Preoperative FDG-PET predicts early recurrence and a poor prognosis after resection of pancreatic adenocarcinoma.

OBJECTIVE: The aim of this study was to evaluate the clinical utility of preoperative 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) as a prognostic predictor of resectable pancreatic adenocarcinoma. METHODS: A total of 128 patients with resected pancreatic adenocarcinoma who preoperatively underwent FDG-PET examinations were studied. The maximum standard uptake value (SUVmax) was calculated for each primary lesion. A receiver operating characteristics (ROC) curve was constructed to estimate the optimal cutoff value of the SUVmax. In order to determine which outcomes of interest were appropriately demonstrated, ROC curve analyses were conducted for six outcomes: 6-, 12-, and 24-month disease-free survival (DFS), and 6-, 12-, and 24-month overall survival (OS). A multivariate analysis was conducted to identify prognostic factors. RESULTS: The ROC curves revealed that the SUVmax predicted the 6-month DFS most optimally (area under the curve 0.757), with a cutoff value of 6.0. Of the 69 patients with an SUVmax ≥ 6.0, 34 (49 %) developed recurrence within 6 months. In contrast, only 3 of 59 (5 %) patients with an SUVmax < 6.0 exhibited early recurrence (p < 0.001). The median OS time was 37 months in patients with an SUVmax < 6.0 and 18 months in patients with an SUVmax ≥ 6.0 (p < 0.001). The multivariate analysis revealed lymph node metastasis (hazard ratio [HR] 2.31; p = 0.001) and an SUVmax ≥ 6.0 (HR 2.05; p = 0.002) to be significantly correlated with a poor survival. CONCLUSIONS: An SUVmax ≥ 6.0 was a significant predictor of early postoperative recurrence and subsequent poor survival following resection of pancreatic adenocarcinoma.

[A case of endocrine cell carcinoma of the ascending colon with liver metastasis treated with hepatectomy after excision of the primary lesion and systemic chemotherapy].

A 77-year-old man who complained of melena was admitted to our department. Colonoscopy revealed a type 2 tumor in the hepatic flexure of the ascending colon. Biopsy examination revealed a poorly differentiated adenocarcinoma. Abdominal computed tomography(CT)revealed 3 tumors within the posterior segment of the right hepatic lobe. Initially, a right hemicolectomy was performed. Immunohistochemically, the tumor was diagnosed as an endocrine cell carcinoma. After surgery, a capecitabine, oxaliplatin, and bevacizumab(CapeOX/BEV)regimen was administered. However, after 5 chemotherapy courses, abdominal CT revealed enlargement of the 3 tumors in the posterior segment of the right hepatic lobe. There was no metastasis besides the liver metastasis. The patient underwent a radical hepatectomy of the posterior segment. At 8 months post-surgery, the patient remains alive and well. Endocrine cell carcinoma of the colon and rectum is usually malignant and is associated with a very poor prognosis because of rapid hematogenous or lymphogenous metastasis. Effective multimodal treatment regimens, including surgery and new chemotherapies such as molecular targeted therapies, should be established to improve the prognosis of patients with endocrine cell carcinomas of the colon and rectum.

Necrotizing fasciitis secondary to carcinoma of the gallbladder with perforation.

We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.