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OBJECTIVE: To compare the detection rate and diagnostic accuracy of cardia polyps using endoscopy with blue laser imaging (BLI) and white-light imaging (WLI). METHODS: Patients were randomly divided into the BLI group and WLI group according to the endoscopic procedures. BLI followed by WLI was conducted in the BLI group, whereas WLI followed by BLI examination was conducted in the WLI group. The number, size, microstructure, and microvascular patterns of cardia polyps detected were recorded. Biopsy of the polyps was then performed. RESULTS: The detection rate of cardia polyps in the BLI group was higher than that in the WLI group (7.87% vs 4.22%, P = 0.018). The rate of overlooked lesions in the BLI group was lower than in the WLI group (0.64% vs 3.38%, P = 0.003). The diagnostic coincidence rate between magnifying BLI and histopathology was 88.16%. The sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of neoplastic lesions by magnifying endoscopy with BLI were 90.91%, 87.69%, 55.56%, and 98.28%, respectively. The most remarkable patterns for predicting inflammatory polyps were the prolonged and fine network patterns (sensitivity 71.43%, specificity 93.75%). Small round combined with honeycomb patterns were the most common among fundic gland polyps (sensitivity 80.00%, specificity 98.48%). Neoplastic lesions presented as villous or ridge-like combined with core vascular or unclear pattern for both microvascular and microstructure patterns. CONCLUSION: BLI is more effective than WLI in the detection and diagnosis of cardia polyps, and magnifying endoscopy with BLI may help diagnose such lesions.
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Cardias , Estudios de Factibilidad , Neoplasias Gástricas , Humanos , Femenino , Masculino , Persona de Mediana Edad , Cardias/patología , Cardias/diagnóstico por imagen , Adulto , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Anciano , Pólipos/diagnóstico por imagen , Pólipos/diagnóstico , Gastroscopía/métodos , Sensibilidad y Especificidad , Valor Predictivo de las Pruebas , Rayos LáserRESUMEN
Objective: To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating cardia-left gastric lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC). Methods: A total of 477 patients with primary thoracic ESCC who underwent surgical treatment in the Affiliated Cancer Hospital of Zhengzhou University from January 2013 to December 2017 were collected. All of them underwent McKeown esophagectomy plus complete two-field or three-field lymph node dissection. Picture archiving and communication system were used to measure the largest cardia-left gastric lymph node short diameter in preoperative CT images. The postoperative pathological diagnosis results of cardia-left gastric lymph node were used as the gold standard. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of CT lymph node short diameter in detecting the metastasis of cardia-left gastric lymph node in thoracic ESCC, and determine the optimal cut-off value. Results: The median short diameter of the largest cardia-left gastric lymph node was 4.1 mm in 477 patients, and the largest cardia-left gastric lymph node short diameter was less than 3 mm in 155 cases (32.5%). Sixty-eight patients had cardia-left gastric lymph node metastases, of which 38 had paracardial node metastases and 41 had left gastric node metastases. The lymph node ratios of paracardial node and left gastric node were 4.0% (60/1 511) and 3.3% (62/1 887), respectively. ROC curve analysis showed that the area under the curve of CT lymph node short diameter for evaluating cardia-left gastric lymph node metastasis was 0.941 (95% CI: 0.904-0.977; P<0.05). The optimal cut-off value of CT examination of the cardia-left gastric lymph node short diameter was 6 mm, and the corresponding sensitivity, specificity and accuracy were 85.3%, 91.7%, and 90.8%, respectively. Conclusion: CT examination of lymph node short diameter can be a good evaluation of cardia-left gastric lymph node metastasis in thoracic ESCC, and the optimal cut-off value is 6 mm.
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Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Humanos , Carcinoma de Células Escamosas de Esófago/diagnóstico por imagen , Carcinoma de Células Escamosas de Esófago/cirugía , Carcinoma de Células Escamosas de Esófago/patología , Cardias/diagnóstico por imagen , Cardias/patología , Cardias/cirugía , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Metástasis Linfática/patología , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático , Tomografía Computarizada por Rayos X/métodos , Esofagectomía/métodos , Estudios RetrospectivosRESUMEN
An esophagogastroduodenoscopy revealed a submucosal lesion in the gastric cardia of a 55-year-old man.Endoscopic ultrasonography showed a hypoechoic echo lesion originated from the muscularis propria layer considering a leiomyoma or stromal tumor.a submucosal tunneling endoscopic resection was successfully performed to remove the lesion and the diagnosis is hepatoid adenocarcinoma.This is the first report on a case of gastric HAC originated from submucous layer.
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Leiomioma , Neoplasias Gástricas , Masculino , Humanos , Persona de Mediana Edad , Cardias/diagnóstico por imagen , Cardias/cirugía , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Gastroscopía , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/cirugía , Mucosa Gástrica/patología , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Background: To analyze the time trends in cardia cancer detection rates using endoscopic surveillance from 1999 to 2019 in a high-volume Chinese hospital. Methods: In this retrospective, single-center study, data were collected from the Endoscopy Center of the Department of Gastroenterology, Tianjin Medical University General Hospital, from 1999 to 2019. Cases of cardia cancer (n = 1567) were extracted from a database of patients who underwent endoscopy. Clinical and epidemiological characteristics of patients with cardia cancer were analyzed, including sex, age, and proportion of early gastric cancer and degree of tumor differentiation. The joinpoint regression method was used to identify change points in incidence trends. Annual percent change (APC) values, with 95% confidence intervals (CI), were calculated for time periods before and after change points. Results: Of the 343942 patients who underwent endoscopy during 1999-2009, 1567 (4.6%) were identified with cardia cancer. The overall cardia adenocarcinoma detection rate decreased significantly from 1999 to 2004 (APC = -37.3, 95% CI: -20.9, -6.4), followed by a relatively slower decline rate from 2004 to 2019 (APC = -7.7, 95% CI: -4.4, -7.6). The crude rate of detection of early cardia cancer could not be determined by joinpoint analysis. Rates of detection reduced significantly in patients aged 60-69 and 70-79 years (APC = -8.3, 95% CI: -9.8, -6.8 and APC = -7.3, 95% CI: -8.8, -5.8, respectively). The detection rate in males decreased rapidly from 1999 to 2004 (APC = -35.9, 95% CI: -18.2, 5.6, P < 0.05), while the decline rate was relatively slow from 2005 to 2019 (APC = -6.9, 95% CI: -3.4, -6.1, P < 0.05). Among females, the detection rates also decreased from 1999 to 2004 (APC = -21.2, 95% CI: -28.1, -13.7), but remained stable from 2007 to 2019 (APC = -3.8, 95% CI: -7.9, -0.5). Detection of poorly differentiated cardia cancer also declined from 2009 to 2019 (APC = -12.8, 95% CI: -15.3, -10.0). Conclusions: The detection rate of cardia cancer among gastric cancers has been stable from 2008 to 2019. The trend of detection rate of early cardia cancer showed no significant statistical meaning; hence, it remains necessary to carefully observe the cardia area during endoscopy examination.
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Neoplasias Gástricas , Cardias/diagnóstico por imagen , Cardias/patología , China/epidemiología , Endoscopía , Femenino , Hospitales , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/epidemiologíaRESUMEN
ABSTRACT: The diagnostic accuracy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) according to the gastric location of subepithelial tumors (SETs) has not been well established. We aimed to evaluate the efficacy of EUS-FNTA for the diagnosis of gastric SETs according to tumor location.Thirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Patient demographics, diagnostic yields, and complications were evaluated.Nineteen patients (57.6%) were female, with a mean age of 57.7âyears. Endoscopic ultrasound revealed a mean longitudinal diameter of 25.6âmm. The most common location of SETs was in the gastric body (nâ=â18, 54.5%), followed by cardia and fundus (nâ=â10, 30.3%), and antrum (nâ=â5, 15.2%). A 20-gauge biopsy needle was most frequently used (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (73.9%), followed by leiomyoma (17.4%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than that in the gastric body and cardia (23/28, 82.1%, Pâ=â.001). A case of immediate bleeding after EUS-FNTA occurred in 1 patient (3.0%) who recovered uneventfully. According to related literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than that in the gastric body, fundus, and cardia (29.7% vs 71.4%, Pâ<â.001, nâ=â191).EUS-FNTA is ineffective in the diagnosis of SETs in the gastric antrum. Although EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Tumores del Estroma Gastrointestinal/diagnóstico , Leiomioma/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Anciano , Cardias/diagnóstico por imagen , Cardias/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/estadística & datos numéricos , Femenino , Fundus Gástrico/diagnóstico por imagen , Fundus Gástrico/patología , Hemorragia Gastrointestinal/etiología , Tumores del Estroma Gastrointestinal/epidemiología , Tumores del Estroma Gastrointestinal/patología , Humanos , Leiomioma/epidemiología , Leiomioma/patología , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Antro Pilórico/diagnóstico por imagen , Antro Pilórico/patología , Estudios Retrospectivos , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patologíaRESUMEN
INTRODUCTION: Intramural bronchogenic cysts of the esophagus are very rare. They are mostly found in the upper mediastinum. Symptoms are caused by compression of surrounding structures by the cyst or complications of the cyst. However, the majority are asymptomatic. CASE REPORT: We describe the case of a 30-year-old female patient who underwent surgery at our institution for a tumor of the gastric cardia protruding intraluminally. The tumor was found incidentally during upper endoscopy before a planned bariatric surgery. A solid lesion originating from the muscle layer of the cardia wall was described based on endoscopic ultrasound. A CT scan did not show any infiltration of surrounding structures or disease dissemination. We performed laparoscopic enucleation of the tumor combined with partial fundoplication to close the defect in the muscular layer of the esophagus. Histopathology report surprisingly confirmed a bronchogenic cyst in the gastric cardia wall. The patient healed primarily and was soon discharged without complications. Two months later she underwent sleeve gastrectomy for obesity. Seven months following the bronchogenic cyst enucleation an endoscopic balloon dilation was performed on the patient with good effect upon diagnosing a relative gastric cardia stenosis. CONCLUSION: The diagnosis of esophageal bronchogenic cysts is usually difficult. Histopathology results are crucial to determine the definitive diagnosis. Endoscopy and imaging techniques, including endoscopic ultrasound, play an important role in the diagnostic process. Most authors prefer complete removal of the cyst, endoscopic or surgical, due to possible cyst complications, diagnostic uncertainty, and certainly in symptomatic patients. The complication rate is minimal.
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Quiste Broncogénico , Quiste Esofágico , Adulto , Quiste Broncogénico/diagnóstico por imagen , Quiste Broncogénico/cirugía , Cardias/diagnóstico por imagen , Cardias/cirugía , Endosonografía , Femenino , Humanos , MediastinoRESUMEN
The use of transabdominal color Doppler ultrasound after oral administration of an oral cellulose-based contrast agent (TUS-OCCA) in depicting varices at the cardia and fundus was explored. Both gastroscopy and transabdominal color Doppler ultrasound (TUS) were performed for this purpose, with gastroscopy serving as the gold standard. Patients were assigned by TUS protocol to one of three groups: TUSâ¯+â¯empty stomach (TUS-ES); TUSâ¯+â¯oral water intake (TUS-OW); and TUS-OCCA. TUS-based grading of varices reflected venous diameters and blood flow velocities, designated as follows: Uxâ¯=â¯difficulty discerning gastric fundus and cardia or delineating varices; U0â¯=â¯no detectable varices; U1â¯=â¯diameter <5 mm, flow rate <10 cm/s; U2â¯=â¯diameter <5 mm, flow rate ≥10 cm/s; U3â¯=â¯diameter 5-10 mm, flow rate <10 cm/s; U4â¯=â¯diameter 5-10 mm, flow rate ≥10 cm/s; and U5â¯=â¯diameter >10 mm, any flow rate. Between August 2016 and August 2019, 239 patients with cirrhosis were enrolled prospectively, including bleeding (nâ¯=â¯71) and non-bleeding (nâ¯=â¯168) groups. Varices were directly observed in 10.5% (25/239) of TUS-ES group members, compared with 59.2% (58/98) of the TUS-OW group and 89.6% (104/116) of the TUS-OCCA group; all detection rates differed significantly (TUS-OCCA > TUS-OW > TUS-ES, p < 0.05). TUS-based grading (as defined) revealed the following patient distribution: Ux, nâ¯=â¯34; U0, nâ¯=â¯18; U1, nâ¯=â¯50; U2, nâ¯=â¯41; U3, nâ¯=â¯16; U4, nâ¯=â¯46; U5, nâ¯=â¯34. In grading by variceal diameter, overall correspondence between TUS and gastroscopy was 93% (174/187). TUS-OCCA greatly improved rates of detection of varices at the cardia and fundus, offering a new method by which diagnosis and quantitative grading may be achieved and affording an excellent, non-invasive approach to dynamic follow-up.
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Cardias/diagnóstico por imagen , Celulosa/administración & dosificación , Medios de Contraste/administración & dosificación , Várices Esofágicas y Gástricas/diagnóstico por imagen , Fundus Gástrico/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Administración Oral , Agua Potable , Ayuno , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery. AIM: To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia. METHODS: The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed. RESULTS: The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs (n = 20) and leiomyoma (n = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected. CONCLUSIONS: Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.
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Cardias/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Tumores del Estroma Gastrointestinal/patología , Leiomioma/patología , Neoplasias Gástricas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cardias/diagnóstico por imagen , Cardias/cirugía , Coristoma/diagnóstico , Coristoma/patología , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurilemoma/patología , Páncreas , Estudios Retrospectivos , Gastropatías/diagnóstico , Gastropatías/patología , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Adulto JovenRESUMEN
BACKGROUND: Most melanomas identified in the stomach are metastatic; primary gastric melanoma (PGM) is extremely rare, and the relevant studies are relatively scarce. PGM may be incorrectly diagnosed as other gastric malignant tumor types. CASE SUMMARY: We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis. A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain. Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia. Computed tomography (CT) revealed a heterogeneous tumor with uneven enhancement. Enlarged lymph nodes were noted in the lesser curvature of the stomach. On magnetic resonance imaging (MRI), T1- and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor, respectively, both of which increased substantially after uneven enhancement. Near total gastrectomy was performed, and the tumor was pathologically confirmed to be a gastric melanoma. Because no other possible primary site of malignant melanoma was suspected, a clinical diagnosis of PGM was made. The patient was followed for nearly 5 years, during which she received CT reexamination, but no recurrence or metastasis was observed. CONCLUSION: Certain imaging characteristics could be revealed in PGM. Imaging examination can be of great value in preoperative diagnosis, differential diagnosis, and follow-up of patients with PGM.
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Cardias/diagnóstico por imagen , Melanoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Anciano , Cardias/patología , Cardias/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Imagen por Resonancia Magnética , Melanoma/patología , Melanoma/cirugía , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
To the best of our knowledge, this is the first report of ectopic gastric mucosa appearing between muscularis mucosae and submucosa, at esophagogastric junction. Currently there are two theories explaining the mechanism. The most widely accepted one is that Ectopic gastric mucosa is an embryological remnant, and an alternative theory is abnormal proliferation under inflammation1.Although we don't have many evidences to clarify this case into specific mechanism mentioned above, Nomura et reported two cases of Adenocarcinoma of the cervical esophagus arising from ectopic gastric mucosa, Completely resected by ESD with no signs of recurrence2. Therefore, In this present case, the lesion was successfully managed with ESD. The symptoms were released after the operation and the patient remained well during a year follow-up. Long-term follow-up is recommended in case of recurrence or gastric cancer.
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Coristoma/diagnóstico por imagen , Enfermedades del Esófago/diagnóstico por imagen , Unión Esofagogástrica , Mucosa Gástrica , Adulto , Cardias/diagnóstico por imagen , Coristoma/patología , Enfermedades del Esófago/patología , Unión Esofagogástrica/patología , Fundus Gástrico/diagnóstico por imagen , Humanos , Masculino , Enfermedades Raras/diagnóstico por imagenRESUMEN
BACKGROUND AND AIMS: There is controversy about finding intestinal metaplasia (IM) of the gastric cardia on biopsy. The most recent American College of Gastroenterology guideline comments that IM cardia is not more common in patients with Barrett's esophagus (BE). It provides limited guidance on whether the cardia should be treated when patients with BE undergo endoscopic eradication therapy (EET) and whether the cardia should undergo biopsy after ablation. The aims of our study were to determine the frequency in the proximal stomach of (1) histologic gastric cardia mucosa and (2) IM cardia. A third aim was to explore the frequency of advanced pathology (dysplasia and adenocarcinoma) in the cardia after patients with BE have undergone EET. METHODS: Consecutive patients undergoing esophagogastroduodenoscopy between January 2008 and December 2014 who had proximal stomach biopsies were included. Patients who had histologically confirmed BE were compared with those without BE. RESULTS: Four hundred sixty-two patients, 289 with BE and 173 without BE, were included. Histologically confirmed cardiac mucosa was found in 81.6% of all patients. This was more frequent in those with versus without BE (86% vs 75%; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.28-3.32; P = .003). IM cardia was more common in the BE group (17% vs 7%; OR, 2.67; 95% CI, 1.38-5.19; P = .004). Advanced pathology was more likely in the patients with BE who had undergone EET. CONCLUSIONS: Cardiac mucosa is present in most patients who undergo endoscopy for upper GI symptoms. IM cardia is more common in patients with BE than those without. Advanced histologic changes in the cardia were seen only in the subgroup of patients with BE who had undergone EET.
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Adenocarcinoma/patología , Esófago de Barrett/patología , Cardias/patología , Mucosa Gástrica/patología , Neoplasias Gástricas/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/epidemiología , Anciano , Esófago de Barrett/diagnóstico por imagen , Esófago de Barrett/epidemiología , Esófago de Barrett/cirugía , Cardias/diagnóstico por imagen , Endoscopía del Sistema Digestivo , Femenino , Mucosa Gástrica/diagnóstico por imagen , Humanos , Masculino , Metaplasia/diagnóstico por imagen , Metaplasia/epidemiología , Metaplasia/patología , Imagen de Banda Estrecha , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/epidemiologíaAsunto(s)
Adenocarcinoma/diagnóstico , Liposarcoma/patología , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/patología , Cardias/diagnóstico por imagen , Cardias/patología , Diagnóstico Diferencial , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Endosonografía , Fundus Gástrico/diagnóstico por imagen , Fundus Gástrico/patología , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/patología , Tumores del Estroma Gastrointestinal/diagnóstico , Gastroscopía , Humanos , Leiomioma/diagnóstico , Persona de Mediana Edad , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Pathologic response to neoadjuvant chemotherapy (neoCTX) is a prognostic factor in many cancer types, and early prediction would help to modify treatment. In patients with gastric and esophagogastric junction (AEG) cancer, the accuracy of FDG PET-CT to predict early pathologic response after neoadjuvant chemotherapy (neoCTX) is currently not known. METHODS: From a consecutive cohort of 72 patients, 44 patients with resectable, locally-advanced gastric cancer or AEG Siewert type II and III received neoCTX after primary staging with endoscopic ultrasound, PET-CT and laparoscopy. Overall, 14 patients did not show FDG uptake, and the remaining 30 were restaged by PET-CT 14 days after the first cycle of neoCTX. Metabolic response was defined as decrease of tumor standardized uptake value (SUV) by ≥35%. Major pathologic regression was defined as less than 10% residual tumor cells. RESULTS: Metabolic response after neoCTX was detected in 20/30 (66.7%), and non-response in 10/30 (33.3%) patients. Among metabolic responders, n = 10 (50%) showed major and n = 10 (50%) minor pathologic regression. In non-responders, n = 9 (90%) had minor and 1 (10%) a major pathologic regression. This resulted in a sensitivity of 90.9%, specificity 47.3%, positive predictive value 50%, negative predictive value 90% and accuracy of 63.3%. CONCLUSION: Response PET-CT after the first cycle of neoCTX does not accurately predict overall pathologic response. However, PET-CT reliably detects non-responders, and identifies patients who should either immediately proceed to resection or receive a modified multimodality therapy. TRIAL REGISTRATION: The trial was registered and approved by local ethics committee PB_2016-00769.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Gástricas/diagnóstico por imagen , Adulto , Anciano , Cardias/diagnóstico por imagen , Cardias/patología , Cardias/cirugía , Endosonografía , Unión Esofagogástrica/diagnóstico por imagen , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Estudios de Factibilidad , Femenino , Fluorodesoxiglucosa F18/administración & dosificación , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Valor Predictivo de las Pruebas , Pronóstico , Radiofármacos/administración & dosificación , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Resultado del TratamientoRESUMEN
RATIONALE: Low-grade myofibroblastic sarcoma (LGMS) is a rare mesenchyme-derived tumor, which usually occurs in head, neck (especially tongue and mouth), and limbs. In this report, we described a case of gastric LGMS by F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT), which has not been reported previously. PATIENT CONCERNS: A 51-year-old female patient was admitted to our hospital with upper abdominal discomfort for 1 year and gradually increased eating difficulties over the last 3 months. From gastroscopy, an ulcer of 1.0âcmâ×â1.2âcm at the entrance of cardia and stiffness of peripheral mucosa were found, leading to suspicion of cardia cancer. F-FDG PET/CT was performed for further diagnosis and staging. DIAGNOSES: According to pathological findings in combination with immunohistochemical features, diagnosis of gastric LGMS was made. INTERVENTIONS: To relieve symptoms of upper gastrointestinal obstruction in the patient, proximal gastrectomy was carried out 1 week after the F-FDG PET/CT scan. OUTCOMES: The patient died due to advanced tumor. LESSONS: F-FDG PET/CT scan showed local thickening of the gastric wall, invasion of adjacent soft tissue, diaphragmatic and peritoneal metastasis at early stage, absence of regional lymph node metastasis, and increased F-FDG metabolism in primary tumor and metastatic tumor.
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Cardias/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Miosarcoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos , Neoplasias Gástricas/diagnóstico por imagen , Cardias/patología , Femenino , Humanos , Persona de Mediana Edad , Miosarcoma/patología , Clasificación del Tumor , Neoplasias Gástricas/patologíaAsunto(s)
Unión Esofagogástrica/diagnóstico por imagen , Tumores Fibrosos Solitarios/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Biomarcadores de Tumor , Cardias/diagnóstico por imagen , Cardias/patología , Cardias/cirugía , Diagnóstico Diferencial , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Tumores del Estroma Gastrointestinal/diagnóstico , Gastroscopía , Hematemesis/etiología , Humanos , Masculino , Melena/etiología , Persona de Mediana Edad , Tumores Fibrosos Solitarios/complicaciones , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
AIM: To present the result of transhiatal esophagectomies with simultaneous repair. MATERIAL AND METHODS: The study included 67 procedures. In 35 cases surgery was carried out for adenocarcinoma of distal esophagus or cardia with high transition to esophagus, in 32 cases - for epidermal carcinoma of the esophagus. Gastric graft and left half of the colon were used in 60 and 7 cases respectively for simultaneous repair. 29 patients underwent transhiatal instrumental esophagectomy using author's original technique.
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Carcinoma , Neoplasias Esofágicas , Esofagectomía , Laparotomía , Complicaciones Posoperatorias , Neoplasias Gástricas , Adulto , Anciano , Carcinoma/patología , Carcinoma/cirugía , Cardias/diagnóstico por imagen , Cardias/cirugía , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Esofagectomía/métodos , Unión Esofagogástrica/diagnóstico por imagen , Unión Esofagogástrica/cirugía , Esófago/diagnóstico por imagen , Esófago/cirugía , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Análisis de SupervivenciaRESUMEN
BACKGROUND AND AIMS: Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH. METHODS: We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically. RESULTS: Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5â mm, p=0.01). There was no excessive acid reflux 5â cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11â mm above the pH transition point after the meal when supine (pH<4 for 5.5% vs 0.3% of time, p=0.01). The SCJ and pH transition point were proximally displaced within the gastro-oesophageal junction in those with HH versus controls (p<0.05). The pH transition point was proximal to the peak LOS pressure point in HH subjects but distal to it in controls after the meal (p<0.05). When supine, the postprandial pH transition point crossed the SCJ in those with HH (p=0.03). CONCLUSIONS: Healthy volunteers with HH have increased intrasphincteric reflux and lengthening of cardiac mucosa in the absence of traditional transsphincteric reflux.
Asunto(s)
Cardias/diagnóstico por imagen , Esfínter Esofágico Inferior/diagnóstico por imagen , Unión Esofagogástrica/diagnóstico por imagen , Reflujo Gastroesofágico/etiología , Hernia Hiatal/complicaciones , Membrana Mucosa/diagnóstico por imagen , Adulto , Anciano , Biopsia , Cardias/patología , Estudios de Casos y Controles , Endoscopía Gastrointestinal , Esfínter Esofágico Inferior/patología , Unión Esofagogástrica/patología , Femenino , Fluoroscopía , Determinación de la Acidez Gástrica , Voluntarios Sanos , Humanos , Imagen por Resonancia Magnética , Masculino , Manometría , Persona de Mediana Edad , Membrana Mucosa/patologíaRESUMEN
BACKGROUND AND AIMS: Targeting neoplasia in Barrett's esophagus (BE) is challenging. Volumetric laser endomicroscopy (VLE) is a new imaging technique that allows for real time cross-sectional microstructure imaging that can detect BE neoplasia. The interobserver agreement among users in practice is unknown. METHODS: Eight high-volume users of VLE from different academic centers in the United States evaluated 120 stored VLE images blinded to the endoscopic and clinical findings. There were 30 images for each tissue type: gastric cardia, esophageal squamous mucosa, nonneoplastic BE, and neoplastic BE. Each image with BE had corresponding histology confirming the tissue diagnosis. Each normal esophagus and gastric cardia had matching endoscopic images confirming normal mucosa. These were considered the criterion standard. Respondents were asked to classify the images into 1 of each category. Agreement among the users was measured. RESULTS: The overall agreement among users was almost perfect (kappa = 0.81; 95% confidence interval [CI], 0.79-0.83). For esophageal squamous and gastric cardia, the agreement was almost perfect (kappa 0.95 and 0.86, respectively [95% CI, 0.92-0.98 and 0.83-0.89]). For nonneoplastic BE and neoplastic BE, the agreement was strong (kappa 0.66 [95% CI, 0.63-0.69] and 0.79 [95% CI, 0.75-0.82], respectively). When compared with the criterion standard, the median accuracy for identifying normal squamous mucosa, normal gastric mucosa, nonneoplastic BE, neoplastic BE, and all tissue types was 99% (95% CI, 98%-100%), 97% (95% CI, 95%-99%), 93% (95% CI, 88%-98%), 95% (95% CI, 91%-99%), and 96% (95% CI, 94%-99%), respectively. CONCLUSIONS: VLE has a high level of agreement and accuracy among high-volume users.
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Esófago de Barrett/diagnóstico por imagen , Endoscopía Gastrointestinal/métodos , Neoplasias Esofágicas/diagnóstico por imagen , Microscopía Intravital/métodos , Esófago de Barrett/patología , Cardias/diagnóstico por imagen , Cardias/patología , Mucosa Esofágica/diagnóstico por imagen , Mucosa Esofágica/patología , Neoplasias Esofágicas/patología , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/patología , Humanos , Microscopía Confocal , Variaciones Dependientes del Observador , Curva ROCRESUMEN
Granular cell tumors (GCTs) usually develop in patients aged 30-50 years in the skin, tongue, and mammary gland, with 5-9% of GCTs occurring on the esophagus, ascending colon, and cecum. We report a case of gastric GCT in a 16-year-old male who presented with nausea and abdominal discomfort. Esophagogastroduodenoscopy (EGD) revealed an elastic hard and yellowish submucosal tumor of the gastric cardia anterior wall. GCT was suspected upon biopsyâ¯; after total endoscopic submucosal dissection, histology of the resected tumor confirmed the diagnosis. Endoscopic treatment should be considered in youths with GCT.