[Endoscopic ultrasonography in the diagnosis of submucosal tumors of the upper digestive tract]
Berenstein E. Ghigliani M. Caro L. Uehara U.
Division Gastroenterologia, Hospital de Clinicas Jose de San Martin, UBA.
Endoscopic Ultrasonography (EUS) was performed in 520 patients. In 78 subjects, it was indicated because of endoscopic suspicion of submucosal tumors (SMT), later confirmed in 67 patients. Thirty seven patients were symptomatic; in 22 patients the finding was incidental and in 7 the indication was unknown. According to the ecogenic pattern of the lesions found and the layer of the tumor origin the following were diagnosed: 14 leiomyomas, 1 lipoma, 3 granular cell tumors and 2 without precise diagnosis in the esophagus. Thirty leiomyomas, 6 leiomyosarcomas, 4 lipomas, 4 ectopic pancreas and 2 without precise diagnosis in the stomach. One leiomyoma in the duodenum. From the 11 SMT initially suspected by endoscopy which showed an integrity of the wall there were 10 extrinsic compressions and 1 without pathological findings. To date, surgery was performed on 22 patients with SMT complicated with ulcer and/or hemorrhage and on those larger than 3 cm with an ecogenic pattern, suspected of malignancy. Thirteen gastric leiomyomas, 2 gastric lipomas and 1 ectopic pancreas, with a 100% correlation in the postresection histological studies, 2 Abricosoff tumors of the esophagus, 2 leiomyosarcomas with 100% correlation and a giant lipoma of the esophagus which resulted in a liposarcoma, and 1 leiomyoma which resulted in a leiomyosarcoma were found. According to these results 90% diagnostic specificity and 100% sensitivity make this imaging technique the ideal method to evaluate these lesions and one of the main indications together with the staging of gastrointestinal tumors.
[Post-treatment assessment of Helicobacter pylori eradication, by polymerase chain reaction in gastric biopsies]
Pedrana R. Pigatto V. Fay M. Naves A. Begnis S. Banchio C. Trini E. Fay F.
Centro de Gastroenterologia.
BACKGROUND: The pre-treatment detection of H.p. in the stomach of patients is easily achieved with routine methods. Conversely, with conventional methods, it is difficult to detect the presence of H.p. after treatment. OBJECTIVE: To estimate the actual percentage of successfully treated patients by using a more sensitive and specific technique (PCR) in the same biopsies where standard methods were negative for H.p. MATERIALS AND METHODS: We selected 97 treated patients (31 Gastric Ulcers/66 Duodenal Ulcers, 62 male/35 female, age: 49 +/- 14 years), in whom success of treatment was defined by histological means and CLO Test. In the same gastric biopsies H.p-DNA PCR was performed. Different therapeutic schemes were utilized, but all included Proton Pump Inhibitors + ATB. Eight weeks after the end of the treatment, without medication, the patients were controlled as follows: 5 biopsies per patient, 2 of antrum, 2 of corpus (in different zones) and 1 for CLO Test. H.p. eradication was defined on histological grounds (gastric biopsy histology: 10% formaldehide buffer fixation, paraffin inclusion, Giemsa, HE staining and inmunohistochemistry), CLO Test (Delta West Pty. Ltd. Bentley, Australia) and by the absence of H.p.-DNA by PCR (amplification of a 296 bp of the species-specific antigen of H.p. and visualization of the amplified product in agarose gel with Ethidium Bromide and UV light). RESULTS: [table: see text] CONCLUSIONS: The higher sensitivity of PCR (10(3) fold more than conventional methods) allowed us in this group of patients to detect 13% of false eradication. It would be necessary to follow up this group of patients in order to know whether they develop or not clinical symptoms and/or histological evidence of disease. If such a case PCR could become an important tool for treatment evaluation.
[Neoadjuvant therapy in advanced carcinoma of the esophagus: prognostic value of the histopathological response]
Giacoia A. Dodoli C. Thomas P. Giudicelli R. Fuentes P.
Hospital Santa Margarita, Marsella, Francia.
The purpose of this study was to determine the prognostic value of the histopathological response to preoperative radio-chemotherapy in patients with locally advanced oesophageal cancer. Among the 57 patients included in this open prospective study, the disease-free cervical of 48 patients who underwent an oesophagectomy was correlated with the histopathological finding. The 5-years probability of disease-free cervical was 22.1%. Cervical of the patients whose tumor had been downstaged to no residual carcinoma or superficial oesophageal carcinoma was significantly shorter than that of patients with superficial oesophageal carcinoma at presentation treated during the same period (35% vs 57%). Univariate analysis could identify 4 prognostic variables after induction therapy: adenocarcinoma, macroscopic, residual tumor, invaded oesophageal stump, and lymph node involvement. After multivariate analysis according to the Cox model, the remaining independent predictors of recurrence were: adenocarcinoma, invaded oesophageal stump, and lymph node involvement.
[Functional characteristics of the Langerhans islets in type I gastric heterotopic pancreas]
Gualco Neves G. Angujar Blanco R. Ortega Ortuzar V. Pizzarossa C.
Departamento de Anatomia Patologica, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay.
In a retrospective five years study of gastric wall tumors, we selected the type 1 heterotopic pancreas. The assessment of fibrosis and inflammatory infiltrate were performed. Also the immunohistochemical evaluation with monoclonal antibodies for insulin, glucagon, p substance, somatostatin, gastrin and antichimotrypsin. None of the case showed remarkable fibrosis or inflammatory infiltrate. All the Langerhans's islets stained positive for 2 or 3 hormones, gastrin and antichimotrypsin were always negative. These findings are comparable with others previously reported, but no cases of evaluation of islet's gastrin exist in the literature reviewed.
[Human papillomavirus, neonatal giant cell hepatitis and biliary duct atresia]
Drut R. Gomez MA. Drut RM. Cueto RE. Lojo M.
Servicio de Anatomia Patologica, Hospital de Ninos Sor Maria Ludovica, La Plata.
We previously recognized the presence of HPV-DNA in cases of idiopathic neonatal giant cell hepatitis (INGCH) and extrahepatic biliary duct atresia (EBDA) in archivated tissue using the PCR technique. In order to investigate a possible vertical transmission we looked for the presence of HPV-DNA in cervical swabs in the mothers along with formalin-fixed paraffin-embedded hepatic tissue from 3 infants with INGCH and 4 patients with EBDA by nested-PCR. Cervical smears showed koilocytosis consistent with HPV infection in 2 cases. Delivery was vaginal except for one that was by cesarean section. All infants were males. Amplification of HPV-DNA was demonstrated in all cases, the types being concordant in infants and mothers. Although this is a small group, the findings appear in line with previous data. The presence of the same type of HPV-DNA in the infants' livers and their mothers' cervical swabs is another argument supporting the possibility of vertical transmission of the virus.
[Congenital dilatation of extrahepatic bile ducts]
Nari G. Moreno E. Nassar M. Mana R. Lopez Vinuesa F. Prenna J.
Servicio de Cirugia III del Hospital San Roque, Cordoba, Republica Argentina.
The authors present 3 cases of congenital dilatation of extrahepatic bile ducts and performed a review of the bibliography of this frequent pathology. They concluded that the diagnosis could be difficult in the pre-operatory and the cholangeographic methods are the beds. The treatment of choice in the actuality is the ++quistectomy with hepaticojejunostomy in "Y of Roux".