Masatoshi Kawamura

Gastric and Intestinal Phenotypic Marker Expression in Gastric Carcinomas and Its Prognostic Significance: Immunohistochemical Analysis of 136 Lesions

Objective: It is well known that both gastric and intestinal phenotypic cell markers are expressed in gastric carcinomas, irrespective of their histologic type. However, the clinicopathologic significance of these expressions has not yet been clarified. Methods: We analyzed the correlations among gastric and intestinal phenotypic marker expression patterns of the tumor, clinicopathologic findings and the patient’s outcome in 136 advanced gastric carcinomas. Results: Phenotypic marker expression was immunohistochemically evaluated using the monoclonal antibodies 45M1 (anti-human gastric mucin; HGM), CLH5 (anti-MUC6), Ccp58 (anti-MUC2) and 56C6 (anti-CD10). All tumors were classified as gastric (G), gastric and intestinal mixed (GI), intestinal (I) or unclassified (UC) phenotype. Of the 136 gastric carcinomas, 50 (36.8%), 56 (41.2%), 21 (15.4%) and 9 (6.6%) were classified as G, GI, I and UC phenotype, respectively. The G-phenotype tumors were associated with a higher rate of undifferentiated-type and infiltrative histology as compared with the I-phenotype tumors (p < 0.05 and p < 0.001, respectively). Furthermore, both univariate and multivariate analysis of survival revealed the G-phenotype tumor to be associated with a significantly poorer outcome than the I-phenotype tumor (p < 0.05). Conclusion: Our present results indicate that the gastric and intestinal phenotypic marker expression pattern of tumors, determined by the combination of HGM, MUC6, MUC2 and CD10 expression, is prognostically useful for patients with gastric carcinoma.

Recurrent colonic cancer developing at the site of a stapled stump: Report of a case

We report herein the case of a 54-year-old woman who developed a recurrence of carcinoma in a stapled colon stump 2 years after undergoing an anterior resection for carcinoma of the rectosigmoid colon. At this time an end to end anastomosis (EEA) stapler had been used to perform a side-to-end anastomosis. The implantation of cancer cells was thought to have caused the recurrence.

Association of gastric and intestinal phenotypic marker expression of gastric carcinomas with tumor thymidylate synthase expression and response to postoperative chemotherapy with 5-fluorouracil

PurposeIt is well known that both gastric and intestinal phenotypic markers are expressed in gastric carcinomas, irrespective of their histological type. In the present study, the associations among phenotypic marker expression of gastric carcinomas, tumor thymidylate synthase (TS) expression, and the chemotherapeutic response to 5-fluorouracil (5-FU) were examined.MethodsThe gastric and intestinal phenotypic marker expression of the tumor was determined by the combination of the expression of human gastric mucin (HGM), MUC6, MUC2, and CD10, and was evaluated in comparison with tumor TS expression in 137 advanced gastric carcinomas in 137 patients (75 with postoperative chemotherapy with 5-FU and 62 without postoperative chemotherapy). Tumors were classified into the gastric- (G-), gastric and intestinal mixed- (GI-), intestinal- (I-), or unclassified- (UC-) phenotype according to the immunopositivity of HGM, MUC6, MUC2, and CD10 stainings. The associations among the gastric and intestinal phenotypic marker expression of the tumor, tumor TS expression, effect of postoperative chemotherapy with 5-FU, and the patient’s prognosis were examined.ResultsOf the 137 gastric carcinomas, 48 (35.0%), 58 (42.3%), 23 (16.8%), and 8 (5.8%)were classified as the G-, GI-, I- and UC-phenotype, respectively. The high TS expression of more than 25% tumor cell positivity was found in 25 (52.1%) of the 48 G-phenotype tumors, 39 (67.2%) of the 58 GI-phenotype tumors, 18 (78.3%) of the 23 I-phenotype tumors, and 4 (50.0%) of the 8 UC-phenotype tumors. The I-phenotype tumors were significantly correlated with the higher rate of the high TS expression as compared with the G-phenotype tumors (P<0.05). Among 48 patients with the G-phenotype tumor, the 5-year survival rate in patients with and without postoperative chemotherapy was 39.7 and 27.8%, respectively. The patients with postoperative chemotherapy had a significantly better prognosis than those without postoperative chemotherapy (P<0.05). Conversely, there were no significant correlations between the presence of postoperative chemotherapy and the patient’s prognosis among patients with GI-, I-, and UC-phenotype tumors.ConclusionsThese results indicate that postoperative chemotherapy with 5-FU could be effective for patients with the G-phenotype tumor, since the incidence of intratumoral expression of TS, the target enzyme of 5-FU, is significantly low in G-phenotype tumors.

Successful curative resection of gastric cancer with AIDS infection

This report describes the case of a 47-year-old Japanese man with human immunodeficiency virus (HIV) infection with AIDS, who was successfully treated for gastric cancer. A review of gastric cancer associated with HIV is also presented. Prior to surgical treatment, azidothymidine (AZT), nerfinavir (NFV), and lamivudine (3TC) were administered to the patient in order to improve his blood CD4 count and reduce the viral burden. Consequently, distal gastrectomy was performed as a curative resection without any complications. The gastric cancer included a signet-ring cell carcinoma, as was noted in eight of the nine reported cases associated with HIV. This suggests that the HIV virus may play a role in causing signet-ring cell carcinoma, especially in the stomach.

The Indications of Proximal Gastrectomy for Gastric Cancer in the Upper Third of the Stomach.

過去44年間に当教室で切除された上部胃癌 (C, CM, CE) 318例を対象とし, 噴門側胃切除術の適応について検討した. 各深達度別のリンパ節転移の割合はm: 0% (0/23), sm: 6.1% (2/33), mp: 25% (4/16), ss: 74.1% (43/58), se: 81.3% (104/128), si: 91.7% (55/60) で, ss以上でリンパ節転移が高率であったが, mp以深ではリンパ節転移112までであった. またsm, mp癌の転移リンパ節の詳細はsmがNo1, 7, mpがNo1, 2, 3, 11で, No4d, 5, 6, 10に転移を認めなかった. 治癒切除後の再発形式でも深達度mpまでの癌でリンパ節再発を認めたものはなく, 深達度mpまでの5年生存率でも噴切群86.7%に対し全摘群74%と両群間に差を認めなかった. 以上よりC領域の早期胃癌においてはD1+No7, mp癌においてもD1+No7, 11の郭清を加えることにより噴切は適応となる. 深達度ss以深ではn2以上の転移が高率であり噴切の適応とはならず, 拡大郭清が適応となろう.

A case of ruptured aneurysm of the left gastric artery with early gastric cancer.

症例は70歳男性.言語・構音障害を主訴に当院入院.左側頭葉に血腫を認め, 保存的治療を行っていたが, 突然, 出血性ショックに陥り, 厳重な全身管理下に出血源精査を行った.上部消化管内視鏡検査では胃体上部にIIc型早期胃癌を認めたが, 出血源とは断定できず, 腹部超音波検査および腹部computed tomography検査を行った.肝下面を中心とする腹腔内血腫が認められ, 腹部血管造影検査を行い左胃動脈瘤の存在を認めたため, 早期胃癌を併存した左胃動脈瘤破裂と診断し, 胃全摘術を施行して救命しえた.本症は, 調べえた本邦報告例では10例とまれであり, かつ破裂例は6例のみであった.画像診断, 全身管理の進歩により, 近年予後の改善をみているが, いまだ診断に難渋している症例が多かった.原因不明の腹痛, 急激なショックを呈した症例に遭遇した際には本症も念頭に置くべきと思われた.