Metastatic colorectal cancer (mCRC) differs clinically based on RAS and BRAF mutations or DNA methylation. However, in mCRC, the prognostic value and biological characteristics of genome-wide DNA methylation status (GWMS) in each RAS/BRAF genotype is unknown. To clarify this, primary tumor samples from patients with informed consent in the phase III TRICOLORE study were collected, and RAS and BRAF mutations, immunohistochemical staining of mismatch repair-related proteins, comprehensive gene expression, and genome-wide DNA methylation were analyzed. The tumor samples were classified into high-methylated colorectal cancer (HMCC) and low-methylated colorectal cancer (LMCC). Gene set enrichment analysis (GSEA) was conducted using microarray data. A total of 226 patients were included and classified into the RAS/BRAF wild-type (wt) (n = 125), RAS mutant (mt) (n = 87), and BRAF mt (n = 14), of whom 22 (17.6%), 30 (34.5%), and 14 (100%) had HMCC. HMCC exhibited significantly worse overall survival (OS) than that of LMCC in the RAS/BRAF wt group but not in the RAS mt group. In GSEA, RAS/BRAF wt HMCC was associated with microsatellite instability and BRAF V600E mutation. The poor prognosis of RAS/BRAF wt HMCC may be attributed to gene expression patterns associated with microsatellite instability and BRAF V600E mutation.
A 73-year-old woman underwent total arch replacement with an open stent graft for a distal arch thoracic aortic aneurysm. Six months later, purulent discharge appeared from the upper edge of the median sternotomy wound. She had no fever, inflammatory markers were minimal, and repeated bacterial, fungal, and mycobacterial cultures were negative. Computed tomography (CT) revealed a peri-graft abscess extending to the upper mediastinum. Because local wound care failed, redo sternotomy, thorough irrigation, and pedicled omental flap filling around the graft were performed nine months after the initial operation. Intraoperative cultures were also negative, and the lesion was diagnosed as a sterile peri-graft abscess. She has remained free from recurrence for one year after reoperation.
INTRODUCTION:Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) are the most common and second most common primary liver cancers, respectively. In contrast, double primary hepatic cancer (DPHC), the synchronous occurrence of these two tumors in different locations of the liver, is an uncommon pathology, occurring in less than 0.8% of all liver malignancies. CASE PRESENTATION:A man in his 70s was referred to our department for the treatment of multiple liver tumors. He had previously been treated with a direct-acting antiviral agent for chronic liver disease due to hepatitis C virus infection and alcohol consumption. His carbohydrate antigen 19-9 (CA19-9) and des-γ-carboxy prothrombin levels were 36058 U/mL and 159 mAU/mL, respectively. Imaging studies revealed two separate lesions with different contrast features in segments VIII (SVIII, 2.5 cm in size) and IV/II/III (SIV/II/III, 3.5 cm). Therefore, the preoperative diagnosis was DPHC, consistent with HCC in SVIII and iCCA in SIV/II/III. The patient underwent an extended left hemihepatectomy with regional lymph node dissection and cholecystectomy, and DPHC was confirmed histologically. CONCLUSIONS:Accurate diagnoses and appropriate therapeutic strategies are essential for patients presenting with multiple liver tumors showing heterogeneous imaging features and elevated CA19-9 levels.
BACKGROUND:The number of robotic rectal surgeries being performed in Japan is rapidly increasing. Therefore, the training of young surgeons in robotic rectal surgery has received significant attention. We herein examined the safety and short-term clinical outcomes of robotic rectal surgery performed by young non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons. METHODS:Patients who underwent robotic surgery for rectal cancer between November 2019 and October 2023 were included. Robot-assisted rectal surgeries were performed from February 2022 by two young non-ESSQS-qualified surgeons. Young surgeons were defined as those within 12 years after medical graduation. The clinical outcomes of robotic rectal surgery performed by non-ESSQS-qualified surgeons and by qualified surgeons were evaluated. Patients who received preoperative chemoradiotherapy or required complex procedures were excluded. RESULTS:A total of 269 patients underwent robotic surgery for rectal cancer, and 178 were investigated. We included 35 (19.7%) and 143 (80.3%) patients who underwent robotic surgery by non-ESSQS-qualified surgeons and qualified surgeons, respectively. Median total operative time was longer in the non-qualified group (334 vs. 285 minutes, p<0.001), but postoperative complication rates (6% vs. 10%, p=0.67) and hospital stay (10 vs. 10 days, p=0.85) were similar. CONCLUSIONS:Robotic rectal surgery by young non-ESSQS-qualified surgeons appears feasible with acceptable short-term outcomes, though longer operative times and the need for proctor supervision should be considered.
INTRODUCTION: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion. Because histopathological confirmation is required for a definitive diagnosis, splenectomy is typically necessary. We report a case of laparoscopic splenectomy (LS) for splenic SANT in a patient with a history of Whipple procedure for pancreatic serous cystadenoma. CASE PRESENTATION: A woman in her 40s presented with a splenic mass 6 months after undergoing a Whipple procedure for a serous cystadenoma of the pancreatic head. Contrast-enhanced CT (CE-CT) revealed a 10-mm low-density, space-occupying lesion in the spleen. Twelve months after the Whipple procedure, follow-up CE-CT demonstrated interval growth of the lesion to 14 mm. Fluorodeoxyglucose PET (FDG-PET) showed increased FDG uptake within the mass. LS was performed for complete resection and definitive diagnosis. Histopathological examination confirmed SANT. The postoperative course was uneventful, and there was no evidence of recurrence 12 months postoperatively. CONCLUSIONS: We report a rare case of splenic SANT detected after a Whipple procedure and successfully treated with LS to exclude malignancy. Further studies are warranted to establish reliable noninvasive diagnostic approaches for SANT.
