Synchronous incidental gastrointestinal stromal and epithelial malignant tumors

AIM:To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis.METHODS: From January 1, 2000 to December 31, 2007, 13 804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed.RESULTS: Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk.CONCLUSION: Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.

Synchronous Mucinous Borderline Tumor of the Ovary and Low-Grade Appendiceal Mucinous Neoplasm

We present a rare case of synchronous mucinous borderline tumor of the ovary and low-grade appendiceal mucinous neoplasm (LAMN). We performed a left adnexectomy to diagnose the left ovarian borderline malignancy and an ileostomy because of the swollen appendix during the operation. It was diagnosed as left ovarian mucinous borderline malignancy and LAMN. LAMN causes peritoneal dissemination, ovarian metastasis, and peritoneal pseudomyxoma. The appendix and ovary are close to each other anatomically and can metastasize if there is a tumor in either. For ovarian mucinous tumors, it is necessary to search the gastrointestinal tract, especially the appendix, as the primary lesion. For appendix tumors, it is necessary to search for the ovary. Since LAMN may be associated with borderline ovarian malignancies, as in this case, there is a possibility of the duplication of tumors when searching for ovarian mucinous tumors as the primary tumor and if ovarian tumors are found. Since LAMN and mucinous ovarian tumors have similar histological features, immunohistochemical staining is useful for their differentiation because they show different immunostaining patterns.

Ipsilateral synchronous papillary and clear renal cell carcinoma:A case report and review of literature

BACKGROUND There is limited information on ipsilateral synchronous papillary renal cell carcinoma(PRCC)and clear cell renal cell carcinoma(CCRCC).Therefore,these rare tumors are often misdiagnosed preoperatively as a single tumor with intrarenal metastasis or some other diseases.Effective management and long-term overall survival might be affected because the prognosis of the two tumors differs.CASE SUMMARY We describe a case of ipsilateral synchronous PRCC and CCRCC with two histological variants in a 72-year-old man,whose mass was found incidentally,with no other chief complaints and vital signs were normal.Initial ultrasound revealed a hypoechoic lobular mass with a volume of 7.8 cm×4.8 cm×2.8 cm in the middle to lower pole of the left kidney.A subsequent contrast-enhanced computed tomography scan showed a single endophytic mass of 7.5 cm in diameter.The patient underwent laparoscopic left radical nephrectomy.A final diagnosis of ipsilateral synchronous PRCC and CCRCC was confirmed by pathological examination.There was no recurrence or metastasis after 25 mo follow-up.CONCLUSION We report a case of ipsilateral synchronous PRCC and CCRCC,and review related literature to estimate the prevalence of similar cases.The above descriptions may be expected to help understand the disease,and improve diagnosis in the future.

Intraoperative endoscopy in obstructive hypopharyngeal carcinoma

AIM： To demonstrate the necessity of intraoperative endoscopy in the diagnosis of secondary primary tumors of the upper digestive tract in patients with obstructive hypopharyngeal carcinoma. METHODS： Thirty-one patients with hypopharyngeal squamous cell carcinoma had been operated, with radical intent, at our Institution in the period between 1978 and 2004. Due to obstructive tumor mass, in 7 （22.6%） patients, preoperative endoscopic evaluation of the esophagus and stomach could not be performed. In those patients, intraoperative endoscopy, made through an incision in the cervical esophagus, was standard diagnostic method for examination of the esophagus and stomach. RESULTS： We found synchronous foregut carcinomas in 3 patients （9.7%）. In two patients, synchronous carcinomas had been detected during preoperative endoscopic evaluation, and in one （with obstructive carcinoma） using intraoperative endoscopy. In this case, preoperative barium swallow and CT scan did not reveal the existence of second primary tumor within esophagus, despite the fact that small, but T2 carcinoma, was present. CONCLUSION： It is reasonable to use intraoperative endoscopy as a selective screening test in patients with obstructive hypopharyngeal carcinoma.

The added clinical value of performing CT colonography in patients with obstructing colorectal carcinoma

Background:A small percentage of incomplete optical colonoscopies(OCs)are the result of an obstructing tumor.According to current guidelines,CT colonography(CTC)is performed to prevent missing a synchronous tumor.The aim of this study was to evaluate how frequently a synchronous tumor was found on CTC and how often this led to a change in the surgical plan.Methods:In this retrospective study,a total of 267 patients underwent CTC after an incomplete OC as a result of an obstructing colorectal carcinoma(CRC).Among them,210 patients undergoing surgery met the inclusion criteria and were included in the analysis.The OC report,CTC report and surgical report of these patients were retrospectively evaluated for the presence of synchronous tumors using surgery and post-operative colonoscopy as the gold standard.Results:Six of the 210 patients(2.9%)showed signs of a synchronous CRC proximal to the obstructing tumor on CTC.In three of these patients,a synchronous CRC was confirmed during surgery.All these tumors caused a change in the surgical plan.Three out of the six tumors found on CTC were found to be large,non-malignant polyps.All these polyps were located in the same segment as the obstructing tumor and therefore did not alter the surgical plan.Conclusion:In patients with obstructing CRC,the frequency of synchronous CRCs proximal to this lesion is low.Performing a CTC leads to a change in surgical plan based on the presence of these synchronous tumors in 1.4%of the cases.CTC should be employed as a one-stop shop in patients with an obstructing CRC.