Jae Kyoon Joo

Clinicopathological characteristics of signet ring cell carcinoma of the stomach.

Background:  Signet ring cell (SRC) carcinoma of the stomach is characterized by its poor prognosis and potential to infiltrate the wall of stomach, although survival studies comparing carcinomas with and without SRC features have yielded inconsistent results. This study compared the clinicopathological features and prognosis of patients with SRC carcinoma with those with non‐signet ring cell carcinoma of the stomach (NSRC).

Expression of standard CD44 in human colorectal carcinoma: association with prognosis.

The aim of the present study was to evaluate the expression of standard CD44 (CD44s) in colorectal cancer (CRC), its relationship with clinicopathological characteristics, and its potential prognostic significance. CD44s levels were measured on immunohistochemistry in tumors and surrounding normal mucosa from 74 patients with primary colorectal carcinomas. The patients were followed for a median period of 37 months. Expression of CD44s in primary tumor and surrounding normal mucosa tissues was demonstrated in 100% (74/74) and 37.9% (28/74), respectively. The expression of CD44s in tumors was significantly associated with the depth of invasion (P = 0.034) and lymph node involvement (P = 0.031). A significant difference was observed between the overall survival and level of tumor CD44s expression, especially for stage IV carcinoma (P = 0.038). Multivariate analysis indicated that TNM stage (P = 0.020) and tumor CD44s expression (P = 0.008) were independent predictors of overall survival in adenocarcinomas. CD44s overexpression may be an independent unfavorable prognostic factor for overall survival in advanced CRC, especially stage IV disease. Further investigation, however, is necessary to assess the biological roles of CD44 in CRC, and validate their possible value as novel therapeutic targets.

Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

E-cadherin expression in early gastric carcinoma and correlation with lymph node metastasis.

Abnormal expression of E‐cadherin plays an important role in the differentiation and progression of gastric carcinoma. However, the relationship between molecular changes in E‐cadherin and metastasis in early gastric carcinoma (EGC) is poorly understood.

Clinicopathological characteristics and prognosis of carcinoma of the gastric cardia.

Objective: The prognosis of patients with carcinoma of the gastric cardia (CGC) is poorer than that of patients with distal third gastric carcinoma (DTGC). The main aim of this study is to investigate whether the tumor location is an important prognostic factor. Methods: 312 patients (8.1%) were diagnosed with CGC and reviewed retrospectively. Results: T1 stage tumors were less common in patients with CGC than in those with DTGC (p< 0.001). Lymph node invasion was more common in CGC patients than in DTGC patients (p< 0.01). Multivariate analysis showed that patient age, lymph node status, and resection with curative intent were significant prognostic factors for the survival of CGC patients. Of the patients who underwent tumor resection with curative intent, the 5-year survival rate of CGC patients was lower than that of DTGC patients (57.4 vs. 63.1%), but no significant difference was observed between the two groups (p> 0.05). When the CGC group was divided into patients who underwent resection with or without curative intent, the 5-year survival rates were 52.8 and 6.0%, respectively (p< 0.001). Conclusion: According to our results, curative resection itself, rather than tumor location, was the determining factor in improving 5-year survival.

Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer

Purpose Downstaging after chemoradiotherapy (CRT) for rectal cancer usually occurs. The present study aimed to evaluate pathologic y-stage (yp-stage) and its influence on local recurrence and systemic recurrence in rectal cancer patients treated with CRT followed by surgical resection. Methods We retrospectively analyzed 261 patients underwent preoperative CRT and radical resection for rectal cancer between August 2004 and December 2010. Patients received preoperative CRT consisting of 5-fluorouracil and leucovorin delivered with concurrent pelvic radiation of 45.0-50.4 Gy, followed by radical surgery at 6-8 weeks after CRT. Results Of the 261 patients, 24 (9.2%) had yp-stage 0, 83 (31.8%) had yp-stage I, 86 (32.9%) had yp-stage II, and 68 (26.1%) had yp-stage III. Patients with yp-stage III had a greater prevalence of preoperative CEA, poorly differentiated tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) than patients with lower yp-stages. We found that yp-stage, preoperative CEA, LVI, PNI and tumor regression grade were significant prognostic factors for both local and systemic recurrence. In multivariate analysis, yp-stage, LVI and PNI were significant factors for local and systemic recurrence. During the median follow-up of 37.5 months, the five-year local recurrence-free survival rate was 100.0%, 95.0%, 89.3%, and 80.6% of yp-stage 0-III, respectively. The five-year systemic recurrence-free survival was 95.8%, 75.3%, 71.4%, and 48.8% of yp-stages 0-III, respectively. Conclusion The yp-stage after preoperative CRT for rectal cancer is closely correlated with local and systemic recurrence-free survival. Therefore, yp-stage should be considered as a prognostic factor for rectal cancer patients having a course of preoperative CRT.

Mesenteric extraskeletal osteosarcoma with telangiectatic features: a case report

BackgroundExtraskeletal osteosarcoma is a rare malignant mesenchymal tumor, with a predominant occurrence in the extremities. Only two cases of mesenteric extraskeletal osteosarcoma have been documented. We describe an unusual case of extraskeletal osteosarcoma with telangiectatic features occurring in the mesentery.Case presentationA 67-year-old male presented with blood-tinged stool of 1-months duration. On colonoscopy, a solid mass was detected protruding from the colon wall. Computed tomography showed a 15 × 9.7 cm heterogeneously enhancing mass, with mottled calcification and a cystic portion, occupying the left upper quadrant of the abdominal cavity. Curative resection of the tumor was performed, and the excised tumor was composed of large multilocular cysts containing old hematomas and necrotic debris. The histology revealed an osteosarcoma showing osteoid formation and blood-filled spaces lined with atypical cells. Despite postoperative chemotherapy, he developed a recurrent peritoneal mass and multiple lung metastases 3 months postoperatively.ConclusionGiven the rarity of cases of mesenteric extraskeletal osteosarcoma, its biologic behavior at this location remains to be determined. However, extraskeletal osteosarcoma with telangiectatic features is an uncommon entity to be recognized because of the possible fatal outcome related to the tumors.

Is palliative resection necessary for gastric carcinoma patients

Background and aimsThe benefit of palliative resection for gastric carcinoma patients remains controversial. We thus evaluated the survival benefit of palliative resection in advanced gastric carcinoma patients.Materials and methodsWe reviewed the hospital records of 466 gastric carcinoma patients who had palliative resection and compared the clinicopathologic findings to those of patients who underwent a bypass or exploration from 1986 to 2000.ResultsCox’s proportional hazard regression model revealed only one independent statistically significant prognostic parameter, the presence of peritoneal dissemination (risk ratio, 0.739; 95% confidence interval, 0.564–0.967; P < 0.05). The 5-year survival rate of patients who had palliative resection was higher than that of patients who did not (7.03 vs 0%, P < 0.001). When the 5-year survival rates of patients with peritoneal dissemination were examined, the rate was higher for those who underwent resection (4.43 vs 0%, P < 0.001).ConclusionThe results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.

Clinicopathological features of gastric carcinoma patients with other primary carcinomas

BackgroundMultiple primary carcinomas are increasingly being found because of the development of diagnostic techniques and the increasing incidence of early stage carcinoma. The purpose of this study was to determine the prevalence and clinicopathological features of gastric carcinoma patients with other primary carcinomas.MethodsThere were 65 (incidence 2.6%) gastric carcinoma patients with other primary carcinomas compared with 2,444 patients with gastric carcinoma alone.ResultsAssociated primary carcinomas were often found in the gastrointestinal (GI) tract, especially in the colon (33.8%). In patients with gastric carcinoma only, poorly differentiated adenocarcinoma was the most common (43.2%), followed by moderately and well-differentiated adenocarcinoma. Similarly, poorly differentiated adenocarcinoma (33.8%) was also the prevalent histological type in gastric carcinoma patients with other primary carcinomas, although its incidence was lower. The stage of gastric carcinoma did not differ between the two groups. The estimated 5-year survival rate was 51.6% for patients with gastric carcinoma alone, and 50.7% for those with other primary carcinomas; the difference was not significant (P=0.82).ConclusionGastric carcinoma should be treated aggressively, since the prognosis of gastric carcinoma patients treated for other primary carcinomas is not poorer than that of patients treated for gastric carcinoma alone.

Clinicopathological characteristics of patients with proximal third gastric carcinoma.

Abstract Objective : Epidemiological studies show a continuing rise in the prevalence of proximal third gastric carcinoma (PGC), and the prognosis of patients with this carcinoma is poorer than that of patients with more distally located gastric carcinomas. We compared the clinicopathological features and prognosis of PGC patients with those of patients with middle/distal gastric carcinoma (MGC/DGC). Material and methods : Of the 2696 patients diagnosed with gastric carcinoma who underwent surgery in our hospital in a 15-year period, 271 patients (10.1%) were diagnosed with PGC and retrospectively reviewed. Results : T1-category tumours were less common in patients with PGC than in patients with MGC/DGC (p < 0.001). Lymph node invasion was more common in patients with PGC than in patients with MGC/DGC (p < 0.05). Tumour stage (stage I) and T category (T1) significantly influenced the 5-year survival rates of patients whose tumours were resected with curative intent. The 5-year survival rate of patients whose PGC were resected with curative intent was higher than that of patients whose PGC were resected with palliative intent (57.4 vs. 12.6%, p < 0.001). The 5-year survival rate was 49.3% for patients with PGC and 57.3% for patients with MGC/DGC (p = 0.0273). Multivariate analysis showed that tumour size, lymph node status, and resection with curative intent were significant prognostic factors for survival in patients with PGC. Conclusion : The poor prognosis of PGC is mainly due to its more advanced stage at diagnosis compared with that of more distally located gastric carcinoma. Early detection is important for improving the prognosis of patients with proximal third gastric carcinoma.