Incidental gastrointestinal stromal tumor at a gastroscopic polypectomy specimen: A case report and review of literature

Although gastrointestinal stromal tumors (GISTs) comprise less than 1% of all gastrointestinal (GI) tract tumors, they are the most common mesenchymal tumors of the GI tract. Gastrointestinal stromal tumors can occur anywhere along the GI tract, but the stomach and small intestine are the most frequently involved sites. Gastrointestinal stromal tumors are frequently asymptomatic, and one-third of all cases are found incidentally. Endoscopy, endoscopic ultrasonography, and computed tomography are useful tools in the diagnosis. Endoscopic mucosal resection, endoscopic submucosal dissection, laparoscopic endoscopic cooperative surgery, and surgery with either laparoscopic or open approaches are treatment modalities for GISTs. An R0 resection is the principle surgery. Imatinib is the main medical agent used in the adjuvant or neoadjuvant treatment of GIST. We present a 65-year-old woman with an asymptomatic GIST that arose from a gastric polyp treated via endoscopic polypectomy.

Can horizontal diameter of colorectal tumor help predict prognosis?

OBJECTIVE

We aimed to investigate the relationship between the horizontal tumor diameter and prognosis.

MATERIAL AND METHODS

Patients' records were analyzed retrospectively. Patient data, including age, gender, vertical penetration, anatomic location, differentiation of the tumor, tumor node metastasis (TNM) stage, survival rate, and disease-free survival, were analyzed to find out if there was any correlation with horizontal tumor diameter.

RESULTS

A total of 439 colorectal cancer patients were enrolled. Patients were stratified into two groups according to the horizontal tumor diameter (≤4.5 cm vs. >4.5 cm). Poorly differentiated tumors were significantly larger than other differentiation groups (p=0.003). The horizontal diameter increased with increase in T-stage (p<0.001). Similarly, the number of positive lymph nodes increased significantly as the size of the horizontal tumor diameter increased (p<0.001). The relationship between TNM staging and the horizontal diameter of tumors in both groups was examined, and it was found that the progression of tumor stage was accompanied by increased horizontal diameter (p<0.001). It was also found that the horizontal tumor diameter was not correlated with local recurrence (p=0.063). However, distant metastasis was higher in patients with a tumor larger than 4.5 cm (p=0.02). Although the disease-free survival was shorter in patients with a horizontal tumor diameter more than 4.5 cm, the difference was not statistically significant.

CONCLUSION

There is a significant relation between horizontal diameter of the tumor and depth of the tumor, lymph node involvement, overall survival, and distant metastasis. Horizontal diameter of the tumor can possibly be used as a prognostic factor in colorectal cancer patients.

A rare clinical manifestation of rectal adenocarcinoma and synchronous scalp metastasis: A case report

In this case report, our aim was to emphasize that cutaneous involvement can be seen at the time of diagnosis or during the clinical course of visceral organ cancers in general and in colorectal cancers particularly. We also aimed to demonstrate that cutaneous lesions occurring in patients under follow up for visceral organ cancers could be metastases. A rapid progressing scalp lesion was detected in a newly diagnosed rectal cancer patient and the tru-cut biopsy revealed adenocarcinoma metastasis. This patient died due to a myocardial infarction during neoadjuvant chemotherapy. Cutaneous metastatic lesions in colorectal cancers must be evaluated as a sign of advanced disease and treatment protocols should be determined accordingly.

Prognostic value of oncoprotein expressions in thyroid papillary carcinoma

The aim of this study was to evaluate the expressions of oncoproteins and to correlate the results with clinicopathologic parameters in papillary thyroid carcinoma (PTC). Papillary thyroid cancer (PTC) is the most common form and accounts for about 80% of all thyroid cancers. Although PTC generally has a good prognosis, some patients suffer from local recurrence and/or distant metastasis. Oncogenes have reported to be related not only in carcinogenesis but also in tumor prognosis, tumor type, differentiation and site of tumor in epithelial malignant tumors such as thyroid, breast, ovarian, and stomach cancer. This study was planned retrospectively and was performed in 87 patients (47 PTC, 40 benign lesions). The data of clinicopathologic parameters and tissue samples were collected from the archives. Sections stained with H&E were evaluated for each case and after confirming the diagnosis of PTC, oncoprotein expressions were determined by immunohistochemical analysis. The differences of oncoprotein expressions in PTC compared with control group were statistically significant. Cyclin D1 and p53 expressions were significantly increased in PTC. The expressions of bcl-2 and c-erbB-2 in PTC were found as increased, but the correlation between these proteins and poor prognostic parameters were not significant. We suggest that increased expressions of cyclin D1 and p53 could be used as prognostic factors in patients with PTC.

Constipation as a defecation disorders: what do we expect from the physiologic tests?

BACKGROUND

Constipation is often associated with some clinical signs as hard stool, incomplete defecation, chronic straining, and abdominal pain and long stays in bathroom. Some diagnostic uncertainties came from functional and structural variations of the anorectum and the assessment from few imaging procedures, which were thought as the best but could not always give the expected result. Then physiologic tests were required to be used. The aim was to study which physiologic test correlated to the clinical symptoms, was valuable and have to be performed in the patients with chronic constipation in this series.

METHODS

One hundred twenty-seven patients (56.3 % females; mean age, 56.7) with chronic constipation according to the Rome II criteria were initially treated by dietary change and increased physical activation. The unresponsive (80) patients were instructed to be evaluated by the physiologic tests (anal manometry, defecography, colonic transit time-CTT) and clinical symptoms. The assessments from physiologic tests, which were originated from 4 distinctive categories, were investigated by factor analysis. ROC curve analysis was used to take involved assessments, which had a big impact on the constipation status.

RESULTS

80 patients, mostly female (89 %), had experienced several symptoms in 11.9 years. The CCT, scoring system, evacuation problem, hard stool, habitual laxative use and digital assist for defecation were significantly different in 17 factors originated from different categories. We analyzed the extracted factor, which had an important effect on the constipation and consequently considered the necessary physiologic test and other related symptoms.

CONCLUSIONS

Scoring system, CTT, anal manometry and other physiologic tests are important to establish a true diagnosis of the etiology of the constipation. However, defecography and clinical symptoms are the factors, which has a great impact on the diagnosis of constipation (Tab. 7, Ref. 25).