Chi-Long Chen

High expression of thymidylate synthase is associated with the drug resistance of gastric carcinoma to high dose 5-fluorouracil-based systemic chemotherapy.

In the past 4 years, the weekly 24‐hour infusion of high dose 5‐fluorouracil (5‐FU) and leucovorin in the treatment of patients with advanced gastric carcinoma has been prospectively studied at the authors institution. This has enabled them to explore the possibility that the level of expression of thymidylate synthase (TS), the target enzyme of 5‐FU, is related to the drug sensitivity of gastric carcinoma to 5‐FU‐based chemotherapy.

Prospective Study of Helicobacter pylori Eradication Therapy in Stage IE High-Grade Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach

PURPOSEnHigh-grade mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach are generally believed to be Helicobacter pylori-independent, autonomously growing tumors. However, anecdotal cases of regression of high-grade lymphomas after the cure of H pylori infection had been described. The present prospective study was conducted to evaluate the effect of anti-H pylori therapy in stage I(E) high-grade gastric MALT lymphomas.nnnPATIENTS AND METHODSnSixteen patients with H pylori infection and stage I(E) gastric high-grade MALT lymphoma consented to a brief antibiotic therapy as first-line treatment from June 1995 through April 2000. Then, patients underwent intensive endoscopic follow-up examinations (+/- endoscopic ultrasonography) with biopsy to evaluate tumor response. Patients with significant improvement of gross lesions that accompanied regression of large cells were followed up without additional treatment. Patients without significant improvement were immediately referred to systemic chemotherapy.nnnRESULTSnEradication of H pylori was achieved in 15 patients and was accompanied by rapid gross tumor regression and disappearance of large cells in 10. All 10 of these patients with early response had subsequent complete histologic remission of lymphoma. The complete remission rate was 62.5% (95% confidence interval, 35.8% to 89.1%). The response rate was not affected by the tumor grading (proportion of large blast cells within the tumor) but was adversely affected by the depth of tumor invasion. At a median follow-up of 43.5 months (range, 21.1 to 67.4 months), all 10 of these patients remained lymphoma-free. The median duration of complete response was 31.2 months (range, 14.4 to 49.1 months).nnnCONCLUSIONnThese results suggest that high-grade transformation is not necessarily associated with the loss of H pylori dependence in early-stage MALT lymphomas of the stomach.

Chemotherapy Alone Versus Surgery Followed by Chemotherapy for Stage I/IIE Large-Cell Lymphoma of the Stomach

The optimal treatment of localized large‐cell lymphoma of the stomach remains controversial. In particular, the role of surgical resection of the primary tumor needs to be clearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma and treated in our institutions between 1988 and 1998. Patients fulfilling the following criteria were included in this study: (1) histologically proven large‐cell lymphoma of the stomach; (2) adequate pathological materials and complete clinical information for analysis; (3) clinical stage I/II disease according to the Musshoff modification of Ann Arbor system; and (4) received primary chemotherapy alone with anthracycline‐ or anthracenedione‐containing regimens (group A) or curative surgery followed by adjuvant chemotherapy (group B). There were 38 and 21 patients in group A and group B, respectively. All pertinent clinicopathologic features were similar between the two groups of patients, except that patients of group A had significantly more stage II‐2 disease (P = 0.004). Of group A, among 36 patients who could be evaluated for response to chemotherapy, there were 29 complete and 1 partial responses, with an overall response rate of 83.3% (95% CI, 71.1–95.5%). The projected 5‐year relapse‐free survival (RFS) and overall survival (OS) were 86.0% (95% CI, 73.3–98.7%) and 72.6% (95% CI, 57.0–88.2%), respectively. On the other hand, the projected 5‐year RFS and OS of group B were 77.9% (95% CI, 58.0–97.8%) and 77.8% (95% CI, 57.9–97.7%), respectively, not significantly different from that of group A. Our data suggest that systemic chemotherapy alone may be a reasonable alternative treatment for stage I/II large‐cell lymphoma of the stomach. Resection of the primary tumor before systemic chemotherapy does not appear to improve the cure rate of this group of patients. Am. J. Hematol. 64:175–179, 2000.

Pathology of nasopharyngeal carcinoma. Proposal of a new histologic classification correlated with prognosis

To establish a new histologic classification with better correlation with patient prognosis, the histologic features of nasopharyngeal carcinoma (NPC) were correlated with prognosis and clinical stage among 494 patients who had been followed a minimum of 5 years after initial radiotherapy. A slight modification of World Health Organization (WHO) classification by the separation of spindle cell variant from the nonkeratinizing (NK) and undifferentiated carcinomas (UD) provided a better prognostic correlation: keratinizing squamous cell carcinoma (KS), spindle cell carcinoma (SP), round cell carcinoma (RC), and mixed cell carcinoma (Mix, or NK); 5‐year survival rates were 21%, 41%, 51.8%, and 54% respectively. This prognostic distinction was further improved by dividing the three nonkeratinizing carcinomas (SP, RC, and Mix) into two subtypes each, according to the degree of cell anaplasia and pleomorphism: Type A (with marked anaplasia and/or pleomorphism), and Type B (with moderate or little anaplasia). The three Type A carcinomas had very similar 5‐year survival rates (33.3 to 38.6%), as did the three Type B carcinomas (60% to 71.8%). Therefore, a working formulation for the malignancy of NPC emerged: (1) high‐grade malignancy (KS; 5‐year survival, 21%), (2) intermediate malignancy (Type A carcinomas, 5‐year survival, 30%–40%), and (3) low‐grade malignancy (Type B carcinomas, 5‐year survival rate, 60%–72%). The prognostic distinction remained true after stratification by clinical stage. Therefore, the histologic condition of the tumor of NPC correlated with patients prognosis. Cancer 59:945‐951, 1987.

Prolonged ischemia potentiates apoptosis formation during reperfusion by increase of caspase 3 activity and free radical generation

ISCHEMIC injury to the kidney or renal allograft before implantation is an important cause of renal dysfunction and delayed graft function. In the setting of prolonged ischemia, a major source of primary renal dysfunction comes from the generation of reactive oxygen species (ROS) during the reperfusion phase. The overproduction of ROS after reoxygenation of the kidney may initiate the cascade of renal tubular injury and necrosis/apoptosis and can lead to oxidative damage of DNA, proteins, and lipids. It has been implicated that the prolonged ischemic interval during renal surgery potentiates damage to the kidneys. However, it is uncertain whether the kidney damage elicited by the prolonged ischemic interval is directly related to the overproduction of ROS. Lucigenin luminescence can be used as the basis for assaying superoxide dismutase activity, but should not be used for measuring, or even detecting O2 . In this investigation, by using MCLA-amplified ultrasensitive chemiluminescence (CL), we studied the production of reactive oxygen species (ROS) in rat kidneys after ischemia-reperfusion (I/R) injury in vivo and the relationship of ROS production to the duration of the ischemic interval.

Early gastric cancer as a possible cause of cauda equina syndrome and disseminated intravascular coagulation

Abstract: Early gastric cancer is an important gastric malignancy which is defined as adenocarcinoma confined to the mucosa or submucosa of the stomach with or without simultaneous metastases involving regional lymph nodes. The prognosis of early gastric cancer is generally good with a 5‐year survival rate of about 95%. Distant metastases and disseminated intravascular coagulation (DIC) usually occur in the advanced stage of gastric cancer but are relatively rare in early gastric cancer. Cauda equina syndrome has never before been reported as the initial presentation of gastric cancer, and to our knowledge, up to 1993, only 17 cases of early gastric cancer with synchronous liver metastases had been reported. Bone metastases with DIC and adrenal metastasis are both rare in early gastric cancer. Herein, we present a case of early gastric cancer with an initial presentation including cauda equina syndrome and DIC. Synchronous hepatic, adrenal gland, pulmonary, bone and bone marrow metastases were found two days after admission. The patient had a fulminant clinical course and died 45 days after the diagnosis. A small focus (0.8 × 0.5cm) of poorly differentiated adenocarcinoma located in the mucosa and submucosa at the gastric lower body with extensive lymphatic permeation around the primary focus and duodenum were noted at autopsy. Cancers with an unknown primary accounted for 4.9% of cancers presenting with disseminated intravascular coagulation. Our experience disclosed that early gastric cancer is a potential cause of cauda equina syndrome and disseminated intravascular coagulation.

Duodenal Lipoma ‐A Report of Two Cases Resected by Endoscopic Polypectomy‐

Duodenal lipomas are rarely reported. We reported two asymptomatic pedunculated duodenal lipomas successfully resected by endoscopic polypectomy. Case 1 was a 48‐year‐old Chinese female who came for a physical check‐up. Upper gastrointestinal series and endoscopic examination revealed a 2.0 × 1.0 cm pedunculated polyp in the posterior wall of the bulb. Case 2 was a 67‐year‐old female. A 1.7 times 1.0 cm olive‐shaped pedunculated polyp was found by endoscopic examination during a health check‐up. Both tumors were polypectomised by endoscopy and proven to be duodenal lipomas pathologically. The diagnosis of duodenal lipoma has largely been made by surgery and autopsy in the past. It may be made nowadays with abdominal computed tomography and repeated deep biopsies. Duodenal lipomas may be treated by endoscopic polypectomy if the tumor is small and pedunculated.>