• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.76-84
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• 1999

The differentiation between malignancy-related ascites(MRA) and non-malignant ascites (NMA) is important for further diagnostic and therapeutic purposes. Although many parameters were investigated, none has provided a complete distinction between MRA and NMA. We investigated several ascitic fluid parameters to determine the differential power, and to differentiate malignant-related from nonmalignant-related ascites with a sequence of sensitive parameters followed by specific parameters. For the present study, 80 patients with ascites were divided into two groups: MRA and NMA, The MRA group was consisted of 27 patients with proven malignancy by image study, biopsy, and follow up: 21 of these patients had peritoneal carcinomatosis, but the remaining 6 showed no evidence of peritoneal carcinomatosis. The NMA group was consisted of 53 patients with no evidence of malignancy: among these patients, one had SLE, and others had liver cirrhosis, The samples of blood and ascites were obtained simultaneously, and then the levels of ascites cholesterol, CEA. protein and LDH, cytology, albumin gradient, ascites/serum concen-tration ratios of LDH(LDH A/S), and ascites/serum concentration ratios of protein(protein A/S) were measured. Applying cut-off limits for determined parameters, we estimated the diagnostic efficacy of each parameter, Among the eight parameters investigated, ascites fluid cholesterol yielded the best sensitive value of 93%(cut-off value 30mg/dl), and cytologic examination and the protein A/S(cut-off value 0.5) showed the most specific value of 100% and 96%, respectively. Based on the above results, the diagnostic sequence with cholesterol as a sensitive parameter followed by the combination of cytologic examination and protein A/S as specific parameters, was tested in 80 patients. This diagnostic sequence identified 81.5% of patients with malignancy, and all patients with peritoneal carcinomatosis were classified as malignancy-related ascites. In spite of many limitations, this proposed diagnostic sequence may permit a cost-effective and simple differentiation of malignancy-related ascites from nonmalignant ascites.

• Journal of Gastric Cancer
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• v.19 no.3
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• pp.301-314
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• 2019

Purpose: Peritoneal carcinomatosis in gastric cancer (GC) patients results in extremely poor prognosis. Malignant ascites samples are the most appropriate biological material to use to evaluate biomarkers for peritoneal carcinomatosis. This study identified exosomal MicroRNAs (miRNAs) differently expressed between benign liver cirrhosis-associated ascites (LC-ascites) and malignant gastric cancer-associated ascites (GC-ascites), and validated their role as diagnostic biomarkers for GC-ascites. Materials and Methods: Total RNA was extracted from exosomes isolated from 165 ascites samples (73 LC-ascites and 92 GC-ascites). Initially, microarrays were used to screen the expression levels of 2,006 miRNAs in the discovery cohort (n=22). Subsequently, quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) analyses were performed to validate the expression levels of selected exosomal miRNAs in the training (n=70) and validation (n=73) cohorts. Furthermore, carcinoembryonic antigen (CEA) levels were determined in ascites samples. Results: The miR-574-3p, miR-181b-5p, miR-4481, and miR-181d were significantly downregulated in the GC-ascites samples compared to the LC-ascites samples, and miR-181b-5p showed the best diagnostic performance for GC-ascites (area under the curve [AUC]=0.798 and 0.846 for the training and validation cohorts, respectively). The diagnostic performance of CEA for GC-ascites was improved by the combined analysis of miR-181b-5p and CEA (AUC=0.981 and 0.946 for the training and validation cohorts, respectively). Conclusions: We identified exosomal miRNAs capable of distinguishing between non-malignant and GC-ascites, showing that the combined use of miR-181b-5p and CEA could improve diagnosis.

• Journal of Gastric Cancer
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• v.24 no.3
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• pp.246-256
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• 2024

Purpose: Peritoneal carcinomatosis (PC) presents a major challenge in the treatment of late-stage, solid tumors, with traditional therapies limited by poor drug penetration. We evaluated a novel hyperthermic pressurized intraperitoneal aerosol chemotherapy (HPIPAC) system using a human abdominal cavity model for its efficacy against AGS gastric cancer cells. Materials and Methods: A model simulating the human abdominal cavity and AGS gastric cancer cell line cultured dishes were used to assess the efficacy of the HPIPAC system. Cell viability was measured to evaluate the impact of HPIPAC under 6 different conditions: heat alone, PIPAC with paclitaxel (PTX), PTX alone, normal saline (NS) alone, heat with NS, and HPIPAC with PTX. Results: Results showed a significant reduction in cell viability with HPIPAC combined with PTX, indicating enhanced cytotoxic effects. Immediately after treatment, the average cell viability was 66.6%, which decreased to 49.2% after 48 hours and to a further 19.6% after 120 hours of incubation, demonstrating the sustained efficacy of the treatment. In contrast, control groups exhibited a recovery in cell viability; heat alone showed cell viability increasing from 90.8% to 94.4%, PIPAC with PTX from 82.7% to 89.7%, PTX only from 73.3% to 74.8%, NS only from 90.9% to 98.3%, and heat with NS from 74.4% to 84.7%. Conclusions: The HPIPAC system with PTX exhibits a promising approach in the treatment of PC in gastric cancer, significantly reducing cell viability. Despite certain limitations, this study highlights the system's potential to enhance treatment outcomes. Future efforts should focus on refining HPIPAC and validating its effectiveness in clinical settings.

• Journal of Yeungnam Medical Science
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• v.26 no.2
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• pp.114-119
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• 2009

Colon cancer is the second most common malignancy in Korea. It is classified as superficial type, the mass type, the ulcerative type, the ulceroinfiltrative type, the diffuse infiltrative type and the unclassified type according to the colonoscopic findings. We report here on a case of colon cancer that was initially misdiagnosed as acute infectious colitis at the initial presentation. A 64-year-old man visited to Yeungnam University Hospital for watery diarrhea and lower abdominal pain. Colonoscopy revealed long segmental edematous mucosa and hyperemic mucosa with stenosis in the transverse colon. He was diagnosed as having acute infectious colitis according to the colonoscopic finding. However, two days later after colonoscopy, he visited the emergency room for hematochezia. We performed computerized tomography (CT) and obtained blood samples to find the origin of the bleeding. We found thickening of the transverse colon lumen and ascites on the CT finding and an elevated level of tumor markers; we also obtained the results of the colonoscopic biopsy that was done via colonoscopy. He was finally diagnosed as having colon cancer with carcinomatosis, a poorly differentiated adenocarcinoma.

• The Korean Journal of Cytopathology
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• v.3 no.2
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• pp.82-89
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• 1992

Electron microscopy (EM) can provide a valuable contribution to light microscopy (LM) In the Interpretation of fine needle aspiration cytology (FNAC) specimen, especially in the diagnosis of the tumor. However, considerable care in processing the specimen is mandatory to recover the cells and avoid altering the fine structures. We experienced a case of malignant melanoma in 33-yrs-old female, diagnosed by EM study of FNAC specimen from the axillary mass, who was initially thought as disseminated carcinomatosis on LM study. The technique of EM study on FNAC specimen consisted of washing the needle and syringe in 2.5% glutaraldehyde after a rapid stain (Diff-Quik), which was used to obtain a preliminary diagnostic impression and to assure the adequacy of the EM specimen. After centrifugation in the steps of fixation and dehydration, the sediment was made into an epon block and examined. The whole processing time of EM study can be shortened within 7 or 8 hours, and results can be available within 48 to 72 hours. Our experience suggests the EM study on FNAC can be a useful diagnostic method in the diagnosis of difficult FNAC cases.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.89-92
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• 1997

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer pain. Conventional approach for splanchnic nerve block is conducted in the prone position to ensure proper orientation and to allow insertion of needles on each side of the vertebral body. However, the prone position has some technical disadvantages as this position is frequently poorly tolerated by a majority of patients with advanced cancer due to severe abdominal pain, ascites and so on. Male patient, 53-year old with transverse colon cancer, carcinomatosis peritonei and $L_1,\;L_2$ vertebral body metastasis, was admitted for treatment of severe right upper quadrant and right iliac crest pain. We performed neurolytic splanchnic nerve block with transdiscal technique in the lateral decubitus position under fluoroscopic guidance, and well noted the usefulness and the advantage of this technique. The benefits of this technique are safe, simple and effective because the lateral position is better tolerated by patients and makes bony landmarks more accessible during fluoroscopy.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7289-7294
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• 2013

We here document discovery of a new and simple model of tumor seeding involving the mouse peritoneum. Irradiated tumor cells administered by i.p. injection provided effective vaccination against peritoneal carcinomatosis and distal metastasis with colorectal carcinomas. In flow cytometric analysis, CD4+ and CD8+ T lymphocytes, macrophages and myeloid-derived suppressor cells (MDSCs), which are easy to obtain in the peritoneal cavity, were revealed to have significant differences between immunized and non-immunized mice and these contributed to antitumor responses. We also observed that both serum and peritoneal lavage fluid harvested from immunized mice showed the presence of CT26-specific autoantibodies. In addition, increase in level of TGF-${\beta}1$ and IL-10 in serum but a decrease of TGF-${\beta}1$ in peritoneum was found. Taken together, these findings may provide a new vaccine strategy for the prevention of peritoneal and even systemic metastasis of carcinomas through induction of an autoimmune response in the peritoneum.

• Journal of Gastric Cancer
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• v.14 no.4
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• pp.266-270
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• 2014

Purpose: Palliative gastrectomy and chemotherapy are important options for peritoneal seeding of gastric cancer. The treatment stage IV gastric cancer patient who respond to induction chemotherapy, is converted to gastrectomy (conversion therapy or conversion surgery). This study explored the clinical outcomes of gastric cancer patients with peritoneal seeding who had undergone conversion therapy. Materials and Methods: Between 2003 and 2012, gastric cancer patients with peritoneal seeding, as determined by preoperative or intraoperative diagnosis were reviewed retrospectively. Clinicopathologic characteristics and clinical outcomes of patients with peritoneal seeding were analyzed. Results: Forty-three patients were enrolled. Eighteen patients had undergone conversion surgery and 25 patients continued conventional chemotherapy. Among the 18 conversion patients, 10 received clinically curative resection. The median follow-up period was 28.5 months (range 8 to 60 months) and the total 3-year survival rate was 16.3%. The median survival time of the patients who received clinically curative conversion therapy was 37 months, and the 3-year survival rate was 50%. The median follow-up for non-curative gastrectomy patients was 18 months. No patient treated using chemotherapy survived to 3 years; the median survival time was 8 months. The differences in survival time between the groups was statistically significant (P<0.001). Conclusions: In terms of survival benefits for gastric cancer patients with peritoneal seeding, clinically curative conversion therapy resulted in better clinical outcomes.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.199-203
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• 1993

Inferior mesenteric plexus block(IMPB) is a nerve block for lower abdominal pain originating from GI tract of distal transverse colon to sigmoid colon and other polvic organ where the inferior mesenteric plexus contains visceral afferent fibers of that organ. We performed IMPB on two patients with lower abdominal pain. Case I: 61 year old female diagnosed with cancer of stomach and uterine cervix and carcinomatosis, experienced complete relief from pain for a period of 7 months after IMPB. Case II: male, 28 years old, who had contracted cancer of the descending colon with obstructive jaundice and pancreatitis had complained of pain in the whole of the abdominal area. IMPB was performed for lower abdominal pain. Seven days after, a celiac plexus block was also performed for upper abdominal pain. The patient complained of recurring pain in the left & upper lower abdomen 30 days after the IMPB. The intensity of the pain was visual analogue scale 4 and it was managed by continuous epidural block. Conclusion: It is our recommendation that IMPB is a reliable method for treatment of lower abdominal pain originating from malignant condition of GI tract from distal transverse colon to sigmoid colon and urinary bladder.

• Archives of Craniofacial Surgery
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• v.22 no.3
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• pp.157-160
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• 2021

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.