Immunological milieu in the peritoneal cavity at laparotomy for gastric cancer

AIM： To investigate the immunological repertoire in the peritoneal cavity of gastric cancer patients. METHODS： The peritoneal cavity is a compartment in which immunological host-tumor interactions can occur. However, the role of lymphocytes in the peri- toneal cavity of gastric cancer patients is unclear. We observed 64 patients who underwent gastrectomy for gastric cancer and 11 patients who underwent lapa-roscopic cholecystectomy for gallstones and acted as controls. Lymphocytes isolated from both peripheral blood and peritoneal lavage were analyzed for surface markers of lymphocytes and their cytokine production by flow cytometry. CD4＋CD25h＋gh T cells isolated from the patient＇s peripheral blood were co-cultivated for 4 d with the intra-peritoneal lymphocytes, and a cytokine assay was performed. RESULTS： At gastrectomy, CCR7-CD45RA- CD8＋ effector memory T cells were observed in the peritoneal cavity. The frequency of CD4＋ CD25 h＋ghT ceils in both the peripheral blood and peritoneal cavity was elevated in patients at advanced stage [control vs stage IV in the peripheral blood： 6.89 （3.39-10.4） vs 15.34 （11.37-19.31）, P 〈 0.05, control vs stage IV in the peri- toneal cavity： 8.65 （5.28-12.0） vs 19.56 （14.81-24.32）, P 〈 0.05]. On the other hand, the suppression was restored with CD4＋ CD25h＋QhT cells from their own pe- ripheral blood. This study is the first to analyze lympho- cyte and cytokine production in the peritoneal cavity in patients with gastric cancer. Immune regulation at ad- vanced stage is reversible at the point of gastrectomy. CONCLUSION： The immunological milieu in the peri- toneal cavity of patients with advanced gastric cancer elicited a Th2 response even at gastrectomy, but this response was reversible.

Mucosa-associated lymphoid tissue lymphoma of the transverse colon: A case report

We herein present a case of a 75-year-old female with mucosa-associated lymphoid tissue （MALT） lymphoma of the transverse colon with the stage IE （Ann Arbor classification）. Colonoscopy revealed the tumor＇s appearance as a IIa plus Ⅱ c-like early colon cancer as defined according to the macroscopic classification of the Japanese Research Society for Cancer of Colon, Rectum and Anus, measuring less than 2 cm in diameter. Histologically, the tumor was diagnosed as MALT lymphoma because of the presence of lymphoepithelial lesions consisting of diffuse proliferation of atypical lymphocytes and glandular destruction. The majority of these lymphocytes immunohistochemically stained for the B-lymphocyte marker. The patient first underwent H pylori eradication therapy with Lansap. However, the tumor size gradually increased over the next 4 mo and the patient eventually underwent surgical resection. The operative procedure included a partial colectomy with dissection of the paracolic lymph nodes. The tumor measured 45 mm × 30 mm in diameter and histological examination showed that the lymphoma cells had infiltrated the muscle layer of the colon without nodal involvement. The patient has had no recurrence postoperatively without any chemotherapy.

Small bowel anisakiosis: A report of two cases

Small bowel stenosis is a serious complication of intestinal anisakiosis. The aim of this report is to investigate whether severe stenosis of the small intestine can be conservatively managed. We treated two patients with severe stenosis of the small intestine caused by anisakiosis. Surgical intervention was eventually performed on the 23^rd and 35^th in the hospital, respectively. Histopathological examination of the resected specimens revealed that the intestinal wall had been completely damaged by the inflammatory reaction of anisakiosis, and that the damage was irreversible, thereby suggesting that laparotomy is needed in cases of severe small bowel stenosis caused by intestinal anisakiosis, even if a long period of conservative treatment for the intestinal anisakiosis allowed the patient to pass successfully through the acute phase.