Objective: To investigate the clinical features of patients with cardiac metastases from digestive system tumors. Methods: This retrospective study collected and analyzed the medical records of patients with cardiac metastases from digestive system tumors who received treatments in the Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and January 2021. Kaplan-Meier method was used for survival analysis. Results: A total of 19 patients were identified. The primary tumors were esophageal squamous cell carcinoma (n=7), gastric or gastroesophageal junction adenocarcinoma (n=6), hepatobiliary cancers (n=3) and colorectal cancers (n=3). 16 patients had pericardial metastases, 2 patients had right atrium metastases, and 1 patient had left ventricle metastasis. The most common symptom was dyspnea, which was present in 8 cases. 7 patients received locoregional treatment, while 11 patients underwent systemic therapies. The median overall survival from diagnosis of primary cancer was 31.4 months, and the median overall survival time from diagnosis of cardiac metastasis was 4.7 months. Conclusion: Cardiac metastasis from digestive system tumors is associated with low incidence and a poor prognosis. Systemic treatment remains the cornerstone of management, while novel anti-tumor drugs may improve therapeutic efficacy.
Humans ; Esophageal Neoplasms/pathology* ; Retrospective Studies ; Prognosis ; Esophageal Squamous Cell Carcinoma ; Digestive System Neoplasms/drug therapy* ; Gastrointestinal Neoplasms

Gastric cancer involving the placenta during pregnancy is rare; however, we present 1 such case in this report. A 31-year-old Japanese woman was referred at 26 weeks of gestation for the evaluation of a swollen left supraclavicular lymph node. Biopsy revealed poorly differentiated adenocarcinoma, and esophagogastroduodenoscopy with biopsy of the stomach confirmed the diagnosis of gastric cancer. Her epigastric and back pain became more pronounced and her general status worsened, and we performed a cesarean delivery at 29 weeks. Microscopic examination of the placental specimen revealed poorly differentiated adenocarcinoma cells diffused into the intervillous space. Postpartum chemotherapy consisted of S-1 plus oxaliplatin. Unfortunately, this treatment was ineffective, and the patient died 3 months after delivery. The infant did well, without clinical or laboratory manifestations of metastasis. In patients with advanced gastric cancer during pregnancy, it is important to perform a microscopic examination of the placenta to evaluate for metastatic involvement.
Adenocarcinoma ; Adult ; Asian Continental Ancestry Group ; Back Pain ; Biopsy ; Diagnosis ; Drug Therapy ; Endoscopy, Digestive System ; Female ; Humans ; Infant ; Lymph Nodes ; Neoplasm Metastasis ; Placenta ; Postpartum Period ; Pregnancy ; Stomach ; Stomach Neoplasms

OBJECTIVETo examine the association of preoperative carcinoembryonic antigen (CEA) level with the efficacy of neoadjuvant radiochemotherapy and postoperative metastasis and relapse in patients with rectal cancer.

METHODSBetween January 2011 and January 2014, 325 patients with local advanced rectal cancer underwent preoperative radiochemotherapy and radical operation in Department of Colorectal Cancer Surgery, Beijing University Cancer Hospital, including 194 males and 131 females. According to preoperative MRI, all the patients suffered from clinical T3-4 tumors or positive lymph nodes. Their Zubrod-ECOG-WHO score was 0-1. These patients received preoperative intensity modulated radiotherapy which consisted of 50.6 Gy in 22 fractions (IMRT GTV 50.6 Gy/CTV 41.8 Gy/22 f) with capecitabine(825 mg/m, twice per day) as radiosensitizer. According to the preoperative serum CEA level, patients were divided into high group (125 cases) and normal group (200 cases). In high group, serum CEA level decreased into normal range in 60 patients (high-normal group) after radiochemotherapy, while it was still in high level in other 65 patients (high-high group). The differences in sensitivity to radiochemotherapy and 3-year disease free survival (DFS) of these patients were both evaluated.

RESULTSIn high group and normal group, the complete response rates were 18.4% (23/125) and 17.5% (35/200) (χ=0.319, P=0.660); the percentages of tumor regression grade(TRG) 0-1 patients were 68.0%(85/125) and 67.5%(135/200)(χ=0.009, P=0.925); the T downstage rates were 63.2%(79/125) and 70.0%(140/200)(χ=1.266, P=0.274), respectively, whose differences were all not significant. The 3-year DFS rate in high group was 62.4%, which was significantly lower than 93.5% in normal group (χ=53.147, P=0.000). There were 65 patients in high-high group, accounting for 52% (65/125) of high group. Among these 65 patients, 44(67.7%) presented recurrence and metastasis within 3 years and the 3-year DFS was 32.3%, which was much lower than 95.0% of 60 patients in high-normal group(χ=182.085, P=0.000).

CONCLUSIONSPreoperative serum CEA level may not be used to predict tumor response of rectal cancer patients who receive preoperative radiochemotherapy. However, the prognosis of patients with high CEA level is worse. Recurrence and metastasis are more likely to occur in patients with high CEA level after radiochemotherapy.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoembryonic Antigen ; blood ; Chemoradiotherapy ; statistics & numerical data ; Digestive System Surgical Procedures ; statistics & numerical data ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; statistics & numerical data ; Neoplasm Metastasis ; prevention & control ; Neoplasm Recurrence, Local ; prevention & control ; Predictive Value of Tests ; Prognosis ; Rectal Neoplasms ; drug therapy ; mortality ; surgery ; Survival Rate

OBJECTIVEThe aim of this study is to discuss the curative effect of introperitoneal hyperthermic perfusion chemotherapy(IHPC) combined with systemic neoadjuvant chemotherapy on the gastric cancer patients with peritoneal carcinomatosis.

METHODSSixty-four patients with gastric cancer and peritoneal carcinomatosis who were hospitalized in the Department of Gastrointestinal Surgery of First Hospital of Jilin University from December 2006 to December 2013. After peritoneal carcinomatosis was confirmed during laparoscopic exploration, FOLFOX6 (oxaliplatin and calcium folinate and 5-Fu) was performed for systemic chemotherapy. One course was 14 days and a complete treatment includes four courses. At the same time, patients underwent peritoneal catheter insertion and received IHPC(5-Fu 1 500 mg/m(2) and Cisplatin 35 mg/m(2) were added into 0.9% NaCl solution 2 000 ml, the infusion velocity was 35-45 ml/min, infusion time was 45-60 minutes, the temperature was controlled to 41°C). A comprehensive evaluation was taken after the fourth course of treatment before operation. Further surgical therapy was performed according to the assessment result.

RESULTSSixty-four patients received IHPC combined with systemic chemotherapy. Thirty-two patients(50.0%) had partial response, 18(28.1%) stable disease, and 14(21.9%) progressive disease after chemotherapy. No severe complications or death occurred during the neoadjuvant chemotherapy. Thirty-two patients(50.0%) received radical resection, 10(15.6%) palliative operation, and another 22 patients(37.4%) didn't comply with inclusion criteria of operation. Patients receiving operation had a median survival time of 678 days, which was significantly longer than patients without operation, with a median survival time of 251(χ(2)=23.34, P=0.02).

CONCLUSIONSIHPC combined with systemic chemotherapy is an effective therapeutic method for gastric cancer patients with peritoneal carcinomatosis in terms of reducing preoperative tumor load and achieving radical resection.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma ; drug therapy ; Chemotherapy, Cancer, Regional Perfusion ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Digestive System Surgical Procedures ; Fluorouracil ; therapeutic use ; Humans ; Hyperthermia, Induced ; Laparoscopy ; Leucovorin ; therapeutic use ; Neoadjuvant Therapy ; Organoplatinum Compounds ; therapeutic use ; Peritoneal Neoplasms ; drug therapy ; Peritoneum ; Stomach Neoplasms ; drug therapy ; Treatment Outcome

OBJECTIVETo clarify the natural course and explore impact factors of distant metastasis in rectal cancer patients who received total mesorectal excision(TME) following neoadjuvant chemoradiotherapy (CRT).

METHODSBetween Januray 2008 and December 2013, 317 patients with locally advanced rectal cancer who underwent radical surgical resection following neoadjuvant CRT (pre- and postoperative simple fluorouracil or fluorouracil combined with oxaliplatin plus preoperative three dimensional conformal radiotherapy) at Department of Colorectal Surgery in Fujian Medical University Union Hospital were included. Univariate analysis and Cox regression were performed to evaluate the clinicopathological parameters that may be associated with distant metastasis.

RESULTSDuring a median follow-up of 39 months(range 15 - 89 months), 72 patients(22.7%) had disease recurrence, including local recurrence in 8 patients, and distant metastasis in 67 patients (among whom 3 patients had both). Distant metastasis occurred in 86.5%(58/67) patients during the first three years after surgery. The 3-year cumulative distant metastatic rate in all the patients was 22.4%. The 5-year overall survival rate in distant metastatic patient was significantly lower than that of non-distant metastatic patients following neoadjuvant CRT (36.2% vs. 81.2%, P=0.000). Univariate analysis showed that ypT stage (χ(2)=13.304, P=0.010), ypN stage(χ(2)=23.416, P=0.000), ypTNM stage (χ(2)=31.765, P=0.000) and RCRG(χ(2)=16.246, P=0.000) were associated with distant metastasis. Cox regression revealed that ypTNM stage(HR=1.959, 95% CI:1.171 ~ 3.277, P=0.010) was the only independent risk factor of distant metastasis.

CONCLUSIONSDistant metastasis is the early event during the progression in rectal cancer. ypTNM stage is the only independent risk factor of distant metastasis in locally advanced rectal cancer patients who undergo TME following neoadjuvant CRT.

Chemoradiotherapy ; Digestive System Surgical Procedures ; Fluorouracil ; therapeutic use ; Humans ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Organoplatinum Compounds ; therapeutic use ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Risk Factors ; Survival Rate

Gastric metastasis from ovarian carcinoma is extremely rare and the prognosis for patients is poor. We report a case of multimodal treatment improving the survival time of a patient with gastric metastasis from ovarian cancer. A 73-year-old woman with known serous ovarian cancer was admitted to the hospital due to epigastric pain and dyspepsia. On esophagogastroduodenoscopy, a protruding mass was noted at the gastric antrum. She underwent distal gastrectomy with Billroth I anastomosis and lymph node dissection, including the para-aortic lymph nodes. The final pathology revealed gastric metastasis from ovarian serous adenocarcinoma. In this case, after cytoreductive surgery, chemotherapy was performed each time a recurrence was diagnosed, and remission was accomplished. She survived for 108 months after the first diagnosis of the metastatic tumor in the stomach. Multimodal treatment of metastatic lesions since the first diagnosis allowed the patient to survive longer than those in previous reports.
Adenocarcinoma ; Aged ; Combined Modality Therapy* ; Diagnosis ; Drug Therapy ; Dyspepsia ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Pathology ; Prognosis ; Pyloric Antrum ; Recurrence ; Stomach

We report a case of duodenal metastasis from squamous cell carcinoma of the cervix confirmed by histopathological diagnosis. A 48-year-old woman was diagnosed with uterine cervix cancer stage IVB and underwent chemotherapy. During follow-up after chemotherapy, a mass suspicious of malignancy was found at the 3rd portion of the duodenum on the magnetic resonance imaging of the abdomen. Esophagogastroduodenoscopy with biopsy was done for an ulcerofungating mass at the 3rd portion of the duodenum. Squamous cell carcinoma was confirmed on the biopsy which was same as the histopathological diagnosis confirmed by cervix biopsy and right supraclavicular lymph node biopsy resulting from metastasis of cervix. Since 1981, only ten cases of small bowel metastasis from squamous cell carcinoma of cervix have been reported. It is exceedingly rare to find metastasis to the duodenum from uterine cervix cancer.
Abdomen ; Biopsy ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Duodenum ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Uterine Cervical Neoplasms

PURPOSE: Evolving therapies have improved the prognoses of patients with breast cancer; and currently, the number of long-term survivors is continuously increasing. However, these patients are at increased risk of developing a second cancer. Thus, late side effects are becoming an important issue. In this study, we aimed to investigate whether patient and tumor characteristics, and treatment type correlate with secondary tumor risk. METHODS: This case-control study included 305 patients with a diagnosed second malignancy after almost 6 months after the diagnosis of primary breast cancer and 1,525 controls (ratio 1:5 of cases to controls) from a population-based cohort of 6,325 women. The control patients were randomly selected from the cohort and matched to the cases according to age at diagnosis, calendar period of diagnosis, disease stage, and time of follow-up. RESULTS: BRCA1 or BRCA2 mutation, human epidermal growth factor receptor 2 (HER2)+ status, chemotherapy, and radiotherapy were related to increased risk of developing a second cancer, whereas hormonotherapy showed a protective effect. Chemotherapy, radiotherapy, and estrogenic receptor level <10% increased the risk of controlateral breast cancer. HER2+ status increased the risk of digestive system and thyroid tumors, while BRCA1 or BRCA2 mutation increased the risk of cancer in the genital system. CONCLUSION: Breast cancer survivors are exposed to an excess of risk of developing a second primary cancer. The development of excess of malignancies may be related either to patient and tumor characteristics, such as BRCA1 or BRCA2 mutation and HER2+ status, or to treatments factors.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Cohort Studies ; Diagnosis ; Digestive System ; Drug Therapy ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Neoplasms, Second Primary ; Prognosis ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Survivors* ; Thyroid Gland

OBJECTIVES: In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone. METHODS: This study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was performed. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically. RESULTS: Pharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group. CONCLUSION: This study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula.
Animals ; Collagen ; Digestive System ; Drug Therapy ; Fistula* ; Growth Hormone ; Head and Neck Neoplasms ; Human Growth Hormone* ; Humans* ; Incidence ; Injections, Subcutaneous ; Laryngeal Neoplasms ; Larynx ; Pharynx ; Polyglactin 910 ; Rats ; Rats, Sprague-Dawley ; Recurrence ; Wound Healing

Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; DNA, Helminth/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Endoscopy, Digestive System ; Female ; Histocytochemistry ; Humans ; Korea ; Male ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA ; Stomach Neoplasms/*complications/*diagnosis/pathology ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*complications/*diagnosis/drug therapy/pathology ; Treatment Outcome