Focal Intramucosal Adenocarcinoma Occurring in Gastric Hyperplastic Polyps Treated with Endoscopic Mucosal Resection

Hyperplastic polyps are the most frequent benign epithelial gastric polyps. Although they are considered nonneoplastic, some cases have been reported with focal adenocarcinoma. We present the case of a 59-year-old woman with a sessile lesion of 15 mm on the distal gastric body associated with an extensive atrophic gastritis. Magnifying endoscopy with Fuji Intelligent Color Enhancement (FICE) revealed an irregular microsurface pattern at the apex, suggesting malignancy. A mucosectomy was performed. The histopathology revealed that the base corresponded to a hyperplastic polyp, where a tubular adenoma with high-grade dysplasia was established, with focal well-differentiated intramucosal tubular adenocarcinoma.

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BİR EĞİTİM ARAŞTIRMA HASTANESİNDE ALT GASTROİNTESTİNAL SİSTEM BULGULARININ DEĞERLENDİRİLMESİ

Euroasia Journal of Mathematics, Engineering, Natural and Medical Sciences ◽

10.38065/euroasiaorg.536 ◽

2021 ◽

Vol 8 (16) ◽

pp. 16-20

Author(s):

Nursel ÜSTÜNDAĞ ÖCAL ◽

Sevda YAMAN ◽

Serdar YANIK

Keyword(s):

Hyperplastic Polyp ◽

Occult Blood ◽

Outpatient Clinics ◽

Central Anatolia ◽

Bowel Habit ◽

Tubular Adenoma ◽

Hyperplastic Polyps ◽

Tubulovillous Adenoma ◽

Important Place ◽

The Mean

Patients with complaints about colorectal region refer to general surgery, gastroenterology and other outpatient clinics with an increasing frequency. Rectal bleeding, abdominal pain, unexplained anemia, changes in bowel habit, occult blood positivity in stool can be a sign of serious colon disease. In this study, patients under the age of 65 who underwent AGIS endoscopy in the endoscopy unit of the Research and Application Hospital in Central Anatolia Region between 2015 and 2018 were examined. The data were reviewed retrospectively. 214 patients under the age of 65 were included in the study. Colitis in 37 (17.29%), hyperplastic polyp in 38 (17.76%), tubular adenoma in 86 (40.19%), tubular adenoma in 40 (18.69%), Adenocarcinoma was detected in 13 (6.7%) of results. Tubular adenoma, tubulovillose adenoma and adenocarcinomas were more common at the age of fifties, with colitis and hyperplastic polyps detected in the mean age of forties. Adenocarcinomas were found to be more common in female sex, unlike other results. Lower gis endoscopy has an important place in the diagnosis and treatment of colorectal cancer. In our study, in which the results of AGIS endoscopy were examined, tubular adenoma was high in individuals under 65 years of age. Keywords: Tubulovillous Adenoma, Colitis, Hyperplastic Polyp

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Endoscopic submucosal dissection by using Clutch cutter and IT knife 2 for early gastric cancer with severe submucosal fibrosis: a case report

MedPharmRes ◽

10.32895/ump.mpr.2.3.17 ◽

2018 ◽

Vol 2 (3) ◽

pp. 17-21

Author(s):

Nhan Le ◽

Phuong Vien ◽

Nghia Le

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Gastrointestinal Cancers ◽

Pathological Result ◽

Well Differentiated ◽

Submucosal Fibrosis

Introduction: Gastric cancer is one of the highly malignant gastrointestinal cancers and the third leading cause of cancer death. In the last decade, early gastric cancer (EGC) has been reported by using narrow-band imaging (NBI) magnifying endoscopy. Advances in endoscopic techniques, such as endoscopic submucosal dissection (ESD), have enabled the en bloc resection of these EGC. Although ESD is performed for early gastric cancer, there are still many difficult problems in technique of this procedure. The difficulty of gastric ESD depends on the size and location of a tumor, presence of severe submucosal fibrosis, presence of ulceration... We report a case of our successful ESD by using Clutch cutter and IT knife 2 in treatment of EGC with severe submucosal fibrosis. Case presentation: A 62-year-old man felt an epigastric discomfort two months ago. The narrow-band imaging (NBI) magnifying endoscopy revealed a suspected early gastric cancer type 0 - IIa + IIc (Japanese classification of early gastrointestinal cancers) at the incisura angularis, the size of this lesion was 15 mm in diameter, and pathological result of endoscopic biopsy was a well-differentiated adenocarcinoma. ESD was performed and we found there was severe submucosal fibrosis which was dissected safer and faster by using Clutch cutter and IT knife 2. There were no complications such as severe bleeding and perforation. The size of resected specimen was 60 x 35 mm and the time of procedure was 150 minutes. After ESD, the pathological result was a well differentiated adenocarcinoma, pT1a, UL(-), LY(-), V(-), no cancer cell in vertical and horizontal margins. The healing time of ESD-induced ulcer was 5 weeks without local recurrence. Conclusion: Through this case, we aim to emphasize the importance of using Clutch cutter and IT knife 2 as a modified technique which makes ESD a safe procedure in treatment of EGC with severe submucosal fibrosis.

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HER2 OVEREXPRESSION IN ENDOSCOPIC BIOPSY SAMPLE OF GASTRIC ADENOCARCINOMA BY IMMUNOHISTOCHEMISTRY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.5.14 ◽

2012 ◽

pp. 109-118

Author(s):

Viet Nho Le ◽

Van Huy Tran ◽

Cong Thuan Dang ◽

Van To Ta

Keyword(s):

Gastric Adenocarcinoma ◽

Undifferentiated Carcinoma ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Endoscopic Biopsy ◽

Her2 Overexpression ◽

Tubular Adenocarcinoma ◽

Signet Ring ◽

Poorly Differentiated ◽

Well Differentiated

Background and aim: HER2 overexpression by immunohistochemistry is a prognostic maker in gastric cancer and helps to select candidates benefitted from targeted therapy with trastuzumab. This study is aimed at the assessing HER2 overexpression and its relationship with endoscopic and histopathological findings of gastric adenocarcinoma. Objectives and methods: Biopsy samples from 92 gastric cancer patients were examined for HER2 status by immunohistochemical staining. Results: 6.5% of tumors were cardia tumors and 93.5% were non-cardia tumors. Using the Lauren classification, 51.1% were intestinal type and 48.9% were diffuse type. Using WHO classification, 54.3% were tubular adenocarcinoma, 7.6% were mucinous adenocarcinoma, 15.2% were signet-ring cell carcinoma, and 22.8% were undifferentiated carcinoma. 32.6% were well-differentiated, 15.2% were moderately-differentiated, and 52.2% were poorly-differentiated carcinoma. HER2 was positive in 20.7% of gastric carcinomas, 50% cardia tumors and 18.6% non-cardia tumors. HER2 positivity among polypoid, fungating, ulcerated, and infiltrative types were 38.5%, 29.7%, 9.1% and 0%, respectively. HER2 overexpression in intestinal type was higher than that in diffuse type (31.9% vs. 8.9%, p = 0.009). HER2 overexpression in tubular adenocarcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma, and undifferentiated carcinoma was 28.0%, 14.3%, 7.1% and 14.3%, respectively. HER2 overexpressions were different between differentiation degrees: 30% of well-differentiated tumors, 35.7% moderately-differentiated tumors, and 10.4% of poorly-differentiated tumors (p = 0.037). Conclusions: HER2 overexpression was found in 20.7% of endoscopic biopsy sample of gastric adenocarcinoma and was associated with endoscopic gross characteristic, Lauren histologic type and differentiation degree.

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A133 GASTRIC ESD: PRELIMINARY EXPERIENCE IN A TERTIARY CENTER IN QUEBEC

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.131 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 117-118

Author(s):

D Maillet ◽

E Desilets ◽

T Maniere

Keyword(s):

Curative Resection ◽

Residual Disease ◽

High Grade Dysplasia ◽

R0 Resection ◽

Low Grade ◽

High Grade ◽

En Bloc ◽

Delayed Bleeding ◽

Tertiary Center ◽

Intramucosal Adenocarcinoma

Abstract Background Endoscopic submucosal dissection (ESD) is an endoscopic procedure developed in Asian countries to treat early gastric cancer (EGC). Western countries have less experience with this challenging technique. Aims The goal of this study is to evaluate the effectiveness of ESD as a preliminary experience. Methods This is an unicentric retrospective study of all consecutive gastric ESD for adenomas or EGC from 07/2017 to 08/2020. The primary endpoints were en bloc and R0 resection rates. Results Nineteen patients (mean age 74.2 (54–88), sex ratio 3F/16M) and 23 lesions were included. Mean diameter was 25 mm (10–90). Treatment was previously performed in 7 cases (30.4%), by ESD (5) or EMR (2). The procedure, performed under general anaesthesia, lasted on average 148 minutes (45–412). En bloc resections were performed in 16 cases (69.6%); 5 cases (21.7%) were converted to P-EMR and there was a failure to resect the lesion because of deep invasion or perforation in 2 cases (8.7%). Pathologic examination demonstrated 2 low-grade dysplasia, 4 high-grade dysplasia and 15 adenocarcinomas: intramucosal (8), sm1 (2), sm2 (2), sm3 (1) or sm deep (2). R0 and curative resection rates were 43.5% and 39.1% respectively. The complication rate related to the procedure was 30.4% including 5 perforations and 2 delayed bleeding: all were managed endoscopically. Five patients (21.7%) underwent subsequent gastrectomy for non-curative resection (4) or failed resection (1); 3 had no residual disease on final pathology, 1 had high grade dysplasia and 1 had intramucosal adenocarcinoma. One patient went to palliative care because he was unfit for surgery. Follow-up endoscopy was completed in all 17 patients who underwent endoscopic resection (mean 10 months (2–24)). Recurrence occurred in 23.5% (4/17); all were successfully treated by another ESD. Conclusions In our preliminary experience, the rate of en bloc and R0 resection were 70% and 44%. Compared to other studies, these low en bloc and curative resection rates may be explained by technically difficult lesions during the learning curve and might improve with experience. Nevertheless, surgery has been avoided in 13/19 patients (68%) with endoscopic intervention. Funding Agencies None

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Overexpression of Replication-Dependent Histone Signifies a Subset of Dedifferentiated Liposarcoma with Increased Aggressiveness

Cancers ◽

10.3390/cancers13133122 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3122

Author(s):

Yongjin Yoo ◽

Sang-Yoon Park ◽

Eun Byeol Jo ◽

Minji Choi ◽

Kyo Won Lee ◽

...

Keyword(s):

Copy Number ◽

Fold Change ◽

High Grade ◽

Rna Seq ◽

Fat Tissue ◽

Normal Tissues ◽

Whole Exome ◽

Well Differentiated ◽

Genetic Signatures ◽

Subtype Differences

Liposarcoma (LPS) is an adult soft tissue malignancy that arises from fat tissue, where well-differentiated (WD) and dedifferentiated (DD) forms are the most common. DDLPS represents the progression of WDLPS into a more aggressive high-grade and metastatic form. Although a few DNA copy-number amplifications are known to be specifically found in WD- or DDLPS, systematic genetic differences that signify subtype determination between WDLPS and DDLPS remain unclear. Here, we profiled the genome and transcriptome of 38 LPS tumors to uncover the genetic signatures of subtype differences. Replication-dependent histone (RD-HIST) mRNAs were highly elevated and their regulation was disrupted in a subset of DDLPS, increasing cellular histone molecule levels, as measured using RNA-seq (the averaged fold change of 53 RD-HIST genes between the DD and WD samples was 10.9) and immunohistochemistry. The change was not observed in normal tissues. Integrated whole-exome sequencing, RNA-seq, and methylation analyses revealed that the overexpressed HMGA2 (the fold change between DD and WD samples was 7.3) was responsible for the increased RD-HIST level, leading to aberrant cell proliferation. Therefore, HMGA2-mediated elevation of RD-HISTs were crucial events in determining the aggressiveness of DDLPS, which may serve as a biomarker for prognosis prediction for liposarcoma patients.

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Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽

10.3390/cancers13061453 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1453

Author(s):

Chiara Fabbroni ◽

Giovanni Fucà ◽

Francesca Ligorio ◽

Elena Fumagalli ◽

Marta Barisella ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Case Series ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Low Grade ◽

High Grade ◽

Retrospective Case ◽

Well Differentiated ◽

The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

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Controversies in the Diagnosis of Barrett Esophagus and Barrett-Related Dysplasia: One Pathologist's Perspective

Archives of Pathology & Laboratory Medicine ◽

10.5858/2010-0249-ra.1 ◽

2010 ◽

Vol 134 (10) ◽

pp. 1479-1484 ◽

Cited By ~ 4

Author(s):

John R. Goldblum

Keyword(s):

English Literature ◽

Goblet Cells ◽

High Grade Dysplasia ◽

Barrett Esophagus ◽

Low Grade ◽

High Grade ◽

Biopsy Specimens ◽

Columnar Lined Esophagus ◽

Intramucosal Adenocarcinoma ◽

Rule Out

Abstract Context.—Pathologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. Objective.—To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. Data Sources.—Sources were the author's experience and review of the English literature from 1978 to 2009. Conclusions.—Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.

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The Role of the Anti-Aging Protein Klotho in IGF-1 Signaling and Reticular Calcium Leak: Impact on the Chemosensitivity of Dedifferentiated Liposarcomas

Cancers ◽

10.3390/cancers10110439 ◽

2018 ◽

Vol 10 (11) ◽

pp. 439 ◽

Cited By ~ 4

Author(s):

Vanessa Delcroix ◽

Olivier Mauduit ◽

Nolwenn Tessier ◽

Anaïs Montillaud ◽

Tom Lesluyes ◽

...

Keyword(s):

Cell Proliferation ◽

Endoplasmic Reticulum ◽

Poor Prognosis ◽

Therapeutic Strategy ◽

Therapy Resistance ◽

High Grade ◽

Extracellular Signal Regulated Kinase ◽

Extracellular Signal ◽

Well Differentiated

By inhibiting Insulin-Like Growth Factor-1-Receptor (IGF-1R) signaling, Klotho (KL) acts like an aging- and tumor-suppressor. We investigated whether KL impacts the aggressiveness of liposarcomas, in which IGF-1R signaling is frequently upregulated. Indeed, we observed that a higher KL expression in liposarcomas is associated with a better outcome for patients. Moreover, KL is downregulated in dedifferentiated liposarcomas (DDLPS) compared to well-differentiated tumors and adipose tissue. Because DDLPS are high-grade tumors associated with poor prognosis, we examined the potential of KL as a tool for overcoming therapy resistance. First, we confirmed the attenuation of IGF-1-induced calcium (Ca2+)-response and Extracellular signal-Regulated Kinase 1/2 (ERK1/2) phosphorylation in KL-overexpressing human DDLPS cells. KL overexpression also reduced cell proliferation, clonogenicity, and increased apoptosis induced by gemcitabine, thapsigargin, and ABT-737, all of which are counteracted by IGF-1R-dependent signaling and activate Ca2+-dependent endoplasmic reticulum (ER) stress. Then, we monitored cell death and cytosolic Ca2+-responses and demonstrated that KL increases the reticular Ca2+-leakage by maintaining TRPC6 at the ER and opening the translocon. Only the latter is necessary for sensitizing DDLPS cells to reticular stressors. This was associated with ERK1/2 inhibition and could be mimicked with IGF-1R or MEK inhibitors. These observations provide a new therapeutic strategy in the management of DDLPS.

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