Pathology definitions and resection strategies for early colorectal neoplasia: Eastern versus Western approaches in the post-Vienna era.

There is a well-known discrepancy between East and West classifications of colorectal neoplasm, especially "intramucosal carcinoma," categorized as subgroup 4.4 in the Vienna classification, usually recognized as high-grade dysplasia in the United States and as carcinoma in situ in Japan. Focusing on management, in the current National Comprehensive Cancer Network algorithm, high-grade dysplasia, carcinoma in situ, and intramucosal carcinoma are managed similarly, whereas submucosal invasion by carcinoma requires en bloc resection. To bridge the differences with regard to these conceptual problems in the definition and management of carcinoma in situ and intramucosal carcinoma, endoscopists and pathologists from Japan and the United States gathered and discussed from their perspectives how to accurately assess specimens of en bloc/piecemeal resection and to effectively predict lymph node metastasis risk.

A simple two-gene prognostic model for adenocarcinoma of the lung.

OBJECTIVE: We hypothesized that clinical outcome of resected early-stage adenocarcinoma of the lung can be predicted by the expression of a few critically important genes as measured by quantitative real-time reverse-transcriptase polymerase chain reaction in formalin-fixed paraffin-embedded primary tumors. METHODS: Twenty-two prognostic genes for the metastatic phenotype were identified through complementary DNA microarray analysis of 4 cancer cell lines and bioinformatics analysis. Expression levels of a subset of these genes (n = 13) were measured by real-time time reverse-transcriptase polymerase chain reaction in formalin-fixed paraffin-embedded primary adenocarcinoma from patients whose disease recurred within 2 years (n = 9) and in patients who did not have a recurrence (n = 11). Receiver operating characteristic curves were analyzed to establish prognostic values of single genes. The most informative gene was combined with the remaining genes to determine whether there was a particular pair(s) that yielded high diagnostic accuracy. A small validation study was performed. RESULTS: Receiver operating characteristic curve analysis of the single genes revealed that high expression of CK19 was associated with nonrecurrence (area under the curve = 0.859, confidence interval = 0.651-0.970). The CK19/EpCAM2 gene ratio had the most reproducible prognostic accuracy, followed by the CK19/P-cadherin ratio. A Kaplan-Meier survival analysis generated from the CK19/EpCAM2 ratio resulted in highly significant curves as a function of marker positivity (P = .0007; hazard ratio = 10.7). Significance declined but was maintained in the validation study. CONCLUSIONS: This preliminary study provides evidence that the CK19/EpCAM2 and/or CK19/P-cadherin ratio(s) may be a simple and accurate prognostic indicator of clinical outcome in early-stage adenocarcinoma of the lung. If further validation studies from large patient cohorts confirm the results, adjuvant therapy could be targeted to this high-risk group.

Selenium concentrations in pancreatic juice of patients with chronic pancreatitis.

BACKGROUND: Free radicals have been implicated as an important mediator in the pathogenesis of tissue injury. Experimental animal models would suggest selenium deficiency contributes to the pathogenesis of chronic pancreatitis (CP). In clinical studies, low plasma selenium levels have been reported in patients with CP. To the best of our knowledge, selenium levels have not been measured in pancreatic juice. METHODS: Twenty-seven patients with chronic intermittent upper quadrant abdominal pain were studied. The diagnosis of CP was made by endoscopic retrograde cholangiopancreatography. Patients were allowed to eat an ad libitum western diet. None of the patients was taking selenium supplements. Patients underwent upper endoscopy with routine conscious sedation. Secretin (0.2 microg/kg) was given i.v. immediately before intubation. Pancreatic juice collected from the duodenum was immediately frozen in liquid nitrogen and stored at -80 degrees C until the assay was performed. Selenium levels of the pancreatic juice were determined using the inductively coupled plasma-mass spectrometry method. RESULTS: Twelve patients had an abnormal pancreatogram. The gender and median age in controls and CP were 11 females and 4 males (54 years, range 32-78) and 7 females and 5 males (56 years, range 37-79), respectively. The etiology of CP was alcohol and idiopathic. The median selenium concentration in controls was 4 microg/mL (range, 2-11.5) and in CP 4.5 microg/mL (range, 2-16). There was not a statistically significant difference between the 2 groups (p = not significant). CONCLUSIONS: The pancreatic juice concentration of selenium is similar in patients with CP compared with age matched controls. Our results would therefore suggest that the effects of selenium on pancreatic injury might be systemic rather than local tissue effect.