[Laparoscopic Gastrectomy for Gastric Adenocarcinoma of the Fundic Gland Type - Report of a Case].

A 69-year-old man underwent esophagogastroduodenoscopy, which showed a slightly depressed lesion at the greater curvature of the gastric body. We diagnosed gastric adenocarcinoma of the fundic gland type(GA-FG)from examination of the biopsy specimen. Endoscopic submucosal dissection(ESD)was performed for curative resection. The pathological examination revealed a positive vertical margin. Consequently, laparoscopic gastrectomy was additionally performed. GA-FG has recently been proposed as a new entity of gastric adenocarcinoma. GA-FG mostly develops without Helicobacter pylori infection and often invades the submucosa, regardless of size. However, GA-FG rarely demonstrates lymphatic and venous invasion despite deep submucosal invasion. Since most GA-FG cases undergo ESD, few reports of surgical resection exist. Here, we report our experience of laparoscopic gastrectomy for GA-FG.

RhoC upregulation is correlated with reduced E-cadherin in human breast cancer specimens after chemotherapy and in human breast cancer MCF-7 cells.

Therapy-resistant cancer cells are a major problem in cancer research. Recent studies suggest that the epithelial-mesenchymal transition (EMT) is a key mechanism in therapy resistance. Yet, the expressions of EMT markers, EMT core regulators, and a stem cell marker of BMI1 during chemotherapy have been poorly analyzed in clinical breast cancer specimens. In the present study, we investigated the roles of RhoC under chemotherapy to follow up on earlier findings demonstrating the involvement of RhoC in prostate cancer resistance to endocrine therapy. Immunohistochemically, E-cadherin expression was significantly lower in human breast cancer specimens analyzed after chemotherapy than specimens biopsied before chemotherapy. Significant upregulation of fibronectin, a mesenchymal EMT marker, was found in post-chemotherapy analysis. A study of the EMT core regulators of SNAIL1, SNAIL2, TWIST1, and a well-known stem cell marker of BMI1 revealed no post-chemotherapy upregulation of these molecules. In contrast, RhoC expression was significantly upregulated in post-chemotherapy breast cancer specimens. MCF-7 cells stably transfected with the constitutive active (CA) RhoC plasmid manifested a reduced level of E-cadherin at the peripheries and disorganization of actin fibers, with no accompanying upregulation of SNAIL1, SNAIL2, TWIST1, or BMI1 in Western blots. Exposure of etoposide on MCF-7 cells showed RhoC upregulation together with reduced membranous expression of E-cadherin and disorganization of actin fibers. In MTT assay, however, the CA-RhoC-expressing MCF-7 cells failed to show chemotherapy resistance under etoposide treatment. Taken in sum, RhoC may contribute to an EMT-like process in human breast cancer during chemotherapy.

Immunohistochemical assessment of primary breast tumors and metachronous brain metastases, with particular regard to differences in the expression of biological markers and prognosis.

In this study, we conducted an immunohistochemical analysis of primary breast tumors and metachronous brain metastases to compare the differences in the expression of biological markers between the two. Carcinoma tissues from primary breast tumors and metachronous brain metastases collected from 21 patients were examined immunohistochemically for the expression status of the estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor (HER)-2, Ki-67, bcl-2 and p53, and the results were compared. In addition, the relationships between the expression of these factors and prognosis were evaluated. There were no significant differences in the frequencies of ER-, PgR-, HER-2-, bcl-2- or p53-positivity between the primary breast tumors and metachronous brain metastases. While the Ki-67 labeling index (LI) was high in both the primary breast tumors and brain metastases, it was significantly higher in the brain metastases than in the corresponding primary breast tumors (P=0.003). With regard to the prognosis, breast cancer patients who showed ER-positivity in the primary tumors showed significantly longer survival after primary diagnosis (P=0.0076). Furthermore, breast cancer patients who exhibited ER-positivity, bcl-2-positivity or p53-negativity in the primary tumors showed significantly longer intervals from primary diagnosis to the detection of the brain metastases. Of all the markers, only the Ki-67 LI was significantly higher in the brain metastases than in the primary breast tumors. We confirmed that the tumor characteristics were worse in the metachronous brain metastases.

Sentinel node detection method using contrast-enhanced ultrasonography with sonazoid in breast cancer: preliminary clinical study.

This study aimed to evaluate the usefulness of sentinel lymph node (SLN) detection in breast cancer using contrast-enhanced ultrasonography (CEUS) with subareolar Sonazoid injection. The subjects were 20 breast cancer patients. General anesthesia was induced and 2 mL of Sonazoid was injected subareolarly. After massage of the injection site, the axillary area was observed transdermally using coded phase inversion harmonic ultrasonography with mechanical indices of 0.15 to 0.19. When contrast-enhanced lymph nodes (LNs) were seen, they were defined as CE-SLN. Two other SLN detection methods, the gamma-probe-guided and dye-guided methods, were performed together. We evaluated the SLNs detected by each method to determine if they corresponded with each other and calculated the SLN detection rate. After the SLNs were resected, pathologic examinations were done. The SLN detection rate of the CEUS-guided method, the dye-guided method and the gamma-probe-guided method were 70%, 75% and 100%, respectively. There was no statistically significant difference in these rates between the CEUS-guided and dye-guided methods (p = 0.99) but the CEUS-guided method showed a significantly lower rate than the gamma-probe-guided method (p = 0.020), and dye-guided method also showed a significantly lower rate than the gamma-probe-guided method (p = 0.047). The number of CE-SLNs was 1 or 2 (average 1.1) and each took 2 to 20 (average 5.3) min to detect. The CE-SLNs corresponded grossly with SLNs detected by the gamma-probe-guided and dye-guided methods. The pathologic results indicated no metastasis from the resected SLNs in 15 of 20 cases. However, the CEUS-guided method detected 12 cases of these 15 and CE-SLNs were detected in two of the remaining five metastasis cases. In summary, in breast cancer patients, after subareolar injection of Sonazoid, contrast-enhanced LNs were observed in real time with ultrasonography. In an initial clinical study of 20 cases, the detection rate of the CEUS-guided method was less than that of the gamma-probe-guided method. It is suggested that the CEUS-guided method using Sonazoid may, with some improvements, be a useful new modality for sentinel node identification.

Metastasis-related factors expressed in pT1 pN0 breast cancer: assessment of recurrence risk.

OBJECTIVES: Previous reports have indicated that small breast cancers without lymph node metastasis present a favorable prognosis. However, 10-20% of patients with T1 N0 invasive ductal carcinoma experience recurrence and have a poor prognosis. The objective of this study was to examine whether certain metastasis-related factors are prognostic of cancer recurrence in such patients at risk for relapse. METHODS: Nineteen patients with the carcinoma who had recurrence 1-15 years after margin-free resection were examined. The control group consisted of 20 patients with pT1 pN0 invasive ductal carcinoma who had no recurrence for > or =10 years after radical surgery. The two groups were compared with respect to clinical profiles, conventional neoplastic features, and immunohistochemical expressions of 16 metastasis-related factors. RESULTS: No significant difference was found between the two groups in clinical profiles and conventional neoplastic features. However, six factors (MMP-2, MT1-MMP, T1MP-2, VEGF, cMET, and PCNA) were significantly expressed in the recurrence group against the control group. MMP-9 was significantly less expressed in the recurrence group. Of these factors, MMP-2, MT1-MMP, and VEGF showed the highest adjusted odds ratios. CONCLUSION: MMP family and growth factors may be promising predictors of recurrence risk of early stage breast cancer.

Sentinel node detection in breast cancer using contrast-enhanced sonography with 25% albumin--Initial clinical experience.

PURPOSE: To determine the clinical usefulness of a sentinel lymph node (SLN) identification technique using contrast-enhanced sonography (CEUS) with 25% albumin. METHODS: The subjects were 23 women with breast cancer. Each was injected subcutaneously with 5 ml of 25% albumin solution as a negative contrast agent directly superficial to the breast tumor. The area was massaged, and the inferior axillary hairline was examined continuously using gray-scale sonography with a 7.5- or 10-MHz transducer. Any contrast-enhanced lymph node was considered a CEUS-detected SLN, was differentiated from other level I and II nodes, and was resected and pathologically assessed. RESULTS: In all 23 patients, 1 or 2 CEUS-detected SLNs (mean, 1.3 SLNs) were identified. Their sizes ranged from 5 mm to 25 mm (mean, 11.3 mm), and their depths (from the skin surface) ranged from 5mm to 20 mm (mean, 12.6 mm). Pathologic examination revealed a metastasis in 5 of the 23 patients, all in CEUS-detected SLNs. CONCLUSION: In a clinical study using CEUS with 25% albumin, contrast-enhanced nodes were identified in all subjects. The pathologic findings suggested that any metastatic nodes observed were SLNs, indicating that this technique may represent a new modality for SLN identification.

New method of sentinel node detection using a combination of contrast-enhanced ultrasound and dye guidance: an animal study.

PURPOSE: To determine whether a combination of contrast-enhanced ultrasound-guided methods and dye-guided methods can identify sentinel lymph nodes in animals. METHODS: Seven pigs were put under general anesthesia and injected subcutaneously in the neck: three with 2 ml saline and four with 2 ml fluid comprising 0.4 ml 5% patent blue violet solution and 1.6 ml of hydroxyethylated starch (Salinhes) solution (PB + HS). The regional lymph nodes were observed by ultrasound; blue-stained regional lymph nodes found after the skin was cut were situated as ultrasound had shown they would be. RESULTS: The regional lymph nodes of the pigs given saline were unchanged, but in the pigs receiving PB + HS, the echo level in the lymph nodes nearest the injection site was altered, producing a clear contrast with the surrounding tissues. The area of the relevant regional lymph node in each PB + HS-injected pig increased significantly (t-test, P < 0.01; from 25.7, 39.6, 9.36, 70.2 mm(2), and mean, 36.2 mm(2); to 50.7, 65.5, 21.1, 98.3 mm(2), and mean, 58.9 mm(2), respectively). These enlarged regional lymph nodes were easily found by contrast-enhanced ultrasonography. When excised under ultrasound guidance, all were stained blue, indicating that they were sentinel lymph nodes. CONCLUSION: These results suggest that this combination of contrast-enhanced ultrasound-guided and dye-guided methods warrants use as a quick, simple procedure for detecting sentinel lymph nodes.

[A case report of adjuvant chemotherapy (TS-1) for far advanced gastric cancer in which the patient maintained a good quality of life].

A 44-year-old male patient underwent total gastrectomy for gastric cancer with peritoneal dissemination and direct invasion into the pancreas. After the operation, the patient received daily oral administration of TS-1, a novel oral anticancer agent. Each treatment course consisted of four-week administration of 120 mg TS-1 daily followed by two drug-free weeks. The patient was confirmed to be cancer-free by abdominal CT from the eighth course. With this chemotherapy, slight decrease of WBC (grade 1 or 2) and mild bowel obstruction appeared as the side effects of TS-1, but no other serious effects were observed. (A dose reduction of TS-1 from 120 mg to 100 mg per day was done at the beginning of the fifth course.) This patient could return to his work (physical labor) in the sixth month after the operation. The cancer-free period has persisted for sixteen months since the operation, and a good quality of life has been maintained simultaneously. TS-1 revealed a high effectiveness without deteriorating the patient's quality of life.