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Kooffreh-Ada M, Iheanacho OE, Nwagbara VI, Okpebri KO, Anisi CO, Itam-Eyo A, Uba-Mgbemena O, Ali OE, Essien OB, Akintomide AO, Eyong ME, Effa EE, Ngim NE. Case studies of multi-disciplinary team management of atypical gastric cancer: challenges and lessons learned (about two cases). Pan Afr Med J 2023; 45:113. [PMID: 37745919 PMCID: PMC10516756 DOI: 10.11604/pamj.2023.45.113.38579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/22/2023] [Indexed: 09/26/2023] Open
Abstract
There is a paradigm shift towards adopting a multidisciplinary team (MDT) model in the care of cancer patients, with increasing evidence to support its effectiveness. Cancers are biologically distinct, patients present in diverse ways and require, different therapeutic approaches in their management. Patient symptoms and treatment side-effects as well as physical and psychological impact vary according to cancer location and treatment plan. The varied clinical scenarios cancer patients present further buttress the need for MDT practice in hospitals to improve the quality of patient care, in contrast to the outdated concept of holistic treatment offered by a single physician. Unlike Europe, United States of America and Australia which have implemented successful MDT cancer care programs, Nigeria is just coming on board. We present two cases of gastric cancer (seen two months apart) with atypical presentation and the role of MDT in their evaluation and management. These case studies highlight the role of MDT in the management of cancer patients in Nigeria lending credence to the urgent need to implement this model of care in our cancer patients in a bid to improve the quality of care and outcome.
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Affiliation(s)
- Mbang Kooffreh-Ada
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Obinna Ebere Iheanacho
- Department of Haematology, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Victor Ikechukwu Nwagbara
- Department of Surgery, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Komommo Okoi Okpebri
- Department of Obstetrics and Gynaecology, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chukwuemeka Okechukwu Anisi
- Department of Orthopaedics and Traumatology, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Okezie Uba-Mgbemena
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Oliver Emmanuel Ali
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ofonime Benjamin Essien
- Department of Haematology, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Michael Eteng Eyong
- Department of Paediatrics, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel Edet Effa
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ngim Ewezu Ngim
- Department of Internal Medicine, University of Calabar, University of Calabar Teaching Hospital, Calabar, Nigeria
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Chavarría C, García-Alonso FJ, de Benito-Sanz M, Mata-Romero P, Madrigal B, Sanchez-Ocaña R, Diez-Redondo P, Núñez H, Perez-Miranda M, de la Serna-Higuera C. Endoscopic ultrasound-guided fine-needle biopsy in patients with unexplained diffuse gastrointestinal wall thickening. Endosc Int Open 2021; 9:E1466-E1471. [PMID: 34540537 PMCID: PMC8445677 DOI: 10.1055/a-1526-0407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022] Open
Abstract
Background and study aims Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is recommended after non-diagnostic biopsy in gastrointestinal wall thickening, although the performance of currently available FNB needles in this setting is unknown. We aimed to assess the diagnostic accuracy and safety of EUS-FNB and to evaluate the "T" wall staging in malignant pathology. Patients and methods This was a single center retrospective study that included all consecutive patients undergoing EUS-FNB for diffuse gastrointestinal wall thickening with at least one previous negative conventional endoscopic biopsy between January 2016 and November 2019. EUS-FNB was performed using linear-array echoendoscopes with slow-pull/fanning technique. Tissue acquisition was done with 19- or 22-gauge biopsy needles. Samples were included in formalin without rapid on-site evaluation and submitted for histopathological processing. The final diagnosis was based on conclusive histology or absence of evidence of disease progression after follow-up at least 6 months. Results Twenty-nine patients (21 men), with a median age of 68 (IQR: 56-77), were included. EUS-FNB was technically feasible and the sample quality was adequate for full histological assessment in all patients (100 %). Sensitivity, specificity, positive and negative predictive values, and overall accuracy for diagnosis of malignancy were 95.5 %, 100 %, 100 %, 83.3 %, and 96.3 %, respectively. In patients with malignant disease, the samples obtained allowed detection of signs of deep layer infiltration ("histological staging") in 17 of 21 cases (81 %). No adverse events were noted. Conclusions The EUS-FNB technique demonstrated excellent diagnostic performance and safety in the study of unexplained diffuse gastrointestinal wall thickening. Histological staging was obtained in a high percentage of samples.
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Affiliation(s)
- Carlos Chavarría
- Endoscopy Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Pilar Mata-Romero
- Endoscopy Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Beatriz Madrigal
- Pathology Department, Hospital Universitario Río Hortega, Valladolid. Spain
| | | | - Pilar Diez-Redondo
- Endoscopy Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Henar Núñez
- Endoscopy Department, Hospital Universitario Río Hortega, Valladolid, Spain
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Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy. J Clin Med 2021; 10:jcm10163716. [PMID: 34442011 PMCID: PMC8397167 DOI: 10.3390/jcm10163716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings.
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Okamoto T, Suzuki H, Fukuda K. Gastric linitis plastica due to signet-ring cell carcinoma with Krukenberg tumors diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:994-1003. [PMID: 33740238 DOI: 10.1007/s12328-021-01387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Gastric linitis plastica is a rare condition characterized by the stiffening and thickening of the gastric wall, presenting a "leather bottle" appearance. It is generally associated with infiltration of poorly differentiated gastric cancer cells, but similar findings can arise due to metastases from other cancers and benign inflammatory processes. Despite advances in imaging modalities, pathological evaluation is required for diagnosis. As endoscopic mucosal biopsies may not be diagnostic, endoscopic ultrasound-guided fine-needle aspiration of the thickened stomach wall presents a potential diagnostic option. We report a case which presented with bilateral ovarian tumors and was ultimately diagnosed as gastric signet-ring cell carcinoma with Krukenberg tumors by endoscopic ultrasound-guided fine-needle aspiration of the stomach wall. The preoperative diagnosis allowed the patient to avoid surgery and to start chemotherapy for gastric cancer. We also review the existing literature on endoscopic ultrasound-guided fine-needle aspiration in the context of gastric linitis plastica.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
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Motoo I, Ando T, Mihara H, Tanaka S, Nanjo S, Kajiura S, Fujinami H, Takahashi K, Yasuda I. Endoscopic Ultrasound-guided Fine Needle Aspiration for the Diagnosis of Duodenal Stenosis Due to Urothelial Carcinoma. Intern Med 2021; 60:719-724. [PMID: 32963164 PMCID: PMC7990641 DOI: 10.2169/internalmedicine.5685-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) initially presents with hematuria and hydronephrosis. We report a case of UTUC presenting with initial findings of duodenal stenosis before the appearance of hydronephrosis. A 59-year-old man presented with upper abdominal symptoms on his initial visit. Esophagogastroduodenoscopy (EGD) revealed circumferential stenosis at the descending part of the duodenum. However, the underlying cause of duodenal stenosis was unknown as repeated histopathological examinations of endoscopic biopsy specimens showed no specific findings. We then performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the thickened duodenal wall, and successfully diagnosed duodenal metastasis of UTUC. EUS-FNA is an effective diagnostic method in cases in which the cause of duodenal stenosis is unknown.
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Affiliation(s)
- Iori Motoo
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Takayuki Ando
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Hiroshi Mihara
- Third Department of Internal Medicine, University of Toyama, Japan
| | | | - Sohachi Nanjo
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Shinya Kajiura
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Haruka Fujinami
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Kosuke Takahashi
- Third Department of Internal Medicine, University of Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Japan
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Gastric carcinoma with lymphoid stroma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:471-477. [PMID: 33386563 DOI: 10.1007/s12328-020-01300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
A 78-year-old man with a subepithelial lesion (SEL) in the gastric body and two carcinomas in the gastric antrum was referred to our hospital. Following a diagnosis of SEL, the patient was followed-up by esophagogastroduodenoscopy annually for 4 years. Although the SEL had increased in size over the years, histological evaluation of the forceps biopsies did not reveal any significant findings. We detected a hypoechoic mass in the submucosa by endoscopic ultrasonography, and suspected the lesion to be an aberrant pancreas or mesenchymal tumor. The patient first underwent endoscopic submucosal dissection for the 2 gastric cancers. Histological examination of the resected specimens revealed intramucosal well-differentiated tubular adenocarcinomas. Next, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed for the gastric SEL. Aspirated specimens revealed an adenocarcinoma with lymphocyte infiltration. The lesion was diagnosed as a gastric carcinoma with lymphoid stroma (GCLS). Subsequently, he underwent distal gastrectomy, and the surgical specimen was confirmed as GCLS corresponding to preoperative diagnosis. In addition, the adenocarcinoma cells were positive for Epstein-Barr (EB) virus-encoded small RNA-1 by in situ hybridization. Finally, the lesion was diagnosed as GCLS associated with EB virus. Thus, EUS-FNA is advantageous for diagnosing GCLS associated with EB virus.
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