Long-Term Survival in Two Cases of Resected Gastric Metastasis of Pulmonary Pleomorphic Carcinoma

We report two pulmonary pleomorphic carcinoma patients both of which underwent surgical resection of solitary gastric metastases. A 69-year-old man developed anemia 5 months after right upper lobectomy for pulmonary pleomorphic carcinoma and gastric metastasis was detected endoscopically. He underwent distal gastrectomy and has survived for 5 years without any other recurrence or metastasis. Preoperative abdominal computed tomography detected a submucosal gastric tumor in a 62-year-old man with left upper lobe pleomorphic carcinoma. A gastrointestinal stromal tumor was suspected. Left upper lobectomy was performed followed by partial gastrectomy with splenectomy. The histologic diagnosis was primary pulmonary pleomorphic carcinoma with gastric metastasis. He has survived for 4 years without any other recurrence or metastasis. Resection of gastric metastasis following complete pulmonary pleomorphic carcinoma resection may be indicated if the metastasis is solitary.     

Resection of skin metastases from gastric carcinoma with long-term follow-up: an unusual clinical presentation

BACKGROUND: Skin metastases from gastric cancer are rare and generally occur at a very late stage in the course of the disease. CASE REPORT: A 60-year-old patient with localized adenocarcinoma of the cardia (stage II) was primarily treated with extended total gastrectomy with transhiatal resection of the distal esophagus. 6 isolated skin metastases occurred on the head and on the thigh 2 years later. These lesions where all surgically removed. Morphologically and according to an extensive immunohistochemical comparison the skin lesions and the primary tumor were identical. The patient presented with dysphagia more than 6 years after the primary diagnosis, and a local recurrence was diagnosed. Again a surgical procedure was chosen and a transthoracal esophagectomy with intrathoracic esophagojejunostomy was performed. This patient remains free of symptoms and is clinically in complete remission 7.5 years after the primary diagnosis. CONCLUSION: We report a long-term disease-free survival of a patient with isolated cutaneous metastases of a gastric cancer. Usually the prognosis after occurrence of metastases to the skin is poor, but long-term survival after systemic therapy has been reported. This patient is clinically in remission more than 5 years after surgical resection of several cutaneous metastases and after successful resection of a local recurrence more than 1 year ago. One should be aware of such unusual clinical courses of a disease, and that the prognosis can deviate significantly from the average when the pattern of metastasis is unusual.     

Tumor recurrence and its timing following curative resection of early gastric carcinoma

BACKGROUND: Although the prognosis of patients with early gastric carcinoma has improved, we still sometimes encounter recurrences following curative resection. Which carcinomas will recur and when a patient will die of recurrence are difficult to predict. PATIENTS AND METHODS: We retrospectively analyzed clinicopathological findings in 552 patients with early gastric carcinoma in terms of predicting recurrent cases and postoperative intervals to death from tumor recurrence. Predictive factors for postoperative recurrence were examined by multivariate analysis. RESULTS AND CONCLUSION: Patients developing recurrence were significantly older, and regional lymph node metastasis, lymphatic invasion and limited surgery were significantly more frequent. Two-thirds of patients who died of tumor recurrence survived more than 2 years after gastrectomy. The predictive factors for recurrence of early gastric carcinoma were regional lymph node metastasis, limited lymphadectomy and invasion of carcinoma into the submucosa. Extended radical lymphadectomy with gastrectomy and long-term intensive follow-up are needed for patients showing these factors.     

A case of gastric cancer with multiple liver metastasis responding to combination therapy of CPT-11 and CDDP

A 63-year-old man suffering from advanced gastric carcinoma after distal gastric resection had multiple liver metastases 5 months after the operation. He underwent 3 courses of combination chemotherapy of 5-FU 600 mg/day with CDDP 50 mg/day, etoposide 100 mg/day and Leucovorin 30 mg/day for 5 days (FLEP), but progressive disease (PD) was noted. One additional course of combination chemotherapy with CPT-11 140 mg/day and CDDP 40 mg/day biweekly was performed and a complete response (CR) was noted. After 4 months, recurrence of a liver metastasis on S8 was demonstrated and 2 courses of the same chemotherapeutic regimen were carried out. Over 5 months, recurrence of the liver metastasis showed no change (NC) and resection of S8 of the liver was performed. No recurrence was after 6 months, but the patient died 34 months after the first detection of the occurrence of multiple liver metastases. The combination chemotherapy of CPT-11 with CDDP was also administered to other patients at our outpatient clinic and seems to be useful therapy for improving outcome.     

Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease.

INTRODUCTION: From 1986 to 1999 we operated on 963 patients with primary hyperparathyroidism (pHPT). METHODS AND RESULTS: Parathyroid carcinoma was diagnosed clinically and histologically in four patients (0.4%). In two of these patients diagnosis of parathyroid cancer was delayed by misinterpretation of the histopathology leading to an autotransplantation of malignant parathyroid tissue in one case. In two patients multivisceral surgery was performed: beside thyroidectomy, neck dissection, tracheal wall resection and resection of the muscular layer of the oesophagus one patient received oesophagectomy and gastric transposition and one patient a lung wedge resection. Both patients had a temporary palliation of tumour-associated symptoms after multivisceral surgery. The first patient died 2 years after oesophagectomy and 12 years after primary diagnosis from local tumour recurrence and cachexia. The second patient is living with tumour recurrence presenting a serum calcium level of 4.2 mmol/l (normal range 2.0 to 2.5 mol/l) and multiple brown tumours 2 years after lung resection and 6 years after the primary diagnosis. CONCLUSIONS: We conclude that parathyroid carcinomas, being difficult to diagnose, warrant radical surgery, including multivisceral resection to prolong survival and reduce tumour and hypercalcaemia associated symptoms. Copyright Harcourt Publishers Limited.     

Weekly administration of paclitaxel attenuated rectal stenosis caused by multiple peritoneal recurrence 8 years after the resection of gastric carcinoma

We report a patient with rectal stenosis caused by peritoneal recurrence 8 years after a curative resection of advanced stage gastric carcinoma; the recurrence was effectively treated with the weekly administration of paclitaxel. The patient was a 66-year-old Japanese woman who was admitted to our hospital complaining of abdominal pain and frequent bowel movements. She had undergone total gastrectomy, due to advanced-stage gastric carcinoma with extensive lymph node metastasis, 8 years before, and had taken an oral anticancer agent, fluoropyrimidine, for 4 years after the operation. Colonofiberscopy performed on admission revealed circumferential rectal stenosis located 10cm from the anal verge. Barium enema study demonstrated extensive poor expansion of the upper and lower rectum and irregularity of the descending colon. Abdominal computed tomography (CT) scanning revealed wall thickening in the rectum and descending colon. These findings were compatible with rectal stenosis caused by the peritoneal recurrence of gastric carcinoma. Weekly administration of paclitaxel was started. The abdominal symptoms soon disappeared when the second cycle of paclitaxel was completed, and they have not appeared since then. The rectal stenosis was attenuated, as confirmed by imaging analyses. Weekly paclitaxel has been effective for more than 13 months, suggesting that the patient is in a state of tumor dormancy of recurrent gastric carcinoma.     

Arterial infusion therapy with low-dose cisplatin and continuous 5-fluorouracil for isolated hepatic recurrence of gastric carcinoma

Patients with metachronous liver metastasis after curative resection of gastric carcinoma generally have a poor prognosis, even when recurrence is confined to the liver. We report a patient in whom hepatic arterial infusion therapy with bolus low-dose cisplatin (CDDP) and continuous 5-fluorouracil (5-FU) was effective against large metastases confined to the liver. An 83-year-old man was admitted with huge liver metastases from gastric carcinoma. Intra-arterial bolus injection of low-dose CDDP (5 mg) and continuous intra-arterial infusion of 5-FU (250 mg/day for 7 days) was started. After four courses of this arterial infusion therapy, computed tomography scans revealed shrinkage of the liver metastases. He was followed-up as an outpatient and continued to receive the arterial infusion therapy once every 4 weeks. Throughout the course of the chemotherapy, a partial response of the liver metastases was maintained. The patient had an improved quality of life after starting the chemotherapy, and he survived for 16 months from the commencement of the therapy. Arterial infusion therapy with bolus low-dose CDDP and continuous 5-FU may be recommended for patients with isolated hepatic recurrence of gastric carcinoma. Received: September 6, 1999 / Accepted: January 31, 2000     

A case of small undifferentiated intramucosal gastric cancer with lymph node metastasis

Early gastric cancer (EGC) has a favorable prognosis after surgical gastrectomy. For intramucosal EGC with little risk of lymph node metastasis, endoscopic mucosal resection (EMR) is an accepted treatment method. Herein we document a noteworthy case of small undifferentiated gastric cancer with nodal metastasis. A 60-year-old Japanese woman underwent gastrectomy with D2 lymph node dissection for the treatment of EGC in the lower gastric body. Histological examination revealed that signet-ring cell carcinoma was located in approximately one-third of the superficial portion of the mucosal layer, with a tumor size of 13 mm. No lymphatic invasion, venous invasion, or fibrosis was observed in the submucosal layer. This case had nodal metastasis and was finally diagnosed as stage IB (T1N1M0) according to the Japanese Classification of Gastric Carcinoma (JCGC). The patient is alive without recurrence 6 years after treatment.     

Resection of local recurrent gastric cancer following total gastrectomy

We report a case of patient who underwent resection for local recurrent gastric cancer at the anastomotic site curatively. The patient was a 72 years old male with a history of undergoing total gastrectomy for gastric cancer located at the gastric cardia in February 2005. The histological findings of the resected tumor showed a Type 3 advanced gastric cancer invaded into subserosa in the cardia of the stomach with positive lymphatic and venous invasion and lymph node metastasis. The histological diagnosis was moderately differentiated tubular adenocarcinoma. Both the proximal and distal margins were negative for cancer. Endoscopy, 4 years after the first operation, showed a recurrent tumor at the site of esophago-jejunal anastomosis. A resection of the tumor was carried out curatively through the left thoraco-abdominal approach in June 2009. We recommend a resection of anastomotic recurrence especially if it occurs from the first operation in the long interval.     

Solitary metastasis to the left axillary lymph node after curative gastrectomy in gastric cancer

Regional lymph node metastasis in advanced gastric cancer is common, whereas axillary lymph node metastasis (ALNM) is rare. We experienced a patient with a solitary ALNM in gastric cancer. A 48-year-old woman underwent curative distal gastrectomy for advanced gastric cancer (P0H0T3N3M0CY0, stage IV). Twenty-one months after the surgery, she complained of an asymptomatic left axillary tumor. Mammography and computed tomography (CT) scans showed the presence of tumors in neither breast nor lung. Fine-needle aspiration of the axillary tumor demonstrated poorly differentiated adenocarcinoma cells, which coincided with the cells of the resected gastric carcinoma. We diagnosed ALNM from gastric cancer and operated on the patient with radical left axillary lymph node dissection. One year after the reoperation, she has had no recurrence. We conclude that gastric cancer can metastasize to unusual sites. A re-radical resection is recommended if curative resection is feasible. Received: March 6, 2002 / Accepted: April 23, 2002 Offprint request to: O. Kobayashi     

Isolated gastric metastasis from renal cell carcinoma 19 years after radical nephrectomy

Metastatic tumors in the stomach are rare. We report a case of solitary gastric metastasis from renal cell carcinoma (RCC) 19 years after radical excision of the primary tumor. During evaluation for anemia with melena, a small elevated tumor with ulceration was detected in the gastric fundus of this patient. The tumor was diagnosed as RCC based on endoscopic biopsy findings. There was no evidence of any other metastatic lesion, and a wedge resection of the stomach was performed. No additional metastasis or recurrence has been detected in the patient 12 months after discharge. This case confirms the existence of a very slow growing type of RCC with the potential for late solitary metastases and describes the surgical resectability.     

Gastric GIST: a single institutional retrospective experience with surgical treatment for primary disease.

AIMS: Because gastric GISTs show variable clinical behavior, we reviewed our experience with primary gastric GISTs after surgical treatment and imatinib mesylate treatment for advanced disease. METHODS: Between December 1995 and December 2005, 111 patients who underwent surgical treatment for primary gastric GISTs were enrolled in this study. Patients were grouped according to the risk assessment classification, and clinicopathological features, tumor recurrence and patient survival were assessed. RESULTS: One patient was included in the very low risk group, 35 in the low risk group, 31 in the intermediate risk group and 44 in the high-risk group. All patients with very low, low and intermediate risk GISTs and 70% of patients with high risk GISTs underwent R0 resection. While there was no recurrence or metastasis in patients with very low, low and intermediate risk GISTs, 23% of those with high risk GISTs showed a distant metastasis at diagnosis and 35% of these patients had a recurrence after R0 resection. The overall 5-year survival rate of the high risk patients was 77.1%. Nineteen patients received imatinib mesylate therapy due to an incomplete resection or recurrence; 7 with no measurable lesion at the CT scan by a local tumor control showed no tumor progression after imatinib mesylate therapy, however, 12 patients with measurable lesions showed variable clinical courses after treatment. The overall 5-year survival rate of 19 patients with imatinib mesylate treatment was 80.0%. CONCLUSIONS: The clinical outcome of the very low, low and intermediate risk gastric GISTs was excellent, while high risk gastric GISTs had a high rate of recurrence and therefore a less favorable outcome. A complete resection is the most important treatment for cure; however imatinib mesylate treatment may improve the clinical outcome of the patients with metastatic or recurrent gastric GISTs.     

Hepatic resection for synchronous liver metastases of gastric cancer]

Since 1970, we have treated 125 patients with synchronous liver metastases from gastric cancer. We analyzed 4 of these 125 patients who underwent hepatic resection, and studied the indications for hepatic resection. There were 3 H1 patients and 1 H2 patient. Lateral segmentectomy was performed for 2 patients and partial segmentectomy was performed for 2 patients. Hepatic arterial infusion (HAI) chemotherapy followed by surgery was performed for patients, one of whom died of recurrence in the residual liver at 49 months. The other patient has survived without recurrence for 30 months. Two patients without HAI died after 11.3 months and 1.9 months, respectively. The survival time of 3 H1 patients who underwent hepatectomy was 30.2 months, while that of the other H1 patients without hepatectomy was 8.3 months. In conclusion, when local control is obtained during surgery and the liver metastasis is H1 in a patient with synchronous liver metastasis of gastric cancer, aggressive hepatectomy supported by HAI should be performed to improve the prognosis.     

A noteworthy case of postoperative liver metastasis from gastric cancer which responded well to UFT therapy

A 66-year-old male underwent partial gastrectomy (resection of the pyloric side of the stomach) at another hospital on the basis of a diagnosis of gastric cancer (Fig. 1). Five months later, his CEA level began to rise. At that time, multiple liver metastases were detected by ultrasonography and CT scans. The patient received oral UFT therapy (400 mg/day) at our hospital. A reduction in CEA was observed 63 days after the start of this therapy. A judgment of CR (complete response) was made after 4 months of the therapy. At present, 2 years and 4 months after UFT was first administered, the patient shows no signs of tumor recurrence. This case is noteworthy since there has been no previous report of a case where UFT showed a high efficacy in treating liver metastasis after surgical resection of gastric cancer.     

Carcinosarcoma of pancreas with liver metastasis combined with gastrointestinal stromal tumour of the stomach: is there a good prognosis with the complete resection?

SHEN Z.L., WANG S., YE Y.J., WANG Y.L., SUN K.K., YANG X.D. & JIANG K.W. (2009) European Journal of Cancer Care 19 , 118–123
Carcinosarcoma of pancreas with liver metastasis combined with gastrointestinal stromal tumour of the stomach: is there a good prognosis with the complete resection? We report a carcinosarcoma of the pancreas with liver metastasis combined with gastrointestinal stromal tumour (GIST) of the stomach in a 72‐year‐old woman who presented with right upper quadrant pain, nausea and vomiting. A radical resection including pancreaticoduodenectomy, left hepatic lobe resection and local resection of the gastric mass was performed. The tumour in the head of pancreas was found to be grossly yellow‐white, and it infiltrated the common bile duct and duodenum; the mass of the liver metastasis is solitary. Pathologic examination showed two components separated from each other: one component was a conventional infiltrating pancreatic ductal adenocarcinoma, and the other component showed sarcomatous growth pattern composed of pleomorphic spindle cells. The neoplasm of the stomach was confirmed a low malignant potential GIST by histology and immunohistochemistry. The patient was obliged to be in hospital because of abnormal bowel function; moreover, surveillance CT scans performed at 1.5 months post‐operatively showed multiple liver metastasis and recurrence in the tail of pancreas. Unfortunately, the patient died of multiple organ failure at 2 months post‐operatively. To our knowledge, this is the first experience report about surgical treatment of carcinosarcoma of pancreas with liver metastasis combined with GIST of the stomach. The patient performed a radical surgery for the metastatic carcinosarcoma even if that could be resected completely did not have a good consequence.     

Surgical treatment of early gastric carcinoma

From January 1965 until December 1982, early gastric carcinoma cases comprised 765 of 2,235 curative resections and 17 of 620 noncurative resections, for a total of 782 cases. The rate of lymph node metastasis for mucosal carcinoma was 1.2%, and that for submucosal carcinoma was 18.2%. Gastrectomy with removal of the second-group lymph node proved adequate for submucosal carcinoma. The five-year survival rates for mucosal carcinoma and for submucosal carcinoma were 94.9% and 93.6% respectively. The rate of recurrence of mucosal carcinoma was 0.6%, against 2.5% for submucosal carcinoma. Adjuvant chemotherapy is necessary to obtain improved surgical results for submucosal carcinoma. Important factors affecting the recurrence of submucosal carcinoma are lymph node metastasis, macroscopic findings and histological findings. Ten out of 17 cases of noncurative resection had cancer cells at the resection margin, caused by inadequate resection.     

The relationship between prognosis and CEA-dt after hepatic resection in patients with colorectal carcinomas.

AIMS: CEA-doubling time (CEA-dt) was calculated by measuring serum CEA at two voluntary points. As CEA-dt is correlated with tumour doubling time the growth rate of liver metastasis could be determined. We investigated the relationship between CEA-dt and prognosis to determine the indications for resection of liver metastasis. METHODS: We examined 334 patients diagnosed with resected liver metastasis of colorectal carcinoma. Patients were divided into three categories based on CEA-dt; Group A, CEA-dt <30 days; Group B, 30 days /=s80 days. Clinicopathological parameters, the 3-year or 5-year survival rate and the rate of recurrence were compared among the three groups. RESULTS: In Group A, the survival time after hepatic resection was significantly shorter compared to the other groups. Furthermore, multiple liver metastasis showed slightly reduced CEA-dt levels compared with solitary metastasis, but even in patients with solitary liver metastasis, the rate of survival was poor. In 70% of Group A patients, recurrent tumour was recognized within 1 year of hepatic resection. CONCLUSION: When surgery for liver metastasis of colorectal cancer is considered. Group A patients should be recognized as having a poor prognosis and a high rate of recurrence after hepatic resection, and CEA-dt should be employed as a prognostic factor.     

A case of advanced gastric cancer with hepatic metastasis successfully treated by combined chemotherapy with UFT and lentinan

We have experienced successful treatment of a hepatic metastasis of gastric cancer with UFT and lentinan. The patient was a 65-year-old male, who underwent distal gastrectomy for gastric cancer with hepatic and lymphatic metastases. After operation, administrations of UFT 300 mg/day and lentinan 2 mg/2 weeks were given, and the hepatic metastasis disappeared by 17 months. We performed a resection of the residual stomach and lymphatic metastasis at 52 months after operation. For over 5 years the patient has shown no evidence of a recurrence of the hepatic metastasis. This chemotherapy regimen was very effective and improved the patients quality of life.     

Diagnostic différentiel entre récidive tumorale et radionécrose après radiothérapie stéréotaxique d’une métastase cérébrale

Magnetic resonance imaging (MRI) is a method of choice for follow-up of irradiated brain metastasis. It is difficult to differentiate local tumour recurrences from radiation induced-changes in case of suspicious contrast enhancement. New advanced MRI techniques (perfusion and spectrometry) and amino acid positron-emission tomography (PET) allow to be more accurate and could avoid a stereotactic biopsy for histological assessment, the only reliable but invasive method. We report the case of a patient who underwent surgery for a single, left frontal brain metastasis of a breast carcinoma, followed by adjuvant stereotactic radiotherapy in the operative bed. Seven months after, she presented a local change in the irradiated area on the perfusion-weighted MRI, for which the differentiation between a local tumour recurrence and radionecrosis was not possible. PET with 2-deoxy-(¹⁸F)-fluoro-D-glucose (FDG) revealed a hypermetabolic lesion. After surgical resection, the histological assessment has mainly recovered radionecrosis with few carcinoma cells. The multimodal MRI has greatly contributed to refine the differential diagnosis between tumour recurrence and radionecrosis, which remains difficult. The FDG PET is helpful, in favour of the diagnosis of local tumour recurrence when a hypermetabolic lesion is found. Others tracers (such as carbon 11 or a fluoride isotope) deserve interest but are not available in all centres. Stereotactic biopsy should be discussed if any doubt remains.     

Serum concentrations of immunoglobulins and complement components in patients with recurrence after resection of gastric carcinoma

Immunoglobulins and complement components were quantitated in sera sampled at 3-6-month intervals from 20 patients with recurrence after resection of gastric carcinoma stages I-III (pTNM). Concentrations of IgA, C3, C4, and C1-INH at clinical recurrence were increased in a significant number of patients as compared to the concentrations 3-6 months prior to recurrence. The mean concentration of C3, C4, and C1-INH were higher than prior to recurrence. At the time of recurrence, the concentrations of C3, C4, and C1-INH were higher than the corresponding postoperative concentrations among 14 patients alive and disease-free for 5 years or more. Three to six months prior to recurrence, the concentrations of C4 and C1-INH were also higher than those of the 5-year survivors. The data indicate that serial quantitation of immunoglobulins and complement components may beof value in the follow-up after resection of gastric carcinoma.