Clinical Implication of Tumor-invasive Status into the Muscularis Propria in T2 Gastric Cancer.

BACKGROUND/AIM: Several studies have investigated prognostic factors in patients with T2 gastric cancer, but no consensus has been reached to date. The aim was to investigate the clinicopathological significance of the status of tumor invasion into the muscularis propria (MP) in T2 gastric cancer patients. PATIENTS AND METHODS: A total of 113 patients with T2 cancer were enrolled. The status of caner invasion was analyzed according to width (extent of horizontal invasion) and depth (extent of vertical invasion). RESULTS: The prognosis of the group with wide width of invasion (≥1.5 cm) was significantly poorer than that of the group with narrow width of invasion (<1.5 cm) (p=0.001). Multivariate analysis identified the width, and not the depth, as an independent prognostic factor. The analysis according to AJCC N stage showed that the width, and not the nodal status, was an independent prognostic factor in the N2-N3 patients (p=0.005). CONCLUSION: Measurement of the width of tumor invasion into the MP was useful to understand the malignant potential of T2 gastric cancer.

Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign.

The Torricelli-Bernoulli sign is a computed tomography (CT) finding that occurs when ulceration/necrosis of a submucosal gastrointestinal tumor releases a stream of air bubbles into the intestinal lumen. A 75-year-old man developed acute abdominal pain at night and presented to a local doctor. Acute abdomen was diagnosed and he was referred to the Emergency Department at Tokai University Oiso Hospital. On CT scans, disseminated intestinal tumor-like lesions were seen in the right lower abdomen. The Torricelli-Bernoulli sign and free intraabdominal gas were observed, so perforation of an intestinal tumor was diagnosed and emergency surgery was performed. At operation, there was scanty opaque ascites in the right lower abdomen and an ileal tumor associated with nodules that suggested peritoneal dissemination. Partial resection of the ileum was performed and peritoneal lavage was conducted. The patient was discharged on postoperative day 11. Histopathological examination revealed a high risk gastrointestinal stromal tumor. The abdominal nodules were metastases, indicating that the tumor was Stage IV. The patient is currently on treatment with an oral tyrosine kinase inhibitor (imatinib).

An Intra-Abdominal Desmoid Tumor, Embedded in the Pancreas, Preoperatively Diagnosed as an Extragastric Growing Gastrointestinal Stromal Tumor.

A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

Clinical Implication of the Width of Subserosal Invasion in T3N0 Gastric Cancer.

BACKGROUND: The aim of this study was to clarify the impact of the horizontal width of tumor invasion into the subserosal layer on prognosis in patients with T3N0 gastric cancer. PATIENTS AND METHODS: A total of 72 patients with T3N0 cancer were enrolled. Relapse-free survival of the subgroups classified according to width of subserosal invasion was compared to that of 34 patients with T4aN0 cancer. RESULTS: The group with wide invasion (≥1.5 cm) had a significantly poorer prognosis than those with narrow invasion (<1.5 cm) (p=0.014). Multivariate analysis revealed the width of subserosal invasion to be an independent prognostic factor. There was no significant difference between the T3N0 group with wide invasion and the T4aN0 group in the prognosis and recurrent status. CONCLUSION: The malignant potential of T3N0 gastric cancer with wide subserosal invasion was found to be similar to that of T4aN0 cancer.

Repeated Hepatectomy for Recurrent Intrahepatic Cholangiolocellular Carcinoma: Report of a Case.

The patient was a 59-year-old female. A liver tumor measuring 10 cm was found in the right hepatic lobe by medical examination of August, 2008 and she underwent extended right hepatectomy in September. Microscopically, the tumor was composed of small cuboidal cells possessing oval nuclei and resembling cholangiole. These formed small tubular structures with fibrous stroma. From a result of histopathological features, a diagnosis of a cholangiolocellular carcinoma was made. She received postoperative adjuvant chemotherapy with gemcitabine and S-1. After that, the patient underwent six partial hepatectomies by August, 2013 for recurrent intrahepatic cholangiolocellular carcinoma. The patient is doing well 7 years after the first hepatectomy. Cholangiolocellular carcinoma is a rare tumor accounting for less than 1% of primary liver cancer, and the clinicopathologic features are not fully understood. Aggressive surgical resection may be one of the choices to assure a good outcome.

Solitary Fibrous Tumor of the Stomach Treated with Laparoscopic and Endoscopic Cooperative Surgery.

A 43-year-old Japanese woman with melena underwent an upper gastrointestinal endoscopy and was preoperatively diagnosed with sarcoma of the stomach. Physical examination revealed no abnormalities. Findings on the upper gastrointestinal endoscopy showed a pedunculated submucosal tumor measuring 17 mm in the antrum. An enhanced computed tomography showed wall thickening in the gastric antrum. The patient underwent a laparoscopic and endoscopic cooperative surgery (LECS) for wedge resection of the stomach. The excised tumor measured 27 × 20 × 15 mm in size. Histopathology showed spindle-shaped cells in the submucosal layer. Immunohistochemistry showed that the tumor was positive for CD34, bcl-2, and MIC-2. The final diagnosis was solitary fibrous tumor (SFT) of the stomach. The postoperative course was uneventful, and no evidence of recurrence was observed at the 8-month follow-up. We report a case of SFT arising from the stomach that was treated with wedge resection by LECS.

Combination of Laparoscopic and Endoscopic Approaches to Neoplasia with Non-exposure Technique (CLEAN-NET) for GIST with Ulceration.

Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) was developed to avoid intraoperative tumor dissemination. We report two cases of gastric gastrointestinal stromal tumor (GIST) with ulceration surgically treated with CLEAN-NET at our institution. The first case was a 55-year-old male with hematemesis. Gastric endoscopy revealed a gastric GIST with ulceration of the fornix. CLEAN-NET was performed with the insertion of five trocars and a liver retractor. The operative time was 202 min (including cholecystectomy), with a perioperative blood loss volume of 29 ml; the postoperative hospital stay duration was 8 days. The second case was a 66-year-old male with a gastric submucosal tumor (SMT) with ulceration. CLEAN-NET was performed in a similar fashion to the first case. The operative time was 128 min, with a preoperative blood loss volume of 16 ml; the postoperative hospital stay duration was 9 days. In conclusion, CLEAN-NET was found to be safe and useful in the treatment of gastric GIST with ulceration.

Clinicopathologic features and clinical outcomes of gastric cancer patients with bone metastasis.

OBJECTIVE: We conducted a retrospective analysis to evaluate the clinical manifestations and outcomes of a population of gastric cancer patients with bone metastasis. METHODS: The subjects were 31 gastric cancer patients who were diagnosed with bone metastasis between January 2000 and December 2010. RESULTS: The overall median survival time (MST) was 100 days. The results of a multivariate analysis in relation to overall survival showed that the absence of extraosseous metastasis and having received chemotherapy were favorable prognostic factors. MST was 269 days in the bone metastasis alone group (n = 6) and 65 days in the extraosseous metastasis group (n = 25). We divided the extraosseous metastasis group into two subgroups according to whether the patient had received chemotherapy. Evaluation of the response in the chemotherapy group showed that the subgroup of patients with progressive disease had a significantly longer MST than the no-chemotherapy group (63 days vs. 21 days, p = 0.012). CONCLUSIONS: We concluded that it is useful to divide gastric cancer patients with bone metastasis into two groups according to whether they have extraosseous metastasis. Aggressive chemotherapy should be considered as a means of improving the prognosis of gastric cancer patients with extraosseous metastasis.