[A Case of Scirrhous Gastric Carcinoma Diagnosed by Staging Laparoscopy].

We report a case of scirrhous gastric carcinoma diagnosed by staging laparoscopy and discuss some literature reviews. A 60-year-old man was referred because of a choking sensation and weight loss, and gastroendoscopy revealed thickening of the entire circumference of the wall at the gastric cardia. Scirrhous gastric carcinoma was suspected, and biopsy was performed at many points and times by endoscopic examination, but the histologic findings revealed no malignant features. We performed staging laparoscopy, peritoneal washing cytology, and biopsy of the nodules in the abdominal wall. He was diagnosed with advanced gastric cancer with peritoneal dissemination and has received chemotherapy. Staging laparoscopy is a useful method for diagnosis and determination of the management of scirrhous gastric carcinoma.

[A Patient with Scirrhous Gastric Cancer Diagnosed and Resected Subsequently by Laparotomy Examination Due to Difficulty to Take Cancer Specimen by Endoscopic Biopsy].

Some of scirrhous gastric cancer are difficult to diagnose on the surface view or to take correct biopsy specimen.A 85-yearold man with dysphagia was diagnosed scirrhous gastric cancer endoscopically, but could not be taken a biopsy specimen showing cancer.We informed cases of scirrhous gastric cancer difficult to take correct biopsy specimen and recommended surgical operation to take correct specimen and to start a treatment.Patient underwent total gastrectomy after cancer diagnosis( P0CY0cT4aN0).He can eat more food and survive longer than 1 year without any chemotherapies.Scirrhous gastric cancer needs early diagnosis and treatment to improve patient prognosis.

Identification of novel transmembrane proteins in scirrhous-type gastric cancer by the Escherichia coli ampicillin secretion trap (CAST) method: TM9SF3 participates in tumor invasion and serves as a prognostic factor.

OBJECTIVE: Scirrhous-type gastric cancer (GC) is highly aggressive and has a poor prognosis due to rapid cancer cell infiltration accompanied by extensive stromal fibrosis. The aim of this study is to identify genes that encode transmembrane proteins frequently expressed in scirrhous-type GC. METHODS: We compared Escherichia coli ampicillin secretion trap (CAST) libraries from 2 human scirrhous-type GC tissues with a normal stomach CAST library. By sequencing 2,880 colonies from scirrhous CAST libraries, we identified a list of candidate genes. RESULTS: We focused on the TM9SF3 gene because it has the highest clone count, and immunohistochemical analysis demonstrated that 46 (50%) of 91 GC cases were positive for TM9SF3, which was observed frequently in scirrhous-type GC. TM9SF3 expression showed a significant correlation with the depth of invasion, tumor stage and undifferentiated GC. There was a strong correlation between TM9SF3 expression and poor patient outcome, which was validated in two separate cohorts by immunostaining and quantitative RT-PCR, respectively. Transient knockdown of the TM9SF3 gene by siRNA showed decreased tumor cell-invasive capacity. CONCLUSION: Our results indicate that TM9SF3 might be a potential diagnostic and therapeutic target for scirrhous-type GC.

Primary diagnosis of metastatic breast cancer in the third trimester of pregnancy: a case report and review of the literature.

To the best of our knowledge, we are presenting the first documented primary diagnosis of a 32-year-old pregnant patient at 29 + 4 weeks' gestation with poorly differentiated, metastatic scirrhous breast cancer, with negative hormone receptors, HER-2/neu receptor overexpression and metastases in the lumbar spine. The patient was administered neoadjuvant chemotherapy with vinorelbine and trastuzumab, and received ibandronate for the bone metastases. The tumor responded well to treatment; however, treatment was associated with anhydramnios, probably related to the trastuzumab treatment. Delivery was planned for 33 + 5 weeks' gestation by cesarean section due to concurrent breech presentation and anhydramnios, and the infant is in good health. After delivery, the patient underwent a mastectomy. Following completion of six courses of vinorelbine and ongoing treatment with trastuzumab and ibandronate, the patient's tumor went into regression and currently the patient does not present with any clinical evidence of disease.

Recent results of therapy for scirrhous gastric cancer.

The prognosis of patients with scirrhous gastric cancer (SGC) is extremely poor. However, recent advances in therapeutic strategies against SGC, using effective anticancer drugs, have prolonged the survival of patients with SGC. This paper reviews the recent therapeutic outcomes of this type of gastric cancer and introduces a new treatment protocol for SGC.

Progressive dysphagia in a dog caused by a scirrhous, poorly differentiated perioesophageal carcinoma.

Investigation of canine dysphagia is performed by a combination of diagnostic imaging, direct visualisation of the upper gastrointestinal tract, and ancillary diagnostic testing to differentiate between structural and functional causes. Video fluoroscopy may be especially helpful. The case of a seven-year-old Border collie that presented with a history of progressive pharyngeal dysphagia is described. Fluoroscopic investigation was initially suggestive of functional pharyngeal disease, but magnetic resonance imaging and surgical exploration demonstrated the presence of a diffuse, scirrhous, poorly differentiated carcinoma with extensive oesophageal involvement. This case highlights that, in some circumstances, fluoroscopy may occasionally be of limited use in the investigation of dysphagia in the dog.

Diagnostic significance of tumor markers.

Progress in the immunological detection of malignant tumors has been delayed by two major obstacles: (a) the lack of true cancer specificity of the known tumor-marker substances; and (b) the lack of a close relationship between the concentration and/or first appearance of the marker antigens and the malignant disease, especially at its early stage. An additional, important, and complicating factor implicating the specificity of the reactions of the test substances is the existence of immunological cross-reactions. Until recently, only two approaches have been pursued to resolve this difficulty of cross-reactivity, both concerned with the antigen. Now there is a third way, namely, the production of monoclonal antibodies. The poor correlation between the stage of the neoplastic disease and the level of circulating tumor markers, e.g., carcinoembryonic antigen, may be explained on a histological basis, or by inherent differences in the carcinoembryonic antigen molecule of different tumor sources. Few studies are available dealing with these problems.

[Proptosis as the first sign of recurrent scirrhous breast carcinoma]. / Proptosis como primera manifestación de recidiva de cáncer escirro de mama.

OBJECTIVE: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome. CASE REPORT: The case of a 61-year-old woman, diagnosed and treated seven years ago for a scirrhous breast carcinoma is presented. She complained of blurred vision and proptosis of the left eye and these symptoms were the first manifestation of tumor relapse. DISCUSSION: When orbital inflammation is detected in an adult female patient, a full medical history must be obtained and physical examination performed, as orbital metastases have been reported to be the initial manifestation of malignancy in 30 to 50% of cases.

Fibrolamellar carcinoma versus scirrhous hepatocellular carcinoma : diagnostic usefulness of CD68.

BACKGROUND: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma that commonly affects young individuals without a prior history of liver disease. The principal differential diagnosis is conventional hepatocellular carcinoma especially the scirrhous variant. Despite their distinctive appearance, recent studies have demonstrated a lack of consistency in how FL-HCC are diagnosed by pathologists. AIM: To investigate the diagnostic utility of CD68 in differentiating between FL-HCC and scirrhous hepatocellular carcinoma. PATIENTS AND METHODS: In our retrospective study, we reviewed four cases of FL-HCC that were diagnosed at the pathology department of Mongi Slim hospital over a thirteen-year period (2002-2014). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. Immunohistochemical analysis was performed using the avidin-biotin complex technique with antibodies against CD68 and CK7. RESULTS: Our study group included one man and three women (sex ratio M/F=0.33) aged between 23 and 34 years (mean=28 years). All cases arose in non-cirrhotic liver. Immunohistochemically, all cases were positive for CK7 and for CD68 (n=4). CONCLUSIONS: CD68 immunostaining is a sensitive marker for FL-HCC that may be of use in routine diagnostic surgical pathology. Lack of CD68 staining should suggest caution in making a diagnosis of FL-HCC.

Primary linitis plastica carcinoma of urinary bladder.

Primary linitis plastica type carcinoma of the urinary bladder in a sixty-one-year-old man is described. Only 2 other cases have been reported in the English medical literature.

Clinical studies of type-I procollagen carboxyterminal peptide in serum of patients with gastric cancer: comparison with CEA and CA19-9.

The serum level of a newly developed monoclonal antibody against type-I procollagen carboxyterminal peptide (P-1-P) was determined in patients with gastric cancer. The location of P-1-P in gastric cancer tissue was also investigated. We found that: (1) The serum P-1-P level and the positivity rate in patients with gastric cancer were similar to those in patients with other malignant or benign GI diseases and healthy individuals. (2) In patients with gastric cancer, the P-1-P positivity rate was significantly lower than that of CEA or CA19-9. (3) In patients with gastric cancer, the P-1-P positivity rate increased as the disease stage advanced. (4) Among patients with gastric cancer, the P-1-P positivity rate was significantly higher in those with scirrhous type than in those with medullary or intermediate type. (5) P-1-P was detected in the cytoplasm of cancer cells. P-1-P staining was stronger in scirrhous type and histologically undifferentiated gastric cancer. These results show that P-1-P can serve as a good marker for scirrhous type gastric cancer. The production of collagen by cancer cells themselves seems to be involved in collagen production in scirrhous type gastric cancer.

Optical attenuation characteristics of breast tissues at visible and near-infrared wavelengths.

Optical experiments are described for measuring the attenuation characteristics of breast tissues at visible and near-infrared wavelengths. Total attenuation coefficients post mortem were measured directly in thin tissue sections. They are usually within the range from 10 to 30 mm-1, are rather higher in fat than in fibroglandular specimens and decrease with increasing wavelength. The scattering phase function is strongly forward-peaked with the mean cosine of scattering in the range from 0.85 to 0.97 and appearing more forward-peaked in fat than in fibroglandular tissue. The reduced scattering coefficient is of the order of 1 mm-1 in all tissues. Absorption coefficients were measured indirectly in optically thick sections. They are typically between 0.1 and 0.5 mm-1 at wavelengths around 580 nm and an order of magnitude lower at 850 nm. At 580 nm and shorter wavelengths the absorption in carcinoma is significantly higher than in adjacent uninvolved tissue. Significant differences were observed in the first-order derivatives of the transmission spectra of carcinoma and surrounding tissues at certain infrared wavelengths. Transmission spectra measured in vivo across the wavelength range from 500 to 860 nm have a similar form to the spectra of excised samples. Linear absorption coefficients are generally of the same order of magnitude as those found in vitro although they are lower at green wavelengths.

Saturation transfer ratio imaging in invasive ductal carcinomas of the breast.

A prospective study was performed to investigate the correlations between saturation transfer ratio (STR) and histologic parameters of invasive ductal carcinomas in human breast. The histologic parameters investigated were the extent of fibrosis in the intercellular matrix, dysplastic changes of nuclei, and mitotic index. Twenty-seven patients with breast carcinoma were examined using an off-resonance saturation pulse in conjunction with conventional field-echo T(1)-weighted imaging at frequency offsets of 448 Hz and 1200 Hz from water resonance. The values of STR at frequency offset of 1200 Hz (STR(1200)) increased from non-scirrhous carcinoma to scirrhous carcinoma. Although STR(1200) showed correlation with the extent of fibrosis in the intercellular matrix (p<0.01, n = 27), they did not correlate with the dysplastic changes of nuclei or mitotic index. On the other hand, the values of STR at frequency offset of 448 Hz (STR(448)) demonstrated close correlation to dysplastic changes of nuclei and mitotic index (p<0.01, n = 27). STR(1200) correlates with the structural characteristics and STR(448) correlates with the nature of malignant cells with regard to nuclear dysplasia and mitotic potential.

Characteristic echographic features of circumscribed cancer.

Of 964 amputated breast cancers which had been examined preoperatively by ultrasound and mammography, 147 breast (17.0%) contained macroscopically circumscribed tumors and 596 cases (69.0%) showed infiltrative tumors on examination of the cut surface. It is well known that infiltrative types of cancer show ultrasonic images that usually possess clear cut signs of malignancy, such as jagged augmented boundary echoes and acoustic shadows. On the other hand, circumscribed types of cancer do not usually show such signs, but exhibit lobulated shapes and strong, coarse and non-uniform internal echoes. These latter features are intermediate between those of infiltrative cancers and those of solid benign tumors. As such circumscribed cancers are often difficult to diagnose correctly by ultrasonic techniques. The diagnostic accuracy rates by ultrasound were 88.0% in the infiltrative types and 69.4% in the circumscribed types. The ultrasonic pictures of the 147 cases of such circumscribed tumors are classified and discussed.

[Clinical experiences with ultrasound-reflection computerized tomography of the breast]. / Klinische Erfahrungen mit der Ultraschall-Reflexions-Computertomographie der Brust.

Ultrasound-reflection computed tomography (URCT) of the breast can produce astonishingly detailed high resolution images of the breast, particularly in the coronal plane. In some cases it improves the demonstration of the structure of scirrhous carcinomas in this plane. On the other hand, some valuable diagnostic features known from conventional breast sonography, such as acoustic shadows and hyper-reflective area (cysts) are suppressed on URCT images and are not readily recognized. Despite individual outstanding images, a comparison carried out on 100 patients showed no advantages of URCT compared with high-resolution real-time sonography.

[Nuclear magnetic resonance tomography of the breast: diagnosis, differential diagnosis, problems and possible solutions. II: Diagnosis]. / Kernspintomographie der Mamma: Diagnose, Differentialdiagnose, Probleme und Lösungsmöglichkeiten. Teil II: Diagnostik.

Eighty-five MR examinations were carried out on both breasts of 72 patients. A special surface coil was used. The results were compared with the findings of mammography and with the post-operative findings. There were 16 fibrocystic mastopathies, seven isolated cysts, 22 fibro-adenomas and 25 carcinomas. Differentiation between fibro-adenomas and carcinomas is only possible on the basis of morphological criteria. Cysts and fibrocystic mastopathies can be identified with certainty. Typical patterns of the various pathological conditions are described, but these will have to be confirmed by the study of a larger number of patients, in order to make them statistically significant. The advantage of MR consists in the simultaneous demonstration of the thoracic wall and the axilla.

[The sonographic appearance of the diffuse infiltrates stomach cancer (author's transl)]. / Das sonographische Bild des diffus infiltrierenden Magentumors.

Using 5 cased of diffuse infiltrated stomach cancer we have described its characteristic sonographic appearance. We emphasize that sonography cannot replace endoscopic and x-ray measures, but it is a beneficial supplement.

[Technical aspects of breast sonography. Experience with an immersion scanner (Octoson) (author's transl)]. / Methodische Aspekte der Mammasonographie. Erfahrungen mit einem Immersionsscanner (Octoson).

The experience with the sonographic examination of 80 patients with an Octoson body unit is described. It was found that with the present technique immersion of the breast in most cases is less satisfactory than compression of the breast. The compound scan improves the information as compared with a single scan up to a point. Immersion sonography, like all other types of ultrasound examination, is at present not satisfactory as the sole method for examining the breast. As an addition to mammography and palpation, sonography is, however, already an important complementary method.