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1/49. Treatment of upper abdominal malignancies with organ cluster procedures.

    Upper abdominal exenteration for upper abdominal malignancies was carried out in 15 patients with removal of the liver, spleen, pancreas, duodendum, all or part of the stomach, proximal jejunum and ascending and transverse colon. Organ replacement was with the liver, pancreas and duodenum plus, in some cases, a short segment of jejunum. Eleven of the 15 patients survived for more than 4 months; 2 died, after 61/2 and 10 months, of recurrent tumor. Of the 9 patients who are surviving after 61/2 to 14 months, recurrent tumor is suspected in only 1 and proven in none. Four patients with sarcomas and carcinoid tumors (2 each) have had no recurrences. The other 5 survivors had duct cell cancers (3 examples), a cholangiocarcinoma (1 example), and a hepatoma (1 example). The experience so far supports further cautious trials with this drastic cancer operation.
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2/49. Endosonographic examination of gastrointestinal anastomoses with suspected locoregional tumor recurrence.

    BACKGROUND: Endoscopic ultrasound is considered one of the best tools for the preoperative staging of esophageal, gastric, and rectal carcinoma. Depending on the individual investigator, the sensitivity of preoperative tumor staging by endosonography of the upper gastrointestinal tract (GEUS) is 80-92% for gastric carcinoma and 86-95% for esophageal carcinoma. However, the sensitivity and specificity of endosonography for the staging of lymph node metastases is less accurate. The accuracy of rectal endosonography (REUS) is approximately 90% for tumor assessment and approximately 80% for the detection of lymph node metastases. In this study, we address the question of whether endosonography enables the surgeon to distinguish scar tissue, which is rather homogeneous and echo-rich, from changes such as an anastomositis or a locoregional tumor recurrence, which are typically non-inhomogeneous and echo-poor. methods: During a 24-months period, we studied patients enrolled in a special tumor follow-up care program by either upper gastrointestinal (GEUS, n = 37 patients) or rectal endosonography (REUS, n = 49 patients) for exclusion of a locoregional tumor recurrence. In each patient, local tumor recurrence was suspected because of either medical history, clinical examination, or other diagnostic procedures. RESULTS: As in previous studies, our retrospective analysis revealed that endosonography has a high sensitivity in the detection of local tumor recurrences (>90%) for both GEUS and REUS. CONCLUSION: endosonography is a highly accurate means of detecting local tumor recurrence.
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3/49. Gastrointestinal presentation of germ cell malignancy.

    OBJECTIVES: To summarize monoinstitutional experience with gastrointestinal (GI) presentations of germ cell malignancy and to review recent medical literature on this issue. methods: Retrospective review of 5 cases with advanced germ cell malignancy (testicular 2 and retroperitoneal 3) and involvement of the upper GI tract and a comparison with published observation. RESULTS: In 4 patients the duodenum and in 1 patient the distal part of the esophagus were involved in germ cell malignancy. In 3 patients grade 3 or grade 4 anemia represented the principle initial symptom. Ulceration of the upper GI tract was in 1 case complicated by an aortoduodenal fistula with rupture of the aorta. This patient and 2 other cases needed emergency surgery due to GI hemorrhage before and/or during the initial phase of chemotherapy. Our observations compare well with the literature, showing the need of multimodality therapy of these complications. CONCLUSION: In young males with a malignant tumor in the upper GI tract, the diagnosis of germ cell malignancy should be considered. Treatment of this condition requires a multimodality approach, not rarely including emergency surgery. Though these patients often belong to a poor-prognosis group, our results and the literature review show that long-term survival is possible using modern treatment principles. In particular, the risk of GI hemorrhage, during the initial phase of therapy, should not be overseen.
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4/49. Dual presentation of extranodal marginal B-cell lymphoma involving the skin, viscera and bones.

    A 65-year-old man presented with an erythematous indurated plaque on the scalp and forehead. A low-grade marginal-zone B-cell lymphoma with small cells and kappa-chain monoclonality was diagnosed. radiotherapy was initiated. He soon developed abdominal pain and hematemesis. A high-grade marginal-zone B-cell lymphoma with large cells and lambda-chain predominance was disclosed infiltrating the stomach and lungs. Bone localizations were also found. There was no evidence for lymph node and bone marrow involvement. The distinct cytological and immunophenotypic presentations in the skin and viscera are a puzzling finding.
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ranking = 1.6377639316278
keywords = abdominal pain
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5/49. Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology.

    BACKGROUND: Case studies are presented of fluorescence endoscopy in the upper and lower GI tract to illustrate the ability to detect early-stage lesions that were not observable with white light endoscopy or those in which the assessment of the stage or extension of the lesion were equivocal. methods: A new fluorescence imaging system was used in which blue light excites the naturally-occurring fluorescence of tissues (autofluorescence). The system produces real-time, false-color images that combine green and red fluorescence intensities. In general, abnormal lesions are seen to have an increase in the red-to-green fluorescence intensity compared with surrounding tissue. This system was evaluated in patients at 4 participating institutions, concurrently with standard white light endoscopy, with or without dye staining. RESULTS: Selected cases are presented in which fluorescence imaging identified specific lesions including focal high-grade dysplasia in Barrett's mucosa, signet ring carcinoma of the stomach, and flat adenoma in the colon. CONCLUSIONS: The capability of autofluorescence endoscopy to detect the presence and extent of occult malignant and premalignant GI lesions has been demonstrated. The future development and evaluation of this technology are discussed.
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6/49. Symptomatic lipomas of the gastrointestinal tract.

    Eleven patients with symptomatic lipomas of the gastrointestinal tract have been observed. The lipomas generally are relatively large, and the signs and symptoms consist mainly of abdominal pain and chronic blood loss. These lesions most commonly are seen in the colon and in the region of the ileocecal valve and less commonly in the small intestine, stomach and esophagus. Distinguishing thest tumors from carcinomas or sarcomas may be difficult, and patients are generally in the same age range as those with cancer. Roentgenologic contrast studies are helphful in localizing the tumors, but accurate tissue diagnosis usually is not made until the lesions are excised. Operative management by either local excision or segmental resection is required, and the prognosis is excellent.
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ranking = 1.6377639316278
keywords = abdominal pain
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7/49. Mixed neuronal-glial tumor of the digestive tract: distinctive entity from gastrointestinal stromal tumor?

    A 53-year-old-woman presenting with pelvic discomfort was found to have a 9.5 cm tumor located in the wall of the ileon. light microscopy showed that the tumor was made of fascicles of plump spindle cells and bizarre epithelioid cells. A cuff of lymphoid cells was also present at the tumor margin. The tumor cells strongly expressed tau protein, neuron-specific enolase, protein green product 9.5 and glial fibrillary acid protein (GFAP), but did not show positive immunostaining for S-100 protein, CD34 or CD117. The tumor showed unequivocal ultrastructural evidence of neural differentiation. Skeinoid fibers were scattered throughout the tumor. This is the first mixed neuronal-glial tumor of the digestive tract to be described in the literature. Such histological and immunohistochemical features could be misinterpreted as features of digestive schwannoma. We suggest that this tumor is distinct from gastrointestinal stromal tumors in lacking CD34 and CD117 expression.
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keywords = discomfort
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8/49. A malignant gastrointestinal stromal tumor with osteoclast-like giant cells.

    gastrointestinal stromal tumors (GISTs) are a heterogeneous group of mesenchymal tumors with a wide spectrum of histologic features and consistent expression of c-Kit. We describe an 85-year-old woman who presented with left lower quadrant abdominal pain and was subsequently diagnosed as having a malignant GIST. The tumor was composed of short fascicles of spindle cells. In addition to the presence of tumor giant cells, the tumor also demonstrated many osteoclast-like giant cells, a feature that has not been previously described in the literature. These giant cells expressed histiocytic markers CD68 and alpha(1)-antitrypsin but not c-Kit, a marker for GISTs. Electron microscopy showed no features of smooth muscle differentiation in the giant cells. The possible origin of the osteoclast-like giant cells is discussed in the context of immunohistochemical and ultrastructural characteristics.
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ranking = 1.6377639316278
keywords = abdominal pain
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9/49. Gastrointestinal stromal tumor (GIST) and ulcerative colitis.

    A 57 year old woman, affected by Ulcerative colitis (UC) in remission, was admitted to our unit with a history of episodic melena and progressive anemia. Computed tomography (CT) of the abdomen revealed a solid mass in the upper left pelvic cavity. After surgical laparotomy, the mass showed histological characteristics of a gastro intestinal stromal tumor. This report describes a GIST in a patient with extensive UC, which was in remission at the time of diagnosis. To our knowledge, this is the first report of an association of this type.
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10/49. Merkel cell carcinoma: a report of gastrointestinal metastasis and review of the literature.

    Merkel cell carcinoma (MCC) is an uncommon, highly aggressive cutaneous neoplasm of neuroendocrine differentiation with a poor prognosis. MCC most often presents as a painless, firm, raised lesion in sun-exposed sites of the head and neck region of the elderly. We report a case of a metastatic MCC to the stomach presenting as upper gastrointestinal bleeding. To our knowledge, this is the second reported case of MCC presenting as upper gastrointestinal bleeding and the first case confirmed by the newer immunohistochemical techniques. The literature is reviewed.
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ranking = 0.4
keywords = upper
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