S. Weissman, T. Mehta, Alex Zhornitskiy, R. Tondon, J. Tabibian
Distinguishing between a primary malignancy and a metastasis can be challenging in some cases. Herein, we describe 2 cases of gastric lesions that were endoscopically sampled and ultimately found to be metastatic from a renal-cell carcinoma. In both cases, the gastric metastases were endoscopically homomorphic to the primary organ (the kidney); i.e., grossly resembling and thus providing an endoscopic clue as to the primary tumor source. We report on the evaluation of obscure metastatic gastric involvement of malignancy and present the concept of homomorphism as a potential diagnostic clue in determining the source of unknown and often unsuspected primary malignancy.
{"title":"“Homomorphic” Tumor Metastases as an Endodiagnostic Clue: A Case Series of Renal-Cell Carcinoma Metastatic to the Stomach","authors":"S. Weissman, T. Mehta, Alex Zhornitskiy, R. Tondon, J. Tabibian","doi":"10.1159/000502520","DOIUrl":"https://doi.org/10.1159/000502520","url":null,"abstract":"Distinguishing between a primary malignancy and a metastasis can be challenging in some cases. Herein, we describe 2 cases of gastric lesions that were endoscopically sampled and ultimately found to be metastatic from a renal-cell carcinoma. In both cases, the gastric metastases were endoscopically homomorphic to the primary organ (the kidney); i.e., grossly resembling and thus providing an endoscopic clue as to the primary tumor source. We report on the evaluation of obscure metastatic gastric involvement of malignancy and present the concept of homomorphism as a potential diagnostic clue in determining the source of unknown and often unsuspected primary malignancy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"147 - 152"},"PeriodicalIF":1.6,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43361694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Rovesti, G. Orsi, Andrikou Kalliopi, C. Vivaldi, G. Marisi, L. Faloppi, F. Foschi, N. Silvestris, I. Pecora, G. Aprile, E. Molinaro, L. Riggi, P. Ulivi, M. Canale, A. Cucchetti, E. Tamburini, G. Ercolani, L. Fornaro, P. Andreone, P. Zavattari, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini
Background: Sorafenib has been established as the standard of care for patients with advanced hepatocellular carcinoma (HCC) since 2007 on the basis of two landmark trials (SHARP and Asia-Pacific). Ten years have passed since then and, despite much research in the field, still no validated real-life prognostic markers are available for HCC patients treated with this drug. Therefore, going through 10 years of research into sorafenib of several Italian Cancer Centers, we conducted a field-practice study aimed at identifying baseline clinical factors that could be significantly associated with overall survival (OS). Method: Univariate/multivariate analyses were conducted to retrospectively identify the impact of baseline characteristics on the OS of 398 advanced HCC patients treated with sorafenib. Results: Based on univariate analysis, α-fetoprotein (AFP), albumin, AST, bilirubin, Child-Pugh, ECOG, systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) grade, and portal vein thrombosis were significantly associated with shorter OS. Following adjustment for clinical covariates positive in univariate analysis, the multivariate analysis including AFP, age, etiology, albumin, aspartate transaminase (AST), bilirubin, Child-Pugh, LDH, platelet-to-lymphocyte ratio, ECOG, ALBI grade, portal vein thrombosis, SII, and BCLC stage identified increase in LDH, age >70 years, no viral etiologies, ECOG >0, albumin <35, ALBI grade 2, and AST >40 as prognostic factors for poorer OS based on the 5% significance level. Conclusion: Our study highlights that baseline hepatic function, patient-centered variables, and etiology have prognostic value. These findings might have implications in terms of therapeutic decision-making and patient counseling.
{"title":"Impact of Baseline Characteristics on the Overall Survival of HCC Patients Treated with Sorafenib: Ten Years of Experience","authors":"G. Rovesti, G. Orsi, Andrikou Kalliopi, C. Vivaldi, G. Marisi, L. Faloppi, F. Foschi, N. Silvestris, I. Pecora, G. Aprile, E. Molinaro, L. Riggi, P. Ulivi, M. Canale, A. Cucchetti, E. Tamburini, G. Ercolani, L. Fornaro, P. Andreone, P. Zavattari, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini","doi":"10.1159/000502714","DOIUrl":"https://doi.org/10.1159/000502714","url":null,"abstract":"Background: Sorafenib has been established as the standard of care for patients with advanced hepatocellular carcinoma (HCC) since 2007 on the basis of two landmark trials (SHARP and Asia-Pacific). Ten years have passed since then and, despite much research in the field, still no validated real-life prognostic markers are available for HCC patients treated with this drug. Therefore, going through 10 years of research into sorafenib of several Italian Cancer Centers, we conducted a field-practice study aimed at identifying baseline clinical factors that could be significantly associated with overall survival (OS). Method: Univariate/multivariate analyses were conducted to retrospectively identify the impact of baseline characteristics on the OS of 398 advanced HCC patients treated with sorafenib. Results: Based on univariate analysis, α-fetoprotein (AFP), albumin, AST, bilirubin, Child-Pugh, ECOG, systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) grade, and portal vein thrombosis were significantly associated with shorter OS. Following adjustment for clinical covariates positive in univariate analysis, the multivariate analysis including AFP, age, etiology, albumin, aspartate transaminase (AST), bilirubin, Child-Pugh, LDH, platelet-to-lymphocyte ratio, ECOG, ALBI grade, portal vein thrombosis, SII, and BCLC stage identified increase in LDH, age >70 years, no viral etiologies, ECOG >0, albumin <35, ALBI grade 2, and AST >40 as prognostic factors for poorer OS based on the 5% significance level. Conclusion: Our study highlights that baseline hepatic function, patient-centered variables, and etiology have prognostic value. These findings might have implications in terms of therapeutic decision-making and patient counseling.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"92 - 107"},"PeriodicalIF":1.6,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46631956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal hypertensive polyposis is a rare finding represented in about 2.5% of all patients with portal hypertension. The diagnostic criteria are not yet clearly defined. It has been mentioned in a few case reports; its distribution was mainly duodenal and less frequently gastric. Here, a patient with type 2 diabetes and liver cirrhosis was hospitalized for vomiting, abdominal pain, and melena. The patient was admitted to the intensive care unit for stabilization and urgent esophagogastroduodenoscopy (EGD). EGD revealed a single antral polyp occluding the pyloric ring which was the cause of gastric outlet obstruction. Complete debulking by argon plasma was done which improved gastric outlet obstruction and melena. We conclude that argon plasma coagulation is a safe, rapid, and effective method for treating portal hypertensive polyposis.
{"title":"Management of a Portal Hypertensive Polyp: Case Report of a Rare Entity","authors":"Waseem M. Seleem, A. Hanafy","doi":"10.1159/000501909","DOIUrl":"https://doi.org/10.1159/000501909","url":null,"abstract":"Portal hypertensive polyposis is a rare finding represented in about 2.5% of all patients with portal hypertension. The diagnostic criteria are not yet clearly defined. It has been mentioned in a few case reports; its distribution was mainly duodenal and less frequently gastric. Here, a patient with type 2 diabetes and liver cirrhosis was hospitalized for vomiting, abdominal pain, and melena. The patient was admitted to the intensive care unit for stabilization and urgent esophagogastroduodenoscopy (EGD). EGD revealed a single antral polyp occluding the pyloric ring which was the cause of gastric outlet obstruction. Complete debulking by argon plasma was done which improved gastric outlet obstruction and melena. We conclude that argon plasma coagulation is a safe, rapid, and effective method for treating portal hypertensive polyposis.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"137 - 141"},"PeriodicalIF":1.6,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501909","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41396439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Kolli, S. Weissman, Saad Saleem, O. Chan, Maria R. Ver, Richard Inae, M. Ona
The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.
{"title":"An Unlikely Route: Metastatic Ovarian Malignancy within the Duodenum","authors":"S. Kolli, S. Weissman, Saad Saleem, O. Chan, Maria R. Ver, Richard Inae, M. Ona","doi":"10.1159/000502094","DOIUrl":"https://doi.org/10.1159/000502094","url":null,"abstract":"The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"142 - 146"},"PeriodicalIF":1.6,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44490565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kobayashi, J. Kaneko, Takamune Yamaguchi, Y. Kawaguchi, J. Arita, N. Akamatsu, T. Ishizawa, R. Sekine, H. Ijichi, N. Kubota, K. Fukatsu, N. Kokudo, K. Hasegawa
Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-sevenpatients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.
{"title":"Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition","authors":"K. Kobayashi, J. Kaneko, Takamune Yamaguchi, Y. Kawaguchi, J. Arita, N. Akamatsu, T. Ishizawa, R. Sekine, H. Ijichi, N. Kubota, K. Fukatsu, N. Kokudo, K. Hasegawa","doi":"10.1159/000501452","DOIUrl":"https://doi.org/10.1159/000501452","url":null,"abstract":"Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-sevenpatients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"81 - 91"},"PeriodicalIF":1.6,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41616661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Casadei‐Gardini, L. Solaini, L. Riggi, E. Molinaro, V. Dadduzio, M. Rizzato, A. Pellino, L. Faloppi, G. Marisi, P. Ulivi, M. Canale, G. Orsi, G. Rovesti, K. Andrikou, A. Spallanzani, F. Gelsomino, F. Foschi, F. Conti, A. Cucchetti, G. Ercolani, P. Biason, S. Lonardi, S. Cascinu, M. Scartozzi
Background and Aims: The aim of the present study is to evaluate a new index influenced by the balance between the immune system, α-fetoprotein (AFP), and lactate dehydrogenase (LDH) (RAPID index) as a prognostic factor in patients treated with sorafenib. Methods: This study was conducted on a training cohort of 159 hepatocellular carcinoma (HCC) patients and a validation cohort of 68 HCC patients treated with sorafenib. The RAPID index was calculated as neutrophil/lymphocyte count × LDH × AFP. Results: In the training cohort, the median overall survival (OS) was 23.2 months (95% CI 11–25) and 12.1 months (95% CI 9–15) for patients with a low (≤3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.56, 95% CI 0.35–0.88, p = 0.017). Following adjustment for clinical covariates, multivariate analysis confirmed the RAPID index ≤3,226 versus >3,226 (HR = 0.37, 95% CI 0.18–0.74, p = 0.0054) as an independent prognostic factor for OS. In the validation cohort, the median OS was 26.9 months (95% CI 17.6–26.9) and 7.0 months (95% CI 6.2–9.2) for patients with a low (≤ 3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.19, 95% CI 0.10–0.36, p < 0.0001). Performing the same multivariate analysis of the training cohort (AFP, Eastern Cooperative Oncology Group, aspartate aminotransferase, neutrophil, platelet, systemic inflammatory index and RAPID index), the RAPID index <3,226 versus >3,226 (HR = 3.86, 95% CI 1.45–10.29, p = 0.007) was found to be an independent prognostic factor for predicting OS. Conclusion: The low cost, easy assessment, and reproducibility of a full blood count make the RAPID index a promising tool for assessing HCC prognosis in future clinical practice.
{"title":"Prognostic Role of a New Index (RAPID Index) in Advanced Hepatocellular Carcinoma Patients Receiving Sorafenib: Training and Validation Cohort","authors":"A. Casadei‐Gardini, L. Solaini, L. Riggi, E. Molinaro, V. Dadduzio, M. Rizzato, A. Pellino, L. Faloppi, G. Marisi, P. Ulivi, M. Canale, G. Orsi, G. Rovesti, K. Andrikou, A. Spallanzani, F. Gelsomino, F. Foschi, F. Conti, A. Cucchetti, G. Ercolani, P. Biason, S. Lonardi, S. Cascinu, M. Scartozzi","doi":"10.1159/000501593","DOIUrl":"https://doi.org/10.1159/000501593","url":null,"abstract":"Background and Aims: The aim of the present study is to evaluate a new index influenced by the balance between the immune system, α-fetoprotein (AFP), and lactate dehydrogenase (LDH) (RAPID index) as a prognostic factor in patients treated with sorafenib. Methods: This study was conducted on a training cohort of 159 hepatocellular carcinoma (HCC) patients and a validation cohort of 68 HCC patients treated with sorafenib. The RAPID index was calculated as neutrophil/lymphocyte count × LDH × AFP. Results: In the training cohort, the median overall survival (OS) was 23.2 months (95% CI 11–25) and 12.1 months (95% CI 9–15) for patients with a low (≤3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.56, 95% CI 0.35–0.88, p = 0.017). Following adjustment for clinical covariates, multivariate analysis confirmed the RAPID index ≤3,226 versus >3,226 (HR = 0.37, 95% CI 0.18–0.74, p = 0.0054) as an independent prognostic factor for OS. In the validation cohort, the median OS was 26.9 months (95% CI 17.6–26.9) and 7.0 months (95% CI 6.2–9.2) for patients with a low (≤ 3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.19, 95% CI 0.10–0.36, p < 0.0001). Performing the same multivariate analysis of the training cohort (AFP, Eastern Cooperative Oncology Group, aspartate aminotransferase, neutrophil, platelet, systemic inflammatory index and RAPID index), the RAPID index <3,226 versus >3,226 (HR = 3.86, 95% CI 1.45–10.29, p = 0.007) was found to be an independent prognostic factor for predicting OS. Conclusion: The low cost, easy assessment, and reproducibility of a full blood count make the RAPID index a promising tool for assessing HCC prognosis in future clinical practice.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"71 - 80"},"PeriodicalIF":1.6,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43696676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from interstitial Cajal cells. A 54-year-old male patient without any comorbidities presented to the emergency department with complaints of abdominal distension, inability to pass flatus, and no motion for the past 2 days. Abdominal X-ray showed multiple air-fluid levels suggesting bowel obstruction. The patient was managed conservatively at first. Later, ultrasonography and contrast-enhanced computed tomography (CECT) of the abdomen were done, which revealed a mass lesion arising from the jejunum suggestive of GIST. The patient was taken up for exploratory laparotomy, and a tumor was found in the proximal jejunum around 10 cm from the duodenojejunal junction and encompassing the hepatic flexure of the transverse colon, with the omentum found adhered to the anterior surface of the lesion and distended proximal bowel loops. There was no evidence of mesenteric lymphadenopathy. The mass was resected along with the jejunal loop and the hepatic flexure of the colon, followed by end-to-end jejunojejunal anastomosis and end-to-end colocolic anastomosis. The patient’s postoperative stay was uneventful. Imatinib therapy was started following histopathological confirmation and continued. The patient was followed up for 1 year postoperatively with CECT of the abdomen every 6 months, with no evidence of recurrence or any gastrointestinal symptoms.
{"title":"Huge Gastrointestinal Stromal Tumor of the Jejunum Presenting as Bowel Obstruction: A Rare Presentation","authors":"Tanweerul Huda, M. Singh","doi":"10.1159/000501744","DOIUrl":"https://doi.org/10.1159/000501744","url":null,"abstract":"Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from interstitial Cajal cells. A 54-year-old male patient without any comorbidities presented to the emergency department with complaints of abdominal distension, inability to pass flatus, and no motion for the past 2 days. Abdominal X-ray showed multiple air-fluid levels suggesting bowel obstruction. The patient was managed conservatively at first. Later, ultrasonography and contrast-enhanced computed tomography (CECT) of the abdomen were done, which revealed a mass lesion arising from the jejunum suggestive of GIST. The patient was taken up for exploratory laparotomy, and a tumor was found in the proximal jejunum around 10 cm from the duodenojejunal junction and encompassing the hepatic flexure of the transverse colon, with the omentum found adhered to the anterior surface of the lesion and distended proximal bowel loops. There was no evidence of mesenteric lymphadenopathy. The mass was resected along with the jejunal loop and the hepatic flexure of the colon, followed by end-to-end jejunojejunal anastomosis and end-to-end colocolic anastomosis. The patient’s postoperative stay was uneventful. Imatinib therapy was started following histopathological confirmation and continued. The patient was followed up for 1 year postoperatively with CECT of the abdomen every 6 months, with no evidence of recurrence or any gastrointestinal symptoms.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"116 - 121"},"PeriodicalIF":1.6,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45670576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kriger, S. Berelavichus, A. Kaldarov, V. Panteleev, D. Gorin, R. S. Dugarova, M. Yukina
Background: Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports. Materials and Methods: We studied 177 patients with NET of the pancreas who underwent surgical treatment in the A.V. Vishnevsky National Medical Research Centre of Surgery from January 2007 to December 2018. Results: Of 81 patients with organic hyperinsulinism caused by functioning NETs of the pancreas during the study period, 3 (3.7%) had a proinsulinoma; 2 were female; and 1 was male. None of them admitted to weight gain during this period, and their BMI was normal. All patients presented with Whipple’s triad during the 72-h fast. Tumor-enucleating surgery was performed: one robot assisted, two laparotomies. A normal glucose level after treatment was achieved in all cases. Conclusion: In cases where clinical hypoglycemia is present, but the serum insulin level is within the normal range or even decreased, proinsulinoma should be suspected. For now, surgical resection remains the only effective method of treatment. Further investigation of proinsulinomas is needed.
{"title":"Proinsulin-Secreting Neuroendocrine Tumors of the Pancreas: A Single-Centre Experience","authors":"A. Kriger, S. Berelavichus, A. Kaldarov, V. Panteleev, D. Gorin, R. S. Dugarova, M. Yukina","doi":"10.1159/000501455","DOIUrl":"https://doi.org/10.1159/000501455","url":null,"abstract":"Background: Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports. Materials and Methods: We studied 177 patients with NET of the pancreas who underwent surgical treatment in the A.V. Vishnevsky National Medical Research Centre of Surgery from January 2007 to December 2018. Results: Of 81 patients with organic hyperinsulinism caused by functioning NETs of the pancreas during the study period, 3 (3.7%) had a proinsulinoma; 2 were female; and 1 was male. None of them admitted to weight gain during this period, and their BMI was normal. All patients presented with Whipple’s triad during the 72-h fast. Tumor-enucleating surgery was performed: one robot assisted, two laparotomies. A normal glucose level after treatment was achieved in all cases. Conclusion: In cases where clinical hypoglycemia is present, but the serum insulin level is within the normal range or even decreased, proinsulinoma should be suspected. For now, surgical resection remains the only effective method of treatment. Further investigation of proinsulinomas is needed.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"64 - 70"},"PeriodicalIF":1.6,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48723331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Javier Santiago-Reynoso, Karina Senyase Zamaripa-Martínez, Juan Manuel Dorantes-Loya, Guillermo J Gaytán-Fernández, Evelia Apolinar-Jiménez, Francisco Paz-Gómez, Felipe Farias-Serratos, María Maldonado-Vega
We present a female patient, 13 years old, with diagnosis of hepatocellular carcinoma of fibrolamellar type, which was rapidly evolving. The fibrolamellar hepatocellular carcinoma invaded more than 80% of the hepatic parenchyma without surgical possibility or liver transplantation. Measures applied corresponded to chemotherapy of 1 cycle of cisplatin 40 mg/s/5 days + vincristine 1.5 mg/m2/day, 5-fluorouracil, doxorubicin, and dexrazoxane. The case presented aggressive evolution of hepatocellular carcinoma, which led to acute liver failure, with hyperammonemia, sepsis, pulmonary focus plus septic shock, grade III-IV encephalopathy, portal hypertension, and ascites with intra-abdominal hypertension. Death occurred due to multiple organ failure, which involved respiratory failure type KDIGO 1 and 2, acute liver failure, severe pneumonia, pericardial effusion, AKIN 2 acute kidney injury, carcinoma, and pulmonary metastasis. This type of ailment is infrequent in children and adolescents, and the first symptoms are crucial to achieve treatment possibilities.
{"title":"Hepatocellular Carcinoma of Fibrolamellar Type in an Adolescent: Case Report and Literature Review.","authors":"Javier Santiago-Reynoso, Karina Senyase Zamaripa-Martínez, Juan Manuel Dorantes-Loya, Guillermo J Gaytán-Fernández, Evelia Apolinar-Jiménez, Francisco Paz-Gómez, Felipe Farias-Serratos, María Maldonado-Vega","doi":"10.1159/000499581","DOIUrl":"https://doi.org/10.1159/000499581","url":null,"abstract":"<p><p>We present a female patient, 13 years old, with diagnosis of hepatocellular carcinoma of fibrolamellar type, which was rapidly evolving. The fibrolamellar hepatocellular carcinoma invaded more than 80% of the hepatic parenchyma without surgical possibility or liver transplantation. Measures applied corresponded to chemotherapy of 1 cycle of cisplatin 40 mg/s/5 days + vincristine 1.5 mg/m<sup>2</sup>/day, 5-fluorouracil, doxorubicin, and dexrazoxane. The case presented aggressive evolution of hepatocellular carcinoma, which led to acute liver failure, with hyperammonemia, sepsis, pulmonary focus plus septic shock, grade III-IV encephalopathy, portal hypertension, and ascites with intra-abdominal hypertension. Death occurred due to multiple organ failure, which involved respiratory failure type KDIGO 1 and 2, acute liver failure, severe pneumonia, pericardial effusion, AKIN 2 acute kidney injury, carcinoma, and pulmonary metastasis. This type of ailment is infrequent in children and adolescents, and the first symptoms are crucial to achieve treatment possibilities.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1-2","pages":"43-50"},"PeriodicalIF":1.6,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000499581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10466637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Tannapfel, A. Reinacher-Schick, Jing-yuan Fang, P. Malfertheiner
{"title":"Front & Back Matter","authors":"A. Tannapfel, A. Reinacher-Schick, Jing-yuan Fang, P. Malfertheiner","doi":"10.1159/000502464","DOIUrl":"https://doi.org/10.1159/000502464","url":null,"abstract":"","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"1 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49141963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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