Abstract:Background. Increased numbers of mast cells are found in various solid tumors. To investigate the role of mast cells in the vicinity of gastric cancer cells, we used special staining and an immunohistochemical technique. Methods. Specimens were surgically obtained from 102 patients with gastric cancer. Mast cells around the tumor edge of gastric cancer nests were counted by staining with 0.05% toluidine blue solution. Blood vessels in these areas were also counted, by immunohistochemical staining of endothelial cells for factor VIII. Results. The average number of mast cells and blood vessels in gastric cancer specimens was significantly higher than that in normal gastric tissue. Specimens from patients with advanced disease with metastases to lymph nodes had more mast cells than specimens from patients with early-stage disease. Mast cells in specimens from patients with metastatic lymph nodes were significantly increased in comparison with numbers in specimens from those without nodal metastases. Mast cell numbers in the specimens of patients with lymphatic or blood vessel invasion were significantly higher than numbers in specimens from patients without such invasion. Mast cells were localized near the new vessels around gastric cancer cells. Mast cell numbers increased as the number of blood vessels increased (correlation coefficient, 0.783). Postoperative survival curves revealed that patients with increased numbers of mast cells had a poor prognosis. Conclusions. All these results suggest that mast cell accumulation at the tumor site may lead to increased rates of tumor vascularization and, consequently, increased rates of tumor growth and metastasis.
Generally, LN metastases are seen in a small percentage of patients with early gastric cancer with mucosal or submucosal invasion [7]. In recent years, the technique of laparoscopy-assisted distal gastrectomy (LADG) with regional LN dissection has been developed and employed for early gastric cancer [8]. In March, 1997, we began to perform LADG as a minimally invasive surgery for early gastric cancer. However, the feasibility of LADG for early gastric cancer and the associated clinical outcome of patients who undergo LADG for early gastric cancer remain unclear.We therefore conducted a review of patients who underwent LADG for early gastric cancer, in an effort to compare the operative times, intra-operative blood loss, number of removed lymph nodes, postoperative recovery, and morbidity and mortality rates of LADG and conventional open distal gastrectomy (ODG). Our research was aimed at determining whether the laparoscopic procedure of LADG for early gastric cancer is really safe and minimally invasive, and whether or not the LADG improves quality of life, compared with ODG. Patients and methods PatientsThe patients were preoperatively diagnosed as having an early gastric cancer located in the lower or middle third of the stomach, from the results of endoscopy, endoscopic ultrasonography (EUS), and examination of biopsy specimens. The indications for LADG were that: (1) the tumor was located in the middle or lower part of the stomach, (2) the invasion of the tumor was limited to the mucosal layer or the submucosal layers (SM1). Results. The clinical and pathological backgrounds of the patients in the two groups were similar. The duration of surgery was not significantly different between the two groups, but the blood loss in the LADG group was significantly less than that in the ODG group. The number of removed lymph nodes was not significantly different between the two groups. The times to the first passing of flatus, first walking, and the restarting of oral intake; the length of hospital stay; and the duration of epidural analgesia were significantly shorter in the LADG group. The morbidity rate in the LADG group was lower than that in the ODG group. Conclusions. LADG is a safe and minimally invasive surgical technique, after which we can expect a faster recovery.
The results of this study suggest that absorbable clips are as safe and effective as standard metal clips for vessel and duct ligation in LC.
The technique of laparoscopy-assisted colectomy (LAC) was developed for benign and malignant diseases of the colon and rectum; however, its feasibility and the associated clinical outcome remain unclear. We reviewed 45 patients who underwent LAC (LAC group) and 62 patients who underwent traditional open surgery (Open group) for colorectal carcinoma in our hospital, and compared the clinical data between the two groups in an effort to determine whether LAC is really minimally invasive and if it enhances the quality of life. So that the backgrounds of the patients in both groups were almost the same, we only compared data of patients with colorectal carcinoma of stages 0, I, and II. The duration of surgery in the Open group was significantly shorter for all procedures except sigmoid resection, but the blood loss was not significantly different between any of the procedures except for right colectomy. The time to the first passing of flatus and restarting oral intake, length of hospital stay, and duration of epidural analgesia were significantly shorter in the LAC group. The morbidity and mortality rates in the LAC group were almost the same as those in the Open group at 29.5% and 3.3% versus 22.6% and 1.6%, respectively. However, five major complications of LAC for advanced colorectal carcinomas might be prevented by performing an open procedure. In conclusion, LAC is a safe and minimally invasive surgical technique following which we can expect a faster recovery; however, patients with advanced colorectal carcinomas must be carefully selected for this operation.
Abstract:Primary squamous cell carcinoma (SCC) of the stomach is extremely rare; only 32 cases are found in the Japanese literature. The pathogenesis of this neoplasm remains obscure and controversial. Furthermore, the optimal treatment, including adjuvant chemotherapy, remains unclear. We report herein a case of SCC of the stomach in a 70-year-old male with amazing effectiveness of neoadjuvant chemotherapy, low-dose FP chemotherapy. To our knowledge, no case of this disease has ever been reported that was given neoadjuvant chemotherapy and histologically showed its effectiveness. Our case demonstrated a striking effectiveness of chemotherapy in the neoplasm both radiologically and histologically.
Solitary splenic metastasis is an extremely rare phenomenon for which splenectomy is generally indicated because a good prognosis can be achieved if chemotherapy is given postoperatively. We report herein a case of solitary splenic metastasis from ovarian cancer, which was completely removed by hand-assisted laparoscopic surgery.
considered to be stage IV, with distant metastasis (M1), according to the Japanese classification of gastric cancer [1], and is usually not an indication for surgery. The prognosis of unresectable stage IV gastric cancer is extremely poor, and several chemotherapy regimens have been introduced to attempt to prolong survival [2,3] or to achieve downstaging, followed by curative resection [4,5]. However, to the best of our knowledge, few previous reports have documented chemotherapy that enables the curative resection of gastric cancer with metastasis to Virchow's lymph node, even though the response rate of recent combined chemotherapeutic modalities is 30% to 50%. We encountered a patient with gastric cancer with Virchow's lymph node metastasis, who subsequently received curative resection following treatment with the newly developed oral anticancer drug, TS-1. There were no significant adverse reactions to the chemotherapy. Case reportA 67-year old woman, who had complained of upper abdominal discomfort for 3 months, presented on June 6, 2000, with advanced gastric cancer, with swelling of Virchow's lymph nodes. Gastrointestinal fiberscopy (GIF) and upper gastrointestinal series (UGI) showed a type 2 tumor, i.e., ulcerated carcinomas with sharply demarcated and raised margins, on the greater curvature in the middle third of the stomach (Fig. 1A,C). A biopsy specimen showed poorly-to-moderately differentiated adenocarcinoma. Four swollen lymph nodes, up to 1.5 cm diameter, in the left supraclavicular area were considered to be metastasis to Virchow's lymph node, based on fine-needle aspiration cytology (Fig. 2). Abdominal computed tomography (CT) and ultrasound sonography (USG) showed swelling of several paraaortic lymph nodes ( Fig. 3A; USG is not shown). Abdominal magnetic resonance imaging (MRI) showed Gastric Cancer (2002) 5: 96-101 AbstractWe encountered a patient with advanced gastric cancer, with Virchow's lymph node metastasis, who subsequently underwent curative resection after neoadjuvant chemotherapy with the newly developed oral anticancer drug, TS-1. The patient was a 67-year-old woman who had a type 2 tumor in the middle third of the stomach, and Virchow's lymph node metastasis, which was diagnosed by fine-needle aspiration cytology; she also had swollen paraaortic lymph nodes. Curative resection was considered impossible, and TS-1 (100 mg/day) was administered for 28 days in one course, mainly in the outpatient clinic. Although grade 2 stomatitis interrupted the therapy on day 21 of the second course and on day 7 of the third course, the type 2 tumor showed marked remission (partial response; PR) and the metastasis in the Virchow's and paraaortic lymph nodes had completely disappeared after the third course (complete response; CR). Eleven weeks after the completion of the TS-1 treatment, total gastric resection with D3 lymph node dissection was performed. Histopathological examination revealed tumor involvement only in the mucosal and submucosal layers of the stomach and the no. 4d lymph node. Mos...
Programmed cell death /Whole body /Organ culture /Low dose radiation /Mouse New whole-body and organ systems were established to detect interphase cell death in the thymus, spleen and epithelial cells of intestinal crypts by low-dose radiation. Frozen sections of the thymus, spleen and intestine as thick as 8,um were made after X-irradiation of whole body or removed organs, and then sections were stained with 0.02% erythrosin B solution. In unirradiated controls, a few numbers of erythrosin B positive cells (dead or dying cells) were observed in the thymus, spleen and intestinal crypt as a single cell death. When X rays were given to various strains of mice as a whole body dose, clusters of erythrosin B positive cells were produced. They appear at 2 hr after irradiation and reached maximum at 4 hr, remaining at a similar level until 8 hr after irradiation. The number of erythrosin B positive cells decreased after then by the elimination of dead cells, and they were observed like a single cell death at 24 hr after irradiation. When erythrosin B positive cells were scored 4 hr after irradiation, their total number and the number of cluster increased with increasing doses of X rays in the dose range from 0.05 to 0.5 Gy. It is noted that there were large differences in the radiation susceptibility among the inbred strains of mice for the induction of interphase cell death of thymic lymphocytes: e.g., high susceptibility in C57BL/6J and AKR/J, intermediate in N4, A/J, PT and ST, low in C3H/HeJ, HT, 101/H and DBA/2J, indicating that interphase cell death is genetically programmed.Similar results were observed with some chemical mutagens. Although a large increase of erythrosin B positive cells was observed in the thymus and spleen with methylprednisolone, there was no increase in the intestinal crypt, and vice versa with bleomycin, suggesting the organ specificity for the induction of interphase cell death by chemicals.For the in vitro method, the removed thymus was irradiated on the agar plate, and then incubated on the agar plate which was placed on the grid in the medium, so that the medium comes up to the organ through the agar plate. Frozen sections were made and stained with erythrosin B solution in the same way as the in vivo method. The number of erythrosin B positive cells in the organ culture system reached maximum at 5 hr after X-irradiation, e.g. slightly later than in the whole-body system. The efficiency was about 60% in C57BL/6J mice when compared with whole-body system.
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