A 53-year-old man developed bilateral pleural effusion with respiratory failure. The amylase level in the pleural effusion was elevated. He had neither abdominal symptoms nor abdominal physical findings. Abdominal computed tomography (CT) also showed no abnormalities. Magnetic resonance cholangiopancreatography (MRCP) was non-diagnostic, but endoscopic retrograde cholangiopancreatography (ERCP) and subsequent CT showed a fistula connecting the pancreatic duct with the right pleural cavity. The pleural effusion was refractory to drug therapy, leading to the need for surgical intervention. The pathological findings revealed chronic pancreatitis without pseudocysts. The elevated pancreatic amylase in the pleural effusion offered an important clue to the correct diagnosis.

Abstract. Signal transducer and activator of transcription 3 (Stat3), the mammalian target of rapamycin (mtOr) and epidermal growth factor receptor (EGFr), proteins that mediate intracellular signaling related to cell growth, proliferation and differentiation, have received considerable interest as possible targets for cancer treatment. We examined whether the expression of Stat3, mtOr and EGFr correlates with clinicopathological features and patient outcome in gastric cancer. tumor samples were obtained from 126 patients with gastric adenocarcinomas who underwent a radical gastrectomy between 1999 and 2002. the expression of phosphorylated Stat3 (p-Stat3), p-mtOr and EGFr was analyzed by immunohistochemical staining. the relations of these to clinicopathological factors and outcomes were assessed. the expression of p-Stat3 p-mtOr and EGFr positively correlated with the following variables related to tumor progression: the depth of tumor invasion (t1 vs. t2-4; p<0.001, p=0.036 and p<0.001, respectively), lymph node involvement (p=0.008, p=0.027 and p=0.007) and tumor stage (i vs. ii-iV; p<0.001, p=0.041 and p<0.001). the expression of p-STAT3 and EGFR was significantly related to distant metastasis and recurrence (p=0.001 and p=0.039), as well as significantly poorer disease-specific survival (DSS; p=0.0018 and p=0.026). the expression of p-Stat3 was a marginally non-significant prognostic factor for DSS (hazard ratio=2.0, 95% ci 0.91-4.5, p=0.082). increasing expression of p-Stat3, p-mtOr and EGFr was associated with progressively worse dSS. interactions among p-Stat3, p-mtOr and EGFr may play an important role in tumor progression and outcomes in patients with gastric cancer.

Background Hepatic adrenal rest tumors are rare and show similar findings to hepatocellular carcinoma (HCC). It is difficult to distinguish an adrenal rest tumor from HCC due to radiological similarity. We report a case of an adrenal rest tumor in the liver that mimicked HCC radiologically. Case Presentation A 67-year-old female was referred to our hospital due to the finding of a hepatic mass. Enhanced computed tomography revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase in the posterosuperior subsegment of the right hepatic lobe, and HCC was suspected. We performed a subsegmental resection of the liver. Microscopic findings showed that the tumor was composed of pale cells, and tumor cells were aligned in alveolar or fascicular arrangements in a similar manner to features of adrenocortical tissue. Immunohistochemically, the tumor expressed synaptophysin and CD56. The final histopathologic diagnosis in this case was an adrenal rest tumor of the liver. Conclusions An adrenal rest tumor is similar to HCC in radiological findings. This hepatic tumor should be added to the list of radiological differential diagnoses of hypervascular hepatic tumors.

Abstract. The majority of human solid tumors exhibit aneuploidy caused by impairment of the mitotic checkpoint. Since the Mad2, Bubr1 and aurora kinase B (aurKB) proteins are involved in the mitotic checkpoint, we investigated Mad2, BubR1 and AURKB mrna expression and its effect on clinicopathological parameters and prognosis in 100 consecutive patients who underwent surgical resection for gastric cancer. Mad2, BubR1 and AURKB mrna expression levels in gastric cancer tissues and corresponding normal gastric mucosa were compared by real-time quantitative rT-Pcr. The data were then correlated to clinicopathological parameters and prognosis. The expression of Mad2, BubR1 and AURKB mrna was found to be significantly higher in cancer tissue compared to normal tissue. BubR1 and AURKB expression was significantly higher during the earlier stages of the disease. Patients with high BubR1 expression had improved relapse-free survival and overall survival compared to patients with low BubR1 expression. Multivariate analysis of stage ii and iii patients indicated that high expression of BubR1 and/or AURKB was associated with improved overall survival. We conclude that overexpression of BubR1 and AURKB is associated with a low risk of gastric cancer progression, and that overexpression of BubR1 and/or AURKB can therefore be used to identify gastric cancer patients with a favorable prognosis. Introductiondespite the declining incidence of gastric cancer, the disease remains the fourth most common cancer and the second most frequent cause of cancer-related death worldwide (1,2). recent progress in diagnostic and treatment technologies has improved the long-term survival of patients with earlystage gastric cancer, although the prognosis for patients with advanced disease remains unfavorable (3). Surgical treatment is the mainstay of therapy for patients with localized disease, but adjuvant chemotherapy is required after surgical resection in advanced cases (4). Thus, the identification of prognostic factors may contribute to improved treatment strategies for gastric cancer patients. This requires further insight into carcinogenesis and cancer progression.The majority of human solid tumors exhibit aneuploidy (5), which is a very early event in the progression of gastric cancer (6). Tumor cells become aneuploid as a result of aberrant mitotic division, caused by a defective mitotic checkpoint response. The mitotic checkpoint is a signaling cascade that arrests the cell cycle in mitosis when even a single chromosome is not properly attached to the mitotic spindle (5,7).The mitotic checkpoint complex contains the anaphasepromoting complex/cyclosome activator cdc20, as well as mitotic checkpoint kinases (McKs) such as Mad2 (mitotic arrest deficient-like 1; MAD2L1), BubR1 (budding uninhibited by benzimidazoles 1 homolog ß; BUB1B) and Bub3. The McKs are regarded as effectors of the mitotic checkpoint. Within the McK complex, both Mad2 and Bubr1 directly bind cdc20 (8). a large number of aneuploid cell lines do not appear to harbor mut...

Aspergillosis is a common fungal infection in immunocompromised patients undergoing chemotherapy. The incidence of invasive fungal infection in these patients has increased dramatically in recent years. We report a case of small-bowel infarction caused by Aspergillus in a 48-year-old man who was receiving chemotherapy for acute myeloid leukemia. On day 20 after the start of chemotherapy, right lower abdominal pain and rebound tenderness developed, with a high fever. A contrast-enhanced computed tomography scan showed a semicircular perfusion defect in the ileum. Thus, we performed partial resection of the ileum with primary anastomosis. Macroscopically, the ileum had mucosal ulcerations. Microscopically, there was transmural necrosis with microperforation and Aspergillus invading necrotic tissue and blood vessels. The patient had an uneventful postoperative course and was discharged 14 days after the procedure. Intestinal aspergillosis is rare and associated with high mortality. Thus, it should be considered in the differential diagnosis of neutropenic patients with sudden abdominal pain and fever.