Triple carcinomas in Cronkhite-Canada syndrome

The present report describes a 69-year-old man displaying the clinical features of the Cronkhite-Canada syndrome. After taking medicine for the common cold, he suffered hypogeusia and watery diarrhea, eruptions on the lower extremities and an 8 kg loss in body weight. All his finger and toenails began to fall out. He underwent an upper gastrointestinal examination, upon which multiple polyps of the stomach were detected. Three years later, he again developed diarrhea, bloody stools, body weight loss and eruptions on the lower extremities. An upper gastrointestinal series showed a diverticulum of the esophagus and multiple polyps in the stomach. A barium enema examination revealed polyps throughout the entire colon. Endoscopical biopsy specimens revealed juvenile type polyps and adenomas. The patient was treated with predonine therapy and, in a few days, his symptoms improved. Following the predonine therapy, an upper gastrointestinal endoscopy revealed superficial esophageal cancer and early gastric cancer. The patient received successful surgical treatment. Macroscopically, the esophageal cancer was of the superficial type, and its histologic type was that of moderately-differentiated squamous cell carcinoma. The gross finding on the stomach cancer was one of superficial depressed type, and its histologic type was that of well-differentiated tubular adenocarcinoma. One year later, lung cancer was detected. The gross appearance of the resected lung tumor was one of a grayish-white color and the neoplasm was histologically diagnosed as undifferentiated carcinoma, small and large cell type. The coexistence of carcinoma of the gastrointestinal tract with Cronkhite-Canada syndrome has been reported in 21 cases. We have found no report, however, of lung cancer associated with Cronkhite-Canada syndrome. The case described herein is, therefore, the first case of Cronkhite-Canada syndrome to be associated with esophageal, gastric and lung cancer.     

An autopsy case of Cronkhite-Canada syndrome developing after hemicolectomy for colonic cancer

This is the patient previously reported as Cronkhite-Canada syndrome developing after left hemicolectomy for cancer of the descending colon. Ultimately, he died at the age of 62 of metastatic colonic cancer 8 years after the onset of the syndrome. In this paper, the findings of autopsy as well as the follow-up examination including the right hemicolectomy are presented, with particular emphasis on the histology of the polyps. The polyps of the stomach and colon were composed of cysticalydilated glands with inflamed and edematous stroma. In addition, most of the colonic polyps showed adenomatous foci at the surface, one of them being associated with focal severe atypia. This case supports the possibility of adenomatous to malignant transformation of the retention-type polyps, rather than the incidental occurrence of adenoma de novo in Cronkhite-Canada syndrome.     

Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach

The standard lymph node dissection for advanced gastric cancer is a D2 dissection, performed in accordance with the new Japanese classification of gastric carcinoma (13th edition). Although laparoscopic D2 dissections according to the General rules for gastric cancer study (12th edition) have been reported, no studies have reported laparoscopic D2 dissections according to the revised classification for advanced gastric cancers located in the middle or lower portions of the stomach. The lack of such studies is due to the perceived technical difficulty of the procedure. However, we successfully performed this novel procedure in five patients with advanced gastric cancer located in the middle or lower portions of the stomach. In fact, this surgical procedure is technically feasible and safe. Received: January 31, 2000 / Accepted: May 11, 2000     

Cronkhite-Canada syndrome complicated with huge intramucosal gastric cancer

Cronkhite-Canada syndrome (CCS) is a rare nonhereditary disorder with gastrointestinal polyposis and associated ectodermal changes. This report documents a 59-year-old Japanese man with CCS who underwent a total gastrectomy for gastric tumors. The resected specimen showed a huge gastric adenocarcinoma with numerous polyps throughout the stomach. The cancer was pathologically limited to within the mucosa and its histological structure resembled that of hyperplasia in CCS polyps, which led us to suppose that the carcinoma had arisen from hyperplastic CCS polyps. These results urged us to study the phenotypic expression of mucins, which revealed MUC2(−) and MUC5AC(+) and supported the diagnosis of the tumor as a gastric-type well-differentiate adenocarcinoma. A literature search revealed that 32 gastric carcinomas which developed in patients with CCS were mostly limited to within the submucosa in spite of their huge sizes, and such cancer development in CCS polyposis is therefore not considered to be unusual.     

Successful curative resection of gastric cancer with AIDS infection

This report describes the case of a 47-year-old Japanese man with human immunodeficiency virus (HIV) infection with AIDS, who was successfully treated for gastric cancer. A review of gastric cancer associated with HIV is also presented. Prior to surgical treatment, azidothymidine (AZT), nerfinavir (NFV), and lamivudine (3TC) were administered to the patient in order to improve his blood CD4 count and reduce the viral burden. Consequently, distal gastrectomy was performed as a curative resection without any complications. The gastric cancer included a signet-ring cell carcinoma, as was noted in eight of the nine reported cases associated with HIV. This suggests that the HIV virus may play a role in causing signet-ring cell carcinoma, especially in the stomach. Received: June 20, 2000 / Accepted: September 5, 2000     

Diffuse submucosal cysts of the stomach associated with gastric cancer: contribution of Helicobacter pylori infections

Diffuse submucosal cysts (DSCs) in the stomach are often associated with gastric cancer and a high occurrence of multiple gastric cancers. We studied the clinicopathological features of four early gastric cancer patients with DSCs in the submucosal layer of the stomach. All patients had early gastric cancers with gastritis and erosion in the gastric mucosa, and were positive for Helicobacter pylori (H. pylori). Based on a review of the reported cases, we found that a very high proportion (>94%) of DSCs are associated with infection by H. pylori. Although DSCs have previously been considered to be paracancerous lesions of gastric cancer, we speculate that DSCs might be post-inflammatory changes following infection by H. pylori, which may result in the high incidence of gastric cancer development.     

Stomach cancer history in the siblings of patients with gastric carcinoma.

A case-control study in the population of the Eastern Black Sea region of Turkey was conducted to learn the incidence of stomach cancer in the siblings of patients with gastric carcinoma. Among 1240 patients with gastric carcinoma, 168 had sibling(s) with a history of stomach cancer versus 19 cases in the control group matched according to age and gender (OR 10.07, P < 0.0001). The frequency of a history of stomach cancers and cancer of other organs in first- to third-degree relatives was 60.7% and 38.0%, respectively, of 168 sibling cases with gastric carcinoma (P < 0.0001). Fifty-two point three per cent of sibling cases having a history of cancer in other organs in their relatives also reported stomach cancer in the same-degree relatives. The number of stomach cancers in the first- to third-degree relatives of sibling cases was higher than the number of other organ cancers in the same-degree relatives (P < 0.01). Familial clustering of stomach cancer was reported in 12.5% of sibling cases. The study of stomach cancer history in the siblings suggests: the presence of a genetic susceptibility, high risk of the disease occurrence in the siblings of patients, higher predisposition to gastric than to other organ cancers in the relatives, and not infrequent familial clustering.     

Gastric cancer occurring in a patient with Plummer-Vinson syndrome: an unusual association about one case

Plummer-Vinson syndrome (Paterson-Kelly syndrome) is characterized by cervical dysphagia due to an upper esophageal web in patients with chronic irondeficiency anemia. Much attention has been paid to Plummer-Vinson syndrome as a precancerous condition. It’s known to be associated with an increased risk of upper alimentary tract cancers. However, it’s more unusual for this syndrome to be accompanied by gastric cancer. Only four cases were reported in the literature. Herein, we report the unusual case of a 45-year-old woman with Plummer-Vinson syndrome who developed gastric cancer.     

河南省林州市人群胃癌的现时生存分析

目的:分析1988-2004年河南省林州市人群胃癌的生存率及不同时期的变化,评估当地胃癌二级预防及临床诊治的水平.方法:从林州市肿瘤登记处提取1988-2004年全部的胃癌发病和死亡个案记录,剔除重复和仅有死亡证明书(death certificate only, DCO)的病例.计算该地区的去肿瘤死因寿命表,并与胃癌发病死亡数据相链接.采用现时生存分析(period survival analysis)方法计算1990-1994年、1995-1999年和2000-2004年这3个时期的胃癌5年观察生存率和相对生存率,并绘制相对生存曲线.结果:林州市3个时期的胃癌5年相对生存率分别为26.66%、32.01%和40.43%,呈逐年上升趋势.男性患者的生存率要高于女性.前2个时期的贲门癌生存率要高于非贲门胃癌,而在2000-2004年则低于非贲门胃癌.结论:林州市人群胃癌生存率自20世纪90年代起逐渐提高,反映了当地胃癌二级预防及临床诊疗水平的不断提高.     

Hepatoid Adenocarcinoma of the Stomach - A rare pathological entity

Hepatoid adenocarcinoma is a rare cancer with an extremely poor prognosis. Here, we describe two cases referred to our hospital with suspected gastric cancer. Gastrointestinal endoscopy revealed lesions in the stomach. Biopsy from the lesions was reported as adenocarcinoma. Both the patients underwent exploratory laparotomy. One was an operable lesion and the other was an inoperable lesion. Total gastrectomy was done in the operable lesion and feeding jejunostomy was done in the inoperable case. Histologically, both turned out to be hepatoid adenocarcinomas. Retrospective analysis showed the serum levels of alphafetoprotein (AFP) are markedly elevated in both cases. We describe this rare entity of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects of the cases. Keywords: Gastric cancer, Hepatoid adenocarcinoma, Alpha Feto Protein, Stomach.     

Diagnostic significance of ferritin assay in peritoneal fluid and gastric juice

Ferritin was assayed by immunoradiometrical procedure in peritoneal fluid (26 patients with various ovarian pathologies) and gastric juice (18 patients with stomach cancer and 28 cases of gastric ulcer disease). It was found that diagnostic significance of ferritin measurements in peritoneal fluid in ovarian pathology is compromised by inflammation. Therefore, this marker cannot be used to differentiate between malignant and benign ovarian tumor. Single measurements of ferritin for detecting stomach ulcers were also diagnostically irrelevant since the data for stomach cancer and gastric ulcer exacerbation showed no significant difference.     

Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer

Recently, a minimally invasive operation for gastric malignancies has been developed, and this laparoscopic operation is seen as a technique that will raise quality of life for patients. Previously, we reported this technique, as well as the results of a distal gastrectomy with regional lymph node dissection using hand-assisted laparoscopic surgery (HALS) for gastric cancer located in the middle or lower third of the stomach. This paper describes total or proximal gastrectomy with regional lymph node dissection by HALS on 28 cases of gastric cancer located in the upper portion of the stomach. After the mobilization of stomach and lymph node dissection via HALS, an anastomosis of the esophagus was performed intracorporeally with a conventional circular stapling device (PCEEA), whereas jejunojejunostomy and jejunogastrostomy were carried out extracorporeally with a conventional hand-sewn procedure through a HALS wound. The operation time and the amount of blood loss in all the patients were considered to be satisfactory, and the average number of dissected lymph nodes per patient was similar to that in open surgery. The patients had minimal morbidity and quick recovery after their operation. This technique was thought to be not only less invasive, but also similarly curative compared with open gastrectomy. Received: May 2, 2002 / Accepted: September 12, 2002 Offprint requests to: S. Tanimura     

Epstein-Barr virus-associated gastric carcinoma in Papua New Guinea

Using in situ hybridization assay, we examined Epstein-Barr virus (EBV) encoded RNA (EBER) expression in 66 cases of oral cancer, 40 esophageal cancer cases, 150 stomach cancer cases, and 46 colorectal cancer cases diagnosed in the Pathology Department of Port Moresby General Hospital, University of Papua New Guinea during the period between 1986-2002. There were no malignancies with positive EBER expression except for the following two male stomach cancer cases: a male case with a gastric carcinoma in pylorus whose age was unknown; and a male case aged 55 years without information on location of tumor. Both cases were histologically classified as non-solid poorly differentiated adenocarcinoma of the Japanese histological classification. The frequency of EBV-associated gastric carcinomas was 1.3% (2/150), and was the lowest ever reported in the world. We examined genotypes of two EBV strains detected from gastric carcinomas. Four different regions of EBV genome were examined by PCR-RFLP, coupled with Southern blot hybridization. The EBV genotype of the first case were type A, wild-type F at BamHI-F region, type D of BamHI-I region and the kept type of the XhoI cleavage site in LMP1. The second case had EBV whose genotypes were type A, wild-type F at BamHI-F region, and the kept type of the XhoI cleavage site in LMP1. The BamHI-I region of this case could not be analyzed.     

Present and future state of cancer screening for esophageal cancer and gastric cancer

Recently, endoscopic examinations have played a major role in the diagnosis and treatment in the field of gastroenterology. It is considered that endoscopy would be an important examination for cancer screening of the esophagus and the stomach. However, endoscopic services for cancer screening are in short supply. Furthermore, we have to take the complications and poor economic benefits of endoscopy in to consideration when we apply it as a practical cancer screening system. Thus, an effective primary screening system must be provided for the endoscopic screening of cancer of the esophagus and the stomach. People with a defect in aldehyde dehydrogenase-2(ALDH2)should be distinguished by their facial flushing in drinking and for their high risks of esophageal cancer. In cases with gastric cancer screening by endoscopy, an x-ray study is expected to be a primary screening because of its efficacy. It already has been recommended for population-based screening in Japanese guidelines for gastric cancer screening. In cases with opportunistic screening of gastric cancer, patients should be allowed to choose from several studies such as the x-ray study, direct endoscopy, and the so-called high risk screening of gastric cancer for estimating risks and planning of screening for gastric cancer.     

Efficacy of Helicobacter pylori eradication on the chronic mucosal inflammation of the remnant stomach after distal gastrectomy for early gastric cancer

Although eradication of Helicobacter pylori (Hp) after early gastric carcinoma has been recommended, very limited studies have been reported and the method differs from standard therapy. Here, we attempted the eradication of Hp in the remnant stomach after surgery for primary gastric cancer with the standardized method. We examined efficacy and the safeness of the treatment. Thirty-three H. pylori-positive patients after distal gastrectomy were treated with proton pump inhibitor (PPI)-based triple therapies. After eradication, endoscopic and histological changes were classified on the basis of the Updated Sydney System. The eradication rate in the remnant stomach was 90.9% (30 out of 33 cases) after triple therapy. Temporal minor side effects were notified in 3 cases. After eradication, the remnant stomach showed significant decreases in inflammation- and activity-scores. Moreover, significant improvement in glandular atrophy to normal mucosa was found. In conclusion, PPI-based standard therapy is just as effective for Hp eradication in the remnant stomach than it is in the non-operative stomach. Eradication therapy could be performed safely and resulted in a significant improvement in inflammation and atrophy of the mucosal layer in the remnant stomach after early gastric cancer surgery.     

Gastric tumor from metastasis of breast cancer

Metastatic tumours of the stomach have been reported to result from various types of cancer. Among them, gastric metastasis from breast cancer has been recognised in 0.3-18% patients (1-4). Here, a rare case of metastatic gastric tumour derived from breast carcinoma is reported. Gastric endoscopy confirmed a large, friable mass (approximately 5 cm in diameter) in the upper part of the gastric body. The mass within the stomach was difficult to distinguish from primary gastric cancer, although biopsies of this lesion revealed the characteristics of adenocarcinoma. In addition, immunohistochemistry showed the positive expression of mammaglobin. Taken together, the evidence pointed to metastasis of breast cancer to the stomach. The patient was treated with hormonal therapy (letrozole), and the size of the metastasis in the stomach was markedly reduced. Therefore, a gastric metastasis from breast cancer was diagnosed successfully using immunohistochemistry and unnecessary surgery was avoided. In conclusion, although gastric metastatic tumours derived from breast carcinoma are rare, their accurate pre-operative diagnosis and appropriate systemic treatment is essential.     

高龄胃癌患者的外科治疗及围手术期处理

背景与目的：高龄胃癌患者在提高诊治水平、制定手术方式及围手术期的处理方面仍是目前探讨的难题.本研究探讨高龄胃癌患者外科治疗和围手术期处理的有关问题.方法：回顾性分析了手术治疗的82例70岁以上胃癌病例,其中64例合并有1种或1种以上其他器官组织的疾病.结果：82例均经手术探查,其中根治性胃大部切除术56例,根治性全胃切除术9 例（其中联合脏器切除3例,胰体尾及脾切除2例,合并脾脏切除1例）;胃大部切除加大网膜切除术1例;姑息性切除8例;胃空肠吻合术5例;探查术3例.术后有并发症67例,围手术期死亡4例,病死率4.8%.结论：高龄胃癌患者首选还是手术治疗,只要重视手术前合并症的诊治,做好术前准备,合理选择手术方式,加强术中及术后的监测和并发症的防治,对有效降低病死率,提高生活质量有重要的意义.     

Occurrence of a heterochronous cancer in the remnant stomach following partial gastrectomy in gastric cancer

Thirty-six cases of a heterochronous cancer in the remnant stomach following a partial gastrectomy for gastric cancer have been compared with 12 cases of gastric cancer following a gastrectomy for benign diseases. Lesions of a heterochronous cancer are characteristically similar to those of a synchronous multiple gastric cancer. Patients with a heterochronous cancer were found to have high rates of synchronous multiple cancers in the resected stomach as compared with none found in gastric cancer patients following surgical operation for a benign disease. Lesions of cancer after surgery for a benign disease when found were mostly in the anastomosis of the remnant stomach. These findings suggest that a heterochronous gastric cancer may develop into lesions of multiple cancers.