Gastrointestinal Neoplasia Research Articles

International consensus classification of gastrointestinal epithelial neoplasia: Usefulness for esophageal carcinoma

International consensus classification of gastrointestinal epithelial neoplasia: Usefulness for esophageal carcinoma

International consensus classification of gastrointestinal epithelial neoplasia: Usefulness for esophageal carcinoma

International consensus classification of gastrointestinal epithelial neoplasia: Usefulness for esophageal carcinoma

The association between diverticulosis and lower gastrointestinal neoplasia: A study of 7,544 patients undergoing colonoscopy

The association between diverticulosis and lower gastrointestinal neoplasia: A study of 7,544 patients undergoing colonoscopy

The pathology of epithelial pre-malignancy of the gastrointestinal tract

This chapter deals with pre-malignant epithelial lesions of the gastrointestinal tract that have the potential to become cancers. Pre-malignant lesions are divided into two types: those characterized by dysplastic mucosa and those without dysplasia. Examples of the two types are present in the oesophagus, stomach and intestine.In the oesophagus, dysplasia of the squamous epithelium is a precursor to squamous carcinoma. There are differences in interpretation between Western and Japanese pathologists in the diagnosis of oesophageal squamous lesions. Dysplasia in Barrett's oesophagus is regarded as a precursor of adenocarcinoma. The goal of endoscopic surveillance in Barrett's mucosa is the detection of high-grade dysplasia. There are several problems with our current knowledge of high-grade dysplasia and controversies regarding its management. There are differences in the interpretation of biopsies of gastric epithelial dysplasia between Japanese and Western pathologists. In the colon, pre-malignant lesions include dysplasia seen in inflammatory bowel disease and colonic adenomas. The most significant predictor of the risk of malignancy in patients with inflammatory bowel disease is the presence of dysplasia in colonic biopsies.Because of the similarity of neoplasia throughout the gastrointestinal tract, there have been attempts to unify its classification, terminology and diagnostic criteria internationally, the most recently proposed modified classification of gastrointestinal neoplasia being the Vienna classification. Dysplasia of the columnar mucosa has a similar appearance in Barrett's oesophagus, the stomach and the colon. Criteria for its histological diagnosis and grading are reviewed, with an emphasis on areas of diagnostic difficulty such as interobserver variation, and discrepancies between Western and Japanese pathologists. Implication of the presence of dysplasia that are specific to each organ site are discussed, highlighting weaknesses and controversies in current knowledge.

Gastrin, growth, and colon neoplasia

See article on page 820 The ability of the gastric hormone gastrin to stimulate gut epithelial cell proliferation has been appreciated since the late 1960s.1 However, aside from the special...

Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia.

Large differences have been found between Western and Japanese pathologists in their diagnosis of adenoma/dysplasia and early carcinoma for gastric, colorectal and oesophageal epithelial neoplastic lesions. Common worldwide terminology based on clinical usefulness, that is, on neoplastic severity and depth of invasion, is needed. Thirty-one pathologists from 12 countries reviewed 35 gastric, 20 colorectal and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics. Suspected or definite carcinoma was diagnosed in 17-66% 'of gastric, in 5-40% of colorectal, and in 10-67% of oesophageal slides by pathologists with a Western viewpoint, but in 77-94% of gastric, in 45-75% of colorectal and in 81-100% of oesophageal slides by pathologists with a Japanese viewpoint (from Japan, Germany, Austria and UK). Overall, there was poor agreement between the conventional Western and Japanese diagnoses (kappa values lower than 0.3 for gastric, colorectal and oesophageal lesions). There was much better agreement among the pathologists (kappa values higher than 0.5 for gastric and colorectal lesions) when the original assessments of the slides were regrouped into the five categories of the following classification of GI epithelial neoplasia we hereby propose: C1, negative for neoplasia; C2, indefinite for neoplasia; C3, mucosal low-grade neoplasia (low-grade adenoma/dysplasia); C4, mucosal high-grade neoplasia (high-grade adenoma/dysplasia plus mucosal carcinoma); C5, submucosal invasion of neoplasia. The intercountry differences in the diagnoses of adenoma/dysplasia and early carcinoma can, in large part, be resolved by adopting terminology based on neoplastic severity and depth of invasion. Problems with defining intramucosal invasion are thus avoided. Moreover, grouping high-grade adenoma/dysplasia and mucosal carcinoma together in one category is clinically useful, as patients with small mucosal neoplastic lesions can be cured by endoscopic local resection.

The Vienna classification of gastrointestinal epithelial neoplasia

BACKGROUNDUse of the conventional Western and Japanese classification systems of gastrointestinal epithelial neoplasia results in large differences among pathologists in the diagnosis of oesophageal, gastric, and colorectal neoplastic lesions.AIMTo develop...

Low-power laser therapy for gastrointestinal neoplasia.

The purpose of this study was to evaluate changes in the degree of neoplasia-induced stenosis and clinical symptoms before and after therapy with a contact low-power neodymium yttrium aluminum garnet (Nd:YAG) laser. Fifty patients with pathologically proven gastrointestinal (GI) neoplasia were studied; 21 with benign lesions and 29 with malignant tumors. The low-power contact Nd:YAG laser was applied toward the lesion, using an antegrade method as the scope was moved circumferentially and downward along the length of the lesions, step-by-step. The energy of the laser was 20W, with a duration of 1 to 2 min for each shot. Either the tumor was eradicated completely, or the neoplasia-induced stenosis was recanalized by laser via the endoscope. All benign lesions were completely remitted by laser therapy. The clinical symptoms in the 29 patients with malignant GI neoplasia showed a significant improvement (P < 0.001; Wilcoxon matched-pairs signed-rank test, one-tailed) after laser therapy in comparison with the symptoms before treatment. Malignant GI stenosis treated by laser resulted in recanalization in 93.1% of the 29 patients. Unfortunately, in 1 patient with gastric cancer, the disease progressively worsened after treatment. One of 3 patients with early cancer of the stomach who received laser therapy was found to have distant metastasis 2 years later. A patient with esophageal cancer developed an esophagobronchial fistula that was not a direct complication of the laser effect. Four patients with malignancies died of cancer progression during the 2 years of follow-up. We conclude that the low-power contact laser is a safe, convenient method for the treatment of both benign and malignant tumors. Patients with advanced obstructive lesions have a better quality of life after laser therapy.

5-Amin Ole Vulinic Acid-Induced Protoporphyrin IX for the Detection of Gastrointestinal Dysplasia

The detection of gastrointestinal dysplasia is an unresolved problem. Fluorescence detection of these premalignancies after exogenous application of 5-aminolevulinic acid, which is converted to protoporphyrin IX and accumulates selectively in tumors, is an interesting approach. Illumination with light of appropriate wavelength allows the discrimination and detection of gastrointestinal neoplasia either by spectroscopy or fluorescence endoscopy because of a typical red fluorescence of protoporphyrin IX. Surveillance of patients with Barrett's esophagus and ulcerative colitis might benefit from this new technique.

Ultrasonographic features of canine gastrointestinal pythiosis.

Pythiosis is a chronic pyogranulomatous infection of the gastrointestinal tract or skin caused by the water borne pathogen Pythium insidiosum. The ultrasonographic features of nine dogs with gastrointestinal pythiosis are reported. The stomach, duodenum, jejunum or colon were affected. All dogs had thickening of the gastrointestinal wall and areas with obliteration of the normal layered appearance. In one dog an eccentric mass was found arising from the serosal surface of the wall of the colon with mild diffuse wall thickening. Regional lymph node enlargement was seen in seven of the nine dogs. One dog had invasion of the pancreas and signs compatible with extrahepatic biliary obstruction. When compared to previous reports of gastrointestinal neoplasia, the features of wall thickening, loss of layering and regional lymphadenopathy are not considered specific for gastrointestinal pythiosis. Histological examination of tissue specimens is required for diagnosis.

Initial Intermittent Microwave Irradiation for Fluorescence In Situ Hybridization Analysis in Paraffin-Embedded Tissue Sections of Gastrointestinal Neoplasia

Initial Intermittent Microwave Irradiation for Fluorescence In Situ Hybridization Analysis in Paraffin-Embedded Tissue Sections of Gastrointestinal Neoplasia

Lectin staining patterns in models of gastrointestinal neoplasia

Lectin staining patterns in models of gastrointestinal neoplasia

Review article: the stages of gastrointestinal carcinogenesis--application of rodent models to human disease.

The development of gastrointestinal cancer in humans and animals occurs through a consecutive series of stages termed initiation, promotion and progression. The characterization of each of these stages has been elucidated in several model systems as well as in human neoplasms. Both single, putatively initiated cells and preneoplastic foci have been identified by marker protein differences as well as by mutational changes. The promotion stage involves the clonal expansion of single initiated cells. Such expansion can be rapidly reversed by a variety of means, of which acute fasting (as exemplified in rat hepatocarcinogenesis) is among the most rapid and efficient. This reversal involves a selective apoptosis of preneoplastic cells and preneoplastic lesions, associated with a marked increase in expression of the proto-oncogene c-myc. Transition of cells from the stage of promotion to that of progression initially involves specific karyotypic alterations, as noted in both the rat liver model and human colon carcinogenesis. In the former, the transition appears to be associated with enhanced expression of the H119 imprinted putative tumour suppressor gene. Thus, the use of model systems may be applied directly to the human circumstance, increasing the potential both for rational prevention of gastrointestinal neoplasia and for new approaches to the therapy of neoplastic disease in the progression stage.

Biochemistry and pathological importance of mucin-associated antigens in gastrointestinal neoplasia

Publisher Summary This chapter focuses on mechanisms of alterations of Mucin-Associated Antigens in gastrointestinal neoplasia and their implications in clinical diagnostic and therapeutic oncology. The chapter focuses on real mucins (MUC), taking MUC1 and MUC2 as models. In addition, the chapter defines mucins and discusses the biochemistry and molecular biology of mucins, such as structural aspects of mucins, biosynthesis of mucins, glycosylation site specificity and biosynthetic routes of O-glycosylation, and antigenicity of mucins. During carcinogenesis, alterations of mucin peptide and mucin glycosylation occur. Although glycosylation of proteins should be dependent on the rate of synthesis, and overexpression of mucin species in certain cancers is associated with reduced glycosylation, there is no clear-cut evidence for a causal relationship between these events. The chapter provides an account for the expression of mucin-asssociated antigens in gastric tissues (in non-neoplastic and neoplastic gastric tissues); and expression in colorectal tissues (in non-neoplastic colorectal tissues and colorectal adenoma-carcinoma sequence). Mucin-associated peptide and carbohydrate antigens play an important role in different aspects of proliferation, local invasion, and metastasis of cancer cells. Thus, the carbohydrate antigens gained clinical importance as prognostic markers in a great variety of human carcinomas. Serum tumor markers (circulating antigens) also help in clinical tumor diagnostics. The chapter concludes with the perspectives in tumor immunology and cancer therapy. Mucin peptide cores, in addition to substituting carbohydrate structures, are involved in different types of cellular and humoral immune response in cancer. Biosynthesized glycopeptides containing clustered saccharide domains and peptides that mimic carbohydrates may be applied in future studies on therapy of gastrointestinal carcinomas.

Photodynamic therapy using 5-aminolaevulinic acid for oesophageal adenocarcinoma associated with Barrett’s metaplasia

Photodynamic therapy (PDT) is a novel technique for local endoscopic treatment of gastrointestinal neoplasia. Current photosensitisers for PDT may cause prolonged skin phototoxicity. 5-Aminolaevulinic acid (ALA), a precursor of the photosensitiser protoporphyrin IX (PpIX), is more acceptable because of its short half-life and preferential accumulation in mucosa and mucosal tumour. We have treated 12 patients, median age 73 years (range 55–88) with oesophageal adenocarcinoma arising from Barrett’s metaplasia (two carcinomas-in-situ, grade 0; 10 carcinomas, grade l–llA based on endoluminal ultrasound in two and CT scanning in 10 patients). ALA (60 and 75 mg/kg body weight) was given orally in two or five equally divided doses. The PpIX distribution in stomach, normal oesophagus, Barrett’s mucosa and carcinoma was measured by quantitative fluorescence photometry. PDT was performed using laser light (630 nm) delivered via a cylindrical diffuser 4–6 h after the first dose of ALA. The patients received one to four sessions of PDT. PpIX accumulation in the mucosa was two to three times that in the lamina propria. The differential distribution between carcinomatous and normal oesophageal mucosa was less marked (carcinoma:normal mucosa ratio=1.4). Higher doses of ALA increased PpIX accumulation in all tissues but did not increase the differential PpIX distribution between tumour and normal oesophageal mucosa. After PDT using ALA (ALA/PDT), all mucosa showed superficial white necrotic changes and the histology confirmed fibrinoid necrosis. One patient with carcinoma-in-situ had the tumour eradicated after one treatment with no recurrence at 28 months. Another patient with a small T1 tumour required four ALA/PDT treatments, and died of other disease after 36 months. There was no evidence of recurrence. The tumour bulk in the other carcinomas was not significantly reduced. ALA/PDT has a potential for the eradication of small tumours but careful patient selection with endoluminal ultrasound is needed when using ALA/PDT to treat oesophageal cancer.

Early oral feeding reduced recovery time after surgery for gynaecological malignancies

Cutillo G, Maneschi F, Franchi, M , et al. Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: a randomized study. Obstet Gynecol1999 Jan; 93 : 41 –5....

Gelatinase (MMP-2 and -9) expression in gastrointestinal malignancy.

The aim of the study was to investigate expression of the active and inactive gelatinases (MMP-2 and -9) in colorectal neoplasia and gastric cancer compared with normal mucosa. A total of 53 colorectal cancers and corresponding normal mucosa were studied using gelatin zymography as well as 15 colorectal adenomas and 13 gastric cancers with corresponding normal mucosa. Overexpression of all the gelatinases occurs in both colorectal and gastric cancer, with activation of MMP-2 appearing to be a feature of the malignant phenotype. Overexpression of MMP-9 occurs in colorectal adenomas. The gelatinases are overexpressed in gastrointestinal neoplasia, suggesting that these enzymes may have an important role in tumour invasion and metastasis.

Emergency and Critical Care of Ferrets

Ferrets are becoming increasingly popular as pets in the United States. Emergency situations involving ferrets are most often caused by gastrointestinal disease, neoplasia, cardiac disease, or endocrinopathy. Hospitalization and supportive care of the critically ill ferret, emergency treatment techniques, and diagnostic procedures are discussed. Diseases most commonly involved in critical presentations are reviewed along with treatment protocols.

Endoscopic therapeutic esophageal interventions

Endoscopic modalities for the treatment of esophageal disease continue to expand. Botulinum toxin, already well established for the treatment of primary achalasia, has been used for the treatment of secondary achalasia, motility disorders associated with diverticula, and muscular A-rings. Argon plasma coagulation, recently approved for clinical use in the United States, has been used to treat different types of esophageal pathology. A novel and promising application is the treatment of Zenker's diverticulum. Photodynamic therapy has secured a role in the curative and palliative treatment of esophageal malignancy. Fractionation of laser application was explored as one method to improve treatment efficacy. Expandable metal stents remain popular, but they are expensive and have drawbacks. The early complication rate associated with their deploying can be remarkably high, and up to one third of patients require placement of a second stent. New expandable stent designs, including the first prototypes of a biodergradable stent and an ultraviolet-cured balloon expandable plastic stent, have been introducted to addrees limitations such as non-retrievability and tumor ingrowth. The most exciting developments have been in the detection and treatment of early gastrointestinal neoplasia. A preliminary in vitro and in vivo study investigated the use of laser-induced fluorescence spectroscopy after administration of a photosensitizer to discriminate between maligant and normal tissue. Endoscopic mucosectomy for the treatment of early cancer, a standard procedure in Japan, is rapidly gaining popularity in the United States and Europe. Tissue fluorescence spectoroscopy is a new diagnostic modality that is likely to heavily impact on our ability to detect dysplasia and neoplasm in the esophagus.

Characterization of Gastrointestinal Tumors

Transabdominal ultrasonography is used increasingly for the evaluation of gastrointestinal disorders in small animals, including neoplasms such as lymphosarcoma, carcinoma, and smooth muscle tumors (leiomyoma, leiomyosarcoma). An updated summary of the clinical studies currently investigating the use of ultrasonography to detect and to characterize gastrointestinal neoplasia is presented in this article.