[A Case of Scirrhous Gastric Carcinoma Diagnosed by Staging Laparoscopy].

We report a case of scirrhous gastric carcinoma diagnosed by staging laparoscopy and discuss some literature reviews. A 60-year-old man was referred because of a choking sensation and weight loss, and gastroendoscopy revealed thickening of the entire circumference of the wall at the gastric cardia. Scirrhous gastric carcinoma was suspected, and biopsy was performed at many points and times by endoscopic examination, but the histologic findings revealed no malignant features. We performed staging laparoscopy, peritoneal washing cytology, and biopsy of the nodules in the abdominal wall. He was diagnosed with advanced gastric cancer with peritoneal dissemination and has received chemotherapy. Staging laparoscopy is a useful method for diagnosis and determination of the management of scirrhous gastric carcinoma.

[A Patient with Scirrhous Gastric Cancer Diagnosed and Resected Subsequently by Laparotomy Examination Due to Difficulty to Take Cancer Specimen by Endoscopic Biopsy].

Some of scirrhous gastric cancer are difficult to diagnose on the surface view or to take correct biopsy specimen.A 85-yearold man with dysphagia was diagnosed scirrhous gastric cancer endoscopically, but could not be taken a biopsy specimen showing cancer.We informed cases of scirrhous gastric cancer difficult to take correct biopsy specimen and recommended surgical operation to take correct specimen and to start a treatment.Patient underwent total gastrectomy after cancer diagnosis( P0CY0cT4aN0).He can eat more food and survive longer than 1 year without any chemotherapies.Scirrhous gastric cancer needs early diagnosis and treatment to improve patient prognosis.

Fibrolamellar carcinoma versus scirrhous hepatocellular carcinoma : diagnostic usefulness of CD68.

BACKGROUND: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma that commonly affects young individuals without a prior history of liver disease. The principal differential diagnosis is conventional hepatocellular carcinoma especially the scirrhous variant. Despite their distinctive appearance, recent studies have demonstrated a lack of consistency in how FL-HCC are diagnosed by pathologists. AIM: To investigate the diagnostic utility of CD68 in differentiating between FL-HCC and scirrhous hepatocellular carcinoma. PATIENTS AND METHODS: In our retrospective study, we reviewed four cases of FL-HCC that were diagnosed at the pathology department of Mongi Slim hospital over a thirteen-year period (2002-2014). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. Immunohistochemical analysis was performed using the avidin-biotin complex technique with antibodies against CD68 and CK7. RESULTS: Our study group included one man and three women (sex ratio M/F=0.33) aged between 23 and 34 years (mean=28 years). All cases arose in non-cirrhotic liver. Immunohistochemically, all cases were positive for CK7 and for CD68 (n=4). CONCLUSIONS: CD68 immunostaining is a sensitive marker for FL-HCC that may be of use in routine diagnostic surgical pathology. Lack of CD68 staining should suggest caution in making a diagnosis of FL-HCC.

Identification of novel transmembrane proteins in scirrhous-type gastric cancer by the Escherichia coli ampicillin secretion trap (CAST) method: TM9SF3 participates in tumor invasion and serves as a prognostic factor.

OBJECTIVE: Scirrhous-type gastric cancer (GC) is highly aggressive and has a poor prognosis due to rapid cancer cell infiltration accompanied by extensive stromal fibrosis. The aim of this study is to identify genes that encode transmembrane proteins frequently expressed in scirrhous-type GC. METHODS: We compared Escherichia coli ampicillin secretion trap (CAST) libraries from 2 human scirrhous-type GC tissues with a normal stomach CAST library. By sequencing 2,880 colonies from scirrhous CAST libraries, we identified a list of candidate genes. RESULTS: We focused on the TM9SF3 gene because it has the highest clone count, and immunohistochemical analysis demonstrated that 46 (50%) of 91 GC cases were positive for TM9SF3, which was observed frequently in scirrhous-type GC. TM9SF3 expression showed a significant correlation with the depth of invasion, tumor stage and undifferentiated GC. There was a strong correlation between TM9SF3 expression and poor patient outcome, which was validated in two separate cohorts by immunostaining and quantitative RT-PCR, respectively. Transient knockdown of the TM9SF3 gene by siRNA showed decreased tumor cell-invasive capacity. CONCLUSION: Our results indicate that TM9SF3 might be a potential diagnostic and therapeutic target for scirrhous-type GC.

The value of diffusion-weighted magnetic resonance imaging in the differential diagnosis in diffuse bowel wall thickening.

BACKGROUND/AIMS: We aimed to investigate the value of diffusion-weighted magnetic resonance imaging in the differentiation of benign-malignant diffuse bowel wall thickening (scirrhous colon carcinoma) and to discuss the diagnostic importance and potential use of apparent diffusion coefficient measurements. MATERIALS AND METHODS: A total of 41 patients (32 males, 9 females; mean age, 57 years) with diffuse bowel wall thickening diagnosed on computed tomography were included in this study. The magnetic resonance imaging was performed on a 1.5 T scanner (Siemens-Espree). Changes in the signal intensity of the lesions were determined by their appearance in images at b800 s/mm 2 , and apparent diffusion coefficient values were also calculated. Lesions were classified in two groups according to the presence of hyperintensity on b800 images and results of endoscopic biopsies. The differences in mean apparent diffusion coefficient values between the two groups were compared with the Mann-Whitney U test, and threshold values were determined with receiver operating characteristic curve analysis. RESULTS: The difference between the mean apparent diffusion coefficient values of benign and malignant groups was statistically significant, and the apparent diffusion coefficient values of benign lesions were significantly higher than of malignant lesions (p<0.05). By using a cut-off value of 1.21 x 10-3mm2 /s, apparent diffusion coefficient had a sensitivity of 100%, specificity of 87.3%, and accuracy of 89.3% in the discrimination of malignant colorectal pathologies. With the visual assessment of the diffusion weighted images and the measurement of apparent diffusion coefficient values, malignant and benign lesions could be differentiated, with 100% sensitivity, 89.2% specificity, and 90.4% accuracy. Although some benign lesions were interpreted as malignant,no malignant lesion was determined as benign in the visual assessment. CONCLUSIONS: Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient values together can successfully differentiate malignant from benign diffuse bowel wall thickening.

Primary diagnosis of metastatic breast cancer in the third trimester of pregnancy: a case report and review of the literature.

To the best of our knowledge, we are presenting the first documented primary diagnosis of a 32-year-old pregnant patient at 29 + 4 weeks' gestation with poorly differentiated, metastatic scirrhous breast cancer, with negative hormone receptors, HER-2/neu receptor overexpression and metastases in the lumbar spine. The patient was administered neoadjuvant chemotherapy with vinorelbine and trastuzumab, and received ibandronate for the bone metastases. The tumor responded well to treatment; however, treatment was associated with anhydramnios, probably related to the trastuzumab treatment. Delivery was planned for 33 + 5 weeks' gestation by cesarean section due to concurrent breech presentation and anhydramnios, and the infant is in good health. After delivery, the patient underwent a mastectomy. Following completion of six courses of vinorelbine and ongoing treatment with trastuzumab and ibandronate, the patient's tumor went into regression and currently the patient does not present with any clinical evidence of disease.

Time-resolved optical mammography and its preliminary clinical results.

We have been developing an optical mammography prototype consisting of a multi-channel time-resolved spectroscopy system for breast cancer screening. The system utilizes the time-correlated single photon counting method, and the detector modules and the signal processing circuits were custom-made to obtain a high signal to noise ratio and high temperature stability with a high temporal resolution. Pulsed light generated by a Ti: Sapphire laser was irradiated to the breast, and the transmitted light was collected by optical fibers placed on the surface of a hemispherical gantry filled with an optical matching fluid. To reconstruct a 3D image of the breast, we employed a method using a time-resolved photon path distribution based on the assumption that scattering and absorption are independent of each other. We verified the possibility of human breast imaging by using a three-dimensional phantom model, which provides a simulation of human breast cancer, in the gantry. The clinical study was also started in January 2007. In a comparative study with conventional modalities, the breast cancers were detected as regions of optically higher absorption. Moreover, the results suggest that optical mammography is useful in monitoring the effects of chemotherapy.

[Orbital metastases of breast cancer. Radiologic features]. / Mammakarzinommetastasen der Orbita. Radiologische Eigenschaften.

BACKGROUND: We reviewed the radiologic features of 15 patients with orbital metastases originating from breast cancer. METHODS: This was a retrospective consecutive case series. Fifteen consecutive patients with orbital metastases originating from breast carcinoma were identified between March 1997 and September 2008. A retrospective chart review was carried out, and the radiologic findings were reviewed. RESULTS: The metastases were preseptal in 53%, intraconal in 60%, and both intraconal and extraconal in 33%. Lacrimal gland enlargement was noted in 33%, episcleral space involvement in 33%, bone involvement in 13%, and globe dystopia in 53%. The extraocular muscles were involved in 87%; in 60%, two or more muscles were involved. The medial and lateral rectus muscles were affected in 53% and 47%, respectively, and the inferior and superior rectus muscles in 33%. In 47% one or more radiologic features had not been noted by the radiologist, and in 20% the findings were misinterpreted as an"orbital pseudotumor." CONCLUSION: Orbital metastases originating from breast cancer may present heterogeneously. Orbital imaging most commonly shows unilateral and multifocal involvement of multiple extraocular muscles and intraconal and preseptal areas by an irregular lesion.

Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies.

We describe a 15-mm scirrhous hepatocellular carcinoma (HCC) in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase. Contrast-enhanced computed tomography (CT) revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase. Magnetic resonance imaging (MRI) revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hyperintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC. Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically, the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.

Recent results of therapy for scirrhous gastric cancer.

The prognosis of patients with scirrhous gastric cancer (SGC) is extremely poor. However, recent advances in therapeutic strategies against SGC, using effective anticancer drugs, have prolonged the survival of patients with SGC. This paper reviews the recent therapeutic outcomes of this type of gastric cancer and introduces a new treatment protocol for SGC.

Flare-up of dermatomyositis along with recurrence of breast cancer.

Dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous manifestations. The association between dermatomyositis and malignancy is becoming more clearly delineated. A sort of dermatomyositis is thought to be paraneoplastic syndrome and dermatomyositis may follow clinical course of malignancy. We report a 68-year-old woman with dermatomyositis, whose clinical onset of dermatomyositis was apparently concomitant with breast cancer. Dermatomyositis had settled down and oral steroid could be tapered after the resection of breast cancer. Creatine kinase value was elevated before the detection of the first and second recurrence and in the terminal state. At the second recurrence, skin lesions and creatine kinase value had flared up and immediate metastatic check-up revealed the recurrence. Our case shows dermatomyositis, which was thought to be paraneoplastic syndrome, that followed clinical course of malignancy and suggests immediate check-up is needed for early detection of recurrence when dermatomyositis flares up after the resection of the malignancy.

Progressive dysphagia in a dog caused by a scirrhous, poorly differentiated perioesophageal carcinoma.

Investigation of canine dysphagia is performed by a combination of diagnostic imaging, direct visualisation of the upper gastrointestinal tract, and ancillary diagnostic testing to differentiate between structural and functional causes. Video fluoroscopy may be especially helpful. The case of a seven-year-old Border collie that presented with a history of progressive pharyngeal dysphagia is described. Fluoroscopic investigation was initially suggestive of functional pharyngeal disease, but magnetic resonance imaging and surgical exploration demonstrated the presence of a diffuse, scirrhous, poorly differentiated carcinoma with extensive oesophageal involvement. This case highlights that, in some circumstances, fluoroscopy may occasionally be of limited use in the investigation of dysphagia in the dog.

[Proptosis as the first sign of recurrent scirrhous breast carcinoma]. / Proptosis como primera manifestación de recidiva de cáncer escirro de mama.

OBJECTIVE: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome. CASE REPORT: The case of a 61-year-old woman, diagnosed and treated seven years ago for a scirrhous breast carcinoma is presented. She complained of blurred vision and proptosis of the left eye and these symptoms were the first manifestation of tumor relapse. DISCUSSION: When orbital inflammation is detected in an adult female patient, a full medical history must be obtained and physical examination performed, as orbital metastases have been reported to be the initial manifestation of malignancy in 30 to 50% of cases.

Proptosis como primera manifestación de recidiva de cáncer escirro de mama / Proptosis as the first signo of recurrent scirrhous breast carcinoma

Objetivo: Informar a los clínicos que las metástasis orbitarias son con frecuencia catalogadas de síndromes inflamatorios.Caso clínico: Se presenta el caso de una mujer de 61 años diagnosticada y tratada siete años antes de un carcinoma escirro de mama. La paciente aquejaba visión borrosa y proptosis en su ojo izquierdo como primera manifestación de la recidiva tumoral.Discusión: Cuando se diagnostica una inflamación orbitaria en una paciente mujer adulta, se debe realizar una meticulosa historia clínica, debido a que las metástasis orbitarias han sido descritas como manifestación inicial de malignidad en el 30 a 50% de los casos

Objective: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome. Case report: The case of a 61-year-old woman, diagnosed and treated seven years ago for a scirrhous breast carcinoma is presented. She complained of blurred vision and proptosis of the left eye and these symptoms were the first manifestation of tumor relapse. Discussion: When orbital inflammation is detected in an adult female patient, a full medical history must be obtained and physical examination performed, as orbital metastases have been reported to be the initial manifestation of malignancy in 30 to 50% of cases

Scirrhous gastric carcinoma: endoscopy versus upper gastrointestinal radiography.

PURPOSE: To compare the accuracy of upper gastrointestinal (UGI) series and endoscopic examination in the diagnosis and localization of scirrhous gastric carcinoma. MATERIALS AND METHODS: Seventy-two patients with pathologically proved scirrhous gastric carcinoma in surgical specimens were included. Preoperative reports at UGI series and endoscopic examination, which included impressions on the location and extent of the tumor, were compared with pathology reports, and the accuracy of the preoperative reports was calculated. Two gastrointestinal radiologists retrospectively reviewed the appearance of mucosa at UGI series. RESULTS: Preoperative diagnoses at endoscopy were Borrmann type IV carcinoma in 28 patients (39%), type III carcinoma in 29 (40%), early gastric carcinoma in seven (10%), lymphoma in six (8%), atrophic gastritis in one (3%), and type II carcinoma in one (3%). Preoperative diagnoses at UGI series were type IV carcinoma in 44 patients (61%), type III carcinoma in 25 (35%), lymphoma in two (3%), and early gastric carcinoma in one (1%). Pathology reports were compared with the preoperative reports, and tumor location and extent were correct in the endoscopic examination reports of 24 patients (33%) and the UGI series reports of 49 patients (68%). In 68 patients, UGI series revealed thickened and irregular folds in 62 (91%), ulceration in 42 (62%), and nodularity in 22 (32%) at consensus review. Endoscopic biopsy samples were positive for malignancy in 66 patients (93%). CONCLUSION: UGI series is superior to endoscopic examination in the diagnosis and localization of scirrhous gastric carcinoma.