Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue.

BACKGROUND: Primary gastric lymphomas are distinct entities with an indolent clinical course and biologic behavior. They account for 2-8% of all gastric malignancies. We conducted this study to evaluate the role of gastroscopy as the principal diagnostic method in detecting gastric MALT lymphomas. METHODS: Sixty-three consecutive patients with gastric MALT lymphomas, who were evaluated and treated at our institution between January 1978 and December 1997, are retrospectively reviewed. There were 36 males and 27 females, with a mean age of 53 years (range 20-80 years). All patients underwent the standard diagnostic evaluation, including gastroscopy and biopsy. Patients were staged according to revised Musshof modification of the Ann Arbor classification system, whereas histological evaluation was made according to the Isaacson classification system for gastric MALT lymphomas. RESULTS: According to endoscopic findings, the antrum harbored the neoplasm in 31 patients (49%), the body in 38% (24 patients), and the fundus in 4% (3 patients), whereas in 5 patients (8%) the neoplasm occupied the entire stomach. The macroscopic appearance was not in most cases pathognomonic of the disease. Three macroscopic patterns were recognized at endoscopy: (a) the ulcerative in 51% (32 patients), (b) the polypoid in 33% (21 patients) and (c) the diffuse infiltrative in 16% (10 patients). The neoplasm was characterized as a benign disease in 24 patients (38%), with malignancy being suspected in 62% (39 patients). Endoscopy displayed a sensitivity of 61% in detecting malignancy; however, the sensitivity dropped to 27% when endoscopic diagnosis of non-Hodgkin's lymphoma was hypothesized. CONCLUSIONS: Although the impact of gastroscopy as a diagnostic tool in the patients of our study was of limited value, due to the nonspecific gross pattern of gastric MALT lymphomas, it should be maintained in the diagnostic intervention of the upper GI tract pathologies.

Unusual spread of liposarcoma.

BACKGROUND: The aim of our study was to investigate the unusual pattern of metastatic spread of liposarcoma. MATERIALS AND METHODS: We retrospectively studied thirty-two patients with liposarcoma (in seventeen located in the retroperitoneum and in fifteen in the extremities) who were managed at our institution over a ten-year period. Six patients with extremity liposarcoma developed local recurrence and or distal metastases and in three the site of the distal spread was other than the lungs. In only one patient with retroperitoneal liposarcoma we observed extra-pulmonary spread. The histologic type of all four cases with unusual spread was myxoid, with small areas of round cell differentiation in two cases. RESULTS: The survival of the patients after the initial recurrence was relatively prolonged (6, 1.5, 8 and 3 years with the last patient alive and well). CONCLUSION: Physicians should maintain a low threshold for initiating evaluation of relatively minor symptoms in patients with liposarcoma, as these symptoms may reflect the first manifestation of an extrapulmonary metastasis. Such an approach should result in earlier detection and hopefully improve survival for patients with liposarcoma.

Treatment-related acute gastric bleeding managed successfully with surgical devascularization.

BACKGROUND AND OBJECTIVES: Patients with gastric lymphoma treated by chemotherapy or radiation therapy are at high risk of developing complications, most commonly perforation or bleeding. In any case of upper gastrointestinal tract bleeding during conservative treatment for gastric lymphoma, thorough investigation is required to exclude other causes of hemorrhage which could be managed appropriately. When the source of bleeding is the tumor, the only effective measure is resection of the stomach, a very dangerous operation in these poor-risk patients. METHODS: We treated 3 consecutive patients with life-threatening gastric bleeding from lymphoma treated by chemotherapy. RESULTS: We successfully controlled the hemorrhage by surgical devascularization. CONCLUSION: Devascularization of the involved part of the stomach is safe and effective.

Administration of tamoxifen in the perioperative period to patients with breast carcinoma prolongs axillary fluid drainage.

Compelling evidence points to an estrogen receptor independent mechanism of action of tamoxifen in the extracellular matrix, in addition to its action via the estrogen receptors. We retrospectively studied 380 patients who underwent curative resection for primary breast cancer in our institution from January 1994 to December 1998, of which 227 received tamoxifen in the perioperative period and the remaining 153 never received tamoxifen or delayed the initiation of treatment for at least two weeks following the operation. The administration of tamoxifen in the perioperative period resulted in the prolongation of axillary drainage (mean 10.07 SD 4.18 days vs mean 8.33 SD 2.85 days), which was statistically significant for patients younger than 70 years. There was no difference in the duration of fluid drainage in relation to the number of positive nodes, except in cases of more than 9 nodes involved by the tumor. We assumed that tamoxifen causes a delay in would healing through the secretion of active transforming growth factor beta(TGF-beta), which is the principle negative growth modulator and which can be secreted from epithelial and stromal elements, independently of hormonal receptor status.

Peripheral neuroepithelioma developing in the abdominal cavity.

Peripheral neuroepitheliomas are rare malignant tumors of presumed neural crest origin, arising outside the central and sympathetic nervous system. We present herein a case of a young man with diffuse peripheral neuroepithelioma of the abdominal cavity. Although we twice attempted a debulking procedure on this patient, and treated him with alternating VIP-CAV combined chemotherapy, his disease showed a relentless course without responding to any treatment. The development of peripheral neuroepithelioma in the abdominal cavity is an extremely rare occurrence. These rare malignant tumors, of presumed neural crest origin, arise outside the central and sympathetic nervous systems (1). Other names for this tumor are: extracranial primitive neuroectodermal tumor (PNET), Askin tumor, peripheral or adult neuroblastoma (2,3,4). We present a case of a young man with diffuse development of this tumor in the abdominal cavity.