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9.
Adv Exp Med Biol ; 913: 207-228, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27796890

RESUMEN

The first decade of the twenty-first century witnessed the presence and light microscopic, immunophenotypic, and ultrastructural characterization of interstitial Cajal-like cells (coined as 'telocytes') in virtually every extragastrointestinal site of the human body by Laurentiu M. Popescu and his co-workers. Not surprisingly, stromal tumours, immunophenotypically similar to that of telocytes [CD117 (c-KIT) +/CD34 +], have also been sporadically reported outside the tubular gut (so-called extragastrointestinal stromal tumours, EGISTs), including the gall bladder, liver, and pancreas. A meticulous literature search from January 2000 to November 2015 have found 9 such case reports of EGISTs in the gall bladder, 16 in the liver, and 31 occurring in the pancreas. The site wise mean age at presentation for these tumours were reported to be 62.2 ± 16.6, 50.9 ± 20.1, and 55.3 ± 14.3 years, respectively. Six of nine EGISTs in the gall bladder were associated with gallstones. On pathological evaluation, these tumours exhibited prominent spindled cell morphology and consistent expression of CD117/c-KIT and CD34 on immunohistochemistry and variable expression of vimentin and α-smooth muscle actin. The biological behaviour of hepatic and pancreatic lesions was favourable compared to that in the gall bladder, following definitive surgery with or without imatinib therapy. While the exact pathophysiologic role played by telocytes in various organs is yet to be fully elucidated, there seems to be a direct link between these enigmatic stromal cells and pathogenesis of gallstones and origin of EGISTs, and a hope for targeted therapies. Furthermore, the possible role of telocytes in hepatic regeneration and liver fibrosis opens a new dimension for futuristic research.


Asunto(s)
Biomarcadores de Tumor/genética , Vesícula Biliar/patología , Cálculos Biliares/complicaciones , Tumores del Estroma Gastrointestinal/complicaciones , Hígado/patología , Páncreas/patología , Telocitos/patología , Actinas/genética , Actinas/metabolismo , Adulto , Anciano , Antígenos CD34/genética , Antígenos CD34/metabolismo , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/metabolismo , Femenino , Vesícula Biliar/efectos de los fármacos , Vesícula Biliar/cirugía , Cálculos Biliares/tratamiento farmacológico , Cálculos Biliares/genética , Cálculos Biliares/cirugía , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/genética , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Mesilato de Imatinib/uso terapéutico , Hígado/efectos de los fármacos , Hígado/cirugía , Masculino , Persona de Mediana Edad , Páncreas/efectos de los fármacos , Páncreas/cirugía , Proteínas Proto-Oncogénicas c-kit/genética , Proteínas Proto-Oncogénicas c-kit/metabolismo , Telocitos/efectos de los fármacos , Telocitos/metabolismo , Resultado del Tratamiento , Vimentina/genética , Vimentina/metabolismo
10.
Abdom Radiol (NY) ; 2024 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-39325211

RESUMEN

Budd Chiari syndrome is a potentially treatable disease, and imaging is the key to its diagnosis. Clinical presentations may vary, ranging from asymptomatic to fulminant disease. Subacute BCS is the most common type encountered in clinical practice, characterized by ascites, hepatosplenomegaly, dilated abdominal wall veins, and varicosities in the lower limb and scrotum. While hepatic vein thrombosis is the leading cause in the West, membranous and short segmental occlusion are predominant in the Asian populations. These geographical variations have an impact on the treatment algorithm in managing BCS. Anticoagulation alone often fails to prevent disease progression, demanding further interventional therapy. Interventional therapy carries a lower morbidity and mortality than surgery. Anatomical recanalization and portosystemic shunting form the basis of endovascular management. Membranous or short-segment occlusion are best treated by angioplasty, which restores the physiological venous outflow and possibly disease reversal. Suboptimal results with angioplasty require stenting. Transjugular intrahepatic shunt (TIPS) or direct IVC to portal vein shunt (DIPS) decompresses the portal pressure and reduces the sinusoidal congestion, which in turn diminishes hepatocellular damage and hepatic fibrosis. Despite its ability to modify the disease course, TIPS carries several procedure and shunt-related complications, mainly hepatic encephalopathy. Thus, anatomical recanalization precedes TIPS in the traditional step-up approach in managing BCS. However, this concept is challenged by some authors, necessitating future reseach. TIPS is a valid bridge therapy in BCS with acute live failure awaiting liver transplantation. Despite all, interventional therapies fail in a subset of BCS patients, leaving them with only option of liver transplantation.

11.
J Gastrointest Cancer ; 55(2): 940-949, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38530597

RESUMEN

INTRODUCTION/BACKGROUND: Colorectal carcinoma (CRC) is a common malignancy, with its diverse clinical, pathological, and molecular features. The immune microenvironment of a tumor comprises of interplay between various cells and molecules, and has a significant role in deciding the tumor behavior and overall prognosis. PD-L1 (programmed cell death ligand-1) has been implicated in the regulation of the tumor immune microenvironment (TIME). There is limited data regarding the correlation of PD-L1 expression with immune cell profile in CRCs, especially in the Indian setting. The study aimed to assess the PD-L1 expression in CRC tumor cells and its association with TIME, mismatch repair (MMR), and various other clinicopathological parameters. METHODS: This is a hospital-based, cross-sectional observational study. PD-L1 expression was assessed at the protein level by immunohistochemistry and mRNA level by qRT-PCR. Immune cell markers (CD4, CD8, CD20, FOXP3, and CD163) were interpreted using the ImageJ Fiji platform. RESULTS: Of the 104 cases, 21% were PD-L1 positive and were more common in right-sided CRCs. PD-L1 positive cases showed significantly higher concentrations of all T-cell subsets (CD4+ , CD8+ , and FOXP3+), CD20+ B-cells, and CD163+ macrophages were noted. No statistical significance was seen between PD-L1 expression with clinical profile, pathological subtype, grade or stage, mismatch repair status (proficient vs deficient), and survival. CONCLUSIONS: The present study showed a relatively lower frequency of PD-L1 in CRC from the Eastern Indian cohort. The immune cell concentration in the present study was calculated using image analysis-based objectivised methods. Significant correlation of PD-L1 expression in tumor cells with the tumor-infiltrating immune cells indicated its crucial role in the pathobiology of CRC especially by regulating the TIME. Considering the therapeutic implication of PD-L1 in various malignancies, it may be one of the crucial therapeutic targets in a proportion of cases.


Asunto(s)
Antígeno B7-H1 , Neoplasias Colorrectales , Microambiente Tumoral , Humanos , Microambiente Tumoral/inmunología , Antígeno B7-H1/metabolismo , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Anciano , Biomarcadores de Tumor/metabolismo , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Pronóstico , Adulto , Linfocitos Infiltrantes de Tumor/inmunología
12.
Artículo en Inglés | MEDLINE | ID: mdl-39230660

RESUMEN

BACKGROUND: Endoscopic ultrasound guided fine-needle aspiration (EUS FNA) is the first-line modality to diagnose suspected solid pancreatic malignant lesions. Elastography-guided FNA has been shown to improve the diagnostic yield of EUS FNA but prospective studies are limited. The aim of the study was to compare diagnostic accuracy, sensitivity and specificity of conventional and elastography-guided EUS FNA in patients with suspected malignant pancreatic solid masses. METHODS: Patients with suspected malignant solid pancreatic lesions presenting to our institute from July 2021 to January 2023 were recruited and randomized to conventional and elastography-guided EUS FNA using a 22-G EUS FNA needle. Diagnostic accuracy, sensitivity, specificity and positive and negative predictive values were calculated. RESULTS: Total 48 patients were initially screened for inclusion in the study, of which six were excluded and 42 patients underwent randomization. Finally, 20 patients in each group underwent the assigned intervention and were analyzed further. Baseline patient characteristics were similar in conventional FNA and elastography-guided FNA group with median age 52 (range 29-74) years and 51.8 (range 31-72) years, respectively, males being 70% and 75%, respectively. Median size of the lesion was 34 mm (range 14-48 mm) and 37 (range 18 to 50 mm), respectively, for both conventional and elastography arm. The average size of the lesion was 35.7 mm. Overall, the diagnosis of adenocarcinoma was made in 65% of cases. In the remaining cases, diagnoses were inflammatory mass, Castleman's disease, solid pseudopapillary epithelial neoplasm (SPEN), diffuse large B-cell lymphoma (DLBCL), pancreatic gastrointestinal stromal tumor (GIST) and metastasis. Conventional EUS FNA had diagnostic accuracy, sensitivity, specificity and positive and negative predictive values of 90%, 87.5%, 100%, 100% and 62.92%, respectively, and elastography-guided EUS FNA had diagnostic accuracy, sensitivity, specificity and positive and negative predictive values of 85%, 100%, 100% and 54.59%, respectively. No severe adverse events were noted. CONCLUSION: There is no significant difference between conventional and elastography-guided EUS FNA in terms of diagnostic accuracy, sensitivity, specificity and positive and negative predictive values. Both techniques appear safe and effective for characterizing solid pancreatic masses and elastography did not score numerically over the conventional arm.

13.
Indian J Gastroenterol ; 43(4): 785-790, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38112914

RESUMEN

INTRODUCTION: Shankhaprakshalana (SP) is a yogic method aiming to cleanse the bowel. It involves the use of warm saline water and a combination of five asanas. This study was designed to assess the effectiveness and safety of bowel preparation by SP. METHODS: This is a retrospective observational study of prospectively collected data. Patients planned for colonoscopy were screened and enrolled to undergo bowel preparation by SP on the day of the colonoscopy. Patients having comorbid conditions, poor performance status, suspected or previously diagnosed intestinal stricture and past history of major abdominal surgery and those unable to perform asanas of SP were excluded. A low-fiber diet was advised for one day before the colonoscopy. Patients were advised to drink 400 mL of lukewarm saline water followed by five asanas (exercises) of SP, each done eight times dynamically and sequentially. After completing six such cycles, patients underwent colonoscopy. Boston Bowel Preparation Scale (BBPS) score was used to assess the quality of bowel preparation. RESULTS: Total 238 patients were included. The major indications for colonoscopy were abdominal pain (35.3%), hematochezia (23.9%), diarrhea (20.2%), constipation (10.9%) and anemia (9.7%). The mean age was 37.7 (± 12) years. The mean BBPS was 8 (± 1.2). Bowel preparation was inadequate (BBPS < 6) in only two patients. Mean segmental BBPS for the three segments of the colon (right, transverse and left) was 2.6 (± 0.5), 2.7 (± 0.4) and 2.6 (± 0.7), respectively. Minor adverse events (nausea, abdominal pain, vomiting, giddiness and bloating) were noted in 10 participants (4.2%), which did not require hospitalization. Bowel preparation was completed in 133 (± 35) minutes. CONCLUSION: Shankhaprakshalana is an effective and safe method to achieve adequate bowel preparation before colonoscopy. Since this is a single-center and retrospective study, future multi-centric, prospective studies comparing it with the standard bowel preparation regimens are warranted.


Asunto(s)
Colonoscopía , Humanos , Colonoscopía/métodos , Estudios Retrospectivos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Catárticos/administración & dosificación , Catárticos/efectos adversos , Adulto Joven
14.
J Gastrointest Cancer ; 55(2): 829-837, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38315330

RESUMEN

BACKGROUND: Gastric cancer is a global health concern with varying clinical outcomes. This study aims to investigate the influence of preoperative Body Mass Index (BMI) on survival in patients who underwent curative resection for gastric cancer in Eastern India. METHODS: Data from a prospectively maintained Surgical Oncology database were analysed for patients who underwent curative resection for primary gastric adenocarcinoma between May 2016 and March 2022. Patients with incomplete data were excluded. Preoperative BMI was categorised into three groups: Underweight (< 18.5 kg/m2), Normal (18.5-22.9 kg/m2), and Overweight/Obese (=23 kg/m2). Clinicopathological details, short-term outcomes, and long-term oncological outcomes were assessed. Statistical analysis included survival estimates, Cox proportional hazard models, and subgroup analysis. RESULT: Of 162 patients, 145 met the inclusion criteria. Patients were predominantly male (68%) with middle or lower socioeconomic status. No significant differences amongst BMI groups were observed in performance score, tumour grade, clinical stage, or short-term outcomes. Postoperative complications and 30-day mortality were similar. However, underweight patients had poorer 4-year disease-free survival (DFS) compared to overweight/obese patients (14.3% vs. 39.7%, p = 0.03). Overweight/obese patients showed significantly better 4-year overall survival (OS) than underweight patients (47.8% vs. 20.4%, p = 0.03). CONCLUSIONS: In Eastern Indian gastric cancer patients undergoing curative resection, preoperative higher BMI (overweight/obese) was associated with better long-term survival. Understanding these findings could guide tailored interventions to improve outcomes in this population.


Asunto(s)
Índice de Masa Corporal , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Masculino , Femenino , Persona de Mediana Edad , India/epidemiología , Anciano , Gastrectomía/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Obesidad/complicaciones , Adenocarcinoma/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Tasa de Supervivencia , Adulto , Periodo Preoperatorio , Delgadez/complicaciones , Estudios de Cohortes , Pronóstico
17.
Respirology ; 18(3): 463-7, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23062059

RESUMEN

BACKGROUND AND OBJECTIVE: To study the incidence and pattern of gastro-oesophageal reflux disease (GORD) in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) using dual-probe 24-h oesophageal pH recording. METHODS: This was a prospective study of 50 patients with mild-to-moderate stage COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. A detailed history of illness along with spirometry was done in all patients. In the study group, reflux symptoms were measured using a validated scoring system. All the patients underwent oesophageal manometry and dual-probe 24-h oesophageal pH recording. RESULTS: Symptoms of gastro-oesophageal reflux were present in 38 patients. Twenty-four-hour oesophageal pH monitoring revealed pathological reflux in 31 out of 38 symptomatic and 8 out of 12 asymptomatic patients. The overall rate of GORD was 78% in our study. Only distal GORD was observed in 11 (28.9%), and both distal and proximal GORD was observed in 20 (52.6%) out of the 38 symptomatic subjects. In the remaining 12 asymptomatic patients, eight had GORD. Distal GORD was present in six (50%) patients, and two (16.6%) had both distal and proximal GORD in this group. Isolated proximal GORD was not observed in any patient. CONCLUSIONS: There is an increased occurrence of GORD in patients with even mild-to-moderate COPD.


Asunto(s)
Reflujo Gastroesofágico/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Monitorización del pH Esofágico , Esófago/metabolismo , Esófago/fisiopatología , Femenino , Estudios de Seguimiento , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/epidemiología , Humanos , Incidencia , India/epidemiología , Masculino , Manometría , Persona de Mediana Edad , Presión , Pronóstico , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Índice de Severidad de la Enfermedad , Espirometría
18.
JOP ; 14(1): 92-5, 2013 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-23306344

RESUMEN

CONTEXT: Waldenstrom macroglobulinemia is a rare lymphoplasmacytic lymphoma characterized by a wide range of clinical presentations related to direct tumor infiltration and the production of IgM. Most commonly it presents with cytopenia, hepatosplenomegaly, lymphadenopathy, constitutional symptoms, and hyperviscosity syndrome. CASE REPORT: We report a case of Waldenstrom macroglobulinemia in an 60-year-old female who initially presented with intermittent abdominal pain. The patient had no peripheral lymphadenopathy. On extensive investigation she was found to have pancreatic mass. The diagnosis of Waldenstrom macroglobulinemia was established after cytomorphology and immunohistochemical analysis of the patient's bone marrow revealed the presence of a lymphoid/lymphoplasmacytoid-like bone marrow infiltrate along with an elevated serum IgM level. The patient responded both clinically and serologically to chemotherapy. This case is unusual because the patient lacked all common clinical features of Waldenstrom macroglobulinemia with exception of anemia. CONCLUSION: To our knowledge this is the first report of a patient with Waldenstrom macroglobulinemia presenting with a pancreatic mass adding to the spectrum of clinical presentations seen in this disease. This adds to the wide variety of gastrointestinal related clinical presentations of Waldenstrom macroglobulinemia and points to the need for considering Waldenstrom macroglobulinemia along with other lymphoid neoplasms in the differential diagnosis of pancreatic lesions.


Asunto(s)
Médula Ósea/patología , Páncreas/patología , Macroglobulinemia de Waldenström/diagnóstico , Anemia/sangre , Anemia/diagnóstico , Anemia/terapia , Antígenos CD20/análisis , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Transfusión Sanguínea , Médula Ósea/química , Femenino , Humanos , Inmunoglobulina M/sangre , Inmunohistoquímica , Persona de Mediana Edad , Neprilisina/análisis , Resultado del Tratamiento , Macroglobulinemia de Waldenström/sangre , Macroglobulinemia de Waldenström/tratamiento farmacológico
19.
Indian J Gastroenterol ; 42(4): 517-524, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37195552

RESUMEN

BACKGROUND AND AIM: There is regional variation in the eradication rates of Helicobacter pylori (H. pylori) regimens depending on the local antibiotic resistance patterns. The aim of this study was to compare the efficacies of triple, quadruple and sequential antibiotic therapy in eradicating H. pylori infection. METHODS: A total of 296 H. pylori-positive patients were randomized to receive one of the three regimens (triple, quadruple or sequential antibiotic therapy) and eradication rate was assessed by H. pylori stool antigen test. RESULTS: The eradication rates of standard triple therapy, sequential therapy and quadruple therapy were 93%, 92.9% and 96.4%, respectively (p = 0.57). CONCLUSION: Fourteen days of standard triple therapy, 14 days of bismuth-based quadruple therapy and 10 days of sequential therapy are equally efficacious in eradicating H. pylori and all regimens have optimum H. pylori eradication rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CTRI/2020/04/024929.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Humanos , Infecciones por Helicobacter/tratamiento farmacológico , Quimioterapia Combinada , Antibacterianos/uso terapéutico , Bismuto/uso terapéutico , Amoxicilina , Metronidazol/uso terapéutico
20.
J Clin Exp Hepatol ; 12(2): 677-685, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35535111

RESUMEN

Follicular dendritic cell (FDC) sarcoma is an uncommon tumor of the liver with only 30 previous cases reported in the English literature. Histopathological examination is the gold standard for the diagnosis of FDC sarcoma although the diagnosis is often missed because of its rarity. It usually presents with spindle-cell morphology although epithelioid/biphasic morphology is also well-known. This morphological variation can also pose a diagnostic challenge. We discuss a case of unresectable hepatic FDC sarcoma in an adult male who was diagnosed in core biopsy. We highlight the relevant histomorphological differentials and diagnostic approaches to FDC sarcoma in this anecdote.

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