RESUMO
BACKGROUND/AIMS: Only a small part of visible gas tric mucosal lesion can be removed by endoscopic resection. This study is aimed to identify incidence rate and associated risk factors of multiple and missed gastric lesions, and proper timing of follow-up en doscopy. METHODOLOGY: Endoscopic surveillance was performed on 1 week, and 1, 6, 12 months af ter endoscopic resection. All multiple gastric lesions were divided into main and accessory lesions. The accessory lesions were subdivided into detected and missed lesions. RESULTS: Totally, 250 lesions of 215 patients were analyzed. There were 81 early gastric cancers, 50 high grade dysplasias and 119 low grade dysplasias. Thirty patients (14%) had multiple gastric neoplastic lesions, either adenoma or cancer, within 1 year follow-up after endoscopic resection. Old age, male gender and severe intestinal metaplasia were independent risk factors of multiple gastric lesions. Small size (≤ 1 cm) and flat morphology were major risk factors of missed lesion. Among 10 missed lesions, 9 (90%) could be detected within 6 month after resection. CONCLUSIONS: Old age, male gender, severe intestinal metaplasia were risk factors for multiple gastric lesions after endoscopic resection. Follow-up endoscopy is needed at least one time within six months after resection, with careful inspection of entire stomach.
Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Gastrectomia/métodos , Mucosa Gástrica/cirurgia , Gastroscopia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adenoma/patologia , Fatores Etários , Idoso , Diagnóstico Tardio , Feminino , Gastrectomia/efeitos adversos , Mucosa Gástrica/patologia , Gastroscopia/efeitos adversos , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasia Residual , Neoplasias Primárias Múltiplas/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , República da Coreia , Fatores de Risco , Fatores Sexuais , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: To evaluate the efficacy and safety of sodium hyaluronate solution (SH) in endoscopic submucosal dissection (ESD) of gastric neoplasms. METHODS: A prospective multicenter randomized, double blind, controlled trial was designed and utilized in this study. A total of 76 patients with 5-20 mm sized gastric neoplasms were enrolled at three academic hospitals in South Korea from June 2011 to October 2011. Patients were randomly assigned to the 0.4% sodium hyaluronate or control groups. All lesions underwent endoscopic ESD. ESD was performed with 0.4%SH and normal saline (NS) solution for submucosal injection. Efficacy was assessed using en bloc resection and the number of additional injections. Secondary evaluation variables were the volume of injection material, steepness of mucosal elevation, bleeding rate, procedural time and operator satisfaction. Finally, the safety was assessed by analyzing adverse events during the study. RESULTS: The usefulness rate in the 0.4%SH group and the controlled group had statistically significant difference under intention to treat (ITT) analysis (90.91% vs 61.11% P = 0.0041). Under per protocol (PP), the usefulness rate is statistically significant different (93.10% vs 61.76%, P = 0.0036). The difference in volume of the solution injected between 0.4%SH group and the controlled group and NS group was also statistically significant under intention to treat and per protocol analysis (ITT: 0.03 ± 0.02 mL vs 0.06 ± 0.03 mL, P = 0.0003, PP: 0.03 ± 0.02 mL vs 0.06 ± 0.03 mL, P = 0.0004). Satisfaction above the grade good was significantly higher in the SH group under intention to treat and per protocol analysis (ITT: 90.91% vs 61.11%, P = 0.0041, PP = 93.11% vs 61.77%, P = 0.0022). Adverse events above grade 3 were not noticed in either group. All adverse events were treated and were judged as not associated with the submucosal injection solutions. CONCLUSION: 0.4%SH solution is a safe and effective agent that doesn't cause any significant adverse events and is useful for submucosal injection during ESD.
Assuntos
Adenoma/cirurgia , Dissecação/métodos , Gastroscopia , Ácido Hialurônico/administração & dosagem , Neoplasias Gástricas/cirurgia , Adenoma/patologia , Idoso , Distribuição de Qui-Quadrado , Dissecação/efeitos adversos , Método Duplo-Cego , Feminino , Gastroscopia/efeitos adversos , Humanos , Ácido Hialurônico/efeitos adversos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , República da Coreia , Neoplasias Gástricas/patologia , Resultado do Tratamento , Carga TumoralRESUMO
Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m²) and CDDP (60 mg/m²). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option.
Assuntos
Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Docetaxel , Quimioterapia Combinada , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Humanos , Masculino , Tomografia por Emissão de Pósitrons , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Taxoides/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis.
Assuntos
Dor Abdominal , Adenocarcinoma/diagnóstico , Neoplasias Gastrointestinais/patologia , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Fator de Transcrição CDX2 , Colonoscopia , Diagnóstico Diferencial , Neoplasias Gastrointestinais/secundário , Proteínas de Homeodomínio/metabolismo , Humanos , Imuno-Histoquímica , Queratina-20/metabolismo , Queratina-7/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Proteínas Nucleares/metabolismo , Fator Nuclear 1 de Tireoide , Tomografia Computadorizada por Raios X , Fatores de Transcrição/metabolismoRESUMO
1,4-Dioxane is one of the by-products from the polyester manufacturing process, which has been carelessly discharged into water bodies and is a weak human carcinogen. In this study, a laboratory-scale, up-flow biological aerated filter (UBAF), packed with tire chips, was investigated for the treatment of 1,4-dioxane. The UBAF was fed with effluent, containing an average of 31 mg/L of 1,4-dioxane, discharged from an anaerobic treatment unit at H Co. in the Gumi Industrial Complex, South Korea. In the batch, a maximum of 99.5 % 1,4-dioxane was removed from an influent containing 25.6 mg/L. In the continuous mode, the optimal empty bed contact time (EBCT) and air to liquid flow rate (A:L) were 8.5 hours and 30:1, respectively. It was also found that the removal efficiency of 1,4-dioxane increased with increasing loading rate within the range 0.04 to 0.31 kg 1,4-dioxane/m(3)·day. However, as the COD:1,4-dioxane ratio was increased within the range 3 to 46 (mg/L COD)/(mg/L 1,4-dioxane), the removal efficiency unexpectedly decreased.
Assuntos
Bactérias Aeróbias/metabolismo , Reatores Biológicos , Dioxanos/metabolismo , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/metabolismo , Aerobiose , Bactérias Aeróbias/classificação , Bactérias Aeróbias/genética , Biofilmes/classificação , Análise da Demanda Biológica de Oxigênio , Reatores Biológicos/microbiologia , DNA Bacteriano/genética , DNA Ribossômico/genética , Filtração , Resíduos Industriais , Microscopia Eletrônica de Varredura , Oxigênio/análise , Poliésteres , Esgotos/microbiologiaRESUMO
AIM: To investigate the role and clinicopathological significance of aberrant expression of Notch receptors and Delta-like ligand-4 (DLL4) in extrahepatic cholangiocarcinoma and gallbladder carcinoma. METHODS: One hundred and ten patients had surgically resected extrahepatic cholangiocarcinoma (CC) and gallbladder carcinoma specimens examined by immunohistochemistry of available paraffin blocks. Immunohistochemistry was performed using anti-Notch receptors 1-4 and anti-DLL4 antibodies. We scored the immunopositivity of Notch receptors and DLL4 expression by percentage of positive tumor cells with cytoplasmic expression and intensity of immunostaining. Coexistent nuclear localization was evaluated. Clinicopathological parameters and survival data were compared with the expression of Notch receptors 1-4 and DLL4. RESULTS: Notch receptor proteins showed in the cytoplasm with or without nuclear expression in cancer cells, as well as showing weak cytoplasmic expression in non-neoplastic cells. By semiquantitative evaluation, positive immunostaining of Notch receptor 1 was detected in 96 cases (87.3%), Notch receptor 2 in 97 (88.2%), Notch receptor 3 in 97 (88.2%), Notch receptor 4 in 103 (93.6), and DLL4 in 84 (76.4%). In addition, coexistent nuclear localization was noted [Notch receptor 1; 18 cases (18.8%), Notch receptor 2; 40 (41.2%), Notch receptor 3; 32 (33.0%), Notch receptor 4; 99 (96.1%), DLL4; 48 (57.1%)]. Notch receptor 1 expression was correlated with advanced tumor, node, metastasis (TNM) stage (P = 0.043), Notch receptor 3 with advanced T stage (P = 0.017), tendency to express in cases with nodal metastasis (P = 0.065) and advanced TNM stage (P = 0.052). DLL4 expression tended to be related to less histological differentiation (P = 0.095). Coexistent nuclear localization of Notch receptor 3 was related to no nodal metastasis (P = 0.027) and Notch receptor 4 with less histological differentiation (P = 0.036), while DLL4 tended to be related inversely with T stage (P = 0.053). Coexistent nuclear localization of DLL4 was related to poor survival (P = 0.002). CONCLUSION: Aberrant expression of Notch receptors 1 and 3 play a role during cancer progression, and cytoplasmic nuclear coexistence of DLL4 expression correlates with poor survival in extrahepatic CC and gallbladder carcinoma.
Assuntos
Colangiocarcinoma/fisiopatologia , Neoplasias da Vesícula Biliar/fisiopatologia , Receptores Notch/metabolismo , Transdução de Sinais/fisiologia , Proteínas Adaptadoras de Transdução de Sinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Proteínas de Ligação ao Cálcio , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Progressão da Doença , Feminino , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Masculino , Pessoa de Meia-Idade , Taxa de SobrevidaRESUMO
OBJECTIVE: Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. METHODS: A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. RESULTS: The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18-42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. CONCLUSIONS: We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.
Assuntos
Adenocarcinoma/patologia , Adenoma/patologia , Mucosa Gástrica/patologia , Segunda Neoplasia Primária/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/cirurgia , Adenoma/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Antro Pilórico/patologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Fatores de TempoRESUMO
Sorafenib, a multitargeted tyrosine kinase inhibitor, has been shown to improve survival in patients with advanced hepatocellular carcinoma (HCC). As the clinical use of sorafenib increases, many adverse effects have been reported, such as hand-foot skin reaction, diarrhea, anorexia, asthenia, alopecia, weight loss, hypertension and arterial thromboembolism. However, there are no prior reports of splenic infarction as an adverse effect of sorafenib. Here, a case of splenic infarction in a patient with HCC who was treated with sorafenib is reported. The patient had no other predisposing factors to explain the splenic infarction except for the administration of sorafenib. The splenic infarction improved after sorafenib was discontinued; however, the HCC progressed.
Assuntos
Benzenossulfonatos/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Piridinas/efeitos adversos , Baço/patologia , Infarto do Baço/induzido quimicamente , Idoso , Antineoplásicos/efeitos adversos , Aspirina/administração & dosagem , Meios de Contraste/farmacologia , Feminino , Humanos , Niacinamida/análogos & derivados , Compostos de Fenilureia , Inibidores de Proteínas Quinases/efeitos adversos , Sorafenibe , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.