Non-polypoidal, synchronous mantle- cell lymphoma of small intestine: a rare case

Herein is reported the case of a mantle cell lymphoma (MCL) with synchronous double intestinal location. A 74 - year old male presented with mild abdominal pain. CT scan imaging indicated invasion of lateral intestinal cavity by large mass formation. Exploratory laparotomy was performed and two solid extra-mural masses were isolated and excised. Histology revealed non- polypoid double synchronous lymphoma of mantle cell origin, an unusual presentation of the disease

Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen's disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen's patients

Metastasis to the breast from an adenocarcinoma of the lung with extensive micropapillary component: a case report and review of the literature

Breast metastasis from extra-mammary malignancy is rare. Based on the literature an incidence of 0.4-1.3% is reported. The primary malignancies most commonly metastasizing to the breast are leukemia-lymphoma, and malignant melanoma. We present a case of metastasis to the breast from a pulmonary adenocarcinoma, with extensive micropapillary component, diagnosed concomitantly with the primary tumor. A 73-year-old female presented with dyspnea and dry cough of 4 weeks duration and a massive pleural effusion was found on a chest radiograph. Additionally, on physical examination a poorly defined mass was noted in the upper outer quadrant of the left breast. The patient underwent bronchoscopy, excisional breast biopsy and medical thoracoscopy. By cytology, histology and immunohistochemistry primary lung adenocarcinoma with metastasis to the breast and parietal pleura was diagnosed. Both the primary and metastatic anatomic sites demonstrated histologically extensive micropapillary component, which is recently recognized as an important prognostic factor. The patient received chemotherapy but passed away within 7 months. Accurate differentiation of metastatic from primary carcinoma is of crucial importance because the treatment and prognosis differ significantly

THE RELATIONSHIP BETWEEN THE HISTOLOGICAL TYPES AND THE EPIDEMIOLOGICAL CHARACTERISTICS OF GASTRIC CANCER IN GREECE

TO INVESTIGATE THE TWO MAIN HISTOLOGICAL TYPES OF GASTRIC CANCER AND CORRELATETHESE TYPES WITH THE EPIDEMIOLOGIC PARAMETERS, 448 SURGICAL SPECIMENTS OF GASTRIC CANCER COVERING THE PERIOD 1971-1981 CLASSIFIED BY MICROSCOPICAL EXAMINATION ACCORDING TO LAUREN CLASSIFICATION FOR THE GASTRIC CANCER INTO INTESTINAL,DIFFUSE AND UNCLASSIFATED. THE RESULTS OF THE CLASSIFICATION WERE LINKED WITHTHE AVAILABLE EPIDEMIOLOGICAL PARAMETERS AND THE FOLLOWING CONCLUSIONS WERE REACHED: IN OUR SAMPLE 82% OF GASTRIC CANCER ARE INTESTINAL, 15% DIFFUSE AND 3%UNCLASSIFATED. THE RELATIVE FREQUENCY OF INTESTINAL AND DIFFUSE GASTRIC CANCER VARIES BY SEX AND IT IS IN GENERAL HIGHER AMONG MEN (85%) THAN AMONG WOMEN (76%). THE PROPORTION OF INTESTINAL CARCINOMA INCREASES WITH AGE AMONG BOTH MEN AND WOMEN. THE INCREASE OF THE RELATIVE FREQUENCY OF THE INTESTINAL TYPE BECOMES EVIDENT AFTER THE 55TH YEARS OF AGE AMONG MEN BUT AFTER 65TH YEARS OF AGEAMONG WOMEN. IN THE YOUNGER AGE GROUP (< 55) AMONG MEN, THERE IS A GRADUAL SECULAR DECREASE OF THE RELATIVE FREQUENCY OF INTESTINAL TYPE OF CANCER. INTESTINAL METAPLASIA IS MORE FREQUENTLY RELATED TO THE INTESTINAL TYPE (83%) AND LESS WITH THE DIFFUSE TYPE (57%). MOST OF THE FINDINGS ARE IN AGREEMENT WITH THEINTERNATIONAL LITERATURE AND INDICATE THAT THE CLASSIFICATION BY LAUREN IS ALSO APPLICABLE IN GREECE. HOWEVER THE FACT THAT THE INTESTINAL TYPE SEEMS TO BEMORE COMMON IN GREECE POINTS AN EPIDEMIOLOGIC PECULIARITY WHICH DESERVES FURTHER INVESTIGATION.ΜΕ ΣΚΟΠΟ ΤΗ ΔΙΕΡΕΥΝΗΣΗ ΤΗΣ ΕΠΙΔΗΜΙΟΛΟΓΙΑΣ ΤΩΝ ΙΣΤΟΛΟΓΙΚΩΝ ΤΥΠΩΝ ΤΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΣΤΟΜΑΧΟΥ ΣΤΗΝ ΕΛΛΑΔΑ ΚΑΙ ΤΟΝ ΚΑΘΟΡΙΣΜΟ ΧΡΗΣΤΙΚΩΝ ΚΡΙΤΗΡΙΩΝ ΓΙΑ ΤΗΝ ΠΑΘΟΛΟΓΟΑΝΑΤΟΜΙΚΗ ΤΑΞΙΝΟΜΗΣΗ ΤΩΝ ΚΑΡΚΙΝΩΜΑΤΩΝ ΑΥΤΩΝ ΣΕ "ΕΝΤΕΡΙΚΟΥ" ΤΥΠΟΥ ΚΑΙ "ΔΙΑΧΥΤΟΥ" ΤΥΠΟΥ ΚΑΤΑ LAUREN, ΕΠΑΝΕΞΕΤΑΣΘΗΚΑΝ ΚΑΙ ΤΑΞΙΝΟΜΗΘΗΚΑΝ, ΒΑΣΕΙ ΠΡΩΤΟΚΟΛΛΟΥ, 448ΧΕΙΡΟΥΡΓΙΚΑ ΠΑΡΑΣΚΕΥΑΣΜΑΤΑ ΚΑΡΚΙΝΩΜΑΤΩΝ ΣΤΟΜΑΧΟΥ, ΠΟΥ ΠΡΟΕΡΧΟΝΤΑΝ ΑΠΟ ΤΟΥΣ ΝΟΣΗΛΕΥΘΕΝΤΕΣ ΓΙΑ ΤΗ ΝΟΣΟ ΣΤΟΝ "ΕΥΑΓΓΕΛΙΣΜΟ" ΤΗ ΧΡΟΝΙΚΗ ΠΕΡΙΟΔΟ 1971- 1981. Ο ΙΣΤΟΛΟΓΙΚΟΣ ΤΥΠΟΣ ΣΥΣΧΕΤΙΣΘΗΚΕ ΜΕ ΤΟ ΦΥΛΟ, ΤΗΝ ΗΛΙΚΙΑ, ΤΗΝ ΕΝΤΟΠΙΣΗ ΣΤΟΝ ΣΤΟΜΑΧΟ, ΤΗΝ ΕΝΤΕΡΙΚΗ ΜΕΤΑΠΛΑΣΗ ΣΤΟ ΠΑΡΑΚΕΙΜΕΝΟ ΒΛΕΝΟΓΟΝΟ ΚΑΙ ΤΕΛΟΣ ΕΞΕΤΑΣΘΗΚΕ Η ΔΙΑΧΡΟΝΙΚΗ ΤΑΣΗ ΤΗΣ ΣΧΕΤΙΚΗΣ ΤΟΥ ΣΥΧΝΟΤΗΤΟΣ. ΣΤΟ ΥΛΙΚΟ ΜΑΣ ΤΟ ΕΝΤΕΡΙΚΟΥ ΤΥΠΟΥ ΚΑΡΚΙΝΩΜΑ ΕΙΝΑΙ ΤΟ 82%, ΤΟ ΔΙΑΧΥΤΟΥ ΤΥΠΟΥ ΚΑΡΚΙΝΩΜΑ ΤΟ 15% ΚΑΙ ΤΑ ΔΥΣΤΑΞΙΝΟΜΗΤΑ ΤΟ3%. ΤΟ ΕΝΤΕΡΙΚΟΥ ΤΥΠΟΥ ΕΙΝΑΙ ΣΥΧΝΟΤΕΡΟ ΣΤΟΥΣ ΑΝΔΡΕΣ (85%) ΠΑΡΑ ΣΤΙΣ ΓΥΝΑΙΚΕΣ (76%). Η ΑΝΑΛΟΓΙΚΗ ΤΟΥ ΣΥΧΝΟΤΗΤΑ ΑΥΞΑΝΕΙ ΜΕ ΤΗΝ ΗΛΙΚΙΑ ΤΟΣΟ ΣΤΟΥΣ ΑΝΔΡΕΣ ΟΣΟΚΑΙ ΣΤΙΣ ΓΥΝΑΙΚΕΣ. Η ΑΥΞΗΣΗ ΤΗΣ ΔΕ ΓΙΝΕΤΑΙ ΕΚΔΗΛΗ ΓΙΑ ΜΕΝ ΤΟΥΣ ΑΝΔΡΕΣ ΜΕΤΑ ΤΟ55ΟΝ ΕΤΟΣ ΕΝΩ ΓΙΑ ΤΙΣ ΓΥΝΑΙΚΕΣ ΜΕΤΑ ΤΟ 65 ΕΤΟΣ ΤΗΣ ΗΛΙΚΙΑΣ. ΕΠΙΣΗΣ ΓΙΑ ΤΟ ΕΝΤΕΡΙΚΟΥ ΤΥΠΟΥ ΚΑΡΚΙΝΩΜΑ ΠΑΡΑΤΗΡΕΙΤΑΙ ΠΡΟΟΔΕΥΤΙΚΗ ΜΕΙΩΣΗ ΤΗΣ ΣΧΕΤΙΚΗΣ ΤΟΥ ΣΥΧΝΟΤΗΤΑΣ ΣΤΙΣ ΝΕΩΤΕΡΕΣ ΗΛΙΚΙΕΣ < 55 ΕΤΩΝ, ΕΥΡΗΜΑ ΣΥΜΒΑΤΟ ΜΕ ΤΗΝ ΠΑΡΑΤΗΡΟΥΜΕΝΗ ΔΙΑΧΡΟΝΙΚΗ ΜΕΙΩΣΗ ΤΗΣ ΣΥΧΝΟΤΗΤΑΣ ΤΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΣΤΟΜΑΧΟΥ ΣΤΗΝ ΕΛΛΑΔΑ. ΕΠΙΣΗΣ ΤΟ ΕΝΤΕΡΙΚΟΥ ΤΥΠΟΥ ΚΑΡΚΙΝΩΜΑ ΣΥΝΟΔΕΥΟΤΑΝ ΣΥΧΝΟΤΕΡΑ ΑΠΟ ΕΝΤΕΡΙΚΗ ΜΕΤΑΠΛΑΣΗ (83%) ΠΑΡΑ ΤΟ ΔΙΑΧΥΤΟΥ ΤΥΠΟΥ (57%). ΤΕΛΟΣ ΤΟ ΔΙΑΧΥΤΟΥ ΤΥΠΟΥ ΚΑΡΚΙΝΩΜΑ ΕΝΤΟΠΙΖΟΤΑΝ ΣΥΧΝΟΤΕΡΑ ΣΤΟ ΣΩΜΑ ΤΟΥ ΣΤΟΜΑΧΟΥ (63%0 ΕΝΩ ΤΟ ΕΝΤΕΡΙΚΟΥ ΤΥΠΟΥ ΕΝΤΟΠΙΖΟΤΑΝ ΤΟ ΙΔΙΟ ΣΥΧΝΑ ΣΤΟ ΣΩΜΑ (33%) ΚΑΙ ΣΤΟΝ ΠΥΛΩΡΟ (37%). ΤΑ ΕΥΡΗΜΑΤΑ ΑΥΤΑ ΕΙΝΑΙ ΣΥΜΒΑΤΑ ΜΕΤΑ ΠΕΡΙΣΣΟΤΕΡΑ ΔΕΔΟΜΕΝΑ ΤΗΣ ΔΙΕΘΝΟΥΣ ΒΙΒΛΙΟΓΡΑΦΙΑΣ ΚΑΙ ΣΥΜΒΑΛΛΟΥΝ ΣΤΗΝ ΚΑΤΑΞΙΩΣΗ ΤΗΣ ΤΑΞΙΝΟΜΗΣΗΣ ΤΟΥ LAUREN ΚΑΙ ΤΗΣ ΧΡΗΣΙΜΟΤΗΤΑΣ ΤΗΣ ΣΤΗΝ ΕΠΙΔΗΜΙΟΛΟΓΙΚΗ ΔΙΕΡΕΥΝΗΣΗ ΤΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΣΤΟΜΑΧΟΥ. ΕΞΑΛΛΟΥ ΤΟ ΓΕΓΟΝΟΣ ΟΤΙ Ο ΕΝΤΕΡΙΚΟΣ ΤΥΠΟΣ ΕΙΝΑΙ ΥΨΗΛΟΤΕΡΟΣ ΑΠΟ ΤΟ ΑΝΑΜΕΝΟΜΕΝΟ ΥΠΟΔΗΛΩΝΕΙ ΜΙΑ ΕΠΙΔΗΜΙΟΛΟΓΙΚΗ ΙΔΙΟΜΟΡΦΙΑ ΤΗΣ ΧΩΡΑΣ ΜΑΣ ΠΟΥ ΔΙΚΑΙΟΥΤΑΙ ΠΕΡΑΙΤΕΡΩ ΔΙΕΡΕΥΝΗΣΕΩΣ

Management of carbon tetrachloride-induced acute liver injury in rats by syngeneic hepatocyte transplantation in spleen and peritoneal cavity

AIM: Acute hepatitis may seldom have a fulminant course. In the treatment of this medical emergency, potential liver support measure must provide immediate and sufficient assistance to the hepatic function. The goal of our study was to study the adequacy of hepatocyte transplantation (HCTx) in two different anatomical sites, splenic parenchyma and peritoneal cavity, in a rat model of reversible acute hepatitis induced by carbon tetrachloride (CCl4). METHODS: After CCl4 intoxication, 84 male Wistar rats used as recipients were divided in to four experimental groups accordingly to their treatment: Group A (n=24): intrasplenic transplantation of 10x10(6) isolated hepatocytes, Group B (n=24): intraperitoneal transplantation of 20x10(6) isolated hepatocytes attached on plastic microcarriers, Group C (n=18): intrasplenic injection of 1 mL normal saline (sham-operated controls), Group D (n=18): intraperitoneal injection of 2.5 mL normal saline (sham-operated controls). Survival, liver function tests (LFT) and histology were studied in all four groups, on d 2, 5 and 10 post-HCTx. RESULTS: The ten-day survival (and mean survival) in the 4 groups was 72.2% (8.1+/-3.1), 33.3% (5.4+/-3.4), 0% (3.1+/-1.3) and 33.3% (5.4+/-3.6) in groups A, B, C, D, respectively (P-AB&lt;0.05, P-AC&lt;0.05, P-BD=NS). In the final survivors, LFT (except alkaline phosphatase) and hepatic histology returned to normal, independently of their previous therapy. Viable hepatocytes were identified within splenic parenchyma (in group A on d 2) and both in the native liver and the fatty tissue of abdominal wall (in group B on d 5). CONCLUSION: A significantly better survival of the intrasplenically transplanted animals has been demonstrated. Intraperitoneal hepatocytes failed to promptly engraft. A different timing between liver injury and intraperitoneal HCTx may give better results and merits further investigation

Gastrointestinal and Extragastrointestinal Stromal Tumors: Report of Two Cases and Review of the Literature

We present two cases, one of a gastrointestinal stromal tumor (GIST) in the stomach and one of an extragastrointestinal stromal tumor (EGIST) in the hepatogastric ligament, which were discovered as incidental findings during computed tomography (CT) scans performed for other reasons. In both cases the diagnosis of the tumor was confirmed histologically and immunohistochemically. During the follow-up CT examinations these tumors proved to have a completely different natural course. The first case refers to an 82-year-old male patient with GIST of the stomach who refused to be operated and was followed by CT scans for a 4-year period. This patient did not show any significant changes in the morphology, size and density of the lesion. The second case refers to a 58-year-old female patient with EGIST of the hepatogastric ligament who presented with simultaneous liver metastases and remained healthy for 2 years after surgical resection, but developed local recurrence later. As a conclusion, both GISTs/EGISTs can be revealed as incidental findings in a CT scan performed for other purposes. Moreover, an untreated GIST located in the stomach can remain unchanged and without metastatic lesions for a long period of time, as in our case for a 4-year period. To our knowledge, this is the first report in the literature in whom a GIST was proved to remain almost unchanged for many years without any treatment, and we therefore attempt a further review of the current literature on stromal tumors

Soluble triggering receptor expressed on myeloid cells (sTREM-1): a new mediator involved in the pathogenesis of peptic ulcer disease

Objectives Triggering receptor expressed on myeloid cells (TREM-1) is a promoter of cytokine production triggered by microbial components. To investigate the significance of its soluble counterpart, sTREM-1, for the pathogenesis of peptic ulcer disease, sTREM-1 was compared with the proinflammatory mediators and the pathology score of gastritis. Methods Forty patients with dyspepsia were enrolled: 20 with peptic ulcer and 20 controls without any macroscopic abnormalities. All patients were examined by endoscopy; gastric juice was aspirated and biopsy specimens were collected from the antrum and corpus of the stomach. sTREM-1 was estimated by at hand-made enzyme immunoassay. Interleukin-8 was estimated by enzyme-linked immunosorbent assay and lipid peroxidation, indexed by malondialdehyde, by the thiobarbituric assay, after passage through a high-performance liquid chromatography system. Results The median (+/- SE) of sTREM-1 of controls and patients with ulcer was 3.91 +/- 0.57 and 44.27 +/- 241.55 R U, respectively (P=0.006). The median (+/- SE) of interleukin-8 of controls and patients with ulcer was 1802.97 +/- 122.10 and 2030.66 +/- 64.44 pg/ml, respectively (P = 0.023). sTREM-1 was positively correlated with the density of neutrophil and mononuclear infiltration scores and the total Sydney score (P=0.029, 0.043 and 0.041, respectively). sTREM-1 was positively correlated with interleukin-8 (P=0.042). Conclusions sTREM-1 might be an independent factor involving with the peptic ulcerative inflammatory process that is positively correlated with histopathological abnormalities of gastritis

Deferoxamine Attenuates Lipid Peroxidation, Blocks Interleukin-6 Production, Ameliorates Sepsis Inflammatory Response Syndrome, and Confers Renoprotection After Acute Hepatic Ischemia in Pigs

We have previously shown that deferoxamine (DFO) infusion protected myocardium against reperfusion injury in patients undergoing open heart surgery, and reduced brain edema, intracranial pressure, and lung injury in pigs with acute hepatic ischemia (AHI). The purpose of this research was to study if DFO could attenuate sepsis inflammatory response syndrome (SIRS) and confer renoprotection in the same model of AHI in anesthetized pigs. Fourteen animals were randomly allocated to two groups. In the Group DFO (n = 7), 150 mg/kg of DFO dissolved in normal saline was continuously infused in animals undergoing hepatic devascularization and portacaval anastomosis. The control group (Group C, n = 7) underwent the same surgical procedure and received the same volume of normal saline infusion. Animals were euthanized after 24 h. Hematological, biochemical parameters, malondialdehyde (MDA), and cytokines (interleukin [IL]-1 beta, IL-6, IL-8, IL-10, and tumor necrosis factor-a) were determined from sera obtained at baseline, at 12 h, and after euthanasia. Hematoxylineosin and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling were used to evaluate necrosis and apoptosis, respectively, in kidney sections obtained after euthanasia. A rapid and substantial elevation (more than 100-fold) of serum IL-6 levels was observed in Group C reaching peak at the end of the experiment, associated with increased production of oxygen free radicals and lipid peroxidation (MDA 3.2 +/- 0.1 nmol/mL at baseline and 5.5 +/- 0.9 nmol/mL at the end of the experiment, P &lt; 0.05) and various manifestations of SIRS and multiple organ dysfunction (MOD), including elevation of high-sensitivity C-reactive protein, severe hypotension, leukocytosis, thrombocytopenia, hypoproteinemia, and increased serum levels of lactate dehydrogenase (fourfold), alkaline phosphatase (fourfold), alanine aminotransferase (14-fold), and ammonia (sevenfold). In sharp contrast, IL-6 production and lipid peroxidation were completely blocked in DFO-treated animals offering remarkable resistance to the development of SIRS and MOD. Profound proteinuria, strips of extensive necrosis of tubular epithelial cells, and occasional apoptotic tubular epithelial cells were already present in Group C, but not in Group DFO animals at the time of euthanasia. DFO infusion attenuated lipid peroxidation, blocked IL-6 production, and substantially diminished SIRS and MOD, including tubulointerstitial damage in pigs after acute ischemic hepatic failure. This finding shows that iron, IL-6, and lipid peroxidation are important participants in the pathophysiology of renal injury in the course of generalized inflammation and provides novel pathways of therapeutic interventions for renal protection