Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.486
Filtrar
1.
Am J Gastroenterol ; 115(3): 381-387, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31899705

RESUMO

OBJECTIVES: The risk of noncardia gastric cancer is increased in the presence of gastric intestinal metaplasia. We aimed to identify demographic and lifestyle factors independently associated with the risk of gastric intestinal metaplasia. METHODS: We used data from a cross-sectional study of patients attending primary care and endoscopy clinics at the Michael E. DeBakey VA Medical Center in Houston, Texas, between February 2008 and August 2013. All patients completed standardized questionnaires and underwent endoscopy with gastric mapping biopsies. Gastric intestinal metaplasia cases included patients with intestinal metaplasia on any noncardia gastric biopsy; we defined extensive gastric intestinal metaplasia as antrum and corpus involvement. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic regression models. RESULTS: We identified 423 cases with gastric intestinal metaplasia and 1,796 controls without gastric intestinal metaplasia. Older age (vs <60 years: 60-69 years AdjOR, 1.50; 95% CI, 1.17-1.93; ≥70 years AdjOR, 2.12; 95% CI, 1.48-3.04), male sex (AdjOR, 2.76; 95% CI, 1.50-5.10), nonwhite race/ethnicity (vs non-Hispanic white: Hispanic, AdjOR, 2.66; 95% CI, 1.89-3.76; black, AdjOR, 2.36; 95% CI, 1.85-3.02), and current smoking status (AdjOR, 1.78; 95% CI, 1.29-2.48) were independently associated with gastric intestinal metaplasia. These risk factors remained statistically significantly associated with gastric intestinal metaplasia after adjusting for Helicobacter pylori infection, and their effect sizes were larger for associations with extensive gastric intestinal metaplasia compared with focal gastric intestinal metaplasia. DISCUSSION: Older age, male sex, nonwhite race/ethnicity, and current smoking status were the nonendoscopic factors independently associated with gastric intestinal metaplasia in a predominantly nonimmigrant US population.


Assuntos
Demografia , Intestinos/patologia , Estilo de Vida , Lesões Pré-Cancerosas/etiologia , Gastropatias/etiologia , Estômago/patologia , Saúde dos Veteranos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Fatores de Risco , Gastropatias/diagnóstico , Gastropatias/patologia , Texas
2.
World J Gastroenterol ; 25(31): 4343-4359, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496617

RESUMO

the bile duct system and pancreas show many similarities due to their anatomical proximity and common embryological origin. Consequently, preneoplastic and neoplastic lesions of the bile duct and pancreas share analogies in terms of molecular, histological and pathophysiological features. Intraepithelial neoplasms are reported in biliary tract, as biliary intraepithelial neoplasm (BilIN), and in pancreas, as pancreatic intraepithelial neoplasm (PanIN). Both can evolve to invasive carcinomas, respectively cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC). Intraductal papillary neoplasms arise in biliary tract and pancreas. Intraductal papillary neoplasm of the biliary tract (IPNB) share common histologic and phenotypic features such as pancreatobiliary, gastric, intestinal and oncocytic types, and biological behavior with the pancreatic counterpart, the intraductal papillary mucinous neoplasm of the pancreas (IPMN). All these neoplastic lesions exhibit similar immunohistochemical phenotypes, suggesting a common carcinogenic process. Indeed, CCA and PDAC display similar clinic-pathological features as growth pattern, poor response to conventional chemotherapy and radiotherapy and, as a consequence, an unfavorable prognosis. The objective of this review is to discuss similarities and differences between the neoplastic lesions of the pancreas and biliary tract with potential implications on a common origin from similar stem/progenitor cells.


Assuntos
Neoplasias dos Ductos Biliares/etiologia , Carcinoma in Situ/etiologia , Carcinoma Ductal Pancreático/etiologia , Colangiocarcinoma/etiologia , Neoplasias Pancreáticas/etiologia , Lesões Pré-Cancerosas/etiologia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/terapia , Sistema Biliar/patologia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/metabolismo , Carcinogênese/patologia , Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/terapia , Colangiocarcinoma/patologia , Colangiocarcinoma/terapia , Progressão da Doença , Humanos , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Células-Tronco/patologia
3.
World J Gastroenterol ; 25(30): 4105-4124, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31435167

RESUMO

Gastric cancer remains the third leading cause of mortality from cancer worldwide and carries a poor prognosis, due largely to late diagnosis. The importance of the interaction between Helicobacter pylori (H. pylori) infection, the main risk factor, and host-related genetic factors has been studied intensively in recent years. The genetic predisposition for non-hereditary gastric cancer is difficult to assess, as neither the real prevalence of premalignant gastric lesions in various populations nor the environmental risk factors for cancer progression are clearly defined. For non-cardiac intestinal-type cancer, identifying the factors that modulate the progression from inflammation toward cancer is crucial in order to develop preventive strategies. The role of cytokines and their gene variants has been questioned in regard to non-self-limiting H. pylori gastritis and its evolution to gastric atrophy and intestinal metaplasia; the literature now includes various and non-conclusive results on this topic. The influence of the majority of cytokine single nucleotide polymorphisms has been investigated for gastric cancer but not for preneoplastic gastric lesions. Among the investigated gene variants onlyIL10T-819C, IL-8-251, IL-18RAP917997, IL-22 rs1179251, IL1-B-511, IL1-B-3954, IL4R-398 and IL1RN were identified as predictors for premalignant gastric lesions risk. One of the most important limiting factors is the inhomogeneity of the studies (e.g., the lack of data on concomitant H. pylori infection, methods used to assess preneoplastic lesions, and source population). Testing the modifying effect of H. pylori infection upon the relationship between cytokine gene variants and premalignant gastric lesions, or even testing the interaction between H. pylori and cytokine gene variants in multivariable models adjusted for potential covariates, could increase generalizability of results.


Assuntos
Citocinas/genética , Mucosa Gástrica/patologia , Infecções por Helicobacter/epidemiologia , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Atrofia/epidemiologia , Atrofia/etiologia , Atrofia/patologia , Progressão da Doença , Mucosa Gástrica/microbiologia , Predisposição Genética para Doença , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Metaplasia/epidemiologia , Metaplasia/etiologia , Metaplasia/patologia , Polimorfismo de Nucleotídeo Único , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia
4.
Asian Pac J Cancer Prev ; 20(7): 2177-2180, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31350982

RESUMO

Background: In the recent years, hepatitis B virus (HBV) infection has been considered as a risk factor for gastric cancer, but further studies are required to confirm these claim. The present study was aimed to evaluate the correlation between gastric pathology (precancerous and cancerous conditions) with HBV infection in Helicobacter pylori (H. pylori) positive or negative patients. Methods: In this cross-sectional study, 728 patients under endoscopy examination in Yazd Shaheed Sadoughi Hospital between 2017 and 2018 were participated. Histopathological analysis was performed on gastric specimens. Hepatitis B surface antigen (HBsAg) in sera was detected by the enzyme-linked immunosorbent assay (ELISA). The relationship between gastric pathology and HBV infection were explored by logistic regression analysis. Results: Of 728 patients, HBsAg and H. pylori infection were detected in 83 and 408 patients, respectively. Sixty nine patients were co-infected with H. pylori/HBV. H. pylori infection detected in patients with HbsAg positive significantly more than those were negative for HbsAg (p=0.029). None of HBV/H. pylori co-infected patients did not have normal gastric tissue. A significant difference was seen in histopathology of gastric tissue between HBsAg positive patients with and without H. pylori infection (p<0.0001). The HBsAg was associated with histopathology of gastric (OR=21.56, 95℅CI=7.070-65.741, p<0.001) and as a risk factor for gastritis (OR=12.457, 95℅CI= 3.007-51.614, P=0.001) but no cancer (OR=2.127, 95℅CI=0.242-18.704, P=0.496). Conclusion: The HBV infection alone is associated with some precancerous lesions but is not correlated with gastric cancer. It can increase development of premalignant conditions and carcinoma significantly in H. pylori positive patients.


Assuntos
Coinfecção/epidemiologia , Gastrite/patologia , Infecções por Helicobacter/complicações , Hepatite B/epidemiologia , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Estômago/patologia , Idoso , Coinfecção/virologia , Estudos Transversais , Feminino , Seguimentos , Gastrite/etiologia , Infecções por Helicobacter/virologia , Helicobacter pylori/isolamento & purificação , Hepatite B/virologia , Vírus da Hepatite B/isolamento & purificação , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/etiologia , Prognóstico , Fatores de Risco , Estômago/virologia , Neoplasias Gástricas/etiologia
5.
Surg Pathol Clin ; 12(2): 249-261, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097103

RESUMO

The pathogenesis of vulvar squamous neoplasia has 2 pathways: human papillomavirus (HPV)-dependent and HPV-independent. The HPV-dependent pathway in the vulva follows the same progression as HPV-dependent lesions elsewhere in the gynecologic tract-HPV infection results in high-grade squamous intraepithelial lesion with subsequent progression to basaloid squamous cell carcinoma. The HPV-independent pathway is more complex, with a variety of precursor lesions and molecular alterations. Although the most recognized form of HPV-independent vulvar lesion is differentiated vulvar intraepithelial neoplasia, recent explorations have elucidated new precursors. This review provides an update on HPV-independent risk factors and precursor lesions for squamous cell carcinoma of the vulva.


Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias Vulvares/etiologia , Carcinoma in Situ/etiologia , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso e Atrófico/patologia , Neurodermatite/complicações , Neurodermatite/diagnóstico , Neurodermatite/patologia , Infecções por Papillomavirus/complicações , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/patologia , Prognóstico , Neoplasias Vulvares/patologia
6.
Gastrointest Endosc Clin N Am ; 29(3): 531-548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078251

RESUMO

This article begins with a brief overview of risk factors for colorectal neoplasia in inflammatory bowel disease to concretize the approach to risk stratification. It then provides an up-to-date review of diagnosis and management of dysplasia in inflammatory bowel disease, which integrates new and emerging data in the field. This is particularly relevant in an era of increased attention to cost- and resource-containment from the health systems vantage point, coupled with a heightened prioritization of patient quality of life and shared decision-making. Also provided is a brief discussion of the status of newer therapeutic techniques, such as endoscopic submucosal dissection.


Assuntos
Neoplasias Colorretais/terapia , Doenças Inflamatórias Intestinais/complicações , Intestinos/patologia , Lesões Pré-Cancerosas/terapia , Neoplasias Colorretais/etiologia , Gerenciamento Clínico , Humanos , Hiperplasia , Lesões Pré-Cancerosas/etiologia , Qualidade de Vida , Fatores de Risco
7.
J Drugs Dermatol ; 18(3s): s121-123, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30909358

RESUMO

Photoaging is a complex and chronic process that induces structural and functional changes in sun-exposed skin, including coarse wrinkles, laxity, dyschromia, telangiectasias, and potential precancerous lesions. Pigmented skin presents different structure and physiology that contribute to distinctive photoaging process. The skin of color population is reported to "age better" than their Caucasian counterparts in general, with fewer wrinkles and better skin texture. However, pigmentary disorders and sun-exposure related dyschromia are highly prevalent in skin of color. Hispanics are the fastest growing population in the U.S. and represents a heterogenous group of people with different skin tones and Fitzpatrick phototypes. They demonstrate large diversity and heterogeneity in skin physiology, pigmentary disorders, and photoaging-related skin color shifting. Specific concerns around hyperpigmentation, skin tone evenness, and texture or roughness are very common among Hispanics, demanding targeted medical and cosmeceutical solutions. Customized daily routines including sufficient photo-protection are essential to address such needs. This mini review identifies some of the specific skin concerns of Hispanics in America and emphasizes the needs for long-term sunscreen use and education. J Drugs Dermatol. 2019;18(3 Suppl):s121-123.


Assuntos
Hispano-Americanos , Transtornos da Pigmentação/prevenção & controle , Lesões Pré-Cancerosas/prevenção & controle , Envelhecimento da Pele/efeitos da radiação , Adulto , Idoso , Cosmecêuticos/administração & dosagem , Feminino , Humanos , Estilo de Vida/etnologia , Educação de Pacientes como Assunto , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/etiologia , Transtornos da Pigmentação/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/patologia , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/fisiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Pigmentação da Pele/efeitos dos fármacos , Pigmentação da Pele/fisiologia , Pigmentação da Pele/efeitos da radiação , Luz Solar , Protetores Solares/administração & dosagem , Estados Unidos
8.
Asian Pac J Cancer Prev ; 20(2): 411-415, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30803200

RESUMO

Background: Oral potentially malignant disorders (OPMDs) and oral cancer (OC) are preventable oral mucosal diseases prevalent in Asian region. This epidemiological study aims to identify oral potentially malignant disorders (OPMDs) and oral cancer (OC), confirm histopathologically, and treat or refer these cases among the population of Eastern Development Region (EDR) of Nepal. It also attempts to assess the risk factors associated in order to compare dose­response measurements of oral habits in these patients. Methods: Cross-sectional epidemiological study was conducted over a period of 2 years in 16 districts of EDR. A total of 3,200 people were screened. A brief history was taken and visual screening examination was conducted in two phases as described by British Columbia Oral Cancer Prevention Program. Suspicious oral lesions were biopsied either by punch or scalpel after toluidine blue staining. Tissue specimen was transported to the institutional lab for histopathological processing. The reports were sent to the patients through the local leaders or organizations. Results: More than 40% of the study population either chewed areca nut and/or tobacco. Eighteen percent were smokers. OPMDs were prevalent among 468 study population with male-female ratio of 3:1. Tobacco pouch keratosis (50.4%) was the most prevalent OPMD, followed by OSF (29.1%). Fifty-two had squamous cell carcinoma and 8 had verrucous carcinoma. Conclusion: Chewing areca nut, tobacco, commercial areca nut/tobacco preparation and smoking being the major risk factors, there is high prevalence of oral cancer and OPMDs in the EDR of Nepal.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Detecção Precoce de Câncer , Neoplasias Bucais/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Tabaco sem Fumaça/efeitos adversos , Adulto , Areca/efeitos adversos , Carcinoma de Células Escamosas/etiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/etiologia , Nepal/epidemiologia , Lesões Pré-Cancerosas/etiologia , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco
9.
J Exp Ther Oncol ; 13(1): 59-63, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30658029

RESUMO

Background: Risk factors such as chronic use of tobacco, smoking and alcohol consumption of individual's lifestyle may possibly influence the significant role in the etiopathogenesis of precancerous lesions (PL) and Conditions (PC) and lead to oral cancer. Previous studies have revealed that genetic factors have contributed to a remarkable extent in the development of this chronic disease. Limited studies have confirmed that ABO blood groups remain reportedly possible genetic factor to the specific disease such as oral malignant. In this context, we have reported that individuals in a particular blood group are more prone to develop lesions and certain types of cancer. This has thrown a light to take up an effort to conduct this present study. Materials and methods: The present study covering 105 patients and grouped into three subjects with 35 participants in each. a) oral squamous cell carcinoma b) oral leukoplakia and c) submucous fibrosis. Gender and age group impact was also made to understand the interaction between the focused sample groups. A separate control was gathered from a same geographical population composed of gender-matched healthy volunteers. Slide agglutination was employed for blood grouping and results were tabulated for statistical analysis. Results: Blood group "A" exhibited a significant relationship between oral squamous cell carcinoma patient and odd ratio shown 1.74 times higher risk of developing oral cancer. Gender different and habit stimulation have increased the risk. A significant relationship was observed between ABO blood group and oral leukoplakia and oral submucous fibrosis. Conclusion: Study inferred that blood group "A" is found to be at the high risk in developing oral malignant syndrome due to its susceptibility, whereas oral pre-cancer is hypothesized that individual habits are the host risk factor and transformed to carcinoma by interacting genetic factors to act upon ABO blood group.


Assuntos
Tipagem e Reações Cruzadas Sanguíneas , Neoplasias Bucais , Fibrose Oral Submucosa , Lesões Pré-Cancerosas , Humanos , Leucoplasia Oral , Neoplasias Bucais/etiologia , Fibrose Oral Submucosa/etiologia , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Síndrome
10.
Esophagus ; 16(1): 98-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30145681

RESUMO

BACKGROUND: Esophageal adenocarcinoma (EAC) is frequently found on the right-anterior wall of the distal esophagus in short-segment Barrett's esophagus (SSBE) patients. However, the endoscopic characteristics of EAC in cases with long-segment BE (LSBE) and squamous cell carcinoma (ESCC) in the lower esophagus remain to be fully evaluated. Here, we determined the circumferential distribution and clinical characteristics of esophageal cancer occurring in the lower esophagus based on histological subtype. METHODS: We retrospectively reviewed the medical records of 150 patients with esophageal cancer (ESCC, n = 100; EAC, n = 50) diagnosed at our hospital or a related facility between January 2002 and June 2017, including information regarding endoscopic findings, etiology, and clinical parameters. RESULTS: Of the 100 patients with ESCC, 28 lesions were located in the lower esophagus, though characteristic circumferential distribution was not seen regardless of location. Those showed a greater frequency of smoking and drinking habit and gastric mucosal atrophy as compared to patients with EAC. Consistent with the previous reports, EAC in SSBE (n = 41) was frequently located on the right-anterior wall. Likewise, EAC at the esophagogastric junction (EGJ) in LSBE was frequently located on the right-anterior wall, while EAC distant from the EGJ showed no characteristic circumferential distribution. CONCLUSION: Our results showed no circumferential predilection for ESCC in the lower esophagus, suggesting that development of this type of lesion may be less affected by gastroesophageal reflux. In addition, EAC at the EGJ was frequently found on the right-anterior wall irrespective of BE length.


Assuntos
Esôfago de Barrett/patologia , Neoplasias Esofágicas/patologia , Lesões Pré-Cancerosas/patologia , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esôfago de Barrett/etiologia , Neoplasias Esofágicas/etiologia , Esofagite Péptica/complicações , Esofagoscopia , Feminino , Gastrite Atrófica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/etiologia , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/etiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia
11.
J Gastroenterol Hepatol ; 34(5): 852-856, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30357905

RESUMO

BACKGROUND AND AIM: Chronic Helicobacter pylori infection causes gastric mucosal inflammation as an important antecedent of gastric cancer. We aimed to evaluate associations of blood markers of inflammation with gastric intestinal metaplasia and dysplasia in H. pylori-infected individuals. METHODS: We compared pre-treatment serum levels of immune-related and inflammation-related markers between 99 individuals with intestinal metaplasia or dysplasia and 75 control individuals with non-atrophic gastritis within an H. pylori eradication trial in Mexico. Serum levels of 28 markers measured with Luminex bead-based assays were categorized in tertiles as low (T1), middle (T2), and high (T3). Logistic regression models were used to calculate age-adjusted and sex-adjusted odds ratios and 95% confidence intervals. All statistical tests were two-sided, and significance values were adjusted for multiple comparisons using false discovery rate methods. RESULTS: Five markers were nominally associated (Ptrend  < 0.05) with the presence of advanced premalignant gastric lesions. Adjusted odds ratios (95% confidence interval) of T2 and T3 versus T1 were 4.09 (1.65-10.17) and 3.08 (1.23-7.68) for CCL3/MIP1A, 3.21 (1.33-7.75) and 2.69 (1.10-6.57) for CCL20/MIP3A levels, 1.79 (0.77-4.18) and 2.39 (1.02-5.60) for IL-1ß, 1.34 (0.56-3.19) and 3.02 (1.29-7.12) for IL-4, and 1.07 (0.44-2.59) and 3.07 (1.32-7.14) for IL-5, respectively. Two (IL-4 and IL-5) of the five markers had false discovery rate adjusted Ptrend  < 0.2. CONCLUSIONS: Our results suggest that certain Th2 and other cytokines may have a role in promoting carcinogenesis in the setting of H. pylori infection. Additional research is needed to replicate these findings, extend to pre-diagnostic samples, and elucidate the underlying mechanisms.


Assuntos
Biomarcadores Tumorais/sangue , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/etiologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia , Proteínas Adaptadoras de Transdução de Sinal/sangue , Idoso , Idoso de 80 Anos ou mais , Quimiocina CCL20/sangue , Quimiocina CCL3/sangue , Doença Crônica , Feminino , Gastrite/microbiologia , Infecções por Helicobacter , Helicobacter pylori , Humanos , Inflamação , Interleucina-1beta/sangue , Interleucina-4/sangue , Interleucina-5/sangue , Intestinos/patologia , Masculino , Metaplasia , Pessoa de Meia-Idade , Células Th2
12.
Gastrointest Endosc ; 89(3): 565-575.e3, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30326231

RESUMO

BACKGROUND AND AIMS: The appropriate site for targeted biopsy during surveillance colonoscopy for ulcerative colitis (UC) is still unclear. We aimed to clarify key endoscopic findings suggestive of neoplastic lesions for targeted biopsy in UC. METHODS: First, we created 769 stereomicroscopic pictures (509 neoplastic, 260 non-neoplastic) mimicking magnifying colonoscopic images from surgically resected specimens, including areas surrounding 25 neoplastic lesions in 15 patients with colitis-associated cancer at a single referral center. Second, we validated the results by using 113 magnifying endoscopic images (64 neoplastic, 49 non-neoplastic) from 39 lesions in 26 patients. Two evaluators, blinded to the pathologic diagnosis, independently classified them according to Kudo's pit pattern and surface morphology, such as pine-cone/villi patterns. The correlation between stereomicroscopic and pathologic findings (neoplastic vs non-neoplastic) for each image was investigated. The interobserver agreement was assessed using kappa statistics. RESULTS: In the stereomicroscopic analysis, neoplastic pit patterns (types III-V) were significantly correlated with the presence of neoplasia (sensitivity 77.4%, specificity 89.5%, kappa value 0.677). Pine-cone/villi patterns also showed high specificity (96.8%) but low sensitivity (21.4%, kappa value 0.625) for neoplasia. Endoscopic validation showed similar trends. A revision of the endoscopic findings of flat dysplasia with non-neoplastic pit patterns revealed that a reddish area may facilitate the identification of such lesions. CONCLUSIONS: Targeted biopsies are recommended, especially for lesions showing pine-cone/villi patterns in addition to neoplastic pit patterns. For flat "non-neoplastic pit patterns," a reddish area may be an indication for a biopsy.


Assuntos
Adenocarcinoma/patologia , Colite Ulcerativa/patologia , Neoplasias Colorretais/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Adenocarcinoma/cirurgia , Adulto , Biópsia/métodos , Colite Ulcerativa/complicações , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/cirurgia , Corantes , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Sensibilidade e Especificidade , Adulto Jovem
13.
Pathol Oncol Res ; 25(3): 1135-1142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30467699

RESUMO

Gastric cancer (GC) is the first cancer-related cause of death in Chile; however, no plan for GC early detection has been implemented in this country. The OLGA system characterizes gastritis from stages 0 to IV according to the risk of developing GC based on H. pylori infection, atrophy, metaplasia and GC. In this study, the performance of the OLGA system was evaluated in 485 Chilean patients receiving routine endoscopy to improve the detection of early GC or preneoplastic lesions. The results showed that OLGA scores, atrophy, metaplasia and GC increased significantly with age (p < 0.001). Conversely, H. pylori infection was higher in younger groups (p < 0.05). All gastric lesions were more frequent in men than women. The majority of patients with atrophy also had metaplasia (99%, p < 0.0001). Patients with H. pylori infection had more gastric atrophy and metaplasia than those without infection (p < 0.05). Of the 485 patients, 21 (4.3%) had GC, being 2.3 times more frequent among men than women and about 2/3 (14) were in OLGA stage ≥2. In addition, 19 (90%) GC patients had atrophy and 18 (85%) had metaplasia (p < 0.001). In conclusion, the OLGA system facilitated the evaluation of GC precursor lesions particularly in patients with an OLGA score > 2 between 45 and 56 years old, because this group showed atrophy and intestinal metaplasia more frequently. Therefore, biennial endoscopic surveillance of patients with an OLGA >2 can be an important health policy in Chile for diagnosing GC in its early stages and reducing mortality over the next two decades.


Assuntos
Detecção Precoce de Câncer/métodos , Gastrite/diagnóstico , Infecções por Helicobacter/complicações , Metaplasia/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Índice de Gravidade de Doença , Neoplasias Gástricas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Seguimentos , Gastrite/etiologia , Gastrite/patologia , Infecções por Helicobacter/virologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metaplasia/etiologia , Metaplasia/patologia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/patologia , Prognóstico , Fatores de Risco , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologia , Adulto Jovem
14.
Dis Colon Rectum ; 62(1): 112-120, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30451747

RESUMO

BACKGROUND: Anal canal carcinoma is relevant because it commonly occurs in high-risk groups, and its incidence has been increasing. OBJECTIVE: This study evaluated the accuracy of anal cytology in the screening of precursor lesions of anal cancer, compared with histopathologic examination as the reference, in all subjects and in men who have sex with men, HIV-infected men and women, and men who have sex with men and HIV-infected subgroups. DATA SOURCES: The data included studies identified in the MEDLINE, Latin American and Caribbean Health Sciences, Cochrane Library, and Embase electronic databases, as well as in the grey literature. The search terms included anal cancer, anal dysplasia, anal intraepithelial neoplasia, screening, and anal cytology. STUDY SELECTION: After excluding studies with no histopathological data and those with duplicate and missing data, 34 primary studies were included. INTERVENTION: Cytology of anal smears was studied. MAIN OUTCOME MEASURES: Sensitivity, specificity, diagnostic OR, and area under the curve were measured. RESULTS: A total of 5093 patients were included. The pooled sensitivity of anal cytology was 85.0% (95% CI, 82.0%-87.0%) and pooled specificity was 43.2% (95% CI, 41.4%-45.1%) for the detection of anal intraepithelial neoplasia grade 2 or worse versus anal intraepithelial neoplasia grade 1 and normal when measuring all subjects. The accuracy of anal cytology was higher in the men who have sex with men and HIV-infected and men who have sex with men only subgroups. LIMITATIONS: This study was limited by its specificity. CONCLUSIONS: The study results support the hypothesis that cytology is a good test for the screening of anal cancer.


Assuntos
Canal Anal/patologia , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias do Ânus/etiologia , Citodiagnóstico , Feminino , Infecções por HIV/complicações , Homossexualidade Masculina , Humanos , Masculino , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Sensibilidade e Especificidade
15.
Turk J Gastroenterol ; 30(2): 139-147, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30460897

RESUMO

BACKGROUND/AIMS: Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). High-grade dysplasia (HGD) and low-grade dysplasia (LGD) are premalignant conditions. The aim of this study is to evaluate the risk of CRC/dysplasia in patients with UC, and the related risk factors. MATERIALS AND METHODS: Medical records of 1659 patients dating between 1993 and 2016 were scanned from an inflammatory bowel disease database. A total of 801 patients with UC who underwent at least one colonoscopic procedure with at least 1-year follow-up period were included in the study. Clinical, endoscopic, and histopathological data were assessed. RESULTS: The mean disease duration was 6.7±6.6 years. The total disease duration was 5334 person-years duration (pyd), and 34% of patients had the disease for 8 years or longer. The prevalence of UC-associated CRC was 0.7%, and the prevalence of dysplasia was 0.85%. The overall incidence of CRC was determined to be 1.1/1000 pyd. The cumulative risk of CRC was 0.3% at 10 years, 1.3% at 20 years, and 5.9% at 30 years. The Cox regression analysis indicated that primary sclerosing cholangitis (HR:13.677, 95% CI:2.6-70.8, p = 0.012) was an independent risk factor for developing UC-associated CRC. CONCLUSION: This study underlined the low risk of CRC and dysplasia in patients with UC in a tertiary referral center in the western part of Turkey. Primary sclerosing cholangitis was found to be the most important risk factor for the development of CRC in patients with UC. Identification of risk factors is important to categorize patients into subgroups to know which patients will require frequent surveillance.


Assuntos
Colite Ulcerativa/complicações , Colo/patologia , Neoplasias Colorretais/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Reto/patologia , Idoso , Colite Ulcerativa/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/etiologia , Bases de Dados Factuais , Feminino , Humanos , Hiperplasia/epidemiologia , Hiperplasia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/etiologia , Prevalência , Fatores de Risco , Centros de Atenção Terciária , Turquia/epidemiologia
16.
Oral Oncol ; 87: 58-63, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527244

RESUMO

OBJECTIVES: To elucidate the risk of malignant transformation to invasive oral cancer by subtypes of oral potentially malignant disorders (OPMD) and to examine the independent effects of risk factors, particularly alcohol drinking, by subtype based on a nationwide oral cancer screening program targeting at general population with habits of smoking and/or betel quids chewing. MATERIALS AND METHODS: The total of 8501 subjects diagnosed as different subtypes of OPMDs from the Taiwanese screening program between 2004 and 2009 were followed up over time to ascertain the occurrence of invasive oral cancer. The hazard ratios of malignant transformation were estimated by using Cox proportional hazards regression model. RESULTS: The overall malignant rate (per 1000 person-years) to oral cancer was 8.4 (407 incident cases with an average of 5.7 years of follow-up). The highest rate was noted in exophytic verrucous hyperplasia (33), followed by erythroplakia (11.8), erythroleukoplakia (10.7), oral submucous fibrosis (OSF) (8.6), and leukoplakia (5.4). After adjusting for confounders, exophytic verrucous hyperplasia still had a 5.69 (4.47-7.24) times risk compared with leukoplakia. The corresponding figures for erythroplakia, erythroleukoplakia, and OSF were 2.25 (1.31-3.89), 2.00 (1.13-3.53), and 1.63 (1.29-2.06), respectively. Alcohol drinking elevated the overall risk of malignant transformation by 23% (1-52% and also triggered a higher risk in OSF (aHR = 1.62 (1.06-2.47)). The higher risk attributed to betel quids chewing was noted for exophytic verrucous hyperplasia (aHR = 4.23 (1.55-11.55)). CONCLUSIONS: The risk of malignant transformation to oral cancer varied with the subtypes of OPMD and was elevated in OSF and verrucous hyperplasia attributed to alcohol drinking and betel quids, respectively.


Assuntos
Transformação Celular Neoplásica/patologia , Detecção Precoce de Câncer/estatística & dados numéricos , Leucoplasia Oral/patologia , Neoplasias Bucais/epidemiologia , Lesões Pré-Cancerosas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Areca/efeitos adversos , Feminino , Seguimentos , Humanos , Hiperplasia/epidemiologia , Hiperplasia/etiologia , Hiperplasia/patologia , Incidência , Leucoplasia Oral/epidemiologia , Leucoplasia Oral/etiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/etiologia , Estudos Prospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
18.
Ann Dermatol Venereol ; 145(10): 587-592, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30243819

RESUMO

Lesions occurring in actinic keratoses (AK) form erythematous, squamous, crusty and keratotic papules that appear on skin chronically exposed to the sun due to ultraviolet radiation. They are formed by the proliferation of atypical keratinocytes limited to the epidermis and may progress to squamous cell carcinoma in situ and to cutaneous squamous cell carcinoma (CEC). Although low, the metastatic risk associated with the CEC is not negligible. The concept of field cancerization was introduced in 1953 following studies of neoplastic lesions of the oral mucosa. A cancer field is a normal-looking pre-tumoral zone with subclinical, multifocal anomalies, which may constitute a base for new neoplastic lesions. Such fields are frequently seen in areas of photo-exposed skin and around the edges of AK and CEC. In this event, treatment should not be limited to visible or palpable AK lesions, and if a cancer field is suspected, treatment involving the physical destruction or elimination of atypical keratinocytes from the entire area should be considered. Such an approach may improve the long-term prognosis, reduce treatment costs and ensure optimal cosmetic outcome.


Assuntos
Carcinoma de Células Escamosas/etiologia , Epiderme/patologia , Ceratose Actínica/patologia , Neoplasias Induzidas por Radiação/etiologia , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/etiologia , Carcinoma in Situ/etiologia , Carcinoma in Situ/patologia , Carcinoma in Situ/prevenção & controle , Carcinoma in Situ/cirurgia , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/prevenção & controle , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Diagnóstico Diferencial , Progressão da Doença , Epiderme/efeitos da radiação , Epiderme/cirurgia , Humanos , Queratinócitos/patologia , Queratinócitos/efeitos da radiação , Ceratose Actínica/diagnóstico , Ceratose Actínica/etiologia , Metástase Neoplásica , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/prevenção & controle , Oncogenes , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/prevenção & controle , Lesões Pré-Cancerosas/cirurgia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos
19.
J Dig Dis ; 19(10): 596-604, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30187683

RESUMO

OBJECTIVES: Histological discrepancies between biopsy and resection specimens are common. In this study, we aimed to analyze the risk factors predicting histological upgrade or downgrade of biopsy-diagnosed gastric low-grade dysplasia (LGD). METHODS: The medical records of patients with 104 biopsy-diagnosed gastric LGD from January 2011 to December 2017 were collected. The association of endoscopic characteristics with histological discrepancies between the biopsy and resection specimens was analyzed. The risk factors for histological upgrade were studied using the multivariate analysis. RESULTS: Among the 104 lesions, 88 were removed by endoscopic resection and 16 were monitored. The upgrade and downgrade rates of the pathological diagnosis were 48.9% and 12.5%, respectively. Lesion size >20 mm, surface redness and positive results in magnifying endoscopy with narrow band imaging (ME-NBI) were risk factors for histological upgrade. Compared with the negative ME-NBI group, the positive ME-NBI group had a higher upgrade rate (56.8% vs 7.1%) but a lower downgrade rate (2.7% vs 64.3%). In addition, 11 of the 16 the gastric LGD with negative ME-NBI findings were monitored, and all 11 lesions regressed to gastritis during follow-up. CONCLUSIONS: Endoscopic resection should be recommended in cases of LGD showing surface redness, with a lesion size of >20 mm or positive ME-NBI result, whereas regular follow-up may be an option for LGD with negative ME-NBI result.


Assuntos
Mucosa Gástrica/patologia , Lesões Pré-Cancerosas/etiologia , Neoplasias Gástricas/etiologia , Adulto , Idoso , Biópsia , Feminino , Mucosa Gástrica/diagnóstico por imagem , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita , Estudos Retrospectivos , Fatores de Risco
20.
Asian Pac J Cancer Prev ; 19(9): 2485-2492, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30256041

RESUMO

Background: Oral Cancer is a major public health problem in most of the South East Asian countries including Sri Lanka. Use of tobacco in the form of smokeless tobacco and smoking, use of alcohol and betel quid chewing are the major contributory factors for causation oral cancer. The aim of this study was to investigate the prevalence of lifestyle factors responsible for causation of oral cancer and Oral Potentially Malignant Disorders (OPMD) in the Sabaragamuwa province of Sri Lanka. Methods: A cross-sectional community based study was conducted in Sabaragamuwa province by interviewing, then conducting an oral examination, on 1029 subjects over 30 years of age, over a one year period from November 2006. The study protocol included an interviewer-administered questionnaire to gather socio-demographic factors, recording of habits that included areca/betel chewing, smoking, and alcohol consumption. A three-day food diary was obtained, particularly to assess the consumption of tea, fruits and vegetables. The weight and height of residents was taken for calculation of Body Mass Index (BMI). Results: One hundred and two individuals with one or more OPMD were detected among these 1029 subjects. The prevalence of OPMD, weighted according to the estate sector and gender, was estimated as 11.3%. The prevalence of daily betel quid chewing in this study was 53.8%: 15.7% without tobacco and 47.4% with tobacco. The prevalence of individuals who reported consumption of alcohol at least weekly was 13.4%. A significant minority, 31.7%, were under nourished, with a BMI < 18.5. Forty six percent of the males practiced combined habits of betel quid chewing, smoking and regular use of alcohol. Conclusions: This study discloses high prevalence of OPMD and of lifestyle factors for oral cancer in these communities. There is an urgent need for a comprehensive strategy to control the use of tobacco, betel quid chewing and alcohol for prevention of oral cancer.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Areca/efeitos adversos , Índice de Massa Corporal , Estilo de Vida , Neoplasias Bucais/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Fumar/efeitos adversos , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/etiologia , Lesões Pré-Cancerosas/etiologia , Prevalência , Prognóstico , Fatores de Risco , População Rural
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA