[A Resected Case of Intraperitoneal Foreign Body Granuloma Mimicking Peritoneal Dissemination].

Foreign body granuloma(FBG)is a granuloma that occurs due to chronic inflammation caused by various residual foreign objects. In the field of gastrointestinal surgery, intraperitoneal foreign body granulomas(IPFBGs)are often caused by sutures materials or residual gauzes, but those caused by food residue are extremely rare. We present an IPFBG case of food residue caused by anastomotic leakage, which was difficult to be distinguished from peritoneal dissemination. The patient is a 74- year-old male. Anastomotic leakage occurred following low anterior resection for rectal cancer, peritoneal drainage and ileostomy were performed. 1.5 years after rectal resection, liver metastasis was diagnosed by CT and peritoneal dissemination was diagnosed by PET-CT. Both lesions were resected at the same time. The pathological findings were liver metastasis and FBG. It was presumed to be an FBG formed by food residue left behind after anastomotic leakage. It has reported that FBG caused by residual gauzes were shown a ring-shaped uptake by PET-CT, but that was not observed in our case. In addition, since a nodule suspected of liver metastasis was observed simultaneously, we considered no differential diagnosis other than peritoneal dissemination. IPFBG resembling peritoneal dissemination, occurred after anastomotic leakage. A food residue can cause IPFBG, it is necessary to consider IPFBG in decision making treatment strategy for peritoneal nodule.

[A Strategy of Treatment for Perforated Gastric Cancer].

In past reports, the incidence of gastric perforation accounts for 0.08 to 3.6% of all gastric cancers, and the proportion of perforated gastric cancer(PGC)in gastric perforations is 26 to 32%. In the treatment of PGC, critical care for peritonitis, diagnosis of gastric cancer and curability for gastric cancer are required simultaneously, so it is not easy to decide the treatment strategies. Therefore, for the purpose to consider treatment strategies for PGC, we conducted a clinicopathological study on PGC in our hospital for the past 12 years. There were 22 cases of PGC, and we analyzed clinicopathologically 19 cases excluding perforation during endoscopic resection and perforation during chemotherapy. The R0 surgery group tended to have a good prognosis even in PGC cases, and there was surgery-related death in the one-stage gastrectomy group. So it was considered desirable to perform radical surgery after the general condition was stable by the treatment of peritonitis was given priority in the PGC.

[Clinicopathological Examination of 81 Cases Added Gastrectomy for Early Gastric Cancer after ESD].

As a general rule, our department has performed additional gastrectomy with lymph node dissection(radical surgery: RS) for non-curative endoscopic submucosal dissection(ESD)cases. This time, we performed a clinicopathological study on 81 patients who underwent RS after ESD for 10 years from May 2009 to April 2019. Lymph node metastasis(LNM)was observed in 5 cases and local cancer residue(LCR)was observed in 8 cases. Examination of the presence or absence of LNM and LCR by clinicopathological factors(histopathological type, tumor size, lymphatic invasion[ly], venous invasion[v], horizontal margin[HM], vertical margin[VM], submucosal invasion, ulceration[scar])revealed no significant risk factor for LNM, however, tumor size and HM were significant risk factors for LCR. The relationship between the eCura system and the case rate associated with LNM in our hospital was similar to that in the original report. Regarding the prognosis, there was one local recurrence and no death from the primary disease.

Anion exchanger 2 suppresses cellular movement and has prognostic significance in esophageal squamous cell carcinoma.

BACKGROUND: Recent studies have reported essential roles for various intracellular pH regulators in epithelial carcinogenesis and tumor progression. The aims of the present study were to investigate the role of anion exchanger 2 (AE2) in the regulation of tumor progression-related genes and the prognostic value of its expression in esophageal squamous cell carcinoma (ESCC). RESULTS: AE2 was strongly expressed in KYSE170 and TE13 cells. The depletion of AE2 in these cells increased cell migration and inhibited the induction of apoptosis. The results of the microarray analysis revealed that various matrix metalloproteinase (MMP) signaling pathway-related genes, such as MMP1, MMP12, and TIMP4, were up- or down-regulated in AE2-depleted KYSE170 cells. Immunohistochemical staining showed that AE2 was primarily located in the cell membranes or cytoplasm of carcinoma cells, and its expression pattern at the invasive front of the tumor was related to the pT category. Prognostic analyses revealed that the low-grade expression of AE2 at the invasive front was associated with shorter postoperative survival. CONCLUSIONS: The results of the present study suggest that reductions in AE2 in ESCC enhance cellular movement by activating MMP signaling pathways and are related to a poor prognosis in patients with ESCC. METHODS: In human ESCC cell lines, knockdown experiments were conducted using AE2 siRNA, and the effects on cellular movement and survival were analyzed. The gene expression profiles of cells were examined using a microarray analysis. An immunohistochemical analysis was performed on 61 primary tumor samples obtained from ESCC patients who underwent esophagectomy.

Transient Receptor Potential Melastatin 7 as an Independent Prognostic Factor in Human Esophageal Squamous Cell Carcinoma.

BACKGROUND: Transient receptor potential melastatin 7 (TRPM7) is a Mg2+/Ca2+-permeable channel with kinase activity and is expressed in many solid tumor types. However, it has not been evaluated in esophageal squamous cell carcinoma (ESCC). The aim of this study was to evaluate the prognostic impact of TRPM7 in ESCC and to determine the role of TRPM7 in proliferation, migration and invasion of ESCC. MATERIALS AND METHODS: Immunohistochemistry of TRPM7 for 52 primary tumor samples obtained from patients with ESCC undergoing esophagectomy was performed. Expression of TRPM7 in human ESCC cell lines was analyzed by real-time polymerase chain reaction (PCR). Knockdown experiments were conducted with TRPM7 siRNA, and the effect on cell proliferation, migration and invasion was analyzed. RESULTS: Immunohistochemical staining showed that TRPM7 was found in the cytoplasm of carcinoma cells, and that expression was an independent prognostic factor of good postoperative survival. Suppression of TRPM7 expression with TRPM7-siRNA increased the proliferation, migration and invasion of TE5 ESCC cells. CONCLUSION: The expression of TRPM7 has an impact on the prognosis of patients with ESCC.

The Role of cIAP1 and XIAP in Apoptosis Induced by Tumor Necrosis Factor Alpha in Esophageal Squamous Cell Carcinoma Cells.

BACKGROUND: The inhibitor of apoptosis protein (IAP) family are reported to play important roles in cancer cells evading apoptosis. However, the significance of their expression in human esophageal squamous cell carcinoma (ESCC) cells remains uncertain. AIMS: The present study aimed to investigate the role of the IAP family members in tumor necrosis factor-α (TNF-α)-induced apoptosis of human ESCC cells. METHODS: Five human ESCC cell lines were pretreated with TNF-α, cycloheximide (CHX, protein synthesis inhibitor), epoxomicin (proteasome inhibitor). Apoptosis assay and protein study with Western blot testing were conducted. Knockdown experiments with IAP siRNA were conducted, and the effect on cell apoptosis was analyzed. RESULTS: Significant apoptosis was induced in five ESCC cell lines by TNF-α plus CHX stimulation, but not when treated with TNF-α or CHX alone. The protein expression levels of cIAP1 and XIAP were decreased by treatment with TNF-α in the presence of CHX, and the degree of cIAP1 and XIAP expression decrease was correlated with sensitivity to TNF-α plus CHX-induced apoptosis. Epoxomicin suppressed TNF-α plus CHX-induced degradation of survivin, cIAP1, and XIAP, in addition to apoptosis. A caspase inhibitor (z-VAD-fmk) suppressed TNF-α plus CHX-induced apoptosis, but did not suppress degradation of survivin, cIAP1, and XIAP. Furthermore, cIAP1 or XIAP siRNA transfected cells underwent apoptosis in response to treatment with TNF-α alone. Double knockdown of both genes resulted in further increased apoptosis. CONCLUSION: cIAP1 and XIAP play an essential role in the resistance of ESCC cells against apoptosis.

[Outcome of Patients with Pathological Complete Response after Neoadjuvant Chemotherapy in Advanced Esophageal Cancer].

Neoadjuvant chemotherapy(NAC)has been proven to have survival benefit for patients with resectable advanced esophageal squamous cell carcinoma(ESCC). Among a total of 208 patients with ESCC who underwent radical surgery following NAC between March 2000 and January 2017, 6 patients achieved histologically complete response. Before NAC, the average major axis length of the tumor was 57 mm, and the clinical stages were Stage II (2 patients)and Stage III (4 patients). FP therapy(cisplatin and 5-fluorouracil)was administered to 4 patients, and DCF therapy(docetaxel, cisplatin, and 5-fluorouracil) to 2 patients. Five patients showed partial response(PR)and 1 showed stable disease(SD). The average number of days between NAC and surgery was 26.2(16-44). Postoperative complications were observed in 2 patients(anastomotic leakage and recurrent nerve paralysis). There was no treatment-related mortality. All patients are surviving without relapse. The present study indicated that DCF therapy for patients with resectable advanced ESCC prior to surgery could further improve prognosis.

[A Case of Laparoscopic-Endoscopic Cooperative Surgery for Duodenal Neuroendocrine Tumor(NET G1)].

We report a case of duodenal neuroendocrine tumor(NET)G1 resected by laparoscopic-endoscopic cooperative surgery (LECS). A 78-year-old woman underwent upper gastrointestinal endoscopy, revealing an 8 mm, rising tumor on the anterior wall of the duodenal bulb. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic ultrasonography showed the tumor might invade the submucosal layer. We performed LECS. The endoscopist marked the dissection line around the tumor and penetrated the duodenal wall. The duodenal wall in the excision area around the tumor was dissected using ultrasonically activated scalpel by the laparoscopist. The closure of the defect in the duodenal wall was performed by the laparoscopic hand-suturing technique. The patient was discharged with no complication on postoperative day 8. The horizontal and vertical margins were free of tumor cells. We demonstrated that LECS for NET of the duodenal bulb anterior wall was useful and safe method to enable appropriate surgical margin and minimum intestinal resection.

[A case of ARDS after esophagectomy treated with low-dose steroid therapy].

A 48-year-old woman was found to have an esophageal cancer, and after preoperative chemotherapy with cisplatin (CDDP)/5-fluorouracil (5-FU), radical subtotal esophagectomy was performed. On the fifth day after surgery, her respiratory condition suddenly worsened and a chest radiograph showed low permeability in both lung fields, leading to a diagnosis of acute respiratory distress syndrome (ARDS) and intubation for mechanical ventilation. Since clinical examination did not detect signs of infection on the seventh day, we began administering hydrocortisone at a dose of 300 mg. Her inflammatory response and respiratory condition improved by the next day and the dose of hydrocortisone was gradually reduced. The patient was extubated on the 13th day, administration of steroids was halted on the 22nd day, and she was discharged from the hospital on the 26th day. ARDS remains a refractory disease and no drug has proven to be effective in randomized controlled trials. The use of steroids for ARDS management remains controversial. Our present case suggests that low-dose steroids from an early stage in uninfected ARDS patients may improve prognosis.