Carcinosarcoma of the stomach is a rarely occurring malignant biphasic tumor that consists of both carcinomatous and sarcomatous components simultaneously in a single tumor. The common carcinoma component is tubular or papillary adenocarcinoma and the mesenchymal sarcomatous components are variable and these include leiomyosarcoma, rhabdomyosarcoma, osteosarcoma and chondrosarcoma. However, neuroendocrine carcinomatous differentiation in the carcinomatous component is extremely rare. We present here a rare gastric carcinosarcoma that demonstrated neuroendocrine carcinomatous and leiomyosarcomatous differentiation in a 47-year-old man.
Jang K‐S, Song Y S, Jang S‐H, Min K‐W, Na W, Jang S M, Jun Y J, Lee K H, Choi D & Paik S S (2010) Histopathology 56, 229–239 Clinicopathological significance of nuclear PTEN expression in colorectal adenocarcinoma Aims: Tumour suppressor phosphatase and tensin homologue ( PTEN ) is an important negative regulator for the PIP3/Akt signalling pathway that promotes cell proliferation and inhibits apoptosis. Inactivation of PTEN by mutation, deletion and promoter hypermethylation has been demonstrated in a range of cancers. The aim was to investigate whether the loss of nuclear PTEN protein expression correlates with conventional clinicopathological parameters and patient survival. Methods and results: Immunohistochemistry staining for PTEN was performed on a tissue microarray of 19 samples of normal colonic mucosa, 14 adenomatous polyps, 482 adenocarcinomas and 56 metastatic lymph nodes. All 19 normal colonic mucosa samples (100%) were positive and 12 (85.7%) out of 14 adenomatous polyps were positive for PTEN. However, only 241 (50.0%) of the 482 colorectal adenocarcinomas and 26 (46.4%) of the 56 metastatic lymph nodes were positive for PTEN. Loss of PTEN expression was related to defective mismatch repair protein expression and colonic localization rather than rectal localization. On univariate survival analysis, patients with PTEN− adenocarcinoma revealed a poor overall and disease‐free survival ( P = 0.030 and P = 0.046, respectively). On multivariate analysis, a significant difference was observed in patients with stage II cancer that was not observed in other stages. Conclusions: Nuclear PTEN expression gradually decrease during the normal–adenoma–adenocarcinoma–metastasis sequence, which suggests an important role for PTEN in carcinogenesis. Moreover, loss of nuclear PTEN expression was a marker of poor clinical outcome in patients with stage II colorectal cancer.
Microsatellite-unstable (MSI) cancers have distinct genetic and clinical features from microsatellite-stable cancers, but the molecular functional differences between MSI cancers originating from different tissues or organs have not been well studied because the application of usual differentially expressed gene (DEG) analysis is error-prone, producing too many noncancer-specific normally functioning genes. To maximize therapeutic efficacy, biomarkers reflecting cancer-specific differences between MSI cancers of different tissue origins should be identified. To identify functional differences between MSI colon and endometrial cancers, we combined DEG analysis and biclustering instead of DEG analysis alone and refined functionally relevant biclusters reflecting genuine functional differences between the 2 tumors. Specifically, using The Cancer Genome Atlas and genome-tissue expression as data sources, gene ontology (GO) enrichment tests were performed after routinely identifying DEGs between the 2 tumors with the exclusion of DEGs identified in their normal counterparts. Cancer-specific biclusters and associated enriched GO terms were obtained by biclustering with enrichment tests for the preferences for cancer type (either colon or endometrium) and GO enrichment tests for each cancer-specific bicluster, respectively. A novel childness score was developed to select functionally relevant biclusters among cancer-specific biclusters based on the extent to which the enriched GO terms of the biclusters tended to be child terms of the enriched GO terms in DEGs. The selected biclusters were tested using survival analysis to validate their clinical significance. We performed multiple sequential analyses to produce functionally relevant biclusters from the RNA sequencing data of MSI colon and endometrial cancer samples and their normal counterparts. We identified 3066 cancer-specific DEGs. Biclustering analysis revealed 153 biclusters and 41 cancer-specific biclusters were selected using Fisher exact test. A mean childness score over 0.6 was applied as the threshold and yielded 8 functionally relevant biclusters from cancer-specific biclusters. Functional differences appear to include gland cavitation and the TGF-β receptor, G protein, and cytokine pathways. In the survival analysis, 6 of the 8 functionally relevant biclusters were statistically significant. By attenuating noise and applying a synergistic contribution of DEG results, we refined candidate biomarkers to complement tissue-specific features of MSI tumors.
ABSTRACT Background and aim: Survivin, an antiapoptotic protein, is involved in both the control of the cell division and the inhibition of apoptosis. The regulation of apoptotic cell death may have a profound effect on the carcinogenesis and progression of colorectal cancer. This study was designed to evaluate the survivin expression in colorectal tissues and to investigate whether the survivin expression is associated with the clinicopathologic characteristics and the patient survival. Methods: Immunohistochemical analysis of survivin was performed using the tissue microarrays of 622 colorectal tissue samples from 529 colorectal adenocarcinomas, 40 normal mucosa, 34 adenomatous polyps, and 59 metastatic lymph nodes. Results: Normal colorectal mucosa were completely negative for survivin (0/40, 0%), but survivin was expressed in adenomatous polyps (8/34, 23.5%), adenocarcinomas (327/529, 61.8%), and metastatic lymph nodes (27/59, 45.8%). In the analyses between the survivin expression and clinicopathologic parameters, the survivin expression was correlated with tumor location in colon ( P = 0.026), lymph node metastasis ( P = 0.003) and American Joint Committee on Cancer (AJCC) stage ( P = 0.040). The patient survival was significantly associated with age, histologic grade, AJCC stage, and lymphovascular invasion. On stage wise analyses of patient survival, the survivin expression was significantly correlated with overall survival ( P < 0.001) and disease free survival ( P < 0.001), especially in stage II colorectal adenocarcinomas. Conclusions: The results suggest that the survivin expression is a relatively frequent early event of colorectal carcinogenesis and may play an important role in the adenoma‐carcinoma transition sequence. Survivin expression provides important prognostic information and an apoptosis‐based therapeutic target in colorectal adenocarcinomas.
Purpose: Traditionally, an interval of 4 to 6 weeks has been recommended after prostate biopsy before open radical prostatectomy.However, such an interval is not explicitly specified in robot-assisted laparoscopic radical prostatectomy (RALP).This study was designed to determine whether the interval from prostate biopsy to RALP affects surgical difficulties.Materials and Methods: Between January 2008 and May 2009, a total of 237 men underwent RALP in our institution.The interval from biopsy to RALP was categorized as follows: ≤ 2 weeks, ＞2 to ≤ 4 weeks, ＞4 to ≤ 6 weeks, ＞6 to ≤ 8 weeks, and ＞8 weeks.Multivariate analysis was used to identify whether the interval from prostate biopsy to RALP was an independent predictor of operative time, estimated blood loss (EBL), margin positivity, continence, and potency.Results: Among the 5 groups, there were no significant differences in age, body mass index (BMI), preoperative serum prostate-specific antigen (PSA), prostate volume, or preoperative International Index of Erectile Dysfunction-5 score (all p＞0.05).In the multivariate analysis, operative time was significantly associated with prostate volume.EBL was associated with prostate volume and BMI.Margin positivity was associated with preoperative serum PSA, prostate volume, and biopsy Gleason score.Postoperative continence and potency were significantly associated with age.However, in univariate and multivariate analyses, the interval from biopsy to RALP was not significantly associated with operative time, EBL, margin positivity, postoperative continence, or potency (all p＞0.05).Conclusions: Our data suggest that the interval from prostate biopsy to RALP is not related to surgical difficulties.
Background:The study aimed to compare the efficiency and safety of transurethral enucleation with bipolar (TUEB) and holmium Laser enucleation of the Prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH). Method:The study was retrospectively analyzed with 132 patients who underwent TUEB (n=53) and HoLEP (n=79) between May 2017 and December 2021.To evaluate the changes of pre-and postoperative urinary symptoms, we measured the peak flow rate (Qmax, mL/s), post-voided residual volume (PVR, mL) and International Prostate Symptom Score (IPSS).In addition, we statistically conducted the resected weight (g), resection time (min), resection efficiency (g/min) by the prostate weight into ＜50, 50-80 and ＞80 g groups.The urinary catheter reinsertion, urinary tract infection, bladder neck contracture, incontinence, bladder injury and change in hemoglobin correlated with postoperative complications were analyzed. Results:The mean age was 71.0±7.4 years for TUEB group and 71.4±7.4 years for HoLEP group.Prostate resected weight, resection time, and resection efficiency were 46.9±22.1 g, 59.6±30.9min, 0.81±0.11g/min in TUEB group respectively and were 49.7±25.9g, 46.7±25.9min, 0.79±0.12g/min in HoLEP group respectively.The resection efficiency had better outcome in TUEB group (0.86±0.12 g/min) than that of HoLEP group (0.67±0.08 g/min) in Subgroup 1 (prostate weight ＜50 g).In both group, there was pronounced improvement in the IPSS, Qmax and PVR at 3 months after surgery.Any patient was not needed for blood transfusion. Conclusion:Our study suggested that TUEB was not inferior to HoLEP in resection efficiency and postoperative outcome.Also, it may be the best consideration for surgical treatment with BPH patients, especially those with a prostate less than 50 g.
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