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In the last five years, 3 carcinomas of the intestine were found in a total of 1961 necropsies of dogs. One proved to be a primary gastric carcinoma situated in the area of the Curvatura minor, another a primary carcinoma of the ileocaecal valve and the third one a signet-cell carcinoma in the end of the jejunum. The morphological characteristics of the carcinomas are discussed.
A monoclonal antibody designated RWP1.1 was produced against a human pancreatic carcinoma cell line RWP1. This antibody was shown to recognize an epitope of carcinoembryonic antigen. The reactivity of the antibody was evaluated on formalin-fixed normal tissues, 86 malignant neoplasms, 10 colonic polyps, and 6 cases of chronic pancreatitis using the peroxidase anti-peroxidase technique. RWP1.1 did not react with normal tissues apart from weak staining of fetal pancreatic ducts. This antibody preferentially reacted with primary and metastatic adenocarcinomas of the colon, stomach, pancreas, and colonic polyps but not with most adenocarcinomas from other sites nor with other types of tumors or cases of chronic pancreatitis. It also reacted with colon adenocarcinomas on frozen sections. The restricted specificity of this antibody could be used in differentiating gastrointestinal adenocarcinomas from other types of tumors including adenocarcinomas from other sites and most pancreatic adenocarcinomas from chronic pancreatitis.
Selenium concentrations in the full blood and erythrocyte and plasma GSH-Px activity were determined in patients with cancer of the stomach, colon and rectum. The results were compared with those in the group of healthy subjects. Blood samples were collected into heparinized tubes prior to surgery. Selenium concentrations in the full blood and plasma were lower (75.5 ng/mL and 56.2 ng/ml, respectively) in patients with the cancer of the stomach than healthy subjects (99.5 ng/ml and 78.5 ng/mL, respectively; p < 0.0001). Concentration of this element in both full blood and plasma was also lower in patients with cancer of the colon and rectum (77.7 ng/mL and 61.0 ng/ml, respectively; p < 0.0001). Erythrocyte and plasma GSH-Px activity was also significantly lower (p < 0.001) in patients with cancer of the stomach than in healthy subjects, and amounted to 13.6 U/g Hb and 188 U/L, respectively. Activity of this enzyme in patients with cancer involving lower segment of GI tract amounted to 15.9 U/g Hb and 190 U/L of plasma, and was significantly lower (p < 0.001) than in normal subjects in whom it amounted to 21.0 U/g Hb and 256 U/L of plasma.
A new monoclonal antibody (NS24) directed to the N-acetylneuraminyl alpha 2-3Gal beta 1-4GlcNAc residue in type II sugar chain of N-acetylneuraminyllactoneotetraosylceramide [sialylparagloboside, IV3(NeuAc)nLc4Cer] was prepared by hybridoma technique. Liposomes composed of dipalmitoylphosphatidylcholine, cholesterol, IV3(NeuAc)nLc4Cer, and lipopolysaccharides from Salmonella minnesota R595 were used for immunization with IV3(NeuAc)nLc4Cer isolated from human erythrocytes. This method allowed the fusion of spleen cells of immunized mouse with myeloma cells only three days after immunization. NS24 reacted specifically to both naturally occurring and chemically synthesized IV3-(NeuAc)nLc4Cer, whereas it has no reactivity to structurally related gangliosides, such as IV6(NeuAc)nLc4Cer, N-glycolylneuraminyl alpha 2-3lactoneotetraosylceramide [IV3(NeuGc)-nLc4Cer], i-active ganglioside [VI3(NeuAc)nLc6Cer], I-active ganglioside [VIII3(NeuAc)-VI3(NeuAc)IV6kladoLc8Cer], GM4(NeuAc), GM3(NeuAc), GM3(NeuGc), GM1b(NeuAc), GD3-(NeuAc), other ganglio-series gangliosides, sulfatide, and paragloboside (nLc4Cer). Synthetic N-acetylneuraminyl alpha 2-3lactotetraosylceramide [IV3(NeuAc)Lc4Cer] and its asialo-derivative (Lc4Cer) carrying type I sugar chain also showed no reaction with NS24. One to 100 pmol of IV3(NeuAc)nLc4Cer was detected dose-dependently by a thin-layer chromatography/enzyme immunostaining procedure. Human gastric carcinomas showed positive reactions with NS24 immunochemically and histochemically. NS24 reacted preferentially with poorly differentiated adenocarcinomas rather than well differentiated ones.
Inefficiency of x-ray and endoscopic examinations of a bleeding hollow organ of the gastrointestinal tract may be explained by the effection of its wall with nonepithelial tumor (lipoma, neurinoma, leiomyoma). In some cases only laparotomy and examination of the abdominal cavity succeed in localization of the tumor. Intraoperative cytodiagnosis of nonepithelial benign tumors is a method conducive to sparing surgery (partial resection, dissection).
Positron Emission Tomography (PET) is rapidly evolving into a useful imaging modality for early and accurate detection of malignant tumor sites. Several recent studies have documented improved efficacy of detecting recurrent colorectal and hepatic (primary and metastatic) tumor sites with a sensitivity ranging from 92% to 100% and an accuracy of 90% to 96%. PET-FDG imaging using 2-[18F]-fluoro-2-deoxy-D-glucose has been found to be superior to computed tomography (CT) in detecting recurrent colorectal, hepatic, and abdominopelvic recurrent tumor sites from different primary cancers. PET-FDG imaging can be a cost-effective tool in the screening of patients with an elevated carcinoembryonic antigen and/or equivocal CT findings and suspected colorectal cancer. The role of PET scanning using FDG or C-11-5-HTP or C-11-L-DOPA appears promising in pancreatic carcinoma and functional endocrine tumors. Further studies are being carried out to assess the role of PET scanning in other gastrointestinal cancers.
The relationship between cancer and coagulation disorders is widely accepted. Such disorders can contribute to the metastatic spreading of the primary tumor. Aim of our study was to evaluate the alterations of thrombin-antithrombin III complex (TAT) measured by an ELISA plasma assay in a population of 78 patients suffering from various gastrointestinal tumors. We found high levels of TAT in 68.6% of the patients. Our data show that assay of TAT plasma levels may be a useful test in detecting early coagulation disorders in cancer patients.
In this prospective study, 108 patients presenting with gastrointestinal cancer were examined for liver metastasis before and during surgery. The investigations emphasized a comparison of pre- and intraoperative ultrasound (US) examinations. The results of intraoperative liver inspection and palpation served as control parameters. In addition, an exact description and characterization of the liver metastases was attempted. Liver metastases were found in 30 of the 108 patients (28%). They could be identified in 17 subjects by preoperative US (57% sensitivity), in 21 patients by intraoperative palpation and inspection (70% sensitivity), and in 27 cases by intraoperative US (90% sensitivity). We concluded that 7%-34% of patients with liver metastases can be identified with 95% reliability using intraoperative US alone or in combination with palpation and inspection.
This paper presents the results of the clinical trial with the use of hr TNF-alpha (human recombinant tumor necrosis factor-alpha) in 16 advanced gastrointestinal cancer patients. Hr TNF-alpha was administered intravenously in a short, 30-min infusion. According to authors' previous experiences with daily dose escalation (modified Fibonacci scheme), a daily dose of 150 microg/m2 was established as safe, and was well tolerated by the patients. The treatment consisted of 5-day cycles, repeated six times, every 14 days. Special attention was paid regarding the possible side-effect and safety of hr TNF-alpha administration in men, as many acute and chronic haematological toxicities have been reported. After careful analysis of TNF-alpha side-effects, we did not find any acute haematological complications (e.g. thrombosis, DIC, embolism) in any of the patients. Haemoglobin values and erythrocyte and leucocyte counts gradually decreased during each cycle, with the tendency for spontaneous renewal after the treatment had been completed. No cases of thrombocytopenia and severe neuropenia were observed.
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Based on preclinical studies which demonstrated synergy between recombinant interferon alfa-2a (rIFN alpha-2a) and 5-fluorouracil (5FU), clinical studies have been initiated to investigate this combination. The initial study conducted by investigators from the Albert Einstein Cancer Center reported a response rate of 76% with 13/17 patients with advanced colorectal carcinoma responding. To further evaluate this regimen, two clinical trials have been conducted in previously untreated advanced colorectal carcinoma patients with measurable disease. The regimen consisted of 5FU administered as a continuous infusion, 750 mg/m2/d for 5 consecutive days. Intravenous bolus administration of 5FU 750 mg/m2 was given weekly for 7 weeks starting 1 week after completion of the continuous infusion. rIFN alpha-2a, 9 MU, was administered subcutaneously three times weekly. In The University of Texas M.D. Anderson Cancer Center trial, 15/45 evaluable patients experienced partial response, and one patient achieved a complete response for an overall response rate of 35%. Another trial of this regimen conducted by Memorial Sloan-Kettering has reported a 26% response rate with 9/34 evaluable patients experiencing a partial response. Current randomized trials comparing this schedule of 5FU with rIFN alpha-2a to 5FU plus folinic acid or single-agent 5FU may clarify its role in the treatment of advanced colorectal carcinomas.
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1. Due to their common origin from the neural crest the hormonogenic cells of the intestinal tract show similar cyto-chemical and ultra-structural characteristics. 2. Hyperplasiae and tumors of these cells lead to excessive hormone production with its consequences on the reacting organs. 3. Hormone producing tumors can be confined to one organ only, but as multiple endocrine adenomatosis they can afflict several organs. 4. Diagnosis of most hormone producing tumors is possible with the adequate radio-immunologic tests. Radiologic and endoscopic examinations can contribute to the localization of the tumor. 5. Surgical resection of the tumor or of the reacting organs impaired by the overproduction of hormones from the tumor is the indicated therapy. Medicamentous therapy is rarely successful. 6. The growth of most hormonogenic tumors is relatively slow. Rates of survival of up to 30 years have been known, even after formation of metastases of the tumor. Effects of hormone overproduction on other organs can reduce the prognosis.
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Primary gastrointestinal lymphomas (PGLs) are the most frequent extranodal non-Hodgkin's lymphomas and involve stomach more commonly than small bowel in Western countries. PGLs need to be differentiated from a variety of tumor-like hyperplastic lymphoid lesions; this may be facilitated by immunotyping of lymphoid cells. In PGLs, large-cell types predominate. Our study of 76 PGLs utilizing the ABC immunoperoxidase technique has led us to conclude that the majority are of B cell origin and that, while true histiocytic PGLs do indeed exist, their incidence is not greater than in nodal lymphomas. An important observation was that 26% of the cases showed an intense admixture of muramidase-positive reactive histiocytes, a feature that could result in an erroneous impression of a histiocytic derivation of the neoplasm. The prognostic significance of immunologic subtypes is currently not known. However, survival in PGL is determined by the clinical stage of the disease and to a lesser extent by the histologic type. Current optimal therapy includes resection of tumor-bearing bowel followed by radiotherapy and/or chemotherapy.
BACKGROUND/AIMS: Optimal management of gastrointestinal carcinoid neoplasms that metastasize to the liver is controversial. Although operative resection seems to be the most effective approach to metastatic disease, hepatic metastases are usually multicentric and often non-resectable. We investigated the effectiveness of several forms of palliative tumor cytoreduction followed by administration of somatostatin analogues in advanced carcinoid neoplasms. METHODS: We reviewed our experience with 34 patients with gastrointestinal carcinoid neoplasms. Eighteen patients had metastases and 14 had hormonal symptoms. Twenty-two patients underwent radical surgery, ten with multiple liver metastases were treated with a combination of debulking (resection, radiofrequency ablation, chemoembolization), followed by medical treatment with long-acting octreotide and eventually by radiolabelled somatostatin analogues, and two patients with intractable disease received only biotherapies. RESULTS: The six patients with metastatic disease who underwent radical curative liver resection had a median survival of 52 months, compared with a median survival of 48 months in the ten patients who underwent palliative debulking. Symptomatic improvement was observed in all the patients after debulking procedures. The two patients who underwent only medical treatment died after 9 and 18 months. CONCLUSIONS: Aggressive tumor debulking should be performed in patients with liver metastases already at diagnosis even when complete resection is not feasible because the combination of cytoreductive procedures followed by biotherapies may provide good long-term survival and achieves symptom control in most patients with advanced disease.