Diagnostic yield of repeat screening colonoscopy ten years after an adenoma-negative index screening endoscopy.

In Germany, colonoscopy was introduced as a screening instrument about 20 years ago. Ten years after an adenoma-negative index endoscopy, a second screening colonoscopy can be performed in younger persons, but this approach is based on limited evidence. We therefore prospectively analyzed the diagnostic yield of second screening colonoscopies in clinical routine.Ten years following adenoma-negative screening endoscopy a second screening colonoscopy was performed in 401 persons (210 women and 191 men); mean age was 70 years. A total of 244 benign neoplastic lesions were removed in 135 persons (34%). Eight persons had three or more small tubular adenomas removed; 19 persons had at least one tubular adenoma measuring ≥ 10 mm; 14 persons had adenomas with villous characteristics; 19 persons had serrated adenomas; one person had an adenoma with high grade dysplasia. Thus 61 persons (33 men and 28 women) were classified as bearing a significant risk for the development of colorectal cancer (15%). An additional patient had a low-risk malignant polyp removed endoscopically.We conclude that a significant number of small and advanced adenomas can be identified in a second screening colonoscopy ten years after an adenoma-negative index screening endoscopy, but malignant lesions are rare. Whether or not removal of the benign lesions in a second screening colonoscopy will reduce incidence and mortality of colorectal carcinoma remains to be seen in this elderly group.

Invasive Breast Carcinoma with Neuroendocrine Differentiation: A Single-Center Analysis of Clinical Features and Prognosis.

Introduction Invasive breast cancer with neuroendocrine differentiation is a rare subtype of breast malignancy. Due to frequent changes in the definition of these lesions, the correct diagnosis, estimation of exact prevalence, and clinical behaviour of this entity may be challenging. The aim of this study was to evaluate the prevalence, clinical features, and outcomes in a large cohort of patients with breast cancer with neuroendocrine differentiation. Patients Twenty-seven cases of breast cancer with neuroendocrine differentiation have been included in this analysis. Twenty-one cases were identified by systematic immunohistochemical re-evaluation of 465 breast cancer specimens using the neuroendocrine markers chromogranin A and synaptophysin, resulting in a prevalence of 4.5%. A further six cases were identified by a review of clinical records. Results Median age at the time of diagnosis was 61 years. 70% of patients had T2 - 4 tumors and 37% were node-positive. The most common immunohistochemical subtype was HR-positive/HER2-negative (85%). 93% were positive for synaptophysin and 48% for chromogranin A. Somatostatin receptor type 2A status was positive in 12 of 24 analyzed tumors (50%). Neuroendocrine-specific treatment with somatostatin analogues was administered in two patients. The 5-year survival rate was 70%. Conclusions Breast cancer with neuroendocrine differentiation is mostly HR-positive/HER2-negative and the diagnosis is made at a higher TNM stage than in patients with conventional invasive breast carcinoma. Moreover, breast cancer with neuroendocrine differentiation was found to be associated with impaired prognosis in several retrospective trials. Due to somatostatin receptor 2A expression, somatostatin receptor-based imaging can be used and somatostatin receptor-targeted therapy can be offered in selected cases.

High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe.

The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a nonendemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf,Germany over the past 19 years (1990­2009) were evaluated. Thirty-nine patients had persistently normal transaminases, 86 patients had ALT with 1­2 x ULN (upper limit of normal) and 128 patients had ALT >2 x ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2)was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥ 40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis.Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis.

[Hemangiosarcoma after breast-conserving therapy of breast cancer: report of four cases with molecular genetic diagnosis and literature review]. / Hämangiosarkom nach brusterhaltender Therapie beim Mammakarzinom: vier Fallbeispiele mit molekulargenetischer Diagnostik und Literaturübersicht.

BACKGROUND: Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor. PATIENTS AND METHODS: In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature. RESULTS: Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients. CONCLUSION: Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.

Immunohistochemical detection of hepatic CEA+ cells: hepatic tumor cell dissemination in colorectal cancer patients--limits of surgery?

AIMS: Hepatic recurrence following resection of liver metastases occurs in about half of the patients. This is attributed to insufficient margins by some authors, while others accuse the presence of occult tumor cell dissemination. METHODS: Representative samples of the hepatic margin of 32 patients were examined. Clinicopathologic parameters of the primary tumors of metastatic lesions as well as the width of hepatic resection margin and postoperative adjuvant therapies were recorded. RESULTS: Occult tumor cells were identified in 18 patients (56%). Postoperative adjuvant therapy was associated with longer relapse-free survival. CONCLUSIONS: Immunohistochemical detection of occult tumor cells is feasible and a frequent finding in the remaining tissue after hepatic metastasectomy.

Prognostic significance of EpCAM-positive disseminated tumor cells in rectal cancer patients with stage I disease.

Here we evaluated the prevalence and prognostic impact of epithelial cell adhesion molecule (EpCAM)-positive disseminated tumor cells (DTCs) in stage I rectal cancer. Further we tested the association of these single tumor cells or small tumor cell groups with the extent of peritumoral lymphangiogenesis. A total of 845 regional lymph nodes (LN) of 44 patients classified as negative on conventional histopathology were retrospectively reanalyzed with immunohistochemistry (IHC) using the monoclonal antibody Ber-Ep4 directed against EpCAM for the detection of DTCs. The degree of lymphangiogenesis in the primary tumors was assessed by IHC of the primary tumor tissue using the monoclonal antibody D2-40, which reacts with the lymphatic endothelium. The IHC results were correlated with clinico-pathologic parameters and clinical follow-up data. EpCAM-positive DTCs in LNs were detected in 8 (18.2%) of the 44 patients. During a median follow-up of 59 months, 3 (37.5%) of the 8 patients with EpCAM-positive DTCs relapsed, whereas none of the DTC-negative patients developed tumor recurrence (P=0.004). Survival analysis revealed a significant effect of the prevalence of DTCs on overall survival (P=0.0009) and on recurrence-free survival (P=0.0001). Finally, the prevalence of EpCAM-positive DTCs in perirectal LNs was significantly correlated with a high density of peritumoral lymphatic vessels (P=0.015). Our results show that DTCs may occur in stage I of rectal cancer and are associated with poor prognosis. Their occurrence seems to be linked to a high density of newly formed lymphatic vessel at the primary tumor site. According to our data, patients with DTCs in their LN might benefit from adjuvant therapy.

Genital schistosomiasis as a cause of female sterility and acute abdomen.

OBJECTIVE: To report the case of a Nigerian patient who suffered from sterility and underwent abdominal laparotomy to remove an adnexal tumor. Histologic analysis revealed Schistosoma haematobium ova. DESIGN: Case report. SETTING: Multidisciplinary group practice and teaching hospital. PATIENTS: One patient who underwent an abdominal laparotomy to remove an adnexal tumor. INTERVENTION(S): In vitro fertilization and adnexal tumor resection via laparotomy. MAIN OUTCOME MEASURE(S): Treatment of the adnexal tumor affecting the reproductive health. RESULT(S): Histologic analysis performed on the tissue removed at surgery revealed fibrous patches around aggregates of calcified Schistosoma haematobium eggs in the fallopian tube wall. CONCLUSION(S): Schistosomiasis needs to be considered as a differential diagnosis of female infertility and sterility.