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At least 19 recordsLinked to original sources
PubMed1978

Epidermotropically metastatic malignant melanoma. Differentiating malignant melanoma metastatic to the epidermis from malignant melanoma primary in the epidermis.

In four instances, metastases to epidermis from primary cutaneous malignant melanomas at different sites showed histological features similar to those of cutaneous malignant melanoma primary in the epidermis. In these metastases, atypical melanocytes were present within the epidermis and in the upper part of the dermis much as in primary cutaneous malignant melanoma. Therefore, the presence of atypical melanocytes within the epidermis is not in itself an absolute criterion of malignant melanoma primary in skin. Nor does that finding absolutely deny malignant melanoma metastastic to the skin. Features that may enable histologic differentiation of epidermotropically metastatic malignant melanoma from primary cutaneous malignant melanoma are emphasized.

Adult↗
PubMed2001

Expanding the spectrum of malignant change in schwannomas: epithelioid malignant change, epithelioid malignant peripheral nerve sheath tumor, and epithelioid angiosarcoma: a study of 17 cases.

Schwannomas (neurilemmomas) rarely undergo malignant change, most often in the form of either malignant peripheral nerve sheath tumor (MPNST) or angiosarcoma. We characterize the clinical features and the histopathologic spectrum of 17 schwannomas with evidence of malignant change. The study group comprised 7 males and 10 females with an age range of 16 to 76 years, (median, 40 yrs). None of the patients had neurofibromatosis. Lesions ranged in size from 0.6 to 10.5 cm (median, 4.0 cm) and arose mainly in the limbs/limb girdles (7 cases) or head and neck region (7 cases). All tumors contained areas of conventional benign schwannoma. Four cases of pure epithelioid malignant peripheral nerve sheath tumor (EMPNST) were identified, three of which showed immunopositivity for S-100 protein. Four angiosarcomas were identified, predominantly epithelioid-type. Ten schwannomas had an appearance that we have designated epithelioid malignant change (EMC) and, in one of these, EMC coexisted with EMPNST. Large epithelioid cells with abundant eosinophilic cytoplasm, vesicular chromatin, and prominent nucleoli (morphologically similar to cells of EMPNST) were distributed throughout the schwannoma--singly, in clusters, and in one case a microscopic nodule of such cells was also present. These large epithelioid cells were strongly positive for S-100 protein. Although follow-up data so far are limited, 1 of 5 patients with EMC in whom meaningful follow up was available developed repeated local recurrence (median follow up, 21 mos), one patient each with EMPNST and angiosarcoma died of local and metastatic disease. Pure EMPNST is rare; however, we confirm the tendency of MPNST to show epithelioid cytomorphology when arising in a benign schwannoma. We also confirm the distinctive (albeit infrequent) tendency of angiosarcoma to arise in schwannomas. We describe EMC in schwannomas and suggest that this represents a putative precursor lesion of EMPNST. At this time, we do not have an explanation for the tendency of schwannomas to show epithelioid cytomorphology when they undergo malignant change.

Adolescent↗
PubMedDate not supplied

[Intersexuality and malignancy. Case report of an unreported association between a malignant disease in a child with androgen resistance syndrome in comparison with the most frequently expected malignant tumors in children with intersexuality].

Patients with specific disorders in sexual differentiation have an increased risk for development of malignancies. The most frequent malignant tumors to be expected especially in childhood are gonadoblastoma (carcinoma-in-situ) by children with pure gonadal dysgenesis (Swyer-syndrome) with a calculated risk of approximately 30%. In this disorder the so called streak gonads have an age related, increased risk for development of malignancies. Furthermore, malignant tumors may be expected in children with mixed gonadal dysgenesis (in 10-20%), pure hermaphroditism (in the testes significantly higher than in the ovaries) and with androgen insensitivity syndrome. Risk values for the last are reported in the literature very differently. Rare disorders in this context are virilizing tumors of the adrenal cortex, the DRASH-syndrome (nephropathy, most male pseudohermaphroditism, Wilms-tumor) and similar disorders. Practical prophylactic and therapeutic procedures of the separate disorders respectively were discussed. We report about a child with androgen resistance syndrome and acute leukaemia. This would be to our knowledge the first description of such an unusual association of these two distinct disorders.

Androgens↗
PubMed1980

Diagnosis of malignant tumors on the basis of the current generating capacity of malignant tumorous tissue. II. Study of the malignant tumors of female genital organs.

Description of an electrochemical measuring method for the in vivo quick-diagnosis of malignant tumors and dysplastic alterations of the cervical epithelium is given. The measuring results carried out in 660 cases on the surface of the cervical epithelium are reported. The current generating capacity of planocellular carcinoma of the cervical epithelium exceeds the upper limit of the normal value with 40% and is significantly higher than the values measured in dysplastic areas. With the aid of measuring, dysplastic alteration are demonstrable even in cases, in which the cytologic or coloposcopic examination is not indicative of dysplasia. Measurings in the benign and malignant tumorous tissue were carried out with needle electrode in 41 cases, during operation. The current generating capacity of malignant tumors exceeded with 150--170% the values measured in the healthy tissue, respectively in benign tumorous alterations.

Cervix Mucus↗
PubMed1997

Epstein-Barr virus (EBV)-induced CD30+ natural killer cell-type malignancy resembling malignant histiocytosis: malignant transformation in chronic active EBV infection associating hypogammaglobulinemia.

A 27-year-old male suffered from Epstein-Barr virus (EBV)-related liver dysfunction with persistent hypogammaglobulinemia. IgG titers to EBV antigens were significantly high, while other hepatitis markers were negative. Liver biopsy disclosed active intralobular inflammation. Two years later, he manifested persistent fever, leukopenia, effusions and hypoproteinemia, and his general condition worsened progressively. The peripheral blood small lymphocytes predominantly expressed natural killer (NK)-like phenotypes (CD2+, CD7+, CD16+, CD56+). Hepatosplenomegaly and marked elevation of serum lactic dehydrogenase were observed. He died of respiratory failure at the age of 29. At autopsy, the liver (2190 g), spleen (860 g), small bowel and mesenteric lymph nodes showed massive infiltration of large atypical lymphoid cells in close association with hemophagocytic histiocytes. Involvement was mildly noted also in the bone marrow, lungs, gall-bladder and kidneys. The atypical cells belonged to CD30+ activated NK-type cells expressing CD2, cytoplasmic CD3 epsilon, CD7, CD45RO, CD56, HLA-DR and HLA-DQ. T cell receptors (TCR), surface CD3, CD4, CD5 and CD8 were not expressed. Epstein-Barr virus-related small nuclear RNA (EBER1) and Epstein-Barr virus-associated nuclear antigen 1 were detected in the nuclei of a significant number of atypical cells, while EBV-related latent membrane protein-1 was negative. EBER1 was also identified in the nuclei of non-neoplastic small lymphocytes at both biopsy and autopsy. Monoclonal integration of the EBV genome into the lymphoma cells was shown by Southern blot analysis. Clonal rearrangement of TCR was undetectable. Roles of chronic active EBV infection in the development of NK cell-type malignancy resembling malignant histiocytosis are discussed.

Adult↗
PubMed2004

Other primary malignancies in patients with uterine corpus malignancy.

OBJECTIVE: The purpose of this study was to determine the occurrence of multiple primary malignancies in patients with uterine corpus malignancy. STUDY DESIGN: We conducted a tumor registry search and a medical record review. RESULTS: Uterine corpus malignancy was reported in 1505 of 25605 women (6%) in the registries, of which 131 of 1505 women (9%) had multiple primary malignancies. Patients with uterine corpus malignancy with multiple primary malignancies were more likely to have had primary malignancies of the ovary (relative risk, 10; 95% CI, 6.2-17) and colon (relative risk, 2; 95% CI, 1.0-4.3) and less likely to have had primary malignancies of the cervix (relative risk, 0.4; 95% CI, 0.17-0.97) compared with women who had only one primary malignancy. A family history of malignancy was reported in only 44% of the patients with uterine corpus malignancy with multiple primary malignancies and 32% of those patients whose multiple primary malignancies were from the ovary or colon. CONCLUSION: The development of multiple primary malignancies in patients with uterine corpus malignancy may indicate an inherited predisposition, especially in those patients whose multiple primary malignancies include the ovary or colon. That predisposition may not be detected by routine family history.

Adult↗
PubMed1996

p53 protein expression in malignant, pre-malignant and non-malignant lesions of the lip.

AIM: To elucidate the role of the p53 tumour suppressor gene in the pathogenesis of lip cancer. METHODS: Expression of p53 was evaluated immunocytochemically in a retrospective study of formalin fixed, paraffin wax embedded tissue. Five cases each of four types of lip lesions were studied; these comprised squamous cell carcinoma (SCC), solar keratosis (SK), chronic hyperplastic candidosis (CHC), and lichen planus (LP). Five cases each of normal lip mucosa, SCC, and SK from sun exposed facial skin as well as LP, CHC, and SCC from buccal mucosa were also analysed. Immunolocalisation of p53 was scored semiquantitatively. The degree of apoptosis was also assessed in selected lesions by determining cell nuclear fragmentation. RESULTS: All SCCs from lip lesions were immunopositive for p53. All cases of SK and two of five CHC lip lesions were also p53 positive. Normal lip mucosa samples were p53 negative. Sun exposed skin lesions of SCC and SK were all positive for p53, but only three of five cases of SCC from the buccal mucosa had detectable levels of p53. p53 expression was not detected in CHC and LP lesions of the buccal mucosa. CONCLUSIONS: The aberrant expression of p53 is likely to occur early in the pathogenesis of lip cancer and may be related to exposure to the sun. The immunopositive p53 cells identified in the benign LP lesions do not necessarily correlate with commitment of cells within the lesion to programmed cell death. In light of the prior reports which indicate that p53 positive cells may progress to form malignant tumours, it is suggested that patients with p53 positive but otherwise benign lesions should be followed more closely.

Biomarkers↗
PubMed1990

T lymphocytes in non-malignant, pre-malignant and malignant changes of the cervix.

T lymphocytes play an important role in the immune response to both neoplasia and viral infection. Normally about 60% of T lymphocytes in the peripheral blood are T4 lymphocytes, while 20-30% are T8 ones. The T4/T8 ratio is usually 2:1. When this ratio is inverted the most significant changes occur. The aim of our study was to examine the T4/T8 lymphocyte ratio in the peripheral blood of patients with histologically confirmed non-malignant and premalignant changes of the cervix and to compare it both with the ratio in patients with squamocellular carcinoma of the cervix and those without any cytological or colposcopical cervical abnormality. The study group consisted of 118 patients, 17 of them had leukokeratosis of the cervical epithelium, 20 had cervical intraepithelial neoplasia (CIN) and 42 patients had cervical cancer, 39 patients had normal cervical findings and comprised the control group. Peripheral blood lymphocytes were examined by indirect immunoperoxidase technique, using OKT 4 and OKT 8 monoclonal antibodies. The average T4/T8 lymphocyte ratio in the peripheral blood of patients with leukokeratosis was 1.55, and in those with CIN 1.19. In patients with cancer the ratio was 1.34. The differences was not statistically significant. The control group had an average T4/T8 ratio of 2.31 which was significantly different compared to the results of the other groups. The value of these and similar results obtained by other authors is still uncertain. The alteration of T lymphocyte subsets may occur in the peripheral blood of patients with viral infections and some viruses are considered important in the etiology of CIN.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗
PubMed2002

The lactate dehydrogenases in malignant and non-malignant diseases.

The objective of this paper was to determine different patterns of Lactate Dehydrogenase(LD) isoenzymes in serum, pleural effusions and ascitic fluid collections and their usefulness in the differential diagnosis of malignant and non-malignant diseases. It was a case control study carried out at the Lagos University Teaching Hospital. Forty- six patients with pleural or ascitic fluid collection (male and female, age range between 18 and 65 years) made up of Twenty-two patients with malignant diseases and twenty-four with non- malignant diseases were recruited. Control group comprised 50 apparently healthy subjects of both sexes with age ranging between 18 and 65 years. Serum, pleural and ascitic fluid collections were assayed for total lactate dehydrogenase(LD) and it s isoenzymes. Total LD was estimated using the pyruvate to lactate reaction. LD isoenzyme analysis was estimated by cellulose acetate electrophoresis and stained with formazan. The mean total serum LD activity in the disease groups (malignant and non-malignant) was significantly higher than the mean total serum LD activity in the control group. The pleural fluid LD was highest in patients with empyema thoracis. Five isoenzymes of LD (LD1 - LD5) were present in both control and patient sera. The serum LD1 and LD2 isoenzymes were predominant in the controls. The serum LD4 and LD5 isoenzymes were predominant in the disease groups (malignant and non-malignant). LD4 and LD5 were the predominant isoenzymes in both pleural and ascitic fluids obtained in malignant and non-malignant diseases. Serum LD4 was significantly higher than serum LD5 in non-malignant disease while serum LD5 was significantly higher than serum LD4 in malignant disease. The types of malignancies could not be differentiated by serum and effusion fluid LD isoenzyme pattern. Pleural fluid total LD estimation is useful in monitoring patients on chest tubes and may be used to determine when to insert them. Serum LD4 and LD5 differentiates malignant from non-malignant disease but the effusion LD isoenzyme pattern does not.

Abdominal Neoplasms↗
PubMed2003

Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging.

PURPOSE: To retrospectively evaluate the features of benign versus malignant bowel obstruction on unenhanced and gadolinium-enhanced spoiled gradient-echo magnetic resonance (MR) images in patients with malignancy. MATERIALS AND METHODS: Forty-eight patients with malignancy and bowel obstruction underwent abdominal and pelvic MR imaging. Two blinded radiologists independently evaluated each study for dilated bowel, transition point, level of obstruction, obstructing mass, mural thickening and enhancement, and peritoneal disease. Benign obstruction was recorded if no mass was present and if mural thickening (when present) was segmental or diffuse. Malignant bowel obstruction was recorded if there was a mass, a disseminated abdominal tumor, or focal mural thickening. MR images were compared with surgical findings, follow-up imaging studies, and clinical outcome. chi2 test and Fisher exact test were used to assess the relationship between the MR features and benign versus malignant obstruction. RESULTS: Bowel obstruction had a benign cause in 19 patients and a malignant cause in 29 patients. Observer 1 correctly characterized benign bowel obstruction in 17 of 19 patients and malignant bowel obstruction in 27 of 29 patients. The sensitivity of observer 1 for characterizing malignant obstruction was 93%, specificity was 89%, and accuracy was 92%. Observer 2 correctly characterized benign bowel obstruction in 18 of 19 patients and malignant bowel obstruction in 26 of 29 patients. The sensitivity of observer 2 for characterizing malignant obstruction was 90%, specificity was 95%, and accuracy was 92%. Malignant bowel obstruction was present in 24 of 25 patients with an obstructing mass (P <.001). All 16 patients with focal mural thickening had malignant obstruction. Benign obstruction was present in four of five patients with diffuse mural thickening. Segmental mural thickening occurred in four patients with serosal metastases and in 11 patients with benign bowel obstruction. More extensive peritoneal thickening and enhancement correlated with malignant obstruction. CONCLUSION: In patients with malignancy who have symptoms indicative of bowel obstruction, gadolinium-enhanced MR imaging can help distinguish benign from malignant causes of bowel obstruction.

Adult↗
PubMed1999

Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data.

Although the association between malignancy and thromboembolic disease is well established, the relative risk of developing initial and recurrent deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with malignancy versus those without malignancy has not been clearly defined. The Medicare Provider Analysis and Review Record (MEDPAR) database was used for this analysis. Patients hospitalized during 1988-1990 with DVT/PE alone, DVT/PE and malignancy, malignancy alone, or 1 of several nonmalignant diseases (other than DVT/PE) were studied. The association of malignancy and nonmalignant disease with an initial episode of DVT/PE, recurrent DVT/PE, and mortality were analyzed. The percentage of patients with DVT/PE at the initial hospitalization was higher for those with malignancy compared with those with nonmalignant disease (0.6% versus 0.57%, p = 0.001). The probability of readmission within 183 days of initial hospitalization with recurrent thromboembolic disease was 0.22 for patients with prior DVT/PE and malignancy compared with 0.065 for patients with prior DVT/PE and no malignancy (p = 0.001). Among those patients with DVT/PE and malignant disease, the probability of death within 183 days of initial hospitalization was 0.94 versus 0.29 among those with DVT/PE and no malignancy (p = 0.001). The relative risk of DVT/PE among patients with specific types of malignancy is described. This study demonstrates that patients with concurrent DVT/PE and malignancy have a more than threefold higher risk of recurrent thromboembolic disease and death (from and cause) than patients with DVT/PE without malignancy. An alternative management strategy may be indicated for such patients.

Aged↗
PubMed2004

Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies.

OBJECTIVES: Chest ultrasonography is a useful diagnostic tool for the detection of pleural effusions of different etiologies. Our purpose was to determine whether the echogenic swirling pattern identifiable on real-time chest ultrasonographic images is a predictor of malignant pleural effusions in patients with malignancies. DESIGN: Medical records of patients undergoing chest ultrasonography in the Tri-Service General Hospital (Taiwan) between January 2000 and December 2002 were reviewed retrospectively. Patients with an echogenic swirling pattern in the pleural effusion, or with malignant diseases associated with pleural effusions, whose pleural fluids had been examined cytologically or whose pleural tissues had been examined pathologically, were enrolled in this study (n = 140). Malignant pleural effusions were defined by the presence of malignant cells in the pleural fluid identified by thoracentesis or by pleural biopsy. The echogenic swirling pattern was defined as numerous echogenic floating particles within the pleural effusion, which swirled in response to respiratory movement or heartbeat. Correlation between malignant pleural effusions and the echogenic swirling pattern was compared in patients with an underlying malignant disease. RESULTS: In patients with underlying malignancies, malignant pleural effusions were diagnosed in 81.8% of patients with a positive echogenic swirling pattern and in 48% of those with no echogenic swirling pattern. The presence of echogenic swirling was significantly more predictive of malignant pleural effusions than was the absence of echogenic swirling (p < 0.01). CONCLUSIONS: The echogenic swirling pattern is a useful predictor of possible malignant pleural effusions, and may be a good marker for malignant pleural effusions in patients with underlying malignancies.

Adult↗
PubMed2004

Familial association of specific histologic types of ovarian malignancy with other malignancies.

BACKGROUND: Population-based data on the familial association of specific histologic types of ovarian malignancy with other malignancies are limited. Such data may help to elucidate etiologic differences among histologic types of ovarian malignancy. METHODS: The nationwide Swedish Family-Cancer Database, which includes 10.3 million individuals and 20,974 ovarian carcinomas, was used to calculate standardized incidence ratios and 95% confidence intervals for age- and histology-specific ovarian malignancies in women whose parents or siblings were affected with malignancies at the most common disease sites. RESULTS: Ovarian malignancy was found to be associated with ovarian, laryngeal, breast, endometrial, liver, and colon carcinoma, as well as myeloma; epithelial ovarian malignancy was found to be associated with ovarian, endometrial, and skin malignancies and with melanoma and myeloma; papillary serous cystadenocarcinoma was found to be associated with ovarian and skin malignancies and with myeloma; and endometrioid carcinoma was found to be associated with endometrial, ovarian, and prostate malignancies and with melanoma. For younger women (ages 40-45 years) whose mothers were affected with endometrial malignancies, the risk of developing endometrioid carcinoma was slightly greater than the risk of developing papillary serous cystadenocarcinoma. CONCLUSIONS: Specific types of ovarian malignancy may be associated with specific familial disease sites, with such associations depending on age at diagnosis; the strength of the observed associations varied according to histology. Associations were found between endometrioid carcinoma and endometrial malignancy and between serous carcinoma and Hodgkin disease.

Adult↗
PubMed1993

[Elderly cases of hematological malignancies with second malignancies].

Recently an increase of the elderly patients with hematological malignancies has been pointed out. We analyzed second malignancies in elderly patients with hematological malignancies (95 age 65 or more), and made a comparative study with non-elderly case for the past 5 years. Second malignancies were observed in 26 cases out of the total of 282 hematological malignancies (9.2%). The percentage of patients with second malignancies in the elderly group (19/95; 20%) was significantly higher than that of the non-elderly group (7/187; 3.7%). Among the all kinds of hematological malignancies, the second malignancies were mainly observed in cases with myelodysplastic syndrome and chronic myelo-proliferative disorder. Colon carcinoma, gastric carcinoma and lung carcinoma accounted for nearly half of all the second malignancies. On 11 of the 26 cases with second malignancies, the first malignancies had been treated with some anti-cancer drug such as alkylating agents. Development of a second cancer was greater in cases in which the first hematological malignancy was treated with alkylating agents more than in cases in which the first carcinoma was not treated with alkylating agents.

Aged↗
PubMed1985

Differentiation between malignant and non-malignant pleural effusion.

In a prospective study of 334 consecutive patients with chronic pleural effusion 156 or 47% had a malignant etiology. The sensitivity of cytological examination of pleural fluid in detecting malignancies was 43%. Thoracoscopy had a sensitivity of 80% and could reveal malignancy in 37 of 47 patients with malignant effusions and a negative cytology. A malignant etiology must also be suspected when atypical cells are found in the pleural fluid as in our study 16 out of 19 fluid samples with atypical cytology represented malignant effusions. The predictive value for a malignant etiology was estimated for the following variables: sex, size of effusion, colour and eosinophils of pleural fluid, smoking habits and asbestos exposure. The predictive value of each variable was estimated separately, combining two by two and by a logistic regression function to exclude correlation to yet another variable. The single variable with the strongest positive predictability towards malignancy was a bloody fluid. Conversely, more than 30 per cent eosinophils in the fluid had the strongest negative predictability towards malignancy. The ability of our statistical method, a logistic regression function to discriminate between malignant and non-malignant etiology was 79%. The estimated probability of a malignant etiology should influence the choice of invasive procedures and the duration and intensity of follow-up.

Adolescent↗
PubMed2004

[Lymphocyte and lymphocyte subsets in pleural fluid--comparison of malignant and non-malignant disorders].

The role of lymphocytes in host defence in neoplastic disorders is known. Accumulation of lymphocytes in pleural cavity frequently occurs in different diseases. The aim of the study was to evaluate: 1) the frequency of lymphocyte predominance in different malignant and non-malignant pleural effusions; 2) lymphocyte phenotype and the ratio between helper (CD4+) and cytotoxic/suppressor (CD8+) lymphocytes in malignant and non-malignant effusions. Patients with mesothelioma, lung cancer, lymphoma and metastatic neoplasms were analysed. Analysis was performed on fluids with or without malignant cells. Non-malignant fluids were obtained from patients with: congestive heart failure, liver cirrhosis, pneumonia and tuberculosis. Lymphocytes were the predominant cell type in neoplastic effusions. For further analysis effusions with more than 10% of lymphocytes were included: 12 malignant and 9 non-malignant. For lymphocyte subpopulations analysis, the monoclonal antibodies anti-CD4 and anti-CD8 and APAAP method was used. We observed lower percentage of CD4+ lymphocytes (47%) and higher percentage of CD8+ (39%) lymphocytes in malignant when compared to non-malignant fluids (58% vs 31% respectively). The CD4+/CD8+ ratio was significantly lower in pleural fluid in cases with neoplastic disease when compared to benign cause of pleural involvement (1.03 vs 1.85). Our observations suggest the potential role of lymphocytes, especially CD8+ cells in local response in malignancy in pleural disease.

Adult↗
PubMed2006

Endoscopic ultrasonography in patients with large gastric folds at endoscopy and biopsies negative for malignancy: predictors of malignant disease and clinical impact.

OBJECTIVES: The aims of the study were to assess in patients with large gastric folds at endoscopy and endoscopic biopsies that tested negative for malignancy: (i) the predictive variables of malignancy in endoscopic ultrasonography (EUS), (ii) the impact of EUS. METHODS: Patients with this condition evaluated with radial EUS (following the standard study protocol of our Unit in these patients) during a 5-yr period were included. Nine variables were evaluated as possible predictors of malignancy (chi2, t-test, and logistic regression procedure) using pathology results, or a minimum of 2 yr of follow-up as gold standard. Likelihood ratios (LR), pre-EUS, and post-EUS probabilities for the diagnosis of malignancy were used to assess the clinical impact of the technique. RESULTS: Sixty-one patients were included (40 benign and 21 malignant). Predictive factors of malignancy were as follows: thickened gastric wall, thickened deep layers, impaired gastric distension, loss of the wall structure, and presence of ascites or lymph nodes, whereas the enlargement of superficial layers was a predictor of a benign condition. The enlargement of deep layers, as assessed by EUS was the only independent predictive factor for malignancy. When using this parameter, the pre-EUS probability of malignancy in our series (34%) increased up to 95% when EUS suggested malignancy (positive LR = 45), whereas it decreased to 4.7% when EUS precluded this diagnosis (negative LR = 0.102). CONCLUSIONS: (i) The enlargement of deep layers is the only independent predictive factor for malignancy in patients with large gastric folds at endoscopy and biopsies testing negative for malignancy and (ii) EUS has a high clinical impact in these patients.

Adult↗