Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity:Report of a case

促结缔织增生的小圆房间肿瘤(DSRCT ) 是有特殊组织学的特征的稀罕、高度好攻击的恶意：在稠密的促结缔织增生基质以内的细胞的生长的一个嵌套的模式，与男优势发生在年轻人口。吝啬的幸存时期仅仅关于 1.5-2.5 年。肿瘤共同表示上皮，在免疫的肌肉，和神经标记组织化学的研究。这个工作报导与吐血和长期的便秘介绍的一个 27 岁的人。包括内视镜检查法，上面的胃肠的系列，腹的计算断层摄影术和钡灌肠的连续研究学习内脏的机关的显示出的传播参与。病人经历了好攻击的外科并且收到了由 5 氟尿嘧啶，出租机动三轮车磷酰胺， etoposide， doxorubicin，和 cisplatin 组成的手术后的辅助化疗。没有任何疾病，他在外科以后为 20 瞬间幸存。没有标准疗法协议被建立了。与手术后的多代理人助手化疗相结合的好攻击的外科被认为正当不仅减轻症状而且试着在这个先进 DSRCT 年轻病人改进结果。

Surgical management of gallbladder sarcomatoid carcinoma

AIM:To study the behavior as well as optimal treatment of gallbladder sarcomatoid carcinoma, we reviewed the results of treatment of gallbladder sarcomatoid carcinoma from Chang Gung Memorial Hospital. METHODS:From 1987 to 2005,six patients were diagnosed with gallbladder sarcomatoid carcinoma and treated at our institution.Tumor staging was based on 2002 revised tumor-node-metastasis(TNM)staging for gall bladder cancer from the American Joint Committee on Cancer.The clinical presentation,laboratory data and preoperative workup were reviewed retrospectively. RESULTS:Five patients were female and one was male.The age ranged from 51 to 66 years(median, 58 years).Surgical procedures included three curative resections,two palliative resections and one biopsy. There were two surgical complications(33.3%)and one case of surgical mortality(16.7%).The followup time ranged from 30 d to 5 mo.The median survival was 2.5 mo.The prognosis was extremely poor,even after curative resection and postoperative chemotherapy. CONCLUSION:The prognosis of gallbladder sarcomatoid carcinoma was not dependent on TNM stage and was always dismal.The clinicopathological features were different from those of gall bladder cancer.

Clinicopathological study of solid and pseudopapillary tumor of pancreas: Emphasis on magnetic resonance imaging findings

AIM: To report the clinicopathological features and magnetic resonance imaging (MRI) findings of solid and pseudopapillary tumor (SPT) of pancreas.METHODS: From 1981 to 2005, 26 surgically treated cases of SPT were retrospectively reviewed. MRI findings of the latest 11 consecutive SPT cases were investigated.RESULTS: There were 25 women and one man having SPT (median age: 23 year) with a median tumor size of 7.5 cm. Among them, nine patients developed solid pseudopapillary carcinoma. During the median follow-up period of 66 mo, the 5-year survival rate of the 26 SPT patients was 96.2%. Three MRI features were proposed including Type 1 image, displaying SPT with completely solid part. All SPT patients with type 1 image were detected incidentally. Type 2 image displays of SPT with solid mass hemorrhage and type 3 image with massive hemorrhage. All the eight SPT patients with type 2 and 3 images suffered abdominal pain due to hemorrhage from SPT.CONCLUSION: SPT had a favorable survival rate irrespective of surgical procedures, malignancy, and MRI findings, however, MRI could reliably correlate with its clinicopathological features.

CCL7 and CCL21 overexpression in gastric cancer is associated with lymph node metastasis and poor prognosis

AIM:To investigate how a complex network of CC chemokine ligands(CCLs) and their receptors influence the progression of tumor and metastasis.METHODS:In the present study,we used immunohistochemistry to examine the expression of CCL7,CCL8 and CCL21 in 194 gastric cancer samples and adjacent normal tissues.We analyzed their correlation with tumor metastasis,clinicopathologic parameters and clinical outcome.RESULTS:We found that the higher expression of CCL7 and CCL21 in cancer tissues than in normal tissues was significantly correlated with advanced depth of wall invasion,lymph node metastasis and higher tumor node metastasis stage.Moreover,Kaplan-Meier survival analysis revealed that CCL7 and CCL21 overexpression in cancer tissues was correlated with poor prognosis.CONCLUSION:These results suggest that overexpression of these two CC chemokine ligands is associated with tumor metastasis and serves as a prognostic factor in patients with gastric cancer.

Prognosis and feasibility of en-bloc vascular resection in stage Ⅱ pancreatic adenocarcinoma

AIM:To establish the prognosis and feasibility of en-bloc vascular resection of stage pancreatic adenocarcinoma of the head and uncinate process.METHODS:We retrospectively analyzed 87 patients with stage pancreatic adenocarcinoma,who were subjected to pancreaticoduodenectomy (PD) and pylo-rus-preserving PD (PPPD) between 1996 and 2006 in Chang Gung Memorial Hospital,Taiwan. Twelve and 75 patients underwent PD/PPPD with and without resection of portal vein/superior mesenteric vein (PV/SMV),respectively.RESULTS:The overall 1-and 3-year survival rates of patients undergoing PD/PPPD with and without vas-cular resection were 50.0% and 16.7%,and 44.4% and 12.2%,respectively. Morbidity and mortality rates in the PV/SMV resection vs non-resection group were 50.0% and 0.0%,and 40.0% and 2.7%,respectively. In multivariate analysis,serum bilirubin,histological differentiation and adjuvant chemotherapy were independent prognostic factors that influenced survival.CONCLUSION:In stage adenocarcinoma of the pancreatic head and uncinate process,serum bilirubin,histological differentiation and adjuvant chemotherapy were independent prognostic factors,and en-bloc vascular resection is a feasible option in carefully selected patients.

Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2cm undergoing resection

AIM:To investigate the differences in clinicopathological features between patients with pancreatic cancer greater or less than 2 cm situated over the pancreatic head and the prognostic factors for survival of patients with pancreatic cancer<2 cm over the pancreatic head. METHODS:From 1983 to 2006,159 patients with histologically proven pancreatic adenocarcinoma(PAC) at the pancreatic head undergoing curative resection at the Department of Surgery,Chang Gung Memorial Hospital,Taipei,Taiwan were reviewed,comprising 123 cases of large(L)-PAC(tumor>2 cm)and 36 cases of small(S)-PAC(tumor≤2 cm).We compared the clinicopathological characteristics and prognosis of L-PAC and S-PAC patients.The clinicopathological characteristics of S-PAC were investigated to clarify the prognosis predictive factors of S-PAC. RESULTS:One hundred and fifty-nine PAC patients, aged 16-93 years(median,59.0 years)with a tumor at the pancreatic head undergoing intentional curative resection were investigated.The S-PAC and L-PAC patients had similar demographic data,clinical features,and tumor markers(a similar positive rate of carcinoembryonic antigen and carbohy- drate antigen 19-9).There were also similar rates of lymph node metastasis,portal vein invasion,stage distribution,tumor differentiation,positive resection margin,surgical morbidity and mortality observedbetween the two groups.During a follow-up period ranging from 1.0 to 122.7 mo(median,10.9 mo), S-PAC and L-PAC patients had a similar prognosis after resection(P=0.4805).Among the S-PAC patients group,patients with higher albumin level(>3.5 g/dL) had more favorable survival than those with lower albumin levels,which was the only favorable predictive prognostic factor.Meanwhile,early-staged(stageⅠ,Ⅱ) S-PAC patients tended to have a more favorable outcome than late-stage(stageⅢ,Ⅳ)S-PAC patients, but this was not statistically significant. CONCLUSION:S-PAC patients should not be regarded as early PAC.Only higher albumin level(>3.5 g/dL) and early stage disease(stageⅠ,Ⅱ)were the favorable prognosis factors for S-PAC patients.

Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas, papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982. It has been most commonly described in 60 to 70 years old males, and represents a relatively ''new'' but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.