Gastric ciliated metaplasia. A study of 3406 gastrectomy specimens from dwellers of the Atlantic and the Pacific basins.

BACKGROUND: Ciliated cells in gastrectomies from patients dwelling in the Pacific and Atlantic basins have been reported previously. AIM: To compare all the results in an attempt to explain the findings. METHODS: Sections from 3406 gastrectomies were reviewed: 1966 and 1440 from the Atlantic and Pacific basins, respectively. Ciliated cells and intestinal metaplasia (IM) were recorded; IM was classified into focal or extensive IM. The total number of sections/gastrectomy was noted. RESULTS: In the Atlantic basin, 5% of specimens had ciliated metaplasia (CM); it was more frequent in intestinal carcinoma (IC; 9%) than diffuse carcinoma (DC; 3%) or miscellaneous gastric diseases (MGD; 3%). In the Pacific basin, the frequency of specimens with CM was 29%: it was more frequent in IC (43%) than in DC (16%) or MGD (10%). The difference between the frequency of CM in specimens with IC or with DC/MGD in the Atlantic and the Pacific basins was significant (p < or = 0.05). The presence of CM was influenced by age and the extent of IM in both basins, but not by sex or the number of sections investigated. CONCLUSIONS: CM-apparently an independent microscopic marker-was significantly higher in the Pacific than in the Atlantic basin. Environmental carcinogens involved in the evolution of IM and IC seem to be implicated in gastric ciliogenesis. Carcinogens that differ in nature and/or in strength in both basins might activate the latent natural genes encoding ciliated processes in gastric cells in patients subsequently developing gastric carcinoma, more notably of intestinal type.

Gastric carcinomas of intestinal type concur with distant changes in the gastric mucosa. A multicenter study in the Atlantic basin.

Population studies in the Pacific Basin showed that gastric carcinomas of intestinal type often concur with distant mucosal changes (DMCs). In the present work, the presence of DMCs was investigated in populations dwelling in the Atlantic Basin. A total of 1737 gastrectomy specimens were reviewed: 627 in New York, 435 in Reykjavik, 198 in Buenos Aires, 186 in Florence, 174 in London and the remaining 117 in Stockholm. A total of 17,282 sections were carefully scrutinized. The following DMCs were investigated: intramucosal glandular cysts, gastric cells with ciliated metaplasia, with large or small mucus negative vacuoles, and extensive intestinal metaplasia (IM). The highest frequencies of DMCs were found in Florence for specimens with intestinal type carcinoma: 41.3% had intramucosal cysts, 22.4% had cells with ciliated metaplasia, 12.9% cells with large vacuoles, and 50.9% had high IM. The highest frequency of gastric cells with small vacuoles was recorded in New York (9.1%), also in specimens with intestinal type carcinoma. Significantly lower DMCs percentages were found in specimens with carcinomas of diffuse type, and miscellaneous gastric diseases. The occurrence of DMCs was not influenced to a significant degree by the number of sections available per gastrectomy. Since environmental factors trigger the evolution of intestinal type carcinomas and as DMCs also occurred in specimens without carcinoma-although at a significantly lower rate--it is conceivable that DMCs are also evoked by environmental factors (before a gastric carcinoma ensues). DMCs were found in specimens having intestinal carcinomas either in the cardia, the corpus or the antrum. Thus, DMCs seem to provide the adequate "soil" for the development of gastric carcinomas of intestinal type, independently of the future localization of that tumor in the stomach.

[Cystadenoma and cystadenocarcinoma of the pancreas]. / Cistoadenomas y cistoadenocarcinomas del páncreas.

In the past 28 years 298 pancreatic tumors have been observed, out of which 2% (6 cases) were cystadenomas and 1.3% (4 cases) were cystadenocarcinomas. Cystadenomas appear around the 6th decade of life, what constitutes an argument against its congenital origin. They are more frequent in woman (2 to 1). The histopathologic differentiation of the mucinous cystic neoplasma often forming papillae of the serous cystadenoma is useful because those are likely to become malignant. Association of pancreatic cystadenomas with different pathologies (biliary lithiasis, cancer of a different location, cysts in other organs, diabetes) has been observed, but these would be mere coincidences. Cystadenomas are frequently operative findings (3 cases) in patients who had been operated on for different reasons, but they may have different symptoms, mainly pain and a abdominal mass. Visual method of diagnosis are useful in preoperative diagnosis. In cystic formations of the pancreas with surgical possibilities, operative biopsy a must be preferred to that one obtained by means of pre-operating needle puncture. Surgical resection is the method to be chosen, either enucleation (1 case) or pancreatectomy (3 cases), being more important in mucinous cystadenoma because they may become malignant. Cystadenocarcinomas are not so frequent and seem to originate in benign cystadenomas. Palpable tumors, compression signs and pain are the late clinical manifestations. The resection is the treatment to be chosen although the most cases are unresectable. An external drainage is not a satisfactory operation but it sometimes helps to lessen the symptoms, and sometimes its posterior resection was possible.

[Effect of acute irradiation on small bowel morphometry and D-xylose absorption in rats]. / Efecto de la irradiación aguda sobre la morfometría del intestino delgado y la absorción de D-xilosa en ratas.

UNLABELLED: In previous study in our laboratory, we had shown the effect of radiation on morphometry of small bowel of rats after 7 days of a single external doses of 1,000 rads with liver protection. Our aim was to determine the effect of the same procedure of gamma radiation in rats on the morphometry and D-Xylose absorption 7, 14 and 21 days after injury and compared with a control group matched by weight. The D-Xylose absorption was measured by plasmatic D-Xylose, 60' after an intragastric doses of the pentose (0.5 grs/kg of body weight). RESULTS: In the control group the mucosal thickness was 880 +/- 40 mu (X +/- SD), the vellous height was 640 +/- 37.6 mu and the xylosemia 15.91 +/- 11.39 mg%. At 7 days in the irradiated group (n: 11) the weight decreased 33.36 +/- 6.29% (Vs. control p less than .001), the mucosal thickness and the vellous height were 666 +/- 97 (p less than .001) and 466 +/- 66.9 mu (p less than .001) and the xylosemia 6.16 +/- 2.3 (p less than .05). The figures at 14 days (n: 16) showed improving and completed recovery at 21 days (n: 14). Irradiated rats were shown to be affected in weight, morphology and D-Xylose absorption, they began recovering after 7 days, and completed recovery at 21 days.

[Primary lymphoma of the small bowel and malabsorption]. / Linfoma primario de intestino delgado y malabsorción.

Between 1974 and 1984 we saw 69 patients with lymphoma that involved the gastrointestinal tract. In ten patients the lymphoma compromised the small bowel and were associated to malabsorption. Seven patients fulfilled the criteria to be considered as primary small bowel lymphoma. We presumed the intestinal origin in the other 3 patients, but it was impossible to confirm it. The peroral small bowel biopsy showed histological findings compatible with celiac disease in 7 patients. Other particular histological signs were patchy alterations, inconstant epithelial pseudo-stratification and ulcerations. In 2 cases we found findings that suggested the diagnosis of lymphoma. In 50% of patients we found unspecific malabsorption signs in the small bowel radiology. We found giant ulcers and stenosis too. The gluten-free diet or the steroid therapies resulted in temporary or inconstant improvement. The laparotomy was the most effective diagnostic approach. It was performed electively in 6 patients and in 1 because of a small bowel perforation. The primary small bowel lymphoma is an entity of difficult diagnosis. The most important trouble is to differentiate it with celiac disease.

Epithelioid hemangioendothelioma of the liver: report of two cases.

This report describes two patients with hepatic epithelioid hemangioendothelioma: a 33-year-old woman and a 28-year-old man. The first case presented with a palpable abdominal mass and has survived without treatment for 6 years since diagnosis, with ascites but a good general condition. The other patient presented with abdominal pain and cholestasis. He had a rapid course and death occurred 6 months after the onset of symptoms. Histologically the tumors consisted of a proliferation of neoplastic cells with an angiogenic tendency embedded in a myxohyaline stroma. Positivity for the factor VIII-related antigen, for UEA-I and for vimentin and negativity for keratin of the neoplastic cells in the immunohistochemical investigation permitted identification of their endothelial origin. In both cases, the initial diagnosis was erroneous.

Antigenic markers of hepatocellular carcinoma.

One hundred thirty-five hepatocellular carcinomas were examined for the presence of antigenic tumor markers by the avidin-biotin-peroxidase complex method. Ninety-seven were from the US and 38 came from Argentina. The following markers were tested: alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT), hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg), hepatitis D delta antigen (HD delta Ag), and Mallory's bodies (MB). In the US cases, AFP was present in 43%, AAT in 41%, HBsAg in 17%, and MB in 48%. Both HBcAg and HD delta Ag were absent. In the cases from Argentina, AFP was found in 26% and AAT in 18%. None of the other antigens were seen. Thirteen US tumors expressed three antigens and two four antigens simultaneously. This study reveals in humans a heterogenous expression of antigens by neoplastic hepatocytes with geographic differences, possibly due to multiple factors such as alcohol consumption or prevalence of hepatitis B infection.

Hiperplasia nodular focal hepatica. / Hepatic focal nodular hyperplasia

1) Se presentan 7 casos de hiperplasia nodular focal hepatica. 2) Se discute ubicacion nosologica y patogenia, senalando su trascendencia clinico-quirurgica. 3) Se describen caractes macro y microscopicos, estabeleciendose diagnostico diferencial con otros procesos nodulares. 4) No se comprueba vinculacion con anticonceptivos orales

Enfermedad de Darier con compromiso esofagico. / Darier's disease with esophageal involvement

Los autores presentan un caso de enfermedad de Darier con afectacion esofagica, estudiado desde el punto de vista clinico, radiologico, endoscopico e histopatologico. Se hace una breve resena bibliografica de esta infrecuente localizacion digestiva de la enfermedad

Biopsia del pancreas con aguja de Nordenstrom. Nota previa. / Biopsy of the pancreas using the Nordenstrom needle. Previous note

Se presentan 55 casos de biopsia del pancreas con aguja de Nordenstrom, efectuadas en los ultimos 5 anos. Se obtuvo un 76% de aciertos diagnosticos, con 1 solo caso de fistula pancreatica que curo a los pocos dias