[A Case of Multiple Hepatic Metastases after Surgery for Low Differentiated Mucous Cancer of Sigmoid Colon with Notable Mesenteric Infiltration in Which Chemotherapy Was Effective].

Mucinous adenocarcinoma of the colon occasionally develops from the submucosa, depending on the pattern of onset; therefore, in many cases, it is already advanced at the time of diagnosis. This type of cancer is known to have a poor prognosis. We report the case of a 59-year-old woman who presented with abdominal pain on defecation for 1 month. A mass was palpable in the lower part of her abdomen. On computed tomography(CT), an extrinsic mass was seen in the sigmoid colon, and lower gastrointestinal endoscopy findings suggested an invasive tumor originating from another organ outside the intestinal wall. A high level of the tumor marker CEA(40.8 ng/mL)was observed. No findings suggestive of malignancy were present on biopsy examination, Colorectal cancer was suspected, for which a sigmoidectomy was performed. On histopathological examination, though there was little to indicate a primary colon tumor on HE staining, due to strong CDX2 positivity it was suspected to be an intestinal-type adenocarcinoma. The final clinical diagnosis was unclassifiable, poorly differentiated, mucinous adenocarcinoma of the colon. Multiple liver metastases appeared 4 months postoperatively, which were treated with XELOX plus BV and FOLFIRI plus BV. CT evaluation 24 months postoperatively showed a complete response radiographically. This case of mucinous adenocarcinoma of the colon, in which chemotherapy was successful and long-term survival of 5 years and 2 months was achieved postoperatively, is reported together with a discussion of the literature.

Clinical outcome of esophagogastrostomy after proximal gastrectomy for gastric cancer.

BACKGROUND/AIMS: In order to prevent reflux esophagitis after proximal gastrectomy, reconstruction by jejunal interposition (EJ) is often performed; however, this procedure is considered to be extremely complex. The purpose of this research is to consider the indication and usefulness of esophagogastrostomy (EG), as a less-invasive method of reconstruction. METHODOLOGY: From 1999, 64 proximal gastrectomy cases have been reviewed. In 46 cases, EG combined with a reflux prevention procedure was performed while in the remaining 18 cases, EJ was performed. An endoscopic examination was conducted 1 year after surgery in all cases. RESULTS: Compared to EJ, EG required less surgical time, thus resulting in less blood loss. Reflux esophagitis was frequently present in the EG cases (22 vs. 11%). In the EG group, 36 cases involving abdominal esophagus (AE) conservation due to the site of the cancer in comparison to the resection group (10), experienced a lower probability of reflux esophagitis (5.6 vs. 60%) and endoscopic examinations showed a lower severity (Grade B,C,D; 0 vs. 50%). CONCLUSIONS: EG combined with a reflux prevention procedure is simple and less invasive. In cases in which the conservation of AE is possible, less reflux esophagitis is observed and EG is therefore recommended as an appropriate reconstruction method.

[The feasibility of oral fluoropyrimidines as adjuvant chemotherapy after resection and local coagulation therapy of colorectal liver metastases].

OBJECTIVE: To evaluate the feasibility of oral fluoropyrimidines after resection and microwave coagulation(MCT), or radiofrequency ablation(RFA)of liver metastases from colorectal cancer. PATIENTS AND METHODS: Background factors, fluoropyrimidine administration(S-1 or UFT/LV), and adverse events were analyzed in 20 patients(17 males, 3 females; an average of 62. 4 years)with colorectal liver metastases after resection and RFA or MCT. RESULTS: The synchronous: metachronous metastases ratio was 13:7. Fifteen patients received the recommended dose and 5 received a reduced dose. S-1 was administered for 4 weeks followed by a 2-week rest for 7 patients, and for 2 weeks followed by a 1-week rest for 9 patients. UFT/LV was administered for 4 weeks followed by a 1-week rest for 4 patients. Fourteen patients(70%)had adverse events. One patient showed grade 3 leukocyte toxicity while other patients showed grade 1 or 2. Two patients discontinued chemotherapy because of grade 2 delirium and grade 2 CPK elevation; another 2 discontinued voluntarily. Eight patients with recurrence changed the rugs, while 8 of 12(67%)continued for 1 year. Median disease-free and med ian overall survival lengths were 16. 1 and 4 7. 6 months, respectively. CONCLUSION: S-1 and UFT /LV were used safely as adjuvant chemotherapies after the resection and local coagulation therapy of liver metastases.

[Roles of positron emission tomography/computed tomography (PET/CT) in the management of colorectal cancer].

In diagnosis and treatment of colorectal cancer, PET/CT has high sensitivity and specificity in comparison to other modalities, and in the near future is expected to play important roles in these areas. However, because of the high cost, PET/CT must be used cost-effectively. In the diagnosis of colorectal cancer with PET/CT, evaluation of cancer growth is possible, but evaluation of tumor invasion is inadequate. In the diagnosis of lymph node metastases, PET/CT provides higher sensitivity of evaluation in distant lymph nodes. The reason for difficulty in proximal lymph node evaluation is due to the close proximity of the main cancer tumor. In the diagnosis of liver metastases, meta-analysis indicates the need for higher sensitivity and specificity compared to CT and MRI. In the diagnosis of pulmonary metastases, chest CT should be obtained in very early pulmonary metastases because of the tiny tumor size in the early stage. In the diagnosis of local recurrence, discrimination between postoperative change and recurrence is difficult, but PET/CT is very useful as a qualitative diagnostic tool. Recent reports have also indicated the usefulness of PET/CT in the evaluation of treatment efficacy in chemotherapy or radiotherapy.

[Radiofrequency ablation of liver metastasis from breast cancer].

As the hepatic metastasis from breast cancer has a tendency to have an extrahepatic lesion, systemic therapy therefore becomes acclimatization. However, local therapy is regarded as one of the choices if there is no extrahepatic lesion. We present three cases of liver metastasis from the breast treated by radiofrequency ablation (RFA). Case 1: A 65-year-old woman was treated by left mastectomy in 1997. Radiation exposure was performed for lung metastasis, and a weekly paclitaxel therapy was administered in 2001. We performed RFA percutaneously for liver metastasis of 2.8 cm in 2002. The aggravation spread to the lung lesion and she died after RFA within one year. The liver metastasis finally enlarged to 4 cm in size. Case 2: A 36-year-old woman was treated by left mastectomy (Stage IIIa), and was followed by chemotherapy in 2000. We performed RFA for metastasis of 2 cm of liver (S7) percutaneously in 2001, and didn't recognize a recurrence to date for 3 years and 8 months. Case 3: A 43-year-old woman was treated by left mastectomy (Stage IIIa), and followed by chemotherapy in 2003. We performed RFA for a liver metastasis of 3.5 x 4 cm under laparotomy in 2004. She has been disease free for 15 months.

[Prediction and treatment of peritoneal dissemination in gastric cancer].

In advanced gastric cancer, the frequency of relapses such as metastasis to the peritoneum is high. For this reason, prognostic and treatment methods were studied. In 457 cases in which diagnostic cytology was utilized, 36 (61%) of the 59 cases in which dissemination had been macroscopically observed (P 1) were positive. Moreover, 13 cases of P 0 were also positive. The prognosis of the positive cases was worse, but there was not a significant statistical difference between the positive and negative cases. Chemotherapy has become the most common treatment because of the appearance of new anticancer drugs. TS-1 and paclitaxel were repeatedly administered in 10 cases, and the median survival time was 17 months. These drugs were effective even in carcinoma of the peritoneum, and an improvement in the prognosis can be expected. Surgery was performed in 23 cases due to stenosis of the digestive tract, and in 21 cases the patients were able to eat after surgery. The median postoperative survival time was 7 months, and surgery improved the prognosis. The improved sensitivity of diagnostic cytology and the standardization of chemotherapy and surgery warrant further study.