BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 pat...BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.展开更多
AIM： To evaluate the feasibility and efficacy of endo- scopic submucosal dissection （ESD） for foregut neuro- endocrine tumors （NETs）. METHODS： From April 2008 to December 2010, pa- tients with confirmed histolog...AIM： To evaluate the feasibility and efficacy of endo- scopic submucosal dissection （ESD） for foregut neuro- endocrine tumors （NETs）. METHODS： From April 2008 to December 2010, pa- tients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography （EUS）. ESD was attempted under general anesthesia. After making several mark-ing dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submu- cosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological char- acteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or dis- tant metastasis. RESULTS： Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows： esophagus （n = 1）, cardia （n = 1）, stomach （n = 23）, and duodenal bulb （n = 4）. All le- sions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preop- erative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 le- sions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The av- erage maximum diameter of the lesions was 9.4 mm （range： 2-30 ram）, and the procedure time was 20.3 rain （range： 10-45 rain）. According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric le- sions were NET-G2, and 1 esophageal lesion was neu- roendocrine carcinoma （NEC）. Complete resection was achieved in 28 lesions （28/29, 96.6%）, and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The re- maining patient with NEC underwent additional surgery because the resected specimens revealed angiolym- phatic and muscularis invasion, as well as incomplete resection. Delayed bleeding occurred in 1 case 3 d af- ter ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo （range： 12-48 too）, local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died dur- ing the study period. CONCLUSION： ESD appears to be a safe, feasible, and effective procedure for providing accurate histo- pathological evaluations and curative treatment for eligible foregut NETs.展开更多
Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A li...Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.展开更多
基金Supported by the National Key R&D Program of China,No.2019YFC1315800National Natural Science Foundation of China,No.82170555+3 种基金Shanghai Rising-Star Program,No.19QA1401900Major Project of Shanghai Municipal Science and Technology Committee,No.19441905200Shanghai Sailing Program of the Shanghai Municipal Science and Technology Committee,No.19YF1406400and the 74th General Support of China Postdoctoral Science Foundation,No.2023M740675.
文摘BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.
基金Supported by Grants from the Medical Leading Project of Shanghai Municipal Science and Technology Committee,No. 10411969600 and No. 11411950502Major Project of Shanghai Municipal Science and Technology Committee, No.09DZ1950102 and No. 11DZ2280400Key Project of Shanghai Municipal Science and Technology Committee, No.09JC1403300
文摘AIM： To evaluate the feasibility and efficacy of endo- scopic submucosal dissection （ESD） for foregut neuro- endocrine tumors （NETs）. METHODS： From April 2008 to December 2010, pa- tients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography （EUS）. ESD was attempted under general anesthesia. After making several mark-ing dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submu- cosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological char- acteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or dis- tant metastasis. RESULTS： Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows： esophagus （n = 1）, cardia （n = 1）, stomach （n = 23）, and duodenal bulb （n = 4）. All le- sions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preop- erative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 le- sions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The av- erage maximum diameter of the lesions was 9.4 mm （range： 2-30 ram）, and the procedure time was 20.3 rain （range： 10-45 rain）. According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric le- sions were NET-G2, and 1 esophageal lesion was neu- roendocrine carcinoma （NEC）. Complete resection was achieved in 28 lesions （28/29, 96.6%）, and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The re- maining patient with NEC underwent additional surgery because the resected specimens revealed angiolym- phatic and muscularis invasion, as well as incomplete resection. Delayed bleeding occurred in 1 case 3 d af- ter ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo （range： 12-48 too）, local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died dur- ing the study period. CONCLUSION： ESD appears to be a safe, feasible, and effective procedure for providing accurate histo- pathological evaluations and curative treatment for eligible foregut NETs.
基金supported by grants from the National Natural Science Foundation of China(No.81502523)grant from Shanghai Committee of Science and Technology(Nos.17140901100,16DZ2280900,and 14411950505).
文摘Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.
