gastro-esophageal malignancies in Northern Iran research project: impact on the health research and health care systems of Iran

The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations

Obstructive and inflammatory gastric heterotopic pancreatic tissue

Heterotopic pancreas is defined as pancreatic tissue arising ectopically with no vascular or anatomic contiguity with the pancreas proper and is believed to arise embryologically during rotation of the foregut and fusion of the dorsal and ventral pancreatic buds. We report a case of gastric heterotopic pancreas presenting as an obstructive inflammatory mass with the clinical differential diagnosis of gastric carcinoma. A 54 year-old woman presented with a history of four days of severe, acute-onset abdominal pain. Abdominal ultrasound showed a gastric antral mass. This was confirmed on computerized tomography, which revealed a hypodense mass with heterogeneous enhancement in the gastric antrum and multiple ill-defined hypo-dense areas in the liver suspicious for metastases. A preoperative diagnosis of malignant neoplasm was strongly favored, and a subtotal gastrectomy was performed. Microscopic examination of the specimen revealed submucosal and deeply seated intra-muscular and mural heterotopic pancreatic tissue, comprised of both ductal and acinar structures, surrounded by exuberant acute and chronic inflammation. The ducts were inflamed and showed marked cytologic atypia, favored to be of reactive nature. There was overlying mucosal ulceration with marked acute and chronic full-thickness gastric mural inflammatory response with abscess formation. This is the second reported case of obstructive gastric heterotopic pancreas, presenting as an inflammatory mural gastric mass