Early gastric cancer associated with synchronous liver metastasis and portal tumorous embolism: Report of a case

(Received for publication on July 25, 1996; accepted on July 8, 1997)     

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.     

Metastasis of cancer to cancer: Report of a case of esophageal carcinoma metastasizing to early gastric cancer

A rare case of esophageal carcinoma metastasizing to early gastric cancer is reported herein. A 66 year old man who had experienced dysphagia for 8 months was preoperatively diagnosed as simultaneously having esophageal and gastric cancers. Thus, a lower esophagectomy and total gastrectomy with paraesophageal and paragastric lymph node dissection were performed. The surgical specimen revealed an ulcerative tumor in the lower esophagus and a slightly depressed lesion with a central elevation similar to that of early type IIc+IIa¹ gastric cancer in the upper part of the stomach. Microscopically, the esophageal tumor was revealed to be well differentiated squamous cell carcinoma while the gastric tumor was found to be early gastric cancer with a metastatic focus of esophageal cancer in the center. Though less than one hundred cases of metastasis of cancer to cancer have previously been reported, metastasis from cancer of one digestive organ to that of another digestive organ is very rare. To our knowledge, this report represents the first case of an esophageal carcinoma metastasizing to a gastric carcinoma.     

Clinicopathological study of brain metastasis in gastric cancer patients

P = 0.0177). Aggressive multidisciplinary treatment, including a resection, for brain metastasis should improve the quality of life and prolong life expectancy. (Received for publication on Aug. 5, 1999; accepted on Jan. 7, 2000)     

伴远隔转移的早期胃癌临床病理特征

目的分析原发病灶局限于黏膜或黏膜下层,但同时伴有远隔转移早期胃癌的临床病理特征。方法回顾性分析1973年4月至1998年11月,中日两家大学8所附属医院的4420例(每家医院220~1270例)早期胃癌,其中22例伴有远隔转移。分析伴远隔转移的早期胃癌(远转组)和不伴远隔转移的早期胃癌(无转组)在性别、年龄、肿瘤大小、浸润深度、分化类型、长期存活率等方面的差异。结果远转组肿瘤与无转组在性别、肿瘤大小、浸润深度、5年存活率(远转组34.7%,无转组91.3%)方面差异有非常显著性意义(P<0.01);两组在年龄、分化程度方面差异无显著性意义。结论早期胃癌也可能发生远隔转移并导致预后不佳。女性、肿瘤浸润至黏膜下层且肿瘤直径>4cm可能是早期胃癌发生远隔转移的危险因素。     

Long-term survival of 5 years following initial surgery for gastric cancer and simultaneous disseminated peritoneal metastasis: Report of a case

We report herein the rare case of a patient who survived for 5 years and 10 months after commencing treatment for gastric cancer with simultaneous disseminated peritoneal metastasis. A 45-year-old man was diagnosed as having advanced gastric cancer following the discovery of numerous nodules in the peritoneal cavity at laparotomy. The patient was treated by palliative gastrectomy and continuous hyperthermic peritoneal perfusion (CHPP) immediately after surgery on November 11, 1987. Postoperatively, he underwent radiofrequency (RF) hyperthermia with intraperitoneal cisplatin a total of seven times. He continued on a combination of uracil and tegafur (UFT) administered orally with a protein-bound -d-glucan extracted from the mycelia ofCariolus versicolor(PSK). Long-term survival was achieved following the initial palliative gastrectomy despite simultaneous disseminated peritoneal metastasis.     

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.     

Simultaneous early gastric cancer in identical twins: Report of a case

We report the unusual case of identical male twins developing early gastric cancers that were found almost simultaneously. A 39-year-old man underwent a barium-swallow examination to investigate the cause of right hypochondrial discomfort; the examination revealed evidence of gastric cancer in the upper body of the stomach. A diagnosis of adenocarcinoma was confirmed by endoscopic biopsy, and a total gastrectomy was performed. Subsequent screening of the patient's asymptomatic identical twin revealed gastric cancer in the lower body of the stomach, for which distal gastrectomy with Billroth I reconstruction was performed. The histopathological types of the two cancers were similar and both had infiltrated the submucosa. The relevant etiological factors contributing to the development of gastric adenocarcinoma in these identical twins is discussed, following the case report.     

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.     

The macroscopic diagnosis of lymph node metastasis from early gastric cancer

As the proportion of early gastric cancers (EGC) has been steadily increasing, modifications of the radical lymphadenectomy approach to stomach cancer have been attracting considerable attention; however, accurate pre- and intraoperative evaluations of tumor extent are essential for the successful application of this method. We examined the reliability of macroscopically diagnosing node involvement by reviewing the operative and pathological records of 522 patients with EGC. Of 59 patients histologically diagnosed as node-positive (n+), only 19 (32%) had been macroscopically diagnosed as node-positive (N+). In contrast, of 61 N+ patients, 42 (69 %) were in fact n-. Metastases from histologically diffuse type carcinomas were less accurately diagnosed than those from intestinal type tumors. In 44% of the false-positive (N+/n-) patients, the tumor had been preoperatively diagnosed as advanced, which seemed to have lead to intraoperative overdiagnosis. These results suggest that lymph node metastases from EGC cannot be reliably diagnosed during surgery. The indications for a modified radical operation should thus be decided according to preoperative tumor evaluation based on the depth of invasion.     

Pseudomyxoma peritonei concomitant with early gastric cancer: Report of a case

The preoperative diagnosis of both appendiceal carcinoma and pseudomyxoma peritonei is difficult because of the nonspecific nature of the associated symptoms. More than 50% of all patients with carcinoma of the appendix are diagnosed with and treated for acute appendicitis. In addition, there have been few reports on patients with an appendiceal carcinoma or pseudomyxoma peritonei in association with other synchronous or metachronous malignancies of the alimentary tract. We herein report the first known patient with synchronous early gastric cancer and pseudomyxoma peritonei, in which the origin was correctly identified preoperatively.     

早期胃癌淋巴结转移相关危险因素研究

目的 探讨早期胃癌淋巴结转移危险因素。方法 回顾性分析首都医科大学附属北京友谊医院自2008年1月至2015年1月手术治疗（开放手术或腹腔镜手术）112例早期胃癌病人临床病理学资料,采用Logistic回归模型进行研究。结果 多因素分析示,年龄、浸润深度、组织学类型、脉管内瘤栓与淋巴结转移存在相关性。分层分析示,年龄＜60岁、侵犯黏膜下层、分化不良且合并脉管内瘤栓者更易出现淋巴结转移。结论 年龄、浸润深度、组织学类型及脉管内瘤栓是淋巴结转移的危险因素;年龄≥60岁、肿瘤局限于黏膜内、分化型且无脉管内瘤栓者可行单纯内镜下切除,具有以上高危因素者,建议根据具体情况加行淋巴结清扫术。     

Rib metastasis appearing 8 years after surgery for lung cancer: Report of a case

(Received for publication on May 17, 1999; accepted on Nov. 11, 1999)     

早期胃癌淋巴结转移相关因素分析

目的 探讨早期胃癌病人临床病理特征及免疫病理与淋巴结转移的相关性。方法 对2006年1月至2008年l2月第二军医大学长海医院普通外科诊治的212例早期胃癌病例进行回顾性分析,采用t检验、χ2检验和Logistic回归等统计学方法对肿瘤大小、浸润深度、组织学类型等临床病理特征以及p53、Ki?67、CAM5.2等免疫组化指标与淋巴结转移进行相关性分析。结果 肿瘤大体类型、大小、浸润深度、组织分化程度与淋巴结转移存在明显的相关性（P值为0.014、0.001,0.012,0.006,相关系数R为2.213、1.779、4.737、4.15）。免疫病理指标中p53、CAM5.2与淋巴结转移也存在明显相关（P值为0.001和0.000,相关系数R为1.922、3.632）。而年龄、性别、肿瘤位置、多发肿瘤及免疫病理指标中p16、TopoⅡ、Ki?67与淋巴结转移无明显相关性。结论 早期胃癌淋巴结转移与肿瘤大小、肿瘤分化程度、浸润深度等明显相关,可参考上述因素判断淋巴结转移风险,同时根据免疫病理指标CAM5.2、P53判断是否存在微转移可能,从而决定治疗方案。     

Distant lymph node metastasis of early gastric cancer

Among 601 patients with early gastric cancer (EGC), the clinicopathological findings of 5 patients (invasion of the mucosal layer in 2 and of the submucosal layer in 3) with distant lymph node metastasis according to TNM classification (third-or fourth-tier lymph node metastasis according to the Japanese classification) were investigated. The proliferating-cell nuclear antigen (PCNA) expression of EGC was also examined immunohistologically. The sites of distant metastasis were the nodes at the root of the mesentery, in the hepatoduodenal ligament, and the paraaortic nodes, while the PCNA-positive rate of EGC with distant lymph node metastasis (35.4%) was significantly higher than that of EGC without lymph node metastasis (14.7%,P=0.01), it was similar to that of EGC with perigastric lymph node metastasis. The cumulative survival rate of the EGC patients with distant lymph node metastasis (5-year survival rate 20.0%) was significantly lower than that without lymph node metastasis (88.2%,P<0.0001), first-tier lymph node metastasis (76.9%,P<0.04), or second-tier lymph node metastasis (77.1%,P<0.04). Thus, although the prognosis of EGC patients with distant lymph node metastasis was poor, a dissection of the distant lymph nodes should be performed when metastasis is suspected.     

A giant tumor of the mesocolon found to be metastasis from an alpha-fetoprotein-producing gastric carcinoma: Report of a case

We present herein an extremely rare case of metastasis from a gastric carcinoma to the mesocolon. A 71-year-old woman underwent a laparotomy for gastric cancer with an intra-abdominal mass. Her serum alpha-fetoprotein level was very high at 3,560 ng/ml. The abdominal mass was subsequently revealed to be a metastatic tumor of the transverse mesocolon derived from an alpha-fetoprotein-producing gastric carcinoma, but no other metastatic focus was found. An immunohistochemical study revealed alpha-fetoprotein-positive cells in both lesions. The serum alpha-fetoprotein level became normal after the operation which was followed by a course of chemotherapy, and no recurrence has been observed thus far in 6 months of follow up.     

Impact of skip metastasis in gastric cancer

BACKGROUND: Several studies have shown the features of skip metastasis in other cancers besides gastric cancer. Since minimally invasive surgery has been applied to gastric cancer, the concerns and awareness of skip metastasis have grown in the medical community. We conducted the present retrospective study to reveal the clinicopathological characteristics of patients with skip metastasis. We also wished to clarify the clinical impact of skip metastasis for gastric cancer. METHODS: Five hundred and eighty-nine patients having lymphatic metastases were enrolled in the present study. Among them, 266 patients had positive nodes extending into the N2 group. We divided these patients into the skip positive (+) and the skip negative (-) group, and we comparatively analysed clinicopathological factors and calculated the survival probabilities for the two groups. RESULTS: The skip (+) and skip (-) groups involved 14 (5.3%) and 252 (94.7%) patients, respectively. Of all the investigated factors, a significant difference between two groups was observed only in the total number of retrieved nodes. Stations of skip nodes were along left gastric (7), anterior common hepatic (8a), celiac (9), splenic (11) artery and right paracardial nodes (1). The survival curves calculated in the present study did not show any statistical differences between the groups. CONCLUSIONS: Due to problems of skip metastasis in gastric cancer, D2 lymph node dissection should be performed until sentinel node detection is feasible and reliable. The potential risk from skip metastasis is not great and skip metastasis itself should not be a major consideration in therapeutic decisions.     

Endo-organ full-thickness excision for gastric cancer: Report of a case

(Received for publication on June 8, 1998; accepted on May 27, 1999)     

Cutaneous metastasis revealing a relapse of gastric linitis: Another case

INTRODUCTIONCutaneous metastasis from gastric cancer is a rare occurrence. The linitis gastric carcinoma accounts only 8.7% of all gastric cancers.PRESENTATION OF CASEWe report a case of female patient who was followed for linits cancer with peritoneal metastasis treated by six cycles of chemotherapy. After seventeen months of control, the relapse of the disease revealed by occurrence of cutaneous metastatsis.DISCUSSIONCutaneous metastasis from linit gastric is rare and the prognostic remains poor. The treatment is palliative.CONCLUSIONThis rare presentation should encourage the practitioners to biopsy any suspicion skin lesion.     

Liver metastasis with intraductal invasion originating from rectal cancer: Report of a case

We report a case of liver metastasis with intraductal invasion from colorectal cancer. The patient underwent abdominoperineal resection of the rectum for rectal cancer, and a computed tomography (CT) scan, done 4 years later, revealed a low-density lobular mass in the left lobe of the liver, with a tumor embolus in the second branch of the left bile duct (B2). Because the preoperative imaging findings showed an intraductal growth pattern, we performed a left lobectomy of the liver for intrahepatic cholangiocarcinoma (IHCC). Immunohistochemically, the carcinoma cells, including the intraductal growth, were focally positive for Cytokeratin (CK) 20, but negative for CK 7. This CK staining pattern suggested that the liver tumor was a metastasis from the previously resected rectal cancer. Thus, metastases from colorectal cancer can involve intraductal growth.