplantation in our hospital. The incidence of adenovirus-associated hemorrhagic cystitis in patients who had received a hematopoietic stem cell transplantation was 3.5% (14/402). Among these 14 patients, 4 developed acute necrotizing tubulointerstitial nephritis all of whom died, which yielded the incidence and mortality rates of the disease of 1.0% and 100%, respectively. Once adenovirus infection extends to major organs in a rapid manner, the patient's general condition becomes fatal. Further study is necessary to establish the diagnosis and treatment of adenoviral infections in a compromised host.

[The study of the autopsies of six patients with progressive esophageal cancer to investigate complications caused by esophageal stents].

Endoscopic placement of metal stents are used widely for patients with esophageal obstruction and fistula due to progressive esophageal cancer, but cause high rate of severe complications associated with the immediate causes of death. To determine severe complications caused by stents, we studied clinical data and autopsy of six patients who had been treated with stents for inoperable progressive esophageal cancer. Occording to the clinical records only two patients had severe complications due to stents. But at autopsy, three patients had massive hemorrhage in the stent placement, one patient had mediastinitis, and one patient were in imminent danger of perforation whose stent had been incorporated into the adventitia of the wall. More severe complications were revealed than those expected clinically. Endoscopic placement of metal stents have a great deal for the improvement of quality of life. But we should carefully decide the indication because endoscopic placement of metal stents could cause severe complications associated with the immediate causes of death.

[Metastatic gastrointestinal stromal tumors responded to the treatment with STI571 after polysurgery for recurrent lesions--report of two cases].

Two cases of metastatic gastrointestinal stromal tumors (GIST) that had responded to the treatment with STI571 were presented. Case 1 was a 49-year-old woman who had undergone proximal gastrectomy because of a giant submucosal tumor of the stomach. For 21 months after surgery, the patient received repeated tumor removal four times due to hepatic metastasis and/or peritoneal recurrence. Thereafter, the treatment with STI571 at a dose of 400 mg/day was initiated. Eight months after the administration, only a small hepatic metastasis was detected on a film of CT scan, and any signs of peritoneal recurrence were observed. Case 2 was a 61-year-old man who underwent emergency surgery for a retroperitoneal tumor that had caused massive intestinal hemorrhage resulting in critical shock. The patient underwent the surgery three times for recurrent lesions. Because further tumor removal had become nearly impossible, STI571 at a dose of 400 mg/day was administered 35 months after initial surgery. Six months after treatment the hepatic lesions were shrunk, but the number of retroperitoneal lesions increased. At present, the patient has no abdominal complaints and has a good quality of life. GIST was confirmed in both cases, by histopathological analyses of the resected specimens: positive expression of c-kit and CD34. These clinical observations suggest that ST1571 therapy for metastatic lesions from GIST may be preferred over aggressive, repeated tumor removal.

Detection and treatment of an asymptomatic case of early esophageal cancer using chromoendoscopy and endoscopic mucosal resection.

Recent trends in the management of superficial esophageal cancer consist of improved detection and curative endoscopic therapy. However, successful endoscopic therapy has not been reported in Taiwanese patients with this disease. We describe the case of a male, 38-year-old habitual drinker admitted for a general health check-up, whose endoscopic examination revealed a slightly depressed discolored lesion in the middle esophagus. Chromoendoscopy with 3% Lugol's iodine solution showed a mesh-like unstained pattern occupying approximately two-thirds of the circumferential esophageal mucosa. Spraying with 2% toluidine blue solution stained a 3 x 6 cm suspect area pale blue. Endoscopic biopsy confirmed squamous cell carcinoma. Histopathologic examination revealed the lesion was a type IIc superficial esophageal cancer. Endoscopic ultrasonography showed the lesion was limited to the epithelial layer with no evidence of lymph node involvement. The lesion was removed en bloc using endoscopic mucosectomy. Microscopic examination of the resected specimen demonstrated that the depth of invasion was confined to the epithelial layer except for some areas with small nests of tumor cells within the lamina propria. Balloon dilatation to prevent post mucosectomy stricture was performed and the patient recovered uneventfully. At 1 year of follow-up, the patient was alive without any endoscopic signs of local recurrence. This case suggests that chromoendoscopy in combination with endoscopic resection is likely to benefit patients with early-stage esophageal cancer.

Correlation of histology and molecular genetic analysis of 1p, 19q, 10q, TP53, EGFR, CDK4, and CDKN2A in 91 astrocytic and oligodendroglial tumors.

PURPOSE: The histological diagnosis of human gliomas is of great importance for estimating patient prognosis and guiding therapy but suffers from being subjective and, therefore, variable. We hypothesized that molecular genetic analysis could provide a more objective means to classify tumors and, thus, reduce diagnostic variability. EXPERIMENTAL DESIGN: We performed molecular genetic analysis on 91 nonselected gliomas for 1p, 19q, 10q, TP53, epidermal growth factor receptor, and cyclin-dependent kinase 4 abnormalities and compared with the consensus diagnoses established among four independent neuropathologists. RESULTS: There were six astrocytomas, seven anaplastic astrocytomas, 45 glioblastomas, 21 oligodendrogliomas, eight anaplastic oligodendrogliomas, three oligoastrocytomas, and one anaplastic oligoastrocytoma. Twenty-nine cases had either 1p or 19qloss of heterozygosity (LOH) while retaining both copies of 10q, of which 25 (86%) were histologically oligodendroglioma, anaplastic oligodendroglioma, oligoastrocytoma, or anaplastic oligoastrocytoma. As for the oligodendroglial tumors, unanimous agreement of the initial diagnoses was almost restricted to those cases with combined 1p/19qLOH, whereas all nine tumors without 1p loss initially received variable diagnoses. Interestingly, TP53 mutation was inversely related to 1pLOH in all gliomas (P = 0.0003) but not 19qLOH (P = 0.15). CONCLUSIONS: These data demonstrate that molecular genetic analysis of 1p/19q/10q/TP53 has significant diagnostic value, especially in detecting oligodendroglial tumors. In addition, 1pLOH and TP53 mutations in gliomas may be markers of oligodendroglial and astrocytic pathways, respectively, which may separate gliomas with the same histological diagnosis, especially oligodendroglial tumors and glioblastomas. Testing for those molecular genetic alterations would be essential to obtain more homogeneous sets of gliomas for the future clinical studies.