Massimo Conio

CA 19‐9 and CA 50 in Benign and malignant pancreatic and biliary diseases

Serum concentrations of the CA 19‐9 and CA 50 antigens were determined in 129 patients with malignant and benign biliary and pancreatic diseases. Values for the two markers were highly correlated (P < 0.001). The concentrations of CA 19‐9 and CA 50 were positive in 84.6% and 80.7% of patients with pancreatic cancer, respectively. The overall specificity of CA 19‐9 (92.4%) was slightly higher than that of CA 50 (88.5%). The sensitivity of CA 50 (91.3%) was greater than that of CA 19‐9 (73.9%) in patients with diseases of the biliary tract. Elevated concentrations of CA 19‐9 (12.9%) and CA 50 (35.2%) were also found in a number of cases with benign disease, especially in patients with obstructive jaundice. These data suggest that both CA 19‐9 and CA 50 can be useful markers of pancreatic cancer in nonjaundiced patients. The joint use of the two markers does not yield a better diagnostic resolution than the use of either one alone.

Primary signet‐ring carcinoma of the large bowel report of nine cases

Nine cases of signet‐ring carcinoma have been observed from among 800 consecutive histologic cases diagnosed as adenocarcinoma of the colon during a period of 10 years (0.9%). This group of nine patients (Group A) has been matched for sex, age, and stage with a group of 45 patients affected by oridinary carcinoma of the colon (Group B). Clinical and histologic parameters, including symptoms, primary tumor site, free interval from primary surgery, histochemical investigation of intracytoplasmic mucins, and survival, were evaluated. The results of this investigation showed no clinical differences between signet‐ring carcinoma and ordinary carcinoma, and no statistically significant results were observed regarding the frequency of local recurrence and actuarial survival.

Tissue sampling from the common bile duct through endoscopic retrograde cholangiopancreatography, endoscopic papillo(sphinctero)tomy and drainage in juxtapapillary malignancies

SummaryIn 22 patients with radiological evidence of a malignant stricture or an obstruction of the common bile duct, endobiliary tissue specimens were obtained through endoscopic retrograde cholangiopancreatography. An endoscopic papillo(sphinctero)tomy was necessary in 9 of the 22 patients. The following techniques were employed: (1) forceps biopsy of the papillary infundibulum and/or of the common bile duct; (2) brush cytology in the same sites as above; (3) biliary juice cytology obtained by a nasobiliary drainage tube. In 8 patients, two different sampling techniques were used. The final diagnosis was established by means of pathological evaluation of surgical or necroscopic material. The diagnostic adequacy was 100% for biopsy, 88% for brush cytology, and 62% for bile cytology. The sensitivity was 100%, 66%, and 25%, respectively, for the above techniques. From 6 cases without biliary cancer, the specificity was 100%. These data show that biopsy specimens alone provide a definitive preoperative diagnosis in most cases, provided adequate samples are obtained.

Cancer of the pancreas: Clinical outcome in 76 cases

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

Analyse des données cliniques et biologiques de ľœsophage de Barrett et du risque de développement ďun adénocarcinome œsophagien chez les patients porteurs de la lésion métaplasique: une étude multicentrique

La majorit6 des 6tudes 6valuant la relation entre E.B. et risque dad6nocarcinome, sont r6trospectives. Le petit nombre d6tudes prospectives publi6es dans la litt6rature na pas utilis6 de groupe-contr61e, ce qui rend impossible lexclusion des bias de s61ection. De plus, la grande variabilit6 des donn6es rapport6es concerne un petit nombre de patients inclus dans chaque 6tude et les modalit6s diff6rentes appliqu6es dans chacune des 6tudes. Malgr6 la publication de donn6es biologiques relatives h I E.B., fournies par la cin6tique ceUulaire et la cytom6trie de flux, l6valuation biologique de ce processus m6taplasique demeure impr6cise [6, 8, 10].

Subocclusion intestinale consécutive à un lipome colique sous-muqueux. A propos d'un cas

RésuméLes auteurs rapportent un cas de volumineux lipome sous-muqueux du côlon sigmoïde. L’intérêt de l’observation réside dans le caractère brusque et la récurrence des crises de subocclusion intestinale.Le diagnostic histologique a été établi sur la pièce de résection chirurgicale.SummaryThis is a case report of a large submucosal lipoma in the sigmoid colon. Its clinical interest lies in the sudden onset as recurrent abdominal subocclusive episodes.The histological diagnosis was ascertained on the surgical specimen.