[Giant Retroperitoneal Liposarcoma Treated by Surgical Resection and Chemotherapy - A Case Report].

As the treatment for the liposarcoma, there is no effective chemotherapy and a surgical remedy is required. We present the case of a 64-year-old man who complained about difficulty in swallowing and discomfort of throat. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the retroperitoneal space and it was displaced to the right. Preoperative diagnosis was retroperitonealmal ignant tumor. Tumor excision were performed and around 4.0 kg tumor was removed though its size was too big and resected it separately. Tumors increased 5 months later and became the second enucleation. After the second operation, we used eribulin as postoperative adjuvant chemotherapy. However, we needed extraction 3 times by the surgery because it recurred as peritonealdissemination. We continue surgicaltreatment and chemotherapy together as there are a part increasing relatively slowly and a high grade part increasing rapidly.

[A Case Involving the Re-Application of TAE for the Rupture of Recurrent Dissemination Lesion after Initial TAE and Hepatectomy Was Performed for A Previous Rupture of HCC].

The patient was a 65-year-old man who had been previously diagnosed with chronic hepatitis B, but the patient had discontinued treatment while in his thirties. The patient was admitted to the emergency department after losing consciousness due to abdominal pain. Emergency contrast CT was performed in the shock state, and the diagnosis was hemorrhagic shock due to rupture of hepatocellular carcinoma(HCC). Emergency TAE was performed, and hemostasis was successful due to left hepatic arterial embolism. The tumor was confined to the liver lateral area and it was judged to be resectable curatively, upon state restoration. Ten days after TAE, lateral segmentectomy of the liver was performed. Pathological findings indicated moderately differentiated HCC, mostly necrotic and partially viable. He was discharged on 11POD. On 69POD, the patient reexperienced sudden abdominal pain after lunch. The abdominal pain continued while emergency contrast CT was performed at the time of visit in the shock state. Recurrence of multiple dissemination via high-absorption ascites was found around the largest tumor nest with lower left diaphragm diameter of 15cm, and it was judged that the HCC disseminated recurrence had ruptured. Emergency TAE was performed again, and hemostasis was successful by embolization of the left gastric artery and lower left diaphragm artery. Subsequently, tumor growth slowed after initiating oral administration of sorafenib, and the patient is alive 8 months after re-TAE.

Surgical resection following combination chemotherapy with oral S-1 and biweekly docetaxel in a patient with advanced gastric cancer and a prior coronary artery bypass graft with the right gastroepiploic artery: report of a case.

Cardiothoracic surgeons commonly use the internal thoracic artery (ITA) and the right gastroepiploic artery (RGEA) when performing a coronary artery bypass graft (CABG). Although the development of CABG surgery has enabled long-term survival in patients with coronary artery disease, malignant diseases are more common in older patients. We present the case of a 75-year-old man who had previously undergone CABG with the RGEA and had later developed advanced gastric cancer. We treated this patient with two courses of combination chemotherapy using S-1 and docetaxel as induction therapy, followed by successful tumor resection. Therefore, neoadjuvant chemotherapy was effective for preserving the CABG with the RGEA in a patient with advanced gastric cancer.

Curative surgery improves the survival of patients with perforating colorectal cancer.

PURPOSE: Colorectal cancers that manifest as a perforation are generally regarded as carrying a poor prognosis. We conducted this study to assess the outcome of colorectal cancer complicated by perforation. METHODS: Between 1996 and 2004, 848 patients underwent surgery for colorectal cancers in our department. We reviewed 22 (2.6%) consecutive patients who presented with perforation at one institution. RESULTS: Fifteen (69%) patients underwent potentially curative resection. The overall operative morbidity and mortality rates were 50% and 9%. The overall 5-year survival rate was 17.4%, although by excluding patients who either had stage IV disease at diagnosis or who died during or soon after surgery (n = 7), the 5-year survival rate increased to 32% (n = 15). Furthermore, the 5-year survival rate of patients who underwent a potentially curative resection (36.9%) was significantly better than that of those who underwent a noncurative resection (0%, P = 0.0093). CONCLUSIONS: Perforating colorectal cancers are associated with high postoperative mortality and poor long-term survival. However, the intensive management of radical lymph node dissection and surgical resection are recommended to improve the long-term prognosis.

Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus.

BACKGROUND: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 80 years of age) with esophageal cancer. METHODS: A total of 668 patients with thoracic esophageal cancer who underwent an esophagectomy by the transthoracic approach were divided into three groups according to age, namely, groups I (>80 years, n=16), II (70-79 years, n=158), and III (

Retrospective study of S-1 versus tegafur/uracil and oral leucovorin in patients with metastatic colorectal cancer.

UNLABELLED: THE AIM of this study was to compare the efficacy and toxicity of S-1 to an oral combination regimen of tegafur and uracil (UFT) with leucovorin (LV) in metastatic colorectal carcinoma (CRC) patients. PATIENTS AND METHODS: Fifty-two patients were treated with either S-1 (80 mg/m2/d), administered for 28 days every 42 days, or UFT (300 mg/m2/d) and LV (90 mg/d), administered for 28 days every 35 days. The clinical results were compared retrospectively. RESULTS: There were no statistically significant differences in overall response between the two patient groups. The overall response rate was 11.8% in the S-1 group, and 11.1% in the UFT/LV group. No statistically significant difference in-time- to progression (TTP) or survival time was observed between the treatments. The median survival time was 29 months with S-1 and 12 months with UFT/LV. CONCLUSION: The oral S-1 provided similar safety and efficacy, compared to UFT/LV for metastatic CRC.

[The efficacy and safety of docetaxel for elderly advanced breast cancer patients].

We studied the efficacy and safety of docetaxel (DOC) for elderly breast cancer patients. Between September 1997 and June 2003, five consecutive women with advanced breast cancers who were 75 years of age or older received DOC at a dose of 60 mg/m(2) every three weeks. No premedications to prevent hypersensitive reactions and fluid retention by DOC were given. The number of DOC dosages per case was 5-16 times (12 times the median) and the relative dose intensity (RDI) was 80-100% (95% of medians). Objective partial responses were observed in all patients. The median time to partial response was 21 days (range: 21-50 days). The median time to treatment failure was 12 months (range: 5-22 months). The grade and the frequency of major side effects were the following: leukocytopenia of grade 3 (80%), edema of grade 2-3 (40%), and alopecia of grade 2 (100%). It was concluded from these findings that DOC could be safely and effectively administered to elderly advanced breast cancer patients.

Characterization of the 5'-untranslated region of YB-1 mRNA and autoregulation of translation by YB-1 protein.

The eukaryotic Y-box binding protein YB-1 is involved in various biological processes, including DNA repair, cell proliferation and the regulation of transcription and translation. YB-1 protein is abundant and expressed ubiquitously in human cells, functioning in cell proliferation and transformation. Its concentration is thought to be highly regulated at both the levels of transcription and translation. Therefore, we investigated whether or not the 5'-UTR of YB-1 mRNA affects the translation of YB-1 protein, thus influencing expression levels. Luciferase mRNA ligated to the YB-1 mRNA 5'-UTR was used as a reporter construct. Ligation of the full-length YB-1 5'-UTR (331 bases) enhanced translation as assessed by in vitro and in vivo translation assays. Deletion constructs of the YB-1 5'-UTR also resulted in a higher efficiency of translation, especially in the region mapped to +197 to +331 from the major transcription start site. RNA gel shift assays revealed that the affinity of YB-1 for various 5'-UTR probe sequences was higher for the full-length 5'-UTR than for deleted 5'-UTR sequences. An in vitro translation assay was used to demonstrate that recombinant YB-1 protein inhibited translation of the full-length 5'-UTR of YB-1 mRNA. Thus, our findings provide evidence for the autoregulation of YB-1 mRNA translation via the 5'-UTR.

[A case of advanced rectal cancer responding to oral UFT and Leucovorin-based preoperative chemoradiation therapy].

We report a case of a 44-year-old male with advanced lower rectal cancer that showed a significant effect after preoperative chemoradiation therapy. Preoperative radiation and chemotherapy included whole pelvis irradiation (30 Gy in total), oral UFT (500 mg/day), and Leucovorin (75 mg/day) was administered daily for 4 weeks. Consequently, the patient underwent a total pelvic exenteration with lymph node dissection (D 3). Histopathological findings showed: invasion to peritoneum(Ai); stage IIIa with n(-); and histological grading, Grade 2. Preoperative chemoradiation therapy appears to be effective for locally advanced lower rectal cancer.

A case of gastric hyperplastic polyp with malignant transformation.

In this paper we report a case of hyperplastic polyp with malignant transformation. The patient was followed up by annual radiographic and endoscopic examination during 9 years. The first gastroscopy revealed a semi-pedunculated polyp beneath the esophageal-cardiac junction, 1.5cm in diameter and slightly reddish with smooth surface. Histological findings showed a hyperplastic polyp. There was slight change in size, but no change in histological examination of the lesion during the follow-up. In 1996, the biopsy specimen showed an atypical epithelium and the polyp was removed by snear polypectomy. A microscopic examination revealed a well-differentiated adenocarcinoma. Immunohistochemically, p53 and Ki-67 immunostaining showed positive in the carcinoma portion of the adenocarcinoma bearing a hyperplastic polyp in the stomach.

[Evaluation of positive cases with peritoneal lavage cytology in gastric cancer].

Peritoneal dissemination with advanced gastric cancer is of significant problem. Peritoneal lavage cytology has been an effective method for the detection of early peritoneal dissemination since 1999. The accurate evaluation of peritoneal lavage cytology is unclear except for the same prognosis of peritoneal dissemination. We examined the clinical findings and the prognosis with positive cases in peritoneal lavage cytology. The prognosis of cases with P1CY1 or P2P3 group was poorer than in the P0CY1 or P0, CY1 group. We thus review the evaluation of peritoneal lavage cytology with gastric cancer in the Japanese and English literature. In addition, we describe the diagnosis of early peritoneal dissemination using peritoneal lavage tumor markers or molecular markers of peritoneal lavage.

Detection of disseminated cancer cells in bone marrow of gastric cancer using real time quantitative reverse transcriptase polymerase chain reaction.

Bone marrow is a prognostically relevant indicator organ for micrometastasis. In the present study, real time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect disseminated gastric cancer cells in bone marrow. We compared CEA, CK18 and CK20 expression using four gastric cancer cell lines and three normal tissue cell lines in order to select the most appropriate marker for detection of disseminated gastric cancer cell in bone marrow. CK20 proved to be the most promising marker since the expression level of normal cell lines was extremely low and about 50--100-fold differences were found between gastric carcinoma cell lines and normal tissue cell lines. We also screened bone-marrow RNA of 47 patients with gastric cancers, using this system. Among the three markers we tested, with only about CK20 could we find that 27 of 47 patients were positive. Though long-term clinical follow up studies are needed to evaluate the clinical significance of this method, real time quantitative RT-PCR is sensitive and quantitative for detection of micrometastasis in bone marrow.

The role of adenoma for colorectal cancer development: differences in the distribution of adenoma with low-grade dysplasia, high-grade dysplasia, and cancer that invades the submucosa.

BACKGROUND: The purpose of this study was to elucidate the role of adenoma in the early stage of colorectal cancer development, we focused on the clinicopathologic relationship between adenoma with low-grade dysplasia (ALGD), adenoma with high-grade dysplasia (AHGD), and cancer that invades the submucosa in the colorectum. METHODS: We clinicopathologically examined a total of 553 adenomas and 58 cancers that invaded the submucosa. The tissues were excised from 479 patients who underwent total colonoscopy. RESULTS: The percentage of ALGD was 79.9% in the proximal colon, 70.5% in the distal colon, and 48.3% in the rectum, respectively. The percentages of AHGD and cancer were 14.5% and 5.6% in the proximal colon, 21.3% and 8.2% in the distal colon, and 35.4% and 16.3% in the rectum, respectively. In contrast with the distribution of ALGD, the distribution of both AHGD and cancer shifted from the proximal to the distal site, with a statistical significance (P <.01). When the distribution of adenoma was compared according to tumor size, both large- and small-sized AHGD showed a similar cancer distribution, however, both large- and small-sized ALGD showed different distributions. CONCLUSION: An important role of AHGD for cancer development in the colorectum may relate to the similar distribution between AHGD and cancer; however, the different distributions observed between ALGD, AHGD, and cancer suggested that ALGD has only a slight association with the development of cancer.

Clinical significance of micrometastasis in bone marrow of patients with gastric cancer and its relation to angiogenesis.

BACKGROUND: Detection of micrometastasis is an important problem of clinical significance for a better understanding and control of tumor progression, which will improve patients' survival time.METHODS: To identify micrometastases in bone marrow, an immunocytochemical assay for epithelial cytokeratin protein was performed in 106 patients with primary gastric cancer. Also, in 40 of the 106 patients, vascular endothelial growth factor (VEGF) expression and intratumoral vessel density were examined by an immunohistochemical staining method.RESULTS: Of the 106 patients, 22 (20.8%) presented with cytokeratin-positive cells in bone marrow at the time of primary surgery. The positive findings were related to depth of invasion, peritoneal dissemination, and liver metastasis. Patients with cytokeratin-positivity in bone marrow had a higher VEGF positive rate (73%; 8/11) than did cytokeratin-negative patients (48%; 14/29). Intratumoral vessel density in VEGF-positive patients was 26.9 +/- 10.3, which was significantly higher than that in VEGF-negative patients (13.2 +/- 8.7, P < 0.05). Thus, the presence of cytokeratin-positive cells in bone marrow was closely related to angiogenesis in the primary tumor.CONCLUSIONS: Cytokeratin staining can be useful for identifying patients at high risk for metastasis. Prophylactic lymph node dissection, adjuvant chemotherapy, and antiangiogenic treatment may be necessary for patients with micrometastasis.

Overexpression of cyclooxygenase-2 and tumor angiogenesis in human gastric cancer.

BACKGROUND/AIMS: Cyclooxygenase-2 (COX-2) protein is overexpressed in various cancers, including esophageal, gastric, colon, and pancreatic. To better comprehend the role of COX-2 in gastric cancer, especially with regard to angiogenesis, we investigated COX-2 and vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) in 108 patients with gastric cancer. METHODOLOGY: We used immunohistochemical analysis of formalin-fixed tissues of gastric cancer. RESULTS: Expression of COX-2 showed diffuse staining in the cytoplasm of tumor cells, however, no staining in normal epithelial cells. Of the 108 tumors examined, 71 (65%) were positive for COX-2 expression, the VEGF-positive cases numbered 43 of 108 cases (39.8%). The intensity of COX-2 expression did not correlate with any clinicopathological characteristics. The positive rate of VEGF expression in COX-2-positive cases was significantly higher than in COX-2-negative ones (47.9% vs. 24.3%, P<0.05). MVD in COX-2-positive cases was significantly higher than in COX-2-negative ones (22.0+/-7.8 vs. 18.5+/-7.5/1 mm2; P<0.05). CONCLUSIONS: Our study provides evidence that COX-2 is closely related with angiogenesis.

Genetic suppression of inflammation blocks the tumor-promoting effects of TGF-ß in gastric tissue.

The contributions of TGF-ß signaling to cancer are complex but involve the inflammatory microenvironment as well as cancer cells themselves. In mice encoding a TGF-ß mutant that precludes its binding to the latent TGF-ß binding protein (Tgfb1(-/C33S)), we observed multiorgan inflammation and an elevated incidence of various types of gastrointestinal solid tumors due to impaired conversion of latent to active TGF-ß1. By genetically eliminating activators of latent TGF-ß1, we further lowered the amount of TGF-ß, which enhanced tumor frequency and multiorgan inflammation. This model system was used to further investigate the relative contribution of TGF-ß1 to lymphocyte-mediated inflammation in gastrointestinal tumorigenesis. Toward this end, we generated Tgfb1(-/C33S);Rag2(-/-) mice that lacked adaptive immune function, which eliminated tumor production. Analysis of tissue from Tgfb1(-/C33S) mice indicated decreased levels of P-Smad3 compared with wild-type animals, whereas tissue from Tgfb1(-/C33S);Rag2(-/-) mice had normal P-Smad3 levels. Inhibiting the inflammatory response normalized levels of interleukin (IL)-1ß and IL-6 and reduced tumor cell proliferation. In addition, Tgfb1(-/C33S);Rag2(-/-) mice exhibited reduced paracrine signaling in the epithelia, mediated by hepatocyte growth factor produced by gastric stroma. Together, our results indicate that many of the responses of the gastric tissue associated with decreased TGF-ß1 may be directly or indirectly affected by inflammatory processes, which accompany loss of TGF-ß1, rather than a direct effect of loss of the cytokine.

Production of gastrointestinal tumors in mice by modulating latent TGF-ß1 activation.

TGF-ß and its signaling pathways are important mediators in the suppression of cancers of the gastrointestinal tract. TGF-ß is released from cells in a latent complex consisting of TGF-ß, the TGF-ß propeptide [latency associated protein (LAP)], and a latent TGF-ß binding protein (LTBP). We previously generated mice in which the LTBP-binding cysteine residues in LAP TGF-ß1 were mutated to serine precluding covalent interactions with LTBP. These Tgfb1(C33S/C33S) mice develop multiorgan inflammation and tumors consistent with reduced TGF-ß1 activity. To test whether further reduction in active TGF-ß levels would yield additional tumors and a phenotype more similar to Tgfb1(-/-) mice, we generated mice that express TGF-ß1(C33S) and are deficient in either integrin ß8 or TSP-1, known activators of latent TGF-ß1. In addition, we generated mice that have one mutant allele and one null allele at the Tgfb1 locus, reasoning that these mice should synthesize half the total amount of TGF-ß1 as Tgfb1(C33S/C33S) mice, and the amount of active TGF-ß1 would be correspondingly decreased compared with Tgfb1(C33S/C33S) mice. These compound-mutant mice displayed more severe inflammation and higher tumor numbers than the parental Tgfb1(C33S/C33S) animals. The level of active TGF-ß1 in compound mutant mice seemed to be decreased compared with Tgfb1(C33S/C33S) mice as determined from analyses of surrogate markers of active TGF-ß, such as P-Smad2, C-Myc, KI-67, and markers of cell-cycle traverse. We conclude that these mutant mice provide a useful system for modulating TGF-ß levels in a manner that determines tumor number and inflammation within the gastrointestinal tract.

Retrograde colon intussusception in an adult due to adenoma: treatment by combined laparoscopic and endoscopic approach.

This report describes the case of a young patient who underwent laparoscopic surgery to reduce for a retrograde intussusception of the sigmoid-descending colon caused by adenoma of the sigmoid colon. A 36-year-old woman visited our hospital, complaining primarily of vomiting and abdominal pain. Abdominal CT scan showed the typical finding of intussusception. An emergency colonoscopy revealed that the invaginated colon with a polypoid mass was protruding into the descending colon. A gastrografin enema showed the invaginated bowel segment at the descending colon. We performed endoscopic polypectomy and then hand-assisted laparoscopic reduction. The pathological finding showed tubular adenoma. Laparoscopy is a diagnostic or therapeutic tool for selected cases of adult intussusception. Benign tumor is one of the causes of intussusception in adults and a good indication for laparoscopic surgery.

Colon metastasis 20 years after the removal of ovarian cancer: Report of a case.

This report describes the case of a patient who had undergone surgery to resect bilateral ovarian tumors and then presented with colon metastasis 20 years later. A 69-year-old woman was admitted to the hospital for a clinical survey. She had been operated on for bilateral ovarian cancer in 1987 and was treated by postoperative adjuvant chemotherapy. The patient's follow-up showed no abnormality until 2006. Colonoscopy revealed an elevated irregular lesion in the cecum. A biopsy of the lesion showed a group V, moderately differentiated adenocarcinoma. A right hemicolectomy with a partial resection of the ileum and a lymphadenectomy was performed. Immunohistochemical staining during the pathological diagnosis showed the lesion to be colon metastasis from a serous papillary adenocarcinoma of the ovary. Immunohistochemical staining was positive for cytokeratin 7, carbohydrate antigen (CA)-125, and estrogen receptors, and negative for cytokeratin 20, carcinoembryonic antigen, and CA19-9. The use of immunohistochemistry demonstrated the tumor to be of ovarian origin.

Transient elastography for the prediction of oxaliplatin-associated liver injury in colon cancer patients: a preliminary analysis.

OBJECTIVE: The prognosis of advanced colon cancer has improved significantly over the last decade since new chemotherapy regimens including oxaliplatin have been developed. However, oxaliplatin-induced liver injury and characterized hepatic hemostatic status can occur after chemotherapy. The assessment of this type of liver injury is often difficult. METHODS: Elastography (Fibroscan) was used to evaluate liver injury in five cases before and after 5-FU, leucovorin, and oxaliplatin combination (FOLFOX) treatment. RESULTS: A clear change was observed in the stiffness of liver after chemotherapy within 48 h, and the hepatic stiffness was normalized in most cases after 2 weeks. Among the five patients, one patient showed aberrant elevation after a FOLFOX treatment, and the patient showed liver injury pathologically. CONCLUSION: Elastography is a good tool for evaluating hepatic injury after FOLFOX treatment.