[A resected case of pathologically complete response of a pelvic recurrence from rectal cancer after chemoradiotherapy with S-1]

The patient was a 58-year-old man who had been performed a low anterior resection for an advanced upper rectal cancer (T3N0M0, Stage II). At fourteen months after primary operation, follow-up CT scan, MRI and FDG-PET showed a pelvic recurrence located at upper presacral region. Following radiotherapy combined with S-1, we performed a curative surgical resection. Pathologically, an extensive fibrosis was shown without a tumor cell. Complete surgical removal of the recurrent disease remains the best chance of cure after a local recurrence. But in the case of recurrent tumor located in upper presacral region and extended to the pelvic side-wall, it is very difficult to achieve negative resection margins. So selection of patients is very important to reduce the risk of positive surgical margins. We experienced a resected case of pathologically complete response of a pelvic recurrence from rectal cancer after chemoradiotherapy with S-1. This case suggests the neoadjuvant chemoradiotherapy has potential to improve management of locally recurrent rectal cancer.

[A case report of multiple liver metastases from colorectal cancer effectively treated with systemic chemotherapy and hepatic arterial infusion]

A 61-year-old man admitted to our hospital for diarrhea and general fatigue was found in endoscopic and radiological examination to have sigmoid colon cancer with multiple liver metastases. The patient underwent sigmoidectomy (S, type 2, 105x78 mm, sSI (urinary bladder), sN0 (0/22), sH3 (Grade C), sP0, sM0, sStage IV). Pathological report was following: tub2, pSI (urinary bladder), ly0, v1, pN0(0/22), PM0, DM0, RM0. After operation, the patient received systemic chemotherapy (CPT-11+UFT/LV) with hepatic arterial infusion therapy(HAI). We could not observe any severe adverse events. We conducted hepatectomy because of partial response by chemotherapy. As of this writing 41 months after surgery, the patient continues to do well with no signs of recurrence. The combination chemotherapy of CPT-11+UFT/LV with HAI was safe and effective treatment for the patients with unresectable liver metastases from colorectal cancer.

DQB1 intron 3 sequences provide an insight into the evolution of DQB1 alleles and form the basis for intron-based sequencing

The goal of this project was to obtain sequences of intron 3 of DQB1 in order to develop a sequencing-based typing protocol that provides a complete DQB1 exon 3 sequence. Current protocols do not provide complete sequences of exon 3, thus not allowing to differentiate common and well-documented alleles DQB1*0301 and *0319 and resolve some common trans-ambiguities with group-specific sequencing primer (GSSP) sequencing using positions 641 and 650. Samples homozygous for the most common DQB1 alleles were used to obtain intron 3 sequences, which were used to design intron-based primers for exon 3 amplification. The protocol was extensively validated; no allele dropouts were observed. The presented protocol allows differential typing of DQB1*0301 and *0319 and resolves some common trans-ambiguities.

Efficacy of orally administered superfine dispersed lentinan (beta-1,3-glucan) for the treatment of advanced colorectal cancer

BACKGROUND

Lentinan (LNT) is an immune adjuvant medicine for advanced gastric cancer in Japan. Recently, an oral formulation of superfine dispersed lentinan (SDL) has become clinically available. To investigate the safety and effectiveness of SDL, a multi center clinical study in patients with advanced colorectal cancer was conducted.

PATIENTS AND METHODS

Adverse events were assessed and the patients' quality of life (QOL) and the binding ability of peripheral blood monocytes (PBM) to LNT were also evaluated.

RESULTS

Four grade 2 adverse events associated with SDL treatment were observed among the 80 patients. Adverse events associated with chemotherapy were observed in 9 out of the 64 chemotherapy-treated patients. Among the 48 patients assessed for QOL, the patients with low QOL scores before SDL treatment (n=23) reported a significant improvement in their QOL scores after 12 weeks of SDL administration. The rates of LNT-binding PBM in the QOL-improved group were significantly higher than those in the QOL-not-improved group (p<0.05).

CONCLUSION

SDL was safe and effective for suppressing the adverse effects of chemotherapy as well as improving QOL. The binding ability of PBM to LNT appears to be a promising predictor of QOL improvement after SDL administration.

Schwannoma of the esophagus: a case exhibiting high 18F-fluorodeoxyglucose uptake in positron emission tomography imaging

Esophageal schwannoma is rare and it is difficult preoperatively to confirm a definitive diagnosis, even using current imaging techniques. We present a case of a benign esophageal schwannoma that was surgically excised and confirmed by immunohistochemical staining. Conventional radiological studies, including barium meal, computed tomography and endoscopic examination had shown a solid submucosal tumor of the upper thoracic esophagus but had been unable to confirm the diagnosis. Positron emission tomography was carried out to evaluate the malignant potential and showed a high uptake of 18F-fluorodeoxyglucose (FDG) into the tumor in both the early and delayed phase, suggesting that the tumor was a potentially malignant tumor such as a gastrointestinal stromal tumor. This is the first reported case of esophageal schwannoma that indicated a high FDG uptake. Although consensus has not been reached regarding the precise mechanism of FDG accumulation in schwannomas, we discuss our clinicopathological findings and review other studies of the subject.

[A case of marked response to CPT-11+CDDP neoadjuvant chemotherapy for advanced gastric cancer with paraaortic lymph node metastasis enabling curative resection and over 10-year survival]

We report a case of advanced gastric carcinoma successfully treated with a combination of irinotecan and cisplatin as neoadjuvant chemotherapy. The patient, a 51-year-old woman, had a type 2 gastric carcinoma, which had metastasized to paraaortic lymph nodes. She was treated with irinotecan, 70 mg on day 1 and day 15, and cisplatin, 80 mg on day 1. The course was repeated every 4 weeks. Two courses of treatment resulted in a marked reduction of both the primary tumor and lymph nodes. Subsequently, the patient underwent curative surgery consisting of pancreatoduodenectomy and D3 lymph node dissection. No surgical complication was observed. On microscopic examination, only a few tumor cells were detected in the granulation tissues of the lymph nodes, but viable cancer cells still remained in the resected stomach. This patient has been free of disease for more than 10 years after operation. This case demonstrates the effectiveness and safety of irinotecan and cisplatin used in an neoadjuvant setting for treatment of advanced gastric carcinoma.

Physical function is weakly associated with angiotensin-converting enzyme gene I/D polymorphism in elderly Japanese subjects

BACKGROUND

The turning point in the deterioration of physical function seems to occur between the ages of 70 and 80 years. In particular, muscle strength may decline even more in subjects older than 75. A recent study found that the angiotensin-converting enzyme (ACE) genotype also affects physiological left ventricular hypertrophy. A very limited number of papers have examined genetic differences in resistance and endurance forms of a single sporting discipline.

OBJECTIVE

The purpose of this study was to evaluate the relationship between ACE genotype and physical function by controlling the known confounding factors including dental status.

METHODS

We selected 431 subjects who were aged 76 years and did not require special care for their daily activities. We conducted a medical examination, followed by 5 physical function tests, as follows: (1) maximum hand grip strength, (2) maximal isometric knee extensor strength, (3) maximal stepping rate for 10 s, (4) one-leg standing time with eyes open and (5) 10-meter maximum walking speed. Subjects were genotyped for the ACE intron 16 Alu insertion. In addition, serum concentrations of total cholesterol, total protein, IgA and IgG were measured at a commercial laboratory. The Eichner index was used as an indicator of occlusal condition. Multiple linear regression analysis was performed to evaluate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and physical function considering confounding factors.

RESULTS

The ACE gene I/D polymorphism was positively associated with hand grip strength and 10-meter maximum walking speed. Betas of hand grip strength were 0.09 for I/D (p = 0.022) and 0.12 for insertion/insertion (I/I; p = 0.004). Betas of 10-meter walking speed were -0.11 for I/D (p = 0.093) and -0.14 for I/I (p = 0.039). Dental status such as Eichner index class C was significantly associated with one-leg standing time with eyes open (beta -0.11; p = 0.028).

CONCLUSION

This study suggests that there is a significant relationship between ACE genotype and physical function. In particular, subjects with the ACE deletion/deletion genotype were associated with upper extremities.

Postoperative reorganization of gastric pacemaker activity in patients after an extended period following distal gastrectomy

We recorded and analyzed electrogastrograms (EGGs) from 12 patients following distal gastrectomy. The EGGs were recorded from between 3 and 262 months post-operatively. Gastric electrical activity, which showed a distinct repeating pattern with a frequency of 3 cycles per minute (cpm), was easily recognizable in subjects who were recorded 16-20 years postoperatively, but was not clearly evident in EGG running spectra of subjects with a shorter postoperative period. Although the postprandial instability factor of the 3-cpm components (standard deviation of mean spectral frequency of peak 3-cpm group/mean of the 3-cpm spectral frequency) of the epigastric and supraumbilical EGGs showed a significant negative linear correlation with postoperative months, no such correlation was seen in the postprandial to fasting power ratio (postprandial power / fasting power) of the 3-cpm activity component. Therefore, we hypothesized that the disorganized pacemaker activity of the remnant stomach following distal gastrectomy can be reorganized to work as a synchronized unit over a long postoperative recovery period of from 15 to 20 years. A greater degree of epigastric and supraumbilical fasting 6-cpm power seemed to result in a worse quality of life (QOL). Similarly, a larger ratio of the supraumbilical postprandial to fasting power ratio of the 6-cpm activity seemed to result in a worse QOL. In contrast a larger ratio of the infaraumbilical postprandial to fasting power content of the 6-cpm activity seemed to result in a better QOL.

Development of pressure cell for specific heat measurement at low temperature and high Magnetic field

We report the performance of Ag-Pd-Cu alloy as the material of a pressure cell to carry out specific heat measurements at low temperatures and high magnetic fields. The Ag-Pd-Cu alloy is advantageous to reduce the background due to the nuclear specific heat in the pressure cell growing at low temperatures and high magnetic fields. We prepared 70-20-10 alloy composed of 70 mass % of Ag, 20 mass % of Pd, and 10 mass % of Cu. The maximum hardness over 100 HRB (Rockwell-B scale) is achieved by the heat treatment. The magnetization and susceptibility results show that the alloy includes a small amount of magnetic ions, whose concentration is smaller than that in the Be-Cu alloy. We confirm that the specific heat of a piston cylinder cell made of the 70-20-10 alloy increases smoothly from 0.2 to 9 K and the nuclear specific heat decreases drastically in magnetic field compared to that expected in the Be-Cu alloy. The pressure value in the cell at low temperature increases almost linearly up to P=0.4 GPa, which is nearly the limit of the inner piston made of the 70-20-10 alloy, with increasing of the load applied at room temperature.

Rhesus lymphocryptovirus type 1-associated B-cell nasal lymphoma in SIV-infected rhesus macaques

Epstein-Barr virus (EBV) is a worldwide endemic gamma herpesvirus of the genus Lymphocryptovirus (LCV) that infects more than 90% of the world's population. EBV has been associated with a variety of malignancies, but it has a demonstrated role in lymphomas, especially in immunosuppressed individuals. Lymphomas of the nasal cavity, paranasal sinuses, and nasopharynx are uncommon and constitute less than 5% of all extranodal lymphomas. Sinonasal non-Hodgkin's lymphomas have been reported in patients infected with human immunodeficiency virus (HIV) at an increased frequency. Rhesus LCV (rhLCV), the rhesus viral homolog of EBV, has been cloned and is associated with B-cell lymphomas in immunosuppressed rhesus macaques. We report two cases of B-cell lymphoma within the nasal cavity from 2 simian immunodeficiency virus-infected rhesus macaques with acquired immunodeficiency syndrome. The B-cell phenotype and rhLCV association were demonstrated by immunohistochemistry and confocal microscopy. The majority of the nuclei of the neoplastic B lymphocytes were EBNA-2 positive. RhLCV type 1 sequences were verified from the neoplasms by polymerase chain reaction. Nasal lymphoma is an unusual presentation of rhLCV-associated B-cell lymphoma in immunosuppressed rhesus macaques. These tumors demonstrate comparable viral pathogenesis with EBV-induced nasal lymphomas in HIV-positive people.

Gastrojejunostomy as induction treatment for S-1-based chemotherapy in patients with incurable gastric cancer

PURPOSE

The development of new generation anticancer agents, including the oral drug, S-1, may alter the clinical importance of gastrojejunostomy in the treatment of incurable gastric cancer. We reviewed a series of patients who underwent gastrojejunostomy for this reason between 2002 and 2005.

METHODS

Fourteen patients underwent gastrojejunostomy followed by S-1-based chemotherapy for incurable gastric cancer with obstruction or stenosis of the gastric outlet at Niigata University Medical and Dental Hospital and two affiliated hospitals. The safety of gastrojejunostomy, outcome of palliation, and survival time were analyzed retrospectively. We compared the survival times with those of patients who underwent palliative gastrectomy or exploratory laparotomy between 1987 and 2001.

RESULTS

The median operative time and blood loss were 153 min and 66 ml, respectively. There were no major complications. The median starting time for chemotherapy after gastrojejunostomy was 15.5 days. All patients were discharged after gastrojejunostomy, and the median postoperative home stay ratio was 68%. The median survival time after gastrojejunostomy was 354 days, which was significantly longer than that of patients who underwent palliative gastrectomy or exploratory laparotomy.

CONCLUSION

Gastrojejunostomy for incurable gastric cancer contributes not only to improving quality of life (QOL), but to prolonging survival through the induction and maintenance of S-1-based chemotherapy.

[CT-guided radiofrequency ablation therapy for pelvic recurrence from rectal carcinoma--a case report]

A 48-year-old man, who had undergone a low anterior resection for advanced lower rectal cancer on May 27, 2003, was admitted to our hospital with anastomosis recurrence in November 2004. After chemo-radiotherapy (5-FU 250 mg/ body continuous infusion, 5 Gy each 5 fragments), an abdomino-perineal resection was performed on December 1, 2004. A follow-up CT scan showed pelvic local recurrences located dorsal to prostate in January, and the presacral region in July 2006. Because of presence of complication of acute promyelocytic leukemia (APL), this patient had a poor general condition. So radiofrequency ablation (RFA) therapy was performed as a palliative therapy. A presacral relapse was revealed in three months after RFA. As a complication, two weeks after RFA for the presacral region, a vesicoctaneous fistula occurred, and it required a urinary diversion. He died of APL on August 27, 2007. CT-guided radiofrequency ablation is useful for pelvic recurrence from rectal cancer of poor-risk patient.

[Treatment for advanced gastric cancer with positive lavage cytology-systemic versus intraperitoneal chemotherapy]

The prognosis of advanced gastric cancer patients complicated with positive lavage cytology is poor, similar with that of peritoneal dissemination. For these diseases, we had reported the usefulness of intraperitoneal chemotherapy with cisplatin. Recently, systemic chemotherapy with S-1 and cisplatin is effective even for gastric cancer with peritoneal dissemination. Therefore, we compared the combination chemotherapy of S-1 and intraperitoneal cisplatin (IP group) with systemic S-1 plus cisplatin chemotherapy (IV group) for positive lavage cytology without peritoneal dissemination (P0CY1) gastric cancer. In this trial, 8 patients were enrolled after gastrectomy. Four were IP group and another 4 were IV group. The average chemotherapy courses for IV group and IP group are 3.5 times and 4.8 times, respectively. There was no difference in prognosis. Grade 3/4 events occurred for IV group and IP group were 3 patients and only 1 patient, respectively. The combination chemotherapy of S-1 and intraperitoneal cisplatin was found to be well tolerated and effective in patients with advanced gastric cancer with P0CY1.

[A case of submucosal invasive cancer of the sigmoid colon, recurring as multiple liver metastases one year after the surgery]

A 55-year-old woman underwent colonoscopy due to a positive fecal occult blood test during a mass screening examination, and a 0-Ip type early cancer in the sigmoid colon was found. Endoscopic mucosal resection was performed for this lesion. Histological examination of the endoscopic resected specimen showed a well-differentiated adenocarcinoma invading submucosal layer (depth of invasion, 6,000 microm), positive lymph vessel invasion, and cut end negative. The patient was referred to our hospital, and an additional sigmoidectomy with lymphadenectomy was conducted. Histological examination revealed no residual cancer and no lymph node metastasis. One year after the surgery, an abdominal CT scan showed liver metastases in the segment 4 and 7. The patient underwent a medial segmentectomy and partial resection of the segment 7 of the liver. After the surgery, 8 courses of oral UFT/LV therapy as adjuvant chemotherapy were administered. The patient remains free of recurrence 2 years and 7 months after the first surgery.

[Observations on staging of advanced gastric cancer using contact rigid endoscopy]

A rigid contact scope is a recent development of optical instrument which allows observations of the superficial layers of the mucosai epithelium in gynecology and otorhinolaryngology. To assess the evaluation of 25 patients with advanced gastric cancer, whose lesions had been diagnosed to be more than T3 or suspected to have peritoneal deeding, we performed pre operative laparoscope with rigid contact scope. After inspecting a usual laparoscopic observation of the abdominal cavity, serosal exporsure and peritoneal seeding were confirmed. All the patients who had serosal exporsure and cancer cells showed an irregularity of cell distribution with the extent of heterogeneity of the cells with nuclei size and shape. Five patients had peritoneal seeding, and the findings with rigid contact scope showed a similar view to cancer cells which were observed in serosal exposure. The result suggests that this new endoscopic technique enabled a new diagnostic approach in advanced gastric cancer.

[The treatment strategy for type 4 gastric cancer with positive lavage cytology--a decision making of the therapeutic strategy by the change of the result of the lavage cytology]

It has been difficult to improve the prognosis of the type 4 advanced gastric cancer because the peritoneal dissemination develops frequently. In the present study, the therapeutic strategy, an administration of chemotherapy followed by gastrectomy, for the type 4 advanced gastric cancer with positive lavage cytology (CY) was discussed. CY has changed to negative in 3 of 6 cases (50%) at the surgery and in 1 of another 3 cases during the post operative chemotherapy. MST was 1487 days (966-2354 days) in cases with negative CY after pre-operative treatment, while 193 and 395 days in another 2 cases remained in positive CY, respectively. It may be important to perform re-staging laparoscopy with the evaluation of CY after preoperative chemotherapy for the type 4 advanced gastric cancer with positive CY, because the survival was comparatively better in cases with the change from positive CY to negative CY after the treatment. In conclusion, the treatment strategy for the type 4 advanced gastric cancer with positive CY was to administer chemotherapy followed by curative intent surgery for the case with negative CY after pre-operative treatment, while the other regimen of chemotherapy administration for the case with positive CY remained.

[A case report-the marked response to S-1 + CDDP chemotherapy for post-operative local recurrence of advanced gastric cancer]

A 55-year-old woman, underwent a total gastrectomy with super extended lymphadectmy for type 4 gastric cancer 4 years ago, suffered a locoregional recurrence at the esophagojejunostomy. She was given S-1 with cisplatin for a treatment against the recurrent site. Although grade 2 leucocytopenia and grade 3 anorexia were observed, consecutive twenty five courses of the regimen were carried out with a dose modification of anticancer drugs, and home parentenral nutrition system was used for severe anorexia. She has been alive for more than 3 years since the start of the treatment with a good control of locoregional recurrent lesion, and no other apparent metastatic sites were observed.

[A successful case of liver metastasis from gastric cancer treated with S-1 + induced hypertensive hepatic arterial infusion chemotherapy--a case report]

We have experienced a successful case of liver metastasis from gastric cancer treated with S-1 plus induced hypertensive hepatic arterial infusion chemotherapy. A 50-year-old man had undergone distal gastrectomy with extended lymphadenectomy for advanced gastric cancer. Although he was given 100 mg/day of S-1 for postoperative adjuvant therapy, an abdominal CT scan showed a liver metastasis at the hepatic segment 6 after 3 courses of adjuvant chemotherapy. Then, intra-arterial hepatic cannulation connecting to a subcutaneously implanted port system was indwelt via left subclavial artery. Mitomycin C (10 mg) was injected through out the induced hypertension with intravenously-administered angiotensin II once a month. After he received three courses of this combination chemotherapy, the liver metastasis has disappeared on CT scan and a complete response (CR) has been maintained.

[Establishment of a CXCR4-expressing gastric cancer cell line in nude mice and the effect of AMD 3100 on tumor regression]

BACKGROUND AND OBJECTIVE

CXCR4 plays a central role in cell migration in metastasis and dissemination of cancer. We have recently established a CXCR4-expressing gastric cancer cell line. Then we have prepared a therapeutic model for it, and assessed its usefulness in the in vivo system.

METHODS

Tumors from gastric cancer patients were transplanted into BALB/C (nu/nu) nude mice. After several subcultures in vivo, the tumor cell line was successfully established. In addition, this cell line expressed the CXCR4 receptor. The nude mice bearing these cell line tumors were administered AMD 3100, an inhibitor of the CXCR4 receptor, and its anti-tumor activity was assessed.

RESULTS AND DISCUSSION

The tumor volume was reduced by 27.6% in mice administered AMD 3100 compared with the control group (p < 0.02). None of the nude mice showed toxic signs of toxicity. Establishment of a CXCR4 expressing human gastric cancer cell line transplantable into nude mice seems to be important in discussing the possibility of an in vivo model of treatment with AMD 3100 in the in vivo system.

Extranodal Spreading of Esophageal Squamous Cell Carcinoma: Clinicopathological Characteristics and Prognostic Impact

BACKGROUND

Microscopic cancer spreading to extranodal connective tissues (extranodal spreading: ENS) is occasionally found in resected specimens from patients with esophageal squamous cell carcinoma (SCC), but the prognostic impact of ENS remains unclear. The aims of this study were to elucidate the prognostic impact of ENS to help determine the most suitable management for the patients with ENS.

METHODS

We histologically re-evaluated 7,349 lymph nodes obtained from 171 patients with SCC of the thoracic esophagus who underwent potentially curable resection between 1992 and 2003. We defined ENS as microscopic penetration of tumor cells from metastatic lymph nodes or tumor cell dissemination into extranodal connective tissues.

RESULTS

Extranodal spreading was found in 37 (21.6%) patients, and it had a significant relationship with diameter and depth of the tumor, lymphatic and venous invasion, intramural metastasis, and number of metastatic nodes. Patients who were ENS positive were at higher risk of recurrence, and their overall survival rate was lower than that for ENS-negative patients. Furthermore, recurrent risk was higher and overall survival rate was lower in ENS-positive patients than in ENS-negative patients when they had 1-3 metastatic nodes, but recurrent risk and overall survival rate of the patients with 4 or more metastatic nodes were very similar in ENS-positive and ENS-negative patients.

CONCLUSIONS

The present findings suggest that in SCC of the thoracic esophagus, the presence of ENS increases recurrent risk and reduces the overall survival of the patients with 1-3 metastatic nodes. Patients showing ENS should be managed in the same way as patients with 4 or more metastatic nodes.