high-sensitivity-detection-micrometastases-generated-gfp-lentivirus

High-sensitivity Detection of Micrometastases Generated by GFP Lentivirus-transduced Organoids Cultured from a Patient-derived Colon Tumor

Despite current advances in human colorectal cancer (CRC) treatment, few radical therapies are effective for the late stages of CRC. To overcome this ...

Juntendo University Faculty of Medicine

Systemic inflammatory responses have been reported to be independent predictors of cancer-specific survival in colorectal cancer. The Glasgow Prognostic Score (GPS), which is an inflammation-based prognostic factor, is defined by the presence of elevated C-reactive protein and hypoalbuminemia. The purpose of this study was to estimate whether GPS can be a prognostic factor in patients undergoing curative surgery for colorectal cancers.

Glasgow prognostic score as a prognostic factor in patients undergoing curative surgery for colorectal cancer.

The patient was a 68-year-old man who was admitted to our hospital with a liver tumor. Abdominal ultrasonography and computed tomography revealed a liver tumor 30 mm in diameter. On colonoscopy, a pedunculated tumor with a central depression (20 mm in diameter) was observed in the ascending colon, and this tumor was considered to be invading deeply into the submucosal layer. Right hemicolectomy with D3 lymphadenectomy and partial hepatectomy were performed simultaneously. On histopathological examination of the resected specimen, the tumor was a well-differentiated tubular adenocarcinoma with 3,000 μm invasion of the submucosal layer. The liver tumor showed histological findings similar to those of the primary colorectal carcinoma. The pathological stage according to the 7th edition of the TNM classification was stage IV (T1N0M1). Nine months after the operation, computed tomography revealed hepatic hilar lymph node metastases and a great deal of ascites. The patient ultimately died 14 months after the operation. 

T1 colorectal cancer with synchronous liver metastasis.

Because the TNM system disregards the number of lymph nodes dissected and inter-individual differences exist in the number of regional lymph nodes, the lymph node ratio (LNR), which is estimated by dividing the number of metastatic lymph nodes by the number of dissected lymph nodes, has been proposed as a prognostic factor in recent years. The purpose of the present study is to examine the validity of predicting prognosis using the LNR in node-positive colon cancer.

The validity of predicting prognosis by the lymph node ratio in node-positive colon cancer.

Therapy comprising 5-fluorouracil, levofolinate, and oxaliplatin is currently the most common chemotherapy for colorectal cancer. We experienced a successful case of advanced colon cancer and recurrent breast cancer with 5-fluorouracil, levofolinate, and oxaliplatin therapy.

An effective 5-fluorouracil, levofolinate, and oxaliplatin therapy for recurrent breast cancer: a case report.

Capsule endoscopy (CE) is commonly used for examining and diagnosing gastrointestinal disease, especially small bowel disease. Capsule retention is a well-known and significant complication of CE and requires surgical or endoscopic removal. Most reports described the retrieval of retained CE via laparotomy. We report a case of successful retrieval of the capsule using single incision laparoscopic surgery. 

Successful retrieval of a retained capsule endoscope with single incision laparoscopic surgery.

We report a case of sigmoid colon carcinoma that developed from a sessile-type cancer in a short period of time. An 83-year-old man was found to have a round sessile polyp, about 2 cm in diameter, in the sigmoid colon. Because he had taken anticoagulants, immediate endoscopic mucosal resection and biopsy were not performed. Forty-three days later, the apical surface of the sessile polyp had become depressed and ulcerated, and we judged that an endoscopic resection was not indicated for this lesion. The histologic diagnosis of the biopsy specimens was a well-differentiated adenocarcinoma. We recommended surgical treatment; however, the patient was not in favor of surgical treatment and would not consent to surgery. Two more examinations were performed and the tumor was found to have developed into an invasive cancer with ulcerated, nodular margins involving 3/4 of the colonic lumen. At 271 days after the initial examination, the patient finally consented to surgery and a partial resection of the sigmoid colon was performed. The tumor was classified as stage I (T2N0M0). The several examinations performed from presentation within a short time span provide evidence of the morphologic changes that occur when a sessile-type cancer develops into an ulcerating invasive cancer. We hypothesize that remarkable configuration changes and development take place when a tumor becomes invasive in the muscularis propria from massive submucosal invasion. Our findings suggest that among the tumors discovered as typical ulcerating invasive type colon cancers are those that developed from protuberant tumors in a short period of time. 

Sigmoid colon carcinoma that developed from a sessile-type cancer in a short period of time.

This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery. 

A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer.

A 75-year-old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.

Two-stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report.

A 76-year-old woman with muscle ache, weakness of the extremities, and skin rash was diagnosed with dermatomyositis (DM). Upon the diagnosis of DM, a systemic survey of malignancy revealed an advanced carcinoma of the ascending colon. The patient underwent right hemicolectomy approximately 2 months after the onset of DM. The symptoms and signs of DM disappeared after the surgery without additional therapy. DM is an idiopathic systemic inflammatory disease characterized by muscle ache, muscle weakness, and skin rash. In some cases, DM develops as paraneoplastic syndrome, and it is assumed that 30% of DM patients have cancer. Symptoms and signs of DM can be attenuated by treatment of the malignancy, and they reappear if the malignancy recurs. It is essential to perform a systemic survey of malignancy in DM patients, and treatment of the malignancy has to precede treatment of DM. 

Ascending Colon Cancer Associated with Dermatomyositis Which Was Cured after Colon Resection.

An accessory liver lobe is a rare developmental abnormality, which is often not diagnosed preoperatively, and is usually detected incidentally during abdominal surgery. This condition is often asymptomatic; here, we report on a case where the accessory liver lobe was diagnosed preoperatively using ultrasonography.

Accessory liver lobe attached to the gallbladder wall preoperatively detected by ultrasonography: A case report.

Generally, lesions of rectal neuroendocrine tumors (NETs) 10 mm or smaller are less malignant and are indicated for endoscopic therapy. However, the vertical margin may remain positive after conventional endoscopic mucosal resection (EMR) because NETs develop in a way similar to submucosal tumors (SMTs). The usefulness of EMR with a ligation device, which is modified EMR, and endoscopic submucosal dissection (ESD) was reported, but no standard treatment has been established. We encountered 2 patients in whom rectal NETs were completely resected by combined dissection and resection of the circular muscle layer using the ESD technique. Case 1 was an 8-mm NET of the lower rectum. Case 2 was NET of the lower rectum treated with additional resection for a positive vertical margin after EMR. In both cases, the circular muscle layer was dissected applying the conventional ESD technique, followed by en bloc resection while conserving the longitudinal muscle layer. No problems occurred in the postoperative course in either case. Rectal NETs are observed in the lower rectum in many cases, and it is less likely that intestinal perforation by endoscopic therapy causes peritonitis. The method employed in these cases, namely combined dissection and resection of the circular muscle layer using the ESD technique, can be performed relatively safely, and it is possible to ensure negativity of the vertical margin. In addition, it may also be useful for additional treatment of cases with a positive vertical margin after EMR.

Two Cases of Rectal Neuroendocrine Tumor Resection Combined with Dissection of the Circular Muscle Layer Using the Endoscopic Submucosal Dissection Technique.

Retrocecal hernia is a rare type of pericecal hernia. Because it is difficult to diagnose preoperatively, it is often treated with emergency operation.

Retrocecal hernia preoperatively diagnosed by computed tomography: A case report.

Perineal hernia (PH) is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present a case report of perineal hernia after laparoscopic APR and discuss its management. The patient was a 77-year-old man who was diagnosed with lower rectal cancer. He underwent laparoscopic APR and bilateral lateral lymph node dissection. Two months after the surgery, pain and bulging in the perineal region developed, and PH was diagnosed by CT. Repair with a polypropylene mesh was performed using a combination of laparoscopic abdominal and transperineal approaches. Reportedly, the incidence of secondary PH after APR has increased along with the rate of laparoscopic surgery. Treatment of secondary PH with transperineal repair alone may cause injuries to other organs because of adhesion of the pelvic viscera. In the present case, we safely repaired the hernia repair using a laparoscopy-assisted perineal approach.

Case report of perineal hernia after laparoscopic abdominoperineal resection.

Superior mesenteric artery syndrome (SMAS) is a relatively rare disease that involves bowel obstruction symptoms, such as vomiting and gastric distension, owing to the compression of the third portion of the duodenum from the front by the superior mesenteric artery (SMA) and from the rear by the abdominal aorta and the spine. SMAS is diagnosed on the basis of an upper gastrointestinal examination series indicating the obstruction of the third portion of the duodenum or a computed tomography scan indicating the narrowing of the branch angle between the aorta and the SMA (i.e., the aorta-SMA angle). Here, we report the case of a 78-year-old woman diagnosed with SMAS after a laparoscopic right hemicolectomy for cecal cancer, whose condition was improved by enteral nutritional therapy. We used her controlling nutritional status (CONUT) score as a nutrition assessment and noted the changes in the aorta-SMA angle over the course of the disease. This patient appeared to develop SMAS, on the basis of a worsened CONUT score and a decreased aorta-SMA angle, owing to the inflammation resulting from the intraoperative dissection of the tissues around the SMA and prolonged postoperative fasting. After the initiation of enteral nutritional therapy, the patient exhibited body weight gain and an improved aorta-SMA angle and CONUT score. Hence, assessment of the aorta-SMA angle and CONUT score is an important preoperative consideration.

Article	Year
Glasgow prognostic score as a prognostic factor in patients undergoing curative surgery for colorectal cancer. Digestive surgery\| PubMed ID: 23392422	2012
T1 colorectal cancer with synchronous liver metastasis. Case reports in gastroenterology\| PubMed ID: 23898232	2013
The validity of predicting prognosis by the lymph node ratio in node-positive colon cancer. Digestive surgery\| PubMed ID: 24107470	2013
An effective 5-fluorouracil, levofolinate, and oxaliplatin therapy for recurrent breast cancer: a case report. Journal of medical case reports\| PubMed ID: 24969166	2014
Successful retrieval of a retained capsule endoscope with single incision laparoscopic surgery. Case reports in gastroenterology\| PubMed ID: 25028577	2014
Sigmoid colon carcinoma that developed from a sessile-type cancer in a short period of time. Clinical journal of gastroenterology\| PubMed ID: 26190612	2011
A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer. Surgical case reports\| PubMed ID: 26943447	2015
Two-stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report. Asian journal of endoscopic surgery\| PubMed ID: 27456545	2016
Ascending Colon Cancer Associated with Dermatomyositis Which Was Cured after Colon Resection. Case reports in gastroenterology\| PubMed ID: 27482193	2016
Accessory liver lobe attached to the gallbladder wall preoperatively detected by ultrasonography: A case report. International journal of surgery case reports\| PubMed ID: 27508861	2016
Two Cases of Rectal Neuroendocrine Tumor Resection Combined with Dissection of the Circular Muscle Layer Using the Endoscopic Submucosal Dissection Technique. Case reports in gastroenterology\| PubMed ID: 27990103	2016
Retrocecal hernia preoperatively diagnosed by computed tomography: A case report. International journal of surgery case reports\| PubMed ID: 28700968	2017
Case report of perineal hernia after laparoscopic abdominoperineal resection. Asian journal of endoscopic surgery\| PubMed ID: 28880495	2018
Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score. Case reports in gastroenterology\| PubMed ID: 29430225	2017

Yutaka Kojima

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