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Misdraji J.,Harvard University | Lauwers G.Y.,Harvard University | Irving J.A.,University of British Columbia | Batts K.P.,Virginia Piper Cancer Institute | Young R.H.,Harvard University
American Journal of Surgical Pathology

Appendiceal or cecal endometriosis uncommonly presents diagnostic challenges, but rare cases with intestinal metaplasia can mimic mucinous tumors of the appendix. We describe 6 cases of appendiceal or cecal endometriosis with intestinal metaplasia that grossly and microscopically mimicked appendiceal mucinous tumors. The cases were characterized by marked mural hypertrophy and elastosis, with distortion of the appendix, and virtual obliteration of the lumen of the appendix. All cases had conventional endometriosis, together with varying amounts of endometriosis with intestinal-type epithelium. In 2 cases, scant or virtually no stroma around some mucin-filled glands made their recognition as endometriosis more difficult. None of the cases had dysplasia of the mucinous epithelium. All patients had benign follow-up (mean 3.6 y). Endometriosis with intestinal metaplasia is a rare phenomenon that, when it occurs in the appendix or cecum, may lead to misdiagnosis as a low-grade appendiceal mucinous neoplasm or mucinous carcinoma. © 2014 by Lippincott Williams and Wilkins. Source

Siddiqui U.D.,Yale University | Rossi F.,Virginia Piper Cancer Institute | Padda M.S.,Yale University | Rosenthal L.S.,Yale University | Aslanian H.R.,Yale University

Background: Endoscopic ultrasound with fine needle aspiration (EUS-FNA) is used for the diagnosis of pancreatic malignancy. However, there are limited data as to patient preferences regarding the delivery of cancer diagnoses. Objectives: This study aimed to assess if patients had met the endosonographer before their EUS, their suspicion of having cancer, and whether they would like the cytology results given to them by their referring physician (with whom they had a previous relationship) or the endosonographer. This question was also asked with respect to the timing of receiving cytology results. Methods: A total of 131 patients with a suspected solid pancreatic mass undergoing EUS-FNA at 2 tertiary referral centers were prospectively enrolled and completed a preprocedure questionnaire. Results: One hundred twenty patients (92%) had not met the endosonographer before their EUS-FNA, and only 37 patients (28%) thought they had a pancreatic malignancy. Of the 131 patients, 89 (68%) stated that they wanted to hear results from the endosonographer (P = 0.0001) and 100 patients (76%) chose to hear results as soon as possible from the endosonographer (P = 0.001). Conclusions: Our data highlight the importance of the endosonographer's role in the delivery of cancer diagnoses and that patients value expediency of reporting results over long-term physician relationships. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Chun Y.S.,Virginia Piper Cancer Institute | Huang M.,Fox Chase Cancer Center | Rink L.,Chase Medical | Von Mehren M.,Chase Medical
World Journal of Surgical Oncology

Background: The insulin-like growth factor (IGF) pathway is implicated in the pathogenesis of hepatocellular carcinoma (HCC) and may be important in nonalcoholic fatty liver disease (NAFLD). The aim of this study is to determine expression levels of IGFs and receptors in NAFLD-associated HCC.Methods: Tissue microarrays were constructed from patients who underwent hepatectomy for HCC. Immunohistochemistry was performed using antibodies for IGF ligands and receptors. Immunostain results were scored by a pathologist blinded to clinical data.Results: Among 27 patients with HCC, the most common underlying liver diseases included NAFLD, hepatitis C, and alcoholic hepatitis. Expression levels of IGFs and receptors were not associated with patients' underlying liver disease. In all patients, IGF-2 expression was upregulated in tumor and adjacent non-neoplastic liver. Expression of IGF-1 was low in adjacent liver in 6 of 10 patients with cirrhosis, compared with 2 of 17 patients without cirrhosis (P = 0.025). Higher IGF-1 expression in liver adjacent to tumor was associated with poorer median survival of 22 months, compared with 72 months with equal or lower IGF-1 expression in adjacent liver relative to tumor (P = 0.006).Conclusions: Our preliminary results demonstrate significant associations between IGF-1 expression and liver cirrhosis and survival after resection in patients with HCC, independent of their underlying liver disease. © 2014 Chun et al.; licensee BioMed Central Ltd. Source

Sjogren P.P.,University of Minnesota | Banerji N.,John Nasseff Neuroscience Institute | Batts K.P.,Pathology | Graczyk M.J.,Minnesota Oncology | Dunn D.H.,Virginia Piper Cancer Institute
International Journal of Surgery Case Reports

INTRODUCTION Gastrointestinal stromal tumors (GISTs) of the alimentary canal are malignant tumors with <1% of cases diagnosed in esophagus. These cases require special consideration given their close proximity to vital structures and propensity to be highly aggressive. Management of patients with GISTs has been transformed since the introduction of tyrosine kinase inhibitors. In this report, we present an unusual case of GIST with spontaneous esophageal perforation. PRESENTATION OF CASE A 39-year-old Caucasian male presented to our hospital with complaints of severe chest and abdominal pain. A diagnostic chest radiograph revealed a moderate right-sided pleural effusion. Subsequently, an esophagram demonstrated a perforation proximal to an elongated stricture in the distal esophagus. A left thoracotomy was performed whereby a large mediastinal mass firmly attached to the esophagus and gastroesophageal junction was encountered. The neoplasm involved proximal one-third of the stomach and perforated into the right hemithorax. Histopathological evaluation of the tumor led to a diagnosis of GIST. DISCUSSION GISTs of the gastroesophageal junction are uncommon and may rarely present with esophageal perforation. The standard of care for treating GIST at present includes tyrosine kinase inhibitors. This pharmacologic agent, along with improved surgical techniques and understanding of molecular markers for accurate diagnosis, will assuredly continue to improve overall survival of patients with GISTs. CONCLUSION When stricture or achalasia is detected on imaging, GIST should be considered in the differential diagnosis for individual patients. Additionally, chest and abdomen CT scans of may be performed to confirm presence of a tumor mass, thereby ruling out achalasia. © 2013 Surgical Associates Ltd. Source

Dragovich T.,Banner Anderson Cancer Center | Dragovich T.,Arizona Cancer Center | Laheru D.,Johns Hopkins University | Dayyani F.,Banner Anderson Cancer Center | And 11 more authors.
Cancer Chemotherapy and Pharmacology

Purpose: Vatalanib (PTK 787/ZK22584) is an oral poly-tyrosine kinase inhibitor with strong affinity for platelet-derived growth factor and vascular endothelial growth factor (VEGF) receptors. We conducted an open-label, phase II multicenter therapeutic trial investigating the efficacy and tolerability of vatalanib in patients with metastatic or advanced pancreatic cancer who failed first-line gemcitabine-based therapy. Methods: Vatalanib treatment consisted of a twice daily oral dosing using a "ramp-up schedule," beginning with 250 mg bid during week 1,500 mg bid during week 2, and 750 mg bid on week three and thereafter. The primary objective of this study was to evaluate the 6-month survival rate. Results: Sixty-seven patients were enrolled. The median age was 64, and 66 % (N = 43) had only one prior regimen. Common grade 3/4 adverse events included hypertension (20 %; N = 13), fatigue (17 %; N = 11), abdominal pain (17 %; N = 11), and elevated alkaline phosphatase (15 %; N = 10). Among the 65 evaluable patients, the 6-month survival rate was 29 % (95 % CI 18-41 %) and the median progression-free survival was 2 months. Fifteen patients survived 6 months or more. Two patients had objective partial responses, and 28 % of patients had stable disease. Changes in biomarkers including soluble VEGF and vascular endothelial growth factor receptor did not correlate with response to drug. Conclusion: Vatalanib was well tolerated as a second-line therapy and resulted in favorable 6-month survival rate in patients with metastatic pancreatic cancer, compared with historic controls. © 2014 Springer-Verlag. Source

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