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At least 613 records · Page 34Linked to original sources
PubMed1999

High mitotic index associated with poor prognosis in gastrointestinal autonomic nerve tumour.

AIMS: Three gastrointestinal autonomic nerve tumours (GANT) were characterized by immunohistochemistry and flow cytometry. Two of the three cases occurred in the small intestine, while the third was found in the stomach. Besides the immunohistochemical and ultrastructural description, the aim of this study was to examine the relation between the known and accepted predictive factors (ploidy data, the S-phase fraction, the mitotic and MIB-1 index and the size of the tumour) and the survival of the patients. METHODS AND RESULTS: The immune profile showed that 3/3 cases were vimentin and NSE, 2/3 were synaptophysin and PGP 9.5 positive, while 1/3 also showed S100 positivity. Ultrastructurally, all the cases had dense core granules, one of them contained skenoid fibres. The flow cytometry revealed diploid DNA in all cases, however, significant differences could be seen in the proliferative activity of the individual neoplasms. CONCLUSIONS: In spite of the published data of gastrointestinal stromal tumours (GIST) generally, neither the MIB-1 index and the ploidy data nor the size of the primary tumour helped to predict the clinical progression of the examined GANTs. However, the high proliferative activity (57 mitoses/10 HPF) and the elevated S-phase fraction (24%) was associated with advanced, metastatic and recurring disease in case 3. On the basis of these three cases, high mitotic activity is the most reliable factor in predicting aggressive clinical behaviour.

Adult↗
PubMed2001

Adjuvant therapies using biliary stenting for malignant biliary obstruction.

The aim of this study was to analyze the patency of expandable metallic stents in malignant biliary obstruction and to evaluate the efficacy of adjuvant therapy accompanied by biliary stenting. We analyzed 29 patients in whom bile duct stenting was performed for malignant biliary obstruction. Their types of disease were: hilar ductal carcinoma (n = 8), gallbladder carcinoma (n = 11), and pancreatic carcinoma (n = 10). Initially, 46 expandable metallic stents were placed in 29 patients. In 23 of the 29 patients, adjuvant therapy was administered. Seventeen patients underwent radiotherapy, and 16 patients received various systemic chemotherapies. In principle, hyperthermia was performed twice a week, simultaneously with radiotherapy. Patient survival and the probability of stent patency were calculated using actuarial life table analysis. There was no significant difference in stent patency among the patients according to type of disease. Hyperthermia did not influence the stent patency rate. The median stent patency time was significantly greater in the chemo-radiation group than in the no-adjuvant therapy group: 182 days versus 68 days, respectively (P = 0.017). Moreover, a significant increase was seen in the median survival time in the chemo-radiation group: 261 days versus 109 days (P = 0.0337). Complications occurred in 9 patients (31.0%). Stent occlusion occurred in 6 patients (20.7%), with all of these patients managed successfully using a transhepatically placed new expandable metallic stent, employing the stent-in-stent method. Stent migration occurred in 2 patients after radiotherapy. Adjuvant therapies such as radiotherapy and systemic chemotherapy, in combination with stent insertion, resulted in an increase in the patency period of expandable metallic stents and in increased patient survival time.

Aged↗
PubMedDate not supplied

Double cancer of gallbladder and bile duct associated with anomalous junction of the pancreaticobiliary ductal system.

We report a case of double cancer of the gallbladder and the common bile duct associated with anomalous junction of the pancreaticobiliary ductal system, and review the literature of similar case reports. A 66-year-old woman was admitted to an associated hospital complaining of upper abdominal pain, and was diagnosed as having pancreatitis. Abdominal imaging revealed an irregularly protruding mass at the body of the gallbladder and an intraluminal protrusion at the lower third of the common bile duct. Endoscopic retrograde cholangiopancreatography also revealed anomalous junction of the pancreaticobiliary ductal system with congenital biliary dilatation of 14 mm in the largest diameter. She underwent surgical resection of the gallbladder, the extrahepatic bile duct and the gallbladder bed of the liver with a dissection of the regional lymph nodes for double cancer of the gallbladder and the bile duct associated with anomalous junction of the pancreaticobiliary ductal system. She is still alive 33 months after surgery without any signs of recurrence. There were 12 patients (including our case) reported in the literature who had double cancer of the gallbladder and the extrahepatic bile duct associated with anomalous junction of the pancreaticobiliary ductal system. Only 33% of these 12 patients had jaundice. Tumors of the 12 patients were commonly early-stage cancer both in the gallbladder (36%) and in the extrahepatic bile duct (73%). Therefore, we concluded that precise preoperative imaging of the total biliary tract should be required in order to detect early-stage cancer in patients with anomalous junction of the pancreaticobiliary ductal system before planning surgical procedures, and consideration should be given to the possibility of multiple occurrences of biliary tract cancers.

Adenocarcinoma, Papillary↗
PubMed2001

Surgical management of hepatic metastases from colorectal malignancies.

Liver metastasis represents the major cause of death of patients who have been treated for colorectal adenocarcinoma. Spontaneous survival rarely exceeds two years. Surgery can offer long-term survival and resection should be considered when liver metastases can be totally resected with clear margins and when there is no non-resectable extra-hepatic disease. The choice between anatomical or wedge resection depends on the number and the location of the metastases but does not influence survival. Clamping methods limit blood loss. Operative mortality is generally less than 5%. The five-year survival rate after surgical resection varies from 20% to 45% according to several prognostic factors. The longer survival is observed in patients with fewer than four lesions, with lesions smaller than 4 cm, without extra-hepatic disease, with lesions that appeared more than two years after the resection of a stage I or II colorectal cancer and whose CEA level is normal. After resection, follow-up can detect hepatic recurrence that can be treated with repeat hepatectomy. The efficacy of systemic chemotherapy using new agents can increase the number of patients amenable to surgery. Regional therapies with cryotherapy or radiofrequency ablation can help to treat unresectable or non-totally resectable lesions and may improve survival. The effects on survival of adjuvant treatments, including pre- or postoperative systemic or postoperative intra-arterial chemotherapy, are currently under evaluation.

Adenocarcinoma↗
PubMed1990

[Digestive cancer mortality in a Mediterranean urban area (Barcelona, 1983-1987)].

This study presents the main epidemiologic features of general, site and age-specific, and premature mortality due to digestive cancer in Barcelona residents in the 1983-87 period, selecting death certificates where digestive cancer was coded as the primary cause of death (codes 150 to 159 of the ICD-9). Eight percent (6,269) of all deaths were due to malignant neoplasms of the digestive system, representing 30.3% of all deaths due to neoplasms. The main contribution was due to gastric cancer (18.8 cases per 100,000) and colon cancer (17.2 per 100,000), followed by rectal cancer (8.8 per 100,000) and pancreatic cancer (8.7 per 100,000). The annual increase in colon cancer among women--where it is the main digestive cancer site was statistically significant. Premature deaths due to digestive cancer yielded 3.5 years of potential life lost per 1,000 people (21.8% of all premature cancer deaths). In men, most cases of these premature deaths were due to gastric cancer (24.3%), while in women premature deaths were more often due to colon cancer (25.3%). Excess mortality due to esophagus, stomach and liver cancer was observed in Ciutat Vella, the most socioeconomically deprived district in Barcelona.

Age Factors↗
PubMed1993

Differential diagnosis of fat-containing lesions with abdominal and pelvic CT.

Recognition of fat within an organ or lesion on abdominal and pelvic computed tomographic scans is an important clue to guiding a differential diagnosis. A systematic approach to these lesions, including a patient's age and clinical history, along with the appearance and location of the lesion often allows a specific differential diagnosis. The anatomic sites of origin for these lesions are the gastrointestinal tract, genitourinary system, and retroperitoneum. Some of the more common entities include various forms of fatty change in the liver, fibrofatty mesenteric proliferation in Crohn disease, ovarian dermoids, and herniations of abdominal fat. In addition, pitfalls such as pathologic processes engulfing normal fat (eg, perirenal abscess) and iatrogenic incorporation of normal fat (eg, omental packing in liver lacerations) should also be included in the differential diagnosis. Familiarity with certain benign occurrences, such as focal fat in the liver adjacent to the falciform ligament and lipomatous infiltration of the ileocecal valve, obviates invasive diagnostic procedures.

Abdominal Neoplasms↗
PubMed1994

[Computerized tomography in the differential diagnosis of non-gynecologic abdomino-pelvic masses].

The female pelvis is an anatomical region where masses can be found originating from pelvic organs, mostly from the genital system or else from abdominal organs and systems, by continuity, by contact or by metastatic spread. The clinician needs to define and characterize a pelvic mass since treatment options can vary greatly. If a malignant pelvic lesion is clinically suspected, ultrasonography is the investigation technique of choice, whose differential diagnosis accuracy is good especially in gynecologic conditions. However, in nongynecologic masses, US diagnostic yield is poorer, which led us to retrospectively review 31 such cases. CT was used to assess the mass origin and tissue characterization to define the clinical role of this method. On the whole, CT yielded good results (80.6% overall diagnostic accuracy, 25/31 cases) which however differed according to the different pathologic conditions. Gastrointestinal system conditions, tumors and inflammations were easy to diagnose with CT (11/15 cases, 73.3%), except for the patients with intestinal cancer spreading to the ovaries, that is, a Krukenberg's lesion, or the cases with an abscess hiding the annexa and thus preventing CT from detecting the mass origin, be it intestinal or annexial. CT diagnostic accuracy was high in extraperitoneal (retro- and properitoneal) masses (8/8 cases, 100%), but much lower (75%, 6/8 cases) in the diagnosis of primary intraperitoneal organs conditions. To conclude, CT is confirmed as an accurate imaging technique in the differential diagnosis of nongynecologic abdominopelvic masses. The mass origin is usually correctly detected and tissue characterization is accurate, which provides the clinician with enough pieces of information for best treatment planning.

Abdominal Neoplasms↗
PubMed1991

Incidence estimation of stomach cancer among Koreans.

A series of incidence estimation studies of cancers among Koreans through a nationwide survey has been undertaken by authors since 1988. The medical records were studied of inpatients with diagnoses of either ICD-9 151 (malignant neoplasm of the stomach), or 197 (secondary malignant neoplasm of the respiratory and digestive systems), or 211 (benign neoplasm of other parts of the digestive system) in claims sent in by medical care institutions throughout the country to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987. These records were abstracted in order to identify and confirm the new cases of stomach cancer among the beneficiaries of the KMIC, which covers about 10% of whole Korean population. Using these data from the KMIC, the incidence patterns of stomach cancer among Koreans were estimated as of July 1, 1986 to June 30, 1987. The crude incidence rates of stomach cancer among Koreans are estimated to be 36.2 (95% tonfidence interval; 35.3-36.9) and 21.0 (95% CI; 20.3-21.6) per 100,000 in males and females, respectively. The cumulative rates for age spans 0-64 and 0-74 are 3.8% and 7.3% in males, respectively. In females they are 1.8% and 3.0%. The adjusted rates for the world population are 57.9 in males and 25.1 in females, which are similar to those of Shanghai, China '78-'82 but lower than those of Osaka, Japan. The truncated rates for ages 35-64 years, however, are 108.3 in males and 49.1 in females, which may be the highest in the world. Among Koreans in Korea, an increased risk of stomach cancer in this age group is the notable finding. Incidence patterns of stomach cancer by age, sex, and area, which are the first report in Korea, are analyzed and presented.

Adolescent↗
PubMedDate not supplied

Treatment of liver metastases from colorectal cancer: what is the best approach today?

Liver is the common site for metastases from colorectal cancer. The 5-year overall survival rate of patients following radical operations is 25%. Surgery can be carried out in only 10-15% of the patients, yet it remains the potential curative treatment for resectable lesions. For the unresectable cancers, only chemotherapy is recommended. New drugs such as Irinotecan prolongs the overall survival of patients affected by advanced disease. In patients with unresectable metastases at diagnosis, pre-surgical treatment with Oxaliplatin leads to reduction of the lesions, allowing resection in 16% of cases. Chemotherapy may be delivered directly into the liver via the hepatic artery. No, clinical trials, to date, have shown convincing survival results in patients treated with this procedure. Combined hepatic artery and systemic treatment may provide a new strategy as adjuvant therapy for patients undergoing resections.

Colorectal Neoplasms↗
PubMed2003

Clinical significance of detecting elevated serum DcR3/TR6/M68 in malignant tumor patients.

TR6/DcR3/M68 is a soluble receptor that belongs to the TNF receptor family. It is expressed in malignant cells of several tumor types and has been postulated to help tumor cells to gain survival advantage by inhibiting apoptosis and by interfering with immune surveillance. In our study, we assessed for the first time serum TR6 in tumor patients to explore its diagnostic and prognostic value. We examined serum TR6 levels with ELISA in 146 tumor patients, 19 patients with acute infection, 5 patients with liver cirrhosis and 29 healthy individuals. TR6 expression in tumor mass was studied with immunohistochemistry. TR6 gene copy number in tumor tissues was evaluated by real time PCR. Ninety-seven point nine percent (47 of 48 cases) of healthy individuals and patients with acute infection were serum TR6-negative. In contrast, 56.2% (82 of 146 cases) of the tumor patients were serum TR6-positive. Almost all serum TR6-positive individuals (98.8%, 82 out of 83 cases) had malignancy, excluding the cases of liver cirrhosis. In gastric carcinomas, serum TR6 levels were closely correlated with tumor differentiation status and TNM classification. Tumor mass was the source of serum TR6 because its levels decreased drastically after curative tumor resection. TR6 gene amplification occurred in about half of liver carcinomas, but not in gastric or pancreatic carcinomas, indicating plural mechanisms of TR6 upregulation. Our study demonstrated that serum TR6 should be considered as a novel parameter for the diagnosis, treatment and prognosis of malignancies.

Adenocarcinoma, Follicular↗
PubMed1990

Prevention of formation of important mutagens/carcinogens in the human food chain.

Etiological factors for gastric cancer, among others, involve consumption of smoked, salted, and pickled fish of certain types. Their chemical nature is not yet fully established but probably involves diazo phenols, and their formation can be prevented either by omitting the salting and pickling process, or by using vitamins C and E on the food prior to salting, pickling, or smoking. Both preventive approaches would limit the formation of mutagenic and carcinogenic diazo phenols. Sugimura and associates discovered new types of mutagens as heterocyclic amines that are formed during frying or broiling of meats and fish. In rats, these amines induce cancer specifically in organs such as breast, colon, or pancreas, associated with Western-type nutrition where promotional elements such as dietary fat play an enhancing role. Thus, inhibition of the formation of these new carcinogens during cooking would remove the genotoxic components from the diet. Mixing 10% soy protein with ground meat prior to frying prevents the formation of these mutagens presumably by affording a lower surface temperature. More effective is the addition of tryptophan, proline, or mixtures thereof, which specifically blocks the formation of these mutagens/carcinogens, probably by competing for reactive intermediary aldehydes, so that these cannot interact with the normal essential target, creatinine. Thus, we have available practical, yet science-based, mechanistically understood procedures to prevent the formation of carcinogens associated with important types of cancer prevalent in many countries.

Animals↗
PubMed2003

A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer.

To avoid permanent colostomy, we perform a new ultimate anus preserving operation for extremely low rectal cancer or for anal canal cancer. According to our pathologic study, two different removal methods of anal canal were theoretically considered. One is internal sphincter resection (ISR method), and the other is both deep-superficial external sphincter and internal sphincter resection (ESR method). Six patients received ISR and ten patients ESR. No severe intraoperative complications occurred and the postoperative course was uneventful. All patients receiving ISR had excellent anal function without soiling. Some patients receiving ESR sometimes complained of night soiling but satisfied the anus preservation. The median follow-up was 15 months, (range, 3-28 months). We had recurrences in two female patients receiving ISR. One had para-aortic and lateral lymph node recurrences without anastomotic recurrence. She underwent lateral and para-aortic lymphadenectomy, but died of lung metastasis, regardless of intensive chemotherapy. Another had pelvic recurrence with abdominal dissemination. She underwent abdominoperineal resection and is alive with pelvic re-recurrence. ISR and ESR are excellent procedures for anus preservation, but ISR needs a strict indication.

Anus Neoplasms↗