[Villous adenoma of the urinary tract: a clinicopathological study].

OBJECTIVE: To explore the clinicopathological features, immunophenotype, differential diagnosis, pathogenesis and prognosis of villous adenoma with poorly differentiated adenocarcinoma of the urinary tract. METHODS: Clinical and pathologic findings of 3 cases of villous adenoma with poorly differentiated adenocarcinoma of the urinary tract were analyzed by gross examination, microscopic investigation and immunohistochemical staining. The related literatures were reviewed. RESULTS: All of the three cases were middle-aged or elderly patients. Three cases all presented with hematuria and mucusuria. Endoscopic examination identified that case 1 had a polyp with broad attachment in the dome of bladder, case 2 had a solid mass in the ureter, and case 3 had a exophytic fungating tumor in the renal pelvis. Microscopically, case 1 revealed a papillary lesion with finger-like processes lined by pseudostratified columnar epithelium with abundant goblet cells. The cells demonstrated moderate degree dysplasia. In case 2 and case 3, both villous adenomas and poorly differentiated adenocarcinoma were observed, the adenoma cells arranged in a cribriform pattern, and the tumor cells showed severe atypia, mitotic activity, and transition with invasive poorly differentiated adenocarcinoma. Immunohistochemically, the tumor cells in three cases were positive for CK20, CEA,EMA and MUC-1; none of them expressed cdx-2 and PSA; In case 2 and 3, the same immunophenotype of villous adenomas and their associated adenocarcinomas was observed, but the number of the positive cells of p53 and Ki-67 staining were significantly increased in the area of adenocarcinomas than in that of the villous adenomas. CONCLUSIONS: Villous adenoma of the urinary tract is rare. It can occur in the urinary bladder, urachus, renal pelvis, ureter and urethra. These lesions may have malignant potential and frequently coexist with other malignant tumors. So, villous adenoma of the urinary tract should be removed completely and sampled thoroughly to avoid missing a more aggressive component.

Gastrointestinal cancer educational case series: the history and management of complex cases in gi oncology. A 72 year-old man with metastatic gastric cancer.

INTRODUCTION: Gastric cancer is the third most common cancer worldwide and the second leading cause of cancer deaths. Appropriate staging and treatment options relate to the stage of disease and performance status of the patient. CASE REPORT: Here we present the case of a 72 year old male, with an initial presentation of apparently locally advanced gastric cancer. On discovery of metastatic disease, the utility of palliative gastrectomy, and first and second line chemotherapy are discussed. DISCUSSION: This case demonstrates the potential value of sequential lines of chemotherapy in good performance status patients with advanced gastric cancer. Further research will be necessary in order to assess the utility of newer targeted agents in this setting.

Successful antiangiogenic combination therapy for pseudomyxoma peritonei with bevacizumab and capecitabine.

Effective systemic therapy for advanced pseudomyxoma peritonei (PMP) is the focus of investigation. We describe a case of PMP arising from an adenoma of the appendix in a 58-year-old man. First, the patient underwent explorative laparotomy with ileocoecal resection, but without possibility of major tumor debulking due to adhesive gross tumor masses. Subsequently, six cycles of Folfox IV chemotherapy were administered, without response, but with severe side effects. Upon progressive disease, a combination of bevacizumab and capecitabine led to a long term stabilization of disease and obvious improvement of performance status. Our case suggests that modulation of tumor microenvironment and angiogenesis by bevacizumab, potentially augmented by moochemotherapy, may be beneficial in borderline tumors such as PMP.

Ex vivo sentinel lymph node mapping in colon cancer: improving the accuracy of pathologic staging?

BACKGROUND: A subset of patients with colon cancer staged by conventional methods have occult micrometastases and do not receive adjuvant chemotherapy. Sentinel lymph node (SLN) mapping and staining by immunohistochemistry is a technique that may identify such occult micrometastases, thereby upstaging patients with positive findings. The purpose of this study was to determine whether ex vivo SLN mapping in colon cancer could be applied successfully to patients at our institution. METHODS: Seventeen patients with intraperitoneal colon tumors undergoing resection were studied prospectively. SLNs were identified as the first blue stained node(s) after ex vivo peritumoral injection of isosulfan blue dye. Additional lymph nodes were harvested and processed in accordance with standard pathologic evaluation for colon cancer. All nodes were examined after routine hematoxylin and eosin (H&E) staining. SLNs that were negative on H&E were analyzed further by multilevel sectioning and immunohistochemistry staining using anticytokeratin monoclonal antibody. RESULTS: Of the 17 study patients, SLNs were identified in 16 (94%) cases. The SLN was the only positive node in 3 patients. An identified SLN was positive (by H&E) in all patients with associated positive non-SLN nodes. The average number of nodes retrieved per patient was 16 (range, 4-54). Overall, SLNs accurately reflected the status of the entire lymph node basin in 16 (94%) patients. Two (12%) patients with negative nodes by H&E potentially were upstaged after further SLN analysis. The negative predictive value for SLN mapping was 89%. CONCLUSIONS: The ex vivo technique of SLN mapping for colon cancer is feasible. In the current study, SLN results were concordant with non-SLNs in the majority of patients. Furthermore, this technique may have upstaged 2 (12%) patients. Whether this ultimately will affect overall survival has yet to be determined.

Tubulovillous adenoma of the vulva.

BACKGROUND: We report the second case of enteric-type villous adenoma of the vulva. The differential diagnosis, histogenesis, and pathogenesis are discussed. CASE: A 66-year-old woman had a tumor resected from the posterior aspect of the vulva. The tumor was characterized by its villous architecture, with columnar epithelium and goblet cells. This vulvar tubulovillous adenoma was identical to a tumor resected 6 months before from this patient's rectal wall. CONCLUSION: These two tumors behaved benignly, and the vulvar adenoma possibly originated with the müllerian vestige.

Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.

BACKGROUND: We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment. STUDY DESIGN: From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant. RESULTS: Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14). CONCLUSIONS: Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.

Abdominal wall recurrence after laparoscopic colectomy for colon cancer.

BACKGROUND: Although rare, abdominal wall recurrences after laparoscopic surgery for cancer have been increasing at an alarming rate as the range and sheer number of laparoscopic surgical procedures have increased. Overall, 13 case reports of abdominal wall cancer recurrence after laparoscopic surgery have been published. METHODS AND RESULTS: We present the fourth known case of abdominal wall recurrence after laparoscopic colectomy involving a patient with a TNM stage III (T3, N2, M0) colon cancer. Recurrent cancer was located in the abdominal wall incision and also in all four port sites 9 months after surgery. These four cases have all involved patients with advanced cancers of the right side of the colon who underwent a laparoscopic-assisted right hemicolectomy. These cases of abdominal wall cancer recurrence carry ominous implications for the future of laparoscopic surgical procedures involving colorectal malignancy. Recurrent cancer in minilaparotomy incisions may simply be due to local spread of cancerous cells. However, remote port site recurrence may be due to the liberation of cancer cells throughout the abdomen from advanced colorectal cancer no longer confined to the bowel wall facilitated by intraperitoneal carbon dioxide insufflation during laparoscopy. CONCLUSIONS: Abdominal wall cancer recurrence is enhanced by the laparoscopic approach to colectomy for colorectal cancer. Except for controlled, clinical studies, laparoscopic colectomy for malignancy should be abandoned.