Undifferentiated Adenocarcinoma with Rhabdoid Features in the Stomach: A Case Report

Rhabdoid tumor has been considered to be a rare subtype of Wilm's tumor with Rhabdomyoma features. Since rhabdoid tumor that developed in the kidney was described for the first time in 1989, it has been reported in the gastrointestinal tract, although this is rare. The appropriate treatment is radical resection, and the effect of adjuvant chemotherapy has not yet been reported on. The outcome of extra-renal rhabdoid tumor is different from renal rhabdoid tumor and the former shows a poor prognosis. Among extra-renal rhabdoid tumors, undifferentiated gastric adenocarcinoma with rhabdoid features is very rare and its prognosis is poor. A 63 years old male patient underwent total gastrectomy for a tumor that developed in the greater curvature of the gastric body and this was diagnosed as undifferentiated gastric adenocarcinoma with rhabdoid features, according to the histopathology. We experienced an undifferentiated gastric adenocarcinoma with rhabdoid features that was diagnosed by immunohistochemical staining and we report here on this case.

DNA Methylation of Multiple Genes in Gastric Cancer: Association with CpG Island Methylator Phenotype and Helicobacter pylori Infection

PURPOSE: Methylation of gene regulatory elements plays an important role in gene inactivation without genetic alteration. Gastric cancer is one of the tumors that exhibit a high frequency of CpG island hypermethylation. The purpose of this study was to investigate the occurrence of CpG island hypermethylation in gastric carcinoma in relation to H. pylori infection, CIMP and clinicopathologic variables. MATERIALS AND METHODS: We investigated the promoter methylation status of six genes (hMLH1, p16, p14, COX-2, MGMT, E-cadherin) and CIMP in 36 gastric carcinoma tissues as well as in nontumor tissues. CIMP status was investigated by examining the methylation status of MINT 1, 2, 12, 25 and 31. The methylation status of the promoter was examined by methylation-specific PCR (MSP) and H. pylori infection was examined by histological diagnosis after staining with Warthin-Starry silver. RESULTS: Among the 36 gastric carcinoma tissues, DNA hypermethylation was detected in the following frequencies: 14 (38.9%) for p14, 13 (36.1%) for p16, 8 (22.2%) for MGMT, 10 (27.8%) for COX-2, 21 (58.3%) for E-cadherin, and 6 (16.7%) for hMLH1. The frequencies for MINT1 and MINT25 hypermethylation were significantly higher in tumor tissues than in nontumor tissues. 16 (44.4%) of the 36 gastric carcinoma tissues were positive for the CIMP. CIMP-H tumors were associated with older patients and larger tumor size than CIMP-L tumors. We found a significant association between the presence of the CIMP and hypermethylation of p16. Hypermethylation of p16 and MINT2 were significantly different when compared by age. MINT1 gene methylation was significantly associated with H. pylori infection (P=0.004). CONCLUSION: Our results suggest that aberrant hypermethylation of multiple tumor related genes (hMLH1, p16, p14, COX-2, MGMT, E-cadherin, MINT1, 2, 12, 25, 31) occurs frequently in gastric carcinoma tissues. The hypermethylation of MINT1 was significantly higher in the tumor tissues and was associated with H. pylori infection.

A Clinicopathological Analysis of Gastric Cancer in Young Patients

PURPOSE: Gastric cancer is believed to be a disease of the elderly, and rarely occurs in young patients. The aim of this study was to analyze the clinicopathological and prognostic factors related to young gastric cancer patients. METHODS: A total of 877 patients with gastric cancer from 1995 to 2004 in a secondary referral center in Suwon City were enrolled in this study. The clinicopathological features of the young (aged or =40 years) patients. The overall survival was the main outcome measure. The survival curves were constructed using the Kaplan-Meier method, Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using with Cox regression. A P value<0.05 was considered significant. RESULTS: Of the 877 patients, 65(7.4%) were in the young age group. The mean age of this group was 34.9 years (range, 19~39 years). The male-to-female ratio of the patients younger than 40 was 1.24/1; whereas the ratio was 2.07/1 in those older than 40. 7.7 percent of the patients had a family history of gastric cancer. A significantly higher percentage of young patients had a poorly differentiated histology than the older patients (P=0.0001). Twenty-three patients (38.9%) were stage III or IV disease, whereas 36 patients (61.0%) presented with stage I or II disease. A resection with a curative intent was undertaken in 53 patients (81.5%), and a resection with a palliative intent was performed in 12 patients (18.4%). With a mean follow-up of 39 months, the disease-specific 5-year survival rates were similar to those observed in the older group of patients. The variables with a significant impact on survival were a curative resection, a lymph node metastasis, lymphatic invasion, peritoneal metastasis, and adjuvant chemotherapy. CONCLUSION: There were no significant differences in the clinicopathological characteristics and clinical outcome of a gastric adenocarcinoma between the younger and older patients. The important prognostic factors were curability, lymph node metastasis, lymphatic invasion, peritoneal metastasis, and adjuvant chemotherapy.

Ectopic Paragonimiasis Presented as Thyroid Nodule

Ectopic paragonimiasis is found in many organs, such as the mesentery, liver, spleen, peritoneum, omentum and central nervous system. However, thyroid gland involvement is quite rare. A 55 year old woman was admitted to our hospital on account of a painless anterior neck mass. A ultrasonographic examination showed ill-defined, hypoechoic nodule with calcification in the right lobe of the thyroid gland. A right lobectomy was performed after a fine needle aspiration biopsy showed there were no malignant cells histologically. The histological diagnosis was a foreign body granuloma with multiple ova of Paragonimus in the thyroid gland. Postoperatively, the immunoserologic test for Paragonimus westermani was positive it. A diagnosis of this rare clinical entity before a surgical excision and histopathology examination is unlikely. Therefore an ectopic paragonimiasis of the thyoid gland should be considered when making a differential diagnosis of thyroid masses. We present a case of ectopic paragonimiasis, which presented as a thyroid nodule with a review of the relevant literatures.

Laparoscopic-assisted Aortic Surgery

Since the initial success and widespread acceptance of laparoscopic cholecystectomy (1), the application of this laparoscopic technique to vascular surgery has been somewhat limited. However, after laparoscopic techniques were first applied to vascular surgery in 1993 (2), many technological developments for this procedure have been accepted. Laparoscopy confers three major benefits: better visualization of the aorta, less bowel manipulation, and avoidance of hypothermia. However, advanced total laparoscopic surgery can be difficult and time-consuming, and its benefits are not yet readily apparent. Laparoscopic-assisted aortic surgery enables the surgeon to use a smaller incision and this reduces surgical trauma when compared with the conventional surgical techniques (3). The use of the HandPort device enables the surgeon to use their hands while maintaining the pneumoperitoneum; this allows the vascular surgeon to maintain the sense of touch, and to perform the aortoprosthetic anastomosis safely with use of a MultiTool instrument. Our two case reports illustrate the feasibility of laparoscopic-assisted aortic surgery via minilaparotomy.