Adenocarcinoma arising from heterotopic pancreas in the duodenum.

We present a rare case of adenocarcinoma arising from a heterotopic pancreas in the duodenum, and review the associated literature. A 62-year-old woman was admitted to our hospital, complaining of vomiting and epigastralgia. Imaging studies revealed advanced gastric cancer with a gastric outlet obstruction. Whipple's operation and resection of the regional lymph node were performed because of a direct invasion to the pancreas. Histopathologic examination of the resected specimen demonstrated the malignant transformation of a hetrotopic pancreas in the duodenum. At the 12-month follow-up, there was no recurrence of symptoms. The prognosis of adenocarcinoma arising from a heterotopic pancreas is not known. Further accumulation of cases and investigation of this entity are necessary.

A rare case of xanthogranuloma of the stomach masquerading as an advanced stage tumor.

BACKGROUND: Xanthogranuloma of the stomach is an extremely rare disease, and this lesion has only been found to coexist with early gastric cancer in 2 cases in the literature. CASE PRESENTATION: We report a case of xanthogranuloma of the stomach combined with early gastric cancer that mimicked an advanced stage tumor. A 65-year-old female was referred to our hospital because of epigastralgia. During a physical examination, a defined abdominal mass was palpable in the region of the left hypochondrium. Imaging studies revealed an advanced gastric cancer, which was suspected of having infiltrated the abdominal wall. Total gastrectomy and resection of the regional lymph node and abdominal wall were performed. Histopathologic examination of the resected specimen demonstrated xanthogranuloma combined with early gastric cancer. CONCLUSION: Xanthogranuloma presenting as a form of SMT (submucosal tumor) of the stomach is an extremely rare disease, and diagnosing it preoperatively is difficult. Further accumulation and investigation of this entity is necessary.

Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients.

BACKGROUND: Preoperative assessment of the lateral pelvic lymph nodes is important for treatment strategy to patients with lower rectal cancer. MATERIALS AND METHODS: Fifty-three patients with primary lower rectal cancer were preoperatively assessed by spiral computed tomography (CT) and magnetic resonance imaging (MRI) at 1.5 T with a phased-array coil. Preoperative tumor and lymph node stages were compared with the final histological findings. RESULTS: The MRI tumor stage coincided with the histological stage in 36 of 53 patients (68%). The MRI and CT lymph node stage coincided with the histological stage in 33 (62%) and 26 (49%) of 53 patients, respectively. However the accuracy of MRI in detecting the lateral pelvic lymph node involvement was 83%, compared to 77% of CT (p<0.05). CONCLUSIONS: With the use of MRI, the lateral pelvic lymph node involvement can be predicted with high accuracy, allowing preoperative identification of patients who need radiotherapy or extensive surgery to escape recurrence.

Potential predictors of long-term survival after surgery for patients with stage IV colorectal cancer.

BACKGROUND: The prognosis of patients with colorectal cancer is considered to be affected by several factors. Recently, chemotherapy for this disease has been demonstrated to be effective for long-term survival. In this study, the potential predictors, including chemotherapy regimens for survival after surgery, in patients with stage IV colorectal cancer are presented. PATIENTS AND METHODS: Univariate and multivariate analyses of potential predictors of survival after surgery were carried out for 56 patients with stage IV colorectal cancer who had undergone surgery, including 22 with rectal and 34 with colon cancer. RESULTS: The survival in patients who had had a primary liver resection was longer than that in patients who had not (p=0.007). There was a significant difference among chemotherapy regimens (p=0.021). The survival in patients who were administered l-leucovorin/5-fluorouracil (l-LV/5FU) was longer than that in patients who received uracil-tegafur (UFT) and cisplatin (CDDP)/5FU (p=0.024, p=0.004, respectively). In multivariate analyses, there were 5 favorable factors that influenced overall survival after surgery: lymph node metastasis (p=0.029), no bone metastasis (p=0.012), no peritoneal invasion (p=0.018), no primary liver resection (p=0.004) and the chemotherapy regimen (p=0.008). Furthermore, the survival in patients with a continued l-LV/5FU plus modified IFL regimen (additional irinotecan) was longer than for those patients who received other regimens, in both univariate and multivariate analyses. CONCLUSION: Five factors, namely lymph node metastasis, bone metastasis, peritoneal invasion, primary liver resection and chemotherapy, are potential predictors of survival after surgery for patients with stage IV colorectal cancer.

Clinical impact of adjuvant chemotherapy on patients with stage III colorectal cancer: l-LV/5FU chemotherapy as a modified RPMI regimen is an independent prognostic factor for survival.

BACKGROUND: Patients with stage III colorectal cancer have a substantial risk of microscopic metastatic disease at the time of resection. Treatment with leucovorin (LV)/5-Fluorouracil (5FU) has been demonstrated to be effective for advanced colorectal cancer; however, the clinical impact of l-LV/5FU is still unclear. 1-LV/5FU for patients with stage III colorectal cancer may play an important role, as an adjuvant chemotherapy, in improving survival. PATIENTS AND METHODS: The clinicopathological features of 36 patients receiving adjuvant l-LV/54 administration and 16 not, univariate analysis of potential predictors of overall survival and disease-free survival, relative risk of overall survival and disease-free survival by multivariate analysis and the occurrence of chemotherapy-induced toxic effects were studied in 52 patients with stage III colorectal cancer, including 30 with rectal and 22 with colon cancer, who had undergone surgery. RESULTS: No significant differences were found in the clinicopathological features of the 2 groups. On univariate analysis, there were no significant differences in overall survival in either group; disease-free survival in patients with adjuvant I-LV/5FU was longer than that in patients without it (p<0.001). Moreover, multivariate analysis demonstrated that I-LV/5FU adjuvant chemotherapy was an independent prognostic factor in terms of disease-free survival (p =0.001; RR, 17.492; 95% CI, 3.298-92.778). CONCLUSION: I-LV/5FU adjuvant chemotherapy in patients with stage III colorectal cancer is important as an independent prognostic factor in terms of disease-free survival.

Toxicity during l-LV/5FU adjuvant chemotherapy as a modified RPMI regimen for patients with colorectal cancer.

l-leucovorin (LV)/5-fluorouracil (5FU) may play an important role, as an adjuvant chemotherapy, in improving the survival of patients with stage III colorectal cancer. However, severe toxicity of the chemotherapeutic agent could be fatal. Adverse effects, including bone marrow suppression, liver damage, renal damage, and glucose tolerance, were evaluated daily during 3 courses of l-LV/5FU-modified RPMI regimen adjuvant chemotherapy for 22 patients with stage III colorectal cancer. Decrease in the serum levels of neutrophils and platelets occurred in the 1st course, which became more obvious after three or four administrations of l-LV/5FU in the 1st course. Furthermore, serum levels of leukocytes, neutrophils, and platelets on the re-start day of this chemotherapy after 2-week intervals were lower than those on the start day of this chemotherapy. In the evaluation of liver damage, renal damage, and glucose tolerance; serum alanine aminotransferase level in the 2nd course, serum total bilirubin (T.Bil) level in the 1st course, and serum creatinine level in the 1st course deteriorated during the course. T.Bil levels on the re-start day of this chemotherapy after 2-week intervals were especially high compared to that on the start day. The more courses of this chemotherapy we perform, the more attention we must pay to bone marrow suppression and hyperbilirubinemia. Thus, we clarified the attentive point of side effect of l-LV/5FU adjuvant chemotherapy for colorectal cancer.

Radiation-induced rectal cancer originating from a rectocutaneous fistula: report of a case.

This report describes a patient with radiation-induced rectal cancer with an unusual history. A 51-year-old man was admitted in 2000 because of ichorrhea of the skin on the left loin. The patient had received irradiation for a suspicious diagnosis of a malignant tumor in the pelvic cavity in 1975. A subcutaneous abscess in the right loin appeared in 1989, and rectocutaneous fistula was noted in 1992. Moreover, radiation-induced rectal cancer developed in 2000. Plain computed tomography and magnetic resonance imaging of the pelvis demonstrated a presacral mass and tumor in the rectum. Finally, we diagnosed the presacral mass to be an abscess attached to the center of the rectal cancer. The rectum was resected by Miles' operation and a colostomy of the sigmoid colon was also performed. Many cases of radiation-induced rectal cancer have been reported. However, this is a rare case of radiation-induced rectal cancer originating from a presacral abscess and rectocutaneous fistula.

[Microwave coagulation therapy for unresectable colorectal metastatic liver tumor].

INTRODUCTION: We evaluate the utility of microwave coagulation therapy (MCT) for the patients with unresectable liver metastasis from colorectal cancers. METHODS: Forty-four patients unresectable synchronous colorectal hepatic metastasis between January 1, 1989 and December 31, 2000, were enrolled in the present study. The patients courses were followed until March, 2002. To evaluate the efficacy of MCT for unresectable liver metastasis from colorectal cancers, a retrospective comparative study was done between a MCT with CT (hepatic arterial trans-infusion chemotherapy and/or systemic chemotherapy) group and a CT group. The background factors were examined included the maximum tumor diameter, the number of liver metastasis and disease of other metastatic sites, which influenced the outcome. RESULTS AND CONCLUSION: The survival curves of the patients with unresectable synchronous colorectal hepatic metastasis undergoing MCT with CT and CT alone were significantly different (p = 0.03). No significant differences were found in the background factors that had a prognostic influence. It is confirmed that using MCT can prolong the survival rate for the patients with unresectable synchronous colorectal hepatic metastasis.