Stenosing Tumor Research Articles

Diagnostika a endoskopická intervence u raritního MALT lymfomu proximálního jejuna

Summary: Extranodal lymphoma from the marginal zone mucosa-associated lymphoid tissue (MALT lymphoma) is one of the primary extranodal non-Hodgkin‘s lymphomas with low degrees of malignancy but with the risk of spreading to distant locations in the body. B-lymphomas are sometimes associated with other diseases (eg. Helicobacter pylori and Campylobacter jejuni infections or inflammatory bowel disease). B-lymphomas may manifest with a variety of clinical signs, from dyspeptic syndrome with malabsorption and weight loss to ileus or massive gastrointestinal bleeding. Dia­gnosis is based on the clinical condition and the results of laboratory tests and imaging techniques, while endoscopy is the essential procedure for visualizing the tumor mass and collecting a bio­psy sample to determine the definitive histopathological dia­gnosis. MALT lymphoma treatment is managed by oncologists and includes chemotherapy and/or radiotherapy, with resection indicated in rare cases. In this case report we present an elderly female patient who was referred to our IBD centre for non-specific abdominal pain with a positive fecal occult blood test. Computed tomography (CT) examination was used before endoscopy and showed an infiltration of the splenic flexure by an unspecified mass, a subsequent colonoscopy showed intact mucosa of the colon, including the terminal ileum. In the second reading of the CT scan the location of the infiltrate was identified more specifically as the area of the proximal jejunum and jejunal mesentery. Subsequent upper endoscopy revealed a stenosing exulcerated tumor in the proximal jejunum, with the stenosis impassable even for a pediatric colonoscope. The dia­gnosis of MALT lymphoma was confirmed by a histological examination of the bio­psied tissue. A follow-up upper endoscopy was performed after the patient had completed her oncological treatment (chemotherapy in combination with radiotherapy), showing the presence of stenosis at the proximal jejunum, still impassable for the endoscope. In clinical terms, the patient experienced weight loss, which was to some extent caused by intermittent pseudo-obstruction when on a solid diet, therefore we decided to enrich her oral intake with high-calorie sip feed. The next follow-up CT scan of the abdomen showed a regression of the infiltrate, but the stenosis of the proximal jejunum, about 7 centimeters long, persisted. To respect the patient‘s wishes, no surgical resection of the stenotic section of the intestine was performed, but we proceeded with endoscopic dilatation of the stenotic section of the jejunum with a balloon. After the first two endoscopic dilatations of the stenotic area the patient experienced a temporary improvement in solid food tolerance. Because of restenosis, a third endoscopic dilatation was performed, with the development of complications that included short-term circulatory instability with abdominal pain and eventually required an urgent surgical solution. Key words: marginal zone B-cell lymphoma – stenosis – dilatation – intestinal perforation – jejunum – MALT

Endoscopic tumour morphology impacts survival in adenocarcinoma of the oesophagus

BackgroundPrognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims to explore the relationship between pre-treatment endoscopic tumour morphology and postoperative survival. MethodsPatients with endoscopic descriptions of tumours were identified from the prospectively managed databases including the OCCAMS database. Tumours were classified as exophytic, ulcerating or stenosing. Kaplan Meier survival analysis and multivariable Cox regression analyses were performed to determine hazard ratios (HR) with 95% confidence intervals. Results262 patients with oesophageal adenocarcinoma undergoing potentially curative resection were pooled from St Thomas’ Hospital (161) and the OCCAMS database (101). There were 70 ulcerating, 114 exophytic and 78 stenosing oesophageal adenocarcinomas. Initial tumour staging was similar across all groups (T3/4 tumours 71.4%, 70.2%, 74.4%). Median survival was 55 months, 51 months and 36 months respectively (p < 0.001). Rates of lymphovascular invasion (P = 0.0176), pathological nodal status (P = 0.0195) and pathological T stage (P = 0.0007) increased from ulcerating to exophytic to stenosing lesions. Resection margin positivity was 21.4% in ulcerating tumours compared to 54% in stenosing tumours (p < 0.001). When compared to stenosing lesions, exophytic and ulcerating lesions demonstrated a significant survival advantage on multivariable analysis (HR 0.56 95% CI 0.31–0.93, HR 0.42 95% CI 0.21–0.82). ConclusionThis study demonstrates that endoscopic morphology may be an important pre-treatment prognostic factor in oesophageal cancer. Ulcerating, exophytic and stenosing tumours may represent different pathological processes and tumour biology.

Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer.

Backgrounds: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. Materials and Methods: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type—no findings around the stricture; A2: Hypoecho stricture type—localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type—tumor on the stricture; B: Dilation type—the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type—tumor located apart from the MPD. Results: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. Conclusions: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC.

Occlusive stenosis - atypical presentation of right colon cancer

Colorectal cancers are one of the most frequent malignancies worldwide. Significant differences are described in relation to the location of tumors within the colon. Thus, between right and left colon cancer there are epidemiological, clinical, genetic, evolutionary and prognostic differences. Considering these premises, right and left colon cancers can be seen as distinct pathological entities. In right colon cancer the initial phases are often asymptomatic and the presence of symptoms is in relation to advanced phases and complications. We report the case of a 64-year-old man with no significant medical history who was admitted and operated as an emergency for stenotic and perforated tumor of the right colon. Operative exploration revealed distended small bowel loops and caecum up to the ascending colon where a stenosing tumor is found. The tumor extends to a small bowel loop and also exhibit a perforation. Right hemicolectomy was performed, with favorable postoperative evolution and discharge on 7th day.

A comparative analysis of the treatment of patients with acute colonic obstruction obstructive tumor genesis

In a retrospective study, a comparative analysis of treatment of 509 patients with acute obstructive colonic obstruction, tumor genesis, which are made of different kinds of surgery (n=384) and stenting of the tumor stricture self-expanding metal stents (n=79). For statistical comparison of results concluded that the endoscopic stenting accompanied by fewer complications, a low mortality, reduces hospitalization time as compared to conventional operations. Stenting may be applicable for continuous decompression in patients with malignant strictures as the final treatment, as well as to the time of decompression in potentially resectable patients as the first stage of treatment («bridge to surgery»). In a retrospective study evaluated the results of clinical observation 509 patients from 2010 to October 2016 were carried out surgery for malignant obstruction of the colon. The first group included 79 patients who performed endoscopic stenting. These patients are the main group. A control group, consisting of two sub-groups, made up of 384 patients whom underwent surgery were performed. First subset patients (330 patients) performed a resection of the left colon departments to form a single-barrel colostomy (Hartmann type of operation), right-sided hemicolectomy with the formation ileotransverzoanastomosis; the second subgroup (54 patients) were formed colonies or ileostomy due to hemodynamic instability and/or the presence of unresectable tumors. We describe the results of the comparison of colorectal stenting and colostomy. The conclusion about the prospects of the use of colorectal stenting in patients with acute colonic obstruction obstructive tumor genesis.

FLUORESCENCE DIAGNOSIS AND PHOTODYNAMIC THERAPY IN COMBINED TREATMENT OF CHOLANGIOCARCINOMA

The results of the pilot study of combined treatment for non-resectable cholangiocarcinoma complicated with obstructive jaundice are represented this paper. Method included percutaneous transhepatic biliary drainage, endoscopic fluorescence diagnosis, photodynamic therapy of tumor stricture, and stenting of bile ducts. Fourteen patients who underwent the treatment in the surgery department clinic of I.M. Sechenov First Moscow State Medical University were enrolled in the study. Fluorescence diagnosis and photodynamic therapy were carried out using photosensitizers photosens (0.5 mg/kg), fotolon (1 mg/kg), and radachlorin (1 mg/kg). The average light dose for one session was 115±5 J/cm2. Fluorescence diagnosis using endoscopic video-fluorescence system for endoscopy and minimally invasive surgery allowed to obtain videoassisted fluorescence image of the tumor and to measure level of photosensitizer fluorescence in tumor in all patients. Malignant tumor was confirmed by morphological study in 12 patients, biopsy of material for morphological study failed in 2 patients with Klatskin tumor. The preliminary results of combined minimally invasive treatment were assessed as promising. The survival time in 4 patients after treatment accounted for 21, 17, 13 and 11 months, respectively. For now 5 patients are under follow-up. Follow-up periods are 13 and 19 months in 2 of them and from 4 to 6 months in 3 of them. Five patients with multiple distant metastases before the treatment died in 3±1 months after therapy. The average lifetime in the treatment group is 9.5 months up to date, however the duration is expected to be longer because 5 of 14 patients are alive.

Colon carcinoma staging by endoscopic ultrasonography miniprobes.

Background and Objectives:Due to the increasing use of endoscopic techniques for colon cancer resection, pretreatment locoregional staging may gain critical interest. The use of endoscopic ultrasonography (EUS) miniprobes in this context has been seldom reported. Our aim was to determine the accuracy of EUS miniprobes for colon cancer staging.Materials and Methods:Forty patients with colon cancer (2 in the cecum, 9 in the ascending colon, 5 in the transverse colon, 5 in the descending colon, and 19 in the sigmoid colon) were submitted to staging using 12 MHz EUS miniprobes. EUS and the anatomopathological results were compared with regard to the T and N stages. It was assessed if the location, longitudinal extension, or circumferential extension of the tumor had any influence on the accuracy in EUS staging.Results:Tumor staging was feasible in 39 (98%) patients except in one case with a stenosing tumor (out of 6). Globally, T stage was accurately determined in 88% of the cases. In the assessment of the presence or absence of lymph node metastasis, miniprobes presented an accuracy of 82% with a sensitivity of 67%. These results were neither affected by the location nor by the longitudinal or circumferential extension of the tumor.Conclusions:EUS miniprobes may play an important role in assessing T and N stages in colon cancer and may represent an incentive to the research of new therapeutic areas for this disease.

Consequences of CT colonography in stenosing colorectal cancer.

In patients with stenosing colorectal cancer (CRC), visualization of the entire colon prior to surgery is recommended to exclude synchronous tumors. Therefore, most centers combine computed tomographic colonography (CTC) with staging CT. The aims of this study were to evaluate the yield and clinical implications of CTC. In this multicenter retrospective study, patients with stenosing CRC that underwent CTC and subsequent surgery between April 2013 and November 2015 were included. Result of the CTC, its influence on the surgical treatment plan, and final histology report were evaluated. One hundred sixty-two patients with stenosing CRC were included. Nine (5.6%) synchronous cancers proximal to the stenosing tumor were suspected with CTC. In four of nine patients, the CTC did not change the primary surgical plan because the tumors were located in the same surgical segment. In five of nine patients, CTC changed the surgical treatment plan. Three of these five patients underwent an extended resection and the presence of the tumors was confirmed. Two of these three synchronous CRCs were also visible on abdominal staging CT. In the other two patients, the result of CTC was false positive which led to an unnecessary extended resection in one patient. The yield of CTC was relatively low. In only three patients (1.9%), CTC correctly changed the primary surgical plan, but in two of them, the tumor was also visible on abdominal staging CT. Moreover, in two patients, CTC was false positive. The clinical value of CTC in stenosing CRC appears to be limited.

Synchronous gastric and colonic cancer: A case report

Synchronous gastric and colorectal cancer is present in 4% of cases, commonly as additional finding. This is the case of invasive, synchronous gastric and sigmoid colon cancer. A 63-years-old male patient admitted to our institution complaining on pains in epigastrium, vomiting, rapid weight loss and occasional constipation. Using the method of esophagogastroduodenoscopy (EGD) the presence of ulcero-infiltrative tumor of gastric fundus was verified, and colonoscopy revealed stenosing tumor of sigmoid colon. Undergoing a multislice computed tomography (MSCI) of the thorax and the abdomen the changes on the patient's right lung appeared, while video-assisted thoracoscopy (VATS) and biopsy of the right lung excluded malignant dissemination. A total gastrectomy with omentectomy, splenectomy, D2 lymphadenectomy and typical left hemicolectomy were also performed. Histopathological examination verified invasive, diffuse gastric adenocarcinoma and invasive, tubular colon adenocarcinoma. The patient underwent systemic postoperative chemotherapy. Two years after the surgical procedure, the patient is alive, with no signs of recidivism. In patients with symptomatology which does not correspond to primary malignancy, just like in the presented case, additional diagnostics is required. Combined resection is adequate surgical procedure for synchronous gastric and colonic cancer.

Small bowel obstruction caused by a large B-cell lymphoma in a patient with multicentric Castleman’s disease

Multicentric Castleman's disease is a rare condition of systemic nonclonal lymph node hyperplasia. Because of its strong association with human herpes virus 8 (HHV8), the multicentric, more aggressive, form may progress to Kaposi sarcoma or non-Hodgkin lymphoma. While surgery is curative in the treatment of localized Castleman's disease, operative treatment of the diffuse form has as yet been unsatisfactory. We report the case of a patient presenting with postprandial vomiting of 1 month duration consistent with partial small bowel obstruction secondary to terminal ileum intussusception. Resection of the small bowel showed a stenosing tumor triggering the intussusception. On pathological examination, the tumor was found to be composed of HHV8-positive plasmablastic lymphoma cells. To our knowledge, this represents the first case of a complication due to the progression of multicentric Castleman's disease requiring surgical intervention for intussusception.

Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

Gastric Adenocarcinoma after Gastric Bypass for Morbid Obesity: A Case Report and Review of the Literature

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

Gastric obstruction secondary to metastatic breast cancer: a case report and literature review

IntroductionGastrointestinal tract soft tissues metastasis is a well-known occurrence with invasive lobular breast cancer subtypes. Gastric involvement is more common, with reports of both diffuse and localized involvements. Usually, a gastric localized involvement presents as wall thickening with an appearance similar to that of a gastrointestinal stromal tumour; rarely does a localized metastatic deposit grow aggressively to present as a large tumour causing obstructive symptoms. Our case highlights one such unusual presentation in a patient presenting with non-specific gastrointestinal symptoms. To the best of our knowledge, there have been no previous reports on a similar presentation occurring from a localized metastasis.Case presentationA 65-year-old Caucasian woman awaiting an outpatient oral gastroduodenoscopy for symptoms of intermittent vomiting, epigastric pains and weight loss of six weeks’ duration presented acutely with symptoms of haematemesis and abdominal distension. An initial contrast-enhanced computed tomography scan showed a grossly dilated stomach with a locally advanced stenosing tumour mass at the pylorus. Our patient had a history of left mastectomy and axillary clearance followed by adjuvant endocrine therapy for an oestrogen receptor- and progesterone receptor-positive, grade 2, invasive lobular breast cancer. The oral gastroduodenoscopy confirmed the computed tomography findings; biopsies of the pyloric mass on immunohistochemistry stains were strongly positive for pancytokeratin and gross cystic disease fluid proteins, consistent with an invasive lobular breast cancer metastasis. She received a palliative gastrojejunal bypass and her adjuvant endocrine treatment was switched over to exemestane.ConclusionOur case highlights the aggressive behaviour of a localized gastric metastasis that is unusual and unexpected. Gastrointestinal symptomatology can be non-specific and, at times, non-diagnostic on conventional mucosal biopsies. A high index of clinical suspicion in patients with a previous history of invasive lobular breast cancer can aid in an early diagnosis and treatment. A combined treatment approach with chemoendocrine therapies achieves remission and improves patient survival.

Laparoscopic treatment of acute small bowel obstruction*

BACKGROUND: Symptoms of obstruction in the intestinal tract involve the small intestine in three quarters of cases and the large intestine in one-quarter. The most common causes of an acute small intestinal obstruction are postoperative adhesions (64.8%) and strangulated hernias (14.8%). The overall incidence of postoperative small bowel obstruction is 4.6%. Because it offers a conservative and targeted means of removing the obstruction, laparoscopy is increasingly used for acute small bowel obstruction. With proper selection of patients, the success rate is very high. This work presents the selection criteria, technique and results for a three-year period. METHODS: Twenty-one patients, 13 men and 8 women aged 28 to 69 years, underwent surgery between January 2008 and December 2010. Selection criteria for a laparoscopic procedure were anesthesia risk of not more than ASA 3, diameter of the dilatated loop of small intestine of not more than 5 cm, radiological image of a change in caliber as an indication of a focal passage disorder, exclusion of paralytic ileus, and no history of diffuse peritonitis. The patients underwent surgery in general anesthesia. The approach for the first trocar was umbilical in 18 cases and in the right or left flank in three cases, but always with open technique. Three trocars were always used. RESULTS: In 7 patients, there was an isolated band from a previous operation, usually an appendectomy; in 5 cases there were postoperative adhesions and a band. Three patients had a volvulus and in one of them, a 20 cm segment of the small intestine was already gangrenous. Two patients had an incarcerated hernia, one inguinal and one Bochdalek. Two patients had a stenosing tumor in the terminal ileum, one of which was a carcinoid and the other, the first manifestation of a lymphoma. One patient had an endometriosis focus as stenosis focus and another had a massively inflamed Meckel's diverticulum that obstructed passage in the small intestine. Two patients – the volvulus with small intestinal gangrene and the Bochdalek hernia – required conversion to open technique. One patient with diffuse adhesions and a band had to undergo open surgery 10 days later. There was no case of an intraoperative accidental intestinal injury. All the patients who underwent laparoscopy were discharged within a week. Hospitalization was significantly longer for the converted patients. The patient with the Boachdalek hernia died after 26 days of irreversible cardiopulmonary failure. CONCLUSIONS: With strict selection, laparoscopic treatment of small intestinal obstruction is a valuable option in visceral acute surgery. Patients with an isolated focal obstruction seem to benefit from laparoscopic surgery on the basis of reduced perioperative morbidity and short hospitalization.

Carcinoma epidermoide de esófago, estenosante, estadio IV, en mujer de 41 años. Descripción de un caso clínico

ObjectiveTo present a clinical case of a 41 year-old woman, with a stage IV squamous cell carcinoma of the oesophagus. Methods and patientsWe present a clinical case of 41 year-old woman with a history of type 2 diabetes mellitus, and resection of a haemosiderin plaque on the tongue. A space occupying lesion (SOL) was studied using ultrasound and Nuclear Magnetic Resonance (NMR), detecting, but unable to differentiate, a gradually increasing haemangioma or hepatocarcinoma. She was seen at the clinic due to dysphagia and loss of weight. In oesophagogastroscopy with biopsy a squamous cell carcinoma of the oesophagus was diagnosed. The Computed Tomography (CT) of the neck, thorax and abdomen showed a stenosing tumour in the oesophagus with metastasis in the lungs and left adrenal gland, and a SOL in the liver compatible with a neo-formative process. The erythrocyte sedimentation rate was 55mm. She was referred to Surgery and Oncology, who performed a gastrostomy for enteral feeding and started treatment with palliative chemotherapy. ConclusionsSquamous cell carcinoma of the oesophagus is very frequent. The two most important risk factors are alcoholism and nicotine poisoning. The dysphagia is the most common symptom (96% of the patients). The prognosis is a poor, with high mortality. Surgery is the standard treatment when the tumour is located. Chemotherapy and radiotherapy are palliative treatments, but has not shown to be very effective.

Tumor length assessed by miniprobe endosonography can predict the survival of the advanced esophageal squamous cell carcinoma with stricture receiving concurrent chemoradiation

There were tumor strictures commonly encountered in the esophageal squamous cell carcinoma (ESCC) to limit the conventional echoendoscope for exact tumor staging and size measurements. This study evaluated the role of miniprobe endosonography (EUS) to predict the survival of ESCC patients after concurrent chemoradiation therapy (CCRT). This study prospectively enrolled ESCC patients to receive high-frequency miniprobe EUS for the assessments of the tumor size and tumor-node-metastasis (TNM) stage. For the patients defined with advanced stages to receive CCRT as initial therapy, the tumor size parameters assessed by EUS were analyzed for their correlation with the treatment response and the patients' survivals. Fifty-four patients, >96% with advanced TNM stage III or IV, were enrolled with a medium follow-up of 320.5 days. Almost all of the 54 cases had partial or complete stricture of the esophageal lumens due to the tumor obstructions at enrollment. The overall median survival was 18.6 months, and the 1- and the 2-year survival rates were 64.9 and 45.2%, respectively. Patients with initial tumor length <6 cm assessed by the pre-CCRT EUS had a better survival than those with length ≥6 cm (median survival: >56.5 months vs. 11.5 months, P= 0.006). The patients with initial tumor length <6 cm had a higher rate of downstage than those with tumor length ≥6 cm after the first course of CCRT (80.0% vs. 16.7%, P= 0.035). Multivariate Cox regression confirmed the initial tumor length (hazard ratio [HR]= 1.21, P= 0.034) as well as the presence of distal metastasis are both independent predictors of the survival in ESCC patients receiving CCRT. For the ESCC patients, commonly with tumor stricture, the miniprobe EUS to assess tumor length before CCRT can predict the treatment response and the survivals.

High chromosomal instability in adenocarcinoma of the ileum arising from multifocal gastric heterotopia with gastritis cystica profunda

Adenocarcinoma of the small intestine arising from heterotopic gastric mucosa is extremely rare. In this report, we present the case of a 68-year-old woman who complained of abdominal pain, weight loss and subileus. Gross examination of resected small bowel revealed multiple flat polypous lesions with cysts in the ileal submucosa, one of which containing an ulcerated, stenosing tumour. On microscopic examination, an adenocarcinoma of the ileum arising from multifocal gastric heterotopia with secondary gastritis cystica profunda was diagnosed. Comparative genomic hybridization of the adenocarcinoma revealed chromosomal gains at 1q, 3q, 5p, 8q, 11p, 12p, 13q and losses at Xp, 4q, 8p, 10p, 14q, 17p, 20p, compatible with a high degree of genomic instability.

Value of Dilation in the EUS Staging of Obstructing Esophageal Cancer

Introduction: Endoscopic ultrasound (EUS) staging of esophageal cancer is often limited by a tumor stricture preventing passage of the endosonoscope, and thus evaluation of potential distal metastatic lesions. It remains controversial whether dilation should be performed to allow complete EUS examination in these cases. The objective of this study was to assess the benefit and safety this approach. Patients and Methods: 114 consecutive patients underwent EUS staging of esophageal cancer at our institution from 2004-2007. Data were retrospectively obtained regarding need for and success of dilation, cancer staging, sampling of lesions distal to the stricture, complications, type of endosonoscope used, and treatment recommendations. Results: 114 patients underwent EUS staging of esophageal cancer. 56 patients (49%) had strictures that prevented endosonoscope passage. Of those, 52 patients underwent dilation, which allowed successful passage of the echoendoscope in 41 (79% success rate). Dilation was performed to a median diameter of 15 mm (range 10-18 mm) with a balloon (n = 5), Savary dilators (n = 45) or both (n = 2). Cases with an obstructing stricture were more often staged T3 or greater than those without an obstructing stricture (93% vs. 59%, p < 0.001). Biopsy of additional structures distal to the stricture was performed in 14 of the 41 cases (34%) where distal endosonoscope passage was possible after dilation, and demonstrated M1a (n = 7) or M1b disease (n = 2) in 9 cases (22%). This altered the therapeutic recommendations in 8 patients (20%). Perforation occurred in 2 patients who underwent dilation and in one patient who did not undergo dilation. All perforations were managed conservatively. Conclusions: A tumor stricture requiring dilation for endosonoscope passage is a strong indicator of T3 disease or greater. Dilation provides the opportunity for identification of metastatic involvement which can justify the small risk of perforation. Detection of M1a and M1b status distal to the stricture altered management in most of our cases. However, this may be different at other institutions since treatment recommendations for patients with non-regional lymph node metastases are not uniform.

Small cell carcinoma of the esophagus

BACKGROUND: Small cell carcinoma of the esophagus is a rare disease, characterized by aggressive progression, which is similar in appearance and behavior to its counterpart of the lung. It has a high incidence of metastatic disease at presentation and a poor prognosis. Treatment protocols are not well established because of the small number of cases and lack of large studies. CASE REPORT: 66 year-old woman, was admitted to the hospital with persistent dysphagia. Radiologic and endoscopic examination revealed an stenosing tumor in the lower third of the esophagus. The biopsy specimen was diagnosed as small cell carcinoma of the esophagus. The patient underwent an esophagectomy with esophagogastric anastomosis. CONCLUSION: The role of surgery remains controversial and the improvement of life quality is to be considered. Therapeutic approach is mainly esophageal resection.

Ackerman-Tumor des Larynx und berufliche Asbestexposition

The so-called "Ackerman's tumor" is a neoplasm of uncertain dignity. Aim of this paper is to clarify, whether this is an asbestos-induced tumor of the larynx in accordance with German regulations for occupational diseases. A 43-year old male presented the clinical picture of a stenosing laryngeal tumor. A verrucous neoplasm without a proven malignity in the sense of an Ackerman's tumor was diagnosed through several sequential biopsies. Approximately 2 years later a total laryngectomy was performed, because of a squamous cell carcinoma of the larynx. An occupational disease in accordance with 4104 BKV was claimed in connection with an asbestos exposition of 28,3 fibre years (fibres/m3 x years). An Ackerman's tumor is--in accordance with its definition in the German-speaking area--not conclusively malignant, there is no indication of a relation between asbestos and such a tumor in literature, there is no specific benign disorder of the larynx caused by asbestos. This brings us to the conclusion that the Ackerman's tumor of the larynx is no asbestos-induced laryngeal tumor as per German occupational disease regulations.