Shoji Takagi

The Outcome of Gastrointestinal Stromal Tumors (GISTs) After a Surgical Resection in Our Institute

PurposeGastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract arising from Cajals cells and expressing c-kit. In a consensus report, the clinical behavior of GISTs was categorized into risk classes according to the tumor size and mitotic count. We analyzed the risk categories based on GIST patients who underwent a surgical resection at our institute during a period of 15 years.MethodsWe evaluated the risk categories of GISTs and analyzed the outcome and risk categories retrospectively. We presented the MIB-1 score of the tumor instead of mitotic counts for the evaluation of cellular growth because of inaccuracies regarding the mitotic counts.ResultsPatients were classified into 4 cases of very low risk, 11 of low risk, 8 of intermediate risk, and 5 of high risk. Four high-risk patients showed recurrence as either liver metastasis or peritoneal dissemination. In addition, local recurrence occurred in one low-risk and one intermediate-risk patient each.ConclusionOur cases confirmed the correlation between the risk categories and the prognosis. A complete resection with sufficient margin must be confirmed even in low-risk cases to prevent local recurrence. Since high-risk patients showed poor prognosis, the adjuvant treatment with chemotherapeutic regimens must therefore be further studied for high-risk patients.

A Case of Quadruple Cancer with Metachronous Colon Cancer -A Case of Operation for Synchronous Triple Cancer-

重複癌の報告は近年増加しており, 要因の1つに診断機器・技術の向上が考えられる. 今回われわれは, 異時性大腸癌を含む同時性胃癌, 十二指腸癌, 腎癌の4重複癌を経験し, 同時性3重複癌に対し1期的手術を施行した. 平成7年1月S状結腸の上皮内癌に対し, 内視鏡的大腸ポリープ切除術を施行した. 平成12年8月汎発性腹膜炎で緊急手術をした際, 胃癌の穿孔が疑われ, 術後に上部消化管内視鏡検査を施行したところ, 胃癌, 十二指腸癌を発見した. また腹部CTで右腎癌の診断を得て, 平成12年9月胃全摘術・膵頭十二指腸切除術・右腎摘出術を施行した. 病理学的にも3重複癌であったが, 本症例の4重複癌はいずれも根治的に治療できた. 文献上4重複癌の報告は年ごとに増加し, 同時多発癌の報告頻度も近年増加している. 特に共通の危険因子を持つ癌は重複しやすいと考えられ, 今日では重複癌の発生にも注意し診療することが必要と思われた.