Malignant Gastrointestinal Tumor Research Articles

Solitary schwannoma of the ascending colon

Schwannomas are uncommon neoplasms arising from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare, accounting for 1% of all malignant gastrointestinal tumors. Colonoscopic biopsy with immunohistochemical (IHC) staining is useful for confirming this tumor. We report on a patient with schwannoma arising from the ascending colon, which was detected by colonoscopy and endoscopic submucosal dissection was attempted. A 41-year-old man presented with abdominal discomfort. The patient was diagnosed with a subepithelial tumor on colonoscopy. He underwent endoscopic submucosal dissection. Histopathology and IHC staining confirmed that the colonic lesion was a benign schwannoma. However, the resection margin was positive. Therefore, laparoscopic ileocolectomy was performed.

Prognostic Value of Immunohistochemical Expressions of the Stem Cell Biomarker "LGR5" and the Proliferation Biomarker "TPX2" in Colorectal Carcinoma

Aim: Colorectal carcinoma (CRC) is the commonest and most deathly malignant gastrointestinal tumors. Carcinogenic process starts in a group of cancer cells, called cancer stem cells (CSCs) having the ability to start and maintain tumor growth and invasion. In order to detect and remove colon CSCs, a selective biomarker (leucine-rich-repeat-containing G-protein-coupled receptor 5) might be required. At the same time, an abnormal expression of TPX2 (targeting protein for xenopus kinesin-like protein 2) has been found to be related to the development and progression of tumors. We aimed to evaluate the immunohistochemical expressions of LGR5 and TPX2 in CRC in a trial to clarify their relations to proliferation and metastasis of CRC, and hence its prognosis. Methods: Immunohistochemical staining of both LGR5 and TPX2 was assessed in sections from sixty paraffin blocks of CRC . The relationships between their levels of expressions with the clinicopathological parameters and patient outcome were statistically analyzed. Results: The immunoexpression of LGR5 in CRC was signifi­cantly positively correlated with location of the tumor, grade, stage, local recurrence, lymph node and distant metastasis (p <0.001). The expression of TPX2 in CRC was also found to be signifi­cantly correlated with the previous parameters (p <0.001). High LGR5 and TPX2 immunohistochemical expressions were strongly correlated with worse 3-year overall survival (OS), local recurrence free survival (LRFS) and distant metastases free survival (DMFS) (P <0.001). Conclusion: High immunohistochemical expressions of both LGR5 and TPX2 and the positive correlation between both of them represent signs of poor prognosis of CRC.

An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer.

During the 1990s, laparoscopic resection was established as a treatment for gastrointestinal malignant tumors. A number of randomized controlled trials comparing laparoscopic-assisted colorectal surgery with conventional open colorectal surgery for colon cancer have been conducted. These trials have shown short-term benefits, and the vast majority demonstrated no significant difference in long-term outcomes. Laparoscopic-assisted colorectal surgery is widely performed for the treatment of colon cancer, whereas laparoscopic-assisted colorectal surgery for rectal cancer is less commonly performed. In recent years, there have been an increasing number of reports of laparoscopic-assisted colorectal surgery for rectal cancer, where improving short-term outcomes was shown, but no definitive effect on long-term survival has been shown to date. Randomized controlled trials focusing on long-term survival are currently ongoing.

Xanthogranulomatous gastritis of the remnant stomach mimicking a malignant tumor: A case report.

Xanthogranulomas are known to develop in the gallbladder and kidney. Xanthogranuloma of the stomach is a rare disease, and to the best of our knowledge, only a few cases have been reported to date. The present patient was a 64-year-old man who underwent a wide resection of the stomach following a Billroth-I reconstruction for a gastric ulcer ~40 years prior to the current presentation. Due to tarry stools, a gastrointestinal endoscopy was performed, leading to identification of an ulcerated gastric lesion located at the previous suture line at the lesser curvature of the remnant stomach. This lesion was elevated, appearing to indicate a submucosal tumor. Positron emission tomography revealed uptake of fluorodeoxyglucose radiotracer by the tumor. Although not indicated by the biopsy specimens, a malignant tumor of the remnant stomach was suspected, in the form of a malignant gastrointestinal tumor or remnant gastric cancer. Curative resection of the tumor was successfully performed. Histological examination of the resected specimens revealed xanthogranulomatous inflammation consisting of foamy histiocytes and plasma cells, however, no cancer cells were observed. The tumor was diagnosed as xanthogranulomatous gastritis that mimicked a malignant tumor of the remnant stomach. The present study therefore indicates that inflammatory tumors should be considered in the differential diagnosis of malignant tumors.

Role of the bile acid receptor TGR5 (Gpbar-1) in gastrointestinal tumors

The G-protein coupled bile acid receptor TGR5 (GPBAR1) is expressed in biliary epithelial cells of the liver as well as epithelial cell of the intestine. Receptor activation induces proliferation and anti-apoptotic effects in liver but in the intestine its function is relatively unclear. It was shown that secondary bile acids (BA) are involved in the development of different gastrointestinal (GI) malignant tumors of the intestine and liver. High TGR5 expression levels were detected in cell lines generated from adenocarcinomas of the esophagus and cholangiocarcinoma (CCA). Interestingly, high concentrations of secondary BAs (DCA and LCA) were found in faeces of colon cancer patients. Since these two secondary BAs represent potent TGR5 ligands, aim of this project is to uncover the role of TGR5 in GI tumor formation with a main focus on colon cancer and CCA.

便携式输液泵联合深静脉导管治疗胃肠道肿瘤

Objective: Explore the deep vein catheter connect portable infusion pump infusion for small doses than ordinary needle joint regulation fluorouracil infusion of gastrointestinal tumor chemotherapy is better. Methods: Continuous intravenous chemotherapy in terms of efficacy and side effects is superior to the traditional pattern of impact of chemotherapy. In order to coordinate the development of continuous intravenous chemotherapy of malignant gastrointestinal tumor, ensure the smooth implementation of the chemotherapy to reduce such effective permeability and the occurrence of phlebitis, from the traditional ordinary needle joint control infusion infusion with small dose fluorouracil method instead I now use the deep vein catheter (PICC or CVC) combined with a portable infusion pump continuous intravenous chemotherapy. Results and conclusion: Joint portable infusion pump for deep vein chemotherapy can improve the quality of life of patients, alleviate patients pain, improve drug efficacy.

A Novel tele-operation controller for wireless microrobots in-pipe with hybrid motion

Intracavity intervention is expected to become increasingly popular in medical practice for both diagnosis and surgery. Wireless microrobots are employed in a wide range of biomedical application and they may have the potential to accomplish various radical medical procedures because they can be transported deep into the human body to perform tasks safely and reliably. In particular, colonoscopy is an important procedure during the diagnosis of various pathologies, especially cancer of the colon and rectum. However, the colonoscopy process is often painful for the patient and complex for the operator, so wireless microrobots could be employed for the early diagnosis of gastrointestinal malignant tumors. In this study, we developed a novel tele-operation system that can be used in biomedical applications, where we designed a master controller and slaver controller for the system. We also designed a novel type of wireless microrobot with hybrid motion, which can be driven by differences in an external magnetic field. Thus, a doctor could operate joysticks from the master side to control the wireless microrobot on the slave side in real time. Using a control algorithm based on an eight-step rotating magnetic field, the slave controller can generate a more uniform rotating magnetic field and avoid many of the problems that affect traditional control methods. We evaluared the performance of a tele-operated controller and the wireless microrobot with hybrid motion in experiments. The experimental results indicated that the wireless microrobot with hybrid motion could complete forward–backward and upward–downward movements easily with similar kinematic characteristics, where the available frequency band was widened by the control algorithm based on an eight-step rotating magnetic field. The maximum velocity was measured as 29.8 mm/s at around 18 Hz in the horizontal direction and as 9.6 mm/s at around 16 Hz in the vertical direction with an input current of 0.7 A. The tele-controller obtained good performance in the experiments and it could be used widely in medical clinics in the future.

An unusual association of malignant gastrointestinal neuroectodermal tumor (clear cell sarcoma-like) and Ewing sarcoma

Very recently a new designation of “Malignant Neuroectodermal Gastrointestinal Tumor” has been proposed for an aggressive form of neuroectodermal tumor with features similar to that of Clear Cell Sarcoma of Soft Tissue, however without a melanocytic differentiation. Also known as “clear cell sarcoma-like tumors of the gastrointestinal tract”, these tumors show some features strongly suggesting an origin from a gastrointestinal neuroectodermal precursor cell unable to differentiate along the melanocytic lineage. They occur mainly in young and middle-aged adults, and have a poor prognosis with a high rate of liver and lymphnode metastases. Histologically they are composed of epithelioid or oval-to spindle cells with a sheet-like or nested pattern of growth, strongly positive for neural markers (S-100, SOX10, and vimentin) and negative for the melanocytic ones. EWSR1 gene rearrangements including EWSR1-ATF1 or EWSR1-CREB1 GENE fusions are typically assessed in these tumors. Here we report a case of malignant neuroectodermal gastrointestinal tumor which immunophenotypically unusually expressed FLI-1, occurring in a 29-year-old man with a previous medical history of Ewing sarcoma. We finally suggest that this case might be a further evidence of a link between these two entities.

High neuroendocrine component is a factor for poor prognosis in gastrointestinal high-grade malignant mixed adenoneuroendocrine neoplasms

BackgroundHigh-grade malignant mixed adenoneuroendocrine carcinoma (MANEC) is a highly malignant combined neoplasm formed by an adenocarcinomatous component and a poorly differentiated (Grade 3) neuroendocrine (NE) carcinoma. MethodsTumors from 21 patients with gastrointestinal high-grade malignant MANECs or tumors with varying percentages of Grade 3 NE component were examined, and the NE component was confirmed by morphological analysis and immunohistochemical staining. Patients were divided into high NE (NE component > 50% in the primary tumor) and low NE (NE component ≤ 50% in the primary tumor) component groups. ResultsHigh NE component was a poor prognostic factor for patients with high grade MANEC (p = 0.021). Out of 13 patients with high-grade malignant MANEC, eight had a pure NE component, one had a pure adenocarcinomatous component, and four had mixed-type cancer in the metastatic lymph nodes. We further enrolled eight patients who had a Grade 3 NE component in the primary tumor and found that the pure NE component in tumor emboli and distant liver metastases were more frequent in the high NE than in the low NE component group (p = 0.012 and p = 0.046, respectively). ConclusionThe predominant tumor component in primary tumors was a prognostic factor and could predict tumor emboli and liver metastases pathology in high-grade malignant MANECs.

Gastrointestinal manifestations of Malignant Melanoma – Observations from a single center study

Background: Gastrointestinal manifestation of malignant melanoma (GMM) is a rare entity. It usually occurs as a metastasis of extra-intestinal malignant melanoma (MM), but rarely no primary tumor can be detected. Histopathological differentiation from other gastrointestinal (GI) malignant tumors is challenging. Methods: All GMM cases diagnosed between 2004 and 2014 were retrieved from the histopathological database of the 1st Department of Pathology and demographic, clinical and pathological parameters were analyzed. Results: During the 11-year study period 14 GMM cases were found. In 4 cases, despite extensive diagnostic workup, no primary tumor could be detected. The most common location of GMM was small intestine in 6 cases, followed by rectum in 4 cases, upper GI tract in 3 cases and colon in 2 cases. In 2 cases multiple locations were affected, simultaneous liver metastases were present in 6 cases. Age at diagnosis was ranging from 26 to 75, gender distribution was similar (7 males, 7 females), females (mean age: 67 years) tended to be older than males (mean age: 62 years). Cases in the upper GI tract and small intestine were younger than cases in the colorectum. Immunohistochemical stainings (S-100, Melan- A, HMB-45) for MM were highly positive. Conclusions: MM can manifest in the entire GI tract either as a primary or as a metastatic malignancy. It affects both genders equally. Small intestine and rectum seems to be the most common location. Although a rare entity, GMM should be considered as a differential diagnostic possibility of GI tumors, especially in cases with a history of MM. This study was supported by the Hungarian Scientific Research Fund (OTKA-K111743 grant).

Effect of ω-3 polyunsaturated fattty acids-supplemented nutrition support on immune function and nutritional status of patients with gastrointestinal malignant tumor: a meta-analysis

Objective To systematically review the effect of ω-polyunsaturated fatty acids-supplemented nutrition support on the immune function and nutritional status of patients with gastrointestinal malignancies. Methods Databases of MEDLINE, EMBASE, Cochrance Central register of controlled trials, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM) were searched. The search words were omega-3 polyunsaturated fatty acids, fish oil, cancer, turmor, neoplasms in English or Chinese. All the high quality randomized controlled trials were included after assessed with Jadad scale. RevMan 5.2 was used for statistical analysis. Results Altogether 12 studies were included. Meta-analysis results showed that CD4+%(I2=0%, 95% CI=3.44~6.93, Z=5.82, P<0.000 01), CD8+%(I2=0%, 95% CI=2.44~7.13, Z=4.00, P<0.000 1), CD4+%/CD8+%(I2=74%, 95% CI=0.16~0.83, Z=2.87, P=0.004), IgA (I2=14%, 95% CI=0.21~0.43, Z=5.84, P<0.000 01), prealbumin (I2=0%, 95% CI=0.02~0.05, Z=3.94, P<0.000 1) in the treatment group were higher than in the control group, C-reactive protein (I2=76%, 95% CI=-21.33~-5.03, Z=3.17, P=0.002) in the treatment group was lower than in the control group, the differences were all statistically significant. But there were no statistically significant differences in CD3+%(I2=0%, 95% CI=-3.50~2.56, Z=0.31, P=0.76), IgG (I2=92%, 95% CI=-0.32~5.54, Z=1.74, P=0.08), IgM (I2=99%, 95% CI=-0.52~1.89, Z=1.11, P=0.27), total protein (I2=0%, 95%CI=-4.08~1.77, Z=0.78, P=0.44), albumin (I2=29%, 95% CI=-0.87~1.45, Z=0.49, P=0.63), transferrin (I2=0%, 95% CI=-0.23~0.19, Z=0.19, P=0.85) between treatment and control groups. Conclusion Omega-3 polyunsaturated fatty acids can improve the perioperative immune function of patients with gastrointestinal malignant tumor, reduce inflammatory and stress reactions, but have no obvious effect on the improvement of the nutritional status. Key words: Omega-3 polyunsaturated fatty acid; Cancer; Perioperative; Immune function; Nutritional status; Meta-analysis

Diagnosis value of membrane glycolipids biochemistry index in intracranial and gastrointestinal tumors.

The diagnostic value of membrane glycolipid biochemistry index, the lipid-bound sialic acid (LSA) and total sialic acid (TSA) in cerebrospinal fluid (CSF) was evaluated in 30 intracranial and 65 gastrointestinal tumors. The plasma LSA, TSA and red cell membrane sialic acid (R-SA) in were determined according to the method of Sevenmerhulm. Our results showed that the levels of LSA and TSA in CSF of intracranial tumor patients was higher than that of normal group(p<0.01). The concentration of TSA and LSA in patients with malignant glioma was higher than that of benign meningioma patients(P<0.01). No significance was found between intracranial halmatoma patients and normal control group for levels of membrane glycolipids (p>0.05). Results also found that the plasma LSA, TSA and R-SA of gastric carcinoma were significantly higher than those of control group (p<0.05); while no significant difference was found in the plasma LSA, TSA and R-SA levels between chronic gastritis, gastrohelcoma and normal control group (p>0.05). Plasma LSA, TSA and R-SA levels of gastric carcinoma patient were significantly higher than those of chronic gastritis patients and gastrohelcoma patients(p<0.05). It was also found that plasma LSA, TSA and R-SA contents were significantly higher in large intestine carcinoma patients than in benign in stestine tumor patients (p<0.05) while no significant difference was found between intestine benign tumor and normal control group (p>0.05). The levels of LSA, TSA and R-SA were obviously higher in the patients with metastasis than in the ones without (p<0.05.) The membrane glycolipid biochemistry index LSA and TSA in CSF are sensive markers for diagnosing intracranial tumors. For gastrointestinal malignant tumors the plasma LSA TSA and red blood cell membrane SA may be considered as auxiliary indicators for diagnosis. They can be used for distinguishing benign from malignant tumors.

Preliminary study of improved quality of computed tomographic angiography on tumor blood supply arteries of gastrointestinal tract malignant tumors with low tube voltage and low concentration contrast medium

To assess the image quality of gastrointestinal tract malignant tumors arteries using low tube voltage, low contrast medium concentration and 50% adaptive statistical iterative reconstruction (ASiR) algorithm. A total of 58 patients with pathologically confirmed gastrointestinal tract malignant tumors and body mass index (BMI) under 22 kg/m² undergoing computed tomography (CT) scanning during March-December 2013. They were randomly divided into group A (270 mgI/ml of contrast medium, 80 kVp tube voltage scanning and 50% ASiR; 21 males and 11 females with an age range of 40-90 years) and group B (350 mgI/ml of contrast medium, 120 kVp routine tube voltage; 22 males and 4 females with an age range of 40-76 years). The inter-group differences of age and gender ratio were compared with Mann-Whitney U and Fisher exact tests respectively. Two independent radiologists reviewed reconstructions and separated the reconstructed image into 5 points according to image quality. The CT value of tumor blood supplying artery (CT1 value) and fat in anterior abdominal wall (SD value) were measured and image noise, contrast-to-noise ratio (CNR) and figure of merit (FOM) calculated. The interobserver variation was estimated by weighted kappa statistics and intra-class correlation coefficients (ICC) test. The point of image quality of two groups was compared by Mann-Whitney U test. The paired Student t test was used to compare the inter-group differences in CT1, SD, CNR, FOM and CT dose index (CTDIvol). No inter-group difference existed in patient age or gender ratio. The consistency of two radiologists was excellent (kappa value > 0.80; ICC value > 0.75). The subjective image quality scores of tumor blood supplying arteries showed no inter-group difference (P = 0.09). The tumor blood supply arteries CT value, CNR and FOM of group A (459 ± 69 HU, 20.2 ± 3.3 and 85 ± 37) were significantly higher than those of group B (250 ± 42 HU, 9.3 ± 1.9 and 9 ± 4) (both P < 0.01). The SD value of group A (20.0 ± 1.7) was obviously lower than that of group B (22.4 ± 3.2) (P < 0.01). And the CTDIvol of group A (5.2 ± 1.2 mGy) was obviously lower than that of group B (13.5 ± 4.7 mGy) (P < 0.01). For patients of BMI ≤ 22 kg/m², low tube voltage and low contrast medium concentration scan condition with 50% ASiR algorithm is feasible for acquiring better quality image and ensuring significant reduction in effective dose.

Magnesium isoglycyrrhizinate prevention of chemotherapy-induced liver damage during initial treatment of patients with gastrointestinal tumors

To investigate the preventive effect of magnesium isoglycyrrhizinate against acute drug-induced liver damage from initial chemotherapy treatment in patients with gastrointestinal cancer. A total of 216 cases with early stage gastric cancer and indications for systemic chemotherapy that had been diagnosed with gastrointestinal malignant tumors by pathology in our hospital were enrolled for study during the period of January 2011 to June 2013.Using a prospective randomized controlled study design,differences were assessed between groups treated with glycyrrhizic acid magnesium (experimental group; n=114) or glutathione (control group; n=102) and the FOLFOX regimen (n=104) or the XELOX regimen (n=112).Patients in the FOLFOX group received intravenous infusion of L-OHP (85 mg/m²) at day 1,followed by a bolus injection of 5-FU (400 mg/m²) at days 1-2 and continuous intravenous infusion of 5-FU (600 mg/m²) for 22 h at days 1-2,with one cycle comprising 2 weeks. Patients in the XELOX group received intravenous infusion of L-OHP (130 mg/m²) at day 1, followed by capecitabine (1 000 mg/m²) oral twice a day at days 1-14,with one cycle comprising 3 weeks.In the first cycle of chemotherapy,serum was extracted from the patients at 1 day before chemotherapy and 1 week after chemotherapy.An automated biochemistry analyzer was used to measure alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and alkaline phosphatase (ALP). Differences between groups were statistically analyzed by the t-test and x² test. Among the total 216 cases treated with chemotherapy,40 showed hepatic biochemical abnormalities (12 cases in the experimental group, 28 cases in the control group), and the effect of prevention was significantly different between the two groups (10.53% vs. 27.25%; x² =10.219, P less than 0.005).The acute and subacute hepatic toxicity reaction degrees for the experimental and the control groups were: 0:94.78% vs. 88.2%; 1:5.3% vs. 11.8% (x² =6.99, P < 0.01). One week after chemotherapy, the liver biochemical indexes in the experimental group (ALT:35.93 ± 8.33 U/L; AST:24.84 ±2.91 U/L; TBil:13.29 ± 5.89 mumol/L; ALP:125.1 ± 53.61 U/L) were statically different from those in the control group (all P < 0.05). The liver biochemical indexes before and after chemotherapy were also significantly different between the experimental group (ALT:13.18t3.23 U/L; AST:5.39 ± 2.57 U/L; TBil:2.79 ± 0.23 mumol/L; ALP:52.08 ± 4.83 U/L) and the control group (all P < 0.05).One week after chemotherapy in the experimental group, the groups treated with the FOLFOX regimen or the XELOX regimen showed no statistical differences in the liver biochemical indexes.One week after chemotherapy in the control group, though, the groups treated with the FOLFOX regimen showed significantly lower AST (26.24 ± 3.50 U/L vs. 29.80 ± 6.57 U/L, t=-2.431, P < 0.05),but the residual liver biochemical indexes were not significantly different.In the experimental group, the FOLFOX group showed significantly lower ALP (53.44 ± 2.47 U/L vs. 56.58 ± 6.70 U/L, t =-2.201, P < 0.05), AST (6.48 ± 3.15U/L vs. 9.88 ± 4.57 U/L, t =-5.223, P < 0.05), but the residual liver biochemical index was not significantly different. Magnesium isoglycyrrhizinate is an effective drug for the prevention of drug-induced liver damage after initial chemotherapy in patients with early stage gastrointestinal cancer.

Esophageal subepithelial lesion diagnosed as malignant gastrointestinal neuroectodermal tumor

A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days. Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth. Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin. Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117, SMA, and cytokeratin. The patient underwent excision of the subepithelial lesion at the distal esophagus. On pathologic examination of the specimen, the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei. The tumor cells were positive for S-100 and SOX10 and negative for CD117, SMA, HMB-45, melan-A, cytokeratin, and CD99. The split-apart signal was detected in EWSR1 on FISH, suggesting a malignant gastrointestinal neuroectodermal tumor. At the time of writing, the patient is on radiation therapy at the operated site of esophagus and doing well, with no recurrence for three months. Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma, without melanocytic differentiation, and shows a poor prognosis. This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.

Solitary brain metastasis as an initial manifestation of gall bladder carcinoma

Gallbladder cancer is a common malignancy in Northern India, and it accounts for 2-4% of all malignant gastrointestinal tumors. It is an aggressive tumor with early dissemination to liver and lymph nodes and associated with poor prognosis. Systemic metastases from gall bladder carcinoma (Ca) frequently occur; however, metastatic involvement of the central nervous system is rare and late manifestation and remains an ominous sign. Initial presentation of gall bladder Ca with brain metastasis is rare. We report a case of 65-year-old women who initially presented with a solitary brain metastasis from an adenocarcinoma of the gallbladder, which was diagnosed incidentally when the patient presented with headache, vomiting, and right temporal region swelling. Palliative chemotherapy and cranial radiotherapy were prescribed. She is symptom-free from 3 months after the completion of the treatment.

Five miRNAs Considered as Molecular Targets for Predicting Esophageal Cancer.

BackgroundEsophageal cancer (EC) is one of the most aggressive malignant gastrointestinal tumors; however the traditional therapies for EC are not effective enough. Great improvements are needed to explore new and valid treatments for EC. We aimed to screen the differentially expressed miRNAs (DEMs) in esophageal cancer and explore the pathogenesis of esophageal cancer along with functions and pathways of the target genes.Material/MethodsmiRNA high-throughput sequencing data were downloaded from The Cancer Genome Atlas (TCGA), then the DEMs underwent principal component analysis (PCA) based on their expression value. Following that, TargetScan software was used to predict the target genes, and enrichment analysis and pathway annotation of these target genes were done by DAVID and KEGG, respectively. Finally, survival analysis between the DEMs and patient survival time was done, and the miRNAs with prediction potential were identified.ResultsA total of 140 DEMs were obtained, 113 miRNAs were up-regulated including hsa-mir-153-2, hsa-mir-92a-1 and hsa-mir-182; while 27 miRNAs were down-regulated including hsa-mir comprising 29a, hsa-mir-100 and hsa-mir-139 and so on. Five miRNAs (hsa-mir-103-1, hsa-mir-18a, hsa-mir-324, hsa-mir-369 and hsa-mir-320b-2) with diagnostic and preventive potential were significantly correlated with survival time.ConclusionsThe crucial molecular targets such as p53 may provide great clinical value in treatment, as well to provide new ideas for esophageal cancer therapy. The target genes of miRNA were found to play key roles in protein phosphorylation, and the functions of the target genes during protein phosphorylation should be further studied to explore novel treatment of EC.

60-Year-Old Man With Chronic Diarrhea and Peptic Ulcer Disease

Resident in Internal Medicine (D.K.C.) and Fellow in Gastroenterology (D.A.S.), Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN; Adviser to resident and fellow and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.C.H.). A 60-year-old man was transferred to our hospital with a 5-year history of worsening daily watery, nonbloody, nongreasy diarrhea. One year previously, recurrent vomiting had developed. Over the month preceding the current admission, he experienced 4 episodes of intractable, largevolume diarrhea with abdominal pain, upper and lower extremity muscle cramping, and orthostatic light-headedness. His diarrhea did not improve with fasting, and each of these episodes required hospitalization for intravenous fluid and electrolyte replacement. On the fourth episode, he was transferred to our institution for further diagnostic evaluation. The patient reported no symptomatic correlation to dietary habits and no associated fever, gastrointestinal bleeding, flushing, arthralgia, or rash. He had not experienced fecal incontinence. His medical history was notable for gastroesophageal reflux disease diagnosed 4 years previously and treated with 40 mg of esomeprazole daily. He had no surgical history. His only other medication was lisinopril for hypertension, and he reported no recent medication changes or antibiotic therapy. His family history did not include any gastrointestinal illness or malignant neoplasms, and he did not use tobacco or alcohol. His last screening colonoscopy was within the past 5 years and yielded normal findings. The patient had been stabilized with intravenous fluids before arrival at our institution, and physical examination at presentation revealed a well-nourished man with a body mass index of 26.3 kg/m, normal orthostatic vital signs, and normal physical examination findings, including no evidence of rash, abdominal tenderness, fecal impaction, or other abnormality. The results of laboratory studies including red and white blood cell count, complete metabolic profile, calcium level, liver function tests, total protein, albumin, thyrotropin, and tissue transglutaminase antibody values, erythrocyte sedimentation rate, and C-reactive protein

Hartmann's procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer.

IntroductionColorectal carcinoma is the most common malignant gastrointestinal tumour. There is still a considerable controversy when it comes to urgent surgical treatment of obstructive carcinoma of the left colon and rectum.MethodsSeventy-five patients from the randomized trial were followed up. This study was designed as a stratified randomized trial with four stratums according to age and ASA score (older/younger than 60 years and ASA score <>3). Each of the four groups is then divided into two sub-groups according to the operating technique: loop colostomy or Hartmann’s procedure.ResultsThere were no difference found in hospitalization among the groups (loop colostomy vs. Hartmann’s procedure) in the same stratus (P = 0.3192, P = 0.5760, P = 0.9023 respectively), except in the case of doing reconstructive procedure after loop colostomy (P = 0.0049) in the fourth stratum (patients younger than 60 years with ASA score lower than 3). Type of operation had no influence over the blood test values observed on admittance and during hospitalization (P = 0.319, P = 0.871, P = 0.7, P = 0.843, P = 0.52 respectively for the blood values). In terms of surgical and non-surgical complications it has been shown that there is no statistically significant difference between patients treated by two methods. Age, gender, ASA score, type of operation and surgical complications were not singled out as a risk factor for fatal outcome (P = 0.199, P = 0.155, P = 0.764, P = 0.452 and P = 0.724 respectively). The only factors that are singled out as a risk factor for death are the emergence of non-surgical complications and angina pectoris (P = 0.006, P = 0.001).ConclusionsThere is no difference in surgical treatment of large bowel obstruction caused by rectosigmoid carcinoma. Neither of those two methods showed significant advantage in treatment of large bowel obstruction caused by rectosigmoid cancer.

Extra - Intestinal Gastrointestinal Stromal Tumor of Omentum

Gastrointestinal stromal tumors are rare tumors, constituting less than 3% of all gastrointestinal malignant neoplasms but are the most common mesenchymal tumors of the gastrointestinal tract. Approximately 10% of gastrointestinal stromal tumors are extraintestinal and mostly arise from the mesentery or omentum. Here we report a rare case of an extraintestinal gastrointestinal stromal tumor of mesentery. Morphological and immunohistochemical features led to a diagnosis of extra-gastrointestinal stromal tumor.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11610 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 682-684