Primary gastric synovial sarcoma is rare and challenging to diagnose. We present a case of a gastric ulcer that was diagnosed as primary gastric synovial sarcoma only after surveillance endoscopy with repeat biopsies....Primary gastric synovial sarcoma is rare and challenging to diagnose. We present a case of a gastric ulcer that was diagnosed as primary gastric synovial sarcoma only after surveillance endoscopy with repeat biopsies. The diagnosis was established with the identification of the pathognomonic chromosomal translocation t(X;18)(p11;q11). The patient was treated with wedge resection and has remained disease-free on surveillance imaging and endoscopy. This case demonstrates the difficulty in diagnosing primary gastric synovial sarcoma and the benefits of early disease detection.展开更多
Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunate...Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.展开更多
BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals....BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals.AIM To create and internally validate a risk prediction model for detection of AN in METHODS Prospective study of asymptomatic individuals undergoing first screening colonoscopy.Detailed characteristics including diet,exercise and medications were collected.Multivariate logistic regression was used to elucidate risk factors for AN(adenoma≥1 cm,villous histology,high-grade dysplasia or carcinoma).The model was validated through bootstrapping,and discrimination and calibration of the model were assessed.RESULTS 980 consecutive individuals(51%F;49%M)were enrolled.Adenoma and AN detection rates were 36.6%(F 29%:M 45%;P<0.001)and 5.1%(F 3.8%;M 6.5%)respectively.On multivariate analysis,predictors of AN[OR(95%CI)]were age[1.036(1.00-1.07);P=0.048],BMI[overweight 2.21(0.98-5.00);obese 3.54(1.48-8.50);P=0.018],smoking[<40 pack-years 2.01(1.01-4.01);≥40 pack-years 3.96(1.86-8.42);P=0.002],and daily red meat consumption[2.02(0.92-4.42)P=0.079].Nomograms of AN risk were developed in terms of risk factors and age separately for normal,overweight and obese individuals.The model had good discrimination and calibration.CONCLUSION The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West.Age,smoking,and BMI are important predictors of AN,with obesity being particularly powerful.Though external validation is needed,this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.展开更多
文摘Primary gastric synovial sarcoma is rare and challenging to diagnose. We present a case of a gastric ulcer that was diagnosed as primary gastric synovial sarcoma only after surveillance endoscopy with repeat biopsies. The diagnosis was established with the identification of the pathognomonic chromosomal translocation t(X;18)(p11;q11). The patient was treated with wedge resection and has remained disease-free on surveillance imaging and endoscopy. This case demonstrates the difficulty in diagnosing primary gastric synovial sarcoma and the benefits of early disease detection.
文摘Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.
文摘BACKGROUND In resource-limited countries,risk stratification can be used to optimize colorectal cancer screening.Few prospective risk prediction models exist for advanced neoplasia(AN)in true average-risk individuals.AIM To create and internally validate a risk prediction model for detection of AN in METHODS Prospective study of asymptomatic individuals undergoing first screening colonoscopy.Detailed characteristics including diet,exercise and medications were collected.Multivariate logistic regression was used to elucidate risk factors for AN(adenoma≥1 cm,villous histology,high-grade dysplasia or carcinoma).The model was validated through bootstrapping,and discrimination and calibration of the model were assessed.RESULTS 980 consecutive individuals(51%F;49%M)were enrolled.Adenoma and AN detection rates were 36.6%(F 29%:M 45%;P<0.001)and 5.1%(F 3.8%;M 6.5%)respectively.On multivariate analysis,predictors of AN[OR(95%CI)]were age[1.036(1.00-1.07);P=0.048],BMI[overweight 2.21(0.98-5.00);obese 3.54(1.48-8.50);P=0.018],smoking[<40 pack-years 2.01(1.01-4.01);≥40 pack-years 3.96(1.86-8.42);P=0.002],and daily red meat consumption[2.02(0.92-4.42)P=0.079].Nomograms of AN risk were developed in terms of risk factors and age separately for normal,overweight and obese individuals.The model had good discrimination and calibration.CONCLUSION The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West.Age,smoking,and BMI are important predictors of AN,with obesity being particularly powerful.Though external validation is needed,this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.
