Sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery:A case report

We report a case of sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery.A 38-year old asymptomatic woman was referred to our hospital for evaluation of a submucosal tumor of the stomach.Endoscopic examination showed a solitary submucosal tumor without ulceration or central depression on the posterior wall of the antrum and biopsy specimens were not sufficient to determine the diagnosis.Endoscopic ultrasound revealed a tumor nearly 2 cm in diameter arising from the muscle layer and a computed tomography scan showed the tumor enhanced in the arterial phase.Laparoscopic wedge resection was performed for definitive diagnosis.Pathologically,the tumor was shown to be gastric carcinoid infiltrating the muscle layer which indicated the probability of lymph node metastasis.Serum gastrin levels were normal.As a radical treatment,laparoscopy-assisted distal gastrectomy with regional lymphadenectomy was performed 3 wk after the initial surgery.Finally,pathological examination revealed no lymph node metastasis.

Expected clinical applications of circulating tumor cells in breast cancer

Tumor cell invasion and intravascular filtration lead to the presence of circulating tumor cells(CTCs)in peripheral blood.CTCs have,thus,been counted in patients with cancer to analyze metastatic mechanisms or in the hope of developing clinical applications for diagnosis and therapy;various CTC-related studies have been performed.However,the clinical significance of CTCs remains to be established because of the extremely small number of CTCs in peripheral blood as compared with the number of blood cells.Technical problems(e.g.reproducibility and reliability)in the detection of CTCs also remain to be solved.The use of flow cytometric analysis,which can be performed with tumor-cell markers such as anti-epithelial cell adhesion molecule antibodies and anti-cytokeratin antibodies and nontumor-cell markers such as anti-CD45 antibodies has enhanced specificity for the detection of tumor cells.The CellSearch System?can detect 1 CTC in 7.5 mL of peripheral blood,with high reproducibility.Its detection rate and accuracy for CTCs have been confirmed.In the United States,clinical trials have used this system to detect CTCs in patients with metastatic breast cancer,metastatic colorectal cancer,and metastatic prostate cancer,and CTCs have been confirmed to be a useful prognostic factor.This system was also suggested to be useful for monitoring treatment response in patients with metastatic breast cancer and was approved by the United States Food and Drug Administration in 2004.Measuring CTC counts can facilitate the early prediction of treatment response and thereby avoid unnecessary therapy.CTCs may also be a useful biomarker for molecular targeted agents,enabling the identification of patients most likely to respond to a given treatment and facilitating treatment selection.However,the widespread use of CTC monitoring as a routine examination requires a further improvement in measurement sensitivity,the establishment of criteria for quantitative and qualitative evaluations,and additional clear-cut evidence supporting the clinical significance of CTCs.We expect that CTCs will be established to be a new diagnostic and therapeutic index for breast cancer.