RESUMEN
Among malignant neoplasms, pancreatic ductal adenocarcinoma (PDAC) has one of the highest fatality rates due to its late detection. Therefore, it is essential to discover a noninvasive, early, specific, and sensitive diagnostic method. MicroRNAs (miRNAs) are attractive biomarkers because they are accessible, highly specific, and sensitive. It is crucial to find miRNAs that could be used as possible biomarkers because PDAC is the eighth most common cause of cancer death in Mexico. With the help of microRNA microarrays, differentially expressed miRNAs (DEmiRNAs) were found in PDAC tissues. The presence of these DEmiRNAs in the plasma of Mexican patients with PDAC was determined using RT-qPCR. Receiver operating characteristic curve analysis was performed to determine the diagnostic capacity of these DEmiRNAs. Gene Expression Omnibus datasets (GEO) were employed to verify our results. The Prisma V8 statistical analysis program was used. Four DEmiRNAs in plasma from PDAC patients and microarray tissues were found. Serum samples from patients with PDAC were used to validate their overexpression in GEO databases. We discovered a new panel of the two miRNAs miR-222-3p and miR-221-3p that could be used to diagnose PDAC, and when miR-221-3p and miR-222-3p were overexpressed, survival rates decreased. Therefore, miR-222-3p and miR-221-3p might be employed as noninvasive indicators for the diagnosis and survival of PDAC in Mexican patients.
Asunto(s)
Carcinoma Ductal Pancreático , MicroARN Circulante , MicroARNs , Neoplasias Pancreáticas , Humanos , MicroARN Circulante/genética , México , Regulación Neoplásica de la Expresión Génica , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , MicroARNs/metabolismo , Biomarcadores , Biomarcadores de Tumor/genética , Neoplasias PancreáticasRESUMEN
Atrophic carcinoma and microcystic carcinoma have previously been classified as variants of conventional acinar adenocarcinoma. In this article, we studied 4 cases of atrophic carcinoma and 4 cases of limited microcystic carcinoma. We found an incidence of 0.8% in 250 needle prostatic biopsies and 1.3% of atrophic carcinoma in 150 radical prostatectomies. Microcystic carcinomas were found in 3 prostatectomies (1.2%) and in 1 needle biopsy (0.67%). The useful histological criteria for atrophic carcinoma included the irregular disposition of the glands, infiltrative pattern, "rigid" luminal borders, and intraluminal secretions. Cytological changes included scant cytoplasm, nucleomegaly, hyperchromatic nuclei, and visible nucleoli. The glands of the microcystic carcinoma differ from the benign glands because the malignant ones show a markedly greater dilatation and exhibit rigidity of glandular lumens. In some cases of microcystic carcinoma, the nuclei were flattened, small, and hyperchromatic; therefore, they can be difficult to recognize as malignant.
Asunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Biopsia con Aguja , Humanos , Masculino , ProstatectomíaRESUMEN
BACKGROUND: Study of minimum adenocarcinoma has been done almost exclusively on conventional acinar adenocarcinoma. Pseudohyperplastic adenocarcinoma can be confused with benign lesions because of its well-differentiated appearance and has not been studied when the biopsy shows few malignant glands (limited carcinoma). METHODS: We reviewed 94 pseudohyperplastic adenocarcinomas diagnosed in prostatic biopsies for a period of 12 years and selected those measuring less than 1 mm or involving less than 5% of the biopsied tissue. We also reviewed 200 consecutive consultations. RESULTS: Four (4.2%) of the 94 cases were limited pseudohyperplastic adenocarcinomas, and 3 were from consultations. Three of them were mistaken for hyperplastic nodules, prostatic adenosis, or prostatic intraepithelial neoplasm. The number of glands varied between 6 and 50 (average 23). Three nodular histological patterns were identified-nodular, adenosis-like, and pseudohyperplastic carcinoma resembling prostatic intraepithelial neoplasia. The diagnosis of adenocarcinoma was not related to the number of neoplastic glands. Histological criteria that were useful included: crowded medium to large glands, papillary infoldings, branching glands, straight luminal borders, hyperchromatic nuclei, nucleomegaly, and apparent nucleoli. Areas of transition to conventional acinar adenocarcinoma were useful in recognizing four of these neoplasms, but were barely apparent in 2 of them. Hyperchromatic nuclei were found in all cases, whereas apparent nucleoli and nucleomegaly were only present in 4. CONCLUSIONS: The architectural and cytological criteria for limited acinar adenocarcinoma are only partially useful in interpreting minimum pseudohyperplastic adenocarcinomas. Knowledge of the criteria for malignancy in both neoplasms is important in order to avoid underdiagnosis of malignancy.
Asunto(s)
Adenocarcinoma/patología , Próstata/patología , Neoplasia Intraepitelial Prostática/patología , Neoplasias de la Próstata/patología , Anciano , Biopsia con Aguja , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Derivación y ConsultaRESUMEN
We report an example of a cystic hepatic angiosarcoma that to our knowledge has not been previously described. The patient was a 70 year old woman who was admitted to the emergency room because of hypovolemic shock. A computed tomography showed four heterogeneous hepatic cystic masses varying from 2.5 to 11.2 cm; one of these with rupture and formation of a subcapsular hematoma. The cyst wall was lined by several layers of neoplastic epithelioid and spindle shaped endothelial cells that in some areas extended to the underlying stroma. They expressed CD31 and CD34, and were negative for cytokeratin. The patient is alive with residual hepatic cystic angiosarcoma. However, follow up is too short to be significant.
Asunto(s)
Hemangiosarcoma/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Anciano , Antígenos CD34/metabolismo , Femenino , Hemangiosarcoma/metabolismo , Hemangiosarcoma/patología , Humanos , Inmunohistoquímica , Queratinas/metabolismo , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Neoplasias Quísticas, Mucinosas y Serosas/metabolismo , Neoplasias Quísticas, Mucinosas y Serosas/patología , Neoplasias Primarias Múltiples/metabolismo , Neoplasias Primarias Múltiples/patología , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Tomografía Computarizada por Rayos XRESUMEN
Phosphaturic mesenchymal tumor (PMT) is a morphologically heterogeneous soft tissue and bone neoplasm, producing a paraneoplastic syndrome due to phosphate wasting. These tumors produce fibroblast growth factor 23, which is implicated in renal tubule phosphate loss. Medical records of patients seen from 1999 to 2013 with osteomalacia associated or not with a tumor were reviewed. Clinical and laboratory data, radiographic studies, and follow-up of 8 patients were tabulated. Histologic features and the immunoprofile of the tumors were analyzed. There were 208 patients with osteomalacia, but only 8 (3.84%) had osteomalacia associated with a tumor. The median age of the patients was 40 years. The tumor size ranged from 1.5 to 4 cm. Five were located in soft tissues and skin; and 3, in bones. Osteomalacia symptoms lasted from 2 to 14 years with a median of 6 years. Laboratory data showed hypophosphatemia and phosphaturia in all patients. All tumors were histologically benign. Histologically, the salient features were a hemangiopericytoid pattern, chronic hemorrhage, and microcystic areas. All neoplasms were diffusely positive for vimentin and focally positive for epithelial membrane antigen, CD34, and S-100 protein. Ki-67 was positive in approximately 10% of neoplastic cells in 2 cases and less than 1% in the remainder. We report 8 cases of PMTs producing osteomalacia, from a single third-level Mexican medical institution. These tumors occurred in soft tissues, skin, and bones. All tumors were benign, small, not easily detected by physical examination and diagnosed due to the metabolic abnormalities.
Asunto(s)
Hipofosfatemia/patología , Mesenquimoma/patología , Neoplasias de los Tejidos Conjuntivo y Blando/patología , Osteomalacia/patología , Adulto , Femenino , Humanos , Hipofosfatemia/etiología , Masculino , Mesenquimoma/complicaciones , México , Persona de Mediana Edad , Neoplasias de los Tejidos Conjuntivo y Blando/complicaciones , Osteomalacia/etiología , Estudios RetrospectivosRESUMEN
We report the case of a 31-year old woman with recurrent cholangitis secondary to hepatolithiasis. The stones were composed of calcium bilirubinate. The patient also had a supernumerary hepatic lobe connected to the inferior aspect of the segment III of the liver. The role of the supernumerary hepatic lobe in the development of hepatolithiasis is unclear and may be coincidental.
Asunto(s)
Cálculos/complicaciones , Colangitis/etiología , Coledocolitiasis/complicaciones , Colelitiasis/complicaciones , Hígado/anomalías , Adulto , Bilirrubina/análisis , Biopsia , Cálculos/diagnóstico , Cálculos/metabolismo , Cálculos/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Colangitis/diagnóstico , Colangitis/cirugía , Colecistectomía Laparoscópica , Coledocolitiasis/diagnóstico , Coledocolitiasis/metabolismo , Coledocolitiasis/cirugía , Colelitiasis/diagnóstico , Colelitiasis/metabolismo , Colelitiasis/cirugía , Femenino , Hepatectomía , Humanos , Hígado/cirugía , Imagen por Resonancia Magnética , Recurrencia , Resultado del TratamientoRESUMEN
We describe 8 cases of cholecystectomy specimens (6 laparoscopic and 2 open cholecystectomies) with Rokitansky-Aschoff (R-A) sinuses that were misinterpreted as adenocarcinomas. They were compared with 8 examples of classical R-A sinuses and 6 cases of R-A sinuses containing foci of adenocarcinoma. Five cases misinterpreted as adenocarcinomas consisted of densely packed, closely opposed R-A sinuses with little intervening stroma or surrounded by a desmoplastic stroma. They were lined by a single layer of cuboidal or columnar cells. There were also pseudostratified columnar cells with mucin-containing cytoplasm and hyperchromatic or vesicular nuclei but without mitotic figures. In 2 cases, the columnar cells had subnuclear vacuoles. Small papillary projections into R-A sinuses were seen in 4 cases, and in 3 others collections of metaplastic pyloric glands, some connected to the epithelium of the sinuses, were recognized. There was focal reactive atypia in both the epithelium of the surface and that of the sinuses. The R-A sinuses resembling gland-like structures had a laminar distribution rather than a disorderly haphazard distribution seen in well-differentiated adenocarcinoma. The remaining 3 cases misinterpreted as adenocarcinomas consisted of numerous deeply penetrating long and short R-A sinuses that branched in different directions and which reach the subserosal or perimuscular connective tissue mimicking invasion. The sinuses were surrounded by hyperplastic smooth muscle bundles and lined by pseudostratified columnar cells mixed with a few goblet cells showing reactive atypia and no mitotic figures. There was focal reactive atypia in both the epithelium of the surface and that of the sinuses. The 2 types of R-A sinuses did not label with carcinoembryonic antigen or p53 and had very low proliferative activity as measured by the MIB1-labeling index. All patients are alive and disease free from 8 months to 17 years (mean follow-up 7 y). In contrast, the foci of invasive adenocarcinoma that arose in R-A sinuses consisted of glands lined by atypical cuboidal or columnar cells with loss of polarity, large hyperchromatic or vesicular nuclei, prominent nucleoli, and mitotic figures, quite different from the cells lining the R-A sinuses. Because of increasing number of laparoscopic cholecystectomies performed annually in the United States, pathologists should become familiar with these gallbladder lesions that are usually incidental findings but can simulate malignant epithelial neoplasms.
Asunto(s)
Adenocarcinoma/patología , Carcinoma in Situ/patología , Neoplasias de la Vesícula Biliar/patología , Adenocarcinoma/química , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Biomarcadores de Tumor/análisis , Antígeno Carcinoembrionario/análisis , Carcinoma in Situ/química , Carcinoma in Situ/mortalidad , Carcinoma in Situ/cirugía , Colecistectomía , Colecistectomía Laparoscópica , Diagnóstico Diferencial , Errores Diagnósticos , Supervivencia sin Enfermedad , Femenino , Vesícula Biliar/anomalías , Enfermedades de la Vesícula Biliar , Neoplasias de la Vesícula Biliar/química , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Valor Predictivo de las Pruebas , Factores de Tiempo , Resultado del Tratamiento , Proteína p53 Supresora de Tumor/análisis , Ubiquitina-Proteína Ligasas/análisisRESUMEN
Among 31 benign cystic neoplasms of the pancreas diagnosed as mucinous cystadenomas, we identified 9 (29%) cases of nonmucinous cystadenomas with a pancreatobiliary phenotype and an ovarian-like stroma. Although both cystic tumors belong to the same family, they should be separated because their epithelial lining and cyst fluid are different. The lining cells of the nonmucinous cystadenomas consisted of a single layer of cuboidal cells, similar to the epithelial cells of the normal pancreatic ducts, and were not dysplastic (90%-100% of the lining cells). The cyst fluid was described as serous or clear. The remaining 22 classical mucinous cystadenomas, lined predominantly by mucinous and foveolar epithelium, revealed focal pancreatobiliary epithelium in 86% of the cases, and 6 pancreatic invasive mucinous cystadenocarcinomas failed to show pancreatobiliary differentiation. We believe that these nonmucinous cystadenomas of the pancreas represent a distinctive subset of cystic neoplasms of the pancreas that probably have no malignant potential.
Asunto(s)
Conductos Biliares/patología , Cistoadenoma Mucinoso/patología , Cistadenoma Seroso/patología , Ovario/patología , Neoplasias Pancreáticas/patología , Células del Estroma/patología , Adulto , Conductos Biliares/metabolismo , Biomarcadores de Tumor/metabolismo , Cistoadenoma Mucinoso/metabolismo , Cistadenoma Seroso/metabolismo , Diagnóstico Diferencial , Células Epiteliales/metabolismo , Células Epiteliales/patología , Femenino , Humanos , Persona de Mediana Edad , Ovario/metabolismo , Neoplasias Pancreáticas/metabolismo , Fenotipo , Células del Estroma/metabolismo , Adulto JovenRESUMEN
The differential diagnosis of fever of unknown origin (FUO) includes infectious, neoplastic, rheumaticinflammatory and miscellaneous diseases. We report the case of a 35-year-old man with FUO caused by Q fever. A liver biopsy showed the characteristic fibrin-ring lipogranulomas compatible with Q fever. The serologic tests confirmed the diagnosis of acute infection by Coxiella burnetii. The therapeutic response was excellent. In conclusion, we described a patient with acute Q fever and granulomatous hepatitis.
Asunto(s)
Fiebre de Origen Desconocido/etiología , Fiebre Q/complicaciones , Adulto , Biopsia , Diagnóstico Diferencial , Granuloma/patología , Hepatitis Viral Humana/patología , Humanos , Hígado/patología , Masculino , Fiebre Q/patologíaRESUMEN
We report the case of a 26-year-old woman with a 19 cm malignant hepatic neoplasm with morphological features that closely resembled a follicular thyroid carcinoma. Despite this, it was interpreted as a cholangiocarcinoma due to the absence of a primary thyroid tumor and the lack of thyroglobulin and TTF-1 immunoreactivity by the hepatic tumor. The left hepatic lobectomy specimen showed an encapsulated and multinodular gray-white mass with cystic and hemorrhagic areas. Microscopically, it displayed predominant macro and microfolicullar patterns with focal solid, trabecular and insular areas. The small and distended follicles contained a colloid-like secretion and were lined by low cuboidal cells with scant cytoplasm, round or oval hyperchromatic nuclei with fine chromatin. The solid areas, trabecular and insular structures were similar to those of follicular or papillary thyroid carcinomas. In addition, some of the neoplastic cells had clear nuclei with occasional grooves. The tumor was positive for cytokeratin (CK) 7, CK 19 and CD138, and negative for TTF-1, thyroglobulin, Hepar-1, Glypican-3, alpha-fetoprotein and neuroendocrine markers. A thyroid neoplasm was excluded clinically and by ultrasound and computed tomography. Although, the residual hepatic parenchyma was initially not cirrhotic, the patient eventually developed cryptogenic cirrhosis. The patient received adjuvant chemotherapy and died of metastatic disease 18 months after surgery. The thyroid-like pattern broadens the morphologic spectrum of cholangiocarcinoma.
Asunto(s)
Adenocarcinoma Folicular/patología , Carcinoma/patología , Colangiocarcinoma/patología , Neoplasias Hepáticas/patología , Neoplasias de la Tiroides/patología , Adulto , Neoplasias de los Conductos Biliares , Conductos Biliares Intrahepáticos , Biomarcadores de Tumor/análisis , Carcinoma Papilar , Quimioterapia Adyuvante , Colangiocarcinoma/química , Colangiocarcinoma/tratamiento farmacológico , Colangiocarcinoma/cirugía , Resultado Fatal , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/química , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética , Cáncer Papilar Tiroideo , Resultado del Tratamiento , Carga TumoralRESUMEN
Hepatic inflammatory myofibroblastic tumors are uncommon low grade malignant neoplasms. They can be confused clinically and by imaging studies with abscess.
Asunto(s)
Neoplasias Hepáticas , Miofibroblastos , Neoplasias de Tejido Muscular , Actinas/análisis , Biomarcadores de Tumor/análisis , Biopsia , Femenino , Hepatectomía , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/química , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Miofibroblastos/química , Miofibroblastos/patología , Neoplasias de Tejido Muscular/química , Neoplasias de Tejido Muscular/diagnóstico por imagen , Neoplasias de Tejido Muscular/patología , Neoplasias de Tejido Muscular/cirugía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Carcinomas of the extrahepatic bile ducts are uncommon and morphologically heterogeneous. We report 3 unique examples of adenocarcinomas that show predominantly pyloric gland differentiation (80%-100%) and compare their immunohistochemical profile with that of pyloric gland adenomas of the gallbladder, foveolar, and intestinal-type adenocarcinomas of the extrahepatic bile duct. The 3 patients with pyloric gland adenocarcinomas were younger than those with conventional adenocarcinomas. The 3 tumors were very well differentiated but showed extensive perineural invasion. They consisted of a variable proportion of small, medium-sized, and cystically dilated glands separated by abundant desmoplastic stroma. The glands were lined by columnar cells with abundant mucin-containing cytoplasm and small hyperchromatic basally placed nuclei with inconspicuous nucleoli. A characteristic feature of these pyloric gland adenocarcinomas was that the glands had a stellar pattern that was not seen in foveolar-, intestinal-, or biliary-type adenocarcinomas. Two pyloric gland adenocarcinomas coexpressed MUC6 and MUC5AC. The diffuse pattern of reactivity of MUC5AC and MUC6 was similar to that of 10 pyloric gland adenomas of the gallbladder and 2 foveolar adenocarcinomas of the extrahepatic bile duct. In contrast, 5 intestinal adenocarcinomas of the extrahepatic bile duct labeled with the intestinal marker CDX2 and 3 with the colonic MUC2 but were negative for MUC6 and MUC5AC. We believe that these pyloric gland adenocarcinomas represent a previously unrecognized distinct clinicopathologic entity. Despite their deceptively benign microscopic appearance, 1 patient died with local recurrence and liver metastasis, another patient is living with tumor, and the third patient is asymptomatic but only 5 months after surgery.
Asunto(s)
Adenocarcinoma/patología , Neoplasias de los Conductos Biliares/patología , Conductos Biliares Extrahepáticos/patología , Mucosa Gástrica/patología , Adenocarcinoma/clasificación , Adenocarcinoma/metabolismo , Adulto , Neoplasias de los Conductos Biliares/clasificación , Neoplasias de los Conductos Biliares/metabolismo , Conductos Biliares Extrahepáticos/metabolismo , Femenino , Mucosa Gástrica/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Mucinas/metabolismoRESUMEN
We report 201 gallbladder adenomas from 91 patients most of whom were adult females. Fifty-three (58%) patients had gallstones. In 83 (91%) patients the adenomas were single. One gallbladder had 102 adenomas. Histologically, 165 (82%) of 201 adenomas were classified as pyloric, 28 (14%) as intestinal, 5 (2.4%) as foveolar, and 3 (1.4%) as biliary. Two patients had intestinal-type adenomas coexisting with biliary papillomatosis. Twenty-eight percent of pyloric gland adenomas contained squamoid morules. Two pyloric gland adenomas were composed predominantly of columnar oxyphil cells. High-grade dysplasia/carcinoma in situ was identified in 44 (27%) of 165 pyloric gland adenomas and low-grade dysplasia in 25 (15%) of 165. However, only 2 (1%) invasive adenocarcinomas, both of intestinal type, arose in pyloric gland adenomas. Both patients survived more than 5 years. Intestinal-type adenomas were classified as tubular, papillary, and tubulopapillary. High-grade dysplasia/carcinoma in situ was recognized in 13 (46%) of 28 intestinal adenomas. However, only 1 (3.5%) invasive adenocarcinoma with biliary phenotype arose in an intestinal-type adenoma. Foveolar adenomas showed low-grade dysplasia, and biliary adenomas were composed of columnar cells similar to the normal biliary cells of the gallbladder. None of these tumors progressed to adenocarcinoma. MUC5AC and MUC6 labeled 44 (95%) of 46 pyloric gland adenomas, whereas CDX2 was positive in 14 (78%) of 18 intestinal adenomas and MUC2 in 6 (33%) of 18. MUC5AC and MUC6 labeled 2 foveolar adenomas, and 2 biliary adenomas expressed only CK7. The immunophenotype of gallbladder adenomas justifies their classification into pyloric, intestinal, foveolar, and biliary. Our results indicate that adenomas of the gallbladder play a minor role in the pathway of gallbladder carcinogenesis.
Asunto(s)
Adenoma/patología , Carcinoma in Situ/patología , Neoplasias de la Vesícula Biliar/patología , Vesícula Biliar/patología , Mucinas/metabolismo , Adenoma/metabolismo , Adulto , Anciano , Biomarcadores de Tumor/metabolismo , Carcinoma in Situ/metabolismo , Transformación Celular Neoplásica/patología , Femenino , Vesícula Biliar/metabolismo , Neoplasias de la Vesícula Biliar/metabolismo , Mucosa Gástrica/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Estómago/patologíaRESUMEN
Aim. Evaluate the feasibility to overcome the learning curve in a western training center of the en bloc circumferential esophageal (ECE-) ESD in an in vivo animal model. Methods. ECE-ESD was performed on ten canine models under general anesthesia on artificial lesions at the esophagus marked with coagulation points. After the ESD each canine model was euthanized and surgical resection of the esophagus and stomach was carried out according to "the Principles of Humane Experimental Technique, Russel and Burch." The specimen was fixed with needles on cork submerged in formalin with the esophagus and stomach then delivered to the pathology department to be analyzed. Results. ECE-ESD was completed without complications in the last 3/10 animal models. Mean duration for the procedures was 192 ± 35 minutes (range 140-235 minutes). All the procedures were done at the animal lab surgery room with cardio pulmonary monitoring and artificial ventilation by staff surgery members and a staff member of the Gastroenterology department trained during 1999-2001 at the Fujigaoka hospital of the Showa U. in Yokohama, Japan, length (range 15-18 mm) and 51 ± 6.99 width (range 40-60 mm). Conclusion. ECE-ESD training is feasible in canine models for postgraduate endoscopy fellows.
RESUMEN
BACKGROUND: Gallstone disease affects over 20 million people in the U.S. and is a major risk factor for gallbladder cancer (GBC). In 1988, a less invasive, low-cost procedure, laparoscopic cholecystectomy (LC), was introduced and became the standard of care for management of gallstones. METHODS: GBC incidence (1973-2007) and mortality rates (1969-2006) were calculated using SEER Program data. LC rates (1993-2008) were obtained from NAMCS, NHAMCS, and HCUP. Annual percent change was estimated by gender, age, and race, and the statistical significance was assessed at p < 0.05. Correlation analysis was performed on GBC and LC trends. RESULTS: Since the early 1970s, GBC incidence and mortality rate have declined. Women and older age groups continue to have the highest risk for GBC, despite having greater declines. Incidence significantly decreased among whites, but did not among blacks. The number of inpatient LC procedures increased by 15% between 1994 and 2008; however, inpatient and outpatient LC rates remained stable. LC rate was not significantly correlated with either GBC incidence or mortality. CONCLUSIONS: The decline in incidence and mortality of GBC began decades before the introduction of LC and apparently has stabilized in the past decade. No temporal relationship existed between LC rate and the incidence and mortality rates of GBC. Our study suggests that prevention of a rare tumor may be extremely difficult if the surgical removal of a risk factor is involved.
Asunto(s)
Colecistectomía Laparoscópica/tendencias , Neoplasias de la Vesícula Biliar/epidemiología , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de la Vesícula Biliar/etiología , Neoplasias de la Vesícula Biliar/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Programa de VERF , Factores Sexuales , Tasa de Supervivencia , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Well established complications of essential thrombocythemia are multiple thrombohemorrhagic phenomena in various abdominal organs. We describe the case of a 22 year old man with essential thrombocythemia and thrombosis of the mesenteric and splenic veins as well as cavernomatous transformation of the portal vein. The patient also had a splenic infarction and a subphrenic hematoma. Additionally, he developed signs and symptoms of acute cholecystitis which in turn led to an open cholecystectomy. The gallbladder had a markedly thickened wall due to multiple recent and recanalized thrombi predominantly in subserosal veins. Only a few arteries were occluded by thrombi. A marked vascular proliferation in the subserosal connective tissue mimicking a hemangioma was most likely the result of collateral circulation. There was also a mild acute and chronic inflammatory infiltrate and edema in the lamina propria of the gallbladder. Hyperplasia of interstitial cells of Cajal in the lamina propria and between smooth muscle cells and proliferation of nerve trunks in the subserosal connective tissue adjacent to the thrombosed veins and arteries was also noted. To our knowledge this unique gallbladder thrombotic complication of essential thrombocythemia has not been previously reported.
Asunto(s)
Colecistitis Aguda/etiología , Vesícula Biliar/irrigación sanguínea , Trombocitemia Esencial/complicaciones , Trombosis/etiología , Colecistectomía , Colecistitis Aguda/cirugía , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Enfermedades de la Vesícula Biliar/etiología , Enfermedades de la Vesícula Biliar/patología , Humanos , Masculino , Venas Mesentéricas/patología , Vena Esplénica/patología , Trombosis/patología , Adulto JovenRESUMEN
Pseudohyperplastic carcinoma (PHPC) is a prostatic neoplasm that can be easily mistaken for nodular hyperplasia or atypical adenomatous hyperplasia. To determine the frequency and clinicopathologic characteristics of PHPC, we reviewed 200 simple prostatectomy specimens. We found 3 cases (1.5%) of PHPC. The tumors were small and ranged in size from 4 to 6 mm. Two of them were erroneously diagnosed as benign glandular proliferations in the original interpretation. Their histologic aspect at low magnification showed nodules of well-differentiated medium-sized glands with cystic dilation in a tight arrangement that imparted a benign appearance. Corpora amylacea were found in 2 cases. However, the lining cells showed nucleomegaly and prominent nuclei in most of the neoplastic glands, and the high-molecular-weight keratin (34BE12) immunostain revealed absence of basal cells. α-Methylacyl-CoA-racemase was positive in 2 cases. In one case, a small focus of moderated acinar adenocarcinoma was found adjacent to the pseudohyperplastic glands facilitating the diagnosis. The 3 patients are disease-free 3 and 4 years after surgery probably because of the small size of the tumors; however, it must be emphasized that most PHPC are considered moderately differentiated and potentially aggressive neoplasms.
Asunto(s)
Adenocarcinoma/patología , Hiperplasia Prostática/patología , Neoplasias de la Próstata/patología , Adenocarcinoma/cirugía , Anciano , Biomarcadores de Tumor/metabolismo , Núcleo Celular/patología , Humanos , Queratinas/metabolismo , Masculino , Persona de Mediana Edad , Prostatectomía , Hiperplasia Prostática/cirugía , Neoplasias de la Próstata/cirugía , Racemasas y Epimerasas/metabolismo , Resultado del TratamientoRESUMEN
We report the clinicopathologic features of 13 cases of intramucosal carcinoma (IMC) of the gallbladder. All IMCs were incidental findings in cholecystectomy specimens for cholelithiasis. However, one of the patients had a carcinoma of the pancreas, and the gallbladder incidentally removed during the Whipple procedure showed an IMC. Another patient had a small cell carcinoma of the gallbladder, and one of the sections showed an IMC. Of the IMCs, 10 were well-differentiated adenocarcinomas, 1 was a moderately differentiated adenocarcinoma, 1 was an undifferentiated carcinoma, and 1 was a squamous cell carcinoma. Of the patients, 8 were disease-free from 3 to 11 years, and 2 patients died, one as a result of the pancreatic ductal carcinoma and the other with disseminated metastases of the small cell carcinoma. The follow-up of another patient was too short to be significant. Two patients were lost to follow-up. Our findings suggest that a simple cholecystectomy is a curative procedure for IMCs of the gallbladder.