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F-actin capping protein α1 subunit (CAPZA1) was previously identified in a proteomic analysis of human gastric cancer clinical specimens and selected for further study. The association between CAPZA1 overexpression, detected by immunohistochemistry, and clinicopathological features including survival were evaluated. In vitro gain-of-function and loss-of-function approaches were utilized to assess the function of CPAZA1 in malignancy. Univariate analysis revealed that poorly differentiated disease, according to the World Health Organization (WHO) classification, advanced T stage, positive lymph nodes, high TNM stage, D2 lymph node dissection, adjuvant chemotherapy and CAPZA1 underexpression were significantly associated with cancer-related death (p

The risk of recurrence after laparoscopy-assisted radical gastrectomy (LAG) was investigated. Clinical data of 398 consecutive patients who underwent radical gastrectomy with R0 resection for gastric cancer at Gyeongsang National University Hospital between January 2005 and December 2007 were reviewed retrospectively. Of the patients, 65.4% (n = 261) and 34.6% (n = 138) underwent LAG and open radical gastrectomy (OG), respectively. Of the LAG cases, 73.2% (n = 192), 10.7% (n = 28), 12.6% (n = 33), and 3.1% (n = 8) had stage I, II, III, and IV gastric cancer, respectively. All patients were followed up for a mean of 36.8 ± 13.7 months, and 14.6% (n = 58) had recurrence during the follow-up period. Univariate analysis revealed that tumor size, tumor–node–metastasis (TNM) stage, method of approach (LAG versus OG), and operation type were associated significantly with recurrence. Multivariate analysis revealed that only high TNM stage was significantly associated with recurrence (P = 0.00). While patients who underwent OG had higher incidence of recurrence than patients who underwent LAG, OG was not significantly associated with recurrence on multivariate analysis (P = 0.06). LAG and OG did not differ significantly in terms of recurrence, even when used in advanced gastric cancer cases. Multivariate analysis revealed that high TNM stage was significantly associated with recurrence. Thus, LAG appears to be a safe and feasible procedure that has the potential to be an alternative to open surgery, even for advanced gastric cancer.

This study investigated the factors affecting the length of the minilaparotomy incision (LOMI) in laparoscopy-assisted distal gastrectomy with Billroth I reconstruction. By using abdominal computed tomography scans, we measured the thickness of the rectus muscle (TRM), the thickness of the abdominal wall (TAW), and the distance from the gastroduodenal artery to the skin (GDAS) in 80 patients with early gastric cancer who had undergone surgery. There were positive correlations between the LOMI and body mass index (BMI), TRM, and TAW, and the LOMI increased significantly in patients with BMI > or =25 kg/m2, TAW > or =2.1 cm, and TRM > or =1.0 cm. These observations suggest that patients with two or more of the following clinical factors, BMI > or =25 kg/m2, TAW > or =2.1 cm, and TRM > or =1.0 cm, may require surgical procedures other than laparoscopy-assisted Billroth I, such as total laparoscopic intracorporeal Billroth I, Billroth II, or uncut Roux-en-Y reconstruction.

As more patients undergo diagnostic thyroid surgery, the development of posthemithyroidectomy hypothyroidism is becoming a major concern. We hypothesized that the preoperative thyrotropin (thyroid-stimulating hormone, TSH) level and ultrasonographically measured thyroid volume, both commonly available in thyroid nodule patients, may predict the development of posthemithyroidectomy hypothyroidism. Among the 132 patients who underwent hemithyroidectomy from January 2004 to January 2006, a total of 101 patients who were followed for more than a year were included in the analysis. Biochemical hypothyroidism developed in 37 patients (36.6%). Patients who developed postoperative hypothyroidism showed higher TSH levels (P

Sentinel-node navigation surgery (SNNS) for breast cancer and melanoma has been accepted as a reasonable oncologic surgery worldwide. On the other hand, in gastric cancers that do metastasize well to the lymph node, the use of SNNS has been approached with care and performed in only limited cases. Some obstacles still have to be overcome, such as the shortcomings of SN tracers and the technical limitations of laparoscopic SN detection. The aims of this study were to determine whether laparoscopic SNNS is possible, and which biopsy method is more suitable for SN tracers, in gastric cancer, preoperatively diagnosed asor =T2 and withor =4-cm-sized lesions.Between January 2005 and October 2006, 92 consecutive patients that underwent LSNNS, using a combined indocyanine green and (99m)Tc-labeled tin colloid technique, were prospectively studied. SNs were laparoscopically removed by using two biopsy methods: a basin dissection and pick-up method, with the results of these two SN biopsy methods then compared with the final diagnosis obtained from a permanent section.With the pick-up method, SNs were identified in 23 of 42 patients (54.8%); however, with basin dissection, the detection rate was 96% (48 of 50 patients). The average number of SNs detected by the two methods were 2.1 (range, 0-4) and 3.5 (range, 1-7), respectively. The sensitivities of the two methods were 66% (4/6) and 85.7% (12/14), with specificities of 100% (17/17) and 100% (34/34), respectively.In gastric cancer, it was possible to perform LSNNS. At this moment, we believe the laparoscopic basin dissection technique with a dual-tracer injection, followed by SN detection on the back table, will be a reasonable procedure for gastric cancer, owing to the shortcomings related to the dye and radioisotope, the so-called "stained lymphatic duct only" and "shine-through phenomenon."

Obesity is closely related to the development of colorectal cancer as well as other metabolic complications. We investigated the prognostic significance of visceral obesity and body mass index (BMI) in 161 resectable colorectal cancer patients. Ratios of visceral fat area (VFA) to subcutaneous fat area (SFA) were measured from the digital images of patients’ computed tomography taken before the surgery, and patients were divided into those with high and those with low VFA/SFA ratio according to the degree of proportional visceral adiposity, and into an overweight and a normal-weight group according to their preoperative BMI. The overweight group showed a borderline decrease in cumulative disease-free survival compared to the normal-weight group (P = 0.064). Patients with high VFA/SFA ratio (more than 50 percentiles) had significantly lower cumulative disease-free survival rate compared to patients with low VFA/SFA ratio (P = 0.008). BMI and visceral adiposity showed no influence on overall survival of patients. Increased visceral adiposity was a significant predictor of disease-free survival in patients with resectable colorectal cancer. The prognostic significance of visceral adiposity should further be determined in a larger set of patients.

The use of ultrasonography (USG) has become an essential part of endocrine surgical practice. We evaluated the value of USG in predicting malignancy of thyroid nodules. The accuracy of USG in 857 patients who underwent fine-needle aspiration (FNA) with or without surgery was analyzed in a prospective setting. The diagnostic accuracy of USG was compared to that of FNA and of combined models in 153 operated patients. The malignancy-predicting value of USG in follicular neoplasms and its relation to nodule size were also investigated. Sensitivity, specificity, and overall accuracy (OA) of USG were 84.9%, 95.5%, and 93.7%, respectively. In operated patients, USG had accuracy comparable to that of FNA and combined models (sensitivity 93.3%, specificity 90.6%, OA 92.0%) regardless of nodule size but showed a significant rate of indeterminate results (29.4%). For follicular neoplasms, the sensitivity, specificity, and OA of USG were 100%, 95.4%, and 96.1%, respectively, with indeterminate results for three malignant nodules (42.8%). This acceptable malignancy-predicting value of USG in thyroid nodules supports the potential role of USG for predicting malignancy in selected patients with thyroid nodules. However, the high rate of indeterminate results precludes it from being a standard independent diagnostic method for the present time.

Gastric cancer is one of the most common cancers worldwide. The purpose of this study was to find out potential markers for gastric cancer. Tumor and normal tissues from 152 gastric cancer cases were analyzed by two-dimensional gel electrophoresis (2-DE). The images of silver stained gels were analyzed and statistical analysis of spot intensities revealed that spot 4262 showed higher expression (5.7-fold increase) in cancer tissues than in normal tissues (P ＜0.001). It was identified by peptide mass fingerprinting as nicotinamide N-methyltransferase (NNMT). A monoclonal antibody with a detection limit down to 10 ng was produced against NNMT in mouse. Using the prepared monoclonal antibody, western blot analysis of NNMT was performed for gastric tissues from 15 gastric cancer patients and two gastric ulcer patients. The results corroborated those of 2-DE experiments. A single spot was detected in gastric ulcer tissues while four to five spots were detected in gastric cancer tissues. In cancer tissues, two additional spots of acidic and basic form were mainly detected on 2-DE gels. This suggests that NNMT receives a post-translational modification in cancer- specific manner.

We herein report a rare case of myositis ossificans originating from the abdominal rectus muscle, found in a 38-year-old woman who presented with a left upper abdominal mass. The mass was initially suspected to be a malignant neoplasm because no history of either operation or trauma existed for this patient. Moreover, the location of the mass was unusual and the enhancement patterns of the dynamic magnetic resonance images were similar to that of a malignant tumor. Based on the radiologic findings, a surgical exploration was performed. A well-circumscribed mass, which measured 3.2 x 2 cm, was found in the rectus muscle. Microscopic findings showed a typical zonal pattern with a fibroblastic central zone and a zone of ossification at the periphery. Although abdominal myositis ossificans is extremely rare, it is one of the causes of abdominal mass lesions and can be mistaken for a malignant tumor. Therefore, a thorough knowledge of the evolution of myositis ossificans is necessary and in cases with malignant suggestion on magnetic resonance imaging, like that seen in our case, we suggest that a surgical excision may be necessary for both the diagnosis and treatment.

The intraoperative assessment of lymph node status is important when performing limited surgery in gastric cancer patients. Currently available techniques for this assessment are frozen section, imprint cytology, and other molecular methods; most current studies use the frozen-section method. In the present study, we focused on the accuracy and feasibility of imprint cytology as a tool to assess lymph node status intraoperatively in gastric cancer surgery.Between April 2001 and March 2003, we performed imprint cytology of the sentinel nodes in 260 consecutive patients. After review by an experienced cytopathologist, the sensitivity, specificity, and overall accuracy of the method were determined.The time required for the intraoperative imprint cytology was 8 min, and the sensitivity, specificity, and overall accuracy were 52.2%, 88.8%, and 73.8%, respectively.Imprint cytology could be a useful technique for the assessment of lymph node status intraoperatively if the sensitivity and specificity can be improved to an acceptable level.

In advanced gastric cancer, laparoscopic management has been associated with trocar-site recurrence, even though laparoscopy-assisted gastrectomies have reported positive results to treat early-stage gastric cancer in the world. There are no reports of port-site recurrence after laparoscopic gastrectomy in the literature. In this paper, we present a case report of advanced gastric cancer with port-site recurrence 12 month after the initial operation. A wide excision of this recurrence was performed. Otherwise, the evaluation of metastasis in other sites remained negative at 18 months after the original operation. The laparoscopic surgeon should be aware of trocar-site recurrence when dealing with advanced gastric cancer.

The current widespread use of modern mammography has increased the detection of suspicious mammographic lesions, which has led to a greater number of diagnostic surgical biopsies. Most of these lesions referred for surgical biopsy have been benign. The reduction in the number of benign surgical biopsies can reduce medical costs and unnecessary invasive breast surgery. Stereotactic large-core needle biopsies in patients with suspicious mammographic lesions can preselect the breast lesions that need further evaluation with surgical excisional biopsy. Our results with stereotactic large-core needle biopsies support this alternative approach to the workup of suspicious mammographic lesions.

Seventy-one ductal carcinoma in situ (DCIS) patients were reported to the tumor registry at the National Naval Medical Center between 1986 and 1995. This number represents 6.5% of all breast cancer patients. We did not include the patients with microinvasion or infiltrating ductal carcinoma with extensive DCIS in this study. After excluding 16 cases because of inaccessable clinical records, 55 cases of pure DCIS were analyzed. The mean age at presentation was 52.0 years (32 year-old to 74 year-old) and the most common clinical feature was an abnormal mammographic finding (40 cases, 73%). Family history of breast cancer was positive in 14 cases among the 39 cases with DCIS (35.9%) according to the medical records. Total mastectomy was the most common form of treatment for DCIS (19 cases, 34.5%) during this period, followed by modified radical mastectomy, lumpectomy only, lumpectomy with radiation therapy. Three hundred and two axillary lymph nodes were examined but revealed no nodal metastasis. Comedo type DCIS was the most common subtype (21 cases, 38.2%). There were no local recurrences or DCIS related deaths reported to the tumor registry during this period (mean follow-up interval of 51 months).

Background Aberrant DNA hypermethylation plays a pivotal role in carcinogenesis and disease progression; therefore, accurate measurement of differential gene methylation patterns among many genes is likely to reveal biomarkers for improved risk assessment. We evaluated the gene hypermethylation profiles of primary breast tumors and their corresponding normal tissues and investigated the association between major clinicopathological features and gene hypermethylation. Methods A single reaction using methylation-specific multiplex ligation-dependent probe amplification was used to analyze the DNA methylation status of 24 tumor suppressor genes in 60 cancerous tissues and their corresponding normal tissues from patients with primary breast cancer. Results In cancerous breast tissues, 21 of 24 genes displayed promoter methylation in one or more samples. The most frequently methylated genes included RASSF1 (43.3%), APC (31.7%), CDKN2B (25.0%), CDH13 (23.3%), GSTP1 (16.7%), and BRCA1 (10%). APC was associated with lymph node metastasis, and BRCA1 was associated with negative estrogen receptor and negative progesterone receptor expression. In normal breast tissues, 8 of 24 tumor suppressor genes displayed promoter hypermethylation; CDKN2B (28.3%) and RASSF1 (8.3%) hypermethylation were most frequently observed. Conclusions RASSF1 and CDKN2B hypermethylation in Korean breast cancer patients were the most frequent in cancerous tissue and corresponding normal tissue, respectively. Our data indicates that methylation of specific genes is a frequent event in morphologically normal breast tissues adjacent to breast tumors as well as the corresponding breast cancers. This study also suggests that gene methylation is linked to various pathological features of breast cancer; however, this requires confirmation in a larger study.

Intrahepatic cholangiocarcinoma (ICC) is a rare primary malignant liver tumor with an extremely poor prognosis. Recently its incidence has increased, however, little attention has been directed to factors related to its molecular carcinogenesis, including oncogenes, tumor suppressor genes and cell cycle-related proteins. ICC is generally characterized by strong proliferation, invasion and early metastasis. These biological behaviors of ICC, with respect to the genetic and molecular aspects, remain to be clarified. In this study, we performed a proteomic analysis to identify the proteomic alterations associated with carcinogenesis of ICC. Protein expression profiles of sixteen cases of ICC were compared with those of adjacent non-involved bile duct tissue. Among the 151 protein spots that showed a statistically significant expression difference (P

Although natural orifice extraction is now widely performed, there have been no reports of this procedure following subtotal gastrectomy for gastric cancer. This report describes trans-vaginal specimen extraction in four patients with early gastric cancer. The clinical data of four patients with early gastric cancer were reviewed. Totally laparoscopic subtotal gastrectomy and D1 + β lymph node dissection was performed using five trocars and a conventional procedure. Posterior colpotomy was performed by an experienced gynecologist, who retrieved the specimens in a retrieval bag via the trans-vaginal route. The colpotomy site was repaired immediately following specimen removal. Reconstruction was performed using the intracorporeal Billroth II method and an endo-GIA 60. Totally laparoscopic subtotal gastrectomy and trans-vaginal specimen extraction was successfully accomplished in all patients without intraoperative complications. The present technique may be a safe and feasible operative procedure for some limited groups of elderly female patients with early gastric cancer.

This retrospective study determined whether extracorporeal esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer can be considered minimally invasive surgery, compared to the conventional open total gastrectomy (OTG).This retrospective study involved 60 patients seen between January 2004 and July 2006. Twenty-seven patients underwent LATG, and 33 patients had OTG. The surgical procedure included the use of five ports with an upper vertical midline incision. In all patients, reconstruction was performed by using a Roux-en-Y esophagojejunostomy through the minilaparotomy site. In all cases, the jejunojejunostomy was performed extracorporeally as the conventional method. In OTG, a Roux-en-Y esophagojejunostomy was performed with an upper midline incision.The mean number of retrieved lymph nodes was smaller and the mean operating time was longer in the LATG group. The postoperative hospital course was similar in both groups. In the LATG group, the mean length of the minilaparotomy incision was 8.0+/-1.2 cm (maximum length, 11 cm), and a direct relationship was observed between the distance from the xiphoid process to the esophageal hiatus (DisXE) and the minilaparotomy incision length (Spearman's correlation of rank coefficient: 0.386; P=0.046).With the concept of minimal invasiveness, if the patient's DisXE exceeds 9 cm, the length of the minilaparotomy incision in laparoscopic surgery could be disadvantageous. Nevertheless, we consider LATG the treatment of choice for early gastric cancer. If the patient's DisXE exceeds 9 cm, we consider intracorporeal anastomosis with the laparoscopic total gastrectomy. The type of esophagojejunostomy may be determined preoperatively by using three-dimensional abdominal computed tomography.

We have recently developed an endoscopic thyroidectomy using a gasless axillary approach and report the surgical outcome of the procedure.The gasless axillary approach was performed through a 3-cm axillary incision using a retractor instead of carbon dioxide insufflation. We performed a total of 35 thyroidectomies using this technique in patients with benign thyroid nodules.Thirty-four cases were successfully completed with the gasless axillary approach; one case had to be converted to a conventional technique after intraoperative frozen section revealed papillary carcinoma. The mean operative time and mean hospital stay were 180.6 +/- 54.5 minutes and 7.1 +/- 0.9 days, respectively. The mean tumor size was 2.9 +/- 1.4 cm. There were three minor postoperative complications: one case each of wound seroma, transient voice change, and persistent wound pain. All patients were satisfied with the cosmetic result. The axillary scars were not visible when the ipsilateral arms were in their natural position.Endoscopic thyroidectomy using a gasless axillary approach is a safe procedure that offers a good cosmetic result and has the merits of minimal invasiveness even in patients with a large thyroid mass. It is a safe and feasible alternative to traditional thyroid surgery, especially in young female patients with a large thyroid mass.

Understanding the molecular background of breast cancer biology is critical in developing new biomarkers for earlier diagnosis and more optimized treatment. We performed a proteomic analysis of human breast carcinoma tissues to investigate the tumor-specific protein expression in breast carcinoma. Using 2-dimensional electorphoresis (2-DE) and matrix-assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS), we were able to identify a list of proteins which are upregulated in cancerous tissue. There was significant increase of galectin-1 expression in all cancerous tissues compared to noncancerous tissues, and its increased expression was further confirmed by western blot immunostaining. Subsequent immunohistochemical staining against galectin-1 in 105 breast cancer specimens showed significant correlation between galectin-1 expression in cancer-associated stromal cells and tumor invasiveness, T stage, TNM stage, and axillary lymph node metastasis. Galectin-1 expressionin cancer cells showed no correlation to above-mentioned pathologic variables. Hormonal receptor status and galectin-1 expression showed no correlation. This study demonstrates the upregulation of galectin-1 in breast carcinoma tissues and the clinical significance of galectin-1 in breast cancer patients. Our data supports the recently highlighted roles of galectin-1 in cancer-associated stroma and in tumor immune privilege. © 2006 Wiley-Liss, Inc.

Billroth I gastroduodenostomy is an anastomotic procedure used widely after gastric resection for distal gastric cancer. As laparoscopy-assisted distal gastrectomy (LADG) gains increasing popularity, various techniques of laparoscopic gastroduodenal anastomosis are being introduced.To investigate the feasibility and benefit of their novel surgical technique of intracorporeal Billroth I stapled anastomosis using a hand access device (IBISA-HAD), the authors performed LADG using IBISA-HAD for 23 patients with distal gastric cancer and LADG using minilaparotomy Billroth I stapled anastomosis (MLBISA) for 10 patients.The time required for the anastomosis procedure of IBISA-HAD was 45.5 +/- 12.0 min, and the operative time, perioperative transfusion, and hospital stay were not significantly different between IBISA-HAD and MLBISA. The IBISA-HAD procedure provided a markedly enhanced vision of the stapling process, leading to less wound retraction and extension than MLBISA.The IBISA-HAD technique can provide a markedly enhanced view of the stapling procedure with the help of a current state-of-art laparoscopy system. The authors believe that this novel technique can guide an accurate laparoscopic anastomosis for the surgeon dealing with obese patients who have distal gastric cancer.

A malignant peripheral nerve sheath tumor (MPNST) is a rare neoplasm arising from peripheral nerve sheath. Here, we report the first case of MPNST arising in the colon and also the youngest case of MPNST in the gastrointestinal tract. The patient was a 2-day-old neonate with symptoms and signs of intestinal obstruction. The patient had no family history or stigmata of neurofibromatosis type 1. A computed tomographic scan revealed a 5-cm-sized mass in ascending colon causing intestinal obstruction, and emergent right hemicolectomy was performed. The microscopic examination showed atypical spindle cells with hyperchromatic nuclei and high mitotic activity. The results of immunohistochemical staining, which showed positivity for S-100 and vimentin as well as negativity for smooth muscle actin, CD34, and c-Kit, supported the final diagnosis of MPNST. Genetic analysis of the patient revealed no abnormalities. After surgery, the patient recovered uneventfully and has been free of the disease for 17 months.

We examined the possible alteration of circulating transforming growth factor-beta1 (TGF-beta1) concentrations in a time-dependent fashion in human plasma. Plasma TGF-beta1 was measured three times at 2 week-intervals from each of 12 healthy participants. Platelet factor 4 (PF4) was measured in parallel with TGF-beta1 to estimate the degree of platelet degranulation. TGF-beta1 levels of the second and third plasma samples, in which PF4s were measured asapproximately 1000 IU/ml, were relatively low and fell in a narrow range. However, TGF-beta1 levels of the first samples, in most of which PF4s wereapproximately 1000 IU/ml, appeared much higher and more variable than those of the second or third samples. These results indicate that the platelet degranulation accounted for the higher TGF-beta1 levels in the first samples, and thus did not support our initial assumption. We, nevertheless, could propose a useful guidance in the assessment of TGF-beta1 levels in plasma. When the PF4 level is measured asapproximately 1000 IU/ml under our assay conditions, the TGF-beta1 level in a given plasma sample might be accepted as a reliable value considering the effect of platelet degranulation on TGF-beta1 level.

In cases of early gastric cancer (EGC), the depth of tumor invasion and histologic type are important factors in its prognosis. To predict the depth of invasion and histologic type by a double-contrast barium study of the stomach, 304 consecutive patients with EGC were analyzed, comparing barium study with pathologic findings. We predicted the depth of invasion and histologic type according to the lesion size, surface pattern, and surrounding mucosal pattern. The depth of tumor invasion was correctly diagnosed in 65.3% (66 of 101) of cancers limited to the mucosal layer (m), and in 59.1% (110 of 186) of cancers which have invaded to the submucosal layer (sm). The histologic type was correctly predicted in 78.9% (56 of 71) of a differentiated adenocarcinoma, and 73.1% (57 of 78) of an undifferentiated adenocarcinoma. Prediction of the depth of tumor invasion and histologic type was promising and showed good correlation to the pathologic findings.

2 65-year-old woman reported vague discomfort and pain n her upper abdomen and chest with migratory pain and ensed a mobile lump, mainly in the sternal and epigastric rea, lasting for 5 years. Physical examination showed no bnormalities, but her right breast had a 4-cm irregular ard mass she had not noticed before the examination. CT can of the abdomen, performed to rule out intraabdomial pathology, showed no significant abnormalities in the bdomen, but showed multiple tubular structures and enanced surrounding mammary tissue at the lower inner uadrant of her right breast (A, arrow). Mammography showed tubular density without calcifiation in her right lower inner breast (B, arrows). Breast ltrasonography showed multifocal tubular structures and iffuse increased background echogenecity (C). These imge results and the patient’s history of eating poorly cooked rogs and snakes during her childhood suggested the diagosis of breast sparganosis with parasite-induced mastitis, ather than true breast neoplasm. Direct surgical removal, nstead of percutaneous needle biopsy, was chosen to diagose and treat her breast mass. At operation, the palpable breast mass was removed, and uring the dissection, tapeworms were visually identified.The esected specimen revealed multiple spargana within the inlammatory mammary tissue (D). Microscopic evaluation howed infiltration of inflammatory cells including neutrohils and eosinophils. The patient’s symptoms disappeared fter the removal of the breast sparganosis. Cases of human sparganosis are reported worldwide, but