Background and Aim: Esophageal squamous cell carcinoma (SCC) is related to smoking and drinking. Betel nut chewing is prevalent in southern Taiwan and is also a risk factor of esophageal SCC. The study aimed to evaluate the accuracy of EUS in staging esophageal SCC and the possible prognostic factors. Materials and Methods: Eighty-seven patients with esophageal SCC undergoing pretreatment EUS were enrolled from January 2002 to December 2005. Using pathological stages as the gold standard in the 22 operative patients, the EUS accuracy in determining tumor (T) and nodal (N) stages were evaluated. We recorded patient age, tumor location, EUS staging and personal habits including smoking, drinking and betel nut chewing as variables and try to seek the possible prognostic factors. Results: In total 22 operative patients, the EUS accuracies in T1, T2, T3, T4 and N1 were 86.4%, 63.7%, 50.0%, 72.7% and 36.4%, respectively and increased to 100%, 90.9%, 90.9%, 100% and 45.5% in 11 operative patients without chemoradiotherapy interference. Median survivals for 87 patients in pretreatment EUS stage Tis/T1/T2 (not available due to good prognosis), stage T3 (29.9 months), and stage T4 (7.2 months) were statistically different (P＜0.001). Pretreatment EUS T staging and betel nut chewing were the prognostic factors and EUS T staging was the only independent predictor. Conclusions: EUS T staging is useful in pretreatment esophageal SCC and is the only independent prognostic factor. But the accuracy of N staging is not as good as T staging, the effort toward the accurate N staging is necessary.
The precise roles of mast cells in liver allograft rejection and tolerance are still unknown. This study aimed to explore the roles of mast cells in immune regulation and liver regeneration for tolerance induction by using rat models of orthotopic liver transplantation (OLT). Stem cell factor (SCF) and its receptor c-Kit, which are critical to the migration and development of not only stem cells but also mast cells, significantly increased in the tolerogenic livers as compared with rejected livers. The significant elevation of mast cell tryptase, high-affinity IgE receptor, and histamine suggested the activation of mast cells in liver allografts at the tolerogenic phase after OLT. Immunohistochemical analysis using confocal microscope clearly showed colocalization of mast cells, Foxp3+ Tregs, γδ T cells, and recipient-derived hepatic progenitor cells with higher expression of SCF, IL-9, IL-10, TGF-β1, and IL-17 related to immunoregulation and liver regeneration in the donor grafts of a tolerogenic OLT model. Cross-talk among mast cells and other cells was evaluated by in vitro studies demonstrating that syngeneic bone marrow−derived mast cells (BMMCs) co-cultured with naïve splenocytes or primary hepatocytes significantly increased the population of splenic γδ T cells by mitogen stimulation or by mast cell degranulation, and also significantly induced the hepatocyte proliferation, respectively. Our results suggested that mast cells in the donor grafts may play important roles in the induction/maintenance of immune tolerance and liver regeneration resulting in the replacement of hepatic cells from donor to recipient.
Background. Preoperative delineation of any vascular anomalies offers planning for possible alteration of surgical procedures, especially in pediatric recipients undergoing living-related liver transplantation. Purpose. We assess the efficacy of three-dimensional (3D) multislice computed tomography (CT) angiography in the hope of replacing conventional angiography as the pretransplant evaluation of the hepatic vascular system for potential recipients of liver transplantation. Methods. 3D CT angiography was performed in 38 children with biliary atresia. Conventional angiography was also performed in the first 15 patients. Twelve patients underwent living-related liver transplantation. The findings on 3D CT angiography were compared with conventional angiography and operative findings. Results. 3D CT angiography was successfully performed in 37 pediatric patients. All findings of 3D CT angiography on hepatic artery, portal vein, and inferior vena cava paralleled those of catheter angiography and operative findings. Four patients were unsuitable to receive living grafts because of pathologic insults of the hepatic artery (one patient) and the portal vein (three patients). Three patients were advised to undergo a venous graft for portal anastomoses. Eight patients demonstrated portosystemic shunts that may require closure. Conclusion. 3D CT angiography proves to be a better tool in the demonstration of the vascular system and identification of pathologic insults in pediatric patients. It is superior to conventional angiography because it is less invasive, more convenient, and more efficient in providing thorough preoperative information that would have a major impact on patient selection and surgical planning.
Pancreatic Neuroendocrine Tumors (PNET) are rare neoplasms, diagnosed via CT, MRI, Octreotide scan or EUS, which has the highest sensitivity & tissue obtaining ability. Management is based on resection, dependent on size & spread. Serum Chromogranin-A (CgA) is still widely used in diagnosis despite its lack of evidence. Hence, the North American Neuroendocrine Tumor Society (NANETS) and the Canadian expert group considers serum CgA diagnostic utility a controversial area and advise caution in its interpretation, requiring further studies in its validation Despite the widespread use of serum CgA in PNET diagnosis, we believe serum CgA has poor diagnostic utility Aims include: 1. Evaluate the diagnostic sensitivity of serum CgA in our cohort 2. Delineate different modalities utilized in tissue diagnosis Retrospective chart review of patients with a histological diagnosis of PNET from a pathology database covering Vancouver BC, Canada, from January 1st, 2011 till July 31st, 2016 Exclusion criteria: 1. Patients with a nonpancreatic primary neuroendocrine tumor 2. Patients with no CgA levels prior to diagnosis We correlated serum CgA levels, patient characteristics, disease manifestations and characteristics such as size and metastases, dianostic modalities used and treatments undertaken 143 patients with histological diagnosis of PNET. Mean age 60 & 58% females. EUS used in diagnosis of 90 (63%), surgical resection in 34 (24%) & remaining had percutaneous or intra-operative biopsy. Serum CgA prior to tissue diagnosis was performed in 60% (87) and had a sensitivity of only 48% (42/87), median of 109 U/L (normal <40 U/L) & 212 ug/L (normal <94 ug/L) from two different lab assays. Comparing CgA positive versus negative patients, no significant difference was found in location of PNET (most commonly in the tail in 33% & 37% of positive & negative patients respectively, 95% CI -17.3–24.8%, p=0.69). A significant difference was found in the size of the lesion in patients with a positive CgA as compared with the negative group (mean 3.31cm vs. 2.32cm; 95% CI 0.11–1.86, p=0.02). A significant proportion of CgA positive patients had metastatic disease as compared to CgA negative patients (38% vs. 15%; 95% CI 2.97–41.53, p=0.015) PNET are rare neoplasms, usually diagnosed via EUS. We corroborated this with approximately two thirds of our cohort undergoing EUS sampling for diagnosis. Serum CgA, although thought to have some diagnostic utility, has a very low sensitivity with less than half of our cohort of patients having positive CgA levels. Hence, CgA levels should not be used as a diagnostic modality in PNETs, and if negative, should be interpreted cautiously. CgA levels may however, have a utility in helping identify metastatic disease and thus altering surgical management None
Primary gastro-intestinal lymphoma (PGIL) has various presentations in the gastrointestinal tract. Between 1987 and 1993, we examined 90 cases, using radiography, sonography and/or endoscopy, in an attempt to characterize the lesions of PGIL.Patients suffering from PGIL lesions were investigated with the combined modalities of radiology. Sonography and endoscopy. The data was reviewed retrospectively. All cases were proven by tissue histology obtained by biopsy or surgical resection.We characterized seven growth patterns of PGIL: ulceration, infiltration, stricture, obstruction, erosion-like lesion, new growth (divided into 3 sub-groups: nodule, polypoid and mass) and perforation. Ulcerative lesion was found to be predominant in stomach (80.5%, P < 0.001) and duodenum (71.4%, P< 0.01) comparing with small (19.2%) and large (43.8%) bowel. The positive rate of gastric biopsy using endoscopy was 86% (31/36 biopsy cases). New growth pattern was the second main feature in PGIL, and one of the new growths, namely the mass, was predominant feature in terminal ileum (71.4%, P<0.001) and colon (62.5%, P < 0.001) when compared with stomach. Ulceration was a more frequent lesion in gastric and duodenal lymphoma. Cecal and terminal ileal lymphomas were mainly presented as new growth lesions, following the mass pattern.Radiographic, sonographic, and endoscopic studies showed different patterns in PGIL. A combination of these modalities was recommended in the evaluation of various lesions of PGIL.
The aim of this study is to elucidate the biogenetic modification of donor and recipient interleukin-28B (IL-28B) genotypes in liver graft biopsies after living donor liver transplantation (LDLT) for chronic hepatitis C virus-(HCV-) related, end-stage liver disease.Fifty liver graft biopsies were collected from recipients during LDLT treatment for HCV-related, end-stage liver disease.DNA was extracted from all 50 liver tissues, and the IL-28B single-nucleotide polymorphisms (SNPs) rs8099917 and rs12979860 were studied for allelic discrimination by real-time PCR analysis.Blood samples were obtained from donors and recipients on postoperative day 0 (POD0), POD7, and POD30.We randomly selected five liver biopsies and isolated the hepatocytes by laser capture microdissection (LCM) to evaluate genotype modifications resulting from LDLT.After LDLT, the IL-28B SNP rs8099917 was identified not only in the liver graft biopsies and donors' sera (TT = 41 : 43; GT = 9 : 5; GG = 0 : 2), but also in liver graft biopsies and recipients' sera on POD0 (TT = 41 : 44; GT = 9 : 4; GG = 0 : 2), POD7 (TT = 41 : 30; GT = 9 : 18; GG = 0 : 2), and POD30 (TT = 41 : 29; GT = 9 : 19; GG = 0 : 2).A significant difference was observed between the rs8099917 allele frequencies of liver graft biopsies and recipients' sera on POD30 ( = 0.039).In addition, a significant difference was also noted between the rs12979860 allele frequencies of liver graft biopsies and donors' sera (CT = 49 : 39; TT = 1 : 10) ( = 0.012) and of liver graft biopsies and recipients' sera on POD0 (CT = 49 : 39; TT = 1 : 11) ( = 0.002), POD7 (CT = 49 : 42; TT = 1 : 8) ( = 0.016), and POD30 (CT = 49 : 41; TT = 1 : 9) ( = 0.008).This phenomenon was confirmed by pyrosequencing of hepatocytes isolated by LCM.Following LDLT, the TTto-GT IL-28B genotype modification predominated in rs8099917, and the CC-to-CT modification predominated in rs12979860.In conclusion, these modified phenomena suggested that the selected donor with a predictable and favourable IL-28B genotype will not confer a benefit on the recipient in the living donor liver transplantation setting.
A 66-year-old male patient without a history of risk factors for pancreatitis suffered from pancreatitis and developed pseudocyst. During the course of treatment and follow-up, the pseudocyst was found to have migrated through the pancreatic tail, left hepatic lobe, caudate lobe, and spleen on abdominal sonography and computed tomography scan. Finally, emergent laparotomy was done for splenic abscess and removal of infected pseudocyst in the spleen and lesser sac of the abdomen. The patient made a full recovery after operation.
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