First description of a PEComa (perivascular epithelioid cell tumor) of the colon: report of a case and review of the literature.

We describe a young female patient suffering from a PEComa (perivascular epithelioid cell tumor) of the cecum, incidentally found at an examination made by her family physician. The perivascular epithelioid cell tumor is a very rare tumor, until today reported in a few cases in falciform ligament, uterus, jejunum, terminal ileum, rectum, liver, kidney, lung, pancreas, prostate, and soft tissue of the thigh. This tumor is part of a new group of tumors, comprised of angiomyolipoma, lymphangiomyolipoma, and clear-cell myomelanocytic "sugar" tumor. Defined by coexpression of melanocytic (HMB-45) and muscle markers (smooth muscle actin and desmin) the perivascular epithelioid cell tumor does not have predictable histopathologic behavior. Some cases of metastasis are described, comorbidities such as tuberous sclerosis of the brain "Bourneville" and lymphangioleiomyomatosis have to be excluded. The therapy consists of the radical resection. An adjuvant therapy is not known. Recommended is a close and long-term follow-up clinically and by CT scan.

Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding.

BACKGROUND: We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB). METHODS: Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately. RESULTS: The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only. CONCLUSION: With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

Re-operations following laparoscopic adjustable gastric banding.

BACKGROUND: Re-operations after laparoscopic adjustable gastric banding operation (LAGB) are band-associated or due to complications of the access-port. Symptoms, diagnostics, operations, and follow-up of patients with re-operations were analyzed. METHODS: Between December 1996 and January 2002, 250 morbidly obese patients were treated with LAGB and prospectively evaluated using a standardized protocol. Since June 2000 the pars flaccida technique was applied, since October 2000 with the new 11-cm Lap-Band. All adjustments of the band were done under radiological control. RESULTS: Of 250 patients, 39 had to be re-operated because of band-associated complications: 27 laparoscopic re-gastric bandings after 12 (3-26) months because of slippage; 6 laparoscopic removals of the band (band intolerance - 4, pain - 1, pouch dilatation - 1); 12 biliopancreatic diversions with duodenal switch (BPD-DS) after 29 (18-43) months due to pouch and/or esophageal motility disorders (9) or insufficient weight loss (3), in 6 patients after having already performed a re-banding for slippage. 9 revisions of the access-port were done after 6 (2-53) months (disconnection - 3, dislocation - 6). The morbidity of the re-operations was 5.3%: 1 hematoma in the abdominal wall and 1 temporary dysphagia after re-banding, 1 pulmonary embolism following BPD-DS. There have been no deaths. In patients with a minimal follow-up of 3 years (n = 92), the yearly re-operation rate was 11-12%. No slippage has occurred with the new 11-cm Lap-Band. CONCLUSION: Re-operations after LAGB for band-associated complications were frequent but could be performed safely with little morbidity. When the new 11-cm Lap-Band was employed, the high slippage rate dropped.

Overexpression of Wnt target genes in adenomas of familial adenomatous polyposis patients.

Germline mutations within the adenomatous polyposis coli (APC) gene, a key member of the Wnt signalling pathway, have been shown to cause adenoma development in familial adenomatous polyposis (FAP), a dominantly inherited predisposition to colorectal cancer. Although it has been suggested for several years that alterations within the Wnt pathway are the underlying events for the development of colorectal adenomas in FAP patients, no detailed analysis of the gene expressions of Wnt pathway members has been available in fresh colorectal tissue of FAP patients, so far. Thus, we investigated potential differences in the expressions of APC and its Wnt partners conductin, beta-catenin, cyclin D1, and c-myc in normal colorectal mucosa and matched adenoma tissue of 14 FAP patients using real-time quantitative PCR. The expressions of both Wnt target genes, cyclin D1 and c-myc, were significantly increased in adenoma compared to matched normal mucosa. Furthermore, the overexpressions of these two genes showed a highly significant positive correlation. Our data suggest that the concomitant overexpression of the Wnt targets and cell cycle regulators cyclin D1 and c-myc plays an important role in the neoplastic proliferation of adenomas in FAP patients.