Mixed Adenoneuroendocrine Carcinoma Arising in a Papillary Adenoma of Gallbladder

Introduction: Neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma (MANEC) in the gallbladder are rare. Here, we reported an unusual case of a mixed high-grade neuroendocrine carcinoma and adenocarcinoma, arising in a papillary adenoma with high-grade dysplasia.Presentation of case: The patient, a 73 year-old woman, had a cholecystectomy for chronic calculous cholecystitis, in which a mixed high-grade neuroendocrine carcinoma and adenocarcinoma arising in a papillary adenoma with high-grade dysplasia was incidentally noted. The carcinoma invaded into lamina propria, without any evidence of invasion into muscularis layer or perimuscular soft tissue, hence was pathologically staged as T1. The patient was treated with chemoradiation after cholecystectomy. Desspite the unusually low tumor stage at presentation of this rare tumor, there were four recurrences / metastases involving abdominal wall, an unusual site for this tumor, which were treated with surgery and / or chemotherapy. The patient is alive with metastatic disease at 45 months after initial cholecystectomy.Conclusion: We detail the unusual presentation of a mixed high-grade neuroendocrine carcinoma and adenocarcinoma arising in a papillary adenoma with high-grade dysplasia, which sheds some light on the clinical course of this rare tumor

The angular spectrum of the scattering coefficient map reveals subsurface colorectal cancer

Abstract Colorectal cancer diagnosis currently relies on histological detection of endoluminal neoplasia in biopsy specimens. However, clinical visual endoscopy provides no quantitative subsurface cancer information. In this ex vivo study of nine fresh human colon specimens, we report the first use of quantified subsurface scattering coefficient maps acquired by swept-source optical coherence tomography to reveal subsurface abnormities. We generate subsurface scattering coefficient maps with a novel wavelet-based-curve-fitting method that provides significantly improved accuracy. The angular spectra of scattering coefficient maps of normal tissues exhibit a spatial feature distinct from those of abnormal tissues. An angular spectrum index to quantify the differences between the normal and abnormal tissues is derived, and its strength in revealing subsurface cancer in ex vivo samples is statistically analyzed. The study demonstrates that the angular spectrum of the scattering coefficient map can effectively reveal subsurface colorectal cancer and potentially provide a fast and more accurate diagnosis

Clinical characteristics and outcomes of colorectal cancer in the ColoCare Study: Differences by age of onset

Early-onset colorectal cancer has been on the rise in Western populations. Here, we compare patient characteristics between those with early- (\u3c50 years) vs. late-onset (≥50 years) disease in a large multinational cohort of colorectal cancer patients

Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum: A case series and systematic literature review

BACKGROUND: Heterotopic pancreas (HP) is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract. While the majority of heterotopic pancreatic lesions are asymptomatic, many manifest severe clinical symptoms which require surgical or endoscopic intervention. Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature. The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease. AIM: To classify the common clinical manifestations of heterotopic pancreas. METHODS: A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018. Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location. Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated. These were compared to a systematic review of the literature utilizing PubMed and Embase searches for papers pertaining to heterotopic pancreas. Publications describing symptomatic presentation of HP were selected for review. Information including demographics, symptoms, presentation and treatment were compiled and analyzed. RESULTS: Twenty-nine patient were identified with HP at a single center, with six of these identified has having clinical symptoms. Clinical manifestations included, gastrointestinal bleeding, gastric ulceration with/without perforation, pancreatitis, and gastric outlet obstruction. Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients. Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients. The majority of patients presented with abdominal pain (67%) combined with one of the following clinical categories: (1) Dyspepsia, (n = 445, 48%); (2) Pancreatitis (n = 260, 28%); (3) Gastrointestinal bleeding (n = 80, 9%); and (4) Gastric outlet obstruction (n = 80, 9%). The majority of cases (n = 832, 90%) underwent surgical or endoscopic resection with 85% reporting resolution or improvement in their symptoms. CONCLUSION: Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract. Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation

Identifying Differences in Spatial Transcriptomics Between Subtypes of Pancreatic Ductal Adenocarcinoma

https://openworks.mdanderson.org/sumexp22/1072/thumbnail.jp

Spatially restricted drivers and transitional cell populations cooperate with the microenvironment in untreated and chemo-resistant pancreatic cancer

Pancreatic ductal adenocarcinoma is a lethal disease with limited treatment options and poor survival. We studied 83 spatial samples from 31 patients (11 treatment-naïve and 20 treated) using single-cell/nucleus RNA sequencing, bulk-proteogenomics, spatial transcriptomics and cellular imaging. Subpopulations of tumor cells exhibited signatures of proliferation, KRAS signaling, cell stress and epithelial-to-mesenchymal transition. Mapping mutations and copy number events distinguished tumor populations from normal and transitional cells, including acinar-to-ductal metaplasia and pancreatic intraepithelial neoplasia. Pathology-assisted deconvolution of spatial transcriptomic data identified tumor and transitional subpopulations with distinct histological features. We showed coordinated expression of TIGIT in exhausted and regulatory T cells and Nectin in tumor cells. Chemo-resistant samples contain a threefold enrichment of inflammatory cancer-associated fibroblasts that upregulate metallothioneins. Our study reveals a deeper understanding of the intricate substructure of pancreatic ductal adenocarcinoma tumors that could help improve therapy for patients with this disease