Number of Lymph Nodes in Rectal Cancer is Correlated with Response to Preoperative Chemoradiotherapy but is not Associated with Patient Survival.

BACKGROUND/AIMS: We aimed to clarify the oncological significance of the number of lymph nodes in rectal cancers treated with preoperative chemoradiotherapy. METHODOLOGY: We studied 126 curatively operated patients with clinical T3-T4 and M0 rectal cancers. The number of lymph nodes and clinicopathological features were compared between the patients treated with surgery alone (OP group, n = 45) and those treated with preoperative chemoradiotherapy (50-50.4 Gy in 25-28 fractions with tegafur-uracil and leucovorin, CRT group, n = 81). Factors influencing lymph node count and its prognostic significance were analyzed. RESULTS: The CRT group had significantly fewer lymph nodes than the OP group (12.4 vs. 21.1, P < 0.0001). High histological regression of rectal lesions was significantly correlated with decreased lymph node count in the CRT group. In the OP group, the 5-year cancer-specific survival rate of the patients with 12 or more lymph nodes was significantly better than those with fewer than 12 lymph nodes (75.1% vs. 33.3%, P = 0.02); in the CRT group, on the other hand, these survival rates did not differ (84.5% vs. 77.5%, P = 0.6). CONCLUSIONS: The number of lymph nodes in rectal cancer was correlated with the response of primary rectal lesions to chemoradiotherapy, and was not associated with patient survival.

A case report of thyroid gland metastasis associated with lung metastasis from colon cancer.

Thyroid gland metastasis of malignant tumors is observed in 1.9% to 9.5% of histologically examined autopsy cases. Thyroid metastasis from colon cancer is extremely rare and the prognosis is poor. Here we report a case of lung metastasis and thyroid gland metastasis following sigmoid colon cancer surgery. In 2000, a 58-year-old woman underwent a sigmoid colectomy for sigmoid colon cancer. In 2005, a metastatic lung tumor was detected by chest CT. The patient underwent a partial thoracoscopic resection of the left lung in April 2005. On a CT scan taken 3 years and 4 months after the lung resection, a tumor mass was observed in the left lung and a low-absorption region with an unclear border was seen in the left lobe of the thyroid gland. Thyroid aspiration cytology showed adenocarcinoma, and a diagnosis of thyroid gland metastasis from sigmoid colon cancer was made. In April 2008 a subtotal thyroidectomy was performed. Following surgery, the patient underwent chemotherapy with mFOLFOX6 and bevacizumab. Nevertheless a number of lung metastases and expressions of lung metastasis were subsequently observed. Histopathological examination revealed a number of metastases of differentiated papillary adenocarcinoma in the thyroid gland from colon cancer.

Perforation of the small bowel due to metastasis from tongue cancer.

Distant small bowel metastases from head and neck squamous cell carcinomas are extremely rare, and tongue cancer metastasizing to the small bowel has not been previously reported. We describe a 40-year-old male patient who underwent subtotal gross laryngectomy for squamous cell carcinoma of the tongue in February 2007 and then presented in November 2008 with severe abdominal pain. Abdominal computed tomography (CT) and X-rays revealed free air, suggesting intestinal perforation. Emergency surgery revealed a 10-mm perforation at the ileum and a palpable hard tumor at the perforation site. The ileum was resected, and pathologic findings showed squamous cell carcinoma at the perforation site, which was consistent with metastasis from tongue cancer.

Skin metastasis from sigmoid colon cancer.

Skin metastases from visceral cancers are rare and the reported incidence from all visceral cancers is 1.4% to 10%. Skin metastases from colorectal cancers account for only 5% of metastatic skin cancers, among which scalp metastases are very rare. We describe a 53-year-old man with scalp metastasis derived from sigmoid colon cancer that was diagnosed and surgically resected in 2005. Metastatic lung tumors that developed thereafter were surgically resected and then chemotherapy was administered. However, metastatic brain tumors occurred in 2008, and these were treated by gamma-knife radiosurgery. Around the same time, a raised lesion that appeared on the scalp was diagnosed as skin metastasis and treated with best supportive care. Thereafter, the brain metastases continued to spread, and the patient died in October 2008.

Predictive value of cancer stem-like cells and cancer-associated genetic markers for peritoneal recurrence of colorectal cancer in patients after curative surgery.

OBJECTIVE: The new concept of cancer stem cells has implications in terms of possible application for novel diagnostic and therapeutic procedures. Recently, the CD133 molecule was reported as a marker of cancer stem-like cells in colorectal cancer (CRC). In this study, we examined the prognostic value of free cancer cells in peritoneal washings from CRC patients after curative resection using multiple molecular markers, including cancer stem-like cells. METHODS: A total of 170 CRC patients who had undergone curative surgery were studied. Peritoneal washings of the Douglas cavity were collected and used for cytology and molecular diagnosis. Real-time RT-PCR for carcinoembryonic antigen (CEA), cytokeratin 20 (CK20) and CD133 mRNA was performed to detect free cancer cells. RESULTS: Molecular detection of CEA, CK20 and/or CD133 (CEA/CK20/CD133) mRNA of the peritoneal washings showed a significant correlation with lymph node metastasis and the tumor stage. The overall survival (OS) rates and peritoneal recurrence-free survival (PFS) rates in CEA/CK20/CD133 mRNA-positive patients were significantly lower than those of marker gene-negative patients. CD133/CEA/CK20 mRNAs in peritoneal washings were independent prognostic factors for OS and PFS. CONCLUSION: Molecular detection of free cancer cells using multimarkers, including cancer stem-like cells in peritoneal washings of post-curative surgery CRC patients, are useful in prognosis prediction.

A case of appendiceal Crohn's disease in which a laparoscopic appendectomy was performed.

A 74-year-old female had occasionally experienced right lower abdominal pain in the past. She underwent a barium enema examination during a medical checkup, which revealed a wall irregularity around the appendix, but the appendix itself was not visualized. The patient was referred to our hospital for possible appendiceal neoplasm. Colonoscopy revealed a tumor-like protrusion with marked redness at the entrance to the appendix. Pathologic analysis of biopsy specimens revealed only inflammatory cells. Differential diagnosis of appendiceal Crohn's disease or appendiceal neoplasm was made, and laparoscopic appendectomy was performed. Pathologic examination revealed inflammation in all layers of the appendiceal wall and noncaseating epithelioid cell granuloma, and a diagnosis of appendiceal Crohn's disease was made. The postoperative course was uneventful, and the patient was discharged from the hospital 3 days after surgery. No sign of recurrence has been observed up to now, 6 months after surgical treatment.

A case of paracecal hernia.

A 63-year-old male patient suddenly suffered right lower abdominal pain. The patient had tenderness and rebound tenderness at the right lower abdomen. Marked small bowel dilatation and an intestinal obstruction were evident upon abdominal X-ray and abdominal computed tomography (CT) imaging. CT imaging also revealed a dilated small bowel cluster in a wrapped round shape in the right lower abdomen. The cecum and the ascending colon were displaced inward. Strangulation in the ileocecal region was suspected, and emergency surgery was performed. A part of the small bowel was incarcerated within the retrocecal recess, and the intestinal tract was strangulated in the hernia orifice, by which paracecal hernia was diagnosed. The strangulated intestinal tract was repositioned, and the orifice to the hernia was closed. Paracecal hernia is a rare disease; an internal hernia should always be considered in patients with ileus without a history of surgery.

[A treatment for pulmonary metastases from colorectal cancer by pre-operative CPT-11/5'-DFUR combination therapy].

There is no standardized consensus at each institution about a treatment for pulmonary metastases from colorectal cancer. A case of pulmonary radical resection can expect a good result. However, a result of a nonoperative case is extremely poor. A focal control until the time of operation to a metastatic lesion is very important. We want to have a safe and effective chemotherapy. We experienced a resectable case by CPT-11/5'-DFUR combination therapy.

Association of plasma VEGF-A, soluble VEGFR-1 and VEGFR-2 levels and clinical response and survival in advanced colorectal cancer patients receiving bevacizumab with modified FOLFOX6.

For individualized bevacizumab-based therapy, non-invasive biomarkers are necessary. This study assessed the predictive value of plasma vascular endothelial growth factor (VEGF)-A, soluble VEGF receptor (sVEGFR)-1 and sVEGFR-2 levels as biomarkers for clinical response and survival in advanced colorectal cancer (CRC) patients treated with bevacizumab and modified FOLFOX6 (mFOLFOX6). Forty-six unresectable advanced CRC patients and 20 healthy controls were included in this study. CRC patients were treated with bevacizumab and mFOLFOX6. Pretreatment plasma VEGF-A, sVEGFR-1 and sVEGFR-2 levels were measured using the multiplex immunoassay. Plasma VEGF-A, sVEGFR-1 and sVEGFR-2 levels were significantly higher in CRC patients than in the healthy subjects. The plasma sVEGFR-1 levels in the responder patients [complete response (CR)/partial response (PR)] and stable disease (SD) patients were significantly lower than those in the progressive disease (PD) patients (CR/PR vs. PD, p=0.025; SD vs. PD, p=0.032), while the plasma VEGF-A and sVEGFR-2 levels did not show any significant differences between the two groups of patients. Patients with higher sVEGFR-1 levels showed a significantly poorer progression-free survival (PFS) and overall survival (OS) than those with lower VEGFR-1 levels. In contrast, VEGF-A and sVEGFR-2 did not show any significant relationship between PFS and OS according to the status of each level. In the multivariate Cox proportional hazard regression analysis, sVEGFR-1 levels showed a significant relationship between PFS and OS. These results suggest that plasma sVEGFR-1 levels have a predictive value for clinical response and survival in advanced CRC patients treated with bevacizumab and mFOLFOX6. Larger scale studies are needed to further validate our results.

Combined surgery for ischemic cardiomyopathy: report of a case.

A 65-year-old female with catecholamine-dependent ischemic cardiomyopathy was admitted to our hospital. Preoperative examination revealed severe triple vessel coronary artery disease, severe mitral valve regurgitation and left ventricular (LV) dilatation associated with low ejection fraction. Coronary artery bypass grafting with four distal anastomoses, mitral valve plasty using original papillary muscle application method, LV volume reduction using overlapping method and biventricular pacing were performed. Postoperative course was uneventful and quality of life at 2 years after surgery was good. Active combined surgery has the possibility of improving the outcome of patients with severe ischemic cardiomyopathy.