Precursor lesions of early onset pancreatic cancer

Early onset pancreatic cancer (EOPC) constitutes less than 5% of all newly diagnosed cases of pancreatic cancer (PC). Although histopathological characteristics of EOPC have been described, no detailed reports on precursor lesions of EOPC are available. In the present study, we aimed to describe histopathological picture of extratumoral parenchyma in 23 cases of EOPCs (definition based on the threshold value of 45 years of age) with particular emphasis on two types of precursor lesions of PC: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMNs). The types, grades, and densities of precursor lesions of PC were compared in patients with EOPCs, in young patients with neuroendocrine neoplasms (NENs), and in older (at the age of 46 or more) patients with PC. PanINs were found in 95.6% of cases of EOPCs. PanINs-3 were found in 39.1% of EOPC cases. Densities of all PanIN grades in EOPC cases were larger than in young patients with NENs. Density of PanINs-1A in EOPC cases was larger than in older patients with PC, but densities of PanINs of other grades were comparable. IPMN was found only in a single patient with EOPC but in 20% of older patients with PC. PanINs are the most prevalent precursor lesions of EOPC. IPMNs are rarely precursor lesions of EOPC. Relatively high density of low-grade PanINs-1 in extratumoral parenchyma of patients with EOPC may result from unknown multifocal genetic alterations in pancreatic tissue in patients with EOPCs

Detection of Helicobacter pylori in gastric cancer Detecção do Helicobacter pylori no câncer gástrico

Background and Objectives &#151; Considering the high prevalence of stomach cancer in the northern region of Brazil and the recognized relationship between chronic gastric inflammation caused by Helicobacter pylori, and its carcinogenic potential, the objective we had with this study was to investigate the presence of the microorganism in macro and microscopic presentations of neoplasm in different regions of the stomach, and in non-malignant lesions concomitant to the adenocarcinoma in patients originating from the metropolitan area of Belém (State of Pará, Brazil). Methods - Examinations were made on 172 patients divided into two groups: group I, formed by 75 patients with gastric carcinoma, and group II, formed by 97 patients with mild enanthematic gastritis, considered control group. The diagnosis was obtained during endoscopic examination and the respective biopsy. Gastric neoplasms were classified macroscopically in accordance with Borrmann's classification, and microscopically in accordance with Laurén's classification. In group I, 54 patients were male and 21 female while in group II, 22 patients were male and 75 female. The average age in group I was 61.2 years (range 27 to 86 years), while in group II it was 37.5 years (range 16 to 69 years). Thin sections were prepared and stained using the hematoxylin-eosin method. In the Helicobacter pylori research, the modified Gram stain was utilized. Statistical analysis was done by utilizing the chi-squared (chi ²) test, Mann-Whitney test (U), and Fisher's exact test. Results - The results showed the detection of Helicobacter pylori were significantly greater in patients with mild enanthematic gastritis than in patients with gastric carcinoma. The presence of Helicobacter pylori in patients with gastric carcinoma and mild enanthematic gastritis was significantly greater in the antral region than in other gastric regions. Helicobacter pylori detection in patients with gastric carcinoma did not present a significant difference in relation to the macroscopic aspect of the tumor either intestinal or diffuse histological types. Conclusions - These data suggest the presence of the bacteria is predominant in the antral region and it does not show relation with the macroscopic types or histological intestinal or diffuse types of gastric carcinoma.<br>Racional e Objetivos &#151; Considerando a elevada prevalência de câncer gástrico na região norte do Brasil e a conhecida relação entre a inflamação por gastrite crônica causada pelo Helicobacter pylori e seu potencial carcinogênico, os objetivos deste estudo foram detectar a presença do microorganismo nas apresentações macro e microscópicas da neoplasia nas diferentes regiões do estômago, e nas lesões não-malignas concomitantes ao adenocarcinoma, em doentes oriundos da área metropolitana de Belém (Estado do Pará, Brasil). Método - Foram examinados 172 doentes divididos em dois grupos: grupo I, constituído por 75 enfermos com carcinoma gástrico e grupo II composto por 97 doentes com gastrite enantemática leve, considerado grupo controle. Os diagnósticos foram obtidos por meio de exame endoscópico e respectiva biopsia. As neoplasias gástricas foram classificadas macroscopicamente de acordo com a classificação de Borrmann e microscopicamente de acordo com a classificação de Laurén. No grupo I, 54 doentes eram do sexo masculino e 21 do sexo feminino. No grupo II, 22 enfermos eram masculinos e 75 femininos. A média de idade no grupo I foi de 61,2 anos (27 a 86 anos) e a do grupo II foi de 37,5 anos (16 a 69 anos). As lâminas foram preparadas e coradas pelo método da hematoxilina e eosina, utilizando-se o método de Gram modificado na pesquisa do H.pylori. A análise estatística foi realizada com os testes do chi ², teste de Mann Whitney e teste exato de Fisher. Resultados - A detecção do H.pylori foi significativamente maior nos doentes com gastrite enantemática leve do que nos enfermos com adenocarcinoma gástrico. A presença do H.pylori nos doentes com adenocarcinoma gástrico e nos enfermos com gastrite enantemática leve foi significativamente maior na região antral do que nas demais localizações gástricas. A presença do H.pylori nos doentes com adenocarcinoma gástrico não apresentou diferença significativa em relação aos tipos macroscópicos ou com os tipos microscópicos intestinal ou difuso do tumor. Conclusões - Estes dados sugerem que a presenças do H.pylori em doentes com adenocarcinoma gástrico é predominante no antro e não apresenta relação com os subtipos macroscópicos ou histológicos do carcinoma gástrico