This study compared the dynamic plasma ghrelin levels of patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer and who had a relatively long postoperative follow-up periods. We selected 23 subjects : 9 patients who underwent DG and 14 patients who underwent TG. The plasma ghrelin and insulin levels of these subjects were compared with those of nine healthy volunteers. The fasting plasma levels of ghrelin (pg/ml) were 837.6 ± 222.1 in patients after DG, 492.2 ± 96.7 in patients after TG, and 923.1 ± 249.2 in healthy volunteers. In both the DG and TG subjects, there was no correlation between the fasting plasma ghrelin levels and duration of postoperative follow-up. The ghrelin level after TG was significantly lower than that after DG or that of healthy volunteers (P < 0.01), although there was no significant difference between the DG subjects and healthy volunteers. The post-prandial plasma ghrelin levels in the DG patients, TG patients, and healthy volunteers were 697.6 ± 105.8, 507.6 ± 105.8, and 747.4 ± 232.3, respectively. In the DG subjects and healthy volunteers, the plasma ghrelin levels decreased significantly after meals (P < 0.05), while in the TG subjects, there was no significant decrease in plasma ghrelin level after meals. These results suggest that TG patients lose their diurnal functional rhythm for ghrelin, which is independent of insulin level. The regulatory function of ghrelin is lost after TG for gastric cancer, which may result in loss of appetite, reduced food intake, and the promotion of weight loss at long-term postoperative follow-up.

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The tumor suppressor gene maspin serves to inhibit cancer infiltration/metastasis, and maspin's involvement in apoptosis-inducing action has been noted. In the current research, we studied the relationship between maspin expression and apoptosis using clinical specimens of stomach and colon cancer. Subjects were 39 cases of stomach cancer (20 cases of early cancer, 19 cases of advanced cancer) and 36 cases of colon cancer (16 cases of early cancer, 20 cases of advanced cancer) in which the cancer was surgically resected. We performed immunohistochemical staining of maspin and ss-DNA for apoptotic cell extraction. Based on the degree of maspin expression, we classified subjects into a high expression and low expression group, calculated the number of ss-DNA-positive cells for both, and compared the proportion of these cells. In early stomach cancer, the proportion of ss-DNA-positive cells was significantly higher in the group with high maspin expression (high expression group vs. low expression group 0.014 vs. 0.005; P = 0.022) . In advanced cancer, a significant difference was not found (0.013 vs. 0.005: P = 0.09) . However, the proportion of such cells with advanced stomach cancer tended to be high in high expression groups. With colon cancer, the proportion of ss-DNA-positive cells with both early and advanced cancer was significantly higher in the group with high maspin expression (early cancer 0.009 vs. 0.002, P = 0.021; advanced cancer 0.012 vs. 0.003, P = 0.006) . Results suggested that the expression of maspin in both stomach and colon cancer may induce apoptosis regardless of the extent of the tumor. Future study of molecular therapies targeting maspin is anticipated for cancer that is difficult to cure surgically.

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Many reports have shown that human papillomavirus (HPV) plays an important role in the carcinogenesis of cervical adenocarcinoma. In the present study, 106 cases of uterine cervical adenocarcinoma, comprising 95 cases of adenocarcinoma and 11 cases of adenosquamous carcinoma, were examined for HPV-DNA using in situ hybridization (ISH) . Using ISH, we were able to show the expression of HPV-DNA on a glass slide. Forty-eight of 106 cases (45.3%) of adenocarcinoma and adenosquamous carcinoma were positive for high-risk HPV-DNA according to ISH. Of 79 cases of invasive adenocarcinoma, 35 (44.3%) were positive for high-risk HPV-DNA, compared with eight of 16 cases (50%) of adenocarcinoma in situ. In the underlying non-neoplastic epithelium, positive foci were found in the squamous epithelium of 11 of 64 cases (17.2%), but no glandular or columnar epithelium was positive for HPV. HPV infection seems to play a role in the induction rather than the progression of cervical adenocarcinoma. High-risk HPV infection in the underlying squamous epithelium may be related to the carcinogenesis of adenocarcinoma, but there was no relationship found with the underlying glandular and columnar epithelium.

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A 64-year-old woman complained of vomiting and back pain after eating. A space-occupying lesion (SOL) was discovered. Advanced hepatocellular carcinoma (HCC) was suspected because of liver cirrhosis (LC) and elevated serum concentrations of HCC-related tumor markers. The patient underwent follow-up care because diagnosis of the SOL as a neoplastic lesion could not be confirmed. Interestingly, 5 months after discharge, the hepatic SOL had disappeared completely. We concluded that ascending cholangitis caused spontaneous portal vein thrombosis, leading to the hepatic nodule. When a liver SOL complicated by cholangitis is detected in an LC patient, the possibility of a neoplastic lesion must be ruled out. Elevated serum levels of tumor markers and the presence of a hepatic nodule in an LC patient are not always sufficient for a diagnosis of HCC.

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A 67-year-old woman was admitted to our hospital with severe abdominal pain. Emergency laparotomy was performed, and intestinal perforation was diagnosed. Wide resection of the distal ileum and cecum with ileostomy was performed. Resected specimens revealed three small perforated ulcers and two pedunculated tumors in the small intestine. The ulcers and tumors were diagnosed histopathologically and immunohistochemically as storiform-pleomorphic-type malignant fibrous histiocytoma (MFH) . The patient died 1 month after surgery due to liver and renal failure with aortic occlusion. At the primary site, an encapsulated mass (4.0×1.0×2.0 cm) was situated around the wall of the aorta at autopsy. The grayish white tumor tightly encircled half of the circumference at the level of the celiac axis. It is very unusual for the metastatic foci of MFH to be found before discovery of the primary focus. In addition gastrointestinal (GI) involvement from MFH has rarely been reported. We found 11 cases of metastasis of MFH to the small intestine in the English language literature. Our case is the first reported case of MFH causing perforation of the small intestine.

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