A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.
Background: To evaluate the clinicopathological and prognostic significance of the percentage change between maximum standardized uptake value (SUV max) at 60 min (SUV max 1) and SUV max at 120 min (SUV max 2) (ΔSUV max %) using dual time point 18 F-fluorodeoxyglucose emission tomography/computed tomography (18 F-FDG PET/CT) in breast cancer. Methods: Four hundred and sixty-four patients with primary breast cancer underwent 18 F-FDG PET/CT for preoperative staging. ΔSUV max % was defined as (SUV max 2 − SUV max 1) / SUV max 1 × 100. We explored the optimal cutoff value of SUV max parameters (SUV max 1 and ΔSUV max %) referring to the event of relapse by using receiver operator characteristic curves. The clinicopathological and prognostic significances of the SUV max 1 and ΔSUV max % were analyzed by Cox's univariate and multivariate analyses. Results: The optimal cutoff values of SUV max 1 and ΔSUV max % were 3.4 and 12.5, respectively. Relapse-free survival (RFS) curves were significantly different between high and low SUV max 1 groups (P = 0.0003) and also between high and low ΔSUV max % groups (P = 0.0151). In Cox multivariate analysis for RFS, SUV max 1 was an independent prognostic factor (P = 0.0267) but ΔSUV max % was not (P = 0.152). There was a weak correlation between SUV max 1 and ΔSUV max % (P < 0.0001, R 2 = 0.166). On combining SUV max 1 and ΔSUV max %, the subgroups of high SUV max 1 and high ΔSUV max % showed significantly worse prognosis than the other groups in terms of RFS (P = 0.0002). Conclusion: Dual time point 18 F-FDG PET/CT evaluation can be a useful method for predicting relapse in patients with breast cancer. The combination of SUV max 1 and ΔSUV max % was able to identify subgroups with worse prognosis more accurately than SUV max 1 alone.
Mesothelin is expressed in various types of malignant tumors. The present study immunohistochemically investigated mesothelin expression and its clinicopathological significance in each subtype of breast cancer, with special reference to its cellular localization, in particular, membrane mesothelin expression. Using tissue specimens from 482 patients with breast cancer, immunohistochemistry was used to study mesothelin expression and help classify its localization as membrane or cytoplasmic expression. Mesothelin expression was detected in 77 (16.0%) cases and was the highest in triple-negative breast cancer (31/75; 41.3%), followed by human epithelial growth factor receptor type 2 type (6/33, 18.2%) and luminal type (36/374; 9.6%). Among the 482 cases, membrane mesothelin expression was detected in 73 cases and was significantly associated with a negative hormone receptor status, higher Ki-67 labeling index, nuclear grade 3 and a lower relapse-free survival rate. Cytoplasmic mesothelin expression was not significantly associated with a lower relapse-free survival rate (P=0.058). In the 343 cases of luminal type, the membrane mesothelin expression-positive group had significantly worse prognosis than the membrane mesothelin-expression-negative group (P= 0.042). There was no significant difference in the relapse-free survival rate according to the membrane mesothelin expression status in the triple-negative type and other types. It was suggested that membrane mesothelin expression in luminal type breast cancer is associated with a lower rate of relapse-free survival.
The expression of mesothelin correlates with a poor prognosis in patients with breast cancer. Since mesothelin plays a role in cancer metastasis in association with CA125, we herein examined the expression of mesothelin and CA125, and the clinicopathological meaning and prognosis of the co-expression of mesothelin and CA125 in breast cancer. Our results showed that among 478 patients, mesothelin and CA125 were co-expressed in 48 (10 %), mesothelin only in 75 (16 %), CA125 only in 217 (45 %), and neither in 234 (49 %). A high correlation was observed between the expression of mesothelin and CA125 (P =0.0004). The co-expression of mesothelin and CA125 correlated with poor patient relapse-free survival (RFS) (P = 0.0001) and was identified as an independent predictor of RFS by Cox’s multivariate analysis. In conclusion, this is the first to report the prognostic significance of the co-expression of mesothelin and CA125 in breast cancer. The co-expression of mesothelin and CA125 may be clinically useful for prognostication after surgical therapy in patients with breast cancer.
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