Gastric cancer with metastasis to the gingiva

The present case report describes a gastric cancer which showed unusual metastasis in the oral region. A 56-year-old male patient underwent total gastrectomy and splenectomy due to advanced gastric cancer in the upper third of the stomach. Fifteen months later, he presented with anorexia and gingival swelling of durations of approximately 3 and 1 month, respectively. The gastric tumor was histologically a signet ring cell and a poorly differentiated cancer with a moderate degree of vascular invasion. Biopsy specimens from the gingival tumor revealed a signet ring cell cancer. Other metastatic sites were the brain, limb bones and abdominal lymph nodes. A bone scintigram revealed an abnormal uptake in the limb bones, while it did not exhibit any abnormality in the oral region. Correlation between the histology of the gingival tumor with that of the gastric cancer, as well as the absence of a gingival tumor at the time of prior gastrectomy, led to a diagnosis that the gingival tumor was a metastasis from gastric cancer. Gastric cancer metastasizing to the oral region, either the osseus or the oral soft tissue, is very rare. Although it cannot be proved without an autopsy, negative findings in the mandible by bone scanning in the present case suggest that direct gingival metastasis can be considered, rather than mandibular metastasis involving the gingiva. Hematogenous spread could be a mechanism of metastasis for this unusual tumor.     

肠生物反馈对孤立性直肠溃疡综合征患者直肠黏膜血流的影响

目的研究孤立性直肠溃疡综合征(solitary rectal ulcer syndrome,SRUS)患者的直肠黏膜血流变化,并分析肠生物反馈对SRUS患者症状及直肠黏膜血流的影响.方法16例SRUS患者及20例正常对照组,于生物反馈治疗前后分别采用激光多普勒血流计检测16例SRUS患者的直肠黏膜血流量,同时采用标准问卷表分别记录治疗前后症状变化.结果16例中有12例(75%)自觉症状缓解;16例中有5例(31%)结肠镜检查示溃疡愈合;治疗前SRUS患者直肠黏膜血流量明显低于正常对照组(P＜0.01),生物反馈治疗后,治疗组直肠黏膜血流量明显上升(P＜0.01),其中自觉症状缓解者直肠黏膜血流量增加尤为显著(P=0.001).结论肠生物反馈是一种治疗SRUS患者的有效行为疗法,其治疗效果与直肠黏膜血流的增加有关.     

The predictive role of infiltrative growth pattern in early pharyngeal cancers

Conclusion: The infiltrative growth pattern may predict tumor depth and lymph node metastasis. INF-a seems to fall into a low-risk category, and no additional treatment may be required immediately. Objectives: Tumor depth is a predictor of lymph node metastasis in early pharyngeal cancers. An infiltrative growth pattern is also a prognostic factor in other cancers. This study aimed to elucidate the predictive role of infiltrative growth pattern in early pharyngeal cancers. Methods: Thirty-eight lesions from 37 patients who had undergone trans-oral resection of pharyngeal cancers were included. According to the Japanese Classification of Esophageal Cancer, infiltrative growth pattern was classified into three groups; INF-a, INF-b, and INF-c. The correlation between infiltrative growth pattern and tumor depth, cervical lymph node metastasis was analyzed. Results: Of the 38 lesions, 25 were INF-a, nine were INF-b, and four were INF-c lesions. Lymph node metastasis was observed in three INF-b and one INF-c lesions. In contrast, no INF-a had lymph node metastasis. All INF-a lesions showed shallow invasion of the sub-epithelium; INF-b and INF-c lesions had significantly greater depth than INF-a.     

Moving toward an understanding of the metastatic process in hepatocellular carcinoma

INTRODUCTION Clinical factors contributing to the therapeutic challenge of hepatocellular carcinoma (HCC) are manifold :tumors arise often in patients with compromised liver function ,therefore limiting therapeutic options ;symptoms develop only at later stages of tumor progression ,and tumors tend to invade normal stuctures or occur in multiple locations simultaneously.     

Prognostic factors in hepatic metastases of colorectal carcinoma: immunohistochemical analysis of tumor biological factors

The present study was designed to provide a systemic analysis of prognosis in 62 patients who underwent hepatic resection for colorectal liver metastasis. The analyzed factors included microvessel counts stained by CD34 and expression of two adhesion molecules, E-cadherin and CD44 variant exon 6-(v6) in these tumors. No significant factors related to recurrence were identified and only negative expression of CD44v6 tended to correlate with recurrence (P = 0.075). A short disease-free period to recurrence was noted in patients with high CEA levels (>10 ng/ml) and H2/3 classification. A short surgical margin, H2/3 classification, high microvessel counts (>60/field, x200), and negative expression of CD44v6 and E-cadherin tended to be associated with poor prognosis. A high microvessel count was the most significant prognostic factor by multivariate Cox proportional hazards regression model. Hepatic resection without tumor exposure and a careful follow-up in cases identified with poor prognostic factors are necessary.     

Ghrelin和MMP-9在直肠癌组织中的表达及其与淋巴结转移的关系

目的：探讨直肠癌组织中生长激素释放肽（Ghrelin）和基质金属蛋白酶-9（MMP-9）的表达与淋巴结转移的关系。方法：应用免疫组织化学方法及Westernblot检测Ghrelin和MMP-9在21例无淋巴结转移及35例有淋巴结转移直肠癌组织中的表达水平的表达,分析Ghrelin和MMP-9与直肠癌淋巴结转移中的关系及两者的相关性。结果：Ghrelin和MMP-9在直肠癌组织中的阳性表达率分别为53．57％和80．36％,明显高于癌旁正常组织（P〈0．05）;Ghrelin和MMP-9蛋白表达与肿瘤淋巴结转移比率联系密切,并且在直肠癌组织中的阳性表达随着淋巴结转移个数增加而增加（P〈0．05）;Ghrelin与MMP-9的阳性表达呈正相关（x=0．832,P〈0．001）。结论：Ghrelin和MMP-9表达升高与直肠癌的淋巴结转移呈正相关,联合检测Ghrelin和MMP-9可能对直肠癌患者淋巴结转移及预后评估具有重要临床价值。     

肺癌脑转移瘤三维适形放疗和立体定向放疗疗效的比较分析

目的：分析和总结三维适形放疗与立体定向放疗在治疗脑转移瘤中的疗效。方法回顾性分析2009年11月～2011年11月于我院行全脑放疗后行三维适形放疗或立体定向放疗的60例肺癌脑转移患者的放疗资料、随访资料及影像学资料,比较两种放疗方式的疗效。结果本组含1～2个脑转移灶的患者共21例,12例行三维适形放疗,9例行立体定向放疗,两组患者的中位生存期、有效率和1年生存率分别为12月、83.3%、58.3%和14月、88.9%、66.7%。脑转移灶数≥3的患者共39例,17例行三维适形放疗,22例行立体定向放疗,两组的中位生存期、有效率和1年生存率分别为7月、58.8%、41.2%和13月、81.8%、68.2%。在脑转移灶数≥3的患者中,立体定向放疗组的中位生存期、有效率和1年生存率都明显优于三维适形放疗组（P＜0.05）。结论对于多发性脑转移瘤患者,立体定向放疗较三维适形放疗更有效。     

All-trans-retinoic acid counteract the tumor-stimulating effect of hepatectomy and increases survival of rats bearing liver metastases

Background

We previously demonstrated a stimulating effect of hepatectomy on residual tumor cells after resection of liver metastases. The aim of this study was to analyze the effect of all-trans-retinoic acid (ATRA) on the protumor effect of hepatectomy and survival of hepatectomized rats bearing liver metastases. We also explored whether ATRA interfered with the tumor promoting effect of hepatotropic growth factors (GFs).

Methods

The in vitro effect of ATRA on proliferation of S4MH rhabdomyosarcoma tumor cells was assessed when cultured with laparotomized or hepatectomized rat serum (HRS), or in the presence of GFs (hepatocyte growth factor, insulin growth factor 2, Platelet Derived Growth Factor (PDGF)-BB, and vascular endothelial growth factor). For the in vivo studies, rats were partially hepatectomized on day 10 after metastasis induction, one group being treated with ATRA from day 7 to 14, and a second receiving cyclophosphamide (CY; on days 10 and 14) alone or with ATRA. We determined the size and number of liver and lung metastases. Finally, we analyzed the effect of treatments on rat survival.

Results

Hepatotropic GFs increased cell proliferation in a similar manner to HRS. In vitro, ATRA blocked the protumor effect of both HRS and GFs. In vivo, ATRA reduced the size and number of liver and lung metastases, and significantly increased rat survival. Furthermore, adding ATRA to CY significantly increased survival compared with CY alone.

Conclusions

In our model, ATRA minimizes the tumor-stimulating effect of hepatectomy, reducing the number and size of liver metastases and improving survival. The results suggest that the ATRA may be useful for blocking the growth-promoting effect of hepatotropic GFs released after liver metastasis resection.