RESUMEN
The patient was a 71-year-old man with the pancreatic cancer. He underwent subtotal stomach-preserving pancreaticoduodenectomy and D2 lymphadenectomy. CT conducted 38 months after the surgery revealed the 10-mm mass at the lower lobe in the left lung. On PET-CT, the mass showed an abnormal uptake. We suspected that the mass was either a lung metastasis or a primary lung cancer. Partial resection of the left lung was performed, and pathological findings led to the diagnosis of lung metastasis originating from the primary pancreatic cancer. Currently at 9 years post-surgery, the patient has not had any recurrence of the metastasis. In this study, we report our case and discuss the literature.
Asunto(s)
Neoplasias Pulmonares , Neoplasias Pancreáticas , Anciano , Humanos , Neoplasias Pulmonares/secundario , Masculino , Pancreatectomía , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
A 73-year-old female was referred from a local clinic with abdominal pain. A diagnosis of gastric cancer(cT3, cN0, M0, cStage â ¡B)and acute cholecystitis was made. Distal gastrectomy, D2, and cholecystectomy were performed. Postoperative pathological examination led to a diagnosis of adenosquamous cell carcinoma(pT3, pN2, M0, pStage â ¢A). SOX therapy was administered as postoperative adjuvant chemotherapy. However, multiple liver metastases were detected. XP and DTX therapies were administered; however, there was a reduction in performance status. The patient died 10 months after surgery. Gastric adenosquamous cell carcinoma is classified as a specific type according to the Japanese Classification of Gastric Carcinoma(15th edition). This carcinoma accounts for 0.3 to 0.5% of patients undergoing gastric cancer surgery and is relatively rare. Its malignancy level is higher than that of gastric adenocarcinoma, and its prognosis is poorer.
Asunto(s)
Carcinoma Adenoescamoso , Neoplasias Gástricas , Femenino , Humanos , Anciano , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Gastrectomía , Carcinoma Adenoescamoso/cirugía , Carcinoma Adenoescamoso/tratamiento farmacológico , Pronóstico , Quimioterapia Adyuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéuticoRESUMEN
A 65âyearâold man was diagnosed with gastric cancer during a detailed examination for anemia and hospitalized for surgery. Laparoscopyâassisted distal gastrectomy, D1+ dissection, and Billroth â reconstruction were performed. The postoperative course was favorable, and he was discharged on postoperative day 8. The histopathological stage of the cancer was pStage â A(T1aN0M0). A malignant lymphoma was found in the dissected No. 3, No. 4d, and No. 8a lymph nodes. He was diagnosed with a large Bâcell lymphoma(Stage â ¢)by hematological examination and is currently being administered Râ CHOP. No gastric cancer recurrence has occurred for 2 years since the surgery. There is no published report on the diagnosis of such a double cancer, ie, malignant lymphoma diagnosed by lymph node dissection during surgery for gastric cancer. We herein report this case with reference to the literature.
Asunto(s)
Recurrencia Local de Neoplasia , Neoplasias Gástricas , Anciano , Gastrectomía , Gastroenterostomía , Humanos , Escisión del Ganglio Linfático , Masculino , Neoplasias Gástricas/cirugíaRESUMEN
The patient was a 38-year-old woman who visited our hospital with a chief complaint of abdominal pain. She was diagnosed with strangulation ileus and was subsequently admitted to our hospital to undergo surgery. During the surgical procedure, we observed mucus adhesion accumulating within the peritoneal cavity and identified strangulation ileus resulting from a cord-like structure. We did not observe intestinal necrosis. Given that the appendix was swollen, we made the diagnosis of strangulation ileus caused by pseudomyxoma peritonei of appendiceal origin and performed ileocolic resection. The patient recovered well postoperatively and was discharged on postoperative day 9. Pseudomyxoma peritonei is often diagnosed in patients who present with ascites, abdominal swelling, or appendicitis. This is the first case report of pseudomyxoma peritonei diagnosed in a patient with strangulation ileus.
Asunto(s)
Apéndice , Ileus , Seudomixoma Peritoneal , Adulto , Neoplasias del Apéndice , Femenino , Humanos , Neoplasias PeritonealesRESUMEN
A 70-year-old woman with unresectable advanced gastric cancer accompanied by peritoneal dissemination underwent jejunostomy, and was treated with S-1 and low-dose CDDP. One course consisted of S-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14. This was followed by 7 days rest, and CDDP (20 mg/day) was administered by 1-hour continuous intravenous infusion on day 1 and 8. She continued to receive this chemotherapy for a total of 14 courses, followed by 3 courses of a weekly paclitaxel regimen. She died 14 months after surgery. All chemotherapy had been conducted in an outpatient setting. We concluded that the administration of S-1, combined with low-dose CDDP (div) through a jejunostomy, can improve the quality of life (QOL) of a patient who has unresectable advanced gastric and is incapable of oral intake. We report this rare case with a review of the literature.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Ácido Oxónico/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Tegafur/uso terapéutico , Anciano , Cisplatino/administración & dosificación , Terapia Combinada , Combinación de Medicamentos , Resultado Fatal , Femenino , Humanos , Yeyunostomía , Ácido Oxónico/administración & dosificación , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificaciónRESUMEN
BACKGROUND: A multicenter phase II study was conducted to evaluate the efficacy and safety of a combination regimen of weekly paclitaxel plus S-1 in patients with advanced gastric cancer. METHODS: Patients with previously untreated metastatic or recurrent gastric cancer received intravenous paclitaxel 50 mg/m(2) on days 1, 8, and 15, plus oral S-1 40 mg/m(2) b.i.d. on days 1 to 14 followed by 2 weeks off, in a 28-day cycle. RESULTS: A total of 54 patients were registered. All of them had measurable disease and were determined to be eligible for the present study. Two complete responses and 23 partial responses were confirmed, giving an overall response rate of 46.3%. At a final follow up of 3 years, the median progression-free survival and median overall survival were 6.0 and 14.3 months, respectively. Grade 3 neutropenia occurred in 14 patients, and grade 4 in 1 patient (total, 27.8%). The most serious nonhematological toxicity was diarrhea, where grade 3 occurred in 5 patients (9.3%). There were no treatment-related deaths. CONCLUSION: A combination of weekly paclitaxel plus S-1 was found to be well tolerated and effective in patients with advanced gastric cancer. Further investigation with comparative trials is needed for confirmation.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Antineoplásicos Fitogénicos/uso terapéutico , Ácido Oxónico/uso terapéutico , Paclitaxel/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Tegafur/uso terapéutico , Adulto , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/efectos adversos , Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos Fitogénicos/efectos adversos , Intervalos de Confianza , Progresión de la Enfermedad , Combinación de Medicamentos , Femenino , Humanos , Japón , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Ácido Oxónico/administración & dosificación , Ácido Oxónico/efectos adversos , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Tegafur/administración & dosificación , Tegafur/efectos adversosRESUMEN
The patient was a 74-year-old man whose chief complaint was epigastralgia. A detailed examination revealed a gastric cancer located from antrum to duodenal bulb with multiple liver metastases. Because of a difficulty with oral intake, we performed a distal gastrectomy at first. After the operation, a combination chemotherapy with S-1 and weekly paclitaxel was performed, and liver metastases were successfully disappeared after 4 courses of the regimen. A subsequent CT evaluation after 6 courses of the regimen revealed that liver metastases maintained the clinical complete response (cCR), but a right adrenal tumor was detected. We performed a right adrenalectomy after 13 months from gastrectomy, and a histopathological examination revealed that the adrenal tumor was a recurrent gastric cancer. After the second operation, only one course treatment of S-1 alone was performed because the patient rejected the chemotherapy. The patient is alive without a chemotherapy and maintained cCR for 75 months after the second operation.
Asunto(s)
Adrenalectomía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Gastrectomía , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Antineoplásicos Fitogénicos/administración & dosificación , Combinación de Medicamentos , Humanos , Masculino , Ácido Oxónico/administración & dosificación , Paclitaxel/administración & dosificación , Inducción de Remisión , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/mortalidad , Tegafur/administración & dosificaciónRESUMEN
We describe here two cases of locally advanced rectal cancer treated with neoadjuvant chemotherapy prior to surgery. The first patient was a 54-year-old man whose chief complaint was bloody stool. A detailed examination revealed a rectal cancer with direct invasion of the primary rectal carcinoma into the prostate. Four courses of FOLFOX4 were administered as neoadjuvant chemotherapy. Because the invasion to the prostate was difficult to determine by subsequent CT evaluation, we performed a radical resection. The pathological examination revealed that all surgical margins were negative for malignancy and no metastasis to lymph nodes was found, therefore a surgical evaluation of curability was classified as A. The second patient was a 49-year-old woman whose chief complaint was irregular menstruation. A detailed examination revealed a rectal cancer with metastasis to an ovary and paraaortic lymph node. One course of FOLFOX4 and six courses of mFOLFOX6 (combined with bevacizumab in the first five courses) were administered as neoadjuvant chemotherapy. Subsequent examinations revealed significantly reduced primary tumor and the size of metastatic lesion. Given that metastasis to the paraaortic lymph node was difficult to determine, we performed a radical resection. The pathological examination revealed that all surgical margins were negative for malignancy, and the postoperative FDG-PET evaluation did not find FDG accumulation to paraaortic lymph node. We determined that there was no residual cancer and evaluated the surgery as curability B. We conclude that neoadjuvant chemotherapy against locally advanced rectal cancer may improve the curability of the surgery and save the surrounding organs.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Neoadyuvante , Neoplasias del Recto/terapia , Femenino , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/uso terapéutico , Neoplasias del Recto/cirugíaRESUMEN
A cytokine gene therapy approach was conducted against metastatic lesions of cytotoxic T lymphocyte (CTL)-unsusceptible tumor in mice. The EBV-based and conventional plasmid vectors that encode murine interleukin-12 (IL-12) gene (pGEG.mIL-12 and pG.mIL-12, respectively) were intravenously transfected into the mice that had received a subcutaneous inoculation of M5076 sarcoma cells. The pGEG.mIL-12 transfection drastically suppressed the subcutaneous as well as hepatic metastatic tumors, resulting in significant prolongation of survival period of the animals. Although single administration with pG.mIL-12 was not effective, repetitive transfection with the plasmid significantly prolonged the longevity of the mice-bearing the metastatic liver tumors. Multiple transfection with either pGEG.mIL-12 or pG.mIL-12 also suppressed peritoneal carcinomatosis in mice that had been injected with M5076 cells into the peritoneal cavity. It was suggested that a high level IL-12 production elicited by the intravenous delivery of the cytokine gene may be quite effective in inhibiting metastatic and CTL-unsusceptible neoplasms.
Asunto(s)
Interleucina-12/administración & dosificación , Interleucina-12/genética , Neoplasias Hepáticas Experimentales/terapia , Metástasis de la Neoplasia/prevención & control , Linfocitos T Citotóxicos/inmunología , Animales , Femenino , Terapia Genética , Neoplasias Hepáticas Experimentales/inmunología , Neoplasias Hepáticas Experimentales/patología , Ratones , Ratones Endogámicos C57BL , Metástasis de la Neoplasia/inmunologíaRESUMEN
To treat established melanoma in mice, intratumoral transfer of bleomycin and/or an interleukin (IL)-12 expression vector was performed by means of electroporation. Although either bleomycin alone or the IL12 gene alone significantly suppressed the subcutaneous tumors, the combination therapy drastically improved the therapeutic outcome. Three of eight mice (37.5%) that received both bleomycin and the IL12 gene showed complete remission of the preestablished tumors and rejected subsequent rechallenge with the tumor cells. We also examined whether electrochemo-gene therapy for subcutaneous tumor mass induced suppression of pulmonary metastasis that had been established by intravenous inoculation of the melanoma cells. Although metastatic foci were significantly reduced in number in groups that were given IL12 gene alone or bleomycin plus IL12 gene, it was only the combination therapy that significantly prolonged the mean survival period of the tumor-bearing animals. Natural killer (NK) and cytotoxic T lymphocyte cytolytic activities were markedly enhanced in the mice that received the chemo-gene therapy, while IL12 gene therapy alone partially elevated the NK cytotoxicity. The present study suggests that the electroporation-mediated delivery of the IL12 gene and bleomycin synergistically elicits innate and adaptive anti-melanoma immune responses, resulting in marked suppression of the treated tumors as well as bystander metastatic lesions.
Asunto(s)
Bleomicina/uso terapéutico , Electroporación/métodos , Terapia Genética/métodos , Interleucina-12/genética , Melanoma/terapia , Neoplasias/terapia , Neoplasias Cutáneas/terapia , Animales , Antimetabolitos Antineoplásicos/uso terapéutico , Ensayo de Inmunoadsorción Enzimática , Genes Reporteros , Vectores Genéticos , Interleucina-12/metabolismo , Interleucina-12/uso terapéutico , Células Asesinas Naturales/metabolismo , Luciferasas/metabolismo , Neoplasias Pulmonares/metabolismo , Melanoma/inmunología , Melanoma/metabolismo , Ratones , Ratones Endogámicos C57BL , Plásmidos/metabolismo , Neoplasias Cutáneas/inmunología , Factores de Tiempo , Resultado del TratamientoRESUMEN
We assessed therapeutic potential of intravascular insulin gene delivery in a diabetic murine model. The rat proinsulin-1 gene cDNA engineered to harbor furin consensus cleavage sequences was inserted into EBV-based plasmid vectors that contained CAG promoter or multimerized rat insulin promoter (RIP). Normal or streptozotocin (STZ)-induced diabetic mice were given an injection of the plasmids via the tail vein under high pressure. Transfection of the CAG-proinsulin construct markedly improved hyperglycemia of diabetic mice, accompanied by a considerable increase in serum insulin concentrations. Although the RIP-plasmid failed to reduce fasting blood glucose, the glucose tolerance test and RT-PCR analysis revealed that insulin production was regulated in the liver in a blood glucose level-dependent manner. The present results suggest a potential therapeutic means of controlling DM.
Asunto(s)
Diabetes Mellitus Experimental/tratamiento farmacológico , Técnicas de Transferencia de Gen , Insulina/genética , Animales , Glucemia/metabolismo , ADN Complementario/metabolismo , Relación Dosis-Respuesta a Droga , Genes Reporteros , Terapia Genética/métodos , Glucosa/metabolismo , Prueba de Tolerancia a la Glucosa , Ratones , Plásmidos/metabolismo , Regiones Promotoras Genéticas , Ratas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Tiempo , TransfecciónRESUMEN
IL-21 supports proliferation of mature T and B cells and facilitates expansion and maturation of natural killer (NK) cells in synergy with IL-15. However, the biological implications of IL-21 in vivo have not been fully elucidated. IL-21 and IL-15 expression plasmids were intravenously injected under high pressure into the tail veins of mice, which were subsequently challenged by an intravenous injection of RLmale1 lymphoma cells. The IL15 gene transfection significantly reduced the numbers of metastatic tumor foci in the liver. In contrast, when IL21 and IL15 genes were cotransfected, complete regression was achieved in 80% of the mice. The cytokine gene therapy was also performed in mice that had been intravenously inoculated with the tumor cells. Forty percent of mice that received a single injection of a mixture of cytokine genes successfully rejected the preestablished metastatic lymphoma and showed tumor-free survival for more than 300 days. IL-21 significantly elevated the cytotoxic T lymphocyte activity in the spleens of tumor-inoculated mice, while the two cytokines augmented NK killing activity in a synergistic manner. These results strongly suggest that the codelivery of IL-21 and IL-15 elicits powerful antitumor immune responses, resulting in marked therapeutic efficacy against metastatic tumors.