Neoplasia fusocelular - tumor de gist: presentación de un caso / Fusocellular neoplasia - gist tumor: presentation of a case

Los tumores del estroma gastrointestinal (TEGI) son las neoplasias mesenquimales más frecuentes del tracto digestivo con una frecuencia de 0,1 a 3 % de todas las neoplasias gastrointestinales. Son derivadas de las células intersticiales de Cajal, localizadas a lo largo del plexo mioentérico de la pared intestinal. Comprenden leiomisarcomas, leiomioblastomas, leimiomas, schwannomas. Están formadas por células fusiformes, en la mayoría, epitelioides o ambas. Se localizan predominantemente en estómago e intestino delgado. Inmunohistoquimicamente se detecta expresión de receptores KIT (antígeno CD117) que puede ser focal, variable o difusa. Involucran tumores benignos pero con potencial malignidad hasta sarcomas metastizantes. Su pronóstico se basa el tamaño y porcentaje de mitosis. La sintomatología depende del lugar de origen, en este caso como masa palpable abdominal y obstrucción intestinal. El tratamiento es la resección completa con márgenes limpios. En caso de metástasis preoperatoria, esta no cambia la conducta quirúrgica, debido a la posibilidad de obstrucción y sangrado. El Imatinib a dosis de 400 mg controla el crecimiento eventual de enfermedad residual. Se presenta el caso clínico de paciente con masa abdominal y cuadro de obstrucción intestinal que evoluciona a la perforación de un TEGI localizado en yeyuno proximal con cuadro peritoneal y absceso subfrenico. Se procede a resección intestinal con yeyuno yeyuno anastomosis resección completa. La histopatología reporta Tumor estronal gastrointestinal y la inmunohistoquimica Neoplasia Fusocelular. CONCLUSION: Los TEGI son de origen mesenquimal, comprenden espectro grande de tumores desde benignos, hasta carcomas altamente malignos. Los factores pronósticos se asocian al tamaño e índice mitótico del tumor. La inmunohistoquimica reporta su expresión para CD117. La resección quirúrgica completa es el pilar de tratamiento y en casos de resección incompleta o irresecabilidad puede usarse imatinib.

Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal neoplasms of the digestive tract with a frequency of 0.1 to 3% of all gastrointestinal neoplasms. They are derived from the interstitial cells of Cajal, located along the myoenteric plexus of the intestinal wall. They include leiomysarcomas, leiomioblastomas, leimiomas, schwannomas. They are made up of spindle cells, in the majority, epithelioids or both. They are located predominantly in the stomach and small intestine. Immunohistochemically, KIT receptor expression (CD117 antigen) is detected, and they can be focal, variable or diffuse. They involve benign but potentially malignancy tumors up to metastatic sarcomas. Their prognosis is based on the size and percentage of mitosis. The symptoms depend on the place of its origin. Treatment is complete resection with clean margins. In the case of preoperative metastases, this does not change the surgical approach, due to the possibility of obstruction and bleeding. Imatinib at a dose of 400 mg controls the eventual growth of residual disease. We present the clinical case of a patient with an abdominal mass and a small bowel obstruction that progresses to perforation of a GIST located in the proximal jejunum with a peritonitis and subphrenic abscess. Intestinal resection is performed with jejunum jejunoanastomosis and complete resection. Histopathology reports gastrointestinal stromal tumor and immunohistochemistry, Fusocellular neoplasia. Conclusion: GIST are of mesenchymal origin, they include a wide spectrum of tumors from benign to highly malignant sarcomas. Prognostic factors are associated with tumor size and mitotic index. Immunohistochemistry reports its expression for CD117. Complete surgical resection is the mainstay of treatment and in cases of incomplete resection or unresectability imatinib can be used.

Upper Endoscopy up to 3 Years Prior to a Diagnosis of Gastric Cancer Is Associated With Lower Stage of Disease in a USA Multiethnic Urban Population, a Retrospective Study / 예방의학회지

OBJECTIVES: In the USA, certain races and ethnicities have a disproportionately higher gastric cancer burden. Selective screening might allow for earlier detection and curative resection. Among a USA-based multiracial and ethnic cohort diagnosed with non-cardia gastric cancer (NCGC), we aimed to identify factors associated with curable stage disease at diagnosis. METHODS: We retrospectively identified endoscopically diagnosed and histologically confirmed cases of NCGC at Mount Sinai Hospital in New York City. Demographic, clinical, endoscopic and histologic factors, as well as grade/stage of NCGC at diagnosis were documented. The primary outcome was the frequency of curable-stage NCGC (stage 0-1a) at diagnosis in patients with versus without an endoscopy negative for malignancy prior to their index exam diagnosing NCGC. Additional factors associated with curable-stage disease at diagnosis were determined. RESULTS: A total of 103 racially and ethnically diverse patients were included. Nearly 38% of NCGC were stage 0-Ia, 34% stage Ib-III, and 20.3% stage IV at diagnosis. A significantly higher frequency of NCGC was diagnosed in curable stages among patients who had undergone an endoscopy that was negative for malignancy prior to their index endoscopy that diagnosed NCGC, compared to patients without a negative endoscopy prior to their index exam (69.6% vs. 28.6%, p=0.003). A prior negative endoscopy was associated with 94.0% higher likelihood of diagnosing curable-stage NCGC (p=0.003). No other factors analyzed were associated with curable-stage NCGC at diagnosis. CONCLUSIONS: Endoscopic screening and surveillance in select high-risk populations might increase diagnoses of curable-stage NCGC. These findings warrant confirmation in larger, prospective studies.

Gastrointestinal cancer risk in patients with a family history of gastrointestinal cancer / 대한소화기학회지

BACKGROUND/AIMS: This study was performed to evaluate the relationship between family history of gastrointestinal (GI) cancers and incidence of any GI cancer in the Korean population. METHODS: Between January 2015 and July 2016, 711 GI cancer patients and 849 controls in 16 hospitals in Korea were enrolled. Personal medical histories, life styles, and family history of GI cancers were collected via questionnaire. RESULTS: There was a significant difference in the incidence of family history of GI cancer between GI cancer patients and controls (p=0.002). Patients with family history of GI cancer tended to be diagnosed as GI cancer at younger age than those without family history (p=0.016). The family members of GI cancer patients who were diagnosed before 50 years of age were more frequently diagnosed as GI cancer before the age of 50 years (p=0.017). After adjusting for major confounding factors, age (adjusted odds ratio [AOR] 1.065, 95% confidence interval [CI]; 1.053–1.076), male gender (AOR 2.270, 95% CI; 1.618–3.184), smoking (AOR 1.570, 95% CI; 1.130–2.182), and sibling's history of GI cancer (AOR 1.973, 95% CI; 1.246–3.126) remained independently associated with GI cancers. CONCLUSIONS: GI cancer patients tended to have a first relative with a history of concordant GI cancer. Personal factors (old age and male) and lifestyle (smoking) contribute to the development of GI cancer, independently. Individuals with high risk for GI cancers may be advised to undergo screening at an earlier age.

Clinicopathologic features of metastatic gastrointestinal stromal tumors / 临床与实验病理学杂志

Purpose To explore the clinicopathologic features of metastatic gastrointestinal stromal tumors (GIST) and the mechanism of lymph node metastasis.Methods 45 cases of surgical specimens with metastasis were selected as the research object and 50 cases of primary tumors in the same period were compared.All materials were stained with immunohistochemical method that marked Ki-67,CD31,D2-40,and then micro vessel density (MVD) and lymphatic microvessel density (LMVD) in each group were calculated.Results The total metastatic rate was 5.45％,the blood metastatic rate was 1.33％ and the lymph node metastatic rate was 1.09％.MVD of metastatic GIST was 398.39 ± 68.20/mm2and MVD of non-metastatic GIST was 192.07 ± 56.85/mm2,and the difference between them was statistically significant.There was no lymphatic vessels distribution in the essence of GIST regardless of metastasis.About metastatic GIST,LMVD of the edge area of the essence was 13.28 ±2.40/mm2 and LMVD of normal tissue around the essence was 25.36 ± 6.71/mm2.In regard to non-metastatic GIST,LMVD of the edge area of the essence was 12.21 ± 1.83/ mm2 and LMVD of normal tissue around the essence was 24.23 ± 8.64/mm2.No statistically significant existed between LMVD of the edge area of the essence and LMVD of normal tissue around the essence.All of the 9 cases of lymph node metastatic GIST and 12 from 86 cases of non-metastatic GIST showed invasive growth.Conclusion MVD of metastatic GIST is higher than that of non-metastatic GIST.There is no lymphatic vessel within the essence of GIST.The invasive growth way may be the cause of the lymph node metastasis.

Single nucleotide polymorphisms analysis of drug related genes in digestive tract cancer / 中国药学杂志

OBJECTIVE: To analyze of the characteristics of single nucleotide polymorphisms of the commonantineoplastics in the treatment of gastric cancer and colorectal cancer in our hospital. METHODS: Venous blood was collected from patients with digestive tract tumor, and the drug related gene loci were detected by fluorescence staining in situ hybridization. The original data are stored in Microsoft Excel to establish a database for routine statistics and chi square test was conducted to determine whether the distribution of allele frequency distribution is in accordance with the law of Hardy Weinberg. RESULTS: A Total of 1 743 loci of 14 drug related genes were detected in 242 patients. The loci genotype distribution were in accordance with Hardy Weinberg equilibrium except dihydrotestosterone dihydropyrimidine dehydrogenase gene (DPYD), methylenetetrahydrofolate reductase gene (MTHFR) and cytochrome P4501B1 gene (CYP1B1). CONCLUSION: The patients with digestive tract tumor in China have their own characteristics in single nucleotide polymorphisms of drug related genes. We should take this as the basis for accurate anti-tumor drug treatment.

El signo de Leser-Trélat ¿Un predictor de neoplasias útil en clínica? / The Leser-Trélat sign A useful predictor of neoplasms in clinic?

Propósito: el signo de Leser-Trélat conjuga la presencia simultánea de queratosis seborreica eruptiva con una neoplasia maligna, pero existen publicaciones de pacientes con queratosis con o sin la neoplasia. Se buscó establecer si hay evidencia sobre esta asociación para considerar la potencialidad de la aparición de tales lesiones dermatológicas como un hallazgo precoz de neoplasias malignas. Fuente de datos: revisión sistemática de la literatura ubicada en Medline, Cochrane, Lilacs, Scholar Gloogle e Imbiomed. Selección de estudios: se evaluaron todos los artículos afines a queratosis seborreica eruptiva y cáncer, sin límite en edad, sexo, tipo de artículo o idioma. Extracción de datos: se leyeron de 668 resúmenes y se revisaron 120 artículos completos, 66 utilizados en este informe. Resultados: la evidencia que apoya la asociación entre queratosis seborreica súbita y cáncer es pobre: sólo existen cuatro estudios de casos y controles cuyos resultados no apoyan esta asociación. Conclusiones: la gran mayoría de las publicaciones son producto del hallazgo al azar de las dos entidades y no producto de la búsqueda sistemática de una de ellas cuando aparece la otra, lo que refleja una especie de sesgo de selección a la hora de publicar dichos casos.

Purpose: the sign of Leser-Trélat conjugates the simultaneous presence of eruptive seborrheic keratoses with a malignancy, but there are reports of patients with keratosis with or without neoplasia. The establishment of whether there is evidence for this association to consider the potential for the occurrence of such skin lesions as an early finding of malignant neoplasms was sought. Data Sources: a systematic review of the literature located on Medline, Cochrane, Lilacs, Schoolar Google and Imbiomed. Study Selection: all articles related to eruptive seborrheic keratosis and cancer, with no limit on age, sex, type of article or language were evaluated. Data Extraction: 668 abstracts were read and 120 full articles were reviewed, 66 used in this report. Results: the evidence supporting the association between sudden seborrheic keratosis and cancer is poor: there are only four case-control studies whose results do not support this association. Conclusions: the vast majority of publications are the product of chance finding of the two entities and not the result of a systematic search of one of them when the other appears, reflecting a kind of selection bias in publishing such cases.

Perioperative Nutritional Status Changes in Gastrointestinal Cancer Patients

PURPOSE: The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. MATERIALS AND METHODS: Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. RESULTS: A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (p60, p<0.001), male sex (p=0.020), preoperative weight loss (p=0.008), gastric cancer (p<0.001), and open surgery (p<0.001) were indicated as risk factors of postoperative severe malnutrition. In multivariate analysis, old age, preoperative weight loss, gastric cancer, and open surgery remained significant as risk factors of severe malnutrition. CONCLUSION: The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.

To be or not to be: disección endoscópica submucosa o resección endoscópica de la mucosa en el tratamiento de las neoplasias gastrointestinales / To be or not to be: endoscopic sub-mucosal dissection or endoscopic mucosal resection for treatment of gastrointestinal neoplasia

Endoscopic treatment of early gastrointestinal neoplasias has become the standard treatment in Japan and other Asia-Pacific countries, while it is still a developing technology in the West. The advent of endoscopic mucosal resection and endoscopic sub-mucosal dissection in the last decade has allowed early treatment of malignancies in a manner that preserves the organ, avoiding major surgery with less morbidity and mortality, and overall survival rates compared to standard surgery. In Japan and other Asia-Pacific countries, submucosal dissection has shifted over endoscopic mucosal resection as the technique of choice in the recent years, because of the possibility of treating deeper and larger lesions, with higher rates of bloc and curative resections, and lower recurrence rates, but with a higher rate of complications and a longer learning curve.

El tratamiento endoscópico de las neoplasias gastrointestinales precoces se ha convertido en el estándar de tratamiento en Japón y otros países del Asia-Pacífico, siendo aún una técnica en desarrollo en occidente. La aparición de la resección endoscópica de la mucosa y la disección endoscópica submucosa en la última década, ha permitido tratar las neoplasias precoces, logrando preservar el órgano, y evitando así una cirugía mayor, con menor morbi-mortalidad y cifras de sobrevida comparables con el tratamiento quirúrgico convencional. En Japón y otros países del Asia-Pacífico, la disección sub-mucosa ha desplazado en los últimos años a la resección endoscópica de la mucosa como técnica de elección, debido a la posibilidad de resecar lesiones más profundas y de mayor tamaño, con mayor tasa de resección en bloque y curativa, y menor recidiva. Sin embargo, con una mayor tasa de complicaciones y una curva de aprendizaje más larga.

Non-Hodgkin lymphoma as a cause of acute intestinal obstruction/perforation in patients with adenocarcinoma of the sigmoidcolon: a case report

Report of a rare case of an 83-year-old patient with lymphoma of the terminal ileum causing obstructive/perforated acute abdomen synchronous with sigmoid colon adenocarcinoma and review of literature data about small bowel malignancies, particularly lymphomas. It seems to correspond to a rare disease (2% of all bowel cancers), more prevalent in elderly and immunocompromised patients, whose symptoms are vague and early diagnosis is difficult, often making it impossible to establish the correct therapy. (AU)

Relato de caso raro de um paciente de 83 anos, com linfoma de íleo terminal causador de abdome agudo obstrutivo/perfurativo sincrônico à adenocarcinoma de cólon sigmoide e revisão dos dados disponíveis na literatura acerca das neoplasias de intestino delgado, em especial os linfomas. Constata-se que corresponde a uma afecção rara (2% de todas as neoplasias intestinais), mais predominante em pacientes idosos e imunodeprimidos, cuja sintomatologia é vaga e o diagnóstico precoce difícil, fato que impossibilita muitas vezes a instituição da terapêutica correta. (AU)

Tumor do estroma gastrintestinal (GIST): relato de caso / Gastrintestinal stromal tumor (GIST): case report

The authors report a case of a male patient in his forties with progressive abdominal pain associated with weight loss, dyspnea, and edema of the inferior limbs, culminating in a surgical acute abdomen. A segmental enterectomy containing a lesion of about 10cm in diameter was performed. It was later confirmed, by means of immuno-hystochemistry, as being a Gastrointestinal Stromal Tumor of high biological aggressiveness. Etiology, diagnosis, classification, prognosis and therapeutic with Imatinib Mesylate - STI-571 (Glivec® - Novartis) are hence discussed.

Porposal for Creating a Guideline for Cancer Registration of the Gastrointestinal Tumors (I)

BACKGROUND: Cancer registries are fundamental for cancer control and multicenter collaborative research. However, there have been discrepancies among pathologists in classifying cancer and assigning the codes according to the International Classification of Disease Oncology 3 (ICD-O3). To improve the quality of cancer registries as well as to prevent the conflict with medical insurance compensation, a guideline for the coding of cancer is mandatory. METHODS AND RESULTS: Funded by the Management Center for Health Promotion, 40 members of the Gastrointestinal Pathology Study Group and the Cancer Registration Committee of the Korean Society of Pathologists participated in the 1st workshop for gastrointestinal tumor registration. The subjects of gastric epithelial tumor, intramucosal carcinoma of the colon, carcinoid tumor, gastrointestinal stromal tumor and appendiceal mucinous tumor were discussed to create a guideline. A survey to obtain consensus for the guideline proposed by the workshop was carried out by the members of the Korean Society of Pathologists and 240 members completed the questionnaire. CONCLUSION: Although there are some issues to be discussed further, such as coding of high grade dysplasia/adenoma and intramucosal carcinoma of stomach and colon, the members agreed upon most parts of the proposed guideline. Therefore, we suggest using the ICD-O3 coding guideline for gastrointestinal tumor.

Hemorragia digestiva provocada por tumor estromal gastrointestinal avançado de duodeno / Gastrointestinal hemorrhage caused by advanced duodenal gastrointestinal stromal tumor

INTRODUÇÃO: O tumor estromal gastrointestinal (GIST) é neoplasia pouco freqüente, sendo rara a combinação de acometimento duodenal e hemorragia digestiva, por isso apresenta-se este relato. RELATO DO CASO: Homem de 64 anos admitido com quadro de dor abdominal, melena e tumoração palpável em epigástrio e hipocôndrio esquerdo, sendo notado um tumor de paredes espessadas e conteúdo cístico na tomografia computadorizada de abdome, em topografia de cauda pancreática. Encontrado na laparotomia de urgência tumor em quarta porção duodenal com invasão de cólon em ângulo esplênico, sendo realizada ressecção em bloco do duodeno acometido, segmento de cólon transverso e descendente, com boa evolução pós-operatória. Diagnosticado por imunoistoquímica GIST de duodeno com invasão de parede colônica, sendo o tratamento complementado com mesilato de imatinib. CONCLUSÃO: A hemorragia digestiva é uma das possíveis complicações do GIST. Apenas o tratamento cirúrgico precoce é capaz de prevenir as graves complicações do choque hemorrágico.

BACKGROUND: Gastrointestinal stromal tumor (GIST) represents an uncommon form of neoplasm. The combination of duodenal GIST and gastrointestinal bleeding consist of a rare presentation for such tumors. AIM: To report duodenal GIST case complicated by gastrointestinal bleeding. CASE REPORT: A 64-year-old male was admitted presenting abdominal pain, melena and a palpable mass in epigastrium and left upper abdomem regions. CT scan reveled a thick wall tumor containing cystic content in the pancreatic tail topography. At emergency laparotomy, a tumor in the fourth portion of the duodenum presenting colonic invasion in splenic flexure was found. En-bloc resection of the tumor was carried out, included the fourth portion of the duodenum and the transverse and descending colon, without postoperative complications. Immunohistochemical staining of the resected specimen confirmed the diagnosis of duodenal GIST with colon wall invasion. CONCLUSION: Gastrointestinal hemorrhage is one of the possible complications of GIST. Early surgical treatment is the only effective therapeutic option to avoid severe complications of hemorrhagic shock.

Analysis on the risk factors associated with fungal infection following operation of gastrointestinal neoplasm / 中国感染与化疗杂志

Objective To investigate the relevant risk factors for fungal infection following operation of the gastrointestinal neo- plasm and offer supporting data for the prevention of fungal infection.Methods Medical records from 116 patients who under- went the operation of gastrointestinal neoplasm in the special group of this hospital from January 2006 to June 2006 were retro- spectively reviewed on the relevant risk factors by univariate and multivariate Logistic regression analysis.Results Of the 116 patients reviewed, 18 had fungal infection.Forty-six samples were positive for fungal pathogen.The most frequently isolated fungal strain was Candida albicans (15/20) and the most common infection site was gastrointestinal tract (14/18).Fungal in- fection after the operation of gastrointestinal neoplasm was significantly relevant with the duration of antibiotic use, duration of post-operative fasting, low serum albumin, high blood glucose and complication of bacterial infection.The duration of antibiotic use was a significantly independent risk factor.Conclusions Reasonable antibiotic use, nutritional support, early enteral nutri- tion and control of blood glucose should be taken into account after the operation of gastrointestinal neoplasm in order to prevent fungal infections.

Clinical analysis of gastrointestinal stormal tumor:areport of 38 cases / 中国基层医药

Objective To investigate the clinical and immunohistochemical features,diagnosis and treatment of gastrointestinal stromal tumor(GIST). Methods Clinic and pathological datas of 38 cases with GIST were retrospectively analyzed. Results The most common clinal maifestions were abdominal pain,distention or discomfort in 24 cases(50%), abdominal mass in 10,melena and liematemesis in 8 cases. The tumor was located in the stomach in 20 cases, the small infestine in 14,the colorectum in 4.All the cases underwent operation. Conclusion Endoscopy and imaging examination are main methods to detect GIST. Surgical resection is the main mothod of pathologic diagnosis and treatment.

Malignant Extragastrointestinal Stromal Tumor of the Gallbladder / 한국간담췌외과학회지

The demonstration of CD 117 (KIT) expression in extragastrointestinal lesions has helped to validate extra-gastrointestinal stromal tumors. We report here on an exceedingly rare case of a malignant extragastrointestinal stromal tumor of the gallbladder. A 68-year-old male patient presented with a palpable and nontender mass occupying the entire right upper quadrant of his abdomen. The patient underwent open cholecystectomy. On gross examination, a firm, polypoid, 10x6 cm tumor protruded from the lumen of the gallbladder. Histologically, there were 88 mitotic figures per 10 high-power fields. The tumor cells were immunoreactive for CD 117, vimentin and CD 34. Immunostaining for CD 117 showed a dot-like staining pattern in about 20% of the tumor cell. The present case was an exceedingly rare entity occurring in the gallbladder, Currently, the patient is under follow-up for 6 months with no abnormal findings such as recurrence.

Usefulness of Plasma Tumor M2-Pyruvate Kinase in the Diagnosis of Gastrointestinal Cancer / 대한소화기학회지

BACKGROUND/AIMS: Pyruvate kinase (PK) is a key enzyme of glycolysis. Different isoforms of this enzyme are tissue-specifically expressed (M2-PK, M1-PK, R-PK, L-PK). The concentration of the dimeric M2-PK is increased in a metabolic state of tumor cells. In this case, the dimeric M2-PK is termed Tumor M2-PK. We investigated EDTA-plasma of 73 patients with gastrointestinal (GI) cancer and 61 healthy controls to evaluate its significance in diagnosing GI cancer. METHODS: Plasma Tumor M2-PK was measured using an ELISA assay based on two monoclonal antibodies which specifically react with the dimeric Tumor M2-PK. RESULTS: The sensitivity of Tumor M2-PK was 67.1% for all GI cancers, that of CA 19-9 was 38.4% and that of CEA was 34.3%. The specificity of Tumor M2-PK was 91.8% (cutoff=20 U/mL). Tumor M2-PK showed a high sensitivity in gastric cancer (62.2%), colorectal cancer (66.7%) and bile duct cancer (75.0%). In colorectal cancer, the combination of Tumor M2-PK with CEA resulted in a remarkable increase in the sensitivity (86.2%). The average Tumor M2-PK levels were generally elevated in the metastatic GI cancer patients compared to nonmetastatic patients, especially in stomach cancer with statistical significance (p=0.005). CONCLUSIONS: Tumor M2-PK in EDTA-plasma seems to be a new valuable tumor marker in GI cancer.

Ureteral Obstruction Secondary to Gastrointestinal Malignancies

Metastasis from primary malignancies anywhere in the body can spread to the retroperitoneum and lead to ureteral obstruction. Seventeen patients who had ureteral obstructions caused by advanced gastrointestinal malignancies have been retrospectively analyzed. The results are as follows: 1) Of the 17 patients, 9 were male and 8 were female, and the mean age was 56.9: with a range from 33 to 75. 2) In the 16 patients whose pathologic diagnose were confirmed by primary surgery, the pathologic stages of stomach cancer were stage III in 1 patient and IV in 6 patients, and those of colorectal cancer were stage B in 2 patients, C in 6 patients and D in 1 patient. 3) Urologic symptoms and signs were micro- or macroscopic hematuria (58.8%), elevated BUN (52.9%), and flank pain (29.4%). Sixteen out of 17 patients had one of these findings. 4) The time interval between the original diagnosis of a gastrointestinal malignancy and the subsequent ureteral obstruction in 11 patients (64.7%) was within 2 years. The time interval for a11 17 patients was 33.9 months with a range from 2 months to 10 years. 5) Ureteral involvement was bilateral in 10 patients (58.8%) and unilateral in 7 (41.2%). The levels of ureteral obstruction in stomach cancer were upper (5) and midureter (3), and those in colorectal cancer were upper (1), mid (1) and lower ureter (7). 6) Twenty out of 27 kidneys were managed by a double-J stent (5 kidneys) or a percutaneous nephrostomy (15 kidneys). In conclusion, we believe that the possibility of ureteral obstruction by direct invasion or lymph node metastasis should be taken into account in patients who have advanced gastrointestinal malignancies. If such patients show hematuria, elevated BUN, or flank pain, a secondary ureteral obstruction should be suspected. Also malignant ureteral obstructions should be detected and managed early to preserve the renal function.

Ureteral Obstruction Secondary to Gastrointestinal Malignancies

Metastasis from primary malignancies anywhere in the body can spread to the retroperitoneum and lead to ureteral obstruction. Seventeen patients who had ureteral obstructions caused by advanced gastrointestinal malignancies have been retrospectively analyzed. The results are as follows: 1) Of the 17 patients, 9 were male and 8 were female, and the mean age was 56.9: with a range from 33 to 75. 2) In the 16 patients whose pathologic diagnose were confirmed by primary surgery, the pathologic stages of stomach cancer were stage III in 1 patient and IV in 6 patients, and those of colorectal cancer were stage B in 2 patients, C in 6 patients and D in 1 patient. 3) Urologic symptoms and signs were micro- or macroscopic hematuria (58.8%), elevated BUN (52.9%), and flank pain (29.4%). Sixteen out of 17 patients had one of these findings. 4) The time interval between the original diagnosis of a gastrointestinal malignancy and the subsequent ureteral obstruction in 11 patients (64.7%) was within 2 years. The time interval for a11 17 patients was 33.9 months with a range from 2 months to 10 years. 5) Ureteral involvement was bilateral in 10 patients (58.8%) and unilateral in 7 (41.2%). The levels of ureteral obstruction in stomach cancer were upper (5) and midureter (3), and those in colorectal cancer were upper (1), mid (1) and lower ureter (7). 6) Twenty out of 27 kidneys were managed by a double-J stent (5 kidneys) or a percutaneous nephrostomy (15 kidneys). In conclusion, we believe that the possibility of ureteral obstruction by direct invasion or lymph node metastasis should be taken into account in patients who have advanced gastrointestinal malignancies. If such patients show hematuria, elevated BUN, or flank pain, a secondary ureteral obstruction should be suspected. Also malignant ureteral obstructions should be detected and managed early to preserve the renal function.

The nutritional status evaluation of gastrointestinal carcinoma patients by mini-nutritional assessment / 肠外与肠内营养

Objective: To evaluate the nutritional status of gastrointestinal carcinoma patients by mini-nutritional assessment(MNA),and to compare the relationship with different tranditional evaluative methods. Methods: The nutritional state and the malnutritional incidence were analysed by MNA questionnaire in 496 gastrointestinal carcinoma patients,and the relationship among MNA score and anthropometric measurements and laboratory test was studied.Results: ①According to the scores of MNA, 16.94%(84/496) patients were of mal-nutrition and 42.54%(211/496) patients were at risk of malnutrition.② In terms of each single index,BMI,TSF,AC and AMC,the prevalence of malnutrition was 13.5%,21.9%,15.1% and 15.5% respectively.③According to laboratory test,including serum albumin,PA,TLC,the incidence of malnutrition was 14.9%,25.4% and 30.8%.④ There was a significant correlation between the MNA score and tranditional nutritional estimated markers.The correlation coefficients of MNA with BMI,ALB,AC,TSF,AMC and TLC were between 0.18 and 0.53(P

Non-surgical transcatheter arterial implant and subcutaneous infusion port for chemotherapy of hepato-gastrointestinal neoplasms / 中华消化杂志

The authors reported their experience in treatment of 17 patients with hepato-gastrointestinal neoplasms with lipiodol embolization chemotherapy via subcutaneous infusion port by a non-surgical method since March, 1994. According to the seldinger method implanted catherter was placed in the suitable target artery, and the Subcutaneous infusion port was linked to the implanted catheter through a subcutaneous tunnel. Antitumor chemotherapeutic drugs, biological response modifiers and lipiodol were injected through the port. These results suggest that the non-surgical implant method is simple, safe and effective for regional chemotherapy.