Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.

BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.

Malignant bile-duct obstruction: experience with self-expanding metal endoprostheses (Wallstents) in Austria.

Fifty-two patients in nine Austrian hospitals were treated with biliary self-expanding metal endoprostheses (Wallstents) for malignant biliary obstruction, and followed up retrospectively using questionnaires, answered by the endoscopists. Stent placement was successful in all patients. The technical failure rate at the first attempt was 7.7%, and stenting-associated mortality was 3.8% due to mispositioning of stents, leading in two cases to death. The 30-day mortality was 13.5%, and early complications occurred in 15.4%. The median survival was 216 days, and the median stent patency was 291 days. During follow-up, stent occlusion was observed in ten patients, acute cholangitis in 12 patients, acute pancreatitis in three patients, acute cholecystitis in one patient, and duodenal ulceration due to stent erosion in one patient. Routine use of biliary self-expanding metal endoprostheses by averagely experienced endoscopists can be recommended. Attention has to be paid to the correct placement of the guidewire and stent.

[Colorectal cancer. Precancerous conditions]. / Kolorektales Karzinom. Präkanzerosen.

Colorectal precancerous stages are primarily benign lesions of the colon mucosa with a potential to malignant degeneration. They are macroscopically seen as polypoid lesions, but not only "adenomas" are to be seen as precancerous. Polypoid lesions which are not of neoplastic origin are not capable of malignant degeneration. Precancerous dysplasias are also found in the flat atrophic mucosa of chronically inflamed colon mucosa , which complicates the macroscopical judgement in the endoscopy. Problems also arise for the pathologist in the separation between inflammatory regenerative epithelatypia and high-grade dysplasia.

[76-year-old patient with adenocarcinoma of the rectum and fibrolamellar hepatocellular 2d carcinoma. Case report with literature review of hepatocellular carcinoma of the fibrolamellar type]. / 76jähriger Patient mit einem Adenokarzinom des Rektums und fibrolamellärem hepatozellulärem Zweitkarzinom. Kasuistik mit Literaturübersicht über das hepatozelluläre Karzinom von fibrolamellären Typ.

This paper presents the case report of the coincidental presence of an adenocarcinoma of the rectum and fibrolamellar hepatocellular carcinoma in a 76 year-old man. The tumours were successfully removed by simultaneous resection. The characteristics of hepatocellular carcinoma of the fibrolamellar type are discussed in detail on the basis of the presented case and a survey of the literature. This variant of hepatocellular carcinoma is predominantly found in younger patients. It appears in non-cirrhotic livers and is preferentially localized in the right lobe. Histologically, fibrolamellar hepatocellular carcinoma is characterized by large eosinophilic tumour cells. The cells show trabecular or solid arrangement separated by fibrous septa. Cytoplasmic globules are often found in the tumour cells. In the literature, fibrinogen, CEA, alpha-1-antitrypsin, copper binding protein and copper have been demonstrated in the tumour cells by immunohistochemistry and histochemistry. The fibronectin content is increased in the tumour and seems to correlate with a higher degree of differentiation, as well as a better prognosis. The serum alpha-fetoprotein levels of patients with fibrolamellar carcinomas are normal, in contrast to those in patients with other types of hepatocellular carcinomas. The serum vitamin B12 binding-capacity, as well as neurotensin concentrations are increased. Patients with fibrolamellar carcinomas have a much better prognosis than patients with ordinary hepatocellular carcinomas because of the earlier onset of symptoms, slower tumour progression with late metastasis, and better operability. Two-year survivals of 82% and five-year survivals of 63% have been reported. The prognosis is also better after total hepatectomy followed by liver transplantation.

[Clinical experience with occult blood test in 8784 patients (author's transl)]. / Erfahrungen mit dem Haemoccult-Test bei 8784 Patienten.

The faeces of 8784 patients were tested for occult blood, using the "Haemoccult-II" method. 347 (4.0%) gave at least one positive result. Endoscopic examination of the gastrointestinal tract was performed in 301 patients. In 62.8% of cases the lesion responsible for the bleeding was located in the lower gastrointestinal tract, in 17.6% in the upper gastrointestinal tract. In 19.6% no cause was found for the positive test. In 133 out of 301 haemoccult-positive patients (44.2%) tumours were identified as sources of bleeding. Our results were compared with the findings obtained with other screening programmes for colorectal carcinomas. Haemoccult-II test are recommended as a yearly routine procedure for early detection of colorectal tumours.

[Endoscopic papillotomy in Austria]. / Endoskopische Papillotomie (EPT) in Osterreich.

In 5 gastroenterologic centres in Austria 383 EPT were performed at a total of 10031 ERCP until July 1980. In 350 cases this procedure was successful (91.3%). The most frequent indication was a choledocholithiasis in 300 cases (85.7%). Complete disappearance of gall stones was achieved in 94%. Complications happened in 14 patients (4%), in 4 patients (12%) surgical procedures were necessary consequently. The death rate was 0.6% (2 patients). These favorable results and the low rates of complications and letality of this procedure encourage for the more frequent use of this method for the treatment of choledocholithiasis also in Austria in capable and experienced hands. In view of reducing complications the limitation of the EPT to few specialised centres is demanded.