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A 73-year-old man underwent laparoscopy-assisted partial resection of the rectum to treat rectal cancer diagnosed in September 2011 at a previous hospital. Lymph node dissection was not performed and the vertical margin was positive. When multiple liver tumors were detected 10 months later, the patient was referred to our hospital. A computed tomography (CT) scan revealed local recurrence of the rectal cancer, lymph node metastasis, and 9 liver metastases, which had a maximum diameter of 10 cm, and where curative resection would have been difficult. The rectal cancer expressed epidermal growth factor receptor (EGFR) and wild type K-ras gene, and we initiated cetuximab/irinotecan (CPT-11) chemotherapy. After 2 courses of chemotherapy, the liver tumors had markedly decreased in size and anterior resection of the rectum with regional lymph node dissection was performed. The pathological diagnosis of the rectal tumor was mixed adenoneuroendocrine carcinoma ( MANEC). Extended right hepatectomy was performed four months later. The liver tumors were also diagnosed as metastases of MANEC of the rectum. The therapeutic efficacy of chemotherapy was assessed as Grade 1b. The patient is alive without recurrence 34 months since the initial rectal surgery and 15 months after the liver resection. Thus, an anti-EGFR antibody agent might be effective against MANEC of the colon and rectum.

Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-year-old male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.

Purpose: To determine the diffusion-weighted imaging (DWI) characteristics of ano-rectal mucinous carcinoma. Apparent diffusion coefficient (ADC) and DWI findings for mucinous and tubular adenocarcinomas were retrospectively compared., Materials and Methods: Eight-one consecutive surgically resected ano-rectal adenocarcinomas were evaluated. The patient group consisted of 15 mucinous and 66 tubular adenocarcinomas. The DWI signal intensity (SI) pattern of each tumor was visually classified into one of three groups. Differences in the proportions in each group were statistically compared for the two types of tumor. The ADCs of each tumor, calculated from two different b-factors (0 and 1500 s/mm(2)) were compared statistically., Results: Visual evaluation revealed ten mucinous carcinomas as predominantly hypointense lesions, and the remaining five as mixed SI lesions. Sixty-one of 66 tubular adenocarcinomas had hyperintensities; the remaining five had mixed SI. The different proportions in each group were statistically significant. The mean ADC for mucinous carcinomas was 1.49 ± 0.34 × 10(-3) mm(2)/s whereas that for tubular adenocarcinomas was 0.80 ± 0.15 × 10(-3) mm(2)/s. The difference between those figures was statistically significant., Conclusion: In DWI, mucinous carcinomas had higher ADCs and lower SI than tubular adenocarcinomas. DWI and ADC measurements were useful for differentiating these two tumors.

A case is a woman of 81-year-old. She was admitted to our hospital for a close examination of anemia from her family doctor. Gastroscopy revealed a 15 mm diameter of the type 0-IIa+IIc lesion at the posterior wall to the lesser curvature of the gastric body. And the biopsy of the lesion revealed a moderately differentiated adenocarcinoma (tub2). In consideration of the gastrectomy at this point, but firstly, an endoscopic submucosal dissection (ESD) was planned to perform for gaining the total pathological diagnosis of the lesion. Pathological findings revealed that the cancer cell invaded massively to submucosa (sm2), and that lymphatic permeation and venous permeation were also presented (ly2, v2). We explained it to the patient about the necessity of additional gastric resection, but she rejected the operation. So we had no choice but to observe the patient closely. Two months after the ESD, gastroscopy revealed no recurrent signs. But six months after the ESD, the local area of the stomach was revealed type 2 advanced gastric cancer, and computed tomography (CT) revealed a lymphoid swelling at the side of lesser curvature. We performed distal gastrectomy and D2 lymphoid dissection at this point. The final pathological diagnosis was T2 (ss) N2H0P0M0, Stage IIIA, based on the Japanese classification of gastric cancer. Adjuvant chemotherapy (oral fluoropylimidine) was interrupted in short period because of the side effects such as nausea, appetite loss, and diarrhea. There has been no recurrence for 1 year and six months since the operation. ESD is a minimally invasive technique and it is safe, convenient, and efficacious from the gastric functional point of view. However, the therapeutic strategies of the early gastric cancer, especially submucosally invasive gastric cancer, must be decided carefully and individually, considering the risk factors and the postoperative quality of life (QOL).

We report a case of primary pulmonary adenocarcinoma which metastasized to the uterine cervix. A 69-year-old postmenopausal Japanese female was admitted to our hospital because of general fatigue and atypical genital bleeding. Four years before, she had undergone video-assisted thoracoscopic right upper lobectomy, for primary lung cancer (adenocarcinoma), stage IIIb, pT3N1M0. Gynecologic investigation showed a cauliflower-like tumor in the uterine cervix and parametrial invasion towards the bilateral pelvic wall. Metastasis of extragenital carcinoma to the cervix uteri is rare. Most such reported cases originated in the breast and gastrointestinal tract. In this case, cervical biopsy specimens were revealed to be adenocarcinomatous, similar in pathological features to the previously resected lung cancer. Immunohistochemical staining was positive for thyroid transcription factor-1 and pulmonary surfactant apoprotein A and negative for CA125 and thyroglobulin. Although rare, the respiratory tract should be considered as a possible primary site of uterine cervical metastatic carcinoma., (2009 S. Karger AG, Basel.)

A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21460 cells/muL (neutrophils, 18240 cells/muL) and this elevated to 106040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bone scintigraphy and chest CT should also be considered for distant metastasis.

ErbB proteins are widely expressed in human and animal tissues, notably in cells of epithelial or neuroendocrine origin. Protein expression and interactions of ErbBs were examined in prostate cancer specimens. Expression of ErbB1-4 proteins was determined with immunohistochemical methods using each monoclonal antibody in 20 prostatic adenocarcinomas. The 4 ErbB proteins were widely expressed in normal, hyperplastic and cancerous tissues of the prostate. ErbBs may contribute to normal development or tumor growth and progression in human prostate.

Objective: To evaluate the expression of cathepsin L in normal endometrium and endometrial adenocarcinoma., Study Design: Tissue from eight cases of G1 and eight of G2 endometrioid adenocarcinoma, and 15 normal endometrial specimens were examined by immunohistochemistry., Results: In the normal endometrium, cathepsin L was expressed in a few cell layers of the apical part of the glandular epithelium throughout the menstrual cycle. In the carcinomas, there was an inverse correlation between the grade of tumor and the cathepsin L expression., Conclusion: Cathepsin L expression may cease during endometrial carcinogenesis and its expression may be less important in tumor progression than it is in tumors of other tissues.

The protein kinases includes many oncogenes and growth-factor receptors, as well as genes that are involved in cell cycle regulation. EphB4 receptors are a subfamily of receptor tyrosine kinases that are activated by ephrin-B2 ligands and are thought to play an important role in the development and oncogenesis of various tissues. However, very little experimental evidence exists to support this hypothesis. To elucidate the involvement of EphB4 and ephrin-B2 in endometrial carcinogenesis, we used fluorescent immunohistochemistry to analyze serial frozen sections of 20 endometrial carcinomas and 20 normal endometria for EphB4 and ephrin-B2 protein expression. We analyzed the relationship between the patient's characteristics and the percentages of EphB4- and ephrin-B2-stained cells. EphB4 expression was significantly associated with histological grade (p < 0.001) and certain clinical stages. Ephrin-B2 Expression was significantly associated with the presence of invasion to > 1/2 myometrium (p = 0.002). Our results demonstrate that increased EphB4 and ephrin-B2 expression may reflect or induce in endometrial carcinomas increased potential for growth and tumorigenicity. Furthermore, these results suggest that EphB4 receptor kinase may modulate the biological behavior of endometrial carcinomas through autocrine and/or paracrine activation, which is caused by ephrin-B2 ligands that are expressed in the same or neighbouring cells by immunohistochemistry.

In spite of many references to carcinoma arising from endometriosis at extrauterine sites, there are few documented cases of carcinoma developing in association with adenomyosis. We present 2 rare cases of adenocarcinoma arising from adenomyosis. The relationship between prior frequent estrogen use and carcinogenesis and the possible effects of chemotherapy and radiation therapy are reviewed.

A case of mucin-producing adenocarcinoma arising from a mature cystic teratoma of the right ovary is reported in a 67-year-old multiparous Japanese woman. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and adjuvant chemotherapy containing cisplatin, Adriamycin, and cyclophosphamide with the diagnosis of ovarian cancer, probable stage Ic. Treatment was successful even though the tumor extended through the cyst wall.

In 8 cases of advanced and/or relapsed gastric cancer (7 cases advanced, 1 case relapsed), we undertook combination chemotherapy with systemic administration of cisplatin and celiac arterial infusion of carboquone intermittently under continuous administration of OK-432 i.m. and UFT p.o. The male to female ratio was 5 to 3 and the age distribution from 53 to 77 years (mean age, 70 years.) Eight cases were divided into the following histological types: 1 papillary adenocarcinoma, 1 well-differentiated tubular adenocarcinoma, 3 moderately differentiated tubular adenocarcinomas, and 3 poorly differentiated adenocarcinomas. Complete response (CR) was obtained in one case, partial response (PR) in four cases, minor response (MR) in two cases, and no change (NC) in one case. The response rate was 62.5%. CR was noted in a relapsed case. The median survival time from the beginning of the chemotherapy was 8 months (ranging from 6 to 13 months). The major toxicity was bone marrow suppression, but there were no cases of serious renal damage.

The article presents a case study of a 46-year-old multigravid Japanese woman with atypical vaginal bleeding. She had undergone total hysterectomy and bilateral salpingo-oophorectomy for endometriosis. The article discusses mucinous adenocarcinoma of the vagina with aggressive behavior. Primary mucinous adenocarcinoma of the vagina is a rare disease characterizing aggressiveness and poor prognosis because of its rapid growth and recurrence.

Recurrent ovarian cancer after front-line chemotherapy is incurable. In most institutions, chemotherapy is continued as salvage therapy after primary chemotherapy failure and despite the fact that long-term survival and complete responses are infrequent. Radiation therapy for patients with recurrent ovarian cancer has often been done with palliative intent. A patient with ovarian clear cell adenocarcinoma received irradiation with palliative intent to the whole pelvis after chemotherapy (paclitaxel, carboplatin, and irinotecan) produced no effect. Although she developed a rectovaginal fistula due to cancer invasion during radiation therapy. One year and half after the therapy, she is still alive with no evidence of disease. In an effort to maximize salvage potential and quality of life while minimizing toxicity, selected patients with ovarian cancer should be treated with radiation therapy directed to residual or recurrent sites. [ABSTRACT FROM AUTHOR]