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Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 424
Author(s):  
Ching-Ya Wang ◽  
Bo-Huan Chen ◽  
Cheng-Han Lee ◽  
Puo-Hsien Le ◽  
Yung-Kuan Tsou ◽  
...  

Background: Endoscopic submucosal dissection (ESD) combined with selective adjuvant chemoradiotherapy may be a new treatment option for cT1N0M0 esophageal squamous cell carcinoma (ESCC) invading muscularis mucosa or submucosa (pT1a-M3/pT1b). We aim to report the effectiveness of this treatment by comparing the results of esophagectomy. Methods: This retrospective single-center study included 72 patients with pT1a-M3/pT1b ESCC who received ESD combined with selective adjuvant chemoradiotherapy (n = 40) and esophagectomy (n = 32). The main outcome comparison was overall survival (OS). The secondary outcomes were treatment-related events, including operation time, complication rate, and length of hospital stay. Disease-specific survival (DSS) and progression-free survival (PFS) were also evaluated. Results: There were no significant differences in the rates of OS, DSS, and PFS between the two groups (median follow-up time: 49.2 months vs. 50.9 months); these were also the same in the subgroup analysis of pT1b ESCC patients. In the ESD group, the procedure time, overall complication rates, and length of hospital stay were significantly reduced. However, the metachronous recurrence rate was significantly higher. In a multivariate analysis, tumor depth and R0 resection were the independent factors associated with OS. Conclusions: ESD combined with selective adjuvant chemoradiotherapy can be an alternative treatment to esophagectomy for cT1N0M0 ESCC invading muscularis mucosa or submucosa.


2021 ◽  
pp. 106689692110677
Author(s):  
Bella Lingjia Liu ◽  
Huifang Zhou ◽  
Martina Risech ◽  
Alex Ky ◽  
Jane Houldsworth ◽  
...  

Solitary Peutz-Jeghers type polyps are characterized by a hamartomatous polyp of the gastrointestinal (GI) tract in a patient without mucocutaneous pigmentation, family history of Peutz-Jeghers syndrome, or STK11/LKB1 mutations. Histologically identical to the polyps in Peutz-Jeghers syndrome, these sporadic polyps can arise anywhere along the GI tract, with typical arborizing smooth muscles extending from the muscularis mucosa. While the lining mucosa is generally the same as the organ in which it arises, gastric pyloric and osseous metaplasia have been reported in intestinal polyps in Peutz-Jeghers syndrome. Herein, the authors report the first case of a small intestinal solitary Peutz-Jeghers type polyp with gastric antral and fundic gland lining mucosa. A 43-year-old male was admitted for small bowel obstruction. Diagnostic laparoscopy revealed jejuno-jejunal intussusception with an associated polyp measuring 7.2 cm. Histological examination showed a hamartomatous polyp with arborizing smooth muscle bundles extending from the muscularis mucosae. The polyp was lined by non-dysplastic gastric antral and fundic gland mucosa, and was sharply demarcated from the adjacent non-polypoid intestinal mucosa. Colonoscopy, esophagogastroduodenoscopy and small bowel enteroscopy revealed no additional polyps or masses. Thorough investigation of the patient's family history was negative for Peutz-Jeghers syndrome or mucocutaneous pigmentation. Molecular analysis of the lesion was negative for STK11/LKB1 mutations. A diagnosis of solitary Peutz-Jeghers type polyp of the small bowel with gastric antral and fundic gland mucosal lining was rendered.


Author(s):  
Anna Budina ◽  
Sahar J. Farahani ◽  
Priti Lal ◽  
Anupma Nayak

Context.— Despite continued surveillance and intravesical therapy, a significant subset of patients with lamina propria–invasive bladder cancer (T1) will progress to muscle-invasive disease or metastases. Objective.— To analyze the value of pathologic subcategorization of T1 disease in predicting progression. Design.— Six substaging methods were applied to a retrospective cohort of 73 patients, with pT1 urothelial carcinoma diagnosed on biopsy/transurethral resection. Additionally, the immunohistochemistry for GATA3 and cytokeratin 5/6 (CK5/6) was performed to study the prognostic value of stratifying T1 cancers into luminal or basal phenotypes. Results.— On follow-up (mean, 46 months), 21 (29%) experienced at least 1 recurrence without progression, and 16 (22%) had progression to muscle-invasive disease and/or distant metastasis. No differences were noted between progressors and nonprogressors with regard to sex, age, treatment status, medical history, tumor grade, and presence of carcinoma in situ. Substaging using depth of invasion (cutoff ≥1.4 mm), largest invasive focus (≥3.6 mm), aggregate linear length of invasion (≥8.9 mm), and number of invasive foci (≥3 foci) correlated significantly with progression and reduced progression-free survival, whereas invasion into muscularis mucosa or vascular plexus, or focal versus extensive invasion (focal when ≤2 foci, each <1 mm) failed. Patients with luminal tumors had higher incidence of progression than those with nonluminal tumors (27% versus 11%), although the difference was statistically insignificant (P = .14). Conclusions.— Substaging of T1 bladder cancers should be attempted in pathology reports. Quantifying the number of invasive foci (≥3) and/or measuring the largest contiguous focus of invasive carcinoma (≥3.6 mm) are practical tools for prognostic substaging of T1 cancers.


2021 ◽  
pp. 960-965
Author(s):  
Adnan Alkurdi ◽  
Diana Rubin ◽  
Alexander Seelhoff ◽  
Hermann Herbst

Brown bowel syndrome (BBS) is an exceedingly rare condition usually associated with longstanding malabsorption of any etiology. As a result of vitamin E deficiency and subsequent mitochondrial degeneration due to oxidative stress induced by free radicals, lipofuscin granules accumulate in the smooth muscles of the gastrointestinal tract resulting in myopathy and dysmotility with underlying disease aggravation. The current study reports a BBS case in a 64-year-old female patient who had undergone jejunoileal bypass surgery as a bariatric procedure. The patient was admitted with signs of malabsorption and ileus in computed tomography imaging. Endoscopic workup revealed no stenosis or obstruction. The colon histologically showed periodic acid-Schiff-positive lipofuscin granules in the lamina muscularis mucosa consistent with BBS. The vitamin E level in the patient was extremely low. Moreover, clinical improvement was documented following high-dose substitution. BBS should be considered in patients with malabsorption of any cause especially with signs of gastrointestinal dysmotility. Vitamin E substitution may improve clinical status and prevent further deterioration.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Su ◽  
Jin Peng ◽  
Xiong Chen ◽  
Zhiming Xiao ◽  
Rui Liu ◽  
...  

Abstract Objective To determine the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of upper gastrointestinal submucosal lesions (SMLs). Methods This was a retrospective study involving patients diagnosed with SMLs using EUS and confirmed by histopathology from November 2014 to December 2020 at The Third Xiangya Hospital of Central South University. Results A total of 231 patients with SMLs were examined by EUS. Histologically, 107 lesions were stromal tumors, and 75 lesions were leiomyomas. Stromal tumors were mainly located in the stomach (89.7%), and leiomyomas were predominantly seen in the esophagus (69.3%). The diagnostic accuracy of EUS for stromal tumors and leiomyomas was 80.4% and 68.0%, respectively. The diagnostic accuracy was highest for lesions located in the muscularis mucosa. The mean diameter of stromal tumors measured using EUS was significantly larger than that of leiomyomas (21.89 mm vs. 12.35 mm, p < 0.001). Stromal tumors and leiomyomas originated mainly from the muscularis propria (94.4%) and the muscularis mucosa (56.0%), respectively. Compared with the very low-risk and low-risk groups of stromal tumors according to the National Institute of Health guidelines, the intermediate-risk and high-risk groups were more likely to have a lesion > 3 cm (p < 0.001) and a surface ulcer (p < 0.01) identified by EUS. Conclusions EUS has good diagnostic value for the diagnosis of upper gastrointestinal SMLs based on the lesion size and the muscle layer of origin. The diagnostic accuracy of EUS lesions is related to the origin, and the diagnostic accuracy is greatest in the mucosal muscularis layer. Stromal tumors > 3 cm and a surface ulcer on EUS are likely to be intermediate or high risk for invasion.


2021 ◽  
Vol 21 (2) ◽  
pp. 128-140
Author(s):  
Bagus Dwijayanti ◽  
Erdiansyah Rahmi ◽  
Ummu Balqis ◽  
Fitriani Fitriani ◽  
Dian Masyitha ◽  
...  

ABSTRACT. Usus adalah salah satu organ pencernaan yang berperan penting pada proses absorpsi nutrisi sebagai sumber energi. Penelitian ini bertujuan mengetahui histologi, histomorfometri dan histokimia sebaran glikogen pada usus ayam buras (Gallus gallus domesticus) sebelum dan setelah menetas menggunakan pewarnaan Haematoksilin-Eosin (HE) dan pewarnaan Periodic Acid Schiff (PAS). Sampel penelitian terdiri atas empat kelompok tingkat umur berbeda, setiap kelompok berjumlah enam usus ayam. Hasil penelitian menunjukkan perbedaan nyata (P˂0,05) morfometri usus ayam buras secara makroskopis. Secara histologis pada setiap perkembangan sudah terlihat lapisan usus yang terdiri atas tunika mukosa, submukosa, muskularis, dan serosa. Pada tunika mukosa, didapati tiga lamina yaitu lamina epitelia, propria, dan muskularis mukosa yang mulai teramati pada masa inkubasi hari ke-14. Lamina epitelia berupa sel epitel silindris selapis dengan mikrovili, lamina propria berupa jaringan ikat, dan lamina muskularis mukosa berupa berkas otot polos. Pada tunika mukosa dijumpai adanya sel Goblet dan kripta Liberkuhn yang teramati pada masa inkubasi hari ke-20 dan setelah menetas hari ke-7. Hasil histomorfometri ketebalan lapisan usus, panjang vili, lebar vili, dan diameter lumen usus ayam buras pada masa inkubasi dan setelah menetas menunjukkan perbedaan nyata (P˂0,05). Temuan reaksi positif kuat terhadap pewarnaan PAS dijumpai pada masa inkubasi hari ke-20 dan setelah menetas hari ke-7 dan positif lemah pada masa inkubasi hari ke-14. Dapat disimpulkan bahwa terdapat korelasi antara perkembangan usus ayam secara makroskopis, histomorfometri ketebalan tunika dan vili, serta sebaran reaksi positif kuat terhadap pewarnaan PAS pada masa inkubasi hari ke-20 dan setelah menetas hari ke-7.  (Histological, histomorphometrical, and histochemical of intestine on native chicken (Gallus gallus domesticus) during pre and posthatch period) ABSTRAK. The intestines are one of the digestive organ that play an important role in the nutrient absorption process as an energy source. The aim of this study was to determine the histomorphometric and histochemical of glycogen distribution in the intestines of native chickens pre and post hatching periods using Haematoxylin-Eosin (HE) staining and Periodic Acid Schiff (PAS) staining. The samples of this study was consisted of four different age groups, each group consisting of six chicken intestines. The results showed a significant difference (P˂0.05) on macroscopic morphometry of the native chicken’s intestine. Histologically in each group has been found the intestines consisting of mucosa, submucous, muscularis, and serous tunic. In the mucosal tunic, there were three layers; ephitelial, propria, and muscularial mucous can be observed during the 14th day of incubation period. Ephitelial layer in the form of cylindrical epithelial cells with microvilli, proprial layer in the form of connective tissue, and layer of the muscularis mucosa form smooth muscle thread. In the mucosal tunic, there was Goblet cells and Liberkuhn crypts that can be observed during the 20th day incubation period and 7th day post hatch. Histomorphometry results of intestinal lining thickness, villi length, villi width, and lumen diameter of native chicken intestine during incubation and post hatching showed significant differences (P˂0.05). The findings of a strong positive reaction to the staining of PAS were found on the incubation period of the 20th day and post hatching the 7th day and positively weak on the incubation period of the 14th day. It can be concluded that there is a correlation between macroscopic development of chicken intestine, histomorphometric of tunica and villous thickness, as well as the distribution of strong positive reactions to the staining of PAS during the incubation period of the 20th day and post hatching the 7th day.


2021 ◽  
Vol 8 ◽  
Author(s):  
Chao Yan ◽  
Jinlong Xiao ◽  
Zhiwei Li ◽  
Hao Liu ◽  
Xinjie Zhao ◽  
...  

Fecal microbiota transplantation (FMT) documented transplanting a donor fecal sample to a receipt individual for a desired physiologic effect. However, whether the gut microbiota construction, intestinal maturation, and behavioral plasticity are modulated by FMT during the early life of broilers is waiting for verification. To evaluate the role of transfer of fecal microbiota from aged broilers donor (BD) to another individual, 96 birds were equally divided into a check (CK, control) group and a broiler recipient (BR) group. FMT was conducted daily from 5 to 12 days of age to determine the future impact on body weight, behavior, intestinal development, and gut microbiota. Results indicated that fearfulness in the CK group was higher than the BR group in both the behavioral tests (p &lt; 0.05). The muscularis mucosa, thickness of muscle layer, and thickness of serous membrane layer in the BR group were higher compared with those of the CK group in the jejunum (p &lt; 0.05). In the gut microbiota, Shannon diversity showed no difference, while beta diversity presented a difference in principal coordination analysis (PCoA) between the CK and BR groups. At the phylum level, the relative abundance of Lentisphaerae in the CK group was lower than the BR (p = 0.052) and BD (p = 0.054) groups. The relative abundance of Tenericutes in the BD group was higher than that in the CK and BR groups (p &lt; 0.05). At the genus level, Megamonas in the CK group was higher than the BR (p = 0.06) and BD (p &lt; 0.05) groups. In the BR group, the functional capabilities of microbial communities analyzed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were increased in the glutamatergic synapse and N-glycan biosynthesis pathways in comparison with the CK and BD groups (p &lt; 0.05). Some characteristics of gut microbiota in the donor chickens could be transferred to recipient chickens by FMT. In conclusion, exogenous FMT as a probiotic-like administration might be an efficient way to improve the physiology and behavior of chickens. Notably, the role of microbiota for various individuals and periods remains undefined, and the mechanism of microbiota on behaviors still needs further investigation.


2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
J Mahadik ◽  
K Patel ◽  
N Cortes-Santiago

Abstract Introduction/Objective Signal transducer and activator of transcription 3 (STAT3) is a transcription factor involved in inflammation, proliferation, differentiation and survival. STAT3 gain-of-function (GoF) disorders are characterized by immune dysregulation and present with polyendocrinopathy, enteropathy, X-linked syndrome (IPEX)- or autoimmune lymphoproliferative syndrome (ALPS)-like features. While patients with STAT-3 GoF are known to have an increased risk for hematologic malignancies, neither solid tumors nor an increased risk for EBV-associated disorders have been described. We report the first case of an EBV-associated solid organ tumor in a patient with STAT-3 GoF. Methods/Case Report A 21-year-old male with germline mutation in STAT3 (variant p. M329K) presented with early satiety, abdominal pain and worsening of chronic anemia. Serology showed high EBV DNA PCR levels. Endoscopy showed multiple nodular lesions in the stomach, which were biopsied to reveal EBV-associated high-grade dysplasia and intramucosal adenocarcinoma. Initiation of chemotherapy with a poor response led to a total gastrectomy. Gross examination of the specimen showed a 7.9 x 6.5 x 1.8 cm tan-brown, exophytic mass in the posterior wall of the body and antrum, involving the greater curvature. Histology revealed an adenocarcinoma with tubulovillous morphology extending into the lamina propria, without invasion into the muscularis mucosa or submucosa. EBER in-situ hybridization was diffusely positive in the tumor cells. The background mucosa showed severe chronic active and atrophic gastritis with intestinal metaplasia and low-grade dysplasia. All the seventy examined lymph nodes were negative for metastasis. Helicobacter-like organisms were not seen. Results (if a Case Study enter NA) NA Conclusion This is the first report of a solid tumor in a patient with STAT3 GoF mutation. The role of the patient’s underlying immune dysregulation disorder in the development of EBV-associated gastric adenocarcinoma is unclear and warrants further investigation. The case also highlights the importance of a close clinical follow-up in this patient population, as unexpected malignancies can develop at younger ages.


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Mahshid Saleh ◽  
Amir Ali Sohrabpour ◽  
Mohammad Reza Mehrabi ◽  
Iman Seyhoun ◽  
Amir Abbas Vaezi

AbstractPeptic ulcer is one of the most common gastrointestinal tract disorders worldwide, associated with challenges such as refractory morbidity, bleeding, interference with use of anticoagulants, and potential side effects associated with long-term use of proton pump inhibitors. A peptic ulcer is a defect in gastric or duodenal mucosa extending from muscularis mucosa to deeper layers of the stomach wall. In most cases, ulcers respond to standard treatments. However, in some people, peptic ulcer becomes resistant to conventional treatment or recurs after initially successful therapy. Therefore, new and safe treatments, including the use of stem cells, are highly favored for these patients. Adipose-derived mesenchymal stem cells are readily available in large quantities with minimal invasive intervention, and isolation of adipose-derived mesenchymal stromal stem cells (ASC) produces large amounts of stem cells, which are essential for cell-based and restorative therapies. These cells have high flexibility and can differentiate into several types of cells in vitro. This article will investigate the effects and possible mechanisms and signaling pathways of adipose tissue-derived mesenchymal stem cells in patients with refractory peptic ulcers.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ken Ohnita ◽  
Shuntaro Higashi ◽  
Satoshi Hirai ◽  
Ai Kuwahara ◽  
Kana Kakigao ◽  
...  

Abstract Background Esophageal metastasis of renal cell carcinoma (RCC) is extremely rare. We have described herein a case of a 59-year-old man with esophageal metastasis of RCC that was endoscopically resected. Case presentation The case was a 59-year-old man who had undergone left nephrectomy for renal clear cell carcinoma 17 years ago and splenectomy for splenic metastasis 3 years ago. Esophagogastroduodenoscopy (EGD) performed 9 years ago revealed a small reddish elevated lesion with a smooth surface in the middle esophagus; this lesion increased in size 4 years ago. However, no biopsy was performed. The lesion continued to grow in size and was found to have become nodular during the present observation. Biopsy revealed clear cell carcinoma. Endoscopic ultrasound (EUS) revealed that the lesion had not invaded the submucosa, and contrast-enhanced computed tomography did not reveal any other metastasis. The lesion was successfully removed en bloc via endoscopic submucosal dissection (ESD). Pathologically, the tumor was detected in the subepithelium with focal infiltration of the muscularis mucosa. It consisted of monotonous cells with small nuclei and a clear cytoplasm. Immunohistological findings indicated that the tumor was a metastasis of RCC. The lateral and vertical margins were noted to be free. Conclusions We have presented herein a case of esophageal metastasis of RCC that had progressed over 9 years and was then resected en bloc through endoscopic submucosal dissection.


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