[A case of long survival after resection and treatment with imatinib mesylate against metachronous liver metastases and a lung metastasis of a small intestine gastrointestinal stromal tumor].

A 68-year-old man was admitted to our hospital because of an abdominal tumor. Computed tomography(CT)showed a 6 cm tumor in the abdominal cavity. Surgery was performed. Upon laparotomy, a 6 cm tumor was found at the small intestine (210 cm)on the anal side from the Treitz ligament. A partial resection of the small intestine was performed. Immunohistochemistry showed positive staining for c-kit, and the diagnosis of gastrointestinal stromal tumor was confirmed. Multiple liver metastases and a lung metastasis were observed over the next 2 years. We started chemotherapy with imatinib mesylate at a dose of 400mg/day. The size of the tumors was unchanged, and no new lesion was observed. The patient has been alive and well as of 6 years after the initial operation.

Minilaparoscopic versus conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials.

PURPOSE: We evaluated reports of minilaparoscopic cholecystectomy as compared to conventional laparoscopic cholecystectomy. MATERIALS AND METHODS: We searched the Medline, Embase, and Cochrane library databases for randomized controlled trials reported between January 1996 to December 2005. The outcome measures used were operative time, length of hospital stay, postoperative pain, postoperative analgesic requirement, and cosmetic results. Meta-analysis methods were used to measure the pooled estimate of the effect size. RESULTS: Data from 712 patients (352 minilaparoscopic cholecystectomy and 360 conventional laparoscopic cholecystectomy) in 12 randomized controlled trials were analyzed. The statistically significant advantages of minilaparoscopic cholecystectomy were less postoperative pain and better cosmesis. Conventional laparoscopic cholecystectomy showed a trend to shorter operative time that did not reach statistical significance. CONCLUSION: Minilaparoscopic cholecystectomy could be a feasible alternative to conventional laparoscopic cholecystectomy in select patients, resulting in less pain and better cosmetic results. Additional well-designed randomized controlled and, if possible, blinded trials, with large sample sizes, are required to confirm this conclusion.

Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer?

PURPOSE: A sentinel node is defined as the initial lymph node, to which cancer cells metastasize from a primary tumor. Recently, sentinel node navigation surgery has been done using the dye-guided method. However, no study has shown that a lymph node detected by the dye-guided method is the true sentinel node from the viewpoint of micrometastasis. Micrometastases of lymph nodes, in which no metastasis was found by H&E staining, were examined to establish whether a lymph node detected by the dye-guided method is the true sentinel node. EXPERIMENTAL DESIGN: Isosulfan blue was injected endoscopically as the dye-guided method at a submucosal lesion of early gastric cancer. Total 345 lymph nodes, including 150 blue-dyed lymph nodes and 195 nondyed lymph nodes were collected from 57 patients and each was quartered. Two quarters were examined histologically by H&E staining and cytokeratin staining. The other specimens were used for quantitative reverse transcription-PCR of CEA and CK20 mRNAs. RESULTS: Lymph node disease was not found in any of 345 lymph nodes from the 57 patients by routine H&E staining. By contrast, either CEA or CK20 mRNA expression was detected in 21 of 345 lymph nodes obtained from the 10 (18%) of 57 patients by quantitative reverse transcription-PCR. Eight of the 21 micrometastasis-positive lymph nodes were confirmed to be positive for cytokeratin staining. Although micrometastasis of nondyed lymph nodes was found in three cases, these were included in the 10 cases with micrometastasis of blue-dyed nodes, such that there was no patient who only had micrometastasis in nondyed nodes. Six of 10 cases were micrometastasis-positive in a single node; all six were blue-dyed nodes. CONCLUSION: A lymph node detected by the dye-guided method should be a true sentinel node to which cancer cells metastasize initially.

A case of osteoclast-type giant cell tumor of the pancreas with high-frequency microsatellite instability.

It has been reported that osteoclast-type giant cell tumor of the pancreas (OGTP) is rare, with a frequency of only 0.2% of the total reported pancreatic carcinomas. We report herein a rare case of OGTP in a 57-year-old Japanese man. Preoperative examinations showed a solid and cystic tumor, measuring 20 x 15 cm at the pancreas body. The resected specimen was a solid tumor with a giant cyst containing bloody contents. The tumor was composed of a proliferation of mononuclear cells admixed with osteoclast-type giant cells. The tumor cells were immunoreactive for vimentin, alpha1-antitrypsin, and EMA but not for CEA and cytokeratin. These findings indicated that this case was a malignant OGTP. The tumor cells showed microsatellite instability with high frequency (MSI-H). The present patient is alive 3 years after the operation, while OGTP has been reported to have a poor outcome. It has been reported that pancreatic carcinomas with MSI-H status have a favorable outcome. MSI-H might be one of the predictive markers for the long survival in OGTP.

Tranilast (N-3,4-dimethoxycinamoyl anthranilic acid): a novel inhibitor of invasion-stimulating interaction between gastric cancer cells and orthotopic fibroblasts.

BACKGROUND: Fibroblasts produce various cytokines that affect the invasion ability of cancer cells. We have previously reported that gastric fibroblasts play an important role in the metastatic process of gastric cancer. Tranilast is a clinical drug for inhibition of fibroblast growth. To develop a drug for cancer invasion, the effect of Tranilast on the invasion-stimulating interaction was examined. MATERIALS AND METHODS: The human gastric carcinoma cell line, OCUM-2D, and the gastric fibroblast cell line, NF-10, were used. The effect of Tranilast on the invasion ability of OCUM-2D cells with NF-10 cells was examined by invasion assay. RESULTS: The invasion ability of OCUM-2D cells was significantly increased by co-culturing with NF-10 cells (p < 0.01). Tranilast, at concentrations of more than 0.01 mM, significantly suppressed the invasion ability of OCUM-2D cells co-cultured with NF-10 cells. Tranilast decreased matrix metalloproteinase-2 (MMP-2) and transforming growth factor-beta 1 (TGF-beta 1) production from fibroblasts. TGF-beta 1 enhanced the MMP-2 production from fibroblasts. The invasion ability of gastric cancer cells was increased by MMP-2 and TGF-beta 1 from fibroblasts and this effect was inhibited by Tranilast, which decreased the MMP-2 and TGF-beta 1 production from fibroblasts. CONCLUSION: Tranilast may be a promising new drug for preventing the metastasis of gastric cancer.