De Novo Malignancies After Liver Transplantation: A Single Institution Experience

OBJECTIVES

Our objective was to analyze characteristics, risk factors, and incidence of de novo malignancies after liver transplant.

MATERIALS AND METHODS

The hospital records of 557 patients who underwent liver transplant were analyzed from the point of de novo malignancy development. We evaluated the demographic features and survival of these patients retrospectively.

RESULTS

The research covered 429 patients, 9 (2%) of whom developed de novo malignancy. All of these patients were male (100%), and their mean (SD) age was 51.33 (4.69) years (range, 45-65 y). Indications for transplant included alcohol related in 4 cases, chronic hepatitis B in 2 cases, chronic hepatitis B and C in 1 case, chronic hepatitis B and D in 1 case, and chronic hepatitis C and alcohol-related cirrhosis in 1 case. The mean (SD) time from transplant to cancer diagnosis was 63.41 (37.10) months (range, 17-122 mo). The types of tumors were lung cancer, lymphoma, neuroendocrine tumor of lung, nasopharyngeal cancer, and squamous cell carcinoma of the skin. Seven cases received chemotherapy with or without radiotherapy. Two cases received surgery and radiotherapy. One patient underwent surgical treatment. One patient died before treatment was started.

CONCLUSIONS

In recent years, improvements in surgical techniques and immunosuppressive therapies have helped prolong survival of patients who undergo liver transplant. However, this also has led to a rise in the incidence of long-term complications such as de novo malignancy. These patients are more likely to develop de novo malignancy than the general population, for which chronic immunosuppression is identified as a major risk factor. Early diagnosis and treatment of de novo malignancies can help obtain better prognosis and higher survival rates in these patients.

Are N-acetylcysteine and adalimumab effective for non-alcoholic steatohepatitis?

Due to the lack of effective medical treatment for non-alcoholic steatohepatitis (NASH), we aimed to evaluate new treatment options. In particular, our goal was to investigate and compare the effects of N-acetylcysteine (NAC) and Adalimumab treatment on tumor necrosis factor alpha (TNF-α) and oxidative stress during the development of NASH in a rat model of the disease. Our study included a total of 35 female Wistar albino rats that were divided into 5 groups of 7 each, and evaluated over a 6 week period. One group received a normal diet, while the other four groups received a methionine and choline deficient (MCD) diet. One of the groups receiving the MCD diet did not take any medicine, while the other three were administered NAC, adalimumab, or a NAC/adalimumab combination therapy. NASH was successfully established in the MCD diet group. Levels of TNF-α were effectively suppressed in the three groups that received therapy. Even though adalimumab significantly enhanced suppression of TNF-α, the NASH score was suppressed to a more statistically significant extent in the groups receiving NAC. Our study showed that TNF-α and oxidative stress play an important role in NASH pathogenesis. The antioxidant agent, NAC, was found to be superior to the anti-TNF agent, Adalimumab, in the improvement of total NASH score. Although these drugs did not prevent the development of NASH, it was shown that they mildly reverse the NASH histopathology score, suggesting improvement of and overall liver function.

A comparison of the effects of infliximab, adalimumab, and pentoxifylline on rats with non-alcoholic steatohepatitis

BACKGROUND/AIMS

Non-alcoholic steatohepatitis (NASH) lacks effective medical treatment. Since tumor necrosis factor alpha (TNF-α) plays an important role in NASH pathogenesis, we aimed to investigate drugs affecting TNF-α as possible treatment options during the development of NASH.

MATERIALS AND METHODS

A total of 35 rats were divided into five groups and evaluated over a 6 week period. One group received a normal diet alone or in combination with the administration of infliximab, adalimumab or pentoxifylline.

RESULTS

NASH was successfully established in the MCD diet group. Levels of TNF-α were effectively suppressed in the three groups that received anti-TNF agents. No statistically significant differences were observed between the three agents in terms of the histological NASH score.

CONCLUSION

Our study showed that the anti-TNF agents infliximab, adalimumab, and pentoxifylline effectively suppress TNF-α. Although these drugs did not prevent the development of NASH, they were able to slightly reverse the NASH histopathology score and positively affect liver function tests.

Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: single-center experience in 513 procedures

BACKGROUND/AIMS

Double-balloon endoscopy (DBE) is a technique that enables the evaluation and treatment of small intestinal diseases. The aim of the study was to evaluate the indications, therapeutic interventions, complications, and safety and to describe the experience with DBE in Turkish patients.

MATERIALS AND METHODS

Four hundred twenty consecutive patients undergoing DBE were included in our study. Demographic features, indications, diagnostic findings, therapeutic interventions, complications, and technical aspects of the procedure were recorded. A total of 513 DBEs were carried out.

RESULTS

In all, 420 patients underwent a total of 513 DBE procedures (369 (72%) oral and 144 (28%) anal). The most common clinical indications were obscure bleeding (26%), abdominal pain (25.2%), anemia (20%), chronic diarrhea (10.5%), and inflammatory bowel diseases (5.2%). A proper diagnosis was obtained or confirmed in 222 of 420 patients (52.3%). Ulcers/erosions (23.6%), vascular lesions (8.1%), and polyps/tumors (7.4%) represented the most common endoscopic findings. Perforation occurred in one patient as a complication after polypectomy. No major complications due to sedation occurred.

CONCLUSION

Double-balloon endoscopy is effective for the diagnosis and treatment of small intestinal diseases. Therapeutic interventions carried out by DBE seem to be useful and safe.

The efficacy and safety of tenofovir in the prevention of hepatitis B virus recurrence following liver transplantation

BACKGROUND/AIMS

In this study, a tenofovir disoproxil fumarate (TDF) + hepatitis B immunoglobulin (HBIG) regimen was compared with lamivudine (LAM) + HBIG to determine the efficacy and safety of TDF in the prevention of hepatitis B virus (HBV) recurrence following liver transplantation (LT).

MATERIALS AND METHODS

Thirty-six patients, 18 treated with TDF+HBIG (TDF group) and 18 with LAM+HBIG (LAM group), were evaluated retrospectively over a median 36-month follow-up in the Liver Transplantation Outpatient Unit of Dokuz Eylül University after having an LT. In the TDF group, TDF treatment was initiated in six patients due to resistance to LAM, in one patient due to relapse, in three patients to prevent relapse, and in eight patients due to de novo hepatitis. In the LAM group, LAM therapy was initiated in two patients due to de novo hepatitis and in 16 patients to prevent relapse.

RESULTS

In the TDF group, an increase of greater than 0.5 mg/dL in creatinine values was observed in two patients. In the LAM group, creatinine values did not increase to greater than 0.5 mg/dL. No cases of acute renal failure associated with TDF or LAM, mild or serious adverse events, or HBV recurrence were observed among the patients. Glomerular filtration rates (GFRs) of these patients were calculated with a modification of renal disease (MDRD) formulation. There was no significant difference (p<0.05) in the GFRs between the two groups.

CONCLUSION

The results of this study, after a 36-month follow-up period, were encouraging and demonstrated that TDF therapy is safe and efficacious in treating HBV-positive organ transplant patients. However, patients should be monitored carefully in terms of renal function. Given the limited experience with TDR in LT, this study is of importance due to its long follow-up period.

The association between insulin resistance and hepatic fibrosis in patients with chronic hepatitis C: an observational, multicenter study in Turkey

BACKGROUND/AIMS

To evaluate the association between insulin resistance and hepatic fibrosis in patients with chronic hepatitis C.

MATERIALS AND METHODS

A total of 104 chronic hepatitis C patients were included in this non-interventional, open-label, observational, multicenter, cross-sectional study conducted at 20 gastroenterology clinics in Turkey. The primary end point was the correlation between stage of hepatic fibrosis and insulin resistance evaluated via the homeostasis model of assessment-insulin resistance index. Confounders of hepatic fibrosis and insulin resistance were the secondary end points.

RESULTS

The mean age of patients was 52.8 years; 65.4% were female. Type 2 diabetes was present in 6.8% and insulin resistance noted in 38.0% of patients. Further, 45.7% of the patients had mild (A0/A1) and the remaining had moderate/severe (A2/A3) hepatic necroinflammatory activity. Patient distribution according to Metavir fibrosis stage was as follows: F0/F1 (57.0%); F2 (6.5%); F3 (23.7%); and F4 (12.9%). A univariate analysis revealed significant positive correlations between Metavir fibrosis stage and insulin resistance (r=0.297; p=0.007). Logistic regression analysis showed that significant predictors of insulin resistance were high alanine transaminase levels (odds ratio, 0.97; 95% confidence interval, 0.944-0.997) and liver fibrosis stage (odds ratio, 0.114; 95% confidence interval, 0.021-0.607).

CONCLUSION

Our findings revealed significant associations between insulin resistance and hepatic fibrosis.

Liver Transplantation in Cases with Acute Liver Failure

Background

Acute liver failure (ALF) is a rare, life-threatening clinical condition that is characterized by severe hepatocellular necrosis, jaundice, coagulopathy and encephalopathy. The aim of this study was to evaluate patients who underwent liver transplantation at Dokuz Eylul University of Medicine Faculty (DEUMF) due to ALF.

Materials and methods

The patients who underwent liver transplantation at DEUMF due to ALF were evaluated retrospectively.

Results

All of the liver transplantations performed in this study were successful; toxicity was the major cause of ALF in these patients (84%).

Conclusion

Results of this study may not be generalizable to all of Turkey since the patients included in this study were only from one region. However, our study is in accordance with others that show that liver transplantation is a very safe and effective method for the treatment of ALF.

How to cite this article

Yalçin M, Bengİ G, Akarsu M, İnek T, Astarcioşlu İ. Liver Transplantation in Cases with Acute Liver Failure. Euroasian J Hepato-Gastroenterol 2015;5(2):80-82.

The validity and reliability of "The liver disease symptom index 2.0" for Turkish society

BACKGROUND/AIMS

Chronic liver diseases have been shown to adversely affect the quality of life. Standardized tools for patient assessment are of great importance for treatment and follow-up of these patients. In this study, we aimed to determine the validity and reliability of the Liver Symptom Index 2.0 (LDSI 2.0) for Turkish society, for use in other studies and in daily clinical practice.

MATERIALS AND METHODS

A total of 308 patients with chronic liver disease attending to the outpatient liver clinic of the Department of Gastroenterology, Faculty of Medicine, Dokuz Eylül University between September 2011 and May 2012 were included in this study. A sociodemographic data questionnaire, the LDSI 2.0 comprising 24 items, and the Short Form-36 (SF-36) were completed by the participating patients. After 6 weeks, these tools were re-administered to a total of 115 patients. After obtaining the required permissions, LDSI 2.0 was translated into Turkish using the translation/re-translation method.

RESULTS

Of the 308 participants, 160 (51.9%) were male and 184 (43.1%) were female, with an average age of 48.67±13.31 years. Of all cases, 70.5% had viral hepatitis. The average Child-Pugh score was 5.9±1.2, and the average Model For End-Stage Liver Disease (MELD) score was 10.2±3.2. The assessment tool comprised the following sub-items: itching, joint pain, abdominal pain, sleepiness, worry, appetite, depression, fear, jaundice, memory, personality, financial status, use of time, sexual desire, and sexual activity. For more than 50% of the patients, worry (68.8%), depression (65.3%), joint pain (62.3%), itch (56.5%), sleepiness (54.2%), memory problems (53.6), and sexual problems (50%) were present. The internal coefficient of consistency (Cronbach alpha coefficient) was 0.908, which indicates a very high level of consistency. The correlation coefficient for the intraobserver test/re-test reliability was 0.746 (p<0.000), which denotes a significant and good level of reliability. The construct validity between each sub-item of the tool and sub-items of SF-36 was assessed using Spearman's correlation test, which showed a weak to moderate correlation (<0.04 and 0.4-0.7) in the reverse direction.

CONCLUSION

Our study findings provide supportive evidence of the reliability of the assessment tool. Its validity is similar to the original construct validity and was confirmed in our sample. Therefore, it was concluded that LDSI 2.0 was an appropriate tool for daily clinical use and research purposes. Simultaneous use of this life-quality assessment tool and SF-36 will enable a comprehensive but practical assessment of our patients.

Prevalence and risk factors for obesity after liver transplantation: a single-center experience

BACKGROUND

The study of weight gain after transplantation and its associated factors is necessary to propose strategies to prevent and treat this problem.

OBJECTIVES

This study aims to investigate factors affecting the development of obesity after liver transplantation (LTx).

PATIENTS AND METHODS

Medical records of 343 liver transplantation cases, which were followed between January 2001 and January 2010 at Dokuz Eylul University, were retrospectively analyzed. Patient pre-liver transplantation height, body weight, body mass index (BMI) measurements, as well as changes in body weight at the beginning, 6 months, 12 months, and 5 years post-transplantation were observed. BMI measurements with records of immunosuppressive therapies were obtained.

RESULTS

The study was carried out with the records of 226 patients. 151 patients (66.8%) were male; 75 (33.2%) were female. The mean age was 46.19 ± 10.2 years. 123 of these liver transplants were performed from living donors, while 103 were from cadaveric donors. The causes of liver transplantation were hepatitis D virus (HDV) infection (28%), hepatitis B virus (HBV) infection (24%), hepatitis C virus (HCV) infection (24%), alcoholic liver disease (9%), cryptogenic liver disease (9%), autoimmune hepatitis (4%), and other (2%). In this study, the prevalence of obesity was 21% at the end of the second year, decreasing to 14% by the end of the fifth year. The mean BMI gradually increased during the follow-ups, reaching 25.1 kg/m² and 26 kg/m² six months after liver transplantation and at the end of the first year, respectively (P < 0.002). Obesity developed in 18.2% of post-transplant patients who were receiving a calcineurin inhibitor (CNI). Regarding the development of obesity after transplantation, no statistically significant difference was found between patients using cyclosporine (CsA) and tacrolimus (TAC) (P = 0.07). Six months after liver transplantation, the mean body weight gain in the groups receiving steroids and not receiving steroids were 4.71 kg and 2.7 kg, respectively (P = 0.03). In the post-transplant period, there was no significant difference in patients who had received TAC and CsA for development of diabetes mellitus (DM), hypertension (HT), or hyperlipidemia (HL) (P = 0.30).

CONCLUSIONS

Obesity prevalence before and after liver transplantation was comparable. Education of obese patients prior to surgery and recommendation of medical nutrition therapy should be appropriate. Similar medical care for the non-obese subjects could prevent increase in obesity prevalence. Non-corticosteroid immunosuppressive agents had no significant effect on the development of weight gain and obesity. Avoiding the use of long-term steroid therapy and obesity education are the key measures for preventing obesity after liver transplantation.

Changes of Some Hormones Levels in Patients With Hepatitis B Virus-Related Chronic Liver Disease

Background

The purpose of the study was to evaluate some of the hormones in patients with chronic liver disease and cirrhosis.

Methods

The men patients with chronic hepatitis B (Group 1), liver cirrhosis secondary to hepatitis B (Group 2), were included in this study. Additionally, a control group of healthy volunteers (Group 3) was formed. We investigated serum levels of Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Total testosterone (T. TES), Free-testosterone (F. TES), Estradiol (E2), Androstenedione (ANDR), Dihydroepiandrosterone (DHEA), Progesterone (PPOGES), Prolactin (PRL), Sex hormone binding protein (SHGB) were measured by radioimmunoassay and chemiluminescent immunoassay methods.

Result

A total of 73 patients with chronic liver disease and cirrhosis were included in the study. Patients were grouped as cirrhosis (n = 28), chronic hepatitis B (n = 41) according to the type of their chronic liver disease. Serum F.TEST level in patient groups (group 1, group 2) was found to be lower than control group (P = 0.045, P = 0.047). Serum LH value was found to be higher in patient group (group 2) than control group (P = 0.048). Serum estradiol was higher in the group 2 compared to the control group (P = 0.046).

Conclusions

The described disturbances of some of the observed hormones (LH, E2, F. TES) are complex, particularly in their relationship by which the clinical picture of the hepatitis B related cirrhotic patients and chronic liver disease can be explained.

Double-balloon endoscopy in patients with Peutz-Jeghers syndrome

BACKGROUND/AIMS

Peutz-Jeghers syndrome is a rare hereditary syndrome characterized by mucocutaneous pigmentation and hamartomatous polyps of the gastrointestinal tract, especially in the small intestine. Double-balloon endoscopy is a new endoscopic technique that enables both endoscopic visualization of the entire small bowel and therapeutic interventions in a single procedure. In this study, we evaluate the efficacy and safety of double-balloon endoscopy for both treatment and surveillance of patients with Peutz-Jeghers syndrome.

MATERIALS AND METHODS

We retrospectively evaluated 7 consecutive patients who were referred to Dokuz Eylül University, Gastroenterology Department, with the diagnosis of Peutz-Jeghers syndrome between 2007 and 2010.

RESULTS

Patients with Peutz-Jeghers syndrome (M/F: 5/2) underwent a total 31 double-balloon endoscopy procedures: 21 by the oral route, 9 by the anal route, and 1 intraoperatively. All of the patients had a history of laparotomy and small bowel resection due to complications such as invagination and ileus. In 7 patients, we found a total of 110 polyps ≥10 mm in diameter (10-100 mm) and polypectomies were performed in all of them. The only complication was a bleeding after polypectomy, which was controlled by sclerotherapy. In 1 patient, because of the intraabdominal adhesions due to past laparotomies, polypectomy was done by intraoperative endoscopy. In 2 of our patients, we made surveillance colonoscopies, found new polyps in the small intestine, and performed polypectomies.

CONCLUSIONS

Double-balloon endoscopy is an effective and safe endoscopic technique, and represents a milestone for both treatment and surveillance of patients with Peutz-Jeghers syndrome. Polypectomies made in the small intestine might decrease the complication rate due to these polyps and the need for surgery.

Evaluation of early atherosclerosis in patients with inflammatory bowel disease

BACKGROUND

Data regarding early atherosclerosis and inflammatory bowel disease are limited and conflicting results are present.

AIMS

The purpose of this study was to evaluate serological and sonographical evidence of subclinical vascular involvement in patients with inflammatory bowel disease.

METHODS

Thirty-nine patients with inflammatory bowel disease (20 Crohn's disease, and 19 ulcerative colitis patients) and 31 healthy controls were consecutively enrolled in the study. Flow mediated dilatation of the brachial artery and intima media thickness assessments of the common carotid artery were measured sonographically. Soluble CD40 ligand levels were evaluated. Crohn's disease activity index and modified Truelove-Witt's criteria were also noted.

RESULTS

Age, sex distribution, serum lipids, smoking status, and intima media thickness of the common carotid artery were similar between the inflammatory bowel disease patients and controls (p > 0.05). However, both endothelium dependent and independent flow mediated dilatation values were significantly impaired in the inflammatory bowel disease group compared with healthy controls (p < 0.05). Erythrocyte sedimentation rate, C-reactive protein and soluble CD40 ligand values were significantly increased in inflammatory bowel disease patients compared with controls (p < 0.05), and soluble CD40 ligand was negatively correlated with flow mediated dilatation (r = -0.3, p < 0.05). Flow mediated dilatation was significantly predicted from the concentrations of C-reactive protein and soluble CD40 ligand.

CONCLUSION

Functional atherosclerosis is present in inflammatory bowel disease before early structural changes occur in vasculature. Higher sCD40L may indicate worse vascular outcome for IBD.

Comparison of Milan and UCSF criteria for liver transplantation to treat hepatocellular carcinoma

AIM: To assess the validity of the Milan and University of California San Francisco (UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) in a single-center study.

METHODS: This study is a retrospective review of prospectively collected data. Between 1998 and 2009, 56 of 356 OLTs were performed in patients with HCC. Based on pathological examination of liver explants, patients were retrospectively categorized into 3 grou-ps: Milan + (n = 34), Milan -/UCSF + (n = 7) and UCSF - (n = 14).

RESULTS: Median follow-up period was 39.5 (1-124) mo. The 5-year overall survival rates in the Milan +, Milan -/UCSF + and UCSF-groups were 87.7%, 53.6% and 33.3%, respectively (P < 0.000). Within these groups, tumor recurrence was determined in 5.8%, 14.3% and 40% of patients, respectively (P < 0.011). Additionally, the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival (74.7% vs 46.7%, P < 0.044).

CONCLUSION: The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC. For cases of OLT involving living donors, the UCSF criteria may be applied.

[A real-time PCR assay for the quantification of hepatitis B virus DNA and concurrent detection of YMDD motif mutations]

Monitoring therapy in chronic hepatitis B patients receiving lamivudine therapy, is done by two different assays; determination of viral load and genotypic resistance. These methods are labor intensive and time consuming. It was aimed to develop an assay to quantitate hepatitis B virus (HBV) DNA in serum and detect YMDD (thyrosine, methionine, aspartate, aspartate) motif mutations in the same run. The assay was based on real-time polymerase chain reaction (Rt-PCR) with YMDD-specific hybridization probes. Determination of YMDD motif was done by melting temperature analysis. External standard curve was used for quantifying viral DNA, which was generated by standard sera (VQC S2220) including HBV-DNA between concentrations of 1000 to 3 million copies/ml. The assay was compared with commercial quantitative kit (Artus HBV RG PCR; Qiagen, Germany), commercial line prob assay (INNO-LiPA HBV DR v1.0; Innogenetics, Belgium) and direct DNA sequencing method. Thirty-eight serum samples obtained from 20 chronic hepatitis B patients (7 female, 13 male; age range: 27-70 years) treated with only lamivudine and were negative for HIV and HCV antigen and antibodies were tested in the study. The analytical sensitivity of the assay was found as 200 copies/ml, with a dynamic range of 1 x 103 to 3 x 107 copies/ml. PCR efficiency of the in-house assay was found to be 1.98. Comparison of log10 HBV-DNA concentrations determined by the in-house and commercial quantitative kits showed a significant correlation (r= 0.681). Melting temperature (Tm) analysis was used for the YMDD motif determination and found to be 59.86°C for YMDD, 56.34°C for YVDD and 55.10°C for YIDD. The results of the in-house assay, DNA sequencing and LiPA were concordant in samples with homogeneous virus population, and in-house assay could also detect the major type of YMDD motif in mixed viral populations The Rt-PCR method which was developed in this study is a rapid, accurate and reproducible method for quantifying HBV-DNA and detecting the predominant YMDD motif in the same run in two hours duration. It was concluded that this method may be a convenient tool for monitoring HBV-infected patients receiving lamivudine treatment.

Ectopic pancreas presenting with intractable diarrhea: case report

Ectopic pancreas is an uncommon congenital anomaly, which is usually found incidentally in clinical practice. It presents with nonspecific gastrointestinal symptoms like epigastric pain and dyspepsia and rarely with the clinical findings of obstructive jaundice or intestinal obstruction, or it may mimic gastrointestinal system cancer. Herein, we describe a case of ectopic pancreas in the duodenum, which was the cause of the intractable diarrhea. In our patient, upper gastrointestinal endoscopy and endoscopic ultrasonography revealed a 1.5 cm submucosal lesion, which was umbilicated centrally with a normal in appearance overlying mucosa. Endoscopic biopsy of the lesion was normal. Pathological examination of the lesion after surgical excision was compatible with ectopic pancreas. After total excision of the lesion, the clinical findings of the patient normalized. Ectopic pancreas presenting with diarrhea has not been reported previously in the literature.

Does glucagon like peptide-2 receptor expression have any effect on the development of human colorectal cancer?

BACKGROUND/AIMS

Glucagon like peptide-2 may play an important role in human colon cancer and polyp development because of its proliferative and antiapopitotic effects especially in colon. In this study, we investigated the role of human glucagon like peptide and it's receptor in development of human colorectal carcinogenesis.

MATERIAL AND METHODS

The study includes 30 patients in colon cancer group and 20 patients in colonic polyp group who have been diagnosed by endoscopic and pathologic examination in Dokuz Eylül University, Department of Gastroenterology within 2 year-period. For comparison biopsies were taken from normal appearing colonic mucosa of the same patient. The cancer, polyp and normal colon mucosa samples were stained with glucagon like peptide receptor antibody by immunohistochemical method.

RESULTS

Glucagon like peptide 2 receptor positivity of colon cancer patients was 20 % (6/30) in focal cytoplasmic coloration while it was 0 % in colonic adenomas and 100 % in enteroendocrine cells of normal colonic mucosa. Statistically significant differences were found by the comparison of colonic polyp and normal colonic tissue (p=0.000), colonic cancer and normal colonic tissue (p=0.000) and colonic polyp and cancer tissues (p= 0.023).

CONCLUSION

Glucagon like peptide-2 receptor expression in colonic adenomas was not detected in human in contrary to the study on mice. Our study suggested that Glucagon like peptide-2 receptor expression is not a factor in adenoma-cancer pathogenesis. More studies are needed on this subject with more facts and different methods.

A patient with nonfunctional pancreatic neuroendocrine tumor and incidental metachronous colon carcinoma detected by positron emission tomography: case report

Pancreatic neuroendocrine tumors constitute about 2% of all gastrointestinal neoplasms. Approximately half of the pancreatic euroendocrine tumors are nonfunctional. Due to lack of specific symptoms, most patients with nonfunctional pancreatic neuroendocrine tumors present with locally advanced or metastatic disease. Second primary malignancies are seen very rarely in these patients. Colon carcinoma ranks third in frequency among primary sites of cancer in both men and women in western countries. Presence of a metachronous colon adenocarcinoma in a patient with nonfunctional pancreatic neuroendocrine tumor has not been reported before. We present a patient who had an asymptomatic mass in the head of the pancreas, detected by ultrasonography in 1996. The patient did not consent to operation. In 2002, after the diagnosis of an unresectable, nonfunctional pancreatic neuroendocrine tumor, interferon alpha- 2b and octreotide were started. A year after biological treatment, he refused further treatment. In 2004, during the evaluation of dissemination of the asymptomatic disease, positron emission tomography revealed a high uptake by the descending colon despite the failure of other imaging methods. After surgery for operable colon carcinoma, the patient received chemotherapy and biological therapy for both tumors. Since 2005, he has been doing well without any further treatment thus far. In conclusion, computerized tomography/magnetic resonance imaging and octreotide scintigraphy may be insufficient to show disseminated disease and asymptomatic second primary malignancies. Therefore, positron emission tomography is a valuable promising option for the evaluation of gastroenteropancreatic neuroendocrine tumors and concomitant or metachronous malignancies. Lifelong follow-up by a multidisciplinary oncology team is needed so that a long-term survival can be achieved with integrated multimodal systemic treatment approaches.