Meng-Dar Lee

Aberrant FHIT transcripts in cancerous and corresponding non-cancerous lesions of the digestive tract

The FHIT gene was recently discovered and proposed as a tumor‐suppressor gene. We examined the FHIT gene in a panel of digestive‐tract cancers along with their corresponding non‐tumorous tissues by reverse transcription of FHIT mRNA followed by PCR amplification and sequencing of the products. A normal FHIT transcript was found to be expressed at robust levels in 44 of 46 cancerous tissues and in all of 46 non‐cancerous tissues tested. Of the 46 cancerous specimens, 21 (45.7%) revealed the occurrence of aberrant transcripts. In addition, of the 46 matched normal tissues, 14 (30.4%) showed the existence of aberrant transcripts. Sequence analysis confirmed that aberrant transcripts were missing in one or more exons of the FHIT cDNA, while 8 cases displayed aberrant transcripts of the FHIT gene both in cancerous and in non‐cancerous tissues. However, sequence analysis revealed that the patterns of the aberrant transcripts were different between the corresponding paired samples. In addition, there were 6 cases displaying aberrant FHIT transcripts only in their normal‐tissue counterparts. These studies indicate that abnormalities of the FHIT gene transcripts occur at a fairly high frequency in cancerous and corresponding non‐cancerous lesions of the digestive tract. However, they might not be causally related to the tumorigenesis of the digestive tract. Int. J. Cancer 72:955–958, 1997.

Appendectomy timing: Will delayed surgery increase the complications?

Background This study investigated whether the time from emergency room registration to appendectomy (ETA) would affect the incidence of perforation and postoperative complications in patients with acute appendicitis. Methods Patients who underwent an appendectomy at the Ren‐Ai branch of Taipei City Hospital between January 2010 and October 2012 were retrospectively reviewed. Their demographics, white blood cell count, C‐reactive protein, body temperature, computed tomography scan usage, operation method, pathology report, postoperative complication, length of hospital stay, and ETA were abstracted. Multivariate analysis was performed to search the predictors, including ETA, of outcomes for the perforation and postoperative complication rates. Results A total of 236 patients were included in the study. Perforation occurred in 12.7% (30/236) and postoperative complications developed in 24.1% (57/236) of these patients. There were 121 patients with ETA <8 hours, 88 patients with ETA of 8–24 hours, and 27 patients with ETA >24 hours; patients with ETA >24 hours had significantly longer hospital stay. Univariate analysis showed that perforated patients were significantly older, and had higher C‐reactive protein level, longer hospital stay, and higher complication rate. Patients who developed postoperative complications were significantly older, and had higher neutrophil count, less use of computed tomography, and higher open appendectomy rate. After multivariate analysis, age ≥55 years was the only predictor for perforation [odds ratio (OR) = 3.65; 95% confidence interval (CI), 1.54–8.68]; for postoperative complications, age ≥55 years (OR = 1.65; 95% CI, 1.84–3.25), perforated appendicitis (OR = 3.17; 95% CI, 1.28–7.85), and open appendectomy (OR = 3.21; 95% CI, 1.36–7.58) were associated. ETA was not a significant predictor in both analyses. Conclusion In our study, it was observed that although longer ETA was associated with longer hospitalization, ETA was not correlated with postoperative complications. Our results inclined toward the position that appendectomy can be performed as a semielective surgery.

A framework for cancer-related genes mining over the Internet

Clinically, cancer is a complex family of diseases. From the view of molecular biology, cancer is a genetic disease resulting from abnormal gene expression. This alternation of gene expression could be resulting from DNA instability, such as translocation, amplification, deletion or point mutations. A large amplification or deletion of a chromosome region can be easily detected by two methods: loss of heterozygosity (LOH) and comparative genomic hybridization (CGH). The different gene expression pattern can be monitored by high throughput microarray analysis. Enormous data accumulated by practicing these technologies and the data pool is continuing enlarging with an amazing rate. To aid investigators mining useful information in these data deposits, new data storing and analysis tools must be developed. Two value-added databases are constructed to achieve this purpose. They contain information of genes in the unstable regions of cancer cells basing on the data accumulated from LOH and CGH experiments and information of cancer cell gene expression profiles according to microarray analysis, respectively. An automatic system to retrieve interesting gene information, to compare with the known databases, to analyze and predict the protein functions, and to group the genes of the same function will be integrated into the database circuit. An automatic update system will be installed and performed after the setup of the two databases. The system keeps also the probability to modify and to accept new data obtained from any new techniques. Our goal is to help biologists to find the needles in a haystack that is, to find the real cancer-related genes (oncogenes or tumor suppressor genes) for further research purpose.

Myxoid Malignant Fibrous Histiocytoma: Two Cases Report

Soft tissue sarcomas are rare and can involve various different types of cells. Malignant fibrous histiocytoma (MFH) is one type of soft tissue sarcoma and is common in adults. It has several subtypes and the myxoid type is one of the rarest. We reported here two cases of myxoid type MFH and review the literature in terms of clinical features, treatment, and prognosis.

Malignant Hemangiopericytoma Presenting as a Huge Retroperitoneal Mass: Report of a Case

A healthy 47-years-old man presented with body weight loss of 15 kgs in 2 months. Radiological examinations revealed a mass with multiple heterogeneous densitycalcifications in the left lower abdomen. The patient underwent laparotomy for differantial diagnosis and treatment. During the operation, a 20×15×10 cm mass arising from the left retroperitoneum with multiple calcifications was excised. Histologic examinations confirmed a diagnosis of malignant hemangiopericytoma (HPC) of the retroperitonum. Such a huge retroperitoneal hemangiopericytoma is rare in the literature.

Clinicopathology of Early Gastric Cancer

Background and Purpose: The prognosis of early gastric cancer is considered to be satisfactory after a curative resection. The incidence of early gastric cancer is higher in Japan than that in the Western countries. Limited surgery is recommended now for early gastric cancer. Methods: 254 patients of early gastric cancer were retrospectively analyzed who were operated on in the period from 1974 to 2004. Lymph node dissection (D1 or D2) was performed in over 95% of all these patients. 242 patients (95.3%) underwent distal subtotal gastrectomy and 7 patients (2.8%) underwent proximal gastrectomy. 5 patients (2.0%) of larger tumor received total gastrectomy. Results: The most common symptom was abdominal pain (45.7%) followed by bleeding (18.1%) Over half (157 cases; 61.8 %) of the tumors were located in the lower third of the stomach. Macroscopically, most of the lesions were Ⅱc or Ⅱc+Ⅲ(113 lesions: Ⅱc; 86 lesions: Ⅱc+Ⅲ) 24 patients (9.5%) had level 1 lymph node metastasis and metastasis to the level 2 nodes was detected in 7 patients (2.8%). The 5-year survival rate for all the patients with early gastric cancer was 94.4%. The 5-year survival rates for patients of pN1 and pN2 were 85.7% and 80% respectively. Conclusion: There was no survival difference between mucosal and submucosal cancer. Lymph node involvement is the most important prognostic factor for early gastric cancer.

Surgery for Gastric Cancer: A 1154 Patients Experience

Background and Purpose: The major controversy for surgical treatment of gastric cancer now is in regard to the extent of lymph node dissection necessary to achieve a best chance of cure and an accurate staging. This study was aimed to compare the difference in survival and postoperative mortality between extended lymphadenectomy and limited lymphadenectomy. Methods: We retrospectively assessed 1154 patients who underwent total or subtotal gastrectomy for primary gastric cancer in the department of gastrointestinal surgery of Renai hospital between 1974 and 2000. 901 of them were treated with potentially curative resection. The patients were divided into three groups (group A: R0D2; group B: R0 D1 or D1+; group C: noncurative). The clinical and pathologic characteristics and survival difference were analyzed. Results: Five-year survival rate for all patients was 47.4 %. The 5-year survival rates for the patients of group A, B and C were 61.6%, 42.1% and 1.7%, respectively. The 5-year survival rates related to stage were: Stage Ⅰa, 95.5%; Stage Ⅰb78.4%; Stage Ⅱ, 64.5%; Stage Ⅲ, 29.9%; Stage Ⅳ, 4.8%. Postoperative hospital mortality totaled 2.3% (26/1154). The rate for group A patients was 1.5% (12/801). Postoperative hospital mortality rates were 3.9% (4/103) for group B patients and 4% (10/250) for group C patients. Conclusion: Radical gastrectomy with extended lymph node dissection in this study had survival rates similar to the Japanese investigations with a low postoperative mortality. Our results showed that extended (D2) gastrectomy had a superior survival result than the limited lymphadenectomy and should be the better option for advanced gastric cancer that is potentially resectable.

Lymph Node Metastasis of Gastric Cancer

Background and Purpose: The local invasion and lymphatic involvement are the most important prognostic factors for patients with gastric carcinoma undergoing curative resection. Because of the differences among the present classification systems defined by the international Union Against Cancer (UICC), American Joint Committee on Cancer (AJCC) and Japanese Gastric Cancer Association (JGCA), international comparison of treatment result is difficult. The aim of this study is to provide an anatomic analysis of lymph node status as a theoretical basis of extended lymph node dissection which is now considered the choice of procedure for gastric cancer. Methods: Between 1974 and 2004, 1264 patients of gastric cancer underwent gastrectomy at the surgical department of Zen-Ai hospital. 880 of them (88.2%) had a D2 or greater lymphadenectomy. For these 880 patients, the number of dissected cases and number of metastasized cases in each station were calculated to analyze the incidence of metastasis. Results: The surgical procedure included 998 distal gastrectomies (79%), 176 total gastrectomies (13.9%) and 84 proximal gastrectomies (6.6%) for limited proximal lesions. There were 254 cases of early gastric cancer (20.1%). According to the Japanese N staging, pN1 represented 18% (228 cases), pN2 25.2% and pN3 12.2% of the cases. The 5-year survival rate for node-negative patients was 83.6%. The 5-year survival rates of the patients staged by the AJCC/UICC pN classification were 56.7% for pN1, 29.8% for pN2 and 20.7% for pN3. When classified by the Japanese system, the 5-year survival rates of the patients were 61.9% for pN1, 34.7% for pN2 and 23.1% for pN3. Conclusion: Dissection of the tier two lymph node is theoretically beneficial for gastric cancer based on the incidence of lymph metastasis shown in this study. Although the AJCC TNM system is more easily applied in the Western country and more reproducible because of its simplicity, the accuracy of stage needs further comparison and study.

A case of simultaneous multiple gastric cancers with p53 gene mutation.

Simultaneous multiple gastric cancers are rarely observed in clinical practice, and its association with p53 gene mutation has not been mentioned in any previous reports. We report a case of advanced gastric cancer with two primary lesions in the stomach who received total gastrectomy. Tumor and surrounding normal tissues from the surgical specimen were studied by using polymerase chain reaction-single strand conformation polymorphism analysis, restriction enzyme digestion method and direct sequencing. Point mutations of p53 gene at codon 248 (CGG-->TGG) were found in both primary tumor foci. The patient developed cancerous peritonitis eight months after the operation and expired six months later. This report suggests that p53 gene mutation can occur at an earlier stage in the tumorigenesis of gastric cancer than previously reported and it might be associated with an unusual clinical and pathological presentation.