RESUMEN
BACKGROUND AND AIM: In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence. METHODS: A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models. RESULTS: At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs. CONCLUSIONS: IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.
Asunto(s)
Adenocarcinoma/patología , Transformación Celular Neoplásica/patología , Gastritis Atrófica/patología , Lesiones Precancerosas/patología , Neoplasias Gástricas/patología , Estómago/patología , Adenocarcinoma/epidemiología , Adulto , Biopsia , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Gastritis Atrófica/epidemiología , Humanos , Estudios Longitudinales , Masculino , Metaplasia , Persona de Mediana Edad , Análisis Multivariante , Lesiones Precancerosas/epidemiología , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Neoplasias Gástricas/epidemiología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases.
Asunto(s)
Carcinoma Neuroendocrino/patología , Carcinoma Neuroendocrino/secundario , Neoplasias del Colon/patología , Neoplasias Hepáticas/secundario , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Resumen Los tumores neuroendocrinos del tubo digestivo son lesiones muy poco frecuentes. Se presenta el caso de una mujer de 57 años de edad que consulta por síndrome tóxico, vómitos y diarrea de 3 meses de evolución, con diagnóstico final de tumor neuroendocrino pobremente diferenciado. A partir de esta observación clínica se revisan las características clínicas y procedimientos diagnósticos, los factores pronósticos y las posibilidades terapéuticas en este tipo de tumores. Ante una tumoración colónica con metástasis hepáticas hiperecogénicas se debe considerar siempre el diagnóstico de tumor neuroendocrino (AU)
Abstract Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Carcinoma Neuroendocrino/patología , Neoplasias del Colon/patología , Metástasis de la Neoplasia/patología , Endoscopía del Sistema DigestivoRESUMEN
Introducción: Las cromograninas son proteínas extensamente distribuidas en el sistema neuroendocrino, y su expresión puede usarse en la caracterización de los tumores neuroendocrinos.Material y métodos: Este estudio analiza mediante inmunohistoquímica la presencia de cromogranina A en 32 biopsias de adenomas hipofisarios humanos, secretores y no secretores.Resultados: Todos los adenomas secretores de FSH y los no secretores muestran inmunoreactividad intensa para cromogranina A, mientras que otros adenomas hipofisarios son negativos o débilmente positivos en escasas células.Conclusiones: La cromogranina A puede utilizarse como marcador de adenomas hipofisarios humanos no secretores. (AU)