Rapidly growing double cancer of the gallbladder: A case report.

INTRODUCTION: Gallbladder cancer is a rare malignancy and double cancer of the gallbladder is extremely rare. Biliary tree malignancies including cholangiocarcinoma and gallbladder cancer are aggressive cancers and have a poor prognosis. This reports a rare case of double adenocarcinoma of the gallbladder. PRESENTATION OF CASE: A 77-year old woman with a cholelithiasis and decreased body weight was diagnosed with rapidly growing gallbladder tumor by abdominal computed tomography scan. A combined resection of the gallbladder, extrahepatic bile duct, segments 4a and 5 of the liver and regional lymph node dissection were performed. Pathologic examination revealed double poorly differentiated adenocarcinoma of the gallbladder. The patient had no evidence of recurrence for 40 months after resection. DISCUSSION: This patient had double cancer of the gallbladder. Gallbladder cancer is an aggressive cancer and has a poor prognosis. The only curative therapy is radical resection. In this patient, radical laparotomy and adjuvant chemotherapy were performed. The pathological diagnosis of the resected specimen was double cancer of the gallbladder. CONCLUSION: This is a report of rapidly growing double cancer of the gallbladder. Patients with gallbladder cancer may benefit from aggressive surgical resection and adjuvant chemotherapy.

Simultaneous laparoscopic treatment of median arcuate ligament syndrome and segmental adenomyomatosis of the gallbladder: A case report.

INTRODUCTION: Median Arcuate Ligament Syndrome (MALS) is a condition in which the median arcuate ligament tightly compresses the celiac artery. A patient presented with MALS and segmental adenomyomatosis of the gallbladder, both treated simultaneously using a laparoscopic approach. PRESENTATION OF CASE: A 48-year-old male with adenomyomatosis of the gallbladder presented with postprandial epigastric pain. Abdominal three-dimensional computed tomography scan showed compression of the celiac artery, and the patient was diagnosed with MALS. Laparoscopic dissection of the median arcuate ligament and cholecystectomy were performed to treat both conditions. By optimizing port positions, both conditions could be treated simultaneously. The patient was discharged on postoperative day 6 and has no recurrent symptoms 20 months postoperatively. DISCUSSION: To the best of our knowledge, there are no previously reported cases of simultaneous laparoscopic division of the median arcuate ligament and cholecystectomy. CONCLUSION: By optimizing the port positions, laparoscopic division of the median arcuate ligament and cholecystectomy were performed simultaneously, minimally invasively, safely and effectively.

[Two case reports of metastatic liver carcinoma with the effective treatment of radiofrequency ablation and intraarterial chemotherapy].

We report two cases of metastatic liver carcinoma with the treatment of radiofrequency ablation (RFA) and intraarterial chemotherapy. The 57-year-old man of Case 1 had resectable multiple liver metastases of rectal carcinoma in November 2007. He refused a liver resection, but accepted a low anterior resection of the rectum and RFA and intraarterial chemotherapy (5-FU 1,000 mg WHD). After this treatment, he had accepted systemic chemotherapy and found no liver recurrence within a year. The 66-year-old man of Case 2 had unresectable multiple liver metastases of locally-advanced esophageal carcinoma in July 2006. He had accepted radiochemotherapy (FP+65 Gy), and then RFA and intraarterial chemotherapy (5-FU 1,000 mg WHD). After this treatment, solitary brain metastasis and lymph node metastasis of mediastinum were found and treated, and now he has been alive with systemic chemotherapy.

[A case report of intra-operative radiotherapy and gemcitabine for unresectable pancreatic body cancer].

We report an effective case of fifty-seven year-old female with unresectable pancreatic cancer. Its chief complaint of the case was epigastralgia in April 2007, and the diagnosis was locally-advanced cancer of pancreatic body (4 cm, Stage IVa) in June 2007. Laparotomy was performed, but the locally-advanced cancer was unresectable because of the invasion to the celiac trunk and superior mesenteric artery. Tumor biopsy and intra-operative radiotherapy (IORT, 12 MeV, 20 Gy) were only performed. The result of biopsy was moderately-differentiated adenocarcinoma. After laparoptomy, systemic chemotherapy (gemcitabine 1,000 mg/body) was performed once a week. After 4-set chemotherapy, her cancer pain was completely relieved and the tumor size was decreased to 25 mm on CT scan in October 2007. She has been treated as an outpatient.

[Study on adjuvant MTX-5-FU intraperitoneal chemotherapy for advanced gastric cancer].

The intraperitoneal administration of anti-cancer drug is a rationale route to adjuvant chemotherapy. We applied adjuvant MTX-5-FU intraperitoneal chemotherapy for 60 advanced gastric cancer cases which had undergone gastrectomy (Stage II 18, Stage III A 19, Stage IIIB 13, and Stage IV 10 cases). A 5-year survival rate of Stage II, III A, IIIB and IV was 66.2%, 60.7%, 46.5% and 18.8%, respectively. Five-year survival rates of both Stage III A and IIIB on this study were likely to be higher than the rates of Stage III A and IIIB of other institutions. The 24 out of 42 cases with the serosal surface exposure of cancer demonstrated a cancer recurrence. Seventy percent (17 cases) of the 24 recurred cases developed a peritoneal recurrence, which means that the intraperitoneal chemotherapy did not touch a pattern of the recurrence of the gastric cancer with the serosal surface exposure.

[Outpatient chemotherapy with home enteral nutrition for gastric cancer patients].

The jejunostomy catheters were placed with needle catheter jejunostomy (NCJ) kits at the time of gastrectomy for the gastric cancer patients. When the oral intake of the post-operative patient is insufficient, home enteral nutrition (HEN) was introduced to the patient. Forty seven cases out of the 278 gatrectomy patients with jejunostomy were applied to HEN (400-1,200 kcal/day in the night). Twenty nine HEN gastric cancer cases received the chemotherapy in the outpatient clinic. The mean age was 71 years old, the number of total gastrectomy and distal gastrectomy were 21 and 8, respectively, and the number of Stage III and IV were 21 and 8, respectively. The chemotherapy for these 29 cases was continued for a long period unevenly in the outpatient clinic, even though the oral intake of the cases was insufficient. HEN is a good arm for keeping the chemotherapy secure and efficient in the outpatient clinic.

[Influence of intraperitoneal chemotherapy to a recurrence pattern of gastric cancer with serosal exposure].

We analyzed a recurrence pattern and prognosis of 42 gastric cancer cases with histological serosal exposure of cancer and without macroscopical residual cancer in the operation. These cases received adjuvant MTX-5-FU chemotherapy intraperitoneally. Twenty four patients showed a recurrence of gastric cancer. Twenty two patients died of recurrence, and two patients were still alive with recurrence. Seventeen patients (71%) developed peritoneal seeding, which means intraperitoneal chemotherapy made no influence to the pattern of recurrence of gastric cancer with serosal invasion. All of the recurred patients with Stage II and IIIA gastric cancer and about 60% of the recurred patients with Stage IIB and IV developed peritoneal metastasis. The prognosis of recurred 24 patients showed that 9 patients (38%) were kept alive for more than 3 years, and 5 patients (21%) were kept alive for more than 5 years. Intraperitoneal chemotherapy of MTX-5-FU did not touch the pattern of recurrence of gastric cancer with serosal invasion, but the analysis of the prognosis revealed a possibility of improvement of the prognosis.

[A case report of intraabdominal bleeding in unresectable pancreatic cancer after intraoperative radiotherapy].

We report a death case of 56-year-old male with unresectable pancreatic cancer. Its diagnosis was locally-advanced cancer of pancreatic head (Stage IVa) in February 2006. However, he desired no medical treatment until obstructive jaundice (T-Bil 25 mg/dL) appeared. In September 2006, endoscopic biliary metallic stenting was performed and the obstructive jaundice had improved. In November 2006, systemic chemotherapy (S-1 +gemcitabine) was performed. After the chemotherapy, vomiting had appeared because of duodenal stenosis. In December 2006, gastrojejunostomy and intraoperative radiotherapy (IORT) were performed, and the dose of oxicodon was decreased. However, in January 2007, he was suddenly in a state of bleeding-shock and died because of intraabdominal bleeding. The autopsy demonstrated the rupture of splenic pseuoaneurysm due to necrotizing pancreatitis of pancreatic tail, and cancer of pancreatic head was almost viable and IORT was not effective.

[Evaluation of peritoneal cytology in colorectal carcinoma].

We investigated the incidence of free cancer cells in the peritoneal washings of 278 patients who had undergone surgery for colorectal cancer to evaluate its influence as a prognostic factor of the disease. Twenty-two cases (7.9%) were found to have malignant positive cytology (CY(+)). The rate of CY(+) in the cases with peritoneal dissemination (P(+)) was significantly higher than that in P(-) (66.7% vs 3.8%). In 244 cases, those who had tumors exposing to the peritoneum, both CY(+) and P(+) were observed highly in poorly differentiated adenocarcinoma. Among 18 P(+) cases, the rates of CY(+) were higher in both P3 and cur C than in P1, 2 and cur B. When restricted to 260 P(-) cases, CY(+) was observed more often in stage IV cases (14.3% vs 1.8%). Rate was significantly high in M+ (66.7%). Prognosis of 4 P(-) CY(+) cur A cases was as follows; 2 survived for a long time with no recurrence (20 and 60 months), 1 had curable liver metastases after half a year and obtained a 2 year disease free period after surgery, and another one died with brain, liver, and peritoneal recurrence one year later. The incidence of CY(+) is correlated with P(+); CY(+) increased when P(+) is extended more highly and incurable. CY(+) alone doesn't become a prognostic factor for peritoneal recurrences, because CY(+) is found rarely in curable P(-) cases. However, CY(+) is also associated with far advanced cancer with remote metastases, therefore we should consider the risk of such metastases for CY(+) cases with curable colorectal cancer.

[The docetaxel radiosensitization experience for the treatment of unresectable esophageal cancer].

BACKGROUND: Docetaxel is an increasingly important drug for the treatment of esophageal cancer. The docetaxel radiosensitization has been established in cancer cell lines. The therapeutic response and toxicity of a weekly docetaxel in combination with radiotherapy for unresectable esophageal cancer were examined. METHODS: Ten patients with locally advanced or metastatic squamous cell esophageal cancer were recruited in the following protocol. The median age was 65.7 years. Patients received radiation in 2 Gy single daily fractions to a total dose of 60 Gy. Docetaxel (10 mg/m2) was administered weekly for 6 consecutive weeks. RESULTS: One patient could not be evaluated. The overall response rate was 77% with 11% CR and 66% PRs. Mild grade 2 leukocytes toxicity was observed in 2/10 patients, which enforced the treatment absence for 7-14 days. Grade 2 stomatitis was noted in one patient. No severe grade 3 adverse effects were observed. CONCLUSION: It is concluded that low dose docetaxel with radiotherapy is feasible and, a high response rate can be expected. Toxicity is modest, and this protocol may be useful for the outpatients or neoadjuvant chemotherapy.

[A case of intraperitoneal paclitaxel administration in a gastric cancer patient with severely impaired renal function].

This study was designed to evaluate the pharmacokinetics and toxicity of paclitaxel, administered via an intraperitoneal route for a gastric cancer patient with renal dysfunction. The patient was a woman in her 50's, who had been diagnosed with severe renal dysfunction but no treatment history was known. She complained of dyspnea for a large quantity of ascites and was urgently hospitalized. It was diagnosed as gastric cancer with peritoneal dissemination. At this hospital, PTX was administered weekly intraperitoneally through an infusion port without complication. This result suggested that intraperitoneal PTX chemotherapy for a patient with renal dysfunction was a safe treatment.

[An effective weekly paclitaxel administration for gastric cancer with malignant ascites--a case report].

A 71 year-old woman underwent total gastrectomy for advanced gastric cancer of p stage IV (pathological findings: por1 type 3 pT3, pN3 (12p: 1/1, 16b1 int: 3/3, 16b1 lat: 2/2), P1, CY1, H0) in March 2002. She was treated with the double modulation therapy of MTX/CDDP/5-FU intraperitoneally after the surgery. After leaving the hospital, she was carrying out the chemotherapy with MTX/5-FU continually. In August 2002, she became hospitalized once again because an appetite decrease and diarrhea appeared. CT of abdomen showed that malignant ascites had obviously accumulated, and she was admitted. Because it was conceivable in all cases of an inflammation by the chemical stimulation that originated in an anticancer drug, we suspended the intraperitoneal chemotherapy. Paclitaxel 90 mg/body administration was started intravenously on a weekly basis from the end of the same month. Those symptoms improved and she was discharged from the hospital, and was continued the paclitaxel administration. In CT of the abdomen that was taken in November in 2002, malignant ascites had obviously been decreasing and disappeared completely after that.

[A case of gastric cancer with extraordinary liver metastasis effectively treated by adjuvant chemotherapy].

This was an extraordinary liver metastasis case with complication when the patient, a 70-year-old male, was diagnosed with stomach cancer for the first time. However, the patient has been in remission and is a long-term survivor due to an active chemotherapy after the operation. His chief complaints were stomachache and a loss of weight. He was diagnosed with stomach cancer by endoscopy. During the surgery, the mass was found to be 3 QFB palpable caused from hepatomegaly. The liver dysfunction was revealed in the blood biochemistry inspection. The abdominal CT revealed that the stomach cancer had spread to the whole liver. Distal gastrectomy was performed on May 22, 1997. In pathological findings, the tumor was diagnosed as a well-differentiated adenocarcinoma. Final findings: M, type3, T3 (SE), N2, H3, P0, CY0, and Stage IVb. The 5-FU based chemotherapy was performed and a complete response was temporarily obtained. However, it has recurred one year later and two or more kinds of chemotherapy have continued. He is alive for more than 7 years and comes to our hospital as an outpatient.

[MTX/CDDP/5-FU double modulation intra-peritoneal chemotherapy for advanced and metastatic gastric cancer--comparison with intra-aortic route and intra-venous route].

We studied the efficacy of MTX/CDDP/5-FU intra-peritoneal chemotherapy for advanced and metastatic gastric cancer (n=24), and compared the results with intra-aortic (n=26) and intra-venous (n=21) routes of MTX-CDDP-5-FU double modulation therapy. I.p. administration was more efficient for reduction of malignant acites (p=0.049). However, median survival duration of malignant acites cases showed no difference between the i.p. group and i.a., i.v. groups (p=0.103). Survival rate of the i.p. group was no different with those of i.a. and i.v. groups (p=0.36). Frequency of side effects is much lower in the i.p. group.

[The 5-fluorouracil hepato-arterial infusion with oral UFT therapy for the hepatic and extra hepatic metastases of colorectal cancer].

BACKGROUND: The 5 fluorouracil hepato-arterial infusion (5-FU HAI) therapy has a good effect on the liver metastases of colorectal cancer. To gain the antitumor effect of the extra-hepatic lesion, an oral UFT was combined with 5-FU HAI (pharmacokinetic modulating chemotherapy, PMC) to enhance the plasma 5-FU concentration. METHODS: UFT (200-400 mg/day) was orally administered daily and a continuous infusion of 5-FU (1,000-1,500 mg/5 h) was given once a week. Eight patients were treated with this regimen. Five of the eight have extra-hepatic lesions with liver metastases when this treatment was started. The response, time to progression, survival, and toxicity were detected. RESULTS: Four of the five patients with extra-hepatic lesion were evaluated. The response rate was 50% (1 CR, 1 PR, and 2 SD). For the liver metastases, the response rate was 62.5% (1 CR, 4 PR, 2 SD, and 1 PD). Grade 2 leukopenia was found in 1 patient. CONCLUSIONS: The 5-FU HAI with an oral UFT therapy had a good effect on the extra-hepatic lesions as well as hepatic metastases of colorectal cancer.

[A case of gastric cancer with peritoneal dissemination which shows a remarkable efficacy by a weekly administration of paclitaxel intraperitoneally].

We treated a 65-year-old female with gastric cancer who underwent peritoneal dissemination after 6 successive weeks of paclitaxel intraperitoneal therapy (90 mg/body), and obtained a disappearance of ascites and a reduction of the primary carcinoma. Operative findings: U ant, type 5, 26x20 mm, por, T2, n1(+), H0, P0, CY0, M0, stage II, and grade 2. A weekly paclitaxel intraperitoneal therapy could be a useful for both peritoneal dissemination and the primary carcinoma of advanced gastric carcinoma.

[A case of gastric endocrine cell carcinoma with neck lymph node metastasis resected after neoadjuvant chemotherapy].

A relatively rare case of gastric endocrine cell carcinoma was reported. The prognosis of this disease appears to be very poor due to its rapid rate of growth and invasiveness. A 75-year-old woman underwent a gastric endoscopy because the patient complained of an appetite loss. A gross Borrmann 3 type lesion in the greater curvature of the fornix was found. Biopsy specimens showed endocrine cell carcinoma. Abdominal CT examination revealed metastases in left neck and paraaortic lymph nodes. The serum sample showed an elevation of NSE level to be 53. A combination chemotherapy was performed using cisplatin and etoposide, which resulted in remarkable reduction of the main tumor two months later. The total gastrectomy associated with D2 lymph node dissection was performed. However, abdominal tumor was observed again in a month and it progressed rapidly. No clear response to the chemotherapies with cisplatin/etoposide or paclitaxel was found. The patient died 5 months after the operation.