Intracranial metastasis of prostate cancer: report of two cases

Metastases from prostate cancer to the brain are very unusual and are seldom reported in the clinical literature. We report 2 cases of advanced stage prostate cancer with intracranial metastasis. One patient developed intracranial metastasis 5 years after step-up treatment. He had hormone refractory prostate cancer with a high level of prostate specific antigen (PSA). Unfortunately, he died of sepsis 3 weeks after craniotomy. The other patient with various neurologic symptoms and a normal PSA level responded to hormone therapy well. He had an uneventful postoperative course and has survived for more than 21 months after surgery. We also reviewed the literature and suggest that aggressive treatment, including neurosurgery, could improve the survival of certain patients with advanced prostate cancer with intracranial metastasis.     

Alpha-fetoprotein-producing early gastric cancer: report of two cases

We have experienced two cases of alpha-fetoprotein (AFP)-producing early gastric cancer. One patient was a 73-year-old man diagnosed as having an early gastric cancer type 0 I + IIa at 40 x 40 mm on the greater curvature of the lower body of the stomach. The histological findings showed that proliferation of a well-differentiated tubular adenocarcinoma with hepatoid pattern was massively invading to the middle layer of the submucosa, with positive lymph vessel, and lymph node metastasis. The other patient was a 76-year-old man diagnosed as having an early gastric cancer type 0 IIa + IIc at 25 x 25 mm on the anterior wall on the greater curvature of the antrum. The histological findings showed that proliferation of a small cell carcinoma was massively invading to the deep layer of the submucosa, with positive lymph vessel, and lymph node metastasis. AFP was immunohistochemically found in the tumor cells of these two cases. Both patients died from liver metastasis. AFP-producing early gastric cancer was concluded to be at high risk of liver metastasis.     

Long-term survival of lung cancer with brain metastasis

Two patients presented with adenocarcinoma of the lung and subsequently brain metastasis. Lobectomies were performed initially. One patient had a lung recurrence and was treated effectively by irradiation, the other had primary lung cancer controlled by surgery. Solitary brain metastases developed in both of them and was surgically removed. They were given postoperative radiation to the brain. Both survived, one more than five years and the other more than four years. They are women in their early 40s and 50s and are in good general condition. Contrary to the accepted method of treatment for patients with brain metastasis, which is usually palliation, surgical treatment followed by radiation could achieve the most rewarding results.     

胃癌骨髓转移并发血小板减少性紫癜1例报告

1 临床资料 患者女性,51岁.因"腰背部疼痛1个月余,伴皮肤瘀斑2周"于2007年9月6日入院.患者于2007年8月无明显诱因自觉腰背部疼痛,活动后加剧,2周前四肢皮肤出现数个大小不等的紫红色瘀斑,伴间断低热,无寒战、畏寒,大便每日1～2次,色黑,基本成形,在当地医院查血小板示38×109/L;骨髓细胞学检查示粒系、红系增生活跃,巨核数增多、成长障碍,血小板小簇散在分布;胸椎MRI检查示第8、11胸椎椎体变扁伴信号异常;予口服泼尼松50 mg/d治疗,皮肤瘀斑有所消退,但腰背痛进行性加重,复查血小板示27×109/L.既往无胃病史.     

培美曲塞治疗胰腺癌肝转移2例报告

1临床资料 例1:患者,女,67岁,于2006年9月因"反复中上腹胀痛1个月余"入院.反复中上腹疼痛呈牵拉痛,与饮食无关,当时无远处放射.实验室检查AFP 3.2 μg/L,CEA 17.32 μg/L,CA19-9>1 000 U/ml,CA125 369 U/ml.B超提示:肝脏多发占位性病变,胰腺低回声病变.     

肺癌术后肾转移行患肾切除术2例报告

1病例资料病例1,男,55岁。因肺癌术后2年,体检发现左肾占位2 d入院。患者2009年4月因"右肺下叶鳞癌"行右肺下叶切除并纵隔淋巴结清扫术,术后定期复查。2011年9月行CT示:左肾占位,最大径6.9cm,考虑恶性肿瘤可能性大。红细胞沉降率(ESR)43mm/1 h。胸片示:右侧少量胸腔积液,余未见明显异常。PET-CT示:左肾恶性肿瘤可能并肾门淋巴结转移;右肺癌术后,肺容积缩小。肾ECT示:左肾肾小球滤过率     

胃癌肝转移治疗进展

肝脏是胃癌主要远处转移部位,肝转移是导致胃癌患者死亡的主要原因之一。胃癌肝转移(GCLM)患者的临床特征和病理特征存在个体差异性,治疗效果差,治疗方法的选择存在一定争议。复习相关文献,对GCLM治疗的现状及研究进展进行综述。     

Clinicopathological study for gastric cancer with liver metastasis

Clinicopathological characteristics, stromal volume (Vvf), nuclear DNA content and cell protein were retrospectively analyzed in order to scrutinize the risk factors of hepatic metastasis from carcinoma of the stomach. We conducted a clinicopathological study of 327 patients with gastric cancer, including 34 patients with liver metastasis (synchronous, 22; metachronous, 12) and 294 patients without liver metastasis. Univariate analysis revealed significant inter-group differences in tumor size (p<0.001), depth of invasion (p<0.001), lymph node metastasis (p<0.001), vascular involvement (p<0.001), lymphatic involvement (p<0.001), peritoneal dissemination (p<0.05), Vvf (p<0.01) and DNA content (p<0.01). Vvf and DNA content were estimated in the liver metastasis group (n=20) and in the group of patients with stage III-IVa carcinoma but without liver metastasis (n=11). In multivariate analysis, only Vvf and DNA content showed significant correlations with liver metastasis (p<0.01). A comparison of Vvf and expression of the amount of interstitial connective tissue showed that there as a significant correlation between them. Our results indicate that gastric cancer with low Vvf and high DNA content carries a high risk of hepatic metastasis. Therefore, mean DNA content and Vvf are useful indices for predicting liver metastasis from gastric carcinoma.     

Two cases of early gastric carcinoma with synchronous liver metastasis

We have experienced two cases of early gastric cancer with synchronous liver metastasis. One patient was a 64-year-old man diagnosed as having early gastric cancer type 0 IIa at 15 x 10 mm on the lesser curvature of the cardia. The other patient was a 58-year-old man diagnosed as having early gastric cancer type 0 IIa + IIc at 24 x 18 mm on the posterior wall of the antrum. The histological findings showed that proliferation of moderately differentiated tubular adenocarcinoma with hepatoid pattern was massively invading to the deep layer of the submucosa, with positive lymph vessel, vein invasion and lymph node metastasis, in both cases. These results suggested that elevated or mixed macroscopic type, differentiated adenocarcinoma massively invading to the deep layer of submucosa, positive lymph vessel and vein invasion, lymph node metastasis, and hepatoid adenocarcinoma were risk factors for liver metastasis from early gastric cancer.     

Unresectable advanced gastric cancer effectively treated by combined chemo-immunotherapy: a report of two cases

We have experienced two cases of unresectable advanced gastric cancer effectively treated by chemo-immunotherapy. One case was of a 68-year-old male patient diagnosed as having inoperable advanced gastric cancer with liver and lung metastasis. This patient was treated by combined chemo-immunotherapy of MMC 10 mg/M, 5'-DFUR 800 mg/day and OK-432 5 KE/2W. At 6 months later, a computed tomography (CT) scan and upper gastrointestinal (GI) series revealed that the metastatic liver tumors and stomach lesion were remarkably decreased in size, and endoscopic biopsy confirmed no cancer cells in the stomach lesion. Moreover, the metastatic lung tumor had disappeared on chest X-ray. The other case was of a 68-year-old female patient with unresectable advanced gastric cancer treated by combined administration of MMC 10 mg/M, 5-FU 200 mg/day and OK-432 5 KE/2W. At 2 months after commencing the treatment, there was a reduction in the serum carcinoembryonal antigen (CEA) level. At 6 months later, the CEA had decreased to normal, the primary and metastatic sites had completely disappeared on CT, and endoscopic biopsy confirmed no cancer cells in the stomach lesion. This patient has survived to date for 5 years and 6 months after commencing the treatment. These results suggested that combined chemo-immunotherapy of MMC, antimetabolite, and OK-432 was an effective treatment for unresectable advanced gastric cancer.     

皮肤大汗腺癌伴肝转移1例报告

1病例资料患者,男性,52岁,因“发现头枕部肿物10个月,术后7个月余,肝转移3个月”为主诉来我院复诊。2008年2月发现右侧一头皮肿物,椭圆形,突出于皮肤表面,与周围组织界限不清,质硬,活动度差,轻度压痛。因肿物进行性增大,中央表面溃破,同年5月取头枕部破溃部周围组织活检,提示恶性肿瘤,血常规、头颅及胸腹联合CT未见异常。随后行局部肿物手术切除,肿块大小为3 cm×3 cm×4 cm,周围组织无明显异常,组织病理镜检显示肿瘤呈浸润性生长,肿瘤细胞排列成条索状或小巢状,与周围组织分界较清楚,病理诊断为大汗腺癌。术后放疗,总量45 Gy。之后每2个月复查头颅及胸腹联合CT未见异常。2008年9月在我院复查肝脏CT发现肝转移,头颅MRI及胸部CT均未见异常,随后予卡铂+紫杉醇化疗2周期后复查肝脏CT提示转移灶缩小,继续以上方案再化疗2周期。     

胃癌肝转移患者治疗过程中血管内皮细胞生长因子水平的变化

目的:检测胃癌肝转移患者治疗前后的血浆可溶性血管内皮细胞生长因子(VEGF)水平,并探讨其临床意义?方法:采用定量酶联免疫吸附试验双抗体夹心法检测43例胃癌肝转移患者治疗前后和20例浅表性胃炎患者(对照组)的血浆可溶性VEGF水平?结果:胃癌肝转移患者血浆可溶性VEGF水平显著高于对照组?经治疗后病情好转的胃癌肝转移患者[疗效评价为完全缓解(CR)或部分缓解(PR)],其血浆可溶性VEGF水平较治疗前明显下降,两者之间的差异有统计学意义(P < 0.05)?治疗后病情进展的胃癌肝转移患者[疗效评价为疾病进展(PD)],其血浆可溶性VEGF水平较治疗前明显升高,两者之间的差异有统计学意义(P < 0.05)?在经治疗后病情稳定的胃癌肝转移患者[疗效评价为疾病稳定(SD)],其血浆可溶性VEGF水平与治疗前的差异无统计学意义?结论:用ELISA方法检测血浆可溶性VEGF浓度对于评价胃癌肝转移的治疗疗效有一定的参考价值?     

Early gastric cancer associated with synchronous liver metastasis.

During the 14 years from 1976 to 1989, 1442 gastric cancers were resected in the Department of Surgery at Kurume University. 546 (37.9%) were primary early gastric cancers. One (0.2%) of these was associated with a synchronous liver metastasis. In the advanced gastric cancers, the rate of synchronous liver metastasis was 12.8%. However, synchronous liver metastasis with an early gastric cancer is quite rate. Only 19 cases have been reported in the Japanese literature. A case involving an early cancer, 10 mm in diameter, that was associated with liver metastasis is reported.     

腹腔镜辅助下胃癌根治术22例报告

目的探讨腹腔镜辅助下胃癌根治术的手术方法及效果。方法回顾分析22例腹腔镜胃癌根治术的临床资料,近端胃大部切除术3例,远端胃大部切除术19例。结果22例病人均顺利完成腹腔镜手术,无中转开腹。平均手术时间195 min（180～250 min）,平均出血量130 ml（85～170 ml）,平均下床活动时间52 h（41～61 h）,平均排气时间75 h（58～92 h）,平均住院时间9天（7～17天）。术后并发症3例,均经保守治疗治愈。结论腹腔镜辅助下胃癌根治术,在保留腹腔镜手术微创优点的同时减少了腔镜下的操作步骤,降低了腹腔镜胃癌根治术的手术难度,具有较好的临床应用价值。     

Waist cancer: report of two cases

Saree is a type of female costume unique to Indian subcontinent. This includes a superficial cloth and a skirt underneath which is fastened securely to the waist by a cord. Persistent and long-term wearing of this costume has resulted in waist dermatoses. This waist dermatoses giving rise to malignancy is being reported here and 'saree cancer' is the term used to this entity of waist cancer. Here two cases of waist cancer are reported.     

Acute fatty liver of pregnancy: a report of two cases

Acute fatty liver of pregnancy is an uncommon, potentially fatal disorder. Between 1998 and 2000, two patients with acute fatty liver of pregnancy presented at the Christian Medical College Hospital, Vellore. Both patients were in the thirty-sixth week of pregnancy. jaundice and encephalopathy were the predominant symptoms. Both the mothers died after they delivered a stillborn Infant each. The maternal deaths were due to multiorgan failure and/or postpartum haemorrhage and sepsis. The route of delivery was vaginal in both the patients. Extrahepatic and metabolic complications in both cases Included renal failure, sepsis, hypoglycaemia, disseminated intravascular coagulation and gastrointestinal bleeding. Liver biopsy done in both patients was consistent with the diagnosis of acute fatty liver of pregnancy. To the best of our knowledge, this is the first report from India on acute fatty liver of pregnancy.     

肝移植术后结直肠恶性肿瘤的诊疗(附6例报告)

目的 了解肝移植术后结直肠恶性肿瘤(新发结直肠癌及肝癌结直肠复发)的发病情况,探讨病因、诊疗及预后情况.方法 收集1996年5月至2011年3月共982例肝移植患者的临床资料,并进行回顾性分析.结果 (1)非肿瘤肝移植患者483例,术后存活1年以上有391例,结直肠发生新发恶性肿瘤3例(发病率为0.76％),其中,2例结肠癌行姑息切除,分别于发病后6个月或3个月死亡,另1例为直肠癌,手术后存活已10个月.(2)肿瘤肝移植患者499例,出现肿瘤复发140例,复发率为28.06％,其中结肠复发3例,占复发的2.14％,均行再次切除术,分别于发病后14、4、7个月死亡;未见直肠复发病例.结论 肝移植术后结直肠恶性肿瘤虽较为少见,但总体预后不佳,需在术前及术后详细排查及尽早处理以改善预后,定期结肠镜检查对于该病的诊断有重要的意义,应列为肝移植术后常规随访项目.     

Current status and progress in gastric cancer with liver metastasis

Objective This review discusses the current status and progress in studies on gastric cancer with liver metastasis (GCLM), involving the routes, subtypes, and prognosis of GCLM; the genes and molecules associated with metastasis; the feasibility and value of each imaging modality; and current treatment options.

Data sources The data used in this review were mainly from Medline and PubMed published in English from 2005 to August 2010. The search terms were “gastric cancer” and “liver metastasis”.

Study selection Articles regarding the characteristics, diagnostic modalities, and various therapeutic options of GCLM were selected.

Results The prognosis of GCLM is influenced by the clinicopathological characteristics of primary tumors, as well as the presence of liver metastases. Improved understanding of related genes and molecules will lead to the development of methods of early detection and targeted therapies. For the diagnosis of GCLM, each imaging modality has its relative benefits. There remains no consensus regarding therapeutic options.

Conclusions Early detection and characterization of liver metastases is crucial for the prognosis of gastric cancer patients. Multidisciplinary team discussions are required to design optimal treatment strategies, which should be based on the clinicopathological characteristics of each patient.

     

腹腔镜同期手术治疗胃神经内分泌癌肝转移1例

胃神经内分泌癌（Gastric neuroendocrine carcinoma,G-NEC）是一类少见的起源于胃神经内分泌细胞的高度恶性肿瘤。GB-NEC 侵袭性强,易于发生淋巴结和远处转移,预后较差。肝脏是G-NEC 最常见的远处转移部位。目前,对于G-NEC 伴肝脏转移的治疗仍存在争议,尚无腹腔镜手术治疗G-NEC 伴肝转移的相关报道。在这里,本文回顾性分析了1 例G-NEC 伴肝转移患者的临床特点和诊治经过。患者因“恶心伴食欲不振3 个月”入院,结合病史、体格检查及辅助检查结果,术前考虑诊断为胃恶性肿瘤伴肝转移,接受了腹腔镜胃癌根治术（全胃切除+食道空肠Roux-en-Y 吻合+D2 淋巴结清扫）+左肝外叶切除+空肠造瘘术,术后无严重并发症发生并顺利出院。术后予以6 个周期的“依托泊苷+顺铂”方案化疗,随访患者术后2 年未见肿瘤复发。