Primary Gastrointestinal Carcinoma Research Articles

Clinicopathological Features and Prognosis of Gastrointestinal Metastases From Breast Carcinoma: A Clinicopathological Study of 22 Patients.

Background. Breast carcinoma is the most common malignancy in women. Gastrointestinal metastasis is rarely found or diagnosed in patients with breast cancer. Methods. Clinicopathological features, treatment options, and prognosis were evaluated retrospectively for 22 patients with gastrointestinal metastases of breast carcinoma in Chinese women. Results. Presenting symptoms were non-specific: anorexia (21/22), epigastric pain (10/22), and vomiting (8/22), and 2 patients (2/22) presented with nonfatal hemorrhage. The first sites of metastases were skeleton (9/22), stomach (7/22), colorectal (7/22), lung (3/22), peritoneal (3/22), and liver (1/22). ER, PR, GATA binding protein 3 (GATA3), gross cystic disease fluid protein-15 (GCDFP-15), and keratin 7 can effectively confirm the diagnosis, especially in the case of keratin 20 negativity. Histology showed mainly ductal breast carcinoma (n = 11) was the predominant source of gastrointestinal metastases in this study, and lobular breast cancer (n = 9) accounted for a considerable proportion. The disease control rate to systemic therapy was 81% (17 of 21 treated patients), and the objective response rate was 10% (2 of 21 treated patients). Median overall survival was 71.5 months (range, 22-226 months), median survival for distant metastases was 23.5 months (range, 2-119 months) and the median survival for the time of gastrointestinal metastases diagnosis was 6 months (range, 2-73 months). Conclusions. Performing the endoscopy with biopsy was crucial for patients with any subtle gastrointestinal symptoms and a history of breast cancer. It is important to distinguish primary gastrointestinal carcinoma from breast metastatic carcinoma in order to select the optimal initial treatment and avoid unnecessary surgery.

Gastrointestinal carcinoma first presenting as pituitary mass: recognition of a rare case and multidisciplinary approach for the management of pituitary metastases

Abstract Introduction PMs (pituitary metastases) are rare and only a few cases are reported in the literature. In half of the documented cases, PMs originate from breast and lung cancers, rarely from other sites. They can grow rapidly and present local invasiveness, leading to acute onset of neurological symptoms, such as headache, visual and oculomotor disturbances, or endocrinological signs, such as diabetes insipidus and hypopituitarism. Their rarity and the lack of specific clinical and radiological features often impede their differentiation from other more common sellar area lesions, particularly when history of malignancy is absent. As PMs can be life-threatening, they must be recognized and treated promptly. Management of PMs may also be difficult because the prognosis depends on the course of the primary neoplasm. The case presented below is one of the few documented cases in the world of a pituitary metastasis from a primary gastrointestinal carcinoma. Clinical Case A 76-year-old woman, with no history of malignancy, presented with headache, dizziness and diplopia. Neurologic examination was remarkable for complete left ophthalmoplegia associated with sensitivity deficit in the left half face. Radiologic investigations documented a voluminous sellar and suprasellar formation, with extension in the ipsilateral cavernous sinus, compressing the optic chiasm and ipsilateral temporal lobe. The mass appeared heterogeneous as component of apoplectic infarction. Left cavernous sinus syndrome in apoplectic macroadenoma was diagnosed. Surgical removal of the lesion was performed through a transsphenoidal endoscopic endonasal approach. The histological exam disclosed a metastasis of adenocarcinoma with widespread necrotic-haemorrhagic elements. The immunohistochemical profile suggested an origin from a primary gastrointestinal carcinoma. Hormone replacement therapy and adjuvant therapy were instituted, although radiological investigations failed to identify the site of the primary gastrointestinal carcinoma. Postoperative MRI showed a parasellar residual tumor, which was radiologically stable at 6-month follow-up. The patient will undergo a radiotherapy and neurosurgical evaluation. Conclusions Clinicians should consider the possibility of PMs in patients with symptoms and signs that may suggest the presence of a pituitary mass. Since PMs can be cancer first manifestation, the recognition of PMs determines the referral to adequate oncological therapy. Prognosis is usually poor and it's difficult to estimate as it varies significantly depending on the systemic disease and the primary histology. Recognition and management of PMs remain complex and require a multidisciplinary team of endocrinologists, oncologists, neurosurgeons and neuroradiologists.

Undifferentiated large cell/rhabdoid carcinoma presenting in the intestines of patients with concurrent or recent non-small cell lung cancer (NSCLC): clinicopathologic and molecular analysis of 14 cases indicates an unusual pattern of dedifferentiated metastases

Undifferentiated carcinoma metastatic to the bowel is uncommon in surgical pathology practice and might be confused with primary gastrointestinal carcinoma, melanoma, lymphoma, and others. We present 14 cases of uni- (n = 9) or multifocal (n = 5) undifferentiated large cell/rhabdoid carcinoma presenting in the bowel of patients with concurrent (n = 9) or recent (diagnosed 1 to 25 months earlier; median, 4) non-small cell lung cancer (NSCLC). Patients were 6 females and 8 males, aged 52 to 85 years. Primary NSCLC was verified histologically in 10 cases and by imaging in 4. The undifferentiated histology was present in the lung biopsy in 4/10 patients (as sole pattern in 3 and combined with adenocarcinoma in 1) and was limited to the intestinal metastases in the remainder. PDL1 was strongly expressed in 7/9 cases (CPS: 41 to 100). Loss of at least one SWI/SNF subunit was detected in 7/13 cases (54%). SMARCA2 loss (n = 6) was most frequent and was combined with SMARCA4 loss in one case. PBRM1 loss was observed in one tumor. Successful molecular testing of 11 cases revealed BRAF mutations in 4 (3 were non-V600E variants), KRAS mutations in 3, and wildtype in 4. None had EGFR mutations. Analysis of 4 paired samples revealed concordant KRAS (2) and BRAF (1) mutations or wildtype (1). Our study indicates that undifferentiated carcinoma within the intestines of patients with concurrent/recent NSCLC represents dedifferentiated metastasis from the NSCLC. Recognition of this unusual presentation is cardinal to avoid misdiagnosis with inappropriate therapeutic and prognostic implications.

Gastrointestinal Carcinoma with Plasmacytoid Morphology: Positivity for c-MET, Arylsulfatase, and Markers of Epithelial-Mesenchymal Transition, as Indicators of Aggressivity.

Background Plasmacytoid urothelial carcinoma is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder. Few than 250 cases have been reported in the urinary bladder till January 2019. In this paper, a case series of unusual gastrointestinal carcinomas with plasmacytoid morphology was included. Only one similar case of the stomach was previously published and no such cases were found in colon. Methods We present the complex immunoprofile, using a panel of 39 biomarkers, of the largest group of primary gastrointestinal carcinomas with plasmacytoid morphology reported in literature (one from upper rectum and six from stomach). Results All of the seven cases showed lymph node metastases and only one survived over 25 weeks after surgical excision. The indicators of aggressivity were age (over 60), advanced stage (from IIIA to IV), E-cadherin negativity, and vimentin positivity. The immunoprofile indicated unfavorable prognosis for mesenchymal-type carcinomas (negativity for E-cadherin and positivity for vimentin, with membrane to nuclear translocation or negativity of β-catenin). The survivor showed an “epithelial-type adenocarcinoma with plasmacytoid dedifferentiation”, with membrane positivity for E-cadherin and β-catenin and vimentin negativity. All of the cases expressed c-MET and were negative for HER-2. Conclusions Primary carcinoma with plasmacytoid morphology is a dedifferentiated variant of adenocarcinoma or poorly cohesive carcinomas. Vimentin positive dedifferentiated-poorly cohesive carcinomas should be considered as mesenchymal-type highly malignant carcinomas. This rare histologic variant of gastrointestinal cancer might respond to anti-c-MET tyrosine kinases.

Association of HIPEC with survival in patients with ovarian metastases of gastrointestinal origin.

e15124 Background: Metastatic ovarian involvement in primary gastrointestinal (GI) carcinomas (CA) is associated with a poor prognosis. We performed a survival analysis in patients with ovarian metastases, based on site of primary GI CA (appendiceal, colorectal (CRC), gastric, and pancreatic). We also examined the association between hyperthermic intraperitoneal chemotherapy (HIPEC) and death in these patients. Methods: A search was conducted in a single institution pathology database for patients with primary GI CA and ovarian metastases diagnosed from 2010 to 2017. The search yielded 39 patients, and data pertaining to tumor characteristics and treatment were obtained by chart review. Chi-square (log rank) test was used to test for associations between both site of primary GI CA and HIPEC, and death, and Kaplan-Meier analysis was done. P-value < 0.05 was deemed statistically significant. Results: CRC accounted for the majority of patients (51.29%) with appendiceal CA accounting for 23.08% and gastric and pancreatic cancer making up the remainder. Primary site of malignancy was associated with survival (p = 0.036), favoring those with appendiceal and colorectal primaries. A total of 30 patients (76.92%) received HIPEC. Having undergone HIPEC was significantly associated with survival (p = 0.017). Conclusions: Ovarian metastases secondary to gastric and pancreatic cancer were associated with inferior survival as compared to those with appendiceal or colorectal primaries. A significant association was demonstrated between HIPEC and survival. Further investigation to define the role of HIPEC in the treatment of carcinomas of gastrointestinal primaries is warranted.

Clinicopathological analysis of gastric stromal tumor with primary gastrointestinal carcinoma

Objective To analyze the clinicopathological features of gastric stromal tumor with primary gastrointestinal carcinoma. Methods 469 cases of gastrointestinal stromal tumor (GIST) from January 2011 to December 2014 admitted to PLA General Hospital were retrospectively analyzed. Gastric stromal tumor patients with primary gastrointestinal carcinoma were screened. The concomitant gastrointestinal cancer site, stromal tumor size, mitotic activity, immunohistochemistry were also detected. Results The gastric stromal tumor with primary gastrointestinal carcinoma accounted for 14.7 % (69/469) of all the GIST, in which the small gastric stromal tumor accounted for 65.2 % (45/69) of the total and 9.59 % (45/469) of all the GIST. The diameter of all tumors was < 5 cm, and the mitotic was < 5/50 HPF. The positive rates of CD117, CD34, DOG-1 were 92.8 % (64/69), 92.8 % (64/69), 94.1 % (65/69). The Fletcher was classified as low-risk and extreme low-risk. Conclusions Gastric stromal tumor with primary gastrointestinal carcinoma has no specific clinical features and pathological immunohistochemical markers. Its malgnant degree is lower than GIST. Its prognosis is associated with primary gastrointestinal cancer staging. Key words: Gastrointestinal stromal tumors; Small gastric stromal tumor; Primary gastrointestinal tract neoplasms

Rectosigmoid Endometriosis Mimicking Cancer: Presenting with Intestinal Obstruction

Endometriosis is a common benign gynecological disease in women of reproductive age with a variety of clinical presentations ranging from asymptomatic to intractable and intolerance. Intestinal involvement occurs in 3% to 37% of patients with pelvic endometriosis, and rectosigmoid colon is the most frequently involved site [1]. Involvement of the gastrointestinal tract may mimic primary gastrointestinal carcinoma. Bowel obstruction is rare because it usually involves the serous layer, sparing the mucosa. We report a case of a 43-year-old woman presented with gastrointestinalsymptoms of bowel obstruction as the first manifestation of disease and highlight the diagnostic difficulty.

Abstract 4683: Coexistence incidence and clinicopathologic characteristics of gastrointestinal stromal tumors with gastrointestinal carcinoma

Abstract Objective Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumors of the digestive tract. The coexistence with other gastrointestinal carcinoma is unique. The aim of this study was to investigate the coexistence of GIST with other primary gastrointestinal carcinoma and its clinicalpathologic features. Methods 113 patients had been diagnosed as GIST in three local hospitals from 2002 to 2008. The surgical specimens were analyzed with an immunohistochemical panel that included staining for CD117, CD34, SMA and Ki-67. Results 16.8 % of (19 of 113) patients with GIST were co-diagnosed as gastrointestinal carcinoma. The average age at diagnosis was 57 years (range, 43 to 66), two years older than that of the patients only with GIST (range, 43 to 71). The patients with the coexistence of GIST and gastrointestinal carcinoma included 11 males and 8 females. The male-to -female ratio was 1.38:1, which is higher than that of the patients of GIST without the carcinoma (1.24:1). 26.3% GIST with the carcinoma was found in the esophagus (5 of 19) and 73.7% in the stomach (14 of 19) and non in the intestine. In contrast, only 5.3% GIST without the carcinoma was found in the esophagus (5 of 94) which was less incidence in the esophagus than that of coexistence of GIST and the carcinoma (P &amp;lt; 0.05), 84.0% in the stomach and 10.6% in the intestine, which higher incidence in the intestine than that of coexistence of GIST and the carcinamo (P &amp;lt; 0.05). The mean diameter of 19 GISTs with the carcinoma was 1.91 cm (range, 0.6 to 3.8 cm) smaller than that of 94 GISTs without the carcinoma (5.42 ± 6.17 cm, p &amp;lt; 0.05). 15.8% of the patients with coexistences of GIST and the carcinoma showed lower dysplasia, whereas 41.5 % of GIST patients without the carcinoma had the dysplasia and 33.0 % was malignant (p &amp;lt; 0.05). The average mitotic count in GIST with the carcinoma was 0.74/high-power field (HPF) (range, 0-4/HPF), and much less than that (3.78/HPF) of GIST without the carcinoma (range, 0 to 53/HPF, P &amp;lt; 0.05). The average proliferative index (positive number of Ki-67/HPF) of GIST with the carcinoma was 7.16/HPF (range 0 to 22) and less than that (19) of GIST without the carcinoma (range, 0 to 107). Conclusion 16.8% of GIST was co-diagnosed with gastrointestinal carcinoma. More coexistence of GIST and the carcinoma occurred in the esophagus. The GIST with the carcinoma was less proliferative and aggressive than the GIST without the Carcinoma. [Key words] gastrointestinal stromal tumor; pathology; carcinoma 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 4683.

Distinguishing primary mucinous ovarian carcinomas from primary gastrointestinal carcinomas metastatic to the ovaries: Are we trying hard enough and does it matter?

Distinguishing primary mucinous ovarian carcinomas from primary gastrointestinal carcinomas metastatic to the ovaries: Are we trying hard enough and does it matter?

An Unusual Case of Three Synchronous Primary Gastrointestinal Carcinomas

FigureA 57 year old man presented with complaint of on and off vomiting and 20 lb weight loss within 8 months. He was treated for prostate cancer with radiation therapy about a year ago. Family history was significant for prostate cancer in his uncle and uterine cancer in his sister in their fifties. Lab studies showed iron deficiency anemia and positive fecal occult blood test. Esophagogastroduodenoscopy was unremarkable. Colonoscopy revealed a large fungating mass in the ascending colon and biopsy showed moderately differentiated adenocarcinoma. A right hemicolectomy was performed which showed two separate tumors in the ascending colon measuring 3 cm and 6.5 cm respectively, separated by 1.5 cm of normal mucosa. The postoperative course was complicated by obstipation and increased amount of nasogastric tube drainage. Computed tomography of abdomen and pelvis showed markedly distended stomach and duodenum and abrupt transition point in the proximal small bowel with no contrast beyond that level. Exploratory laparotomy showed an obstructing mass in the 3rd portion of the duodenum for which duodenectomy with primary duodenojuejunostomy was performed. Pathological examination revealed a 3.5 cm circumferential obstructing adenocarcinoma of the duodenum. Tumor tissue was tested high for microsatellite instability and genetic testing showed homozygous MSH 2 mutation. Small intestinal carcinomas are among the rarest types of cancer accounting for only 2% of gastrointestinal carcinomas. Though it is included in the tumor spectrum of Hereditary Non-Polyposis Colorectal Cancer, its incidence in those patients is rare. To the best of our knowledge, this is the first case report of three synchronous primary gastrointestinal carcinomas. [figure1][figure2]Figure

Gastrointestinal tract involvement by gynecologic diseases.

Involvement of the gastrointestinal tract by gynecologic disease processes-endometriosis, gynecologic neoplasms, inflammatory processes, and complications from radiation therapy or surgery for gynecologic tumors-may mimic primary gastrointestinal carcinoma on radiologic images. Endometriosis most often involves the anterior wall of the rectosigmoid colon, adjacent to the pouch of Douglas, and typically produces extrinsic mass effect on the serosa, with the overlying mucosa left intact. Direct extension of ovarian cancer to the colon through the subperitoneal space produces mass effect with serosal spiculation, tethering, and fixation; annular constriction; or partial or complete obstruction. Intraperitoneal seeding of ovarian carcinoma most frequently involves the colon and is seen as extrinsic masses, often with serosal spiculation and tethering. Cervical carcinoma, which most commonly spreads by direct invasion of the pelvic side wall and adjacent structures, produces serosal spiculation and circumferential narrowing. Benign ovarian or uterine tumors are purely extrinsic and have a smooth interface with the colonic wall. Tubo-ovarian abscesses are difficult to differentiate from cystic ovarian neoplasms or endometriomas. Radiation colitis causes narrowing of the rectum with intact mucosa and can be differentiated from recurrent tumor, unlike radiation-induced injury of the small bowel, which may be difficult to distinguish. Surgical adhesions produce a discrete transition point between dilated bowel proximally and nondilated distal bowel. Familiarity with the varied patterns of gastrointestinal tract involvement is important for accurate interpretation of imaging studies.

Krukenberg tumors of the ovary: a clinicopathologic analysis of 27 cases.

A series of 27 typical Krukenberg tumors of the ovary were analyzed. By definition, all examples were characterized by the presence of mucinous signet-ring carcinoma cells within a cellular, nonneoplastic ovarian stroma. The patients' ages ranged from 20-70 years; almost one-half were 40 years of age or younger. A primary carcinoma of the stomach (16 cases) or colon (four cases) was found in 20 (90.9%) of 22 patients with available follow-up data. The primary gastrointestinal carcinomas had been diagnosed before emergence of the ovarian tumors in only five cases. The ovarian and gastrointestinal tumors were synchronously diagnosed in ten cases, while in five instances the primary carcinomas were not discovered until after the ovarian tumors had been treated. An acceptable primary extraovarian cancer was not detected in two women. Both had bilateral Krukenberg tumors and died with widespread carcinomatosis less than two years postoperatively. Typically, the ovarian tumors were bilateral, asymmetrically large and solid. Important histologic features included a greater abundance of intracellular neutral glycoproteins than acidic mucins, a storiform pattern of hyperplastic cortical stromal cells (44.4%) and carcinomatous emboli (51.6%). While the entity of "primary" Krukenberg tumor cannot be unequivocally denied, all women with typical Krukenberg tumors should be considered as having metastatic carcinoma, usually from the stomach, until proven otherwise.