AIM:To analyze the mismatch repair(MMR)status and the ARID1A expression as well as their clinicopathological significance in gastric adenocarcinomas.METHODS:We examined the expressions of MMR proteins and ARID1A by im...AIM:To analyze the mismatch repair(MMR)status and the ARID1A expression as well as their clinicopathological significance in gastric adenocarcinomas.METHODS:We examined the expressions of MMR proteins and ARID1A by immunohistochemistry in consecutive 489 primary gastric adenocarcinomas.The results were further correlated with clinicopathological variables.RESULTS:The loss of any MMR protein expression,indicative of MMR deficiency,was observed in 38cases(7.8%)and was significantly associated with an older age(68.6±9.2 vs 60.4±11.7,P<0.001),a female sex(55.3%vs 31.3%,P=0.004),an antral location(44.7%vs 25.7%,P=0.021),and a differentiated histology(57.9%vs 39.7%,P=0.023).Abnormal ARID1A expression,including reduced or loss of ARID1A expression,was observed in 109 cases(22.3%)and was significantly correlated with lymphatic invasion(80.7%vs 69.5%,P=0.022)and lymph node metastasis(83.5%vs 73.7%,P=0.042).The tumors with abnormal ARID1A expression more frequently indicated MMR deficiency(47.4%vs 20.2%,P<0.001).A multivariate analysis identified abnormal ARID1A expression as an independent poor prognostic factor(HR=1.36,95%CI:1.01-1.84;P=0.040).CONCLUSION:Our observations suggest that the AIRD1A inactivation is associated with lymphatic invasion,lymph node metastasis,poor prognosis,and MMR deficiency in gastric adenocarcinomas.展开更多
Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediat...Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.展开更多
AIM To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.METHODS One-hundred and five institutions responded to the questionnaire.The sur...AIM To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.METHODS One-hundred and five institutions responded to the questionnaire.The survey included the following items: Number of experiences,whether performed prophylactically and/or therapeutically,whether preoperative chemotherapy was provided,number of preoperative chemotherapy rounds,and therapeutic options after chemotherapy.RESULTS Eighty-seven of the 105 institutions(83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at present.However,D3 gastrectomy was rarely performed prophylactically in clinical practice.Seventy-eight institutions(74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node(PAN) metastases.After chemotherapy,a D3 gastrectomy was scheduled for patients with a complete or partial response,stable disease,and progressive disease at 36(46%),28(36%),and 13(17%) of the institutions,respectively.CONCLUSION For patients with apparent PAN metastasis,a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.展开更多
A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,w...A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.展开更多
It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN)...It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.展开更多
An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesi...An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum.The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma.ESD was performed for this lesion and en bloc resection with negative margins was achieved.Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer(1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection.Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection.Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD.Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known.The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.展开更多
文摘AIM:To analyze the mismatch repair(MMR)status and the ARID1A expression as well as their clinicopathological significance in gastric adenocarcinomas.METHODS:We examined the expressions of MMR proteins and ARID1A by immunohistochemistry in consecutive 489 primary gastric adenocarcinomas.The results were further correlated with clinicopathological variables.RESULTS:The loss of any MMR protein expression,indicative of MMR deficiency,was observed in 38cases(7.8%)and was significantly associated with an older age(68.6±9.2 vs 60.4±11.7,P<0.001),a female sex(55.3%vs 31.3%,P=0.004),an antral location(44.7%vs 25.7%,P=0.021),and a differentiated histology(57.9%vs 39.7%,P=0.023).Abnormal ARID1A expression,including reduced or loss of ARID1A expression,was observed in 109 cases(22.3%)and was significantly correlated with lymphatic invasion(80.7%vs 69.5%,P=0.022)and lymph node metastasis(83.5%vs 73.7%,P=0.042).The tumors with abnormal ARID1A expression more frequently indicated MMR deficiency(47.4%vs 20.2%,P<0.001).A multivariate analysis identified abnormal ARID1A expression as an independent poor prognostic factor(HR=1.36,95%CI:1.01-1.84;P=0.040).CONCLUSION:Our observations suggest that the AIRD1A inactivation is associated with lymphatic invasion,lymph node metastasis,poor prognosis,and MMR deficiency in gastric adenocarcinomas.
文摘Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.
文摘AIM To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.METHODS One-hundred and five institutions responded to the questionnaire.The survey included the following items: Number of experiences,whether performed prophylactically and/or therapeutically,whether preoperative chemotherapy was provided,number of preoperative chemotherapy rounds,and therapeutic options after chemotherapy.RESULTS Eighty-seven of the 105 institutions(83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at present.However,D3 gastrectomy was rarely performed prophylactically in clinical practice.Seventy-eight institutions(74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node(PAN) metastases.After chemotherapy,a D3 gastrectomy was scheduled for patients with a complete or partial response,stable disease,and progressive disease at 36(46%),28(36%),and 13(17%) of the institutions,respectively.CONCLUSION For patients with apparent PAN metastasis,a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.
文摘A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.
文摘It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.
文摘An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric antrum.The estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated adenocarcinoma.ESD was performed for this lesion and en bloc resection with negative margins was achieved.Histopathological examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer(1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative resection.Additional gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical resection.Systemic chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second ESD.Early gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well known.The present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.
