Esophageal superficial adenosquamous carcinoma resected by endoscopic submucosal dissection: A rare case report.

BACKGROUND: Adenosquamous carcinoma (ASC), which is comprised of squamous cell carcinoma (SCC) and adenocarcinoma elements, is a rare histological type of esophageal carcinoma. Few reports have focused on the endoscopic findings and the effectiveness of the endoscopic treatment of early ASC. CASE SUMMARY: A 77-year-old man underwent esophagogastroduodenoscopy for heartburn. A flat lesion with an uneven and slightly elevated central portion was found in the distal esophagus. Magnifying endoscopy with narrow-band imaging showed a well-demarcated brownish area with dendritically branched abnormal vessels and highly irregular intrapapillary capillary loops. A histopathological diagnosis of SCC was obtained by endoscopic biopsy. Endoscopic ultrasonography revealed a hypoechoic mass confined to the mucosa layer. The lesion was suspected to be SCC with invasion into the muscularis mucosa. The lesion was resected en bloc by endoscopic submucosal dissection and histologically diagnosed as esophageal ASC limited within the muscularis mucosa, which was completely resected without lymphovascular or neural invasion. The SCC element was the pre-dominant element. The adenocarcinoma element formed ductal and nested structures distributed in a focal pattern. The patient underwent only endoscopic submucosal dissection and has been under annual endoscopic and radiographic surveillance for 3 years without recurrence. CONCLUSION: For early ASC confined within the mucosal layer, complete endoscopic resection might also be a curative treatment.

Intra-rectal use of epinephrine in radiotherapy of prostate cancer.

Purpose: The aim of the study was to evaluate the feasibility and toxicity of intra-rectal epinephrine during prostatic radiotherapy. Materials and methods: A total of 34 patients with prostate cancer were randomized to receive daily intra-rectal epinephrine (4 mg in 40 mL, n=16) or placebo (40 mL normal saline, n=18) 5 min before daily radiotherapy. Physical examination including systolic blood pressure (SBP) and heart rate (HR) was performed before, 5 min after, and 20 min after intra-rectal use. Toxicities were graded using the Radiation Therapy Oncology Group standard. A two-sided Fisher's exact test was used to compare proportions between groups. A mixed-effects model was used to analyze multiple measurements of SBP and HR. Survival curves were calculated using the Kaplan-Meier method and compared between groups using the log-rank test. Results: All patients completed the protocol treatment and reported no cardiovascular symptoms after intra-rectal administration. There were no differences in SBP and HR between these two groups at any time point (before, 5 min after, and 20 min after epinephrine). At 5 weeks after the start of radiotherapy, the incidence of rectal toxicity≥grade 2 was 27.8% (5/18) for the control group versus 12.5% (2/16) for the epinephrine group, but was not statistically significant (p=0.4). There was no rectal toxicity≥grade 2 in these two groups beyond 2-year follow-up. The 5-year biochemical relapse-free survival was 75.0% and 72.2% for the epinephrine and control group, respectively. Conclusion: Results of this pilot randomized trial have demonstrated that intra-rectal administration of epinephrine is feasible and safe in prostatic radiotherapy. Its radio-protective effect warrants further investigation.

A case of esophageal tuberculosis with unusual endoscopic feature.

A 59-year-old man experienced epigastric pain and an upper gastrointestinal endoscopy revealed a bulging lesio n 0.5×0.6cm in size in the middle esophagus. EUS showed a homogenous hypoechoic lesion, which interrupted the five layers structure of esophageal wall. Biopsies revealed epithelioid granuloma with central caseous necrosis and several acid-fast bacilli.

[Clinical analysis of 63 cases with gastric gastrointestinal stromal tumors].

OBJECTIVE: To analyze the clinicopathological characteristics of gastric gastrointestinal stromal tumors (gastric GISTs) and to explore the diagnosis, treatment and prognosis of gastric GISTs. METHODS: Clinical data of 63 cases with gastric GISTs from January 1997 to May 2007 were analyzed retrospectively. All patients were treated by surgery. All the 63 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank analysis and Cox regression model respectively to evaluate the prognostic factors. RESULTS: The accuracy of preoperative ultrasonography, CT and EUS was 72.2%, 81.0% and 94.3% respectively. The diagnostic accuracy of EUS was significantly higher than those of ultrasonography and CT(chi(2)=6.065, P<0.05). Of the 63 gastric GISTs, 31 cases(49.20%) were at fundus. Immunohistochemistry staining revealed that the positive rates of CD117 and CD34 were 88.9% and 95.1% respectively. The 1-, 3- and 5-year total survival rates of 63 patients were 96.4%, 84.7% and 71.7% respectively. Univariate analysis revealed that the differences of Fletcher classification and tumor size were significant. No significant differences in gender, age, mitotic index, immunohistochemistry expression and multi-organ resection existed among the groups. Multivariate analysis demonstrated that Fletcher classification was the independent poor prognostic factor for survival. CONCLUSIONS: The preoperative diagnostic accuracy of EUS is significantly higher than those of ultrasonography and CT. Fletcher classification is reasonable and feasible to evaluate the prognosis of gastric GISTs.