Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature

A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN) arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: An individual participant data meta-analysis

Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGCs) of the pancreas is a rare neoplasm that accounts for less than 1% of all pancreatic malignancies. The aim of this study was to review the literature regarding UC-OGC, and to highlight its biological behavior, clinicopathologic characteristics, prognosis, and therapeutic options. A systematic review of the literature in PubMed/Medline and Scopus databases was performed (last search October 31st, 2023) for articles concerning pancreatic UC-OGC in the adult population. Fifty-seven studies met the inclusion criteria, involving 69 patients with a male-to-female ratio of 1.1:1 and a mean age of 62.96. Main symptoms included abdominal pain (33.3%), jaundice (14.5%), weight loss (8.7%), while fourteen patients (20.3%) were asymptomatic. Surgical resection was performed in 88.4% of cases. Survival rates at one, three, and five years were 58%, 44.7%, and 37.3% respectively. Sex, age, size (cut-off of 4 cm), location, and adjuvant treatment did not significantly affect patient survival. UC-OGC of the pancreas is a rare subtype of undifferentiated pancreatic carcinoma with a better prognosis than conventional pancreatic ductal adenocarcinoma or undifferentiated carcinoma without giant cells. The establishment of a dedicated patient registry is imperative to further delineate the optimal treatment for this uncommon clinical entity

A role for surgery in primary pancreatic B-cell lymphoma: a case report

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The role of oncogene HER2 in current management of gastric cancer

Aim: Anti-HER2 therapy was recently applied to advanced gastric cancer with HER2 overexpression and/or amplification tested by immunohistochemistry (ICH) and fluorescent in situ hybridization (FISH). However, FISH is technically demanding and expensive. Chromogenic in situ hybridization (CISH) uses a chromogenic substrate similar to IHC. The slides are visible under light microscopy and show correlation with morphology. Our aim was to assess HER2 status by IHC and CISH in gastric cancer.Methods: 120 gastric carcinomas combined on a multiple-punch tissue microarray, including lymph node metastases in 45 patients, were examined for HER2 overexpression and gene amplification by IHC and CISH.Results: Twenty-four (20%) of 120 tumours expressed HER2 by IHC. An IHC score of ≥2+ was observed in 20 tumours (16.6%). HER2 amplification was detected by CISH in 19 tumours (15.8%) and their matched lymph node metastases . Amplification was associated with intestinal phenotype (p<0.05), but did not show association with grading, staging or survival.Conclusion: In gastric cancer HER2 amplification is the only mechanism for HER2 protein overexpression and is preserved in lymph node metastases. The evaluation of the expression of HER2 protein in patients with gastric adenocarcinoma should be done by immunohistochemistry (ICH) and be verified by in situ hybridization. Chromogenic in situ hybridization (CISH) can be used as an alternative for FISH in HER2 testing. Our data do not support the prognostic role of HER2 status in gastric cancer and, as a result, do not advocate the addition of molecular treatment in the form of trastuzumab in gastric cancer patients

Eosinophilic Esophagitis and Achalasia: Two Distinct Nosologic Entities or a Possible Etiopathogenic Association?

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Despite the fact that researchers have made significant progress in elucidating the pathophysiology of esophageal diseases, the understanding of esophageal motility alterations in patients with eosinophilic esophagitis (EoE) is in its infancy and current published medical literature remains rather scarce on this topic. A growing body of scientific data regarding associations between esophageal motor disorders, such as achalasia and EoE, exists nowadays. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; It seems that the association of EoE and achalasia does not constitute a cause and effect relationship, as it is not clear whether esophageal motility abnormalities are the result of EoE or vice versa. As such, there is no universally accepted treatment algorithm for patients presenting with both of these entities. &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; The aim of this article is to review the existing data on achalasia-like motility disorders in patients with EoE, highlighting a possible association between these 2 esophageal disorders. Moreover, we seek to describe the clinical presentation in such cases, diagnostic modalities to be used, and current treatment strategies in patients suspected to suffer from both disorders. </jats:p

Human epidermal growth factor receptor-2 gene amplification in gastric cancer using tissue microarray technology

AIM: To assess human epidermal growth factor receptor-2 (HER2)-status in gastric cancer and matched lymph node metastases by immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH)

An extremely rare clinical manifestation of acute appendicitis in a nonagenarian patient: lessons still to be learned

Abstract Acute appendicitis is associated with a relatively high mortality rate among elderly patients due to the unusual clinical presentation that often leads to misdiagnosis and, in turn, severe complications. This report describes an extremely uncommon clinical manifestation of acute appendicitis in an elderly patient - a subcutaneous abdominal wall abscess initially treated as cellulitis. Despite the initial misdiagnosis, contrast-enhanced computed tomography revealed a circumscribed inflammatory process of the appendix that was in close proximity to the abdominal wall. The patient underwent a surgical drainage of the abscess, received broad-spectrum antibiotics, and was discharged on day 12 following an uneventful course. Diagnosis of acute appendicitis in elderly patients is challenging due to the atypical clinical presentation and co-existing comorbidities that can be misleading. Early application of high-resolution imaging techniques is necessary to identify the cause of acute abdomen in the elderly population.</jats:p

An extremely rare clinical manifestation of acute appendicitis in a nonagenarian patient: lessons still to be learned

Abstract Acute appendicitis is associated with a relatively high mortality rate among elderly patients due to the unusual clinical presentation that often leads to misdiagnosis and, in turn, severe complications. This report describes an extremely uncommon clinical manifestation of acute appendicitis in an elderly patient - a subcutaneous abdominal wall abscess initially treated as cellulitis. Despite the initial misdiagnosis, contrast-enhanced computed tomography revealed a circumscribed inflammatory process of the appendix that was in close proximity to the abdominal wall. The patient underwent a surgical drainage of the abscess, received broad-spectrum antibiotics, and was discharged on day 12 following an uneventful course. Diagnosis of acute appendicitis in elderly patients is challenging due to the atypical clinical presentation and co-existing comorbidities that can be misleading. Early application of high-resolution imaging techniques is necessary to identify the cause of acute abdomen in the elderly population