Rapidly growing early gastric cancer with microsatellite instability |
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Authors: | Yamashita Kentaro Kato Norihiro Takahashi Hiroaki Shimizu Haruo Suzuki Hiromu Motoya Satoshi Arimura Yoshiaki Endo Takao Ura Hideki Ichimiya Shingo Imai Kohzoh |
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Institution: | (1) First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan, JP;(2) First Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan, JP;(3) Department of Clinical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan, JP |
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Abstract: | A 77-year-old man underwent gastrointestinal endoscopy that revealed a small flat elevated lesion in the gastric antrum. Endoscopically,
we assessed the tumor as intramucosal cancer or adenoma, and biopsy specimens were diagnosed as showing borderline malignancy.
At the second examination, performed 6 months later, the elevated lesion had grown, showing remarkable changes in its appearance,
and a diagnosis of adenocarcinoma was confirmed pathologically. The patient underwent distal gastrectomy about 8 months after
the first examination, and the tumor in the resected specimens showed a moderately differentiated adenocarcinoma invading
through the entire submucosal layer, with metastasis to a regional lymph node. Microsatellite analysis of this early gastric
cancer disclosed mutations in all six markers examined, indicating high-level microsatellite instability (MSI-H). The tumor
also showed frameshift mutations of TGFβRII and BAX genes, as well as hypermethylation of the hMLH1 promoter. These results suggest that a deficiency of the mismatch repair system played a critical role in the progression
of this cancer.
Received: August 13, 2001 / Accepted: January 25, 2002
Reprint requests to: K. Yamashita Present address: The Burnham Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA |
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Keywords: | : gastric cancer microsatellite instability BAX natural history |
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