Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma：A review of the literature

The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.     

结直肠同时性+异时性多原发四重癌一例报道并文献复习

多原发结直肠癌（MPCC）又称重复性结直肠癌,在临床上的发病率呈逐年上升趋势,其发病原因及机制不详,目前尚无统一、规范的诊治指南,临床医师极易漏诊,延误病情。本文报道1例结直肠同时性+异时性多原发四重癌的病例并复习文献,旨在提高临床医师对MPCC诊治的警觉性。     

Laparoscopic resection of synchronous gastric cancer and primary small intestinal lymphoma: A case report

Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.     

Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea

Background and aims Colorectal cancer has been reported to be the malignancy most frequently associated with gastric cancer in Korea. The aim of this study was to define the frequency and clinical characteristics of synchronous gastric cancer detected at preoperative esophagogastroduodenoscopy (EGD) in colorectal cancer patients. Materials and methods This prospective study analyzed the EGD results from 1,542 consecutive colorectal cancer patients who underwent surgery from January 2003 to December 2005 at the Center for Colorectal Cancer, National Cancer Center, Korea. Results Of the 1,542 cases, 1,155 (74.9%) underwent EGD at our center and 387 underwent EGD at other hospitals within 6 months before surgery. Of the 1,542 cases, synchronous gastric cancers were detected in 31 cases (2.0%). Of these 31 cases, 26 had early gastric cancer (EGC; 83.9%) and 5 had advanced gastric cancer. Ten (38.5%) of the 26 EGC cases were managed using endoscopic mucosal resection. Compared to colorectal cancer patients without synchronous gastric cancer, the group of patients with synchronous gastric cancer was older (65.5 ± 9.6 vs 58.4 ± 11.3 years, p = 0.001) and had a greater proportion of males (77.4 vs 59.4%, p = 0.043). Conclusion This study found that 2% of Korean sporadic colorectal cancer patients had synchronous gastric cancer. A preoperative EGD for colorectal cancer patients is likely to greatly assist in the diagnosis of synchronous gastric cancer at an early stage and the implementation of appropriate minimally invasive treatment. Presented at the Tenth Congress of Asian Federation of Coloproctology, Singapore, March 24–26, 2005.     

Triple metachronous colon cancer

A 72-year-old male with an early stage "node-negative" sigmoid colon cancer developed 2 separate "node-negative" early stage colon cancers during a subsequent colonoscopy surveillance regimen, the first in the descending colon 7 years later, and the second in the cecum almost 14 years after the first cancer was resected. After the initial symptomatic cancer, all subsequent neoplastic disease, including malignant cancers were completely asymptomatic. This entity, multiple primary cancers, likely reflected the use of a colonoscopic surveillance regimen.     

Epidemiology and prognosis of synchronous and metachronous colon cancer metastases: A French population-based study

BackgroundEpidemiological data on synchronous and metachronous metastatic colon cancer are scarce. We assessed epidemiological characteristics and survival in synchronous and metachronous metastatic colon cancer in a French population.MethodsOur study included 932 cases of metastatic colon cancer diagnosed in 1999–2010 and registered in a population-based cancer registry; 758 were synchronous colon metastases and 174 metachronous metastases from resected primary colon cancers diagnosed in 1999–2005. Univariate relative survival was calculated and a multivariate model with proportional hazard applied to net survival by interval was used.ResultsMean age at diagnosis was 71.1 years for patients with metachronous metastasis and 71.4 years for those with synchronous metastasis (p = 0.818). Patients with metachronous metastasis were more likely to have R0 resection (Odds Ratio: 3.05 [1.96–4.76], p < 0.001) than patients with synchronous metastasis. Five-year relative survival was 7.2% for synchronous metastasis and 17.6% for metachronous metastasis (p < 0.001), but did not differ significantly for patients with R0 resection (47.3% and 61.5% respectively, p = 0.120). For patients not receiving chemotherapy risk of death was significantly lower in the metachronous metastasis group (Hazard Ratio = 0.44 [0.32–0.60], p < 0.001).ConclusionsOn a population basis, synchronous metastasis is an independent poor prognostic factor in colon cancer. Chemotherapy and resection of all metastatic sites significantly improved the outcome in patients with synchronous metastasis.     

Efficacy of Helicobacter pylori eradication for the prevention of metachronous gastric cancer after endoscopic resection for early gastric cancer

Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.     

Characteristics and prognosis of synchronous multiple early gastric cancer

AIM:To assess the clinicopathologic characteristics,risk factors,and prognosis for synchronous multiple early gastric cancer(SMGC).METHODS:A total of 146 patients with SMGC and1194 patients with single gastric cancer who had undergone gastrectomy between 1989 and 2008 were retrospectively analyzed to determine their clinicopathologic characteristics and postoperative survival.Tumors were classified into groups on the basis of location and histology.Smoking habits were evaluated using the Brinkman index.Clinical and pathological factors were compared using either Fisher’s exact test or Pearson’sχ2test.Logistic regression analysis was performed to identify independent risk factors.Survival rate was calculated using the Kaplan-Meier method.RESULTS:SMGCs accounted for 10.9%of gastric cancer cases and occurred predominantly in elderly male patients with a family history of gastric cancer who were both smokers and drinkers.These tumors were typically macroscopically elevated and histologically differentiated.There were no significant differences between SMGC and single gastric cancer patients with respect to tumor location,tumor size,lymph node metastasis,the number of metastatic lymph nodes,venous invasion,or tumor stage(P=0.052,P=0.347,P=0.595,P=0.805,P=0.559,and P=0.408,respectively).Further,there was no significant difference in postoperative survival between the patient groups(P=0.200).Of the 146SMGC patients,a single patient had remnant cancer.CONCLUSION:A careful preoperative endoscopy is necessary for patients who are at high risk of SMGC,and minimally invasive treatment may be indicated in some cases.     

多原发肺癌的鉴别诊断和治疗选择

随着诊断手段的发展、筛查意识的提高和人口老龄化,全球多原发肺癌的检出率持续上升.多原发肺癌的诊断难点在于和转移病灶的鉴别.由于缺乏可靠的分子标志物来鉴别转移和原发病灶,所以多原发肺癌的诊断和临床处理仍受到限制.该文综述近年来多原发肺癌的发病机制、生物标志物、诊断和治疗选择方面的进展.     

Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.     

右半结肠合并直肠重复癌时的术式选择附四例报告

回顾分析2016年9月至2017年8月收治的4例右半结肠合并直肠癌患者的临床资料。4例均符合右半结肠合并直肠重复性癌的诊断标准,其中3例为同时性多原发癌（SCRC）,1例为异时性多原发癌（MCRC）。4例患者中,3例SCRC患者均行两个部位的联合根治性手术,在右半结肠根治术中均保留中结肠动脉左支和左结肠动脉;MCRC患者第一次行扩大右半结肠切除术时未保留中结肠动脉左支,第二次行保留左结肠动脉的直肠癌根治术。4例患者术后均未发生吻合口漏等相关并发症,术后随访至今,平均随访时间为8.75±4.57个月,未发生转移或复发。对于右半结肠癌合并直肠癌行右半结肠癌加直肠癌根治性手术时,应保留中结肠动脉的左支及/或左结肠动脉,避免出现剩余结肠发生缺血坏死,出现吻合口漏和狭窄。     

Clinical epidemiology of gastric cancer in Hehuang valley of China:A 10-year epidemiological study of gastric cancer

AIM:To investigate the clinical epidemiological characteristics of gastric cancer in the Hehuang valley,China,to provide a reference for treatment and prevention of regional gastric cancer.METHODS:Between February 2003 and February2013,the records of 2419 patients with gastric cancer were included in this study.The patient’s characteristics,histological and pathological features,as well as the dietary habits of the patients,were investigated.RESULTS:The clinical data showed that adenocarcinoma was the leading histological type of gastric cancer in this area.Characteristics of gastric cancer in different ethnic groups and age showed that the 60.55-65.50years group showed the high incidence of gastric cancer in all ethnic groups.There were more male gastric cancer patients than female.Intestinal was the most common type of gastric cancer in the Hehuang valley.There was no significant difference in the proportion of sex in terms of Helicobacter pylori infection.The impact of dietary habits on gastric cancer showed that regular consumption of fried or grilled food,consumption of high-salt,high-fat and spicy food and drinking strong Boiled brick-tea were three important factors associated with gastric cancer in males and females.CONCLUSION:Differences existed in race,sex,and age of patients according to the epidemiology of gastric cancer in the Hehuang valley.Moreover,dietary habits was also an important factor contributing to gastric cancer.     

Multiple primary cancers in extracolonic sites with colorectal cancer

Purpose  The present study was undertaken to clarify the clinical and pathological features of multiple primary cancers, especially those at extracolonic sites, in patients with colorectal cancers. Methods  We reviewed the records of 2,176 patients who underwent surgery for colorectal cancers in our institute from January 1997 to December 2006. A synchronous multiple primary cancer was defined as extracolonic cancer detected within 6-month interval before and after the detection of colorectal cancer. Any metastasis from colorectal cancers was excluded. Results  Synchronous multiple primary cancers were identified in 32 patients. The stomach is the most common organ for synchronous multiple primary cancer development in patients with colorectal cancers (0.9%, 20/2,176). Conclusions  Gastric cancer is the most common synchronous multiple primary cancers occurring concomitantly with colorectal cancers. Careful preoperative screening is necessary for the detection of multiple primary cancers in extracolonic sites in patients with colorectal cancers.     

Gastric cancer patients at high-risk of having synchronous cancer

AIM: To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS: We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS: 111 of 3291 gastric cancer patients (3.4%) registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer (42 patients, 37.2%) followed by lung cancer (21 patients, 18.6%). Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION: Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric cancer.     

Endoscopic surveillance strategy after endoscopic resection for early gastric cancer

Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.     

A study of metachronous cancer after endoscopic resection of early gastric cancer

Abstract

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.     

老年胃癌及癌前病变中幽门螺杆菌感染情况的研究

采用ＰＣＲ方法检测老年胃癌及癌前病变组织中幽门螺杆菌（ＨＰ）感染情况。结果显示：正常组ＨＰ感染率为１５．０％，浅表性胃炎组为７０．０％，胃癌组为６３．３％；萎缩性胃炎组阳性率为８６．８％，不典型增生组为８４．０％，肠化生组为７５．０％。胃癌组中，高、中分化癌阳性率明显高于低分化组（Ｐ＜０．０１），肠型胃癌阳性率明显高于弥漫型（Ｐ＜０．０１）。萎缩性胃炎组及不典型增生组，中、重度者阳性率明显高于轻度者（Ｐ＜０．０５）。以上结果证明，ＨＰ与胃癌、癌前病变、胃炎均有密切相关性     

34例与肺癌相关的多原发癌的临床分析

目的:探讨与肺癌相关的多原发癌的临床特点。方法:回顾性分析34例与肺癌相关的多原发癌患者的临床病历资料。结果:34例患者中,同时癌占38%(13/34),异时癌占62%(21/34)。在多原发癌中肺癌起病隐匿,首发症状以咳嗽、咯血、胸闷气促常见,无症状者16例。肺癌病理分型以腺癌最为常见。再罹患肺癌风险更高的是头颈部肿瘤,肺癌患者最易再罹患消化系统肿瘤。重癌切除率67.6%。第一原发癌中位生存期为4.5年,第二原发癌中位生存期为1年。多原发癌中肺癌发生的先后顺序与预后无明显相关性。结论:与肺癌相关的多原发癌有一定的临床特点,预后较好,应重视初诊肿瘤患者的随诊工作,早期发现,积极治疗,提高患者生存率。     

Synchronous double cancers of the common bile duct

We report an extremely rare case of synchronous double cancers of the common bile duct without pancreaticobiliary maljunction. Only two similar cases have been reported in the English literature. Endoscopic re-trograde cholangiopancreatography showed a tuberous filling defect in the middle and superior parts of the common bile duct, and mild stenosis in the inferior duct. Computed tomography (CT) showed a well enhanced mass in the middle and superior parts of the common bile duct. A single cancer of the middle and superior bile duct was suspected and extra-hepatic bile duct resection was performed. CT eleven months after surgery revealed enhanced inferior bile duct wall and a slightly enhanced tumor within it. Retrospective review of the CT images taken before first surgery showed enhanced inferior bile duct wall without intrabiliary tumor only on the delayed phase. The inferior bile duct tumor was suspected to have originally co-existed with the middle and superior bile duct tumor. Pancreaticoduodenectomy was performed subsequently. Histopathological examination revealed that the middle and superior bile duct tumor was a moderately differentiated tubular adenocarcinoma while the inferior bile duct tumor was a papillary adenocarcinoma. The two tumors were separated and had different histological findings and growth patterns, further suggesting that they were two primary cancers.     

Metachronous intracystic and intraductal papillary neoplasms of the biliary tree

A 77-year-old woman complained of epigastralgia,and a tumor(5 cm in diameter)of the gallbladder neck was detected by image analysis.Following cholecystectomy,the tumor was pathologically diagnosed as intraductal papillary neoplasm(IPN),gastric type,with associated invasive carcinoma.About 10 mo later,intraluminal multiple masses(3 foci,up to 1.8 cm)were noted in the extrahepatic bile duct,and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion,and they were synchronous multiple lesions.This case showed a papillary tumor of the gallbladder of gastric phenotype,and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.