RESUMEN
A 71-year-old man underwent laparoscopic partial gastrectomy for a gastric submucosal tumor in 1997; subsequently, he underwent follow-up without therapy. In December 2008, he noticed a mass at the umbilical wound. Computed tomography and physical examination of the umbilical mass indicated suspected recurrence of the gastric submucosal tumor at the port site. Because the lesion was locally confined, surgery was performed, including resection of the greater omentum; peritoneum; rectus abdominis; and the navel, including the skin. Histologic analysis of the tumor yielded positive results for c-kit, thereby indicating a gastrointestinal stromal tumor (GIST). Mutation analysis of c-kit and platelet-derived growth factor receptor α (PDGFRα) revealed an acquired mutation in exon 18 of PDGFRα in the recurrent tumor. To date, only 4 cases of port-site recurrence after laparoscopic resection of GIST have been reported. This is the first study to report an acquired PDGFRα mutation in port-site recurrence after laparoscopic resection of a GIST.
Asunto(s)
Tumores del Estroma Gastrointestinal/genética , Genes ras/genética , Laparoscopía/efectos adversos , Mutación/genética , Recurrencia Local de Neoplasia/genética , Receptor alfa de Factor de Crecimiento Derivado de Plaquetas/genética , Neoplasias Gástricas/genética , Neoplasias Gástricas/cirugía , Anciano , Resultado Fatal , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Siembra NeoplásicaRESUMEN
In May 2005, a 79-year-old woman was referred to our hospital with complaints of right lower quadrant mass and feces mixed with blood. After examination, she was diagnosed with ascending colon cancer and synchronous multiple liver metastases. Postoperative diagnosis after right hemicolectomy and D3 lymph node dissection was T2, N1, H2, P0, M0, and Stage IV. One month after the operation, we started a combination chemotherapy using 5-FU plus UFT as pharmacokinetic modulating chemotherapy with hepatic arterial infusion (HAI-PMC). But abdominal CT scan revealed the increase of multiple liver metastases, PD, after 4 courses of treatment. We then changed to modified HAI-PMC (additional CPT-11, once every four weeks), but had to cancel it due to her exhaustion and inappetence. Therefore, S-1 was started from October, 2005. Each course consisted of daily oral administration of 80 mg S-1 for 4 weeks and withdrawal for 2 weeks. After 4 courses, abdominal CT scan revealed a reduction in the number of multiple liver metastases, PR. PR has continued for a long term to date. As an adverse event, we had grade 3 neutropenia and grade 2 diarrhea in January 2009, and we changed the administration method (80 mg S-1 for 2 weeks and withdrawal for 1 week). She continues to undergo outpatient treatment with good QOL without a lesion for 4 years and 6 months. S-1 is expected to be an effective agent for the treatment of advanced colon cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Neoplasias Hepáticas/tratamiento farmacológico , Ácido Oxónico/uso terapéutico , Tegafur/uso terapéutico , Anciano , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/cirugía , Combinación de Medicamentos , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Calidad de Vida , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Combination chemotherapy with S-1 and cisplatin(S-1/CDDP)has become the standard treatment for gastric cancer, but the effect for hepatocellular carcinoma has not become clear. We experienced a case with advanced gastric cancer and hepatocellular carcinoma at the same time. We used S-1/CDDP as neoadjuvant chemotherapy for the case and performed surgical resection of the gastric cancer and hepatocellular carcinoma. From histological examination of the resected specimen, we may be able to prove that the S-1/CDDP chemotherapy for the hepatocellular carcinoma was also effective. A 57-year-old man visited our hospital with epigastralgia. Further examinations revealed a type-3 advanced gastric cancer with bulky N2 and hepatocellular carcinoma at segment 5. The gastric cancer was thought to be too advanced for initial surgery, so we performed S-1/CDDP chemotherapy(S-1 100 mg/body/day, CDDP 20 mg/body twice/week for 2 weeks)as preoperative therapy. After remarkable shrinkage of the gastric cancer was obtained, we performed distal gastrectomy, D2+a lymph node excision, liver S5 segmentectomy and cholecystectomy. The histological examination showed remarkable denaturation and necrosis as grade 2 effectiveness in over two-thirds of the hepatocellular carcinoma area and grade 1b in gastric cancer according to the Japanese classification of gastric carcinoma. This result suggests that S-1/CDDP chemotherapy might therefore be effective as systemic therapy for patients with hepatocellular carcinoma. However, further clinical trials are required.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/patología , Ácido Oxónico/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología , Tegafur/uso terapéutico , Combinación de Medicamentos , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/cirugía , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Gastric carcinomas have been classified into the differentiated and undifferentiated type, on the basis of its tendency to gland formation. As a result of recent advances in mucin histochemistry, mucin phenotypes of gastric carcinomas have been investigated. However, no consensus on the evaluation of the grade of malignancy of early gastric carcinomas regarding mucin phenotype expression has developed. To address this issue, we evaluated the lymph node metastasis rate and proliferative activity of a submucosal invasive (sm) gastric carcinoma according to mucin phenotype expression. METHODS: In resected surgical specimens from 108 patients with a single sm gastric carcinoma, the association between clinicopathological factors and lymph node metastasis was evaluated. In all cases, immunohistochemical staining with human gastric mucin, Muc-2, and CD10 and mucin histochemical staining by paradoxical concanavalin A staining were performed. The mucin phenotypes were classified into gastric-type (G-type), intestinal-type (I-type), mixed gastric and intestinal type (M-type), or a lack of mucin (LOM), using these as markers. To evaluate the cell proliferative activity of the gastric carcinoma, proliferating cell nuclear antigen (PCNA) staining was also performed. RESULTS: The rate of lymph node metastasis was higher for G-type sm carcinomas. A multivariate analysis showed that the G-type and lymphatic invasion were independent factors of lymph node metastasis. However, the PCNA-labeling index (PCNA-LI) was low for G-type carcinomas irrespective of the presence or absence of lymph node metastasis. In I-type carcinomas, PCNA-LI was significantly higher in cases that were positive for lymph node metastasis than in negative cases. CONCLUSION: G-type and lymphatic invasion are independent risk factors for lymph node metastasis of an sm gastric carcinoma, and proliferative activity may be a significant parameter for lymph node metastasis in cases with I-type carcinomas.
Asunto(s)
Mucinas/análisis , Neoplasias Gástricas/patología , Adulto , Anciano , Anciano de 80 o más Años , Proliferación Celular , Femenino , Mucosa Gástrica/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica , Fenotipo , Antígeno Nuclear de Célula en Proliferación/análisisRESUMEN
A 67-year-old male visited his physician because of a 2-month history of cough and sputum. An abnormal shadow at the left upper mediastinum on chest x-ray film was detected, and the patient was referred to our department for further examination. Chest x-ray film revealed a round shadow at the left upper posterior mediastinum. Computed tomography(CT)revealed a uniform iso density mass about 4 cm in diameter, with a well-defined border. After the intravenous contrast administration, a slight peripheral enhancement was seen around the mass. On magnetic resonance imaging, the mass was hypointense in T1-weighting and hyperintense in T2-weighting. The contrast pattern was the same as that observed in the CT scan. On sagittal and coronal sections, the mass was adjacent to the aortic arch. Although a benign tumor was mostly suspected based on imaging findings, a malignant tumor was also possible. Accordingly, we resected this mass with video-assisted thoracoscopy. Findings at operation were a cystic mass. The pathological findings were compatible with benign parathyroid cyst, which was suspected to be the cystic degeneration of a parathyroid adenoma.