Double Negativity of MRI-Detected and Pathologically-Diagnosed Extramural Venous Invasion is a Favorable Prognostic Factor for Rectal Cancer.

BACKGROUND: Extramural venous invasion (EMVI) is a prognostic factor in rectal cancer. There are two types: EMVI detected by magnetic resonance imaging (MRI) (mr-EMVI) and EMVI detected by pathology (p-EMVI). They have been separately evaluated, but they have not yet been concurrently evaluated. We therefore evaluate both mr-EMVI and p-EMVI in rectal cancer at the same time and clarify their association with prognosis. PATIENTS AND METHODS: Included were the 186 consecutive patients who underwent complete radical resection of tumors ≤ stage III at Wakayama Medical University Hospital, Japan, between 2010 and 2018. All underwent preoperative MRI examination, and were reassessed for EMVI by a radiologist. Surgically resected specimens were then reassessed for EMVI by a pathologist. We assessed the correlation between positivity of mr-EMVI and p-EMVI and prognosis, and the clinicopathological background behind them. RESULTS: Patients with double negativity for mr-EMVI and p-EMVI had better prognosis than patients with mr-EMVI or p-EMVI positivity (p < 0.0001). Positivity for mr-EMVI or p-EMVI was a poor independent prognostic factor in multivariate analysis. CONCLUSIONS: Combined analysis of mr-EMVI and p-EMVI may enable prediction of postoperative prognosis of rectal cancer. Patients with double negativity of mr-EMVI and p-EMVI had better prognosis than patients with some form of positivity. Stated differently, patients with positivity of mr-EMVI, p-EMVI, or both had a poorer prognosis than those with double negativity. Postoperative adjuvant chemotherapy may improve poor prognosis. Combined evaluation of mr-EMVI and p-EMVI may be used to predict clinical outcomes and may be an effective prognostic predictor of rectal cancer.

Successful endoscopic diagnosis of angiosarcoma of the small intestine: A case report.

A 51-year-old man had hematochezia, anemia, and an intraabdominal mass. Gastroscopy and colonoscopy showed no significant lesions with intraluminal bleeding, while radiological examinations showed bulky swelling of the lymph nodes around the abdominal aorta and a tumor in the left ischial bone. Small intestine endoscopy detected a dark purpuric protruding tumor of the jejunum and its biopsy specimen brought a definitive diagnosis of primary jejunal epithelioid angiosarcoma from positive staining of AE1/AE3, CD31, and erythroblast transformation specific related gene in immunohistochemical studies. The patient underwent surgical resection with adjuvant chemotherapy but died of progression of metastases 7 months after the diagnosis. Epithelioid angiosarcoma of the gastrointestinal tract is an extremely rare malignancy with poor prognosis and it is challenging to distinguish from undifferentiated carcinoma or melanoma. Immunohistochemistry is necessary for a definitive diagnosis. Sufficient biopsy specimen may aid a prompt diagnosis of this disease of the small intestine, which may present as obscure gastrointestinal bleeding.

Appendiceal goblet cell adenocarcinoma with peritoneal recurrence 9 years after surgery.

Goblet cell adenocarcinoma is extremely rare tumor in which the same cells have both exocrine and neuroendocrine properties. It is considered to be more aggressive than conventional carcinoids and more likely to cause metastasis. We report a case of goblet cell adenocarcinoma that developed late peritoneal recurrence, and we review pertinent literature. A 63-year-old male underwent appendectomy for acute appendicitis. Histopathological findings of appendectomy specimen showed mixed adenoneuroendocrine carcinoma, and positive resection margin. He also underwent laparoscopic ileocecal resection and apical lymph node dissection. After 9 years, he presented with ileus and abdominal CT examination indicated possible peritoneal dissemination. Laparoscopic observation revealed disseminated nodules throughout the entire abdominal cavity, and the patient underwent resection of the omental nodule and gastrointestinal bypass surgery. Previous appendectomy specimens showed goblet cell adenocarcinoma (GCA) according to the 5th edition of the WHO classification. Omental specimens confirmed the histopathological findings, and we diagnosed peritoneal recurrence of appendiceal goblet cell adenocarcinoma. Goblet cell adenocarcinoma may develop and cause late recurrence, and long-term follow-up may be required.