Lymphatic Infiltration Research Articles

Tratamiento quirúrgico del adenocarcinoma pancreático mediante duodenopancreatectomía cefálica (parte 2). Seguimiento a largo plazo tras 204 casos

Introduction Surgery is the accepted treatment in adenocarcinoma of the head of the pancreas; however, the long-term survival continues to be low. The aim of this study is to define prognostic factors of long-term survival after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma. Material and methods We have collected data on the treatment of adenocarcinoma of the head of the pancreas (ADHP) by means of a cephalic duodenopancreatectomy (CDP) performed n the Bellvitge University Hospital (Barcelona) from 1991 to 2007. Results A total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3 cms in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02–3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69–19.41). The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion ( p=0.003), the resection of more than 15 lymph nodes during the operation ( P=0.004), and the administration of adjuvant treatment ( p=0.004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables. Conclusions Surgery of head of the pancreas adenocarcinoma must include an adequate lymphadectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion.

Sirolimus addition to tacrolimus-based immunosuppression induces complete remission of post-transplant lymphoproliferative disorder in a liver transplant recipient

Sirolimus addition to tacrolimus-based immunosuppression induces complete remission of post-transplant lymphoproliferative disorder in a liver transplant recipient

Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes of cases, no description of training programs, and few published reports. In 2008, a panel of experts gathered in Rotterdam to discuss indications, training, and the wider use of ESD. The panel of experts and participants reached a consensus on five general statements: 1) ESD aims at treating mucosal cancer; 2) treatment aims for R0 resection; 3) ESD should meet quality standards; 4) ESD should be performed following national or European Society of Gastrointestinal Endoscopy (ESGE) guidelines or under institutional review board approval; and 5) ESD cases should be registered. Due to the high level of expertise needed to perform the technique safely, ESD should be performed in a step-up approach, starting with lesions presenting in the rectum or in the distal stomach, then colon, proximal stomach, and finally in the esophagus. Registration is advised either at the local site or at a national or ESGE level, and should include information on indication (Paris classification of lesion, location, and histological results prior to treatment), technique used (e. g. type of knife), results (en bloc and R0 resection), complications, and follow-up. The panel also agreed on minimal institutional requirements: good quality imaging, experienced histopathologist following the Japanese criteria (2-mm sections, micrometric invasion, vessel and lymphatic infiltration, etc), and dedicated endoscopic follow-up. Moreover, minimum training requirements were also defined: knowledge in indications and instruments, exposure to experts (currently all in Japan), hands-on experience in a model of isolated pig stomach and in live pigs, and management of complications. The experts did not reach a consensus on a minimum case load, or whether the technique should be restricted to expert centers.

Synchronous liver metastasis in colorectal cancer in Sri Lanka

To assess the incidence of synchronous colorectal liver metastasis in patients referred to a tertiary referral center in Sri Lanka and to evaluate the differences in the clinicopathological features of patients with and without synchronous metastasis. Records of 438 patients were retrospectively analyzed. Patients were classified into metastatic group (n = 34, 8%) and non metastastatic group (n = 404, 92%). In the two groups macroscopic features compared were: tumor size (2cm, 2-5cm, and >5cm), site of primary tumor and side of liver involved. Carcinoembryonic antigen (CEA) levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. The rectum was the primary site of the tumor in a majority (60%) of patients. There was no difference in the distribution of the primary site and size of the tumor, pathological stage, lymphatic infiltration and the degree of tumor differentiation in two groups (p > 0.05). Patients with metastasis had higher levels of CEA, higher frequency of vascular infiltration and N3 nodes involved (p < 0.05). The incidence of synchronous colorectal liver metastasis seems to be lower in our patients. Association of higher CEA level, advanced nodal stage and presence of vascular invasion needs to be further assessed with risk of developing metachronous liver metastasis.

Survival of a cohort of patients with Intermediate and advanced gall bladder cancer treated with a prospective therapeutic protocol

To evaluate the results of a prospective therapeutic protocol with long-term follow up in terms of survival rates in a cohort of patients treated with Intermediate and Advanced GBC (GBC). Prospective cohort of patients with intermediate and advanced stages of GBC treated between 1996 and 2006. All cases were treated with a partial hepatic segmentectomy on segments IVb and V and a regional lymph node dissection and six cycles of out-patient chemotherapy (5-FU and leukovorin). With an average follow-up of 31.5 months, the morbidity, operative mortality, hepatic and lymphatic infiltration and actuarial survival were measured. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact test and non-parametrical tests and Kaplan Meier survival curves. Also logistic regression and proportional risk of Cox were applied. 40 patients were included in this protocol, with an average age of 59.5 years (40-85 years), of which 28 were women (70%). Depth of wall infiltration: muscular 8 patients (20%), subserosal 12 patients (30%), serosal 12 patients (30%) and perivesicular adipose tissue 8 patients (20%). The series morbidity was 27.5%. There was no operative mortality. The chemotherapy was well tolerated. The overall actuarial survival in the series was 50% at 60 months. Our protocol treatment has morbidity, mortality and survival rates similar to previously reported series.

High expression level of geminin predicts a poor clinical outcome in salivary gland carcinomas

To examine the prognostic impact of geminin expression, a negative regulator of DNA replication, in salivary gland carcinomas. Tissues from 170 patients with salivary gland carcinoma were assembled in a tissue microarray format, and immunohistochemistry staining for geminin and Ki67 was performed. Patients were categorized into three groups using the tertile values of the labelling index (LI) for each marker as the cut-off points for constructing Kaplan-Meier survival curves. The LI for geminin was relatively low in acinic cell carcinoma (mean 1.55%) and mucoepidermoid carcinoma (mean 2.43%), intermediate in adenoid cystic carcinoma (mean 4.09%), and relatively high in salivary duct carcinoma (mean 15.22%). The geminin LI was significantly correlated with the Ki67 LI and histopathological factors, including pathological T factor, lymphatic and blood vessel infiltration, and lymph node metastasis. The increased expression of geminin was more strongly associated with reduced overall and relapse-free survival rates than with Ki67 expression and was a significant and independent prognostic factor in patient survival and tumour relapse. Geminin expression is potentially a useful marker for predicting tumour aggressiveness and clinical outcome in salivary gland carcinomas.

Abstract 2319: Increased hyaluronan (HA) levels are associated with tumor invasion in murine lymphoma cell lines

Abstract HA is a glycosaminoglycan component of the mammalian extracellular matrix (ECM) where it has a structural function influencing hydration. HA biosynthesis is carried out by HA synthases (Has) existing three isoforms: Has-1,-2 and −3. The control for HA deposition occurs at catabolism mainly by the action of hyaluronidases (Hyal), being Hyal-1, −2 and −3 the most important ones. Increased levels of HA as well as differential expression of Has/Hyals have been found in the ECM within tumors and have been related with tumor invasion and metastasis. The aim of this work was to analyze the ability of lymphoma cells to produce HA and to evaluate HA levels within the tumors induced by these cells. For this purpose, we used murine lymphoma cells resistant to doxorubicin (LBR-D160), vincristine (LBR-V160), and a sensitive line (LBR-) with dissimilar invasive behaviour in vivo, being LBR-V160 the less aggressive one. First we evaluated endogenous HA surface expression by flow cytometry finding that LBR- presented higher HA expression than LBR-D160 and LBR-V160 (p&amp;lt;0.01 respectively). Secondly, we studied mRNA expression for Has-1, Has-2, Has-3 and Hyal-1, Hyal-2 and Hyal-3 by RT-PCR. We observed that none of the cell lines presented Has-1 and Has-2, but all of them expressed similar levels of Has-3 mRNA. Although we were unable to detect Hyal-1, Hyal-2 was found significantly decreased in LBR- compared with LBR-D160 and LBR-V160 (p&amp;lt;0.05 repectively). Besides, Hyal-3 was similarly expressed in the 3 cell lines. Finally BALB/c mice were injected with tumor cells or vehicle, sacrificed and infiltrated lung, lymph nodes, spleen and liver as well as blood were taken for ELISA measurement of HA. Serum HA levels were increased in LBR- and LBR-D160 injected mice compared with control mice (4.1±1.2 and 3.9±0.8 µg/ml vs. 1.9±0.4 µg/ml; P&amp;lt;0.05), finding no differences in LBR-V160 injected mice (2.5±1.1 µg/ml). In lungs from LBR-D160 injected mice, HA concentration was increased compared with control (0.4±0.1 vs. 0.2±0.1 µg/mg tissue wet weight; P&amp;lt;0.05), while no changes were observed in LBR- or LBR-V160 injected mice. Besides, a slight increase in HA levels was observed in lymph nodes from LBR- and LBR-D160 injected mice compared with control mice (3.1±3.0 and 2.7±2.2 µg/mg tissue vs. 1.0±0.8 µg/mg tissue), while no changes were observed in spleen and liver. Our results showed an association between tumor progression and HA levels in this lymphoma model since mice injected with the cell lines with major invasive capacity (LBR- and LBR-D160) presented increased serum HA levels as well as increased deposition of HA in infiltrated lungs and lymph nodes. In LBR- this may be explained by the ability of this cell line to express more HA than the other ones which could be related with decreased Hyal-2 expression. Further analysis of Has/Hyal balance in the infiltrated organs will contribute to understanding the causes of HA increase in LBR-D160 injected mice. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2319.

454 Circulating cross-linked N-telopeptide of type 1 collagen and VEGF in patients with bone metastases from breast cancer treated with zoledronic acid

We report the case of a man with a seven year history of lung adenocarcinoma who was diagnosed with cutaneous lymphangitis carcinomatosa. Skin examination revealed both an asymptomatic erysepelatoid rash localized on the posterior chest and an erythematous, eczematiform, itchy rash on the right anterior chest and on the left shoulder. Histopathologic examination of biopsies of these lesions revealed the same aspect with an infiltration of the dermal lymphatics by metastatic adenocarcinomatous cells. Cutaneous lymphangitis carcinomatosa is a rare condition accounting for less than 5% of skin metastases. A literature review identified eight other cases of cutaneous lymphangitis carcinomatosa in patients with lung cancer.

Surgical treatment of pancreatic adenocarcinoma using cephalic duodenopancreatectomy (Part 2). Long term follow up after 204 cases

IntroductionSurgery is the accepted treatment in adenocarcinoma of the head of the pancreas (ADHP); however, the long-term survival continues to be low. The aim of this study is to define prognostic factors of long-term survival after cephalic duodenopancreatectomy (CDP) due to pancreatic adenocarcinoma. Material and methodsWe have collected data on the treatment of adenocarcinoma of the head of the pancreas by means of a cephalic duodenopancreatectomy performed at the Hospital Universitari de Bellvitge (Barcelona) from 1991 to 2007. ResultsA total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3cm in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02–3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69–19.41).The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion (P=.003), the resection of more than 15 lymph nodes during the operation (P=.004), and the administration of adjuvant treatment (P=.004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables. ConclusionsSurgery of head of the pancreas adenocarcinoma must include an adequate lymphadenectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion.

Expression of Survivin protein in extrahepatic cholangiocarcinoma and its relationship with the prognosis

To investigate the expression of Survivin in patients with extrahepatic cholangiocarcinoma (EHCC) and its relationship with clinicopathological features of EHCC, and the correlation between the expression of Survivin and lymph node micrometastasis, tumor markers, and the prognosis of EHCC. The expression of Survivin protein in paraffin-embedded specimens of 59 patients with EHCC and their 20 para-carcinoma tissues were evaluated by S-P method of immunohistochemical staining. The correlation between the expression of Survivin and the lymph node micrometastasis, clinicopathological features of EHCC and the prognosis of EHCC were analyzed. The positive expression rate of Survivin protein was 67.8% (40/59) in paraffin-embedded specimens of 59 patients with EHCC and was 20.0% (4/20) in para-carcinoma tissues, and difference between carcinoma tissues and para-carcinoma tissues was significant (P<0.01). Histological differentiation in EHCC had a negative correlation with the expression of Survivin protein, while the expression of Survivin protein in EHCC had a positive correlation with TNM of EHCC, lymphatic vessel infiltration, lymph node metastasis and perineural invasion (P<0.05). The serum CA19-9 levels in the positive group with expression of Survivin protein was (290,300+/-55 500) U/L and was obviously higher than that in the negative group [(113,300+/-31,400) U/L, P<0.05]. The mean survival time of the patients with negative expression of Survivin protein was higher than that of the patients with positive expression (43.5 vs. 21.1 months, P<0.01). Screened to significance univariate, the multivariate analysis through Cox proportional hazard model analysis showed that lymph node metastasis, residual tumor margins, and expression of Survivin protein were independent prognosis factors of the patients with EHCC (P<0.05, P<0.01, P<0.01). The expression of Survivin protein in EHCC has a negative correlation with histological differentiation, while has a positive correlation with lymphatic vessel infiltration and serum CA19-9 concentrations. The expression of Survivin protein maybe an independent prognosis factor of the patients with EHCC.

Diffuse cardiac lymphatic involvement by metastatic neuroendocrine carcinoma mimicking hypertrophic cardiomyopathy: a case report

We describe an autopsy case of non-functioning pancreatic neuroendocrine carcinoma metastasizing to the myocardium. A 63-year-old Japanese man was admitted to the hospital presenting with dyspnea. Echocardiography revealed marked left ventricular hypertrophy and diffuse myocardial thickening with pericardial effusion. The patient died of heart failure. An autopsy revealed that the whole pancreas, weighing 400 g, was occupied by tumor cells with neuroendocrine differentiation. The heart, weighing 780 g, showed numerous metastatic nodules and diffuse myocardial thickening. Histopathologically, the tumor was diagnosed as non-functioning pancreatic neuroendocrine carcinoma. Immunohistochemical analysis for D2-40 disclosed severe lymphatic infiltration of tumor cells, characterized by diffuse thickening of the myocardium.

Bladder Cancer Therapy Related Histopathologic Changes

Various forms of modern therapy of urinary bladder cancer are associated with characteristic changes. Surgical therapy related morphology alterations usually do not present significant differential diagnostic problems. Postoperative spindle cell nodule may resemble a spindle cell sarcoma, but the fact that it arises within 120 days following surgery makes the diagnostic interpretation less cumbersome. Changes induced by BCG include epithelial denudation of the bladder, small superficial granulomas and chronic inflammation. Other forms of immunotherapy are associated with formation of lymphatic follicles or diffuse lymphocytic infiltrates. Radiation induced changes may appear many years after therapy and include atypia, bizarre appearance and multinucleation of urothelial cells. In the late phase, stroma is particularly affected. It is important not to misdiagnose radiation induced changes for CIS or invasive nested carcinoma. Chemotherapy-induced atypia may be recognized cytologically and histologically by the characteristic changes of the nuclear/cytoplasmic ratio, multiple nuclei, nuclear vacuolization, and architectural disturbances in the bladder epithelium. Photodynamic therapy induces sharply demarcated necrosis in the short post-therapy course. Laser treatment destroys the tumor, and may induce atypia in adjacent endothelial cells. Gene therapy-related changes have not been well defined yet.

LIV-1 enhances the aggressive phenotype through the induction of epithelial to mesenchymal transition in human pancreatic carcinoma cells

LIV-1 is a downstream target of STAT3 and is essential for the nuclear localization of Snail, a master regulator of epithelial to mesenchymal transition (EMT). Little is known about the association of LIV-1 with pancreatic carcinoma development, therefore, expression of LIV-1 mRNA was analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) in 9 cultured cell lines (8 carcinoma and 1 normal duct cell lines) and 24 pancreatic tissues (12 carcinoma and 12 normal tissues). Localization of this gene product was investigated by immunohistochemistry in 72 pancreatic carcinoma and the relation between its expression and clinicopathological findings was examined. To assess the function of LIV-1 in pancreatic carcinoma cells, stable siRNA expressing Panc-1 cells were generated. Higher expression of LIV-1 mRNA was found in both pancreatic carcinoma cell lines and pancreatic carcinoma tissues compared to normal duct cell line and histologically normal tissues, respectively. Immunohistochemical analysis revealed that LIV-1 expression was frequently found in 76.4% of pancreatic carcinoma tissues and its expression level was associated with tumor size and lymphatic infiltration. Down-regulated LIV-1 cells showed significant inhibition of anchorage-dependent or -independent proliferation and cell motility in vitro and reduction of tumor growth and metastasis in vivo. Furthermore, nuclear expression of Snail was decreased and E-cadherin expression was restored in LIV-1 siRNA expressing pancreatic carcinoma cells. These findings indicate that LIV-1 may be involved in acquisition of the aggressive phenotype of human pancreatic carcinoma cells through the induction of epithelial to mesenchymal transition.

Prospective Investigations of Long-term Normoglycaemic BB/OK-rats: Serial Determination of Glucose Tolerance, Insulitis, B-cell Volume Density and Pancreatic Insulin Content

Pancreatic tissue was obtained by repeated surgical biopsies from BB/OK rats (n = 62), which maintained normoglycaemia up to 250 days. The tissue was used to determine pancreatic insulin content, islet volume density, pancreatic B-cell volume density and the presence of mononuclear cell infiltrations within and around pancreatic islets (insulitis). The BB/OK rats were also characterized by determination of glucose tolerance. In 50 d old BB/OK rats lymphatic infiltration of pancreatic islets are rare. The mean value of relative B-cell volume density amounted to 0.71 +/- 0.05% and the pancreatic insulin content was 21.31 +/- 1.29 pmol/mg wet weight. 70 d old BB/OK rats are characterized by an identical relative B-cell volume density and pancreatic insulin content, although in 70% of the animals an invasion of immunocytes could be observed. At an age of 90 and 120 d the BB/OK rats were characterized by an increased number of islets having insulitis accompanied by a decrease of pancreatic insulin content and B-cell volume density. The individual evaluation of the investigated BB/OK rats revealed in each animal the presence of insulitis accompanied by a decreased B-cell volume density and a diminished pancreatic insulin content. Animals older than 120 d do reenhance the pancreatic insulin content and B-cell volume density attended by an impairment of glucose tolerance. The results suggest that all BB/OK rats are characterized by a spontaneous pancreatic B-cell destruction, which was arrested and/or interrupted in the animals maintaining normoglycaemia up to 250 d.

Prediction model of lymph node metastasis in superficial esophageal adenocarcinoma and squamous cell cancer including D2‐40 immunostaining

It was the aim of our study to establish a model for prediction of lymph node metastases in superficial esophageal cancer. We analyzed the clinical and histopathological data of 50 consecutive patients with pT1-esophageal cancer who underwent oncological resection. Submucosal carcinomas (pT1b) were classified according to sm levels 1-3. D2-40 immunostaining was investigated using the ABC technique. In a first step, we performed univariate analysis (One-way ANOVA: Sigma restricted parameterization; test of SS whole vs. SS predicted) to test the predictive value of the following categorical parameters for lymph node status (positive/negative): sex, histologic tumor type, localization, surgical technique (transhiatal/transthoracic), grading, pT1-subclassification (pT1a, pT1b sm 1-3), pL-, pV-status, and D2-40 labeling. Simple regression was applied for the following continuous predictors: age and tumor size. All significant variables of univariate analysis were included in the multivariate analysis. For this purpose, we used the General Liner Models's analysis (forward stepwise). In a third step, the Kruskal-Wallis test with post hoc comparisons was intended to define the cut-off value of parameters tested. Only the following variables gained statistical significance in univariate analysis: sex, histological tumor type, grading, pT1-subclassification, lymphatic infiltration, microvascular infiltration, D2-40 immunostaining, and tumor size (P < 0.05). Variables reaching significance in multivariate analysis were tumor size (P = 0.017) and pV-status (P = 0.037). In the Kruskal-Wallis test with post hoc comparisons, the cut-off value of tumor size was 2 cm (model P = 0.002) and between the categories (P < 0.05). Lymph node positivity and lymphatic vessel infiltration did not linearly increase with sm tumor infiltration depth. The risk category of lymph node involvement in superficial esophageal cancer exists according to our prediction model on the basis of tumor size of >2 cm and microvascular infiltration. The hitherto common sm levels 1-3 classification of submucosal cancers appears to display a lesser impact than previously assumed with regard to prediction of potential lymph node metastases and consequently the indication for endoscopic or surgical therapy.

Evolución y factores de pronóstico en cáncer diferenciado de tiroides

Evolution and prognosis of differentiated thyroid carcinoma Background: Differentiated thyroid carcinoma has a good prognosis with a 90% survival at 10 years. Follicular carcinoma is more aggressive than papillary carcinoma Aim: To study the clinical presentation, evolution and prognosis of differentiated thyroid carcinoma. Material and Methods: The pathological registries of differentiated thyroid cancer processed in a pathology service of a general hospital, between 1984 and 2007, were searched. The clinical records of patients were reviewed. Results: One hundred six pathology registries were identified but only 89 patients had complete medical records. Seventy six patients aged 44 ± 16 years had a papillary carcinoma and 13 patients aged 42 ± 15 years had a follicular carcinoma. After a mean follow up of 53 months, 65 patients with papillary and 12 patients with follicular thyroid cancer were alive. Five patients with papillary carcinoma and one with follicular carcinoma had a local or distant relapse. Calculated actuarial survival at 10 years was 84 and 100% for papillary and follicular carcinoma, respectively. Ten year survival for stage I, II, III and IV tumors was 100, 92, 68 and 0%, respectively. Mortality was associated with the presence of distant metastases, a stage IV tumor, vascular or lymphatic tumor infiltration, tumor size, lymph node involvement, extra capsular invasion and a multi focal lesions. The relative risk for mortality increases between 2.7 and 9 times with the presence of lymph node infiltration and distant metastases. Conclusions: The prognosis of differentiated thyroid cancer is related to lymph node infiltration and the presence of distant metastases.

A case of a choledochal cyst associated with a lymphatic infiltration of a hyperplastic gallbladder epithelium

A 4-year-old girl with a congenital choledochal cyst (Todani IV-A, Komi type A) underwent a resection of the dilated common bile duct and gallbladder. Histologic studies of the gallbladder showed a general hyperplastic change associated with cribriform proliferation at the gland base of the gallbladder. In this region, clusters of cribriform glands were found within the lymphatic vessels, compatible with lymphatic infiltration of tumor cells. However, careful histologic studies did not reveal any apparent neoplastic changes in the gallbladder and common bile duct, so a final diagnosis of epithelial atypism with reactive hypertrophy was made. The displacements observed in the lymphatics are just an incidental finding in a proliferative process of the hyperplastic gallbladder epithelium. In the follow-up observation for 3 years, the patient is doing well without evidence of tumor recurrence. These results suggest that a mere lymphatic infiltration of hyperplastic gallbladder epithelium should not be directly considered as evidence of carcinogenesis.

Endoscopic Therapy for Barrett's Esophagus

Recent retrospective cohort data and a prospective randomized sham controlled trial have clearly documented the impact of endoscopic ablation therapy on dysplasia and Barrett's esophagus (BE). The clinical indications for ablation of BE includes high-grade dysplasia and intramucosal adenocarcinoma. The techniques of resection of mucosal irregularities and of ablation are reviewed, primarily thermal and photodynamic ablation. Ablation of BE with neoplasia has appropriately entered the clinical arena.

Survival according to the site of bronchial microscopic residual disease after lung resection for non–small cell lung cancer

We performed a retrospective study evaluating the effect on survival of different sites of microscopic residual disease at the bronchial resection margin after surgical intervention for non-small cell lung cancer. Survival of patients with different sites of residual disease was compared with survival of patients with curative resections, taking the pathologic TNM stage of the tumor into consideration. There was a trend for patients with stage I and II non-small cell lung cancer with residual disease limited to the epithelium and with peribronchial invasion to behave like patients with complete resections (61% and 41% five-year survival for stage I and II disease, respectively). This contrasts with patients with submucosal invasion and lymphatic infiltration, among whom there were no survivors at 5 years. There was no difference in survival between curative resections and residual disease of any type when the tumor was stage III or IV. In patients with stage I and II disease, when residual disease consists of submucosal invasion or lymphatic infiltration, specific and aggressive treatments to clear residual margins might be contemplated because of their possible adverse effect on survival. This contrasts with patients with stage III and IV disease, in whom survival is more related to the stage of the primary tumor than to residual disease.

Prognostic impact of intrahepatic lymphatic and microvascular involvement in cases of colorectal liver metastases

The purpose of this study was to evaluate the effect of intrahepatic microvascular and lymphatic infiltration on survival in cases of colorectal liver metastases. Prospectively collected data of 331 patients were analyzed for microvascular invasion (V), lymphatic infiltration (L), and resection margins (R) with respect to overall and disease-free survival. One-, 3-, and 5-year overall survival rates for R0 resected patients were 89%, 64%, and 39%, respectively. The corresponding survival rates for R1 resected patients were 83%, 42%, and 24% (p < 0.001). The sole presence of microvascular invasion (V1) or lymphatic infiltration (L1) was not associated with a diminished overall survival (p > 0.05). However, patients with a combination of L1V1 had a significantly worse overall survival of 68%, 20%, and 0% when compared to L0V0 patients. This difference was not influenced by the status of the resection margin. No other parameter investigated was found to be of predictive value. The presence of combined lymphatic and vascular invasion (L1V1) constitutes a predictor of poor overall and disease-free survival. This subgroup of patients might benefit from adjuvant strategies such as chemotherapeutic treatment.