Gastric Type Research Articles

A case report of mucinous adenocarcinoma derived from intra-ampullary papillary-tubular neoplasm with a malignant course

BackgroundIntra-ampullary papillary-tubular neoplasm (IAPN) has been classified as a Vater papillary tumor. The prognosis of IAPN is generally relatively good. Here, we describe a patient with a mucinous adenocarcinoma cluster in the Vater papilla of IAPN origin.Clinical presentationThe patient was a 66-year-old man who was admitted to our hospital after a diagnosis of pancreatic head carcinoma based on a pancreatic duct dilatation found on abdominal ultrasound. CT showed a 40 mm lesion in the pancreatic head and expansion of the main pancreatic duct to a maximum diameter of 9 mm on the caudal side of the lesion. The extrahepatic bile duct had also expanded to a maximum diameter of 8 mm. PET/CT showed fluorodeoxyglucose (FDG) accumulation of SUVmax 6.02 that corresponded to the tumor in the pancreatic head, though it did not suggest distant metastasis. The patient was diagnosed with pancreatic head carcinoma T3 N0 M0 Stage IIA and underwent a pancreaticoduodenectomy. Pathology indicated that the tumor in the pancreatic head was a benign inflammatory lesion. On the other hand, the papillotubular tumor pervading the lumen in the duodenal papillary common channel met the criteria for IAPN, and a mucinous adenocarcinoma cluster found in the surrounding stroma suggested malignant transformation of IAPN. No metastasis to lymph nodes was demonstrated. With regard to the mucus phenotype of each lesion, the IAPN was MUC2 and MUC5AC positive, while the mucinous adenocarcinoma was MUC2-positive and MUC5AC-negative. In addition, CD10 was negative in both lesions, suggesting that mucus transformation from the gastric type to the intestinal type was a key element. A blood test 10 months after surgery showed increased CA19-9 (105 U/mL) and CEA (7.1 ng/mL). Abdominal CT showed multiple cystoid nodes in the liver, which were diagnosed as multiple liver metastases of mucinous adenocarcinoma transformed from the IAPN.ConclusionsWe reported a case with IAPN that developed in the Vater papilla, which took an extremely malignant course. IAPN generally has a good prognosis, but it is important to understand that a malignant course may occur.

Helicobacter Infection and Gastric Adenoma.

Background: We aimed to provide insight into the actual frequencies of gastric adenoma types and their association with gastritis status and associated mucosal changes with a focus on Helicobacter infection and the operative link on gastritis assessment (OLGA)/operative link on gastric intestinal metaplasia assessment (OLGIM) staging. Methods: From the archive of the Institute of Pathology in Bayreuth, we collected a consecutive series of 1058 gastric adenomas diagnosed between 1987 and 2017. Clinicopathological parameters retrieved from diagnostic reports included adenoma type and localization, associated mucosal changes in antrum and corpus (i.e., type of gastritis, the extent of intestinal metaplasia and atrophy), gender, date of birth, and date of diagnosis. Results: Intestinal-type adenoma was the most frequent adenoma (89.1%), followed by foveolar-type adenoma (4.3%), pyloric gland adenoma (3.4%), adenomas associated with hereditary tumor syndromes (2.8%), and oxyntic gland adenoma (0.4%). Adenomas were found in the background of Helicobacter pylori (H. pylori) gastritis in 23.9%, Ex-H. pylori gastritis in 36.0%, autoimmune gastritis in 24.8%, chemical reactive gastritis in 7.4%, and others in 0.1%. More than 70% of patients with gastric adenomas had low-risk stages in OLGA and OLGIM. Conclusions: We found a higher frequency of foveolar-type adenoma than anticipated from the literature. It needs to be questioned whether OLGA/OLGIM staging can be applied to all patients.

Development and evaluation of interpenetrating polymer network based superporous hydrogel gastroretentive drug delivery systems (SPH IPN-GRDDS)

Super porous hydrogels were developed to retain the drug within intestinal PH which expand rapidly in the gastric region together with its characteristics for longer time while releasing the drug at predetermined rate. The present work focuses on formulation amelioration and advancement about super porous hydrogel tablet dosage forms of esomeprazole, a proton pump inhibitor. The formulations of gastric retentive type are prepared from semi IPN super porous hydrogel (SPH) using different concentrations of two different polymers polyvinyl alcohol (PVA), chitosan (CS) and a crosslinking agent glutaraldehyde to get the desired controlled release profile. Prepared SPH was further loaded with esomeprazole and then finally powdered. The powdered material was finally compressed to prepare SPH gastro retentive tablets of esomeprazole. Pre-formulation studies conform thecompatibility between drug and selected excipients. Prepared super porous hydrogels (SPHS) were shown desired or optimized porosity, swellability, density, mechanical strength. And drug loading. Prepared gastro retentive tablets, were shown extended gastro-retention up to 18 h, with a lag time of 11–16 min. SPH tablets were exhibited programmed drug delivery (Sustained release) behavior of above 60% medication delivery up to 7 h, along with absolute drug release time was achieved in less than 12 h (FT-5 &FT-6). The obtained value of release exponent (n) 0.733, is a sign of anomalous diffusion behavior reasonably because of bulging phenomenon.

The effect on glycemic status in type 2 diabetes mellitus after gastric cancer surgery

Background: Gastric cancer is a leading cause of cancer death worldwide. With progress in the field of gastric cancer treatment, as indicated by the improved survival rate, postoperative quality of life as well as the appropriate surgical treatment for a cure has become very important. Recently, metabolic surgery has become an appealing treatment option for patients with type 2 DM. Although the purpose of metabolic surgery and gastric cancer surgery is completely different, they are related clinically and technically. Thus organized evaluation of the impact of gastric cancer surgery on diabetes is necessary.Methods: 30 patients with gastric cancer and type 2 DM who underwent curative gastrectomy were selected. Patients were followed up till 12 months, the study population grouped depending upon the glycemic status and results compared using chi square test.Results: Three out of 30 patients had complete remission of diabetes at 12 months, 17 patients improved and 10 patients remained stationary. Short duration (<5 years) had a median reduction in insulin by 8.9 units versus 2.5 units in long duration (>10 years) diabetes. Maximum reduction (>10 U/day) and remission occurred in those who underwent total gastrectomy. The results were compared using chi square test and the p value was 0.048428 (<0.05) proving significant.Conclusions: The glycemic status was found to improve following gastric cancer surgery which was found to be related to the extent of gastrectomy and the diabetes duration and was found to be statistically significant.

Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

BackgroundEndoscopic cyanoacrylate (glue) injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts (GRSs). Balloon-occluded retrograde transvenous occlusion (BRTOcc) of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt. This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic (BRTOcc) approach for the treatment of bleeding fundal varices.MethodsWe retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018. Data were extracted for patient demographics, clinical and endoscopic findings, technical details, and adverse events of the endoscopic–BRTOcc approach and patient outcomes.ResultsWe identified 30 patients (13 [43.3%] women; median age 58 [range, 25–92] years) with gastroesophageal varices type 2 (53.3%, 16/30) and isolated gastric varices type 1 (46.7%, 14/30) per Sarin classification, and median clinical and endoscopic follow-up of 151 (range, 4–2,513) days and 98 (range, 3–2,373) days, respectively. The median volume of octyl-cyanoacrylate: Lipiodol injected was 7 (range, 4–22) mL. Procedure-related adverse events occurred in three (10.0%) patients, including transient fever, non-life-threatening pulmonary glue embolism, and an injection-site ulcer bleed. Complete gastric variceal obturation was achieved in 18 of 21 patients (85.7%) at endoscopic follow-up. Delayed variceal rebleeding was confirmed in one patient (3.3%) and suspected in two patients (6.7%). Although no procedure-related deaths occurred, the overall mortality rate was 46.7%, primarily from liver-disease progression and co-morbidities.ConclusionThe combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices, with a high rate of variceal obturation and a low rate of serious adverse events.

A "Just Enough" Gross Proximal Margin Length Ensuring Pathologically Complete Resection in Distal Gastrectomy for Gastric Cancer.

The objective of this study is to determine a "just enough" gross proximal margin (PM) length to ensure a pathologically negative PM in distal gastrectomy for gastric cancer. There is a discrepancy between the gross and pathological proximal boundaries of gastric cancer. We must transect the stomach maintaining some safety margins to obtain a pathologically negative PM. However, we have no standard to indicate where to transect the stomach. Patients undergoing distal gastrectomy for gastric cancer were enrolled. A new parameter named ΔPM, which corresponded to the pathological extension proximal to the gross tumor boundary toward the resection stump, was evaluated. The number of patients was counted in each ΔPM range of 1-cm increments. The maximum ΔPM was defined as the first value at which the number of patients became 0, and it was determined as the recommended gross PM length for each disease type. In cT1, 259 and 330 patients were assigned to differentiated (Dif) and undifferentiated types (Und), respectively. The maximum ΔPM was 20 mm for Dif and 40 mm for Und. In cT2-4, 194 and 490 patients were assigned to the expansive (Exp) and infiltrative (Inf) growth types. The maximum ΔPM was 30 mm for Exp. The maximum ΔPM was 50 mm for Inf of less than 80 mm and 60 mm for Inf of 80 mm or more. A newly recommended gross PM length to ensure pathologically negative PMs in distal gastrectomy for each gastric cancer type was determined.

Long-Term Follow-up of Gastric Precancerous Lesions in a Low GC Incidence Area.

INTRODUCTION:Data on the evolution of gastric precancerous lesions (GPL), especially in countries of a Low gastric cancer incidence area are limited. Our objective was to study a long-term evolution of GPL in France.METHODS:All the patients diagnosed with GPL (atrophic gastritis, intestinal metaplasia [IM], and dysplasia) between 2000 and 2015 and fulfilling criteria for evolution assessment (at least 2 endoscopies, minimal follow-up of 6 months, and at least 2 biopsies obtained from the antrum and corpus) were included. Clinical and endoscopic data were analyzed, and histological samples were reviewed by an expert pathologist with evaluation of the Operative Link on Gastric Intestinal Metaplasia Assessment stage and type of IM.RESULTS:From the 507 patients with GPL, 79 fulfilled the strict criteria. During a mean follow-up of 66 months, during which the patients had a mean number of 4 endoscopies (min–max: 2–21) with 9 biopsies/endoscopy, a stability was observed in 70% of patients. Progression occurred in 14% of patients, within a mean delay of 62.1 months (min–max: 17–99). Progression of the lesions was significantly higher in patients with incomplete type of IM (relative risk of progression for incomplete IM: 11.5; 95% confidence interval 2.5–53.1). Regression of IM occurred in 16% of the patients, after a mean delay of 90 months.DISCUSSION:This study shows that the patients with antrum-limited IM, especially of incomplete type, are at the highest risk of developing gastric cancer. In most patients, however, the lesions remain stable, which highlights the need for additional markers to better target the patients at risk of progression.

Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases

Aim: The inlet patch, also called as the heterotopic gastric mucosa, is often located in proximal esophagus and is generally asymptomatic. These lesions are rarely polypoid and mostly have a patchy pattern. In the literature, there are only few cases of inlet patches that show a malignant progression following a metaplasia- dysplasia- adenocarcinoma sequence. In our study, we aimed to present the endoscopic and morphological features of our case series. Methods: The study, which was conducted in two clinics, included the inlet patch cases diagnosed in esophagus biopsy materials between 2016 and 2019. The slides and the demographic data of the cases were re-analyzed. Results: Among 4190 cases whose esophageal biopsies were examined, 63 inlet patches (1.5%) were diagnosed. Thirty four cases were male and 29 were female. Age range was 16-82 years. The cases were mostly located in proximal esophagus and the size of the lesions ranged between 0.2-3.5 cm. One of the four cases with polypoid appearance was microscopically diagnosed as a hyperplastic polyp. The most common gastric type epithelium was the oxyntic type. Helicobacter pylori was observed in four cases, and intestinal metaplasia and low-grade dysplasia were observed in one. No malignancy was diagnosed in our series. Conclusion: Although benign, the inlet patch is significant due to its risk of progression to malignancy. Thus, obtaining biopsies from each lesion endoscopically considered as inlet patch is recommended. This will help determine the precise incidence of the inlet patch and more importantly, identify neoplasia earlier.

Symptoms Investigate the Frequency of Various Presentations of the Meckel’s Diverticulum and Help Identify Sign Promptly

Background: Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but could also be symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. This study was performed to assess the frequency of various presentations of the patients who underwent surgery with the diagnosis of Meckel's diverticulum in Children's Medical Center, Tehran, Iran from March 2005 to March 2011. Material and Methods: Since this study is a case series report (retrospective descriptive study) and the purpose is assessing the various presentation of Meckel’s` diverticulum, we express the frequency and percent frequency of each presentation. The data collection tool was a five-part survey form. The first part was related to demographic data, the second part was related to clinical data, the third part was related to diagnostic data, the fourth part was related to treatment data and the fifth part was related to histological data. Data were analysed using SPSS statistical program. Result: We found 49 patients in this period (71% male 29% female). The mean age was 3.5 years (1 month to 9 years). The male to female ratio was 2.5. The most common clinical symptoms were abdominal pain (63%). forty-three percent of patients had single symptoms and the others had combined symptoms such as abdominal pain and hematochezia. Only 8 patients with lower gastrointestinal bleeding had a Technetium scan and all of them were positive. Associated findings during surgery included appendicitis and invagination. Our sonographic imaging findings were nonspecific. In the pathologic report, 6 patients had gangrene in specimens and 2 perforations. The lining was of gastric type in 24 specimens pancreatic in 3 and mixed in 2 specimens. None of those with the gastric type of mucosa showed Helicobacter pylori infection. Conclusion: Regarding our findings, clinical findings of Meckel's diverticulum in our study were rather the same as in the literature. Pathologic examination of specimens revealed that most diverticula were lined by gastric type of mucosa. None of those with the gastric type of mucosa showed Helicobacter pylori infection.

Gastric duplication cyst with localization in the pancreas in children

Introduction. Gastric duplication cyst is a rare clinical observation. More often, these cysts are localized in the fundus or body of the stomach and have a common muscle layers and blood supply. Even more rarely, duplication cysts are not anatomically connected to the stomach and are located in other parts of the abdominal cavity or in the retroperitoneal space. Cystic duplication of the gastrointestinal tract, which are localized in the pancreas, is extremely rare.
 The aim of the study is to demonstrate the possibility of using laparoscopy for this disease.
 Materials and methods. The paper describes three rare clinical observations of gastric duplication cyst topographically associated with the pancreas. In the first clinical observation, gastric duplication cyst was combined with mediastinal duplication cysts, an esophageal bronchial fistula, and extralobar pulmonary sequestrations. In the second observation, a duplication cyst had communication with the pancreatic duct system and was clinically manifested by recurrent bleeding. In the third case, a duplication cyst is diagnosed behind the body and tail of the pancreas.
 Results. In all cases, surgical treatment was carried out by the laparoscopic method, leading to complete recovery. Histological examination in all the described observations confirmed the gastric type of epithelium of the mucous membrane of the cysts. The article provides a review of the literature.
 Conclusion. Thus, the efficiency of laparoscopic interventions in children with gastric duplications topographically associated with the pancreas was demonstrated. The described rare clinical manifestations, a combination of defects, as well as the possible presence of heterotopy of the mucous membrane of the duplication cyst confirm the need for surgical correction of the disease.

Newly recognized face of cervical cancer: Gastric type of Mucinous adenocarcinoma- A case report and brief literature review

Gastric type mucinous adenocarcinoma (GAS) is a mucinous type of endocervical adenocarcinoma described in WHO 2014. It is known for its aggressive nature, recurrence rate, distant metastasis and poor response to therapy. It is associated with minimal deviation adenocarcinoma (MDA) which belongs to the same spectrum of the disease. Hence it is very important to diagnose these rare tumors and differentiate it from usual endocervical and metastatic adenocarcinomas. We describe a case of Gastric type of mucinous adenocarcinoma, which is MUC6, mCEA positive and p16 negative.

Survival Benefit from Adjuvant Radiotherapy by Gastric Cancer Histologic Type: A National Cohort Study

Per INT0116, adjuvant chemoradiotherapy (CRT) after curative resection for gastric cancer (GC) has been shown to improve survival. ARTIST-2 challenged the role of adjuvant radiotherapy (RT) after D2 dissection. Few studies evaluate the prognostic impact of histologic subtype on survival and benefit from adjuvant RT. We hypothesized that survival would be different among adenocarcinoma [AC], signet ring carcinoma [SRC], and linitis plastica/diffuse type carcinoma [LPD], and for each, adjuvant RT would improve survival. The National Cancer Database (2004—2015) identified patients with AJCC stage I to III GC (AC, SRC, and LPC) who underwent upfront surgery, with and without adjuvant chemotherapy (CHT), RT, or CRT. On multivariable analysis (MVA), Cox proportional adjusted hazard ratios (aHR) compared overall survival (OS) adjusting for histology, RT (no RT vs 4500-5400cGy), stage, resection margins (positive, negative, or not evaluated), number of lymph nodes dissected (0, 1-14 nodes, 15-25, ≥26), CHT, year, age, sex, race, urban vs. rural, facility type, region, Charlson-Deyo comorbidity coefficient (CDCC), and insurance. Cox MVA for the subset of patients who received adjuvant CHT (CHT only or CRT) assessed survival by histology and receipt of CRT. Among 12,506 patients (AC: 9,353; SRC: 2,458; LPD: 695; median follow-up 5.5yrs) on MVA, OS was worse for SRC and LPD vs. AC (three-year overall survival [3yrOS] for AC = 57.2%, for SRC = 50.3%, for LPD = 46.6%; SRC vs AC aHR 1.26, P<0.001; LPD vs AC aHR 1.30, P<0.001). Receipt of adjuvant RT (N = 2,096) vs. no RT (N = 10,410) was associated with improved OS (3yrOS for RT: 55.9%; 3yrOS for no RT: 55.2%; RT vs no RT aHR 0.79, P<0.001). Other factors associated with improved OS were receipt of CHT (HR 0.91, P = 0.009), extent of LN dissection (15-25 nodes vs no nodes HR 0.85, P = 0.004; ≥26 vs no nodes HR 0.77, P<0.001), negative margins (positive margins HR 2.15, P<0.001), lower stage (stage II vs I HR 1.97, P<0.001; stage III vs I HR 2.73, P<0.001), younger age, female sex (HR 0.87, P<0.001), Asian race (vs white, HR 0.68, P<0.001), treatment at an academic center (vs. community HR 0.76, P<0.001), and lower CDCC (CDCC3 vs 0 HR 1.40, P<0.001). For patients who had adjuvant CHT and CRT (N = 3,859), OS was worse for SRC and LPD vs AC (3yrOS AC = 54.2%, SRC = 46.3%, LPD = 44.7%; SRC vs AC aHR 1.38, P<0.001; LPD vs AC aHR 1.33, P<0.001). CRT (N = 2,004, 51.9%) was associated with improved OS compared to CHT (N = 1,855) (3yrOS CRT: 56.2%; 3yrOS CHT: 46.3%; aHR 0.75, P<0.001). Stratified by histology (AC: 2,568; SRC: 971; LPD: 320), adjuvant CRT had improved OS vs. CHT (AC CRT vs CHT aHR 0.74, P<0.001; SRC CRT vs CHT aHR 0.79, P = 0.008; LPD CRT vs CHT aHR 0.73, P = 0.047). Survival differences existed among different histologic subgroups, with SRC and LPD conferring lower OS compared to AC, even when adjusting for stage and treatment patterns. AC, SRC, and LPD may benefit from adjuvant RT.

Clinical characteristics and prognosis of intraductal papillary mucinous neoplasm of the biliary tract

Objective: To study the clinical features, diagnosis, surgery treatment and prognosis of intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B). Methods: The data of 16 patients with IPMN-B admitted to The First Hospital of Jilin University and Xi'an Third Hospital from January 2014 to January 2018 were retrospectively analyzed. Kaplan-Meier method was used to conduct the survival analysis. These patients included 10 males and 6 females, the median age was 57 years. Results: Clinical manifestations were mainly jaundice (11 cases), upper abdominal pain (12 cases) and hyperpyretic chills (4 cases), combined with bile duct stones (14 cases) and hepatic lobe atrophy (2 cases). The average size of the tumor was (2.6±0.7) cm. All of 16 cases were diagnosed as IPMN-B, including 5 cases of invasive carcinoma (4 cases were perineural invasion) without vascular invasion and 6 cases of non-invasion carcinoma. The pathological type included 8 cases of pancreaticobiliary duct type, 5 cases of gastric type, 2 cases of intestinal type and 1 case of eosinophils type. Laboratory tests showed abnormal liver function (12 cases), increased direct bilirubin (9 cases), increased carbohydrate antigen199 (CA199, 8 cases) and carcinoembryonic antigen (CEA, 4 cases). The enhanced CT detection showed 9 cases of intrabile duct mass and 14 cases of bile duct dilatation. Surgical resection is the main treatment method, including 2 cases of partial resection of liver, 12 cases of bile duct mass resection combined with choledochojejunostomy and 2 cases of pancreatoduodenectomy, all of whom achieved R0 resection. Fifteen patients were followed up and 4 died during the period. The median postoperative progression free survival was 31 months (95% CI: 33-47 months), and the recurrence rate at 1 year, 2-years and 3-years were 6.7%, 40.0% and 73.3%, respectively. The median overall survival was 35 months (95% CI: 23-47 months), and the 1 year, 2-years, and 3-years cumulative survival rates were 100%, 80.0%, and 53.3%, respectively. Conclusions: IPMN-B is a rare tumor of biliary tract system, which is difficult to be diagnosed early. The main treatment is surgical resection, which can achieve a good prognosis.

Hyalinized stroma is a characteristic feature of pancreatic intraductal oncocytic papillary neoplasm: An immunohistochemical study

Hyalinized stroma (HS) is a dense, eosinophilic, and amorphous extracellular material in the stroma. HS is observed in several tumors; however, it has not been comprehensively studied in pancreatic intraductal papillary mucinous neoplasm (IPMN) or intraductal oncocytic papillary neoplasm (IOPN). Here, we aimed to evaluate the immunohistochemical and microscopic characteristics of HS in IPMN and IOPN. The prevalence of HS was determined in 168 cases of IPMN, including intestinal type (IPMN-I), gastric type (IPMN-G), and pancreatobiliary type (IPMN-PB), as well as in 11 cases of IOPN. Immunohistochemical staining for laminin and collagen (types I, II, III, IV, and V), as well as Congo red staining were performed in IPMN and IOPN cases containing HS. The prevalence of HS among the IPMN and IOPN specimens was 1.2% (2/168 cases) and 45.5% (5/11 cases), respectively. The prevalence rates of HS in each IPMN subtype were as follows: 2.2% (2/91 cases) in IPMN-G, and 0% in IPMN-PB and IPMN-I. All seven HS cases were positive for collagen I, III, IV, and V but were negative for Congo red staining. Most cases showed negative, focal, or weak expression of laminin and type II collagen. These findings indicate that HS is associated with IOPN and is primarily composed of collagen fibers.

S3305 Surgical Outcomes of Gastric Cancer Patients Seen at a Safety Net Hospital in an Urban Academic Setting

INTRODUCTION: Gastric cancer remains a significant public health concern, and it is the third leading cause of cancer related deaths worldwide. We evaluated surgical outcomes in gastric cancer patients seen at a safety-net hospital with a high immigrant patient population. METHODS: A retrospective study was conducted to identify patients diagnosed with gastric cancer between 2010 and 2019 (N = 111) at our institution. All cases were histologically confirmed. Data on demographics, pathology, type of gastric cancer, surgery, and chemotherapy were obtained. Kaplan Meier and Cox regression analyses were used to evaluate factors associated with survival. Hazard ratios (HR) and confidence intervals (CI) are reported. RESULTS: Of the 111 patients with gastric cancer included in this study, 41.2% of patients underwent surgery; of which 26.2% were proximal, 52.4% were distal, and 21.4% were total gastrectomies (Table 1). Also, 61.9% of the surgeries were radical, and 38.1% palliative. Likewise, 68.4% had chemotherapy, of which 27.3% was neoadjuvant, 9.1% was adjuvant, and 63.6% was palliative. Gastric adenocarcinoma types were diffuse-type (61%), intestinal-type (33%), and mixed-type (6%). Diffuse-type cancer was more common in the younger population (≤40 years) compared to the older population, >40 years (P = 0.01). Mortality was significantly lower in those who had surgery (HR 0.36 CI 0.18–0.78), chemotherapy (HR 0.43 CI 0.23–0.80) compared to those who did not (P < 0.001). furthermore, patients who had neoadjuvant chemotherapy had a lower mortality compared to those who received palliative chemotherapy (HR 0.37 CI 0.15–0.89). Although survival appeared to be higher in patients with intestinal-type cancer compared to those with diffuse-type cancer who underwent surgery, this difference was not statistically significant (P = 0.136) See Figure 1. CONCLUSION: Gastric cancer surgery was associated with a lower mortality in our patient population. Also, multimodal therapy including surgery, chemotherapy, and neoadjuvant chemotherapy all improved survival outcomes. There was no difference in survival between patients with intestinal-type cancer compared to those with diffuse-type cancer who underwent surgery. In addition, the fact that diffuse-type cancer was more common in the younger population suggest that genetics may play a major role in these gastric cancer subtype. Further research is needed to identify pertinent prognostic indicators in gastric cancer patients.Figure 1Table 1.: Gastric cancer percentages for surgery and chemotherapy

Abstract 747: Pak1, TGFα, Ki 67 and survival in human gastric and gastroesophageal junction adenocarcinomas

Abstract Stomach cancer is the third most common cause of cancer mortality worldwide. Most are adenocarcinomas. Adenocarcinomas of the stomach fall into two obvious groups based on site of origin; those arising in the area of the gastroesophageal junction (GEJ) and those arising from a more distal location, which we term gastric in this study. Adenocarcinomas of the stomach fall into four obvious groups based on a combination of genomic, molecular biologic, clinical and histopathologic characteristics (Nagara A, Kikuchi O, Bass AJ, Cancer Discovery 2019; DOI: 10.1158/2159-8290.CD-19-0487). We are reporting herein a study of 99 patients with adenocarcinoma of the stomach. This study evaluates the location of the tumor, the histopathologic features of the tumor, the immunohistochemically determined nuclear and cytoplasmic expression of P21 activated kinase (Pak 1), Transforming Growth Factor α (TGFα), and Ki67, a marker of cell proliferation. This study correlates these findings with patient survival. The study reveals: 1. significantly lower survival in patients with diffuse type adenocarcinoma compared to intestinal type, in both GEJ and gastric locations. 2. both GEJ and gastric adenocarcinomas had a poor prognosis. 3. increased expression of both TGFα and Pak1 in GEJ adenocarcinomas. 4. Ki67 expression is significantly less in diffuse type than the intestinal type (p=0.01 for GEJ and 0.03 for gastric). 5. cytoplasmic Pak1 and cytoplasmic TGFα were highly positively correlated (p=0.0001). 6. Ki67 expression was significantly inversely correlated with both nuclear Pak1 (p=0.04) and nuclear TGFα (p=0.02). 7. significantly increased expression of nuclear Pak1 in gastric diffuse type compared with gastric intestinal (p=0.0002) and GEJ intestinal (p=0.0001). These data suggest that Pak1 and TGFα might serve as diagnostic biomarkers of subtypes of adenocarcinomas of the stomach and gastroesophogeal junction. Citation Format: Larry E. Douglass, Michael Parritt, Adam Neltner, Mariah Dooley, Michelle Robillard, Molly Frydl, Leah Focke, Kyle Damen, James A. Deddens, Julia H. Carter. Pak1, TGFα, Ki 67 and survival in human gastric and gastroesophageal junction adenocarcinomas [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 747.

Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure. All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB). Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3years. In the PRYGB, the effect lasted only for 2years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these. In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.

The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

BackgroundTo investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach (HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery.MethodsWe retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression.ResultsOur data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P = log rank (Mantel-Cox), (before PSM P = 0.397); (1:1 PSM P = 0.345); (1:2 PSM P = 0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching).ConclusionHAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

Limb-bud and heart as a novel biomarker for gastric intestinal type adenocarcinoma.

The present study compared the expression levels of limb-bud and heart (LBH) between gastric intestinal-type adenocarcinoma (GITA) and healthy gastric tissues; with the aim of investigating the possible effect of LBH on the prognosis of patients with GITA and to analyze the associated signaling pathways in GITA. Three Oncomine gastric datasets were utilized for the preliminary prediction of the expression levels of LBH mRNA in GITA and healthy gastric tissues. Gene expression and corresponding clinical data of 163 patients with GITA were downloaded from The Cancer Genome Atlas. Wilcoxon signed rank-sum test was used to distinguish the clinical value of LBH expression in the various clinicopathological features. Subsequently, Kaplan-Meier univariate and Cox multivariate survival analyses were performed to determine the prognostic significance of LBH expression in patients with GITA. Function enrichment analysis was conducted for the co-expression gene of LBH, defined as correlation coefficient r>0.06 and P<0.05 using Pearson's χ2 test. Bioinformatics data demonstrated that compared with that in the normal gastric mucosa, LBH mRNA expression was dramatically higher in GITA tissues (P<0.05). There were significant relationships between the differential expression levels of LBH and clinicopathological parameters in GITA patients (all p<0.05), including pathological stage T (T3-4 vs. T1-2), lymph node metastasis (no vs. yes), distant metastasis (no vs. yes), histological grade (grade 3 vs. grades 1–2) and tumor stage (stages 3–4 vs. stages 1–2). Additionally, the overall survival and disease-free survival (DFS) of patients in the high expression group were poorer compared with those in the low expression group (P<0.05). Cox multivariate survival analysis indicated that increased LBH expression was an independent predictor of poor DFS prognosis in patients with GITA (P=0.045). In summary, LBH is highly expressed in GITA, which can be used as an independent predictor of poor prognosis in patients with GITA. LBH co-expressed genes are closely associated with GITA tumor migration and metastasis.

The clinicopathological and molecular features of sporadic gastric foveolar type neoplasia

Gastric intraepithelial foveolar type neoplasia (IEFN) is not well defined. In addition, atrophic mucosa (AM) is an important issue to consider when evaluating gastric tumorigenesis. Here, we assessed the clinicopathological characteristics and molecular alterations contributing to the development of IEFN compared with intestinal type neoplasia. We examined the clinicopathological and molecular features of 42 cases of IEFN with low-grade dysplasia (LGD) and those of 77 cases of intraepithelial intestinal type neoplasia (IEIN) with LGD. The clinicopathological and molecular features examined included the AM status, mucin phenotype expression, CDX2 expression, p53 overexpression, β-catenin intranuclear accumulation, microsatellite instability (MSI), DNA methylation status (low methylation epigenotype [LME], intermediate ME, or high ME), allelic imbalances (AIs), and APC promoter 1B mutations. There were no differences in the frequencies of AM and rates of CDX2 expression between IEFN and IEIN cases. Although no differences in the frequencies of p53 overexpression and MSI were observed between the two histological types, intranuclear expression of β-catenin was significantly higher in IEIN than in IEFN. In addition, although the rate of LME was significantly higher in IEFN cases than in IEIN cases, IEFN was characterized by AIs at multiple foci. Finally, mutation of the APC promoter 1B, which is a characteristic of gastric adenocarcinoma and proximal polyposis of the stomach (potentially resembling IEFN), was detected in only one IEFN case. These findings suggested that IEFN may be an independent entity in terms of molecular alterations including the presence of multiple AIs and LME.