: Acute lower gastrointestinal bleeding (LGIB) attributed to malignant colorectal lesion presents an endoscopically demanding task to manage due to multiple contributing factors. This ranges from an array of compounding issues such as tumour friability, neovascularization and coagulopathy arising from either medical comorbidities or pharmacological medications. We present a challenging case of malignant rectosigmoid colonic tumour bleeding in the setting of COVID-19 infection at its highest level in our country where all resources were severely stretched and strained. A 58-year-old man admitted for stage 3 COVID-19 pneumonia had been complaining of intermittent hematochezia for 1 month. Relevant blood investigations revealed a hemoglobin count of 5.1 g/dL with normal coagulation profile. Index colonoscopy demonstrated a bulky, circumferential rectosigmoid colon tumour with significantly narrowed (3–4 mm) luminal opening. As there was no bleeding, no endoscopic intervention was forthcoming. Staging computed tomography (CT) scan done the following day, confirmed a large but localized rectosigmoid colon tumour measuring 5 cm in length with no signs of bowel obstruction. Owing to hospital restrictions in place during the pandemic, he was unable to undergo definitive surgical intervention when he rebled 10 days later. This was complicated with hemodynamic instability which warranted an urgent endoscopic treatment with argon plasma coagulation (APC). This timely intervention was successful in buying sufficient time for him to recover from COVID-19 pneumonia and subsequently undergo surgery. The final overall diagnosis was pT3N0M0 moderately differentiated colonic adenocarcinoma. Though APC has limited role in the management of bleeding colorectal cancers due to high rebleeding rates, its’ temporizing hemostatic benefits may still be of use when other modalities are unavailable. The COVID-19 pandemic has brought about various disruptions in our routine endoscopic practices. Aside from delays in timely diagnosis and definitive intervention, endoscopic practices alongside performance are equally affected by resource limitation which is highlighted in our case.
{"title":"Unique challenges of endotherapeutics in malignant lower gastrointestinal bleeding in a patient with COVID-19 pneumonia—case report and literature review","authors":"K. Chiam, R. Muthukaruppan","doi":"10.21037/dmr-21-56","DOIUrl":"https://doi.org/10.21037/dmr-21-56","url":null,"abstract":": Acute lower gastrointestinal bleeding (LGIB) attributed to malignant colorectal lesion presents an endoscopically demanding task to manage due to multiple contributing factors. This ranges from an array of compounding issues such as tumour friability, neovascularization and coagulopathy arising from either medical comorbidities or pharmacological medications. We present a challenging case of malignant rectosigmoid colonic tumour bleeding in the setting of COVID-19 infection at its highest level in our country where all resources were severely stretched and strained. A 58-year-old man admitted for stage 3 COVID-19 pneumonia had been complaining of intermittent hematochezia for 1 month. Relevant blood investigations revealed a hemoglobin count of 5.1 g/dL with normal coagulation profile. Index colonoscopy demonstrated a bulky, circumferential rectosigmoid colon tumour with significantly narrowed (3–4 mm) luminal opening. As there was no bleeding, no endoscopic intervention was forthcoming. Staging computed tomography (CT) scan done the following day, confirmed a large but localized rectosigmoid colon tumour measuring 5 cm in length with no signs of bowel obstruction. Owing to hospital restrictions in place during the pandemic, he was unable to undergo definitive surgical intervention when he rebled 10 days later. This was complicated with hemodynamic instability which warranted an urgent endoscopic treatment with argon plasma coagulation (APC). This timely intervention was successful in buying sufficient time for him to recover from COVID-19 pneumonia and subsequently undergo surgery. The final overall diagnosis was pT3N0M0 moderately differentiated colonic adenocarcinoma. Though APC has limited role in the management of bleeding colorectal cancers due to high rebleeding rates, its’ temporizing hemostatic benefits may still be of use when other modalities are unavailable. The COVID-19 pandemic has brought about various disruptions in our routine endoscopic practices. Aside from delays in timely diagnosis and definitive intervention, endoscopic practices alongside performance are equally affected by resource limitation which is highlighted in our case.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49320253","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}
Shanmugaraj Kulanthaivel, L. Boccuto, C. Zanza, Y. Longhitano, K. Balasundaram, N. Méndez-Sánchez, L. Abenavoli
Science and Research Department, Naarayani Multi Speciality Hospital, Erode, Tamilnadu, India; School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA; Foundation of Nuovo Ospedale Alba-Bra” and Department of Emergency Medicine, Anesthesia and Critical Care, Pietro and Michele Ferrero Hospital, Verduno, Italy; Department of Anesthesia and Critical Care Medicine, SS. Antonio and Biagio and Cesare Arrigo University Hospital, Alessandria, Italy; Department of Internal Medicine No. 2, Vernadsky Crimean Federal University, Simferopol, Russia; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Department of Health Sciences, Magna Graecia University, Catanzaro, Italy Contributions: (I) Conception and design: S Kulanthaivel; (II) Administrative support: None; (III) Provision of study materials or patients: S Kulanthaivel, L Boccuto, L Abenavoli; (IV) Collection and assembly of data: L Boccuto, L Abenavoli; (V) Data analysis and interpretation: C Zanza, Y Longhitano, K Balasundaram, N Méndez-Sánchez; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ludovico Abenavoli, MD, PhD. Department of Health Sciences, University “Magna Graecia” Viale Europa, 88100, Catanzaro, Italy. Email: l.abenavoli@unicz.it.
{"title":"Biliary acids as promoters of colon carcinogenesis: a narrative review","authors":"Shanmugaraj Kulanthaivel, L. Boccuto, C. Zanza, Y. Longhitano, K. Balasundaram, N. Méndez-Sánchez, L. Abenavoli","doi":"10.21037/DMR-21-23","DOIUrl":"https://doi.org/10.21037/DMR-21-23","url":null,"abstract":"Science and Research Department, Naarayani Multi Speciality Hospital, Erode, Tamilnadu, India; School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA; Foundation of Nuovo Ospedale Alba-Bra” and Department of Emergency Medicine, Anesthesia and Critical Care, Pietro and Michele Ferrero Hospital, Verduno, Italy; Department of Anesthesia and Critical Care Medicine, SS. Antonio and Biagio and Cesare Arrigo University Hospital, Alessandria, Italy; Department of Internal Medicine No. 2, Vernadsky Crimean Federal University, Simferopol, Russia; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Department of Health Sciences, Magna Graecia University, Catanzaro, Italy Contributions: (I) Conception and design: S Kulanthaivel; (II) Administrative support: None; (III) Provision of study materials or patients: S Kulanthaivel, L Boccuto, L Abenavoli; (IV) Collection and assembly of data: L Boccuto, L Abenavoli; (V) Data analysis and interpretation: C Zanza, Y Longhitano, K Balasundaram, N Méndez-Sánchez; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ludovico Abenavoli, MD, PhD. Department of Health Sciences, University “Magna Graecia” Viale Europa, 88100, Catanzaro, Italy. Email: l.abenavoli@unicz.it.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41551280","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}
Alpha-1 antitrypsin deficiency (AATD) is a genetic disease affecting both children and adults. It is caused by >100 different mutations in SERPINA1, the α1-antitrypsin (AAT) gene. While the lung is the main afflicted organ in adults, the liver can be affected in both children and adults. The classical form of AATD is the homozygous “Pi*Z” mutation (“Pi*ZZ” genotype) which may result mainly in neonatal hepatitis syndrome and in liver fibrosis in later adulthood. This narrative review focusses on the highly heterogeneous Pi*ZZ-related liver disease (LD) in children and adults and the transition of care. While in a minority of children Pi*ZZ-related LD typically presents as neonatal cholestasis which is largely self-limiting, the majority of Pi*ZZ children do not develop clinically relevant LD. In Pi*ZZ adults, around one third develop signs of significant liver fibrosis. Consequently, Pi*ZZ-related LD is a relatively common cause of liver transplantation which is the only available cure yet. Risk factors for accelerated fibrosis progression in adults are male sex, age ≥50 years, alcohol misuse, obesity, diabetes mellitus, or metabolic syndrome while there are no well-established risk factors in children. The workup of LD is similar in both age groups and includes liver biochemistry, ultrasound, and non-invasive assessment of fibrosis (e.g., elastography). Further workup including liver biopsy might become necessary. While no guidelines exist, in our view, children and adults with signs of Pi*ZZ-related LD should be offered referral to a specialized center in order to counsel the patients and their families regarding their risk of Pi*ZZ-related complications, to define the individual monitoring plan, and to evaluate whether a patient qualifies for a novel treatment modality or liver transplant. Moreover, transition from pediatric to adult hepatologic care should be warranted.
{"title":"Pi*ZZ-related liver disease in children and adults—narrative review of the typical presentation and management of alpha-1 antitrypsin deficiency","authors":"David Katzer, R. Ganschow, P. Strnad, K. Hamesch","doi":"10.21037/dmr-21-9","DOIUrl":"https://doi.org/10.21037/dmr-21-9","url":null,"abstract":"Alpha-1 antitrypsin deficiency (AATD) is a genetic disease affecting both children and adults. It is caused by >100 different mutations in SERPINA1, the α1-antitrypsin (AAT) gene. While the lung is the main afflicted organ in adults, the liver can be affected in both children and adults. The classical form of AATD is the homozygous “Pi*Z” mutation (“Pi*ZZ” genotype) which may result mainly in neonatal hepatitis syndrome and in liver fibrosis in later adulthood. This narrative review focusses on the highly heterogeneous Pi*ZZ-related liver disease (LD) in children and adults and the transition of care. While in a minority of children Pi*ZZ-related LD typically presents as neonatal cholestasis which is largely self-limiting, the majority of Pi*ZZ children do not develop clinically relevant LD. In Pi*ZZ adults, around one third develop signs of significant liver fibrosis. Consequently, Pi*ZZ-related LD is a relatively common cause of liver transplantation which is the only available cure yet. Risk factors for accelerated fibrosis progression in adults are male sex, age ≥50 years, alcohol misuse, obesity, diabetes mellitus, or metabolic syndrome while there are no well-established risk factors in children. The workup of LD is similar in both age groups and includes liver biochemistry, ultrasound, and non-invasive assessment of fibrosis (e.g., elastography). Further workup including liver biopsy might become necessary. While no guidelines exist, in our view, children and adults with signs of Pi*ZZ-related LD should be offered referral to a specialized center in order to counsel the patients and their families regarding their risk of Pi*ZZ-related complications, to define the individual monitoring plan, and to evaluate whether a patient qualifies for a novel treatment modality or liver transplant. Moreover, transition from pediatric to adult hepatologic care should be warranted.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42908846","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}
Carolina Vanetta, M. Lidsky, G. Herbert, K. Shah, S. Zani
Minimally invasive techniques for gastric resection have become more appealing to many patients and surgeons than open techniques due to their reduction in postoperative pain, hospital stay, and faster recovery. Endoscopic resection of early stage gastric cancer has become an attractive alternative to conventional surgery for very early gastric cancer. In the management of gastric malignancies, learning curves for laparoscopic gastrectomy have been met, and this technique has been implemented by surgeons all around the world. As regards robotic-assisted gastrectomy, this approach has shown non-inferiority in terms of oncological outcomes, but it's longer operation time and high costs imply major drawbacks. In the present article we discuss minimally invasive techniques for gastric surgery, as well as review the most recent studies comparing laparoscopic and robotic gastrectomy in the treatment of gastric cancer. Although the robot hasn’t met the desired expectations, it has shown several advantages over the laparoscopic approach, such as decreased blood loss, decreased hospital stay, decreased complications (pancreatic fistula), and increased number of harvested lymph nodes. To date, there are no results from well-designed randomised controlled trials comparing laparoscopic and robotic gastrectomy, and most studies on robotic gastrectomy come from Eastern hemisphere countries, who encounter early stage gastric cancer in low BMI patients. Contrary to this, Western countries encounter more advanced, cardia gastric cancer, in higher BMI patients, resulting in a technical challenge when surgery is indicated in these patients. We believe the real benefits of the robot will be determined in these more technically demanding cases.
{"title":"Minimally invasive surgical management of gastric malignancies: role of robotic surgery","authors":"Carolina Vanetta, M. Lidsky, G. Herbert, K. Shah, S. Zani","doi":"10.21037/DMR-21-12","DOIUrl":"https://doi.org/10.21037/DMR-21-12","url":null,"abstract":"Minimally invasive techniques for gastric resection have become more appealing to many patients and surgeons than open techniques due to their reduction in postoperative pain, hospital stay, and faster recovery. Endoscopic resection of early stage gastric cancer has become an attractive alternative to conventional surgery for very early gastric cancer. In the management of gastric malignancies, learning curves for laparoscopic gastrectomy have been met, and this technique has been implemented by surgeons all around the world. As regards robotic-assisted gastrectomy, this approach has shown non-inferiority in terms of oncological outcomes, but it's longer operation time and high costs imply major drawbacks. In the present article we discuss minimally invasive techniques for gastric surgery, as well as review the most recent studies comparing laparoscopic and robotic gastrectomy in the treatment of gastric cancer. Although the robot hasn’t met the desired expectations, it has shown several advantages over the laparoscopic approach, such as decreased blood loss, decreased hospital stay, decreased complications (pancreatic fistula), and increased number of harvested lymph nodes. To date, there are no results from well-designed randomised controlled trials comparing laparoscopic and robotic gastrectomy, and most studies on robotic gastrectomy come from Eastern hemisphere countries, who encounter early stage gastric cancer in low BMI patients. Contrary to this, Western countries encounter more advanced, cardia gastric cancer, in higher BMI patients, resulting in a technical challenge when surgery is indicated in these patients. We believe the real benefits of the robot will be determined in these more technically demanding cases.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48989770","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}
Esophageal cancer consists of two distinct histological types, esophageal squamous cell-carcinoma (ESCC) and esophageal adenocarcinoma (EAC). Esophageal carcinoma is a grave malignancy with regards to prognosis and mortality. ESCC remains the dominant histological type of esophageal cancer worldwide, with about 90 percent of all cases worldwide. However, EAC is now much more common in the United States and the Western World, and represents one of the fastest growing cancers there. Despite significant progress in multimodality treatment options, the overall prognosis remains poor, and 5-year survival rates for all-comers are still below 20 percent. Although esophageal cancer initially responds well to systemic therapy, most patients recur and eventually die from their disease. Therefore, new treatment options are urgently needed. The combination of traditional systemic therapy with new biologicals and/or targeted agents is one of these new treatment options. Some of these agents are already approved, while others are currently undergoing clinical trials. These targeted therapies have emerged as an important tool for the treatment of many different cancer types, including esophageal cancer. Herein, we review the recent literature and ongoing clinical trials in esophageal cancer targeted therapies, and discuss the different targeted pathways. Currently, most esophageal cancer patients are still treated with a combination of chemotherapies like taxanes (paclitaxel, docetaxel), platinums (carboplatin, cisplatin), anthracyclines (doxorubicin, epirubicin) or pyrimidine analogs (5-fluorouracil). Future treatment strategies should be based on the molecular features of each patient’s individual tumor, and should include biologicals/targeted agents tailored to these
{"title":"Targeted therapy in esophageal cancer","authors":"S. Hassan, Victoria Makuru, U. Holzen","doi":"10.21037/DMR-21-16","DOIUrl":"https://doi.org/10.21037/DMR-21-16","url":null,"abstract":"Esophageal cancer consists of two distinct histological types, esophageal squamous cell-carcinoma (ESCC) and esophageal adenocarcinoma (EAC). Esophageal carcinoma is a grave malignancy with regards to prognosis and mortality. ESCC remains the dominant histological type of esophageal cancer worldwide, with about 90 percent of all cases worldwide. However, EAC is now much more common in the United States and the Western World, and represents one of the fastest growing cancers there. Despite significant progress in multimodality treatment options, the overall prognosis remains poor, and 5-year survival rates for all-comers are still below 20 percent. Although esophageal cancer initially responds well to systemic therapy, most patients recur and eventually die from their disease. Therefore, new treatment options are urgently needed. The combination of traditional systemic therapy with new biologicals and/or targeted agents is one of these new treatment options. Some of these agents are already approved, while others are currently undergoing clinical trials. These targeted therapies have emerged as an important tool for the treatment of many different cancer types, including esophageal cancer. Herein, we review the recent literature and ongoing clinical trials in esophageal cancer targeted therapies, and discuss the different targeted pathways. Currently, most esophageal cancer patients are still treated with a combination of chemotherapies like taxanes (paclitaxel, docetaxel), platinums (carboplatin, cisplatin), anthracyclines (doxorubicin, epirubicin) or pyrimidine analogs (5-fluorouracil). Future treatment strategies should be based on the molecular features of each patient’s individual tumor, and should include biologicals/targeted agents tailored to these","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46795889","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}
Acquired jejunal diverticulosis is a rare disorder with an unclear pathophysiology that is potentially related to abnormalities in the smooth muscle layer, the myenteric plexus or peristaltic defects and increased intraluminal pressures leading to herniation. Typically occurring in patients older than 60 years of age, jejunal diverticulosis can present without any symptoms, as chronic, nonspecific gastrointestinal complaints, or have an acute onset with high mortality rates for complications such as ileus, fistula, or hemorrhage with the most common being diverticulitis. Of those with jejunal diverticulitis, the most common complications are perforations, bleeding, and bowel obstruction. We presented three cases of complicated jejunal diverticular disease. The first patient presented with unrelenting abdominal pain refractory to analgesia, nausea, fever and associated tachycardia with a localized perforated diverticulum. Patients two and three had a history of pneumatosis intestinalis on CT scan and jejunal diverticulectomy limited to the actively inflamed and microperforated diverticula, three years prior and four months prior, respectively. Patient two was found to have twenty large new jejunal diverticula, two of which had micro perforations. Patient three had extensive diverticulosis, mesenteric abscesses and serositis had an extended ICU stay with intraabdominal infection and fascial dehiscence. Complete segmental resection was performed as a definitive procedure for all three cases, eventually leading to favorable outcomes. Due to the rarity, varied presentation, and high mortality rates, jejunal diverticulosis should always be considered in the diagnostic differential for nonspecific gastrointestinal complaints.
{"title":"Jejunal diverticulitis: three case reports of a rare but clinically significant disease","authors":"Olutayo A. Sogunro, M. Buck, P. Labrias","doi":"10.21037/DMR-20-161","DOIUrl":"https://doi.org/10.21037/DMR-20-161","url":null,"abstract":"Acquired jejunal diverticulosis is a rare disorder with an unclear pathophysiology that is potentially related to abnormalities in the smooth muscle layer, the myenteric plexus or peristaltic defects and increased intraluminal pressures leading to herniation. Typically occurring in patients older than 60 years of age, jejunal diverticulosis can present without any symptoms, as chronic, nonspecific gastrointestinal complaints, or have an acute onset with high mortality rates for complications such as ileus, fistula, or hemorrhage with the most common being diverticulitis. Of those with jejunal diverticulitis, the most common complications are perforations, bleeding, and bowel obstruction. We presented three cases of complicated jejunal diverticular disease. The first patient presented with unrelenting abdominal pain refractory to analgesia, nausea, fever and associated tachycardia with a localized perforated diverticulum. Patients two and three had a history of pneumatosis intestinalis on CT scan and jejunal diverticulectomy limited to the actively inflamed and microperforated diverticula, three years prior and four months prior, respectively. Patient two was found to have twenty large new jejunal diverticula, two of which had micro perforations. Patient three had extensive diverticulosis, mesenteric abscesses and serositis had an extended ICU stay with intraabdominal infection and fascial dehiscence. Complete segmental resection was performed as a definitive procedure for all three cases, eventually leading to favorable outcomes. Due to the rarity, varied presentation, and high mortality rates, jejunal diverticulosis should always be considered in the diagnostic differential for nonspecific gastrointestinal complaints.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47856173","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}
I. Eiriz, A. Rêgo, Ângela Abreu, Sara Machado, M. Silva
: Leptomeningeal carcinomatosis in gastric adenocarcinoma is very rare (0.16–0.69%). Breast cancer, lung cancer, melanoma and hematologic malignancies are the most common causes of leptomeningeal carcinomatosis. The diagnosis is usually established by the presence of malignant cells in cerebrospinal fluid along with magnetic resonance imaging. There are few published studies about this condition and prognosis is very poor. We present a case of a 67-year-old man with a localized gastric cancer adenocarcinoma treated with perioperative chemotherapy and total gastrectomy with D2 lymphadenectomy. During the post treatment surveillance, recurrence occurred after a year, with exclusive leptomeningeal location. Clinical presentation consisted of bilateral optic peri neuritis, a peculiar manifestation which required an extensive differential diagnosis including inflammatory, infectious, autoimmune diseases, genetic and toxic neuropathies. Treatment strategy of this condition is not established. Besides symptomatic therapy, chemotherapy or radiotherapy are treatment options, even though these are palliative treatments and results are disappointing. This patient died 3 months after diagnosis of leptomeningeal involvement. We underline the rarity of this condition, the need for a high level of clinical suspicion and the difficulty in the diagnostic and treatment process. Late diagnosis and shortage of prospective randomized trials may be the reason for poor prognosis. Further studies are needed to better improve gastric leptomeningeal carcinomatosis treatment.
{"title":"Uncommon presentation of leptomeningeal carcinomatosis from gastric cancer: a case report","authors":"I. Eiriz, A. Rêgo, Ângela Abreu, Sara Machado, M. Silva","doi":"10.21037/DMR-21-18","DOIUrl":"https://doi.org/10.21037/DMR-21-18","url":null,"abstract":": Leptomeningeal carcinomatosis in gastric adenocarcinoma is very rare (0.16–0.69%). Breast cancer, lung cancer, melanoma and hematologic malignancies are the most common causes of leptomeningeal carcinomatosis. The diagnosis is usually established by the presence of malignant cells in cerebrospinal fluid along with magnetic resonance imaging. There are few published studies about this condition and prognosis is very poor. We present a case of a 67-year-old man with a localized gastric cancer adenocarcinoma treated with perioperative chemotherapy and total gastrectomy with D2 lymphadenectomy. During the post treatment surveillance, recurrence occurred after a year, with exclusive leptomeningeal location. Clinical presentation consisted of bilateral optic peri neuritis, a peculiar manifestation which required an extensive differential diagnosis including inflammatory, infectious, autoimmune diseases, genetic and toxic neuropathies. Treatment strategy of this condition is not established. Besides symptomatic therapy, chemotherapy or radiotherapy are treatment options, even though these are palliative treatments and results are disappointing. This patient died 3 months after diagnosis of leptomeningeal involvement. We underline the rarity of this condition, the need for a high level of clinical suspicion and the difficulty in the diagnostic and treatment process. Late diagnosis and shortage of prospective randomized trials may be the reason for poor prognosis. Further studies are needed to better improve gastric leptomeningeal carcinomatosis treatment.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49222242","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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