[A Case of Extrahepatic Hepatocellular Cancer Discovered during Gynecological Laparoscopic Surgery].

Recently, laparoscopic surgery has become increasingly popular because of its lesser invasiveness, including smaller incisions, and fewer post-operative complications. It is also possible to observe the abdominal cavity by laparoscopy. We report a hepatocellular carcinoma arising in an accessory liver lobe detected during gynecological laparoscopic surgery. A 48-year-old woman who was undergoing laparoscopic hysterectomy for uterine fibroids was found to have a protruding, extrahepatic pedunculated tumor by intraoperative observation of the abdominal cavity during the fibroid procedure. We suspected FNH based on preoperative imaging findings, including abdominal ultrasound, computed tomographic scanning, and magnetic resonance imaging. We performed a laparoscopic partial hepatectomy. The cut surface of the tumor was similar to normal liver tissue. The pathological findings identified normal liver tissue and vessels, suggesting it was the accessory liver lobe. It also included a well-differentiated hepatocellular carcinoma. The final diagnosis was hepatocellular carcinoma arising in the accessory liver lobe. There have been no prior reports of extrahepatic liver tissue detected during gynecological surgery. This case reminded us of the importance of intra-abdominal observation during laparoscopic procedures. The opportunities to discover other cases of extrahepatic liver tissue by laparoscopy will increase.

[A Case of Removable Self-Expandable Metallic Stent(SEMS)Placement for Gastric Tube Stenosis after Esophageal Cancer Resection].

A 68-year-old man underwent esophagectomy for early esophageal cancer. Postoperative upper gastrointestinal series and esophagogastroduodenoscopy showed gastric tube stenosis. To improve passage, a removable self-expandable metallic stent (SEMS) was placed across the stenotic lesion. Two weeks later, the stent was removed, and passage through the gastric tube improved. The patient has no symptoms of stenosis. A removable SEMS could be an option for the treatment of gastric tube stenosis after esophagectomy.

[A Case of Penetrating Diverticulum of the Small Intestine that Occurred during Chemotherapy for Esophageal Cancer].

An 80-year-old man was seen by his family doctor with chief complaints of fatigue and loss of appetite. Upper gastrointestinal endoscopy showed a type 2 tumor of the lower thoracic esophagus, and the patient was referred to our hospital. Squamous cell carcinoma was diagnosed on biopsy, and computed tomography (CT) showed multiple pulmonary metastases. The patient was diagnosed with Stage Ⅳ thoracic esophageal carcinoma, and was started on combined chemotherapy with 5-FU plus CDDP. Seven days after the start of chemotherapy, the patient developed mild intermittent pain. By day 18, the blood tests showed a marked inflammatory response, and a CT scan showed an abscess in the small bowel mesentery. We suspected an intra-abdominal abscess caused by small bowel perforation, and performed a partial resection of the small bowel and abscess drainage. Postoperatively, pathology tests revealed a diagnosis of a small intestinal diverticulum, which had penetrated the mesentery. We report our experience of a rare case of penetrating diverticulum of the small intestine that occurred during chemotherapy for esophageal cancer, and review the literature.

[Long-Term Survival of Gastric Cancer with Peritoneal Metastasis--A Case Report].

We report a case of almost 9-year survival of a patient with unresected gastric cancer with peritoneal metastasis. A 76-year-old Japanese man was admitted to the hospital for resection of gastric cancer, but it was not resected because of peritoneal metastasis. After discharge, the patient was treated with combination chemotherapy of S-1 and paclitaxel (PTX). After 8 cycles of chemotherapy, the tumor disappeared. We recommended surgical therapy, but he did not agree. The chemotherapy was continued for almost 9 years with 8 regimens including S-1 plus PTX (21+8+5 cycles), S-1 plus CPT-11 (11+2 cycles), S-1 plus docetaxel (DOC) (25 cycles), S-1 plus CDDP plus trastuzumab (1 cycle), PTX (5 cycles), PTX plus trastuzumab (1 cycle), DOC (6 cycles), and nab-PTX (1 cycle). With nutrition support provided through an enterocutaneous fistula and home parenteral nutrition, he has taken chemotherapy throughout without severe complications.

[Analysis of Pancreaticoduodenectomy for Elderly Patients Aged 75 Years or Older].

The feasibility of pancreaticoduodenectomy (PD) for elderly patients is controversial. Of 51 patients with pancreatic or bile duct tumor who underwent PD (except portal vein resection), the surgical results of 27 elderly patients aged 75 years or older (elderly group) we retrospectively evaluated and compared with those of 24 patients younger than 75 years (younger group). Although ASA-PS was significantly higher in the elderly group, we did not observe any significant difference in other background characteristics, complications, or length of hospital stay between the two groups. This study suggests that PD is probably safe and feasible with the appropriate surgical indication for elderly patients.

[A Resected Case of Acinar Cell Carcinoma Diagnosed by Endoscopic Ultrasound Guided Fine-Needle Aspiration Prior to Surgical Treatment].

Acinar cell carcinoma (ACC) of the pancreas is an extremely rare tumor type, accounting for approximately 1% of all pancreatic neoplasm. Here, we report a rare case of ACC of the pancreas diagnosed on the basis of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) findings prior to surgical treatment. A 73-years-old woman was being followed-up for chronic hepatitis C at our institution. Abdominal enhanced computed tomography showed an enhanced region, 16 mm in size, near the head of the pancreas on early-phase images. Magnetic resonance cholangiopancreatography did not show interruption or dilatation of the main pancreatic duct. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed an increased FDG uptake in the mass (SUVmax=12.7). EUS-FNA indicated a diagnosis of ACC, and pancreaticoduodenectomy was performed. Pathological examination confirmed the diagnosis of ACC. The patient was discharged after an 18-day hospital stay. Two years later, the patient has not shown any sings of recurrence.

MACC1 expression levels as a novel prognostic marker for colorectal cancer.

Metastasis-associated in colon cancer-1 (MACC1) is key in promoting tumor proliferation and invasion, and is mediated by the hepatocyte growth factor (HGF) and mesenchymal-epithelial transition factor. Previous reports have revealed that MACC1 is a novel oncogene that is expressed in various types of gastrointestinal cancer. The present study comprised of 174 patients who underwent curative surgery for colorectal cancer (CRC). The correlation between gene expression and clinical parameters of the patients was assessed. It was identified that patients exhibiting high MACC1 expression levels were statistically more susceptible to distant metastases and a poor prognosis, and those exhibiting low MACC1 expression showed improved disease-free and overall survival than those with high expression. Therefore, the present data indicates that MACC1 expression levels may present as a prognostic factor in CRC patients.

[A case of long-term survival in rectal cancer with late lung and kidney metastases treated with combined multimodality therapy].

A 59-year-old man was diagnosed with rectal cancer and a low anterior resection was performed. Bilateral lung metastases appeared 4 years and 4 months after the primary surgery. The lung metastases were resected and FOLFOX6 neoadjuvant chemotherapy was administered. An abdominal computed tomography (CT) scan 7 years and 11 months after the primary surgery revealed bilateral multiple lung metastases, a left renal tumor, and swelling in the surrounding lymph node. A left nephrectomy and lymph node dissection were performed. A diagnosis of renal tumor from rectal cancer metastasis was made. For the lung metastases, chemotherapy (sLV/5FU2+Bmab) was administered in 26 courses and stable disease was achieved. It is important to combine adequate surgical resection and systemic chemotherapy for long survival.

[A case of partial hepatectomy and gastrectomy for hepatocellular carcinoma with direct invasion to the stomach].

An 81-year-old man treated with chronic hepatitis C virus (HCV)-related hepatitis and hepatocellular carcinoma (HCC) was diagnosed in 2010 with HCC recurrence (subclass S2) on computed tomography (CT). He refused surgery and was followed up without treatment. In 2012, he was admitted to our hospital because of hematemesis. Gastrointestinal endoscopy revealed a large tumor in the upper gastric corpus, and pathological examination of the tumor revealed HCC; hence, we diagnosed the patient with direct HCC invasion to the stomach. Although active bleeding from the tumor was controlled, he experienced repeated episodes of hematemesis, and the tumor increased in size. Therefore, partial hepatectomy and gastrectomy were performed. It was confirmed that the tumor invaded the stomach wall. Although surgery was effective for gastrointestinal bleeding caused by HCC invasion, the patient died 12 months after surgery because of multiple liver metastases and exacerbated liver failure.

[Analysis of portal vein resection during pancreaticoduodenectomy in patients with pancreatic cancer].

The feasibility of portal vein resection (PVR) during pancreaticoduodenectomy (PD) for cancer of the pancreatic head is controversial. We retrospectively evaluate the surgical results and prognosis of 26 patients with pancreatic cancer who received PD with PVR (PVR group, n=14) or without PVR (non-PVR group, n=12). The operation time was significantly greater in the PVR group, with a mean time of 13.6 ± 2.4 minutes. There were no differences between the PVR and non-PVR groups in the incidence of complications or the number of days in hospital. In the PVR group, 7 patients were histopathologically diagnosed with portal vein invasion (PV), but there was no difference in the postoperative survival between PV negative and positive patients. PVR during PD appears to be a safe and feasible treatment for appropriate stage pancreatic cancer patients receiving adjuvant chemotherapy.

Potential biological insights revealed by an integrated assessment of proteomic and transcriptomic data in human colorectal cancer.

In the post-genomic era, the main aim of cancer research is organizing the large amount of data on gene expression and protein abundance into a meaningful biological context. Performing integrated analysis of genomic and proteomic data sets is a challenging task. To comprehensively assess the correlation between mRNA and protein expression, we focused on the gene set enrichment analysis, a recently described powerful analytical method. When the differentially expressed proteins in 12 colorectal cancer tissue samples were considered a collective set, they exhibited significant concordance with primary tumor gene expression data in 180 colorectal cancer tissue samples. We found that 53 upregulated proteins were significantly enriched in genes exhibiting elevated gene expression levels (P<0.001, ES=0.53), indicating a positive correlation between the proteomic and transcriptomic data. Similarly, 44 downregulated proteins were significantly enriched in genes exhibiting elevated gene expression levels (P<0.001, ES -0.65). Moreover, we applied gene set enrichment analysis to identify functional genetic pathways in CRC. A relatively large number of upregulated proteins were related to the two principal pathways; ECM receptor interaction was related to heparan sulfate proteoglycan 2 and vitronectin, and ribosome to RPL13, RPL27A, RPL4, RPS18, and RPS29. In conclusion, the integrated understanding of both genomic and proteomic data sets can lead to a better understanding of functional inference at the physiological level and potential molecular targets in clinical settings.

Clinical significance of ASB9 in human colorectal cancer.

Ankyrin repeat and SOCS box-containing 9 (ASB9) is involved in the negative regulation of cytokine signaling. However, its biological function is largely undefined. The aim of this study was to assess the value and role of ASB9 as an indicator of prognosis in colorectal cancer (CRC). In order to demonstrate the importance of ASB9 expression for predicting the prognosis of CRC, we analyzed the ASB9 mRNA expression in 125 paired cases of CRC and non-cancerous regions and the protein expression by immunohistochemistry. To investigate the role of ASB9 in vitro, we performed proliferation and invasion assay with small interfering RNA against ASB9. ASB9 mRNA expression was higher in CRC tissue than corresponding normal tissue (P=0.0282). Patients expressing low levels of ASB9 had a poorer overall survival rate than those expressing high levels (P=0.0301), indicating that decreased ASB9 expression was an independent prognostic factor. The immunohistochemical study revealed that ASB9 was predominantly expressed in cancer cells. A multivariate analysis showed that ASB9 expression status was an independent prognostic factor of overall survival (relative risk, 4.09; 95% confidence interval, 1.47-11.88; P=0.007). In an invasion assay, ASB9 siRNA-transfected cells showed significantly high invasiveness. The results of the present study suggest that ASB9 is a useful prognostic marker for CRC.

TGM2 is a novel marker for prognosis and therapeutic target in colorectal cancer.

BACKGROUND: Transglutaminase 2 (TGM2) plays a role in cell growth and survival through the antiapoptosis signaling pathway. METHODS: We analyzed TGM2 gene expression in 91 paired cases of colorectal cancer (CRC) and noncancerous regions and seven CRC cell lines to demonstrate the importance of TGM2 expression for the prediction of prognosis of CRC. TGM2 expression was higher in CRC tissue than in corresponding normal tissue by real-time reverse transcriptase-polymerase chain reaction (P = .015). RESULTS: Patients in the high TGM2 expression group showed a poorer overall survival rate than those in the low expression group (P = .001), indicating that the increase in TGM2 expression was an independent prognostic factor. TGM2 was also expressed in the seven CRC cell lines. The in vitro proliferation assay showed that TGM2 expression is involved with tumor growth. CONCLUSIONS: The present study suggests that TGM2 is useful as a predictive marker for patient prognosis and may be a novel therapeutic target for CRC.