Summary T lymphocytes, activated by interleukin 2 during an anti-tumour response, release soluble interleukin 2 receptors (slL-2R) into the bloodstream. We analysed the prognostic value of the serum slL-2R level in gastric cancer. Serum concentration of slL-2R in 96 gastric cancer patients and 100 healthy control subjects' was measured by enzyme-linked immunosorbent assay. All survivors were followed for more than 50 months. Serum slL-2R level was considered with respect to prognosis, clinicopathological factors, other tumour markers and peripheral blood cell count. Stage IlIl and IV patients had significantly higher slL-2R levels than lower stage patients and control subjects. Stage Ill and IV gastric cancer patients were divided into 'high' and 'low' slL-2R groups based upon the control subjects' serum slL-2R mean value plus one standard deviation. The high group had a significantly worse prognosis than the low group, although clinicopathological features and treatments were similar. Multivariate analysis demonstrated that the serum slL-2R level is an independent indicator. The sIL-2R level did not correlate with carbohydrate antigen 19-9, however it did correlate with carcinoembryonic antigen (r= 0.22) and with numbers of peripheral blood monocytes (r= 0.54). In conclusion, serum slL-2R may predict the outcome of gastric cancer patients with stage IlIl or IV disease.

Laparoscopic en bloc multivisceral resection for clinically suspected T4 colon cancer is a safe and feasible procedure for precisely selected patients, attaining satisfactory oncological outcomes when R0 resection is achieved.

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A 58-year-old man had adrenocortical carcinoma in the right adrenal gland. The tumour secreted excessive cortisol and dehydroepiandrosterone-sulphate (DHEA-S), and had invaded the right hepatic lobe and vena cava. Eleven months after surgical tumour resection, the serum DHEA-S levels again increased. Local tumour recurrence and a metastasis was found in the lung. Eleven months after surgery chemotherapy with mitotane (o,p'-DDD) was initiated. Twelve weeks of mitotane reduced serum DHEA-S levels and caused these tumours to disappear. The patient was then treated with lowdose mitotane (1.5-2.0 g/day) for 2 years. Serum levels of mitotane remained at less than 10 µg/ml. Although such low serum levels of mitotane and delayed initiation of mitotane after surgery have been proposed to weaken the antineoplastic effect of mitotane, the patient had a remission for 2 years. However, there was then local re-recurrence with an increase in serum DHEA-S and death 4 months later. The histological features of neoplastic cells were quite different comparing tumour resected at surgery and tumour at autopsy. The latter had more frequent mitotic nuclei. This tumour was initially Endocrine-Related Cancer (1999) 6 529-533 sensitive to mitotane, but later became insensitive.

Primary adenocarcinoma rarely develops at the site of an ileostomy performed for ulcerative colitis (UC), familial adenomatous polyposis (FAP), or Crohn's disease. We describe a case of ileostomy cancer found 14 years after proctocolectomy for FAP with cancer of both the sigmoid colon and rectum. Resection of the ileal mucosa around the stoma was performed three times. To our knowledge, only 35 other such cases have ever been reported. Our review of these cases indicates that routine examination of the stoma by a physician, or even by the patient, may lead to earlier detection of this rare complication, and a better chance of cure through minimal surgery.