Solitary extramedullary plasmacytoma (EMP) is a plasma cell neoplasm without bone marrow involvement. EMPs are rare in the gastrointestinal (GI) tract. We report two cases of primary EMP, one in the transverse colon and the other in the stomach. In the first case, a mass on the transverse colon was found on colonoscopy. The patient underwent left hemicolectomy and has been followed-up for 3 years without recurrence postoperatively. The latter case had several masses in the stomach. The patient underwent bypass surgery and has received supportive care for 1 month. Histopathologic specimens of both the cases showed a monoclonal lambda chain EMP. Subsequent investigations included a bone marrow biopsy, serum IgA, IgG, IgM and serum protein electrophoresis, and the results were negative for multiple myeloma in both the cases. Solitary EMP in the GI tract can be mistaken for colon cancer or stomach cancer on endoscopy; therefore, a sufficient number of biopsy specimens can help diagnose solitary EMPs. Surgical resection alone or with radiation therapy in cases with positive surgical margin is currently the only treatment for solitary EMP in the GI tract. Further study is necessary to determine disease prognosis and to investigate other treatment methods.
Colonic Neoplasms/*diagnosis/pathology/therapy ; Endoscopy, Gastrointestinal ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Plasmacytoma/*diagnosis/pathology/therapy ; Positron-Emission Tomography ; Stomach Neoplasms/*diagnosis/pathology/therapy ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical manifestations,treatment,and prognosis of gastric cancer in the elderly patients.

METHODA total of 252 patients with gastric cancer who admitted to the Oncology Department of Peking Union Medical College Hospital were divided into elderly group (≥ 65 years) and non-elderly group (< 65 years) and the clinical characteristics of these two groups were analyzed and compared.

RESULTSThe elderly accounted for 36.0% of all gastric cancer patients in our department. The proportion of male was significantly higher in elderly group than non-elderly group (male:female = 3.74:1, P=0.020). Abdominal satiety and pain were the most common symptoms,which were significantly lower in elderly group (43.3% vs. 61.7%, P=0.005). However,the frequency of weight loss was significantly higher in the elderly group (15.6% vs. 6.2%, P = 0.015). Significantly more elderly patients with gastric cancer were found the second tumors (12.2% vs. 2.5%, P=0.002). The most common tumor location was cardia (36.7%) in elderly group and antrum (34.6%) in non-elderly group. A small proportion (2.2%) of elderly patients had multi-original lesions, which was not found in non-elderly group. The overall rate of surgery and R0 resection rate were 77.8% and 70.9% respectively, which were similar in both groups. The overall rate of chemotherapy was 98%. The ratio was one third compared with younger patients who received three and more than three lines chemotherapy (3.3% vs. 9.3%), but did not reach statistical difference. More elderly patients chose FOLFOX / XELOX regimen (73.3%) compared with younger arm. The median survival time was 26.5 months in elderly group and 28.0 months in non-elderly group (P=0.835). Subgroup analysis showed that the median survival time of stage 4 gastric cancer was longer in elderly group than in non-elderly group (22.7 months and 16.1 months, respectively; P=0.057), which was marginally statistically significant.

CONCLUSIONSMore old men may get gastric cancer. More elderly patients may present with weight loss. Cardia is the most common tumor location. The ratio of multi-original lesions and secondary tumors is higher for elderly patients. Elderly patients with good performance status can receive surgery and chemotherapy safely. The resection rate is similar between elderly and non-elderly patients. Elderly patients receive more two-drug combination regimens. The overall prognoses are similar between elderly patients and non-elderly patients.

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Prognosis ; Stomach Neoplasms ; diagnosis ; pathology ; therapy

Extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) occurs frequently. The most common site of metastasis is the lung, followed by regional lymph nodes and bones. However, gastrointestinal metastasis of HCC is a rare condition and solitary polypoid metastatic lesion on stomach without any evidence of direct invasion from primary mass is very rare. These metastatic lesions are usually asymptomatic, and most are discovered at postmortem examination or are found incidentally during laparotomy. The choice of treatment for gastrointestinal metastatic lesion of HCC includes surgery, transarterial chemoembolization, and local injection but the treatment is often difficult and unsuccessful. We report a case of 69 years old man who presented disappearance of a polypoid metastatic lesion of HCC on the gastric fundus by transarterial chemoembolization.
Aged ; Carcinoma, Hepatocellular/*diagnosis/secondary/therapy ; *Chemoembolization, Therapeutic ; Duodenoscopy ; Gastric Fundus/radiography ; Humans ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Stomach Neoplasms/*diagnosis/secondary/therapy ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinicopathological features, treatment, and prognosis of gastric neuroendocrine carcinoma and gastric carcinoma with neuroendocrine cell differentiation.

METHODSA total of 19 patients were treated for gastric neuroendocrine cancer or gastric cancer with neuroendocrine differentiation in the Beijing Cancer Hospital from January 1997 to December 2008. Clinical data were retrospectively analyzed.

RESULTSFourteen patients had neuroendocrine carcinoma in the gastric cardia (n=9) or gastric body(n=5), and 5 patients had gastric cancer with neuroendocrine differentiation in the gastric cardia(n=2), the antrum(n=2), and the entire stomach(n=1). According to the International Classification of Disease for Oncology(2000), patients were divided into gastric carcinoid type I((n=2, 10.5%), type III( sporadic gastric carcinoid (n=9, 47.4%), small cell carcinoma of the stomach(n=3,15.8%), and gastric cancer with neuroendocrine cell differentiation(n=5, 26.3%). Clinical manifestations were mostly non-specific. Diagnosis was based on pathological and immunohistochemical examination. Eighteen patients underwent surgery including radical subtotal gastrectomy and total gastrectomy, of whom 3 underwent simultaneous resection of the liver metastasis. The remaining one patient with small cell carcinoma of the gastric body received chemotherapy alone because of unresectable liver metastasis. The survival rate was 73.7% at 1 year and 38.6% at 3 years.

CONCLUSIONSGastric neuroendocrine carcinoma usually develops in the cardia and body of the stomach. Gastric carcinoma with neuroendocrine cell differentiation can occur in any locations of the stomach. Immunohistochemistry is important to the diagnosis. Radical resection is the main treatment.

Aged ; Carcinoid Tumor ; diagnosis ; pathology ; therapy ; Carcinoma, Neuroendocrine ; diagnosis ; pathology ; therapy ; Carcinoma, Small Cell ; diagnosis ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; therapy

Tumor deposit (TD) is a common histopathological finding in gastric cancer. With the improved ability of lymphadenectomy and pathological examination, the positive rate and harvested number of TD are also increasing. The role of TD in staging and prognosis prediction for gastric cancer patients is getting more attention. However, due to the lack of standardization and unification, the denomination, definition and diagnostic criteria are still controversial. The previous studies on the definition and diagnostic criteria of TD were reviewed to standardize the items and improve the awareness. TD is an independent prognostic factor in gastric cancer. Each TD should be counted separately as a lymph node in the final pN determination according to TNM staging system of the Union for International Cancer Control (UICC) or American Joint Committee on Cancer(AJCC) or Japanese classification of gastric carcinoma. But this rule is just an experience-based practice, without support from high-level evidence. Several studies have tried to incorporate TD into TNM staging system to improve the accuracy and discriminative ability. With the wide use of the 8th TNM staging system, how to incorporate TD into the new staging system in an easy and reasonable way still needs more investigations.
Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Neoplasm Staging ; methods ; Prognosis ; Stomach Neoplasms ; diagnosis ; pathology ; therapy

OBJECTIVETo discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and treatment strategies.

DATA SOURCESThe data used in this review were mainly from PubMed articles published in English from 2000 to August 2011. The search terms were "gastric cancer" and "recurrence".

STUDY SELECTIONArticles were selected if they involved clinicopathologic factors, detection methods, and treatment strategies of recurrence of gastric cancer.

RESULTSPeritoneal recurrence is the most common pattern in recurrence of gastric cancer. The main risk factors for recurrence of gastric cancer are tumor stage, including depth of tumor invasion and lymph node metastasis, and Borrmann classification. The prognosis of patients with recurrence is very poor, especially patients with peritoneal recurrence. Systemic chemotherapy is still the main treatment method for patients with recurrent cancer. If complete resection can be accomplished, some benefits may be obtained from surgery for recurrence. However, standard treatment for patients with recurrence has not yet been established.

CONCLUSIONSEarly detection and diagnosis of recurrence is quite crucial for treatment and prognosis. The optimal therapeutic strategy for recurrence should be based on a multidisciplinary assessment and the patient's individual state and should involve combined therapy.

Biomarkers, Tumor ; analysis ; Humans ; Neoplasm Recurrence, Local ; diagnosis ; rehabilitation ; surgery ; therapy ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; diagnosis ; mortality ; pathology ; surgery

OBJECTIVETo explore the clinical characteristics, diagnosis and treatment regimens for the primary gastric lymphoma (PGL).

METHODSThe data of 98 PGL patients treated from January 1994 to December 2006 were collected and analyzed retrospectively.

RESULTSAbdominal pain was the common symptom of PGL. All the patients were at stage I or stage II, and the preoperative diagnosis rate was 56.5%. The overall 1-, 3- and 5-year survival rates were 95.1%, 86.0% and 73.0% respectively. The 5-year survival rates of stage I and stage II patients were 89.5% and 66.7% respectively, and the difference was significant. The 5-year survival rate of patients received operations was 77.2% and that without operation was 75.0%, the difference was not significant.

CONCLUSIONSThe therapy based on chemotherapy is preferred for the treatment of PGL. In the cases of serious gastrointestinal complications, indefinite pathological diagnosis or non-effective chemotherapy, operations should be considered.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Lymphoma ; diagnosis ; pathology ; therapy ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; therapy

OBJECTIVETo investigate the clinical characteristics,diagnosis and treatment of hepatoid adenocarcinoma of the stomach.

METHODSClinical data of 13 hepatoid adenocarcinomas of the stomach, collected from 201 cases of gastric cancer, were analyzed retrospectively.

RESULTSOf the 201 gastric carcinomas, there were 13 AFP-producing adenocarcinomas of the stomach, the positive rate was 6.5%. Morphologically, the tumor cells formed glandular, medullary and linear structures. Of the 13 hepatoid adenocarcinomas of the stomach, 10 cases were in gastric antrum and 10 cases were poorly differentiated. The metastasis rates of liver and lymph node in hepatoid adenocarcinoma of stomach were higher than those in non-hepatoid adenocarcinoma of stomach. The treatment of hepatoid adenocarcinoma of stomach depended mainly on radical resection, and adjuvant chemotherapy was needed.The prognosis of hepatoid adenocarcinoma of stomach was poor.

CONCLUSIONHepatoid adenocarcinoma of the stomach has its own special tumor biological behavior and poor prognosis. Special attention should be paid to this disease.

Adenocarcinoma ; diagnosis ; pathology ; therapy ; Adult ; Aged ; Aged, 80 and over ; Chemotherapy, Adjuvant ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; therapy ; alpha-Fetoproteins ; metabolism

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.
Carcinoma/*diagnosis/pathology/therapy ; Combined Modality Therapy ; Humans ; Lymphoma/radiography/surgery ; Male ; Middle Aged ; Pneumoperitoneum/etiology/radiography/surgery ; Rupture, Spontaneous ; Stomach Neoplasms/*complications/*diagnosis/pathology/therapy ; Stomach Rupture/*complications/radiography/surgery ; Tomography, X-Ray Computed

An 84 yr-old male with a history of nausea and vomiting for 3 weeks was admitted to our hospital. Esopahgogastroduodenoscopy showed the diffuse infiltrative type of gastric cancer encircling from the cardia to the lower body. On abdominal computerized tomography, the gastric wall was diffusely thickened with overlying mucosal enhancement without lymph node involvement. Histologic examination revealed poorly differentiated adenocarcinoma. So surgical resection was planned. However, patient refused all medical care, and then he was discharged. He lived without any medical support and then he revisited our hospital and showed relieved symptoms on the follow-up exam. On esophagogastroduodenoscopy, the gastric mucosa of the body looked normal without any dysplastic change. Abdominal CT revealed a decreased thickening of the gastric wall of the body. The histology from the endoscopic forceps biopsy showed no evidence of malignancy. The patient is alive without any sign of tumor recurrence after 14 months.
Adenocarcinoma/*diagnosis/pathology ; Aged, 80 and over ; Diabetes Mellitus/drug therapy ; Endoscopy, Gastrointestinal ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed