Immunohistochemical expression analysis of MMP-1, TIMP-2 and p53 in Barrett's esophagus, dysplasia and esophageal adenocarcinoma.

Barrett's esophagus (BE) is the most important risk factor for the development of esophageal adenocarcinoma. It develops through a progressive sequence of histologic and molecular events that begin with metaplasia and then progresses through various stages of dysplasia. Matrix metalloproteinases are involved in the degradation of the extracellular matrix and play an important role in tumor progression. The immunohistochemical expression of MMP-1, TIMP-2 and p53 in 111 samples from 45 patients diagnosed with BE with and without dysplasia and adenocarcinoma of the esophagus was retrospectively studied, and statistical analysis was conducted to measure the association between their expression and the degree of dysplasia present. MMP-1 was expressed in 33.3% of the samples studied, mainly in the adenocarcinoma subgroup with up to 40% positive cases (p = 0.494). In contrast, TIMP-2 was expressed in 25.2% of the samples, and no positive cases were identified in the adenocarcinoma subgroup (p = 0.037). Aberrant p53 expression was observed in 81.4% of the samples diagnosed with some degree of dysplasia (p < 0.001). MMP-1 showed no statistically significant differences between diagnostic entities. A statistically significant loss of TIMP-2 expression was observed in distal esophageal adenocarcinoma samples, which contrasts with the aberrant expression of p53 in dysplastic cases.

Metástasis mamaria de un adenocarcinoma mucinoso de colon: descripción de un caso y revisión de la literatura / Breast metastasis from mucinous adenocarcinoma of the colon: a case report and review of the literature

Objetivo. Determinar las características de las metástasis mamarias colorrectales para realizar un diagnóstico diferencial y un tratamiento adecuados. Caso clínico. Se presenta un caso de metástasis mamaria de un adenocarcinoma mucinoso de colon y se realiza un análisis de las características patológicas, radiológicas, de localización, latencia y supervivencia de los otros 34 casos publicados en la literatura. Resultados. La edad media al diagnóstico es de 53,3 años. Son tumores avanzados (el 48% en estadio C de Dukes y el 24% en estadio D) y el 75%, asociados a enfermedad metastásica difusa. Existe disparidad en el tratamiento realizado; en 12 no se realiza cirugía, en 7 se trata solo la lesión y en 4 casos más se estadifica también la axila. Conclusiones. Las metástasis en la mama de un primario de colon es una afección a tener en cuenta en el diagnóstico diferencial de las tumoraciones mamarias. La imagen radiológica características es una masa mamaria bien definida sin microcalcificaciones. El uso de citoqueratina 7 y 20 y los anticuerpos CDX2 y mamoglobina permiten diagnosticar el origen de la tumoración. El tratamiento debe ser individualizado y llevado a cabo por un equipo multidisciplinar, ya que en el caso de metástasis única no debe ser considerada una enfermedad diseminada (AU)

Objective. To determine the characteristics of breast metastasis of colorectal origin in order to aid suitable differential diagnosis and treatment. Case report. We present a case of breast metastasis from a mucinous colon adenocarcinoma and describe the pathological and radiological characteristics, location, latency and survival of the other 34 cases reported in the literature. Results. The mean age at diagnosis was 53.3 years. The tumours were typically advanced (Dukes stage C in 48% and stage D in 24%) and 75% were associated with metastatic disease in other locations. There was wide disparity in the treatment provided; surgery was not performed in 12, only the lesion was treated in 7, and the axilla was also staged in 4. Conclusions. Metastases to the breast from a primary colon cancer is rare but should be considered in the differential diagnosis of mammary tumours. The radiological image is a well-defined breast mass usually without microcalcifications. Currently, the use of cytokeratin 7 and 20, CDX2 monoclonal antibodies and mammaglobin allows clear differentiation of the origin of the tumour. Treatment must be individualized and undertaken by a multidisciplinary team, because, in the case of single metastasis, they should not be considered a widely disseminated disease (AU)

Gastritis por Helicobacter heilmannii sensu lato: descripción de un caso y revisión de la literatura / Helicobacter heilmannii sensu lato gastritis: A case report and review of the literature

La infección por Helicobacter heilmannii (H. heilmannii) en humanos es un evento poco frecuente, si bien, es común encontrarla en animales domésticos. Suele causar gastritis crónica, de leve a moderada intensidad, siendo su principal diagnóstico diferencial la infección por Helicobacter pylori (H. pylori), del cual presenta rasgos morfológicos distintivos. En este artículo presentamos un caso de gastritis crónica causada por H. heilmannii, en una paciente de 17 años, con sintomatología de dispepsia. Se estudiaron biopsias gástricas antrales que mostraron un moderado infiltrado inflamatorio y en donde se identificaron microorganismos alargados, en forma de espiral, localizados en las luces glandulares y en el moco de superficie, compatibles con H. heilmannii. Dichos microorganismos mostraron una expresión positiva con la tinción de inmunohistoquímica para H. pylori. A partir de este caso se realiza una descripción de las características clínico-patológicas observadas en pacientes afectados por H. heilmannii (AU)

Helicobacter heilmannii (H. heilmannii) infection is common in domestic animals but is rare in humans, in whom it can cause mild to moderate chronic gastritis. Its distinctive morphology allows a differential diagnosis with a Helicobacter pylori (H. pylori) infection. We present a case of chronic gastritis caused by H. heilmannii in a 17-year-old patient with symptoms of dyspepsia. Gastric antral biopsies showed moderate inflammatory infiltrate and long corkscrew-shaped spiral microorganisms, located in gastric pits as well as in the superficial mucus layer suggestive of H. heilmannii infection. These organisms were positive for anti-H. pylori antibody. The clinical and pathological features of H. heilmannii infection are discussed together with a review of the literatura (AU)

Endoscopic resection techniques and ablative therapies for Barrett's neoplasia.

Esophageal adenocarcinoma is the most rapidly increasing cancer in western countries. High-grade dysplasia (HGD) arising from Barrett's esophagus (BE) is the most important risk factor for its development, and when it is present the reported incidence is up to 10% per patient-year. Adenocarcinoma in the setting of BE develops through a well known histological sequence, from non-dysplastic Barrett's to low grade dysplasia and then HGD and cancer. Endoscopic surveillance programs have been established to detect the presence of neoplasia at a potentially curative stage. Newly developed endoscopic treatments have dramatically changed the therapeutic approach of BE. When neoplasia is confined to the mucosal layer the risk for developing lymph node metastasis is negligible and can be successfully eradicated by an endoscopic approach, offering a curative intention treatment with minimal invasiveness. Endoscopic therapies include resection techniques, also known as tissue-acquiring modalities, and ablation therapies or non-tissue acquiring modalities. The aim of endoscopic treatment is to eradicate the whole Barrett's segment, since the risk of developing synchronous and metachronous lesions due to the persistence of molecular aberrations in the residual epithelium is well established.