In the digestive system, mesenchymal origin of tumors is quite rare; in general, they are recognized as gastrointestinal stromal tumors (GISTs). The incidence of GISTs is very low (2 in 100,000), while jejunal GISTs are extremely rare, accounting for 0.1-3% of all gastrointestinal (GI) tumors. Small intestinal GISTs are the second most common (25%) site in the GI tract, usually occurring in the duodenum. We present the case of a 62-year-old Bangladeshi female with a history of GI bleeding 3 years earlier; the cause of the bleeding had not been found despite extensive investigations. In the meantime, the patient had developed occasional abdominal pain and lumpy feelings in the right side of the abdomen without any GI bleeding. Exploratory laparotomy was carried out in view of a small intestinal mesenteric mass in a computed tomography scan. On midline incision there was a 6 × 6 cm mass in the antimesenteric border of the jejunum approximately 30 cm from the duodenojejunal flexure, which was resected followed by anastomosis. The presentation of GISTs ranges from asymptomatic to mild abdominal pain and mass (5-50%) and mechanical obstruction (5%) as well as hemorrhage - perforation having rarely been reported (0.8%) - making the diagnosis difficult. Exophytic growth of these tumors has been noted in 18-30% of cases. In view of intermediate risk of malignancy, the patient was started with adjuvant imatinib 400 mg once daily due to probability of disease recurrence (24%).
{"title":"Primary Jejunal Gastrointestinal Stromal Tumor: Diagnosis Delay of 3 Years but Successful Management in Early Stage (II) by Surgery and Adjuvant Therapy.","authors":"Ferdous Ara Begum, Md Arifur Rahman, Hashim Rabbi, Golam Mostofa, Qamruzzaman Chowdhury","doi":"10.1159/000496973","DOIUrl":"https://doi.org/10.1159/000496973","url":null,"abstract":"<p><p>In the digestive system, mesenchymal origin of tumors is quite rare; in general, they are recognized as gastrointestinal stromal tumors (GISTs). The incidence of GISTs is very low (2 in 100,000), while jejunal GISTs are extremely rare, accounting for 0.1-3% of all gastrointestinal (GI) tumors. Small intestinal GISTs are the second most common (25%) site in the GI tract, usually occurring in the duodenum. We present the case of a 62-year-old Bangladeshi female with a history of GI bleeding 3 years earlier; the cause of the bleeding had not been found despite extensive investigations. In the meantime, the patient had developed occasional abdominal pain and lumpy feelings in the right side of the abdomen without any GI bleeding. Exploratory laparotomy was carried out in view of a small intestinal mesenteric mass in a computed tomography scan. On midline incision there was a 6 × 6 cm mass in the antimesenteric border of the jejunum approximately 30 cm from the duodenojejunal flexure, which was resected followed by anastomosis. The presentation of GISTs ranges from asymptomatic to mild abdominal pain and mass (5-50%) and mechanical obstruction (5%) as well as hemorrhage - perforation having rarely been reported (0.8%) - making the diagnosis difficult. Exophytic growth of these tumors has been noted in 18-30% of cases. In view of intermediate risk of malignancy, the patient was started with adjuvant imatinib 400 mg once daily due to probability of disease recurrence (24%).</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1-2","pages":"36-42"},"PeriodicalIF":1.6,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000496973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215530","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}
R. Bademci, J. Bollo, M. Carmen Martinez, Maria Pilar Hernadez, E. Targarona
Background: The prognosis for patients with colorectal cancer shows variation. The characteristics of colorectal cancer patients with signet-ring cell carcinoma (SRCC) are still not clear. Materials and Methods: A retrospective comparison was made of the data of signet-ring cell colorectal carcinoma patients operated on between 2009 and 2018 in respect of clinicopathological and operative results, morbidity, mortality, and long-term survival. Results: The study included a total of 34 patients comprising 26 (76%) males and 8 (24%) females with a mean age of 58 ± 11.7 years. Incidence of SRCC was determined as 1.8%. Lymphovascular invasion was determined in 22 (64%) patients. Tumors were determined as stage T2 in 8 (32%) patients, stage T3 in 9 (36%), and stage T4 in 8 (32%). According to the TNM classification, 5 (14.7%) patients were diagnosed with stage 1, 7 (20.6%) with stage 2, 15 (44.1%) with stage 3, and 7 (20.6%) with stage 4. The mean follow-up period was 40.6 ± 30.4 months, and mean disease-free follow-up was determined as 33.1 ± 36.1 months. Fifteen (44.1%) patients died because of the disease. Conclusion: Although SRCC is a poor prognostic factor, it should be kept in mind when determining adjuvant therapies and prognosis of patients determined with advanced-stage SRCC.
{"title":"Colorectal Cancer Prognosis: The Impact of Signet Ring Cell","authors":"R. Bademci, J. Bollo, M. Carmen Martinez, Maria Pilar Hernadez, E. Targarona","doi":"10.1159/000501454","DOIUrl":"https://doi.org/10.1159/000501454","url":null,"abstract":"Background: The prognosis for patients with colorectal cancer shows variation. The characteristics of colorectal cancer patients with signet-ring cell carcinoma (SRCC) are still not clear. Materials and Methods: A retrospective comparison was made of the data of signet-ring cell colorectal carcinoma patients operated on between 2009 and 2018 in respect of clinicopathological and operative results, morbidity, mortality, and long-term survival. Results: The study included a total of 34 patients comprising 26 (76%) males and 8 (24%) females with a mean age of 58 ± 11.7 years. Incidence of SRCC was determined as 1.8%. Lymphovascular invasion was determined in 22 (64%) patients. Tumors were determined as stage T2 in 8 (32%) patients, stage T3 in 9 (36%), and stage T4 in 8 (32%). According to the TNM classification, 5 (14.7%) patients were diagnosed with stage 1, 7 (20.6%) with stage 2, 15 (44.1%) with stage 3, and 7 (20.6%) with stage 4. The mean follow-up period was 40.6 ± 30.4 months, and mean disease-free follow-up was determined as 33.1 ± 36.1 months. Fifteen (44.1%) patients died because of the disease. Conclusion: Although SRCC is a poor prognostic factor, it should be kept in mind when determining adjuvant therapies and prognosis of patients determined with advanced-stage SRCC.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"57 - 63"},"PeriodicalIF":1.6,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43447160","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}
T. Olanipekun, S. Kagbo-Kue, Adekunbi Egwakhe, Maxi Mayette, Mesfin Fransua, M. Flood
Gastrointestinal Kaposi sarcoma (GI-KS) is the most common extra-cutaneous site of KS in HIV/AIDS, and the majority (75%) of affected patients are asymptomatic. GI-KS rarely occurs in the absence of cutaneous lesions. Opportunistic GI infections in HIV/AIDS and GI-KS can present with similar symptoms especially diarrhea, creating a diagnostic challenge. We present a 46-year-old homosexual male with a medical history of HIV/AIDS and neurosyphilis, who presented with 2 weeks of nonbloody diarrhea and abdominal discomfort. He was initially worked up for infectious diarrhea, initiated on highly active anti-retroviral (HAART) and supportively managed with rehydration therapy and analgesia. However, his clinical symptoms did not improve, necessitating abdomen/pelvic CT scan which revealed extensive recto-sigmoid colon thickening and pelvic lymphadenopathy. Due to a high suspicion of malignancy, diagnostic endoscopy and biopsy were done which showed colonic KS. He was treated with intravenous pegylated doxorubicin in addition to HAART which evidently resulted in significant clinical and radiological improvement. The diagnosis of GI-KS could be challenging in the presence of overlapping features with opportunistic GI infections and the absence of cutaneous manifestations of KS because clinicians tend to focus more on infectious etiology. We suggest that clinicians should consider GI-KS in the differential diagnosis of patients with HIV/AIDS that present with diarrhea and other nonspecific abdominal symptoms. Early endoscopic evaluation with biopsy could help to ensure the timely diagnosis and management of GI-KS and ultimately improve outcomes.
{"title":"Lower Gastrointestinal Kaposi Sarcoma in HIV/AIDS: A Diagnostic Challenge","authors":"T. Olanipekun, S. Kagbo-Kue, Adekunbi Egwakhe, Maxi Mayette, Mesfin Fransua, M. Flood","doi":"10.1159/000500140","DOIUrl":"https://doi.org/10.1159/000500140","url":null,"abstract":"Gastrointestinal Kaposi sarcoma (GI-KS) is the most common extra-cutaneous site of KS in HIV/AIDS, and the majority (75%) of affected patients are asymptomatic. GI-KS rarely occurs in the absence of cutaneous lesions. Opportunistic GI infections in HIV/AIDS and GI-KS can present with similar symptoms especially diarrhea, creating a diagnostic challenge. We present a 46-year-old homosexual male with a medical history of HIV/AIDS and neurosyphilis, who presented with 2 weeks of nonbloody diarrhea and abdominal discomfort. He was initially worked up for infectious diarrhea, initiated on highly active anti-retroviral (HAART) and supportively managed with rehydration therapy and analgesia. However, his clinical symptoms did not improve, necessitating abdomen/pelvic CT scan which revealed extensive recto-sigmoid colon thickening and pelvic lymphadenopathy. Due to a high suspicion of malignancy, diagnostic endoscopy and biopsy were done which showed colonic KS. He was treated with intravenous pegylated doxorubicin in addition to HAART which evidently resulted in significant clinical and radiological improvement. The diagnosis of GI-KS could be challenging in the presence of overlapping features with opportunistic GI infections and the absence of cutaneous manifestations of KS because clinicians tend to focus more on infectious etiology. We suggest that clinicians should consider GI-KS in the differential diagnosis of patients with HIV/AIDS that present with diarrhea and other nonspecific abdominal symptoms. Early endoscopic evaluation with biopsy could help to ensure the timely diagnosis and management of GI-KS and ultimately improve outcomes.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"51 - 56"},"PeriodicalIF":1.6,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000500140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44157578","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}
H. Okabe, H. Hayashi, T. Higashi, H. Nitta, Y. Ikuta, Toshihiko Yusa, H. Takeyama, K. Ogawa, N. Ozaki, S. Akahoshi, K. Ogata, Takayuki Osaki, H. Baba, H. Takamori
Background: Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed. Objectives: This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications. Method: One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography. Results: There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (p < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (p = 0.0059), and postoperative in-hospital stay (p = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; p = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group. Conclusion: CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.
{"title":"Frailty Predicts Severe Postoperative Complication after Elective Hepatic Resection","authors":"H. Okabe, H. Hayashi, T. Higashi, H. Nitta, Y. Ikuta, Toshihiko Yusa, H. Takeyama, K. Ogawa, N. Ozaki, S. Akahoshi, K. Ogata, Takayuki Osaki, H. Baba, H. Takamori","doi":"10.1159/000500086","DOIUrl":"https://doi.org/10.1159/000500086","url":null,"abstract":"Background: Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed. Objectives: This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications. Method: One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography. Results: There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (p < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (p = 0.0059), and postoperative in-hospital stay (p = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; p = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group. Conclusion: CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"28 - 35"},"PeriodicalIF":1.6,"publicationDate":"2019-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000500086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42865746","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. Tsuge, B. Saberi, Yulan Cheng, Zhixiong Wang, Amy K Kim, Harry T Luu, J. Abraham, M. Ybanez, J. Hamilton, F. Selaru, C. Villacorta-Martin, F. Schlesinger, B. Philosophe, A. Cameron, Qingfeng Zhu, R. Anders, A. Gurakar, S. Meltzer
Background: Hepatocellular carcinoma (HCC) is now the second-highest cause of cancer death worldwide. Recent studies have discovered a wide range of somatic mutations in HCC. These mutations involve various vital signaling pathways such as: Wnt/β-Catenin, p53, telomerase reverse transcriptase (TERT), chromatin remodeling, RAS/MAPK signaling, and oxidative stress. However, fusion transcripts have not been broadly explored in HCC. Methods: To identify novel fusion transcripts in HCC, in the first phase of our study, we performed targeted RNA sequencing (in HCC and paired non-HCC tissues) on 6 patients with a diagnosis of HCC undergoing liver transplantation. Results: As a result of these studies, we discovered the novel fusion transcript, VTI1A-CFAP46. In the second phase of our study, we measured the expression of wild-type VTI1A in 21 HCC specimens, which showed that 10 of 21 exhibited upregulation of wild-type VTI1A in their tumors. VTI1A (Vesicle Transport via Interaction with t-SNARE homolog 1A) is a member of the Soluble N-ethylmaleimide-Sensitive Factor (NSF) attachment protein receptor (SNARE) gene family, which is essential for membrane trafficking and function in endocytosis, autophagy, and Golgi transport. Notably, it is known that autophagy is involved in HCC. Conclusions: The link between novel fusion transcript VTI1A-CFAP46 and autophagy as a potential therapeutic target in HCC patients deserves further investigation. Moreover, this study shows that fusion transcripts are worthy of additional exploration in HCC.
{"title":"Detection of Novel Fusion Transcript VTI1A-CFAP46 in Hepatocellular Carcinoma","authors":"S. Tsuge, B. Saberi, Yulan Cheng, Zhixiong Wang, Amy K Kim, Harry T Luu, J. Abraham, M. Ybanez, J. Hamilton, F. Selaru, C. Villacorta-Martin, F. Schlesinger, B. Philosophe, A. Cameron, Qingfeng Zhu, R. Anders, A. Gurakar, S. Meltzer","doi":"10.1159/000496795","DOIUrl":"https://doi.org/10.1159/000496795","url":null,"abstract":"Background: Hepatocellular carcinoma (HCC) is now the second-highest cause of cancer death worldwide. Recent studies have discovered a wide range of somatic mutations in HCC. These mutations involve various vital signaling pathways such as: Wnt/β-Catenin, p53, telomerase reverse transcriptase (TERT), chromatin remodeling, RAS/MAPK signaling, and oxidative stress. However, fusion transcripts have not been broadly explored in HCC. Methods: To identify novel fusion transcripts in HCC, in the first phase of our study, we performed targeted RNA sequencing (in HCC and paired non-HCC tissues) on 6 patients with a diagnosis of HCC undergoing liver transplantation. Results: As a result of these studies, we discovered the novel fusion transcript, VTI1A-CFAP46. In the second phase of our study, we measured the expression of wild-type VTI1A in 21 HCC specimens, which showed that 10 of 21 exhibited upregulation of wild-type VTI1A in their tumors. VTI1A (Vesicle Transport via Interaction with t-SNARE homolog 1A) is a member of the Soluble N-ethylmaleimide-Sensitive Factor (NSF) attachment protein receptor (SNARE) gene family, which is essential for membrane trafficking and function in endocytosis, autophagy, and Golgi transport. Notably, it is known that autophagy is involved in HCC. Conclusions: The link between novel fusion transcript VTI1A-CFAP46 and autophagy as a potential therapeutic target in HCC patients deserves further investigation. Moreover, this study shows that fusion transcripts are worthy of additional exploration in HCC.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"11 - 27"},"PeriodicalIF":1.6,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000496795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43530101","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}
Background: Nested stromal-epithelial tumor (NSET) is a rare liver tumor, which is most commonly seen in the pediatric age group. To the best of our knowledge, there has been no published review on this rare tumor in the English literature so far. Summary: In this review, we will discuss all the reported details of the published cases, including demography, clinical presentation, molecular histogenesis, imaging, gross pathology and histopathology, immunohistochemical findings, treatment modalities, and outcome of NSET of the liver. Key Message: Thirty-eight cases of NSET have been reported in the last 20 years in the English literature. This tumor produces a very large and calcified mass in the liver and characteristically can present as Cushing syndrome. NSET is a nonbiliary and nonhepatocytic tumor with biphasic differentiation into 2 components of epithelial and stromal cells. The epithelial cells are arranged as nests of mildly atypical epithelial cells with a few mitotic figures. The stromal component is composed of myofibroblasts and desmoplastic stroma which often shows ossification and calcification. Immunohistochemically, this tumor is positive for both epithelial and mesenchymal markers. The majority of the reported cases in the literature had benign behavior with an indolent course.
{"title":"Nested Stromal-Epithelial Tumor of the Liver: A Review","authors":"B. Geramizadeh","doi":"10.1159/000496339","DOIUrl":"https://doi.org/10.1159/000496339","url":null,"abstract":"Background: Nested stromal-epithelial tumor (NSET) is a rare liver tumor, which is most commonly seen in the pediatric age group. To the best of our knowledge, there has been no published review on this rare tumor in the English literature so far. Summary: In this review, we will discuss all the reported details of the published cases, including demography, clinical presentation, molecular histogenesis, imaging, gross pathology and histopathology, immunohistochemical findings, treatment modalities, and outcome of NSET of the liver. Key Message: Thirty-eight cases of NSET have been reported in the last 20 years in the English literature. This tumor produces a very large and calcified mass in the liver and characteristically can present as Cushing syndrome. NSET is a nonbiliary and nonhepatocytic tumor with biphasic differentiation into 2 components of epithelial and stromal cells. The epithelial cells are arranged as nests of mildly atypical epithelial cells with a few mitotic figures. The stromal component is composed of myofibroblasts and desmoplastic stroma which often shows ossification and calcification. Immunohistochemically, this tumor is positive for both epithelial and mesenchymal markers. The majority of the reported cases in the literature had benign behavior with an indolent course.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"1 - 10"},"PeriodicalIF":1.6,"publicationDate":"2019-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000496339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46566034","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}
Pub Date : 2019-02-01Epub Date: 2018-12-21DOI: 10.1159/000495178
Helen J Trihia
Background: In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. The simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) has been documented rarely.
Summary: The coexistence of primary gastric adenocarcinoma and GIST has been detected incidentally on gastric mucosa, serosa or occasionally intramurally, at surgery, or gastroscopy for other reasons. We present a case of a 79-year-old male patient who underwent surgery for an advanced gastric carcinoma, where multiple nodules of GIST were incidentally discovered during the work-up of his gastrectomy specimen.
Key message: GISTs range from small "low-risk" tumors to sarcomas. Small GISTs are found incidentally during unrelated surgery or autopsy. Multiple GISTs are extremely rare and usually associated with hereditary diseases.
Practical implications: In any case of gastrointestinal neoplasm, the surgeon and pathologist should be alert to perform a thorough investigation. Our case could provide further awareness and insight into the entity of concurrent tumors.
{"title":"Coexistence of Gastric Cancer and Multiple Small Gastrointestinal Stromal Tumors: Report of a Unique Case and Review of the Literature.","authors":"Helen J Trihia","doi":"10.1159/000495178","DOIUrl":"https://doi.org/10.1159/000495178","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. The simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) has been documented rarely.</p><p><strong>Summary: </strong>The coexistence of primary gastric adenocarcinoma and GIST has been detected incidentally on gastric mucosa, serosa or occasionally intramurally, at surgery, or gastroscopy for other reasons. We present a case of a 79-year-old male patient who underwent surgery for an advanced gastric carcinoma, where multiple nodules of GIST were incidentally discovered during the work-up of his gastrectomy specimen.</p><p><strong>Key message: </strong>GISTs range from small \"low-risk\" tumors to sarcomas. Small GISTs are found incidentally during unrelated surgery or autopsy. Multiple GISTs are extremely rare and usually associated with hereditary diseases.</p><p><strong>Practical implications: </strong>In any case of gastrointestinal neoplasm, the surgeon and pathologist should be alert to perform a thorough investigation. Our case could provide further awareness and insight into the entity of concurrent tumors.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"5 3-4","pages":"63-67"},"PeriodicalIF":1.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000495178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308432","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}
Pub Date : 2019-02-01Epub Date: 2018-11-22DOI: 10.1159/000494351
Vikrant Parihar, Julia Sopheno-Falco, Pardeep Maheshwari, Neil O'Moran, Vivien Graziadei, Aishling O'Grady Walshe, Orla O'Dwyer, Lakshman Kumar, Sean Fennessy, Niall Breslin, Barbara M Ryan, Deirdre McNamara
Background and study aim: The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice.
Patients and methods: This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded.
Results: 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to.
Conclusions: This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.
{"title":"Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital.","authors":"Vikrant Parihar, Julia Sopheno-Falco, Pardeep Maheshwari, Neil O'Moran, Vivien Graziadei, Aishling O'Grady Walshe, Orla O'Dwyer, Lakshman Kumar, Sean Fennessy, Niall Breslin, Barbara M Ryan, Deirdre McNamara","doi":"10.1159/000494351","DOIUrl":"https://doi.org/10.1159/000494351","url":null,"abstract":"<p><strong>Background and study aim: </strong>The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice.</p><p><strong>Patients and methods: </strong>This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded.</p><p><strong>Results: </strong>6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in <i>n</i>405 cases (59%). Overall, 16% (<i>n</i> = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to.</p><p><strong>Conclusions: </strong>This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"5 3-4","pages":"82-89"},"PeriodicalIF":1.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000494351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37321355","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}
Pub Date : 2019-02-01Epub Date: 2018-11-05DOI: 10.1159/000493526
Carmela Wetterhall, Elin Mariusdottir, Claire Hall, Fredrik Jörgren, Pamela Buchwald
Purpose: Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors.
Methods: All patients who underwent Hartmann's procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.
Results: 172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (p = 0.03) and Hinchey grade III and IV (p = 0.02) in those patients who underwent Hartmann's procedure for diverticular disease.
Conclusion: Hartmann's procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.
{"title":"Low Incidence of Pelvic Sepsis after Hartmann's Procedure: Radiation Therapy May Be a Risk Factor.","authors":"Carmela Wetterhall, Elin Mariusdottir, Claire Hall, Fredrik Jörgren, Pamela Buchwald","doi":"10.1159/000493526","DOIUrl":"https://doi.org/10.1159/000493526","url":null,"abstract":"<p><strong>Purpose: </strong>Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors.</p><p><strong>Methods: </strong>All patients who underwent Hartmann's procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.</p><p><strong>Results: </strong>172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (<i>p</i> = 0.03) and Hinchey grade III and IV (<i>p</i> = 0.02) in those patients who underwent Hartmann's procedure for diverticular disease.</p><p><strong>Conclusion: </strong>Hartmann's procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"5 3-4","pages":"77-81"},"PeriodicalIF":1.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000493526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308434","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}
Pub Date : 2019-02-01Epub Date: 2018-08-27DOI: 10.1159/000489777
Raquel Gonzalez-Heredia, Samarth Durgam, Mario Masrur, Luis Fernando Gonzalez-Ciccarelli, Antonio Gangemi, Francesco M Bianco, Pier C Giulianotti
Background: Various technical improvements have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) is the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined. The aim of this study was to identify the risk factors and incidence of POPF with different types of pancreatic stump management after robot-assisted pancreaticoduodenectomy (RAPD).
Materials and methods: This study is a retrospective review of consecutive patients who underwent RAPD at the University of Illinois Hospital and Health Sciences System between September 2007 and January 2016. The cohort was divided based on the type of pancreatic stump management: pancreatic duct occlusion with cyanoacrylate glue (CG), pancreaticojejunostomy (PJ), posterior pancreaticogastrostomy (PPG), and transgastric pancreaticogastrostomy (TPG).
Results: The cohort included 69 patients: pancreatic duct occlusion with CG (n = 18), PJ (n = 12), PPG (n = 11), and TPG (n = 28). Pancreatic duct diameter < 3 mm and duct occlusion with CG were identified as risk factors for POPF (p < 0.05). The incidence of POPF was lower when TPG and PJ were performed (p < 0.001).
Conclusions: Reconstruction with PJ and TPG had better results compared to pancreatic duct occlusion with CG and PPG. However, TPG was the technique of choice and showed comparable results to PJ.
{"title":"Comparison of Different Techniques of Pancreatic Stump Management in Robot-Assisted Pancreaticoduodenectomy.","authors":"Raquel Gonzalez-Heredia, Samarth Durgam, Mario Masrur, Luis Fernando Gonzalez-Ciccarelli, Antonio Gangemi, Francesco M Bianco, Pier C Giulianotti","doi":"10.1159/000489777","DOIUrl":"https://doi.org/10.1159/000489777","url":null,"abstract":"<p><strong>Background: </strong>Various technical improvements have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) is the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined. The aim of this study was to identify the risk factors and incidence of POPF with different types of pancreatic stump management after robot-assisted pancreaticoduodenectomy (RAPD).</p><p><strong>Materials and methods: </strong>This study is a retrospective review of consecutive patients who underwent RAPD at the University of Illinois Hospital and Health Sciences System between September 2007 and January 2016. The cohort was divided based on the type of pancreatic stump management: pancreatic duct occlusion with cyanoacrylate glue (CG), pancreaticojejunostomy (PJ), posterior pancreaticogastrostomy (PPG), and transgastric pancreaticogastrostomy (TPG).</p><p><strong>Results: </strong>The cohort included 69 patients: pancreatic duct occlusion with CG (<i>n</i> = 18), PJ (<i>n</i> = 12), PPG (<i>n</i> = 11), and TPG (<i>n</i> = 28). Pancreatic duct diameter < 3 mm and duct occlusion with CG were identified as risk factors for POPF (<i>p</i> < 0.05). The incidence of POPF was lower when TPG and PJ were performed (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Reconstruction with PJ and TPG had better results compared to pancreatic duct occlusion with CG and PPG. However, TPG was the technique of choice and showed comparable results to PJ.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"5 3-4","pages":"68-76"},"PeriodicalIF":1.6,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000489777","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308433","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}
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