Biomedical subjects

Ewen A Griffiths

Publications and source records attributed to Ewen A Griffiths.

4 recordsLinked to original sources

PubMed2006

Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology - an update for the surgical oncologist.

Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesophageal junction (GOJ) pose several specific challenges. Numerous difficulties arise when the existing TNM staging systems for gastric and oesophageal cancers are applied to GOJ tumours. The issues facing the current TNM staging and GOJ tumour classification systems are reviewed in this article. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases, have implications for specimen reporting. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy is carefully documented pathologically. In addition, several controversial and novel areas such as endoscopic mucosal resection, lymph node micrometastases and the sentinel node concept are being studied. We aim to review these aspects, with special relevance to oesophageal and gastro-oesophageal cancer specimen reporting, to update the surgical oncologist with an interest in upper gastrointestinal cancer.

Journal Article↗

PubMed2006

Tumor length as a prognostic factor in esophageal malignancy: univariate and multivariate survival analyses.

BACKGROUND AND OBJECTIVES: Gastrointestinal specialists generally feel that long esophageal tumors carry a worse prognosis and are likely to be more advanced than shorter lesions. Our aim was to investigate the relationship between histologically determined tumor length and aspects of tumor pathology and survival for patients with resected esophageal malignancy. METHODS: Three hundred and nine patients who underwent esophageal resection with curative intent in our unit between 1994 and 2003 were retrospectively analyzed. Pathological details such as TNM stage, differentiation, completeness of surgical resection, and overall stage were collected. Survival data were obtained for each patient and univariate and multivariate analyses were performed. Overall survival was used as the primary endpoint. RESULTS: There were 225 adenocarcinomas, 72 squamous cell carcinomas, and 12 other tumor types with a median tumor length of 3.5 cm (range 0.5-14 cm). Tumor length greater than 3.5 cm was associated with increasing T stage (P = 0.0001), N stage (P = 0.032), overall stage (P = 0.003), and involvement of the longitudinal resection margins (P = 0.02). Univariate analysis found tumor length greater than 3.5 cm was associated with worse overall survival compared with shorter tumors (P = 0.0002). Tumor length remained a significant prognostic factor on multivariate analysis (P = 0.04). Other prognostic factors on multivariate analysis were age, tumor differentiation, nodal involvement, and resection margin status. CONCLUSION: Tumor length greater than 3.5 cm (as determined histologically) is associated with worse disease stage and poor overall patient survival. If preoperative endoscopic tumor length bears a similar relationship, this could assist in patient selection for appropriate treatments.

Adenocarcinoma↗

PubMed2003

Acute inflammation of a congenital cecal diverticulum mimicking appendicitis.

BACKGROUND: Cecal diverticulitis is a relatively rare problem in the Western world. It is often clinically indistinguishable from acute appendicitis. CASE REPORT: We present a case of a young woman who was suspected to have acute appendicitis prior to operation. At operation an unexpected and suspicious cecal mass was found and the procedure was revised to a right hemicolectomy. Subsequent histological examination revealed an acutely inflamed solitary, congenital diverticulum of the cecum. CONCLUSIONS: We would like to highlight this uncommon condition to ensure that its first encounter is not in the operating theatre. The varied and controversial management options are briefly discussed.

Acute Disease↗

PubMedDate not supplied

Bifid vermiform appendix: a case report.

INTRODUCTION: Appendiceal anomalies are extremely rare: they have a reported incidence of between 0.004% and 0.009% of appendectomy specimens. The authors report a case of a patient who was found to have 2 appendices at emergency laparotomy, review the classification system used, and discuss the potential clinical pitfalls of similar cases. CASE REPORT: A 23-year-old man was admitted as an emergency with abdominal pain and vomiting. The operative finding was of a bifid appendix. One appendix was grossly gangrenous and lacked a mesoappendix, whereas the other had a mesoappendix and appeared macroscopically normal. The appendices shared a common base that arose from the cecum in the typical anatomical position. No other intra-abdominal malformations were present at inspection during laparotomy. Histology confirmed features of gangrenous appendicitis. His postoperative recovery was uneventful, and he was discharged after 4 days. CONCLUSION: Although rare, it is important for several reasons that surgeons are aware of the potential anatomical anomalies and malpositions of the vermiform appendix: first, a missed second appendix may result in serious clinical and medico-legal consequences; second, a double appendix can be confused with other intra-abdominal conditions; and finally, they can be associated with other congenital abnormalities.

Adult↗