RESUMEN
BACKGROUND: The majority of gastrointestinal tumors are adenocarcinomas. Rarely, there are other types of tumors, such as acinar cell carcinoma, and these are often called pancreatic-type acinar cell carcinomas. Among these tumors, some are differentiated into neuroendocrine components. A few of them are MiNENs. CASE PRESENTATION: The patient was an 80-year-old male who was referred to our hospital for treatment of a pedunculated gastric tumor. It was 5 cm in diameter and detected in the upper gastric body with upper GI endoscopy conducted to investigate anemia. In the biopsy, although hyperplasia of gastric gland cells was noted, no tumor cells were found. Retrospectively, the diagnosis was misdiagnosed. An operation was arranged because bleeding from the tumor was suspected as a cause of anemia and because surgical resection was considered to be desirable for accurate diagnosis. Hence, laparoscopic and endoscopic cooperative surgery was performed. In the pathological examination, several types of epithelial cells that proliferated in the area between the mucosa and deep inside the submucosa were observed. These consisted of acinar-glandular/trabecular patterns and solid. A diagnosis of pancreatic-type acinar cell carcinoma of the stomach with NET G2 and G3 was made based on characteristic cellular findings and the results of immunostaining tests. Each of them consisted of more than 30% of the lesion; a diagnosis of pancreatic-type mixed acinar neuroendocrine carcinoma (pancreatic-type MiNEN) of the stomach or a type of gastric MiNEN was obtained. Anemia was resolved after the operation, and the patient was discharged from the hospital without perioperative complications. CONCLUSIONS: Pancreatic-type ACC of the stomach that is differentiated into neuroendocrine tumors is very rare. Hence, we report this case along with a literature review.
Asunto(s)
Carcinoma de Células Acinares/diagnóstico por imagen , Carcinoma Neuroendocrino/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Anciano de 80 o más Años , Biopsia , Carcinoma de Células Acinares/patología , Carcinoma Neuroendocrino/patología , Diferenciación Celular , Errores Diagnósticos , Endoscopía del Sistema Digestivo , Humanos , Laparoscopía , Masculino , Tumores Neuroendocrinos/patología , Páncreas/diagnóstico por imagen , Páncreas/patología , Neoplasias Pancreáticas/patología , Estómago/diagnóstico por imagen , Estómago/patología , Neoplasias Gástricas/patología , Neoplasias PancreáticasRESUMEN
A 68-year-old woman was diagnosed with advanced gastric cancer with a type 3 deep ulcer of the middle stomach by endoscopy. An abdominal computed tomography scan revealed multiple lymph node metastases and peritoneal disseminations. The clinical stage was determined to be T4a(SE), N2P1M1(PER), H0 and stage IV . A gastrectomy was scheduled after 2 courses of S-1 plus oxaliplatin(SOX)with curative intent. On day 3 after initiatingSOX therapy, the patient complained of severe abdominal pain. Because the abdominal CT scan showed intra-abdominal free air and a defect in the gastric wall, we performed an emergency total gastrectomy. The defect in the gastric wall was about 1 cm in diameter and was located in the anterior wall of the lower body, consistent with the center of the tumor. The operative findings suggested that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. The patient was discharged 16 days after surgery and received post-operative chemotherapy. Our findings suggest that the risk of gastric perforation should be considered when administeringchemotherapy to patients with advanced gastric cancer and a deep ulcer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Compuestos Organoplatinos/efectos adversos , Ácido Oxónico/efectos adversos , Gastropatías/inducido químicamente , Gastropatías/cirugía , Neoplasias Gástricas/tratamiento farmacológico , Tegafur/efectos adversos , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Combinación de Medicamentos , Femenino , Humanos , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Ácido Oxónico/administración & dosificación , Peritonitis/inducido químicamente , Neoplasias Gástricas/patología , Tegafur/administración & dosificación , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 63-year-old man underwent laparoscopic-assisted distal gastrectomy (LADG) and laparoscopic assisted colectomy (LAC) simultaneously for double cancers of the gastric antrum and sigmoid colon in August 2012. Both cancers, considered to be at an early-Stage, were pathologically diagnosed as tub1, sm, and n0. The patient was observed but no adjuvant chemotherapy was administered. A follow-up computed tomography (CT) in December 2012 detected a 15 mm tumor mass in the lateral segment of the liver and another 5mm mass in the S4. Liver metastasis of the sigmoid colon cancer was suspected, and 6 courses of BEV+mFOLFOX6 were administered. The metastatic tumor in the lateral segment showed stable disease (SD) and the S4 tumor showed a complete response (CR). Thereafter, the lateral hepatic segment was partially resected in March 2013. Pathological examinations led to a diagnosis of stomach cancer liver metastasis, and the patient was given oral TS-1. During the first course of treatment, a CT showed new tumor masses in the lateral segment of the liver and S4. Treatment was changed to TS-1+CDDP in mid-May. However, after completion of the first course of treatment, the patient experienced exacerbation of the liver metastases, pulmonary metastasis, and inflammation of the intrahepatic bile ducts. The patient was hospitalized in mid-June to receive inpatient care, but died in early July.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Quimioterapia Adyuvante , Resultado Fatal , Humanos , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Recurrencia , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/cirugía , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND: Although RF ablation is a promising non-surgical ablation technique for the treatment of breast cancer, assessment of the efficacy requires not only imaging of tumor necrosis but also histological confirmation. METHODS: Two series of patients were treated with RF ablation. In the first series, 17 patients underwent surgical resection immediately and 17 underwent delayed mammotome excision in the second series. The ablated tumor tissue was examined histologically with H&E staining and NADH-diaphorase staining. Furthermore, ssDNA was immunohistochemically stained in the specimen where tumor cells were histologically detected. RESULTS: In the first series, mild response was histologically seen in 14 of 17 patients (82%), whereas complete response was observed in 8 of 16 patients (50%) in the second series. However, NADH-diaphorase staining did not demonstrate any viable tumor tissues in any patient in either the first or the second series. ssDNA staining was positive (non-viable) in 13 of 16 cases in the first series, but it was positive in all 8 cases tested in the second series. CONCLUSION: Although NADH-diaphorase staining is essential to evaluate tumor cell viability immediately after RF ablation, ssDNA may be useful for the assessment of cell viability after some interval following RF ablation.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Ablación por Catéter/métodos , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patología , Carcinoma Intraductal no Infiltrante/metabolismo , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/cirugía , Supervivencia Celular , ADN de Cadena Simple/metabolismo , Dihidrolipoamida Deshidrogenasa , Femenino , Humanos , Persona de Mediana Edad , Biopsia del Ganglio Linfático Centinela , Coloración y Etiquetado/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: There is increasing demand for minimally invasive treatment approaches. Although radiofrequency (RF) ablation therapy is promising for the local treatment of small, well-localized breast cancer, the problem of determining tumor cell death after RF ablation remains. METHODS: In the first series of this study, 17 patients underwent surgical resection immediately after RF ablation and 7 patients received delayed mammotome excision in the second series. The ablated tumor tissue was examined histologically with hematoxylin-eosin (H&E) staining and nicotinamide adenine dinucleotide (NADH)-diaphorase staining to assess tumor cell viability. RESULTS: Histological examination with H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis to normal-appearing tumor cells, although the degenerative changes were more remarkable in the second than in the first series. However, NADH-diaphorase staining revealed no viable tumor cells in the ablated lesion in either series. CONCLUSIONS: NADH-diaphorase staining is essential to assess the effects of RF ablation. However, further studies are needed to determine whether RF ablation may provide equivalent local control and survival compared with conventional BCT for patients with small breast cancer.
Asunto(s)
Biopsia con Aguja/instrumentación , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Ablación por Catéter , Adulto , Anciano , Axila , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Colorantes , Eosina Amarillenta-(YS) , Femenino , Hematoxilina , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , NAD , Biopsia del Ganglio Linfático Centinela , Coloración y Etiquetado , Ultrasonografía Intervencional , VacioRESUMEN
BACKGROUND: With the growing demand from patients for less-invasive procedures, the shift from surgical extirpation to ablative local control of breast tumors is an emerging focus in breast cancer care. This study was performed to determine the feasibility and safety of treating small breast cancer with radiofrequency (RF) ablation. METHODS: Patients with biopsy-proven invasive or non-invasive breast cancer underwent RF ablation under general anesthesia. Before RF ablation, all patients were confirmed to have a localized lesion using imaging modalities. Wide excision or total mastectomy with sentinel lymph node biopsy or axillary lymph node dissection was performed. The resected tumor was examined histologically with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide-diaphorase (NADH) staining. RESULTS: Ten patients completed the treatment without RF ablation-related complications. The mean tumor size was 1.1 cm (range: 0.5-2.0 cm). Histological evaluation of the ablated tissue using H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis of tumor cells to normal-appearing tumor cells. However, NADH-diaphorase showed no staining of viable tumor cells in the RF-ablated region in all of the patients. CONCLUSIONS: RF ablation is promising as a minimally invasive ablation technique in the local treatment of invasive or non-invasive breast cancer. However, further study is necessary before RF ablation can replace conventional breast conservation therapy for patients with small breast cancer.