Evaluation and treatment of malignant ascites secondary to gastric cancer

Malignant ascites affects approximately 10% of patients with gastric cancer(gC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in g C patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points(named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in g C(CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of g C. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for g C patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targetingtherapy. Although each treatment option is valid,further research is imperative to establish the optima choice for each patient.

Pharmacokinetic study of paclitaxel in malignant ascites from advanced gastric cancer patients

AIM： To examine the paclitaxel concentrations in plasma and ascites after its intravenous administration in patients with ascites due to peritonitis carcinomatosa resulting from advanced gastric cancer. METHODS： Two patients with ascites due to peritonitis carcinomatosa resulting from gastric cancer were included in this study. The paclitaxel concentrations in plasma and ascites were investigated for 72 h in case 1 and 168 h in case 2 after intravenous administration. RESULTS： The paclitaxel concentration in plasma peaked immediately after administration, followed by rapid decrease below the threshold value of 0.1 μmol （85 ng/mL） within 24 h. In contrast, the paclitaxel concentration in ascites increased gradually for 24 h after administration to a level consistent with the level found in plasma. After 24 h the level of paclitaxel in ascites and plasma became similar, with the optimal level being maintained up to 72 h following administration. CONCLUSION： The concentration of paclitaxel in ascites is maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration. Paclitaxel is a promising drug for the treatment of malignant ascites of gastric cancer.

Influence of Aidi injection combined with paclitaxel and platinum drugs on malignant molecule expression in malignant ascites of patients with advanced gastric cancer

Objective: To explore the influence of Aidi injection combined with paclitaxel and platinum drugs on malignant molecule expression in malignant ascites of patients with advanced gastric cancer. Methods: A total of 80 patients with advanced gastric cancer complicated by malignant ascites who were treated in the hospital between January 2015 and December 2016 were divided into control group and observation group by random number table, each with 40 cases. Control group were treated with paclitaxel and platinum drugs, and observation group were treated with Aidi injection combined with paclitaxel and platinum drugs. The differences in the malignant molecule expression in malignant ascites were compared between the two groups of patients before and after treatment. Results: Before treatment, the proliferation, invasion and autophagy gene expression in malignant ascites were not statistically different between the two groups of patients. 1 week after treatment, EZH2, I2PP2A, Gal-1, HPA-1, MTA1, TROP2, BNIP3 and LC3 mRNA expression in malignant ascites of both groups of patients were lower than those before treatment while PTPN13, TRIM28, SOX7, Syndecan-1 and Beclin1 mRNA expression were higher than those before treatment, and EZH2, I2PP2A, Gal-1, HPA-1, MTA1, TROP2, BNIP3 and LC3 mRNA expression in malignant ascites of observation group were lower than those of control group while PTPN13, TRIM28, SOX7, Syndecan-1 and Beclin1 mRNA expression were higher than those of control group. Conclusion: Aidi injection combined with paclitaxel and platinum drugs can effectively inhibit the gastric cancer cell proliferation and invasion, and regulate cell autophagy activity in the malignant ascites of patients with advanced gastric cancer.

Influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites

Objective: To explore the influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites. Methods: A total of 80 patients with ovarian cancer complicated by ascites who were treated in this hospital between March 2015 and January 2017 were retrospectively analyzed and divided into the control group (n=43) and the study group (n=37). Control group received intraperitoneal perfusion chemotherapy and study group underwent intraperitoneal perfusion chemotherapy combined with deep hyperthermia. The differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were compared between the two groups before and after treatment. Results: Before treatment, the differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were not statistically significant between the two groups. After treatment, proliferation gene TCEAL7 mRNA expression in ascites of study group was higher than that of control group whereas Clusterin, HOTAIR, ROCK and TNFAIP8 mRNA expression were lower than those of control group;invasion gene DUSP10 mRNA expression in ascites was higher than that of control group whereas MTA1, Nek2, Stathmin and IFITM1 mRNA expression were lower than those of control group;autophagy genes LC3-Ⅱ, Beclin1 and PTEN mRNA expression in ascites were higher than those of control group. Conclusion:Intraperitoneal perfusion chemotherapy combined with deep hyperthermia can effectively balance the expression of proliferation, invasion and autophagy genes in ascites, and ultimately reduce the malignancy of the tumor in patients with ovarian cancer complicated by ascites.

Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.

Expression of TRAP1 in gastric cancer tissue and its correlation with malignant biology

Objective:To study the expression of tumor necrosis factor receptor-associated protein 1(TRAP1)in gastric cancer tissue and its correlation with malignant biology.Methods:Gastric cancer tissue and adjacent normal tissue were collected,and mRNA content and protein content of TRAP1 were detected;gastric cancer cell lines SGC7901,BGC823,AGS and MGC803 were cultured,and mRNA contents and protein contents of TRAP1,CyclinB1,CyclinD1,CyclinE,MMP-2 and VEGF were detected.Results:mRNA and protein expression levels of TRAP1 in gastric cancer tissue were significantly higher than those in adjacent normal tissue,and mRNA and protein expression levels of TRAP1 in gastric cancer tissue with muscularis and serosa infiltration,lymph node metastasis,distant organ metastasis and TNM Ⅲ/Ⅳ stage were significantly higher than those in gastric cancer tissue with mucosa and submucosa infiltration,non-lymph node metastasis,non-distant organ metastasis and TNM Ⅰ/Ⅱ stage.mRNA and protein expression levels of TRAP1,CyclinB1,CyclinD1,CyclinE,MMP-2 and VEGF in MGC803 were the highest,and mRNA and protein expression levels of TRAP1,CyclinB1,CyclinD1,CyclinE,MMP-2 and VEGF in SGC7901 were the lowest.mRNA and protein expression levels of TRAP1 in gastric cancer cell lines were positively correlated with mRNA and protein expression of CyclinB1,CyclinD1.CyclinE,MMP-2 and VEGF.Conclusions:The expression of TRAP1 significantly increases in gastric cancer tissue;TRAP1 may regulate the malignant biology of cells by increasing the expression of CyclinB1,CyclinD1,CyclinE,MMP-2 and VEGF,thereby resulting in the occurrence and development of gastric cancer.

Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer

AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.

Apatinib,S-1 Combined with Paclitaxel Perfusion in the Treatment of Malignant Seroperitoneum of Gastric Cancer

Objective:To analyze the effect of apatinib,S-1 combined with paclitaxel perfusion on malignant seroperitoneum of gastric cancer.Methods:From December 2019 to May 2020,172 patients with gastric cancer treated in our hospital were randomly divided into two groups:observation group and control group,86 cases each.The control group adopted the method of S-1 combined with paclitaxel perfusion therapy in the treatment of malignant seroperitoneum of gastric cancer.The observation group was given oral apatinib on the basis of S-1 combined with paclitaxel perfusion therapy,and the dosage was 500 mg/d.Results:The total effective treatment in the control group was 43.02%,while the total effective rate in the observation group was 69.77%;the drug resistance of the two groups of patients increased and the adverse reactions were low.Conclusion:Apatinib and S-1 combined with paclitaxel perfusion therapy can effectively improve the treatment effect,stabilize the patient's condition,increase the patient's drug resistance to adverse reactions,and have a good prognosis.

In-vitro proliferation assay with recycled ascitic cancer cells in malignant pleural mesothelioma: A case report

BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM-CART).The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)to investigate anticancer drug susceptibility.CASE SUMMARY A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites;more than 4000 mL of ascitic fluid was removed,filtered,and concentrated using KM-CART,and the cell-free ascitic fluid was reinfused into the patient to improve quality of life.Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine.Treatment with gemcitabine maintained stable disease for 4 mo.CONCLUSION The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.

Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery

BACKGROUND Chylous ascites(CA) presents a challenge as a relatively common postoperative complication in gastric cancer(GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a lowfat diet. Drainage tube(DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.AIM To propose novel conservative treatment strategies for CA following GC surgery.METHODS The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.RESULTS 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association(R~2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost(postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001;total hospitalization: 33.2 d vs 24.7 d, P < 0.01;antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01;hospitalization cost: ￥9.2 × 104vs ￥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal.Furthermore, DT removal times were shorter in seven patients who underwent DT clamping(clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047;clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.CONCLUSION Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.

mir-3168 targeted inhibition of TP53 promotes malignant transformation and cisplatin resistance of AGS and AGS/DDP gastric cancer cells

Objective:To investigate the effect of mir-3168 on the malignant transformation and cisplatin resistance of AGS and AGS/DDP gastric cancer cells,and to verify its target gene.Methods:The expression of mir-3168 in AGS and AGS/DDP gastric cancer cells was detected by qPCR,and mir-3168 mimic,inhibitor and negative control were synthesized.They were transfected into AGS and AGS/DDP gastric cancer cells,respectively.The expression of mir-3168 and TP53 mRNA was detected by qPCR.Cell viability was detected by CCK8 under gradient cisplatin treatment and non treatment,apoptosis was detected by flow cytometry,cell invasion was detected by Transwell,and TP53 protein expression was detected by western blot,The database predicted the binding sites of mir-3168 and TP53.According to the binding sites,the double luciferase experiment was used to verify the binding of mir-3168 and TP53.Results:Compared with cisplatin sensitive gastric cancer cell AGS,mir-3168 was significantly overexpressed in cisplatin resistant gastric cancer cell AGS/DDP;mir-3168 mimic promotes cisplatin resistance,proliferation and invasion of AGS and AGS/DDP gastric cancer cells,and inhibits apoptosis of AGS and AGS/DDP gastric cancer cells;mir-3168 inhibitor inhibits cisplatin resistance,proliferation and invasion of AGS and AGS/DDP gastric cancer cells,and promotes apoptosis of AGS and AGS/DDP gastric cancer cells;mir-3168 mimic inhibits the expression of TP53 mRNA and protein,and mir-3168 inhibitor promotes the expression of TP53 mRNA and protein;Targetscan database predicted that there was a binding point between mir-3168 and TP53,and the double luciferase experiment suggested that mir-3168 was bound to TP53 through the predicted binding site.Conclusion:mir-3168 may promote the malignant transformation of AGS and AGS/DDP gastric cancer cells and cisplatin resistance by targeting TP53.

Correlation of serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content with malignant proliferation of cancer cells in patients with gastric cancer

Objective: To investigate the correlation of serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content with malignant proliferation of cancer cells in patients with gastric cancer. Methods:Superficial gastritis group (n=247), gastric ulcer group (n=159) and gastric cancer group (n=97) who were pathologically diagnosed by gastroscopy in Chongqing wanzhou district people's hospital of 5 between August 2016 and August 2017 were selected, and the differences in serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content as well as proliferation and apoptosis gene expression in lesion tissue were compared among the three groups. Pearson test was used to evaluate the correlation of pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content with malignant proliferation activity of cancer cells in patients with gastric cancer. Results: Serum pepsinogenⅠ/Ⅱ ratio and gastrin-17 content in gastric cancer group were lower than those in gastric ulcer group and superficial gastritis group. Proliferation genes EIF5A2, MACF1 and PIK3CD mRNA expression levels in gastric cancer group were higher than those in gastric ulcer group and superficial gastritis group whereas SIRT1 mRNA expression level was lower than that in gastric ulcer group and superficial gastritis group;apoptosis gene Livin mRNA expression level was higher than that in gastric ulcer group and superficial gastritis group whereas Bad and Noxa mRNA expression levels were lower than those in gastric ulcer group and superficial gastritis group;serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content in gastric cancer group were negatively correlated with EIF5A2, MACF1, PIK3CD and Livin mRNA expression levels, and positively correlated with SIRT1, Bad and Noxa mRNA expression levels. Conclusion: The serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17 content abnormally reduce in patients with gastric cancer, and the specific levels are directly correlated with gastric cancer cell proliferation and apoptosis activity.

Aberrant gene methylation in the peritoneal fluid is a risk factor predicting peritoneal recurrence in gastric cancer

AIM:To investigate whether gene methylation in the peritoneal fluid (PF) predicts peritoneal recurrence in gastric cancer patients.METHODS: The gene methylation of CHFR (checkpoint with forkhead and ring finger domains), p16, RUNX3 (runt-related transcription factor 3), E-cadherin, hMLH1 (mutL homolog 1), ABCG2 (ATP-binding cassette, sub-family G, member 2) and BNIP3 (BCL2/adenovirus E1B 19 kDa interacting protein 3) were analyzed in 80 specimens of PF by quantitative methylation-specific polymerase chain reaction (PCR). Eighty patients were divided into 3 groups; Group A (n=35):the depth of cancer invasion was less than the muscularis propria; Group B (n=31): the depth of cancer invasion was beyond the muscularis propria. Both group A and B were diagnosed as no cancer cells in peritoneal cytology and histology; Group C (n=14): disseminated nodule was histologically diagnosed or cancer cells were cytologically defi ned in the peritoneal cavity.RESULTS: The positive rates of methylation in CHFR, E-cadherin and BNIP3 were significantly different among the 3 groups and increased in order of group A, B and C (0%,0% and 21% in CHFR, P<0.05; 20%, 45% and 50% in E-cadherin, P<0.05;26%,35% and 71% in BNIP3, P<0.05). In addition, the multigene methylation rate among CHFR, E-cadherin and BNIP3 was correlated with group A, B and C (9%,19% and 57%, P<0.001). Moreover, the prognosis was analyzed in group B, excluding 3 patients who underwent a non-curative resection. Two of the 5 patients with multigene methylation showed peritoneal recurrence after surgery, while those without or with a single gene methylation did not experience recurrence (P<0.05).CONCLUSION: This study suggested that gene methylation in the PF could detect occult neoplastic cells in the peritoneum and might be a risk factor for peritoneal metastasis.

Dermatosis as the initial presentation of gastric cancer: two cases

Paraneoplastic dermatoses are known to be certain dermatosis related with tumor. The common paraneoplastic dermatoses are acanthosis nigricans, acquired ichthyosis, dermatomyositis, erythroderma, and so on. Here we report two cases of paraneoplastic dermatoses associated with gastric cancer. One case was a 57-year-old man with dermatomyositis and proved to be associated with gastric cancer through stomachoscopy. The other was a 66-year-old man with erythroderma and proved to be associated with gastric cancer through stomachoscopy. Both cases were treated with radical total gastrectomy with lymphadenectomy（D2） and esophagojejunostomy of Roux-en-Y. The skin symptom of both cases had improved a lot but still existed after operation. Paraneoplastic dermatoses can be seen as the early manifestation of visceral carcinomas. As a result, gastric cancers should be excluded in the patients with paraneoplastic dermatoses.

Endoscopic resection for early gastric cancer:Towards a global understanding

Gastric cancer is widespread globally,and disease diagnosis is accompanied by high mortality and morbidity rates.However,prognoses and survivability have improved following implementation of surveillance and screening programs,which have led to earlier diagnoses.Indeed,early diagnosis itself supports increased surgical curability,which is the main treatment goal and guides therapeutic choice.The most recent Japanese guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer consider the degree of endoscopic curability in relation to the characteristics of the gastric lesions.In clinical practice,the management approach for both prevention and treatment should be similar to that of colon lesions;however,unlike the established practices for colorectal cancer,the diagnostic and therapeutic pathways are not shared nor widespread for gastric cancer.Ultimately,this negatively impacts the opportunity to perform an endoscopic resection with curative intent.

Lung cancer screening: Should we be excluding people with previous malignancy?

The National Lung Screening Trial(NLST) was a large,randomized, controlled study showing a 20% reduction of lung cancer mortality and 7% reduction of all cause mortality using annual low dose computed tomography(LDCT) in a high risk population. NLST excluded people with a previous history of cancer treatment within the past 5 years and all people with a history lung cancer. The aim of this work is to review how lung cancer screening trials addressed the confounding effect of previous malignancy. We also review the subsequent recommendations by the United States Preventative Task Force Services, multiple professional societies and the Center for Medicaid and Medicare Services which defer either to NLST criteria or, clinician judgment or refrain from asserting any recommendation on the topic, respectively. Implications of lung cancer screening in the setting of previous malignancies, specifically lung, head and neck, esophageal, gastric, breast, colorectal cancer and lymphoma are also discussed. With lung cancer screening, an antecedent malignancy introduces the possibility of discovering metastasis as well as lung cancer. In some circumstances diagnosis and treatment of oligometastatic disease may confer a survival benefit. The survival benefit of treating either lung cancer or oligometastatic disease as result of lung cancer screening has yet to be determined. Further studies are needed to determine the role of lung cancer screening in the setting of previous malignancy.

FANCA D1359Y mutation in a patient with gastric polyposis and cancer susceptibility: A case report and review of literature

Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia(FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers in a sporadic manner. Aberrations in the FA pathway were reported in all molecular subtypes of gastric cancer. We studied a patient with synchronous gastric cancer from gastric polyposis by conducting a 13-year long-term follow up. Via pathway-driven massive parallel genomic sequencing, a germline mutation at FANCA D1359Y was identified. We identified several recurrent mutations in DNA methylation(TET1, V873I), the β-catenin pathway(CTNNB1, S45F) and RHO signaling pathway(PLEKHG5, R203C) by comparing the genetic events between benign and malignant gastric polyps. Furthermore, we revealed gastric polyposis susceptible genes and genetic events promoting malignant transformation using pathway-driven targeted gene sequencing.

Case of pseudo-Meigs' syndrome caused by gastric cancer-related metastatic ovarian tumor with prolonged survival

A 48-year-old woman presented with bilateral enlarged ovaries, ascites, bilateral pleural effusion, and advanced gastric cancer. Pleural fluid cytology did not reveal malignant cells. Oophorectomy, performed as a palliative procedure, was followed by rapid resolution of the pleural effusion and ascites. The patient was diagnosed with pseudo-Meigs&rsquo; syndrome, and underwent chemotherapy followed by partial gastrectomy. At the last follow-up, 84 mo following oophorectomy, she was alive, and free of disease recurrence, despite not receiving any further treatment. Pseudo-Meigs&rsquo; syndrome should be considered in patients with bilateral ovarian tumors, ascites and pleural effusion, and treatment such as oophorectomy may result in symptomatic improvement and better prognosis in similar patients.

Malignant ascites with omental metastasis: a rare event in prostate cancer

Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and skull.However,prostate cancer metastasis to the omentum with malignant ascites is extremely uncommon.In this study,we report such a case,which also highlights a repeatedly negative ascetic fluid cytology even with multiple omental metastatic nodules.The purpose of this case report is to provide awareness to physicians for this rare occurrence.

E2F transcription factors and digestive system malignancies: How much do we know?

E2F family of transcription factors regulates various cellular functions related to cell cycle and apoptosis. Its individual members have traditionally been classified into activators and repressors, based on in vitro studies. However their contribution in human cancer is more complicated and difficult to predict. We review current knowledge on the expression of E2Fs in digestive system malignancies and its clinical implications for patient prognosis and treatment. E2F1, the most extensively studied member and the only one with prognostic value, exhibits a tumor-suppressing activity in esophageal, gastric and colorectal adenocarcinoma, and in hepatocellular carcinoma (HCC), whereas in pancreatic ductal adenocarcinoma and esophageal squamous cell carcinoma may function as a tumorpromoter. In the latter malignancies, E2F1 immunohistochemical expression has been correlated with higher tumor grade and worse patient survival, whereas in esophageal, gastric and colorectal adenocarcinomas is a marker of increased patient survival. E2F2 has only been studied in colorectal cancer, where its role is not considered significant. E2F4's role in colorectal, gastric and hepatic carcinogenesis is tumor-promoting. E2F8 is strongly upregulated in human HCC, thus possibly contributing to hepatocarcinogenesis. Adenoviral transfer of E2F as gene therapy to sensitize pancreatic cancer cells for chemotherapeutic agents has been used in experimental studies. Other therapeutic strategies are yet to be developed, but it appears that targeted approaches using E2F-agonists or antagonists should take into account the tissue-dependent function of each E2F member. Further understanding of E2Fs' contribution in cellular functions in vivo would help clarify their role in carcinogenesis.