Case report of a successful stage reduction of gastric carcinoma preoperatively treated by combined chemotherapy of 5-FU(UFT) and cisplatin]

A 52-year-old woman was diagnosed to have IIc+IIa-like advanced gastric carcinoma in the upper stomach by X-ray and endoscopic examination with biopsy. CT scan revealed swelling of the para-aortic lymph nodes which was taken to be evidence of metastases of the gastric carcinoma. The patient was considered to have surgically non-curative gastric carcinoma (Stage IV), and preoperative chemotherapy was initiated. The regimen consisted of CDDP 50 mg (day 1-2, drip), 5-FU 750 mg (day 2-7, drip) and UFT 400 mg (from day 8 to the day before operation, oral). About one month after initiating treatment, total gastrectomy with lymph node dissection was performed. Histopathological examination of the section of the primary tumor revealed that only a few cancer cell nests (poorly differentiated adenocarcinoma) remained in the muscle and subserosal layer. In all of the lymph nodes which were suspected to have metastases preoperatively, cancer cells completely degenerated into mucinous lakes or foam cell nests. No liver metastasis nor peritoneal dissemination was detected, and this case was judged to be stage II after chemotherapy.     

Gastric small cell carcinoma with marked response to neoadjuvant chemotherapy

We report a patient with gastric small cell carcinoma (SCC) who showed a marked response to neoadjuvant chemotherapy. The patient was a 72-year-old Japanese man who was admitted because of epigastralgia. Subsequent examination revealed the presence of advanced gastric carcinoma in the lesser curvature of the lower body of the stomach, with multiple abdominal lymph node metastases. Endoscopic biopsy specimens from the tumor revealed SCC with moderately differentiated adenocarcinoma. The patient received neoadjuvant chemotherapy consisting of carboplatin (400 mg/m², for 1 day), epirubicin (27 mg/m², for 1 day), etoposide (70 mg/m², for 3 days), and 5-fluorouracil (330 mg/m², for 11 days). Clinically, the primary tumor and lymph node metastases were markedly reduced. Subsequently the patient underwent curative surgery and was alive without recurrence for more than 3 years after the surgery.     

A case of metastasis to the stomach from primary adenocarcinoma of the lung cancer

We report a case of gastric metastasis of lung cancer performed gastrectomy for the primary foci. A 70s woman was diagnosed as having right lung cancer and underwent right lower lobectomy and lymph node dissection. The histological diagnosis was adenocarcinoma (pT4, N2, M0). Four years later, positron emission tomography (PET)-CT revealed a tumor in the stomach and para-aortic lymph nodes swelling. The submucosal tumor was showed in the cardia by endoscopic examination. Biopsy showed a papillary adenocarcinoma. With the diagnosis of gastric metastasis from lung cancer, she was operated on. A proximal gastrectomy was carried out. The histopathological examination demonstrated papillary adenocarcinoma similar to that of the lung cancer with lymph node metastasis. No postoperative complications occurred and she was discharged from the hospital. Since then, she was treated with adjuvant chemotherapy as an outpatient.     

A recurrent gastric carcinoma found by metastasis to the scrotum

Reported is a case of 67-year-old man with a recurrent gastric carcinoma that was associated with a possible lymphatic metastasis to the scrotum. Seven years earlier (October, 1980), since an adenocarcinoma of the stomach was present, a subtotal gastrectomy was performed. At that time, a IIc-like advanced tumor with a ul-III, measuring 32 x 28 mm in size, was noted on the anterior wall of the corpus near the greater curvature of the stomach, on macroscopical examination of the resected specimen. Microscopic findings showed a poorly differentiated adenocarcinoma with an involvement of the serosa but without a lymph node metastasis (H0, P0, n0, se, stage III). In July 1987, a tumor in the right scrotum was found and the patient underwent surgery. The resected specimen revealed a histologically cancerous involvement of the testis, the epididymis, the tunica vaginalis testis, and the spermatic cord. The cancerous cells showed the same poorly differentiated adenocarcinoma which had been observed in the primary locus of the stomach. Judging from these findings, this case was diagnosed as a recurrent gastric carcinoma with a lymphatic metastasis to the scrotum.     

Neoadjuvant chemotherapy for patients with locally advanced gastric carcinoma: effect on tumor cell microinvolvement of regional lymph nodes

BACKGROUND: In a previous study the authors demonstrated, using immunohistochemical methods for epithelial antigens, that the regional lymph nodes of gastric adenocarcinoma contained individual tumor cells or small clusters of these cells (tumor cell microinvolvement [TCM]) in over 90% of cases. In the current study the authors used the same method to investigate a series of gastric adenocarcinoma cases treated with neoadjuvant chemotherapy prior to tumor resection; their aim was to determine the effect of chemotherapy on TCM in regional lymph nodes. METHODS: Resection specimens from 17 patients with adenocarcinoma of the stomach, resected after neoadjuvant treatment and classified by routine histology as ypN0, were included in this study. One section from each of the 622 lymph nodes dissected from these specimens was stained by immunohistochemical methods for cytokeratins and Ber-Ep4. RESULTS: Six patients (35%) and 25 of the 622 lymph nodes (4.0%) had TCM, compared with 93% of patients and 21.8% of lymph nodes in the previous study of patients treated with surgery alone. The lymph node response to chemotherapy correlated with the pathologic response of the primary tumor. Specifically, none of 5 patients with a complete or major pathologic response versus 6 of 12 (50%) patients with minor, partial, or no response had lymph node microinvolvement. CONCLUSIONS: In comparison to our previous study, this study indicates that chemotherapy has a marked effect on tumor cells in regional lymph nodes and that the extent of this effect can be correlated with the degree of pathologic response of the primary tumor to chemotherapy.     

A case of metastatic gastric endocrine cell carcinoma which could be curably resected after chemotherapy with S-1/CDDP

Gastric endocrine cell carcinoma is known to be highly malignant with a poor prognosis, and no standard treatment has been established. We experienced a case of endocrine cell carcinoma of the stomach with liver and lymph node metastases. The lesions became resectable at curability B after chemotherapy with S-1/cisplatin (CDDP). A 59-year-old man, who had no specific complaint, had gastrointestinal endoscopy for screening. A 30-mm tumor was found at the greater curvature of the lower body of the stomach, and was histologically diagnosed as an endocrine cell carcinoma from the biopsy specimen. A computed tomography (CT) scan and abdominal magnetic resonance imaging (MRI) showed masses at S5 and S6 of the liver, and No. 4 lymph node enlargement. Diagnosed as gastric endocrine cell carcinoma with liver and lymph node metastases, he was referred to our hospital. We started chemotherapy with a daily dose of S-1 administered on days 1 to 14 and CDDP of 70 mg/m(2) on day 8, every 4 weeks. After three courses of treatment, the primary lesion became a small scar and the metastatic lesions vanished from the CT and MRI. Then we performed distal gastrectomy with lymph node dissection and partial liver resectomy. Histological findings revealed no cancer cells, except for a few cells in the S5 liver lesion.     

A case report of primary double cancer of the stomach and choledochus

We encountered a relatively rare case of primary double cancer arising simultaneously from both the stomach and choledochus in a 72-year-old woman with obstructive jaundice. The patient was admitted to Saiseikai Shigaken Hospital, and was diagnosed as having both early gastric cancer at the lesser curvature of the antrum and cancer of the choledochus. She underwent curative pancreato-duodenectomy with extended gastrectomy. One of the resected tumors was histopathologically diagnosed as a well differentiated, tubular adenocarcinoma of the stomach with invasion reaching as deep as the submucosa. The other tumor was a moderately differentiated, tubular adenocarcinoma of the choledochus with lymph node metastases (hepatic, retroligamentic, paracholedochal, and posterior and superior pancreaticoduodenal lymph nodes). Our review of the literature suggests that the incidence of primary double malignancies is on the increase.     

Gastric lymphosarcoma associated with early carcinoma (type IIa)--a case report

We report a case of gastric lymphosarcoma associated with early carcinoma (type IIa). Lymphosarcoma was also seen in the small intestine, but there were no metastatic lesions in the lymph nodes , liver, and peritoneum. This suggest that lymphosarcoma was the primary cancer in both the stomach and small intestine. Microscopically, the early carcinoma was a moderately differentiated tubular adenocarcinoma . Only two earlier cases of coexistent gastric lymphosarcoma and early gastric carcinoma have been reported in the literature.     

A primary gastric adenosquamous carcinoma with remarkable lymphatic metastasis diagnosed by the stomach and lymph node biopsy

This report describes the case of a 74-year-old female, who had been admitted to hospital because of epigastralgia and appetite loss. An ultrasonogram and a CT scan of the abdomen revealed a remarkable lymph node metastasis. Through an upper gastrointestinal tract (UGI) X-ray, a Borrmann III type gastric carcinoma was detected. Under endoscopic guidance, a gastric and a lymph node specimen were taken and biopsied, revealing a keratinous, well-differentiated squamous cell carcinoma and a poorly differentiated adenocarcinoma, leading to a diagnosis of a primary gastric adenosquamous carcinoma with a remarkable lymphnode metastasis. After chemotherapy, a CT scan, a UGI X-ray, and an endoscopic examination revealed distinct tumor reduction.     

Expression of glucose transporter-1 in human gastric carcinoma: association with tumor aggressiveness, metastasis, and patient survival

BACKGROUND: Malignant cells show increased glucose uptake in vitro and in vivo, which is believed to be facilitated by glucose transporters (Gluts). Expression of Glut1, one of the Gluts, has been described in malignancies of the esophagus, colon, pancreas, lung, and brain, but to the authors' knowledge the significance of Glut1 expression in human gastric carcinoma has not been elucidated. The objective of the current study was to examine the expression and distribution of Glut1 and its relation to clinicopathologic parameters in patients with gastric carcinoma. METHODS: Immunohistochemistry with anti-Glut1 antibody was performed on 617 gastric carcinomas and 50 tubular adenomas of the stomach. Glut1-positive and Glut1-negative carcinomas were analyzed for their clinicopathologic characteristics including histologic subtype, depth of invasion, vascular permeation, lymph node and hepatic metastasis, peritoneal dissemination, and prognosis. RESULTS: None of the adenomas expressed Glut1, whereas 182 of 617 carcinomas (29.5%) were positive for the protein. Signet ring cell carcinoma and mucinous adenocarcinoma rarely were positive (2.0% and 6.3%, respectively) and papillary adenocarcinoma (44%) showed slightly higher positivity for Glut1 than tubular (32%) or poorly differentiated adenocarcinoma (28%). Glut1-positive tumor cells were localized mainly in the central part of tumor nests with or without peripheral distribution (92%) but peripheral distribution alone was very limited (8%) (P = 0.0001). Glut1 positivity was associated with depth of invasion (P = 0.0001), lymphatic permeation (P = 0.0001), venous invasion (P = 0.0001), lymph node metastasis (P = 0.0001), hepatic metastasis (P = 0.0001), and carcinoma stage (P = 0.0001). However, peritoneal dissemination was not found to be associated with Glut1 positivity (P = 0.0833). The survival of patients who had tumors that expressed Glut1 was significantly shorter than that of patients with Glut1-negative tumors (P = 0.0001). CONCLUSIONS: In human gastric carcinoma, Glut1 is expressed late in carcinogesis and increases with disease progression. Glut1 expression is associated with tumor aggressiveness and patient survival.     

Primary amyloidosis associated with early gastric carcinoma(IIb like IIa type) diagnosed by preoperative gastric biopsy--a case report

A case of primary amyloidosis associated with intramucosal adenocarcinoma of the stomach, diagnosed by preoperative biopsy, is reported. A 77-year-old man was admitted to our hospital with complaints of vertigo and general fatigue. X-ray and endoscopic examination revealed a IIb-like IIa type protruded lesion on the cardia of the stomach. A biopsy specimen from the protruded lesion disclosed well differentiated tubular adenocarcinoma and amyloid deposition. Partial gastrectomy was performed on August, 18, 1981. Upon histological study, a diagnosis of primary amyloidosis associated with intramucosal well differentiated tubular adenocarcinoma was made. We suggest that the histogenesis of this gastric carcinoma was related to the gastric lesion due to primary amyloidosis. Careful review of the Japanese literature disclosed that ours is the first case report of primary amyloidosis associated with early gastric carcinoma diagnosed by pre-operative gastric biopsy.     

A rare case of poorly differentiated endocrine cell carcinoma of the stomach with signet ring cell differentiation

There have been few reports of the dual differentiation of different cell types within the same gastric tumor. Here, we report a rare case of poorly differentiated endocrine cell carcinoma with an associated differentiated signet ring cell population arising in the stomach. The histological appearance of the tumor by light microscopy matched the phenotype of endocrine cell carcinoma and signet ring cell differentiation with mucinous lakes. Cells with a phenotype intermediate between the two differentiated cell types were also seen in the tumor. Both the endocrine cell carcinoma and the signet ring cells were diffusely positive for chromogranin A and synaptophysin, a finding that is consistent with endocrine differentiation by immunohistochemical examination. The patient’s postoperative clinical course had a poor prognosis, with aggressive tumor progression. Paraaortic lymph node recurrence was found 6 months after the operation, and the patient died of the primary disease 16 months after the surgical treatment.     

肺癌18F-FDG-PETCT的SUVmax与淋巴结转移及肺癌肿瘤标志物之间的关系研究

目的:研究肺癌18F-FDG-PETCT的SUVmax(最大标准摄取值)与肺癌淋巴结转移、肺癌肿瘤标志物、肿瘤大小及临床病理类型之间的关系。方法:经病理确认的98例肺癌住院患者,术前一周内均行18F-FDG PET-CT检查肿块大小、SUVmax及肺门或纵隔淋巴结转移情况;并进行肿瘤标志物神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)和细胞角蛋白片(CYFRA21-1)检查,统计学分析检测结果。结果:原发灶SU-Vmax与原发灶大小之间存在相关性(r=0.497,P<0.05),与单个肿瘤标志物的值之间无明显相关性。整体分析时肺门或纵隔淋巴结转移组与无转移组的原发灶SUVmax均值之间差异无统计学意义,腺癌肺门或纵隔淋巴结转移组及无转移组的SUVmax均数之间差异有统计学意义(P<0.05)。鳞癌肺门或纵隔淋巴结转移组及无转移组的SUVmax均数之间差别无统学意义(P=0.721)。肺鳞癌与腺癌SUVmax均值之间比较差异有统计学意义(P=0.001);细支气肺泡癌与其它腺癌SUVmax均值之间差异有统计学意义(P<0.05)。结论:在病理类型不明确的情况下原发灶SUVmax的高低并不能预测淋巴结转移的有无,肺腺癌原发灶FDG代谢活性与肺门和(或)纵隔淋巴结转移有关,淋巴结转移率随着肿块SUVmax的增加而增加;肺鳞癌FDG代谢活性与肺门和(或)纵隔淋巴结转移无关。SUVmax与病理类型有关,鳞癌SUVmax较高,腺癌较低,细支气管肺泡癌则更低。     

A surgically resected case of advanced gastric carcinoma with peritoneal dissemination after treatment with combined chemotherapy of TS-1 and CDDP

A 60-year-old female had undergone laparoscopic oophorectomy for right ovarian tumor. At the time of surgery, peritoneal dissemination and ascites was observed. Histological examination revealed that the resected ovary, peritoneal nodes and floating cells in the ascites were metastatic adenocarcinomas. Later, the primary malignant lesion was found to be a type 4 gastric carcinoma. The carcinoma was judged to be unresectable and treated by combination chemotherapy with TS-1 and CDDP every 6 weeks. After 3 courses of treatments, upper gastrointestinal series and endoscopic examinations were conducted and revealed a marked reduction of the tumor size. No carcinoma cells were detected by endoscopic biopsy. CT-scan showed complete disappearance of metastatic lesions. Staging laparoscopy was performed for evaluation of the effects of chemotherapy, and no adenocarcinoma cells at peritoneal nodes or ascites were found histologically. We performed total-gasterectomy with D1 + alpha lymph node dissection. Histopathologically, resected specimens showed severe fibrosis in most parts of the stomach. Following chemotherapy, the carcinoma was judged to be Grade 2 by histopathological examination.     

Case of simultaneous triple cancers of the duodenal papilla, gallbladder and stomach

The patient was a 76-year-old man with simultaneous triple cancer arising in the duodenal papilla, gallbladder and stomach, whose complaint was epigastralgia. Endoscopic and radiologic studies revealed early gastric cancer (IIc) at the posterior wall of the antrum; ERCP disclosed obstruction with "apple core" appearance in the distal bile duct. Pancreaticoduodenectomy, cholecystectomy and distal gastrectomy with lymph node dissection were performed. Histopathological examination of the resected specimens revealed papillo-tubular adenocarcinoma in the duodenal papilla, well differetiated tubular adenocarcinoma in the gallbladder, and moderately differentiated tubular adenocarcinoma in the gastric mucosa.     

Colliding gastric and intestinal phenotype well-differentiated adenocarcinoma of the stomach developing in an area of MALT-type lymphoma

A 73-year-old man presented with an abnormal gastric shadow during a check-up of atomic bomb survivors. Radiological examination and endoscopy of the upper gastrointestinal tract revealed a protruding tumor, type 0-I+IIa, on the lesser curvature of the midstomach. An initial diagnosis of early gastric cancer was made and a segmental gastrectomy was planned. However, distal gastrectomy with D3 lymph node dissection was necessary, because intraoperative frozen section showed that the paraaortic lymph nodes (N3) were positive for cancer. The tumor in the resected specimen was, microscopically, a well-differentiated tubular adenocarcinoma (tub1) with pT2 (MP), pN3, ly2, and v1, in final (f) stage IV. The tumor cells of the type 0-I segment appeared as gastric phenotype and those of the type 0-IIa segment as intestinal phenotype. The border between the two was distinct. The tumor had focally invaded the muscularis propria where only the gastric phenotype was shown and the histological type became less differentiated. Thus, special attention should be paid to possible unexpected deep-wall invasion and lymph node metastasis in well-differentiated adenocarcinomas of the gastric phenotype. Further, in this patient, diffusely proliferating low-grade lymphoma was also observed incidentally in the gastric mucosa within and around the carcinoma. This was diagnosed as mucosa-associated lymphoid tissue (MALT)-type lymphoma with aberrant expression of BCL10. Finally, this case was considered to be a colliding gastric and intestinal phenotype well-differentiated adenocarcinoma of the stomach developed in an area involved by MALT-type lymphoma. Because no Helicobacter pylori was detected throughout the mucosae and the patient had no history of its infection, the three tumors may have developed under the same conditions as those seen in Helicobacter pylori infection, but without this infection.     

Gonadotropin and alkaline phosphatase-producing gastric carcinoma with widespread metastasis to the bones

A case of advanced gastric carcinoma in a 47-year-old man with widespread metastasis of generalized bone and associated with high serum levels of human chorionic gonadotropin (hCG) and alkaline phosphatase (ALP) is reported. Macroscopically, the primary tumor was Borrmann type IV. Microscopically, it showed poorly differentiated adenocarcinoma. Bone metastasis, however, showed well-differentiated adenocarcinoma. These lesions did not manifest conspicuous trophoblastic differentiation. Immunohistochemical studies revealed that hCG-positive cells were observed sporadically in the primary tumor and lymph node metastasis, but remarkably in the bone metastasis. Cancer cells in the lymph nodes were positively stained by modified Burstone's ALP staining. The serum levels of hCG and ALP fluctuated with the clinical course. Therefore, the authors concluded that this gastric carcinoma produced hCG and ALP.     

Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type

BACKGROUND: The most important parameters predicting outcome of patients with gastric carcinoma are the depth of wall invasion and the status of lymph node metastasis, but the prognostic significance of histologic type is unclear. The aim of this study was to clarify the prognostic value of two major histologic types of gastric carcinoma, that is well and poorly differentiated types. METHODS: Histopathologic findings and outcomes of 504 patients with gastric carcinoma were evaluated by well and poorly differentiated types. Well differentiated gastric carcinoma (WGC) included papillary and tubular adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma; whereas poorly differentiated gastric carcinoma (PGC) included poorly differentiated scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous carcinoma. RESULTS: Patients with WGC were characterized by old age, male predominance, tumor location in the lower third of the stomach, small tumor size, and liver metastasis; whereas patients with PGC were distinguished by their tumor location in the middle third of the stomach, serosal invasion, lymph node metastasis, advanced stage, and peritoneal dissemination. The overall 5-year survival rate for patients with WGC was higher than that for patients with PGC (76% vs. 67%; P = 0.058), especially for patients with >/= 10 cm tumors (42% vs. 14%; P = 0.017). The 5-year survival rate for patients with serosa positive but node negative tumors was higher in WGC patients than in PGC patients (83% vs. 59%; P = 0.086); whereas the 5-year survival rate for patients with serosa negative but node positive tumors was lower in WGC patients than in PGC patients (63% vs. 88%; P = 0.008). Multivariate analysis indicated that among pathologic variables of the tumor, histologic type (WGC vs. PGC) was one of the independent prognostic factors. CONCLUSIONS: Histologic type is important for estimating the tumor progression and outcomes of patients with gastric carcinoma. In addition to the depth of wall invasion and status of lymph node metastasis, histologic type, including well or poorly differentiated type, should be evaluated in the management of gastric cancer.     

肺癌~（18）F-FDG-PETCT的SUVmax与淋巴结转移及肺癌肿瘤标志物之间的关系研究

目的：研究肺癌18F-FDG-PETCT的SUVmax（最大标准摄取值）与肺癌淋巴结转移、肺癌肿瘤标志物、肿瘤大小及临床病理类型之间的关系。方法：经病理确认的98例肺癌住院患者,术前一周内均行18F-FDG PET-CT检查肿块大小、SUVmax及肺门或纵隔淋巴结转移情况;并进行肿瘤标志物神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）和细胞角蛋白片（CYFRA21-1）检查,统计学分析检测结果。结果：原发灶SU-Vmax与原发灶大小之间存在相关性（r=0.497,P〈0.05）,与单个肿瘤标志物的值之间无明显相关性。整体分析时肺门或纵隔淋巴结转移组与无转移组的原发灶SUVmax均值之间差异无统计学意义,腺癌肺门或纵隔淋巴结转移组及无转移组的SUVmax均数之间差异有统计学意义（P〈0.05）。鳞癌肺门或纵隔淋巴结转移组及无转移组的SUVmax均数之间差别无统学意义（P=0.721）。肺鳞癌与腺癌SUVmax均值之间比较差异有统计学意义（P=0.001）;细支气肺泡癌与其它腺癌SUVmax均值之间差异有统计学意义（P〈0.05）。结论：在病理类型不明确的情况下原发灶SUVmax的高低并不能预测淋巴结转移的有无,肺腺癌原发灶FDG代谢活性与肺门和（或）纵隔淋巴结转移有关,淋巴结转移率随着肿块SUVmax的增加而增加;肺鳞癌FDG代谢活性与肺门和（或）纵隔淋巴结转移无关。SUVmax与病理类型有关,鳞癌SUVmax较高,腺癌较低,细支气管肺泡癌则更低。     

A case of bone metastasis from gastric carcinoma after a nine-year disease-free interval

A case featuring very late and unusual metastasis of gastric cancer is presented. A 49-year-old woman presented with metastatic disease in the seventh cervical vertebra 9 years after a total gastrectomy for gastric carcinoma. The resected primary tumor was a Borrman type III, poorly differentiated adenocarcinoma which had invaded the subserosal layer of the stomach and had generated lymph node metastases. The patient was treated for the metastatic tumor with sequential administration of cisplatin, calcium leucovorin and 5-fluorouracil and subsequent irradiation. Remission was achieved and she survived for a further 13 months without major symptoms.