RESUMO
Tumors with features similar to those of nasopharyngeal carcinoma, so-called lymphoepithelioma-like carcinomas, have been described in several organs but are extremely rare in the colon. We describe a patient with a family history consistent with hereditary nonpolyposis colorectal cancer who had 3 malignant lesions in the right colon, namely, a mucinous cancer, a lymphoepithelioma-like carcinoma, and a well-differentiated adenocarcinoma with prominent lymphoid stroma. To the best of our knowledge, lymphoepithelioma-like carcinoma has not been described previously in hereditary nonpolyposis colorectal cancer.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/genética , Adenocarcinoma Mucinoso/patologia , Adulto , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Neoplasias do Colo/genética , Neoplasias do Colo/patologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Humanos , MasculinoRESUMO
BACKGROUND & AIMS: Upper gastrointestinal tract bleeding is a frequent cause of hospitalization. The goal of this study was to assess whether the cost of treating patients with upper gastrointestinal bleeding varies among surgeons, internists, and gastroenterologists. METHODS: A retrospective study of 124 patients admitted with acute upper gastrointestinal hemorrhage was performed. Patients were stratified into three groups based on a validated risk score; length of stay and hospital costs were compared among patients primarily cared for by internists, surgeons, and gastroenterologists. RESULTS: The median length of stay (2 days) for patients admitted to the gastroenterology service was significantly shorter than for patients admitted under the care of other physicians (P < 0.05). The median hospitalization cost ($2856) for patients admitted to the gastroenterology service was significantly lower than for patients admitted to the other services (P < 0.01). There were no significant differences in the time to endoscopy among services. CONCLUSIONS: Patients admitted to an urban teaching hospital directly under the care of a gastroenterologist had shorter hospital stays that were significantly less costly than patients under the primary care of internists or surgeons. The difference in length of stay reflects the time interval between endoscopy and discharge.
Assuntos
Gastroenterologia , Hemorragia Gastrointestinal/terapia , Custos de Cuidados de Saúde , Medicina , Especialização , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores SexuaisRESUMO
BACKGROUND: Local excision of selected ampullary tumors may result in the same benefit as Whipple resection with less morbidity and mortality. The purpose of this study was to determine if endoscopic ultrasonography could aid in the selection of patients for local resection and to determine if there was a significant cost difference between the two surgical procedures. METHODS: In this retrospective study of 32 patients who underwent surgery for ampullary tumors, endoscopic ultrasonography staging was performed in 18 patients. Resected specimens were used to determine pathologic staging. Local disease was defined as stage T2N0 or less. Cost data were available for 20 patients. RESULTS: The sensitivity and specificity of endoscopic ultrasonography for differentiating local from advanced ampullary tumors were both 83%. The median total cost for a local resection was $9314 versus $16,017 for a Whipple resection (p < 0.0017). CONCLUSION: Endoscopic ultrasonography is an effective tool for identifying patients with localized ampullary tumors. The cost of a local resection for ampullary tumors is significantly less than that of a Whipple resection. The use of endoscopic ultrasonography to select patients for local resection may be a cost-effective technique in the management of patients with ampullary tumors.
