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We present an interesting case in which a patient diagnosed with primary peritoneal cancer after the resection of a greater omentum mass achieved recurrence-free survival without postoperative systemic chemotherapy. The patient was a 78-yearold woman with no history ofmalignant disease. She underwent abdominal ultrasound at a local clinic, which revealed a mass shadow near the descending colon. She was referred to us in May 2014. Contrast-enhanced abdominal computed tomography showed a homogeneously enhanced soft-tissue mass measuring 94×80×34mm in size in the left lower abdomen, which did not connect to the gastrointestinal tract. In June 2014, a gastrointestinal stromal tumor was suspected, and laparotomy was performed. Laparotomy findings suggested a tumor originating from the greater omentum and no evidence of perifocal invasion. The tumor was resected with the surrounding greater omentum. Pathological examination revealed very poorly differentiated adenocarcinoma, also consistent with ovarian serous adenocarcinoma. No lesions were detected in any other organs by pre- and postoperative examinations, and the patient was diagnosed with primary peritoneal cancer. As the patient refused to receive postoperative systemic chemotherapy, we decided to continue with follow-up only. The patient was alive without recurrence as ofApril 2018.

We herein report a patient with postoperative late recurrence ofbreast cancer that was resistant to systemic therapy who achieved long-term survival after aggressive surgical treatment. A 53-year-old woman underwent modified muscle-preserving radical mastectomy for right breast cancer in May 1999. Adjuvant therapy with oral anticancer agents and an antiestrogen were initiated. Since the patient was recurrence free for 5 years postoperatively, only the administration of antiestrogen was continued. In November 2007, the administration oforal anticancer agents was resumed on the suspicion ofmetastasis to the right supraclavicular node. Although cyclophosphamide, epirubicin, and 5-fluorouracil(CEF)therapy plus an oral aromatase inhibitor was initiated in February 2008, lymph node enlargement was noted. As other forms of chemotherapy did not produce a favorable response, the patient underwent cervical lymphadenectomy in December 2009. As repeated recurrences were observed thereafter, surgical excisions of the right cervical mass were performed in January, March, and April 2010. In December 2013, right cervical lymphadenectomy was performed. Histological findings of all the excised specimens were consistent with breast cancer metastasis. Since then, the patient has been well without recurrence, although she continues to receive aromatase inhibitor treatment.

We herein report an interesting case in which a complete response was achieved with oral anticancer monotherapy for unresectable lymph node metastasis after surgery for cecal cancer. A 78-year-old woman was referred to our hospital to undergo a detailed examination for anemia. The examination led to a diagnosis of cecal cancer. She underwent open right hemicolectomy combined with adjacent abdominal wall resection and reconstruction of abdominal wall defects the next month. During follow-up without adjuvant therapy at her request, right iliac lymph node metastasis was detected 5 months later. A lymphadenectomy by laparotomy was attempted 6 months later but ended as only an exploratory laparotomy because the metastatic lymph node was difficult to detach from the vascular wall. Starting the next month, oral anticancer monothera- py(TS-1, 80mg/day for 2weeks followed by 1week of rest)was started at the patient's request. Abdominal ultrasonography performed in March 2011 revealed no evidence of lymphadenopathy, and subsequent imaging tests also confirmed the absence of lymphadenopathy. The anticancer monotherapy was discontinued after 4 years of medication. The patient remains alive, after 3 years and 5 months of medication to date, without recurrence.

症例は82歳の女性で，食欲不振と体重減少を主訴に近医にてCTを受けS状結腸癌を疑われた．精査目的で注腸検査を受け，検査後に腹痛が出現し翌日の画像検査でS状結腸穿孔によるバリウム腹膜炎の診断で当院紹介となった．緊急開腹術の所見で後腹膜腫瘍のS状結腸への浸潤と穿破によるバリウム腹膜炎，腫瘍による左尿管・左総腸骨動静脈の途絶，後腹膜腔に膿瘍形成を認めた．ハルトマン手術と左腎瘻造設を施行した．病理検査で後腹膜腫瘍は高分化扁平上皮癌であり原発巣を検索した．原発部位としては腎盂尿管が最も強く疑われたが確定診断には至らなかった．

We report here a rare case of gastric metastasis after resection ofa transverse colon cancer in which eating ability was restored following mFOLFOX6 (folinic acid plus fluorouracil plus oxaliplatin) plus cetuximab (Cet) chemotherapy. A 56-year-old man with chief complaints of constipation and abdominal fullness was referred to our hospital. In February 2013, he was diagnosed with transverse colon cancer via enema and colonoscopy. We performed transverse colon cancer resection followed by a 6-month course of capecitabine chemotherapy. In July 2014, the patient's serum carcinoembryonic antigen level increased, in October, he was again referred to our hospital with complaints of appetite loss and vomiting. He was diagnosed with multiple lymph node and gastric metastases via ultrasonography, computed tomography, and endoscopy, as well as multiple lung metastases via computed tomography. As the gastric metastases and vomiting rendered him unable to eat, a nasogastric tube was inserted and was administered mFOLFOX6 plus Cet chemotherapy. After 2 courses of chemotherapy his ability to eat was restored. As of March 2015, the patient remains alive following 12 courses of chemotherapy.

It is thought that cases of colonic cancer with multiple organ metastases including the spleen, liver, lung, and peritoneum are in the terminal stage. This time, we experienced a patient with splenic metastasis from colonic cancer who survives for 2.5 years with resection of the splenic metastasis and intensive therapy. A 56-year-old man underwent a curative right hemicolectomy for a cancer of the ascending colon with peritoneal dissemination. Nine months later, he experienced splenic, hepatic metastases. So a splenectomy and a hepatic resection with a cannulation into a proper hepatic artery were performed. Histologically, the splenic tumor revealed moderately differentiated adenocarcinoma and was diagnosed as metastasis of colonic cancer. Resection of peritoneal and lung metastases followed the splenectomy. Thereafter, intra-venous chemotherapy using -FU+Iow dose CDDP was performed for remnant multiple liver and lung metastases. Eleven months later, complete response was obtained. No evidence of recurrence has been found for two years and six months after the splenectomy. These results suggest that intensive resection and chemotherapy for distant meatstases including splenic lesion might lead to a long survival.

We report a rare case of a patient with multiple liver metastases of gastric and rectal cancers after laparoscopic sigmoidectomy, who responded completely to S-1 therapy followed by open gastrectomy. A 72-year-old man with a chief complaint of occult blood in the feces was referred to our hospital and was diagnosed with rectal cancer by colonoscopy. In addition, we found concomitant gastric cancer by gastrointestinal fiberscopy. Abdominal plain computed tomography showed no liver metastasis. In August 2010, we performed laparoscopic resection of the rectal cancer. However, at the time of discharge, abdominal enhanced computed tomography showed multiple liver metastases. Then, we administered 4 courses of S-1 therapy. In December 2010, abdominal enhanced computed tomography showed no liver metastasis. In March 2011, because no other lesion without residual gastric cancer was detected, the patient underwent gastrectomy followed by S-1 therapy. As of January 2012, the patient is alive and disease free. S-1 therapy with laparoscopic resection for rectal cancer and gastrectomy may help prolong the survival of patients with multiple liver metastases of gastric and rectal cancers.

It has been thought that phosphorus in biominerals made of amorphous calcium carbonate (ACC) might be related to ACC formation, but no such phosphorus-containing compounds have ever been identified. Crustaceans use ACC biominerals in exoskeleton and gastroliths so that they will have easy access to calcium carbonate inside the body before and after molting. We have identified phosphoenolpyruvate and 3-phosphoglycerate, intermediates of the glycolytic pathway, in exoskeleton and gastroliths and found them important for stabilizing ACC.

Distinguishing primary ovarian cancer from metastatic colorectal cancer is often difficult by a conventional pathological examination alone. We assessed the usefulness of p53 gene mutation analysis for the differential diagnosis of ovarian adenocarcinoma. A 66-year-old woman suffered multiple organ metastases, including the liver, para-aortic lymph node, and right ovary, following an operation for advanced sigmoid colon cancer. She underwent ovarian resection after effective chemotherapy against the liver and para-aortic lymph node cancer. Histological analysis suggested primary ovarian cancer. Therefore, we applied p53 gene mutation analysis for the differential diagnosis of primary versus metastatic ovarian cancer from sigmoid colon cancer. The direct sequence of the p53 gene demonstrated the same gene mutation in codon 211 (ACT to ATT) in both the sigmoid colon and ovarian cancers. According to the International Agency for Research on Cancer TP53 mutation database, this type of p53 mutation in colorectal cancer and ovarian cancer is 0.13% (5/3,693) and 0% (0/1,494), respectively. Therefore, we determined that the ovarian tumor was metastatic. Although p53 gene mutation analysis has been applied in some cases, this modality is very useful for the differential diagnosis of primary and metastatic cancer.

During hemodialysis, bone is affected by several factors. In order to study the effects of water for dialysate preparation on bone, we compared bone changes in the patients who were hemodialysed for over ten years in two different hospitals. Softed water was used for a dialysate preparation in one hospital A, and reverse osmosis was used in another hospital B. All 3 patients in A have severe bone pain and remarkable radiographic changes in bone such as fractures and bone absorption. All 11 patients except one in B have no symptom. The mineral content of bone is dcreased in all 15 patients. These results show the fact that water for dialysate preparaion is one of the important factor in renal osteodystrophy.

We recently reported that interferon-alpha (IFN-alpha) and 5-fluorouracil (5-FU) combination therapy in advanced hepatocellular carcinoma (HCC) achieved excellent clinical results. However, the mechanism underlying this combination therapy remains to be elucidated. In this study, we examined the anti-tumor effects of IFN-alpha and 5-FU combination therapy in vivo and aimed to reveal its anti-angiogenic effects by investigating the expression of vascular endothelial growth factor (VEGF) and angiopoietins (Ang-1 and Ang-2). Human HCC cells, HuH7, were subcutaneously injected in nude mice. Ten days later, groups of mice received treatment with IFN-alpha alone, 5-FU alone, or with a combination of IFN-alpha and 5-FU for four weeks. Immunohistochemical examinations of proliferating cell nuclear antigen (PCNA), cell differentiation antigen 34 (CD34), Ang-1, -2 and VEGF, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay and quantification of VEGF, Ang-1 and-2 mRNA using real-time RT-PCR were performed. Results showed that IFN-alpha and 5-FU combination therapy significantly inhibited the growth of human HCC cells compared with the control group or single agent treatment. The combination therapy decreased PCNA-positive cells as well as microvessel density (MVD) and induced apoptosis of (TUNEL-positive cells) more than other treatment groups. Immunohistochemical analysis revealed that the combination therapy significantly decreased the expression of VEGF and Ang-2 and increased that of Ang-1. The ANG2/ANG1 mRNA expression ratio was significantly lower in the combination therapy group. In conclusion, our results suggested that IFN-alpha and 5-FU combination therapy has anti-proliferative and anti-angiogenic effects and can induce apoptosis in vivo. The synergistic and anti-angiogenic effects may in part be attributable to the regulation of Ang-1, -2 and VEGF.

We recently reported that interferon-alpha (IFN-alpha) and 5-fluorouracil (5-FU) combination therapy in advanced hepatocellular carcinoma (HCC) achieved excellent clinical results. However, the mechanism underlying this combination therapy remains to be elucidated. In this study, we examined the anti-tumor effects of IFN-alpha and 5-FU combination therapy in vivo and aimed to reveal its anti-angiogenic effects by investigating the expression of vascular endothelial growth factor (VEGF) and angiopoietins (Ang-1 and Ang-2). Human HCC cells, HuH7, were subcutaneously injected in nude mice. Ten days later, groups of mice received treatment with IFN-alpha alone, 5-FU alone, or with a combination of IFN-alpha and 5-FU for four weeks. Immunohistochemical examinations of proliferating cell nuclear antigen (PCNA), cell differentiation antigen 34 (CD34), Ang-1, -2 and VEGF, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay and quantification of VEGF, Ang-1 and-2 mRNA using real-time RT-PCR were performed. Results showed that IFN-alpha and 5-FU combination therapy significantly inhibited the growth of human HCC cells compared with the control group or single agent treatment. The combination therapy decreased PCNA-positive cells as well as microvessel density (MVD) and induced apoptosis of (TUNEL-positive cells) more than other treatment groups. Immunohistochemical analysis revealed that the combination therapy significantly decreased the expression of VEGF and Ang-2 and increased that of Ang-1. The ANG2/ANG1 mRNA expression ratio was significantly lower in the combination therapy group. In conclusion, our results suggested that IFN-alpha and 5-FU combination therapy has anti-proliferative and anti-angiogenic effects and can induce apoptosis in vivo. The synergistic and anti-angiogenic effects may in part be attributable to the regulation of Ang-1, -2 and VEGF.

Extracellular matrix-degrading matrix metalloproteinases (MMPs) are invariably up-regulated in epithelial cancers and are key agonists of angiogenesis, invasion and metastasis. Recent studies have shown high levels of various MMPs, including MT1-MMP, MMP-1, MMP-2 and MMP-9, and their involvement in tumor progression in human hepatocellular carcinoma (HCC). However, the expression and role of MT3-MMP in HCC remains unclear.We examined the immunohistochemical expression of MT3-MMP in surgically resected HCCs (n=58), hepatitis C virus (HCV) and hepatitis B virus (HBV)-related chronic hepatitis (n=34) and cirrhosis (n=24).MT3-MMP expression was observed in all non-cancerous liver tissues. In HCCs, 52% (30/58) of patients showed high MT3-MMP expression while the remaining 48% (28/58) of patients showed low expression. A clinicopathological survey demonstrated a significant correlation between high MT3-MMP expression and capsular invasion of carcinoma (p = 0.034) although there was no correlation between high MT3-MMP expression in HCC and overall survival or disease-free survival.MT3-MMP was expressed not only in chronic hepatitis and liver cirrhosis, but also in HCC, and high MT3-MMP expression correlated significantly with capsular invasion of carcinoma.

To investigate the effect of biochemical modulation on antitumor activity shown by the combination of 5-Fluorouracil (5-FU) and interferon-alpha (IFN-alpha), experimental therapy was performed on human hepatocellular carcinoma cell (HuH7, PLC/PLF/5) xenografts inoculated into nude mice, using 5-FU and IFN-alpha, either alone or in combination. These agents showed antitumor activity in different degrees. Although IFN-alpha, given as 100,000 units/mouse/3 times/week subcutaneously x 6, and 5-FU, given as 0.5 mg/mouse/3 times/week intraperitoneally, showed addititive antitumor effect against HuH7 and PLC/PLF/5, the activities of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP), orotate phosphoribosyltransferase (OPRT), uridine phosphorylase (UP) and uridine kinase (UK) were not significantly influenced in the tumors treated with the 5-FU/IFN-alpha combination, compared with those treated with 5-FU or IFN-alpha alone. This suggested that antitumor activity of 5-FU and IFN-alpha in combination was not significantly involved in 5-FU metabolism in two human hepatocellular carcinoma cell lines examined.

Background/Aims : The prognosis of hepatocellular carcinoma (HCC) is poor because of frequent intrahepatic metastasis (IM) or multicentric carcinogenesis (MC). We compared the effectiveness of loss of heterozygosity (LOH) analysis in the diagnosis of these two forms with that of histopathological diagnosis. Methods : Using LOH analysis of 15 specific DNA microsatellite loci, tumor clonality was assessed in 37 cases. Results : LOH was observed in 30% of seven solitary tumors. According to these results, the selected threshold to diagnose MC was a difference in the LOH status at more than 30% of the analyzed loci, when comparing two samples in the same liver. In nine multiple HCCs, identical genetic and histopathological diagnoses were found in four (IM: 2, MC: 2). Of 21 recurrent tumors, 19 showed LOH for at least one marker. IM and MC were genetically diagnosed in five and ten patients, respectively. Genetic and histopathological diagnoses were identical in ten of 19 patients (IM: 5. MC: 5). Five genetic MC were histopathologically diagnosed as IM (3) and ‘undetermined' (2). Conclusions : Genetic diagnosis by LOH analysis may be more strict and specific than histopathological diagnosis in the differential diagnosis of IM and MC.

Because of the low incidence rate of combined hepatocellular-cholangiocarcinoma (combined HCC-CC), the clinicopathological features of a recurrent tumor of this disease remain to be elucidated. We describe a 47-year-old Japanese woman with a 5-cm diameter mass lesion in the liver. A hepatectomy and dissection of the local lymph nodes were performed and a histological examination of the resected specimen showed combined HCC-CC. After a follow-up of 15 months, intrahepatic recurrence was observed, and a hepatectomy was performed again followed by hepatic arterial infusion chemotherapy. A histological examination revealed that the recurrent tumors consisted of only cholangioacarcinoma. A disease-free survival was obtained for about 7 years after the recurrence. To improve the poor prognosis of combined HCC-CC, clinicopathological features of this disease and the therapy selection for recurrent tumors should be discussed.

In order to detect a hematogenous spread of tumor cells in patients with hepatocellular carcinoma, reverse transcription-polymerase chain reaction assay has been used. In this study, we quantified alpha-fetoprotein (AFP) messenger RNA by real-time PCR approach using LightCyclertrade mark technique. AFP messenger RNA in the blood from 23 hepatocellular carcinoma patients undergoing hepatic resection, 31 healthy volunteers, 10 patients with liver cirrhosis and 5 patients underwent hepatectomy except for hepatocellular carcinoma was quantitated. In the real-time PCR, fluorescence was undetectable in any of the controls. On the contrary, fluorescent signals were detected in 10 out of 39 blood specimens collected from 23 HCC patients. AFP-positive status was significantly associated with the existence of multiple intrahepatic nodules. Out of 8 cases with AFP-positive status, intra- and/or extra-hepatic recurrence has been observed in 3 cases. The quantities of AFP messenger RNA in these 3 cases were relatively high among 8 cases with AFP-positive status. AFP messenger RNA was detectable by newly developed real-time PCR approach with LightCycler and it is suggested that this approach could be applicable in detection of small amounts of tumor cells in the blood of HCC patients.

Interferon-alpha (IFNalpha) plays a crucial role in the antiproliferation and immunoregulatory activity through the specific cell surface receptor, interferon-alpha/beta receptor (IFNalpha/betaR). We examined the immunohistochemical expression of IFNalpha/betaR in 91 hepatocellular carcinoma (HCC), HCV-related chronic hepatitis (n=38) and cirrhosis (n=53), dysplastic nodules (n=5), and normal liver (n=9). The level of IFNalpha/betaR increased in chronic hepatitis and cirrhosis compared with normal liver. All the dysplastic nodules showed moderate or high expression. In HCCs, 26% (24/91) of patients showed high IFNalpha/betaR expression while the remaining 38% (35/91) showed moderate, and 35% (32/91) no or faint expression. Clinicopathological survey demonstrated a significant correlation between IFNalpha/betaR expression and differentiation of carcinoma (P=0.0008) although there was no correlation between IFNalpha/betaR expression in HCC and survival or disease-free survival. Thus, IFNalpha/betaR was expressed not only in chronic hepatitis or liver cirrhosis but in HCC and its expression was significantly correlated with tissue differentiation of carcinoma.

Asymmetric Simmons-Smith reactions of α,β-unsaturated acetals derived from chiral dialkyl tartrate or (2 R ,4 R )-2,4-pentanediol are described. Treatment of the acetal with diethylzinc and methylene iodide gives a cyclopropane with high diastereoselectivity. The acetal group is readily transformed to the aldehyde or the ester group. In addition, the method is successfully applied to the enantioselective synthesis of 5,6-methanoleukotriene A4, a stable and selective inhibitor of leukotriene biosynthesis.

Low-speed wind tunnel investigations are performed for the flat spin of slender bodies at high angles of attack at Reynolds numbers of (1.2-4.4) xlO5. Effects of the geometrical configuration of the model, freestream Reynolds number, and angle of attack on the flat spin motion are analyzed using spin rate measurements, in situ surface pressure distribution, and static aerodynamic characteristics. It is verified that the flat spin is caused by differences in flow patterns at the critical Reynolds number. The measured side moment can be used to predict the actual flat spin rate. The flat spin can be alleviated by causing early transition of the boundary layer with artificial surface roughness.

Optically pure propargylic alclhols are obtained by the reductive cleavages of chiral α, β-alkynyl acetals with organoaluminum reagent followed by removal of chiral auxiliary.

By using a simple interaction potential, the interfacial energy between bcc(110) and fcc(111) surfaces was calculated. Energy minima appear at specific values of the atomic diameter ratio of bcc to fcc for the Nishiyama-Wassermann orientation relationship (NW), [1 1 0]fcc|[001]bcc, and the Kurdjumov-Sachs relationship (KS), [1 1 0]fcc|[1 1 1]bcc. The reason for the appearance of energy minima is well understood by considering the relative atomic arrangements of the two lattices at the interface. From the calculation and from geometrical considerations, one can predict the preferred orientation relationship for epitaxy, namely the NW, and KS or a new [2 1 1 ]fcc|[001]bcc relationship, from the variation of the atomic diameter ratio of bcc to fcc.

Reductive cleavages of homochiral acetals using Lewis acid-hydride systems and of alkynyl acetals using organoaluminum reagents are described. Stereochemical outcomes are found to be the opposite compared with our previous results on the aluminum hydride reduction of the acetal.

Asymmetric Simmons-Smith reactions of α,β-unsaturated acetals derived from chiral dialkyl tartrate or (2 R ,4 R )-2,4-pentanediol are described. Treatment of the acetal with diethylzinc and methylene iodide gives a cyclopropane with high diastereoselectivity. The acetal group is readily transformed to the aldehyde or the ester group. In addition, the method is successfully applied to the enantioselective synthesis of 5,6-methanoleukotriene A4, a stable and selective inhibitor of leukotriene biosynthesis.

Reductive cleavages of homochiral acetals using Lewis acid-hydride systems and of alkynyl acetals using organoaluminum reagents are described. Stereochemical outcomes are found to be the opposite compared with our previous results on the aluminum hydride reduction of the acetal.

Introduction Small bowel adenocarcinoma is a rare malignancy associated with a poor prognosis and there is little evidence of effective treatment. Recurrent small bowel adenocarcinoma is an intractable disease for which there is little information available regarding its treatment by palliative therapy. We present a case of recurrent small bowel adenocarcinoma successfully treated by cytoreductive surgery and palliative chemotherapy. Case presentation We report the case of a 72-year-old Japanese female who developed a peritoneal metastasis from recurrent small bowel adenocarcinoma after curative resection and adjuvant chemotherapy with S-1 and polysaccharide K. She underwent cytoreductive surgery followed by chemotherapy with folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K. Subsequently, no sign of a recurrence was observed 42 months after the second operation. Conclusion To the best of our knowledge, this is the first case report of the successful treatment of peritoneal metastasis from small bowel adenocarcinoma by cytoreductive surgery and combination chemotherapy (folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K).

The numerical calculation of interfacial energy of the fcc-bcc interface has been carried out using a simple two-dimensional interaction potential energy. The results of the calculation for Ag/Mo and Ag/Fe systems by the new model are in good agreement with the experimental evidence, i.e., the Kurdjumov-Sachs orientation relationship and Nishiyama-Wassermann orientation relationship, respectively. Moreover, a prediction of the preferred orientation of epitaxy for various combinations can be made from the dependence of the interfacial energy on bulk atomic diameter ratio between fcc and bcc.