Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection.</p> <p>Case presentation</p> <p>We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT) revealed a markedly dilated common bile duct (CBD) and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter) at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor.</p> <p>Conclusion</p> <p>Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.</p

High fat diet modifies the association of lipoprotein lipase gene polymorphism with high density lipoprotein cholesterol in an Asian Indian population

Background Single nucleotide polymorphisms (SNPs) in lipoprotein lipase gene (LPL) have been shown to influence metabolism related to lipid phenotypes. Dietary factors have been shown to modify the association between LPL SNPs and lipids; however, to date, there are no studies in South Asians. Hence, we tested for the association of four common LPL SNPs with plasma lipids and examined the interactions between the SNPs and dietary factors on lipids in 1,845 Asian Indians. Methods The analysis was performed in 788 Type 2 diabetes cases and 1,057 controls randomly chosen from the cross-sectional Chennai Urban Rural Epidemiological Study. Serum triacylglycerol (TAG), serum total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured using a Hitachi-912 autoanalyzer (Roche Diagnostics GmbH, Mannheim, Germany). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. The SNPs (rs1121923, rs328, rs4922115 and rs285) were genotyped by polymerase chain reaction followed by restriction enzyme digestion and 20% of samples were sequenced to validate the genotypes obtained. Statistical Package for Social Sciences for Windows version 22.0 (SPSS, Chicago, IL) was used for statistical analysis. Results After correction for multiple testing and adjusting for potential confounders, SNPs rs328 and rs285 showed association with HDL-C (P = 0.0004) and serum TAG (P = 1×10−5), respectively. The interaction between SNP rs1121923 and fat intake (energy %) on HDL-C (P = 0.003) was also significant, where, among those who consumed a high fat diet (28.4 ± 2.5%), the T allele carriers (TT + XT) had significantly higher HDL-C concentrations (P = 0.0002) and 30% reduced risk of low HDL-C levels compared to the CC homozygotes. None of the interactions on other lipid traits were statistically significant. Conclusion Our findings suggest that individuals carrying T allele of the SNP rs1121923 have increased HDL-C levels when consuming a high fat diet compared to CC homozygotes. Our finding warrants confirmation in prospective studies and randomized controlled trials

Imaging of renal and prostate carcinoma with refractive index radiology

Aim: Having better edge enhancement and penetrating power, refractive index radiology is suitable for the imaging of weakly absorbing objects such as tissue specimens. In this study the potential of refractive index radiology was evaluated for the imaging of renal cell carcinoma (RCC) and prostate cancer (PCA). Methods: Specimens were cut in 3 mm and 4 mu m thickness for X-ray radiology and hematoxylin and eosin (HE) staining, respectively. Radiographic images of RCC and PCA were obtained using the synchrotron hard X-rays from the 7B2 beam-line of the Pohang Light Source (PLS). The imaging technique applied was phase-contrast radiology based on the refraction enhancement mechanism. The resulting radiographic images were analyzed in correlation with those of optical microscopy. Results: Using unmonochromatized hard X-rays, it was possible to obtain images with clear edge enhancement and relatively large field of view (6 cm x 6 cm). Even with overlapping signals from thick samples (more than 700-fold thicker than microscopic images), radiographic images clearly showed histological information of organelles in normal kidney such as glomeruli, tubules, and collecting ducts. Histological information of RCC including tumor subtypes and minute changes such as cystic degeneration could be identified without difficulty. The radiographic images of the prostate were comparable with those of low magnification optical microscopy, providing good visualization of normal microstructures such as adenoma, smooth muscle, and normal glands, or differentiation of tiny tumors from surrounding normal tissues. Conclusions: These results suggest the potential of refractive index radiology to provide a new way of imaging biological tissues with low absorption contrast such as RCC and PCA.X1110sciescopu