Gastric conduit reconstruction after esophagectomy with right gastroepiploic artery absence: a case report

Gastric conduit reconstruction is the standard choice after esophagectomy. Conduit's vascular supply is of primary importance mainly based on right gastroepiploic vessels. A 57-year-old male with absent right gastroepiploic artery, due to a duodenal bleeding ulcer treated with gastroduodenal artery ligation 10 years ago, was treated for gastroesophageal cancer and required esophagectomy. Surgical merits of this troublesome scenario are highlighted. Previous surgical history is highly important for patients requiring complex surgery as esophagectomy. The use of the stomach as conduit after esophagectomy is always the primary option; however vascular supply of it should not be compromised. Variations are rare and careful planning may overcome obstacles as in this case.

Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma

BACKGROUND

The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit.

METHODS

Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10-50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan-Meier and Cox regression analysis.

RESULTS

Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence.

CONCLUSION

Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.

Angioleiomyoma of the uterus: report of a distinctive benign leiomyoma variant

Angioleiomyoma is a relatively rare type of leiomyoma of the uterus that originates from smooth muscle cells and contains thick-walled vessels. Angioleiomyoma is usually found in the skin of the lower extremities. Uterine angioleiomyoma has similar morphological features to that of the skin. The authors present a case of a 50-year-old woman who was admitted to the present hospital with the complaint of lower abdominal pain. On clinical examination, she was found to have a palpable lower central abdominal mass. Pelvic ultrasound revealed uterine enlargement, multiple small leiomyomas, and a large mass in the myometrium. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy. On histological examination, the mass was diagnosed as angioleiomyoma. Hemangioma, angiofibroma or angiomyofibroblastoma were also included in the differential diagnosis. The treatment of choice for angioleiomyoma is surgical excision, and either angiomyomectomy or simple hysterectomy are proven to be equally effective; the decision depends on the patient's symptoms and her desire to preserve fertility.

Solid neuroendocrine carcinoma of the breast: a rare tumor

Solid Neuroendocrine carcinoma of the breast (SNECB) is a subtype of primary neuroendocrine carcinoma (NEC) of the breast with several distinctive features. In the present study, the authors report a case of 84-year old woman who was admitted in the hospital with a lump in her right breast. Mammography revealed a well-defined nodule in the outer lower quadrant of her right breast. She underwent lumpectomy and sentinel lymph node biopsy, which showed no metastasis. The histological diagnosis was solid neuroendocrine carcinoma of the breast. Microscopically, the tumor is formed from cells arranged in nests or trabeculae and separated by scant connective tissue. Immunohistochemical staining demonstrates strong positivity for NSE, chromogranin, synaptophysin, ER, and PR. The patient is still alive 14 months after diagnosis. Because of the rarity of this disease, there is no standard treatment protocol and a large variety of chemotherapy protocols have been employed in treating this disease.

Rare non-epithelial primary breast neoplasms: a ten-year experience at a Greek University Hospital

PURPOSE

Non-epithelial breast neoplasms cover a large spectrum of histopathological entities. The demographics and clinical features are similar to epithelial breast lesions but the diagnosis, prognosis and management options are often very different.

METHODS

During 2001-2010, 1362 patients were examined at the Pathology Department of the Aretaieion General Hospital for various breast lesions. All specimens were processed routinely and slides stained with hematoxylin-eosin were re-examined. The patient clinical records were examined for demographics, clinical presentation and therapeutic approach.

RESULTS

In 23/1362 cases (1.68%) pathological examination showed non-epithelial lesions: in 12/1362 cases (0.8%) haemangiomas (11 women, one man), in 4 /1362 cases (0.3%) myofibroblastomas (MFB), in 2/1362 cases (0.1%) primary breast non-Hodgkin's lymphoma (NHL), in 3 /1362 cases (0.2%) granular cell tumor (GCT), and in 2/1362 cases (0.1%) angiosarcomas (one developed after radiotherapy for breast cancer).

CONCLUSIONS

Non-epithelial primary breast tumors are rare (1.68%) and present significant difficulty in accurate preoperative diagnosis and in certain cases in pathological diagnosis as well, which is necessary for the selection of the appropriate treatment. Avoidance of inappropriate therapies requires a multidisciplinary management approach.

Expression of pSTAT3 in human colorectal carcinoma: correlation with clinico-pathological parameters

PURPOSE

Signal transducers and activators of transcription (STATs) are tyrosine phosphorylated transcription factors activated by the Jak family kinases. Various ligands, including interferons and growth factors induce activation of STATs. STATs are key signaling molecules in malignant transformation and tumor progression. Constitutive activation of the STAT3 has been observed in a wide variety of human malignancies. The purpose of this study was to evaluate the clinical significance of phosphorylated (p) STAT3 expression in human colorectal adenocarcinomas (CRC).

METHODS

135 primary human CRC were immunohistochemically studied, from which 11 were intramucosal and 124 invasive carcinomas. The observed pattern of pSTAT3 immunostaining was nuclear and cytoplasmic. Nuclear pSTAT3 staining was calculated as the number of pSTAT3 positive nuclei divided by the total number of nuclei in at least 10 fields, and then expressed as a percentage. Cytoplasmic positivity of pSTAT3 was measured, depending on the intensity of immunoreactivity and scored as mild, moderate and intense.

RESULTS

Positive staining for pSTAT3 immunoreactivity was significantly correlated with the depth of tumor invasion (p<0.001), venous invasion (p<0.05), lymph node metastasis (p<0.05) and advanced Dukes stage (p<0.001). There was no significant correlation between pSTAT3 immunoreactivity and poor differentiation of CRC.

CONCLUSION

The expression of pSTAT3 is an important factor related to tumor and vascular invasion, nodal involvement and advanced CRC stage.

Gastric calcifying fibrous tumor: a very rare case report

Calcifying fibrous tumor is a very rare benign mesenchymal tumor which shows a predilection for soft tissue, mesentery and peritoneum. Up to date only 7 cases have been reported in the literature confined to the gastric wall. We report a rare case of a calcifying fibrous tumor of the stomach in a 60-year-old man who presented with dyspepsia, flatulence and feeling weight. A clinical and laboratory investigation was performed with normal results. Gastroscopy revealed a bulge in the gastric body measuring 1 cm with normal overlying mucosa, and mucosal biopsies showed chronic gastritis. Endoscopic ultrasound of the gastric bulge showed a 1 × 0.8 cm hypoechoic lesion involving the gastric wall. After the above finding a wedge resection of the stomach was performed. Microscopically the lesion consisted of well-circumscribed hypocellular hyalinized fibrosclerotic tissue with lympoplasmatic infiltrates, lymphoid aggregates and psammomatous calcifications. Lesional cells were positive for vimentin and factor XIII and negative for actin, desmin, S100p, CD117, CD34, CD31 and ALK-1. The lesion involved the muscularis propria with variable submucosal extension. Calcifying fibrous tumor has shown an excellent prognosis with recurrences being rare and showing the same morphology as the primary lesion.

Synchronous primary adenocarcinoma and ancient schwannoma in the colon: an unusual case report

Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and colon schwannomas are extremely rare. We report a rare case of ascending colon schwannoma with associated synchronous adenocarcinoma of the sigmoid colon. A 68-year-old man presented with a 20-day history of bleeding per rectum. Colonoscopy revealed a mass of 4.2 cm in diameter with endoluminal protrusion in the sigmoid colon and a second submucosal tumor in the ascending colon. Surgical intervention was suggested and ileo-hemicolectomy was done. Microscopically, the submucosal tumor of 4 cm in diameter showed features of schwannoma with degenerative change (ancient schwannoma). Lesional cells were positive for S100p and negative for actin, desmin, CD34, CD117, and pankeratin. The mass showed features of an invasive moderately differentiated adenocarcinoma. Colon schwannoma is a rare submucosal tumor, and the incidental occurrence with adenocarcinoma has not been well described in the literature.