Malignant ileocaecal serotonin-producing carcinoid tumours: the presence of a solid growth pattern and/or Ki67 index above 1% identifies patients with a poorer prognosis.

Patients with malignant serotonin-producing carcinoid tumours in the jejunum, ileum and caecum generally have long survival expectancy. In some patients, however, tumour progression is more rapid and there is a need to identify them at an early stage. The purpose of this study was to determine if histopathological characteristics and/or Ki67 and apoptotic indices are of prognostic value in cases of metastatic disease. Eighty-one patients with this tumour were included in the study; all had metastases and their survival range was 1-223 months. Five growth patterns were identified and described. For 57 patients whose tumour material was available, the Ki67 and apoptotic indices were calculated for ten randomly selected tumour areas and 'hot spots'. A Cox regression analysis was used to test if histopathology and/or Ki67 index >/=1% could identify patients whose survival might be shorter than anticipated. One of the histopathological growth patterns-the solid (non-organoid) cell pattern-was correlated to shorter survival in both primary tumours and metastases, when compared with the organoid growth patterns (hazard ratio 2.9 and 2.3, p/=1%, in both primary tumour and metastases, identified patients at increased risk of shorter survival (hazard ratio 5.4 and 2.5, p/=1%, can be used to identify patients with a poorer prognosis. This study also showed that Ki67 index <2% cannot, as previously suggested, be used to indicate a benign progression for this tumour category.

Angiolipoma of the colon with right lower quadrant abdominal pain.

BACKGROUND/AIM: An angiolipoma is a common benign neoplasm with a characteristic vascular component that occurs in the subcutaneous tissue and rarely in the gastrointestinal tract. We report on a 69-year-old man with a submucosal angiolipoma in the cecum. METHODS: This patient was treated with a laparoscopy-assisted ileocecostomy, and a side-to-side anastomosis was performed extracorporeally. RESULTS: A light microscopic study supported the diagnosis of an angiolipoma of the colon. After 5 years of follow-up, the patient has no symptoms or signs of recurrence. CONCLUSION: The colonic angiolipoma was successfully removed using a minimally invasive laparoscopic technique.

Serum ferritin: it may guide the diagnosis of the anaemic patient.

Crohn's disease is often complicated by anaemia. Assessment of iron deficiency may be hampered by modification of the serum ferritin concentration because of the associated acute phase response when disease is active. However a ferritin value of < 5 micrograms/L is indicative of iron deficiency, which is rarely found in Crohns disease.

Benign epithelial neoplasms of the appendix: classification and clinical associations.

The nomenclature of non-carcinoid epithelial proliferations of the appendix is confused and many of the terms used have no histogenetic basis. A classification based on the well-established diagnostic categories of colonic epithelial polyps has been proposed recently. We have applied this classification to 42 benign epithelial lesions of the appendix in order to determine its suitability for routine diagnostic use, and in order to determine the prognosis of patients with these lesions. All lesions could be classified as either hyperplastic, adenomatous, mixed hyperplastic/adenomatous or dilated appendices. Six cases were associated with a synchronous carcinoma of the colon with all types of appendiceal histology being represented. Follow-up of the remainder of the patients revealed two subsequent colonic carcinomas, at 3 and 6 years post-appendicectomy respectively. In both of these patients, the appendix had shown adenomatous epithelium. We suggest that adenomas of the appendix may have a similar prognostic significance to adenomas elsewhere in the large bowel.

Resistance to acid of canine kidney (MDCK) and human colonic (T84) and ileo-caecal (HCT-8) adenocarcinoma epithelial cell monolayers in vitro.

Monolayers of canine kidney (MDCK) and human lower intestinal (T84 and HCT-8) cell lines generated significant transepithelial electrical resistance (700-5000 omega cm2). Electrical integrity was maintained upon acidification of the apical and/or basolateral surfaces to pH 3.0, and this was associated with increased transepithelial electrical resistance, and generation of a potential difference at pH less than 4.5. These results indicate that resistance to acid is a general phenomenon of epithelial layers, and that monolayers of epithelial cells, including those of human origin, are a homogeneous and simple model for studying epithelial barrier function in vitro.

Differential effects of surgical suture materials in 1,2-dimethylhydrazine-induced rat intestinal neoplasia.

The incidence, distribution, size, and histopathology of rat small and large bowel tumors induced by sequential administration of 1,2-dimethylhydrazine followed by cecal placement of one of six differing types of suture materials were systematically examined. In addition, measurements of beta-glucuronidase activities in large bowel contents followed by fecal trace metal determinations were done. The results indicate that specific slowly absorbed and nonabsorbable suture materials in the absence of a surgical anastomosis promote tumor induction locally in the rat cecum. In addition, cecal suture material composed of multifilament stainless steel wire enhanced tumor development at a "downstream" site in the distal colon, paralleling increased fecal beta-glucuronidase activities at this site and implicating a possible luminally mediated mechanism for colon tumor development in this animal model.