A 66-year-old woman suffering from skin paleness and weakness presented an increasing hypochromic, microcytic anemia. Diagnostic: In an ambulant setting a capsule endoscopy of the small intestine was ...carried out because of multiple polyps of the colon (colonoscopy) in addition to non-invasive (Hämoccult-Test) and invasive (gastroscopy) diagnostic. The patient was then admitted to hospital to clarify a suspicious ulcer of the small bowl. According to biopsies taken via balloon enteroscopy, an adenocarcinoma of the small intestine was diagnosed.
After staging and exploratory laparotomy, histology findings showed an advanced tumour stage. A palliative chemotherapy, analogue to colon cancer treatment, was conducted.
Small bowel diagnostics should be carried out if the aetiology of an anemia is not certain with an existing polyposis of the colon. Individuals with personal or family history of cumulative colorectal adenomas should undergo assessment for an adenomatous polyposis syndrom.
Barrett’s Oesophagus Kiesslich, Ralf; Dunbar, Kerry; Neurath, Markus F.
Atlas of Endomicroscopy,
2007
Book Chapter
Barrett’s oesophagus is known to be a premalignant condition in patients with gastroesophageal reflux disease, and most adenocarcinomas of the distal oesophagus have been shown to arise in Barrett’s ...tissue. Barrett’s oesophagus is defined histologically by the presence of specialised columnar epithelium (SCE) with goblet cells. The columnar-lined lower oesophagus can be identified during standard upper endoscopy. SCE is often present in a patchy mosaic contribution within columnar-lined lower oesophagus and can be overlooked by random biopsies, resulting in biopsies of the cardia or gastric type of mucosa without goblet cells. However, it has been suggested that four-quadrant step biopsies within the columnar-lined lower oesophagus should serve as the gold standard for diagnosing Barrett’s epithelium and Barrett’s-associated neoplastic changes.
The different components making up the complement of immune elements within the alimentary tract vary greatly. In contrast to the Waldeyer’s ring region, the oesophagus and stomach are normally ...almost devoid of such immune apparatus, presumably because of the rapid transit of food and the chemically hostile environment for micro-organisms provided by salivary and gastric secretions. Only in pathological conditions, such as viral or fungal oesophageal infections, reflux oesophagitis or Helicobacter gastritis, does one encounter acquired mucosa-associated lymphoid tissue in these sites 1. By contrast, the large and small bowel normally possess mucosa-associated lymphoid tissue (MALT), most visibly concentrated in the terminal ileum and appendix.
Colorectal cancer is still one of the leading causes of cancer-related death in the Western world. Screening colonoscopy is widely accepted as the gold standard for early diagnosis of cancer. The ...prognosis for patients with colonic neoplasms is strictly dependent on the depth of infiltration and therefore depends on early detection of pre-invasive and neoplastic changes. Early detection makes it possible to cure the patient by means of immediate endoscopic resection.
For ex vivo histological examination of the gastrointestinal tract, fractions of an organ or small pieces of tissue are needed. Several steps are used in the fixation, staining, and mounting process ...to ensure production of good-quality histology on glass slides. The most frequently used stain in routine histology is the haematoxylin and eosin (H&E) stain. The most frequently used tissue-staining methods are shown in ⊡ Table 6.1. The final histopathological diagnosis is always based on examination of the whole sample and the structure and architecture of that sample. In cytology, single cells and nuclei are used for making a diagnosis, so staining procedures in cytology are much faster and easier to perform.
In vivo functional and molecular imaging is an emerging new field in gastroenterology. Ex vivo histopathological examination of tissue specimens offers a snapshot view into the tissue, capturing the ...moment at which the biopsy has been taken. The specimen is subjected to the fixation and staining process, making it prone to artefact. In vivo imaging with confocal endomicroscopy, however, offers the possibility of dynamic monitoring of the living tissue without the need for fixation. To our current knowledge, staining with intravenous fluorescein sodium or topical acriflavine hydrochloride does not alter tissue properties in a way that could influence biological processes. Therefore, with confocal endomicroscopy, a time axis inherent to biological processes can be added to a mere morphological visualisation at a given time point. In this way, confocal endomicroscopy is quite analogous to continuous macroscopic imaging by ultrasonography, providing dynamic microscopic imaging of perfusion and cellular and subcellular function.
Signalling pathways such as Hedgehog (Hh), Wnt, Notch, bone morphogenetic protein (BMP) and transforming growth factor-β (TGF-β) hold a central position in regulation of vertebrate development by ...controlling vital processes such as migration, differentiation and proliferation. Insights into the mechanistic aspects of cancer initiation and progression have pointed to striking similarities between tumourigenesis and embryonic development. These observations can partly be explained by the fact that similar cellular signalling mechanisms are employed in both situations. This review focuses on the role and therapeutic potential of Hh, Wnt, Notch and BMP/TGF-β signalling and discusses i) their signal transduction mechanisms during development and tumourigenesis, ii) evidence of pathway activation in different types of cancers, and, iii) strategies for pharmacological targeting. Numerous studies have demonstrated a crucial role of developmental signalling in a variety of tumours, where their signalling mechanisms contribute to oncogenic properties such as tumour cell proliferation, apoptosis inhibition and / or metastatic migration. From the literature available, it is obvious that the relative importance and the oncogenic mechanisms of developmental pathways vary with the tumour type, the stage of the disease as well as the interaction with the tumour microenvironment, thus highlighting the complexity of cellular signalling strategies employed during tumourigenesis. Intensive research activities are devoted to identification of drugs that interfere with oncogenic signalling by developmental pathways. First clinical data for such compounds--e.g. GDC-0449 for the Hh pathway--are promising and indicate that targeted therapy of developmental signalling pathways has potential for future anti-cancer therapies.
Cancer cells frequently exhibit dysfunctional oxidative phosphorylation (OXPHOS) and a concomitant increase in glycolytic flux. We investigated the expression of OXPHOS complex subunits and ...mitochondrial mass in 34 human cholangiocellular carcinomas (CCCs) and adjacent normal tissue by using tissue microarrays. In the tumor periphery, all OXPHOS complexes were reduced except complex I. In addition, significantly lower levels of complex IV were found at the tumor center (
< 0.0001). Mitochondrial mass, as indicated by VDAC1 expression, was significantly increased in CCCs compared to corresponding normal tissue (
< 0.0001). VDAC1 levels were inversely correlated with UICC (Union Internationale Contre le Cancer) cancer stage classification (
= 0.0065). Furthermore, significantly lower VDAC1 was present in patients with lymph node involvement (
= 0.02). Consistent with this, patients whose carcinomas expressed VDAC1 at low to moderate levels had significantly reduced survival compared to high expressors (
< 0.05). Therefore, low mitochondrial mass is associated with more aggressive CCC. These metabolic features are indicative of a Warburg phenotype in CCCs. This metabolic signature has potential therapeutic implications because tumors with low mitochondrial function may be targeted by metabolic therapies such as a high-fat, low-carbohydrate ketogenic diet.
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