Two Korean women (41 and 23-years of age) presented with painful breast enlargement and redness. The involved breast was confirmed as metastatic signet ring cell carcinoma. Although metastatic signet ring cell carcinoma of the breast shows similar clinical symptoms to inflammatory breast cancer, the difference between the two is that this malignancy showed no microcalcifications or mass on radiographic findings (mammograms and US). Therefore, after the confirmation of signet ring cell carcinoma of the breast has been made, metastatic signet ring cell carcinoma should be considered if there are no microcalcifications or masses evident on radiographic findings.
Adult ; Breast Neoplasms/secondary* ; Breast Neoplasms/radiography* ; Breast Neoplasms/pathology ; Carcinoma, Signet Ring Cell/secondary* ; Carcinoma, Signet Ring Cell/radiography* ; Carcinoma, Signet Ring Cell/radiography* ; Case Report ; Female ; Human ; Stomach Neoplasms/pathology* ; Tomography, X-Ray Computed ; Ultrasonography

Various minimally invasive surgical techniques in some cases of early gastric cancer are becoming common practice. However, there are rare cases of advanced cancer with distant metastasis although the invasion of the gastric wall is limited to the mucosa and/or submucosa (defined as early gastric cancer according to UICC-TNM classification). We report two cases of early gastric cancer with distant metastasis (stage IV). Both tumors were defined as early cancer because they were confined to the submucosa. One was a type IIa early cancer, histologically classifiable as a signet ring cell carcinoma (according to the Japanese Classification of Gastric Carcinoma and UICC-TNM classification); the other was a surface spreading type IIb IIc, classifiable as a signet ring cell carcinoma, too. Stage IV factors were ovarian metastasis (Krukenberg tumor) in the former and N3 in the latter case.
Adult ; Carcinoma, Signet Ring Cell/*pathology/secondary ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms/*pathology

OBJECTIVETo summarize the surgical treatment experiece and to investigate the prognosis of the patients with ovarian metastasis from colorectal cancer.

METHODSThe data of 67 patients with synchronous or asynchronous ovarian metastasis from colorectal cancer surgically treated between January 1989 and December 2005 were collected and analyzed retrospectively using Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). Prognostic factors were analyzed using chi2 test. Survival analysis was estimated by the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis was carried out by Cox regression.

RESULTSThe overall 1-, 3- and 5-year survival of these 67 patients was 71.0%, 18.7% and 9.2%, respectively. Univariate analysis revealed that the metastasis was confined in the ovary or pelvis only, unilateral/double ovarian metastasis, and operation mode were all statistically significant prognostic factors (P <0.05). Cox regression analysis showed that the operation mode was the most important prognostic factor (OR = 3.531, P <0.001).

CONCLUSIONSurgical treatment is still the most effective mode in the treatment for the ovary metastasis from colorectal cancer.

Adenocarcinoma ; secondary ; surgery ; Adenocarcinoma, Mucinous ; secondary ; surgery ; Adult ; Aged ; Carcinoma, Signet Ring Cell ; secondary ; surgery ; Colorectal Neoplasms ; pathology ; Female ; Follow-Up Studies ; Humans ; Hysteroscopy ; methods ; Middle Aged ; Ovarian Neoplasms ; secondary ; surgery ; Ovariectomy ; methods ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone. METHODS: A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also. RESULTS: Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted. CONCLUSIONS: Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.
Adenocarcinoma/pathology ; Age Factors ; Aged ; Body Mass Index ; Carcinoma, Signet Ring Cell/pathology ; Colorectal Neoplasms/complications/*pathology ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Peritoneal Neoplasms/secondary ; Polyps/pathology ; Retrospective Studies ; Stomach Neoplasms/complications/*pathology

BACKGROUND AND OBJECTIVEThere is a mounting evidence of the role of HER2 overexpression inpatients with gastric cancer, and it has been solidly correlated with poor outcomes and more aggressive diseases. This study was to investigate the relationship between the expression of HER2/neu and the clinical characteristics of advanced gastric carcinomas, including survival.

METHODSThe clinical data of 83 patients admitted in Cancer Hospital, Chinese Academy of Science, from 2006 to 2008 were reviewed. The HER2/neu status in 83 advanced gastric carcinomas was evaluated using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The survival rate was calculated by Kaplan-Meier method and the log-rank test using SPSS13.0 software.

RESULTSThe median age of the patients was 60 years and the male-to-female ratio was 2.95:1. HER2/neu overexpression (2+ and 3+) and amplification were found in 25 (30.1%) and 29 (34.9%) advanced gastric carcinomas, respectively. HER2/neu amplification/overexpression was associated with worse survival in patients with advanced gastric carcinoma. The median survival of the patients without HER2/neu amplification was 12.6 months and that of those with HER2 amplification was 5.5 months.

CONCLUSIONSHER2/neu status may be a clinical predictor of prognosis in advanced gastric cancer patients.

Adenocarcinoma ; drug therapy ; genetics ; metabolism ; pathology ; secondary ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Signet Ring Cell ; drug therapy ; genetics ; metabolism ; pathology ; secondary ; Female ; Gene Amplification ; Gene Expression Regulation, Neoplastic ; Genes, erbB-2 ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Receptor, ErbB-2 ; metabolism ; Stomach Neoplasms ; drug therapy ; genetics ; metabolism ; pathology ; Survival Rate

Adenocarcinoma ; metabolism ; secondary ; Adult ; Aged ; CDX2 Transcription Factor ; Carcinoma, Signet Ring Cell ; metabolism ; pathology ; Colonic Neoplasms ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Homeodomain Proteins ; metabolism ; Humans ; Keratin-20 ; metabolism ; Keratin-7 ; metabolism ; Middle Aged ; Ovarian Neoplasms ; metabolism ; pathology ; secondary ; Trans-Activators ; metabolism ; Young Adult

OBJECTIVETo evaluate the pathologic diagnosis of hepatic epithelioid hemangioendothelioma (EH) in needle biopsy specimens.

METHODSFive cases of hepatic EH diagnosed in needle biopsies encountered during the period from 1999 to 2010 in Beijing Cancer Hospital were retrospectively reviewed. The specimens were formalin-fixed, paraffin-embedded and stained with hematoxylin and eosin. Immunohistochemical study was also carried out.

RESULTSAll the 5 patients were females. The age ranged from 23 to 47 years (mean = 39 years). The tumors in 4 patients were multiple and diagnosed as "metastasis" on ultrasound examination. The blood test results in all of the 5 patients were normal. Histologically, the tumor cells had an epithelioid appearance and were arranged in cords, solid nests or isolation, amongst a myxoid or hyaline matrix. The tumor cells contained scattered intracytoplasmic vacuoles which sometimes harbored red blood cells. There was no evidence of significant cellular pleomorphism, high mitotic activity and necrosis. Immunohistochemically, all of the 5 cases were positive for at least two endothelial markers (CD31, CD34 and factor VIII-related antigen). Smooth muscle actin was expressed in 1 case.

CONCLUSIONSThe diagnosis of hepatic EH can be established in needle biopsy specimens. The histologic pattern, when coupled with immunohistochemical findings, is useful in arriving at the correct diagnosis.

Actins ; metabolism ; Adult ; Antigens, CD34 ; metabolism ; Biopsy, Needle ; Carcinoma, Signet Ring Cell ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Hemangioendothelioma, Epithelioid ; diagnostic imaging ; metabolism ; pathology ; Hemangiosarcoma ; metabolism ; pathology ; Humans ; Liver Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Melanoma ; metabolism ; pathology ; secondary ; Middle Aged ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; Radiography ; Retrospective Studies ; Young Adult ; von Willebrand Factor ; metabolism

OBJECTIVETo investigate the FDG uptake characteristics, the factors affecting 18F-FDG uptake and the extra CT diagnostic value of 18F-FDG PET/CT scan in the malignant tumor with false negative 18F-FDG PET image.

METHODSThe data of PET/CT image in 17 patients with various kinds of cancers were reviewed and analyzed by visual observation and semi-quantity analysis ( SUV). The results were compared with the CT and histopathological diagnosis, respectively.

RESULTSOf 6 well-differentiated HCC patients confirmed by histopathological diagnosis, one had two lesions in the right lobe of the liver. One of these two lesions showed low FDG uptake on 18F-FDG PET scan and low density on CT scan. The other one was not shown on either 18F-FDG PET or plain CT scan. But on enhanced CT scan, these two lesions were found to be inhomogeneous with high density at arterial phase. The false negative 18F-FDG PET images of one gastric signet ring cell carcinoma in the gastric fundus with right adnexa metastasis, 3 renal cell carcinoma, one greater omentum and peritoneal metastatic adenocarcinoma and one well-differentiated prostate cancer were caused by normal physical uptake in the digestive tract or FDG retention in the urinary system due to normal excretion. The size of three metastases was smaller than or equal to 1 cm in diameter, however, two primary lesions of these metastases showed high FDG uptake and only one was negative on either 18F-FDG PET or CT scan. In this series, 68.8% of the primary tumors and 66.7% of metastases were found to show abnormal density on CT scan, and 31. 2% of the primary tumors and 33. 3% of metastases were not detectable on either PET or CT images.

CONCLUSIONFalse negative 18F-FDG PET in malignant tumor may be correlated with the pathologic type, differentiation degree and the lesion size. Combining CT information with PET or paying attention to the scan methods during 8 F-FDG PET examination may reduce the rate of false negative 18F-FDG PET diagnosis in various kinds of malignant tumors.

Adenocarcinoma ; diagnostic imaging ; secondary ; Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; Carcinoma, Renal Cell ; diagnostic imaging ; pathology ; Carcinoma, Signet Ring Cell ; diagnostic imaging ; pathology ; False Negative Reactions ; Female ; Fluorodeoxyglucose F18 ; Humans ; Kidney Neoplasms ; diagnostic imaging ; pathology ; Liver Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Omentum ; diagnostic imaging ; Peritoneal Neoplasms ; diagnostic imaging ; secondary ; Positron-Emission Tomography ; methods ; Radiographic Image Enhancement ; Stomach Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate whether correlation exists between mRNA expression of IGF-II and hepatocyte growth factor (HGF) and tumor progression and prognosis in gastric cancer.

METHODSIn situ hybridization technique was used to examine mRNA expression of IGF-II and HGF, and immunohistochemical technique was used to examine protein expression of CD34 in 105 specimens of gastric carcinoma.

RESULTSIn situ hybridization revealed that the positive rates of IGF-II mRNA and HGFmRNA were 49.5% and 57.1%, respectively. In stage T3-T4 cases, positive mRNA expression rates of IGF-II and HGF, the frequencies of vessel invasion, lymph node metastasis and distant metastasis were significantly higher than those in stage T1-T2 cases. The mean microvascular density (MVD) in stage T3-T4 tumors, vessel invasion, lymph node metastasis and distant metastasis were significantly more frequent than those in stage T1-T2 tumors. The mean MVD in tumors with positive IGF-II and HGF expressions was significantly higher than that in tumors without IGF-II and HGF expression. There were positive correlations between MVD and expression of IGF-II and HGF. The mean survival time and 5-year survival rate in cases with positive IGF-II and HGF expression and MVD value > or = 39.5 were significantly shorter those that in cases with negative IGF-II and HGF expression and MVD value < 39.5.

CONCLUSIONIGF-II and HGF promote angiogenesis in gastric cancer, and take part in tumor invasion and metastasis. They can be used as prognostic markers of gastric cancer in clinical practice.

Adenocarcinoma, Papillary ; blood supply ; metabolism ; secondary ; Adult ; Aged ; Carcinoma, Ductal ; blood supply ; metabolism ; secondary ; Carcinoma, Signet Ring Cell ; blood supply ; metabolism ; secondary ; Disease Progression ; Female ; Hepatocyte Growth Factor ; biosynthesis ; genetics ; Humans ; Insulin-Like Growth Factor II ; biosynthesis ; genetics ; Liver Neoplasms ; blood supply ; metabolism ; secondary ; Lymphatic Metastasis ; Male ; Microcirculation ; Middle Aged ; Neoplasm Invasiveness ; Neovascularization, Pathologic ; Peritoneal Neoplasms ; blood supply ; metabolism ; secondary ; Prognosis ; RNA, Messenger ; biosynthesis ; genetics ; Stomach Neoplasms ; blood supply ; metabolism ; pathology ; Survival Rate

OBJECTIVEThe aim of this study is to investigate the efficiency and toxicity of the FOLFOX regimen, the combination of oxaliplatin (L-OHP), 5-fluorouracil (5-Fu) and calcium folinate (CF), for patients with locally advanced or metastatic gastric cancer.

METHODSNinety-six patients with locally advanced or metastatic gastric adenocarcinoma, including 72 males and 24 females, were treated with FOLFOX regimen: L-OHP 85 mg/m(2) iv in 2 hours on D1, CF 200 mg/m(2) iv in 2 hours on D1 and D2, 5-Fu 400 mg/m(2) iv on D1 and D2, and then continuous infusion of it at a dose of 600 mg/m(2) for 44 hours. This regimen was repeated every 2 weeks. The first evaluation was done after four cycles. The median cycle of the chemotherapy was 6 (range: 1 to 12 cycles).

RESULTSOf the 96 patients with gastric cancers, 21 underwent R0 resection and afterward received adjuvant FOLFOX chemotherapy. Ten of those were still alive, while the other 11 died of the disease, with a median disease free survival time of 24.0 months and 3-year survival rate of 51.8%. The other 75 received only palliative chemotherapy due to non-operable advanced disease. Thirty of those achieved partial response (PR), the other 20 had a stable disease (SD), but the remaining 25 experienced disease progression (PD), with an overall response rate of 40.0%. The median TTP and overall survival in those 75 patients was 5.9 and 12.0 months, respectively. All 96 patients were evaluable for toxicity according to NCI criteria. The patients of grade 3 vomiting and neural toxicity were 6 and 4, respectively.

CONCLUSIONIn terms of efficacy and safety, the FOLFOX regimen is effective and well tolerable for patients with locally advanced or metastatic gastric cancers either as adjuvant or palliative chemotherapy.

Adenocarcinoma ; drug therapy ; pathology ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Signet Ring Cell ; drug therapy ; pathology ; secondary ; surgery ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; therapeutic use ; Follow-Up Studies ; Humans ; Leucovorin ; administration & dosage ; adverse effects ; therapeutic use ; Liver Neoplasms ; drug therapy ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neutropenia ; chemically induced ; Organoplatinum Compounds ; administration & dosage ; adverse effects ; therapeutic use ; Palliative Care ; Remission Induction ; Stomach Neoplasms ; drug therapy ; pathology ; surgery ; Survival Rate ; Vomiting ; chemically induced