Impending rupture of a chronic contained abdominal aortic aneurysm with a 14-day history.

This case of an impending abdominal aortic aneurysm rupture emphasizes impaired consciousness with low back pain. Family doctors must be attentive to a patient's physical findings and medical history, even if vital signs are normal at the initial visit.

A case of 18 years disease-free survival after combined pancreatoduodenectomy and hemicolectomy for carcinosarcoma of the transverse colon.

BACKGROUND: Ascertaining the origin of large tumors located in the region of the pancreas head and adjacent mesocolon can pose a challenge preoperatively. En bloc pancreatoduodenectomy with hemicolectomy is often required towards curative tumor resection (R0) of malignant tumors in this region. CASE PRESENTATION: Herein we report a case of a 48-year-old man with two contiguous masses each 5 cm in size, located in the pancreatic head. The masses were detected incidentally by abdominal ultrasonography at an annual health check. Endoscopic biopsies revealed inflammation with no malignancy. Cross-sectional imaging showed the tumor direct invasion of the uncinate process of the pancreas, and the third portion of the duodenum. Based on imaging, a malignant submucosal tumor originating from mesenchymal cells in the mesentery of the transverse colon was made preoperatively. The mass required en bloc pancreatoduodenectomy, right hemicolectomy, and resection of the superior mesenteric vein. The final pathology was carcinosarcoma of the transverse colon. The patient survived 18 years after surgery without recurrence. CONCLUSIONS: Malignant tumors located in the region of the pancreas head should be considered for an en bloc curative tumor resection and adjuvant chemotherapy treatments offered that might be beneficial for carcinosarcoma.

Scirrhous colon cancer presenting as a pseudokidney sign.

This case presents ascending colon cancer with a typical pseudokidney sign on ultrasonography. The cancer extended from the ascending colon to the terminal ileum without intussusception. The pseudokidney sign may represent colon scirrhous cancer.

A Bednar tumor in a healthy woman.

A Bednar tumor (BT) is a soft tissue sarcoma that mimics neurofibroma and rarely occurs in the deeper layers of the skin. Local recurrence of BT is possible with incomplete resection, but the occurrence of distant metastasis is rare.

Case of gastric anisakiasis with no symptoms.

We present a unique image from a case of anisakiasis that was detected incidentally in an elderly man during surveillance esophagogastroduodenoscopy. Given the popularity of sushi and sashimi throughout the world, we believe that our observations will raise awareness about the risk of Anisakis contamination in seafood.

Evaluating the Accuracy of the Endoscopic ABC Classification System in Diagnosing Helicobacter pylori-Infected Gastritis.

AIMS: Evaluating the accuracy of the modified Endoscopic ABC (Endo ABC) classification with an electronic endoscopy with narrow band imaging without magnification in diagnosing Helicobacter pylori (H. pylori)-infected gastritis. METHODS: A total of 576 patients were enrolled and they underwent modified Endo ABC. They were stratified into 5 groups (A to E) based on the grades of endoscopic findings. H. pylori-infected gastritis status was determined in the following ways: current H. pylori gastritis was defined as active gastritis and/or chronic atrophic gastritis (CAG) seen on endoscopy and positive H. pylori test, naïve H. pylori gastritis was defined as regular arrangement of collecting venules in the angle of the lesser curvature without CAG and negative H. pylori test, and previous H. pylori gastritis was defined as negative H. pylori tests regardless of the presence of CAG. RESULTS: Endo A has 97% accuracy and 100% positive predictive value in diagnosing naïve H. pylori gastritis. Endo E has 97% accuracy and 100% positive predictive value in diagnosing previous H. pylori gastritis. The accuracy of Endo B and Endo C in diagnosing current H. pylori gastritis was 89 and 82% respectively. Endo D has 87% accuracy in diagnosing previous H. pylori gastritis. CONCLUSION: This study showed that the modified Endo ABC classification enables to accurately determine the H. pylori-infected gastritis status.

Advanced transverse colon cancer highly indicative of invasion to the duodenum and pancreas.

Our images showed an advanced transverse colon cancer highly indicative of an invasion to the duodenum and pancreas. For en bloc tumor resection, surgeons should make a deliberate operative plan.

[Analysis of the gray-zone cutoff values of new serum Helicobacter pylori antibody kits using latex immunoassay].

The serum Helicobacter pylori titers are good markers for population-based H. pylori screening and treatment programs because the tests used to estimate these titers are noninvasive, inexpensive, and convenient. However, the reference range of 3-10U/mL, which is used as a standard in commercially available serum H. pylori antibody kit E plate Eiken H. pylori antibody II, is regarded as a gray-zone cutoff value to indicate H. pylori infection status. We aimed to clarify the gray-zone cutoff values of H. pylori infection status with new serum H. pylori antibody kits using latex immunoassay. We enrolled 256 patients who underwent endoscopic examination and H. pylori tests at the Inui Clinic of Internal Medicine or IMS Ota Central General Hospital between January 2013 and December 2015. Serum H. pylori titers were measured using Type L Wako H. pylori antibody J (Wako-LIA), H. pylori-latex Seiken (Denka-LIA), and LZ test Eiken H. pylori antibody (Eiken-LZ). In patients with a positive diagnosis of H. pylori infection, the positive diagnostic values (sensitivity, specificity, and positive predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (94.6%, 86.0%, and 79.1%), (95.7%, 90.2%, and 84.6%), and (85.9%, 92.1%, and 85.9%), respectively;in patients with a negative diagnosis of H. pylori infection, the diagnostic values (sensitivity, specificity, and negative predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (96.9%, 83.5%, and 85.6%), (96.9%, 78.7%, and 82.2%) and (95.3%, 67.7%, and 75.0%), respectively. In this study, the gray-zone cutoff value indicating H. pylori infection status was between 4.0 and 8.7U/mL for Wako-LIA, between 10.0 and 15.2U/mL for Denka-LIA, and between 5.6 and 10.0U/mL for Eiken-LZ. Therefore, we propose that lower titers of the positive antibody are important to diagnose H. pylori infection using Wako-LIA and Denka-LIA. However, when using Eiken-LZ, high titers of the negative antibody should be considered diagnostically important.

Case of Six-Year Disease-Free Survival with Undifferentiated Carcinoma of the Pancreas.

Undifferentiated carcinoma of the pancreas (UDC) is rare and has a dismal prognosis. Here, we report a case of 6-year disease-free survival with a mixed type of UDC and UDC with osteoclast-like giant cells, with a high mitotic index as well as perineural, lymphatic, vessel, and diaphragmatic invasion. The patient underwent radical distal pancreatectomy and was subsequently treated with adjuvant chemotherapy using gemcitabine plus S-1 followed by maintenance chemotherapy with oral tegafur-uracil. The patient has been doing well with no evidence of recurrence for more than 6 years after surgery.

[Cost cut of cancer by a shift in gastric cancer risk screening (serum ABC classification) combined with eradication of H. pylori, and H. pylori test and treatment program in young people].

We estimated the costs and the benefits of a shift strategy of gastric cancer risk screening (ABC stratification) with H. pylori eradication, and H. pylori test and treatment program in young people, comparing with the current barium gastrograph. The combination of serum pepsinogen, assessing atrophic gastritis status, and H. pylori antibody testing allows for ABC risk stratification. The ABC risk screening could greatly reduce screening and treating cost of gastric cancer. The H. pylori test and treatment program could be the most effective primary prevention of not only gastric cancer but H. pylori-related disease, thereby reducing national cost of cancer and healthcare expenditure. The Japanese Government should take the initiative to implement this strategy as soon as possible.

The adenomatous polyposis coli-associated exchange factors Asef and Asef2 are required for adenoma formation in Apc(Min/+)mice.

Sporadic and familial colorectal tumours usually harbour biallelic adenomatous polyposis coli (APC)-associated mutations that result in constitutive activation of Wnt signalling. Furthermore, APC activates Asef and Asef2, which are guanine-nucleotide exchange factors specific for Rac1 and Cdc42. Here, we show that Asef and Asef2 expression is aberrantly enhanced in intestinal adenomas and tumours. We also show that deficiency of either Asef or Asef2 significantly reduces the number and size of adenomas in Apc(Min/+) mice, which are heterozygous for an APC mutation and spontaneously develop adenomas in the intestine. We observed that the APC-Asef/Asef2 complex induces c-Jun amino-terminal kinase-mediated transactivation of matrix metalloproteinase 9, and is required for the invasive activity of colorectal tumour cells. Furthermore, we show that Asef and Asef2 are required for tumour angiogenesis. These results suggest that Asef and Asef2 have a crucial role in intestinal adenoma formation and tumour progression, and might be promising molecular targets for the treatment of colorectal tumours.

Severe acute cholestatic hepatitis of unknown etiology successfully treated with the Chinese herbal medicine Inchinko-to (TJ-135).

Severe acute hepatitis of unknown etiology is difficult to treat and often progresses to subacute fulminant hepatitis or late-onset hepatic failure. A 45-year-old well-nourished, healthy man had progressive fatigue and his liver function tests showed severe liver dysfunction. The etiology of sever acute cholestatic hepatitis was unknown. The liver function tests normalized gradually, which excluded high persistent total bilirubin after starting on predonine. A liver biopsy showed chronic active hepatitis with mild fibrosis (A2, F1). Oral Inchinko-to, a Chinese herbal medicine, at 7.5 g daily was prescribed. The treatment was effective with no adverse effects. We present a successfully treated case and discuss hepatoprotective and choleretic effects of Inchinko-to.

[Remarkable effect of gemcitabine-oxaliplatin (GEMOX) therapy in a patient with advanced metastatic mucinous cystic neoplasm of the pancreas].

Gemcitabine(GEM)is the standard therapy for advanced pancreatic cancer. GEM-oxaliplatin (GEMOX) combination treatment has been reported to be superior to GEM alone in terms of clinical progression-free survival, but it is not the therapy of choice for pancreatic cancer. We report a case of advanced mucinous cystic neoplasm (MCN) of the pancreas with multiple hepatic metastases in a 39-year-old female. She was treated with 16 courses of GEMOX (GEM 1,500 mg/day at a rate of 10 mg/m2/min on the first day and oxaliplatin 150 mg/day at 100 mg/m2 on the second day, every 3 weeks). The pharmacist helped her to avoid severe side effects. When the hepatic metastases disappeared after 13 courses, the primary MCN was removed surgically after 16 courses of GEMOX treatment. No recurrence has been observed 22 months postoperatively. GEMOX might be effective for the treatment of MCN of the pancreas.

Prognostic significance of BMP and activin membrane-bound inhibitor in colorectal cancer.

AIM: To investigate the clinical significance of BMP and activin membrane-bound inhibitor (BAMBI) which is a pseudoreceptor of transforming growth factor-beta (TGF-beta) type I receptors and acts as a negative regulator of TGF-beta signaling and expression aberrantly elevated in colorectal cancers (CRCs). We studied BAMBI expression in CRCs. METHODS: We studied BAMBI expression in 183 surgically resected CRCs by immunochemical and immunoblotting analyses using a generated monoclonal anti-BAMBI antibody. Commercially available anti-beta-catenin and anti-p53 antibodies were also applied for immunochemical analyses as a comparison control. RESULTS: Immunohistochemical analysis revealed that BAMBI expression was observed in 148 (80.8%), and strong BAMBI expression was observed in 46% of the CRCs. Strong BAMBI expression was positively correlated with histological type, depth of invasion, lymph node metastases, and tumor node metastasis (TNM) stage (P < 0.05). Clear associations were found between BAMBI and beta-catenin (P = 0.035) and p53 (P = 0.049) expression. In curatively resected CRC, 5-year recurrence-free survival was 51.9% (P = 0.037) for strong BAMBI expression compared to 79.8% for weak BAMBI expression. In the Cox's multivariate analysis, lymph node metastases (RR 6.685; P < 0.001) and depth of invasion (RR 14.0; P = 0.013) were significant indicators for recurrence, and strong BAMBI expression (RR 2.26; P = 0.057) tended to be significant. CONCLUSION: BAMBI was linked to a potentially aggressive tumor phenotype and predicted tumor recurrence and cancer-related death in CRC. BAMBI expression might be applicable in the routine clinical setting of CRC.

Hepatocellular carcinoma with a tumour thrombus extending to the tricuspid valve: report of a successful en bloc resection.

This paper reports the use of cardiopulmonary bypass with mild hypothermia for the successful en bloc resection of a hepatocellular carcinoma in a cirrhotic liver with a tumor thrombus extending into inferior vena cava (IVC) and to the right atrium (RA), often prolapsing the tricuspid valve. The patient was a 77-year-old woman with antibodies against hepatitis C virus (HCV) and a serum alpha-fetoprotein (AFP) concentration of 13,566ng/mL. Imaging showed a large tumor in the left lobe of the liver extending into the RA, which often was prolapsed the tricuspid valve to produce mitral valve regurgitation. To prevent intraoperative pulmonary thromboembolism, both cardiac arrest and hepatic vascular occlusion with mild hypothermia were applied. The RA and IVC tumor thrombus and left liver were resected in en bloc. The cardiac arrest and hepatic vascular exclusion times were 56 and 15 min, respectively. The operation took 11 h, and the total blood loss was 1,078mL. The resected specimen weighed 1,000g and the tumor measured 8.0 x 7.8cm.

PX-RICS mediates ER-to-Golgi transport of the N-cadherin/beta-catenin complex.

Cadherins mediate Ca2+-dependent cell-cell adhesion. Efficient export of cadherins from the endoplasmic reticulum (ER) is known to require complex formation with beta-catenin. However, the molecular mechanisms underlying this requirement remain elusive. Here we show that PX-RICS, a beta-catenin-interacting GTPase-activating protein (GAP) for Cdc42, mediates ER-to-Golgi transport of the N-cadherin/beta-catenin complex. Knockdown of PX-RICS expression induced the accumulation of the N-cadherin/beta-catenin complex in the ER and ER exit site, resulting in a decrease in cell-cell adhesion. PX-RICS was also required for ER-to-Golgi transport of the fibroblast growth factor-receptor 4 (FGFR4) associated with N-cadherin. PX-RICS-mediated ER-to-Golgi transport was dependent on its interaction with beta-catenin, phosphatidylinositol-4-phosphate (PI4P), Cdc42, and its novel binding partner gamma-aminobutyric acid type A receptor-associated protein (GABARAP). These results suggest that PX-RICS ensures the efficient entry of the N-cadherin/beta-catenin complex into the secretory pathway, and thereby regulates the amount of N-cadherin available for cell adhesion and FGFR4-mediated signaling.

NOTCH3 signaling pathway plays crucial roles in the proliferation of ErbB2-negative human breast cancer cells.

ErbB2-negative breast tumors represent a significant therapeutic hurdle because of a lack of effective molecular targets. Although NOTCH proteins are known to be involved in mammary tumorigenesis, the functional significance of these proteins in ErbB2-negative breast tumors is not clear. In the present study, we examined the expression of activated NOTCH receptors in human breast cancer cell lines, including ErbB2-negative and ErbB2-positive cell lines. Activated NOTCH1 and NOTCH3 proteins generated by gamma-secretase were detected in most of the cell lines tested, and both proteins activated CSL-mediated transcription. Down-regulation of NOTCH1 by RNA interference had little or no suppressive effect on the proliferation of either ErbB2-positive or ErbB2-negative cell lines. In contrast, down-regulation of NOTCH3 significantly suppressed proliferation and promoted apoptosis of the ErbB2-negative tumor cell lines. Down-regulation of NOTCH3 did not have a significant effect on the ErbB2-positive tumor cell lines. Down-regulation of CSL also suppressed the proliferation of ErbB2-negative breast tumor cell lines, indicating that the NOTCH-CSL signaling axis is involved in cell proliferation. Finally, NOTCH3 gene amplification was detected in a breast tumor cell line and one breast cancer tissue specimen even though the frequency of NOTCH3 gene amplification was low (<1%). Taken together, these findings indicate that NOTCH3-mediated signaling rather than NOTCH1-mediated signaling plays an important role in the proliferation of ErbB2-negative breast tumor cells and that targeted suppression of this signaling pathway may be a promising strategy for the treatment of ErbB2-negative breast cancers.