Expression of iNOS in Accordance with the Subtypes of Intestinal Metaplasia / 대한내과학회지

BACKGROUND: Intestinal metaplasia (IM) type 3 has been suggested to be associated with gastric cancer of intestinal type. Excess nitric oxide (NO) has been reported to be associated with pathogenesis of various diseases, including gastric cancer. This study measured isoform nitric oxide synthase (iNOS) expression immunohistochemically to examine the possible involvement of NO in the subtypes of intestinal metaplasia. METHODS: The subjects were 71 male and 35 female cases. To classify the IM subtypes, the specimens were stained with alcian blue pH 2.5/PAS and high iron diamine/alcian blue pH 2.5. The expression of iNOS was assessed by means of immunohistochemical stain using polyclonal anti-iNOS antibody. RESULTS: IM type 1 was diagnosed in 42 cases (39.6%), IM type 2 in 42 cases (39.6%), and IM type 3 in 22 cases (20.8%). As the subject become older, the frequency of IM type 3 increased significantly. The expression of iNOS was increased significantly as the subtype was developed into type 3. However, there was no significant difference in the iNOS expression by the existence of sulphomucin, age, positivity of Helicobacter pylori, or biopsy site. CONCLUSION: Increased expression of iNOS in the IM type 3 suggests that IM type 3 is a possible risk factor for gastric cancer.

The Role of Vascular Endothelial Growth Factor (VEGF) and p53 Status for Angiogenesis in Gastric Cancer

BACKGROUND: Angiogenesis is of crucial importance for tumor growth and development of metastases. Vascular endothelial growth factor (VEGF) has a potent angiogenic activity and mutations of the p53 gene has been thought to upregulate VEGF. The purpose of our study was to evaluate the prognostic significance of these tumor biomarkers for angiogenesis relative to the information derived from established clinicopathological parameters in gastric cancer. METHODS: In this study, we conducted an immunohistochemical investigation of VEGF and p53 expression in 145 tissue samples obtained from gastric cancer patients undergoing curative surgical treatment. To evaluate angiogenesis, microvessel density (MVD) was counted by staining endothelial cells immunohistochemically using anti-CD34 monoclonal antibody. RESULTS: High MVD was significantly associated with depth of tumor invasion and distant metastasis (p=0.004, 0.021, respectively). Moreover, overall survival for patients with high MVD were significantly lower than that of low MVD (p=0.048). Positive expression of VEGF correlated significantly with lymph node and distant metastasis (p=0.040, 0.048, respectively). However, no significant correlation was found between p53 expression and various clinicopathological parameters. VEGF positive tumors showed a higher MVD than VEGF negative tumors (p=0.028). The expression of p53 did not correlate with VEGF expression. Also, the relationship between the status of p53 expression and MVD had not statistically significant differences. In the multivariate analysis, status of VEGF, p53 expression and MVD were not an independent prognostic factor. CONCLUSION: VEGF seems to be an important, clinically relevant inducer of angiogenesis and angiogenesis assessed by the MVD may be a useful marker for predicting metastasis in gastric cancer. However, further studies are warranted to clarify the impact of p53 on the angiogenesis and the prognostic significance of angiogenesis in gastric cancer.

A case of primary squamous cell carcinoma of the liver / 대한내과학회지

Primary squamous cell carcinoma of the liver is very rare. It has previously been reported to arise from the lining of developmental hepatic cyst or in hepatic teratoma. Also, there are published reports of the occurrence of such a tumor in association with intrahepatic cholesterol stones, hypercalcemia in a cirrhotic liver, and clonorchiasis. The previous reports showed male predominance. The prognosis of this tumor is extremely grave, and no case has survived more than one year. A 73-year-old woman was found to have a primary squamous cell carcinoma of the liver. The tumor, which measured 11x7 cm and located in the left hepatic lobe, was diagnosed by percutanous biopsy. No evidence of other primary foci was demonstrated in systemic workup. Left hepatectomy was done. In computed scan on 4 months after operation, tumor seedings were revealed on right hepatic lobe, omentum and several lymph nodes. She died on 6 months after operation.