Impacto del virus Epstein Barr en el cáncer gástrico en el Perú / Impact of the Epstein Barr virus on gastric cancer in Peru

El virus de Epstein Barr (VEB) es responsable del 10% del cáncer gástrico (CG) y se correlaciona con mejor tasa de sobrevida. En Perú, no existen estudios sobre prevalencia y características clínicas de CG VEB positivo. Objetivos: Determinar la prevalencia y las características clínico patológicas del CG VEB positivo. Materiales y métodos: 111 muestras de GC fueron examinadas centralmente por hibridización cromogénica in situ del RNA del VEB (EBER CISH). Resultados: El 8,4% de los casos fueron positivos para VEB. La mayoría de los casos VEB positivos tuvieron más de 60 años, varones y la localización, antro / píloro fue la más frecuente. La mayoría de los casos fueron de tipo intestinal y un patrón tubular con una tendencia a un mejor pronóstico en comparación con los casos de VEB negativo. Conclusión: CG VEB positivo es una entidad con una prevalencia de 8,4% en Perú con características clínicas y morfológicas distintivas.

Epstein Barr Virus (EBV) is responsible of 10% of Gastric Cancer (GC), correlating with better survival rates. In Peru, there were not studies about prevalence and clinical characteristics of CG EBV positive. Objective: Determine prevalence and clinicopathological characteristics of GC EBV positive. Materials and methods: 111 GC tumour samples were centrally screened by Chromogenic in situ hybridization (CISH) technique for EBV-encoded RNA (EBER) transcript. Results: 8.4% of cases were positive for EBV. Most cases EBV positive were more than 60 years old; male, antrum/pylorus had more frequent localizations. Most cases had an intestinal type and tubular patter and a tendency to better prognostic in comparison EBV negative cases. Conclusion: EBV positive GC is an entity with a prevalence of 8.4% in Peru with distinctive clinical and morphological characteristics.

Disección submucosa endoscópica de cáncer gástrico temprano transpilórico: Reporte de caso y revisión de la literatura / Endoscopic submucosal dissection of a transpyloric early gastric cáncer: A case report and literature review

La disección submucosa endoscópica (DSE) es una técnica endoscópica avanzada que logra la resección curativa de neoplasias superficiales del tracto gastrointestinal, consiguiendo exéresis en bloque con márgenes libres de neoplasia evitando una cirugía. Sin embargo, los tumores localizados en la unión esófago gástrica, o pilórica son técnicamente más complejos para resecar por DSE. Cuando una neoplasia asienta en el píloro las características anatómicas de esta región pueden afectar la adecuada valoración de los márgenes y la realización del procedimiento. Presentamos el caso de un paciente varón de 70 años a quien en una endoscopia digestiva alta se le evidencia una lesión plana elevada multilobulada de 18 mm x 10 mm, situada mayoritariamente en los 2 cuadrantes inferiores del canal pilórico y compromiso mínimo del cuadrante supero-posterior, abarca principalmente la vertiente gástrica del canal pilórico y se extiende hacia el duodeno. Por todo ello se decide realizar resección en bloque de la lesión con la técnica de disección submucosa endoscópica. Se empleó el sistema ERBEJET con una cuchilla de tipo Hybrid knife, inyección salina con azul de metileno diluido al 0,04% sobre el margen distal, complementándose la inyección submucosa con ácido hialurónico al 0,4%. Se utilizó un "capuchón" o dispositivo plástico distal transparente recto para poder traccionar la lesión y permitir visualizar anterógradamente los márgenes de resección, incluso de la porción intraduodenal, permitiendo una adecuada disección submucosa. Luego de comprobar hemostasia se constató la resección en bloque. La histopatología mostró un adenocarcinoma tubular medianamente diferenciado con bordes quirúrgicos libres de lesión. Gracias a la estrategia de DSE utilizada, nuestro paciente pudo beneficiarse de la resección curativa de su cáncer gástrico con preservación del órgano y con perfecta funcionalidad. Este caso, el primero descrito en el país, muestra el avance de la endoscopía terapéutica nacional.

The endoscopic sumucosal disection (ESD) is an advanced endoscopic technique that achieves the curative resection of superficial neoplasms of the gastrointestinal tract, getting block exeresis with margins free of neoplasia avoiding surgery. However, tumors located in the esophagogastric junction, or pylorus, are technically more complex to resect by ESD. When a neoplasm settles in the pylorus, the anatomical characteristics of this region can affect the adequate assessment of the margins and the performance of the procedure. We present the case of a 70-year-old male patient who, in a high digestive endoscopy, showed a flat multilobulated lesion of 18 mm x 10 mm, located mostly in the lower 2 quadrants of the pyloric canal and minimal compromise of the upper-posterior quadrant, it mainly covers the gastric side of the pyloric channel and extends into the duodenum. Therefore, it was decided to perform en bloc resection of the lesion with the endoscopic submucosal dissection technique. The ERBEJET system was used with a knife type Hybrid knife, saline injection with methylene blue diluted 0.04% on the distal margin, submucosal injection being complemented with 0.4% hyaluronic acid. A "capsule" or straight transparent distal plastic device was used to be able to pull the lesion and allow anterograde visualization of the margins of resection, including the intraduodenal portion, allowing adequate submucosal dissection. Histopathology showed a moderately differentiated tubular adenocarcinoma with surgical edges free of injury. Thanks to the DSE strategy used, our patient could benefit from the curative resection of his gastric cancer with preservation of the organ and with perfect functionality. This case, the first described in the country, shows the progress of national therapeutic endoscopy.

Características endoscópicas y patológicas del cáncer gástrico en un hospital público peruano / Endoscopic and pathological characteristics of gastric cancer in a Peruvian public hospital

RESUMEN Objetivo: Evaluar las características endoscópicas y patológicas del cáncer gástrico del Hospital Nacional Luis N. Sáenz entre 2008 y 2013. Materiales y métodos: Estudio observacional retrospectivo transversal. Se revisó los informes endoscópicos, de pacientes mayores a 30 años, se ingresó al estudio el diagnóstico histológico de adenocarcinoma gástrico, las variables patológicas como tipo histológico, presencia deH. pylori y de metaplasia intestinal e incompleta. Resultados: Se identificó 92 casos de adenocarcinoma gástrico. Prevalencia promedio 0,6%, prevalencia de 0,34% en 2009 y 0,82% en 2013, sexo masculino 62%, femenino 38%, edad menor de 55 años 16%, mayor a 76 años 42%; presentación endoscópica Borrmann III 57%, II 16,3%, IV 15%, V 7,6%, I 3,3%; presentación distal 8 veces más frecuente que la proximal, tipo histológico intestinal 75%, H. pylori presente en 50% casos, metaplasia intestinal en 40% de casos de cáncer gástrico. Conclusiones: Se encontró una alta prevalencia de cáncer gástrico. Frecuente en sexo masculino y en mayores de 76 años, presentación endoscópica más frecuente fue Borrmann III, la presencia de H. pylori y metaplasia intestinal incompleta asociada a cáncer tipo intestinal

ABSTRACT Objective: The endoscopic and pathological characteristics of gastric cancer in Luis N. Sáenz National Hospital between 2008 and 2013. Materials and methods: retrospective cross-sectional observational study. We reviewed the endoscopic reports of patients older than 30 years, we studied the histological diagnosis of gastric adenocarcinoma, pathological variables such as histological type, presence of H. pylori and complete and incomplete intestinal metaplasia. Results: 92 cases of gastric adenocarcinoma were identified. Average prevalence 0.6%, 0.34% in 2009 and 0.82% in 2013; 62% male, 38% female, age less than 55 years 16%, greater than 76 years 42%; endoscopic presentation Borrmann III 57%, II 16.3%, IV 15%, V 7.6%, I 3.3%; 8 times most frequent presentations distal the proximal v, 75% histologic intestinal type, H. pylori in 50% cases, intestinal metaplasia in 40% of cases of gastric cancer. Conclusion: We found high prevalence of gastric cancer. Common in males, and in people over 76, more frequent endoscopic presentation was Borrmann III, the presence of H. pylori and incomplete intestinal metaplasia associated with intestinal cancer type.

Inhibition Effect of Bufalin on Invasion and Metastasis of Gastric Cancer Cells / 医药导报

Objective To study effect of bufalin on invasion and metastasis of gastric cancer cells and related mechanism.Methods AGS human gastric cancer cell line was used for in vitro experiments.Cultured cells were treated by negative control group,bufalin group and oxaliplatin group.Cell proliferation was determined by MTT.Invasion and metastasis were observed by Wound-Healing Assay and Transwell Assay.Expression levels of E-cadherin,matrix metalloproteinases (MMP)-2,MMP-9 were detected by Western blotting.Results Bufalin was found to significantly inhibit the proliferation of AGS cells in a dose and time dependent manner.Wound-Healing Assay and Transwell Assay showed that as compared with the blank control group,bufalin inhibited invasion and metastasis of AGS cells (P＜ 0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞0.05).Western blotting showed the expression of E-cadherin was increased in bufalin group as compared with the blank control group while the expression levels of MMP-9 and MMP-2 were down-regulated (P＜0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞ 0.05).Conclusion Bufalin has anti-cancer activity on gastric cancer cells,and it has the ability of inhibiting cancer cell invasion and metastasis,and regulating the expression of some related gene.

The diagnostic problem of gastric cancer

The problem of early diagnosis of gastric cancer appears to be two fold. The paucity of clinical manifestations and the medical ignorance of our people has been so far the major reasons in the inadvertent delay of the diagnosis. The other minor reason is the inherent limitation of the known methods of diagnosis. Obviously, some stomach carcinomas are not detectable by the present methods of diagnosis and greater efforts should be exerted to extend the frontiers of our diagnostic know-how. Maybe the unexplored investigative field of nuclear medicine may reap for us a richer harvest. (Conclusion)