Atsushi Nashimoto

Expression of heart-type fatty acid-binding protein in human gastric carcinoma and its association with tumor aggressiveness, metastasis and poor prognosis.

Objective: Fatty acid-binding proteins (FABPs) are involved in lipid metabolism by intracellular transport of long-chain fatty acids. Heart-type (H-) FABP has been reported to inhibit cell growth and induce cell differentiation, but to our knowledge the significance of H-FABP expression in human gastric carcinoma has not been elucidated. The aim of the current study was to examine the expression of H-FABP and its relation to clinicopathologic parameters and fatty acid synthase (FAS) status of gastric carcinoma, since gastric cancer shows increased expression of FAS. Methods: Immunohistochemistry with anti-H-FABP antibody was performed in 669 gastric carcinomas and 60 tubular adenomas of the stomach. H-FABP-positive and H-FABP-negative carcinomas were analyzed for their clinicopathologic characteristics and FAS status. Results: None of the adenomas expressed H-FABP, whereas 127 of 669 carcinomas (19.0%) were positive for the protein. H-FABP positivity was associated with the depth of invasion (p < 0.0001), vascular invasion (p < 0.0001), lymph node metastasis (p < 0.0001), hepatic metastasis (p = 0.0011), stage of the carcinoma (p < 0.0001) and FAS status of the carcinoma (p = 0.0476). A higher survival rate was noted in H-FABP-negative cases compared with H-FABP-positive cases (p = 0.0004). Conclusions: A subset of human gastric carcinoma expresses H-FABP and its expression is associated with FAS status, disease progression, tumor aggressiveness and poor patient survival.

Disease-free survival for 6 years and 4 months after dissection of recurrent abdominal paraaortic nodes (No. 16) in gastric cancer: Report of a case

We herein report the case of a 63-year-old woman who underwent curative surgery consisting of a subtotal gastrectomy with D2 lymph node dissection for advanced stomach cancer in June 1984, and later underwent systemic dissection of recurrent abdominal paraaortic lymph nodes by a retromesenteric approach in June 1989. Metastatic nodes were found in nos. 16b1 (interaorticocaval), 16b2 (interaorticocaval), and 280 (aortic carinal). One of the resected nodes, which was histologically diagnosed as being poorly differentiated adenocarcinoma, measured approximately 10×7 cm and infiltrated the inferior caval vein. There was no distant metastasis except for nodal metastases. Since the reoperation, the patient has been disease-free for 6 years and 4 months, and she continues to visit our hospital as an outpatient. The findings of this case therefore suggest the significance of paraaortic lymph node dissection. To our knowledge, this is the first report in the world of a gastric cancer patient who has remained disease-free for more than 5 years after the systemic dissection of recurrent paraaortic lymph nodes.

A giant tumor of the mesocolon found to be metastasis from an alpha-fetoprotein-producing gastric carcinoma: report of a case.

We present herein an extremely rare case of metastasis from a gastric carcinoma to the mesocolon. A 71-year-old woman underwent a laparotomy for gastric cancer with an intra-abdominal mass. Her serum alpha-fetoprotein level was very high at 3,560 ng/ml. The abdominal mass was subsequently revealed to be a metastatic tumor of the transverse mesocolon derived from an alpha-fetoprotein-producing gastric carcinoma, but no other metastatic focus was found. An immunohistochemical study revealed alpha-fetoprotein-positive cells in both lesions. The serum alpha-fetoprotein level became normal after the operation which was followed by a course of chemotherapy, and no recurrence has been observed thus far in 6 months of follow up.

Duplication of the stomach with a triple antrum appearance

We report a rare case of duplication of the stomach concomitant with idiopathic portal hypertension. The woman underwent a gastrectomy, under a tentative diagnosis of gastric carcinoma. The resected specimen revealed a submucosal type duplication of the stomach located on the greater curvature. The lesion had three communications with the true stomach and had the gross appearance of a “triple antrum”.