Pedunculated hamartomatous polyp of the appendix: report of a case.

We experienced a rare case of a pedunculated polyp of the appendix, which had been incidentally found by preventive appendectomy performed when providing surgical treatment for rectal carcinoma. A pathological investigation of this polypoid lesion demonstrated branches of fibro-muscular stalks connecting with the lamina muscularis covered by a hyperplastic mucosa, which proved to be consistent with the features of hamartoma. The patient had no external characteristics of Peutz-Jeghers syndrome, including mucocutaneous pigmentation and gastrointestinal polyposis, observed by endoscopy. This case is considered to be a Peutz-Jeghers type polyp of the appendix with a pedunculated form, which is very rare.

[Combined therapy of lapatinib and capecitabine effective against local recurrence of breast cancer].

A 67-year-old woman after mastectomy was afflicted with local recurrence of left breast cancer during adjuvant trastuzumab therapy. Oral administration of lapatinib and capecitabine served to distinguish the recurrent tumor and also reduce the patient's distressing symptoms. This combined anti-cancer therapy may be available for patients with breast cancer for whom trastuzumab therapy was not adequately effective.

Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy.

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate.

Pathological Prognostic Score: a rational criteria to stratify survival in colorectal carcinoma.

PURPOSE: The aim of this study is to certify a rationality of Pathological Prognostic Score (PPS) in determining the prognosis of patients with colorectal carcinoma. METHODS: Three hundred and thirty-one patients with colorectal carcinoma, which had been treated by surgical resection, were enrolled. One point was added for each element among four tumor-related pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. PPS was determined by an aggregate of the points. RESULTS: There existed a significant difference both between survivals of patients with PPS 0 or 1 and 2 or 3 (P = 0.0005) and between survivals of patients with PPS 2 or 3 and 4 (P < 0.0001). CONCLUSIONS: PPS could be an easy and useful criteria to stratify prognosis of patients with colorectal carcinoma.

Analysis of the impact of the body mass index in patients with gastric carcinoma.

BACKGROUND: Body mass index (BMI) has been suggested to provide clinicopathological information in tumor development and progression in patients with gastric carcinoma. METHODS: The correlation of BMI with clinicopathological features and operation-related factors was analyzed in 308 patients with gastric carcinoma who had undergone distal or total gastrectomy. RESULTS: There was no significant correlation of obesity, indicated by a high value of BMI, with tumor-related factors including survival, or with operation-related factors. On the other hand, more advanced tumors and worse preoperative nutritional and immunological conditions were found in patients with a lower value of BMI. CONCLUSIONS: BMI might be a representation of the physical condition brought about by the extent of tumor progression rather than a factor influencing the factors related to gastric carcinoma.

The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma.

PURPOSE: Preoperative assessments regarding a patient's immunological and nutritional condition are required to predict the outcomes of patients with malignant tumors. The aim of the current study was to clarify the significance of Onodera's prognostic nutritional index (OPNI), which can simply account for the immunological and nutritional conditions, in patients with colorectal carcinoma. METHODS: The correlations of the preoperative OPNI value with clinicopathological features were examined in 219 patients with colorectal carcinoma who had been surgically treated. RESULTS: Not only the tumor stage (P = 0.028) and venous invasion (P = 0.002), but also an OPNI of less than 40 (P = 0.002) were found to be independently correlated with a worse prognosis of patients with colorectal carcinoma. CONCLUSION: The preoperative OPNI can be used as a simple prognostic indicator in colorectal carcinoma.

Surgical Treatment Using Artificial Dermis for Women with Locally Advanced Breast Cancer.

Physicians occasionally come across with patients with locally advanced breast cancer (LABC) bringing about distress, due to tumor growth, invasion to the skin, bleeding or an ill smell. Physicians often experience much difficulty in selecting and administering therapeutic option. The clinical courses of patient who had been treated with total resection of LABC and an attachment of artificial dermis (TERUDERMIS) were mentioned. Elimination of the symptoms derived from the tumors could be successfully accomplished for all of the patients. Except for one patients who initially had bone metastasis and died 13 months after operation, the other patients have been alive under preferable condition without any signs for tumor recurrence. The surgical resection and an attachment of artificial dermis is quite reliable and helpful for both patients and physicians in palliating symptoms and reducing care for infections and hemorrhage due to LABC.

Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer.

PURPOSE: Preoperative elevation of serum C-reactive protein (CRP) is a prognostic indicator for some malignant tumors. We investigated the clinicopathologic importance of an elevated preoperative serum CRP value in gastric carcinoma patients. METHODS: We studied the relationship between the preoperative serum CRP value and clinicopathologic characteristics in 204 patients who underwent curative resection of gastric carcinoma. RESULTS: The patients with preoperative CRP elevation had significantly poorer survival than those without CRP elevation (P < 0.0001). According to multivariate analysis, the factors independently associated with an unfavorable prognosis were a high preoperative CRP value (P = 0.024), lymphatic invasion (P = 0.017) and advanced tumor stage (P = 0.016). CONCLUSION: Preoperative serum CRP elevation can be an independent prognostic indicator in patients with gastric carcinoma.

Primary neuroendocrine carcinoma of the breast: report of a case.

Primary neuroendocrine carcinoma (NEC) of the breast appears to be a rare neoplasm. Due to the limited number of the cases, a definitive therapeutic option for the disease has not yet been established. We herein report the case of a 57-year-old female patient with primary NEC of the breast who underwent a surgical resection and for whom the suitable adjuvant therapy is now being considered.

Gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis.

Surgical palliation of malignant obstructive pancreatitis poses a considerable burden to patients, especially those with extensive disease. We herein present a novel technique for performing gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis. The main pancreatic duct was punctured via the wall of the pyloric antrum. After the insertion of a guidewire, a double pigtail-type tube stent with side holes was inserted into the main pancreatic duct through the wall of the pyloric antrum. This technique was useful as a means of accomplishing less invasive palliative treatment, and has the potential to improve the quality of life for patients with malignant obstructive pancreatitis.

[Prominent efficacy from capecitabine mono-therapy for a case with lymphangiosis carcinomatosa derived from recurrent breast cancer].

We met a 61-year-old woman who had been suffering from dyspnea due to pleuritis carcinomatosa derived from recurrent breast cancer for which no former chemotherapy had been effective. Capecitabine mono-therapy could exert a drastic anticancer effect for lymphangiosis carcinomatosa causing more severe symptoms of dyspnea. This therapeutic option could be selected for patients with recurrent breast cancer for which the first- or second-line chemotherapy could not provide a sufficient anti-cancer efficacy and possibly serve to sustain the life quality of the patients.

Assessment of predictors of mortality and severity in patients with colorectal perforation.

Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16.7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.

Spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer: a case report and literature review.

We report a 69-year-old woman with spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer. She was treated for right breast cancer (invasive ductal carcinoma, ypT4bN1M0, stage IIIB) 2 years earlier, and was admitted for right pneumothorax and chest computed tomography, which showed multiple small cavitating lesions in bilateral lungs. The pneumothorax was treated conservatively with chest drainage, but subsequently recurred ipsilaterally. During video-assisted thoracic surgery, we detected small white nodules with visceral pleural rupture; therefore, we performed partial lung resection. The pathological findings revealed metastatic breast cancer with pleural invasion. Forty days later, ipsilateral pneumothorax recurred, and chemical pleurodesis was performed, which resolved the pneumothorax and prevented subsequent recurrence. Early diagnosis and definitive treatment, including pleurodesis, should be considered to prevent recurrence of spontaneous pneumothorax and improve patients' quality of life, even in patients with advanced malignancy.

Pathological prognostic score as a simple criterion to predict outcome in gastric carcinoma.

PURPOSE: The aim of this study was to establish a simple criterion to predict prognosis of patients with gastric carcinoma. METHODS: Two hundred four patients with gastric carcinoma, who had been treated with curative resection, were enrolled. One point was added for each category among four pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. Pathological Prognostic Score (PPS) was determined by an aggregate of these points for each category. RESULTS: There existed a significant difference between survivals of patients with PPS 0 or 1 and 2 or 3 (P = 0.0002). Similarly, there also existed a significant difference between survivals of patients with PPS 2 or 3 and 4 (P = 0.010). CONCLUSIONS: PPS can be quite simple criteria to predict prognosis of gastric carcinoma with a strict stratification.

Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma.

PURPOSE: The prognostic nutritional index (PNI), which is calculated based on the serum albumin concentration and the peripheral blood lymphocyte count, has been used to assess the immunological and nutritional condition of patients with digestive diseases. However, its value as an indicator of aggressiveness in gastric carcinoma has not been fully investigated. METHODS: Two hundred and forty-eight cases of gastric carcinoma were studied with regard to the relationship between the preoperative PNI value and the clinicopathological characteristics of the patients. RESULTS: A lower preoperative PNI value significantly correlated with greater tumor depth, lymph node metastasis, lymphatic permeation, and venous invasion. Moreover, the PNI value proved to be an independent prognostic indicator in gastric carcinoma. CONCLUSION: The PNI value can be a useful tool to predict the prognosis of patients with gastric carcinoma.

Spindle cell carcinoma of the breast - A case report.

Spindle cell carcinoma (SpCC) of the breast is quite a rare modality classified to the metaplastic carcinoma of the breast. Regarding its biological behavior and the prognosis of the patients with this rare tumor, it has been remaining controversial. We herein report an 88 year-old woman who had a huge bleeding tumor on the right breast. She was a high-aged woman with low activities of daily life, even with some suspicion of distant organ metastasis. While the tumor proved to drastically bleed due to the tumor disintegration, a right simple mastectomy was performed. According to the histopathologic examinations, sarcomatoid spindle cells with severe atypia were observed. By an immunohistochemical examination, the tumor had proved to express neither estrogen receptor, progesterone receptor nor HER2 receptor. Moreover an immunohistochemical expression of AE1/3 and CAM5.2, defining an epithelial neoplasm were observed in addition to an expression of vimentin. From these findings, this bleeding tumor was diagnosed as spindle cell carcinoma of the breast. J. Med. Invest. 67 : 365-367, August, 2020.

Clinicopathological characteristics of invasive lobular carcinoma of the breast.

BACKGROUND: The clinical features of invasive lobular carcinoma (ILC) of the breast have remained unclear due to the rarity of such cases. This study investigated the clinical and pathological features of ILC. METHODS: The medical records of 413 patients with invasive breast cancer who underwent surgery in our department were reviewed. These cases included 13 patients with ILC (3.1%). RESULTS: The age of the patients ranged from 36 to 77 years old (mean, 56). The tumour size was evaluated as T1 in five patients, T2-4 in 8. The lymph node metastasis was diagnosed as negative in six patients, positive in six. In this patient population, 11 (85%) and nine (69%) patients were positive for oestrogen and progesterone receptors, respectively. The 5-year survival rate was 76.2%, which was not significantly different from other types of invasive breast cancer. Extensive intraperitoneal metastasis was observed in two of the three patients. Two patients had bilateral carcinoma and one patient had a multicentric lesion in the ipsilateral breast. CONCLUSION: Multicentric development of breast cancer and intraperitoneal metastasis were one of clinical characteristics of ILC. The prognosis of ILC was not significantly different from other types of invasive breast carcinoma.

New scoring system to create a prognostic criteria in colorectal carcinoma based on serum elevation of C-reactive protein and decrease in lymphocyte in peripheral blood.

BACKGROUND: Both serum elevation of C-reactive protein (CRP) and reduction of lymphocyte in the peripheral blood has been known as indicator for malignant potential of human tumors. METHODS: Whether newly devised CLS (CRP/Lymphocyte Score), based on combined data of serum elevation of CRP and of lymphocyte percentage in the peripheral blood can be an indicator for progressive potential in colorectal carcinoma was examined in 280 cases who had been surgically treated. RESULTS: Significant difference in survival was observed both between CLS 0 and 1 and between CLS 1 and 2, in both cases when analyzed among whole patients and patient who had been treated with curative resection. Multivariate analysis among patients who had been treated with curative resection demonstrated that CLS (P < 0.0001), histologic type (P = 0.0003), and tumor stage (P = 0.039) were factors independently associated with worse prognosis of the patients. CONCLUSIONS: Newly devised criteria CLS could be an independent prognostic indicator in colorectal carcinoma and would be utilized as a helpful information. J. Med. Invest. 66 : 264-268, August, 2019.

Expression of cytochrome P450 in non-small cell lung cancer.

Lung cancer accounts for most of cancer-related deaths in both men and women. Lung cancer is also associated with cigarette smoking that exposes the individual to carcinogenic chemicals. Normally, CYP enzymes (cytochrome P450s) metabolize carcinogens to inactive derivatives, however, occasionally the action of CYP enzymes leads to development of more potent carcinogens. In addition to the metabolism of carcinogenic compounds, CYP enzymes are also involved in the activation and/or inactivation of agents, which are used in the treatment of lung cancer. Therefore, the local level of CYP enzymes in lung cancer and surrounding tissues could be an important determinant in the efficacy of anticancer drugs. Furthermore, the expression of CYP19 (aromatase), estrogen synthesis P450, was found in more than 80 percent of non-small cell lung cancers. Lung cancer was also found to frequently express CYP24A1 that converts 1 alpha, 25-dihydroxyvitamin D3 to its inactive 24-hydroxylated derivatives. The understanding of the local expression of CYP enzymes in tumor tissues is important in the development of better treatment for lung cancer and a standardized treatment, tailor-made, for individual patients.

Significance of immunohistochemical expression of estrogen receptors alpha and beta in squamous cell carcinoma of the esophagus.

PURPOSE: Possible significance of sex hormone estrogen as an antitumor therapeutic arm toward esophageal squamous cell carcinoma (ESCC) cells has been suggested. The aim of the current study was to clarify the clinicopathologic significance of an immunohistochemical expression of estrogen receptors alpha and beta (ER alpha and ER beta) in ESCC. EXPERIMENTAL DESIGN: Expression of ER alpha and ER beta were examined using an immunohistochemical methods in 73 paraffin-embedded sections collected from patients with ESCC who had been subjected to esophageal resection and digestive reconstruction without any preoperative induction therapy. RESULTS: Forty-seven (64.4%) ESCCs had a positive cytoplasmic expression of ER alpha and 21 (28.8%) ESCCs had a positive nuclear expression of ER beta. Univariate analysis showed that both positive ER alpha expression (P=0.0001) and negative ER beta expression (P=0.026) were unfavorable prognostic indicators in ESCC. Moreover, multivariate analysis showed that ER alpha-positive/ER beta-negative expression (P=0.003) and progression of tumor stage (P=0.014) were found to be independent unfavorable prognostic indicators in ESCCs. CONCLUSIONS: Immunohistochemical expression of ER alpha and ER beta were found to be observed in ESCC. Positive expression of ER alpha in addition to negative expression of ER beta proved to be an unfavorable independent prognostic indicator in ESCC.