Prognostic value of desmoplastic reaction characterisation in stage II colon cancer: prospective validation in a Phase 3 study (SACURA Trial).

BACKGROUND: The characterisation of desmoplastic reaction (DR) has emerged as a new, independent prognostic determinant in colorectal cancer. Herein, we report the validation of its prognostic value in a randomised controlled study (SACURA trial). METHODS: The study included 991 stage II colon cancer patients. DR was classified by the central review as Mature, Intermediate or Immature based on the presence of hyalinised collagen bundles and myxoid stroma at the desmoplastic front. All clinical and pathological data, including DR characterisations, were prospectively recorded and analysed 5 years after the completion of the registration. RESULTS: The five-year relapse-free survival (RFS) rate was the highest in the Mature group (N = 638), followed by the Intermediate (N = 294) and Immature groups (N = 59). Multivariate analysis revealed that DR classification was an independent prognostic factor, and based on Harrell's C-index, the Cox model for predicting RFS was significantly improved by including DR. In the conditional inference tree analysis, DR categorisation was the first split factor for predicting RFS, followed by T-stage, microsatellite instability status and budding. CONCLUSIONS: Histological categorisation of DR provides important prognostic information that could contribute to the efficient selection of stage II colon cancer patients who would benefit from postoperative adjuvant therapy.

Adult pancreatic hemangioma: A case report.

Vascular neoplasms of the pancreas are extremely rare and usually manifest as symptomatic, cystic lesions. This study presents a case that includes the clinicopathologic information used to discriminate pancreatic hemangioma from other types of cystic lesion of the pancreas. A 40-year-old female visited hospital with a chief complaint of abdominal pain. The serum CEA and CA19-9 levels of the patient were within the normal limits. An abdominal computed tomography scan and magnetic resonance imaging showed a 100-mm mass lesion in the body and tail of the pancreas, and the tumor extended toward the retroperitoneum and surrounded the splenic vein. The lesion was subsequently resected. Macroscopically, it was a multiloculated cyst with intracystic hemorrhage. Microscopically, the lesion was composed of numerous, heterogeneous cysts lined by a flattened single layer of cells without significant atypia. Notably, numerous neoplastic vessels extended into the interlobular septa of the pancreas and surrounded the main pancreatic duct. Immunohistochemical analysis showed that the lining cells expressed CD31 and CD34. The lesion was diagnosed as adult pancreatic hemangioma. Surgical treatment may be required when a direct contact between the lesion and the pancreatic tissue is demonstrated using imaging.

[Cisplatin and S-1 combination therapy after reduction surgery for stage IV gastric cancer].

To evaluate the efficacy of cisplatin and S-1 combination therapy after reduction surgery for Stage IV gastric cancer, we retrospectively examined 73 patients with Stage IV gastric cancer who underwent gastrectomy. We classified the patients into the following four groups according to their postoperative therapies and analyzed their outcomes: A) S-1 +CDDP therapy (n=22); B) oral 5-FU therapy (n=30); C) 5-FU+CDDP therapy (n=14); and D) S-1 therapy (n= 7). The median survival time was 465 days in the S-1+CDDP therapy group, 158 days in the oral 5-FU therapy group, 332 days in the 5-FU+CDDP therapy group, and 374 days in the S-1 therapy group. The respective 2-year and 3-year survival rate was 37.8% and 20.2% in the S-1+CDDP therapy group, 3.4% and 3.4% in the oral 5-FU therapy group, 7.1% and 0% in the 5-FU+CDDP therapy group, and 0% and 0% in the S-1 therapy group, respectively. We consider that S-1+CDDP therapy after reduction surgery improves survival in patients with Stage IV gastric cancer and should be further investigated.

Effect of fexofenadine hydrochloride on cedar pollinosis.

OBJECTIVE: To investigate the therapeutic efficacy of fexofenadine hydrochloride (Allegra(R) tablets), an antihistaminic launched in 2001, in patients with cedar pollinosis by dividing them into two groups for comparison, i.e. the early-treatment group in which treatment was started before the initial day of the pollen scattering, and the therapeutic-treatment group in which treatment was started after the initial day of the pollen scattering. METHODS: Early-treatment group: patients who visited the hospital before the initial day of cedar pollen scattering were orally given one tablet of the drug twice daily. Therapeutic-treatment group: patients who visited the hospital after the initial day of cedar pollen scattering were orally given one tablet of the drug twice daily. The total number of cases in which the efficacy evaluation was possible was 37 cases (19 cases of the early-treatment group and 18 cases of the therapeutic-treatment group) after application of exclusion criteria. RESULTS: The useful rate of moderately effective or better against sneeze was 90% in the early-treatment group, and 78% in the therapeutic-treatment group, and there was a significant difference between both groups. The degree of satisfaction in the early-treatment group was 3.8 points, and 4.2 points in the therapeutic-treatment group, and the therapeutic-treatment group showed a higher score, but there was no significant difference between both groups. As adverse reaction, there was only one case of mild dizziness (2.7%), and no other adverse reactions such as sleepiness were observed. CONCLUSIONS: It was suggested that fexofenadine hydrochloride administered in patients with cedar pollinosis from before substantial pollen scattering might control their symptoms to mild ones, and might control worsening of their symptoms after the substantial pollen scattering, and, therefore, the drug was considered to be useful in early therapy.

A case of an inverted tooth in the nasal cavity.

We report a case of an inverted tooth in the nasal cavity. The patient was a 27-year-old man who attended our hospital in May 1998, complaining of left cheek-pain. There was nothing remarkable in his medical or family history. Fiberscopic (intranasal) and radiological examinations revealed a white foreign body in the left nasal cavity, within 2 cm of the left nostril. This foreign body was diagnosed as an inverted tooth. It was removed under general anesthesia and found to be 17 mm in length. Although the tooth showed a single root, it possessed two cusps and we deduced it to be a molar.

Two cases of Aspergillus sinusitis with bone destruction.

We experienced the clinical courses of two cases of destructive Aspergillus in paranasal sinuses in which an Aspergillus fungus ball was formed, and which caused bony destruction are described. The case in which a nidus could not be completely surgically removed and with intervening diabetes had an unfavorable prognosis. It is recommend to perform an early expanded operation as well as to administer a sufficient amount of antifungal drugs for the treatment of destructive Aspergillus in paranasal sinuses.