胃癌肝转移的危险因素分析

目的 探讨胃癌肝转移发生的危险因素.方法 回顾性分析1996年1月至2001年12月收治的225例胃癌肝转移患者的临床资料,其中同时性肝转移123例,异时性肝转移102例,分析影响胄癌肝转移发生的危险因素.结果 采用X2检验发现胃癌肝转移在性别、原发灶部位和大小、分化程度、浸润深度、淋巴结转移、八站淋巴结转移、Lauren分型、血管浸润、肝外转移、腹水形成及腹膜转移方面差异有统计学意义(X2=43.560～263.907,P<0.05).其中同时性和异时性肝转移在性别、原发灶部位、分化程度、浸润深度、淋巴结转移、八站淋巴结转移、Lauren分型、血管浸润和腹膜转移方面差异有统计学意义(X2=6.673～26.555,P<0.05).而logistic回归分析却发现仅性别、淋巴结转移和腹膜转移是影响胃癌肝转移发生类型的重要因素.结论 性别、淋巴结转移和腹膜转移是评价不同类型胃癌肝转移发生的重要参考因素.     

A case of metastasis from gastric cancer to the thyroid gland

Metastatic tumors in the thyroid gland are rarely seen in clinical practice. This report describes a case of metastasis from gastric cancer to the thyroid, found five years after removal of the primary gastric lesion. The patient had a large thyroid mass extending to the mediastinum, but there were no obvious metastatic lesions anywhere except in the thyroid. Subtotal thyroidectomy was performed and histological examination revealed the same findings as those of the original gastric cancer. Of additional interest are the findings that led us to believe this metastatic tumor produced alpha-fetoprotein. Seven months following the operation, the patient died suddenly and, although it is difficult to say whether the patient’s survival was prolonged, we believe that the thyroid surgery gave him considerable palliation.     

Pure intramedullary spinal cord metastasis secondary to gastric cancer

Pure intramedullary spinal-cord metastases (ISCM) are a rare manifestation of cancer. We report a case of ISCM from gastric cancer. A 68-year-old man, treated with total gastrectomy for a gastric cancer, presented 9 months later with paresis of the left arm, pain and dissociated sensory loss. Magnetic resonance imaging revealed a pure intramedullary lesion at the C3–C5 level. After surgical resection, pathological findings revealed an undifferentiated adenocarcinoma of gastric origin. To our knowledge, this is only the second report of ISCM from gastric cancer in the literature.     

Solitary splenic metastasis from gastric cancer: report of a case

We report a rare case of metachronous and solitary metastasis to the spleen from gastric cancer. A 69-year-old man who had undergone a distal gastrectomy for gastric cancer 48 months earlier was found to have a solitary lesion in the spleen, and an increased serum carcinoembryonic antigen (CEA) level. The patient underwent a laparotomy for suspected metastasis to the spleen. At laparotomy, a tumor was found in the upper pole of the spleen without involvement of other organs, and a splenectomy was performed. Histological examination confirmed that the splenic tumor was a well-differentiated adenocarcinoma similar to the primary gastric cancer. The postoperative course was uneventful and his serum CEA decreased to within normal levels. The patient died of multiple metastases to the liver and peritoneal dissemination 40 months after the splenectomy. Received: May 31, 2000 / Accepted: January 9, 2001 Reprint requests to: K. Yamanouchi, 2nd Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan     

A case of gastric cancer metastasis to the breast in a female with BRCA2 germline mutation and literature review

Introduction: Gastric cancer is a deadly disease. Common sites of distant metastasis of gastric cancer are the peritoneum, liver, lymph nodes, and lung. The breast is a rare site of metastasis in gastric cancer which occurs in males dominantly.

Patients and methods: Here, we report the first case of metastatic gastric cancer to the breast in a patient with the breast cancer 2 (BRCA2) germline mutation. A 34-year-old female was admitted to the hospital with dyspepsia and a palpable mass in the left breast. Gastric cancer was confirmed to be signet ring cell adenocarcinoma. The breast mass exhibited histological properties consistent with gastric cancer. Immunohistochemistry results showed the breast tumor was CDX-2 and CK20-positive, but ER-, CK7-, and GATA3-negative. The BRCA1 gene had a wild-type sequence, but a heterozygous variant was discovered in BRCA2 in exon 10 (c.1744A?>?C, p.T582P); the significance of this variant is unknown.

Results: The patient received palliative XELOX (capecitabine?+?oxaliplatin) with radiation therapy to the stomach. The breast tumor resolved completely, but the overall response was partial.

Conclusion: Gastric cancer metastasis to the breast is rare, but should be considered in young female patients with signet ring cell type gastric cancer.     

Thirteen cases with intramural metastasis to the stomach in 1259 patients with oesophageal squamous cell carcinoma

Among a total of 1259 patients with oesophageal cancer who underwent surgical resection, intramural metastasis (IMM) was verified in 93 patients (7.4%), of which IMM to the stomach (IMMS) constituted 13 patients (1.0%). In all 13 cases, the primary cancer was located in the middle or lower thoracic oesophagus and all had lymph nodes metastasis, while 12 of the 13 (92.3%) had lymphatic invasion. In our series, as the depth of invasion advanced, the number of patients with IMM or IMMS increased, although even superficial IMMS was revealed. The gross appearance of the metastatic tumours in the stomach resembled submucosal tumours. The possibility exists that metastatsis via a lymphatic duct allows expansive growth in the gastric submucosae. These findings suggest that oesophageal cancer metastasizes to the stomach via a lymph duct. In conclusion, oesophageal cancer with lymphatic invasion may lead to IMM and IMMS. Therefore, careful examination for the existence of IMM, including the stomach, is required.     

Prognostic significance of the location of intramural metastasis in patients with esophageal squamous cell carcinoma

Background Although the presence of an intramural metastasis (IM) from esophageal cancer is associated with a poor prognosis, some patients with IM have a relatively favorable course.Methods Clinicopathological factors including number, location, and size of IM and the distance between the primary tumor and IM were assessed in 212 patients with esophageal squamous cell carcinoma who underwent esophagectomy.Results Twenty-three patients (10.8%) had IM. IM size ranged from 2 to 100 mm (18±26), and the distance between primary lesion and IM ranged from 5 to 70 mm (27±18). Survival of ten patients with an IM less than 20 mm from the primary tumor was significantly longer than that of 13 patients with a more distant IM (P=0.0184); median survival time were 2.3 and 0.7 years, respectively.Conclusion A subgroup of patients with an IM less than 20 mm from the primary esophageal cancer may have a relatively favorable prognosis. When an IM is found preoperatively or in a resected specimen, measurement of the distance between the primary tumor and the IM might be useful in determination of treatment strategy and evaluation of prognosis.     

θ���ٴ������������ܰͽ�ת�ƹ�ϵ�о�

目的 探讨胃癌临床病理特征与淋巴结转移的关系,为临床进行合理的淋巴结清扫范围提供依据。方法 统计1200例胃癌标本,术后常规解剖原发灶及各组淋巴结,并标记和计数,计算肿瘤部位、浸润深度、Borrmann分型及分化程度与淋巴结转移率的关系。结果 胃癌的淋巴结转移率为73％,转移度为35．6％;C、M、A区及全胃癌淋巴结转移率为60．3％、55．4％、63．1％和88．4％;早期胃癌、浆膜内和浆膜外浸润的淋巴结转移率依此呈递增趋势（P＜0．05）;Borramnn Ⅲ、Ⅳ型胃癌淋巴结转移率明显高于BorrmannⅠ、Ⅱ型（P＜0．05）;分化差者明显高于分化好者（P＜0．05）。结论 术中淋巴结清扫应按胃癌的临床病理分期、部位、大小、大体分型和分化程度作出判断,并结合不同分区淋巴结分组、分站转移特点,合理选择淋巴结清扫范围。     

微血管密度与胃癌复发转移相关性研究

目的　探讨微血管密度（ ＭＶＤ） 与胃癌复发转移及预后的相关性。方法　４５ 例手术切除标本应用ＦⅧ相关抗原抗体免疫组化染色，观察癌灶、癌旁及正常组织中ＭＶＤ，分析其与复发转移及预后的关系。结果　ＭＶＤ 在癌组织为３８－１２ ±１２－８７ ，癌旁为２４－６７ ±１１－０９，正常组织为１３－１１ ±７－５６（ Ｐ＜ ０－０５） 。复发转移组和无复发转移组的ＭＶＤ 分别为３８－３１ ±９－６７ 和２１－９８ ±１２－２３（ Ｐ＜ ０－０１） 。两组在淋巴结转移、浸润深度、肿瘤分期三方面差异也有显著性（ Ｐ＜ ０－０５） 。结论　微血管的生长与肿瘤的血行和淋巴结转移有关。除淋巴结转移、浸润深度、肿瘤分期具有预后意义外，胃癌组织中ＭＶＤ 也具有判断预后价值。     

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: Report of a case

We herein present a case of resected synchronous solitary liver metastasis from alpha-fetoprotein (AFP)-producing early gastric cancer. A 61-year-old woman, who was diagnosed at a routine medical checkup as having early gastric cancer with a liver tumor, came to our hospital for surgery. Her serum AFP level was high at 910ng/ml. An examination was performed to determine whether the liver tumor was primary hepatocellular carcinoma or metastasis from early gastric cancer. She had no evidence of either a hepatitis B or C virus infection, and her liver function was normal. A biopsy specimen from the gastric cancer predominantly revealed moderately differentiated adenocarcinoma, but a focally trabecular pattern compatible with AFP-producing gastric cancer was also observed. Preoperatively, it was concluded that the liver tumor was metastasis from an AFP-producing early gastric cancer. We thus performed distal gastrectomy and a posterior segmentectomy of the liver. Her serum AFP level decreased to the normal range within 2 weeks after the operation. An immunohistological examination revealed that AFP-positive cells were present in both the gastric cancer and liver tumor. One year after the operation, there was no sign of recurrence.     

Successful resection of a liver metastasis from gastric leiomyoblastoma: Report of a case

A 20-year-old woman was referred to our hospital for detailed investigation of a gastric submucosal tumor. A leiomyoma was preoperatively diagnosed and laparoscopic-assisted enucleation was performed. The resected tumor was 4 × 3 × 1.5 cm in size and postoperative histological examination identified it as a gastric leiomyoblastoma. Therefore, a secondary resection in the form of a distal gastrectomy was carried out. No tumor cells were found in the gastric specimen or in the lymph nodes; however, 5 months after the operation, an abdominal computed tomography scan revealed a recurrence in the liver, and she was readmitted for further examinations. The lesion was diagnosed as a single liver metastasis from the gastric leiomyoblastoma and successfully resected. The histopathological findings of the liver tumor resembled those of the primary gastric tumor. Her postoperative course was uneventful and she has been well, without any evidence of recurrence, to date. Only 12 other cases of leiomyoblastoma of the stomach with liver metastasis have been reported in Japan, all of which were associated with a very poor prognosis. Therefore, patients with this unusual disease entity should be carefully followed up after resection of the primary tumor. Received: July 14, 1999 / Accepted: May 30, 2000     

Long-term survival after a surgical resection of pulmonary metastases from gastric cancer: Report of a case

We describe a patient who survived for a prolonged period after repeated resections of pulmonary metastases from gastric cancer. A 59-year-old man underwent a distal gastrectomy for gastric cancer. A right middle lobectomy and a left lower lobectomy were performed for metastases from gastric cancer at 34 months and 82 months after the initial gastric resection, respectively. The patient died of cerebral infarction 65 months after the first lung resection, with no further relapse. To our knowledge, long-term survival after resection of pulmonary metastases from gastric cancer has only been reported in 3 patients previously. We herein review the literature and discuss the role of surgery in such patients.     

mdm-2扩-增与胃癌及淋巴转移的关系

目的探索mdm-2扩增与胃癌及其淋巴转移的关系.方法用DC-PCR技术定量分析32例胃癌及转移灶中mdm-2扩增.结果mdm-2在转移淋巴结中的扩增频率(57.1%)高于胃原发癌中的扩增频率(37.5%),3例淋巴管内有瘤栓、淋巴结转移阴性的原发癌灶中发现mdm-2扩增.结论mdm-2扩增与胃癌的淋巴转移关系较密切,它可能成为监测胃癌淋巴转移的潜在性分子标志物.     

Bone metastasis of gastric cancer

Twenty-three patients with bone metastasis from gastric cancer which was resected during the ten years from 1970 through 1979 were investigated. The incidence was 1.2 per cent (23/1,945), and was higher in the younger patients. The main symptom was local bone pain. Change on the X-ray appeared a few months after complaints of pain. Consequently, the confirmation was delayed in most cases. All of the laboratory findings were not specific to bone metastasis. Referring to findings at the primary surgery for gastric cancer, this form of metastasis occurred in cases of a high involvement of regional lymph nodes and of a scirrhous type. The results of histological examination showed a high degree of lymphatic permeation in the submucosal layer. Poorly differentiated adenocarcinoma was readily identified. The lumbar and thoracic vertebra were the areas of frequent metastases. The metastasis occurred within two years after the gastric surgery, in most cases. Chemotherapy was ineffective and radiotherapy was effective for palliation of the bone pain. Prognosis was very poor and all but one patient died within a few months after confirmation of the metastasis. This work was presented at the 20th Congress of the Japan Society for Cancer Therapy, Tokyo, September, 1982.     

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.     

非根治性肿瘤切除术在胃癌伴单纯腹膜转移中的作用

目的:探讨非根治性肿瘤切除术在胃癌伴单纯腹膜转移中的作用及其对病人预后的影响。方法:回顾性研究2006年至2009年经术中探查诊断为胃癌伴单纯腹膜转移的119例胃癌病人。其中63例行非根治性肿瘤切除术,56例未行肿瘤切除术。对两组以及3个亚组病人进行临床病理资料的比较及生存分析。结果:非根治性肿瘤切除组中病人总的平均生存时间要长于未行肿瘤切除组(14.8±1.8个月比7.7±0.8个月,P=0.001)。在亚组分析中发现,在P1或P2腹膜转移的胃癌病人中,非根治性肿瘤切除组的平均生存时间要显著长于未行肿瘤切除组(21.1±3.0个月比7.6±0.9个月,P=0.001),而两组中的P3腹膜转移的胃癌病人间无统计学差异(P=0.489)。多因素生存分析显示,只有非根治性肿瘤切除是P1或P2腹膜转移胃癌病人的独立预后指标(r=4.988,P=0.001),且两组之间的围手术期死亡率并无统计学差异(P=0.747)。结论:非根治性肿瘤切除术能延长胃癌伴单纯P1或P2腹膜转移病人的预后,而P3腹膜转移的胃癌病人不建议接受此类手术治疗。     

以淋巴结转移为主的晚期胃癌的FLEP法新辅助化疗

目的:研究采用经动静脉联合给药的FLEP化疗法,对以淋巴结严重转移为主而不能切除的胃癌进行新辅助化疗,使病人能重新获得手术切除的机会。方法:对14例以淋巴结转移为主的晚期胃癌,以FLEP法进行新辅助化疗。内9例系未经治疗的初诊病人,术前CT检查发现第3、7、9、12组及14、16组淋巴结严重转移,难以手术治疗;5例为术后淋巴结转移性复发,或因淋巴结严重转移而进行过剖腹探查者。FLEP方案为:5-FU 370 mg/m2,iv,第1～5天;Leukovorin 30 mg,第1～5天;CDDP 70 mg/m2与Epotoside 70 mg/m2,ia,第6、20天,每5周重复1次。每一病例视病情进行2～3个疗程的治疗。结果:所有病例症状都明显改善。初次就诊的9例CT评价无变化(NC)1例,未行手术;部分缓解(PR)8例,均进行了胃次全、全胃或联合脏器切除,淋巴结清扫采取了D2加重点淋巴结、D3加第16组淋巴结手术,手术切除率为88.9%,手术治疗的病例均生存至今,最长者已达26个月。在3例术后出现淋巴结转移性复发者及2例因淋巴结严重转移初次手术未能切除者影象学评价PR 3例,病变进展PD 1例,均未再手术治疗。其中2例分别于治疗开始后的8、15个月死亡,另3例至今已生存3～15个月。结论:FLEP新辅助化疗法对于以淋巴结严重转移为主的胃癌具非常显著的治疗效果,可使严重或有远处淋巴结转移的胃癌病人重新获得手术治疗的机会。