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PubMed1981

[Surgical management of malignant obstruction (author's transl)].

Malignant obstructive jaundice is invariably a disease endangering life. Since there are no prodromal symptoms, nearly one-fourth of the patients are primarily inoperable when seen, and in one-fifth is the tumor resectable. Even in operable cases success is moderate; the highest and longest rates of survival can be achieved with papillary carcinoma. A substantial chance lies in the decisive improvement and shortening of preoperative diagnostics.

Ampulla of Vater↗
PubMed2004

Pathogenesis of carcinoma of the papilla of Vater.

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7-, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20-, MUC2-). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.

Adenocarcinoma↗
PubMed1976

Laparoscopy in general surgery.

In the last seven years laparoscopy has become increasingly popular in North America. The procedure has been mainly embraced by the gynecologist. Other specialities have been relatively slow in recognizing its value. Laparoscopy has wide applications in general surgery. It is a useful tool in blunt abdominal trauma and often prevents laparotomy. In patients with acute abdominal conditions, when findings are atypical, uncertainty in diagnosis may be resolved by laparoscopy. In patients with malignant disease it permits assessment of the extent of the lesion and enables accurate selection of the mode of therapy. Numerous procedures per laparoscopy, including biopsies, division of adhesions, cholangiography and collection of samples for bacteriologic studies, may be carried out simultaneously. Complication associated with the procedure are few but may be severe. These can be avoided by careful adherence to proper technic.

Abdomen, Acute↗
PubMed1987

Cavitating metastases of the stomach and duodenum.

Three patients with cavitating gastric or duodenal metastases are presented. Metastatic disease, either by direct extension or by hematogenous spread, should be included in the differential diagnosis of an excavated exoenteric gastric or duodenal mass.

Adenocarcinoma↗
PubMed1986

Traumatic neuroma.

Explore the source record for details and available documents.

Bile Duct Neoplasms↗
PubMed1978

Does bile promote extra-colonic cancer?

The incidence of biliary-tract cancer and of several other gastrointestinal tumours is increased when conditions favour conversion of bile acids to more active substances. This may indicate that bacterial degradation of bile salts is related to the pathogenesis of cancer in parts of the alimentary tract other than the large bowel.

Bile↗
PubMed2002

Gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma in New Zealand: Demographics, pathology and survival.

INTRODUCTION: The aim of present paper was to document the incidence of gall bladder cancer, cancer of the extrahepatic bile ducts and ampullary carcinoma in New Zealand. METHODS: Data were collected from the New Zealand Cancer Registry from 1980 to 1997 and combined with national census statistics to give crude and age standardized incidence rates. RESULTS: Over the 18-year study period, 226 carcinomas of the ampulla of Vater, 608 gall bladder cancers, and 486 extrahepatic cholangiocarcinomas were registered. The age standardized incidence rates for gall bladder carcinoma in all New Zealanders were 0.41/100 000 in men and 0.74/100 000 in women. The age standardized incidence rates for gall bladder cancer in Maori were 1.49/100 000 in Maori men and 1.59/100 000 in Maori women. The corresponding age standardized incidence rates for extrahepatic bile duct cancers were 0.67/100 000 in men and 0.45/100 000 in women. There were insufficient cases to calculate an age standardized incidence in Maori or Pacific Islanders. For carcinoma of the ampulla, the age standardized rates were 0.34/100 000 in men and 0.25/100 000 in women. There were insufficient cases to calculate an age standardized incidence rate for Maori or Pacific Islanders. When histology was defined adenocarcinoma was the most common form of cancer occurring in 66% of gall bladder cancers, 91% of extrahepatic bile duct cancers and 70% of ampullary cancers. Most tumours were advanced at presentation with regional or distant metastases present in 72% of gall bladder cancers, 63% of extrahepatic bile duct cancers and 69% of ampullary tumours at diagnosis. Survival was poor with median survivals of 86 days, 151 days and 440 days recorded for gall bladder cancer, extrahepatic bile duct cancer and ampullary cancer, respectively. CONCLUSIONS: The demographic profile, pathology and survival of patients with gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma are similar in New Zealand to that of other Western countries. However New Zealand Maori have a relatively high incidence of gall bladder cancer, and the incidence is equal in both Maori men and women, while cancers of the extra-hepatic bile duct and ampulla of Vater are rare in Maori. In comparison, cancers of the gall bladder, extrahepatic bile ducts and ampulla are rare in Pacific Islanders.

Adenocarcinoma↗
PubMed2004

Gastrointestinal cancer in older patients.

More than two thirds of gastrointestinal cancers occur in persons 65 years of age or older. The symptoms and presentation in these older individuals appear similar to those of persons of younger age. Although treatments for these cancers have been developed primarily in younger patients, greater expertise over time has permitted similarly safe and efficacious therapy to be extended to older age groups. The majority of gastrointestinal cancers are located in the colon and rectum. Preventative strategies for colorectal cancer are quickly evolving, with the beneficial effect of long-term use of aspirin and estrogen having their greatest impact in the elderly population. The increased acceptance of colonoscopy for screening patients for colorectal cancer will be of greatest benefit in older individuals, who have a higher incidence of proximal neoplasms than younger individuals. Adjuvant therapy for both colon and rectal cancer is underutilized in elderly patients, despite such life-saving treatments resulting in similar survival prolongation, as well as toxicity profiles, as in their younger counterparts. There is a paucity of information concerning the treatment of elderly patients with other gastrointestinal malignancies.

Aged↗
PubMed2001

Xanthogranulomatous cholecystitis.

Seven cases of xanthogranulomatous cholecystitis are presented, and their clinicopathological appearance is described. Three men and 4 women with xanthogranulomatous cholecystitis, aged 53-72 years old, were reviewed. Five patients had had previous attacks of acute cholecystitis lasting from 3 weeks to 6 months. Abdominal ultrasonography was performed in all patients, and computed tomography in 5 patients. Cholelithiasis and sludge were present in all patients. The gallbladder wall was thickened in all patients. On computed tomography, one patient showed no abnormal finding, and 4 patients had abnormal findings such as increased wall thickness and irregularity, and pericholecystic abnormalities. A diagnosis of gallbladder carcinoma was made preoperatively in 1 patient. During laparotomy, the gallbladders in all patients showed signs of chronic cholecystitis, and cholecystectomies were performed. Histological findings showed xanthogranulomatous cholecystitis, and 4 patients had stones in the gallbladder wall. Despite the characteristic histologic appearance of xanthogranulomatous cholecystitis, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm. We report here 7 cases of xanthogranulomatous cholecystitis and review the literature.

Aged↗
PubMed1993

Expression of the breast cancer-associated protein pS2 in adenosquamous carcinomas of the gastrointestinal tract.

The breast cancer-associated protein pS2 is also present in many human gastrointestinal tumors. In contrast to breast carcinomas, gastrointestinal tumors do not express estrogen receptors, indicating that the expression of pS2 is not estrogen-dependent. The pS2 expression was analyzed in 14 adenosquamous tumors of the human gastrointestinal tract. The aim was to investigate if the cell type specific localization of pS2 was limited to the glandular part. The data clearly confirm such a specific compartmentation of the pS2 expression, suggesting pS2 to be a secreted protein. Due to the specific expression, pS2 may become a new and useful diagnostic marker of adenocarcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Laparoscopic surgery for cancer patients.

Laparoscopy is an effective tool for diagnosis and staging of malignancies. Laparoscopic resection of abdominal tumors has been performed rarely, with two exceptions: laparoscopic adrenalectomy and laparoscopic resection of colorectal cancer. One of the best applications of minimally invasive surgery is the use of laparoscopic techniques for palliation of abdominal cancer. Requiring thorough training and preparation of surgeons and mandating their strict credentialing will reduce the risk of complications from laparoscopic surgery.

Abdominal Neoplasms↗
PubMedDate not supplied

[Neoplasms and dysplasias of the gallbladder and their relationship with lithiasis. A case-control clinicopathological study].

BACKGROUND: A strong association has been reported between gallbladder carcinoma, premalignant epithelial or metaplasic inflammatory lesions and cholelithiasis, varying the incidence among different ethnic groups. PURPOSE: To determine the frequency of association between such lesions and gallbladder lithiasis. MATERIAL AND METHODS: We examined histopathologic changes in 1,367 cholecystectomy specimens with (1,096) or without (271) lithiasis and established its frequency of association, correlating with main clinical data. RESULTS: Overall, 80% had lithiasis. In this group, pseudopyloric metaplasia (50%), intestinal metaplasia (16%), low grade dysplasia (40%), high grade dysplasia (16%), carcinoma in situ (1.5%) and invasive carcinoma (2.6%) were observed compared to 25%, 2%, 17%, 2%, 0%, and 0% in the control group. The findings of 80% with lithiasis, 65% with carcinoma in situ and 90% of invasive carcinoma, all were in women. Median age of patients with low and high grade dysplasia, carcinoma in situ and invasive carcinoma was 42, 48, 53 and 61 years, respectively. CONCLUSIONS: Acute and xanthogranulomatous cholecystitis, adenomyomatosis, pseudopyloric and intestinal metaplasia, hyperplastic polyps, low and high grade dysplasia, tubular adenomas, carcinoma in situ and invasive carcinoma were more frequent when cholelithiasis was present (p < .05) than in cases without lithiasis.

Acute Disease↗