RESUMO
We report on an extremely rare case of a giant solitary fibrous tumor (SFT) of the mesentery in a 65-year-old male who was admitted to our hospital because of lower abdominal pain and abdominal fullness. Computed tomography demonstrated a well-defined solid mass of 25 × 11 cm located in the lower abdomen, which was completely resected during surgery. Histopathologically, this lesion had a heterogeneous cell population, mainly comprising spindle cells with fibrous collagen proliferation, and various other cell populations exhibiting patternless growth. Immunohistochemically, the tumor revealed strong and diffuse staining for CD34, bcl-2, and vimentin, and a high mitotic index (seven mitoses per 10 high-power fields). We diagnosed this case as an SFT of the mesentery, which is unusual according to a PubMed search that reported only nine such cases. Our case may be the largest tumor reported to date, and only one retrieved case reported recurrence, although the lesion was exceptionally large with deep invasion. Nonetheless, the lesion in our case was larger than that in the reported case of recurrence and invasive to the ileum. Since surgery, there has been no evidence of recurrence. Hence, we propose that a large SFT and high mitotic index may present risk factors for recurrence. Therefore, long-term careful follow-up is necessary in such cases, although our case exhibited few risk factors for recurrence. A follow-up at 12 months after surgery found no indications of recurrence.
Assuntos
Mesentério/patologia , Tumores Fibrosos Solitários/patologia , Idoso , Humanos , Masculino , Mesentério/cirurgia , Prognóstico , Tumores Fibrosos Solitários/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The coexistence of gastric cancer with duodenal ulcer has been found empirically to be rare, but why it is rare is difficult to explain satisfactorily. To elucidate this question, we carried out a literature review of the subject. The frequency with which the two diseases coexist is 0.1-1.7%, and the main factor associated with both gastric cancer and duodenal ulcer is Helicobacter pylori infection. However, there are marked differences between the disorders of hyperchlorhydria in duodenal ulcer, and hypochlorhydria in gastric cancer. The most acceptable view of the reason for the difference may be that the acquisition of H. pylori infection occurs mainly in childhood, so that the time of acquisition of atrophic gastritis may be the most important, and if atrophic gastritis is not acquired early, high levels of gastric acid may occur, and consequently acute antral gastritis and duodenal ulcer may occur in youth, whereas, in elderly individuals, persistent H. pylori infections and the early appearance of atrophic gastritis may be the causes of low gastric acid, and consequently gastric cancer may occur. In patients with duodenal ulcer, factors such as nonsteroidal anti-inflammatory drugs (NSAIDs) and dupA-H. pylori strains may contribute to preventing the early acquisition of atrophic gastritis, while acid-suppressive therapy and vascular endothelial growth factor and other entities may inhibit atrophic gastritis. In contrast, in gastric cancer, factors such as excessive salt intake, acid-suppressive therapy, polymorphisms of inflammatory cytokines, and the homB-H. pylori strain may contribute to the early acquisition of atrophic gastritis, while factors such as NSAIDs; fruits and vegetables; vitamins A, C, and E; and good nutrition may inhibit it.
Assuntos
Úlcera Duodenal/complicações , Neoplasias Gástricas/complicações , Animais , Antiácidos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Citocinas/genética , Úlcera Duodenal/epidemiologia , Úlcera Duodenal/etiologia , Comportamento Alimentar , Helicobacter pylori , Humanos , Polimorfismo Genético , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
Recently we encountered two cases of early gastric cancer (EGC) with bone metastasis after surgery. As they were not accompanied by overt liver, lung, or peritoneal metastasis, we examined the clinical significance of bone metastasis in EGC and its mechanisms by a review of the literature. We found only 10 cases of EGC complicated with overt bone metastasis in the English literature, so we also examined the Japanese reports of such cases. The main histologic type of cases of bone metastasis from EGC was the diffuse type, and there were long intervals between surgery and overt bone metastasis. One reason for such long intervals may have been the tumor dormancy. Two types of dormancy, dynamic and static, and two types of postoperative overt metastases, that of micrometastatic origin (normograde metastatic process) and that of bone marrow origin (retrograde metastatic process), were considered. We speculated that there may be specific routes by which the cancer cells infiltrate the bone marrow directly from EGC or lymph node metastasis. The procedures for diagnosing bone micrometastasis using monoclonal antibodies have recently been improved, but their accuracy rates are still not universally accepted. New, more reliable examinations are required to improve the survival rates of EGC.
Assuntos
Neoplasias da Medula Óssea/secundário , Neoplasias Ósseas/secundário , Neoplasias Gástricas/patologia , HumanosRESUMO
We searched for cases of perforation of the gastric tube after esophagectomy for esophageal cancer by reviewing the literature. Only 13 cases were found in the English literature, and serious complications were seen in all cases, especially in cases of posterior mediastinal reconstruction. However, in the Japanese literature serious complications were also frequently seen in retrosternal reconstruction. Gastric tubes are at a higher risk of developing an ulcer than the normal stomach, including an ulcer due to Helicobacter pylori infection, insufficient blood supply, gastric stasis, and bile juice regurgitation. H. pylori eradication and acid-suppressive medications are important preventive therapies for ordinary gastric ulcers, but for gastric tube ulcers the effects of such treatments are still controversial. We tried to determine the most appropriate treatment to avoid serious complications in the gastric tubes, but we could not confirm an optimal route because each had advantages and disadvantages. However, at least in cases with severe atrophic gastritis due to H. pylori infection or a history of frequent peptic ulcer treatment, the antesternal route is clearly the best. Many cases of gastric tube ulcers involve no pain, and vagotomy may be one of the reasons for this absence of pain. Therefore, periodic endoscopic examination may be necessary to rule out the presence of an ulcer.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Esofagoplastia/efeitos adversos , Úlcera Péptica Perfurada/etiologia , Ácido Gástrico/metabolismoRESUMO
We report a rare case of an intra-abdominal bronchogenic cyst. An abnormal lesion was detected on an ultrasonogram, done as part of a physical checkup, in an 81-year-old woman. Computed tomography and magnetic resonance imaging showed a cystic mass attached to the lesser curvature of the stomach. Initially, we suspected a congenital cyst without malignant components; however, as the patient wished to have the lesion removed, we performed a minilaparotomy. The cystic lesion was firmly attached to the lesser curvature by fibrous tissue. Microscopic examination subsequently revealed the 26-mm mass to be a benign bronchogenic cyst with a bronchial element. We compared our findings with those of 50 previously reported cases of intraabdominal bronchogenic cysts. None of these patients was older than ours, and lesions attached to the esophagus or stomach were extremely unusual. Bronchogenic cysts are difficult to diagnose preoperatively based on imaging findings, but surgery may be indicated if malignant components are suspected, or if the lesion is enlarging or causing symptoms.
Assuntos
Cisto Broncogênico/patologia , Estômago/patologia , Idoso de 80 Anos ou mais , Cisto Broncogênico/complicações , Cisto Broncogênico/cirurgia , Feminino , HumanosRESUMO
We report a case of multifocal gastric cancer with a variety of macroscopic and histological findings. A 65-year-old woman was admitted with upper abdominal pain. Her familial history was remarkable in that her mother had died of gastric cancer. The hematological and blood biochemical values were normal, but the serum was positive for Helicobacter pylori immunoglobulin G, and the serum pepsinogen test was also positive. Gastrointestinal fiberscopy showed many granulomatous lesions coexisting with pedunculated polypoid lesions and marked atrophic gastritis throughout the stomach. We performed total gastrectomy with regional lymph node dissection. There were four separate cancers and three hyperplastic polyps with entire intestinal metaplasia. The pathological findings of these multifocal gastric cancers varied, with coexisting differentiated and undifferentiated types, and early and advanced types. One of the pedunculated polypoid lesions was accompanied by papillary adenocarcinoma. Although multifocal gastric cancer is not uncommon, the present case is considered an extremely unusual example of gastric cancer.
Assuntos
Adenocarcinoma/patologia , Gastrite Atrófica/patologia , Pólipos/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Idoso , Feminino , Gastrite Atrófica/complicações , Gastrite Atrófica/cirurgia , Humanos , Hiperplasia , Pólipos/complicações , Pólipos/cirurgia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND AND OBJECTIVES: Th2-dominant immunity and high neutrophil/lymphocyte ratios (NLRs) have been reported to reflect tumor progression, and so we examined whether the Th1/Th2 ratio and NLR can act as prognostic indicators or not. METHODS: Peripheral blood samples were taken within 1 week before and 14 postoperative days after curative gastrectomy using 157 gastric cancer cases for the measurement of both ratios. The proportions of Th1 cells (interferon γ-producing CD4 T cells), Th2 cells (interleukin-4-producing CD4 T cells) were counted by two-color flow cytometry analysis. RESULTS: There were significant differences in 5-year survival both between the high and low Th1/Th2 ratio groups, and between the high and low NLR groups. The pattern classifications before and after surgery in the Th1/Th2 ratio showed strongly significant differences in 5-year survival. NLR was especially influenced by tumor size, and there was a negative linear correlation between the two ratios before surgery. CONCLUSIONS: The Th1/Th2 ratio may be a good prognostic indicator and may also be a promising marker for estimating the effectiveness of surgery. NLR may also be a good prognostic indicator and may be a valid marker of tumor recurrence, and it appeared that some interaction between lymphocytes and neutrophils had occurred.
Assuntos
Interferon gama/sangue , Interleucina-4/sangue , Neoplasias Intestinais/sangue , Linfócitos/patologia , Neutrófilos/patologia , Neoplasias Gástricas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Citometria de Fluxo , Humanos , Neoplasias Intestinais/imunologia , Neoplasias Intestinais/patologia , Metástase Linfática , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Células Th1/imunologia , Células Th2/imunologiaRESUMO
AIM: In order to clarify the anti-cancer effects of tumor necrosis factor-alpha (TNFalpha), we examined the relationship between the preoperative evaluations of TNFalpha and the granulocyte/lymphocyte ratio (G/L ratio) in relation to outcome in gastric cancer patients. MATERIALS AND METHODS: Peripheral blood samples were taken within 1 week before curative gastrectomy for measurement of TNFalpha and the G/L ratio. Five-year survival was determined in 71 operative gastric cancer cases. RESULTS: The 5-year survival of the high TNFalpha group (> or =8,000 pg/ml ) was 64.1%, 29.0% for the low TNFalpha group (<8,000 pg/ml) and 13.3 and 73.1% for those of the high (> or =4.0) and low (<4.0) G/L ratio groups, respectively. The comparisons of these 5-year survival rates showed statistically significant differences. Moreover, there was a negative linear correlation between TNFalpha and the G/L ratio regarding outcome. CONCLUSIONS: Preoperative evaluations with TNFalpha and the G/L ratio may be important prognostic indicators, and their correlation may be a good indicator of the degree of effectiveness in activating anti-cancer immunity in gastric cancer patients.
Assuntos
Granulócitos/fisiologia , Linfócitos/fisiologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Fator de Necrose Tumoral alfa/sangue , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biomarcadores Tumorais/sangue , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Seguimentos , Gastrectomia/métodos , Gastrectomia/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Cuidados Pré-Operatórios/métodos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Neoplasias Gástricas/patologia , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Previous reports indicated that Fas Ligand (FasL) in gastric carcinoma might support tumour cells to evade host immune attack. However, the mechanism induced by the Fas/FasL system has not yet been described on the basis of comparison of normal and malignant tissues in terms of the features of regional location of Fas and FasL. By using immunostaining methods, we studied the distribution and regional location of Fas and FasL in gastric epithelial cells (GECs), gastric carcinoma cells (GCCs), normal gastric stroma-infiltrating lymphoid cells (NGILs) and tumour-infiltrating lymphoid cells (TILs) in 59 tissue specimens of human gastric carcinoma. The expression of Fas within the entire GECs was higher than that in all GCCs (P < 0.0001); however, the expression of Fas in NGILs was lower than that in TILs (P < 0.0001). The expression of FasL showed no significant difference between GECs and GCCs, or between NGILs and TILs. When we analyzed the Fas/FasL expression on cytomembrane (CM) in GECs and GCCs, Fas-in-CM was detected in 79.4% and 33.33% (P < 0.05), compared with 3.03% and 56.67%, respectively, for FasL-in-CM (P < 0.001). Our results suggest that there is indeed a possible mechanism to assist cancer cells to evade host immune attack, and this mechanism depends on the dynamic state of Fas/FasL expression, that is, Fas showed a tendency to be expressed within the cells, whereas FasL showed a tendency to be expressed on the cell membrane following carcinogenesis.
Assuntos
Proteína Ligante Fas/metabolismo , Espaço Intracelular/metabolismo , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/metabolismo , Receptor fas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Celular/metabolismo , Membrana Celular/patologia , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Humanos , Linfócitos/metabolismo , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Transporte Proteico , Neoplasias Gástricas/patologiaRESUMO
2',3'-Dihydrophylloquinone (dihydro-K1) is a hydrogenated form of vitamin K1 (K1), which is produced during the hydrogenation of K1-rich plant oils. In this study, we found that dihydro-K1 counteracts the sodium warfarin-induced prolonged blood coagulation in rats. This indicates that dihydro-K1 functions as a cofactor in the posttranslational gamma-carboxylation of the vitamin K-dependent coagulation factors. It was also found that dihydro-K1 as well as K1 inhibits the decreasing effects of warfarin on the serum total osteocalcin level. In rats, dihydro-K1 is well absorbed and detected in the tissues of the brain, pancreas, kidney, testis, abdominal aorta, liver and femur. K1 is converted to menaquinone-4 (MK-4) in all the above-mentioned tissues, but dihydro-K1 is not. The unique characteristic of dihydro-K1 possessing vitamin K activity and not being converted to MK-4 would be useful in revealing the as yet undetermined physiological function of the conversion of K1 to MK-4.
Assuntos
Vitamina K 1/análogos & derivados , Vitamina K 1/farmacologia , Animais , Masculino , Osteocalcina/sangue , Ratos , Ratos Sprague-Dawley , Distribuição Tecidual , Vitamina K 1/metabolismo , Vitamina K 1/farmacocinéticaRESUMO
We analyzed the histological high-risk factors for recurrence of submucosal invasive carcinomas (pT1) of the colon and rectum after endoscopic therapy, examining pT1 cancers treated primarily by endoscopic resection within a 23-year period. We compared recurrent and nonrecurrent cancers, evaluating the following "highrisk factors" of the primary lesion: massive invasion, a surgical margin<2 mm but negativity for cancer in the cut end, poorly differentiated adenocarcinoma (PD) (G3), undifferentiated carcinoma (G4), and/or positive angiolymphatic invasion. The following histological factors were defined as predictive of a low risk: minimum invasion, a surgical margin>2 mm, well or moderately differentiated adenocarcinoma (G1, G2), and no evidence of angiolymphatic invasion. We analyzed the records of 37 patients with pT1 cancers, including 15 with high-risk factors who underwent subsequent resection. Local recurrence with or without liver metastases developed in 4 of these 15 patients. The histological type was PD in three (75%) of the four recurrent lesions. All four (100%) lesions showed a desmoplastic response (DR). Only 1 (9%) of the 11 patients without recurrence after subsequent surgery had a lesion with a small component of PD, and only three (27%) lesions showed a mild DR. We concluded that endoscopic therapy is inadequate for pT1 cancers with a histological PD component, and/or a DR in the cancer stroma.