Cases reported "Adenocarcinoma"

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11/22. Elevated early gastric carcinoma. Differential diagnosis as regards adenomatous polyps.

    Differential diagnostic problems between gastric carcinomas and precancerous lesions with severe dysplasia have become more perceptible with the increasing number of resected early carcinomas. Although such problems come up for all macroscopic and histologic types of gastric cancer they are particularly marked between early carcinomas of the elevated type and adenomatous polyps. Elevated early carcinomas are usually highly differentiated adenocarcinomas with a morphology which often reminds of of adenomas. But sometimes the carcinomas also demonstrate convincing signs of being developed from adenomas. The criterion of distinction between intramucosal carcinomas and adenomas is invasion through the basal membrane, often difficult to evaluate. The morphological relation between elevated early gastric carcinomas and adenomas and the criterion of distinction between them were studied in 20 early gastric carcinomas of the Japanese types I and IIa, 6 intramucosal and 14 submucosal all highly differentiated adenocarcinomas, and in 42 polyps, of which 5 were of the adenomatous type. All lesions were taken from resection specimens. Among the carcinomas 5 demonstrated convincing signs of being malignant transformed adenomas. In addition, 6 carcinomas had a morphology which more or less reminded of adenomas, but their genetic origin was more uncertain. Nine carcinomas revealed no sign of an adenomatous origin. Among the 5 polyps diagnosed as adenomas 2 revealed an extraordinary degree of severe dysplasia which caused uncertainty on the benign diagnosis. The rest of the polyps were without dysplasia. The significance of invasion through the basal membrane as an indispensable factor of distinction between adenoma and carcinoma in the stomach is discussed. It is concluded that the degree of dysplasia can be so severe and the invasion so difficult to evaluate that the classification of some few tumours depends on the subjectivity of the single pathologist. Four of the tumours, 2 adenomas and 2 intramucosal carcinomas, having a remarkable macroscopic appearance like a large mucosal fold are especially mentioned. Their relation to gastric mucosal prolaps is discussed. Furthermore, a tumour apparently demonstrating only a moderate degree of dysplasia, but even so setting up metastases is mentioned in detail.
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keywords = precancerous
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12/22. Management and care of the precanceroses of the stomach in the 11-year material of our clinic.

    The present paper surveys over the past 11 years the cases of the endoscopic laboratory of our clinic which, according to criteria accepted all over the world, were considered as precancerous states of the stomach. According to the authors' experience, an advance in the management of malignant diseases can only be expected by referring to operation the cases in their early stage, if the examination and regular control of the patients are carried out with the predisposing factors being considered by a team involving the surgeon, endoscopist and pathologist.
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keywords = precancerous
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13/22. Small bowel carcinoma in Crohn's disease. Distinguishing features and risk factors.

    An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion. The increasing number of case reports of adenocarcinoma arising at the site of long-standing Crohn's disease, many with dysplasia within areas of diseased bowel, is further evidence that Crohn's disease is a precancerous condition. physicians must continue to search for methods of earlier diagnosis to improve the prognosis of small bowel carcinoma in Crohn's disease.
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keywords = precancerous
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14/22. Vaginal adenocarcinoma in a gravida with prenatal DES exposure.

    The article presents a case of a young pregnant woman with vaginal carcinoma who had been exposed to diethylstilbestrol (DES) in utero. Surgical excision of the lesion was attempted but failed. Interstitial irradiation was then applied and proved successful. The patient's infant, as well as two subsequent children, were delivered by cesarean section after normal pregnancies. There was no evidence of metastatic disease or recurrence in 11 1/2 years following the initial diagnosis. Since 1965, a rising incidence of vaginal adenocarcinoma in women who were exposed to (DES) in utero has been reported. These women should be examined regularly after menarche for prompt evaluation and treatment of precancerous lesions such as adenosis, cervical erosion or transverse ridges. Since most of these patients are young, a conservative treatment is recommended. Extensive surgery and pelvic irradiation is indicated, however, in the cases of widespread disease.
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keywords = precancerous
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15/22. peutz-jeghers syndrome with intestinal carcinoma: report of the association in one family.

    The peutz-jeghers syndrome is a rare, genectically inherited disorder. There are insufficient data to establish this syndrome as a precancerous condition, but documented cases of gastrointestinal cancer arising in this syndrome have been reported with an incidence of 2--3%. Since the syndrome is transmitted as an autosomal dominant and is associated with cancer, family members so afflicted may show an increased cancer risk. This is the first reported case of a father and son with both peutz-jeghers syndrome and colonic carcinoma.
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keywords = precancerous
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16/22. colonic polyps and adenocarcinoma complicating ureterosigmoidostomy: report of a case.

    A case of bilateral juvenile polyps and unilateral adenocarcinoma at the ureterocolic junctions occurring 40 years after ureterosigmoidostomy for exstrophy of the bladder is reported. Although adenocarcinoma of colon at the anastomotic site represents an uncommon late complication of ureterosigmoidostomy, patients undergoing this form of urinary diversion have a risk of developing colonic carcinoma that is 100 to 550 times greater than the normal population. Moreover this complication is being reported with increasing frequency in the literature. Different pathogenetic factors may play a role in carcinogenesis, but none has been satisfactorily proven. We suggest the possibility that polyps developing at the site of a ureterocolic junction may represent precancerous lesions.
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keywords = precancerous
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17/22. Electron microscopic study of adenocarcinoma of the small bowel associated with Crohn's disease.

    "Crohn's Carcinoma" of a 34-year-old patient is presented in this paper. The fine structure of the tumour is discussed in detail, because there have been no previous reports of electron microscopic studies of this tumour. The adenocarcinoma cells were electron microscopically less differentiated than expected on the basis of light microscopic examinations. In the tumor cells, several round dense granules were observed. Similar granules were also described in the cells of intestinal type gastric and colon cancers, being considered a sign of pathologic mucus secretion. In a part of the tumour cells, intracisternal parallel tubular inclusions were seen like those described in malignant melanoma and osteosarcoma. In the dysplastic small-bowel mucosa adjacent to the tumour, the maturation disorder of the epithelial cells was similar to changes described in the precancerous states of the colon.
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keywords = precancerous
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18/22. Colonic "precancer" in Crohn's disease.

    Two patients with longstanding Crohn's disease, who developed colonic carcinoma and showed associated "precancer" identical to that seen with ulcerative colitis, are reported. The first patient developed rectal adenocarcinoma at age 42 yr, 27 yr after the onset of symptoms while the second patient had a clinically silent small colonic carcinoma at the time of colectomy, 40 yr after the onset of disease. Both patients had characteristic Crohn's disease. In both patients, in addition to the carcinoma, there was multifocal "precancer" characterized by (a) epithelial dysplasia and (b) adenomatous growth pattern and villiform proliferation of the mucosa. These changes were identical to those associated with ulcerative colitis and, in both cases, were present adjacent to and distant from the infiltrating carcinomas. It is important to note that such epithelial changes, termed "precancer" in the setting of longstanding ulcerative colitis, can also occur in association with longstanding Crohn's disease. Further studies are needed to define the incidence of such precancerous changes in Crohn's disease more clearly and to evaluate the relationship between these changes and carcinoma. Careful evaluation of patients with longstanding Crohn's disease and "precancer" is warranted to exclude concomitant carcinoma.
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keywords = precancerous
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19/22. Generalized juvenile polyposis with mixed pattern and gastric cancer.

    Generalized gastrointestinal juvenile polyposis is a rare form of diffuse polyposis in which cancer infrequently develops. A clinical case is described in which gastric polyps showed a variety of histological features, including both in situ and invasive adenocarcinoma. Many mixed lesions were observed, confirming a morphological sequence already documented in colorectal tumorigenesis but still undefined in gastric tumors. The patient seems strongly predisposed to gastric cancer, presumably on a genetic basis, because he developed a malignancy in a hyperplastic juvenile polyp, usually not considered a precancerous lesion. There is no doubt that cases like this may be important for accurate genetic evaluation and biological characterization.
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keywords = precancerous
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20/22. Esophageal malignancy after liver transplantation in a patient with Barrett's esophagus.

    patients undergoing liver transplantation are predisposed to develop extrahepatic malignancies. It is also known that patients with predisposed conditions, such as Barrett's esophagus, have higher rates of esophageal carcinoma. We present here a patient who underwent liver transplantation, had Barrett's esophagus, and developed esophageal malignancy a short time after transplantation. liver transplantation may be associated with acceleration of the precancerous condition and the development of malignancies.
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keywords = precancerous
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