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A flow cytometric, clinical, and histological study of stromal neoplasms of the gastrointestinal tract.

Histological sections of 102 stromal neoplasms of the gastrointestinal tract occurring in 100 patients have been assessed for 23 clinical and histological parameters and the corresponding paraffin embedded (archival) material processed for flow cytometry. Where possible, information as to clinical presentation and survival was obtained. The only absolute criterion for malignancy was the presence of spread of tumour beyond the organ of origin at the time of diagnosis. Of the remaining tumours (i.e., tumours locally confined at diagnosis), those found incidentally at operation and those of a small size (less than 60 mm diameter) behaved in a generally benign fashion. Of the histological parameters, six correlated with malignant behaviour: high mitotic count, high cellularity, marked nuclear pleomorphism, rounded as opposed to spindle cell shape, bizarre mitoses, and vascular invasion. The presence of DNA aneuploidy as shown by flow cytometry correlated strongly with a poor prognosis (p less than 0.0005). Tumours with a high mitotic count [greater than 9 per 10 high-power fields (hpf) (1.59 mm2)] behaved in an almost uniformly malignant fashion. Those with a low mitotic count [less than 3/10hpf (1.59 mm2)], behaved in a benign fashion apart from one case where no mitoses were discernible yet the tumour metastasised and killed the patient. The intermediate group of tumours (3-9 mitoses per 10 hpf inclusive) were difficult to predict, although the majority behaved in a malignant fashion. Within this group the presence of DNA aneuploidy appeared most useful in predicting prognosis.

Adolescent↗

[Cooperative procedures between endoscopy, laparoscopy. intervention and laparotomy in palliation].

Within the framework of interdisciplinary palliative treatment strategies for gastrointestinal neoplasms, surgical therapeutic options are of essential importance. They are dominated by the reconstruction of the gastrointestinal passage, ensuring drainage of secretion and the alleviation of pain. Conventional, minimal-invasive and endoscopic procedures are employed individually or in a combined way, integrating all conservative therapies. In many cases, an unnecessary laparotomy with its high morbidity, mortality and prolonged hospitalisation can thus be avoided. This paper describes and discusses current surgical and endoscopic techniques for the palliative treatment of patients suffering from advanced gastrointestinal malignant tumours.

Gastrointestinal Neoplasms↗

The significance of CD44 expression in gastrointestinal neuroendocrine tumors.

BACKGROUND/AIMS: Expression of CD44 and its isoforms has been demonstrated to be a prognostic marker in many neoplasms. Gastrointestinal neuroendocrine tumor is a slow-growing neoplasm, whose behavior is determined by site of occurrence, size or specific histologic growth pattern. In this study, the feasibility of using CD44 as a prognostic marker in gastrointestinal neuroendocrine tumor is evaluated. METHODOLOGY: Representative paraffin-embedded sections of gastrointestinal neuroendocrine tumor from 22 patients were studied by immunohistochemical staining using monoclonal antibodies against CD44, Ki-67, and p53 retrospectively. The correlation between these markers and clinical behavior of the tumors was analyzed. RESULTS: Positive expression of CD44 was observed in 15 cases (68%) of gastrointestinal neuroendocrine tumor. Expression of CD44 showed significant inverse correlation with lymph node status (P=0.049), distant metastasis (p<0.001) and mortality (p=0.002). Neither p53 nor Ki-67 correlated with lymph node status, distant metastasis and overall survival. Both lymph node status and distant metastasis showed strong correlation to survival after multivariate analysis. Patients with the tumor growing from the hindgut had better survival (p=0.024). The patients with stronger CD44 immunoreactivity (> or = 2+) tumors had significantly favorable survival (p=0.004) compared with those with weaker immunoreactivity (< or = 1+) tumors. CONCLUSIONS: Expression of CD44 in gastrointestinal neuroendocrine tumor inversely correlates with tumor metastasis, associates with a favorable outcome and may serve as one of the prognostic indicators.

Adult↗