The value of gastroenterultrasound developer in diagnosis of the stomach tumor

Objective: To study the value of gastroenterultrasound developer in diagnosis of the stomach tumor. Methods: 38 patients who diagnosed as stomach tumor by gastroscopy were chosen, and their images before and after by using gastroenterultrasound developer were compared. Results: The difference between the detectable rate of stomach tumor before and after by using gastroenterultrasound developer was significant (P < 0.01). Conclusion: Gastroenterultrasound developer has a high diagnostic value in diagnosis of the stomach tumor.

Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

Plexiform angiomyxoid myofi broblastic tumor of the stomach

Plexiform angiomyxoid myofibroblastic tumor of the stomach is a unique mesenchymal tumor that we first described in 2007.The tumor is very rare,and to date,only 18 cases confirmed by immunohistochemistry have been reported in the literature.The patients' ages ranged from 7 to 75 years(mean,43 years),and the male-to-female ratio was approximately 1:1.Representative clinical symptoms are ulceration,associated upper gastrointestinal bleeding(hematemesis),and anemia.The tumors are located at the antrum in all cases,and grossly,the tumor is whitish to brownish or reddish,and forms a lobulated submucosal or transmural mass.Microscopically,the tumor is characterized by a plexiform growth pattern,the proliferation of cytologically bland spindle cells,and a myxoid stroma that is rich in small vessels and positive for Alcian blue stain.Immunohistochemically,the tumor cells are positive for α-smooth muscle actin and negative for KIT and CD34.Differential diagnoses include gastrointestinal stromal tumor and other mesenchymal tumors of the gastrointestinal tract.Some authors proposed that this tumor should be designated as "plexiform fibromyxoma",but this designation might cause confusion.The tumor is probably benign and thus far,neither recurrence nor metastasis has been reported.

Glomus tumor in the stomach:Computed tomography and endoscopic ultrasound findings

A 57-year-old man presented with intermittent dull abdominal pain after a period of 1 year.Abdominal computed tomography(CT) was performed.Except for the endoscopy,the work-up for possible medical causes remained inconclusive.An open-abdomen,partial surgical excision of the stomach was performed after the unsuccessful endoscopic resection.The pathology report revealed a glomus tumor of the stomach.Importantly,glomus tumors of the stomach are rare and are almost always benign.Therefore,the most important current role of imaging associated with the diagnostic approach and therapeutic plan for a glomus tumor is to differentiate it from other gastric submucosal tumors(SMTs).We report this case with representative radiologic findings,including CT and endoscopic ultrasound(EUS) reports,and also correlate them with clinical and pathologic presentations that can help in the early detection and differentiation of gastric SMTs from other SMTs.As such,the purpose of this report is to provide a better understanding of relevant CT and EUS features.Alternative treatments should be considered carefully according to the imaging results.

Granular cell tumor of stomach: A case report and review of literature

小粒的房间肿瘤(GCT ) 被 Abrikosoff 在 1926 第一次描述。是一个相对稀罕的瘤可以在皮或软纸巾通常发生在许多地点，而是大多数。在胃肠道的 GCT 的出现是稀罕的，财务近似为 8% 所有肿瘤，最普通的地点在之中是食管，而胃的本地化是很稀罕的。胃的 GCT 能是独居的或，更经常，与另外的胃肠的本地化联系了。尽管 GCT 通常是临床上并且组织学地良性的，一些恶意的案例被报导了。组织学地，这些肿瘤由在紧缩的“巢”和为 S-100 蛋白质的组织化学的染色支持的免疫里处理的多角形、纺锤形的房间组成从 Schwann 房间的建议推导。这个肿瘤的正确外科手术前的诊断能仅仅在 50% 所有病人被做，它总是基于内视镜的活体检视。Laparoscopic 或常规楔切除术代表选择的治疗。在这研究，作者与渗透性的模式与胃的一个独居的小粒的房间肿瘤报导了一个 49 岁的女人的一个案例，成功地与外科的切除术对待。文学的评论也有关恶意的形式在诊断标准上与强调被介绍。

Endoscopic enucleation of gastrointestinal stromal tumors of the stomach: Report of five cases

Gastrointestinal stromal tumor (GIST) of the stomach was treated by endoscopic enucleation in five patients. They were three men and two woman, aged 36-56 years. Tumors located in the cardia were completely enucleated endoscopically without any serious complication. The largest diameter of removed tumors ranged from 1.2 to 2.5 cm. Histopathological diagnosis was GIST with low risk of malignancy (mitotic index < 5/50 high power field) in all cases. The patients were disease-free for 10.5-42.2 mo after endoscopic enucleation.

Metastatic tumors to the stomach: Clinical and endoscopicfeatures

AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. METHODS: A total of 64 patients with gastric meta- stases from solid malignant tumors were retros- pectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history are useful for correct diagnosis of gastric metastases.

A perivascular epithelioid cell tumor of the stomach:An unsuspected diagnosis

Perivascular epithelioid cell tumor(PEComa) is a rare mesenchymal neoplasia and currently well recognized as a distinct entity with characteristic morphological,immunohistochemical and molecular findings.We report a case of PEComa arising in the antrum of a 71-year-old female with melena.The tumor,located predominantly in the submucosa as a well delimited nodule,measured 3.0 cm in diameter and was completely resected,with no evidence of the disease elsewhere.Histologically,it was composed predominantly of eosinophilic epithelioid cells arranged in small nests commonly related to variably sized vessels,with abundant extracellular material,moderate nuclear variation and discrete mitotic activity.No necrosis,angiolymphatic invasion or perineural infil-tration was seen.Tumor cells were uniformly positive for vimentin,smooth muscle actin,desmin and melan A.Although unusual,PEComa should be considered in the differential diagnosis of gastric neoplasia with characteristic epithelioid and oncocytic features and prominent vasculature.

Gastric carcinoid tumor in a patient with a past history of gastrointestinal stromal tumor of the stomach

Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract. It may coexist with other type of cancers,and if so,the tumors usually involve the stomach. The most common associated cancers are gastrointestinal carcinomas. We report a 65-year-old woman with a history of gastric gastrointestinal stromal tumor who had undergone subtotal segmental gastrectomy. New polypoid lesions were detected on a follow-up gastroscopy one year later. The lesions were biopsied and found to be carcinoid tumors. There was serum hypergastrinemia,and type 1 gastric carcinoid tumor was diagnosed. A total gastrectomy was performed. Pathologic examination revealed both carcinoid tumors and a recurrent gastrointestinal stromal tumor.

Plexiform Angiomyxoid Myofibroblastic Tumor of the Stomach

Plexiform angiomyxoid myofibroblastic tumor (PAMT) is a recently described gastric tumor with a peculiar plexiform pattern, bland spindle cells and a myxoid stroma rich in arborizing blood vessels. PAMT of the stomach is a very rare tumor without distinctive clinical manifestations. In this study, we report a new case of PAMT which is the first Chinese case in English literature. A 47-year-old Chinese woman was admitted with a 6-month history of intermittent epigastric discomfort, and abdominal pain for 2 months. Gastroscopy showed an elevated mass in the anterior wall of the gastric antrum. Endoscopic ultrasound revealed a focal hypoechoic lesion protruding into the lumen. A laparoscopic distal gastrectomy was performed, and the patient made an uneventful recovery and remains well 1.5 years later. A diagnosis of PAMT was made by histopathology and immunochemistry.

Diagnostic utility of endoscopic ultrasound-guided fineneedle aspiration biopsy for glomus tumor of the stomach

A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasoundguided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56,desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasoundguided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis.

Bioinformatics Analysis Revealed Potential Tumor Suppressors (KLF4/CGN), Oncogenes (SHH/LIF) and Biomarkers of Asian Stomach Adenocarcinoma

Stomach adenocarcinoma (STAD) is the fifth most prevalent cancer and the third leading cause of cancer-related death in the world and is more common in Asia than in most Western countries. There is an urgent need to identify potential novel oncogenes and tumor suppressor genes, and biomarkers for STAD. 6652 differentially expressed genes were identified between STAD and normal samples based on the transcriptome data analysis of the TCGA and GEO databases. 13 key modules were identified in STAD by WGCNA analysis. 293 potential STAD associated genes were identified from intersection by Venn Diagram. The 293 intersected genes were enriched in cell cortex and infection by GO and KEGG analysis. 10 hub genes were identified from PPI and Cytoscape analyses of the intersected genes. KLF4/CGN low and SHH/LIF high expression were associated with short overall survival of Asian STAD patients. Bioinformatics analysis revealed potential novel tumor suppressors (KLF4/CGN), oncogenes (SHH/LIF) and biomarkers for diagnosis, therapy and prognosis of STAD, specifically for Asian patients.

单孔腹腔镜联合内镜治疗胃血管球1例及国内外文献复习

分析川北医学院附属医院胃肠外科2023年4月收治的1例罕见疾病[胃血管球瘤(GGT)]患者。该例患者术前临床诊断为胃间质瘤,术后通过免疫组织化学确诊为GGT,经单孔腹腔镜联合内镜治疗后痊愈出院。GGT术前难以确诊,且易误诊为胃间质瘤,手术切除肿瘤是其唯一治疗方法。该文深入探讨GGT的临床表现、影像及病理特征、临床诊断、鉴别诊断及治疗方法,并复习国内外相关文献,以便为今后临床工作提供参考信息。

健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响研究

目的 探究健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响。方法 收集我院2019年6月—2022年6月肿瘤科收治的晚期胃癌患者95例,随机分为对照组(47例)与试验组(48例)。对照组予以FOLFOX4方案进行化疗,试验组在对照组的基础上予以健脾养胃法。两组均治疗9周,治疗结束后比较2组中医症状积分、血清肿瘤标志物、免疫功能指标、治疗期间胃肠道反应、远期生存率。结果 治疗后与对照组相比,试验组临床有效率较高(P<0.05)。治疗后与治疗前相比2组脘腹痞闷、胸胁胀痛、食欲缺乏、便溏及神疲乏力等中医症状积分降低;与对照组相比,试验组所有中医症状积分均较低(P<0.05)。治疗后与治疗前相比2组CEA、CA12-5、CA19-9及CA72-4降低;与对照组相比,试验组CEA、CA12-5、CA19-9及CA72-4较低(P<0.05)。治疗后与治疗前相比2组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)升高,IgG、IgM降低(P<0.05);与对照组相比,试验组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)较高,IgG、IgM较低(P<0.05)。2组6个月及1年生存率相比无统计学意义(P>0.05);试验组3年内生存率高于对照组(P<0.05)。结论 健脾养胃法应用于老年胃癌晚期胃癌患者的治疗中近远期治疗效果显著,能提高免疫功能,下调肿瘤标志物水平,适宜临床应用。

45例肝胃间隙占位性病变分析

目的探讨肝胃间隙占位性病变的临床特点。方法对2016年7月至2023年2月于武汉大学人民医院及华中科技大学同济医学院附属同济医院进行诊治的45例肝胃间隙占位性病变患者的临床资料进行回顾性分析。结果肝胃间隙恶性肿瘤占57.78%,良性肿瘤占42.22%。其中胃肠道间质瘤占肝胃间隙占位性病变的31.11%,各种转移癌占33.33%。胃肠道间质瘤的大小以及特殊的EUS特征与其危险度有关(P<0.05)。EUS下病变回声是否均匀以及病变分界是否清晰在占位性病变的良恶性中差异无统计学意义(P>0.05),而病变回声(如低回声、高回声等)在良恶性占位性病变中差异有统计学意义(P<0.05)。结论肝胃间隙恶性占位性病变种类较多,恶性病变多于良性病变,可行EUS-FNA明确病理性质,从而对临床治疗提供指导。

Clinicopathological features of gastric glomus tumor

AIM:To study the clinicopathological features of gastric glomus tumor and review the related Chinese literature published in 1990-2010.METHODS:A case of gastric glomus tumor was re-ported.Clinicopathological findings in 56 cases of gastric glomus tumor were analyzed.RESULTS:Gastric glomus tumor was far more common in women than in men with a female to male ratio of 1.6:1.The median age of the patients was 45 years(range 28-79 years).The patients often complained of epigastric pain and bloody stool.The tumor was located in antrum of the stomach.The greatest diameter of the tumor was 0.8-11cm.Histologically,the tumor was comprised of nests of glomus cells surrounding the capillaries.Glomus cells were small,uniform and round.Vimentin,smooth muscle actin and actin were expressed in the tumor.Other markers,including S-100 protein,CD34,CD117,desmin,CD56,synaptophysin,chromo-granin A,neuron specific enolase and cytokeratin were all negative.CONCLUSION:Gastric glomus tumor is a rare benign mesenchymal neoplasm.Its diagnosis depends on pathologic examination.Differential diagnosis includes gastrointestinal stromal tumor,paraganglioma and carcinoid tumor.

Laparoscopic resection of gastric gastrointestinal stromal tumors presenting as left adrenal tumors

Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal malignancies. They are rarely seen near the urinary tract. In a literature review, only one case of GIST presenting as a left adrenal tumor was reported. We report two documented cases of gastric GISTs mimicking left adrenal tumors which were successfully treated with pure laparoscopic adrenalectomy and wedge resection of the stomach by excising the tumor from the stomach with serial fi ring of endoscopic gastrointestinal staplers. The surgical margins were clear, and the patients recovered smoothly. No adjuvant therapy with imatinib was prescribed. During the surveillance for 9 mo and 44 mo respectively, no tumor recurrence and metastasis were documented. Laparoscopic tumor excision, when adhering to the principles of surgical oncology, seems feasible and the prognosisis favorable for such tumors.

Endoscopic full-thickness resection for gastric submucosal tumors arising from the muscularis propria layer

AIM:To evaluate the efficacy,safety and feasibility of endoscopic full-thickness resection(EFR) for the treatment of gastric submucosal tumors(SMTs) arising from the muscularis propria.METHODS:A total of 35 gastric SMTs arising from the muscularis propria layer were resected by EFR between January 2010 and September 2013.EFR consists of five major steps:injecting normal saline into the submucosa;pre-cutting the mucosal and submucosal layers around the lesion;making a circumferential incision as deep as the muscularis propria around the lesion using endoscopic submucosal dissection and an incision into the serosal layer around the lesion with a Hook knife;a full-thickness resection of the tumor,including the serosal layer with a Hook or IT knife;and closing the gastric wall with metallic clips.RESULTS:Of the 35 gastric SMTs,14 were located at the fundus,and 21 at the corpus.EFR removed all of the SMTs successfully,and the complete resection rate was 100%.The mean operation time was 90 min(60-155 min),the mean hospitalization time was 6.0 d(4-10 d),and the mean tumor size was 2.8 cm(2.0-4.5cm).Pathological examination confirmed the presence of gastric stromal tumors in 25 patients,leiomyomas in7 and gastric autonomous nerve tumors in 2.No gastric bleeding,peritonitis or abdominal abscess occurred after EFR.Postoperative contrast roentgenography on the third day detected no contrast extravasation into the abdominal cavity.The mean follow-up period was 6mo,with no lesion residue or recurrence noted.CONCLUSION:EFR is efficacious,safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer.This technique is able to resect deep gastric lesions while providing precise pathological information about the lesion.With the development of EFR,the indications of endoscopic resection might be extended.

Management of gastric subepithelial tumors:The role of endoscopy

With the wide use of esophagogastroduodenoscopy,the incidence of gastric subepithelial tumor(SET)diagnosis has increased.While the management of large orsymptomatic gastric SETs is obvious,treatment of small(≤3 cm)asymptomatic gastric SETs remains inconclusive.Moreover,the presence of gastrointestinal stromal tumors with malignant potential is of concern,and endoscopic treatment of gastric SETs remains a subject of debate.Recently,numerous studies have demonstrated the feasibility of endoscopic treatment of gastric SETs,and have proposed various endoscopic procedures including endoscopic submucosal dissection,endoscopic muscularis dissection,endoscopic enucleation,endoscopic submucosal tunnel dissection,endoscopic full-thickness resection,and a hybrid approach(the combination of endoscopy and laparoscopy).In this review article,we discuss current endoscopic treatments for gastric SETs as well as the advantages and limitations of this type of therapy.Finally,we predict the availability of newly developed endoscopic treatments for gastric SETs.