Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction.

BACKGROUND: The treatment options for gastrointestinal stromal tumors (GITSs) at the esophagogastric junction (EGJ) are controversial. There have been reports on enucleation for EGJ GISTs in order to avoid gastrectomy. But the number of patients is too small, or the follow-up period is too short to evaluate it. The purpose of this study was to review our experience of 59 patients with EGJ GISTs treated by enucleation by percutaneous endoscopic intragastric surgery (PEIGS) and assess the clinical outcomes. METHODS: PEIGS is performed as described below. Access ports are placed through the abdominal wall and the anterior wall of the stomach. Through the access ports, an endoscope and surgical instruments are inserted into the gastric lumen and tumor enucleation and closure of the defect are carried out. In this study, 59 patients with EGJ GISTs treated by PEIGS between 2005 and 2013 were enrolled. Their hospital records were reviewed, and follow-up data for 8 years were collected to analyze the outcomes. RESULTS: En-bloc enucleation was achieved without tumor rupture in all. Average operation time was 172.3 min. Postoperative complications occurred in 3 (one localized peritonitis, one bleeding, and one surgical site infection). Average tumor size was 35.6 mm. Pathological findings confirmed negative margin in all specimens. The maximum follow-up period was 101 months. Multiple liver metastases were detected in two patients (at 12 and 29 months). The survival rate was 100 %. The disease-free rate was 98.3 % at 12 months and 96.6 % at 29 months, respectively. CONCLUSIONS: As far as the short- and long-term outcomes of our experience are reviewed, PEIGS seems as curative as other aggressive resection methods such as proximal gastrectomy. Tumor enucleation by PEIGS, offering a chance to preserve the stomach, can be a preferable option in carefully selected patients with EGJ GISTs, when performed by a skilled surgeon.

[The case of a giant malignant phyllodes tumor of the breast].

A 75-year-old female patient complained of a mass in her left breast 2 years ago. The patient experienced a rapid enlargement of the mass 2 months later and visited our hospital. A computed tomography (CT) scan indicated a 25-cm tumor with infiltration of the left breast skin. Pectoral muscle invasion was considered. Swelling of the axillary lymph node and remote metastases were not found. A needle biopsy indicated a phyllodes tumor. A pectoral muscle-preserving mastectomy was undertaken. The tumor weighed 7.1 kg. Pathological examination indicated hyperplasia of the stroma and part of the epithelium, which had invaded the skin layer and fatty tissue. The pathological diagnosis was a malignant phyllodes tumor. This paper reports the case of a giant malignant phyllodes tumor.

[A case of locally advanced breast cancer successfully treated with Mohs paste].

We report a case of primary advanced breast cancer that was locally controlled by treatment with Mohs paste. A 57- year-old woman presented with right locally advanced breast cancer with massive exudate and oozing blood. Histopathological examination indicated an invasive ductal carcinoma. Moreover, the patient had lung, liver, and bone metastases. She received chemotherapy, following which the breast tumor was treated using Mohs paste and dissected. The bleeding and exudate stopped almost completely, and the breast tumor became flat. Therefore, it is suggested that locally advanced breast cancer could be controlled by treatment with Mohs paste.

[A case of bilateral breast cancer and metastatic gastric cancer with peritonitis carcinomatosa successfully treated with a combination therapy of S-1 and paclitaxel].

A 46-year-old woman was diagnosed with complaints of bilateral breast tumor with massive ascites retention. The patient was examined as scirrhous carcinoma by lacteal gland inspection and dysplastic cell by ascites cytotechnology. We diagnosed her case to be bilateral breast cancer with peritonitis carcinomatosa, lymph node metastases and bony metastases. In addition to that, gastric metastasis was diagnosed by the result of widespread irregular gastric mucosa, which was inspected through upper gastrointestinal endoscope. The patient was treated with S-1 and paclitaxel and has achieved a remarkable response. The patient's tumor, gastric metastasis, and ascites were disappeared almost completely.

[Palliative home care for advanced and recurrence breast cancer--a six-case report].

Two years of palliative home care for advanced and recurrent breast cancer of six patients was performed since January 2007. The reasons to provide palliative home care include an administration of skin infiltrative tumor, pain, home oxygen therapy (HOT), and chemotherapy. Most important part of home palliative care is to prepare any physical and psychosocial problems among any types of occupation.

First drainage lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patients with pN-1 stage tumors.

BACKGROUND: We attempted to identify the first lymph node(s) involved in metastasis of gastric cancer by studying the topographical pattern of metastasis to regional lymph nodes in patients with pN-1 stage tumors. MATERIALS AND METHODS: A total of 190 patients (108 males and 82 females; age range, 27 to 83 years; mean, 59.7 years), who had undergone curative resection combined with lymphadenectomy for solitary carcinoma of the stomach and were histologically diagnosed as having pN-1 stage tumors, were enrolled in the present study. The topographical patterns of metastasis to regional lymph nodes were reviewed from the pathology records of these patients. RESULTS: A total of 7561 lymph nodes (mean, 39.8/patient; range 15-99/patient) were dissected and metastasis was histologically observed in 523 nodes (6.9%, mean, 2.7/patient). Although perigastric lymph nodes were a common site of metastasis, the distribution of positive nodes depended on tumor location. As the number of positive nodes increased, a more diffuse pattern of regional involvement was noted. Skip metastasis was identified in 10 (5%) out of 190 patients. This unusual pattern of metastasis was found in 9 (14%) out of 63 patients with single positive nodes, while only one (1%) out of 127 patients with 2-6 positive nodes exhibited this pattern of metastasis. The difference between the two groups was statistically significant (p < 0.0001). CONCLUSION: Although perigastric lymph nodes are important first sites of drainage from pN-1 stage gastric tumors, the pattern of lymph node metastasis varies widely within a regional area even in pN-1 stage patients.

Immunohistochemical study of collagen synthesis in an in-vitro model of scirrhous carcinoma of the stomach.

BACKGROUND/AIMS: The mechanisms involved in the unique stromal change that occurs upon cancer invasion are poorly understood in scirrhous carcinoma of the stomach. METHODOLOGY: Three different human gastric cancer cell lines (KATO-III, MKN-28, MKN-45) and human fibroblast cells (TIG-101) were co-cultured three-dimensionally in collagen gels. The gels, in vitro models of gastric cancer, were immunostained by monoclonal antibodies to human placental prolyl 4-hydroxylase (PH, a key enzyme of collagen synthesis) and then examined by light and electron microscopy. RESULTS: Under co-culture of cancer cells and fibroblasts, cytoplasmic staining for PH was observed in both the cancer cells (KATO-III, MKN-28, MKN-45) and fibroblasts. No significant difference in the expression patterns of the alpha- and beta-subunits of PH was observed not only among the KATO-III, MKN-28 and MKN-45 cell lines but also between cancer cells and fibroblasts. CONCLUSIONS: These findings indicate that both cancer cells and fibroblasts can synthesize collagen in gastric cancer models. Moreover, this property may not be a unique characteristic of scirrhous gastric cancer cells, but common to gastric cancer cells and fibroblasts in vitro.