Papular angiolymphoid hyperplasia and lymphoplasmacytic plaque: a clinical and histological spectrum.

Acral pseudolymphomatous angiokeratoma of children (APACHE) is a rare form of cutaneous pseudolymphoma characterized byangiomatous papules with a predilection for the acral regions of children. Classically, a dense dermal lymphocytic infiltrate composed of both T and B cells is seen in histological specimens, together with prominent vessels lined by plump endothelial cells. Increasing evidence suggests that this condition is neither necessarily acral, pseudolymphomatous, nor angiokeratomatous. It may not always be a pediatric disease. Therefore, the correctness of its nomenclature has been questioned. Herein, we report threecases whose clinical and histological features were consistent with the diagnosis of APACHE. To our knowledge, this is the first report of APACHE from Southeast Asia. We also discuss why we believe "APACHE" to be a misnomer and support "papular angiolymphoid hyperplasia" as a more accurate and encompassing term. In addition, we illustrate a case with significant overlapping features with lymphoplasmacytic plaque in children, suggesting that both entities may exist on a clinical andhistological spectrum.

Safety of transorally-inserted anvil for esophagojejunostomy in laparoscopic total gastrectomy.

BACKGROUND: To assess the safety of transorally-inserted anvil (TOA) for use during esophagojejunostomy (EJ) reconstruction during laparoscopic total gastrectomy (LTG). METHODS: Between March 2009 and December 2011, 39 consecutive open total gastrectomies (OTGs) and 36 LTGs using TOA for gastric cancer were comparatively evaluated. We investigated postoperative complications, using the Clavien-Dindo classification. To evaluate the effect of a learning period in using TOA for LTG, we also investigated shifts in the patterns of complications and changes in total operation time over the course of the study. RESULTS: The patient characteristics at baseline were not different between both groups, except for the extent of lymphadenectomy (P < 0.001) and depth of tumor invasion (P = 0.003). Multivariate analysis revealed that TOA usage elevated the occurrence of infectious complications significantly (OR = 3.32, P = 0.042), but was not associated with EJ-related complications. TOA usage did not need a learning period for the length of time required to complete the operation, or the likelihood of developing an EJ-related or infectious complication. CONCLUSIONS: TOA use for EJ during LTG is relatively simple and easy enough not to require a learning period for surgeons. This procedure did not elevated the occurrence of EJ-related complications compared to circular stapling in open surgery, but it does require special prevention efforts to avoid infectious complications.

A phase II study of biweekly dose-intensified oral capecitabine plus irinotecan (bXELIRI) for patients with advanced or metastatic gastric cancer.

Capecitabine, a prodrug of 5-FU, has been reported to generate maximal tumour activity at tumour sites and/or to improve drug tolerability as compared with 5-FU infusion, and it has also been demonstrated to act synergistically with irinotecan against some solid cancers. A previous study concluded that dose-intensified biweekly capecitabine seems to be more effective at increasing both response rate and progression-free survival time than conventional dose and schedule of capecitabine in colon cancer. We conducted this study to ascertain the efficacy and toxicity of dose-intensified biweekly capecitabine and irinotecan combination chemotherapy in chemotherapy-naïve advanced or metastatic gastric cancer patients. Patients were treated with irinotecan 130 mg m(-2) intravenously for 90 min on days 1 and 15. Capecitabine at 3500 mg m(-2) day(-1), divided into two sessions per day, was administered for seven consecutive days from days 1 and 15, and followed by a 7-day drug-free period, respectively. Fifty-five eligible patients were enrolled in this study from November 2003 to April 2006. There were 22 women and 33 men: median patient age was 54 years (range: 27-81). A total of 200 treatment cycles were administered at a median number of four per patient (range: 1-9). Intent-to-treatment analysis showed that one patient achieved complete response (1.8%), 23 partial response (41.8%), 15 stable disease (27.3%), 10 progressive disease (18.2%) and 6 were non-evaluable (10.9%). The overall response rate was 43.6% (95% confidence interval: 30.2-56.9). The common grade 3-4 toxicities were neutropenia in 12 (21.8%), nausea/vomiting in 3 (5.4%) and diarrhea in 4 (7.2%) patients. Median time to progression was 5 months (range: 0.5-11 months), median survival duration was 11 months (range: 0.5-45 months) and median response duration was 6 months (range: 0.5-9 months). Biweekly dose-intensified capecitabine and irinotecan combination chemotherapy was active for the treatment of advanced or metastatic gastric cancers with a tolerable safety profile.

Double cancer of the stomach and oesophagus with situs ambiguus with polysplenia: the importance of preoperative evaluation.

A rare case of double cancer with situs ambiguus with polysplenia is presented. A 58-year-old patient was initially diagnosed with an early gastric cancer. On evaluation, the computed tomography of the abdomen demonstrated situs ambiguus with polysplenia. We performed a subtotal gastrectomy with the stomach being reconstructed in a Billroth-II fashion. Three months after the operation, he again visited our department complaining nausea and dysphagia. Examinations confirmed the other oesophageal malignancy with advanced stage. Because of unfamiliarity to situs anomaly and rarity of double cancer, we missed the other coexistent cancer. This is the first case presentation of a double carcinoma occurring in a patient with situs ambiguus with polysplenia. The literature is reviewed and the importance of preoperative evaluation is discussed.

Inflammatory myofibroblastic tumor of the stomach with peritoneal dissemination in a young adult: imaging findings.

Inflammatory myofibroblastic tumors are lesions that most often affect young adults and children. These tumors have been found in numerous extrapulmonary sites but rarely in the stomach. It is unknown whether this process is reactive or neoplastic. They are infiltrative lesions and often extend through the gastric wall, sometimes reaching adjacent organs including the esophagus, duodenum, peritoneal cavity, spleen. pancreas, and liver. These features mimic malignancy on endoscopy and radiology. We report the ultrasound, color Doppler ultrasound, and helical computed tomographic findings of a gastric inflammatory myofibroblastic tumor with peritoneal dissemination in a young adult. To our knowledge, this is the first report of color Doppler ultrasound and helical computed tomographic findings of this rare disease entity.

Phase II trial of epirubicin, cisplatin, oral uracil and tegafur, and leucovorin in patients with advanced gastric carcinoma.

BACKGROUND: The results of chemotherapy for patients with gastric carcinoma generally have been modest, although regimens developed more recently have produced higher response rates. One such regimen is epirubicin, cisplatin, and protracted infusion of 5-fluorouracil (ECF). The advantage of a long-term oral administration of uracil and tegafur (UFT) is that this treatment may be used to mimic the protracted infusion of 5-fluorouracil (5-FU). In addition, UFT treatment combined with leucovorin had a favorable activity and tolerable toxicity in patients with advanced gastric carcinoma. Instead of the inconvenience of an infusion pump and intravenous catheter for the protracted infusion of 5-FU, the authors administered UFT plus leucovorin in an ECF regimen for the treatment of patients with advanced gastric carcinoma. METHODS: Fifty-two patients with advanced gastric carcinoma received epirubicin, cisplatin, and oral UFT plus leucovorin. Epirubicin 50 mg/m(2) and cisplatin 60 mg/m(2) were administered on Day 1 by intravenous injection. Tegafur and uracil 360 mg/m(2)/day orally was administered in conjunction with leucovorin administered at a fixed dose of 45 mg/day orally in divided daily doses for 21 days followed by a 7-day rest period. These courses were repeated every 4 weeks. The median age of the patients was 59 years with a median World Health Organization performance status of 1. Patients received a median of five courses of treatment (range, 1-10). RESULTS: Among the 47 patients evaluated, three patients achieved complete response, and 24 patients had partial responses, for an overall response rate of 57.5% (95% confidence interval, 71.5-43.3%). Stable disease was reported in 11 patients (23.4%), and another 9 patients (19.1%) showed disease progression. The median duration of survival was 15 months (range, 2-33+). The main toxicity was nausea/vomiting and neutropenia. Significant toxicity (modified National Cancer Institute common toxicity Grade 3 or 4) included neutropenia in 22 patients (42%), nausea in 14(27%), vomiting in 9 (18%), oral mucositis in 3 (6%), and diarrhea in 3 (6%) patients. CONCLUSIONS: The authors conclude that epirubicin, cisplatin, and oral UFT plus leucovorin, a convenient regimen, has a significant activity and tolerable toxicities in patients with gastric carcinoma.

Preoperative evaluation of gastric cancer: value of spiral CT during gastric arteriography (CTGA).

BACKGROUND: To evaluate the utility of dual-phase spiral computed tomography during gastric arteriography (CTGA) in the preoperative staging of gastric cancers. METHODS: We performed CTGA in 21 patients with pathologically proven gastric cancers. CTGA findings were prospectively analyzed and correlated with surgical and pathologic findings. Dual-phase scans were performed at 10 s (early) and 60-100 s (delayed) after injection of 120 mL of contrast medium at an injection rate of 6 mL/s through a preset 5-Fr catheter positioned in the celiac trunk. Spiral CT scans were assessed for enhancing pattern of the normal gastric wall, tumor detectability, and accuracy of tumor staging. RESULTS: Normal gastric mucosa was clearly visible as two or three layers in all patients on early-phase scans and in eight patients on delayed-phase scans. The primary tumors were correctly detected with CTGA in seven (88%) of the eight early gastric cancers and in all 13 (100%) advanced gastric cancers. The accuracy of CTGA for T staging was 50% and 77% in early and advanced gastric cancers, respectively. The overall accuracy for tumor detection and T staging was 95% and 67%, respectively. The accuracy of CTGA for the degree of serosal invasion and regional lymph node metastasis was 77% and 76%, respectively. CONCLUSION: The CTGA technique improved tumor detection rate and accuracy of tumor staging, especially in early gastric cancer, and may be very useful in the preoperative staging of gastric cancer.

Clinical Significance of Peripheral Blood CEA mRNA Expression in Gastric Cancer Patients Underwent Curative Resection.

PURPOSE: Recent advances in molecular technology have made it possible to detect small numbers of circulating tumor cells in the peripheral blood or bone marrow. Carcinoembryonic antigen (CEA) is an oncofetal antigen that is expressed in epithelial tumor cells. CEA mRNA may be a reliable marker for the detection of tumor cells in the peripheral blood of patients with epithelial cancer. MATERIALS AND METHODS: We analyzed the peripheral blood of 46 patients with gastric cancer who had undergone curative resection. The presence of CEA mRNA was serially monitored using RT-PCR (Preop, Post op 15 day, 2 months (m), 4 m, 6 m, 8 m, 10 m, 12 m). The clinical characteristics, serum CEA level and immunohistochemical staining of tumor tissue were also evaluated. Patients were followed up for 6 to 12 months. RESULTS: There was no significant relationship seen between CEA mRNA RT-PCR positivity in the peripheral blood and sex, stage, serum CEA level or immunohistochemical staining for CEA antigen, During follow up,eight patients experienced recurrence; were positve for CEA mRNA RT-PCR recurrence was seen in 66.7% (6/9) of the patients who before clinical recurrence as compared to 5.4% (2/37) of patients who were negative (p=0.0002). Serial changes of CEA mRNA RT-PCR correlated with clinical recurrence; 100% in the positively converted group (3/3), 0% in the negatively converted group(0/18), 50% in all positive group (3/6) and 10.5% in all negative group (2/19) experienced recurrence, respectively. CONCLUSION: RT-PCR analysis of CEA mRNA in the peripheral blood seems to be a promising tool for the early detection of micrometastatic circulating tumor cells in gastric cancer patients and may be useful in determining patients at high risk for recurrence. However, definitive correlation with recurrence certainly requires a longer follow up duration in further studies.

Paclitaxel, 5-fluorouracil, and cisplatin combination chemotherapy for the treatment of advanced gastric carcinoma.

BACKGROUND: Although the clinical efficacy of paclitaxel in the treatment of gastric carcinoma has not been clearly defined, recent reports have suggested a possible role in the treatment of upper gastrointestinal carcinomas in vitro and in vivo. In this study, the authors evaluated the efficacy and toxicity of a combination chemotherapy that included paclitaxel, 5-fluorouracil (5-FU), and cisplatin in the treatment of patients with advanced gastric carcinoma. METHODS: Forty-one gastric carcinoma patients with metastatic disease, unresectable advanced disease, or relapsed disease were treated with the following regimen, administered every 28 days: paclitaxel 175 mg/m2 by 3-hour intravenous (i.v.) infusion on Day 1, 5-FU 750 mg/m2 by 24-hour continuous i.v. infusion on Days 1-5, and cisplatin 20 mg/m2 by 2-hour i.v. infusion on Days 1-5. Twenty-six patients had measurable disease, and 15 had evaluable disease. All patients were assessable for toxicity. RESULTS: Twenty-one of the 41 patients (51%; 95% confidence interval [CI], 36.5-65.7%) demonstrated an objective response, including 4 complete responses (10%; 95% CI, 3.9-22.5%). Sixty-five percent of the patients with measurable disease (17 of 26; 95% CI, 58-92.5%) and 27% of the patients with evaluable disease (4 of 15: 95% CI, 11.1-52.3%) achieved a complete response or a partial response. The median response duration was 17 weeks (range, 4-90 weeks), and the median survival duration for all patients was 26 weeks (range, 8 to 118+ weeks). The major toxicity of this treatment was myelosuppression with neutropenia of World Health Organization Grade 3 and 4 in 24% and 10% of the patients, respectively. Nonhematologic toxicity included mucositis, nausea/vomiting, diarrhea, neurotoxicity, and alopecia. Fluid retention occurred in two patients, and one patient had an anaphylatic reaction. Dose reduction was necessary for one patient, because Grade 4 neutropenia and mucositis occurred. CONCLUSIONS: Paclitaxel, 5-FU, and cisplatin was an active combination regimen in the treatment of advanced gastric carcinoma. The toxicity of this regimen was tolerable. Based on these findings, this combination regimen could be an attractive treatment in the preoperative setting.

Amplification of c-erbB-2 proto-oncogene in cancer foci, adjacent normal, metastatic and normal tissues of human primary gastric adenocarcinomas.

Genetic damages are frequently found in both tumor and normal cells at carcinogen exposed areas in the patients with upper aerodigestive tract cancer. These phenomena are explained by the multistage process and/or field cancerization theories. The c-erbB-2 proto-oncogene has been amplified in many human tumors including breast, stomach, kidney and lung cancers. To study the possible evidence of multistage process and/or field cancerization in the development of gastric adenocarcinoma, the amplification statuses of c-erbB-2 proto-oncogene using the Southern hybridization technique were evaluated at the 45 gastric adenocarcinoma specimen sets consisting of tumor tissue, adjacent normal tissue (within 2 cm of the primary tumor), metastatic tissue and normal stomach tissue (at least 5 cm away from primary tumor). As a result, c-erbB-2 proto-oncogene at 2 specimen sets (4.4%) was amplified 2- to 4-fold to normal control status. In these 2 cases, c-erbB-2 proto-oncogene at histologically normal tissue adjacent to tumor tissue was amplified. And, the metastatic tissue of 1 case also exhibited c-erbB-2 proto-oncogene amplification of which the degree was less than that of tumor tissue. From these results, we were able to suspect that c-erbB-2 proto-oncogene amplification in the normal tissue adjacent to tumor tissue could be a biomarker of premalignant changes in a small proportion of gastric adenocarcinoma patients. And, this result might suggest the possible role of multistage process and/or field cancerization in the development of gastric adenocarcinoma.

Cancer of the stomach: a review of two hospitals in Korea and Japan.

The records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7-year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5-year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p > 0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet-ring-cell cancer. The 5-year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signet-ring-cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet-ring-cell gastric cancer patients in N.C.C. had early gastric cancer.(ABSTRACT TRUNCATED AT 250 WORDS)