Acta Medica Okayama2004Hypermethylation of ο6-Methylguanine-DNA Methyltransferase Promoter May Predict Nonrecurrence after Chemotherapy in Colorectal Cancer CasesENTakeshiNagasakaNo potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155811722005大腸癌におけるKRAS,BRAF 遺伝子突然変異とDNA メチル化97103ENNo potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6052006Detection of Fecal DNA Methylation for Colorectal Neoplasia : Does It Lead to an Optimal Screening Test?249256ENTakeshiNagasakaAjayGoelNagahideMatsubaraNoriakiTanakaReview10.18926/AMO/30741Aberrant promoter methylation, an 'epigenetic' form of genomic instability that leads to transcriptional silencing of tumor suppressor genes, is increasingly being recognized as a crucial component in the evolution of human cancers. With our limited knowledge of the molecular basis and timing of the initiation of altered methylation events in the stepwise progression of cancers, the biggest challenge we currently face is to identify novel biomarkers and technologies for the timely screening of patients carrying such alterations. One such strategy would be to develop tests for the detection of fecal DNA methylation patterns that will improve the sensitivity of noninvasive screening tests for colorectal neoplasia, and moreover, will decrease both mortality and the incremental costs of treating colorectal cancers.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812222010便中メチル化DNA検出による消化器がんスクリーニング:消化器がんを非侵襲的にスクリーニングすることは可能か?107112ENTakeshiNagasakaNoriakiTanakaDong-ShengSunYoshioNaomotoNagahideMastubaraTakahitoYagiToshiyoshiFujiwaraNo potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6532011Expansion of CpG Methylation in the SFRP2 Promoter Region during Colorectal Tumorigenesis169177ENMasanoriTakedaTakeshiNagasakaSunDong-ShengHiroyukiNishieTetsuhiroOkaEijiYamadaYoshikoMoriKunitoshiShigeyasuTatsuyaMorikawaSatoshiMizobuchiToshiyoshiFujiwaraOriginal Article10.18926/AMO/46628Secreted frizzled-related protein 2, (SFRP2) is a Wnt inhibitor whose promoter CpGs were recently found to be methylated at high frequency in colorectal cancers (CRCs). We hypothesized that the pattern of SFRP2 methylation may differ throughout the promoter during progressive tumorigenesis. Using combined bisulfite restriction analysis (COBRA), two methylation-sensitive regions (Regions A and B) of the SFRP2 promoter were investigated in 569 specimens of colorectal tissue:222 CRCs, 103 adenomatous polyps (APs), 208 normal colonic mucosa from CRC patients (N-Cs), and 36 normal colonic mucosa from subjects with no evidence of colorectal neoplasia at colonoscopy (N-Ns). Extensive (including both Regions A and B) and partial (either Region A or B) SFRP2 methylation levels were found in 61.7% and 24.8% of CRCs, 8.7% and 37.9% of APs, 3.9% and 39.9% of N-Cs, and 0% and 30.6% of N-Ns, respectively. Extensive methylation of the SFRP2 promoter was present primarily in CRCs, while partial methylation was common in APs. Whereas APs with the KRAS mutant showed no correlation to any pattern of SFRP2 methylation, extensive methylation of the SFRP2 promoter was significantly associated with KRAS mutant CRCs (p<.0001), suggesting that genetic alteration in the RAS-RAF pathway might precede the spread of CpG methylation through the SFRP2 promoter, which is observed in over 60% of advanced colorectal tumors.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812512013予後不良な経過をたどったBRAF遺伝子変異を伴うStage W大腸癌の1例4750ENRyoInadaTakeshiNagasakaKiyotoTakeharaMasahiroSugiharaYoshikoMoriYuzoUmedaNobuhitoKubotaTatsuyaMorikawaYoshitakaKondoFutoshiUnoYuSadamoriTakahitoYagiToshiyoshiFujiwara A 79-year-old woman visited a previous hospital with a complaint of general fatigue. The patient was diagnosed with cecal cancer with multiple liver metastases and lymph node metastases on colonoscopy, abdominal ultrasonography and CT scan, and was referred to our division for treatment. Based on the diagnosis of non-curative colonic cancer, we planned to perform systematic chemotherapy after local surgical treatment. We performed an ileocecal resection, and the specimen showed poorly differentiated adenocarcinoma with mutation in the BRAF oncogene. After the surgical treatment, the tumor grew rapidly and the patient died from cancer on the 19th postoperative day without having the opportunity to undergo chemotherapy.
Multiple genetic and epigenetic alterations in oncogenes and tumor suppressor genes are involved in the process of colorectal carcinogenesis. Some of the alterations have been identified as predictive and prognostic biomarkers. A mutation in the BRAF oncogene was reported to be associated with a very unfavorable prognosis in colorectal cancers. Some of the cases with rapid progression are suggested to have the BRAF oncogene mutation. According to our experience, chemotherapy before surgical treatment might improve the prognosis of cases with the BRAF mutation.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812512013一次治療でセツキシマブ不耐となった後,三次治療での再使用により奏功した進行大腸癌の一例5155ENRyoInadaTakeshiNagasakaYoshikoMoriYuzoUmedaNobuhitoKubotaTatsuyaMorikawaYoshitakaKondoFutoshiUnoYuSadamoriTakahitoYagiToshiyoshiFujiwara A 55-year-old man who had been diagnosed with rectal cancer with multiple liver metastases and lymph node metastases on colonoscopy and computed tomography (CT) was referred to Okayama University Hospital for treatment. Based on the diagnosis of non-curative rectal cancer, we planned to perform systematic chemotherapy after surgical resection. We performed a low anterior resection of a 36×35 mm upper rectal moderately differentiated adenocarcinoma with wil-type KRAS. After the resection, a FOLFIRI regimen with cetuximab was given as the first-line chemotherapy. Although metastatic lesions in the liver showed shrinkage, we decided to switch regimens because of intolerable adverse events. A modified FOLFOX6 regimen with bevacizumab was administered as the second-line treatment. There were no signs of disease progression until eight months later, when positron emission tomography (PET)/CT scans revealed that the new metastatic lesions appeared. As the third-line treatment, an irinotecan with cetuximab regimen was administered, leading to a good response for over 12 months.
We experienced a successful rechallenge with cetuximab for a case with metastatic rectal cancer. For patients with wild-type KRAS colorectal cancer, rechallenge with cetuximab-based chemotherapy can be an effective therapeutic option.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812522013消化器がんと分子標的治療薬145152ENTakeshiNagasakaToshiyoshiFujiwaraNo potential conflict of interest relevant to this article was reported.Acta Medica Okayama542013CD14 upregulation as a distinct feature of non-alcoholic fatty liver disease after pancreatoduodenectomy189195ENDaisukeSatohTakahitoYagiTakeshiNagasakaSusumuShinouraYuzoUmedaRyuichiYoshidaMasashiUtsumiTakehiroTanakaHiroshiSadamoriToshiyoshiFujiwaraAIM: To investigate the pathogenesis of non-alcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD).
METHODS: A cohort of 82 patients who underwent PD at Okayama University Hospital between 2003 and 2009 was enrolled and the clinicopathological features were compared between patients with and without NAFLD after PD. Computed tomography (CT) images were evaluated every 6 mo after PD for follow-up. Hepatic steatosis was diagnosed on CT when hepatic attenuation values were 40 Hounsfield units. Liver biopsy was performed for 4 of 30 patients with NAFLD after PD who consented to undergo biopsies. To compare NAFLD after PD with NAFLD associated with metabolic syndrome, liver samples were obtained from 10 patients with NAFLD associated with metabolic syndrome [fatty liver, n = 5; non-alcoholic steatohepatitis (NASH), n = 5] by percutaneous ultrasonography-guided liver biopsy. Double-fluorescence immunohistochemistry was applied to examine CD14 expression as a marker of lipopolysaccharide (LPS)-sensitized macrophage cells (Kupffer cells) in liver biopsy specimens.
RESULTS: The incidence of postoperative NAFLD was 36.6% (30/82). Univariate analysis identified cancer of the pancreatic head, sex, diameter of the main pancreatic duct, and dissection of the nerve plexus as factors associated with the development of NAFLD after PD. Those patients who developed NAFLD after PD demonstrated significantly decreased levels of serum albumin, total protein, cholesterol and triglycerides compared to patients without NAFLD after PD, but no glucose intolerance or insulin resistance. Liver biopsy was performed in four patients with NAFLD after PD. All four patients showed moderate-to-severe steatosis and NASH was diagnosed in two. Numbers of cells positive for CD68 (a marker of Kupffer cells) and CD14 (a marker of LPS-sensitized Kupffer cells) were counted in all biopsy specimens. The number of CD68+ cells in specimens of NAFLD after PD was significantly increased from that in specimens of NAFLD associated with metabolic syndrome specimens, which indicated the presence of significantly more Kupffer cells in NAFLD after PD than in NAFLD associated with metabolic syndrome. Similarly, more CD14+ cells, namely, LPS-sensitized Kupffer cells, were observed in NAFLD after PD than in NAFLD associated with metabolic syndrome. Regarding NASH, more CD68+ cells and CD14+ cells were observed in NASH after PD specimens than in NASH associated with metabolic syndrome. This showed that more Kupffer cells and more LPS-sensitized Kupffer cells were present in NASH after PD than in NASH associated with metabolic syndrome. These observations suggest that after PD, Kupffer cells and LPS-sensitized Kupffer cells were significantly upregulated, not only in NASH, but also in simple fatty liver.
CONCLUSION: NAFLD after PD is characterized by both malnutrition and the up-regulation of CD14 on Kupffer cells. Gut-derived endotoxin appears central to the development of NAFLD after PD.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama1078-043219232013A Genetically Engineered Oncolytic Adenovirus Decoys and Lethally Traps Quiescent Cancer Stem-like Cells in S/G(2)/M Phases64956505ENShuyaYanoHiroshiTazawaYuuriHashimotoYasuhiroShirakawaShinjiKurodaMasahikoNishizakiHiroyukiKishimotoFutoshiUnoTakeshiNagasakaYasuoUrataShunsukeKagawaRobert M.HoffmanToshiyoshiFujiwaraPurpose: Because chemoradiotherapy selectively targets proliferating cancer cells, quiescent cancer stem-like cells are resistant. Mobilization of the cell cycle in quiescent leukemia stem cells sensitizes them to cell death signals. However, it is unclear that mobilization of the cell cycle can eliminate quiescent cancer stem-like cells in solid cancers. Thus, we explored the use of a genetically-engineered telomerase-specific oncolytic adenovirus, OBP-301, to mobilize the cell cycle and kill quiescent cancer stem-like cells.
Experimental Design: We established CD133(+) cancer stem-like cells from human gastric cancer MKN45 and MKN7 cells. We investigated the efficacy of OBP-301 against quiescent cancer stem-like cells. We visualized the treatment dynamics of OBP-301 killing of quiescent cancer stem-like cells in dormant tumor spheres and xenografts using a fluorescent ubiquitination cell-cycle indicator (FUCCI).
Results: CD133(+) gastric cancer cells had stemness properties. OBP-301 efficiently killed CD133(+) cancer stem-like cells resistant to chemoradiotherapy. OBP-301 induced cell-cycle mobilization from G(0)-G(1) to S/G(2)/M phases and subsequent cell death in quiescent CD133(+) cancer stem-like cells by mobilizing cell-cycle-related proteins. FUCCI enabled visualization of quiescent CD133(+) cancer stem-like cells and proliferating CD133(-) non-cancer stem-like cells. Three-dimensional visualization of the cell-cycle behavior in tumor spheres showed that CD133(+) cancer stem-like cells maintained stemness by remaining in G(0)-G(1) phase. We showed that OBP-301 mobilized quiescent cancer stem-like cells in tumor spheres and xenografts into S/G(2)/M phases where they lost viability and cancer stem-like cell properties and became chemosensitive.
Conclusion: Oncolytic adenoviralinfection is an effective mechanism of cancer cell killing in solid cancer and can be a new therapeutic paradigm to eliminate quiescent cancer stem-like cells.No potential conflict of interest relevant to this article was reported.Academic Press Inc Elsevier ScienceActa Medica Okayama0022-480417822012Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients700707ENEijiYamadaYasuhiroShirakawaTomokiYamatsujiLeonSakumaMunenoriTakaokaTakakoYamadaKazuhiroNomaKazufumiSakuramaYasuhiroFujiwaraShunsukeTanabeTakeshiNagasakaToshiyoshiFujiwaraYoshioNaomotoBackground: Conventional reconstruction after an esophagectomy uses a gastric tube, which commonly causes several postoperative complaints such as gastric acid reflux in long-term survival cases. Intestinal interposition between the remnant esophagus and the stomach is an option to reduce complaints, and in this study, the advantages of jejunal interposition reconstruction with a stomach preserving esophagectomy (SPE) were assessed.
Materials and methods: Eleven cases of jejunal interposition with an SPE and 16 cases with gastric tube reconstruction as a control were subject to a comparison of operation time, amount of bleeding, postoperative quality of life, and endoscopic findings.
Results: The SPE group had a longer operation time (SPE: 560 +/- 121 min, control 414 +/- 83 min, P = 0.038), whereas there was no significant difference in blood loss. Postoperative weight loss was significantly recovered in the SPE group (SPE versus control = 94.0 +/- 5.4% versus 87.5 +/- 4.7% at 3 mo, P = 0.017; 97.2 +/- 7.5% versus 85.0 +/- 5.2% at 6 mo, P = 0.010), and there was a significant decrease in the occurrence of reflux symptoms such as heartburn, odynophagia, and cough when jejunal interposition with an SPE was done. Furthermore, reflux esophagitis and Barrett's epithelium were found in six out of 12 cases (50%) of the control group by postoperative endoscopy, while no cases in the SPE group had either condition (P < 0.01).
Conclusions: This reconstruction method is a promising option to improve postoperative quality of life, mainly due to the long-term elimination of reflux esophagitis, which assists in the recovery of postoperative weight loss.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama2014Fluorescence virus-guided capturing system of human colorectal circulating tumour cells for non-invasive companion diagnosticsENKunitoshiShigeyasuHiroshiTazawaYuuriHashimotoYoshikoMoriMasahikoNishizakiHiroyukiKishimotoTakeshiNagasakaShinjiKurodaYasuoUrataAjayGoelShunsukeKagawaToshiyoshiFujiwaraBackground Molecular-based companion diagnostic tests are being used with increasing frequency to predict their clinical response to various drugs, particularly for molecularly targeted drugs. However, invasive procedures are typically required to obtain tissues for this analysis. Circulating tumour cells (CTCs) are novel biomarkers that can be used for the prediction of disease progression and are also important surrogate sources of cancer cells. Because current CTC detection strategies mainly depend on epithelial cell-surface markers, the presence of heterogeneous populations of CTCs with epithelial and/or mesenchymal characteristics may pose obstacles to the detection of CTCs.
Methods We developed a new approach to capture live CTCs among millions of peripheral blood leukocytes using a green fluorescent protein (GFP)-expressing attenuated adenovirus, in which the telomerase promoter regulates viral replication (OBP-401, TelomeScan).
Results Our biological capturing system can image epithelial and mesenchymal tumour cells with telomerase activities as GFP-positive cells. After sorting, direct sequencing or mutation-specific PCR can precisely detect different mutations in KRAS, BRAF and KIT genes in epithelial, mesenchymal or epithelial–mesenchymal transition-induced CTCs, and in clinical blood samples from patients with colorectal cancer.
Conclusions This fluorescence virus-guided viable CTC capturing method provides a non-invasive alternative to tissue biopsy or surgical resection of primary tumours for companion diagnostics.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama0172-6390611302014Management Of Peritoneal Effusion by Sealing with a Self-Assembling Nanofiber Polypeptide Following Pelvic Surgery349353ENYoshitakaKondoTakeshiNagasakaSatoruKobayashiNaoyaKobayashiToshiyoshiFujiwaraBackground/Aims: PuraMatrix is a synthetic material consisting of 16-amino acid peptides that self-assemble into nanofibers, previously used as a scaffold for functional cell cultures. We conducted a clinical study to determine the safety and sealing properties of PuraMatrix in post-operative lymphorrhea following pelvic surgery in humans. Methodology: A total of 20 patients who underwent rectal cancer resection were analyzed. The study group (n = 10) consisted of patients who received PuraMatrix, matched with a control group (n = 10) of patients operated on conventionally. Results: During the 2 to 3 month follow-up period, there were no abnormal findings or adverse events in any the patients who received PuraMatrix. We found that the patients who received PuraMatrix had significantly reduced post-operative drainage volumes compared with the patients in the control group. Conclusions: PuraMatrix is a safe and effective bio-compatible sealing material for the management of post-operative peritoneal effusion following pelvic surgery.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama1525-00162014Biological Ablation of Sentinel Lymph Node Metastasis in Submucosally Invaded Early Gastrointestinal CancerENSatoruKikuchiHiroyukiKishimotoHiroshiTazawaYuuriHashimotoShinjiKurodaMasahikoNishizakiTakeshiNagasakaYasuhiroShirakawaShunsukeKagawaYasuoUrataRobert M HoffmanToshiyoshiFujiwaraCurrently, early gastrointestinal cancers are treated endoscopically, as long as there are no lymph node metastases. However, once a gastrointestinal cancer invades the submucosal layer, the lymph node metastatic rate rises to higher than 10%. Therefore, surgery is still the gold standard to remove regional lymph nodes containing possible metastases. Here, to avoid prophylactic surgery, we propose a less-invasive biological ablation of lymph node metastasis in submucosally invaded gastrointestinal cancer patients. We have established an orthotopic early rectal cancer xenograft model with spontaneous lymph node metastasis by implantation of green fluorescent protein (GFP)-labeled human colon cancer cells into the submucosal layer of the murine rectum. A solution containing telomerase-specific oncolytic adenovirus was injected into the peritumoral submucosal space, followed by excision of the primary rectal tumors mimicking the endoscopic submucosal dissection (ESD) technique. Seven days after treatment, GFP signals had completely disappeared indicating that sentinel lymph node metastasis was selectively eradicated. Moreover, biologically treated mice were confirmed to be relapse-free even 4 weeks after treatment. These results indicate that virus-mediated biological ablation selectively targets lymph node metastasis and provides a potential alternative to surgery for submucosal invasive gastrointestinal cancer patients.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6922015Aggressive Multimodality Treatment for Advanced Rectal Cancer113118ENRyoInadaTakeshiNagasakaToshiakiToshimaYoshikoMoriYoshitakaKondoHiroyukiKishimotoTakaoHirakiTaiheiOshiroYukihideKanemitsuToshiyoshiFujiwaraCase Report10.18926/AMO/53340A case of advanced rectal cancer treated by aggressive local and systemic treatment who has survived more than 7 years from initial recurrence is presented. A 55-year-old woman was diagnosed with advanced lower rectal cancer and underwent a low anterior resection with complete removal of all regional lymph nodes and total mesorectal excision. The tumor was diagnosed as a moderately differentiated adenocarcinoma, pStage IIIB (T3, N2a, M0). Twenty-six months after the initial surgery, local recurrence in the pelvis was detected by computed tomography, and total pelvic exenteration with distal sacrectomy (TPES) was performed after systemic chemotherapy with a molecular-targeted drug. Six months after the TPES, multiple lung metastases were detected. Consequently, the patient underwent radiofrequency ablation (RFA) and chemotherapy. The disease has since been controlled for 38 months. As volume control is essential for cancer treatment, it may be important to combine appropriate local therapy with systemic therapy to metastatic or recurrent sites in order to achieve much longer disease control.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812722015超高齢者(95歳)の進行盲腸癌に対して腹腔鏡下回盲部切除を施行した1例117121ENAyakoWatanabeRyoInadaTakeshiNagasakaTomohikoYagiHijiriMatsumotoToshiakiToshimaSatoruKikuchiShinshiKurodaYoshitakaKondoYoshikoMoriHiroyukiKishimotoToshiyoshiFujiwaraWe report a successful laparoscopic resection of a cecal tumor in a 95-year-old Japanese man. The patient visited an initial hospital with a complaint of constipation in March 2014. Computed tomography scan and colonoscopy showed a stenotic ileocecal cancer with pericolic lymph node metastases, and he was referred to our department for management. Since his general condition was maintained, we performed a laparoscopic ileocecal resection with regional lymph node dissection for the patient. The operation achieved curative resection, and the tumor was diagnosed as a moderately differentiated adenocarcinoma and graded as pStage IIIa (pT3, pN0, pM0) according to the Japanese Classification of Colorectal Carcinoma, eighth edition. He was discharged on the 11th postoperative day without perioperative complications. Several large-scale randomized controlled trials (RCTs) revealed that laparoscopic surgeries for colorectal cancers have some advantages compared to open surgeries, including superior short-term outcomes and comparable long-term outcomes. Unfortunately, since these RCTs did not include enough elderly patients, the safety and feasibility of laparoscopic surgery for extremely elderly patients are still unknown. With respect to less-invasive procedures, these advantages of laparoscopic surgery are also thought to be the advantages for elderly colorectal cancer patients.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6952015A Case-matched Comparative Study of Laparoscopic and Open Total Proctocolectomy for Ulcerative Colitis267273ENRyoInadaTakeshiNagasakaYoshitakaKondoAyakoWatanabeToshiakiToshimaNobuhitoKubotaSatoruKikuchiMichihiroIshidaShinjiKurodaYoshikoMoriHiroyukiKishimotoToshiyoshiFujiwaraOriginal Article10.18926/AMO/53672The aim of this single-institution, retrospective, observational case-control study was to evaluate the safety and feasibility of laparoscopic proctocolectomy (PC) for ulcerative colitis (UC), by comparing it with a case-control series of open PC. Twenty UC patients who underwent laparoscopic PC were retrospectively compared with the open PC group of 12 patients matched for age, sex, and urgency of the operation. In the laparoscopic PC group, the operative time was significantly longer, but the amount of blood loss was significantly smaller. The open PC patients underwent an intraoperative blood transfusion significantly more often, and the serum C-reactive protein level on the first postoperative day was significantly higher in the open PC group. In the laparoscopic PC group, the rate of severe postoperative morbidities, grades 3 and 4 on the Clavien-Dindo classification, was significantly lower, and the median length of hospital stay was significantly shorter. Laparoscopic PC for patients with UC showed superior perioperative outcomes to open PC, except for longer operative time.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016Single Center Prospective Phase II Trial of CT-guided Radiofrequency Ablation for Pulmonary Metastases from Colorectal Cancer (SCIRO-1401)317321ENJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology, Okayama University HospitalHideoGobaraDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University HospitalSusumu KanazawaSusumu KanazawaDepartment of Radiology, Okayama University HospitalClinical Study Protocols10.18926/AMO/54512The present single center prospective phase II clinical trial is designed to evaluate the efficacy and safety of percutaneous radiofrequency (RF) ablation for colorectal lung metastases. Patients who have colorectal lung metastases without extrapulmonary metastases are included in this study. The primary endpoint is 3-year overall survival (OS) after RF ablation. The secondary endpoints are the prevalence of adverse events within 4 weeks, local tumor progression rate, 1- and 5-year OS, cause-specific survival, and relapse-free survival. The recruitment of patients commenced in July 2014, and the enrolment of 45 patients is intended over the 3 years of study period.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7062016Acute Bowel Injury due to Cryoablation for Renal Cell Carcinoma: Correlated Radiologic and Pathologic Findings511514ENHideoGobaraDepartment of Radiology,Okayama University HospitalTakaoHirakiDepartment of Radiology,Okayama University HospitalToshihiroIguchiDepartment of Radiology,Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology,Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery, Okayama University HospitalHiroyukiKishimotoDepartment of Gastroenterological Surgery, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Okayama University HospitalSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceCase Report10.18926/AMO/54817An 87-year-old Japanese man underwent percutaneous cryoablation (PCA) therapy for his renal cell tumor. We displaced the colon from the tumor using hydrodissection. Computed tomography (CT) immediately after PCA was indicative of iceball extension to the colon wall, and a discontinuous enhancement of the colon wall was observed. We therefore performed an emergency surgery. On laparotomy, we observed a dark-purple area on the affected area of the colon, and the resected specimen showed focal, deep ulceration on the mucosal surface. Photomicrography revealed mucosal necrosis, submucosal hemorrhage, and necrotic foci in the muscularis propria, corresponding to the discontinuous colon wall enhancement on CT and the deep ulceration and dark-purple area on laparotomy. He recovered from surgery and was discharged without any complications.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812922017家族性大腸腺腫症術後20年後に小腸癌を発症した1例111114ENYuusakuSugiharaDepartment of Gastroenterology and Hepatology, Okayama University HospitalSeijiKawanoDepartment of Gastroenterology and Hepatology, Okayama University HospitalKeitaHaradaDepartment of Gastroenterological Surgery, Okayama University HospitalShihoTakashimaDepartment of Gastroenterology and Hepatology, Okayama University HospitalDaisukeTakeiDepartment of Gastroenterological Surgery, Okayama University HospitalToshihiroInokuchiDepartment of Gastroenterology and Hepatology, Okayama University HospitalMasahiroTakaharaDepartment of Gastroenterology and Hepatology, Okayama University HospitalSakikoHiraokaDepartment of Gastroenterology and Hepatology, Okayama University HospitalYoshikoMoriDivision of Endoscopy, Okayama University HospitalHiroyukiKishimotoDivision of Endoscopy, Okayama University HospitalTakeshiNagasakaDivision of Endoscopy, Okayama University HospitalHiroyukiOkadaDepartment of Gastroenterology and Hepatology, Okayama University HospitalA 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.No potential conflict of interest relevant to this article was reported.Future Science Ltd.Acta Medica Okayama2056-5623Concordance of acquired mutations between metastatic lesions and liquid biopsy in metastatic colorectal cancerFSO757ENFumitakaTaniguchiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesAkihiroNyuyaDepartment of Clinical Oncology, Kawasaki Medical SchoolToshiakiToshimaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesKazuyaYasuiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesYoshikoMoriDepartment of Clinical Genetics & Digestive Tract & General Surgery, Saitama Medical Center, Saitama Medical University,MakotoOkawakiDepartment of Clinical Oncology, Kawasaki Medical SchoolHiroyukiKishimotoDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesYuzoUmedaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesToshiyoshiFujiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesHiroakiTaniokaDepartment of Clinical Oncology, Kawasaki Medical SchoolYoshiyukiYamaguchiDepartment of Clinical Oncology, Kawasaki Medical SchoolAjayGoelDepartment of Molecular Diagnostics & Experimental Therapeutics, Beckman Research Institute of City of Hope Comprehensive Cancer CenterTakeshiNagasakaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical SciencesAim: To evaluate whether PCR-reverse sequence-specific oligonucleotide can examine the concordance between liquid biopsy and metastatic lesions with acquired resistance. Materials & methods: We examined acquired mutations in chemoresistant lesions and blood obtained from four patients with RAS wildtype metastatic colorectal cancer who underwent treatment with anti-epidermal growth factor receptor antibodies. Results: In one patient, metastatic lesions harbored diverse acquired mutations in KRAS in all seven metastases; the two acquired mutations were detectable in blood collected after the patient acquired resistance. None of the other patients exhibited liquid biopsy mutations, except one, with a BRAF mutation confirmed in primary tumor and peritoneal dissemination. Conclusion: Liquid biopsy based on PCR-reverse sequence-specific oligonucleotide is a successful procedure for capturing acquired mutations with precise information on the RAS mutational spectrum.No potential conflict of interest relevant to this article was reported.