Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings

AIM: To evaluate the dynamic computed tomography(CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach(HAS) and compared them with hepatocellular carcinoma(HCC).METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.RESULTS: The body and antrum were the most common site for primary HAS(n = 7), and observed metastatic sites included the liver(n = 8), lymph nodes(n = 7), peritoneum(n = 4), and lung(n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm(n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS(n = 1), direct venous invasion by the liver metastases(n = 7), and isolated portal vein tumor thrombosis(n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.

Myoepithelial carcinoma of the stomach: A diagnostic pitfall

Myoepithelioma/myoepithelial carcinomas are not commonly found in soft tissues and are especially rare at visceral sites.This report describes a case of a rare low-grade myoepithelial carcinoma of the stomach.A61-year-old female patient presented with postprandial abdominal discomfort.Endoscopy revealed a 1.1 cm submucosal lesion.Local excision was performed after malignancy was confirmed by biopsy.The resection margin is free of tumor and she received no adjuvant therapy.The tumor was characterized by multinodular growth with biphasic epithelioid and spindle components.Infiltrative margin and nuclear pleomorphism are seen.Tumor cells were positive for both epithelial and myoepithelial markers.Evidence of epithelial differentiation was confirmed by electron microscopy.No EWSR1 rearrangement was detected.The final diagnosis was low-grade myoepithelial gastric carcinoma.The patient is currently well, and no evidence of recurrence or metastasis was found after ten-month of follow-up.Myoepithelial carcinoma should be considered in the differential diagnosis of a biphasic gastric tumor.

Simultaneous large cell neuroendocrine carcinoma and adenocarcinoma of the stomach

A large cell neuroendocrine carcinoma(LCNEC) of the stomach is very rare.A 76-year-old Japanese man was admitted to our hospital because of epigastralgia and nausea.Endoscopy revealed 2 large tumors in the stomach.He did not have multiple endocrine neoplasia typeⅠor Zollinger-Ellison syndrome.Imaging modalities,including computed tomography and magnetic resonance imaging,revealed no other tumors.Gastrectomy,cholecystectomy,and lymph node dissection were performed.The resected stomach had 2 tumors:one was an antral ulcerated type 3 tumor measuring 5 cm x 5 cm,and the other was a polypoid type 1 tumor measuring 6 cm x 6 cm x 3 cm in the fundus.Microscopically,the antral ulcerated tumor was a well differentiated adenocarcinoma with deep invasion.The fundus polypoid tumor was a LCNEC,being composed of malignant large cells arranged in trabecular and nested patterns.The tumor cells were large and the nuclei were vesicular.Nucleoli were frequently present,and there were many mitotic figures,apoptotic bodies,and necrotic areas.Much lymphovascular permeation was seen.Seven out of 29 dissected lymph nodes showed metastatic foci;6 were from the LCNEC and 1 from theadenocarcinoma.Many intravascular tumor emboli of LCNEC were seen in the peritoneum around the lymph nodes.Mucins were present in the adenocarcinoma but not in the LCNEC.Immunohistochemically,the LCNEC tumor cells were positive for pancytokeratins,synaptophysin(50%positive) ,chromogranin A(10% positive) ,Ki-67(90%labeled) ,and platelet-derived growth factor-α(80%positive) .They were negative for KIT,p53,CD56,and neuron-specific enolase.The non-cancerous stomach showed a normal number of endocrine cells.The patient is now treated with adjuvant chemotherapy.

Screening and Identification Differentially Displayed Genes in Fore Stomach Carcinoma of Mice

Objective： To screen and identify key genes differentially displayed in mouse fore stomach carcinoma, in order to elucidate the molecular mechanism underlying carcinogenesis. Methods： The animal models complied with each period of NIH mouse fore stomach carcinoma induced by N-Nitrososarcosineethylester （NSEE） were used in this study. The mice were euthanized on days 14, 28, 56, 77 and 84, respectively, after NSEE-piped treatment, and classified according to their pathologies. The differentially expressed genes were isolated from both normal and morbid tissues by mRNA differential display technique and screened by using Reverse Northern blot. Bioinformatics were employed to analyze the results observed. After identification, ten fragments were cloned and matched with GENEBANK database through homologous analysis. Results： One gene was found identical to splicing factor 3b subunit 1 （Sf3bl）, while seven fragments hold the homology of known cDNA clones. In contrast, other two fragments had extremely low identity to any genes registered in GENBANK databases. Conclusion： It is the first time to demonstrate in this study that splicing factor3b, subunitl （Sf3bl） is related to mouse fore stomach carcinoma. Furthermore, ESC-3 and ESC-4 are suggested to contribute to the development of mouse fore stomach carcinoma, thus may be candidates of new targets of oncogenes.

The clinical trial research of preoperative induced hypertension chemotherapy on the III staging cardia or fundus of stomach carcinoma

Objective： To observation the therapeutic effect and the adverse reaction of preoperative induced hypertension chemotherapy （IHC） on the Ⅲ staging cardia or fundus of stomach carcinoma. Methods： 49 cases of the Ⅲ staging cardia or fundus of stomach carcinoma were divided into two groups at random. The observation group included 19 cases and the control group included 30 cases. Every case used one cycle chemotherapy. The observation group （IHC group） used chemotherapy and AT Ⅱ. The control group （simple chemotherapy group） used simple chemotherapy. All cases of the two groups operated after 3 weeks rest. The specimen＇s DNA was analyzed by flow cytometry. Results： The effective power of observation group was 63.2% （12/19）, exairesis ratio was 84.2% （16/19）. The effective power of control group was 30% （9/30）, exairesis ratio was 63.3% （19/30）. DNA ploid determination： 13 cases were diploid and 5 cases were heteropioid in the observation group, 9 cases were diploid and 16 cases were heteroploid in the control group. The operative complications and risks of the two groups did not increase. Conclusion： IHC can increase the therapeutic effect of Ⅲ staging cardia or fundus of stomach carcinoma obviously. IHC is one of the chemotherapy methods that have good future, it has good value of clinic enlarge trial.

EXPRESSION OF PCNA,AKP AND ACP DURING DEVELOPMENT OF MOUSE FORE STOMACH CARCINOMA

Objective： To find out the relationship of the expressions of proliferating cell nuclear antigen （proliferating cell nuclear antigen, PCNA）, alkaline phosphotase （alkaline phosphotase, AKP） and acid phosphotase （acid phosphotase, ACP） with the development of mouse fore stomach cancerization. Methods： The animal models, including the various stages during the development of NIH mouse fore stomach carcinoma, were made by N-Nitrososarcosineethylester （N-Nitrososarcosineethylester, NSEE）. The mice were sacrificed on the 14th, 28th, 42nd, 56th, 70th and 84th days respectively after mice were irrigated with NSEE. The fore stomach was taken out and dissected. The methods of histopathology, immunohistochemistry and isoenzyme electrophoresis were adopted to study the dynamic changes of cell shape and expression of PCNA, AKP and ACP. Results： On the 42nd and 56th days after NSEE treatment, the expression of PCNA increased gradually along with the cancerization. Comparing with the control, there were significant differences （P〈0.05）. On the 70th and 84th days, the expression of PCNA increased further （compared with the control P〈0.01）. The activity of AKP increased gradually along with the cancerization. On the 14th, 28th, 42nd and 56th days, there were significant differences （P〈0.05）; on the 70th and 84th days, the activity of AKP increased further （P〈0.01）. The activity of ACP also increased on the 14th, 28th, 42nd and 56th days, and there were significant differences on the 70th days （P〈0.05） and on the 84th days （P〈0.01） compared with the control. Conclusion： During the carcinogenesis of NIH mouse fore stomach, the expressions of PCNA, AKP and ACP increased gradually and were consisted with the changes of cell shapes.

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

CHARACTERISTICS OF MUCINS AND CEA IN GLOBOID DYSPLASTIC CELLS OF HUMAN STOMACH AND ITS RELATIONSHIP WITH SIGNET RING CELL CARCINOMA

Fourty-three cases of globoid dysplasia and signet ring cell carcinoma were stained by mucin and CEA (ABC method). It was found that there were three kinds of mucins (neutral, sialo and sulphomucin in both globoid dysplastic cells and signet ring cells. The percentages of the three kinds of mucins seen in the two kinds of cells were not much different. It was indicated that the altered mucins in the gastric epithelial cells must be a sign of dedifferentiation of the cells and the results of malfunction. The globoid dysplasia type I mainly contained neutral mucin, whereas type II, the acid mucin was predominant, especially the sulphomucin. The CEA positive reaction became stronger as the atypia being remarkable, and the characteristics of distribution of CEA positive particles were similar in the two kinds of cells namely, randomly or disorderly in the cells. Based on the analysis of the results, a conclusion can be made that the variety of mucins in globoid dysplastic cells can be used as a reference point in classification and is not much significant in grading, but the amount of CEA positive matter can be a reference point in grading. The globoid dysplasia is such a lesion with special features in morphology and function manifested in the process of de-differentiation towards signet ring cell carcinoma following the successive action of carcinogens upon the cells of gastric epithelium.

CT动态容积灌注成像检出早期胃癌并评估其病理分型

目的 观察CT动态容积灌注(DVPCT)成像检出早期胃癌并鉴别其病理分型的价值。方法 回顾性分析127例经病理证实的早期胃癌患者,根据术前检查方式分为增强CT组(n=67)或DVPCT组(n=60);比较组间一般资料、CT资料,以及DVPCT组内胃印戒细胞癌(SRCC)与胃腺癌的强化程度、门静脉期与延迟期峰值期相及峰值时间;绘制受试者工作特征(ROC)曲线,计算曲线下面积,评估DVPCT时间-密度曲线(TDC)鉴别早期SRCC与腺癌的效能。结果 DVPCT组肿瘤检出率、剂量长度乘积及有效剂量均高于增强CT组(P均<0.05);2组患者年龄、性别、病理分型、肿瘤位置及肿瘤最大径差异均无统计学意义(P均>0.05)。52例(52/60,86.67%)经DVPCT检出早期胃癌的患者中,SRCC 12例、腺癌39例、黏液腺癌1例;其中,早期胃SRCC与早期胃腺癌患者肿瘤强化程度、门静脉期及延迟期峰值期相及峰值时间差异均有统计学意义(P均<0.05)。以峰值时间37.3 s为最佳截断值,DVPCT TDC鉴别早期胃SRCC与早期胃腺癌的敏感度、特异度、阳性预测值、阴性预测值、准确率及曲线下面积分别为83.33%、84.62%、62.50%、94.29%、84.31%及0.895。结论 DVPCT检出早期胃癌效果优于常规增强CT;TDC可有效鉴别早期胃SRCC与早期胃腺癌。

EBV相关肿瘤和健康人群BALF2基因序列分析

目的探讨BALF2基因的多态性及其分布特征与EB病毒(EBV)相关肿瘤发生发展的关系。方法采用巢式PCR结合DNA测序的方法,对349例EBV阳性标本进行DNA序列分析,利用Lasergene软件将其与EBV标准株B95-8序列进行比对,并生成系统发生树,对基因变异型进行分类。结果根据系统发生树将BALF2分为5个基因型BALF2-A、BALF2-B、BALF2-C、BALF2-D和BALF2-E。其中,BALF2-E在鼻咽癌中的检出率高于健康人群,中国南方鼻咽癌人群BALF2-E的检出率高于北方鼻咽癌人群(χ2=10.26,P<0.01)。结论BALF2基因存在多态性,其变异类型分布与肿瘤类型、地域有关,BALF2-E亚型与鼻咽癌发生相关。

保留远端残胃联合双通道吻合术治疗胃上部癌的临床效果

目的探讨保留远端残胃联合双通道吻合术治疗胃上部癌的临床效果。方法选取80例胃上部癌患者为研究对象,按照入组单双顺序分为观察组与对照组。对照组采用胃全切术联合食管-空肠Roux-en-Y吻合术治疗;观察组采用保留远端残胃联合双通道吻合术治疗。比较2组手术相关指标、术后营养指标、并发症及生活质量。结果观察组术中出血量及肛门排气、住院时间均低于对照组,手术时间高于对照组(P<0.05)。术后观察组总蛋白、白蛋白、血红蛋白水平高于对照组(P<0.05)。观察组术后并发症发生率为20.00%(8/40),低于对照组的60.00%(24/40),P<0.05。术后观察组生活质量各维度评分均高于对照组(P<0.05)。结论保留远端残胃结合双通道吻合术用于胃上部癌治疗,可减少术后并发症,改善机体的营养状态,促进患者快速恢复,提高生活质量。

D1 versus Modified D2 Gastrectomy for Ca Stomach—A Prospective and Comparative Study

Background: Carcinoma stomach remains a major malignancy and accounts for 10.4% of cancer related deaths globally. Despite improvement in chemo-radiotherapy, surgery remains the primary curative modality with special emphasis on lymphadenectomy. However the extent of lymphadenectomy performed by surgeons all over the world differs. Generally speaking, in Japan and Korea, the standard curative protocol would entail a “D2” lymphadenectomy whereas in the western world it would be considered unnecessary and the standard protocol would entail a standard “D1” lymphadenectomy. Thus prompting a newer surgical therapy of modified D2 in dissection in which pancreas and spleen are preserved. Lymph nodes surrounding stomach are divided into 20 stations and these are classified into three groups depending upon the location of the primary tumour. Aims & Objectives: The aims and objectives are to compare: 1) operative time of modified D2 gastrectomy with that of D1 gastrectomy;2) operative morbidity and mortality of modified D2 gastrectomy with that of D1 gastrectomy;3) the disease recurrence between modified D2 & D1 gastrectomy. Materials & Method: The study entitled D1 versus modified D2 gastrectomy for Ca stomach—a prospective, comparative study was conducted in the Postgraduate Department of General Surgery, Government Medical College, Srinagar as a prospective, comparative study over a period of three years 2012-2014. Patients with resectable gastric cancer were taken as subjects for the study and were divided in 2 groups that were closely matched to avoid any bias. Assessment of both the groups was done in identical fashion as per standard protocol. One group underwent gastrectomy with D1 lymph node dissection whereas the other group underwent gastrectomy with a modified D2 lymph node dissection (spleen and pancreas preservation). The type of lymphadenectomy was decided on randomization (simple random sampling). Results: After comparing the two procedures, it was noted that: 1) modified D2 lymphadenectomy took on an average 2 hours more than D1 gastrectomy;2) operative mortality was same in both the procedures. Operative morbidity was seen more in modified D2 group than D1 group however this difference was statistically insignificant;3) number of recurrence was quite significant in D1 group but no recurrence was seen in modified D2 group. Conclusion: On the basis of the study, we recommend that modified D2 gastrectomy is a better procedure than D1 gastrectomy for patients of carcinoma stomach undergoing curative resection.

Lymphoepithelioma-like gastric carcinoma: A case report and review of the literature

Lymphoepithelioma-like gastric carcinoma is a rare type of gastric cancer characterized by a carcinoma with intense stromal lymphocytic infiltration. Although lymphocytic infiltration is closely associated with EpsteinBarr virus(EBV) infection, concomitant occurrence with differentiated adenocarcinoma is relatively rare. The clinical manifestations of lymphoepithelioma-like gastric carcinoma(including EBV-positive and-negative forms) are similar to those of gastric cancer, and the diagnosis is based on pathologic, histologic, and immunohistochemical findings. This report describes the case of a 55-year-old female patient who presented with a 10-year history of recurrent and worsening abdominal pain and melena that had been occurring for 2 mo. An ulcerative lesion was detected in the stomach by endoscopic examination, which raised suspicion of early gastric cancer. A subsequent preoperative endoscopic biopsy showed adenocarcinoma, but the postoperative pathologic, histologic, and immunohistochemical analyses of the resected specimen revealed a final diagnosis of lymphoepithelioma-like gastric carcinoma.

Expression of 8-hydroxy-2'-deoxyguanosine in gastric carcinomas

Reactive oxygen species may be involved in the progression of gastric carcinomas. To clarify whether the pathology of gastric carcinoma are related to oxidative DNA damage, the expression of 8-hydroxy-2＇-deoxyguanosine （8-OHdG） was examined in 30 patients with gastric carcinomas. Methods： The expression of 8-OHdG and apoptosis in the gastric carcinoma were measured using the methods of immunocytochemistry and deoxynucleartididyl transferase-mediated dUTP-biotin nick end labeling （TUNEL）, respectively. Results： Of the 30 cases, 25（83%） showed stronger immunoreactivity than normal control. The patients with poorly differentiated gastric carcinoma had a larger tumor size and higher labeling indices of TUNEL- and 8-OHdG-positive cells than those with well and moderately differentiated gastric carcinoma. Conclusion： Our findings suggest that oxidative DNA damage is increased in association with necroinflammation in chronic gastric injuries and determination of 8-OHdG is useful in assessing high-grade malignancy in gastric carcinomas.

Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

Gastric submucosa-invasive carcinoma associated with EpsteinBarr virus and endoscopic submucosal dissection: A case report

BACKGROUND Epstein-Barr virus(EBV)-associated carcinoma is a gastric cancer subtype with a morphology characterized by gastric carcinoma with lymphoid stroma(GCLS).Clinicopathological studies have indicated a better prognosis for GCLS than for common gastric carcinomas.Some previous cases of early gastric cancer associated with EBV had been diagnosed by endoscopic resection.CASE SUMMARY We present two GCLS cases subjected to endoscopic submucosal dissection(ESD)for a definitive diagnosis.A protruded gastric lesion was identified by routine endoscopic examination,but forceps biopsy showed no atypical cells before ESD.The resected specimen showed a poorly differentiated adenocarcinoma with lymphoid cells involving the mucosa and submucosa.The final diagnosis was submucosa-invasive poorly differentiated gastric adenocarcinoma.Accordingly,additional gastrectomy was recommended to obtain a complete cure.One patient underwent additional distal gastrectomy with lymph node dissection,but the other was refused because of cardiovascular complications.Both patients remained in remission for more than half a year.EBV positivity was determined by EBV-encoded RNA in situ hybridization.We also conducted a literature review of cases of early gastric cancer associated with EBV that had been diagnosed by ESD.CONCLUSION Submucosa-invasive GCLS could be dissected using ESD,and EBV positivity should be subsequently assessed to determine whether or not any additional curative surgery is required.Further prospective investigations on the prevalence of lymph node metastasis in EBV-associated carcinoma should be performed to expand the indications for endoscopic resection.

Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma:A retrospective,propensity score-matched study

BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.METHODS This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach(cT3/4 and cN any)diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis(cTNM)staging system.We performed 1:1 propensity score matching(PSM)to reduce bias in patient selection.The histologic and prognostic effects of neoadjuvant chemotherapy were assessed.The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.RESULTS Of the 144 patients eligible for this study,36 received neoadjuvant chemotherapy,and 108 received initial surgery after diagnosis.After adjustment by PSM,36 pairs of patients were generated,and baseline characteristics,including age,sex,American Society of Anesthesiologists score,tumor location,and cTNM stage,were similar between the two groups.The R0 resection rates were 88.9%and 86.1%in the surgery-first and neoadjuvant chemotherapy groups after PSM,respectively(P=1.000).The median follow-up period was 46.4 mo.The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0%and 65.0%(P=0.235),respectively,before PSM and 50%and 64.7%(P=0.192),respectively,after PSM.Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.CONCLUSION Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma.For resectable gastric signet-ring cell carcinoma,upfront surgery should be the primary therapy.

Gastric Neuroendocrine Carcinoma in a Dog

A gastric biopsy specimen from a 14-year-old Yorkshire terrier was analysed using light microscopy, immunohistochemistry and transmission electron microscopy. The biopsies were obtained from a 3 × 3 × 4 cm mass located at the gastric cardia. Light microscopy revealed solid nests and sheets of tumour cells separated by abundant fibrovascular stroma in all gastric layers. The tumour cells were monomorphic, with eosinophilic cytoplasm and demonstrated palisading at the periphery. Nuclei were round to oval with densely packed chromatin and inconspicuous nucleoli. The tumour cells immunohistochemically stained strongly positive for chromogranin A, synaptophysin, and pan-cytokeratin. Electron microscopy revealed electron dense neurosecretory granules of 100 - 150 nm in diameter. Metastases were found in regional lymph nodes. Gastric neuroendocrine carcinoma was diagnosed, according to the histological, immunohistochemical and electron microscopic features.

Case of gastric neuroendocrine carcinoma showing an interesting tumorigenic pathway

Here, we report a case of gastric neuroendocrine carcinoma showing an interesting tumorigenic pathway. A 57-year-old Japanese woman presented with epigastric tenderness, and distal gastrectomy was performed. In the surgical specimen, histologically, the tumor tissue was composed of three subtypes of tumor components showing different histological architecture and cellular atypia, diagnosed as neuroendocrine tumor(NET) G2, NET G3, and neuroendocrine carcinoma(NEC) components. Immunohistochemically, the Ki-67-positive rates of NET G2, NET G3, and NEC components were 6.5%, 99.5% and 88.1%, respectively. Although allelic imbalance(AI) on chromosomes 1p, 3p, 8q, TP53, 18q and 22 q was commonly found in all components, AI of 4p was found in NET G3 and NEC components(but not in the NET G2 component). In contrast, AIs of 5q and 9p were found in only the NEC component. Thus, we showed the progression from NET G2 to NEC, via NET G3, within the same tumor.

FAM136A调控胃癌进展的分子机制研究

目的:研究FAM136A(family with sequence similarity 136,member A gene)在胃癌进展中的调控作用。方法:通过生信分析筛选出FAM136A在胃癌中转录水平,通过免疫组织化学染色技术分析FAM136A在胃癌组织中表达特点及临床病理意义,通过侵袭实验(Transwell实验)、细胞活力检测实验(MTT实验)检测FAM136A对胃癌细胞迁移、侵袭、增殖能力的影响。结果:FAM136A在胃癌中转录水平明显高于癌旁组织,FAM136A在胃癌组织中高表达,主要定位于细胞质,病理分期Ⅱ、Ⅲ期、T分期T2~4、N分期1~3期的高表达比例高于病理分期Ⅰ期、T分期T1及N分期0期(P<0.01)。FAM136A增强胃癌细胞迁移、侵袭和增殖能力。FAM136A增强胃癌细胞中上皮间质转化(EMT)和细胞周期相关蛋白的表达。结论:FAM136A可通过调控EMT增强胃癌细胞迁移和侵袭能力。FAM136A可通过调节细胞周期促进胃癌增殖能力。