Mesenteric Myxofibrosarcoma: A Case Report.

Myxofibrosarcoma is a soft tissue sarcoma that occurs in elderly patients. Primary myxofibrosarcoma rarely arises in the mesentery; this is the fourth known case of myxofibrosarcoma presenting as a mesenteric tumor. A 62-year-old male with a mesenteric myxofibrosarcoma presented with an abdominal mass; his symptoms were frequent urination and a sense of abdominal pressure. He was admitted for further examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mesenteric lesion. The preoperative diagnosis was a suspected malignant myxoid tumor. We performed a curative resection with wide margins. The histopathological and immunohistochemical findings confirmed that the tumor was mesenteric myxofibrosarcoma. The postoperative course was uneventful, and there have been no signs of relapse for three years to date after surgery. It is difficult to make a definitive diagnosis of mesenteric myxofibrosarcoma using only CT or MRI. However, when the preoperative findings suggest a malignant mesenteric tumor, then the best practice is resection with sufficient margins.

Mixed ductal-acinar cell carcinoma of the pancreas: A case report.

Mixed carcinoma of the pancreas is defined as the concurrent existence of pancreatic ductal carcinoma, acinar cell carcinoma, and/or islet cell carcinoma within the same neoplasm. We herein report a rare case of mixed ductal-acinar cell carcinoma in a 74-year-old man who was undergoing treatment for hypertension and diabetes at another hospital. After an abrupt worsening of his blood glucose control, the patient was referred to our hospital for further evaluation. Abdominal contrast-enhanced computed tomography and magnetic resonance imaging revealed a tumor with a multilocular cystic lesion in the head of the pancreas. Endoscopic retrograde cholangiopancreatography revealed obstruction of the main pancreatic duct and dilation of the dorsal pancreatic duct; in addition, adenocarcinoma was detected in the pancreatic juice cytology. Based on the abovementioned findings, the patient was diagnosed with carcinoma of the pancreatic head and underwent subtotal stomach-preserving pancreaticoduodenectomy. Based on the histopathological and immunohistochemical findings, the patient was diagnosed with mixed ductal-acinar cell carcinoma. The patient was prescribed TS-1 as postoperative adjuvant chemotherapy upon discharge. However, treatment was discontinued 2 months later due to marked general malaise, and the patient succumbed to tumor recurrence in the residual pancreas 12 months after the surgery.

[Endocrine cell carcinoma of the esophagus without recurrence for more than 7 years after chemoradiotherapy].

We report a case of endocrine cell carcinoma (ECC) of the esophagus with long term survival after chemoradiotherapy. The patient had a complete response and remains without any recurrence. A 69-year-old woman visited our hospital because of progressive dysphagia. The patient was diagnosed by computed tomography and histology examination of biopsy specimens with small cell ECC of the esophagus, cT2N1M0, cStage II based on the Classification of Esophageal Carcinoma. She was treated with chemoradiotherapy comprising 45Gy of irradiation and four courses of cisplatin and etoposide chemotherapy. After completion of the treatment, she was found to have a complete response. She remains alive to date without evidence of any recurrence after 7 years. This case suggests that chemoradiotherapy is an effective treatment for ECC of the esophagus.

Successful Resection of a Large Rectal Adenoma Using the Transsacral Approach.

The transsacral approach is not routinely used for treating rectal tumors. We report the case of a 65-year-old man with a large adenoma at the posterior wall of the mid-rectum who was treated via the transsacral approach. The same lesion had been treated using transsacral endoscopic microsurgery 8 years previously. Moreover, 11 years previously he had undergone a laparotomy for bladder cancer, and an Indiana pouch had been constructed. Abdominal computed tomography showed that the pouch was adjacent to the rectum. Therefore, the less-invasive transsacral approach, rather than the transabdominal approach, was chosen for treatment. The lesion was successfully resected, without disturbing the pouch. Histological analysis indicated tubular adenoma, with a small focus of intramucosal adenocarcinoma, and negative margins. Thus, we achieved successful resection of mid-rectal lesions via the transsacral approach, without the morbidity associated with major laparotomy. We suggest that this procedure should be a part of a surgeon's armamentarium.

Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry.

The aim of this study was to elucidate whether fecoflowmetry (FFM) could evaluate more detailed evacuative function than anorectal manometry by comparing between FFM or anorectal manometric findings and the clinical questionnaires and the types of surgical procedure in the patients who received anal-preserving surgery. Fifty-three patients who underwent anal-preserving surgery for low rectal cancer were enrolled. The relationships between FFM or the manometric findings and the clinical questionnaires and the types of procedure of anal-preserving surgery were evaluated. There were significant differences between FFM markers and the clinical questionnaire and the types of the surgical procedure, whereas no significant relationship was observed between the manometric findings and the clinical questionnaire and the types of the surgical procedure. FFM might be feasible and useful for the objective assessment of evacuative function and may be superior to manometry for patients undergoing anal-preserving surgery.

Gemcitabine with paclitaxel therapy against mesocolic leiomyosarcoma: a case report.

A 65-year-old man complained of lower right abdominal pain, and an intra-abdominal mass was identified. An intra-abdominal hemorrhage was discovered during a thorough examination and emergency surgery was performed. The tumor was ruptured and was fragile, making it difficult to perform extirpation; thus, an ileocecal resection was performed. The histopathological diagnosis of the tumor was leiomyosarcoma, and recurrence was observed during the early postoperative period. The patient underwent surgery twice; each time there was a recurrence, but complete resection could not be obtained, and paclitaxel and gemcitabine chemotherapy was performed. A temporary effect was observed, and control of disease progression lasted approximately five months. Standard chemotherapy for leiomyosarcoma has not been established, but this method could become a therapeutic strategy for leiomyosarcoma.

Expression of monocarboxylate transporter (MCT)-4 in colorectal cancer and its role: MCT4 contributes to the growth of colorectal cancer with vascular endothelial growth factor.

BACKGROUND: In tumor cells, monocarboxylate transporter (MCT)-4 regulates the excretion of lactate produced by glycolysis from the cell. MCT4 has also been reported to be involved in tumor growth and infiltration. Similarly, vascular endothelial growth factor (VEGF) is known to be involved in the growth, infiltration, and metastasis of tumors. In this study, we clinically evaluated the relationship between MCT4 and VEGF in colorectal cancer. MATERIALS AND METHODS: A prospective study was conducted in 210 patients with colorectal cancer who underwent surgical treatment. The clinicopathological data were correlated with the expression of MCT4 and VEGF obtained from immunohistochemical analysis. RESULTS: MCT4 and VEGF were expressed in tumors of 102 (49%) and 129 (61%) patients, respectively. A maximum tumor diameter of 45 mm or more (p<0.0001) and a tumor invasion depth of T1 or less (p<0.0119) were factors independently correlated with the expression of MCT4 and VEGF, respectively. The tumor size was significantly smaller (p=0.0031), and the disease was significantly less advanced (p=0.0017), in MCT4-negative/VEGF-positive than MCT4-positive/VEGF-negative cases. CONCLUSION: We suspect that in colorectal cancer, VEGF is involved in the early stages of tumor growth and MCT4 expression appears as the tumor enlarges and contributes to its further infiltration and growth.

Clinicopathological study on poorly differentiated adenocarcinoma of the colon.

Clinicopathological characteristics and grading of poorly differentiated colon adenocarcinoma (Por) were discussed. A total of 1074 patients with colon cancer underwent surgical treatment at Kurume University Hospital in Fukuoka, between 1985 and 2005. Clinicopathological characteristics of 88 cases (8%) of Por and 986 cases (92%) of well differentiated tubular adenocarcinoma/moderately differentiated tubular adenocarcinoma (Tub1/Tub2) were studied. A multiple classification analysis showed that Por was more frequently observed in the right colon than Tub1/Tub2, and that the ratio of macroscopic types 3 and 4 was significantly higher in Por. Significant differences were also observed with regard to lymph vessel and perineural invasion. There were no significant differences between recurrence-free survivals of Por and Tub1/Tub2 after radical resection in Stages II and III. Recurrence of Por was significantly higher in peritonea and lymph nodes. These findings indicate that Por, which is generally considered to have a poor prognosis, has a similar recurrence rate to that of Tub1/Tub2 after the performance of radical surgery.

Challenges in staging systems for colorectal cancer: clinical significance of metastatic lymph node number in colorectal cancer and mesorectal extension in rectal cancer.

In many countries, treatment for cancer is performed based on staging systems in which the degree of cancer development is defined objectively. A common staging system is thus needed to compare outcomes. The staging system for colorectal cancer in Japan has been made to enhance consistency with the TNM classification, and the categorization of metastatic lymph nodes and depth of invasion have been revised in recent years. Although these are important factors that determine disease stage, relationships between each factor and recurrence have shown differing prognoses. In our retrospective study, the prognosis of a group with only one metastatic lymph node was significantly better compared to a group with > or = 2 metastatic lymph nodes. In addition, rectal cancer with mesorectal extension >5 mm showed low relapse-free survival rates and high recurrence rates. The validity of staging systems should thus be inspected from various perspectives.