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Takada S, Makino I, Katano K, Sugita H, Tokoro T, Gabata R, Okazaki M, Nakanuma S, Ikeda H, Toyama T, Yagi S. Clinical impacts of positive intraepithelial neoplasia at pancreatic transection margin in pancreatic cancer surgery. Pancreatology 2024; 24:493-496. [PMID: 38378436 DOI: 10.1016/j.pan.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND/OBJECTIVES The outcomes of patients with intraepithelial neoplasia at the pancreatic transection margin after pancreatic cancer surgery remain unclear. We evaluated the clinical impact of pancreatic transection margin status. METHODS This retrospective observational study included 171 patients who underwent surgery for pancreatic ductal adenocarcinoma between January 2008 and December 2019. Patients were classified into three groups: negative pancreatic transection margin (group N), positive low-grade (group L), and positive high-grade (group H) intraepithelial neoplasia. The clinicopathological findings and prognoses were analyzed for each group. RESULTS There were 140, 14, and 9 patients in groups N, L, and H, respectively. The median age was significantly higher in group H (p = 0.035). There were no significant differences in male ratio, preoperative chemotherapy administration rate, pretreatment tumor markers, operative procedure, operative time, or blood loss. Overall survival and recurrence-free survival were not significantly different; however, the cumulative risk of recurrence in the remnant pancreas was significantly higher in group H (p = 0.018). CONCLUSIONS Intraepithelial neoplasia at the pancreatic transection margin did not affect overall/recurrence-free survival. As patients with high-grade intraepithelial neoplasia at the pancreatic transection margin have an increased risk of recurrence in the remnant pancreas, careful postoperative follow-up is required.
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Affiliation(s)
- Satoshi Takada
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan.
| | - Isamu Makino
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Kaoru Katano
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Hiroaki Sugita
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Tomokazu Tokoro
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Ryosuke Gabata
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Mitsuyoshi Okazaki
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Shinichi Nakanuma
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Japan
| | - Tadashi Toyama
- Innovative Clinical Research Center, Kanazawa University, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Japan
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Sun JR, Chen DM, Huang R, Wang RT, Jia LQ. Transcriptome sequencing reveals novel biomarkers and immune cell infiltration in esophageal tumorigenesis. World J Gastrointest Oncol 2024; 16:1500-1513. [PMID: 38660641 PMCID: PMC11037066 DOI: 10.4251/wjgo.v16.i4.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/07/2024] [Accepted: 02/04/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is one of the most common malignancies worldwide, and its development comprises a multistep process from intraepithelial neoplasia (IN) to carcinoma (CA). However, the critical regulators and underlying molecular mechanisms remain largely unknown. AIM To explore the genes and infiltrating immune cells in the microenvironment that are associated with the multistage progression of ESCC to facilitate diagnosis and early intervention. METHODS A mouse model mimicking the multistage development of ESCC was established by providing warter containing 4-nitroquinoline 1-oxide (4NQO) to C57BL/6 mice. Moreover, we established a control group without 4NQO treatment of mice. Then, transcriptome sequencing was performed for esophageal tissues from patients with different pathological statuses, including low-grade IN (LGIN), high-grade IN (HGIN), and CA, and controlled normal tissue (NOR) samples. Differentially expressed genes (DEGs) were identified in the LGIN, HGIN, and CA groups, and the biological functions of the DEGs were analyzed via Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. The CIBERSORT algorithm was used to detect the pattern of immune cell infiltration. Immunohistochemistry (IHC) was also conducted to validate our results. Finally, the Luminex multiplex cytokine analysis was utilized to measure the serum cytokine levels in the mice. RESULTS Compared with those in the NOR group, a total of 681541, and 840 DEGs were obtained in the LGIN, HGIN, and CA groups, respectively. Using the intersection of the three sets of DEGs, we identified 86 genes as key genes involved in the development of ESCC. Enrichment analysis revealed that these genes were enriched mainly in the keratinization, epidermal cell differentiation, and interleukin (IL)-17 signaling pathways. CIBERSORT analysis revealed that, compared with those in the NOR group, M0 and M1 macrophages in the 4NQO group showed stronger infiltration, which was validated by IHC. Serum cytokine analysis revealed that, compared with those in the NOR group, IL-1β and IL-6 were upregulated, while IL-10 was downregulated in the LGIN, HGIN, and CA groups. Moreover, the expression of the representative key genes, such as S100a8 and Krt6b, was verified in external human samples, and the results of immunohistochemical staining were consistent with the findings in mice. CONCLUSION We identified a set of key genes represented by S100a8 and Krt6b and investigated their potential biological functions. In addition, we found that macrophage infiltration and abnormal alterations in the levels of inflammation-associated cytokines, such as IL-1β, IL-6, and IL-10, in the peripheral blood may be closely associated with the development of ESCC.
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Affiliation(s)
- Jian-Rong Sun
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Dong-Mei Chen
- Integrated Chinese and Western Medicine Oncology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Rong Huang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Rui-Tao Wang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Li-Qun Jia
- Integrated Chinese and Western Medicine Oncology, China-Japan Friendship Hospital, Beijing 100029, China
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Chen Y, Fang C, Huang J, Pan H, He L, Zhuang C, Zheng X. The correlation between the main and minor lesions of synchronous multiple gastric neoplasms assessed gastroscopically and microscopically. Surg Endosc 2024; 38:1211-1221. [PMID: 38092970 DOI: 10.1007/s00464-023-10624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/29/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patients with early gastric cancer (EGC) are at high risk of developing synchronous multiple gastric neoplasms (SMGNs) after undergoing endoscopic submucosal dissection (ESD). However, most previous studies have had small sample sizes, and few have focused on association studies. AIMS This study aimed to analyze the associations between SMGN lesion data from patients with EGC treated with ESD and their correlation coefficients. METHODS The clinical ESD data from two hospitals from January 2008 to January 2021 were retrospectively analyzed. The main lesions were defined as those with a significant depth of infiltration. The larger tumor diameter was considered the main lesion if the lesions had the same infiltration depth. RESULTS Of the 1013 post-ESD cases examined, 95 cases (223 lesions) had SMGN, and 25 patients had more than three lesions. For the correlation analysis, 190 lesions were included. The study revealed a similarity in pathological type between main and minor lesions (rs = 0.37) and a positive correlation in infiltration depth (rs = 0.58). The mean diameter sizes of the main and minor lesions were 20.7 ± 8.3 mm and 13.1 ± 6.4 mm, respectively, with statistically significant differences (P < 0.001). A linear correlation was observed between the diameter size and a linear regression model was constructed, producing r = 0.38 [95% confidence interval (CI) 0.19-0.54], b = 0.29 (95% CI 0.14-0.44), t = 3.94, P < 0.001]. A correlation was identified between the vertical distribution of the main and minor lesions, the horizontal distribution, and the gross endoscopic morphology (ϕc = 0.25, P = 0.02; ϕc = 0.32, P < 0.001; ϕc = 0.60, P < 0.001). CONCLUSIONS The correlation coefficients for microscopic characteristics were higher than those for gastroscopy. There is a significant positive correlation between the main and minor lesions regarding pathological stage and depth of infiltration, respectively. The spatial distribution of the lesions and the gastroscopic morphology were similar.
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Affiliation(s)
- Yudai Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China
| | - Chaoying Fang
- Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China
| | - Jianmin Huang
- Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China
| | - Hui Pan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China
| | - Liping He
- Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China
| | - Chenlin Zhuang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Medicine, Fujian Provincial Hospital, Fuzhou, 350001, China.
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350028, China.
| | - Xiaoling Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, 350001, China.
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350028, China.
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Wang YK, Ran DM, Li YY, Zhu CY, Zhang RB, Jiang B, Wang SN. Histopathological features of glandular atrophy of the lamina propria of the gastric mucosa during its occurrence and development. BMC Gastroenterol 2023; 23:395. [PMID: 37968594 PMCID: PMC10652481 DOI: 10.1186/s12876-023-03033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To explore the histopathological features of glandular atrophy of the lamina propria of gastric mucosa during its occurrence and development. METHOD We performed detailed histological observation and immunohistochemical examination on the endoscopic biopsy and ESD endoscopic resection specimens of 896 patients with glandular atrophy of the lamina propria of gastric mucosa. The EnVision two-step method was used for immunohistochemical staining, and the slices were incubated with primary antibody CK7, CK20, villin, CDX2, MUC5AC, MUC6, p53 and ki-67. Hematoxylin staining was performed and observed under the microscope and statistically analyzed. RESULTS In the initial stage of glandular atrophy of the lamina propria, the proliferation area of the deep gastric pits, and the isthmus and neck of the gastric glands are characterized by roughly normal structure of the glandular structure, increased mesenchyme, and widened space between glands. Subsequently, the gland becomes smaller in volume and less in number, especially at the base, in the gastric glandular part of the gastric unit. The disease at this stage has higher incidence, and occurs more often in the elderly who account for 64.0% (573/896) of our study group. The disease in this stage may exhibit some lesions that are physiologic (age-related degeneration) while others are pathological. Therefore, this condition is called simple glandular atrophy of the lamina propria of the gastric mucosa. When the gastric mucosal epithelium is subjected to infection or repeated infections, chemical stimuli, immune factors, and genetic factors, it can lead to the proliferation and transformation of stem cells in the proliferation area of the deep gastric pits, and the isthmus and neck of the gastric glands, forming single ducts, multiple ducts, or a proliferation of patchy cells. Then, atypical hyperplasia (intraepithelial neoplasia) presents, finally leading to gastric adenocarcinoma. CONCLUSION Understanding the histopathological characteristics of glandular atrophy of the lamina propria of gastric mucosa is of great significance in controlling the occurrence and development of gastric cancer.
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Affiliation(s)
- Yang-Kun Wang
- Department of Pathology, The Fourth People's Hospital of Longgang District, Shenzhen, 518123, China
| | - Dong-Mei Ran
- Department of Pathology, Southern University of Science and Technology Hospital, Shenzhen, 518055, China
| | - Ying-Ying Li
- Shenzhen Polytechnic, Xili Lake, Xilihu Town, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Chao-Ya Zhu
- Third Affiliated Hospital of Zhengzhou University, Shenzhen, 450052, China
| | - Ren-Bing Zhang
- Department of Pathology, Shenzhen Longgang District People's Hospital, Shenzhen, 518172, China
| | - Bo Jiang
- Department of Pathology, No. 990 Hospital of the PLA Joint Logistics Support Force, Zhumadian, 463000, China
| | - Su-Nan Wang
- Shenzhen Polytechnic, Xili Lake, Xilihu Town, Nanshan District, Shenzhen, Guangdong, 518055, China.
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Aghaei H, Kheirkhah A, Alizadeh AM, Es'haghi A, Aliakbar-Navahi R, Keikha Z, Chaibakhsh S. Local ocular safety of the subconjunctival injection of cetuximab in rabbits. BMC Ophthalmol 2023; 23:155. [PMID: 37055797 PMCID: PMC10103399 DOI: 10.1186/s12886-023-02893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND To evaluate the safety of different doses of subconjunctival cetuximab in rabbits. METHODS After general anesthesia rabbits received a subconjunctival injection of 2.5 mg in 0.5 ml, 5 mg in 1 ml, and 10 mg in 2 ml of cetuximab in their right eyes (two rabbits in each group). A similar volume of normal saline solution was injected subconjunctivally in the left eyes. The histopathologic changes were evaluated after enucleation with the aid of H&E staining. RESULTS No significant difference were observed between the treated and control eyes in terms of conjunctival inflammation, goblet cell density, or limbal blood vessel density for all administered doses of cetuximab. CONCLUSION Subconjunctival injection of cetuximab with the administrated doses in rabbit eyes are safe.
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Affiliation(s)
- Hossein Aghaei
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | | | - Acieh Es'haghi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Roshanak Aliakbar-Navahi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Keikha
- Department of Ophthalmology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Liu Y, Zheng P, Jiao T, Zhang M, Wu Y, Zhang X, Wang S, Zhao Z. Paiteling induces apoptosis of cervical cancer cells by down-regulation of the E6/E7-Pi3k/Akt pathway: A network pharmacology. J Ethnopharmacol 2023; 305:116062. [PMID: 36535331 DOI: 10.1016/j.jep.2022.116062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Human papillomavirus (HPV) infection is considered to be the main pathogen causing intraepithelial neoplasia. Paiteling (PTL) has been used to treat intraepithelial neoplasia caused by human papillomavirus (HPV) infection for more than 20 years in China, but its specific mechanism of action is not very clear, and further research is still needed. OBJECTIVE This study designed a comprehensive strategy to study the pharmacological mechanism of paiteling in regulating cervical cancer cell apoptosis by integrating LC-MS/MS, network pharmacology and pharmacological experiments. METHODS We used liquid chromatography-tandem mass spectrometry to detect the active substances in PTL and performed protein-protein interaction analysis on the intersection of the targets of these key compounds and the targets of intraepithelial neoplasia. Additionally, by using Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes (KEGG), the potential pathway of PTL against HPV-induced intraepithelial neoplasia was predicted. Finally, we used HeLa and Ect1/E6E7 cells for experimental verification. RESULTS The protein-protein interaction network predicted that AKT1, TP53, MYC, STAT3, MTOR, and MAPK were pivotal targets for PTL to inhibit epithelial neoplasia. KEGG enrichment analysis showed that the Pi3k/Akt pathway and HPV infection had scientific significance. Compared to the control group, after PTL diluent stimulated HeLa and Ect1/E6E7 cells for 24 h, cell viability, migration, and invasion capabilities were significantly reduced, and cell apoptosis was significantly increased, conforming to a dose-effect relationship and time-effect relationship. PCR, cellular immunohistochemistry, and western blot experiments showed that PTL reduced the expression of E6, Pi3k, E7, Akt, Bcl-xl, while increasing the expression of Bad in HeLa and Ect1/E6E7 cells. CONCLUSION PTL can induce cervical cancer cell apoptosis by inhibiting the E6/E7-Pi3k/Akt signaling pathway. It may provide an effective alternative strategy of traditional Chinese medicine for the treatment of epithelial neoplasia caused by HPV infection.
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Affiliation(s)
- Yunhua Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Pengfei Zheng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Jiao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yingjie Wu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xinjiang Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuyue Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zongjiang Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Clay PA, Thompson TD, Markowitz LE, Ekwueme DU, Saraiya M, Chesson HW. Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States. Vaccine 2023; 41:2376-2381. [PMID: 36907737 PMCID: PMC10198126 DOI: 10.1016/j.vaccine.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/13/2023]
Abstract
The annual direct medical cost attributable to human papillomavirus (HPV) in the United States over the period 2004-2007 was estimated at $9.36 billion in 2012 (updated to 2020 dollars). The purpose of this report was to update that estimate to account for the impact of HPV vaccination on HPV-attributable disease, reductions in the frequency of cervical cancer screening, and new data on the cost per case of treating HPV-attributable cancers. Based primarily on data from the literature, we estimated the annual direct medical cost burden as the sum of the costs of cervical cancer screening and follow-up and the cost of treating HPV-attributable cancers, anogenital warts, and recurrent respiratory papillomatosis (RRP). We estimated the total direct medical cost of HPV to be $9.01 billion annually over the period 2014-2018 (2020 U.S. dollars). Of this total cost, 55.0% was for routine cervical cancer screening and follow-up, 43.8% was for treatment of HPV-attributable cancer, and less than 2% was for treating anogenital warts and RRP. Although our updated estimate of the direct medical cost of HPV is slightly lower than the previous estimate, it would have been substantially lower had we not incorporated more recent, higher cancer treatment costs.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Harrell W Chesson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
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Shimoda Y, Shimizu Y, Takahashi H, Okahara S, Miyake T, Ichihara S, Tanaka I, Inoue M, Kinowaki S, Ono M, Yamamoto K, Ono S, Sakamoto N. Optical biopsy for esophageal squamous cell neoplasia by using endocytoscopy. BMC Gastroenterol 2022; 22:259. [PMID: 35597920 PMCID: PMC9123668 DOI: 10.1186/s12876-022-02335-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/13/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Endocytoscopy (ECS) enables microscopic observation in vivo for the gastrointestinal mucosa; however, there has been no prospective study in which the diagnostic accuracy of ECS for lesions that have not yet undergone histological diagnosis was evaluated. We conducted a surveillance study for patients in a high-risk group of esophageal squamous cell carcinoma (ESCC) and evaluated the in vivo histological diagnostic accuracy of ECS. METHODS This study was a multicenter prospective study. We enrolled 197 patients in the study between September 1, 2019 and November 30, 2020. The patients first underwent white light imaging and narrow band imaging, and ultra-high magnifying observation was performed if there was a lesion suspected to be an esophageal tumor. Endoscopic submucosal dissection (ESD) was later performed for lesions that were diagnosed to be ESCC by ECS without biopsy. We evaluated the diagnostic accuracy of ECS for esophageal tumorous lesions. RESULTS ESD was performed for 37 patients (41 lesions) who were diagnosed as having ESCC by ECS, and all of them were histopathologically diagnosed as having ESCC. The sensitivity [95% confidence interval (CI)] was 97.6% (87.7-99.7%), specificity (95% CI) was 100% (92.7-100%), diagnostic accuracy (95% CI) was 98.9% (94.0-99.8%), positive predictive value (PPV) (95% CI) was 100% (91.4-100%) and negative predictive value (NPV) (95% CI) was 98.0% (89.5-99.7%). CONCLUSIONS ECS has a high diagnostic accuracy and there were no false positives in cases diagnosed and resected as ESCC. Optical biopsy by using ECS for esophageal lesions that are suspected to be tumorous is considered to be sufficient in clinical practice.
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Affiliation(s)
- Yoshihiko Shimoda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan.
- Department of Gastroenterology, National Hospital Organization, Hokkaido Medical Center, 5-7, Yamanote, Nishi-ku, Sapporo, 063-0005, Japan.
| | - Hiroaki Takahashi
- Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Hokkaido, 003-0027, Japan
| | - Satoshi Okahara
- Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Hokkaido, 003-0027, Japan
| | - Takakazu Miyake
- Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Hokkaido, 003-0027, Japan
| | - Shin Ichihara
- Department of Surgical Pathology, Sapporo Kosei General Hospital, Sapporo, Hokkaido, 060-0033, Japan
| | - Ikko Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8648, Japan
| | - Masaki Inoue
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8648, Japan
| | - Sayoko Kinowaki
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8648, Japan
| | - Masayoshi Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Shoko Ono
- Department of Gastroenterology, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8648, Japan
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Erbersdobler A, Dräger D. [Non-invasive precursor lesions of penile carcinoma : Differential diagnosis and treatment]. Urologe A 2021; 60:895-900. [PMID: 34142169 DOI: 10.1007/s00120-021-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Abstract
Clinical diagnosis of preinvasive malignant lesions of the penis is difficult and there are numerous differential diagnoses. Recent decades have been witness to several changes in the terminology of histopathological diagnoses. In the current World Health Organization classification, penile intraepithelial neoplasia (PeIN) is defined, of which several subtypes exist. Just like in invasive carcinoma, the principal classification of PeIN subtypes corresponds with pathogenesis and includes human papilloma virus (HPV)-related and non-HPV-related forms. Subdivision is important for prognosis. Several therapeutic options exist, including surgical and nonsurgical procedures.
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Affiliation(s)
- A Erbersdobler
- Institut für Pathologie, Universitätsmedizin Rostock, Strempelstr. 14, 18057, Rostock, Deutschland.
| | - D Dräger
- Urologische Klinik, Universitätsmedizin Rostock, Rostock, Deutschland
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10
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Dua HS, Deshmukh R, Ting DSJ, Wilde C, Nubile M, Mastropasqua L, Said DG. Topical use of alcohol in ophthalmology - Diagnostic and therapeutic indications. Ocul Surf 2021; 21:1-15. [PMID: 33895368 DOI: 10.1016/j.jtos.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023]
Abstract
Alcohol (ethanol) has been used in medicine since time immemorial. In ophthalmic practice, besides as an antiseptic, it was given as retrobulbar injections to relieve severe ocular pain. Alcohol can be applied topically to the surface of neoplastic or suspicious lesions to kill cells that might desquamate and seed during surgical excision, to treat epithelial ingrowth that can occur following corneal surgeries, particularly laser in situ keratomileusis (LASIK), and to treat superficial infectious keratitis. In view of its ability to achieve a smooth cleavage plane between the epithelium and the Bowman's layer, alcohol-assisted delamination (ALD) of the corneal epithelium has been used widely and effectively for a variety of diagnostic and therapeutic indications, at times delivering both outcomes. Diagnostically, ALD yields an intact epithelial sheet which can be fixed flat to provide excellent orientation for histopathological evaluation. Therapeutically, it is most commonly used to treat recurrent corneal erosion syndrome, where its efficacy is comparable to that of phototherapeutic keratectomy but with several advantages. It has also been used to treat various forms of epithelial/anterior stromal dystrophies, which can obviate or delay the need for corneal transplantation for several years. In addition, ALD is performed in corneal collagen cross-linking and corneal refractive surgery for relatively atraumatic removal of the epithelium. In this review, we aimed to provide a comprehensive overview of the diagnostic and therapeutic use of topical alcohol in ophthalmology, to describe the surgical and fixation techniques of ALD, and to highlight our experience in ALD over the past decade.
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Cody P, Tobe K, Abe M, Elbasha EH. Public health impact and cost effectiveness of routine and catch-up vaccination of girls and women with a nine-valent HPV vaccine in Japan: a model-based study. BMC Infect Dis 2021; 21:11. [PMID: 33407188 PMCID: PMC7789539 DOI: 10.1186/s12879-020-05632-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Combined with cancer screening programs, vaccination against human papillomavirus (HPV) can significantly reduce the high health and economic burden of HPV-related disease in Japan. The objective of this study was to assess the health impact and cost effectiveness of routine and catch-up vaccination of girls and women aged 11–26 years with a 4-valent (4vHPV) or 9-valent HPV (9vHPV) vaccine in Japan compared with no vaccination. Methods We used a mathematical model adapted to the population and healthcare settings in Japan. We compared no vaccination and routine vaccination of 12–16-year old girls with 1) 4vHPV vaccine, 2) 9vHPV vaccine, and 3) 9vHPV vaccine in addition to a temporary catch-up vaccination of 17–26 years old girls and women with 9vHPV. We estimated the expected number of disease cases and deaths, discounted (at 2% per year) future costs (in 2020 ¥) and discounted quality-adjusted life years (QALY), and incremental cost effectiveness ratios (ICER) of each strategy over a time horizon of 100 years. To test the robustness of the conclusions, we conducted scenario and sensitivity analyses. Results Over 100 years, compared with no vaccination, 9vHPV vaccination was projected to reduce the incidence of 9vHPV-related cervical cancer by 86% (from 15.24 new cases per 100,000 women in 2021 to 2.02 in 2121). A greater number of cervical cancer cases (484,248) and cancer-related deaths (50,102) were avoided through the described catch-up vaccination program. Routine HPV vaccination with 4vHPV or 9vHPV vaccine prevented 5,521,000 cases of anogenital warts among women and men. Around 23,520 and 21,400 diagnosed non-cervical cancers are prevented by catch-up vaccination among women and men, respectively. Compared with no vaccination, the ICER of 4vHPV vaccination was ¥975,364/QALY. Compared to 4vHPV, 9vHPV + Catch-up had an ICER of ¥1,534,493/QALY. Conclusions A vaccination program with a 9-valent vaccine targeting 12 to 16 year-old girls together with a temporary catchup program will avert significant numbers of cases of HPV-related diseases among both men and women. Furthermore, such a program was the most cost effective among the vaccination strategies we considered, with an ICER well below a threshold of ¥5000,000/QALY.
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Affiliation(s)
- Palmer Cody
- Merck &Co., Inc., Kenilworth, NJ, USA. .,Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., WP37A-150, PO Box 1000, West Point, PA, 19486, USA.
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Samiee-Rad F, Farajee S. Concurrence of Primary Cutaneous Extra Mammary Paget's Disease and Squamous Cell Carcinoma in situ of Vulva: A Case Report. Iran J Pathol 2020; 15:48-52. [PMID: 32095151 PMCID: PMC6995679 DOI: 10.30699/ijp.2019.93259.1906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extramammary Paget's disease and vulvar intraepithelial neoplasia are common lesions of vulve, but synchronous occurrence is rare in a same location. Herein we describe a concurrence of primary cutaneous extra mammary Paget's disease and squamous cell carcinoma in situ of vulva in an Iranian women. A 59 year old woman, initially presented to Kosar teaching hospital gynecology clinic April 2017 with a single, well defined, scaly, white ulcerated mass, 2 cm in diameter on right minor labia, but other examinations were normal. She had no urinary or gastrointestinal symptoms. Incisional biopsies from the mass represented concurrence extramammary Paget's disease and VIN3. She underwent radical vulvectomy .No evidence of disease recurrence was noted after 16 months follow up. Participant consent was obtained before patient was enrolled in this study. There are lot of diseases that involve genitalia and lead to vulvar lesions. But in this rare case, we diagnosed concurrence of extramammary Paget's disease and vulvar intraepithelial neoplasia in a same location. Additionally, the clinical presentation as a vulvar mass was found unusual. Therefore, we report the case to sensitize gynecologists and pathologists for uncommon pathologies and their manifestations in vulva.
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Affiliation(s)
- Fatemeh Samiee-Rad
- Department of Pathology, School of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sohayla Farajee
- School of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Ma TM, Sun LP, Dong NN, Sun MJ, Yuan Y. Protein expression trends of DNMT1 in gastrointestinal diseases: From benign to precancerous lesions to cancer. World J Gastrointest Oncol 2019; 11:1141-1150. [PMID: 31908719 PMCID: PMC6937440 DOI: 10.4251/wjgo.v11.i12.1141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent years, the incidence of gastrointestinal (GI) cancer in China has increased annually. Early detection and appropriate therapy are considered to be the key to treat GI cancer. DNMT1 takes an active part in the advancement of GI cancer, which will change as the disease progresses. But its expression characteristics in the dynamic variations of GI carcinogenesis are still unclear.
AIM To investigate the expression characteristics of DNMT1 in different GI diseases.
METHODS We detected the expression of DNMT1 in 650 cases of different GI diseases by immunohistochemistry, including 90 cases of chronic superficial gastritis (CSG), 72 cases of atrophic gastritis with intestinal metaplasia (AG/GIM), 54 cases of low-grade intraepithelial neoplasia (GLIN), 66 cases of high-grade intraepithelial neoplasia (GHIN), 71 cases of early gastric cancer (EGC), 90 cases of normal intestinal mucosa (NIM), 54 cases of intestinal low-grade intraepithelial neoplasia (ILIN), 71 cases of intestinal high-grade intraepithelial neoplasia (IHIN), and 82 cases of early colorectal cancer (ECRC).
RESULTS In the CSG group, all cases showed weakly positive or negative expression of DNMT1. However, in other four groups (AG/GIM, GLIN, GHIN, and EGC), the positive expression rate gradually increased with the severity of the diseases; the negative or weakly positive cases accounted for 55.56% (40/72), 38.89% (21/54), 1.52% (1/66), and 1.41% (1/71), respectively. Besides, the moderately positive cases were 44.44% (32/72), 57.41% (31/54), 80.30% (53/66), and 43.66% (31/71), respectively. The strongly positive cases only existed in the GLIN (3.70%, 2/54), GHIN (18.18%, 12/66), and EGC (54.93%, 39/71) groups. The differences between any two groups were statistically significant (P < 0.05). Similarly, in the NIM group, cases with weakly positive expression of DNMT1 were predominant (91.11%, 82/90), and the rest were moderately positive cases (8.89%, 8/90). In the ILIN, IHIN, and ECRC groups, the rates of cases with weak or negative expression of DNMT1 were 46.30% (25/54), 12.68% (9/71), and 4.88% (4/82), respectively; with moderately positive expression were 53.70% (29/54), 71.83% (51/71), and 34.15% (28/82), respectively; and with strongly positive expression were 0.00% (0/54), 15.49% (11/71), and 60.98% (50/82), respectively. The differences between any two groups were also statistically significant (P < 0.05).
CONCLUSION The overexpression of DNMT1 protein could effectively predict early GI cancers and severe precancerous lesions, which may have potential clinical application value.
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Affiliation(s)
- Tian-Miao Ma
- Department of Gastroenterology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li-Ping Sun
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Nan-Nan Dong
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Ming-Jun Sun
- Department of Gastroenterology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yuan Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Kroesen AJ. Early Surgery in Inflammatory Bowel Diseases Is a Better Option than Prolonged Conservative Treatment. Visc Med 2019; 35:355-358. [PMID: 31934583 DOI: 10.1159/000504150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/30/2022] Open
Abstract
Early surgery is a very important aspect of treatment of inflammatory bowel diseases. In Crohn's disease, early surgery should be performed in emergencies, in refractory courses, and in special cases at the beginning of the disease if there is a stenosis limited to the terminal ileum. In ulcerative colitis, prolonged therapy with extended application of all available substances should be avoided. Every therapy with more than 2 biologicals endangers the patient. Low-grade intraepithelial neoplasia (IEN) should also be resected earlier due to a 23% risk of synchronous and metachronous high-grade IEN or cancer.
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Affiliation(s)
- Anton J Kroesen
- Allgemein- und Viszeralchirurgie, Krankenhaus Porz am Rhein, Cologne, Germany
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Joly E, Lefranc H, Comoz F, Lefort F, Pédaillès S, Chevallier JM, Dompmartin A. [Carbon dioxide laser treatment of genital intraepithelial neoplasia: A retrospective study]. Ann Dermatol Venereol 2019; 146:542-549. [PMID: 31320185 DOI: 10.1016/j.annder.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/14/2018] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Genital intraepithelial neoplasias (IEN) are precursors of squamous cell carcinoma. The ideal treatment must be efficacious, conservative and well-tolerated. CO2 laser is one of the recommended therapies, but its efficacy and safety have not been extensively studied. PATIENTS AND METHODS This was a retrospective single-center study. Sixteen patients (8 women and 8 men) treated with CO2 laser for genital IEN, whether high-grade or differentiated, were included. Surgical lateral margins of 3 to 5mm were taken macroscopically during treatment. The CO2 laser session, assessment of therapeutic response and follow-up were undertaken by a dermatologist at the University Hospital of Caen. RESULTS The mean patient age was 68.1 years and mean follow-up was 52.7 months (5-130). Lesions were isolated in 87.5% of patients. The recurrence rates of genital intraepithelial neoplasia after CO2 laser treatment were 58% for women and 40% for men. No impact on quality of life or on sexual activity was reported in over 90% of patients. CONCLUSION Whatever the treatment recommended for intraepithelial neoplasia, recurrence is frequent. CO2 laser is an effective and well-tolerated conservative therapeutic option. It enables rapid clinical remission, but as with all currently available treatments, long-term dermatologic follow-up remains necessary.
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Affiliation(s)
- E Joly
- Service de dermatologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen, France; Faculté de médecine, université de Caen Basse-Normandie, Caen, France.
| | - H Lefranc
- Service de dermatologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen, France; Faculté de médecine, université de Caen Basse-Normandie, Caen, France
| | - F Comoz
- Service d'anatomopathologie, CHU de Caen, 14033 Caen, France
| | - F Lefort
- Service du DIM, CHU de Caen, 14033 Caen, France
| | - S Pédaillès
- Service de dermatologie, CHIC Alençon-Mamers, 61000 Alençon, France
| | - J-M Chevallier
- Service de dermatologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen, France
| | - A Dompmartin
- Service de dermatologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen, France; Faculté de médecine, université de Caen Basse-Normandie, Caen, France
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Kim JM, Sohn JH, Cho MY, Kim WH, Chang HK, Jung ES, Kook MC, Jin SY, Chae YS, Park YS, Kang MS, Kim H, Lee JH, Park DY, Kim KM, Kim H, Suh YJ, Seol SY, Jung HY, Kim DH, Lee NR, Park SH, You JH. Inter-observer Reproducibility in the Pathologic Diagnosis of Gastric Intraepithelial Neoplasia and Early Carcinoma in Endoscopic Submucosal Dissection Specimens: A Multi-center Study. Cancer Res Treat 2019; 51:1568-1577. [PMID: 30971066 PMCID: PMC6790834 DOI: 10.4143/crt.2019.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/29/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. Materials and Methods We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.
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Affiliation(s)
- Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee-Yon Cho
- Department of Pathology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Eun Sun Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yang Seok Chae
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University College of Medicine, Busan, Korea
| | - Kyoung Mee Kim
- Department of Pathology, Samsung Medical Cancer, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoguen Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Suh
- Department of Pathology, Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Sang Yong Seol
- Department of Pathology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hwoon-Yong Jung
- Department of Pathology, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Asan Digestive Disease Research Institute, Seoul, Korea
| | - Deuck-Hwa Kim
- Department of Pathology, Department of Statistics, Inha University, Incheon, Korea
| | - Na Rae Lee
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung-Hee Park
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Hye You
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Li JH, Wang LY, Song XM, Liu JS. Risk factors for intraepithelial neoplasia in patients with colorectal adenoma. Shijie Huaren Xiaohua Zazhi 2018; 26:243-249. [DOI: 10.11569/wcjd.v26.i4.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To identify risk factors for intraepithelial neoplasia in colorectal adenoma by analyzing the clinical, endoscopic, and histopathological features of patients with colorectal adenoma.
METHODS The clinical, endoscopic, and histopathological features of 657 patients with colorectal adenomatous polyps diagnosed by colonoscopy from January 2014 to April 2016 at Wuhan Union Hospital were retrospectively analyzed. The patients were divided into an intraepithelial neoplasia group and a non-intraepithelial neoplasia group according to the pathological diagnosis. χ2 test was applied for univariate analysis between the two groups. Multivariate Logistic regression analysis was used to identify the risk factors for intraepithelial neoplasia and its malignancy degree in adenoma.
RESULTS Most of colorectal adenomas were located in the left colon. The total incidence of intraepithelial neoplasia in colorectal adenoma was 22.68%. Age, polyp diameter, length of pedicle, and pathologic type were identified to be risk factors for intraepithelial neoplasia in adenoma, which could be incorporated in Logistic regression equation: logit P = -4.384 + 0.796X2 (age) + 0.324X3 (polyp diameter) + 1.296X4 (pedicle condition) + 0.944X7 (pathology type). Gender, age, and polyp size were identified to be risk factors for high-grade intraepithelial neoplasia in adenoma, which could be incorporated in Logistic regression equation: logit P = -2.939 + 1.036X1 (gender) + 0.853X2 (age) + 1.023X3 (polyp diameter). Total cholesterol (TC) and triglyceride (TG) in the low-grade and high-grade intraepithelial neoplasia groups were both significantly higher than those in the non-intraepithelial neoplasia group (P < 0.05). Low-density lipoprotein cholesterol (LDL-C) and uric acid (URIC) in the high-grade intraepithelial neoplasia group were both significantly higher than those in the non-intraepithelial neoplasia group (P < 0.05). There was no significant difference in the high-density lipoprotein cholesterol (HDL-C) or CEA among the three groups.
CONCLUSION There is a greater risk of intraepithelial neoplasia among patients older than 40, having villous adenoma with diameter > 1 cm and pedicle. Male, polyp diameter, and age are risk factors for high-grade intraepithelial neoplasia in colorectal adenoma. The occurrence of intraepithelial neoplasia in adenoma may be related to blood lipids and uric acid levels.
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Abstract
Anal cancer is biological similar to cervical cancer, and is preceded by anal intraepithelial neoplasia (AIN). Screening for AIN and treatments to reduce the risk of anal cancer are not established as guidelines of care for HIV-infected patients. It is mainly because screening and treating of AIN is not yet proven to reduce the incidence of anal cancer. The present study preliminarily demonstrated that a successful screening program in preventing squamous cell anal cancer in HIV positive patients. The authors achieved their purpose of controlling the evolution of all abnormalities identified during the anal cancer screening, preventing AIN to progress towards anal cancer, and reversing any form of AIN by surgery, ablation or medical therapy. Randomized controlled multi-center trials with a large sample size should be carried out to validate the study results. It is wise for the physicians to actively screen and treat AIN in HIV-infected patients whenever possible unless the results of randomized controlled study demonstrate that doing so is inappropriate.
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Affiliation(s)
- Jian Xu
- a Department of Surgery , Shanghai Baoshan District Combining Traditional Chinese and Western Medicine Hospital , No. 181, Youyi Road, Shanghai , China
| | - Haiyang Zhou
- b Division of Colorectal Surgery, Changzheng Hospital , Second Military Medical University , No. 415, Fengyang Road, Shanghai , China
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Wu S, Zhu X, Xiang L, Chen J, Chen C. The Diagnostic Accuracy of Conventional Forceps Biopsy Compared to ESD. Open Med (Wars) 2017; 12:261-265. [PMID: 28828409 PMCID: PMC5558105 DOI: 10.1515/med-2017-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 07/18/2017] [Indexed: 11/26/2022] Open
Abstract
Objective conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN). Our study aimed to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD). Methods 105 patients diagnosed GEN finally undertook ESD in our hospital were enrolled. We retrospectively assessed the characteristics of pathological results of CFB and ESD. Results The overall pathologic concordance rate between the CFB and ESD specimens was 68.57%. 55 cases of CFB maintained low-grade intraepithelial neoplasia (LGIN) under ESD,18 cases (23.1%) diagnosis for high-grade intraepithelial neoplasia (HGIN), 5 cases (6.4%) diagnosis for cancer. Moreover, 10 cases of CFB maintained HGIN under ESD. Lesions with surface hyperemia (44.4% vs. 27.54%) or surface ulcer (57.14% vs.26.76%) were more likely to cancerate (P<0.05). Conclusion endoscopic biopsy in the diagnosis of low-grade intraepithelial neoplasia, may exist or progression to high-grade intraepithelial neoplasia, some may have cancer, should take active treatment measures.
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Affiliation(s)
- Shimin Wu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou310003, China.,Shaoxing shangyu people's hospital, Shaoxin, China
| | - Xinjian Zhu
- Shaoxing shangyu people's hospital, Shaoxin, China
| | - Lijuan Xiang
- Shaoxing shangyu people's hospital, Shaoxin, China
| | | | - Chunxiao Chen
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou310003, China
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Limaiem R, Limaiem F. [Conjunctival carcinoma in situ: a rare lesion that should not be ignored]. Pan Afr Med J 2017; 26:203. [PMID: 28690718 PMCID: PMC5491728 DOI: 10.11604/pamj.2017.26.203.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/13/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rim Limaiem
- Service d'Ophtalmologie B, Institut Hédi Rais d'Ophtalmologie, Tunisie
| | - Faten Limaiem
- Service d'Anatomie, Pathologique, Hôpital Mongi Slim La Marsa
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Lian Y, Sang M, Gu L, Liu F, Yin D, Liu S, Huang W, Wu Y, Shan B. MAGE-A family is involved in gastric cancer progression and indicates poor prognosis of gastric cancer patients. Pathol Res Pract 2017. [PMID: 28647208 DOI: 10.1016/j.prp.2017.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND As the best characterized CTA family members, melanoma-associated antigens (MAGE) have been reported to express in various malignant tumors. However, the expression pattern of MAGE-A family in gastric cancer (GC) specimens and their prognostic and therapeutic significance for GC patients is still unclear. MATERIALS AND METHODS Tissue microarray - based immunohistochemistry analysis was used to examine the expression of MAGE-A family members (including MAGE-A1, -A2, -A3, -A4, -A6, -A10, and -A12) in 86 cases of GC specimens, 20 cases of the corresponding adjacent normal gastric specimens, and 9 cases of intraepithelial neoplasia specimens. The association between MAGE-A expression and the clinicopathological parameters as well as the 5-year overall survival of GC patients was analyzed. RESULTS 54.7% of GC specimens showed positive MAGE-A expression. In the adjacent normal gastric specimens, MAGE-A was not expressed in the normal surface mucous cells, but expressed in some normal fundic glands. In addition, MAGE-A expression was also detected in intraepithelial neoplasia specimens. In GC specimens, MAGE-A expression was associated with lymph node metastasis, poor differentiation, and high clinical TNM stage. MAGE-A expression was also correlated with the poor 5-year overall survival of GC patients. However, MAGE-A expression is not an independent prognostic factor for GC patients. CONCLUSIONS MAGE-A family may be involved in the gastric cancer progression, and their expression could be considered to improve the prognostic evaluation for GC patients.
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Affiliation(s)
- Yishui Lian
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Meixiang Sang
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Lina Gu
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Fei Liu
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Danjing Yin
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Shina Liu
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Weina Huang
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Yanyun Wu
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China
| | - Baoen Shan
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China; Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, People's Republic of China.
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22
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Abstract
Gastric cancer is the fifth (men) and sixth (women) most common cause of cancer-related death in Germany. Despite a declining incidence of distal gastric cancer, the prognosis remains dismal: the 5‑year survival rate ranges between 35% for women and 31% for men. The majority are adenocarcinomas, which occur sporadically, familial or hereditary. Adenomas and intraepithelial neoplasms are considered as precursor lesions. Recently, whole genome sequencing and comprehensive molecular profiling described four molecular subtypes of gastric cancer: Epstein-Barr virus (EBV) positive, microsatellite unstable, chromosomal unstable and genomically stable gastric cancer. Currently, only the TNM classification has stood the test of time for the assessment of patient prognosis. Neuroendocrine tumor types 1-3 and soft tissue tumors occur significantly less often in the stomach. Gastrointestinal stromal tumors and inflammatory fibroid polyps are among the more common soft tissue tumors of the stomach and show distinct phenotypes. This review gives an overview of the current World Health Organization (WHO) classification of gastric tumors.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Straße 3/14, 24105, Kiel, Deutschland.
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23
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Oguma J, Ozawa S, Kazuno A, Nitta M, Ninomiya Y, Tomita S. Two-year follow-up period showing the natural history of a superficial esophageal adenocarcinoma arising in a long segment of Barrett's esophagus. Clin J Gastroenterol 2016; 9:289-92. [PMID: 27590624 DOI: 10.1007/s12328-016-0681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Abstract
A 55-year-old woman experienced gastrointestinal dysfunction caused by scleroderma. An initial endoscopy revealed an erosive lesion in a long segment of Barrett's esophagus, and a biopsy led to a diagnosis of ectopic gastric mucosa. Two years later, an irregular, elevated tumor developed at the same site. This tumor was suspected of having invaded the submucosal layer. A second biopsy led to a diagnosis of adenocarcinoma. The patient subsequently underwent a thoracoscopic esophagectomy. The resected specimen revealed an invasive tumor front that had invaded the deep layer of a duplicated muscularis mucosae. Intraepithelial neoplasia partially surrounded the tumor. This lesion was thought to have developed into an adenocarcinoma according to the orderly sequence of metaplasia, intraepithelial neoplasia and finally adenocarcinoma over a 2-year period. The present case suggests that erosive lesions in Barrett's esophagus should be strictly followed up by endoscopy, even if a biopsy does not reveal any neoplastic findings.
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Affiliation(s)
- Junya Oguma
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Akihito Kazuno
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Miho Nitta
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yamato Ninomiya
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Sakura Tomita
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
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24
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Mastropasqua MG, Viale G. Clinical and pathological assessment of high-risk ductal and lobular breast lesions: What surgeons must know. Eur J Surg Oncol 2016; 43:278-284. [PMID: 27544280 DOI: 10.1016/j.ejso.2016.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/16/2016] [Accepted: 07/06/2016] [Indexed: 12/13/2022] Open
Abstract
Terminology in pathology is sometimes over-complicated and may be misinterpreted by clinicians facing patients and having difficulty answering questions posed by them. This may especially be true for some breast lesions with an increased risk of malignant transformation, the complex terminology of which reflects attempts to stratify them according to potential risk. On the basis of morphological and molecular features, both ductal and lobular proliferations have been classified and named in different ways by pathologists, and this often makes it difficult for the treating physicians and the patients to fully understand the nature of the lesions and their associated risks. In order to clarify pathology reports, unambiguous and simple terms are needed.
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Affiliation(s)
- M G Mastropasqua
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.
| | - G Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy; Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, School of Medicine, Milan, Italy
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25
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Abstract
Gastric dysplasia is a neoplastic lesion and a precursor of gastric cancer. The Padova, Vienna, and World Health Organization classifications were developed to overcome the discrepancies between Western and Japanese pathologic diagnoses and to provide a universally accepted classification of gastric epithelial neoplasia. At present, the natural history of gastric dysplasia is unclear. Much evidence suggests that patients with high-grade dysplasia are at high risk of progression to carcinoma or synchronous carcinoma. Therefore, endoscopic resection is required. Although patients with low-grade dysplasia have been reported to be at low risk of progression to carcinoma, due to the marked histologic discrepancies between forceps biopsy and endoscopic specimens, endoscopic resection for this lesion is recommended, particularly in the presence of other risk factors (large size; depressed gross type; surface erythema, unevenness, ulcer, or erosion; and tubulovillous or villous histology). Helicobacter pylori eradication in patients with dysplasia after endoscopic resection appear to reduce the incidence of metachronous lesions.
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Affiliation(s)
- Jae Kyu Sung
- Correspondence to Jae Kyu Sung, M.D. Department of Internal Medicine, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-280-7186 Fax: +82-42-254-4553 E-mail:
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26
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Ettel M, Eze O, Xu R. Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma. World J Hepatol 2015; 7:2563-2570. [PMID: 26557948 PMCID: PMC4635141 DOI: 10.4254/wjh.v7.i25.2563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia, where liver fluke infestation is high. However the etiology in western countries is unknown. Although the incidence of extrahepatic cholangiocarcinoma has remained constant, incidence of intrahepatic CC (ICC) which differs in morphology, pathogenesis, risk factors, treatment and prognosis is increasing. While this increase is associated with hepatitis C virus infection, chronic nonalcoholic liver disease, obesity, and smoking, the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated. Benign biliary lesions such as biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, von Meyenburg complex or bile duct hamartoma, and bile duct adenoma have been associated with ICC. For each of these entities, evidence suggests or supports a role as premalignant lesions. This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis.
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27
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de Witte CJ, van de Sande AJM, van Beekhuizen HJ, Koeneman MM, Kruse AJ, Gerestein CG. Imiquimod in cervical, vaginal and vulvar intraepithelial neoplasia: a review. Gynecol Oncol 2015; 139:377-84. [PMID: 26335596 DOI: 10.1016/j.ygyno.2015.08.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 01/22/2023]
Abstract
Human papillomavirus (HPV) infection is in the vast majority of patients accountable for the development of vulvar, cervical and vaginal intraepithelial neoplasia (VIN, CIN, VAIN); precursors of vulvar, cervical and vaginal cancers. The currently preferred treatment modality for high grade VIN, CIN and VAIN is surgical excision. Nevertheless surgical treatment is associated with adverse pregnancy outcomes and recurrence is not uncommon. The aim of this review is to present evidence on the efficacy, safety and tolerability of imiquimod (an immune response modifier) in HPV-related VIN, CIN and VAIN. A search for papers on the use of imiquimod in VIN, CIN and VAIN was performed in the MEDLINE, EMBASE and Cochrane library databases. Data was extracted and reviewed. Twenty-one articles met the inclusion criteria and were analyzed; 16 on VIN, 3 on CIN and 2 on VAIN. Complete response rates in VIN ranged from 5 to 88%. Although minor adverse effects were frequently reported, treatment with imiquimod was well tolerated in most patients. Studies on imiquimod treatment of CIN and VAIN are limited and lack uniformly defined endpoints. The available evidence however, shows encouraging effect. Complete response rates for CIN 2-3 and VAIN 1-3 ranged from 67 to 75% and 57 to 86% respectively. More randomized controlled trials on the use of imiquimod in CIN, VAIN and VIN with extended follow-up are necessary to determine the attributive therapeutic value in these patients.
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Affiliation(s)
- C J de Witte
- Universal Medical Center Utrecht, The Netherlands
| | - A J M van de Sande
- Erasmus MC Cancer Institute, Department of Gynaecology, Rotterdam, The Netherlands
| | - H J van Beekhuizen
- Erasmus MC Cancer Institute, Department of Gynaecology, Rotterdam, The Netherlands
| | - M M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A J Kruse
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
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28
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Liu FT, Ou-Yang X, Zhang GP, Luo HL. Progress in research of colorectal intraepithelial neoplasia and adenoma. Shijie Huaren Xiaohua Zazhi 2015; 23:3413-3420. [DOI: 10.11569/wcjd.v23.i21.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is a common malignant tumor in the digestive system, and the early diagnosis of colorectal cancer has been the focus of its prevention and control. Colorectal intraepithelial neoplasia and adenoma are considered to be the most important precancerous lesions of colorectal cancer. In recent years, with the development of biological medicine, genetics,
and other disciplines, many studies have explored the relationship between intraepithelial neoplasia and adenoma and colorectal cancer, and some new research progress has been achieved to provide some guidance for the future clinical screening, regular follow-up and chemical prevention. However, it remains to be studied how colorectal intraepithelial neoplasia and adenoma form and evolve to colorectal cancer.
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29
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Kim JW, Jang JY. Optimal management of biopsy-proven low-grade gastric dysplasia. World J Gastrointest Endosc 2015; 7:396-402. [PMID: 25901219 PMCID: PMC4400629 DOI: 10.4253/wjge.v7.i4.396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/22/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia (LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric high-grade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection (ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection (ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.
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Chang LL, Zhang KG. Progress in research of gastric intraepithelial neoplasia. Shijie Huaren Xiaohua Zazhi 2015; 23:1426-1432. [DOI: 10.11569/wcjd.v23.i9.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric carcinoma is one of the most common malignant tumors in the world, and the accurate diagnosis of precancerous lesions plays an important role in gastric cancer prevention. Intraepithelial neoplasia is a form of precancerous lesion of gastric cancer, and many efforts have been done to explore the relationship between gastric cancer and dysplasia. Recently, there has been much progress in the research of intraepithelial neoplasia, including genetic changes at the molecular level, the eradication of Helicobacter pylori (H. pylori), regular follow-up and endoscopic therapy. All of these will play an important role in clinical management of this condition. However, the etiological mechanism, influencing factors and malignant transformation of GIN are still unclear. Hence, further multi-center and long-term prospective studies are needed to solve these problems.
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31
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Trietsch MD, Nooij LS, Gaarenstroom KN, van Poelgeest MIE. Genetic and epigenetic changes in vulvar squamous cell carcinoma and its precursor lesions: a review of the current literature. Gynecol Oncol 2014; 136:143-57. [PMID: 25448458 DOI: 10.1016/j.ygyno.2014.11.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/29/2014] [Accepted: 11/02/2014] [Indexed: 11/20/2022]
Abstract
Vulvar cancer is a relatively rare gynecologic malignancy with an annual incidence in developed countries of approximately 2 per 100,000 women. Vulvar squamous cell carcinoma (VSCC) has two etiological pathways: a high risk human papillomavirus (HPV)-dependent route, which has usual vulvar intraepithelial neoplasia (uVIN) as a precursor lesion, and an HPV-independent route, which is associated with differentiated VIN (dVIN), lichen sclerosus, and genetic alterations, such as TP53 mutations. Research on the molecular etiology of vulvar cancer has increased in the past years, not only regarding genetic alterations, but also epigenetic changes. In genetic alterations, a mutation irreversibly changes the nucleotide sequence of the DNA, or the number of copies of chromosomes per cell is altered. In epigenetics, the nucleotide sequence remains the same but genes can be 'switched' on or off by, for example, DNA methylation or histone modification. We searched the current literature on genetic and epigenetic alterations in VSCC and its precursor lesions. Many studies have reported a higher incidence of somatic mutations in HPV-negative tumors compared to HPV-positive tumors, with TP53 mutations being the most frequent. Allelic imbalances or loss of heterozygosity are more frequently found in higher stages of dysplasia and in invasive carcinomas, but it is not exclusive to HPV-negative tumors. A limited number of studies are available on epigenetic changes in vulvar lesions, with hypermethylation of CDKN2A being the most frequently investigated change. For most genes, hypermethylation occurs more frequently in vulvar squamous cell carcinomas than in precursor lesions. As most studies have focused on HPV infection and TP53 mutations, we suggest that more research should be performed using whole genome or next generation sequencing to determine the true landscape of genetic and epigenetic alterations in vulvar squamous cell carcinoma.
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Affiliation(s)
- Marjolijn D Trietsch
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Linda S Nooij
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
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Boskovic A, Djuricic S, Grujic B, Stankovic I. Early onset of dysplasia in polyps in children with familial adenomatous polyposis: case report and literature review. Arab J Gastroenterol 2014; 15:88-90. [PMID: 25097054 DOI: 10.1016/j.ajg.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/28/2013] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Familial adenomatous polyposis (FAP) is one of the most common hereditary syndromes associated with an increased risk of colorectal cancer. Onset of polyp formation and cancer in childhood is very unusual but has recently been associated with a specific mutation at codon 1309 in exon 15 where a more severe phenotype is sometimes observed .We report a 12-year-old girl who presented with haematochezia. The girl's mother and aunt had died of colon cancer which developed from untreated FAP. The other two aunts also had FAP and underwent colectomy. Endoscopy showed extensive polyps presented on the luminal surface of the entire colon. Histomorphology confirmed a low grade of intraepithelial neoplasia (IEN) in three polyps and the patient underwent colectomy. We present a review of the literature focussed on early onset of IEN in polyps in children with FAP. CONCLUSION Clinicians should take note of the family history and be prepared to consider much earlier intervention if symptoms occur in a child with a family history of FAP.
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Affiliation(s)
- Aleksandra Boskovic
- Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia.
| | - Slavisa Djuricic
- Department of Pathology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
| | - Blagoje Grujic
- Department of Abdominal Surgery, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
| | - Ivica Stankovic
- Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
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33
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Abstract
Human papillomaviruses (HPVs) are ubiquitous, well adapted to their host and cleverly sequestered away from immune responses. HPV infections can be productive, subclinical or latent in both skin and mucosa. The causal association of HPV with cervical cancer, and increasingly with rising numbers of squamous cell carcinomas at other sites in both men and women, is increasingly recognised, while the morbidity of cutaneous HPV lesions, particularly in the immunosuppressed population is also significant. This chapter sets out the range of infections and clinical manifestations of the consequences of infection and its persistence and describes why HPVs are both highly effective pathogens and carcinogens, challenging to eliminate.
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Affiliation(s)
- Heather A Cubie
- HPV Research Group, University of Edinburgh MRC Centre for Reproductive Health, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, UK.
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34
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Fehr MK, Baumann M, Mueller M, Fink D, Heinzl S, Imesch P, Dedes K. Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia. J Gynecol Oncol 2013; 24:236-41. [PMID: 23875073 PMCID: PMC3714461 DOI: 10.3802/jgo.2013.24.3.236] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/10/2013] [Accepted: 04/13/2013] [Indexed: 11/30/2022] Open
Abstract
Objective The malignant potential of intraepithelial neoplasia of the vulva and vagina after treatment is not well defined. Our objective was to examine risk factors for recurrence and invasive disease. Methods Four hundred sixty-four women with biopsy proven high-grade intraepithelial neoplasia of the vulva and vagina were identified in the electronic databases of four colposcopy clinics. Inclusion criteria were a follow-up of more than one year, no history of invasive cancer and no invasive cancer within the first year after initial treatment. We investigated the potential factors associated with recurrence and progression using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 411 eligible patients, 123 patients (29.9%) recurred later than one year after initial treatment and 24 patients (5.8%) progressed to invasive disease. According to multivariate analyses, the risk factors associated with recurrence were multifocality (OR, 3.33; 95% CI, 2.02 to 5.51), immunosuppression (OR, 2.51; 95% CI, 1.09 to 5.81), excision as initial treatment (vs. laser evaporation; OR, 1.79; 95% CI, 1.11 to 2.91) and smoking (OR, 1.61; 95% CI, 1.02 to 2.55). Risk factors for progression to invasive disease were immunosuppression (OR, 4.00; 95% CI, 1.30 to 12.25), multifocality (OR, 3.05; 95% CI, 1.25 to 7.43) and smoking (OR, 2.97; 95% CI, 1.16 to 7.60), but not treatment modality. Conclusion Laser evaporation combined with extensive biopsy is at least as efficacious as initial treatment of intraepithelial neoplasia with excision. Smoking is a risk factor for both recurrence and progression to invasive disease. Hence, smoking cessation should be advised and maintaining a long follow-up period due to late relapses is necessary.
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Affiliation(s)
- Mathias K Fehr
- Department of Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland
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35
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Abstract
AIM: To investigate the expression of PI3Kp110α and PI3Kp110β in colorectal canceration and to analyze their correlation.
METHODS: PI3Kp110α and PI3Kp110β expression was detected by immunohistochemistry in 30 cases of normal colorectal mucosa, 46 cases of low-grade intraepithelial neoplasia (LGIN), 32 cases of high-grade intraepithelial neoplasia (HGIN) and 60 cases of colorectal carcinoma.
RESULTS: The expression of PI3Kp110α in colorectal carcinoma was significantly higher than that in normal colorectal mucosa and LGIN (both P < 0.05), but there was no significant difference between colorectal carcinoma and HGIN (P > 0.05). The expression of PI3Kp110β was highest in colorectal carcinoma, followed by HGIN, LGIN and normal colorectal mucosa (P < 0.05). PI3Kp110α expression was correlated with patient age, tumor size and tumor differentiation (all P < 0.05). PI3Kp110β expression was correlated with TNM stage and degree of tumor differentiation (both P < 0.05). The expression of PI3Kp110α was positively correlated with that of PI3Kp110β in LGIN (P < 0.05). There was no significant correlation between the expression of PI3Kp110α and that of PI3Kp110β in colorectal carcinoma, HGIN or normal colorectal mucosa (all P > 0.05).
CONCLUSION: PI3Kp110α and p110β may play different roles in colorectal canceration.
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Abstract
The development of precancerous lesions of gastric cancer is a critical stage of the evolution of gastric cancer. Early detection and intervention for these lesions are of considerable significance in reducing the morbidity of gastric cancer. The development of precancerous lesions of gastric cancer is controlled by multiple factors such as Helicobacter priori infection, DNA methylation, microsatellite instability, and p53 status. Because of high malignancy and unclear etiology of gastric cancer, there are certain difficulties in carrying out successful primary prevention. This review aims to review the recent advances in understanding the pathogenesis of and preventive strategies for gastric precancerous lesions.
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Abstract
Gastric cancer is a common disease that greatly endangers people's health. The mechanism of gastric carcinogenesis is still unknown. Gastric carcinogenesis is a long-term multistep process, during which a series of precancerous lesions develop sequentially. Intraepithelial dysplasia and intestinal metaplasia are two types of gastric precancerous lesions. Because of high malignancy and unclear etiology of gastric cancer, there are some difficulties in carrying out successful primary prevention. Here, we give an overview of the definitions and classification of gastric intraepithelial neoplasia and intestinal metaplasia, and elaborate the relationship among Helicobacter pylori infection, atrophic gastritis, intestinal metaplasia and gastric carcinoma.
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38
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Kim JM, Cho MY, Sohn JH, Kang DY, Park CK, Kim WH, Jin SY, Kim KM, Chang HK, Yu E, Jung ES, Chang MS, Joo JE, Joo M, Kim YW, Park DY, Kang YK, Park SH, Han HS, Kim YB, Park HS, Chae YS, Kwon KW, Chang HJ, Pathologists TGPSGOKSO. Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists. World J Gastroenterol 2011; 17:2602-10. [PMID: 21677827 PMCID: PMC3110921 DOI: 10.3748/wjg.v17.i21.2602] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/09/2010] [Accepted: 09/16/2010] [Indexed: 02/06/2023] Open
Abstract
The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important, but the diagnostic criteria, terminology, and grading system are not the same in the East and West. A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists, but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion. Although the Vienna classification was introduced to reduce diagnostic discrepancies, it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions. Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine. Japan is geographically close to Korea, and academic exchanges are active. Additionally, Korean doctors are familiar with Western style medical terminology. As a result, the terminology, definitions, and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea. To solve this problem, the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis: (1) a diagnosis of carcinoma is based on invasion; (2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching, budding, or marked glandular crowding; (3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts, the lesion is considered high grade dysplasia; (4) if severe cytologic atypia is present, careful inspection for invasive foci is necessary, because the risk for invasion is very high; and (5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern, papillae, ridges, vesicular nuclei, high nuclear/cytoplasmic ratio, loss of nuclear polarity, thick and irregular nuclear membrane, and nucleoli.
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Yang T, Zhang XQ, Zou XP. Clinical symptoms of esophageal intraepithelial neoplasia: an analysis of 101 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:2909-2912. [DOI: 10.11569/wcjd.v18.i27.2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical symptoms of esophageal intraepithelial neoplasia (EIN), their frequency, and relationship with disease location.
METHODS: One hundred and one patients with EIN treated by endoscopic mucosal resection (EMR) from January 2009 to December 2009 at the Affiliated Nanjing Drum Tower Hospital of Medical School of Nanjing University were enrolled in this study. The patients were given questionnaires to fill in the gastroesophageal symptoms they experienced. The data were then analyzed.
RESULTS: The study population consists of 71 men and 30 women. Of all the patients, 41.58% (42/101) had symptoms of sour regurgitation and belching, 27.72% (28/101) had substernal pain, and 2.97% (3/101) had no symptoms. The frequency of these symptoms is 2-3 d per week. The pathological results after endoscopic mucosal resection showed that 35 patients had high-grade intraepithelial neoplasia, 54 had low-grade intraepithelial neoplasia, and 12 had cancer. More patients with intraepithelial neoplasia in the middle of the esophagus had reflux symptoms than those with the lesions in the upper one third and lower one third of the esophagus (P < 0.001).
CONCLUSION: The majority of patients with EIN have reflux symptoms. The incidence of symptoms is related to the location of EIN. For patients with the above symptoms, comprehensive endoscopic and pathological examinations should be performed.
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Abstract
AIM: To explore the clinic features and turnover of chronic gastritis accompanying low-grade gastric intraepithelial neoplasia (LGIN).
METHODS: One hundred and five patients were pathologically diagnosed with LGIN by endoscopy and gastric biopsy. Pathological inflammation degree was determined. Intestinal metaplasia, endoscopic presentation, endoscopic grading of chronic gastritis and H pylori infection were investigated. Thirty one patients who joined in follow-up study underwent a follow-up gastroscopy examination 60 days later.
RESULTS: All patients were diagnosed with chronic gastritis accompanied with LGIN, including 38 patients with mild inflammation, 55 patients with moderate inflammation, 9 patients with severe inflammation and 3 patients with atrophic inflammation. Among them, 30 patients had intestinal metaplasia. In endoscopic diagnosis, there were 23 patients with superficial gastritis, 72 with erosive gastritis, 5 with hemorrhagic gastritis and 5 with atrophic inflammation. In grading diagnosis of chronic gastritis, there were 21 patients of one-grade, 28 of second-grade and 56 of third-grade. There were 31 patients who underwent a follow-up biopsy. Of them, 9 patients retained pathological diagnosis, 7 patients were adenomatoid hyperplasia and 15 patients were only chronic gastritis. H. pylori infection ratio was 72.4%.
CONCLUSION: Many types of chronic gastritis and a lot of endoscopic appearances can occur in LGIN. LGIN is more common in patients who have more severe inflammation in endoscopic appearance. LGIN is reversible by therapy.
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Zhong XG, Huang SR, Yin W, Mai W, Qin QZ. Clinicopathologic characteristics of high-grade colorectal intraepithelial neoplasia: analysis of 38 cases. Shijie Huaren Xiaohua Zazhi 2007; 15:1968-1971. [DOI: 10.11569/wcjd.v15.i17.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To reveal the clinicopathological features of high-grade colorectal intraepithelial neoplasia and discuss treatment strategy.
METHODS: Thirty-eight cases of high-grade colorectal intraepithelial neoplasia diagnosed by colonoscopy biopsy were treated and followed up for 3 to 36 months. A retrospective review of clinical findings, endoscopic and histopathological features, and prognosis was used to determine appropriate treatment and follow-up for high-grade colorectal intraepithelial neoplasia.
RESULTS: Among the 38 patients, 17 underwent a preoperative endoscopic biopsy and agreed to a surgical operation; lesions in 19 cases were endoscopically resected, while the remaining 2 cases just agreed to being followed-up. Seventeen cases were diagnosed with a malignant carcinoma, and 21 eventually showed high-grade colorectal intraepithelial neoplasia. Pathological diagnosis pre- and post-treatment showed poor consistency; the Kappa value was 0.376, and in the cases of endoscopic clamping biopsy it was 0.580. Of the patients undergoing surgical or endoscopic treatment, one with malignant carcinoma had liver metastasis, and one suffered a recurrence 11 months later. One case with high-grade colorectal intraepithelial neoplasia was found to have an adenocarcinoma at a previous endoscopic resection site after 3 months. There were no new tumors in the other cases during 3 years of follow-up. In accordance with the characteristics of carcinoma cases, cancer risk appears related to tumor size, endoscopic features, severity of clinical symptoms, the villous morphology of biopsy pathology, and a high level of CEA or CA19-9.
CONCLUSION: Close attention needs to be paid when using the WHO's new diagnostic standards of high-grade intraepithelial neoplasia instead of the prestage of tumors of the digestive system. Clinicians should be careful when choosing treatment for high-grade intraepithelial neoplasia, especially in cases of endoscopic clamping biopsy.
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