Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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BACKGROUND: Evaluation of human epidermal growth factor receptor 2 (HER2) overexpression caused by erb-b2 receptor tyrosine kinase 2 (ERBB2) amplification (AMP) by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) is essential for treating unresectable metastatic gastric cancer (GC). A targeted tumour sequencing test enables comprehensive assessment of alterations in cancer-related genes, including ERBB2. This study aimed to evaluate the concordance between the targeted tumour sequencing test and IHC/FISH for detecting HER2-positive GC and to clarify the significance of ERBB2 AMP and concomitant genetic alterations in HER2 downstream pathways (DPs) in anti-HER2 therapy for unresectable metastatic GC patients. METHODS: ERBB2 copy number alteration (CNA) was examined via a targeted tumour sequencing test in 152 formalin-fixed paraffin-embedded (FFPE) GC tissues. ERBB2 CNA was compared to HER2 status evaluated by IHC/FISH in FFPE block sections, which were identical to those subjected to the targeted tumour sequencing test. Treatment outcomes of anti-HER2 therapy in 11 patients with unresectable metastatic GC was evaluated. RESULTS: ERBB2 AMP (≥ 2.5-fold change) was detected by the targeted tumour sequencing test in 15 patients (9.9%), and HER2 positivity (IHC 3 + or IHC 2+/FISH positive) was detected in 21 patients (13.8%). The overall percent agreement, positive percent agreement, negative percent agreement and Cohen's kappa between ERBB2 CNA and HER2 status were 94.7%, 66.7%, 99.2% and 0.75, respectively. Progression-free survival for trastuzumab therapy in patients with ERBB2 AMP was significantly longer than that in patients with no ERBB2 AMP detected by the targeted tumour sequencing test (median 14 months vs. 4 months, P = 0.007). Treatment response to trastuzumab therapy was reduced in patients with ERBB2 AMP and concomitant CNAs of genes in HER2 DPs. One patient with ERBB2 AMP and concomitant CNAs of genes in HER2 DPs achieved a durable response to trastuzumab deruxtecan as fourth-line therapy. CONCLUSIONS: A targeted tumour sequencing test is a reliable modality for identifying HER2-positive GC. ERBB2 AMP and concomitant genetic alterations detected through the targeted tumour sequencing test are potential indicators of treatment response to trastuzumab therapy. The targeted tumour sequencing test has emerged as a plausible candidate for companion diagnostics to determine indications for anti-HER2 therapy in the era of precision medicine for GC.

DOI： 10.1186/s12885-024-12482-5

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BACKGROUND: Initial chemotherapy (Initial-C) followed by surgery is a promising treatment strategy for peritoneal lavage cytology-positive gastric cancer (CY1 GC) with no other noncurative factors. The aim of this study was to investigate the survival advantage of Initial-C compared to initial surgery (Initial-S) for this disease according to the macroscopic type, which was associated with prognosis and the efficacy of chemotherapy in GC. METHODS: One hundred eighty-nine patients who were diagnosed with CY1 GC with no other noncurative factors at four institutions from January 2007 to December 2018 were enrolled. The patients were divided into a macroscopic type 4 group (N = 48) and a non-type 4 group (N = 141). The influence of initial treatment on overall survival (OS) in each group was evaluated. RESULTS: In the type 4 group, the 5-year OS rates of Initial-C (N = 35) and Initial-S (N = 13) were 11.6% and 0%, respectively (P = 0.801). The multivariate analysis could not show the survival advantage of Initial-C. In the non-type 4 group, the 5-year OS rates of Initial-C (N = 41) and Initial-S (N = 100) were 48.4% and 29.0%, respectively (P = 0.020). The multivariate analysis revealed that Initial-C was independently associated with prolonged OS (hazard ratio, 0.591; 95% confidence interval, 0.375-0.933: P = 0.023). CONCLUSIONS: Initial-C improves the prognosis of non-type 4 CY1 GC with no other noncurative factors. On the other hand, further development of effective chemotherapeutic regimens and innovative treatment strategies are required for type 4 CY1 GC.

DOI： 10.1007/s10147-024-02496-1

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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BACKGROUND/AIM: NAD(P)H dehydrogenase [quinone] 1 (NQO1), an antioxidant enzyme, confers resistance to anticancer agents. NQO1 C609T is a single-nucleotide polymorphism associated with reduced protein expression in the non-neoplastic esophageal squamous epithelium (ESE). This study aimed to investigate immunohistochemical NQO1 expression in non-neoplastic ESE and to elucidate its prognostic significance in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant therapy followed by esophagectomy. MATERIALS AND METHODS: NQO1 expression in non-neoplastic ESE was determined in surgical specimens from 83 patients with ESCC using immunohistochemistry. The association between NQO1 expression and clinicopathological factors, and the prognostic significance of NQO1 expression for relapse-free survival (RFS) were statistically evaluated. RESULTS: Patients with complete loss or weak NQO1 expression and patients with moderate or strong NQO1 expression were classified into the NQO1-negative (n=29) and NQO1-positive (n=54) groups, respectively. The downstaging of T classification status after neoadjuvant therapy was significantly more frequent in the NQO1-negative group than in the NQO1-positive group (59% vs. 33%; p=0.036). The NQO1-negative group had significantly more favorable RFS than the NQO1-positive group (p=0.035). Multivariate survival analysis demonstrated that NQO1 negative expression had a favorable prognostic impact on RFS (HR=0.332; 95%CI=0.136-0.812; p=0.016). CONCLUSION: Immunohistochemical evaluation of NQO1 expression in non-neoplastic ESE has clinical utility for predicting patient prognosis after neoadjuvant therapy followed by esophagectomy and might be helpful for selecting candidates for adjuvant therapy to treat ESCC.

DOI： 10.21873/anticanres.16993

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OBJECTIVES: De novo malignancy (DNM) is a major cause of death in long-term recipients of liver transplantation (LT). We herein report our experience with DNM after living-donor LT (LDLT). PATIENTS AND METHODS: A total of 111 LDLT procedures were performed in our institute from 1999 to 2022. Among them, 70 adult (>13 years old) LDLT recipients who survived for more than 1 year were included in this study. RESULTS: During a median follow-up of 146 (range, 12-285) months, 7 out of 70 recipients developed 8 DNMs, including lung cancer in 4, post-transplant lymphoproliferative disease in 3, and skin cancer in 1. One patient developed metachronal skin cancer and post-transplant lymphoproliferative disease. The pre-LT smoking history rate in patients with DNM was higher than in patients without DNM (P = .004). The survival time after DNM was 6 (1-166) months. Only 2 patients underwent R0 resection. DNM did not recur during follow-up. Other patients who underwent R1 resection and/or chemotherapy and/or radiotherapy all died due to DNMs during the follow-up. The cumulative DNM incidence was 3.5% at 10 years and 18.4% at 20 years after LDLT. The cumulative survival rate in patients with DNM was significantly worse than that in patients without DNM after LDLT (P = .049). CONCLUSION: The survival rate of patients with DNM was lower than that of those without DNM. A pre-LT smoking history is a risk factor for DNM. R0 resection is effective for improving the prognosis of patients with DNM. Regular cancer screening is important for detecting DNM early after LDLT.

DOI： 10.1016/j.transproceed.2024.02.015

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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BACKGROUND: Recent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC. METHODS: We enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy. RESULTS: Among 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1-2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713-2.804, P < 0.001 and score ≥ 3: HR 4.813, 95% CI 3.022-7.668, P < 0.001), total gastrectomy (HR 1.620, 95% CI 1.195-2.197, P = 0.002) and the presence of postoperative complications (HR 1.402, 95% CI 1.024-1.919, P = 0.035) were significant independent risk factors for DOD after gastrectomy for GC, in addition to age of 70 years or higher, performance status of one or higher and body mass index less than 22.0 at gastrectomy. CONCLUSIONS: Pneumonia is a leading cause of DOD after curative gastrectomy and lymph node dissection for GC. Paying attention to comorbidities, minimizing the choice of total gastrectomy and avoiding postoperative complications are essential to maintain the long-term prognosis after gastrectomy.

DOI： 10.1186/s12893-024-02313-6

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The patient was a 61-year-old man with a diagnosis of carcinoma of the pancreatic head. Abdominal computed tomography( CT)showed no distant metastasis, and he underwent subtotal stomach-preserving pancreatoduodenectomy. Immediately after surgery, he received liver perfusion chemotherapy with 5-fluorouracil followed by systemic gemcitabine. Eighteen months after surgery, CT revealed liver metastasis in the S6 segment, and partial hepatectomy was performed. The pathological diagnosis was liver metastasis of pancreatic cancer. Postoperatively, the patient was treated with gemcitabine and S-1 therapy for 1 year and then switched to S-1 monotherapy for about 6 months. Four years after the initial surgery, CT showed 2 metastases in the right lung. After 2 months of S-1 monotherapy, wedge resection of the upper and lower lobes of the right lung was performed. Gemcitabine and nab-paclitaxel therapy were administered, after the metastasectomy, but pleural dissemination appeared on CT 5 years after the initial surgery. Modified FOLFIRINOX therapy was started and continued for 8 months, but CT revealed further disseminated lesions in the diaphragm. Palliative irradiation was provided, but the disease gradually progressed. After multidisciplinary treatment, the patient survived for 6 years and 3 months after the initial surgery.

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症例は61歳,男性。閉塞性黄疸で発症し,切除可能膵頭部癌と診断し,亜全胃温存膵頭十二指腸切除術を施行した。術後5-FUの肝灌流化学療法を行い,引き続きgemcitabine(GEM)療法を6ヵ月間施行した。術後1年6ヵ月のCTで肝S6に肝転移が出現し,肝部分切除術を施行した。病理診断では膵癌肝転移であった。術後にGEM+S-1療法を1年間行い,S-1単独療法に切り替え約6ヵ月間施行した。初回手術後4年のCTで右肺に2ヶ所の肺転移を認めた。S-1療法を2ヵ月間施行後に右肺部分切除術を施行した。術後にGEM+nab-paclitaxel療法を開始したが,初回手術後5年のCTで胸膜播種が出現した。modified FOLFIRINOX療法へ変更し8ヵ月治療を継続したが,CTで横隔膜にも播種性病変が出現した。病変に緩和照射を行ったが,病状は徐々に進行した。初回手術から6年3ヵ月で死亡したが,再発後約5年の長期生存を得た。(著者抄録)

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A 66-year-old man was referred to our hospital with fever and abdominal pain. CT showed a mass in the intrapancreatic bile duct but no wall thickness in the perihilar bile ducts. Neither regional lymphadenopathy nor distant metastasis was observed. Biliary cytology showed adenocarcinoma. The diagnosis was distal cholangiocarcinoma, and pancreatoduodenectomy was performed. Intraoperative frozen section examination of the ductal resection margins at the right and left hepatic ducts was positive for carcinoma in situ, and the operation ultimately completed with R1 resection. Histological examination confirmed a diagnosis of cholangiocarcinoma with superficial spread and a single positive lymph node. Adjuvant chemotherapy with S-1 was administered for 1 year. Anastomotic recurrence at the hepaticojejunostomy was found 5 years after resection; biopsy specimens revealed adenocarcinoma. Thereafter, S-1 chemotherapy was resumed, and the patient remains alive and well 9 years and 1 month after resection.

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A 58-year-old woman presented with a complaint of weight loss. Abdominal computed tomography showed dilatation of the biliary and pancreatic ducts and a mural nodule in the pancreatic duct. The diagnosis was intraductal papillary mucinous neoplasm(IPMN). Endoscopic retrograde cholangiopancreatography(ERCP)and cholangioscopy revealed a fistula between the common bile duct and the IPMN. A sudden increase in hepatobiliary enzymes was noted preoperatively. ERCP showed that the common bile duct was obstructed by mucus. A nasobiliary drainage tube was inserted into the bile duct endoscopically and kept open by daily tube washing, and the liver dysfunction improved. Total pancreatectomy, splenectomy, and regional lymph node dissection were performed. Histological examination confirmed that the primary tumor was mixed invasive intraductal papillary mucinous adenocarcinoma. The patient remains alive and well with no evidence of recurrence 18 months after resection.

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We report a case of biliary cystadenocarcinoma in which long-term survival was achieved after 2 operations for intrahepatic recurrence. A 72-year-old man with biliary cystadenocarcinoma located mainly in segment 3 of the liver underwent left hepatectomy, extrahepatic bile duct resection, and lymph node dissection. Seven years and 9 months after the initial resection, he underwent partial liver resection(segment 5)for intrahepatic recurrence detected by computed tomography. Fifteen years and 7 months after the initial resection, he underwent repeat partial resection of the liver(segment 5)for intrahepatic recurrence. Histologically, these tumors were confirmed to be recurrence of biliary cystadenocarcinoma. He remains alive and well with no further recurrence 21 years and 6 months after the initial resection. This case and a literature review suggest that hepatic resection is a useful treatment option for intrahepatic recurrence of biliary cystadenocarcinoma.

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An 87-year-old woman with a gradually enlarging mass in her left breast, diagnosed as having left-sided breast cancer with skin invasion by a local practitioner, was referred to our hospital. Computed tomography revealed ascending colon cancer with abdominal wall invasion and a thoracic aortic aneurysm(Stanford type B), in addition to breast cancer with skin invasion. A thoracic endovascular aortic repair and bypass surgery between the subclavian arteries were both performed for the thoracic aortic aneurysm. After 6 days, a right hemicolectomy and D2 lymphadenectomy were performed for the ascending colon cancer. A postoperative pathological diagnosis of pT3N0M0, pStage Ⅱa, was made. A total left mastectomy with a full-thickness skin graft for left breast cancer was performed after 2 months following the ascending colon cancer surgery. The postoperative pathological diagnosis was pT3N0M0, pStage ⅡB. No evidence of local recurrence or distant metastasis of the ascending colon cancer has been observed at 20 months postoperatively, or of the breast cancer after 18 months following surgery.

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A 72-year-old woman presented with obstructive jaundice. Computed tomography revealed a 12-mm low-density mass in the head of the pancreas. She was diagnosed as having pancreatic cancer by endoscopic ultrasound-guided fine-needle aspiration. She received gemcitabine plus nab-paclitaxel as preoperative chemotherapy. After 2 courses, hepatoduodenal lymph node metastasis appeared and was accompanied by increased tumor marker levels. The regimen was changed to modified FOLFIRINOX. After 5 courses, the lymph node metastasis was reduced in size and the tumor marker levels were decreased, so subtotal stomach-preserving pancreaticoduodenectomy was performed. Adjuvant chemotherapy was administered postoperatively. The patient was alive and well without recurrence 2 years and 9 months after the surgery, but died of sepsis. Nevertheless, this case highlights that when preoperative chemotherapy for resectable pancreatic cancer appears to be ineffective, a change in regimen may be useful.

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A 75-year-old woman presented to our hospital with abdominal pain and melena. Colonoscopy revealed an ulcer at the appendiceal orifice. Histopathological examination of biopsy specimens revealed adenocarcinoma. Computed tomography showed an appendiceal mass of 11.8×6.7 cm in size involving the cecum and terminal ileum without any distant metastatic findings. Ileocecal resection with regional lymph node dissection to the root of the ileocolonic artery was performed. Histopathological examination of the specimen revealed appendiceal adenocarcinoma. Molecular subtype of the tumor was BRAF V600E mutation and microsatellite instability-high(MSI-H). The pathological stage was pT4bpN1bcM0, pStage ⅢC. She received 8 courses of CapeOX as adjuvant chemotherapy and no recurrence was noted 12 months following the surgery. The establishment of standard treatment strategies including surgery, chemotherapy, and immunotherapy for carcinoma of the appendix with BRAF V600E mutation and/or MSI-H is needed.

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症例は87歳,女性。左乳房腫瘤が徐々に増大したため近医を受診した。皮膚浸潤を伴う左乳癌と診断され,当科を受診した。精査の結果,左乳癌に加え,上行結腸癌と胸部大動脈瘤を認めた。上行結腸癌(cT4bN1bM0,cStage IIIc,大腸癌取扱い規約第9版),左乳癌(cT3N0M0,cStage IIB,乳癌取扱い規約第18版),胸部大動脈瘤(Stanford B型)と診断した。まず,胸部大動脈瘤に対して胸部大動脈ステント内挿術,両側鎖骨下動脈バイパス術を施行した。その6日後,上行結腸癌に対して結腸右半切除術,D2郭清を施行した。病理組織診断の結果,pT3N0M0,pStage IIaであった。上行結腸癌手術の2ヵ月後に左乳癌に対して左乳房全切除術,全層植皮術を施行した。病理組織診断の結果,pT3N0M0,pStage IIBであった。上行結腸癌術後20ヵ月,左乳癌術後18ヵ月無再発生存中である。(著者抄録)

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症例は57歳,男性。嚥下困難と嘔吐の精査で進行食道扁平上皮癌(Ut,cT3N0M0)と診断した。経鼻栄養チューブによる栄養管理を行いながら,術前docetaxel,cisplatin,5-fluorouracil併用(DCF)療法を実施した。1コース終了後に気管浸潤を認めた(cT4bN0M0)。根治的化学放射線療法(CF療法併用,照射60Gy)を実施し,気管浸潤の解除を認めた(cT3N0M0)。生検では癌の検出はなかったが,肉眼的に遺残が疑われ狭窄の悪化も認められた。安全に根治切除が可能と判断し,右開胸食道切除術(D0),胸骨後経路胃管再建を行った。病理診断ではpT1bN0M0であった。術後補助治療は実施せず,術後5年が経過して無再発生存中である。術前治療中の注意深い治療効果判定と適切な治療選択により,術前DCF療法不応例であっても根治の可能性を逃さないことが重要である。(著者抄録)

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症例は66歳,男性。発熱と腹痛の精査で肝機能障害を認めた。精査で膵内胆管の不整な壁肥厚と狭窄を認め,遠位胆管癌と診断された。根治切除の方針となり,亜全胃温存膵頭十二指腸切除術を施行された。肝側胆管切離断端は切離限界まで追加切除を行ったが,術中迅速組織診断で上皮内癌陽性であった。病理所見では膵内胆管に浸潤癌が存在し,そこより肝側の切除胆管全域に上皮内癌を認めた。また,No.13aリンパ節に転移を1個認めた。最終診断はpT3N1M0,pStage IIBであった。術後補助化学療法として1年間,S-1を内服した。術後5年目に胆管空腸吻合部に乳頭状隆起性病変を認め,生検で腺癌の診断であった。S-1内服を再開し,その後は腫瘍の増大を認めていない。術後9年1ヵ月現在,生存中である。(著者抄録)

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症例は58歳,女性。体重減少を主訴に来院した。腹部CT検査で胆管および膵管の拡張と膵管内に造影される壁在結節が認められ,膵管内乳頭粘液性腫瘍(IPMN)と診断された。内視鏡的逆行性胆管造影(ERCP)および胆道鏡で総胆管とIPMNとの間の瘻孔が確認された。IPMNの総胆管穿破と診断し,手術適応と判断した。術前待機中に急激な肝胆道系酵素の増加が認められ,ERCPを施行したところ粘液により総胆管が閉塞していたため,内視鏡的経鼻胆道ドレナージ(ENBD)チューブを挿入した。連日の洗浄によりチューブ開存を維持することで,肝機能障害は改善した。膵全摘術,脾臓合併切除,領域リンパ節郭清を施行した。病理診断は混合型浸潤性膵管内乳頭粘液性腺癌であった。術後18ヵ月が経過した現在,無再発生存している。胆管穿破を伴うIPMNに対する胆道ドレナージは,排液量の観察と洗浄が可能なENBDが妥当である。(著者抄録)

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今回,2回の肝内再発巣切除を施行して長期生存が得られた肝嚢胞腺癌の1例を経験したので報告する。症例は72歳,男性。肝S3を主座とする肝嚢胞腺癌に対して,肝左葉切除+肝外胆管切除+リンパ節郭清を施行した。術後7年9ヵ月目のCTで単発の肝内再発を指摘され,肝S5部分切除を施行した。初回手術から15年7ヵ月目には再度S5に肝内再発を来し,肝部分切除術を施行した。これらの肝再発巣は,病理組織学的に肝嚢胞腺癌の転移であることが確認された。以降は再発を認めず,初回手術から21年6ヵ月を経過した現在,生存中である。本症例の経験および文献的考察から,肝嚢胞腺癌の肝内再発に対して,再発巣切除は有用な治療選択肢の一つとなる可能性があることが示された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は72歳,女性。黄疸精査のCTで膵頭部に12mm大の乏血性腫瘤を認め,超音波内視鏡下穿刺吸引法で膵癌と診断した。術前化学療法としてGEM+nab-PTX療法を施行し,2コース終了後に肝十二指腸間膜リンパ節転移,腫瘍マーカーの上昇を認めた。modified FOLFIRINOX療法へレジメン変更を行い,5コース終了後,リンパ節転移の縮小,腫瘍マーカーの低下を認めたため亜全胃温存膵頭十二指腸切除術を施行した。S-1による術後補助化学療法を施行し,膵癌切除後2年9ヵ月間,無再発で経過したが,敗血症で他病死した。切除可能膵癌に対する術前化学療法中,病勢進行時にはレジメン変更が有用な可能性がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Sphingosine-1-phosphate (S1P) is a pleiotropic, bioactive, lipid mediator, produced by sphingosine kinase 1 (SphK1). In this study, we evaluated the expression of phosphorylated SphK1 (pSphK1) in patients with pancreatic ductal adenocarcinoma (PDAC) and investigated its clinical significance. MATERIALS AND METHODS: A total of 111 patients who underwent curative-intent resection for PDAC were enrolled. We investigated pSphK1 (Ser-225) expression in surgically resected specimens of PDAC using immunohistochemistry. The patients were divided into two groups according to pSphK1 immunoreactive expression: a pSphK1-high group (n=63) and a pSphK1-low group (n=48). RESULTS: Logistic regression analyses revealed that lymphatic invasion (p=0.007) was a significantly independent factor associated with high pSphK1 immunoreactive expression. The pSphK1-high group showed significantly worse disease-specific survival (DSS) than the pSphK1-low group (5-year DSS rate, 19.6% vs. 58.7%; p=0.001). High pSphK1 immunoreactive expression (hazard ratio=2.547; 95% confidence interval= 1.434-4.527; p=0.001) was an independent prognostic factor for DSS. CONCLUSION: High pSphK1 expression is independently associated with lymphatic invasion and unfavorable prognosis in PDAC patients. Thus, the SphK1-S1P axis may be important in mechanisms of tumor progression, such as lymphatic invasion, in PDAC patients.

DOI： 10.21873/anticanres.16584

PubMed

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Language：Japanese   Publisher：(一社)日本移植学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470477&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F016%2F0319-0319%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F016%2F0319-0319%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470544&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F083%2F0341-0341%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F083%2F0341-0341%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：新潟医学会  

【緒言】2019年6月よりがん遺伝子パネル検査が保険収載され,本邦におけるがんゲノム医療が始動した.がんゲノム医療では,次世代シークエンサーによる「がん遺伝子パネル検査」を用いて個々の患者における癌の遺伝子変化を明らかにして,その特性に応じた最適な癌治療の機会を提供する.がんゲノム医療においては,多職種による専門家会議である「エキスパートパネル」が重要な位置を占める.エキスパートパネルでは,癌の遺伝子の変化に基づく推奨治療および遺伝性腫瘍に関連する遺伝子の変化(二次的所見)についての議論がなされる.「がんゲノム医療拠点病院」である新潟大学医歯学総合病院は,定期的にエキスパートパネルを開催し,新潟県内のがんゲノム医療を推進している.本研究の目的は,新潟県内におけるがんゲノム医療の現状と今後の課題を明らかにすることである.【方法】(1)2019年9月から2022年8月に,新潟県内のがんゲノム医療連携病院もしくはがんゲノム医療拠点病院においてがん遺伝子パネル検査を実施し,新潟大学医歯学総合病院でエキスパートパネルを実施した503例を対象とした.そして,原発臓器の内訳,がん遺伝子パネル検査の種類,エキスパートパネルで検討された治療推奨および二次的所見の現状を明らかにした.(2)2019年9月から2022年8月に,新潟大学医歯学総合病院からがん遺伝子パネル検査を提出した233例を対象とした.そして,検査提出から結果説明までにかかる期間(Turnaround Time:TAT),治療推奨および治療到達率を明らかにした.【結果】(1)503例の原発臓器の内訳は,消化管が150例(30%),肝胆膵が112例(22%),婦人科系臓器が69例(14%),泌尿器が45例(9%),その他が127例(25%)であった.がん遺伝子パネル検査の種類の内訳では,FoundationOne CDxが359例(72%),FoundationOne Liquid CDxが87例(17%),OncoGuideTM NCCオンコパネルが57例(11%)であった.エキスパートパネルで治療薬を推奨したのは74例(15%)あり,その内訳は治験薬が43例(9%),保険承認薬が32例(6%)であった.また,二次的所見を69例(14%)に認めた.(2)233例のTATの中央値は35日(範囲:19-179日)であった.エキスパートパネルでの治療推奨は36例(15%)であり,治療到達は17例(7%)であった.【結論】がんゲノム医療は,実臨床において着実に広がりつつある.がんゲノム医療では,多職種の専門家の参画が必要であるため,将来を見据えた人材育成が重要である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The definition and classification of regional nodes are not standardized for perihilar cholangiocarcinoma. This study aimed to clarify the rational extent of regional lymphadenectomy and to elucidate the impact of number-based regional nodal classification on survival of patients with this disease. METHODS: Data of 136 patients with perihilar cholangiocarcinoma who underwent surgery were reviewed. The incidence of metastasis and the survival of patients with metastasis were calculated for each node group. RESULTS: The incidence of metastasis for the node groups in the hepatoduodenal ligament (denoted as no. 12) ranged from 3.7% to 25.4%, with 5-year disease-specific survival of 12.9% to 33.3% for patients with metastasis. The incidences of metastasis in the common hepatic artery (no. 8) and posterior superior pancreaticoduodenal (no. 13a) node groups were 14.4% and 11.2%, respectively, with 5-year disease-specific survival rates of 16.7% and 20.0% for the patients with metastasis. When these node groups were defined as regional nodes, the 5-year disease-specific survival rates for the patients with pN0 (n = 80), pN1 (1-3 positive nodes, n = 38), and pN2 (≥ 4 positive nodes, n = 18) were 61.4%, 22.9%, and 17.6%, respectively (p < 0.001). The pN classification was independently associated with disease-specific survival (p < 0.001). When only the no. 12 node groups were regarded as regional nodes, pN classification failed to stratify the patients prognostically. CONCLUSIONS: No. 8 and no. 13a node groups should be considered regional nodes in addition to no. 12 node groups and should be dissected. The number-based regional nodal classification allows patients with this disease to be stratified prognostically.

DOI： 10.1245/s10434-023-13361-2

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DOI： 10.1245/s10434-023-13440-4

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DOI： 10.1245/s10434-023-13418-2

PubMed

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Language：Japanese   Publisher：新潟医学会  

重症胆道感染症から敗血症性ショックに至った症例に対してエンドトキシン吸着療法(polymyxin-direct hemoperfusion:PMX-DHP)を行い,急性期から脱却後に手術を施行し得た2例を経験したので報告する.症例1は79歳の男性で,発熱と呼吸困難を主訴に救急外来を受診した.呼吸数36回/分,経皮的動脈血酸素飽和度81%(room air),心拍数71回/分,血圧85/61mmHgとショック状態であった.腹部造影CT検査で胆嚢結石と総胆管の拡張を認め,総胆管結石による重症急性胆管炎と診断した.気管内挿管と急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆道ドレナージを行なったが,敗血症性ショックが遷延したためPMX-DHPを施行した.PMX-DHP開始後4時間程度で循環動態は安定し,ノルアドレナリンの投与を終了した.急性胆管炎発症から3病日目に人工呼吸器管理を終了し,15病日目に内視鏡下に総胆管結石を採石した.29病日目に自宅へ退院となった.発症から3ヵ月後に腹腔鏡下胆嚢摘出術を施行した.術後2年2ヵ月が経過した現在,胆道感染症の再発なく経過している.症例2は86歳の女性で,大動脈弁置換術後のため入院加療中であった.術後21病日目に発熱し,呼吸数34回/分,経皮的動脈血酸素飽和度96%(酸素8L/分投与下),心拍数125回/分,血圧85/41mmHgとショック状態となった.腹部造影CT検査で腫大した胆嚢と周囲の脂肪織濃度の上昇を認め,重症急性胆嚢炎と診断した.急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆嚢ドレナージを施行した.敗血症性ショックが遷延したためPMX-DHPを施行し,血圧は上昇傾向となった.急性胆嚢炎発症から3病日目にノルアドレナリンの投与を終了できた.46病日目にリハビリ目的に他院へ転院となった.発症から3ヵ月後に開腹下胆嚢摘出術を施行した.術後1年6ヵ月が経過した現在,胆道感染症の再発なく経過している.重症胆道感染症により循環動態が不安定な症例では,PMX-DHPは支持療法として治療選択肢の1つになり得る.(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to clarify potential candidates for anatomic resection (AR) among patients with pathological T1-T2 (pT1-T2) hepatocellular carcinoma (HCC) and to determine whether AR is effective for HCC with microscopic vascular invasion (MVI). METHODS: We retrospectively analyzed 288 patients with pT1a (n = 50), pT1b (n = 134) or pT2 (n = 104) HCC who underwent curative-intent resection between 1990 and 2010. Surgical outcomes were compared between patients who underwent AR (n = 189) and those who underwent nonanatomic resection (NAR; n = 99) according to pT category and MVI status. RESULTS: Patients who underwent AR were more likely to have good hepatic functional reserve and an aggressive primary tumor than those who underwent NAR. When patients were stratified according to pT category, AR had a more favorable impact on survival than NAR only in patients with pT2 HCC in univariate (5-year survival, 51.5% vs. 34.6%; p = 0.010) and multivariate analysis (hazard ratio 0.505; p = 0.014). However, AR had no impact on survival in patients with pT1a or pT1b HCC. In patients with MVI (n = 57), AR achieved better survival than NAR (5-year survival, 52.0% vs. 16.7%; p = 0.019) and was an independent prognostic factor (hazard ratio 0.335; p = 0.020). In patients without MVI (n = 231), there was no significant difference in survival between the two groups (p = 0.221). CONCLUSION: AR was identified as an independent factor in improved survival in patients with pT2 HCC or HCC with MVI.

DOI： 10.1016/j.suronc.2023.101951

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Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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BACKGROUND: Next-generation sequencing (NGS) has enabled comprehensive genomic profiling to identify gene alterations that play important roles in cancer biology. However, the clinical significance of these genomic alterations in triple-negative breast cancer (TNBC) patients has not yet been fully elucidated. The aim of this study was to clarify the clinical significance of genomic profiling data, including copy number alterations (CNA) and tumor mutation burden (TMB), in TNBC patients. METHODS: A total of 47 patients with Stage I-III TNBC with genomic profiling of 435 known cancer genes by NGS were enrolled in this study. Disease-free survival (DFS) and overall survival (OS) were evaluated for their association to gene profiling data. RESULTS: CNA-high patients showed significantly worse DFS and OS than CNA-low patients (p = 0.0009, p = 0.0041, respectively). TMB was not associated with DFS or OS in TNBC patients. Patients with TP53 alterations showed a tendency of worse DFS (p = 0.0953) and significantly worse OS (p = 0.0338) compared with patients without TP53 alterations. Multivariable analysis including CNA and other clinicopathological parameters revealed that CNA was an independent prognostic factor for DFS (p = 0.0104) and OS (p = 0.0306). Finally, multivariable analysis also revealed the combination of CNA-high and TP53 alterations is an independent prognostic factor for DFS (p = 0.0005) and OS (p = 0.0023). CONCLUSIONS: We revealed that CNA, but not TMB, is significantly associated with DFS and OS in TNBC patients. The combination of CNA-high and TP53 alterations may be a promising biomarker that can inform beyond standard clinicopathologic factors to identify a subgroup of TNBC patients with significantly worse prognosis.

DOI： 10.1007/s12282-023-01449-2

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INTRODUCTION: This study aimed to evaluate the association between the preoperative Controlling Nutritional Status (CONUT) score, survival outcomes, and recurrence pattern in patients with resectable biliary tract cancer (BTC). METHODS: A total of 224 BTC patients (gallbladder, n = 69; intrahepatic bile ducts, n = 26; perihilar bile ducts, n = 72; distal bile duct, n = 57) who underwent surgery with curative intent were enrolled. The best cutoff point of the preoperative CONUT score in discriminating survival was determined using χ2 scores. The sites of recurrence were subclassified as locoregional or distant. RESULTS: Patients were subdivided into the CONUT-low (score ≤ 3, n = 156) and the CONUT-high (score > 3; n = 68) groups. In-hospital mortality occurred more frequently in the CONUT-high group than in the CONUT-low group (7.4% vs. 1.3%; p = 0.028). A high preoperative CONUT score was independently associated with worse overall survival (hazard ratio [HR] 1.906, p = 0.001), worse disease-specific survival (HR 1.840, p = 0.006), and worse recurrence-free survival (HR 1.680, p = 0.005). Recurrence developed in 110 (49.1%) patients. A high preoperative CONUT score was independently associated with a higher risk of distant recurrence (HR 2.245, p = 0.001), but not locoregional recurrence. The incidences of distant recurrence at 5 years were 55.4% and 34.2% in the CONUT-high and CONUT-low groups, respectively (p = 0.001). CONCLUSIONS: The preoperative CONUT score independently predicts survival outcomes and may serve as a surrogate marker of aggressive systemic disease recurrence in patients with resectable BTC.

DOI： 10.1016/j.ejso.2022.11.003

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We report a case of intrahepatic cholangiocarcinoma(ICC)with lymph node metastases in which long-term survival was achieved after surgery followed by chemotherapy. A 69-year-old man underwent left hepatectomy, extrahepatic bile duct resection, and lymph node dissection for ICC located mainly in segment 4 of the liver with enlarged lymph nodes in the hepatoduodenal ligament. The histopathologically confirmed diagnosis was ICC(T2N1M0, Stage ⅣA)with 3 positive lymph nodes(No. 12a1, No. 12p1, and No. 12p2). He received chemotherapy with gemcitabine(GEM)plus cisplatin(CDDP)for 9 months, followed by GEM monotherapy for 4 months, and then S-1 monotherapy was started. A right lung nodule was detected 12 months after the initiation of S-1 monotherapy. He received GEM plus S-1 therapy for 28 months, followed by S-1 monotherapy, leading to disappearance of the lung nodule. He remains alive and well without disease 78 months after surgery. Our experience in this case suggests that radical resection followed by chemotherapy may provide a survival benefit in selected patients who have ICC with nodal disease.

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BACKGROUND: Anastomotic leakage (AL) is a serious complication after esophagectomy for esophageal cancer. The objective of this study was to identify the risk factors for AL. METHODS: Patients with esophageal cancer who underwent curative esophagectomy and cervical esophagogastric anastomosis between 2009 and 2019 (N = 346) and those between 2020 and 2022 (N = 17) were enrolled in the study to identify the risk factors for AL and the study to assess the association between the risk factors and blood flow in the gastric conduit evaluated by indocyanine green (ICG) fluorescence imaging, respectively. RESULTS: AL occurred in 17 out of 346 patients (4.9%). Peptic or endoscopic submucosal dissection (ESD) ulcer scars were independently associated with AL (OR 6.872, 95% CI 2.112-22.365) in addition to diabetes mellitus. The ulcer scars in the anterior/posterior gastric wall were more frequently observed in patients with AL than in those without AL (75.0% vs. 17.4%, P = 0.042). The median flow velocity of ICG fluorescence in the gastric conduits with the scars was significantly lower than in those without the scars (1.17 cm/s vs. 2.23 cm/s, P = 0.004). CONCLUSIONS: Peptic or ESD ulcer scarring is a risk factor for AL after esophagectomy in addition to diabetes mellitus. The scars in the anterior/posterior gastric wall are significantly associated with AL, impairing blood flow of the gastric conduit. Preventive interventions and careful postoperative management should be provided to minimize the risk and severity of AL in patients with these risk factors.

DOI： 10.1007/s11605-022-05545-0

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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術後化学療法を併施して,根治切除後に長期生存したリンパ節転移陽性肝内胆管癌の1例を経験したので報告する。症例は69歳,男性。肝十二指腸間膜内リンパ節の腫大を伴う肝S4が主座の肝内胆管癌に対して,肝左葉切除+肝外胆管切除+リンパ節郭清を実施した。進行度はT2N1M0,Stage IVAで,郭清リンパ節3個(No.12a1,No.12p1,No.12p2)に転移を認めた。術後補助化学療法としてgemcitabine(GEM)+cisplatin(CDDP)療法を9ヵ月,GEM療法を4ヵ月実施した後,S-1療法を継続した。S-1開始1年後に出現した右肺結節に対し,GEM+S-1療法を2年4ヵ月間実施した。その後S-1療法に変更し,肺結節は消失した。術後6年6ヵ月が経過した現在,無再発生存中である。本症例の経験から,予後不良なリンパ節転移陽性の肝内胆管癌において,根治切除と化学療法が長期生存に寄与する症例も存在することが示された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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BACKGROUND: Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. METHODS: A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. RESULTS: Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). CONCLUSIONS: CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.

DOI： 10.1186/s12893-022-01874-8

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Publishing type：Research paper (scientific journal)   Publisher：Elmer Press, Inc.  

DOI： 10.14740/wjon1530

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A 71-year-old man with middle thoracic esophageal cancer was treated with neoadjuvant chemotherapy using docetaxel plus 5-FU plus cisplatin therapy and was also administered pegfilgrastim. Blood tests showed elevated white blood cell counts and C-reactive protein levels before the start of the third course. Contrast-enhanced computed tomography revealed wall thickening of the aortic arch. We diagnosed this as aortitis due to pegfilgrastim. Inflammation was improved with conservative treatment. We then performed video-assisted thoracoscopic esophagectomy. Drug-induced vasculitis should be included in the differential diagnosis of patients with elevated inflammation markers of unknown cause following the administration of granulocyte colony-stimulating factor preparations.

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A 53-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)for resectable pancreatic cancer after neoadjuvant chemotherapy. Postoperatively, she received hepatic arterial infusion of 5-FU and S-1 chemotherapy. Two years after SSPPD, abdominal computed tomography showed a 2-cm mass in the remnant pancreas, which was diagnosed as recurrence of cancer by endoscopic ultrasound-guided fine-needle aspiration. Staging laparoscopy was performed and peritoneal washing cytology(CY)was positive. She then received gemcitabine plus nab-paclitaxel chemotherapy for 8 months. After that, staging laparoscopy was performed again and negative CY was confirmed. A total remnant pancreatectomy with splenectomy was performed. She received chemotherapy after pancreatectomy and is now alive and well without recurrence 2 years and 1 month after the second surgery. Although positive CY is a poor prognostic factor, surgery combined with perioperative chemotherapy may contribute to prolonged survival for some patients who have recurrence in the remnant pancreas with positive CY.

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The patient was a 71-year-old man with a diagnosis of duodenal carcinoma. Abdominal computed tomography(CT) showed no distant metastasis, and he underwent subtotal stomach-preserving pancreaticoduodenectomy. Postoperative adjuvant chemotherapy was not administered. A left supraclavicular lymph node recurrence was detected on CT 15 months after surgery. Capecitabine and oxaliplatin(CAPOX)therapy was administered and the metastatic lesion shrank. Positron emission tomography(PET)-CT showed no lesions at other sites and left cervical lymph node dissection was performed 5 months after the recurrence. Postoperative adjuvant therapy with S-1 was administered for 6 months. However, 2 years and 10 months after the first recurrence, CT showed recurrence in the left supraclavicular lymph node. CAPOX therapy was resumed, but due to an allergic reaction to oxaliplatin, the patient was treated with capecitabine alone. The recurrent lesion was gradually increased in size, and FOLFIRI therapy was introduced. One year and 5 months after secondary recurrence, PET-CT showed that the second recurrent lesion had grown but was confined to the left supraclavicular lymph node, so radiation therapy(60 Gy)to the left neck was performed. The disease was stable for about 10 months and chemotherapy could be discontinued. The lesion increased in size thereafter, and the patient died 7 years after initial surgery.

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A 74-year-old man presented to our hospital with a mass in the left supraclavicular fossa. He was diagnosed with advanced gastric cancer with liver metastasis and left supraclavicular and para-aortic lymph node metastasis, cT3N2M1 (LYM, HEP), cStage Ⅳ(the Union for International Cancer Control, TNM 7th edition). He received a total of 3 courses of S- 1 plus cisplatin therapy. Since he developed adverse reactions such as anorexia, renal dysfunction, and thrombocytopenia and the tumor was HER2-positive, he received 25 courses of capecitabine, cisplatin, and trastuzumab chemotherapy. Three years and 2 months after the first chemotherapy, remarkable tumor reduction was observed. The patient then underwent radical distal gastrectomy with D2 lymphadenectomy, and R0 resection was achieved. The histopathological diagnosis was ypT1aN0M0, ypStage ⅠA. Chemotherapy with trastuzumab may improve the long-term prognosis of HER2-positive Stage Ⅳ gastric cancer if the disease is controlled and radical resection can be achieved.

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A woman in her 60s had been aware of perianal erosions for 1 month. Skin biopsy showed Paget's cells in the stratified squamous epithelium, and immunohistochemistry showed negative staining for CK7 and positive staining for CK20. Colonoscopy revealed well-differentiated adenocarcinoma in the anal canal. Computed tomography showed neither regional lymph node metastasis nor distant metastasis. Hence, she was diagnosed with anal canal carcinoma with pagetoid spread. We determined the extent of resection of the skin lesion preoperatively by mapping biopsy, and performed laparoscopic abdominoperineal resection. The pathological findings revealed adenocarcinoma(tub1, tub2), and the skin resection margin was negative. Immunohistochemistry for Paget's cells in the stratified squamous epithelium showed negative staining for GCDFP-15 and CK7, and positive staining for CK20. Twenty-four months after surgery, we detected right inguinal lymph node metastasis and performed right inguinal lymphadenectomy. As of 4 months after the lymphadenectomy, no local recurrence or distant metastasis has been detected during follow-up examinations.

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症例は71歳,男性。進行食道癌に対して術前化学療法としてドセタキセル+5-FU+シスプラチン療法を開始した。2コース目の抗癌剤投与終了後にペグフィルグラスチムを投与した。3コース目開始時に白血球増多とCRP上昇を認めた。精査目的の造影CT検査で大動脈弓部の壁肥厚を認め,ペグフィルグラスチムによる大動脈炎と診断した。保存的治療で炎症所見は改善し,造影CT検査で大動脈弓部の壁肥厚の改善を認めた。手術は胸腔鏡下食道切除,3領域リンパ節郭清,胸骨後経路胃管再建を施行した。大動脈弓部付近の炎症による影響はなく,剥離は容易に可能であった。ペグフィルグラスチム投与後に原因不明の炎症反応の上昇を認めた場合には,薬剤誘発性血管炎も鑑別にあげるべきである。(著者抄録)

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症例は74歳,男性。左鎖骨上窩の腫瘤を主訴に当院を受診した。精査で領域リンパ節転移,肝転移,左鎖骨上窩リンパ節転移,傍大動脈リンパ節転移を伴う切除不能進行胃癌,cT3N2M1(LYM,HEP),cStage IVと診断した。一次化学療法としてS-1+cisplatin療法を計3コース施行後,食欲不振,腎機能障害,血小板減少の有害事象を認め,経過中にHER2陽性と判明したため,二次化学療法としてcapecitabine+cisplatin+trastuzumabに変更して計25コース施行した。原発巣の著明な縮小を認め,遠隔転移巣に対してcomplete response(CR)が得られ,初回化学療法開始から3年2ヵ月後に幽門側胃切除,D2郭清,Billroth I法再建術を施行し,R0切除を達成し得た。術後経過は良好であり,第14病日に退院した。病理組織診断結果はypT1aN0M0,ypStage IAであった。術後補助化学療法としてS-1単剤療法を1年間施行し,術後5年5ヵ月現在,無再発生存中である。HER2陽性Stage IV胃癌に対するtrastuzumab併用化学療法は,病勢コントロールし得て根治切除が可能となれば長期予後が得られる可能性がある。(著者抄録)

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症例は60歳代,女性。1ヵ月前より肛門周囲のびらんを自覚していた。生検で重層扁平上皮内にPaget細胞が散見され,免疫組織化学検査の結果,CK7陰性,CK20陽性であった。また,肛門管内に腺癌(tub1)を認めた。CT検査で遠隔転移や有意なリンパ節腫大を認めなかった。免疫組織化学検査の結果より,重層扁平上皮内のPaget細胞は肛門管癌から皮膚へ進展したpagetoid spread(PS)であると診断した。肛門管癌はcT2N0M0,cStage I(大腸癌取扱い規約第9版)と診断した。会陰部皮膚病変に対しmapping biopsyを行い,病変辺縁から2cmの部位でPS陰性であることを確認した上で,腹腔鏡補助下直腸切断術を施行した。病理組織学的検査では腺癌(tub1,tub2)を認め,皮膚切除断端は陰性であった。術後24ヵ月目に右鼠径リンパ節転移を認め,右鼠径リンパ節切除術を施行した。リンパ節切除術後4ヵ月無再発生存中である。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は53歳,女性。切除可能膵癌に対して術前化学療法後に亜全胃温存膵頭十二指腸切除術を施行した。術後補助化学療法として,5-FU肝動注療法およびS-1療法を施行した。術後2年目のCTで残存膵に2cm大の腫瘤が出現し,超音波内視鏡下穿刺吸引法で残膵再発癌と診断した。審査腹腔鏡検査でCY陽性を確認後,GEM+nab-PTX療法を8ヵ月行い,再度の審査腹腔鏡検査でCY陰転化したため,残膵全摘術,脾臓摘出術を施行した。術後化学療法を施行し,残膵再発癌切除後2年1ヵ月現在,無再発生存中である。CY陽性は予後不良因子であるが,術前・術後化学療法を組み合わせることで,CY陽性残膵再発癌も切除適応となる可能性がある。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は71歳,男性。腹痛,体重減少を主訴に原発性十二指腸癌と診断され,亜全胃温存膵頭十二指腸切除術が施行された。術後15ヵ月後のCTで左鎖骨上リンパ節再発を認めた。カペシタビン+オキサリプラチン(CAPOX)療法を行い,転移巣は縮小した。他部位に病変を認めず,再発から5ヵ月後に左頸部リンパ節郭清術を施行し,S-1による術後補助化学療法を6ヵ月間施行した。しかし初回再発から2年10ヵ月後のCTで左鎖骨上リンパ節の再々発を認めた。CAPOX療法を再開したが薬剤アレルギーを認め,カペシタビン単独療法を行い,その後はFOLFIRI療法とした。再々発から1年5ヵ月後のPET-CTでは病変は限局しており,左頸部に60Gyの体外照射を行った。10ヵ月程度は病状が安定し化学療法を休薬できたが,徐々に病変が増大し術後7年で原病死した。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420086&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F086%2F1648-1650%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F086%2F1648-1650%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English  

Neurenteric cyst (NC) shows benign histopathology and rarely demonstrate malignant transformation. We herein describe a case of NC that exhibited malignant transformation. A 65-year-old female presented with gait disturbance due to compression by a cystic mass on the dorsal surface of the medulla oblongata. Partial resection was performed twice, leading to improvement of her symptoms. Two years after the second surgery, gadolinium-perfused T1-weighted magnetic resonance imaging revealed an invasive lesion with contrast enhancement at the trigone of the left lateral ventricle for which partial resection followed by radiotherapy was performed. However, mass regrowth was observed, with the patient eventually succumbing to her disease 11 months after her third surgery. Histopathological analyses of the first and second surgical specimens identified pseudostratified cuboidal epithelial cells, with no nuclear or cellular atypia resembling gastrointestinal mucosa, lining the inner surface of the cystic wall. Based on these findings the lesion was diagnosed as NC. The third surgical specimen exhibited apparent malignant features of the epithelial cells with elongated and hyperchromatic nuclei, several mitotic figures, small necrotic foci, and a patternless or sheet-like arrangement. Based on these findings, the lesion was diagnosed as NC with malignant transformation. Next-generation sequencing revealed KRAS p.G12D mutation in all specimens. Additionally, the third surgical specimen harbored the following 12 de novo gene alterations: ARID1A loss, BAP1 p.F170L, CDKN1B loss, CDKN2A loss, CDKN2B loss, FLCN loss, PTCH1 loss, PTEN loss, PTPRD loss, SUFU loss, TP53 loss, and TSC1 loss. The aforementioned results suggest that KRAS mutation is associated with the development of the NC, and that the additional gene alterations contribute to malignant transformation of the NC.

DOI： 10.1111/neup.12822

PubMed

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：新潟医学会  

【目的】スフィンゴシン-1-リン酸(S1P)は様々な生理活性を持つスフィンゴ脂質であり,炎症や発癌に関与していると言われている.潰瘍性大腸炎術後回腸嚢炎は晩期合併症として注目されているが,原因については不明な点が多い.本研究では,S1Pと回腸嚢炎の関連を明らかにすることを目的とした.【対象と方法】2020年7月～2021年2月に潰瘍性大腸炎術後,回腸嚢から内視鏡的あるいは手術により組織生検が行われた6名を対象とした.臨床データ(採血結果,回腸嚢炎重症度,消化管内視鏡検査等)をカルテから後方視的に解析した.回腸嚢炎の診断は,厚生労働科学研究費補助金難治性疾患政策研究事業による「潰瘍性大腸炎・クローン病診断基準・治療指針」に準じた.回腸嚢組織における質量分析によるS1P測定,および抗リン酸化S1P産生酵素(pSphK1)抗体を用いた免疫組織化学染色を行った.回腸嚢炎の重症度とS1P値,抗pSphK1抗体免疫組織化学染色の関連について検討した.【結果】対象6名の内訳は,男性5名,女性1名,年齢の中央値は45歳(範囲:33-70歳)であった.回腸嚢の内視鏡所見として,1例は回腸嚢炎なし(正常),2例は軽度,3例は中等度であった.対象6例のS1P測定値(中央値)は0.2pmol/mg(範囲:0.1-0.8pmol/mg)であった.採血データで高度の炎症を伴った中等度症例のS1P値が高値を示していた.免疫組織化学染色の結果では,内視鏡的に回腸嚢炎の所見を認めた5例のうち4例で抗pSphK1抗体陽性が陽性であった.【結論】脂質メディエーターであるS1Pが,潰瘍性大腸炎術後回腸嚢炎の炎症増悪に関与している可能性が示唆された.(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Gastric cancer is a Lynch syndrome (LS)-associated tumor, with the cumulative lifetime risk in LS patients estimated to be 5.8-13%. Hence, surveillance for gastric cancer is important for LS patients, especially in those with a family history of gastric cancer or of Asian descent. We report a very rare case of a LS patient who showed gastric metastasis from jejunal adenocarcinoma curatively resected 8 years prior. A 79-year-old female was diagnosed with a synchronous gastric submucosal tumor (SMT) and right-sided colon cancer. She was referred to our hospital as she and her family had histories of LS-associated tumors. She underwent curative intent surgery for the tumors. Postoperative histopathological examination revealed the gastric SMT was an adenocarcinoma completely covered by non-neoplastic gastric mucosa. Immunohistochemical analyses showed the gastric SMT had the same expression pattern for CDX2, cytokeratins 7 and 20 as the jejunal adenocarcinoma. Thirty-four months after surgery the patient is alive without recurrence or any other LS-associated tumors. To the best of our knowledge, this is the first report of gastric metastasis from small bowel adenocarcinoma in a LS patient. Awareness of this case may be important for gastric cancer surveillance in LS patients.

DOI： 10.1007/s12328-022-01625-5

PubMed

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：English  

DOI： 10.1007/s00535-022-01867-7

PubMed

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：新潟医学会  

【目的】消化器外科術後に発症した播種性血管内凝固(disseminated intravascular coagulation;以下,DICと略記)に対する遺伝子組み換えトロンボモジュリン(recombinant human soluble thrombomodulin;以下,rTMと略記)の効果を検証し,治療成績改善に向けた方策を考察する.【方法】2016年1月から2021年5月に当科で消化器外科術後DICの改善を目的にrTMが投与された48例を対象とした.対象症例におけるDICの改善効果,および在院死亡の危険因子を検証した.DICの診断には,日本救急医学会の急性期DIC診断基準を使用した.患者背景および検査項目に関する2群間のカテゴリー変数の比較にはPearsonのχ2検定,Fisherの直接法を用いた.多変量解析はstepwise法によるロジスティック回帰分析を用いて行った.生存曲線はKaplan-Meier法で算出し,log rank検定で有意差検定を行った.有意水準5%(P<0.05)をもって有意差ありと判断した.【結果】年齢の中央値は76歳(59-91),男女比は21:27であった.原疾患は下部消化管穿孔が22例(45.8%),悪性腫瘍が11例(22.9%),消化管虚血が10例(20.8%),上部消化管穿孔が5例(10.4%)であった.DICを発症した原因は,急性汎発性腹膜炎が38例(79.2%),術後感染症が5例(10.4%),術後肝不全が4例(8.3%),術後出血が1例(2.1%)であった.rTM投与開始後7日目に28例(58.3%)で血小板数増加を認め,31例(64.6%)でDICスコアの改善を認めた.投与開始後28日の生存率は72.9%で,在院死亡率は41.7%であった.在院死亡群と生存群における比較では,在院死亡群において「悪性疾患あり」(P=0.034),「DICの原因が術後肝不全」(P=0.025),rTM投与開始時の「血小板数5万/μl未満」(P=0.009),「総ビリルビン2.0mg/dl以上」(P=0.002),rTM投与開始後7日目の「血小板数増加なし」(P=0.001),「DICスコア改善なし」(P=0.003)の占める割合が高かった.多変量解析ではrTM投与開始後7日目の「血小板数増加なし」(HR 5.076:95%CI 1.145-22.222:P=0.032)が独立した在院死亡の危険因子であった.【結語】消化器外科術後に発症するDICは極めて予後不良な病態であるが,rTM投与開始後早期に血小板数の増加を認めた場合,予後の改善を期待できる可能性がある.(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

【目的】消化器外科術後に発症した播種性血管内凝固(disseminated intravascular coagulation;以下,DICと略記)に対する遺伝子組み換えトロンボモジュリン(recombinant human soluble thrombomodulin;以下,rTMと略記)の効果を検証し,治療成績改善に向けた方策を考察する.【方法】2016年1月から2021年5月に当科で消化器外科術後DICの改善を目的にrTMが投与された48例を対象とした.対象症例におけるDICの改善効果,および在院死亡の危険因子を検証した.DICの診断には,日本救急医学会の急性期DIC診断基準を使用した.患者背景および検査項目に関する2群間のカテゴリー変数の比較にはPearsonのχ2検定,Fisherの直接法を用いた.多変量解析はstepwise法によるロジスティック回帰分析を用いて行った.生存曲線はKaplan-Meier法で算出し,log rank検定で有意差検定を行った.有意水準5%(P<0.05)をもって有意差ありと判断した.【結果】年齢の中央値は76歳(59-91),男女比は21:27であった.原疾患は下部消化管穿孔が22例(45.8%),悪性腫瘍が11例(22.9%),消化管虚血が10例(20.8%),上部消化管穿孔が5例(10.4%)であった.DICを発症した原因は,急性汎発性腹膜炎が38例(79.2%),術後感染症が5例(10.4%),術後肝不全が4例(8.3%),術後出血が1例(2.1%)であった.rTM投与開始後7日目に28例(58.3%)で血小板数増加を認め,31例(64.6%)でDICスコアの改善を認めた.投与開始後28日の生存率は72.9%で,在院死亡率は41.7%であった.在院死亡群と生存群における比較では,在院死亡群において「悪性疾患あり」(P=0.034),「DICの原因が術後肝不全」(P=0.025),rTM投与開始時の「血小板数5万/μl未満」(P=0.009),「総ビリルビン2.0mg/dl以上」(P=0.002),rTM投与開始後7日目の「血小板数増加なし」(P=0.001),「DICスコア改善なし」(P=0.003)の占める割合が高かった.多変量解析ではrTM投与開始後7日目の「血小板数増加なし」(HR 5.076:95%CI 1.145-22.222:P=0.032)が独立した在院死亡の危険因子であった.【結語】消化器外科術後に発症するDICは極めて予後不良な病態であるが,rTM投与開始後早期に血小板数の増加を認めた場合,予後の改善を期待できる可能性がある.(著者抄録)

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Objectives: Diversion colitis (DC) is an inflammatory disorder caused by interruption of the fecal stream and subsequent nutrient deficiency from luminal bacteria. The utility of fecal microbiota transplantation (FMT) for DC was recently investigated; however, the precise pathogenesis of this condition remains unclear. This study aimed to evaluate the utility of autologous FMT in DC and to determine the related changes in the intestinal microbiota. Methods: Autologous FMT was performed to reestablish the intestinal microbiota in five patients (average age, 64.6 ± 8.3 years) with DC. They underwent double-ended colostomy. We assessed the diverted colon by endoscopy and evaluated the microbiota before and after FMT using the 16S rRNA gene sequencing method. Results: All five patients had mild inflammation (ulcerative colitis endoscopic index of severity [UCEIS] 2-3) in the diverted colon based on the colonoscopic findings. Three patients presented with symptoms, such as tenesmus, mucoid stool, and bloody stool. With FMT treatment, all patients achieved endoscopic remission (UCEIS score of 0 or 1) and symptomatic improvement. We observed a significantly decreased α-diversity in DC patients compared to healthy controls. The frequency of aerobic bacteria, such as Enterobacteriaceae, in the diverted colon decreased after autologous FMT. Conclusions: This study was the first to show that the microbiota in the diverted colon was significantly affected by autologous FMT. Since interruption of the fecal stream is central to the development of DC, FMT can be considered a promising treatment.

DOI： 10.1002/deo2.63

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Language：English   Publishing type：Research paper (scientific journal)  

Gastrointestinal duplications are congenital malformations that are usually observed in pediatric patients. Diagnosis in adulthood is quite rare, and preoperative diagnosis of gastrointestinal duplication is difficult, particularly in the small intestine. We encountered an extremely rare adult case of duplication of the jejunum, which showed a stomach-like form diagnosed using double-balloon enteroscopy (DBE). The patient was an 18-year-old male who had been experiencing upper abdominal pain and vomiting repeatedly without any triggers for 3 years. Various examinations were performed, but no cause of symptoms was found. DBE revealed a narrow opening of the lumen at the upper jejunum, and the lumen was covered with mucosal folds similar to those of the stomach. Enteroclysis via DBE showed a tubular structure on the mesenteric side of the jejunum. We diagnosed a jejunal tubular duplication with ectopic gastric mucosa and underwent partial small bowel resection. The patient's abdominal symptoms resolved. From this, DBE can be a useful tool for diagnosing intestinal duplication in adults. We believe that this case and literature review will facilitate the accurate and prompt diagnosis of small intestinal duplication.

DOI： 10.1007/s12328-022-01596-7

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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BACKGROUND: Although monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient. CASE PRESENTATION: A 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery. CONCLUSIONS: Hernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection.

DOI： 10.1016/j.transproceed.2021.09.076

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BACKGROUND: As the number of long-term survivors after organ transplantation increases, malignancy has become a problem as a late complication. We herein report a case of endometrial cancer during the follow-up of pancreas transplantation after kidney transplantation. CASE PRESENTATION: A 49-year-old woman was diagnosed with endometrial cancer. The patient had developed type 1 diabetes at 8 years old and started insulin treatment, and at 29 years old, she started hemodialysis for diabetic nephropathy. At 31 years old, she received living donor kidney transplantation and withdrew from dialysis. Hypoglycemia unawareness began to occur frequently from around 36 years old, and at 48 years old, the patient underwent deceased donor pancreas transplantation after kidney transplantation and achieved insulin independence. At 49 years old, she was diagnosed with endometrial cancer. Surgical treatment (total abdominal hysterectomy with left salpingo-oophorectomy) was performed. The pathologic diagnosis was confirmed as stage 1A uterine endometrioid carcinoma grade 1. The postoperative course was uneventful. She was discharged from our hospital on postoperative day 8. There has been no evidence of recurrence and/or metastasis of endometrial cancer for 16 months since the surgery. CONCLUSIONS: Carcinogenesis after pancreas transplantation may be a lethal late complication. It is important to carry out regular screening examinations with carcinogenesis in mind.

DOI： 10.1016/j.transproceed.2021.12.021

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DOI： 10.1007/s00595-022-02466-y

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Neuroendocrine neoplasms of the colon and rectum are colorectal epithelial neoplasms with neuroendocrine differentiation. A platinum regimen used for small cell lung cancer is the currently recommended chemotherapy for gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs), regardless of the organ. The BRAF V600E mutation has been recently reported as a druggable driver mutation in colorectal NECs. In BRAF V600E mutant colorectal cancer, a combination of BRAF inhibitor and anti-epidermal growth factor receptor (EGFR) antibody, with or without a MEK inhibitor, is recommended. Here, we report the case of 77-year-old man who had lymph node recurrence after surgery for primary ascending colonic NEC. Two cytotoxic regimens, cisplatin plus irinotecan and modified FOLFOX6, were administered as first- and second-line chemotherapies with no remarkable response observed. At this point, genetic analysis confirmed the tumor harbored a BRAF V600E mutation. Thus, a regimen of BRAF inhibitor plus anti-EGFR antibody was administered. After commencing this regimen, carcinoembryonic antigen levels decreased within normal range, and there was dramatic shrinkage of the lymph node metastases observed by chest and abdominal computed tomography scans. To our knowledge, this is the first reported case of a colorectal NEC responding to a BRAF inhibitor and anti-EGFR antibody.

DOI： 10.1007/s12328-022-01599-4

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BACKGROUND/AIM: Tumour repopulation is a major obstacle for successful cancer treatment. This study investigated whether anticancer agents contribute to tumour repopulation in TP53-mutated bile duct cancer cells. MATERIALS AND METHODS: TP53-mutated HuCCT1 and HuH28 cells were exposed to anticancer agents, and recipient cells were exposed to their conditioned media or exosomes. The effect of inhibitors and siRNA-mediated gene silencing of p38 mitogen-activated protein kinase (MAPK) and of TP53 was analyzed by cell proliferation assays and western blotting. RESULTS: Conditioned media from genotoxic agent-treated cells promoted proliferation of recipient cells (p<0.05), and this effect was abrogated by exosome inhibitors. Exosomes from gemcitabine- or cisplatin-treated cells increased cell proliferation by 1.6- to 2.2-fold (p<0.05) through p38 MAPK signalling. These effects of exosomes were inhibited by inhibition/silencing of p38 MAPK but not by TP53 silencing. CONCLUSION: Exosomal p38 MAPK plays a pivotal role in tumour repopulation in a TP53-independent manner.

DOI： 10.21873/anticanres.15533

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Language：Japanese   Publisher：アステラス製薬(株)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 72-year-old man had a chief complaint of anal pain and difficulty in defecation. He was diagnosed with adenocarcinoma by biopsy from a tumor of the anal canal. A computed tomography scan revealed neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa anal canal cancer. Preoperative capecitabine- based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. Digital rectal examination and imaging evaluation 8 weeks after preoperative CRT revealed that the tumor had shrunk. Fifteen weeks after preoperative CRT, laparoscopic abdominoperineal resection was performed. The pathological findings showed mucinous adenocarcinoma associated with anal fistula. At present, 12 months after the operation, no local recurrence and distant metastasis has been detected under follow-up evaluations.

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A 70-year-old female with liver metastases from gastrointestinal stromal tumor(GIST)that were found 3 months after partial gastrectomy for the primary GIST underwent Auchincloss operation for left breast cancer with ipsilateral axillary lymph node metastases. The diagnosis was microinvasive ductal cancer that was pT1miN1M0, pStage ⅡA, hormone receptor negative, and HER2 positive. Given the impact of this cancer on the prognosis of liver metastases of GIST, imatinib therapy, but not adjuvant chemotherapy, was started promptly for breast cancer after surgery. Four months after the surgery, left subclavian lymph node recurrence of breast cancer was found. Since the liver metastases of GIST had been stable, imatinib was discontinued, and paclitaxel and anti-HER2 therapy were administered. After confirming tolerability, imatinib was carefully added in combination. Because the lymph nodes shrank and liver metastases of GIST were stable, both anti-HER2 therapy and imatinib were continued. There are few reports of combined chemotherapy for synchronous double cancer, and we report our experience in which careful treatment was required.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、女性。胃GIST術後3ヵ月目に左乳癌、腋窩リンパ節転移、GIST肝転移を認め、左乳癌に対し手術を施行した。病理組織学的結果はHER2陽性乳癌、pT1miN1M0、pStage IIAであった。予後規定因子はGIST肝転移と考え、イマチニブを開始した。乳癌術後4ヵ月目に乳癌左鎖骨下リンパ節再発を認めた。GIST肝転移の病勢は安定していたためイマチニブをいったん休薬し、パクリタキセル、抗HER2療法を開始した。忍容性を確認した後、慎重にイマチニブを併用した。リンパ節は著明に縮小し肝転移も増大を認めず、パクリタキセルを7コースで終了した。現在は抗HER2療法、イマチニブを継続中である。転移性の重複癌において両者に対する薬物療法を同時併用した報告は少なく、若干の考察を加えて報告する。(著者抄録)

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症例は72歳、男性。肛門痛と排便困難を主訴に来院した。肛門管内に腫瘤を認め、生検で腺癌と診断された。胸腹骨盤部CT検査の結果、遠隔転移を認めず、肛門管癌、cT3N0M0、cStage IIaと診断された。術前化学放射線療法(chemoradiotherapy:CRT)(capecitabine併用、1.8Gy28回、50.4Gy)を施行した。術前CRT8週間後、骨盤部CT検査にて縮小率34%とPR判定であった。術前CRTから15週間後に腹腔鏡下腹会陰式直腸切断術を施行した。病理組織学的診断では、組織型はadenocarcinoma(muc、tub1)であり、肛門周囲皮膚と肛門管重層扁平上皮の境界相当部から直腸粘膜に連続する痔瘻様上皮嵌入部に癌の上皮内病変を認めた。周囲に粘液癌を主体とする浸潤癌を認め、痔瘻癌と診断された。術後12ヵ月となる現在まで無再発生存中である。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は64歳、男性。慢性腎臓病で当院通院中に腹部CTで膵頭部癌と診断された。腹部CTおよびMRIでは遠隔転移や大動脈周囲リンパ節(PALN)転移は認めなかった。手術の方針とし術中にPALNサンプリングを行ったところ、迅速病理診断にてリンパ節4個中2個に転移を認めた。非切除とした場合、腎機能障害のため標準的な化学療法を施行できないと考え、PALN郭清を伴う亜全胃温存膵頭十二指腸切除術を施行した。病理診断は浸潤性膵管癌であり、S-1による術後補助化学療法を減量して行った。術後1年10ヵ月で腸間膜内リンパ節再発および肺転移再発を認めた。さらに、術後2年で腹腔内再発による上腸間膜動静脈狭窄を認めた。腹腔内再発に対し放射線療法を行い、引き続きgemcitabine単独療法を行った。肝外門脈狭窄による腹水貯留や消化管出血は治療により軽快した。結果、術後5年7ヵ月の長期生存を得た。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は64歳、男性。慢性腎臓病で当院通院中に腹部CTで膵頭部癌と診断された。腹部CTおよびMRIでは遠隔転移や大動脈周囲リンパ節(PALN)転移は認めなかった。手術の方針とし術中にPALNサンプリングを行ったところ、迅速病理診断にてリンパ節4個中2個に転移を認めた。非切除とした場合、腎機能障害のため標準的な化学療法を施行できないと考え、PALN郭清を伴う亜全胃温存膵頭十二指腸切除術を施行した。病理診断は浸潤性膵管癌であり、S-1による術後補助化学療法を減量して行った。術後1年10ヵ月で腸間膜内リンパ節再発および肺転移再発を認めた。さらに、術後2年で腹腔内再発による上腸間膜動静脈狭窄を認めた。腹腔内再発に対し放射線療法を行い、引き続きgemcitabine単独療法を行った。肝外門脈狭窄による腹水貯留や消化管出血は治療により軽快した。結果、術後5年7ヵ月の長期生存を得た。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 62-year-old man was incidentally found to have a pancreatic tumor by CT. He was diagnosed with pancreatic cancer by EUS-FNAB. Gemcitabine(GEM)plus nab-paclitaxel(PTX)was started as neoadjuvant chemotherapy(NAC)for resectable pancreatic cancer. However, after the end of the second course, the tumor grew rapidly and invaded the stomach, so NAC was discontinued, and surgery was performed. The pathological diagnosis was anaplastic ductal carcinoma of the pleomorphic cell type, and the histological response was Grade 1a. Multiple liver metastases appeared during adjuvant chemotherapy with S-1, so GEM plus nab-PTX and modified FOLFIRINOX were administered, but the therapeutic response was poor, the patient died 9 months after surgery. Anaplastic carcinoma has a poor response to chemotherapy and may be included with cancers showing treatment resistance to NAC, as seen in our case. It is necessary to pay attention to anaplastic carcinoma during the course of NAC for pancreatic cancer.

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The patient was a 64-year-old man with diagnosis of pancreatic head cancer. Initially, abdominal CT showed pancreatic head tumor with bile duct invasion and no distant metastases including para-aortic lymph nodes(PALN). Although, subtotal stomach-preserving pancreatoduodenectomy(SSPPD)and PALN sampling was performed, intraoperative frozen section examination revealed PALN metastasis. He had chronic kidney disease and was unsuitable for standard chemotherapy, SSPPD and PALN dissection was performed instead of standard chemotherapy. Histopathological examination of the resected specimens revealed invasive ductal carcinoma in the pancreatic head region and 11 nodes out of the 17 dissected PALN. Adjuvant chemotherapy with S-1 was performed. 22 months after surgery, intraabdominal lymph nodes metastasis and lung metastasis was found. 24 months after surgery, palliative radiation therapy at a dose of 40 Gy was performed. Systemic chemotherapy with gemcitabine alone was performed, but he was dead 67 months after the initial therapy.

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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症例は62歳、男性。他疾患の経過観察目的の胸腹部CTで膵腫瘍を指摘され、超音波内視鏡下吸引生検で膵癌と診断された。切除可能膵癌に対する術前化学療法としてgemcitabine(GEM)+nab-paclitaxel(PTX)を開始したが、腫瘍増大および胃浸潤が出現したため、術前化学療法を中止し手術を施行した。術中所見で胃体上部と横行結腸への腫瘍浸潤を認め、膵体尾部切除、脾臓摘出、胃全摘、横行結腸部分切除、領域リンパ節郭清術を施行した。病理組織学的診断は多形細胞型退形成性膵管癌で、進行度はpT3N1aM0、Stage IIB、術前治療の組織学的効果判定はGrade 1aであった。S-1による術後補助化学療法中に多発肝転移が出現し、GEM+nab-PTX、modified FOLFIRINOXを施行したが治療効果に乏しく、術後9ヵ月目に原病死した。退形成性膵管癌は化学療法が無効であることが多く、自験例のように術前化学療法に対して治療抵抗性を示すもののなかに退形成性膵管癌が含まれている可能性に留意し治療を行う必要がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publisher：日本消化器病学会-甲信越支部  

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Language：English   Publisher：日本消化器病学会-甲信越支部  

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BACKGROUND: Activin A receptor type 2A (ACVR2A) is one of the most frequently mutated genes in microsatellite instability-high (MSI-H) gastric cancer. However, the clinical relevance of the ACVR2A mutation in MSI-H gastric cancer patients remains unclear. The aims of this study were to explore the effect of ACVR2A mutation on the tumor behavior and to identify the clinicopathological characteristics of gastric cancer patients with ACVR2A mutations. METHODS: An in vitro study was performed to investigate the biological role of ACVR2A via CRISPR/Cas9-mediated ACVR2A knockout MKN74 human gastric cancer cells. One hundred twenty-four patients with gastric cancer were retrospectively analyzed, and relations between MSI status, ACVR2A mutations, and clinicopathological factors were evaluated. RESULTS: ACVR2A knockout cells showed less aggressive tumor biology than mock-transfected cells, displaying reduced proliferation, migration, and invasion (P < 0.05). MSI mutations were found in 10% (13/124) of gastric cancer patients, and ACVR2A mutations were found in 8.1% (10/124) of patients. All ACVR2A mutations were accompanied by MSI. The 5-year overall survival rates of ACVR2A wild-type patients and ACVR2A-mutated patients were 57% and 90%, respectively (P = 0.048). Multivariate analysis revealed that older age (P = 0.015), distant metastasis (P < 0.001), and ACVR2A wild-type status (P = 0.040) were independent prognostic factors for overall survival. CONCLUSIONS: Our study demonstrated that gastric cancer patients with ACVR2A mutation have a significantly better prognosis than those without. Dysfunction of ACVR2A in MKN74 human gastric cancer cells caused less aggressive tumor biology, indicating the importance of ACVR2A in the progression of MSI-H tumors.

DOI： 10.1007/s11605-020-04889-9

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PURPOSE: This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). METHODS: Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). RESULTS: Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). CONCLUSION: The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.

DOI： 10.1007/s00423-021-02165-1

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Background: Esophageal involvement length (EIL) is a promising indicator of metastasis or recurrence in mediastinal lymph nodes (MLNs) in adenocarcinoma of the esophagogastric junction (EGJ). This study aimed to elucidate the accuracy of the preoperative endoscopic evaluations of EIL and its clinical significance in this disease. Materials and methods: In total, 75 patients with Siewert type II (N = 53) or III (N = 22) adenocarcinoma of the EGJ, who underwent surgical resection without preoperative therapy between 1995 and 2016 were enrolled. We retrospectively examined the accuracy of the preoperative endoscopic evaluations of EIL (preoperative EIL), compared to the pathologically evaluated EIL. Finally, we investigated the association between preoperative EIL and metastasis or recurrence in MLNs. Results: The accuracy of the preoperative EIL within a 1-cm interval was only 53.3%. Among patients with discordance between the pre- and postoperative evaluations, 68.6 % had the underestimation in the preoperative EIL. pN1-3 (OR = 5.85, 95% CI: 1.03-33.17) and undifferentiated histologic type (OR = 2.52, 95% CI: 0.89-7.14) were potential risk factors for the discordance. Regarding metastasis or recurrence in MLNs, preoperative EIL of 2-3 cm (OR = 10.41, 95% CI: 1.35-80.11) and >3 cm (OR = 8.33, 95% CI: 1.09-63.96) were independent predictors. Conclusion: Although the accuracy of the endoscopic evaluations of EIL is insufficient with many underestimations, EIL should be assessed in preoperative staging because of significant predictive power for metastasis or recurrence in MLNs.

DOI： 10.1016/j.amsu.2021.102590

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Tumor mutational burden-high (TMB-H), which is detected with gene panel testing, is a promising biomarker for immune checkpoint inhibitors (ICIs) in colorectal cancer (CRC). However, in clinical practice, not every patient is tested for TMB-H using gene panel testing. We aimed to identify the histopathological characteristics of TMB-H CRC for efficient selection of patients who should undergo gene panel testing. Moreover, we attempted to develop a convolutional neural network (CNN)-based algorithm to predict TMB-H CRC directly from hematoxylin and eosin (H&E) slides. METHODS: We used two CRC cohorts tested for TMB-H, and whole-slide H&E digital images were obtained from the cohorts. The Japanese CRC (JP-CRC) cohort (N = 201) was evaluated to detect the histopathological characteristics of TMB-H using H&E slides. The JP-CRC cohort and The Cancer Genome Atlas (TCGA) CRC cohort (N = 77) were used to develop a CNN-based TMB-H prediction model from the H&E digital images. RESULTS: Tumor-infiltrating lymphocytes (TILs) were significantly associated with TMB-H CRC (P < 0.001). The area under the curve (AUC) for predicting TMB-H CRC was 0.910. We developed a CNN-based TMB-H prediction model. Validation tests were conducted 10 times using randomly selected slides, and the average AUC for predicting TMB-H slides was 0.934. CONCLUSIONS: TILs, a histopathological characteristic detected with H&E slides, are associated with TMB-H CRC. Our CNN-based model has the potential to predict TMB-H CRC directly from H&E slides, thereby reducing the burden on pathologists. These approaches will provide clinicians with important information about the applications of ICIs at low cost.

DOI： 10.1007/s00535-021-01789-w

PubMed

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PURPOSE: Outcomes following surgery for advanced gallbladder carcinoma remain unsatisfactory. This study aimed to determine the surgical outcome and effectiveness of adjuvant chemotherapy according to TNM stage in patients with gallbladder carcinoma. METHODS: A total of 200 patients undergoing surgery for gallbladder carcinoma were enrolled. Clinicopathological data were evaluated and surgical outcomes were compared between patients with and without adjuvant chemotherapy according to TNM stage. RESULTS: The 5-year overall survival (OS) after resection for patients with stage I (n = 27), IIA (n = 18), IIB (n = 28), IIIA (n = 25), IIIB (n = 43), IVA (n = 7), and IVB (n = 52) disease was 90.8%, 94.4%, 73.6%, 33.7%, 57.7%, 14.3%, and 11.8%, respectively (p < 0.001). R0 resection was performed in all patients with stage I or II disease, in 89.7% of those with stage III disease, and 69.5% of those with stage IV disease. For patients with stage III disease, adjuvant chemotherapy was associated with improved OS (5-year OS, 60.9% vs. 41.1%; p = 0.028) and was an independent prognostic factor (hazard ratio, 2.045; p = 0.039). For patients with stage IV disease, adjuvant chemotherapy appeared to affect OS (5-year OS, 25.1% vs. 5.3%; p = 0.041); R0 resection (hazard ratio, 1.882; p = 0.040) was the only independent prognostic factor. CONCLUSION: TNM stage clearly predicts survival after resection of gallbladder carcinoma. R0 resection with adjuvant chemotherapy is recommended for long-term survival in the multimodal management of patients with stage III or IV gallbladder carcinoma.

DOI： 10.1007/s00423-020-02068-7

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(株)へるす出版  

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DOI： 10.1111/1346-8138.15800

PubMed

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.

DOI： 10.3760/cma.j.cn115610-20210303-00107

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

It is reported that an increase in aerobic bacteria, a lack of short-chain fatty acids (SCFAs), and immune disorders in the diverted colon are major causes of diversion colitis. However, the precise pathogenesis of this condition remains unclear. The aim of the present study was to examine the microbiota, intestinal SCFAs, and immunoglobulin A (IgA) in the diverted colon. Eight patients underwent operative procedures for colostomies. We assessed the diverted colon using endoscopy and obtained intestinal samples from the diverted colon and oral colon in these patients. We analyzed the microbiota and SCFAs of the intestinal samples. The bacterial communities were investigated using a 16S rRNA gene sequencing method. The microbiota demonstrated a change in the proportion of some species, especially Lactobacillus, which significantly decreased in the diverted colon at the genus level. We also showed that intestinal SCFA values were significantly decreased in the diverted colon. Furthermore, intestinal IgA levels were significantly increased in the diverted colon. This study was the first to show that intestinal SCFAs were significantly decreased and intestinal IgA was significantly increased in the diverted colon. Our data suggest that SCFAs affect the microbiota and may play an immunological role in diversion colitis.

DOI： 10.1016/j.bbrep.2020.100892

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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BACKGROUND/AIM: This study aimed to evaluate how NAD(P)H: quinone oxidoreductase-1 (NQO1) affects survival after hepatectomy in patients with colorectal liver metastasis (CRLM). PATIENTS AND METHODS: A retrospective analysis was conducted of 88 consecutive patients who underwent hepatectomy for CRLM. Of the 88 patients, preoperative chemotherapy was administered to 30 patients. Immunohistochemistry of the resected specimens was conducted using monoclonal anti-NQO1 antibody. RESULTS: NQO1-positive expression in tumor cells of CRLM was associated with worse overall survival (p=0.026) and was an independent adverse prognostic factor in multivariate analysis (hazard ratio=5.296, p=0.007). Among 30 patients who received preoperative chemotherapy, patients with loss of NQO1 expression in non-neoplastic epithelial cells of the bile ducts (NQO1 polymorphism: n=19) showed significantly better response to preoperative chemotherapy for CRLM (p=0.004). CONCLUSION: NQO1-positive expression in tumor cells of CRLM may be an adverse prognostic factor after hepatectomy for CRLM.

DOI： 10.21873/anticanres.14916

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AIM: The role of preoperative frailty assessment in patients with gastrointestinal (GI) disease remains unclear. This study aimed to clarify the relationship between frailty and postoperative outcomes in patients with GI disease. METHODS: This study investigated 42 patients (aged ≥65 years) with GI disease who underwent abdominal surgery. The frailty status was analyzed using the Japanese version of the Cardiovascular Health Study criteria. We also investigated postoperative outcomes. RESULTS: Of the 42 patients, seven (16.7%) were robust, 24 (57.1%) were prefrail and 11 (26.2%) were frail. Postoperative complications were observed in 45.5% and 63.6% of prefrail and frail patients, respectively, whereas no complications were found in robust patients (P = 0.026). The median hospital stay was 15, 19.5 and 27 days in robust, prefrail and frail patients, respectively (P < 0.01). CONCLUSION: Preoperative frailty status based on the Japanese version of the Cardiovascular Health Study criteria is associated with postoperative complication incidence and hospital stay extension in patients with GI disease. Geriatr Gerontol Int 2021; ••: ••-••.

DOI： 10.1111/ggi.14134

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：金原出版(株)  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00620&link_issn=&doc_id=20210311060007&doc_link_id=10.18888%2Fop.0000002096&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002096&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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AIM: Sphingosine-1-phosphate (S1P) and ceramide are bioactive sphingolipids known to be important in regulating numerous processes involved in cancer progression. The aim of this study was to determine the absolute levels of sphingolipids in hepatocellular carcinoma (HCC) utilizing data obtained from surgical specimens. In addition, we explored the clinical significance of S1P in patients with HCC and the biological role of S1P in HCC cells. METHODS: Tumors and normal liver tissues were collected from 20 patients with HCC, and sphingolipids were measured by mass spectrometry. The Cancer Genome Atlas (TCGA) cohort was utilized to evaluate gene expression of enzymes related to sphingolipid metabolism. Immunohistochemistry of phospho-sphingosine kinase 1 (SphK1), an S1P-producing enzyme, was performed for 61 surgical specimens. CRISPR/Cas9-mediated SphK1 knockout cells were used to examine HCC cell biology. RESULTS: S1P levels were substantially higher in HCC tissue compared with normal liver tissue. Levels of other sphingolipids upstream of S1P in the metabolic cascade, such as sphingomyelin, monohexosylceramide and ceramide, were also considerably higher in HCC tissue. Enzymes involved in generating S1P and its precursor, ceramide, were found in higher levels in HCC compared with normal liver tissue. Immunohistochemical analysis found that phospho-SphK1 expression was associated with tumor size. Finally, in vitro assays indicated that S1P is involved in the aggressiveness of HCC cells. CONCLUSIONS: Sphingolipid levels, including S1P and ceramide, were elevated in HCC compared with surrounding normal liver tissue. Our findings suggest S1P plays an important role in HCC tumor progression, and further examination is warranted.

DOI： 10.1111/hepr.13625

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Language：Japanese   Publisher：(株)へるす出版  

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DOI： 10.1245/s10434-020-09184-0

PubMed

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BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific 'ypTNM' stage grouping for patients with esophageal cancer. OBJECTIVE: This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC). METHODS: We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for disease-specific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses. RESULTS: Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike's information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS. CONCLUSIONS: ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.

DOI： 10.1245/s10434-020-09181-3

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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BACKGROUND: This study aimed to investigate the impact of surgery on outcomes in patients with recurrent biliary tract cancer (BTC) and elucidate factors affecting survival after surgery for this disease. METHODS: A single-center study was undertaken in 178 patients with recurrent BTC, of whom 24 underwent surgery for recurrence, 85 received chemotherapy, and 69 received best supportive care. Then, we carried out a multicenter study in 52 patients undergoing surgery for recurrent BTC (gallbladder cancer, 39%; distal cholangiocarcinoma, 27%; perihilar cholangiocarcinoma, 21%; intrahepatic cholangiocarcinoma, 13%). RESULTS: In the single-center study, 3-year survival after recurrence was 53% in patients who underwent surgery, 4% in those who received chemotherapy, and 0% in those who received best supportive care (p < 0.001). Surgery was an independently prognostic factor (p < 0.001). In the multicenter series, the respective 3-year and 5-year survival after surgery for recurrence was 50% and 29% in the 52 patients. Initial site of recurrence was the only independent prognostic factor (p = 0.019). Five-year survival after surgery for recurrence in patients with single distant, multifocal distant, and locoregional recurrence was 51%, 0%, and 0%, respectively (p = 0.002). Sites of single distant recurrence included the liver (n = 13, 54%), distant lymph nodes (all from gallbladder cancer, n = 7, 29%), lung (n = 2, 9%), peritoneum (n = 1, 4%), and abdominal wall (n = 1, 4%). CONCLUSION: Surgery may be an effective option for patients with less aggressive tumor biology characterized by single distant recurrence in recurrent BTC.

DOI： 10.1016/j.hpb.2021.01.007

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Language：Japanese   Publisher：(株)篠原出版新社  

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Some bacteria are symbiotic in tumor tissues, and metabolites of several bacterial species have been found to cause DNA damage. However, to date, the association between bacteria and host genetic alterations in colorectal cancer (CRC) has not been fully investigated. We evaluated the association between the intra-tumor microbiome and host genetic alterations in 29 Japanese CRC patients. The tumor and non-tumor tissues were extracted from the patients, and 16S rRNA genes were sequenced for each sample. We identified enriched bacteria in tumor and non-tumor tissues. Some bacteria, such as Fusobacterium, which is already known to be enriched in CRC, were found to be enriched in tumor tissues. Interestingly, Bacteroides, which is also known to be enriched in CRC, was enriched in non-tumor tissues. Furthermore, it was shown that certain bacteria that often coexist within tumor tissue were enriched in the presence of a mutated gene or signal pathway with mutated genes in the host cells. Fusobacterium was associated with many mutated genes, as well as cell cycle-related pathways including mutated genes. In addition, the patients with a high abundance of Campylobacter were suggested to be associated with mutational signature 3 indicating failure of double-strand DNA break repairs. These results suggest that CRC development may be partly caused by DNA damage caused by substances released by bacterial infection. Taken together, the identification of distinct gut microbiome patterns and their host specific genetic alterations might facilitate targeted interventions, such as modulation of the microbiome in addition to anticancer agents or immunotherapy.

DOI： 10.1016/j.csbj.2021.05.049

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は72歳、男性。下血を主訴に来院し、大腸内視鏡検査で肛門縁から5cmの直腸前壁に下縁を有する2型腫瘍を指摘された。生検で高分化管状腺癌であった。術前胸腹骨盤部CT検査の結果遠隔転移は認めず、下部直腸癌、cT3N0M0、cStage IIaと診断された。術前の全身検査で徐脈性心房細動および重症肺気腫を認め、全身麻酔のリスクが高い症例と判断された。ペースメーカー留置後、術前化学放射線療法(CRT)(capecitabine併用、1.8Gy28回、計50.4Gy)を開始した。術前CRT後4週間目の直腸診および画像評価では腫瘍は消失し、生検で悪性所見を認めなかった。十分なインフォームド・コンセントの下、全身麻酔のリスクを勘案し、"watch and wait治療"の方針とした。現在、術前CRT後15ヵ月経過し局所の再増大および遠隔転移を認めず、経過観察を行っている。(著者抄録)

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症例は48歳、女性。左腋窩副乳原発の浸潤性小葉癌(invasive lobular carcinoma:ILC)と診断され、当科を受診した。MRI検査では49×43mm大のILC病変と乳管内進展を含む70mm大の広がりを認めた。手術は左腋窩部広範切除、左腋窩リンパ節郭清を施行し、上肢の可動域制限を避けるために広背筋皮弁で腋窩を再建した。病理組織学的検査では副乳原発ILC、浸潤径80×50mm、リンパ節転移陽性、切除検体の外下方の皮膚側断端で浸潤癌陽性であった。局在の特殊性およびILCの浸潤様式の特徴を考慮した画像診断と、外科治療戦略が必要であると考えられた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 72-year-old man was referred to our hospital for treatment for rectal cancer. Digital rectal examination and colonoscopy revealed a 4 cm tumor located at the anterior rectal wall 5 cm away from the anal verge, and pathological examination confirmed that the tumor was adenocarcinoma. A computed tomography scan detected neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa rectal cancer. The preoperative general examination revealed bradyarrhythmia and severe emphysema, and he was considered to be high risk for general anesthesia. After placement of a pacemaker, preoperative capecitabine-based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. The digital rectal examination and imaging evaluation 4 weeks after preoperative CRT revealed that the tumor disappeared, and pathological examination showed no malignant findings. Considering the risks of general anesthesia, the"watch and wait therapy"approach was adopted with sufficient informed consent. At present, 15 months after preoperative CRT, no evidence of regrowth or distant metastasis has been detected under rigorous follow- up evaluations.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は64歳、男性。肝機能障害の精査で肝門部領域胆管癌と診断された。腫瘍は右側優位のBismuth分類IV型で、門脈右枝〜左右分枝への浸潤が認められた。肝予備能、残肝容積は十分であり、拡大肝右葉切除術+肝外胆管切除術+門脈合併切除術が実施された。術中迅速組織診断で十二指腸側・肝側胆管切離断端がともに浸潤癌陽性となったが、進行度や侵襲度を勘案し、膵頭十二指腸切除術の追加や左肝管断端の追加切除は行わなかった。最終的な進行度はpT4b、pN0、cM0、Stage IV A、pDMI(w)、pHM1(w)、pPV1(a)、R1であった。術後化学療法としてgemcitabine(GEM)+cisplatin療法を1年、GEM療法を1年実施した後、S-1療法を継続している。術後5年3ヵ月経過した現在、無再発生存中である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 73-year-old man presented with anemia, and gastroscopy showed a nonpigmented tumor in the esophagogastric junction. The result of the tumor biopsy initially suspected poorly differentiated adenocarcinoma. However, additional immunohistochemical examination revealed malignant melanoma. The final diagnosis was amelanotic malignant melanoma of the esophagogastric junction with adrenal and spinal metastasis. Although immunotherapy was performed, the patient died 132 days after diagnosis.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は73歳、男性。貧血精査目的の上部消化管内視鏡検査で、食道胃接合部に白色から発赤調で易出血性の不整な隆起性腫瘤を認めた。生検では充実型低分化腺癌が疑われたが確定診断が得られず、追加で施行した免疫組織化学染色で悪性黒色腫と診断した。食道胃接合部原発の悪性黒色腫、cT3N1M1(副腎、骨)、cStage IVb(食道癌取扱い規約第15版)に対して、ペムブロリズマブの投与を行ったが肺転移が出現し原病死した。本例は腫瘍の主局在が胃側にあり、メラニン欠乏性悪性黒色腫であったため典型的な肉眼的・組織学的所見が得られず診断に難渋した。食道胃接合部の腫瘍においても、メラニン欠乏性悪性黒色腫の可能性を念頭に置いて診断を行う必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600115&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F115%2F2083b2085%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F115%2F2083b2085%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

Language：Japanese   Publisher：日本臨床外科学会  

症例は76歳,女性.7年前に慢性リンパ性白血病(chronic lymphocytic leukemia,以下CLL)と診断され,無症状のため経過観察していたが,白血球数およびリンパ球割合の上昇と全身の腫大リンパ節の増大を認め,化学療法の導入が検討されていた.マンモグラフィー検診で右乳房に局所的非対称性陰影を指摘され,当科を受診した.超音波検査では右乳房C領域に22mm大の地図状の低エコー領域を認め,非浸潤性乳管癌が疑われた.腋窩リンパ節は両側とも腫大していたが,リンパ門は保たれていた.針生検ではリンパ球浸潤を認め,表面マーカー解析でCD20陽性,CD5陽性,CD23陽性であり,CLLの乳房内浸潤の診断に至った.CLLの病勢進行に対して化学療法が開始され,治療開始3ヵ月後には白血球数およびリンパ球割合の低下とともに乳房内病変の消失を認めた.造血器悪性腫瘍を背景に持つ患者の乳房内に病変を認めた際には,髄外浸潤も鑑別に挙げることが重要である.(著者抄録)

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 64-year-old man with liver dysfunction was given a diagnosis of perihilar cholangiocarcinoma(Bismuth type Ⅳ). The tumor was predominantly right-sided and invaded to the bifurcation of the right and left portal veins. After confirming sufficient liver functional reserve and future liver remnant, the patient underwent extended right hepatectomy, extrahepatic bile duct resection, and portal vein resection and reconstruction. Intraoperative examination of frozen sections revealed the presence of residual invasive carcinoma on both the hepatic and duodenal sides of the ductal resection margins. However, we did not perform pancreaticoduodenectomy or additional resection of the margin-positive proximal bile duct considering the curability and invasiveness of these procedures. He received postoperative chemotherapy with biweekly gemcitabine plus cisplatin for 1 year, followed by gemcitabine monotherapy for 1 year, and S-1 monotherapy has been performed since then. He remains alive and well with no evidence of disease 63 months after surgery.

PubMed

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The patient was a 63-year-old woman with diagnosis of pancreatic cancer. Abdominal CT showed pancreatic head tumor and paraaortic lymph node metastasis. We performed chemotherapy with nab-paclitaxel plus gemcitabine. After 5 courses of chemotherapy, the tumor reduced in size. Pancreaticoduodenectomy followed by adjuvant chemotherapy with S-1 was performed. Fourteen months after surgery, umbilical metastasis(Sister Mary Joseph's nodule: SMJN)was found in the umbilicus near the abdominal incisional hernia. There was no evidence of metastasis except in the umbilicus, we performed the umbilical tumor resection and abdominal incisional hernia repair. Pathological diagnosis was pancreatic cancer metastasis. Although following chemotherapy, multiple skin metastases was found in the lower abdomen 3 months after umbilical resection. We performed skin metastases resection to relieve pain and symptoms of bleeding. But she died 29 months after the initial therapy(7 months after umbilical resection).

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は63歳、女性。黄疸を契機に発見された膵頭部癌で、CTで上腸間膜動脈起始部の大動脈前面にリンパ節転移を認めた。nab-PTX+GEM併用療法を開始し、5コース後の治療効果判定は部分奏効PRで、初診から6ヵ月後に亜全胃温存膵頭十二指腸切除術を施行した。病理組織学的診断は浸潤性膵管癌で、ypT2N1bM0、Stage IIBであった。術後補助化学療法としてS-1療法を行った。術後14ヵ月で腹壁瘢痕ヘルニア近傍の臍部に臍転移(Sister Mary Joseph's nodule:SMJN)を認めた。他の遠隔転移は認めず、腫瘤切除および腹壁瘢痕ヘルニア修復術を施行した。病理組織学的診断では膵癌の転移であった。引き続きGEMOX療法を行ったが、臍切除3ヵ月後に多発の皮膚転移が出現した。mFOLFIRINOX療法に変更したが皮膚転移は増悪し、出血と疼痛の症状緩和のため皮膚切除した。化学療法を継続したが徐々に全身状態が悪化し、初診から2年5ヵ月(臍切除後7ヵ月)で死亡した。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 48-year-old female discovered a mass in her left axilla. A thorough examination resulted in a diagnosis of left invasive lobular carcinoma(ILC)of the accessory mammary gland with wide ductal spread. Considering the wide ductal spread, massive resection of the left axilla mass, left lymph node dissection, and a latissimus dorsi musculocutaneous flap procedure were performed. However, histological analysis revealed ILC measuring 80×50 mm with lymph node metastases(5/23)and extensive cancer spread, resulting in a positive surgical margin. It is important to recognize the characteristics of ILC, axillary accessory breast cancer, and the axilla in a treatment strategy.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although previous experiments have implicated sphingosine-1-phosphate (S1P) as a links between immune reactions and cancer progression, the exact mechanism of this interaction has not comprehensively studied in clinical human samples. This study sought to evaluate the S1P regulation by sphingosine kinase 1 (SPHK1), an S1P-producing enzyme, in the immunity/immuno-reactivity of clinical human breast cancer surgical specimens. METHODS: S1P levels were examined in tumor, peritumoral, and normal human breast samples using mass spectrometry. Genomics Data Commons data portal of The Cancer Genome Atlas cohort was used to assess the expression of S1P-related and immune-related genes. RESULTS: S1P levels were significantly higher in tumor samples compared to peritumoral (P < 0.05) or normal human breast samples (P < 0.001). SPHK1 gene expression was elevated in tumoral samples compared to normal breast samples (P < 0.01). Furthermore, the elevated expression of SPHK1 in breast cancer tissue was associated with an increased expression of the different kinds of immune-related genes, such as CD68, CD163, CD4, and FOXP3 (forkhead box P3), in HER2-negative breast cancer. Network analysis showed the central role of SPHK1 in the interaction of S1P signaling and expression of immune cell-related proteins. CONCLUSIONS: We demonstrated that S1P is mainly produced by tumor tissue, rather than peritumoral tissue, in breast cancer patients. Our data revealed the involvement of S1P signaling in the regulation of immune-related genes, suggesting the links between S1P and complicated immune-cancer interactions in breast cancer patients.

DOI： 10.1016/j.jss.2020.06.057

PubMed

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege-Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege-Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection. CASE PRESENTATION: A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported. CONCLUSIONS: Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege-Potter syndrome.

DOI： 10.1186/s40792-020-01076-5

PubMed

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：新潟県医師会  

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