We investigated the prognostic significance of intraoperative lavage cytology in 276 patients with gastric carcinoma. Lavage cytology was positive in 18.1% of all patients. The degree of serosal invasion and the area of serosal invasion were closely related to the frequency of positive cytology. Poorly differentiated carcinoma was associated with a significantly higher incidence of positive cytology than well differentiated carcinoma. The 5-year survival rate was 65.9% in patients with negative cytology and 5.7% in patients with positive cytology, indicating a very poor prognosis for those with positive cytology. Multivariate analysis revealed that lavage cytology, serosal invasion, and lymph node metastasis were the most important prognostic factors for gastric carcinoma. In conclusion, the results of peritoneal lavage cytology might contribute to determining the need for postoperative adjuvant therapy.
A case of gastric cancer with breast metastasis is presented. The patient was a 57-year-old woman admitted for the treatment of severe emaciation. Evaluation on admission revealed a mass in the epigastrium and a red swollen left breast with multiple enlarged axillary and supraclavicular lymph nodes. An upper gastrointestinal series and endoscopy showed Borrmann type 4 gastric cancer. Biopsy specimens obtained at endoscopy and from the breast revealed signet ring cell carcinoma. Since there were multiple tumor emboli in the subcutaneous lymphatics without involvement of the mammary ducts, the breast lesion was diagnosed as metastatic gastric cancer. Changes in lymphatic flow and retrograde shedding of tumor cells seemed to be the cause of this lesion.
Between January 1978 and March 1995, 37 patients with noninvasive breast carcinoma (excluding Paget's disease) were treated at our department. Out of the 37 patients, 20 were treated with nipple-preserving total glandectomy. Eighteen had noninvasive ductal carcinoma and two had lobular carcinoma in situ. All eighteen noninvasive ductal carcinomas were of the non-comedo type. Nineteen patients received nipple-preserving total glandectomy and axillary dissection. One patient was initially treated with microdochectomy, and then additional nipple-preserving total glandectomy and axillary dissection were done to remove positive margins. All patients received tamoxifen as adjuvant therapy, but no adjuvant radiotherapy was given. These 20 patients had no cancer infiltration of the nipple base and all remain alive without disease after 63 months on the average. In conclusion, breast surgeons should always take nipple-preserving total glandectomy into consideration for patients with noninvasive breast cancer.
Cancer cells must express intercellular adhesion molecule-1 (ICAM-1) to be recognized and killed by lymphocytes. The expression of ICAM-1 by tumor cells was studied in 89 patients with colorectal cancer and the soluble form of this molecule was measured in the systemic and local circulation. No ICAM-1 expression was observed in normal colonic mucosa and the percentage of tumor specimens positive for ICAM-1 decreased as the disease advanced (Dukes' classification, P<0.01). The percentage of positive tumor specimens was lower among patients with nodal involvement (P<0.05) or lymphatic invasion (P<0.01). The soluble ICAM-1 concentration in the tumor draining vein tended to be higher in patients with a greater number of tumor-infiltrating lymphocytes (P<0.01) and in patients with cancer cells expressing ICAM-1 (P<0.01).
Histopathological evaluation of esophageal carcinoma after preoperative irradiation, using the degree of degeneration or the proportion of viable cells to assess the histologic response, has major disadvantages because the viability of cancer cells cannot be predicted accurately. To examine whether tumor proliferative and apoptotic activity could be used as prognostic indicators, we determined the Ki-67 labeling index (LI) and the apoptotic LI in 63 patients with esophageal carcinoma who received preoperative irradiation. While quantitative and qualitative histopathological assessment showed no relationship to survival, the patients with a low Ki-67 LI (<10%) had a better prognosis than those with a high Ki-67 LI (_??_10%) (P<0.05). The Ki-67 LI was not related to histopathological variables, but increased significantly in the patients with a waiting period (the time between completion of irradiation and surgery) longer than 14 days (P<0.01). Among histologic variables, postoperative depth was the only one related to survival, with a better prognosis in patients undergoing complete resection (P<0.01). The apoptotic LI was correlated with tumor differentiation and showed a tendency to be related to tumor deaeneration. but had no relationship with survival. These findings suggested that the Ki-67 LI might be a useful prognostic indicator in patients with esophageal carcinoma receiving preoperative irradiation.
The aim of this study was to determine whether helical CT provides useful additional information in patients with obstructive colorectal tumors. To visualize lesions in a hollow viscus and their three-dimensional extent, helical CT was performed using air as the contrast medium. In six colorectal cancer patients with bowel stricture or obstruction, helical CT demonstrated the three-dimensional extent of the lesion proximal to the tumor site, which could not have been visualized by ordinary barium enema or colonoscopy. Using air as the contrast medium, helical CT can be effective for detecting co-existing abnormalities of the colon and rectum proximal to the site of stricture or obstruction by a tumor.
A 53-year-old woman with breast carcinoma underwent modified radical mastectomy and intensive adjuvant chemoendocrine therapy (including CAF therapy), but developed bone metastasis. After resection of the metastatic focus and further chemoendocrine therapy, she developed multiple bone metastases and pain in the right upper arm. One course of 5-fluorouracil combined with low-dose cisplatin achieved remarkable pain relief and new calcification of the lytic lesion in the humerus. There were no major side effects of this therapy. Unfortunately, spinal cord injury due to vertebral compression fracture forced us to discontinue treatment, so the duration of partial remission was less than two months. However, the response to this modulation regimen in a patient with very intensive prior therapy is notable.