Tumors Of Gastrointestinal Tract Research Articles

Esophageal squamous cell cancer with germline STK11 mutation - A possibility, a nightmare or the Peutz Jeghers Syndrome!

Background: Peutz Jeghers Syndrome (PJS) is characterized by multiple gastrointestinal hamartomatous polyps and muco-cutaneous pigmentation with increased risk of carcinomas of gastrointestinal tract, breast, lung and gynecological tumors. Only 2 % PJS have esophageal cancers, that too adenocarcinoma. So far esophageal Squamous Cell Carcinoma (SCC) has not been reported in association with PJS. We present a unique case in a young female with muco-cutaneous pigmentation who presented with esophageal SCC and was found to have germline Serine/Threonine Kinase 11 (STK11) mutation.

Bacteria derived extracellular vesicles in the pathogenesis and treatment of gastrointestinal tumours.

Extracellular vesicles are fundamentally significant in the communication between cells. Outer Membrane Vesicles(OMVs) are a special kind of EVs produced by Gram-negative bacteria, which are minute exosome-like particles budding from the outer membrane, which have been found to play essential roles in diverse bacterial life events, including regulation of microbial interactions, pathogenesis promotion, stress responses and biofilm formation. Recently, and more researches have explored the substantial potentials of EVs as natural functional nanoparticles in the bioengineering applications in infectious diseases, cardiovascular diseases, autoimmune diseases and neurological diseases, such as antibacterial therapy, cancer drugs and immunoadjuvants, with several candidates in clinical trials showing promising efficacy. However, due to the poor understanding of sources, membrane structures and biogenesis mechanisms of EVs, progress in clinical applications still remains timid. In this review, we summarize the latest findings of EVs, especially in gastrointestinal tract tumours, to provide a comprehensive introduction of EVs in tumorigenesis and therapeutics.

Difficulties in diagnosis of neuroendocrine tumors of the gastrointestinal tract

We present diagnosis and complex minimally invasive surgical treatment of a patient with long-standing neuroendocrine tumor of the upper gastrointestinal tract. We followed-up a 50-year-old female patient after endoscopic resection of polypoid neoplasm of the stomach for 2 non-organ retroperitoneal neoplasms in the area of hepatogastric ligament. After a comprehensive examination and minimally invasive surgery including laparoscopic resection of retroperitoneal neoplasms, immunohistochemical examination, PET-CT and targeted endoscopic ultrasound of the stomach, we diagnosed a highly differentiated gastric neuroendocrine tumor with metastases into lymph nodes of hepatogastric ligament. Combination of endoscopic and morphological diagnosis with rigorous histological examination of specimen provided correct diagnosis and reasonable strategy of aggressive minimally invasive surgical treatment.

Dissociating Fibroepithelioma of Pinkus From Internal Malignancy: A Single-Center Retrospective Study.

Fibroepithelioma of Pinkus (FeP) is a rare skin tumor with a clinical presentation similar to benign neoplasms such as acrochordons and seborrheic keratoses. Our study analyzed if there is an association between FeP and internal tumors, specifically gastrointestinal tract tumors. We retrospectively reviewed the medical records of patients with FeP for other tumors throughout their lives until 2020. Although the quality of documentation for each patient may have differed, this study suggests that the presence of FeP does not indicate the presence of gastrointestinal tract tumors, and there is no need for altered cancer screening recommendations for those with FeP.

Wnt signaling-associated proteins, β-catenin, and E-cadherin as a potential immunohistochemical bi-omarker of the progression of adenoma to colorectal carcinoma

Background: Colorectal carcinoma (CRC) is the most common and one of the main causes of mortality and morbidity globally among gastrointestinal tract tumors. A benign polyp is the first step in the multistage pathogenesis of colorectal cancer, which eventually progresses to an adenoma and a carcinoma. Wnt/ βeta-catenin signaling pathway plays an initiating and rate-limiting role in colorectal tumorigenesis. Aim of the work: To evaluate the association between the immunohistochemistry (expression of E-cadherin, and β-catenin with the histopathological grade, and stage of colorectal cancer. Materials and Methods: The study was retrospectively collected from the archives of the Department of Pathology in Tobruk Medical Center. Eighty-two histopathologically confirmed cases of adenomas (n = 48) (tubular, villous, and tubulovillous), and colorectal adenocarcinoma (Mucinous, and Non-mucinous) (n = 34) were included in this study over two years (2021-2023). The histopathological diagnosis, grade, and staging of the tumors were obtained. While clinical information was obtained from medical records and pathology reports. immunohistochemical staining was performed for all the cases using E-cadherin and β-catenin antibodies, and the results were analyzed. Results: A total of 82 patients were studied out of these, 51(62.2%) patients were male, whereas 31 (37.8%) were females with a male: female ratio of 1.6:1. Age ranged from 30 years to 80 years. The mean age was the mean age of 52.9 (SD±15.8). A high prevalence of adenoma cases was observed in the age group 30– 40 years. The peak incidence for both types of colorectal carcinoma was in 61-70 years. By scoring the intensity of β-catenin there are significant correlation of β-catenin expression with tumor grade, stage, lymph node metastasis, and types of adenomas. The intensity of staining of E-cadherin in 48 cases of adenomas was showing high expression in 39 cases (81.3%), and low expression in only 9 cases (18.7%). While, the majority of the patients with CRC (58.8%) had low expression of E-cadherin levels, and (41.2%) had high expression. Conclusion: Our findings imply that E-cadherin and β-catenin may contribute to the invasion and progression of colorectal cancer, which may serve as prognostic indicators for colorectal carcinoma

Dominantna simptomatologija i klinički značajni endoskopski nalazi kod bolesnika sa dispepsijom

Introduction. The role of esophagogastroduodenoscopy (EGDS) is reflected in the evaluation of various symptoms and signs of numerous organic disorders such as ulcer disease, reflux disease, diverticula, achalasia and tumors of the upper gastrointestinal tract, but also in the exclusion of the same conditions in patients, the basis of which is a functional disorder. Functional diseases of the digestive system are a great challenge in everyday clinical work. Aim. The goal of this study was to determine the frequency of functional dyspepsia in relation to the organic one by sex and age as well as the frequency of Helicobacter pylori infection (HBP) in patients with dyspepsia, performing upper endoscopy as the gold standard in differential diagnosis. Methods. The study analyzed 5,200 patients over a four-year period. All patients underwent upper endoscopy with dyspeptic disorders and all subjects underwent the biopsy of the gastric mucosa and pathohistological verification. Results. The frequency of dyspeptic disorders was higher in women than in men, with the average age being 43 years. The most common complaints were epigastric pain and postprandial fullness. Endoscopic findings were positive in 55% of patients, predominantly over 55 years of age, with no statistical difference between the HBP status. The most common changes were reflux esophagitis, gastric ulcer and duodenal ulcer. Conclusion. Our study showed a high rate of positive endoscopic findings in patients with dyspepsia according to the criteria of Rome IV. Gastroscopy has significant implications in patients with dyspepsia.

Clinico-Histomorphological Spectrum and CD34 in Gastro-Intestinal Stromal Tumours: An Experience from Tertiary Care Centre, Kolkata, India

Introduction: Gastrointestinal Stromal Tumours (GISTs) are an important subcategory of mesenchymal tumours of gastrointestinal tract. The discovery of c-kit mutation in a subset of GIST has made amenable the treatment of this entity by targeted therapy. Although, Cluster of Differentiation 34 (CD34) is a well established marker aiding in diagnosis of GIST, recent development of novel markers like Discovered on GIST1 (DOG1), CD117 have undermined its value. Still it’s a frequently used marker in the resource poor settings. Aim: To study the expression of CD34 immunomarker with respect to site, grade, stage, histomorphological type and risk category of GIST specimens received in the stipulated time period. Materials and Methods: An observational retrospective crosssectional was conducted in the Department of Pathology at R G Kar Medical College and Hospital, Kolkata, West Bangal, India. The duration of the study was three years and 11 months, from September 1, 2019 to August 31, 2022. All the samples diagnosed as GISTs within the study period, were taken from the received specimens in the department and immunohistochemical examination was done on the selected samples using monoclonal antibodies against CD34 after obtaining thin sections from formalin fixed paraffin embedded blocks and retrieval of antigen. The data was interpreted by light microscopy using a semiquantitative method with respect to prefixed parameters, where 50% proportional positivity of CD34 in the tumour cells was considered as positive. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Mean age of the study participants was 49.78 years. A total of 8 (34.7%) cases originating from stomach and 13 (56.5%) from intestine. Eight out of 23 (34.7%) cases showed positive expression of the marker. Six out of eight cases of gastric GISTs were found to be positive and 66.6% cases of high grade GISTs were positive for CD34. Statistically significant association was found between expression of CD34 and the site of tumour;-GISTs arising from stomach, particularly of spindle cell type, showing strong expression (p=0.003). It was found that, high grade GISTs are more likely to be positive for CD34. None of the epithelioid GISTs have shown positivity, neither any significant association was evident between expression of this marker with tumour stage or risk category. Conclusion: GISTs arising from stomach, particularly of spindle cell type, are more likely to show strong CD34 expression. Higher grade GISTs were found to be associated with positive CD34 expression in the present study, but no significant association was evident between expression of this marker.

CLINICOPATHOLOGICAL STUDY ON CARCINOMA OF ESOPHAGUS

Background: Oesophageal cancer is among the most severe gastrointestinal cancers in the world due to its quick progression and often fatal prognosis. There is a lack of available information on oesophageal cancer in India, especially in the research area. This research was performed to outline the clinicopathological as well as endoscopic patterns of oesophageal cancer in this area of the globe. The research offers local data as a baseline for future comparisons. Objectives: To know the occurrence of Squamous Cell Carcinoma (SCC ) and Adenocarcinoma (AC) of the esophagus in patients visiting Shree Krishna Hospital, Karamsad, to know the etiological factors of carcinoma esophagus, to identify disease presentation, prognosis, and progression, and to study the distribution of tumors in relation to age, sex, site of occurrence, and treatment. Study Design: Retrospective, observational study Methodology: This is a retrospective observational analysis of 150 histologically verified cases of oesophageal cancer treated at “Pramukhswami Medical College” (PSMC) and “Shree Krishna Hospital” (SKH), Karamsad between august 2020 to July 2022. Data were obtained and examined from the computer database of medical records. Results: Out of 150 patients,which accounts for 25 percent of all malignant gastrointestinal tract tumors at our hospital. The majority of patients (52 percent) came from rural regions and had poor socioeconomic positions. 43.33 percent of patients had smoking and 41.33 percent had drinking records, respectively. The middle 3rd esophagus (32.17%) was the most prevalent anatomical location for esophageal cancer followed by the cervical esophagus (18.88%) & gastro-oesophageal junction (13.99%). The most frequent histological form was SCC (86.33 percent). Conclusion Lack of awareness of the disease, poor accessibility to healthcare facilities, lack of diagnostic and staging facilities, lack of screening programs and the high cost of care are among the hallmarks of the disease in this region and pose a great challenge in the management of these patients. Addressing these challenges will help reverse this trend.

A case of mesenteric gastro intestinal stromal tumors: a diagnostic dilemma

Gastro intestinal stromal tumors (GIST) are non-epithelial tumors of gastrointestinal tract (GIT) arising from mesenchymal cells and interstitial cells of Cajal. It accounts for <1% of all of gastro-intestinal (GI) tumors and <5% of all GI malignancies. GIST most commonly involves stomach and small intestine, but rarely involves mesentery. Surgical resection is the main stay of treatment. Post-operative use of imatinib, delays the recurrence and improves the survival rate. In our study, we report a case of mesenteric GIST, a very rare entity and discuss the course of clinical presentation, diagnosis, management and prognosis.

FGFR2-amplified tumor clones are markedly heterogeneously distributed in carcinomas of the upper gastrointestinal tract

BackgroundFGFR2 is a therapy-relevant target in tumors of the upper gastrointestinal tract (GIT), and clinical trials are currently underway to test the efficacy of FGFR2 inhibitors. Tumor heterogeneity is one of the relevant causes of treatment failure. Almost nothing is known about the heterogeneous distribution of FGFR2-amplified clones in adenocarcinomas of the upper GIT.Patients and methodsTo assess FGFR2 gene copy number alteration and intratumoral heterogeneity of upper GIT adenocarcinomas, we analyzed 893 patient-derived formalin-fixed paraffin-embedded tumor specimens, including primary operated and neoadjuvant-treated tumors (462 gastric carcinomas and 429 esophageal adenocarcinomas) as well as complementary lymph node and distant metastasis by fluorescence in situ hybridization.ResultsTwenty-six gastric tumors (5.6%) and 21 esophageal adenocarcinomas (4.9%) showed FGFR2 amplification. Overall, 93% of gastric carcinomas and 83% of esophageal carcinomas showed heterogeneous amplification. FGFR2 amplification was found in different histological growth patterns, including intestinal and diffuse type according to the Lauren classification. In the primary gastric carcinoma group, FGFR2 amplification was associated with poor prognosis (p = 0.005).ConclusionHomogeneous FGFR2 amplification in tumors of the upper GIT is the exception. This has highly relevant implications in the nature of FGFR2 diagnostics (sufficient tumor cell number, determination of amplification at metastasis versus primary tumor, etc.) and on the response probability of appropriate inhibitors. It is relevant that the often poorly treatable and aggressive subtype of diffuse carcinomas (poorly cohesive carcinomas) also shows FGFR2 amplification and that an individualized therapy option with FGFR2 inhibitors could be an option in this group.

Endoscopic Ultrasound Localization Microscopy for the Evaluation of the Microvasculature of Gastrointestinal Tract Tumors in Rabbits.

The morphological and hemodynamic characterization of the microvascular network around the gastrointestinal (GI) tract can be of significant clinical value for the early diagnosis and treatment of GI tract cancer. Ultrasound localization microscopy (ULM) imaging has been demonstrated to be capable of resolving the microvascular network. However, the endoscopic application of ULM imaging techniques is still unknown. In this study, an endoscopic ultrasound localization microscopy (e-ULM) imaging technique was developed to evaluate the changes of microvasculature during GI tract tumor growth. A customized circular array transducer (center frequency: 6.8 MHz) and the coherent diverging wave compounding method were used to generate B-mode images. Spatiotemporal singular value decomposition processing was used to eliminate the background signals before signal localizations. The centroids of spatially isolated signals were localized and summed to generate the final super-resolution image. The final microvasculature map of a rabbit GI tract tumor reveals that e-ULM can be used to surpass the diffraction limit in traditional endoscopic ultrasound (EUS) imaging. Furthermore, it is observed that data from different stages of tumor growth exhibit significant differences in microvascular pattern and density. Our study demonstrated the implementation and application of an in vivo e-ULM imaging technique for the evaluation of the microvasculature of GI tumors. The efficient e-ULM imaging technique shows potential for use in the detection of GI tract tumor microcirculation changes and subsequent diagnosis of GI tract cancer.

Histologycally Confirmed Synchronous Pancreatic and Duodenal Double Cancer

Pancreatic adenocarcinoma is the most pervasive form of cancer with high mortality rates. Being obscure at the early stages, non-specific symptoms and their onset only in the late stages of the disease lead to detection of the III–IV stages cancer on initial diagnistics. Gastrointestinal stromal tumor (GIST) is an intramucosal tumor of gastrointestinal tract, which is a derivate of interstitial cells of Cajal. The unicity of the presented clinical case is the rareness of GIST, which was an incidental finding during diagnostics of pancreatic adenocarcinoma. Diagnosed by intravenous contrast computed tomography, synchronous pancreatic and duodenal double cancer was confirmed histologically after Whipple surgery. The opportunities of intravenous contrast computed tomography in diagnostics of synchronous cancer were demonstrated.

An innovative diagnosis in gastrointestinal neuroendocrine neoplasms using Wax-Physisorption-Kinetics-based FTIR Imaging

Neuroendocrine neoplasm (NEN) is a common gastrointestinal (GI) tract tumor divided into the neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC) according to mitosis and Ki-67 index. However, the objective discordance between interobserver may cause unsuitable diagnosis and misleading treatment. Nowadays, aberrant glycosylation of glycoconjugates inducing further populations of elongated complex oligosaccharide covalent attached to glycoconjugates anchored in the cell membrane by neo-synthesis of cancer-associated alteration of carbohydrate determinants were observed during cancer development. This study aimed to demonstrate the wax physisorption kinetics coupled with Fourier transform infrared (WPK-FTIR) imaging between NET and NEC in the rectum, colon, and stomach by utilizing two wax reagents (beeswax and paraplast) as glycan adsorbents for physical binding glycans of glycoconjugates based on dipole-induced dipole interaction. Results showed greater physisorption with beeswax than that of paraplast, suggesting highly populated elongated glycans of glycoconjugates adhering onto the tumor surfaces of NETs than that of adjacent benign mucosa in the rectum and colon. Besides, the WPK results of gastric NEN tissue sections showed a higher infrared absorbance ratio of beeswax-remnant to paraplast-remnant remains onto the tissue sections referring to a higher population of elongated glycans in gastric NET as compared with that of gastric NEC. Based on our findings, different anatomical locations could share similar phenomena with minor variance. In conclusion, WPK-FTIR imaging may have the potential to be employed as an alternative diagnostic method in GI NENs in the future.

Immunotherapies catering to the unmet medical need of cold colorectal cancer

As a common malignant tumor of gastrointestinal tract, the incidence of colorectal cancer (CRC) has gradually increased in recent years. In western developed countries, it has even become the second largest malignant tumor next to lung cancer. Immunotherapy is a hot topic in the field of cancer therapy, including immune checkpoint blockade (ICB), adoptive cell therapy (ACT), cancer vaccines and cytokines, aiming to improve the ability of the immune system to recognize, target and eliminate cancer cells. However, cold CRC, which accounts for a high proportion of CRC, is not so reactive to it. The development of immunotherapy to prevent cancer cells from forming “immune escape” pathways to the immune system in cold CRC, has been under increasing study attention. There is proof that an organic combination of radiotherapy, chemotherapy, and several immunotherapies can considerably boost the immune system’s capacity to eradicate tumor cells. In this review, we summarized the role of immunotherapy in colorectal cancer. In addition, we propose a breakthrough and strategy to improve the role of immunotherapy in cold CRC based on its characteristics.

Gastric glomangioma masquerading gastrointestinal stromal tumour - A case report with review of literature

Glomus tumours (GT) are mesenchymal tumours composed of modified smooth muscle cells of the glomus body. It commonly occurs in skin and soft tissue of the distal extremities. Gastric GT is a rare neoplasm of gastrointestinal tract that frequently mimics other mesenchymal neoplasms clinically and radiologically. We report a case of glomangioma of gastric antrum in a 55-year-old female, mimicking gastrointestinal stromal tumour (GIST) endoscopically. Radiographically, tumour was intramural, 6 cm in size, and initial biopsy was inconclusive. Laparoscopic-assisted partial gastrectomy was done. Histopathological examination showed uniform round cells arranged around the blood vessels, a characteristic of glomangioma. Tumour cells were strongly immunoreactive for smooth muscle actin and h-Caldesmon and negative for desmin, cytokeratin, CD34, CD117 and chromogranin, which helped rule out other differential diagnoses. Recognition of this rare entity is important as most of them are benign and surgical resection is curative.

Modern scientific and clinical developments in the treatment of malignant neoplasms of the upper gastrointestinal tract: results of ASCO-2022

Introduction. Malignant neoplasms of the upper gastrointestinal tract occupy the 6th position in terms of the frequency of detection of new cases of cancer. Within the framework of the Federal project “Fight against oncological diseases”, state tasks have been set that provide for a significant reduction in mortality from neoplasms, including malignant ones, to 185 cases per 100,000 people. The development, standardization and algorithmization of medical methodologies for drug treatment of cancer aimed at improving the quality of oncological care is underway. In early June 2022, the results of the latest clinical developments, including targeted and immune therapy for upper gastrointestinal tumors, were presented at the Annual Congress of the American Society of Clinical Oncology (ASCO). Popularization of innovative approaches to the treatment of cancerous tumors of the gastrointestinal tract fully meets the objectives of the Federal project.
 Materials and methods. This material was the result of a study of innovative clinical developments in drug therapy for tumors of the upper gastrointestinal tract, presented at the ASCO Annual Congress - June 2022 and the digital platform MEDTalks.nl: the Korean clinical trial K-Umbrella; the German-Swiss Phase 2b DANTE clinical trial; French national randomized trial GERCOR.
 Discussion and Conclusions. The results of the presented clinical developments demonstrate positive effects and an acceptable drug safety profile, which opens up prospects for their implementation in practice as part of innovative medical methodologies for the treatment of patients with malignant neoplasms of the upper gastrointestinal tract.

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Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tract with different expressions of CD117 (transmembrane KIT receptor tyrosine kinase) from other related tumors, which provides insights into the disease management of GIST. Tyrosine kinase inhibitors reduce the incidence of tumor recurrence and make the tumor resectable. Despite the malignant potential of GISTs, gastric GIST shows a better prognosis versus GISTs at other locations. Contrast-enhanced computed tomography (CECT) is considered the radiological diagnosis of choice because biopsy increases the risk of bleeding and tumor spreading. In addition to surgical resection which remains the mainstay of GIST treatment, active surveillance is also available for gastric tumor with a size <2cm. Currently, given the clinical consensus of an increased response of the tumor to chemotherapy after resection of the advanced lesion, patients with metastasis are also indicated for cytoreductive surgery. Various minimally invasive techniques including endoscopic (endoscopic band ligation, endoscopic muscularis dissection, endoscopic submucosal dissection, endoscopic submucosal tunnelling, endoscopic full-thickness resection), laparoscopic and combined techniques (laparoscopic endoscopic cooperative surgery, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique) have been developed for surgical resection of tumors. Due to the high recurrence rate even during treatment, patients receive a physical examination and CECT follow-up every 3-5 months for 5 years followed by annual visits.

Study from Tertiary Care Centre Elucidating the Role of CD 117 & DOG 1 Antibodies in Diagnosis of Gastrointestinal Stromal Tumors

Introduction: Gastrointestinal stromal tumors are the most common mesenchymal tumors in the gastrointestinal tract. The diagnosis of GISTs becomes much more accurate by using IHC (CD117/DOG1) and molecular analysis (KIT/PDGFRA), both of which constitute the gold standard of diagnosis in GISTs. Aim: The study was conducted in a tertiary care hospital in western India between January, 2019 to June 2020 to evaluate clinic pathological correlation & agreement between CD117 and DOG1 antibodies that are employed in diagnosis of GIST. Material & Methods: The cases were selected on the basis of inclusion & exclusion criteria defined and thereafter a panel of CD117, DOG1 and other antibodies was applied to diagnose GIST from other mesenchymal tumors of gastrointestinal tract. Results: The average age of the patient was 53.5 years with male preponderance was noted. (M:F=1.66). The clinical complaints included: GI Bleeding (50%), Abdominal pain (30%), lump abdomen (20%).Most common site for GIST was gastric (50%) followed small intestine (40%), mesentry-omentum (7.50%) and colon (2.50%). Spindle cell morphology (75.00%) was the most common histomorphological subtype. DOG1 antibody diagnosed 97.50 % cases of GIST and CD117 diagnosed 92.50% cases of GIST. DOG1 expressed high staining ratio score in 95% cases while CD117 had high staining ratio score in 87.50% cases. Mostly stronger intensity of immunostaining was observed with DOG1 while CD117 expressed variable intensity of immunostaining. Also, CD117 expressed variable immunostaining amongst different histomorphological variants and risk groups. While immunostaining with DOG1 was not significantly variable. The results demonstrated that DOG-1 was found to be a superior marker with higher sensitivity and specificity as compared to CD117, specificity (100% versus 96.43%) and sensitivity (97.5% versus 92.5%). Conclusion: The immunohistochemistry panel should be applied in stepwise manner over “morphologically suspicious” cases Mesenchymal Tumours of GIT to diagnose and rule out GIST with first panel being CD117 and DOG1. DOG-1 was found to be a superior marker with higher sensitivity and specificity as compared to CD117. Cases negative for all the antibodies should definitely be referred for molecular analysis to detect other mutations of GIST (kit/PDGFRA negative wild type GIST). Keywords: GIST, CD 117, DOG 1 antibody

Study of Histomorphological Spectrum of Mesenchymal Tumors of GIT at Tertiary Care Centre

Introduction: Mesenchymal neoplasms of gastrointestinal tract are a group of rare tumors with overlapping histological features. There is significant morphologic overlap among diagnostic entities on the differential of mesenchymal lesions. So, use of a panel of immunohistochemical antibodies is necessary for accurate characterization of mesenchymal lesions of gastrointestinal system. Aim: The study was conducted in a tertiary care hospital in western India between January, 2019 to June 2020 to study the histomorphological spectrum and utility of IHC in the final diagnosis of mesenchymal tumor of GIT. Material & Methods: The cases were selected on the basis of inclusion & exclusion criteria defined and thereafter a panel of IHC antibodies was applied to diagnose mesenchymal tumors of gastrointestinal tract. Results: The study included 92 cases with a clinical and provisional morphologic diagnosis of mesenchymal tumors of GIT, mesentery and omentum. 25.00% cases of MT of GIT and were diagnosed on morphology alone. While, 75.00% required IHC for final diagnosis. Tumors with spindle cell morphology 61.95%, epithelioid cell morphology 5.80%, with mixed (spindle+epithelioid) cell morphology 10.14% and pleomorphic cell morphology 1.45%. Using” WHO 2013 of soft tissue tumors” MT of GIT were classified according to clinical behavior in to Benign tumors in 44.57% cases, lipoma being the commonest tumour diagnosed 34.15% cases. Intermediate tumors in 8.70% cases, all cases 100% being fibromatosis. Malignant tumors in 46.74% cases. Using “WHO 2019 of MT of Digestive System”, tumors were classified based on cell type. The commonest phenotype was “GIST” with 42.39% cases, followed by the second common phenotype “Adipose and Myofibroblastic tumor” with 33.69% cases, “Smooth and Skeletal Muscle tumors” with 9.78% cases. “Neural Tumors” with 7.63% cases, “Vascular and Perivascular” with 5.43% cases. Conclusion: GIST are the commonest MT of GIT. The availability of targeted chemotherapy warrants confirmation and ruling out GIST amongst all MT on priority basis. IHC panel should be applied in stepwise manner over “morphologically suspicious” cases Mesenchymal Tumors of GIT to diagnose and rule out GIST with first panel being CD117 and DOG1. These optimize the use of antibodies and make it cost effective. Keywords: Mesenchymal tumors, GIST, CD 117, DOG 1 antibody

Surgical treatment and survival analysis of primary duodenal malignant tumor: a retrospective cohort study.

BackgroundA primary duodenal malignant tumor (PDMT) is an extremely uncommon malignancy that originates from a gastrointestinal tract tumor. Currently, there is no unified, effective surgical treatment for PDMTs. In this retrospective study, we sought to analyze and evaluate the surgical procedure for PDMTs including pancreaticoduodenectomy (PD) and limited resection (LR), expect to inform the management of PDMT.MethodsWe retrospectively reviewed patients with PDMT who underwent PD and LR in General Surgery Department of Tianjin Medical University General Hospital from January 2014 to December 2019. The clinical characteristics of the malignant tumors among the different segment of the duodenum were analyzed. We analyzed and compared the efficacy and safety of these two surgical treatments. Through survival result of the patients, we analyzed the survival factors affecting the PDMT.ResultsOf the 94 patients, 60 (63.8%) were diagnosed with duodenal adenocarcinomas (DAs), 32 (34.1%) with duodenal gastrointestinal stromal tumors (d-GISTs), and 2 (2.1%) with duodenal lymphomas. Of the duodenal malignancies localized in the descending (D2) segment, 72.6% were DAs, and the initial symptom was jaundice (27.4%). Comparing with D2, d-GISTs were more common in the non-D2 segment (50.0%), and 46.9% of these patients presented with anemia as a primary symptom. PDs (87.1%) were more commonly performed for malignancies localized in the D2 segment, and LRs (59.4%) were more commonly performed for malignancies localized in the non-D2 segment (P<0.05).ConclusionsIn this study, we found that PDMT is more likely to occur in the D2 segment than the other segments, and the most common pathological type is DA. Treatment decisions for PD and LR might depend on the tumor type, location, and whether invasion of the pancreas. PD might be the first choice of treatment for PDMTs located in the D2 segment; otherwise, LR would be preferred. Further studies, preferably large randomized clinical trials, are needed to confirm these results.