Prognostic significance of ?mmunhistochemical axl expression in pancreas ductal adenocarcinomas

Introduction and Aim: Pancreas Ductal Adenocarcinomas (PDACs) are among the leading causes of cancer-related death. Tyrosine kinase receptors (TKRs) are responsible for cell plasticity, chemoresistance, immunosuppression and metastasis potential. Axl is a receptor of the TKR family, and it has come to the fore in cancer treatment in the last decade. This study aimed to investigate the relationship of immunohistochemical Axl expression with histological features and its prognostic importance in PDACs. Materials and Methods: Fifty-three patients who were operated on for PDAC between 2006-2017 were evaluated retrospectively. Features of tumors; size, lymphovascular invasion (LVI), perineural invasion (PNI), resection margin (RM), lymph node metastasis (LNM), differentiation, tumor-infiltrating lymphocyte, stage and overall survival were recorded. Immunohistochemically, membranous and or cytoplasmic staining was considered positive for Axl. Statistically, Pearson Chi-Square, Cox regression and Kaplan Mayer tests were used in the SPSS 21.0 program. Results: Axl was positive in 28 patients (52.8%). Axl positivity was found to be associated with the presence of LVI (P = 0.009) and LNM (P = 0.002) and was an independent prognostic factor in short survival (P = 0.006). Conclusion: It was found that increased expression of Axl, which is known to increase EMT-mediated metastasis in carcinogenesis, may be an indicator of local spread and poor prognosis in PDAC patients. In this respect, it can be promising as a targeted molecule in PDAC patient's individualized treatments.

Metastasis of primary signet ring cell carcinoma of prostate to bone marrow: A rare occurrence with review of literature

We report a case of a 65-year-old male who presented with multiple enlarged intraabdominal lymph nodes with lytic lesions over pelvic and lumbar vertebrae. His serum prostate-specific antigen (PSA) was markedly raised. Bone marrow investigation revealed the presence of diffuse infiltration of single cells having hyperchromatic nuclei, moderate amount of eosinophilic cytoplasm, and eccentrically placed nuclei resembling signet ring cells. Hence, a diagnosis of metastatic signet cell carcinoma of prostate was made on bone marrow biopsy. This variant of prostatic carcinoma is very rare and accounts for only 2.5% of all prostatic adenoacarcinomas that make our case worth reporting. To emphasize the rare occurrence of this variant, we performed a Pubmed-based literature review of 25 years.

Spindle assembly checkpoint complex-related genes TTK and MAD2L1 are over-expressed in lung adenocarcinoma: a big data and bioinformatics analysis / 南方医科大学学报

OBJECTIVE@#To screen the key genes related to the prognosis of lung adenocarcinoma through big data analysis and explore their clinical value and potential mechanism.@*METHODS@#We analyzed GSE18842, GSE27262, and GSE33532 gene expression profile data obtained from the Gene Expression Omnibus (GEO). Bioinformatics methods were used to screen the differentially expressed genes in lung adenocarcinoma tissues and KEGG and GO enrichment analysis was performed, followed by PPI interaction network analysis, module analysis, differential expression analysis, and prognosis analysis. The expressions of MAD2L1 and TTK by immunohistochemistry were verified in 35 non-small cell lung cancer specimens and paired adjacent tissues.@*RESULTS@#We identified a total of 256 genes that showed significant differential expressions in lung adenocarcinoma, including 66 up-regulated and 190 down-regulated genes. Thirty-two up-regulated core genes were screened by functional analysis, and among them 29 were shown to significantly correlate with a poor prognosis of patients with lung adenocarcinoma. All the 29 genes were highly expressed in lung adenocarcinoma tissues compared with normal lung tissues and were mainly enriched in cell cycle pathways. Seven of these key genes were closely related to the spindle assembly checkpoint (SAC) complex and responsible for regulating cell behavior in G2/M phase. We selected SAC-related proteins TTK and MAD2L1 to test their expressions in clinical tumor samples, and detected their overexpression in lung adenocarcinoma tissues as compared with the adjacent tissues.@*CONCLUSIONS@#Seven SAC complex-related genes, including TTK and MAD2L1, are overexpressed in lung adenocarcinoma tissues with close correlation with the prognosis of the patients.

Invasive mucinous adenocarcinoma of lung: A case report and literature review / 吉林大学学报(医学版)

Objective: To investigate the clinical characteristics and diagnosis and treatment process of a patient with invasive mucinous adenocarcinoma (IMAs) of lung, and to improve the clinician's understanding of IMAs. Methods: The general materials, imaging manifestations and treatment plan of a patient with IMAs were collected, and the related literature review was conducted. Results: A 42-year-old female patient was admitted to hospital due to cough and expectoration, the CT examination results showed the bilateral lung patchy shadows∗ the patient was suspected of having pneumonia. After anti-infective treatment, the patient' s symptoms did not improve. The pathological findings of transbronchial lung biopsy (TBLB) and the examination of exfoliated cells of pleural fluid all showed inflammation, and the pathological result of percutaneous biopsy was IMAs. The result of gene detection was 2-point mutation in exon of KRAS. After chemotherapy with paclitaxel plus carboplatin combined with bevacizumab, the symptoms of the patients were improved significantly, and the changes of imaging manifestations were obvious. Conclusion: IMAs is a special pathological type of lung adenocarcinomas (ADCs) with various imaging manifestations and specific gene expression. The treatment principles are different from those of the other types of ADCs.

Perfil dos casos de câncer gástrico em operados na emergência do Hospital Universitário Evangélico Mackenzie / Profile of gastric cancer cases in operated patients in the emergency of Evangelical Mackenzie University Hospital

O câncer gástrico está entre as neoplasias mais prevalentes mundialmente com alta taxa de mortalidade. Uma dificuldade no seu combate é o diagnóstico tardio. Este estudo analisou o perfil dos pacientes com câncer gástrico avançado operados na emergência. Método: estudo transversal-observacional retrospectivo pela coleta de dados de pacientes com câncer gástrico avançado no setor de emergência do Hospital Universitário Evangélico Mackenzie, entre janeiro de 2016 e junho de 2019. Resultados: foram 58 pacientes, representados majoritariamente por indivíduos do sexo masculino (60%) e brancos (79%). A idade média foi de 62,8 anos (variação de 48-78 anos). Principais sinais: hemorragia digestiva (34,4%) e síndrome pilórica (24,1%). O adenocarcinoma prevaleceu (87,9%), sendo 72,5% do tipo difuso. No sexo feminino, o difuso prevaleceu (90,9%). A mortalidade foi de 62%, estando associada principalmente ao tipo difuso. Conclusão: o câncer gástrico avançado apresenta alta morbimortalidade, sendo necessários métodos de rastreio populacional para diagnóstico precoce da doença.

Gastric cancer is among the most prevalent neoplasms worldwide, with a high mortality rate. Among the difficulties in combating this neoplasm, its late diagnosis stands out. This study sought to analyze the profile of patients with advanced gastric cancer operated in the emergency. Method: retrospective cross-observational study of data collection of patients admitted with advanced gastric cancer in the emergency of Evangelical Mackenzie University Hospital, between January 2016 and June 2019. Results: Fifty-eight patients were selected, represented mainly by the male sex (60%) and white (79%). The average age was 62,8 years (range 48-78 years). The main signs were digestive hemorrhage (34,4%) and pyloric syndrome (24,1%). Adenocarcinoma prevailed (87,9%), with 72,5% of the diffuse type. In females, diffuse prevalence prevailed (90,9%). Mortality was 62%, being mainly associated with the diffuse type. Conclusion: advanced gastric cancer has a high morbidity and mortality, requiring methods of population screening for early diagnosis of the disease.

Colonic adenosquamous carcinoma and mucinous adenocarcinoma with microsatellite instability

@#A 43-year-old man presented with two-month history of fatigue, weakness, paleness, rectal bleeding, sweating, and weight loss of 10 kg in the past one month. A complete blood count revealed anaemia. The patient underwent a right hemicolectomy. The microscopic examination revealed an adenosquamous carcinoma associated with a mucinous adenocarcinoma in a patient with microsatellite instability due to loss of MLH1 and PMS2 expression and retention of MSH2 and MSH6 expression in both the squamous and glandular components. We also observed an atypical immunohistochemical phenotype in the adenocarcinoma component showing CK7 expression and reduced CK20 and CDX2 expression.

Genomics and epidemiology for gastric adenocarcinomas

Whereas the pathological aspects of Gastric Adenocarcinomas (GACs) have been well defined, the actual knowledge of its genesis and evolution remains to be translated to better diagnosis and to more effective therapeutics. As a consequence, the current treatment modalities are not yet able to modify the natural history of the disease, which still presents high mortality-rates worldwide. In this review we highlight the current status of relevant epidemiologic, therapeutic and genomics aspects of GACs and point to some of the current knowledge gaps that, if fully addressed, could contribute to a more effective treatment and better management of the patients that suffer from this often-lethal disease (AU)

Does Hepatocyte Paraffin 1 expression stand a role in determining the site origin of an adenocarcinoma from unknown gastrointestinal primary.

Background: Hepatocyte Paraffin 1 (Hep Par 1) was being extensively used to recognize the hepatocellular carcinomas, until recognition of its expression in tumors without hepatocellular differentiation. Aims and Objectives: The aim of this study was to analyze if Hep Par 1 stain can serve as a specific marker of the small intestinal (SI) adenocarcinomas, versus other gastrointestinal tract (GIT) primary tumors. Materials and Methods: In this retrospective cross‑sectional study, normal GIT mucosa (n ‑ 60), corresponding adenocarcinomas (n ‑ 60) and nodal metastatic foci (n ‑ 60) from the same patients, including 10 cases each from the esophagus, stomach, SI periampullary region, colon, rectum, and gall bladder were included. H‑score was calculated by multiplying the stain distribution and intensity scores. The H‑scores were compared with other clinical and histological parameters. Results: While normal SI mucosa showed diffuse strong Hep Par 1 staining, normal esophageal and gastric epitheliums were negative and normal colon, rectal, and biliary epithelium showed weak focal positivity. Adenocarcinomas from all these sites, however, showed Hep Par 1 expression, irrespective of the tumor type, site or origin, and tumor stage. The corresponding metastatic sites also showed variable Hep Par 1 positivity, without any site specificity. Conclusion: Hep Par 1 stain cannot help to determine the exact site of origin of primary GIT tumors. Its expression in adenocarcinomas across the GIT and their metastatic foci proves that it cannot be regarded as a marker of SI differentiation, especially in malignancy.

A comprehensive study on histological features of fusion-positive lung adenocarcinomas and their association with psammoma bodies / 中国癌症杂志

Background and purpose:Gene fusions have been identiifed as recurrent oncogenic events in lung adenocarcinoma. Our purpose are to study the histologic features of anaplastic lymphoma kinase (ALK), c-ros oncogene 1 receptor tyrosine kinase (ROS1) andRETproto-oncogene fusion-positive lung adenocarcinomas and to evaluate the correlation between psammoma bodies and fusion-positive lung adenocarcinomas.Methods:In this study, we performed a comprehensive histologic analysis of 44 fusion-positive (including 15RET, 20ALK and 9ROS1) lung adenocarcinomas and 111 fusion-negative [including 20 epidermal growth factor receptor (EGFR), 20 Kirsten rat sarcoma viral oncogene (K-ras), 71 pan-negative] lung adenocarcinomas.Results:ALK,RET andROS1 fusion-positive lung adenocarcinomas were more prevalent in solid or acinar predominant adenocarcinoma. Multivariate analysis showed that tumors harboring a fusion gene had significantly higher prevalence of the presence of signet ring cells (P=0.000), micropapillary component (P=0.044), mucinous cribriform pattern (P=0.000) and extracellular mucin (P=0.010). The incidence of psammoma bodies was higher in the lung adenocarcinomas with a gene fusion than in tumors without gene fusions (P=0.000). Psammoma bodies were more likely to be found in tumors with any micropapillary component and/or mucinous cribriform pattern than in tumors lacking a micropapillary component and/or mucinous cribriform pattern (P=0.000).Conclusion:Our data showed that the presence of psammoma bodies, micropapillary component, mucinous cribriform pattern, extracellular mucin or signet ring cells may be either sensitive or speciifc to predict tumors harboring a fusion gene. These distinct morphologic features may be helpful in selecting cases for further accurate molecular testing.

Clinicopathological character and prognosis of rectum mucinous adenocarcinomas / 中华普通外科杂志

Objective To evaluate if mucinous subtype has a relevant impact on disease-free survival (DFS) of patients with rectal carcinoma.Methods The clinicopathological data of patients with rectal adenocarcinomas (ring cell carcinoma were excluded)undergoing radical surgery at Beijing Cancer Hospital from Jan 2010 to Jan 2012 were retrospectively studied,survival analysis was done to detect potential prognostic predictors.Results 353 patients with stage Ⅰ-Ⅲ rectal cancer were included in this study,of whom 28 (7.9％) had mucinous histology.The 3-year DFS for patients with a mucinous adenocarcinoma was 50.0％ and 83.4％ for patients with nonmucinous adenocarcinoma (P ＜ 0.001).Mucinous adenocarcinoma was associated with advanced pathologic T (T3/4,100％ vs 52.3％,P ＜0.001) and N stage (N1/2,64.3％ vs.32.6％,P =0.001).More patients were diagnosed under 40 years in mucinous adenocarcinoma group (21.4％ vs.5.5％,P =0.005).Conclusions Patients with mucinous adenocarcinoma more often present at a younger age,mucinous adenocarcinomas are associated with more advanced tumor stages,and should be regarded as a dismal prognostic factor for the survival of patients with rectal cancer.

Neoplasias de la unión esofagogástrica: presentación de tres casos / Three Case Reports of Neoplasms of the Esophagogastric Junction

Los patrones de incidencia de las neoplasias de esófago vienen presentando cambios en las últimas décadas. Es así como en hombres, el adenocarcinoma de esófago es ahora más frecuente que el carcinoma epidermoide. Hay evidencia en las diferencias del comportamiento biológico de los adenocarcinomas y dentro de los mismos carcinomas de células escamosas de acuerdo con su localización. Muchas discrepancias existen en la literatura respecto a la etiología, clasificación y tratamiento quirúrgico para estos tumores. Los adenocarcinomas de la unión gastroesofágica incluyen a los tumores originados en el esófago distal con invasión de la unión gastroesofágica, a los cardiales y a los originados en el estómago proximal. Generalmente se utiliza la clasificación topográfica propuesta por Siewert y Stein, que divide a los tumores en tipo I, cuando hay compromiso proximal a la unión gastroesofágica, tipo II, encontrados directamente en el cardias, y tipo III, encontrados en el estómago proximal. Hacemos la presentación de tres casos. Se lleva a cabo una revisión del enfoque diagnóstico y del manejo de estas lesiones.

Patterns of esophageal tumor incidence have changed in recent decades, now esophageal adenocarcinomas have become more common than squamous cell carcinoma among men. There is evidence of biological differences in behavior among adenocarcinomas and squamous cell carcinomas according to their locations. Many discrepancies exist in the literature regarding the etiology, classification and surgical treatment for these tumors. Adenocarcinomas of the gastroesophageal junction include tumors that arise in the distal esophagus as a result of invasion from the proximal stomach through the gastroesophageal junction and the cardiac glands. The usual topographic classification is that proposed by Siewert and Stein. It divides tumors into Type 1, which is used when the compromise is proximal to the gastroesophageal junction, Type 2 when the tumor is found directly in the cardia, and Type 3 when the tumor is in the proximal stomach. Here we present three cases and a review of the diagnostic approach to, and management of, these lesions.

Comportamiento de los tumores malignos de los párpados en el Instituto Nacional de Oncología y Radiobiología / Behavior of malignant eyelid tumors treated at the National Institute of Oncology and Radiobiology

Objetivo: evaluar el comportamiento clínico-histopatológico de los tumores malignos palpebrales y las modalidades de tratamiento aplicadas en el Instituto Nacional de Oncología y Radiobiología. Métodos: se realizó un análisis retrospectivo de 255 pacientes tratados consecutivamente en el periodo de enero 1995 a julio 2010. Los casos fueron evaluados según localización del tumor, modalidad de tratamiento, recurrencias, recidivas, complicaciones y sobrevida. El estadiamiento se realizó según los criterios de la la Unión Internacional contra el Cáncer como T1N0M0, T2N0M0, T3N0M0, T4N0M0. Resultados: del total de pacientes, 54,1 por ciento fueron masculinos y 45,9 por ciento femeninos con rangos de edad entre 18 y 80 años. La localización más frecuente fue en el párpado inferior (35 por ciento), y el canto externo, la variedad histopatológica predominante fue el carcinoma basocelular (47,8 por ciento). El tratamiento de elección fue la cirugía, la que se realizó a 198 pacientes. El 50,2 por ciento de los casos tratados tuvieron persistencia tumoral con infiltración de los bordes de sección quirúrgicos, los cuales recibieron tratamiento radiante adyuvante. Se presentaron recurrencias en el 3,5 porciento entre 3 y 5 meses y recidivas en el 7,1 por ciento de los casos, a partir del primer año después de terminado el tratamiento inicial, las complicaciones más frecuentes encontradas fueron los pobres resultados cosméticos, disminución de la visión, úlceras corneales, entre otras. La sobrevida fue de 86,3 porciento. Conclusiones: se hace necesaria la introducción de modernos y conservadores tratamientos como alternativa a la cirugía que sean capaces de controlar el tumor y mejorar la calidad de vida de los pacientes con cáncer palpebral en casos específicos

Objective: to evaluate the clinical and histopathological behavior of malignant eyelid tumors and the treatment options followed at the National Institute of Oncology and Radiobiology. Methods: a retrospective analysis of 255 patients consecutively treated from January 1995 to July 2010 was carried out. The cases were evaluated according to location of tumor, treatment modality, recurrence, relapse, complications and survival rate. The staging of each case followed the criteria of the International Union against Cancer such T1N0M0, T2N0M0, T3N0M0, T4N0M0. Results: of the total number of patients, 54.1percent were males and 45.9percent females with age ranging 18 to 80 years. The most frequent location was the lower eyelid (35percent) and the outer border, the predominant histopathological type was basocellular carcinoma (47.8 percent). The treatment of choice was surgery which was performed in 198 patients. In the study group, 50.2 percent of the treated cases showed tumoral persistence with infiltration of surgical section borders, which received adjuvant radiant treatment. Recurrences occurred in 3.5 percent of cases after 3 to 5 months and relapses appeared in 7.1 percent of patients after the first year of the end of the initial treatment. The most common complications were poor esthetic results, reduced vision, corneal ulcers and others. Survival rate was 86.3 percent. Conclusions: it is necessary to implement modern and conservative treatments as alternative to surgery, which may be able to control tumor and to improve the quality of life of specific eyelid cancer cases

Research development of HER2 in gastric and gastroesophageal junction adenocarcinoma / 国际外科学杂志

Amplification of the human epidermal growth factor receptor 2/neu (HER2/neu) gene and overexpression of the HER2 protein (HER2) have been shown to occur in gastric and gastroesophageal junction adenocarcinoma in a number of studies.With a dismal survival rate,patients with these cancers stand to benefit from the identification of possible molecular targets such as HER2 for both prognostic and therapeutic purposes.Although these and other carcinomas that overexpress HER2 may have a poorer prognosis and exhibit resistance to conventional chemo-therapy,they have also recently been shown to respond to targeted therapy with the anti-HER2 antibody Trastuzumab.Here,the author briefly review the molecular biology,histopathology,diagnostic techniques,and interpretation,as well as the clinical implications of HER2 amplification/overexpression in gastric and gastroesophageal adenocarcinoma.

Utility of p63 immunohistochemical stain in differentiating urothelial carcinomas from adenocarcinomas of prostate.

Background: Prostatic adenocarcinoma and urothelial carcinoma of the urinary bladder are common cancers in men. High grade forms of these tumors may present ambiguous morphologic features that do not permit a definite diagnosis. This distinction between the two tumors has significant staging and therapeutic implications. Hence, an accurate diagnosis is essential for optimal patient care. p63 is a new marker which can be used in this context. It is expressed in most of the urothelial carcinomas and negative in majority of prostatic adenocarcinomas. Aim: To compare the expression of p63 in urothelial carcinomas and adenocarcinomas of prostate. Materials and Methods: Comparative cross--sectional study was carried out at a tertiary cancer hospital from 15 June 2006 to 15 December 2006. Immunohistochemical stain p63 was performed on 50 cases of urothelial carcinoma and 50 prostatic adenocarcinomas. Patients' name, age, histology numbers, grade of tumor, and expression of p63 were recorded. p63 expression was seen in 44 of 50 urothelial carcinomas (88%). None of the prostatic adenocarcinomas expressed p63. The ages of patients with prostatic adenocarcinoma ranged from 49 to 86 years with a median age of 71 years and 41 to 83 years for urothelial carcinomas with a median age of 60.5 years. Conclusion: p63 can be used as a reliable marker to distinguish prostatic adenocarcinomas from urothelial carcinomas in difficult cases in conjunction with other markers like PSA.

Polymorphous low-grade adenocarcinoma on hard palate: case report

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms with a propensity to arise from the minor salivary glands. The most frequent location of PLGA is the palate, even though other locations have been described. Previously used terms for PLGA include lobular carcinoma and terminal duct carcinoma. Although the frequency of the tumor is unknown, the recognition of PLGA as an individual tumor has increased with the establishment of specific histopathological criteria characterizing the PLGA. The first choice of treatment is a wide surgical excision including the subjacent bone if necessary. The prognosis is generally good and the recurrence rate ranges from 17% and 22%. Distant metastases is unusual (9%) but occur mainly in the regional lymph nodes. This is a case report of a 67 year old female patient with PLGA who was treated with a wide excision by layers (2 stage) of the lesion including the surrounding bone. We present this case with a review of the relevant literature.

A Case of Advanced Gastric Adenocarcinoma with Synchronous Gastric Diffuse Large B Cell Lymphoma / 대한소화기내시경학회지

Signet ring cell carcinoma is a subtype of adenocarcinoma that is characterized by abundant intracellular mucin accumulation. Diffuse large B-cell lymphoma is the most common histological subtyple of gastrointestinal lymphoma. The gastrointestinal tract is the most frequently involved extranodal site in non-Hodgkin's lymphoma. However, little is known about the coexistence of advanced gastric cancer and gastric diffuse large B cell lymphoma. We report a case of synchronous advanced gastric adenocarcinoma and gastric diffuse large B cell lymphoma in a 62-year-old woman.

Clinical Significance of MUC2 and MUC5AC Expression in Gastric Adenocarcinomas

PURPOSE: We examined the clinical significance of MUC2 and MUC5AC gene expression in gastric adeno-carcinoma tissues. METHODS: Two hundred specimens were obtained from gastric carcinoma patients who underwent gastric cancer operations at Samsung Medical Center between January 2001 and January 2005. MUC2 and MUC5AC expression were examined immunohistochemically, and correlated with clinicopathologic features and prognostic significance. RESULTS: MUC2 expression was positive in 88 tissues (44.0%) and MUC5AC expression was positive in 125 tissues (62.5%). MUC2 expression was associated with cancer advancement, lymph node metastasis, T classification, distant metastasis, and endolymphatic invasion. Loss of MUC5AC expression was significantly related to cancer advancement, lymph node metastasis, advanced T stage, and distant metastasis. MUC2 expression was usually negative in early gastric cancer (78%), but usually positive in advanced gastric cancer (66%). MUC5AC was usually positive in early gastric cancer (74%). The prognosis of the MUC2(-) group was significantly better than the MUC2(+) group (P<0.001). There was no relationship with MUC5AC expression and survival. Multivariate analysis showed that T classification, lymph node metastasis, distant metastasis, endolymphatic invasion, and MUC2 expression were independent prognostic factors, but MUC5AC expression was not. CONCLUSION: MUC2 and MUC5AC expression correlated with several clinicopathologic parameters (cancer advancement, lymph node metastasis, advanced T classification, distant metastasis). MUC2 expression was a significant independent prognostic factor and positive MUC2 expression suggested poor prognosis. MUC2 expression may have prognostic significance in gastric adeno-carcinomas.

Local resection for the tumor of Vater papilla(a report of 17 cases) / 中国普通外科杂志

Objective To evaluate the effect of local resection for the tumor of Vater ampulla. Methods seventeen cases of Vater ampullary tumor were subjected to tumor local resection from November 1987 to December 1998, including 3 adenomas and 14 adenocarcinomas confirmed by pathology. Two methods of excision for the tumor were performed, including through duodenum to perform the tumor local resection in 16 cases, and through common bile duct in 1 case. Results Bile duct infection occurred in 3 cases. There was no death in this series. 12 of the 17 cases (70.6%) had been followed up for 4～61 months, median survival time was twelve months. In three benign cases ,one died with another disease 17 months postoperatively, two still alive well 38 and 7 months after operation respectively. In 14 malignancy, 9 cases (64.3%) had been followed up. Of the 9 cases, 6(66.7%) alived ≥ 12 months, 4 (44.4%) 24 months, two(22.2%) 60 months. Conclusions Local resection of the Vater ampulla tumor has advantages, such as small damage ,less bloodlass, quick recovery and less interference of the body, but it must be performed by rich experienced surgeons. It is suitable for patients with a small benign tumor, or in the high risk patients whose carcinoma showed no invasion or metastasis, and it also can be performed in patients such as those with atypical hyperplasia and suspious malignant tumor.

Immunohistochemical Expression of Neuron Specific Enolase-Positive Cells in Gastric Adenocarcinomas

In order to correlate the frequency of neuroendocrine cells with pathologic parameters in gastric adenocarcinomas, immunoperoxidase staining for neuron specific enolase was performed on 250 consecutive cases of surgically resected gastric adenocarcinomas(201 advanced gastric carcinomas[AGCs], 49 early gastric carcinomas[EGCs] and 2 cases of gastric carcinoid tumors. Of the 252 cases of gastric carcinomas, pure exocrine carcinomas were 174 cases(69%), pure neuroendocrine(NE) carcinomas 2 cases(0.8%), mixed exocrine and NE carcinomas 32 cases(12.7%), and exocrine carcinomas with occasional NE cells 44 cases(17.5%). The frequency of gastric carcinomas with NSE-positive cells increased with age proportionally. NSE positivity was higher in polypoid or fungating tumors(AGC Borrmann type I, II, EGC I and IIa) than ulcerative or scirrhous tumors. There was no significant difference in frequency of NSE-positive cells by histologic type and differentiation of gastric adenocarcinomas. The above findings reflect that most gastric carcinomas are heterogeneous in their constituents and suggest that both exocrine and neuroendocrine carcinomas are the expression of the extreme ends of the exocrine-endocrine differentiation spectrum based on the assumption that they develop from the pluripotent stem cells differentiating into both exocrine endocrine carcinomas.