Clinicopathological characteristics and therapeutic outcomes of synchronous gastric adenocarcinoma and gastric lymphoma.

BACKGROUND: Synchronous primary gastric adenocarcinoma and lymphoma is a rare occurrence. The aim of the present retrospective study was to analyze the clinicopathological characteristics and therapeutic outcomes of patients with this rare condition to identify post-therapeutic prognostic factors. PATIENTS AND METHODS: A PubMed and MEDLINE search was performed to identify relevant articles, using the keywords 'gastric cancer' and 'gastric malignant lymphoma', while additional articles were obtained from references within these papers. A total of 57 patients who were treated for synchronous primary gastric adenocarcinoma and lymphoma were included in the study. A retrospective review was performed on the clinical characteristics of this disease. RESULTS: The median survival time for patients in this study was 81 months and the overall 1- and 5-year survival rates after therapy were 77.6% and 69.0%, respectively. The median survival period of patients with an advanced gastric cancer was significantly shorter than for early gastric cancer (p<0.001), while the depth of gastric lymphoma invasion did not significantly affect survival time. The median survival period of patients who underwent total gastrectomy was significantly shorter than that of those who underwent distal gastrectomy (p=0.035). Gastric lymphomas were significantly larger than the gastric adenocarcinomas (6.0 vs. 2.7 cm, respectively; p=0.012). CONCLUSION: The prognosis for synchronous gastric adenocarcinoma and lymphoma might depend more on the behavior of the adenocarcinoma than on the lymphoma, in which case the treatment and therapeutic outcomes could depend on the adenocarcinoma status.

Study of the intrahepatic surgical margin of hilar bile duct carcinoma.

BACKGROUND/AIMS: The diagnosis and treatment for hilar bile duct carcinoma has greatly improved. Frozen section is one of the modalities used to determine the intrahepatic surgical margin and the surgical approach for tumor resection. But we are sometimes faced with the case where we are perplexed whether to carry out additional surgical resection or not according to the result of frozen section, due to its inaccuracy. We studied herein the relation between the prognosis and the intrahepatic surgical margin according to the result of frozen section. METHODOLOGY: We reviewed 23 cases of hilar bile duct carcinoma whose intrahepatic surgical margin was determined by frozen section and studied the cause of death and surgical procedure. Results of the frozen sections were compared with the permanent paraffin sections. RESULTS: The overall survival rates at 1, 3 and 5 years after operation were 68.1, 41.3, and 33.0%, respectively. The accuracy, sensitivity and specificity of frozen section was 56.5%, 75.0%, and 46.7%, respectively. CONCLUSIONS: We concluded that by evaluating the diagnosis of frozen section during the surgery it was difficult to determine intrahepatic surgical margin. Aggressive hepatic resection sometimes causes a high risk of hepatic failure in which case the histological diagnosis of the frozen section throughout should not be carried out.