Diffuse gastric cancer with peritoneal carcinomatosis can mimic Crohn's disease

A Retrospective Analysis of the Lauren Classification in the Choice of XELOX or SOX as an Adjuvant Chemotherapy for Gastric Cancer

BACKGROUND

We aim to retrospectively explore the guiding value of the Lauren classification for patients who have undergone D2 gastrectomy to choose oxaliplatin plus capecitabine (XELOX) or oxaliplatin plus S-1 (SOX) as a further systemic treatment after the operation.

METHODS

We collected data of 406 patients with stage III gastric cancer(GC)after radical D2 resection and regularly received XELOX or SOX adjuvant treatment after surgery and followed them for at least five years. According to the Lauren classification, we separated patients out into intestinal type (IT) GC together with non-intestinal type(NIT) GC. According to the chemotherapy regimen, we separated patients into the SOX group together with the XELOX group.

RESULTS

Among non-intestinal type patients, the 3-year DFS rates in the SOX group and the XELOX group were 72.5%, respectively; 54.5% (P=0.037); The 5-year OS rates were 66.8% and 51.8% respectively (P=0.038), both of which were statistically significant.

CONCLUSION

The patients of non-intestinal type GC may benefit from the SOX regimen. Differences were counted without being statistically significant with intestinal-type GC in the SOX or XELOX groups.

CircRNA circSLIT2 is a novel diagnostic and prognostic biomarker for gastric cancer

BACKGROUND

Many diseases can mimic the symptoms of gastric cancer (GC). Therefore, misdiagnosis of GC is common. Our preliminary sequencing analysis revealed the altered expression of circSLIT2 in GC. In this study, we further explored the role of circSLIT2 in GC.

METHODS

The research subjects included GC patients, patients with irritable bowel syndrome (IBS), patients with gastric ulcer (GU), patients with gastric tuberculosis (GT), patients with Crohn's disease (CD), and healthy controls (HC). Accumulation of circSLIT2 RNA in both tissue and plasma samples was determined with RT-qPCR. The diagnostic and prognostic values of circSLIT2 for GC were explored by performing ROC and survival curve analysis. The χ2-test was applied for association analysis.

RESULTS

Increased circSLIT2 RNA accumulation was observed in GC tissues compared to non-tumor tissues. Compared to the HC group, increased plasma circSLIT2 RNA accumulation was only observed in the GC group, but not in the IBS, GU, GT, and CD groups. Plasma circSLIT2 showed a positive correlation with circSLIT2 in GC tissues but not circSLIT2 in non-tumor tissues. Using increased plasma circSLIT2 as a biomarker, GC patients were effectively separated from other disease groups and the HC group. Survival curve analysis revealed that most patients who died during the 5‑year follow-up had high levels of circSLIT2 accumulation in GC tissues and plasma. CircSLIT2 in plasma and GC tissue was only closely associated with distant tumor metastases, but not other clinical factors.

CONCLUSION

Increased circSLIT2 accumulation may serve as a novel diagnostic and prognostic biomarker for GC.

Mucinous Signet-Cell Adenocarcinoma of the Ileum: A Diagnostic Challenge—Case Report and Review of the Literature

Malignancies of the small intestine are rare. Signet-ring cell carcinoma (SRCC) is one of the rarest forms of adenocarcinoma that can arise in the small intestines. We present a case of a patient who originally presented with abdominal pain and radiographic findings suggestive of ileal congestion. The ileal biopsy specimens were nonspecific, and the patient began a trial of corticosteroid treatment for suspected Crohn's disease. A repeat colonoscopy yielded biopsies that were positive for malignancy. The patient then underwent an exploratory laparotomy which led to the diagnosis of SRCC. Given their similar presentations and the extreme rarity of this unusual malignancy, it can be difficult to differentiate between new-onset Crohn's disease and SRCC. A review of the literature was conducted to provide us with an improved understanding of previously documented cases of SRCC.

ECCO Topical Review on Clinicopathological Spectrum and Differential Diagnosis of Inflammatory Bowel Disease

INTRODUCTION

Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics.

METHODS

European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search.

RESULTS

Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements.

CONCLUSIONS

Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.

Intestinal and diffuse gastric cancer: a retrospective study comparing primary sites

OBJECTIVE

We assessed differences in primary sites and spread patterns of the intestinal and diffuse subtypes of gastric carcinoma. We also compared survival outcomes based on spread patterns.

MATERIALS AND METHODS

For this retrospective IRB-approved study, our institutional imaging database was mined for patients with gastric cancer. We included 99 treatment-naïve patients. Patient demographics, pathologic data, tumor classification, primary tumor site, and metastasis sites were recorded. Pearson's chi-squared test was used to correlate tumor pathology with metastatic sites. Kaplan-Meier survival curves were compared between baseline metastatic types. A heat map was created based on the relative frequencies of metastatic sites for each primary tumor site.

RESULTS

Of the 99 patients, 66 patients had intestinal and 33 had diffuse gastric carcinoma. The intestinal subtype was significantly associated with hepatic metastases (p < 0.001). Diffuse subtype was associated with peritoneal metastases, including omental metastases (p < 0.006), gastrosplenic ligament involvement (p < 0.004), and mesocolonic implants (p < 0.008). Patients with primary gastric tumors occurring at the greater curvature had longer overall survival than those with primary sites at the antrum, GE junction and lesser curvature (p = 0.0015). Patients with peritoneal metastases had a significantly shorter overall survival than patients without peritoneal metastases (p < 0.001). Patients without mesocolon, gastrohepatic ligament, and gastrosplenic ligament involvement had a better survival (p = 0.005, p = 0.0002, and p = 0.0005, respectively). Presence of hepatic metastases had no effect on survival (p = 0.16).

CONCLUSION

Recognizing distinctive spread patterns for intestinal versus diffuse gastric carcinoma can aid radiologists in diagnosis and guide clinical management.

Metastatic Gastric Signet Ring Cell Carcinoma Mimicking Crohn's Disease

Signet-ring cell carcinoma (SRCC) is an adenocarcinoma characterized by mucin-producing cells and most commonly arises in the stomach. Colonic SRCC can share features of colitis, including long segments of concentric bowel wall thickening and ulcerated mucosa with regions of sparing. We describe a rare case of metastatic gastric SRCC mimicking Crohn’s disease. Our patient underwent 2 colonoscopies, and biopsies revealed chronic active inflammation with no evidence of malignancy. The diagnosis of SRCC was only made after colectomy was performed for recurrent bowel obstruction.

Lauren classification and individualized chemotherapy in gastric cancer

Gastric cancer is one of the most common malignancies worldwide. During the last 50 years, the histological classification of gastric carcinoma has been largely based on Lauren's criteria, in which gastric cancer is classified into two major histological subtypes, namely intestinal type and diffuse type adenocarcinoma. This classification was introduced in 1965, and remains currently widely accepted and employed, since it constitutes a simple and robust classification approach. The two histological subtypes of gastric cancer proposed by the Lauren classification exhibit a number of distinct clinical and molecular characteristics, including histogenesis, cell differentiation, epidemiology, etiology, carcinogenesis, biological behaviors and prognosis. Gastric cancer exhibits varied sensitivity to chemotherapy drugs and significant heterogeneity; therefore, the disease may be a target for individualized therapy. The Lauren classification may provide the basis for individualized treatment for advanced gastric cancer, which is increasingly gaining attention in the scientific field. However, few studies have investigated individualized treatment that is guided by pathological classification. The aim of the current review is to analyze the two major histological subtypes of gastric cancer, as proposed by the Lauren classification, and to discuss the implications of this for personalized chemotherapy.

Recurrence of Crohn's disease in a patient after surgery for gastric cancer

Crohn's disease associated with gastric cancer is an extremely rare clinical entity, and an association between Crohn's disease and gastric cancer has not been clearly defined. In this paper, we present such a case and performed a literature review, with an aim to improve the understanding of its diagnosis and treatment and raise the awareness among clinicians.