[Pulmonary pleomorphic carcinoma; report of 2 cases]

The 1st case was a 74-year-old male diagnosed as femoral neck fracture. Biopsy of the bone revealed metastatic adenocarcinoma. Chest computed tomography (CT) showed a mass lesion located in the right lower lobe. With a diagnosis of primary lung cancer (cT2N1M1), two-staged operation was performed. Pathological diagnosis was pleomorphic carcinoma [pT2N1M1 (OSS), stage IV]. He died 8 months after surgery due to metastasis to the thoracic spine. The 2nd case was a 80-year-old female who complained of lateral chest pain. Chest CT revealed a tumor in the right hilar region, which was diagnosed as adenocarcinoma by transbronchial lung biopsy. Only thoracic drainage was performed since metastases to the brain and the rib were demonstrated. She died 2 months after admission. Autopsy revealed pleomorphic carcinoma of the lung with metastasis to the brain, costa and mediastinal lymph nodes.

Complete response of Sister Mary Joseph Nodule from gastric adenocarcinoma treated with combination chemotherapy of low-dose S-1 and cisplatin

A case of an unresected, advanced gastric cancer with Sister Mary Joseph nodule was presented. It was treated with new combination chemotherapy of low-dose S-1 and cisplatin producing complete response of periumbilical metastasis. Few treatments are efficacious for umbilical invasion of peritoneal dissemination. A complete response for Sister Mary Joseph nodule from gastric adenocarcinoma has not been ever reported.

[A pilot study of low-dose TS-1 and cisplatin combination chemotherapy for advanced gastric cancer]

TS-1, a novel oral formation of 5-fluorouracil, consists of tegafur (5-FU), CDHP and Oxo. Low-dose cisplatin (CDDP) and TS-1 was evaluated in 12 patients with advanced or recurrent gastric cancer. CDDP was given biweekly at a dose of 15 mg/m2 infused for 30 minutes, and 80 mg/body of TS-1 was orally administered as many times as possible. The response rate was 41.7%. Median survival time was 13.3 months. In one case, an adverse reaction of grade 3 leucopenia was observed. Thus, thought it is necessary to watch for leucopenia, this chemotherapy could well be effective for patients with advanced or recurrent gastric cancer.

Cutaneous metastases from gastric adenocarcinoma treated with combination chemotherapy producing complete response with long survival

A case of cutaneous metastases from gastric adenocarcinoma was presented. It was treated with combination chemotherapy producing complete response with prolongation of survival. Skin metastasis will indicate early fatal termination, therefore there has not yet been a reported case of cutaneous metastasis from gastric cancer to have complete response with long survival.

[A case of a combined aortectomy with dissection of recurrent paraaortic lymph nodes of sigmoid colon cancer]

A combined aortectomy was performed on a patient with recurrence of sigmoid colon cancer in the paraaortic lymph nodes. The 48-year-old woman was found to have tumor recurrence in the lymph nodes in the area between the aortic bifurcation and the paraaortic area, accompanied by left hydronephrosis, four years after surgery for sigmoid colon cancer (H0, P0, ss, n3, stage IIIb). No metastasis to distant areas was detected at that time. The woman thus underwent a reoperation. Intraoperatively, the aortic bifurcation and the lymph nodes were seen as a mass. The mass involved the left common iliac vein and the left ureter, as well. Therefore, we resected the area from the aortic bifurcation to the bilateral common iliac arteries, the left common iliac vein, the left ureter and the left kidney en bloc, and replaced them with a Y-shaped graft. One year after the reoperation, a tumor metastasis to the liver was detected, and a partial hepatectomy was performed. At present, the patient is being managed at our outpatient clinic. The results suggest that extended resection, involving the aorta as well, is sometimes useful when dealing with tumor recurrence in the paraaortic lymph nodes, unaccompanied by blood-borne metastasis.

Postoperative results of left upper abdominal evisceration for advanced gastric cancer

BACKGROUND/AIMS

In spite of the improvement of surgical techniques, the prognosis of patients with advanced gastric cancer still remains poor. With the aim of achieving en bloc resection of primary tumor, peritoneal dissemination on the greater omentum and lymph node metastasis, left upper abdominal evisceration (LUAE) was performed for 75 patients. In this report, we investigated the prognostic difference between the LUAE group and standard gastrectomy (total gastrectomy + pancreatosplenectomy).

METHODOLOGY

In the LUAE group, total gastrectomy was performed with the en bloc resection of the transverse colon, pancreas body and tail, spleen and left adrenal gland. In addition, omental bursa, covering retroperitoneum and pancreas body and tail was resected in combination with greater omentum, transverse mesocolon, and lesser omentum.

RESULTS

There were 3 (4.1%) postoperative death in the LUAE group, and 2 (1.7%) in the control group. However, there was no statistical difference in the incidence of postoperative complications between these 2 groups. The overall 5-year survival rates of the LUAE and control groups were 33% and 39%, respectively. There was no statistical survival difference between these 2 groups. Survival difference between the LUAE and control group was not found in terms of tumor location, wall invasion, lymph node status, peritoneal dissemination, and macroscopic type.

CONCLUSIONS

From these results, LUAE cannot improve the survival of patients with advanced gastric cancer. Consequently, LUAE should be indicated for T4 tumors, which directly invade into the transverse colon.

[A case report: modified PMUE therapy might be effective for advanced gastric carcinoma with pulmonary carcinomatous lymphangitis]

A regimen featuring a combination of CDDP, MMC, 5-FU and ETP (Modified-PMUE) was given to a patient with advanced gastric cancer containing pulmonary carcinomatous lymphangitis. This procedure made his carcinomatous lymphangitis disappear and primary and metastatic lesions reduce in size. The subsequent palliative reduction surgery for gastric carcinoma, proximal gastrectomy was feasible. Nevertheless, postoperative Modified-PMUE was ineffective: carcinomatous lymphangitis reappeared and progressed to death of respiratory failure postoperative 68 days. The SDI test, a sensitivity test for carcinostatic agent showed neither CDDP, MMC, 5-FU nor ETP sensitive to resected carcinoma cells. Therefore, we concluded that the Modified PMUE kills carcinoma cells sensitive to the agents and allows carcinoma cells resistant to the agents to grow.

Chemohyperthermic peritoneal perfusion for peritoneal dissemination in various intra-abdominal malignancies

A total of 25 patients with severe peritoneal dissemination underwent chemohyperthermic peritoneal perfusion (CHPP). The primary tumors in these patients comprised colorectal cancer (n = 14), ovarian cancer (n = 6), cervical cancer, (n = 1), small bowel cancer (n = 1), pseudomyxoma retroperitonei (n = 1), cystoadenocarcinoma of liver (n = 1), and pancreas cancer (n = 1). The intraperitoneal perfusion was carried out with a magnet pump for 60 min. The heated perfusate contained anticancer drugs to act synergistically with the hyperthermia. The intraperitoneal temperature was maintained at 42.0-42.5 degrees C. Eight of 25 patients showed CR, four PR, ten NC, and three PD, and the percentage (CR+PR) representing the overall efficacy rate was 48.0%. The morbidity rate was 8% (2/25) and there was no treatment-associated mortality. The percentage (CR+PR) of the patients with colorectal cancer was 57%; ovarian cancer, 50%; and other malignancies, 20%. The 1 year-and 3 year-survival rates of all the patients were 55% and 26%, respectively. The median survival periods of the CR, PR, NC, and PD groups were 4.0, 1.0, 1.0, and 0.7 years, respectively. The survival curve of the CR group was the best of all the groups (P = 0.02). These results indicated that CHPP was a feasible therapy and exerted a direct anticancer effect on peritoneal dissemination especially in the case of ovarian cancer, and the prognosis of complete responders was improved.

[The expression of cMET/hepatocyte growth factor receptor in colorectal cancer]

In this study, we estimated the expression of c-MET/Hepatocyte Growth Factor receptor in colorectal cancers by immunohistochemistry. In 118 patients, c-MET wee expressed in 65 patients (55%). About the clinicopathological findings of metastasis, the proportion of c-MET-positive in the patients with liver metastasis, 78% (18/23), was significantly higher than that without liver metastasis, 49% (47/95), but there was no significant difference about lymph node metastasis and peritoneal dissemination. About the pathological findings of primary lesion, the proportion of c-MET-positive in the patients with infiltration into lymphatic vessels, 63% (48/76), was significantly higher than that without infiltration, 40% (17/42), but there was no significant difference about infiltration into veins. The proportion of c-MET-positive increased as the tumor stage proceeded from t1 to t4 and as the histopathological stage proceeded from I to IV. These results suggest that c-MET may play an important role in the growth and scattering of colorectal cancer cells.

Association of progression and reduced expression of VLA-2 in gastric cancer

We investigated the expression of VLA-2 in gastric cancers by immunohistochemistry using anti-integrin alpha 2 and beta 1 antibodies and the data were compared with the pathological findings of each gastric cancer. The specimens were stained with an immunohistological technique for integrin alpha 2 and beta 1 subunits. Tumors, simultaneously expressing both integrin alpha 2 and beta 1 subunits were defined as positive for VLA-2. Tumors expressing either subunits of integrin alpha 2 or beta 1 or those showing reduced expression of both subunits were defined as VLA-2 negative tumors. In the 77 primary tumors, 55 (71%) were VLA-2 positive. 38 (90%) of 42 tumors showing differentiated type including tubular adenocarcinoma and papillary adenocarcinoma expressed VLA-2, whereas 19 (55%) out of 35 undifferentiated type of cancers including poorly differentiated adenocarcinoma, mucinous carcinoma and signet ring cell carcinoma stained for VLA-2. In the undifferentiated type of cancers, VLA-2 negative tumors had a significantly higher incidence of vessel invasion than VLA-2 positive ones (p<0.05). VLA-2 negative tumors showed a tendency to peritoneal dissemination, lymph node metastases, lymphatic invasion or invasion beyond the subserosal layer. In the specimens of peritoneal dissemination, VLA-2 expression rate was found in 56% (9/16), with a higher expression rate than that of primary lesions. These data indicate that reduced expression of VLA-2 may strongly associate with vessel invasion especially in the undifferentiated type of adenocarcinoma of the stomach.

[Alteration of p15 and p16 gene in gastric cancer]

We analyzed p15 and p16 gene alterations in gastric cancer. Only MKN45 showed both homozygous deletions but other cell lines and all of tumor specimens did not show any alterations. Using RT-PCR analysis, decreased or no expression of the p16 gene was found in 1 of 7 cell lines (except MKN45) (14.2%) and in 8 of 20 tumors (40%), whereas no abnormalities of p15 gene expression were found. These results suggest that the p16 gene may correlate with tumorigenesis and tumor expansion due to decrease or loss of gene products in gastric cancer.

[Jejunal pouch interposition and distal gastrectomy]

We developed a new technique of reconstruction in Billroth 1 gastrectomy, jejunal pouch interposition (JPI). The interposed jejunal segment consists of a proximally double-plicated pouch and a distally isoperistaltic conduit. From 1987 to 1994, the JPI was performed on 102 patients with gastric carcinoma. The postoperative functional assay was carried out at least one year later after surgery. Sixty-five patients with the conventional Billroth 1 reconstruction (B-1) during the same period were employed as the control. Gastric emptying time estimated with scinti-scanning was significantly delayed in the JPI group compared with the B-1 group (p < 0.05). All individuals with JPI had meals three times a day whereas 13% of those with B-1 required those more than three times (p < 0.05). The incidence of dumping syndrome was significantly lower in the JPI group (6%) than the B-1 group (20%) (p < 0.05). The reflux of bile into the residual stomach was observed in the scintiscanning at 78% of patients with B-1 whereas 10% of those with JPI (p < 0.01). Endoscopy revealed that regurgitation gastritis was significantly decreased in the JPI group compared with that in the B-1 group (p < 0.01). These results suggest that the JPI prevents small stomach syndrome, dumping syndrome and alkaline reflux gastritis after the B-1 reconstruction.

[Clinical usefulness of serum CYFRA21-1 in colorectal cancer]

Serum CYFRA21-1 levels were studied in 127 cases of colorectal cancer. The positive rates for serum CYFRA21-1 were 34.6% in primary colorectal cancer. There was a significant correlation between the positive rates of serum CYFRA21-1 and liver metastases, peritoneal dissemination, lymph node metastases, or clinical stage. The survival rate for patients in the CYFRA21-1 positive group was lower than those with CYFRA21-1 negative group. Among patients who underwent curative operation, patients is the CYFRA21-1 positive group gave a recurrence rate of 26.6%, against 9.4% in the CYFRA21-1 negative group. There was no correlation between serum CYFRA21-1 levels and serum CEA levels. These findings suggest that Serum CYFRA21-1 levels may be a useful indicator in estimating the prognosis for colorectal cancer.

[Evaluation of preoperative chemotherapy for colorectal cancer]

Patients who underwent curative resection for colorectal cancer between January 1987 and June 1989 were divided into two groups, to assess the usefulness of preoperative chemotherapy (400 mg UFT therapy daily for 10 days more) and to analyze changes in the proliferative activity of tumor cells. Fifty-five cases were included in the study. Thirty-three had received no preoperative chemotherapy (Group A), and 22 had received the preoperative chemotherapy (group B). The five-year cumulative survival rate was 81.1% for group A and 90.2% for Group B. The proportion of patients with no recurrence was 75.7% in Group A and 85.7% in Group B. Both parameters thus tended to be better in patients who had received preoperative chemotherapy. When PCNA labeling before UFT therapy was compared with that after UFT therapy in 13 cases, the PCNA labeling rate decreased after UFT therapy in 9 (69%) of the 13 cases. These results suggest that preoperative chemotherapy using UFT is useful in treating colorectal cancer, and that the proliferative activity of colorectal cancer can sometimes be reduced by such preoperative adjuvant therapy.