The prognosis for gastric cancer with liver metastasis continues to be poor. We present our preliminary findings from 4 cases of liver metastasis from gastric adenocarcinomas treated using radiofrequency ablation (RFA). Between 1995 and 2004, the clinical history and course of 4 patients who underwent radiofrequency ablation for liver metastases from gastric cancer were reviewed. Two patients with smaller metachronous metastasis are currently alive without recurrence at 16 and 14 months and the other patients with larger synchronous metastatic lesions died after 4 and 12 months after RFA. Although this study was limited to a few cases and had a short follow-up duration, our findings suggest that RFA may provide an alternative treatment modality for liver metastasis resulting from gastric adenocarcinoma. Additional study is needed with a larger group of patients and longer follow up to evaluate the efficacy of RFA.
Adenocarcinoma/radiography/*secondary/*therapy ; Adult ; Aged ; Catheter Ablation/*methods ; Humans ; Liver Neoplasms/radiography/*secondary/*therapy ; Male ; Middle Aged ; *Stomach Neoplasms ; Tomography, X-Ray Computed

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.
Adenocarcinoma/therapy ; Adenocarcinoma/radiography ; Adenocarcinoma/pathology* ; Adult ; Breast Neoplasms/radiography ; Breast Neoplasms/pathology* ; Carcinoma, Infiltrating Duct/therapy ; Carcinoma, Infiltrating Duct/radiography ; Carcinoma, Infiltrating Duct/pathology* ; Case Report ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Nasopharyngeal Neoplasms/therapy ; Nasopharyngeal Neoplasms/radiography ; Nasopharyngeal Neoplasms/pathology* ; Palatal Neoplasms/therapy ; Palatal Neoplasms/radiography ; Palatal Neoplasms/pathology* ; Sella Turcica* ; Skull Neoplasms/therapy ; Skull Neoplasms/secondary* ; Skull Neoplasms/physiopathology

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Female ; Humans ; Male ; Mesenteric Veins/radiography ; Pancreas/abnormalities ; Pancreatic Diseases/*diagnosis/therapy ; Pancreatic Fistula/etiology ; Pancreatic Neoplasms/diagnosis/surgery ; Pancreaticoduodenectomy/adverse effects ; Portal Vein/radiography ; Splenic Vein/radiography ; Tomography, X-Ray Computed

The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.
Acute Disease ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/pathology ; Adenocarcinoma/drug therapy ; Adenocarcinoma/complications* ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/complications* ; Journal Article ; Human ; Lung/radiation effects* ; Lung/pathology ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/pathology ; Lung Neoplasms/drug therapy ; Lung Neoplasms/complications* ; Male ; Middle Age ; Radiation Injuries/radiography ; Radiation Injuries/pathology ; Radiation Injuries/etiology* ; Thorax/radiation effects

The role of neoadjuvant chemoradiation therapy in locally advanced pancreatic cancer (LAPC) is still controversial. The aim of this study was to evaluate surgical downstaging after concurrent chemoradiation therapy (CCRT) for LAPC by measuring the objective changes after treatment. From January 2003 through July 2011, 54 patients with LAPC underwent neoadjuvant CCRT. Computed tomography findings of the tumor size, including major vessel invasion, were analyzed before and after CCRT. Among the total recruited patients, 14 had borderline resectable malignancy and another 40 were unresectable before CCRT. After CCRT, a partial response was achieved in four patients. Stable disease and further disease progression were achieved in 36 and 14 patients, respectively. Tumor size showed no significant difference before and after CCRT (3.6 +/- 1.1 vs. 3.6 +/- 1.0 cm, P = 0.61). Vessel invasion showed improvement in two patients, while 13 other patients showed further tumor progression. Thirty-nine patients with unresectable malignancy and 11 patients with borderline resectable malignancy at time of initial diagnosis remained unchanged after CCRT. Four patients with borderline pancreatic malignancy progressed to an unresectable stage, whereas one unresectable pancreatic malignancy improved to a borderline resectable stage. Only one patient with borderline resectable disease underwent operation after CCRT; however, curative resection failed due to celiac artery invasion and peritoneal seeding. The adverse events associated with CCRT were tolerable. In conclusion, preoperative CCRT in LAPC rarely leads to surgical downstaging, and it could lower resectability rates.
Adenocarcinoma/radiography/therapy ; Adult ; Aged ; Aged, 80 and over ; Antimetabolites, Antineoplastic/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capecitabine/therapeutic use ; Carcinoma, Pancreatic Ductal/*radiography/*therapy ; Chemoradiotherapy/adverse effects/*methods ; Combined Modality Therapy ; Deoxycytidine/analogs & derivatives/therapeutic use ; Disease Progression ; Female ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Pancreas/blood supply/pathology ; Pancreatic Neoplasms/*radiography/*therapy ; Retrospective Studies ; Treatment Outcome

Trousseau's syndrome comsists of migratory thrombophlebitis and thromboembolic disorders of the venous and arterial systems in a malignancy or occult cancer. The overall incidence has been reported to vary from 1 to 11%. Pancreatic, lung, prostate, and stomach cancer is associated with the greatest risk of thromboembolic events. We encountered a 49-year-old man who presented with painful swelling of his lower legs. The chest radiograph showed increased opacity of the Left middle lung fields and Doppler sonography showed a thrombus in the left superficial femoral vein. Chest Computed Tomography showed a 5cm sized left hilar mass invading the pericardium with lymphadenopathy. The bronchoscope biopsy demonstrated an adenocarcinoma of the lung. Platinum based chemotherapy and anticoagulant therapy with warfarin was carried out. The patient was later discharged with an improvement in the painful swelling of his lower legs.
Adenocarcinoma ; Biopsy ; Bronchoscopes ; Drug Therapy ; Femoral Vein ; Humans ; Incidence ; Leg* ; Lung Neoplasms* ; Lung* ; Lymphatic Diseases ; Middle Aged ; Pericardium ; Platinum ; Prostate ; Radiography, Thoracic ; Stomach Neoplasms ; Thorax ; Thrombophlebitis ; Thrombosis ; Warfarin

Because a cavitary pulmonary metastasis is rare, it may not be readily identified. However, various types of cancers can metastasize to the lung in the form of cavities. We report a case of a multiple cavitary metastases to the lung from a cholangiocarcinoma in a 60-year-old man. He complained of generalized weakness and a poor oral intake for 2 months. The plain chest radiography and the chest computed tomography showed multiple small thick-walled cavities and nodules the both lungs. A bronchoscopic examination revealed a focal irregularly elevated surface of the mucosa at the orifice of the superior segment of the right lower lobe and the biopsy demonstrated an infiltrative metastatic adenocarcinoma. The abdomen-pelvis computed tomography showed an ill-marginated and irregularly low-dense area in the right lobe of the liver and a diffuse dilatation of the peripheral intrahepatic bile ducts. The esophagogastroscopy and colonoscopy showed no abnormal findings. It was concluded that the cholangiocarcinoma of the liver metastasized to the lung in the form of cavities. Thereafter, the patient underwent six cycles of the systemic chemotherapy with gemcitabine and cisplatin, and the follow-up imaging studies showed a partial response.
Adenocarcinoma ; Bile Ducts, Intrahepatic ; Biopsy ; Cholangiocarcinoma* ; Cisplatin ; Colonoscopy ; Dilatation ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Lung ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis* ; Radiography ; Thorax

BACKGROUND: The role of second-line chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) is known to be limited. Recently, ZD1839, the small molecule epidermal growth factor receptor-tyrosine kinase inhibitor, has been developed and has shown anti-tumor activity in patients with solid malignant tumors including lung cancer. We evaluated the response rate and toxicities of ZD1839 in patients with advanced NSCLC which has progressed after previous chemotherapy. PATIENTS AND METHODS: We examined 83 patients with advanced NSCLC treated with ZD1839 for more than 1 month in Korea Cancer Center Hospital during the period from January 2002 to September 2003. All the patients were enrolled in the international expanded access program (EAP) with ZD1839 by AstraZeneca. The administered dose of ZD1839 was 250 mg once daily. Chest radiography and laboratory tests were followed-up. We evaluated the response rate, median survival, and toxicity after treatment. RESULTS: Median age of the patients was 59 years (range 33-76). The most predominant cell type was adenocarcinoma and the most stage of the patients was IV. ECOG performance status was as follows; grade 0-1 in 10, grade 2 in 42, and grade 3 in 31 patients. Partial response was achieved in 12 patients (14.5%). Median overall survival was 9.2 (range 1.3-21.6+) months and median time to progression was 3.1 (range 1-21.2+) months. The most common adverse effect of ZD1839 was skin eruption which developed in 25 patients (25.8%). Significantly higher response rate and survival was found in patients with adenocarcinoma or good performance status. CONCLUSION: ZD1839 showed modest activity and tolerable toxicity in the treatment for patients with NSCLC which has progressed after previous chemotherapy.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Drug Therapy* ; Epidermal Growth Factor ; Humans ; Korea ; Lung Neoplasms ; Phosphotransferases ; Radiography ; Skin ; Small Cell Lung Carcinoma* ; Thorax

The prognosis of unresectable advanced gastric cancer is extremely poor. We tried a neoadjuvant chemotherapy in locally advanced unresectable stomach cancer diagnosed by initial explo-laparotomy. After chemotherapy with the FADE regimen (5-fluorouracil + adriamycin + cisplatin + etoposide), the patient was diagnosed clinically as a complete response state on re-staging with radiological gastrointestinal study, fiber-gastroscopy and computerized tomography. During the second-look operation, the advanced cancer was completely resected and the pathological diagnosis was early gastric cancer (EGC) type IIc, stage II (T1N2Mo).
Adenocarcinoma/*drug therapy/radiography ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Case Report ; Cisplatin/*administration & dosage ; Combined Modality Therapy ; Doxorubicin/*administration & dosage ; Etoposide/*administration & dosage ; Fluorouracil/*administration & dosage ; Human ; Male ; Middle Age ; Stomach/pathology/radiography ; Stomach Neoplasms/drug therapy/radiography/*surgery ; Tomography, X-Ray Computed

OBJECTIVEto investigate the pathologic basis of the difference between clinical response and pathologic response of breast carcinoma after neoadjuvant chemotherapy.

METHODStwo hundred and nine cases of breast cancer with neoadjuvant therapy were analyzed and clinical data were collected from June, 2005 to December, 2007. All patients had core needle biopsy taken before neoadjuvant chemotherapy and were operated within 4 weeks after neoadjuvant chemotherapy. Clinical examination, X-ray of breast and/or B ultrasonography of primary breast focus were taken before and after neoadjuvant chemotherapy. Clinical responses of breast primary focus were evaluated according to RECIST (response evaluation criteria in solid tumors) version 1.1.Pathologic responses of breast primary focus were evaluated according to Miller and Payne (MP) grading system. SPSS 15.0 software was used to statistical analysis.

RESULTS(1) Clinical responses basing on clinical examination showed complete response, partial response, stable disease and progressive response, in 33, 124, 41 and 11 cases respectively. (2) Eighty-seven cases had X-ray of breast taken before and after neoadjuvant chemotherapy. Clinical response basing on X-ray, showed complete response, partial response and stable disease in 8, 42 and 37 cases respectively. (3) Pathologic responses of breast primary focus were as MP1 (14 cases), MP2 (35 cases), MP3 (106 cases), MP4 (36 cases) and MP5 (18 cases). (4) The clinical response basing on clinical examination were related to the pathologic response (χ(2) = 33.668, P = 0.001); and the clinical response basing on X-ray of breast were also related to the pathologic response (χ(2) = 22.404, P = 0.004). (5) The pathologic basis of the difference between the pathologic response and the clinical response basing on X-ray of breast were: embolism of carcinoma, mucinous carcinoma, intraductal carcinoma with ossifying-type calcification, nodular fibrosis and others.

CONCLUSIONSthe clinical response may be related to the pathologic response. The difference between the two may be caused by pathologic changes. Some benign and malignant pathologic changes may contribute to the under-estimation of clinical response over pathologic response; whereas embolism of carcinoma may contribute to the over-estimation of clinical response over pathologic response.

Adenocarcinoma, Mucinous ; diagnostic imaging ; drug therapy ; pathology ; Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Lobular ; diagnostic imaging ; drug therapy ; pathology ; Disease Progression ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Radiography ; Remission Induction