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PubMed2006

Synchronous occurrence of gastrointestinal stromal tumors and other primary gastrointestinal neoplasms.

AIM: To review clinical and pathologic features of Gastrointestinal stromal tumors (GISTs) occurring synchronously with other primary gastrointestinal neoplasms. METHODS: Twenty-eight patients with primary GIST were treated at our institution between 1989 and 2005. Clinical and pathologic records were reviewed. RESULTS: The gastrointestinal stromal tumor occurred simultaneously with other primary GI malignancies in 14% of all patients with GIST. The synchronous stromal tumors were located in the stomach and were incidentally found during the operation. The coexistent neoplasms were colon adenocarcinoma, gastric cancer (2 cases) and gastric lymphoma. CONCLUSION: The synchronous occurrence of GISTs and other gastrointestinal malignancies is more common than it has been considered. The development of gastrointestinal stromal tumors and other neoplasms may involve the same carcinogenic agents.

Aged↗
PubMed2005

A classification system of echogenicity for gastrointestinal neoplasms.

BACKGROUND AND AIMS: To confirm the utility of a newly-devised endoscopic ultrasonography (EUS) echogenicity classification system, which is based on the normal five-layer structure of the gastrointestinal wall, for the differential diagnosis of gastrointestinal neoplasms. METHODS: A total of 275 patients with gastrointestinal disease detected by endoscopy, 53 with submucosal tumor (22 esophageal, 27 gastric, and 4 duodenal), 208 with cancer (58 esophageal, 150 gastric), and 14 with gastric malignant lymphoma, were examined. In each case, we performed standard EUS with 7.5, 12, or 20 MHz to evaluate the echogenicity of the lesion. Echogenicity was classified into seven levels that is based on the echogenicity of the normal five-layer structure of the gastrointestinal wall. The levels are stratified from anechoic (level 0) to hyperechoic (level 6), muscularis propria and deep mucosa being referred to as level 2 and level 4, respectively. Level 6 was equivalent to or higher than the echogenicity of submucosa. RESULTS: EUS findings revealed several distinct echogenicities among the diseases. In submucosal tumor, levels 0, 2, and 6 were observed only in patients with cyst, myogenic tumor, and lipoma, respectively. In malignancies, levels 0, 5, and 6 were not observed in this study. The echo level of malignant lymphoma was markedly lower than that of epithelial cancer. CONCLUSION: Our classification system of echogenicity can be a useful method in the differential diagnosis of gastrointestinal neoplasms.

Adult↗
PubMed2001

Role of ultrasonography in the staging of gastrointestinal neoplasms.

This article reviews the capabilities and limits of ultrasonography (US) in the staging of gastrointestinal neoplasms. US is a well-established tool in the investigation of abdominal diseases. Its role is very important in the first approach to liver, gallbladder, biliary, and pancreatic diseases, but its abilities for accurate staging may be limited by various factors, which will be discussed. In the evaluation of the stomach and intestine, US is rarely utilized, but it can occasionally demonstrate an unsuspected gastrointestinal mass that usually must be evaluated further with specific techniques (endoscopy and barium studies) to confirm the diagnosis and to perform an accurate staging (with endosonography and computed tomography).

Diagnosis, Differential↗
PubMed1981

[Immunochemotherapeutic treatment of gastrointestinal neoplasms].

The results obtained with a three-fold association of drugs (VCR, 5Fu, MeCCNU) in the treatment of 68 patients suffering from advanced carcinoma of the gastroenteric system followed up over an approximately four year period at the Savona Oncology Centre are reported. The percentage of positive responses (CR + PR) was 75% for carcinoma of the colon-rectum and 44.4% for stomach cancer. The results obtained in intestinal carcinoma proved more satisfactory than those reported in the literature. This could be attributed to the contemporaneous use of Corynebacterium parvum which boosts the immunitary state and so enhances the defences of the host organism, making it more sensitive to polychemotherapy. In the light of this hypothesis, stress is laid on the need to use an immunochemotherapy approach for the treatment of advanced carcinoma of the gastroenteric apparatus.

Adjuvants, Immunologic↗
PubMed2001

Aberrant drainage and missed micrometastases: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms.

Lymph node analysis is essential for staging gastrointestinal (GI) neoplasms. Our group has conducted several studies of intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) for the staging of GI neoplasms. LM is performed following injection of 0.5-1 ml of isosulfan blue dye, and blue-stained sentinel lymph nodes (SLNs) are analyzed by hematoxylin and eosin (H&E) staining, multiple sectioning, and cytokeratin immunohistochemistry. In feasibility trials, LM identified at least one SLN in 121 of 126 patients. Of the 58 cases with nodal metastasis, 50 (89%) had at least one positive SLN and 24 (42%) had nodal metastasis only in the SLN. In 25 cases, tumor deposits were identified by multiple sectioning (n = 8) or immunohistochemistry (n = 17) only. In 10 cases (8%), LM identified aberrant lymphatic drainage that altered the extent of the lymphadenectomy. Our cumulative experience indicates that focused analysis of the SLNs draining GI neoplasms can increase the detection of micrometastases and may improve selection of patients for adjuvant treatment.

Adenocarcinoma↗
PubMed2000

Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasms.

BACKGROUND: Lymph node analysis is essential for staging gastrointestinal (GI) neoplasms. Intraoperative lymphatic mapping and sentinel lymphadenectomy were originally described for melanoma but have not yet been investigated for most GI neoplasms. HYPOTHESES: (1) Lymphatic mapping and sentinel lymphadenectomy is feasible in GI neoplasms, (2) the sentinel node (SN) status reflects the regional node status, and (3) focused analysis of the SN improves staging accuracy. DESIGN: Prospective patient series. PATIENTS AND METHODS: Lymphatic mapping was performed in 65 patients with GI neoplasms by injecting 0.5 to 1 mL of isosulfan blue dye around the periphery of the neoplasm. Blue-stained SNs were analyzed by hematoxylin-eosin staining, multiple sectioning, and cytokeratin immunohistochemistry. RESULTS: Lymphatic mapping identified at least 1 SN in 62 patients (95%). Of the 36 cases with nodal metastasis, 32 (89%) had at least 1 positive SN and 15 (42%) had nodal metastasis only in the SN. In 11 cases, tumor deposits were identified by multiple sectioning (n = 2) or immunohistochemistry (n = 9) only. In 5 cases (8%), lymphatic mapping identified aberrant lymphatic drainage that altered the extent of the lymphadenectomy. CONCLUSIONS: Lymphatic mapping and sentinel lymphadenectomy are feasible in GI neoplasms and identify aberrant lymphatic drainage. The SN status accurately reflects the regional node status. Focused analysis of the SN increases the detection of micrometastases and may improve selection of patients for adjuvant treatment.

Adult↗
PubMed1990

Endoscopic photodynamic therapy with hematoporphyrin derivative for primary treatment of gastrointestinal neoplasms in inoperable patients.

Endoscopic photodynamic therapy with hematoporphyrin derivative was used in the primary treatment of 54 patients with inoperable gastrointestinal neoplasms. Patients were divided into three groups including 24 with esophageal squamous cell carcinoma, 14 with adenocarcinoma of the stomach or lower third of the esophagus, and 16 with rectosigmoid adenocarcinoma. After infusion of 2.5-5.0 mg hematoporphyrin derivative/kg of body weight, lesions were photoradiated using an argon dye laser with power set at 300-400 mW for 5 min/site. During a follow-up period averaging 14.5 months (range 1-33 months), complete local tumor destruction and negative histology were observed in 24 of 54 cases. The mean recurrence-free period varied from 13.8 to 17.4 months according to groups. Fifteen patients remain alive and disease-free. The results of this open pilot study suggest the potential efficacy of photodynamic therapy as curative treatment for selected cases of inoperable gastrointestinal cancers, possibly in association with locoregional radiotherapy.

Adenocarcinoma↗