Gastric carcinoma in patients less than 45 years old
1
Conclusions: (1) The decrease in antisecretory efficacy of PPIs after Hp eradication is a drug class effect, particularly affecting nocturnal acid control. (2) Curing Hp infection increases intragastric acidity. 250 Antral web presenting in an adult Gregory F. Winters, MD and Steven Goldschmid, MD, FACG*. 1 Gastroenterology, University of Arizona, Tucson, AZ, United States. Purpose: Antral Webs are uncommon sources of gastric outlet obstruction in adults and are often not recognized at the time of endoscopy. Antral Webs are often mistaken for pyloric strictures. The true incidence of antral webs is unknown, with 120 reported adult cases found in the literature. Antral webs are hypothesized to have both congenital and acquired etiol- ogies. The diagnosis of antral webs can be done endoscopically or radio- graphically. Methods: We present a case of a 56-year-old male who presented with nausea, vomiting, bloating, abdominal pain, early satiety and weight loss. The patient’s symptoms had been on going for 6 – 8 months. Prior to endoscopy, the patient had an upper GI study that reported a pyloric mass or stricture as the cause of his obstructive symptoms. On endoscopy, the patient was found to have an antral web. Results: Historically, the treatment of antral webs has been surgical. More recently, endoscopic approaches have been investigated. We found five cases of antral webs treated endoscopically in the literature. These include the use of snares, Nd:Yag lasers, and papillotomes. Our patient refused surgical or endoscopic intervention at the time of diagnosis. The patient was therefore treated with the promotility agent Reglan. This has provided symptomatic relief for the patient. Conclusions: The diagnosis of antral webs should be considered in adult patients with gastric outlet obstruction and the absence of a certain diag- nosis on upper GI study. 251 Gastric carcinoma in patients less than 45 years old Susana Lopes, M.D., Pedro Moutinho-Ribeiro, M.D., So ´nia Barroso, M.D., Guilherme Macedo, M.D., FACG, Armando Ribeiro, M.D., Tome ´ Ribeiro, PhD, Gastrenterology Unit, Hosp. S. Joo ˜, Porto, Portugal. It is a common practice in management of dyspeptic patients with less than 45 years old not to perform upper gastrointestinal endoscopy (UGE), given the low risk of cancer in this age group. However, in a country with high incidence, the biological behaviour of this neoplasia may be different justifying another algorithmic approach. Aim: To analyse the clinico-pathological features and clinical significance of gastric cancer in a young population. Material and Methods: Retrospective analysis of 25811 UGE performed by all members of the Gastroenterology Unit between 1993 and 2000, combined with histological reports from Pathology Department. Results: We have enrolled 44 patients (32 men and 12 women) with median age of 37,3 years (21– 44 years). Main indications for UGE were: gastrointestinal bleeding and anemia in 12 patients, dyspepsia in 8, ab- dominal pain in 8 and dysphagia in 4 patients. Endoscopic appearance was: exophytic lesion in 28, infiltrative in 10, lymphoma like in 3 and Kaposi in 3. The localization was predominantly distal (50%), with 41% located in the fundus/body and 9% with mix localization. Histological type was: intestinal adenocarcinoma in 20 patients (46%), diffuse type in 8 (18%), Kaposi tumor in 3 (7%), lymphoma in 3 (7%) and stromal tumor in 1 (2%); in 9 patients it was not possible to obtain histological identification. Conclusion: Gastric cancer in young patients is not rare among us. The lesions are predominantly located in the distal stomach and the histological type is intestinal adenocarcinoma. 252 Primary gastric lymphoma: a rectrospective analysis of endoscopic and surgical diagnosis Pedro Moutinho-Ribeiro, M.D., Susana Lopes S, M.D., Guilherme Macedo, M.D., FACG, Clara Sambade, Ph.D., and Tome ´ Ribeiro, Ph.D. Gastroenterology Unit, Hospital S.Joa ˜o, Porto, Portugal. Introduction and aim: The treatment of eradication of Helicobacter Pylori in patients with MALT Lymphoma raised the hypothesis of his role in the regression of these type of tumors and in reducing the progression to a higher degree neoplasia. However, the increased number of these more severe tumors in the last years doesn’t support this assumption and stim- ulate a better knowledge of our reality. Material and methods: The cases of primary gastric lymphoma diagnosed in our hospital in the last 10 years, and registered in the Pathology Department, were submitted to a retrospective study. All the histologic slides were reviewed. Results: The study included 53 cases (29 men and 24 women; mean age:61 years), 30 were diagnosed in the surgical specimen and 23 in the endo- scopic biopsy. The most frequent location of the tumor was the antrum (51%) and the most prevalent macroscopic aspect was the ulcerated type (58%). The histologic types according the method of the diagnosis were: a) surgical specimen—MALT of low grade (40%), MALT in progression (17%), B cell high grade (40%) and B cell centrocitic centroblastic (6%); b) endoscopic biopsy—MALT of low grade (22%), B cells high grade (70%), mantle cell lymphoma (4%) and mediterranean lymphoma (4%). The relative percentages of those histologic types of lymphoma, in the first and second periods of 5 years in which we considered the study, was similar. Conclusions: In our study, primary gastric lymphoma comprehended neo- plasias of low grade (MALT, centrocitic centroblastic B, mantle and mediterranean types) and, with a higher frequency, high grade tumors (B cells and MALT in progression types). The percentage of high grade lymphomas was higher in the group of cases diagnosed by endoscopic biopsy than in the group identified in the surgical specimen. This suggest a lower accuracy in diagnosing lymphoma of low grade by endoscopy. This fact reinforces the role of the endoscopy in the clinical cases of “dispepsya” and the necessity of doing systematic biopsies in the cases usually de- scribed as “gastritis”. PANCREATIC/BILIARY 253 Involvement of the superior mesenteric/portal vein (SM/PV) is not a contraindication to pancreaticoduodenectomy EK Abdalla, PWT Pisters, JE Lee, JN Vauthey, KR Cleary, C Charnsangavej, DB Evans. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Purpose: To compare survival duration of patients who required extended pancreaticoduodenectomy with en-bloc venous resection, to those who underwent standard pancreaticoduodenectomy for malignant tumors of the pancreatic head. Methods: 107 patients who underwent en-bloc resection of the SM/PV were identified from a database containing 314 consecutive pancreati- coduodenectomy patients from 1990 to 2000. Clinicopathologic factors, treatment and outcome variables were analyzed to determine margin- negative resection (R0), disease-free and overall survival rates. Results: Of the 107 patients who underwent en-bloc venous resection (VR), 89 had adenocarcinoma. R0 resection rates were comparable with and without vascular resection (79% vs 87%, p NS). For the entire cohort of patients, the actuarial 5-year disease-free survival rate with VR was 33%, versus 38% without VR (p NS). The overall survival rate with VR was 37%, versus 39% without VR (p NS). For the subset of patients with adenocarcinoma, there was no difference in survival rate based on the need for VR: S80 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001
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Transcript of Gastric carcinoma in patients less than 45 years old
Conclusions: (1) The decrease in antisecretory efficacy of PPIs after Hperadication is a drug class effect, particularly affecting nocturnal acidcontrol. (2) Curing Hp infection increases intragastric acidity.
250
Antral web presenting in an adultGregory F. Winters, MD and Steven Goldschmid, MD, FACG*.1Gastroenterology, University of Arizona, Tucson, AZ, United States.
Purpose: Antral Webs are uncommon sources of gastric outlet obstructionin adults and are often not recognized at the time of endoscopy. AntralWebs are often mistaken for pyloric strictures. The true incidence of antralwebs is unknown, with 120 reported adult cases found in the literature.Antral webs are hypothesized to have both congenital and acquired etiol-ogies. The diagnosis of antral webs can be done endoscopically or radio-graphically.Methods: We present a case of a 56-year-old male who presented withnausea, vomiting, bloating, abdominal pain, early satiety and weight loss.The patient’s symptoms had been on going for 6–8 months. Prior toendoscopy, the patient had an upper GI study that reported a pyloric massor stricture as the cause of his obstructive symptoms. On endoscopy, thepatient was found to have an antral web.Results: Historically, the treatment of antral webs has been surgical. Morerecently, endoscopic approaches have been investigated. We found fivecases of antral webs treated endoscopically in the literature. These includethe use of snares, Nd:Yag lasers, and papillotomes. Our patient refusedsurgical or endoscopic intervention at the time of diagnosis. The patientwas therefore treated with the promotility agent Reglan. This has providedsymptomatic relief for the patient.Conclusions: The diagnosis of antral webs should be considered in adultpatients with gastric outlet obstruction and the absence of a certain diag-nosis on upper GI study.
251
Gastric carcinoma in patients less than 45 years oldSusana Lopes, M.D., Pedro Moutinho-Ribeiro, M.D., Sonia Barroso,M.D., Guilherme Macedo, M.D., FACG, Armando Ribeiro, M.D., TomeRibeiro, PhD, Gastrenterology Unit, Hosp. S. Joo, Porto, Portugal.
It is a common practice in management of dyspeptic patients with less than45 years old not to perform upper gastrointestinal endoscopy (UGE), giventhe low risk of cancer in this age group. However, in a country with highincidence, the biological behaviour of this neoplasia may be differentjustifying another algorithmic approach.Aim: To analyse the clinico-pathological features and clinical significanceof gastric cancer in a young population.Material and Methods: Retrospective analysis of 25811 UGE performedby all members of the Gastroenterology Unit between 1993 and 2000,combined with histological reports from Pathology Department.Results: We have enrolled 44 patients (32 men and 12 women) withmedian age of 37,3 years (21–44 years). Main indications for UGE were:gastrointestinal bleeding and anemia in 12 patients, dyspepsia in 8, ab-dominal pain in 8 and dysphagia in 4 patients. Endoscopic appearance was:exophytic lesion in 28, infiltrative in 10, lymphoma like in 3 and Kaposi in3. The localization was predominantly distal (50%), with 41% located inthe fundus/body and 9% with mix localization. Histological type was:intestinal adenocarcinoma in 20 patients (46%), diffuse type in 8 (18%),Kaposi tumor in 3 (7%), lymphoma in 3 (7%) and stromal tumor in 1 (2%);in 9 patients it was not possible to obtain histological identification.Conclusion: Gastric cancer in young patients is not rare among us. Thelesions are predominantly located in the distal stomach and the histologicaltype is intestinal adenocarcinoma.
252
Primary gastric lymphoma: a rectrospective analysis of endoscopicand surgical diagnosisPedro Moutinho-Ribeiro, M.D., Susana Lopes S, M.D., GuilhermeMacedo, M.D., FACG, Clara Sambade, Ph.D., and Tome Ribeiro, Ph.D.Gastroenterology Unit, Hospital S.Joao, Porto, Portugal.
Introduction and aim: The treatment of eradication of Helicobacter Pyloriin patients with MALT Lymphoma raised the hypothesis of his role in theregression of these type of tumors and in reducing the progression to ahigher degree neoplasia. However, the increased number of these moresevere tumors in the last years doesn’t support this assumption and stim-ulate a better knowledge of our reality.Material and methods: The cases of primary gastric lymphoma diagnosedin our hospital in the last 10 years, and registered in the PathologyDepartment, were submitted to a retrospective study. All the histologicslides were reviewed.Results: The study included 53 cases (29 men and 24 women; mean age:61years), 30 were diagnosed in the surgical specimen and 23 in the endo-scopic biopsy. The most frequent location of the tumor was the antrum(51%) and the most prevalent macroscopic aspect was the ulcerated type(58%). The histologic types according the method of the diagnosis were: a)surgical specimen—MALT of low grade (40%), MALT in progression(17%), B cell high grade (40%) and B cell centrocitic centroblastic (6%);b) endoscopic biopsy—MALT of low grade (22%), B cells high grade(70%), mantle cell lymphoma (4%) and mediterranean lymphoma (4%).The relative percentages of those histologic types of lymphoma, in the firstand second periods of 5 years in which we considered the study, wassimilar.Conclusions: In our study, primary gastric lymphoma comprehended neo-plasias of low grade (MALT, centrocitic centroblastic B, mantle andmediterranean types) and, with a higher frequency, high grade tumors (Bcells and MALT in progression types). The percentage of high gradelymphomas was higher in the group of cases diagnosed by endoscopicbiopsy than in the group identified in the surgical specimen. This suggesta lower accuracy in diagnosing lymphoma of low grade by endoscopy. Thisfact reinforces the role of the endoscopy in the clinical cases of “dispepsya”and the necessity of doing systematic biopsies in the cases usually de-scribed as “gastritis”.
PANCREATIC/BILIARY
253
Involvement of the superior mesenteric/portal vein (SM/PV) is not acontraindication to pancreaticoduodenectomyEK Abdalla, PWT Pisters, JE Lee, JN Vauthey, KR Cleary, CCharnsangavej, DB Evans. Department of Surgical Oncology,University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Purpose: To compare survival duration of patients who required extendedpancreaticoduodenectomy with en-bloc venous resection, to those whounderwent standard pancreaticoduodenectomy for malignant tumors of thepancreatic head.Methods: 107 patients who underwent en-bloc resection of the SM/PVwere identified from a database containing 314 consecutive pancreati-coduodenectomy patients from 1990 to 2000. Clinicopathologic factors,treatment and outcome variables were analyzed to determine margin-negative resection (R0), disease-free and overall survival rates.Results: Of the 107 patients who underwent en-bloc venous resection(VR), 89 had adenocarcinoma. R0 resection rates were comparable withand without vascular resection (79% vs 87%, p � NS). For the entire cohortof patients, the actuarial 5-year disease-free survival rate with VR was33%, versus 38% without VR (p � NS). The overall survival rate with VRwas 37%, versus 39% without VR (p � NS). For the subset of patients withadenocarcinoma, there was no difference in survival rate based on the needfor VR:
S80 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001
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