Cutaneous metastases secondary to pancreatic cancer

AIM: To evaluate prognoses after cutaneous metastases, derived from pancreatic cancer. METHODS: We treated two patients with cutaneous metastases from pancreatic cancer. We reviewed 40 reported patients in addition to our cases and analyzed clinical features of cutaneous metastases from pancreatic cancer. RESULTS: The median survival time (MST) was 5 mo after diagnoses of cutaneous metastases. The cumulative 2-year survival rate was 3.5%. The most frequent site of cutaneous metastases was the umbilicus. The MST of patients who were treated with chemotherapy or chemoradiotherapy (CRT) was 6.5 mo, which was statistically longer in comparison to patients without treatment. Prognoses of cutaneous metastases are similar to other metastatic sites from pancreatic cancer. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic cancer.CONCLUSION: The prognoses of cutaneous metastases are similar to other metastatic pancreatic cancers. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic cancer.

Pancreatic pseudocyst-portal vein fistula

Pancreatic pseudocyst-portal vein fistulae are extremely rare, and cause serious complications, including life-threatening sepsis. We report a 57-year-old man with pancreatic pseudocyst who was admitted to our hospital complaining of prolonged abdominal pain. A pancreatic duct tube was placed into the main pancreatic duct, as the pseudocyst was communicated to the pancreatic duct. He fell into septic shock state two weeks later. An ultrasonography-guided percutaneous drainage of the pseudocyst was performed. The amylase level of drained pus was 80,000 U/l. Pancreatic pseudocyst-portal vein fistula was demonstrated by fisterography. Symptoms disappeared immediately after drainage. No recurrence was observed afterward.

A novel comprehensive ALPPS preoperative risk assessment (CAPRA) score is beneficial in creating a treatment strategy for advanced liver malignancy

Curability and safety are essential for patients with advanced liver malignancy undergoing extended liver resection.If the future liver remnant(FLR)volume is insufficient,portal embolization with or without hepatic arterial or venous embolization or a conventional two-stage hepatectomy(TSH)can be performed(1,2).Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)was introduced in 2007.

The Number of Positive Tumor Marker Status Is Beneficial for the Selection of Therapeutic Modalities in Patients with Hepatocellular Carcinoma

Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and des-c-carboxy prothrombin are well-known and useful tumor markers for HCC.The positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local therapy.Although the normal ranges reported have differed by institution,the positivity of tumor markers is consistent and can easily be assessed.Kumamoto and Wakayama's group clearly demonstrated the following:1) Regardless of the degree of tumor stage,a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR;2) For RFA alone,HCC patients with double-and triple-positive status,having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes;3) For HCC patients with lesions ≤5 cm in Child-Pugh grade A,HR is preferred over RFA;4) Microvascular invasion rates increased even in the double-positive patients,while poorly differentiated HCC was frequently observed only in the triple-positive patients;and 5) RFA with chemoembolization,anatomical liver resection,and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor markers.However,the impacts of these therapies still need to be evaluated in prospective comparative studies.

Epithelial-mesenchymal transition in gastroenterological cancer

Epithelial-mesenchymal transition(EMT)was first reported as an essential process in embryonic cells and later showed that cancer cells,regardless of the context,exhibited a similar phenomenon that was crucial for tumor progression.Epithelial cells lose their adhesive characteristic capacity which is necessary for their functions but gain a mesenchymal phenotype.This change from epithelial to the mesenchymal phenotype of cancer cells makes it difficult to understand the mechanism underlying cancer biology and tumor progression.A number of transcription factors involved in tumor cell EMT and microRNA-regulated EMT have been reported.This review discussed recent findings and new players in EMT in gastrointestinal cancers.Since the molecular mechanisms of tumor progression are sometimes context-dependent,the recent findings of EMT have been reviewed in a context-dependent manner.

The impact of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)on liver tumors with unusual indications

An associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been developed as a novel surgical technique for patients with insufficient future liver remnant volume even after portal vein embolization(PVE)±hepatic arterial or venous embolization or conventional two-stage hepatectomy(TSH)(1-5).ALPPS was thought to be a breakthrough but high-risk procedure;however,it recently became a safer technique after the developing phase(1-3).Conversion surgery is strongly recommended for patients with initially unresectable liver tumors that are deemed resectable by systemic chemotherapy or hepatic arterial chemotherapy/embolization(6,7).The primarily targeted diseases are colorectal liver metastases(CRLM)and hepatocellular carcinoma(HCC).ALPPS is indicated for patients undergoing not only primary surgery but also conversion surgery.