ABSTRACT
There are two main types of gastrointestinal connective tissue tumors: differentiated connective tissue tumors arising from smooth muscle tissue, schwanommas or fibroblastic tissue, and non-differentiated connective tissue tumors with no precise origin. Pathologically non-classifiable tumors comprise a group of real gastrointestinal stromal tumors. Stromal tumors are rare and generally develop in the stomach. Immunohistochemistry has been able to identify three entities: stromal tumorswith skenoid fibers, gastoinestinal autonomic nerve tumors, and intraabdominal desmoplastic small round-cell tumors. After resection, survival is almost 50% at 5 years and depends particulary on tumors size, the presence of synchronous metastases and mitosis count.
Subject(s)
Gastrointestinal Neoplasms/surgery , Neoplasms, Connective Tissue/surgery , Aged , Endoscopy , Female , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/pathology , Humans , Immunohistochemistry , Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/pathology , Intestinal Neoplasms/surgery , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasms, Connective Tissue/diagnosis , Neoplasms, Connective Tissue/pathology , Prognosis , Retrospective Studies , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Terminology as Topic , Tomography, X-Ray ComputedSubject(s)
Digestive System Surgical Procedures , General Surgery , Laparoscopy , Societies, Medical , Anti-Ulcer Agents/therapeutic use , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Carcinoma, Hepatocellular/surgery , Cholangiocarcinoma/surgery , Chronic Disease , Endoscopy, Digestive System , Esophageal Diseases/surgery , Follow-Up Studies , Gastrectomy/methods , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/surgery , General Surgery/trends , Hepatectomy/methods , Hepatic Artery/injuries , Hepatic Artery/surgery , Hernia, Hiatal/surgery , Hernia, Ventral/surgery , Humans , Liver Neoplasms/surgery , Omeprazole/therapeutic use , Portal Vein/injuries , Portal Vein/surgery , Proctocolectomy, Restorative/methods , Recurrence , Splenectomy/methods , Stomach Neoplasms/surgery , Stomach Ulcer/surgery , Time Factors , Vagotomy/methodsABSTRACT
BACKGROUND: Stromal tumors of the digestive tract are undifferentiated connective tissue tumors which are difficult to characterize even with immunohistochemistry. CASE REPORT: A stromal tumor of the duodenum (the most frequently encountered location) was resected entirely. Histochemistry was unable to provide a precise identification of the histological nature. The tumor was considered to be low grade due to the low mitosis index despite its large size and the presence of necrosis. Careful surveillance was indicated. DISCUSSION: The risk of these tumors is uncertain and may be assessed on the basis of histological prognosis factors such as tumor size, mitosis index and ploidy. Echoendoscopy can be particularly useful for diagnostic purposes providing information on location in the duodenal musculosa.
Subject(s)
Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/pathology , Duodenal Neoplasms/surgery , Female , Histocytochemistry , Humans , Laparoscopy , Middle Aged , UltrasonographyABSTRACT
Experimental studies have shown a significant inhibition of adenocarcinoma of the pancreas by gonadoliberin (luteinizing hormone-releasing hormone [LH-RH]) and somatostatin. The aim of this prospective randomized study was to compare the potential value of somatostatin (250 micrograms every 8 hours), LH-RH (3.75 mg monthly), or combined, to a control group. One hundred sixty-three patients with adenocarcinoma of the pancreas who did not undergo resection for cure were divided into 4 groups that did not differ in terms of clinical, biologic, or pathologic data. The mean survival times were 6 months in the LH-RH plus somatostatin group, 5.5 months in the LH-RH group, 4.3 months in the control group, and 3.8 months in the somatostatin group. However, the life-table analyses for all randomized patients, and separately according to sex, the lymph node extension, and metastatic spread were not different between groups. Improvement of patient status was observed in 20% of the patients receiving hormone therapy without any difference noted between the treatment regimens. These disappointing results may be explained by the degree of extension of pancreatic carcinoma in the patients studied. The results suggest that different hormone therapy regimens might be considered according to the age and the sex of patients, as well as to the presence or absence of hormone receptors.
Subject(s)
Adenocarcinoma/drug therapy , Gonadotropin-Releasing Hormone/therapeutic use , Pancreatic Neoplasms/drug therapy , Somatostatin/therapeutic use , Adenocarcinoma/pathology , Adenocarcinoma/secondary , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Clinical Protocols , Female , Gonadotropin-Releasing Hormone/administration & dosage , Gonadotropin-Releasing Hormone/adverse effects , Humans , Lymphatic Metastasis , Male , Middle Aged , Pancreatic Neoplasms/pathology , Prospective Studies , Remission Induction , Somatostatin/administration & dosage , Somatostatin/adverse effects , Survival RateSubject(s)
Duodenal Ulcer/surgery , Helicobacter Infections/microbiology , Vagotomy, Proximal Gastric/methods , Duodenal Ulcer/drug therapy , Duodenal Ulcer/microbiology , Follow-Up Studies , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Histamine H2 Antagonists/therapeutic use , Humans , Recurrence , Vagotomy, Proximal Gastric/trendsSubject(s)
Liver Abscess/microbiology , Streptococcal Infections/microbiology , Streptococcus/isolation & purification , Drainage , Humans , Liver Abscess/diagnostic imaging , Liver Abscess/surgery , Male , Middle Aged , Streptococcal Infections/diagnostic imaging , Streptococcal Infections/surgery , Tomography, X-Ray ComputedABSTRACT
Thyroid carcinoma and familial intestinal polyposis are not accidentally associated. A new case is described which, along with the other 32 cases already published, reveals an incidence of thyroid carcinoma 100 times higher in patients with polyposis than in the general population, and 160 times higher in female patients under 35 years of age. Several features of these thyroid carcinomas can be pointed out: greatest incidence in women, occurrence at a young age, existence of a papillary tumor appearing independently from the evolution of the polyposis, and probably familial disease. It is therefore necessary to systematically examine the thyroid body in all subjects with familial intestinal polyposis.
Subject(s)
Adenomatous Polyposis Coli/genetics , Carcinoma, Papillary/genetics , Colorectal Neoplasms/genetics , Neoplasms, Multiple Primary/genetics , Thyroid Neoplasms/genetics , Humans , Male , Middle AgedABSTRACT
A case of oesophageal stenosis due to mediastinal carcinosis from squamous carcinoma of the anus, treated five years before by radiotherapy, is reported. Radiosensitivity of the tumor ensured a good results with complete resolution.
Subject(s)
Anus Neoplasms , Carcinoma, Squamous Cell/secondary , Esophageal Stenosis/etiology , Mediastinal Neoplasms/secondary , Mediastinitis/etiology , Female , Humans , Middle AgedSubject(s)
Duodenal Ulcer/surgery , Vagotomy, Proximal Gastric , Vagotomy , Adult , Aged , Female , Follow-Up Studies , Gastric Acid/metabolism , Humans , Male , Middle Aged , Recurrence , RiskABSTRACT
Villous tumours of the colon and rectum are characterized by a high incidence of malignancy (50%) and by their tendency to recur. Invasive malignant villous tumours require wide excision in the same way as adenocarcinomas. Non-invasive tumours (stage 0 and stage I) should be treated like benign villous tumours. Villous tumours of the colon, i.e. situated more than 15 cm from the anus, are removed by a short colonic resection. Villous tumours of the rectum which are small and pedunculated or sessile, situated less than 8 cm from the anus can be excised via the trans-anal route, provided a margin of healthy mucosa is removed around the villous zone. High rectal tumours which are very large or diffuse are removed by a trans-sacral approach, low extensive tumours are removed by a coccyperineal or trans-sphincteric approach. Recurrences (30 to 40%) always occur after incomplete excision, especially after a trans-anal resection. Benign tumours can also recur, although remaining benign, and require a further local excision.
Subject(s)
Carcinoma in Situ/surgery , Carcinoma/surgery , Colonic Neoplasms/surgery , Intestinal Polyps/surgery , Rectal Neoplasms/surgery , Biopsy , Carcinoma/pathology , Carcinoma in Situ/pathology , Colonic Neoplasms/pathology , Humans , Intestinal Polyps/pathology , Methods , Neoplasm Recurrence, Local , Rectal Neoplasms/pathologyABSTRACT
In cases of reflux disease the therapeutic indications are of special significance. The number of patients in need of operation is limited, thus the patients must be chosen carefully. Different diagnostic methods have been compared to standard acid reflux test in a series of 22 consecutive cases. Radiology was the least reliable method for detecting reflux or reflux complications, whereas endoscopy confirmed the diagnosis in 18 of 22 cases. Three-point stepwise manometry did not give reliable data of the lower esophageal sphincter pressure but yielded valuable information about the location of lower esophageal sphincter zone and of esophageal motility. In contrasts to earlier reports, no considerable overlap regarding lower esophageal sphincter pressure values in healthy and diseased individuals were noted.