Ken Okamoto

A 57-year-old woman presented with a chief complaint of right lower abdominal pain. Abdominal radiography and plain abdominal computed tomography revealed a mass with extensive calcification. A colonoscopy demonstrated a 20-mm-sized mass lesion protruding into the intestinal lumen from the ileocecal valve’s lower lip. The mass was covered with normal mucosa without erosions. Endoscopic ultrasonography indicated that the tumor originated from or beneath the proper muscle layer. To treat the pain, eliminate the obstruction risk, and obtain a definitive diagnosis, the patient chose surgical resection. Laparoscopic-assisted ileocecal resection was performed under the diagnosis of a submucosal ascending colon tumor. Macroscopically, the tumor showed no gross epithelial abnormalities. However, it was filled with fecal material and had an orifice of approximately 3 mm on the proximal side of the tumor. Histopathologically, the cyst wall consisted of an entire colonic structure, and continuity was noted between the cystic lesion’s wall and the ascending colon’s wall, leading to a diagnosis of diverticular expansion due to fecal matter. No malignancies were detected. A diverticulum can collect feces and protrude into the colonic lumen, resembling colonic submucosal tumors with calcification. Although rare, this condition should be included in the differential diagnosis of colon tumors.

This study aimed to evaluate the efficacy of protein-bound polysaccharide K (PSK)-containing chemotherapy in patients with unresectable advanced or recurrent gastric cancer (AGC). We retrospectively analyzed 190 patients with AGC who received systemic chemotherapy including 69 patients who were treated with a PSK-containing regimen. Using propensity score matching, we obtained 62 matched patients in the S-1 and S-1 plus PSK groups for outcomes analysis. There was a tendency for overall survival to be higher in the S-1 plus PSK group than in the S-1 alone group. In particular, there was a tendency for overall survival in the S-1 plus PSK group to be higher in patients with a neutrophil/lymphocyte ratio (NLR)<2.2 than in patients with a NLR<2.2. There was a tendency for fewer changes in the NLR after the beginning of treatment in the S-1 plus PSK group than in the S-1 alone group. PSK-containing chemotherapy may contribute to improved treatment outcomes of AGC patients. In particular, it may be effective in patients with a high NLR. Further investigations, including a prospective randomized controlled trial, are expected to verify the mechanisms of interaction between cancer cells and the immunoreaction.

This report describes a case of recurrent gastric cancer successfully treated with S-1 oral administration. A 77-year old female patient underwent distal gastrectomy for gastric cancer, followed by adjuvant chemotherapy with tegafur-uracil (UFT). However, 1 year after surgical resection, recurrence in the lymph node of the hepatic hilum was diagnosed by abdominal computed tomography. The patient was treated with S-1 alone after refusing in travenous infusion chemotherapy. Three months after treatment, the size of the target lesion decreased significantly, and a complete response was seen on imaging examination during the 2 years of chemotherapy treatment. One year and 5 months after the discontinuation of chemotherapy, recurrence was noted again. Although supportive care was eventually provided to the patient, S-1 oral administration was resumed that resulted in tumor growth control for>6 months. In this patient, S-1 treatment was effective in tumor growth suppression without deteriorating the patient's quality of life (QOL). Further studies are needed to identify patients for whom S-1 therapy is optimal treatment.

Monoclonal antibodies against epidermal growth factor receptor (EGFR) are used in the treatment of advanced colorectal cancer. However, these agents can induce severe dermatological side effects that discourage their administration in patients with chronic dermatological disease. EGFR plays a key role in normal skin development and immunological function, and is expressed in various tissues and organs, although contrarily, it is overexpressed in psoriasis-related skin lesions. Thus, discussion is ongoing regarding the putative pathological role and therapeutic potential of this protein. We herein report on a patient with advanced colon cancer and concomitant long-standing psoriasis vulgaris who received anti-EGFR antibody monotherapy as a third-line treatment for metastatic disease. One week after the initiation of treatment, the patient’s skin lesions dramatically subsided and the improvement was sustained during therapy. Based on this case, we propose that anti-EGFR antibody therapy is not necessarily contraindicated in patients with psoriasis vulgaris. Moreover, the findings reaffirmed that EGFR is an important molecule in the pathology of psoriasis.

The management for the obstructive left sided colorectal cancer is still controversial. A retrospective study was performed on 249 consecutive patients who underwent surgical intervention for left sided colorectal cancer in our hospital. Among 36 patients who had colonic obstruction, 25 patients received tumor resection while the rest of the patients received palliative stoma creation. Clinical characteristics and outcome following tumor resection was compared between patients with and without colonic obstruction. Prior to tumor resection, all patients received colonic decompression. Flowingly, 20 patients received staged surgeries and five patients underwent one stage surgery, with three of the latter requiring reoperation due to anastomotic leakage. The five-year overall survival rate for patients following tumor resection was 75.5 % and 69.1 % for those with and without colonic obstruction respectively. Log-rank test showed no significant difference in overall survival between the two groups (p = 0.91). Onestage surgery for patients with obstructive colorectal cancer in our hospital was associated with frequent anastomotic leakage. Colonic obstruction itself may not be a poor prognostic factor when decompression preceded surgical resection.

In the present study, we aimed to evaluate the efficacy and safety of trastuzumab-containing regimens in patients with unresectable advanced or recurrent gastric cancer( AGC). We retrospectively analyzed 142 patients with AGC who received systemic chemotherapy, including 10 patients treated with trastuzumab-containing regimens. Among the 72 patients, 12 (16.7)% were human epidermal growth factor receptor 2 (HER2)-positive; the HER2-positive rate was significantly greater in patients with intestinal-type than diffuse-type histology( 29.0 vs 7.3%; p=0.014). The median overall survival of patients treated with trastuzumab was significantly longer than that of patients treated without trastuzumab( 22.9 vs 11.6 months; p =0.014). Seven patients continued receiving trastuzumab therapy after disease progression, and 6 patients were treated with trastuzumab after initial chemotherapy. The objective response rate of trastuzumab-containing regimens was 40%. The frequency of hematological and non-hematological toxicities was feasible. The administration of trastuzumab therapy after disease progression may contribute to improved treatment outcomes. However, further investigations, including prospective randomized controlled trials, are needed to verify this finding.

474 Background: Although theCapeOX (capecitabine+oxaliplatin) regimen obviates the need for a central venous port, administration of oxaliplatin through peripheral vein can cause venous pain. One of the reasons is pH. The pH level of oxaliplatin solution is about 4.8 and that of buffered by steroid is approximately 7.0. To test the hypothesis that adjusting the pH of oxaliplatin solution by mixing steroid can reduce venous pain, we have conducted the randomized control study to compare pH-adjusted oxaliplatin solution with unadjusted oxaliplatin solution. Methods: This was a single-blinded multicenter randomized phase II study. Colorectal cancer patients receiving oxaliplatin through peripheral vein were enrolled and randomly assigned to arm A (oxaliplatin 130 mg/m² with dexamethasone (DEX) 2 mg) or arm B (the same, without DEX) (UMIN000004286. Venous pain was evaluated according to CTCAE criteria (ver. 4.0) and the verbal rating scale (VRS). Assessments were conducted every 3 weeks until cycle 4. Results: A total of 53 patients (38 men and 15 women; median age, 67 y.o.) were enrolled at 9 institutions in Japan. Of these, 47 evaluable patients were randomized to either arm A (n = 24) or arm B (n = 23). The incidence of venous pain (grade ≥ 2) was 33.3% in arm A and 60.9% in arm B (relative risk 0.55; p = 0.082). The venous pain (VRS score ≥ 3) was 12.5% in arm A and 26.1% in arm B (relative risk 0.48; p = 0.286). No difference was observed in response rate and safety. Conclusions: Adjusting the pH of oxaliplatin solution by addition of a low dose of DEX reduced severe venous pain without influence on response rate and safety. Clinical trial information: UMIN000004286. [Table: see text]

A 61-year-old man on hemodialysis due to chronic renal failure caused by diabetes mellitus was diagnosed as having ascending colon cancer with multiple liver metastases. Colonoscopy revealed a Type 2 tumor located in the ascending colon. Abdominal CT showed hepatic tumors in S8 measuring 8×7 cm and in S6 measuring 5×4 cm, with a number of small tumors in the other sites. In order to prevent a hemorrhage from the colonic tumor, laparoscope-assisted right colectomy was performed. Seventeen days after the operation, oral administration of tegafur uracil(300mg/body/day)and calcium folinate(75mg/body/day)was initiated for the treatment of hepatic metastases. After three courses of treatment, size reduction of the hepatic metastases(the S8 4×3. 5 cm and the S6 2. 5×2. 5 cm)was obtained. Although nine months with seven courses of chemotherapy had passed without significant side effects, the size of hepatic metastases increased. Currently, therefore, CPT-11 and cetuximab are being administered as second-line treatment.

A 75-year-old man was referred to our department for the treatment of a gastric submucosal tumor-like protrusion which had gradually enlarged over 3 years. After examination with various types of imaging modalities, a splenic mass was diagnosed. Splenectomy was performed because it was difficult to determine preoperatively whether the splenic mass was benign or malignant. The postoperative pathological examination revealed a splenic hamartoma without malignancy. Despite the preoperative examination with advanced diagnostic imaging techniques and equipment, an accurate diagnosis of splenic hamartoma is difficult due to its rarity, lack of specific symptoms, and various inadequacies of radiological imaging techniques. Here we present a rare case of splenic hamartoma and discuss the clinical characteristics obtained from a review of Japanese cases of this rare condition.