[A Case of Subphrenic Lymph Node Metastasis from Gastric Cancer in Which FDG-PET/CT Was Useful for Diagnosis].

A 70-year-old man was admitted for lymph node metastasis detected by FDG-PET/CT showing a mass 10mm in diameter. He had a history of a distal gastrectomy for advanced gastric cancer and was administered postoperative adjuvant chemotherapy consisting of 2 courses of TS-1 with CDDP and TS-1 only for 1 year. Lymph node recurrence was diagnosed and resected 4 years after the initial surgery. Histological examination revealed lymph node metastasis of the gastric cancer. He was administered adjuvant chemotherapy using TS-1 and has been followed-up without recurrences for 17 months after the second operation. We reported a case in which FDG-PET/CT was potentially beneficial for the diagnosis of the postoperative small lymph node metastasis.

[A Case of Rectal Cancer with Lymphangiosis Carcinomatosa Successfully Treated with Chemotherapy Despite Anaphylactic Reaction to Oxaliplatin].

A 64-year-old man was admitted because of dyspnea. He was diagnosed with rectal cancer with lymphangiosis carcinomatosa and metastases in the liver and lymph nodes. The patient was treated with cetuximab and modified FOLFOX6 (mFOLFOX6). After treatment, the primary rectal cancer and metastases were considered to have achieved a partial response (PR) and the lymphangiosis carcinomatosa remarkably improved. However, anaphylactic shock occurred in the 6 courses of treatment, 5 minutes after the infusion of oxaliplatin, and the patient was treated.

Minichromosome maintenance protein 7 is a risk factor for recurrence in patients with Dukes C colorectal cancer.

BACKGROUND: It has been hypothesized that minichromosome maintenance (MCM) proteins, which are replicative control factors, can be used to detect tumor proliferation. The aim of the present study was to investigate the expression of MCM in colorectal cancer tissues and correlate it to clinical outcomes. PATIENTS AND METHODS: The study included 145 patients with colorectal cancer who underwent curative surgery, from January 2002 until December 2004, at the Kurume University Hospital in Fukuoka, Japan. The median follow-up duration was 87 months. The expression of MCM7 in tissues was studied by immuno-histochemical staining. The labeling index (LI) of MCM7 was calculated by dividing the number of positively-stained cells by the total number of cells counted. We divided samples into two groups: positive (MCM7 LI 76% or higher) and negative (MCM7 LI less than 76%). RESULTS: In patients with Dukes A and B, there were no significant differences in either overall survival (OS) or recurrence-free survival (RFS) between patents with MCM7-positive and those with MCM7-negative disease. On the other hand, in patients with Dukes C, there was significantly worse OS and RFS for patients with MCM7-positive compared to those with MCM7-negative disease. CONCLUSION: We found that the expression of MCM7 is an independent risk factor for RFS in patients with Dukes C colorectal cancer. Further studies are required to investigate the validity of MCM7 protein expression for its potential clinical use in colorectal cancer therapy and prognosis.

Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975-2004.

BACKGROUND: Colorectal cancer is the third most common cancer and leading cause of cancer-related death in Japan. One of the major problems in rectal cancer surgery is local recurrence. Pelvic sidewall dissection (PSD) has the potential to reduce local recurrence. PATIENTS AND METHODS: This study included all 994 patients with rectal cancer who underwent curative surgery from January 1975 until December 2004, at the Kurume University Hospital in Fukuoka, Japan. The patients were analyzed to determine whether lateral lymph node (LLN) metastasis correlates with clinicopathological factors, and to determine a diagnostic tool based on magnetic resonance imaging (MRI) findings. RESULTS: The rate of positive LLNs in patients who underwent PSD was 7.5% in the upper rectum, and 14.5% in the lower rectum. Logistic regression analysis disclosed that perirectal lymph nodes metastasis was associated with an increased incidence of positive LLNs and had a greater hazard ratio. Positive LLNs were frequently found to be located along the internal iliac artery (47 patients; 89%) or around the oburator vessels and nerve (17 patients; 32%). MRI has become a promising diagnostic tool in patients with rectal cancer including LLN estimation. CONCLUSION: We speculate that PSD may be a good candidate as an effective strategy for lower rectal cancer. In further studies, it is important to investigate the validity of PSD for its potential clinical use in lower rectal cancer therapy and prognosis.

Virchow lymph node metastatic recurrence of sigmoid colon cancer with severe lymph node metastases successfully treated using systemic chemotherapy combined with radiotherapy.

Metastatic recurrence of colon cancer in the left supraclavicular lymph node (Virchow lymph node) is rare, and to date there are no reports on radiotherapy as treatment. We report on a case of metastatic recurrence of sigmoid colon cancer in the Virchow lymph node with severe lymph node metastases successfully treated with a combined modality therapy of systemic chemotherapy and radiotherapy. The case is of a 58-year-old man, who underwent sigmoid excision and lymph node excision, and subsequently received systemic chemotherapy. After left supraclavicular lymph node recurrence appeared he later received radiotherapy. Complete response was achieved, and there has been no further recurrence, to date, 10 months after the radiotherapy. Radiotherapy was effective as a local treatment, and local control of distant metastasis of colonic cancer may lead to a good prognosis.

Amphiregulin is a prognostic factor in colorectal cancer.

Amphiregulin is an epidermal growth factor (EGF) which is a ligand of epidermal growth factor receptor (EGFR). Amphiregulin is the most enhanced EGFR ligand in colon cancer. Here we report on the expression of Amphiregulin using immunohistochemical staining in primary colorectal cancer, and the correlations between prognosis and various clinicopathological factors. We examined 174 consecutive patients who underwent curative resection of colorectal cancer, from January 2002 to December 2004. Amphiregulin was positive in 156 (90%) patients. Amphiregulin was found to be an independent predictor of overall survival [hazard ratio=6.25 (95% confidence interval=1.3-111.5; p=0.0144)] and relapse-free survival [hazard ratio=6.94 (95% confidence interval=1.5-123.2; p=0.0075)]. We conclude that the expression of Amphiregulin in a primary colorectal tumor is useful as an indicator of prognosis and as a predictor of recurrence.