胃癌合并其他器官原发癌74例临床分析

目的探讨胃癌合并其他器官恶性肿瘤的发生率、临床病理特征、诊断、治疗和预后。方法回顾分析1996年1月至2007年12月复旦大学附属肿瘤医院外科治疗的74例胃癌合并其他器官原发癌患者的临床病理资料。结果本组74例患者占同期收治胃癌患者的1．7％。同时多原发癌10例：异时多原发癌64例．其中胃癌前异时多原发癌42例,胃癌后异时癌22例。共发生胃癌以外恶性肿瘤80个,以结直肠癌最多,占43．8％（35个）,乳腺癌其次,占16．3％（13个）。异时癌的发生时问距胃癌诊断前后7-354（平均82．2）个月。胃癌诊断年龄33～84（平均61）岁。全组患者总的5年生存率为42．3％．其中同时多原发癌为15．2％．胃癌前异时多原发癌为42．9％．胃癌后异时癌为51_3％。36例死亡患者中,24例（66．7％）死于胃癌复发或转移,11例死于其他器官癌,1例死于肾脏衰竭。结论胃癌治疗时需注意同时并发其他器官原发癌的可能。胃癌合并其他器官原发癌患者的主要死凶可能是胃癌．     

Synchronous multiple primary cancers of the stomach and duodenum in aged patients: Report of two cases

We describe herein the cases of two aged patients found to have synchronous multiple primary cancers of the stomach and duodenum. The first patient was an 82-year-old man who was preoperatively diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. At laparotomy, duodenal cancer was incidentally found to have infiltrated the transverse colon. A pancreatoduodenectomy and right hemicolectomy with radical lymph node dissection was performed. Two early well-differentiated adeno-carcinomas of the stomach and an advanced poorly differentiated adenocarcinoma of the duodenum were confirmed. This patient is now well without any evidence of recurrence more than 5 years after surgery. The second patient was a 77-year-old man who was also diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. Preoperatively, duodenal cancer was detected by endoscopy. A pancreatoduodenectomy and partial colectomy with radical lymph node dissection was performed because the duodenal cancer was suspected of having infiltrated the trans-verse colon. An early moderately differentiated adenocarcinoma of the stomach and an advanced moderately differentiated adenocarcinoma of the duodenum were confirmed, but the duodenal cancer was not seen to invade the transverse colon microscopically. This patient died of cancer 7 months after surgery. Because multiple primary cancers commonly develop in elderly patients, a precise preoperative diagnosis must be made and optimal treatment applied. Received: March 5, 1999 / Accepted: March 24, 2000     

Synchronous double cancers of the remnant stomach and pancreas: Report of a case

We present here in the case of a 75-year-old man who developed synchronous double cancers of the remnant stomach and pancreas 12 years after undergoing distal gastrectomy for gastric carcinoma. The patient was referred to our hospital in March, 1993, with a provisional diagnosis of carcinoma of the remnant stomach. Laboratory data on admission showed an abnormal level of CA19-9 (116.1 U/ml) and positive occult blood in the stools. An upper gastrointestinal series and gastroendoscopy demonstrated an ulcerative polypoid tumor in the gastric stump proximal to the gastroduodenostomy anastomosis, and a biopsy confirmed the findings of mucinous adenocarcinoma. Abdominal computed tomography (CT) scan revealed a low-density nodule anterior to the abdominal aorta, suggestive of a nodal metastasis. A laparotomy was performed which also disclosed a low-density mass located within the head of the pancreas. The patient was subsequently diagnosed as having double carcinomas of the remnant stomach and pancreas, and total gastrectomy and pancreatoduodenectomy were carried out. The histologic sections from the remnant stomach showed mucinous adenocarcinoma, whereas those from the pancreas showed tubular adenocarcinoma. Double carcinomas in this association are extremely rare and this case may in fact be the first observation of synchronous double cancers of the remnant stomach and pancreas.     

Simultaneous resection of pancreas and liver metastases from different metachronous primary cancers

Resection of a pancreatic head tumor and partial resection of the liver for metastatic lesions were carried out simultaneously in a 72-year-old woman. The patient had a history of two previous operations, right nephrectomy for renal cell carcinoma (clear cell type), done 14 years previously, and an Autincloss procedure for cancer of the left breast (solid tubular carcinoma); (T1N0M0; stage I) done 7 years previously. At the current presentation, preoperative radiographic examination showed a hypervascular tumor in each of the pancreatic and hepatic lesions, but with different patterns. On the basis of histological findings in the two resected specimens, it was difficult to establish whether the hepatic tumor originated from the renal cell carcinoma or the breast cancer, but postoperative immunohistochemical studies for carcinoembryonic antigen (CEA), estrogen receptors, and gross cystic disease fluid protein (GCDFP)-15 showed that the pancreatic tumor had metastasized from the renal cell carcinoma, and the liver tumor from the breast cancer. The immunohistochemical investigation of different markers thus proved to be useful in making the final diagnosis of metastatic lesions from different and metachronous cancers. Received: February 27, 2001 / Accepted: August 1, 2001     

Metachronous double cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction

A 50-year-old Japanese woman complained of abdominal and back pain. Ten years previously she had undergone cholecystectomy, choledochectomy, and Roux-en-Y choledochojejunostomy for gallbladder cancer associated with pancreaticobiliary maljunction without bile duct dilatation. On the present admission, ultrasonography (US) and computed tomography (CT) demonstrated a large mass, 60 mm in size, in the pancreatic tail. Endoscopic retrograde cholangiopancreatography (ERCP) showed obstruction of the main pancreatic duct in the tail of the pancreas and revealed that the pancreatic duct was joined to the bile duct 25 mm above the papilla of Vater. The patient underwent distal pancreatectomy, splenectomy, left adrenalectomy, and partial gastrectomy. Histological examination revealed moderately differentiated ductal adenocarcinoma that had invaded to the proper muscle of the stomach. Double cancer of the gallbladder and pancreas in a patient with pancreaticobiliary maljunction is rare. Although the etiology of cancer of the pancreas associated with pancreaticobiliary maljunction is unclear, we should pay close attention to the pancreas as well as the biliary tract during the long-term follow-up of patients with pancreaticobiliary maljunction after they have undergone a choledochojejunostomy.     

Thymidylate synthase expression and prognosis of patients with gastrointestinal cancers receiving adjuvant chemotherapy: a review

Background and aims Many studies have been published that report an association between thymidylate synthase (TS) and response to fluoropyrimidine-based chemotherapy and the overall outcome of patients with gastrointestinal cancer. The results have given rise to the possibility that, by determination of TS levels, the physician may decide if the patient has a potential benefit from fluoropyrimidine-based treatment, similar to measurements of oestrogen receptors in breast cancer. The purpose of this review is to summarize critically the reports on TS measurement in gastrointestinal cancer, focusing on the adjuvant fluoropyrimidine treatment situation.Methods We reviewed more than 20 studies that reported the association of TS with the clinical outcome in patients with gastrointestinal cancer who had undergone complete resection of the primary tumour only or were receiving additional adjuvant chemotherapy.Results Patients with metastasized disease who expressed high TS levels display a low probability of responding to fluoropyrimidine-based treatment and have a poorer survival rate. Patients with high TS levels who undergo complete surgical resection of the primary tumour also have a poorer prognosis than those with tumours with low TS expression. In contrast to advanced disease and to surgery alone, patients with high TS levels appear to benefit, especially, from adjuvant fluoropyrimidine-based chemotherapy after complete primary tumour resection, while patients with low TS levels do not.Conclusion Patients with gastrointestinal cancers that express high TS levels have a poor prognosis with regard to fluoropyrimidine-based palliative chemotherapy or complete primary tumour resection. In contrast, patients with high TS levels might benefit from adjuvant fluoropyrimidine-based treatment after primary tumour resection. However, additional prospective studies are mandatory to define the precise role of TS in adjuvant therapy.     

Twenty-two metachronous multiple signet-ring cell carcinomas treated with repeated gastrectomies and repeated endoscopic mucosal resections: Report of a case

A 45-year-old Japanese woman underwent an endoscopic mucosal resection (EMR) for early gastric cancer at the Cancer Institute Hospital in July 1996. The patient then underwent a distal gastrectomy in 2002 because of a new early gastric cancer and repeated EMR for a total of six early gastric cancers in 2007. Finally, a total gastrectomy was performed in February 2008. The pathological examination of the resected specimen indicated 14 synchronous multiple early gastric cancers. Although the incidence of multiple gastric cancers has been reported to range from 5% to 15%, there is usually only a double or triple lesion. Moreover, multiple gastric cancer is typically observed in male elderly patients as differentiated adenocarcinomas. The present case was a young female patient and all of the lesions were intramucosal signet-ring cell adenocarcinomas. The carcinogenetic mechanism in this case may therefore be different from that in typical multiple gastric cancers. A thorough preoperative examination and regular postoperative follow-up are therefore essential for detecting multiple gastric cancers in their early stages.     

Synchronous Rectal and Esophageal Cancer Associated with Prurigo Chronica Multiformis: Report of a Case

The skin lesions that appear in association with internal malignancies are called dermadromes or paraneoplastic cutaneous disorders. These skin changes characteristically develop with progression of the internal malignancy. A 75-year-old Japanese man who had been diagnosed as having prurigo chronica multiformis, a form of dermadrome, 5 years previously was referred to our hospital for further investigation. On admission, numerous itchy red papules were present on the right side of the abdomen and the inner aspect of both thighs. Intensive screening for internal malignancies revealed advanced rectal cancer and early esophageal cancer. After surgical resection, the skin lesions improved without any treatment. To the best of our knowledge, this is the first case of synchronous double cancers associated with prurigo chronica multiformis. Received: October 31, 2000 / Accepted: July 17, 2001     

A case of multiple synchronous quadruple cancers of the stomach,sigmoid colon,rectum, and pancreas

IntroductionMultiple primary neoplasms are relatively rare, but their incidence has increased because of aging and improvements in diagnostic imaging.Presentation of caseA 67-year-old man presented with epigastric pain. On upper gastrointestinal endoscopy, an ulcer was seen at the gastric angle, and biopsy showed moderately differentiated adenocarcinoma (AC). Colonoscopy demonstrated a 15-mm lesion in the sigmoid colon and a submucosal lesion in the lower rectum. The biopsy showed well differentiated AC and neuroendocrine tumor (NET). In addition, abdominal CT and MRI showed a 14-mm nodular lesion in the pancreatic body suggesting pancreatic duct cancer. Based on the above findings, four synchronous cancers, including the pancreas, stomach, sigmoid colon and rectum, were diagnosed, and surgery was performed. A midline incision was made in the upper abdomen, and a distal gastrectomy, pancreatic body and tail resection, and sigmoidectomy were performed. Trans-anal tumor resection was performed for the rectal lesion. Histopathology showed invasive pancreatic duct cancer, moderately differentiated AC of the stomach, moderately differentiated AC of the sigmoid colon, and NET G1 of the rectum. The patient had no postoperative complications, 4 years 3 months after resection, and he was disease-free from all of the cancers.DiscussionThe strategy of perioperative diagnosis and treatment for multiple primary tumors is usually difficult. This process was performed by consulting a cancer board, which could be useful as a practice guideline.ConclusionThis patient in whom four tumors were completely resected at the same time and who has had a good clinical course was reported.     

Laparoscopy-assisted combined resection for synchronous gastric and colorectal cancer: Report of three cases

In gastric cancer patients, the most common form of synchronous cancer is colorectal cancer. To reduce the invasiveness of the resection, a laparoscopy-assisted combined resection was performed in three patients with synchronous gastric and colorectal cancer. Although all gastric lesions were in the early stages, two colorectal lesions were advanced cases. In all cases, the laparoscopic gastric resection and reconstruction was performed first, followed by the colorectal resection. In the case of right-side colon cancer in addition to gastric cancer, it was relatively easy to perform the combined resection with lymph node dissection sharing the same ports used for the gastrectomy, although we needed an additional port. In one case, in which rectal cancer was present in addition to gastric cancer located in the upper portion of the stomach, a totally laparoscopic proximal gastrectomy was combined with a laparoscopy-assisted low anterior resection, leaving only a lower abdominal minilaparotomy wound. All patients quickly returned to normal activity without remarkable complications, with the exception of a wound infection in one patient. With a mean follow-up of 30.7 months, all patients survived without any sign of recurrence. This procedure represents a feasible option for minimally invasive treatment of synchronous gastric and colorectal cancer.     

腹腔镜下胰体尾占位性病变切除16例体会

目的探讨胰体尾占位性病变行腹腔镜手术治疗的临床应用价值。方法回顾性分析自2014年开展腹腔镜胰腺手术以来成功完成的16例患者的临床资料。肿瘤直径1.0~12.6 cm,平均4.4 cm。行腹腔镜胰腺肿瘤摘除术4例,腹腔镜胰体尾脾切除术2例,腹腔镜胰体尾切除术10例。结果 16例患者均成功完成手术。手术时间90~330 min,平均210 min。术中平均出血量150ml。术后住院日4~28 d,平均11 d。术后病理回报黏液性囊腺瘤1例,浆液性囊腺瘤2例,胰岛素瘤5例,胰腺假性囊肿2例,实性假乳头状瘤2例,异位脾1例,自身免疫性胰腺炎1例,胰腺囊肿1例,胰腺癌1例。术后1例出现胰瘘,经通畅引流、抑酶对症治疗后痊愈;1例出现脾梗死,已随访1年,无临床症状及体征;1例出现结肠瘘,保守治疗痊愈。结论腹腔镜治疗胰体尾占位性病变是安全可行的。     

Synchronous primary epithelial tumors of the pancreas

INTRODUCTIONPancreatic incidentalomas are diagnosed at increased rates due to advanced pancreatic imaging. Coexistence of such lesions with another pancreatic pathology, however, is uncommon and their management might be perplexed by the anatomical location and the histological features of the lesion.PRESENTATION OF CASEA patient with obstructive jaundice was diagnosed with adenocarcinoma of the pancreatic head and underwent routine pancreatic imaging (CT) which revealed the coexistence of a small cystic lesion at the pancreatic body. Further investigation with MRCP and ERCP was unable to confirm a benign lesion and total pancreatoduodenectomy was performed. Histological examination showed a rare type of mixed serous–mucinous cystadenoma of borderline malignancy at the pancreatic body coexistent with an adenocarcinoma of the pancreatic head.DISCUSSIONCoexistence of a peripheral pancreatic cystic tumor with a ductal adenocarcinoma of the pancreatic head is a very rare incidence in medical literature. The management of the peripheral lesion is not straightforward and there can be uncertainty as to the extent of the pancreatic resection that may be required.CONCLUSIONAppropriate preoperative imaging has a significant impact on the definitive management of synchronous pancreatic tumors. Implications of a common pathogenetic pathway are also raised for this rare occurrence of two primary epithelial pancreatic tumors.     

共同性水平斜视矫治与重睑成形术一期进行

目的 探讨对单睑又伴有共同性水平斜视者进行一期手术,以达到既节省时间又美容的目的 .方法 首先根据斜视度数计算相关眼肌后徙和缩短尺寸,再设计重睑线高度并定位,然后进行水平肌后徙和缩短以矫正斜视,最后进行切开法重睑成形术.结果 25例伴有内斜视的受术者,斜视均得到正位矫正;11例伴有外斜视的受术者中有4例过矫,其范围在5～10°,余均正位.对于薄眼皮、中厚眼皮的单睑,均在3个月内恢复自然形态,而厚眼皮者则恢复较慢,平均半年左右.伴有内眦赘皮的2例亦得到矫正.结论 尽管斜视手术对整形外科医师陌生并有一定难度,但是, 二者一期手术完成既节省时间、节约经费又能达到美容目的 ,有条件者可以慎重考虑进行.     

不能切除的胰腺癌经腹腔镜旁路手术42例报告

目的 探讨对晚期胰腺癌所致的十二指肠梗阻和胆道梗阻同步行腹腔镜胃肠联合胆肠内引流术的可行性和临床疗效.方法 回顾性分析我们于2002年1月～2006年6月对42例晚期胰腺癌病人行腹腔镜胃空肠吻合术联合胆囊空肠吻合术的临床资料.结果 本组42例手术均获成功.手术时间为66～189 min,平均(92±21)min;术中出血33～411ml,平均(65±23)ml;术后3～5d病人胃肠功能恢复;住院时间10～24d,平均(12.3±3.5)d.术后有2例发生切口感染,无其它手术并发症.术后病人恢复经口进食,黄疸逐渐消退.结论 腹腔镜胃空肠、胆肠吻合姑息治疗晚期胰腺癌具有创伤小、长久保持经口进食,减黄彻底,病人术后痛苦轻、住院时间短等特点.     

胰腺大囊性浆液性囊腺瘤临床分析

目的 探讨胰腺大囊性浆液性囊腺瘤(MSAP)的诊断与治疗.方法 对1999年10月至2009年10月收治的5例MSAP患者的临床资料进行回顾性分析.男性1例,女性4例.结果 5例MSAP患者中,临床表现为腹痛、腹胀3例,黄疸1例,无明显症状1例.超声和CT检查显示胰腺大囊性占位性病变;其中5例均边界清楚、有分隔、囊壁强化、未见囊壁结节及乳头状突起;4例囊壁光滑、较薄;3例病灶为分叶状,2例病灶为类圆形;2例伴胰管扩张,1例伴胆道扩张.5例MSAP中,肿瘤发生于胰头2例、胰体尾3例,肿瘤直径均大于5.0 cm,平均直径8.8 cm.5例均行手术切除,术后2例发生胰瘘,均治愈.随访8～35个月,未见复发.结论 MSAP缺乏特异性临床表现,超声和CT等影像学特征与胰腺黏液性囊性肿瘤相似,肿瘤逐渐增长并产生压迫症状,手术切除后可治愈.     

胰腺腺鳞癌的诊断与治疗：附6例报告

目的:探讨胰腺腺鳞癌诊治经验,以提高对该病的认识和诊治水平。方法:回顾性分析2002年6月—2014年6月期间收治的6例胰腺腺鳞癌患者的临床资料并结合相关文献进行讨论。结果:6例患者中,肿瘤位于胰头部者3例,位于胰体尾部者3例;平均年龄63.3岁;主要症状为腹痛和小便发黄;CA19-9升高5例;CT等影像学检查均提示胰腺占位病变;行胰头十二指肠切除术2例,胰体尾部加脾切除3例;1例术中发现肿瘤侵及胃后壁、十二指肠降部,行姑息性手术治疗;镜下病理检查均可见腺癌和鳞癌成分混杂。术后随访,死亡4例,失访1例,术后生存7~56个月,平均21个月。结论:胰腺腺鳞癌是一种罕见肿瘤,恶性程度高,术前诊断困难,预后差,但手术切除仍是首选治疗手段,通过联合放化疗的综合治疗可能提高疗效。     

Peritoneal Recurrence of Gastric Cancer with Mucin Phenotype 12 Years After Curative Resection: Report of a Case

We report a case of peritoneal recurrence of gastric cancer in a 58-year-old man, 12 years after curative surgery. Urinary wall thickness was seen on follow-up computed tomography and magnetic resonance imaging scans. We performed total nephroureterectomy and cystectomy for urinary tract cancers, but histological examination of the resected specimen revealed poorly differentiated adenocarcinoma with severe fibrosis, resembling the gastric cancer resected 12 years earlier. Immunohistological examination revealed human gastric mucin (45M1) and intestinal mucin (MUC2) phenotype in both the original gastric cancers and the urinary tract cancers. Thus, we concluded that the second cancer was a peritoneal recurrence of gastric cancer with gastric and intestinal mucin phenotypes. Although peritoneal recurrence so many years after curative gastrectomy is rare, careful long-term follow-up should be done for all patients undergoing surgery for gastric cancer with mucin phenotype.     

胰体尾癌的临床诊治体会:附79例报告

目的探讨胰体尾癌的诊断与临床治疗。方法回顾性分析1988—2005年胰体尾癌79例临床资料。结果腺癌70例,黏液腺癌6例,囊腺癌2例,腺鳞癌1例。肿瘤分期(TNM):Ⅰ期2例(2.6%),Ⅱ期20例(25.3%),Ⅲ期23例(29.1%),Ⅳ期34例(43.O%)。75例手术探查,肿块切除27例,48例未切除,切除率36%,基本术式为胰体尾及脾切除,1例保留脾脏;1例全腹腔镜手术;4例未行手术。36例随访资料(至2006年3月)显示:未手术者中3例分别于出院后15 d,1个月,2个月死亡;肿块未切除者中2例术后30 d内死亡,18例平均存活6.1个月;肿块切除者中8例死亡,平均存活16.6个月;5例尚存活。结论早期诊断、根治性手术及合理的辅助治疗是改善胰体尾癌疗效的关键。     

Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction

Pancreaticobiliary maljunction is a congenital anomaly in which the junction between the pancreatic duct and the common bile duct is located outside the sphincter of Oddi. It is well known that pancreaticobiliary maljunction is frequently associated with carcinoma of thebiliary tract. We report a case of metachronous cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction and cystic dilatation of common bile duct in a 68-year-old Tunisian woman who underwent a cholecystectomy for acute cholecystitis. The pancreatic tumor was an adenosquamous carcinoma. Pancreaticobiliary maljunction allows for pancreatobiliary or biliopancreatic reflux which may induce biliary tract carcinoma. Few cases of multifocal cancer associated with this anomaly have been reported. The association with pancreatic carcinoma remains rare. Close attention should be given to both the biliary tract system and pancreas during the long-term follow-up of patients with pancreaticobiliary maljunction, especially after they have undergone a choledochojejunostomy.