Neurofibroma like nodules on shoulder: First sign of gastric adenocarcinoma.

Cutaneous metastasis is a relatively uncommon manifestation of visceral malignancies. It most often occurs late in the course of a disease but may also be the first presenting sign of advanced visceral cancer. The average incidence of cutaneous metastasis from a visceral neoplasm is 5.3 percent. The incidence of cutaneous metastases from carcinomas of the upper digestive tract has been reported as less than 1 percent. Cutaneous metastases of gastrointestinal tumors are usually nodular and their typical location is in the abdominal wall. A 68-year-old woman presented with a three-month history of painless nodules on the right side of her neck. Skin examination revealed two joined nodules on the right side of her neck. The nodules were skin colored, well-circumscribed, non-motile, soft, and non-tender. Histopathological examination of the skin growth revealed diffuse infiltration of the dermis and subcutaneous tissue by tumoral cells. A diagnosis of metastatic gastric carcinoma was made. However,various cutaneous metastases have been reported as erysipelas-like, zosteriform, and epidermoid cyst-like. Cutaneous metastases must always be distinguished from primary skin tumors. This report emphasizes the need for appropriate investigation of newly appearing, unusual, or persistent skin lesions such as non-healing ulcers, persistent indurated erythemas, and all skin nodules of undetermined causes.

Diffuse and psammomatous calcification in intestinal type gastric carcinoma: report of two cases with literature review.

Psammoma bodies are round, concentrically laminated calcospherites ranging from 5 to 100 µm in diameter. They may indicate certain types of tumors including papillary carcinoma of the thyroid, meningioma and papillary serous tumors of the ovary, and to a lesser extent may be found in leiomyomas and angiomas of the gastrointestinal tract. Dystrophic calcification is uncommon in gastric cancer and displays either diffuse or psammomatous pattern. Diffuse type calcification is generally seen within the pools of mucin in advanced mucinous adenocarcinoma. Conversely, psammomatous calcification is associated with non-mucinproducing carcinomas and detected not only within the carcinomatous glandular lumina but also in the stroma. Total gastrectomy specimens of a 74-year-old male and a 54-year-old female with moderately differentiated intestinal type adenocarcinomas revealed diffuse and psammomatous calcification, respectively. Although diffuse type calcification is well-documented, to date it has not been reported in non-mucin-producing intestinal gastric carcinoma. Moreover, the psammomatous type is exceptionally rare, and only six such cases have been reported in the literature; the current patient represents the seventh case.

A follow-up study on the effect of Helicobacter pylori eradication on the severity of gastric histology.

Helicobacter pylori genetic diversity and geographic distribution affect the severity of gastric histology; while eradication heals gastritis, the improvement of atrophy and intestinal metaplasia (IM) is still controversial. We investigated whether H. pylori infection and genotypes (cagA-vacA) influence the histological changes and whether eradication resolves these changes. Twenty-one patients (11 duodenal ulcer, 2 gastric ulcer, 8 gastritis) received treatment. Biopsies for CLO, PCR, histology, and culture were collected before and at 1 and 12 months after treatment, and serum samples at 0, 1, 2, 6, and 12 months. H. pylori eradication was achieved in 71% of the patients. Histological scores for H. pylori densities were significantly higher in the antrum and incisura angularis. Scores for mononuclear cell and neutrophil infiltration were significantly higher in regions with a high H. pylori density and improved progressively after eradication. Eight patients with atrophy including five with IM showed no significant changes 12 months after eradication. The cagA gene, detected in 13 (62%), the vacA-sla gene, in 20 (95%), and the vacA-m1 gene, in 12 (57%) of 21 patients were significantly associated with duodenal ulcer. A gradual decline in antibody titer reached an average of 67% 12 months after eradication. H. pylori infection and the associated genotypes (cagA of Western type) affect the severity of the gastric histology (mild forms of atrophy and IM) and the disease outcome. Eradication of H. pylori resulted in healing of gastritis, but with no significant improvement in atrophy or IM.