Prognostic criteria in patients with gastrointestinal stromal tumors: a single center experience retrospective analysis

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors (GISTs) are morphologically and clinically heterogeneous tumors, and their biological behavior is difficult to predict, ranging from clinically benign to malignant. The aim of our study was to reanalyze the value of the commonly used prognostic criteria and recently reported nomogram in predicting disease recurrence in patients with primary resectable GISTs.</p> <p>Methods</p> <p>The clinicopathological features of 60 patients with GISTs who underwent surgical resection between 1998 and 2010 at Hiroshima University Hospital were retrospectively reviewed. Tumors were classified according to the National Institutes of Health and Armed Forces Institute of Pathology criteria, and nomogram predictions were performed. The relationship between patient and tumor characteristics was tested by univariate analysis using the log-rank test. Furthermore, we assessed nomogram performance with the concordance index and calibration.</p> <p>Results</p> <p>The median patient follow-up was 4.1 years, with 6 of 60 patients experiencing recurrence. Recurrence was observed only in the high-risk group. The recurrence-free survival (RFS) was 93.0 and 89.9% after 2 and 5 years, respectively. The concordance indices of the nomogram prediction were 0.96 and 0.65 for all patients and the high-risk subgroup, respectively. Calibration of the nomogram-predicted RFS tended to overestimate the recurrence risk relative to the actual RFS.</p> <p>Conclusions</p> <p>Although the commonly used criteria provide an excellent estimation of tumor behavior, they are limited by prognostic heterogeneity. The predictive nomogram is a beneficial scoring system but not a direct RFS predictor. We need more consideration for small GISTs, particularly those less than 3 cm in diameter, and small GISTs should be analyzed as a subset with potentiality different biological behavior.</p

Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it

Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. Once a Bochdalek hernia has been diagnosed, surgical treatment is necessary to avoid complications such as perforation and necrosis.</p> <p>Case presentation</p> <p>We present a 17-year-old Japanese boy with left-upper-quadrant pain for two months. Chest radiography showed an elevated left hemidiaphragm. Computed tomography revealed a congenital diaphragmatic hernia. The spleen and left colon had been displaced into the left thoracic cavity through a left posterior diaphragmatic defect. We diagnosed a Bochdalek hernia. Surgical treatment was performed via a thoracoscopic approach. The boy was placed in the reverse Trendelenburg position and intrathoracic pressure was increased by CO₂gas insufflations. This is a very useful procedure for reducing herniated contents and we were able to place the herniated organs safely back in the peritoneal cavity. The diaphragmatic defect was too large to close with thoracoscopic surgery alone. Small incision thoracotomy was required and primary closure was performed. His postoperative course was uneventful and there has been no recurrence of the diaphragmatic hernia to date.</p> <p>Conclusion</p> <p>Thoracoscopic surgery, performed with the boy in the reverse Trendelenburg position and using CO₂gas insufflations in the thoracic cavity, was shown to be useful for Bochdalek hernia repair.</p

Combination therapy with docetaxel and S-1 as a first-line treatment in patients with advanced or recurrent gastric cancer: a retrospective analysis

<p>Abstract</p> <p>Background</p> <p>We performed a single-institution retrospective study to evaluate the efficacy and toxicities of combination therapy with docetaxel and S-1 in patients with advanced or recurrent gastric cancer.</p> <p>Methods</p> <p>Eighty-six patients with advanced or recurrent gastric cancer were enrolled. Patients received docetaxel, 40 mg/m², on day 1 and oral S-1, 80 mg/m²/day, on days 1 to 14 every 3 weeks.</p> <p>Results</p> <p>All 84 patients were assessable for response. The overall response rate was 52.4% (44/84) and the disease control rate was 96.4% (81/84). Median time to progression (TTP) and overall survival (OS) were 6.5 (95% CI, 4.8-8.1 months) and 15.1 months (95% CI, 11.7-18.5 months), respectively. The major toxicities were neutropenia, leukopenia, alopecia and anorexia. Grade 3 or 4 hematologic toxicities included neutropenia in 31 patients (36.0%), leukopenia in 27 (31.7%), febrile neutropenia in four (4.7%), and anemia in one (1.2%). Other grade 3 toxicities included anorexia in five patients (5.8%), and stomatitis, diarrhea and nausea in one each (1.2%). There was one treatment-related death (1.2%).</p> <p>Conclusion</p> <p>The combination of docetaxel and S-1 had good clinical activity with acceptable toxicity in patients with advanced or recurrent gastric cancer.</p

Combined immunohistochemistry of β-catenin, cytokeratin 7, and cytokeratin 20 is useful in discriminating primary lung adenocarcinomas from metastatic colorectal cancer

BACKGROUND: It is important to discriminate between primary and secondary lung cancer. However, often, the discriminating diagnosis of primary lung acinar adenocarcinoma and lung metastasis of colorectal cancer based on morphological and pathological findings is difficult. The purpose of this study was to evaluate the clinical usefulness of immunohistochemistry of β-catenin, cytokeratin (CK) 7, and CK20 for the discriminating diagnosis of lung cancer. METHODS: We performed immunohistochemistry of β-catenin, CK7, and CK20 in 19 lung metastasis of colorectal cancer samples, 10 corresponding primary colorectal cancer samples and 11 primary lung acinar adenocarcinoma samples and compared the levels of accuracy of the discriminating diagnosis by using antibodies against these antigens. RESULTS: Positive staining of β-catenin was observed in all the lung metastasis of colorectal cancer samples as well as in the primary colorectal cancer samples but in none of the primary lung acinar adenocarcinoma samples. Positive staining of CK7 was observed in 90.9% of the primary lung acinar adenocarcinoma samples and in 5.3% of the lung metastasis of colorectal cancer samples, but in none of the primary colorectal cancer samples. Positive staining of CK20 was observed in all the primary colorectal cancer samples and in 84.2% of the lung metastasis of colorectal cancer samples, but in none of the primary lung acinar adenocarcinoma samples. CONCLUSION: Combined immunohistochemistry of β-catenin, CK7, and CK20 is useful for making a discriminating diagnosis between lung metastasis of colorectal cancer and primary lung acinar adenocarcinoma. This method will enable accurate diagnosis of a lung tumor and will be useful for selecting appropriate therapeutic strategies, including chemotherapeutic agents and operation methods

Idiopathic Granulomatous Gastritis Resembling a Gastrointestinal Stromal Tumor

A 41-year-old female presented with a 2 cm gastric submucosal tumor that was suspected to be a gastrointestinal stromal tumor or other malignancy, and local resection of the stomach was performed. However, histopathological examination showed granulomatous gastritis (GG) with a variety of chronic inflammatory cells and multinodular granulomas. Although she had a past history of tuberculosis and advanced breast cancer after surgery, there was no apparent evidence of either tuberculosis or a metastatic tumor. Other causes of GG, such as mycosis, syphilis, sarcoidosis or foreign body reaction were also excluded. There were no clinical features of Crohn’s disease as the principal differential diagnosis. Therefore, she was diagnosed to have idiopathic granulomatous gastritis (IGG). IGG is rare with few reports, and this report presents a surgical case of IGG resembling a gastrointestinal stromal tumor

Fasting Enhances TRAIL-Mediated Liver Natural Killer Cell Activity via HSP70 Upregulation

<div><p>Acute starvation, which is frequently observed in clinical practice, sometimes augments the cytolytic activity of natural killer cells against neoplastic cells. In this study, we investigated the molecular mechanisms underlying the enhancement of natural killer cell function by fasting in mice. The total number of liver resident natural killer cells in a unit weight of liver tissue obtained from C57BL/6J mice did not change after a 3-day fast, while the proportions of tumor necrosis factor–related apoptosis-inducing ligand (TRAIL)⁺ and CD69⁺ natural killer cells were significantly elevated (n = 7, <i>p</i> <0.01), as determined by flow cytometric analysis. Furthermore, we found that TRAIL⁻ natural killer cells that were adoptively transferred into Rag-2^−/− γ chain^−/− mice could convert into TRAIL⁺ natural killer cells in fasted mice at a higher proportion than in fed mice. Liver natural killer cells also showed high TRAIL-mediated antitumor function in response to 3-day fasting. Since these fasted mice highly expressed heat shock protein 70 (n = 7, <i>p</i> <0.05) in liver tissues, as determined by western blot, the role of this protein in natural killer cell activation was investigated. Treatment of liver lymphocytes with 50 µg/mL of recombinant heat shock protein 70 led to the upregulation of both TRAIL and CD69 in liver natural killer cells (n = 6, <i>p</i> <0.05). In addition, HSP70 neutralization by intraperitoneally injecting an anti- heat shock protein 70 monoclonal antibody into mice prior to fasting led to the downregulation of TRAIL expression (n = 6, <i>p</i> <0.05). These findings indicate that acute fasting enhances TRAIL-mediated liver natural killer cell activity against neoplastic cells through upregulation of heat shock protein 70.</p></div