Difficult differential diagnosis of delayed mesh infection following inguinal hernia surgery involving appendiceal cancer: A case report.

INTRODUCTION: We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer. PRESENTATION OF CASE: The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis. DISCUSSION: This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections. CONCLUSION: This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries.

Adenocarcinoma occurring from a sigmoid colostomy 20 years after Hartmann's procedure for rectal cancer: A case report.

INTRODUCTION: Cancer arising from the stoma is relatively rare. There is no established surgical procedure for stomal cancer. Furthermore, when a subcutaneous lymphovascular invasion occurs, there is no consensus on whether lymph node dissection along the lymph flow is required. We diagnosed colorectal cancer 20 years after radical resection of rectal cancer. PRESENTATION OF CASE: We encountered a 70-year-old man who had undergone Hartmann's procedure for rectal cancer 20 years before consultation. Colonoscopy revealed a 30-mm-sized sub-pedunculated polyp with a base at the stoma, and a well-differentiated adenocarcinoma was detected. Approximately 30 mm of the intestinal tract, including the stoma and skin in contact with the tumor, was resected. Pathological examination revealed submucosal invasive cancer with infiltration into the resected skin dermis and invasion of lymphatic vessels under the mucosa. Surgical margins were negative. DISCUSSION: It is thought that several causes overlap for stomal cancer, although a clear cause of occurrence is yet to be identified. However, as no established surgical procedure exists, the necessity for resection of the lymph nodes without exposure appears indisputable. Although it was reported that skin or subcutaneous metastasis in colorectal cancer is generally regarded as a symptom of systemic metastasis, opinions on the subcutaneous dissection margin of stomal cancer are rarely discussed. CONCLUSION: Stomal cancer can be observed macroscopically without colonoscopy. Patients and staff engaged in stoma care should be fully aware that continuous observation of the stoma is necessary even after rectal cancer surveillance is complete.

A large-scale study of MT1-MMP as a marker for isolated tumor cells in peripheral blood and bone marrow in gastric cancer cases.

BACKGROUND: Recently, a marker for predicting metastasis or recurrence precisely in solid cancers has been focused on instead of the identification of isolated tumor cells detected by epithelial genes in circulating system. We identified a candidate marker in gastric cancer by microarray and validated it through a quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay. METHODS: To identify metastasis-related genes, we performed cDNA microarray analysis of total RNA from whole bone marrow blood from six cases with metastasis and three cases without metastasis. We determined clinical significance of the identified gene by microarray analysis with quantitative real-time RT-PCR in bone marrow and peripheral blood from 810 cases of gastric cancer. RESULTS: We focused on membrane type 1 matrix metalloproteinase (MT1-MMP) as a candidate marker to predict distant metastasis among identified genes. MT1-MMP-positive expression in peripheral blood was associated with incidence of peritoneal dissemination, lymphatic permeation, vascular permeation, and lymph node metastasis. MT1-MMP-positive expression in bone marrow was also significantly related to the incidence of distant metastasis and peritoneal dissemination. CONCLUSION: The expression of MT1-MMP in peripheral blood from gastric cancer cases was a powerful indicator of distant metastasis especially for peritoneal dissemination. The presence of MT1-MMP-expressing cells in bone marrow indicated higher risk for distant metastasis in gastric cancer cases.

BAC clones related to prognosis in patients with esophageal squamous carcinoma: an array comparative genomic hybridization study.

PURPOSE: The prognosis of patients with esophageal carcinoma is poor. To identify genomic alterations associated with poor patient prognosis, we analyzed whole DNA copy number profiles of esophageal squamous carcinomas (ESCs) using array-based comparative genomic hybridization (aCGH). MATERIALS AND METHODS: Twenty-one operated and two biopsied cases of esophageal squamous cancer were examined for study. Each sample was laser microdissected to obtain pure cancer cell populations. The extracted DNA was analyzed using aCGH. RESULTS: One of the most representative alterations was a previously reported amplification at 11q13.3. In addition, some novel alterations, such as deletion of 16p13.3, were identified. Of the 19 patients who were reassessed more than 5 years after the operation, nine were still living and 10 had died from disease recurrence. When aCGH profiles from the surviving group and the deceased group were compared, significant differences were recognized in 68 of 4,030 bacterial artificial chromosome (BAC) clones. Almost half of these clones were present at nine limiting regions in 4q, 13q, 20q, and Xq. For 22 of these 68 BAC clones, there also was a significant difference in the Kaplan-Meier survival curve, using the log-rank test, when comparing patients who had an alteration in a particular clone with those who did not. CONCLUSIONS: aCGH study of esophageal squamous cancer clearly identified BAC clones that are related to the prognosis of patients. These clones give us the opportunity to determine specific genes that are associated with cancer progression.