The role of plasma IDO activity as a diagnostic marker of patients with colorectal cancer.

High levels of indoleamine 2,3-dioxygenase (IDO) are involved in tumour escape mechanisms. The aim of this study is the evaluation of L-kynurenine of plasma as marker of diagnostic and prognostic in patients with colorectal cancer. The study included 78 patients with colorectal cancer, of whom 15 % were in stage I/II, 30 % in stage III, and 55 % in stage IV, and was compared with a control group of 70 healthy subjects. The receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.917, with a specificity of 100 % and with a sensitivity to detect cancer of the colon of 85.2 %, taking 1.83 µM as a cut-off point. The overall survival analysis also indicated that patients with low levels of L-kynurenine in plasma increased survival rate after 45 months of follow-up (P = 0.032). These results show that the plasma levels of L-kynurenine could be a good biomarker to differentiate individuals with colorectal cancer from healthy individuals.

[Renal oncocytoma in acquired cystic diseases]. / Oncocitoma renal en enfermedad quística adquirida.

The authors report a case of renal oncocytoma associated with acquired renal cystic disease and we comment on its pathogenesis and course. This case responds a patient with chronic end renal insufficiency, included in a maintenance hemodialysis program for the two previous years nefrectomy. The association of oncocytoma with acquired renal cystic disease has been previously described only twice; both patients have been hemodialyzed for a long time.

Depressed adenoma of the stomach. Conceptual review and study of five cases.

Depressed gastric adenoma is a recently featured lesion, distinguished by a depression in the gastric mucosa, with histologic changes of conventional adenomatous polyp. We observed five cases of depressed gastric adenoma, one of them associated with a peptic ulcer, another with a gastric stump, and yet another with an early gastric carcinoma. None of the cases was detected clinically by radiology or endoscopic study. Endoscopically, this lesion stimulates a peptic ulcer at a re-epithelialization stage or an early carcinoma of the depressed type. Histologically, all the cases showed dysplastic changes of varying degrees, with a relevant risk of malignancy. A similarity is shown to other lesions described in the gastric mucosa.

[Solitary gastric ulcer due to cytomegalovirus: a cause of acute digestive hemorrhage]. / Ulcera gástrica solitaria por citomegalovirus: una causa de hemorragia digestiva aguda.

A 29-year-old homosexual man, with acquired immune deficiency syndrome was admitted to the hospital for evaluation of severe and recurrent epigastric pain, and important weight loss of 3-5 month duration. An upper gastrointestinal GI hemorrhage required an endoscopic examination which demonstrated a larger ulcer of the gastric antrum interpreted as suspicious of malignancy. Gastric cytomegalovirus (CMV) inclusion bodies, indicating CMV infection, were detected in the biopsy tissue from the edge of the gastric ulcer.

[Area of high incidence of gastric cancer in Burgos]. / Area de alta incidencia de cáncer gástrico en Burgos.

This is an statistical of the incidence of gastric cancer in the province of Burgos during the period of 1981-1985. The incidence of the disease in this area was the highest in Europe according to world Registries. We observed a high risk area which comprised the regions of Páramo, Bureda and Sierra and Burgos city. The incidence was 65.3 males and 33.4 females per 100,000 inhabitants/year. This values are two times higher than those observed in neighbouring areas and were only surpassed by areas of Costa Rica and Japan.

Risk of cancer in patients with gastric dysplasia. Follow-up study of 67 patients.

This work is based on the follow-up evaluation of 67 moderate (MD) or severe gastric dysplasias (SD) diagnosed by endoscopic biopsy. Forty-one patients had moderate gastric dysplasia, 22 (53.65%) had regression of MD, 14 patients (34.4%) had persistence, three (7.31%) had progression to SD, and two (4.87%) had transformation in gastric adenocarcinoma. Twenty-six patients were diagnosed with severe gastric dysplasia: in 12 patients (46.15%) gastric lesions regressed to normality (five cases), mild (six cases) or moderate dysplasia (one case); six patients (23.07%) showed persistent histologic changes of SD in the subsequent biopsy specimens; eight patients (30.7%) presented progression of lesions to gastric adenocarcinoma after 1 to 79 months of follow-up evaluation. The authors conclude that moderate and severe gastric dysplasias are preneoplastic lesions and a valuable marker of gastric cancer risk; the risk of gastric cancer after moderate or severe dysplasia is of 9.52%, excluding those cases with short follow-up. The authors claim that these patients may receive a conservative clinical treatment with frequent endoscopic studies until the appearance of either early carcinoma to indicate gastrectomy, or no dysplasia at all or mild dysplasia in specimens from at least two consecutive biopsies.

Melanotic adenocarcinoma of the anorectum.

A variety of tumors, besides those formed by melanocytes, may contain melanin pigment. Most of them have originated from the neural crest. Epithelial tumors with melanosomes are very unusual. We report the case of a 76-year-old woman with rectal adenocarcinoma that invaded the intestine and vagina extensively. At the anorectal site, melanin pigment was found in the cytoplasm of the malignant neoplastic epithelial cells, and melanosomes were ultrastructurally confirmed at various developmental stages. Melanocytes with cytoplasmic processes spreading between neoplastic cells were also present as the apparent source of the pigment contained in the neoplastic cells.