Summary To clarify the relation between bcl-2 and bax protein (Bcl-2 and Bax) expression with regard to apoptosis and cell proliferation, 82 gastric carcinomas were immunohistochemically investigated. The significance of apoptosis for biological behaviour of the tumours was also examined. The apoptotic indices (Als) were significantly lower in early-stage than in advanced-stage lesions (P<0.05), being positively correlated with the mitotic indices (MIs) (r=0.447, P<0.001). No association between either Als or Mls and tumour size (diameter of intramural spreading) was noted. The Als in the high Bcl-2-immunoreactive score group were significantly smaller than in either the low or the negative categories, whereas they were relatively elevated in the high Bax score group. In addition, an inverse correlation between Bcl-2 and Bax expression was revealed for both Als and MIs. Although depth of tumour invasion and lymph node status were clearly associated with favourable outcome, no relation between survival rates and average values of either Als or MIs, or immunoreactive scores for Bcl-2 and Bax was observed. These results indicate that in gastric carcinomas, apoptosis is closely associated with cell proliferation and expression of Bcl-2 and Bax, but appears likely to have no particular biological significance as a prognostic factor.

As well as the high prevalence of H. pylori in young subjects with gastric cancer, it is clear that persistent infection induces mucosal damage, resulting in atrophy and intestinal metaplasia. Thus, acute/chronic gastritis could play an essential role in the early development of neoplasia in the stomach.

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The HydroMARK appears to be a safe and effective marker with the advantageous characteristics of a low tendency for dislocation with time and long-term sonographic detectability.

Context: Systemic metastasis to a primary tumor of the central nervous system is uncommon. Breast carcinomas metastasizing to a possibly preexisting meningioma in the spine are reported very rarely. Study design: Case report. Findings: A 69-year-old female was referred to us with progressive gait disturbance. She had undergone a total mastectomy for carcinoma of the right breast 11 years previously. A magnetic resonance imaging of the thoracic spine showed an intra-and extradural spinal cord tumor. The patient underwent resection of the tumor via laminectomy from T2 to T4. After the operation, the patient's neurological status improved significantly, and she was able to walk without assistance. Histological examination showed the tumor to be a fibrous-type meningioma within a metastatic breast cancer tumor. The patient underwent 40 Gy radiation treatment for local control of the tumor. However, the tumor recurred locally 7 months after the surgery. The patient died of carcinomatous pleurisy 13 months after the surgery. Conclusion: This case illustrates that a primary meningioma in the thoracic spine can be a recipient of breast cancer metastasis, which may alter the treatment strategy.Keywords: Breast carcinoma, Metastasis, Meningioma, Thoracic spine ContextAdvanced cancer metastases to a central nervous system tumor are rare. When it happens, the metastatic tumor is most often a meningioma.1-11 Several hypotheses explaining the mechanism of distant metastases to a pre-existing central nervous system tumor have been proposed, and include the rich vascularity of the preexisting tumor or hormonal or immunologic factors, but the underlying mechanism remains unclear. Most papers published on this subject have been case reports or a small case series, 2-4,7-11 and the clinical features and distinctive radiological characteristics of this condition have not been described in detail. There are few case reports of cancer metastasizing to an intracranial meningioma; however, only two cases of metastasis to a spinal meningioma appear in the literature. 2,9 Here, we present the very rare case of breast cancer metastasis to a possibly preexisting thoracic meningioma. Case presentationA 69-year-old female was referred to our department with a 1-month history of progressive gait disturbance and back pain. The patient had undergone total mastectomy for carcinoma of the right breast (T2N0M0: stage IIA) 11 years previously. Histological examination had revealed the breast cancer to be invasive ductal carcinoma. Estrogen and progesterone receptors were negative. The patient was treated with four cycles of adjuvant chemotherapy. Seven years after the mastectomy, a chest radiograph revealed a right lung metastasis, and the patient underwent apical segmentectomy to remove the metastatic carcinoma. The lung metastasis had transformed into a metaplastic carcinoma, consisting of malignant bone and cartilage in addition to ordinary ductal carcinoma.