Adenocarcinoma cervical: diagnóstico na atenção primária e secundária à saúde / Cervical adenocarcinoma: diagnosis in primary and secondary health care

O adenocarcinoma cervical é uma patologia grave cuja incidência tem aumentado, principalmente em pacientes jovens. Um diagnóstico oportuno, na assistência primária e secundária à saúde, com métodos convencionais, melhora sobremaneira o prognóstico da paciente, a um custo tolerável para países em desenvolvimento.(AU)

The cervical adenocarcinoma is a serious pathology whose incident has increased mainly in young patients. One opportunistic diagnosis, in primary and secondary health care, with conventional methods, greatly improves the prognosis of the patients, at a cost tolerable to developing countries.(AU)

Tubulopapillary rectal adenocarcinoma in dog: clinical, surgical, pathological and immunophenotypical aspects: case report / Adenocarcinoma retal tubulopapilar em cão: descrição clínica, cirúrgica, anátomo-patológica e imunofenotípica: relato de caso

Intestinal carcinomas are rare in dogs. The prognosis and survival time are dependent of the histological type, the invasion of the intestinal wall by the malignant cells and the ability of primary neoplasm to produce metastasis. This study reports a case of a Yorkshire dog that developed a rectal tubulopapillary adenocarcinoma progressing to a peritoneal carcinomatosis and multiple metastasis in large intestines, bladder, kidney, iliac lymph node, liver and lungs, six months after transanal surgical resection of the primary rectal neoplasm. Clinical, surgical, pathological and immunophenotypic findings are described. COX-2 imunohistochemical score was higher in hepatic metastasis (score 9) than in the primary tumour (score 6), and the growth fraction (Ki-67) observed was of 49.2% in the rectal neoplasm.(AU)

Carcinomas intestinais são raros em cães. O prognóstico e a sobrevida são dependentes do tipo histológico, do grau de invasão nas camadas intestinais e da capacidade da neoformação primária em desenvolver metástases. Relata-se um caso de um cão, da raça Yorkshire, que desenvolveu adenocarcinoma tubulopapilar retal com evolução para carcinomatose peritoneal e múltiplos focos metastáticos no intestino grosso, na bexiga, no rim linfonodo ilíaco, no fígado e nos pulmões seis meses após ressecção cirúrgica da neoplasia primária. Aspectos clínicos, cirúrgicos, anatomopatológicos e imunofenotípicos são descritos. O escore de COX-2 na imuno-histoquímica foi maior na metástase hepática (escore 9) do que na massa primária (escore 6), e a fração de crescimento (Ki-67) na neoplasia retal foi de 49,2%.(AU)

Parotid gland adenocarcinoma in a cow: case report / Adenocarcinoma de glândula parótida em vaca: relato de caso

A 9-year-old Girolando dairy cow, weighing 400kg, with a history of increased volume in the right parotid region, which extended to the submandibular region, was assisted. Fine needle aspiration cytology was performed, and the cytological findings were consistent with malignant neoplasm of epithelial origin (carcinoma). Because of the unfavorable prognosis, the animal was euthanized and submitted to an anatomopathological examination. Samples of the increased parotid and affected lymph nodes were collected for histopathological evaluation. The microscopic changes were accentuated features of anaplasia, moderate cell proliferation, atypical mitotic figures, and necrosis. Stroma ranged from delicate to scirrhous, and the tumor boundaries were not distinct. These findings substantiated the preliminary histomorphological diagnosis of undifferentiated carcinoma with metastasis in lymph nodes. Immunohistochemical tests were performed with anti-CK Pan (clone AE1AE3), anti-CK HMW (clone 34ßE12), anti-CK19 (clone RCK108), anti-vimentin (clone V9), anti-S100 (polyclonal), and anti-androgen (polyclonal) antibodies. The immunophenotype favored the diagnosis of salivary gland adenocarcinoma. Despite the rareness in cattle, salivary gland adenocarcinoma should be considered in the differential diagnosis of diseases that occur with increased volume in the head, lymphadenopathy, drooling, dysphagia, and progressive weight loss.(AU)

Foi atendida uma vaca da raça Girolando, de nove anos de idade, de aptidão leiteira, pesando aproximadamente 400kg e com histórico de aumento de volume na região parotídea e submandibular direita. Diante do prognóstico desfavorável, o animal foi submetido à eutanásia e encaminhado para exame anatomopatológico. Fragmentos da glândula parótida e dos linfonodos alterados foram colhidos e encaminhados para exame histopatológico. À avaliação microscópica, observaram-se acentuada anaplasia, moderada proliferação celular, figuras de mitose atípicas e focos de necrose. O estroma variava de delicado a esquirroso e os limites do tumor eram imprecisos. Esses achados fundamentaram o diagnóstico de carcinoma indiferenciado com metástase em linfonodos. No exame imuno-histoquímico, foram utilizados anticorpos primários monoclonais anti-CK Pan (clone AE1AE3), anti-CK alto peso molecular (clone 34ßE12), anti-CK19 (clone RCK108), antivimentina (clone V9), anti-S100 (policlonal) e antirreceptor de andrógenos (policlonal). As células neoplásicas apresentaram imunomarcação para todos os anticorpos testados, resultado que favorece o diagnóstico de adenocarcinoma de glândula salivar. Embora raro em bovinos, o adenocarcinoma de glândula salivar deve ser considerado no diagnóstico diferencial de doenças que cursam com aumento de volume na cabeça, linfadenopatia salivação, disfagia e emagrecimento progressivo.(AU)

Caracterização dos fenótipos de mucina podem prever a recorrência do câncer gástrico precoce após a mucosectomia endoscópica / Characterization of the mucin phenotype can predict gastric cancer recurrence after endoscopic mucosal resection

ABSTRACT BACKGROUND: Endoscopic mucosal resection is still considered an accepted treatment for early gastric cancer for selected cases. Histopathologic criteria for curative endoscopic resection are intramucosal well-differentiated adenocarcinoma, lateral and deep margins free of tumor, no histological ulceration, and no venous or lymphatic embolism. A 5% local recurrence rate has been described even when all the above-mentioned criteria are met. On the other hand, antigen expression by tumoral cells has been related to the biological behavior of several tumors. OBJECTIVE: To evaluate whether early gastric cancer mucin immunoexpression, p53 and Ki-67, can predict recurrence after endoscopic mucosal resection, even when standard histopathologic criteria for curative measures have been attempted. METHODS: Twenty-two patients with early gastric cancer were considered to have been completely resected by endoscopic mucosal resection. Local recurrence occurred in 5/22 (22.7%). Immunohistochemical study was possible in 18 (81.8%) resected specimens. Patients were divided in two groups: those with and those without local recurrence. They were compared across demographic, endoscopic, histologic data, and immunohistochemical factors for MUC2, MUC5a, CD10, p53, and Ki-67. RESULTS: Mucin immunoexpression allowed a reclassification of gastric adenocarcinoma in intestinal (10), gastric (2), mixed (4), and null phenotypes (2). Mixed phenotype (positive for both MUC2 and MUC5a) was found in 80% of cases in the local recurrence group, while the intestinal type (positive MUC2 and negative MUC5a) was found in 76.9% of cases without local recurrence (P=0.004). Other observed features did not correlate with neoplastic recurrence. CONCLUSION: The mixed phenotype of early gastric adenocarcinoma is associated with a higher probability of local recurrence after endoscopic mucosal resection.

RESUMO CONTEXTO: A ressecção endoscópica da mucosa é tratamento aceito para o tratamento do câncer gástrico precoce em casos selecionados. Os critérios histopatológicos favoráveis à ressecção endoscópica curativa são adenocarcinomas intramucosos, bem diferenciados, com margens lateral e profunda livres, ausência de ulceração ou de embolização angiolinfática. Taxas de recorrência local próximas a 5% têm sido descritas mesmo quando se cumprem tais critérios. Por outro lado, a expressão antigênica por células tumorais tem sido relacionada com o comportamento biológico de diversos tumores. OBJETIVO: Avaliar se a imunoexpressão de mucinas, p53 e Ki-67 podem predizer a recorrência tumoral após mucosectomia endoscópica no câncer gástrico precoce, mesmo se critérios de cura histopatológicos forem atingidos. MÉTODOS: Vinte e dois pacientes com critérios de cura para ressecção endoscópica e sumetidos a mucosectomia foram selecionados. A recorrência local ocorreu em 5/22 (22,7%). O estudo imunohistoquímico foi realizado em 18 (81,8%) espécimens. Os pacientes foram divididos em grupos com e sem recorrência local. Foram comparados quanto a dados demográficos, endoscópicos, histológicos e fatores imunohistoquímicos para MUC2, MUC5A, CD10, p53, e Ki-67. RESULTADOS: A imunoexpressão de mucinas permitiu a reclassificação dos adenocarcinomas gástricos em intestinal (10), gástrico (2), e de fenótipo misto (4) e nulo (2). Os fenótipos mistos (positivos tanto para MUC2 quanto para MUC5A) foram encontrados em 80% dos casos no grupo de recorrência local, enquanto tipos intestinais (MUC2 positivo e MUC5A negativo) foram identificados em 76,9% dos casos sem recorrência (P=0,004). Os outros fatores observados não se relacionaram com a recorrência tumoral. CONCLUSÃO: O fenótipo misto do câncer gástrico precoce está associado a maior probabilidade de recorrência local após a mucosectomia.

Cáncer sincrónico y metacrónico detectado con PET/CT en población oncológica / Multiple primary malignant neoplasms detected by PET/CT in cancer patients

Background Imaging with F18-fluorodeoxyglucose PET/CT is used to determine sites of abnormal glucose metabolism and can be used to characterize and localize many types of tumors. Aim To assess the prevalence of multiple primary malignant neoplasms (MPMN) detected by PET/CT in cancer patients. Material and Methods F18-fluorodeoxyglucose PET/CT scans performed to 800 patients with a newly diagnosed cancer or with already treated tumors were retrospectively reviewed. In patients whose examination described incidental findings not related to the primary tumor, a research was done about further laboratory, imaging or pathological studies. Results In 188 PET/CT scans (23%) an incidental finding was found. Of these, 66 (35%) were considered as MPMN, 12 as atypical metastases of a known primary tumor, 14 as false positive images (inflammatory or physiologic uptake) and 29 as benign or low grade tumors. In 67 cases (36% of all incidental tumors), the finding was not confirmed. Seven percent of patients with a newly diagnosed tumor had a synchronic MPMN detected by PET/CT. Nine percent of patients with treated tumors developed a metachronous MPMN during their follow up. The most common incidental tumors were thyroid cancer in 15 cases, kidney cancer in 13, lung cancer in 10, colorectal carcinoma in 9, breast cancer in 6, prostate cancer in 4, non-Hodgkin lymphoma in 3 and pancreatic cancer in 2. Conclusions A MPMN is detected by PET/CT in a significant number of cancer patients.

Nódulos pulmonares / Pulmonary Nodules

La definición clásica de nódulo pulmonar solitario corresponde a una imagen radiológica de menos de 3cms que puede corresponder a múltiples condiciones tanto benignas como malignas. Sin embargo con la masificación del uso del TAC de tórax se detectan actualmente diferentes tipos de NP pequeños, incluso subcentrimétricos: sólidos, en vidrio esmerilado (VE) y mixtos. Cada uno con diferente ritmo de crecimiento y diferente potencial de malignidad. Los recientes avances en oncología torácica, tanto en procedimientos diagnósticos como terapéuticos, han hecho que la definición clásica sea insuficiente para incorporar todas las variaciones en el comportamiento de los diferentes nódulos pulmonares que se pesquisan actualmente. Aparte del enfrentamiento habitual de nódulos sólidos de mayor tamaño, se ha definido el manejo de nódulos pequeños sólidos y subsólidos. Se ha establecido claramente que las lesiones en VE tienen un mayor riesgo de malignidad, existiendo una buena correlación entre el aspecto radiológico y el grado histológico. Las lesiones mixtas que persisten en el tiempo y las lesiones en VE en que se desarrolla un componente sólido son las de más alto riesgo de representar un Adenocarcinoma invasor. Por tanto, todos los nódulos, incluso más pequeños subcentrimétricos, deben ser evaluados por equipos multidisciplinarios, con experiencia en los diferentes algoritmos de manejo y seguimiento. Determinando qué nódulos biopsiar de manera de poder resecar tumores iniciales potencialmente curables. Los tumores pequeños pueden ser operados con técnicas quirúrgicas mínimamente invasivas, incluso resecciones sublobares, con similares resultados oncológicos, pero con menor riesgo y menor deterioro de la capacidad funcional.

The definition of a solitary pulmonary nodule corresponds to a radiological image of less than 3cms that may correspond to multiple conditions both benign and malignant. However with the extended use of Chest CT a great number of small sub-centrimetric Pulmonary Nodules are detected: solids, ground-glass opacities (GGO) and mixed lesions. Each with different growth rates and malignant potential. Diagnostic and treatment advances in thoracic oncology, made the classic definition insufficient to incorporate all the difference in growth rate and behavior of the different lung nodules currently detected. In addition to the management larger solid nodules, new diagnostic and treatment algorithms for small GGO and mixed nodules have been defined. It has clearly established that GGO lesions have an increases risk of malignancy, with correlation between radiologic imaging and pathology. Mixed lesions that persist or enlarge during follow-up, or GGO lesions that develop a solid component have the higher risk of representing an invasive adenocarcinoma. Therefore, all nodules, even small sub-centrimetric, should be evaluated by multidisciplinary teams, with experience in management and treatment algorithms determining when to resect potentially curable tumors. Small tumors can be resected by minimally invasive surgery, including sub lobar resections, with equivalent oncologic outcomes, lower risks and better preservation of pulmonary function.

Validation of Group B Borderline Resectable Pancreatic Cancer: Retrospective Analysis

BACKGROUND/AIMS: Among borderline resectable pancreatic cancer (BRPC), group B BRPC patients have findings that are suggestive but not diagnostic of metastasis. In this study, we attempted to validate whether group B could truly be categorized as a borderline resectable group. METHODS: We placed the BRPC patients into group A or group B. The survival outcomes were compared between the groups. RESULTS: A total of 53 patients with pancreatic adenocarcinoma was classified as either group A or B borderline resectable. In group A, 23 (60.5%) of 38 patients underwent pancreatectomy after concurrent chemoradiotherapy or chemotherapy, but in group B, only five (33.3%) of 15 patients underwent pancreatectomy, mainly because of the progression of suspected distant metastasis. There was a significant difference in overall survival (OS) between group A and B patients (median OS, 21.2 months vs 10.2 months, respectively; p=0.007). Of the patients who underwent pancreatectomy, group B had a higher recurrence rate compared to group A (recurrence rate: 11 of 23 patients [47.8%] vs five of five patients [100%], respectively; p=0.033). CONCLUSIONS: This report is the first to validate the definition of BPRC. Group B had much worse outcomes, and whether group B BRPC can be categorized as BRPC together with group A is questionable.

Cistoadenocarcinoma de glándula salival ectópica: revisión bibliográfica; reporte de un caso / Cistoadenocarcinoma of ectopic salivary gland: review of the literature; report of a case

Los cistoadenocarcinomas son neoplasias raras recientemente incluidas en la nueva clasificaciónde tumores de glándulas salivales de la Organización Mundial de la Salud (OMS), como un tipo específico de carcinoma diferenciado histomorfológicamente por exhibir un patrón quístico y un crecimiento papilar y carecer de otras características histológicas presentes en otras formas de carcinomas de glándulas salivales que pueden formar estructuras quísticas. Los autores presentamos un caso clínico quirúrgico de un cistoadenocarcinoma de glándula salival ectópica y la revisión bibliográfica correspondiente.

Hepatocyte antigen expression in subtypes of intestinal metaplasia of the stomach / Expresión del antígeno del hepatocito en los subtipos de metaplasia intestinal del estómago

OBJECTIVE: Recently, hepatocyte antigen (Hep) was introduced as a sensitive and reliable marker of intestinal metaplasia (IM). However, the distribution of Hep expression in subtypes of IM was not described. METHODS: We examined the expression of Hep in 58 cases of chronic gastritis associated with IM by immunohistochemical staining. Cases were classified as: 19 of IM Type I (complete) cases, 16 cases of IM Type II (incomplete) and 23 cases of IM Type III (incomplete). The distribution of Hep expression was classified into four groups according to the intensity of Hep expressing metaplastic cells: negative, low, moderate and high. We also compared expression of Hep with that of MUC-1, MUC-2 and MUC-5AC. RESULTS: Hep expression showed granular cytoplasmic staining and was specifically identified in columnar cells, but not in goblet cells. There was no significant difference between Hep expression and subtypes of IM (p > 0.005). However, the difference between the distribution of Hep expression among three subtypes of IM was significant (p < 0.001). No relationship was observed among the expression of Hep, MUC-1, MUC-2 and MUC-5AC. CONCLUSION: Results of the present study revealed that the distribution of Hep expression is high in the majority of the complete type (Type I) IM cases, moderate in the majority of the incomplete Type II IM cases and low in all of the incomplete Type III IM cases and suggest that besides its role as a sensitive marker in IM, the evaluation of the distribution of Hep expression might be useful in the classification of IM.

OBJETIVO: El antígeno del hepatocito (Hep) se introdujo recientemente como un marcador sensible y confiable de la metaplasia intestinal (MI). Sin embargo, no se describe la distribución de la expresión de Hep en los subtipos de MI. MÉTODOS: Se examinó la expresión de Hep en 58 casos de gastritis crónica asociados con MI mediante tinción inmunohistoquímica. Los casos fueron clasificados como: 19 casos de tipo MI (completo), 16 casos de tipo MI II (incompleto), y 23 casos de tipo MI III (incompleto). La distribución de la expresión del Hep se clasificó en cuatro grupos según la intensidad de Hep, que expresa las células metaplásticas: negativa, baja, moderada y alta. También se comparó la expresión de Hep con la de MUC-1, MUC-2 y MUC-5AC. RESULTADOS: La expresión de Hep mostró tinción citoplasmática granular, específicamente identificada en las células columnares, pero no en las células caliciformes. No hubo ninguna diferencia significativa entre la expresión de Hep y los subtipos de MI (p > 0.005). Sin embargo, la diferencia entre la distribución de la expresión del Hep entre tres subtipos de MI fue significativa (p < 0.001). No se observó relación alguna entre la expresión de Hep, MUC-1, MUC-2 y MUC-5AC. CONCLUSIÓN: Los resultados del presente estudio revelaron que la distribución de la expresión de Hep es alta en la mayoría de los casos MI de tipo completo (tipo I), moderada en la mayoría de los casos MI de tipo II, y baja en todos los casos MI de tipo III incompleto. Los resultados sugieren que además de su papel como marcador sensible en MI, la evaluación de la distribución de expresión del Hep podría ser útil en la clasificación de MI.

Adenocarcinoma gástrico Borrmann tipo IV: análise dos resultados da ressecção curativa / Type IV Borrmann gastric adenocarcinoma: analysis of curative resection results

OBJETIVO: Avaliar o resultado obtido com a ressecção de intenção curativa do adenocarcinoma gástrico Borrmann IV(B IV), através da análise de variáveis clínicas, cirúrgicas e anatomopatológicas, identificando quais destes fatores prognósticos se associaram à sobrevida. MÉTODOS: Foram analisados retrospectivamente, no período de janeiro de 1997 a dezembro de 2005, 123 pacientes com adenocarcinoma gástrico B IV submetidos ao tratamento cirúrgico no Serviço de Cirurgia Abdômino-Pélvica do Instituto Nacional de Câncer (INCA). O grupo submetido à ressecção curativa teve analisado diversos fatores prognósticos com relação à sobrevida global. RESULTADOS: Dos 123 pacientes estudados, 68 foram submetidos à gastrectomia, 52 (42,3 por cento) com intenção curativa e 16 (13 por cento) como ressecção paliativa, enquanto 55 (44,7 por cento) tiveram doença não passível de ressecção. Três óbitos no pós-operatório seguiram-se à ressecção curativa, configurando uma taxa de mortalidade de 5,76 por cento. Em nove (17,3 por cento) pacientes ocorreram complicações técnicas, sendo a fístula esofagojejunal com sete casos, a mais frequente. Todos os óbitos e complicações técnicas ocorreram após gastrectomias totais, que foi o tipo de ressecção curativa mais realizada nesta série. O padrão de recidiva mais comum foi a carcinomatose peritoneal. A localização do tumor, metástase linfonodal, invasão linfática e estadiamento patológico foram considerados fatores prognósticos significantes. O tempo de sobrevida mediano foi de 29 meses, com taxa de sobrevida em cinco anos de 33 por cento nos pacientes submetidos à ressecção curativa CONCLUSÃO: A ressecção com intenção curativa do adenocarcinoma gástrico B IV apresentou um impacto positivo na sobrevida dos pacientes com a doença nos estágios IB, II e III; com até 15 linfonodos comprometidos (pN2) e no tipo localizado.

OBJECTIVE: To evaluate the results obtained with curative resection of Borrmann IV gastric adenocarcinoma (B IV) through the analysis of clinical, surgical and pathological data, identifying which of these prognostic factors were associated with survival. METHODS: We retrospectively analyzed 123 patients with B IV gastric adenocarcinoma undergoing surgical treatment at the Department of the pelvic-abdominal surgeries of the National Cancer Institute (INCA) from January 1997 to December 2005. The group undergoing curative resection was examined for various prognostic factors regarding overall survival. RESULTS: Of the 123 patients studied, 68 underwent gastrectomy, 52 (42.3 percent) with curative intent and 16 (13 percent) palliative resection, while 55 (44.7 percent) had disease not subject to resection. Three postoperative deaths followed the curative resection, constituting a mortality rate of 5.76 percent. In nine (17.3 percent) patients there were technical complications, and esophagojejunal fistula seven cases, the most frequent. All technical complications and deaths occurred after total gastrectomy, which was the most commonly performed curative resection type in this series. The most common pattern of recurrence was peritoneal carcinomatosis. The location of the tumor, lymph node metastasis, lymphatic invasion and pathological staging were considered significant prognostic factors. The median survival time was 29 months, with a rate of five-year survival of 33 percent in patients undergoing curative resection. CONCLUSION: The curative resection of B IV gastric adenocarcinoma had a positive impact on survival of patients with the disease in stages IB, II and III, with up to 15 lymph nodes (pN2) and localized type.

Polimorfismos genéticos de interleucinas IL-1B-511, IL-1RN, IL-10, factor de necrosis tumoral alfa-308 e infección por Helicobacter pylori CagA positivo en cáncer gástrico y úlcera duodenal en diferentes poblaciones en Colombia / Genetic polymorphisms of IL-1B-511, IL-1RN, IL-10 interleukins, tumor necrosis alfa-308 and Positive Helicobacter pylori CagA infection in gastric cancer and duodenal ulcer in different populations in Colombia

Objetivo: Determinar la asociación entre los polimorfismos IL-1B-511, IL-1RN, TNF-α-308, IL-10-819 e IL-101082 y la infección por Helicobacter pylori CagA positivo en un grupo de pacientes con cáncer gástrico y úlcera duodenal en diferentes poblaciones en Colombia. Métodos: Estudio de casos y controles con 341 pacientes: con gastritis no atrófica, 194; con cáncer gástrico, 58; úlcera duodenal con lesiones preneoplásicas, 54; y con úlcera duodenal, 35. La genotipificación de los polimorfismos se hizo por discriminación alélica usando PCR en tiempo real, y la del IL-1RN, por PCR convencional y electroforesis en agarosa. La infección por Helicobacter pylori CagA se determinó mediante ELISA. Se utilizó la regresión logística en el análisis estadístico. Resultados: Ser portador del genotipo IL-1B-511TT (OR=4,69; IC 95% 1,22-18,09) y tener una infección por Helicobacter pylori CagA positivo (OR=4,43; IC 95% 1,72-11,4) se asociaron a cáncer gástrico. Tener una infección por Helicobacter pylori CagA positivo (OR=4,39; IC95% 1,82-10,59) se asoció a la presencia de úlcera duodenal con lesiones preneoplásicas, y ser portador del genotipo IL-1B-511CT se asoció a úlcera duodenal (OR=0,30; IC 95% 0,10-0,91). Conclusión: Los resultados sugieren que la respuesta pro-inflamatoria y la genética virulenta de la bacteria son factores relacionados con los diferentes desenlaces ocasionados por la infección por Helicobacter pylori en la población estudiada; así, el polimorfismo IL-1B-511 es un factor relacionado con cáncer gástrico y úlcera duodenal, y la infección por Helicobacter pylori CagA positivo es un factor asociado a cáncer gástrico y úlcera duodenal con lesiones preneoplásicas.

Objective: To determine the association between the IL-1B-511, IL-1RN, TNF-α-308, IL-10-819 and IL-101082 polymorphisms and positive Heliocobacter pylori CagA infection in a group of patients with gastric cancer and duodenal ulcer in different populations in Colombia. Methods: A case-control study was performed on 341 patients: those with non-atrophic gastritis, 194; with gastric cancer, 58; duodenal ulcer with preneoplastic lesion, 54; and with duodenal ulcer, 35. The genotyping of polymorphisms was done with allelic discrimination using PCR in real time, and that for IL-1RN with conventional PCR and agarose electrophoresis. Helicobacter pylori CagA infection was ascertained with ELISA. Logistic regression was used in statistical analysis. Results: Being a carrier of genotype IL-1B-511TT (OR=4.69; CI 95% 1.22-18.09) and being positive for Helicobacter pylori CagA infection (OR=4.43; CI 95% 1.72-11.4) are associated with gastric cancer. Positive Helicobacter pylori CagA infection (OR=4.39; CI 95% 1.82-10.59) is associated with the presence of duodenal ulcer with preneoplastic lesions, being a carrier of genotype IL-1B-511CT is associated with duodenal ulcer (OR=0.30; CI 95% 0.10-0.91). Conclusion: The results suggest that pro-inflammatory response and virulent bacterial genetics are factors related to the different outcomes brought about by Helicobacter pylori infection in the population studied; that is, the IL-1B-511 polymorphism is a factor related to gastric cancer and duodenal ulcer, and positive Helicobacter pylori CagA infection is a factor associated with gastric cancer and duodenal ulcer with preneoplastic lesions.

Características clínicas y epidemiológicas del cáncer gástrico en cuatros hospitales de Managua, en el período 2000- 2006 / Clinical and epidemiological characteristics of gastric cancer in four hospitals in Managua, during the period 2000 - 2006

Objetivo: se realizó un estudio con el objetivo de analizar las características clínicas y epidemiológicas del cáncer gástrico en cuatro hospitales de Managua. Material y método: es un estudio de tipo descriptivo, retrospectivo,observacional, en pacientes con diagnóstico de Cáncer gástrico en cuatro hospitales de Managua, periodo 2000- 2006; se revisaron en el Hospital Roberto Calderón Gutiérrez una población de 61 pacientes con Cáncer Gástrico, en el Hospital Antonio Lenin FOnseca 90 pacientes, Hospital Alemán Nicaragüense20 pacientes y Hospital Militar Alejandro Dávila Bolaños 19 pacientes, para un total de 190 pacientes. Resultados: el promedio de edad de los pacientes fue de 71 años, del sexo masculino en un 62.1 por ciento, procedían de zonas urbanas en un 74.7 por ciento, el 70.5 por ciento fue nivel acádemico primaria con ocupación ama de casa. Los principales signos y síntomas de presentación fueron; pédida de peso, náuseas y/o vómitos, dolor abdominal con un período de presentación de los síntomas menor de seís meses...

Pathologic Diagnosis of Gastric Epithelial Neoplasia / 대한소화기학회지

Gastric epithelial neoplasia is a very common disease entity in Korea, encompassing gastric adenoma and adenocarcinoma. There are still discrepancies in pathologic diagnosis of gastric epithelial neoplasia between Western and Japanese pathologists after Vienna consensus classification. With increasing use of endoscopic therapy such as endoscopic mucosal resection and endoscopic submucosal dissection, it is very important to agree on the consensus criteria in the diagnosis of gastric epithelial neoplasia among pathologists in Korea. On this background, the current concepts, and contemporary issues of definition, diagnostic and classification criteria of gastric epithelial neoplasia were reviewed.

Clinicopathologic Characteristics of Adenocarcinoma in Cardia according to Siewert Classification / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to evaluate clinicopathologic differences between Type II and Type III groups that were classified by Siewert in cardia cancer. METHODS: A hundred forty-one patients who were diagnosed as gastric cardia cancer and underwent surgery between January 1990 and December 2006 by single surgeon at Department of Surgery, Yonsei University College of Medicine were included in this study. The Kaplan-Meier method and log rank test were used for survival analysis. RESULTS: Barrett's adenocarcinoma was recognized in two patients so called type I. There were significant differences between type II and III in aspect of depth of invasion, Lauren's classification, and the number of retrieved lymph nodes in which cancer infiltrated. In type III, prognostic factors affecting survival were depth of invasion and nodal status in contrast to the no demonstrable prognostic factors existing in type II. However, there were no differences in recurrence and survival between two groups. CONCULSIONS: Several clinicopathologic differences exist between type II and III cardia cancer. In the future, further evaluation is needed regarding the classification and entities of the cardia cancer.

Concomitância de GIST e adenocarcinoma gástrico: revisão e relato de dois casos / Concomitant gastric adenocarcinoma and GIST: review and report of two cases

A presente monografia tem como objetivo realizar revisão bibiográfica sobre concomitância entre adenocarcinoma gástrico e tumor estromal gastrointestinal (GIST). Foram analisados 106 prontuários de pacientes submetidos à gastrectomia pelos serviços de cirurgia geral I e II num período de cinco anos (2003-2007) no Hospital Universitário Antonio Pedro da cidade de Niterói, Brasil. Os dados obtidos dos prontuários foram confirmados no registro de patologia do mesmo hospital e posteriormente foram relatados dois casos de concomitância entre as duas patologias. Um achado incomum na prática médica.

Observer Agreement Using the ACR Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, First Edition (2003)

OBJECTIVE: This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). MATERIALS AND METHODS: Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics. RESULTS: The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). CONCLUSION: Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.

Surgical management of adenocarcinoma of the esophagogastric AEG junction

This study was performed to analyze the surgical results of 66 patients with adenocarcinoma of the esophagogastric AEG Junction subjected to curative resection. Between Sep. 2000 and Sep 2003, 66 patients with AEG including 20 type I, 16 type II and 30 type Ill were subjected to surgical resection in NCI Cairo University, South Egypt Cancer Institute [SECI] Assiut University, Nasser institute and Aswan Cancer Center. Patients with type I tumors [distal esophagus] underwent total esophagogastric transhiatal transthoracic or through three fields approach [abdominal, thoracic and cervical] or .subtotal esophagectomy with thoracic reconstruction. Patients with type Ill [gastric cardia] anderwent total or proximal gastrectomy with either transhiatal or transthoracic reconstruction For type II tumors [true cardia], total esophagectomy, subtotal esophagectomy, proximal gastrectomy with distal esophagectomy or total gastrectomy with distal esophagectomy were done with transhiatal, transthoracic or three field approach. Pathology, TNM stage, surgical approach, morbidity, mortality and survival were studied among the 3 groups. There were 54 male patients and 12 females with a median age 53 teams twenty patients [30.3%] had type I tumors, 16 [24.2%] had type II tumors and 30 [45.5%] had type Ill tumors twenty seven [41%] [20 type is 7 type II] underwent total esophagectomy or subtotal distal through transhiatal, trans thoracic or abdominal, thoracic and cervical approach Thirty nine patients [59%]. including thirty patients with type III and 7 patients with type II underwent gastrectomy 27 [41%] total and 12 [18%] proximal gastrectomy. Postoperative mortality was 9% and morbidity was 228.7% Overall survival [OS] was 88% at 12 months and 44.6% at 24 months while disease free survival [DFS] was 69.4% and 20.7% respectively. Lymph nodes [+ve vs-ve] and stage [I+II vs Ill+IV] grade percent of ve abdominal lymph nodes and total abdominal and mediastinal lymph nodes had prognostic significance while type of tumour, surgical approach, type of R resection, surgical margin size of the tumour and mediastinal lymph nodes were non significant on univariate analysis. while the abdominal lymph nodes were the only significant variable on multivariate analysis. Adenocarcinoma of the cardia is associated with poor survival. Early diagnosis remains the prerequisite for curative treatment. The classification of AEG into type I, II and III provides a useful tool for selecting the surgical approach

Anatomical classification and results of surgical treatment for adenocarcinoma of the cardia

One hundred and eight patients with histologically proven adenocarcinoma of the cardia were treated. The Siewert's classification was used to categorize these lesions into three types according to the relation of the tumor mass to the anatomical cardia. Total esophagectomy with resection of lymph nodes in the paracardial and posterior mediastinal regions was carried out for all type I lesions and a total gastrectomy with D2 lymphadenectomy as described for gastric cancer was the principal procedure for type III disease. For type II disease, a D2 lymphadenectomy was the essential part of the procedure in addition to either total gastrectomy or total esophagectomy based on the tumor extent. The average follow up period was 15-108 months [median 42.8 +/- 13.7 months]. The analysis included the surgical approaches used, the extent of resection, 30-day death rate, postoperative complications, depth of tumor invasion [pT], nodal status in resected specimens and the overall survival. The study concluded that adenocarcinoma of the cardia continues to carry a dismal prognosis. The topographic and anatomical classification of these lesions provides a useful tool for selecting the surgical approach and guide the extent of resection