BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are pro...BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are prone to distant metastasis,as they possess clinical features of both carcinoma and sarcoma,and generally have with a poor prognosis.Due to the small number of cases reported,clinical experience in the diagnosis and treatment of the disease is lacking.CASE SUMMARY The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo.Computed tomography,magnetic resonance imaging,endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD.The patient ultimately underwent cholecystectomy,CBD resection,and choledochojejunostomy.Postoperative pathological examination revealed carcinosarcoma of the CBD,and the latest follow-up showed that the patient is recovering well.Based on previous case reports,some carcinosarcoma has ossification characteristics in imaging.If it is misdiagnosed as biliary calculi,the use of laser lithotripsy in surgery may lead to tumor diffusion.Choledochoscopy and narrow band staining of mucosa are very important for diagnosis.CONCLUSION We herein present a rare case of carcinosarcomas of the CBD,we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation,while show soft tissue shadow when non bone differentiation.Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established,which leads to the poor prognosis.展开更多
AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012...AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.展开更多
文摘BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are prone to distant metastasis,as they possess clinical features of both carcinoma and sarcoma,and generally have with a poor prognosis.Due to the small number of cases reported,clinical experience in the diagnosis and treatment of the disease is lacking.CASE SUMMARY The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo.Computed tomography,magnetic resonance imaging,endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD.The patient ultimately underwent cholecystectomy,CBD resection,and choledochojejunostomy.Postoperative pathological examination revealed carcinosarcoma of the CBD,and the latest follow-up showed that the patient is recovering well.Based on previous case reports,some carcinosarcoma has ossification characteristics in imaging.If it is misdiagnosed as biliary calculi,the use of laser lithotripsy in surgery may lead to tumor diffusion.Choledochoscopy and narrow band staining of mucosa are very important for diagnosis.CONCLUSION We herein present a rare case of carcinosarcomas of the CBD,we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation,while show soft tissue shadow when non bone differentiation.Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established,which leads to the poor prognosis.
文摘AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.
