Assessment of malignant potential in gastrointestinal stromal tumors (GISTs) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of ...GISTs. The Ki-67 labeling index has recently been used as an index of cell growth, and the prognosis of GISTs was reported to be significantly poor when the value of this index was 10% or higher.
Clinicopathological and immunohistological factors were analyzed in 15 patients who underwent surgical resection of gastric stromal tumors at our department between April 1997 and July 2002. The patients were divided into "metastasis/recurrence" and "benign" groups. Also, the relationship of changes in the Ki-67 labeling index to the degree of malignancy in recurrent lesions was assessed in an 84-year-old woman who underwent five reoperations because of recurrences in the peritoneum.
Significant differences were noted between the metastasis/recurrence and benign groups in relation to the mean maximum tumor diameter (186.7 +/- 80.8 mm vs 41.3 +/- 22.9 mm), mitotic index (88.3 +/- 5.0/50 high-power fields HPF vs 3.0 +/- 2.9/50 HPF), and the Ki-67 labeling index (11.4 +/- 2.5% vs 0.01 +/- 0.51%). In the patient who had metastasis to the liver 3.5 years after initial operation and underwent five reoperations before death, the intervals until detection of recurrence tended to be shortened gradually. The Ki-67 labeling index varied with each operation, and tended to be higher at the time of reoperations than at the initial operation.
The maximum tumor diameter, mitotic index, and Ki-67 labeling index were useful as an index of malignancy for gastric stromal tumor. The efficacy of surgical resection alone may be insufficient in patients with disseminated metastasis to the peritoneum.
Chronic hepatitis C virus (HCV) infection has also been associated with the development of several extrahepatic alterations, including thrombocytopenia, and a variety of pathogenic mechanisms are ...reported to be implicated in this hematological abnormality. Different studies have succeeded in detecting HCV in platelets with discrepant results. Moreover, most of the studies on HCV-associated thrombocytopenia have failed to provide data concerning the infecting genotype, a factor with prognostic implication in chronically HCV-infected patients. To determine whether thrombocytopenia is an extrahepatic alteration dependent on particular HCV genotypes, and to assess the relationship between thrombocytopenia and detection of HCV-RNA (positive strand) in platelets from patients with chronic HCV infection, 106 anti-HCV+/HCV-RNA+ patients (57 thrombocytopenic and 49 non-thrombocytopenic) were prospectively studied. The infecting genotype was analyzed from sera by using direct nucleotide sequencing of the polymerase chain reaction (PCR) products from core region. Genotypes 1a, 1b, and 3a were more prevalent in our patients, and no association between these genotypes and thrombocytopenia was observed ( p=0.891). HCV-RNA was detected in platelets by reverse transcriptase (RT)-nested PCR in the 5' non-coding region with a higher frequency (60%) in thrombocytopenic patients than in non-thrombocytopenic subjects (35%, p=0.017), suggesting that HCV is directly involved in the process that, at least in part, leads to thrombocytopenia.
In a 72 years old woman, abdominal computed tomography (CT) disclosed multicentric hypervascular tumor in S4 of the liver, and it was T1·T2 by the MRI, and a high signal was presented together. ...Stenosis was shown by ERCP at the same site. Cholangiocellular carcinoma was suspected before operation, but malignant change was not recognized by frozen section, so the operation was finished. Later, a diagnosis of solitary necrotic nodule of the liver was established by pathological diagnosis. Solitary necrotic nodule of the liver is a benign tumor.
Highlights • Retroperitoneal abscesses originating from anorectal infection are rare events. • Surgical drainage of widespread retroperitoneal abscesses might be challenging. • Midline ...extraperitoneal approach is a useful option for retroperitoneal abscesses.
A 13-year-old boy was admitted to our hospital because of acute onset epigastric abdominal pain and vomiting. Similar symptoms had started 4 years prior, and he had been managed conservatively with ...the diagnosis of chronic pancreatitis. A CT scan at this admission revealed a duodenal intussusception including the head of the pancreas. We attempted to release the intussusception by using upper gastrointestinal (GI) endoscopy and a long tube. The intussusception was successfully released by pulling out the long tube inserted into the jejunum. An upper GI contrast study and endoscopy were performed again after the improvement of his general condition and the pancreatitis. A duodenal web was revealed in these studies, and the web was thought to cause the intussusception and the pancreatitis. At laparotomy, a windsock web was confirmed in the second portion of the duodenum. The web was excised and the duodenotomy closed transversely. Here we report a rare case presenting duodenal intussusception and pancreatitis secondary to a duodenal web.
An 84-year-old woman was referred to our hospital for further examination and treatment of a liver mass, which was detected incidentally by abdominal US in June, 2016. In 1998, she underwent partial ...resection of the small intestine with a 12-cm mass, which was found to arise from the wall of the small intestine and the pathology was consistent with gastrointestinal stromal tumor (GIST). A CT scan showed a 98×80-mm mass in the right lobe of the liver. A core needle biopsy could not determine the existence of the characteristic spindle cells of GIST, however, her surgical history and the CT scan suggested liver metastasis from the GIST of the small intestine. We performed right hepatectomy, and immunohistochemical staining on histopathological examination revealed positive staining with c-kit, confirming a diagnosis of metastatic GIST. This case was a liver metastasis after a disease-free interval of 18 years. Long term follow-up, therefore, seems to be necessary for patients with a history of GIST tumor resection.
We report a case of a fairly rare mesenchymal gastrointestinal mesenchymal tumor (GIMT) of the colon. A 46 year-old man with a history of sudden epigastric pain was found in Computed Tomography (CT) ...to have 6-cm diameter mass in the transverse colon complicated by peritoneal free air and massive fluid accumulation. Emergency surgery showed the mass to be a perforated submucosal tumor leading to peritonitis. Histologically, the resected tumor showed increased spindle cells with neutrophilic proliferation at the perforation. Immunofluorescence microscopy showed positive findings for vimentin but negative for c-kit, CD34, S-100, and SMA all compatible with GIMT.
Recombinant human thrombomodulin (rTM) is considered to have reasonable pharmacological effects for the treatment of septic disseminated intravascular coagulation (DIC) caused by intestinal ...perforation. However, the efficacy of rTM for septic DIC following abdominal emergency surgery has not yet been established. We evaluated the efficacy of rTM for patients with septic DIC associated with intestinal perforation. Twenty-one patients operated on in our hospital from May 2011 to July 2016 and postoperatively developed septic DIC caused by intestinal perforation were retrospectively analyzed. Their postoperative DIC scores were more than 4. The patients were classified into the rTM treatment group (n=15) and conventional treatment group (rTM not used, n=6). There were no significant differences in the patient's backgrounds between the two groups. The rate of DIC resolution was significantly improved in the rTM group. DIC score and SOFA score in the rTM group were improved on the 5th day that was significantly earlier than those in the non rTM group. Time to DIC resolution, survival rate at 28th day and duration of ICU stay tended to improve in the rTM group than the other, without statistical significance. These results suggest that rTM would be a useful drug for treatment of septic DIC associated with intestinal perforation.
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