[A Case of Rectal Neuroendocrine Carcinoma That Developed Two Years after Curative Resection for Sigmoid Colon Cancer].

We report a rare case ofrectal neuroendocrine carcinoma(NEC)following sigmoidectomy of sigmoid colon cancer. NEC of the rectum is a rare disease. It has an extremely poor prognosis and a high potential for malignancy with hematogenous and lymph node metastases. A 90-year-old man who had carcinoma ofthe sigmoid colon 2 years ago was found to have rectal NEC based on endoscopy findings. He underwent the Hartmann operation. Histological and immunohistochemical analyses showed NEC. Four months after the surgery, he developed local recurrence with lymph node metastasis. He was not administered chemotherapy because ofhis old age. Although the patient needed strict outpatient care, he remained symptom-free 4 months after the Hartmann operation.

[A Case of Recurrent Jejunal Stenosis after Total Gastrectomy Treated with Self-Expandable Metallic Stent].

Case is a 66-year-old male. He was inserted covered self expandable metallic stent(SEMS)for jejunal stenosis due to gastric cancer recurrence. Migration was occurred after 4 days from stent replacement. We had removed SEMS by endoscopy, and re-inserted non-covered SEMS. Two months later, stent stenosis was occurred by tumor ingrowth. We tried to insert another stent in the stenotic stent. The patient was able to maintain oral intake without complication for 3 months. SEMS placement would improve a quality of life for selected patients with recurrent jejunal stenosis.

[Significance of Perioperative Neutrophil Lymphocyte Ratio(NLR)in Gastric Cancer and Colon Cancer].

BACKGROUND: We examined the significance of neutrophil lymphocyte ratio(NLR)in gastric cancer and colon cancer in the perioperative period. METHOD: There were 46 patients(21 with gastric cancer and 25 with colon cancer). We examined the association between preoperative NLR and other indicators of nutritional status, as well as the relationship between preoperative NLR and the incidence of postoperative complications(all complications/infectious complications). RESULT: NLR was higher in those with zinc<65 mg, prognostic nutritional index(PNI)≤40, and modified Glasgow prognostic score(mGPS)of 2 (p<0.05). NLR showed no difference among all patients with complications(12 cases), but was higher in patients with infectious complications(p<0.05). CONCLUSION: Preoperative NLR is correlated with PNI as a predictor of infectious complications.

Occult lung cancer incidentally found during surgery for esophageal and gastric cancer: a case report.

A 70-year-old male was admitted to our hospital because of advanced esophageal squamous cell carcinoma and early gastric adenocarcinoma. A esophagectomy and partial gastrectomy with three-field lymph node dissection (neck, mediastinum and abdomen) was performed. Both tumors had lymph node metastases. In addition, three mediastinal lymph nodes (two subcarinal lymph nodes and a middle thoracic paraesophageal lymph node) were involved with adenocarcinoma. To elucidate whether they were metastases from the gastric cancer, an immunohistochemical analysis was performed. The cancer cells in these lymph nodes were positive for cytokeratin (CK) 7 and negative for CK 20, thus suggesting metastasis from a nondigestive organ. Interestingly, they were positive for thyroid transcription factor 1 (TTF-1), indicating metastasis from a lung cancer. Since the preoperative computed tomographic scan showed no evidence of lung cancer, a diagnosis of metastases from an occult lung cancer was finally recorded. Ten months after surgery, the patient was alive without a recurrence or the appearance of a lung cancer.

Long-term results of endoscopic injection sclerotherapy in 602 patients with esophageal varices.

BACKGROUND/AIMS: Endoscopic injection sclerotherapy (EIS) has been extensively applied world wide. There are few reports, however, addressing the long-term prognosis (>20 years), although more than two decades have elapsed since the introduction of EIS for esophageal varices. Therefore, the cases of EIS performed in the past 25 years were reviewed to evaluate the long-term results of this procedure. METHODOLOGY: There were 602 patients who underwent EIS for esophageal varices between 1981 and 2005, involving a total of 1,964 applications of this procedure. The procedure begins by intravascular injection of 10-20 mL of 5% ethanolamine oleate. The long-term follow-up data were evaluated with primary reference to changes in esophageal varices, survival rate, bleeding rate, causes of death and re-bleeding. RESULTS: In 188 patients with known final endoscopic findings, the gross morphologic status was F1 in 65 patients (34.6%) and F0 in 123 patients (65.4%), only 22 patients (11.7%) were positive for red color sign. The survival rate was 47.4% at 5 years, 25.9% at 10 years, and 13.9% at 15 years. Rebleeding occurred in 93 patients (15.4%). The bleeding rate was 22.9% at 5 years, 28.9% at 10 years, and 28.9% at 15 years. The causes of death were hepatic failure in 244 patients and hepatic cancer in 88 patients, 19 patients died as a result of bleeding from varices (4.8%), 3 patients who died due to therapeutic procedure of EIS. CONCLUSIONS: Both the survival rate and rebleeding rate associated with EIS were comparable to those undergoing surgical treatment in patients whose clinical characteristics were matched. EIS is a minimally invasive treatment method that is considered to be an effective first-line treatment for esophageal varices.

Esophageal cancer associated with right aortic arch: a case study.

Right aortic arch is a rare congenital vascular anomaly, thus, the surgical resection of esophageal cancer in a patient with this anomaly is extremely uncommon. The surgical treatment of esophageal cancer was performed in a 73-year-old man with right aortic arch. An upper GI series and endoscopy revealed Type 2 esophageal cancer in the lower thoracic esophagus. Chest computed tomography revealed a right aortic arch with an aberrant subclavian artery and was classified as an aortic arch anomaly of Type IIIB according to the Edwards' classification. The middle and lower portions of the intrathoracic esophagus were resected through a left thoracoabdominal incision. Type IIIB is the most common form of right aortic arch. For surgical resection, a left thoracotomy was the most common method. It is difficult to adequately visualize the right recurrent laryngeal nerve through a left thoracotomy alone and an additional incision, i.e., a midline stemrnotomy, may be necessary.

Case report: a young woman with advanced esophageal cancer showing pathological complete response to neoadjuvant chemotherapy (CDDP, 5-FU and ADM).

A 32-year-old woman was admitted to our hospital with dysphagia. An upper gastrointestinal series revealed Borrmann type 2 esophageal cancer in the lower thoracic esophagus. Because direct invasion of the thoracic aorta was suspected, FAP therapy (CDDP, 5-FU and ADM) was given as neoadjuvant chemotherapy. After completion of two courses, her dysphagia resolved and the tumor shrank by over 90%, so radical surgery was performed. No lesions were found when the resected specimen was examined macroscopically. The only histological change was hyperplasia of collagen fibers in the submucosa, lamina propria and adventitia of the esophagus. No cancer cells and no metastases to the lymph nodes were observed. Because the tumor had completely disappeared, the histological effect of chemotherapy was classified as grade 3, i.e., pathological complete response (PCR). The response to FAP therapy was excellent and no serious adverse events occurred. Therefore, this is one of the treatments that should be actively applied in patients who have advanced esophageal cancer with suspected lymph node metastasis and invasion of other organs.