Presence Of Adenocarcinoma Research Articles

Association between diverticular disease and prevalence of colorectal adenomatous polyps or adenocarcinomas

Background/Aim: Although the link between diverticular disease (DD) of the colon and colon polyp is known, the relationship between colon adenocarcinoma is not clear. This study evaluated the association between DD and adenomatous polyp or colon adenocarcinoma. Methods: Patients who underwent colonoscopy for the first time in 2020-2021 were evaluated and included in this retrospective cohort study. Patients with a previous history of cancer diagnosis, colon surgery, DD, and inflammatory bowel disease were excluded from the study. Age, gender, colonoscopy indications, colonoscopy diagnoses, presence of DD, characteristics of polyps (pathology, diameter, number, localization), and presence of adenocarcinoma were recorded. Obtained data were analyzed between DD and non-DD groups. Results: A total of 2633 patients were included in the study. The prevalence of DD was 16.4%. Colon adenocarcinoma was detected in 4.7%. The adenomatous polyp rate was 14.1%. A significantly higher rate of adenomatous polyps was detected in the DD group compared to the non-DD group (19.7% vs. 12.9%; P = 0.001). Higher rates of high-grade dysplasia (3.0 vs. 1.1%; P = 0.002) and colon adenocarcinoma (7.2% vs. 4.2%; P = 0.008) were observed in the DD group also. In logistic regression analyses, it was observed that the presence of concomitant DD increases the risk of adenomatous polyps (OR: 1.469, 95% CI: 1.158–1.865), the risk of adenomatous polyps with positive villous component (OR: 2.378, 95% CI: 1.437–3.934), the risk of adenomatous polyps with high-grade dysplasia (OR: 2.822, 95% CI: 1.426–5.582), and the risk of colon adenocarcinoma (OR: 2.953, 95% CI: 1.445–6.533). Conclusion: DD is associated with precancerous lesions of the colon (adenomatous polyp, villous adenoma, high-grade dysplasia) and colon adenocarcinoma. Further studies are needed to investigate its association with colon carcinogenesis and its role and value in cancer screening.

Comprehensive analysis of different tumor cell-line produced soluble mediators on the differentiation and functional properties of monocyte-derived dendritic cells.

Developing dendritic cells (DCs) from monocytes is a sensitively regulated process. One possible way for cancers to avoid immune recognition and antitumor response is the modulation of DC differentiation. Although several studies are available on the examination of tumor-associated macrophages, a comprehensive analysis focusing on the effects of tumor-formed DCs is not known to date. We provide a comparative analysis of the tumor-edited-monocyte derived DCs differentiated in the presence of adenocarcinomas (MDA, HT29, HeLa)- and primary (WM278, WM983A) or metastatic (WM1617, WM983B) melanomas. The immunomodulatory effect of tumors is mediated at least partly by secreted mediators. We investigated the impact of tumor cell-derived conditioned media on the differentiation of DCs from CD14+ monocytes, sequentially determining the phenotype, cytokine production, phagocytic, and the T cell polarizing capacity of moDCs. We completed our observations by analyzing our data with bioinformatic tools to provide objective correlations between phenotypical and functional properties of different tumor-educated moDCs. The correlation analysis revealed significant differences in the characteristics of adenocarcinomas- or melanomas-edited moDCs. We highlight the functional differences in the properties of moDCs differentiated in the presence of various cancer cell lines. We offer new information and options for the in vitro differentiation protocols of various tumor-conditioned moDCs. Our results confirm that various immunomodulatory properties of different tumor cell lines result in multiple manipulations of DC differentiation.

CLINICO-PATHOLOGICAL PROFILE OF BRONCHOSCOPICALLY INVISIBLE MALIGNANT PERIPHERAL PULMONARY LESIONS DIAGNOSED IN A TERTIARY CARE CENTER

Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21 (77.8%) were females. Majority of patients were either current (n=13, 48%) or reformed (n=8, 29.6%) smokers. Adenocarcinoma (n=17, 62.9%) was the most common pathological diagnosis. The most common location of the lesions was upper lobes (n=19, 70.4%) followed by right lower lobe (n=5, 18.5%). Two patients developed pneumothorax and respiratory failure requiring intubation, one with terminal stage adenocarcinoma died during hospitalization. Conclusions: The presence of adenocarcinoma, female sex, smoking status and upper lobe predominance reflects the current trend of peripheral lung cancers. RP-EBUS is a newer modality and may be a useful initial diagnostic tool for PPLs and with a good safety profile.

Pyruvate dehydrogenase E1α represents a reliable prognostic predictor for patients with non-small cell lung cancer resected via curative operation

BackgroundLung cancer is associated with a high morbidity and mortality rate worldwide; however, no reliable and independent prognostic predictor for non-small cell lung cancer (NSCLC) after curative surgery is available. Glucose metabolism is correlated with cancer cell proliferation. Pyruvate dehydrogenase E1α (PDH-E1α) catalyzes the conversion of pyruvate to acetyl-CoA and promotes aerobic glucose metabolism. In this study, we examined the relationship between PDH-E1α expression and clinicopathological factors associated with NSCLC to identify a reliable prognostic predictor of NSCLC after curative surgery.MethodsA total of 445 patients with NSCLC who underwent curative resection were enrolled in this study. PDH-E1α expression was evaluated via immunohistochemistry. We analyzed the correlation between PDH-E1α expression and clinicopathological features of the patients.ResultsIn total, 248 (56%) of the 445 patients with NSCLC were PDH-E1α-positive, and 197 patients were PDH-E1α-negative. PDH-E1α positivity was significantly correlated with the presence of adenocarcinoma (P<0.001) compared to the PDH-E1α-negative group. Patients with NSCLC showing PDH-E1α-negative expression had a significantly poorer overall survival rate (P=0.007) than those showing PDH-E1α-positive expression, especially at stage II. Patients with PDH-E1α negative expression also showed a poorer disease-free survival rate (P=0.02). Multivariate analysis revealed that PDH-E1α negativity (P=0.037) and male sex (P<0.001) were significantly correlated with a poor overall survival.ConclusionsPDH-E1α may represent a reliable prognostic predictor for NSCLC in patients that have recently undergone curative resection, especially at stage II.

Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: Analysis of factors related to treatment outcome and long-term prognosis.

There are few reports on the long-term prognosis of papillary tumors after endoscopic papillectomy. Here, we report a retrospective study of the therapeutic effects, long-term prognosis, and affecting factors. The inclusion criteria were papillary adenoma with/without an adenocarcinoma component on biopsy results and ≤10mm intraductal extension, and the exclusion criteria were moderate to poorly differentiated adenocarcinoma on biopsy results. If no residual lesion was confirmed ≥6months after the last endoscopic treatment, remission was defined. Subsequently, follow-up endoscopy was scheduled once a year. Surgery was required in the case of adenocarcinoma recurrence or intraductal lesions >10mm. The rates of adverse events, remission, recurrence, and need for surgery were examined. The affecting factors were calculated. There were a total of 253 subjects, including 65 with adenocarcinoma. Pancreatitis (7.5%), bleeding (9.1%) and perforation (2.8%) were observed as adverse events. Among 221 subjects with ≥6months of follow-up, 212 (95.9%) were in remission. The cumulative recurrence rate using the Kaplan-Meier analysis at 5years was 16.9% (22 cases), with the need for surgery in 5.9% (5 cases). Intraductal extension on preoperative diagnosis was the only significant risk factor for both recurrence (P<0.001) and the need for surgery (P=0.005). The presence of adenocarcinoma had no significant effect. Although remission was achieved in more than 95% of our patients, we observed a high rate of recurrence at the long-term follow-up, which was significantly associated with intraductal extension but not with the presence of adenocarcinoma.

Case Report Of Adenocarcinoma On Palpebral Of Rotweiler Dog: A Histopathological Evaluation

Eyelid neoplasms cases are the most frequently recorded ophthalmic tumors in dogs, which mostly benign and only few are reported as being malignant. Adenocarcinoma is one of malignant tumor reported in dog eyes beside fibrosarcoma, squamous cell carcinoma, and hemangiosarcoma. A case of adenocarcinoma in palpebral of a 6-year-old male rotweiller dog with 6month history of a progressive mass on the left eye was presented. Pathological examination showed a severe exophytic irregular pink to red cauliflower-like mass occupying all surface of the eye lid. A transpalpebral enucleation was performed to collect the mass, followed by histopathological slide preparation using Hematoxylin-Eosin (HE) staining. Histopathological examination showed various sizes lobules separated by connective tissue. Many angioneogenesis figure were also observed. The irregular arranged of anaplastic cells was obviously seen with hyperchromatic and pleomorphic of the nuclei and various shapes and sizes of cell structures as well. There was no sign of encapsulated area, however, few mitotic figures were seen. The histopathological examination result confirmed the presence of adenocarcinoma.

Erlotinib en 2e ou 3e ligne pour les cancers bronchiques non à petites cellules sans mutation de l’EGFR : données en vie réelle

The benefit of tyrosine kinase inhibitors for patients with an EGFR wild-type non-small cell lung cancer (NSCLC) remains controversial. The survival of patients with an EGFR wild-type NSCLC who received second- or third-line erlotinib treatment was assessed using real-life data that had been collected in a prospective, national, multicenter, non-interventional cohort study. Data from 274 patients were analysed, 185 (68%) treated with erlotinib and 89 (32%) treated with supportive care only. The median overall survival was 4.2months (95% CI [3.5; 5.4]) with erlotinib, and 1.3months (95% CI [1.0; 1.8]) with supportive care. Survival rate at 3, 6, and 12months was 62%, 37%, and 17%, respectively, with erlotinib, versus 20%, 8%, et 3%, with exclusive supportive care. Significant predictive factors for longer overall survival were the presence of adenocarcinoma, and use of 1st line chemotherapy including either taxanes, pemetrexed or vinorelbine (P<0.05). Erlotinib remains a valuable therapeutic option to treat inoperable locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen in fragile patients who are not eligible for chemotherapy.

Neuroendocrine neoplasms of gastrointestinal tract and secondary primary synchronous tumors: A systematic review of case reports. Casualty or causality?

BackgroundNeuroendocrine neoplasms (NENs) can arise in most of the epithelial organs of the body and are not a rare condition in the gastrointestinal tract (GIT). The presence of NENs in GIT associated with other secondary primary malignancies (SPM) has been considered an exotic event. This study aims to describe the case reports of NENs accompanied by synchronous primary tumors.Methods and findingsWe performed a systematic literature search of the databases Scopus, PubMed, Scielo and LILACS to identify case reports that described the presence of NENs in GIT with SPM. 78 case reports were included. The mean of age of the cases was 60.2 years. 60% were male. 95.4% were NENs G1. 17 cases of NENs had metastasis. 80% of SPM were recognized in the GIT (36% in stomach, 27% in large intestine, 11.2% in small intestine, and 5.6% in esophagus). The most common type of SPM was adenocarcinoma (49.4%), followed by GIST (13.5%), other NENs in different GIT segment (7.9%), lymphoma (6.8%), and squamous cell carcinoma (4.5%). The most common tumor in GIT was adenocarcinoma (97.6%) and the presence of adenocarcinoma in the same segment of GIT was found in 68.4% of the cases. Association between adenocarcinomas and NENs in GIT (p:<0.0001) and adenocarcinoma and tumor in the same segment of GIT location were observed (p<0.001).ConclusionThese results demonstrate that NENs with SPM are not a rare condition. Several theories have been proposed to explain this association; one of these is the ability of NENs to generate synchronous tumors by autocrine and paracrine effect. We observed an association between adenocarcinomas and NENs in the same segment of GIT.

Identifying a candidate population for ovarian conservation in young women with clinical stage IB-IIB cervical cancer.

This study seeks to identify risk factors associated with ovarian metastasis and to characterize a population with minimum risk of ovarian metastasis in young women with stage IB-IIB cervical cancer. This was a nation-wide multicenter retrospective study in Japan examining consecutive cases of surgically-treated women with clinical stage IB-IIB cervical cancer who had oophorectomy at radical hysterectomy (n = 5,697). Multivariable analysis was performed to identify independent risk factors for ovarian metastasis. Ovarian metastasis was seen in 70 (1.2%, 95% confidence interval 0.9-1.5) cases. In the entire cohort, adenocarcinoma, lympho-vascular space invasion, uterine corpus tumor invasion, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-p < 0.05). In a sensitivity analysis of 3,165 women aged <50 years (ovarian metastasis, 1.0%), adenocarcinoma, parametrial tumor involvement, uterine corpus tumor involvement, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-P < 0.05). In the absence of these five risk factors (representing 46.1% of women aged <50 years), the incidence of ovarian metastasis was 0.14%. With the presence of adenocarcinoma alone (representing 18.9% of women aged <50 years), the incidence of ovarian metastasis was 0.17% and was not associated with increased risk of ovarian metastasis compared to the subgroup without any risk factors (p = 0.87). In conclusion, nearly two thirds of women aged <50 years with clinical stage IB-IIB cervical cancer had no risk factor for ovarian metastasis or had adenocarcinoma alone: these subgroups had ovarian metastasis rates of around 0.1% and may be a candidate population for ovarian conservation at surgical treatment.

Effect of formalin fixation and tumour size in small-sized non-small-cell lung cancer: a prospective, single-centre study.

Formalin fixation can cause tumour shrinkage. The aim of this study was to prospectively evaluate the effect of overnight formalin fixation on tumour size and the effect of clinicopathological parameters on changes in tumour size in small-sized non-small-cell lung cancer (NSCLC). Our study included 126 surgically resected NSCLC specimens submitted in a fresh state. We measured the largest cross-sectional tumour diameters in the fresh and formalin-fixed specimens. Tumour size significantly differed (mean, 0.66mm; P<0.001) and was positively correlated (r2 =0.982; P<0.001) between fresh and formalin-fixed specimens. The percentage difference after fixation was 4.06%. Formalin fixation caused tumour shrinkage in 46.8%, tumour enlargement in 4.8%, and a tumour stage shift in 3.17%. The risk of a>10% change in tumour size after formalin fixation was increased in tumours with a lepidic pattern [odds ratio (OR): 6.268; P=0.001], in subsolid tumours (OR: 4.068; P=0.011), and in the presence of adenocarcinoma insitu (AIS)/minimally invasive adenocarcinoma (MIA) histology (OR: 6.545; P=0.003). Pleural dimpling lowered the risk of tumour size change after fixation (OR: 0.162; P=0.019). On multivariate analysis, a lepidic pattern (OR: 4.601; P=0.010) and AIS/MIA histology (OR: 4.381; P=0.026) were still significant risk factors. Longer ischaemic time was the single risk factor for tumour shrinkage in the invasive adenocarcinoma subgroup (OR: 5.357; P=0.021). NSCLC tumours shrank or enlarged by 4.06% after overnight formalin fixation. A lepidic pattern and AIS/MIA histology were independent risk factors for both significant tumour shrinkage and growth after fixation. Longer ischaemic time was the single risk factor for significant tumour shrinkage in invasive adenocarcinoma.

Objective response to mTOR inhibition in a metastatic collision tumor of the liver composed of melanoma and adenocarcinoma with TSC1 loss: a case report

BackgroundCollision tumors are uncommon but well described clinical entities composed of distinct tumor histologies occurring within the same anatomic site. Optimal management of patients with collision tumors remains highly variable and depends on clinical characteristics such as the involved tumor types, predominant histology, as well as the extent of disease. Comprehensive genomic profiling is a means of identifying genomic alterations to suggest benefit from targeted therapy.Case presentationA 78-year-old woman presented to medical oncology with liver metastases occurring within the background of a 1-year history of uveal melanoma. Biopsy of the liver metastases revealed presence of adenocarcinoma along with nests of malignant melanoma consistent with a collision tumor. The disease was refractory to several lines of conventional cytotoxic chemotherapy, and the patient later developed pulmonary metastases while on chemotherapy. The patient’s tumor tissue was assayed by comprehensive genomic profiling which revealed presence of a TSC1 partial loss. The patient was subsequently initiated on temsirolimus 15 mg intravenously weekly for 4 months. Restaging imaging demonstrated a partial response to therapy by RECIST 1.1 criteria and clinical benefit for 6 months until the patient passed away secondary to unrelated causes.ConclusionsWe report the first case of a collision tumor composed of adenocarcinoma and melanoma with a TSC1 mutation that objectively and durably responded to mTOR inhibition.

Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery.

ObjectiveTo evaluate the effects of age and the clinical response to neoadjuvant chemotherapy (NACT) in patients with cervical cancer who received neoadjuvant chemotherapy followed by radical surgery.MethodsA total of 1,014 patients with advanced cervical cancer who received NACT followed by radical surgery were retrospectively selected. Patients were divided into young (aged ≤35 years, n = 177) and older (aged >35 years, n = 837) groups. We compared the short-term responses and survival rates between the groups. The five-year disease-free survival (DFS) and overall survival (OS) rates were stratified by age, NACT response, and FIGO stage.ResultsThe overall response rate was 86.8% in the young group and 80.9% in the older group. The young patients had an earlier FIGO stage (P<0.001), a higher rate of adenocarcinoma (P = 0.022), and more lymph node metastasis (P = 0.033) than the older patients. The presence of adenocarcinoma as the histological type (P = 0.024) and positive lymph node metastasis (P<0.001) were identified as independent risk factors for survival. When stratified by age and clinical response, young patients with no response to NACT had a worse clinicopathological condition compared with the other subgroups. Compared with non-responders, responders to NACT had a higher five-year DFS rate (80.1% versus 71.8%; P = 0.019) and OS rate (82.6% versus 71.8%; P = 0.003) among the young patients but not among the older patients.ConclusionsResponders to NACT aged 35 years or younger benefitted the most from NACT, while the young non-responders benefitted the least. Age might represent an important factor to consider when performing NACT in patients with cervical cancer.

Descriptive analysis of endoscopic findings in patients with a family history of colorectal cancer

BackgroundThe presence of a family history implies an increased risk for developing colorectal cancer (CRC), and may require a different screening strategy.The aim of this study was to evaluate lesions found during colonoscopies of patients that had a family history of CRC. Material and methodsA retrospective study was conducted that included consecutive colonoscopies performed on patients with a family history of CRC at a referral center within the period from April 2000 to January 2012. The colonoscopic findings were analyzed in relation to sex, age, and the presence or absence of symptoms. ResultsData from 3,792 colonoscopies were collected. The mean age of the patients was 53.14 years (SD 12.22), and 57.4% were women. Colonoscopy was normal in 71.7% of the cases, with hyperplastic polyps being detected in 7.1%, and adenomatous polyps in 19.8% (39.4% of them were high risk). There was a 1.5% presence of adenocarcinomas in the subjects. Polyps and CRC were predominant in men (P=.001 and P=.027, respectively) and there was a linear increase with age. Symptomatic patients had a higher CRC detection rate (P<.001), but no differences were observed in relation to polyp diagnosis. ConclusionsAge and male sex increased the risk for presenting with CRC or adenomas in the group of patients with a family history of CRC, and the presence of symptoms was associated with a greater risk for presenting with CRC.

Descriptive analysis of endoscopic findings in patients with a family history of colorectal cancer.

The presence of a family history implies an increased risk for developing colorectal cancer (CRC), and may require a different screening strategy. The aim of this study was to evaluate lesions found during colonoscopies of patients that had a family history of CRC. A retrospective study was conducted that included consecutive colonoscopies performed on patients with a family history of CRC at a referral center within the period from April 2000 to January 2012. The colonoscopic findings were analyzed in relation to sex, age, and the presence or absence of symptoms. Data from 3,792 colonoscopies were collected. The mean age of the patients was 53.14 years (SD 12.22), and 57.4% were women. Colonoscopy was normal in 71.7% of the cases, with hyperplastic polyps being detected in 7.1%, and adenomatous polyps in 19.8% (39.4% of them were high risk). There was a 1.5% presence of adenocarcinomas in the subjects. Polyps and CRC were predominant in men (P=.001 and P=.027, respectively) and there was a linear increase with age. Symptomatic patients had a higher CRC detection rate (P<.001), but no differences were observed in relation to polyp diagnosis. Age and male sex increased the risk for presenting with CRC or adenomas in the group of patients with a family history of CRC, and the presence of symptoms was associated with a greater risk for presenting with CRC.

Should screening for colorectal neoplasm be recommended in patients at high risk for coronary heart disease: a cross-sectional study.

Colorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

Intraductal Papillary Mucinous Neoplasms: Can Mesothelin Expression Help us to Classify them Better?

Mesothelin is a cell surface protein and a differentiation antigen of mesothelial cells. Rcently, Mesothelin expression has been reported in mucinous neoplasms of the pancreas. The aim of this study is to study the expression of Mesothelin in Intraductal pancreatic mucinous neoplasms (IPMN) and to see if this can be used to identify lesions with increasing dysplasiaA retrospective search of our Surgical database from 2008‐2014 was done. 30 cases of mucinous cystic lesions of the pancreas were identified. Clinical data including the age, size of lesion, main or branch duct involvement and pathological features including size of lesion, presence of adenocarcinoma, histopathology of the lesion were collected. All the cases were reviewed to select a representative section with the worst lesion on histopathology. The block was recut to obtain 2 unstained slides per block. One was stained with Hematoxylin and Eosin and the other was stained for Mesothelin (Leica RTU Clone5B2). Mesothelin staining pattern was evaluated as shown: Mesothelin stain Pattern Cytoplasmic Luminal/Apical Intensity Weak, Intermediate, Strong Weak, Intermediate, Strong 73% of the mucinous cystic lesions were IPMN, with 21 female patients and 9 male patients. The mean size of the lesion was 3.1 cm. A. Histopathology Number Mesothelin positive Apical stain positive 1. IPMN 16 13 4 2. IPMN with high grade dysplasia 3 3 3 3. IPMN with adenocarcinoma 3 2 2 4. Mucinous cystadenoma 2 1 0 5. Mucinous cystic neoplasm 6 1 0 B. Relation to duct 1. Main duct 8 7 6 2. Branch duct 8 6 2 3. Mixed 3 2 0 4. Not reported 3 2 1 Mesothelin shows strong luminal expression in IPMN associated with high grade dysplasia and adenocarcinoma. It can possibly be used to identify lesions which might recur or as a marker of poor prognosis, hence helpful in stratifying patients who need close follow up. It shows cytoplasmic granular positivity in neoplastic epithelium and is negative in benign pancreatic and duodenal epithelium, which may help in identifying lesional tissue. This feature may also be useful in stratifying FNA specimen which usually have scant cells. Long‐term follow up studies can be helpful to study association with recurrence and prognosis, and identify cases which require close follow‐up.

Adenocarcinoma in the squamous-lined esophagus without Barrett’s mucosa, probably arising from esophageal gland duct

Endoscopic mucosal resection (EMR) was performed for submucosal tumor (SMT)-like lesion of esophagogastric junction in an 81-year-old male. Histopathological findings revealed the presence of adenocarcinoma with high-grade cytological atypia. No foci of Barrett’s esophagus and/or heterotopic gastric mucosa were detected in the specimen. Intraepithelial squamous cell carcinoma was also not detected in the adjacent stratified squamous layer. The contour of the tumor was similar to normal esophageal gland ducts but tumor did have immunohistochemical staining patterns similar to esophageal cardiac glands. Esophageal adenocarcinoma arising in the background without the foci of Barrett’s esophagus is extremely rare and we reported the case with review of the literature in this study.

Incidence and Predictors of Adenocarcinoma Following Endoscopic Ablation of Barrett’s Esophagus

The rate and risk factors of recurrent or metachronous adenocarcinoma following endoscopic ablation therapy in patients with Barrett's esophagus (BE) have not been specifically reported. The aim of this study was to determine the incidence and predictors of adenocarcinoma after ablation therapy for BE high-grade dysplasia (HGD) or intramucosal carcinoma (IMC). This is a single center, retrospective review of prospectively collected data on consecutive cases of endoscopic ablation for BE. A total of 223 patients with BE (HGD or IMC) were treated by ablation between 1996 and 2011. Primary outcome measures were recurrence and new development of adenocarcinoma after ablation. Recurrence was defined as the presence of adenocarcinoma following the absence of adenocarcinoma in biopsy samples from two consecutive surveillance endoscopies. Logistic regression analysis was performed to assess predictors of adenocarcinoma after ablation. One hundred and eighty-three patients were included in the final analysis, and 40 patients were excluded: 22 for palliative ablation, eight lost to follow-up, five for residual carcinoma and five for postoperative state. Median follow-up was 39 months. Recurrence or new development of adenocarcinoma was found in 20 patients (11 %) and the median time to recurrence/development of adenocarcinoma was 11.5 months. Independent predictors of recurrent or metachronous adenocarcinoma were hiatal hernia size ≥ 4 cm (odds ratio 3.649, P = 0.0233) and histology (HGD/adenocarcinoma) after first ablation (odds ratio 4.141, P = 0.0065). Adenocarcinoma after endoscopic therapy for HGD or IMC in BE is associated with large hiatal hernia and histology status after initial ablation therapy.

Amyotropic lateral sclerosis as a para-neoplastic manifestation of gastric adenocarcinoma - A rare case report

Motor neuron diseases(MND) have been reported as a rare paraneoplastic syndrome (PNS) of a systemic neoplasm.Amyotropic Lateral Sclerosis as a paraneoplastic manifestation of gastric carcinoma is even rarer. We present a patient with amyotrophic lateral sclerosis (ALS) in association with adenocarcinoma of stomach. A 48year old man presented with a four months history of progressive dysphagia, spastic dysarthria and marked fasciculation in his atrophic tongue. Gag reflexes were diminished bilaterally. There was significant atrophy in thenar and hypothenar areas of both hands and dorsum of both feet.Electromyography result was compatible with diffuse motor neuronopathy with active denervation.MRI brain showed classical findings of ALS. Upper GI endoscopic study showed ulcerated mucosa in body of stomach. Histological biopsy of stomach confirmed the presence of adenocarcinoma. The importance of considering a paraneoplastic syndrome in a patient with presentation of ALS is that it can lead to searching for underlying neoplasm before its apparent signs and symptoms develop and a scope to initiate treatment for primary carcinoma. Again treating the underlying neoplasm may halt or even resolve the neurologic signs and symptoms.

Oncological outcomes after endoscopic removal of malignant colorectal polyps

malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management. retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes. thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4%) patients: 8 (53.3%) wall disease, 5 (33%) nodal metastasis, and 2 (13.3%) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30%) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03). surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.