Patients with liver metastases from colorectal cancer (CRLMs) frequently receive chemotherapy prior to liver resection. Histopathological assessment of the resected specimen can evaluate the response ...to chemotherapy. The present study analyzed the association between histopathological changes in the primary site and liver metastases. The present study comprised 45 patients with resectable CRLMs at the Surgical Oncology Department of Gifu University School of Medicine (Gifu, Japan) between January 2006 and August 2015. The study included 24 men and 21 women. The primary colonic tumor was located in the right side in 13 (28.9%) patients and the left side in 32 (71.9%) patients. The present study evaluated patients with metastatic colorectal cancer (31/45) after excluding those in whom histopathological heterogeneity between the primary and liver metastasis changed to grade 3 after chemotherapy. The group that underwent hepatectomy after chemotherapy (n=25) was compared with the group that underwent hepatectomy alone (n=6). In 16 (53.3%) out of 25 patients, histopathological heterogeneity of the liver metastasis was lost (P=0.04). In conclusion, chemotherapy appeared to change histopathological heterogeneity. The present study suggested that the histopathological change of intratumoral heterogeneity is reflected by the response to chemotherapy. Key words: histopathological, heterogeneity, colorectal cancer, liver, metastasis
A 32-year-old female patient visited a neighborhood hospital complaining of hematemesis at 25 weeks of pregnancy. Careful examination revealed locally advanced gastric cancer with extensive lymph ...node metastasis, and she was referred to our hospital for treatment. Considering the stage of the pregnancy and the effects of chemotherapy on the fetus, delivery after S-1/DTX treatment was planned to provide for maximum fetal development in utero. After two courses, a baby girl weighing 2,374 g was delivered at 35 weeks of pregnancy. CT after 5 chemotherapy courses showed shrinkage of the primary tumor and lymph nodes. Thereafter, at 11 weeks after delivery, total gastrectomy (D2 + No.10) with splenectomy and Roux-en-Y reconstruction was performed. The histopathological diagnosis was ypT3N1M0, and the histological chemotherapy response was grade 2. She was started on postoperative adjuvant chemotherapy. Gastric cancer during pregnancy is extremely rare and is associated with a poor prognosis, and the effects of chemotherapy on the fetus and mother during pregnancy should be carefully considered.We encountered a case in which chemotherapy was safely administered during pregnancy, and we present a report of the case, with a review of the literature.
Development of diabetic ketoacidosis (DKA) caused by fulminant type 1 diabetes (FT1D) during administration of uracil-tegafur (UFT) with leucovorin (LV) as adjuvant chemotherapy is extremely rare. ...Here, we report a case of DKA caused by FT1D during administration of UFT with LV as adjuvant chemotherapy for colon cancer. A woman in her 60s was transferred to the emergency medical center of our hospital with complaints of impaired consciousness and vomiting. She had undergone left hemicolectomy and D3 lymph node dissection for transverse colon cancer 8 months earlier. She was provided UFT with LV as adjuvant chemotherapy. Laboratory analysis revealed hyperglycemia, high anion gap metabolic acidosis and urinary ketones. She was diagnosed with DKA and was started on intravenous infusion of fluid and continuous subcutaneous insulin injections. Following admission, she was examined and diagnosed with FT1D. The present case describes an extremely rare case of DKA caused by FT1D during adjuvant chemotherapy with UFT + LV for colon cancer.
Postoperative chylothorax after esophagectomy is a relatively rare complication, but treatment can sometimes be complicated. We report 3 cases of Lipiodol lymphangiography via inguinal lymph node ...puncture that was effective for chyle leakage occurring after esophagectomy. Case 1: A 67-year-old man with stage IIIA esophageal squamous cell carcinoma underwent radical esophagectomy by video-assisted thoracic surgery (VATS) following neoadjuvant chemotherapy (NAC). After enteral feeding, right pleural effusion drainage increased sharply and changed to white color that was diagnosed as chylothorax. Conservative treatment was started on postoperative day (POD) 15. On POD 50, intranodal Lipiodol lymphangiography and thoracic duct ligation were performed, resulting in complete improvement by the next day. Case 2: A 69-year-old man with stage IIIC esophageal cancer was treated salvage operation following chemoradiation. Postoperative chylothorax was diagnosed on POD 6. Despite conservative treatment, the pleural fluid volume did not decrease. Intranodal Lipiodol lymphangiography performed on POD 13 showed contrast medium draining from the thoracic duct near the tracheal bifurcation. Thoracotomy for thoracic duct ligation was performed on POD 15. Thereafter, drainage from the thoracic drain decreased significantly, and the right thoracic drain was removed 4 days later. Case 3: A 65-year-old man with Stage IVA hypopharyngeal cancer and Stage IIIA esophageal cancer underwent total pharyngopharyngeal esophagectomy by VATS following NAC. Postoperative chylothorax was diagnosed on POD 7. Despite conservative treatment, the pleural fluid volume did not decrease. Intranodal Lipiodol lymphangiography performed on POD 19 completely visualized the thoracic duct and showed no outflow of contrast from the main thoracic duct into the mediastinum. Pleural fluid decreased remarkably after lymphangiography. Intranodal Lipiodol lymphangiography for postoperative chylothorax accurately visualizes flow within the thoracic duct and clearly depicts its positional relationship with other organs. Besides lymphangiography is not only helps to determine the site of chyle leakage but can also be effective for curing chylothorax by less invasive and safer method.
Our patient, a 70-year-old man, received colonoscopy as part of his employer-provided physical examination. The examiner discovered a 15×8 mm 0-IIc type tumor on the ascending colon, opposite to the ...ileocecal valve. Examination of the tumor by colonoscopy in our hospital showed VI and VN pit patterns in the depressed area and ultrasonic endoscope showed disruption of the quaternary layer. A CT-scan revealed swelling of the No. 202 lymph node suggesting lymph node metastasis. We performed a laparoscopic ileocecal resection with D3 lymph-node adenectomy. The pathological examination results showed the resected specimen had extensive lymphatic vessel involvement in the subserosa close to the cut end of the oral side. We removed an additional portion of the ileum around the cut end. We did not find any malignant cells in the specimen. Although 0-IIc type tumors are small, they are frequently associated with de novo carcinogenesis as they tend to invade the vascular channel. We thought that this tumor was likely to invade the lymph channel because the CT-scan suggested lymph node metastases. We hope to show through this report that a relatively more aggressive resection of the jejunum is advisable for cases such as this one.
Prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) indicate nutritional status and host immunity. We used immunohistochemistry and apparent diffusion coefficient (ADC) values ...calculated using diffusion-weighted imaging (DWI) to investigate relationships of these factors with pathological and radiological characteristics in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT).
We evaluated expression levels of VEGFA, CD8, CD33, and ADC values in tumors pre/post nCRT; and analyzed the relationships between those factors and PNI, NLR in 32 patients.
Pretreatment PNI negatively correlated with change in tumor stromal CD8
T cells and positively correlated with ADC values. Pretreatment NLR and PNI change correlated with recurrence-free survival (RFS).
Patients with higher pretreatment PNI had greater changes in ADC values and stromal CD8
T-cell counts, and those with greater PNI reduction from nCRT had a worse prognosis. Proper nutritional management during nCRT benefits patients and may lead to better prognosis in rectal cancer.
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