Yoshinobu Mitsuyama

Thymidine phosphorylase mRNA expression may be a predictor of response to post‑operative adjuvant chemotherapy with S‑1 in patients with stage III colorectal cancer

The aim of the present study was to investigate markers in surgically resected specimens of colorectal cancer that can be used to predict the response to chemotherapy. The mRNA expression levels of enzymes involved in 5-fluorouracil (5-FU) metabolism and folate metabolism were measured in formalin-fixed, paraffin-embedded tumor sections obtained from the primary tumors of 54 patients with resected stage II or III colorectal cancer who received S-1 for one year. The 5-FU metabolizing enzymes studied were thymidylate synthase, dihydropyrimidine dehydrogenase and thymidine phosphorylase (TP). The folate metabolizing enzymes studied were folypolyglutamate synthetase, γ-glutamyl hydrolase and dihydrofolate reductase. The associations between the mRNA expression levels of these enzymes and clinical variables were investigated. Tumors were classified as exhibiting high or low expression as compared with the median mRNA expression level of each metabolizing enzyme defined as the cutoff value. The associations between the high and low expression levels of each enzyme and disease-free survival (DFS) were analyzed with the use of Kaplan-Meier curves and the log-rank test. DFS was not significantly associated with the relative mRNA expression level of any metabolizing enzyme in the study group as a whole, but there was a trend toward longer DFS in patients with high TP expression (P=0.066). In patients with stage III colorectal cancer, high TP expression was associated with significantly improved outcomes compared with low TP expression (P=0.039). These results indicate that the mRNA expression of TP, a metabolizing enzyme of 5-FU, is a significant predictor of response to post-operative chemotherapy with S-1 in patients with stage III colorectal cancer.

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

Benign retroperitoneal cyst containing a high fluid concentration of cancer antigen 125, carbohydrate antigen 19-9, and amylase. Case report

ZusammenfassungGRUNDLAGEN: Gutartige retroperitoneale Zysten sind selten, jene mit flüssigem Inhalt, der CA-125 und CA 19-9 enthält, noch seltener. METHODIK: Wir berichten über eine 38-jährige Frau mit einer Zyste zwischen Colon ascendens und rechter Niere. Der Zysteninhalt zeigte erhöhte Werte für CA 125 (2.798 U/ml), CA 19-9 (49 U/ml) und Amylase (1.283 U/ml). ERGEBNISSE: Die Zyste wurde reseziert, es fand sich eine gutartige retroperitoneale Zyste. SCHLUSSFOLGERUNGEN: Unser Fall ist der 2. einer retroperitonealen Zyste mit hohen Tumormarker-Konzentrationen und Amylase in der englischsprachigen Literatur.SummaryBACKGROUND: Benign retroperitoneal cystic masses are uncommon clinical entities, and those with high cyst fluid levels of cancer antigen 125 and carbohydrate antigen 19-9 are extremely rare. METHODS: A 38-year-old woman was admitted to our hospital due to a right abdominal cystic mass. Computed tomography revealed a unilocular cystic mass without nodule between the ascending colon and the right kidney. The cyst fluid levels of cancer antigen 125, carbohydrate antigen 19-9, and amylase were elevated to 2,798 U/ml, 49 U/ml, and 1,283 IU/l, respectively. RESULTS: The patient underwent excision of the retroperitoneal cystic mass, and histologic findings confirmed the diagnosis of benign retroperitoneal cyst. CONCLUSIONS: To the best of our knowledge, our patient is the second case of a benign retroperitoneal cyst containing fluid with a high concentration of cancer antigen 125, carbohydrate antigen 19-9, and amylase in the English literature.