P. B. Desai

Primary carcinoid tumor of the liver: Report of four resected cases including one with gastrin production

Four cases of primary hepatic carcinoid were identified during a retrospective study of liver resections for primary tumor. The cases included two adult males, one adult female, and a 9‐year‐old boy in whom gastrin levels were documented. The estimation of gastrin levels was prompted by symptoms suggestive of acid‐peptic disease. One patient died postoperatively. The other three are alive and well at 3 years, 2 years, and at 1 year, respectively, after surgery, outcomes distinctly different from hepatocellular carcinomas. Diagnostic difficulties may be experienced in histologic assessment, and this may require recourse to immunohistochemistry and electron microscopy. Long‐term follow‐up and careful exclusion of a possible primary elsewhere are necessary for establishing the primary nature of liver carcinoids.

Dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus.

During a 2-year period, 103 consecutive patients undergoing dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus were prospectively studied. The length of the strictures ranged from 0.5 to 13.5 cm (median, 5 cm) and the luminal diameter from 1 to 11 mm (median, 6 mm). Patients were referred for dilation from 2 weeks to 5 years (median, 2 months) after completion of radiation therapy. The guide wire was placed using fluoroscopy in 21 patients, endoscopy in 61, and a combination of endoscopy and fluoroscopy in 21. At least one dilator larger than the stricture could be passed in 101 (98%) patients. Five strictures were dilated to 16 mm, 29 to 15 mm, 28 to 14 mm, 16 to 12.8 mm, and 23 to 12 mm or less during the initial procedure. Development of complications and severe resistance were the limiting factors for optimal dilation. Relief of dysphagia was adequate in 66% of patients. The duration of dysphagia relief was 3 to 84 weeks (median, 16 weeks). Complications included persistent pain in 7 patients, unexplained fever in 2, perforation in 2, and delayed tracheo-esophageal fistula in 1. Two patients died of treatment-related complications. Repeated dilation was required in 32 of the 75 patients on long-term follow-up. We conclude that adequate palliation of dysphagia can be achieved by dilation in two-thirds of patients with radiation therapy-induced strictures of the esophagus. Dilation of these strictures is relatively simple and safe if performed with care.

The quality of swallowing for patients with operable esophageal carcinoma

Surgery is considered the standard treatment for operable esophageal carcinoma, although there is no compelling evidence that surgery can achieve better results than radiotherapy. There has previously been no direct randomized comparison of these two modalities with survival or disease specific outcome end points.

Prognosis of operable squamous cell carcinoma of the esophagus. Relationship with clinicopathologic features and DNA ploidy

Background. Reports on the influence of various prognostic factors in carcinoma of the esophagus are conflicting. The prognostic value of a set of clinicopathologic factors and DNA ploidy were examined in 74 patients with surgically resected squamous cell carcinoma of the lower and middle third of the esophagus.

CARCINOMA OF THE ESOPHAGUS IN INDIA.

It is as yet an unrecognised fact in geographic pathology that cancer of the esophagus has the highest incidence in India. An analysis of patient material reveals that 51% of cases are too advanced for any treatment at their initial presentation. The authors present their views regarding the management of cancers of the upper third, the middle third and the lower third of the esophagus (excluding the cervical esophagus). Cancers of the middle segment are the most common and the most debated as regards management. Results of radiotherapy and surgery are presented and compared. Those in whom radiotherapy failed have been analyzed critically, and the authors believe that there is a group of patients which could have been salvaged by timely excision of their growths. Thus, radiotherapy and surgery should have a complementary role in the overall management. Preliminary ideas on the value of preoperative irradiation are presented. The ideal method of preoperative irradiation and the ideal surgical approach are still matters of debate and uncertainty. The management of advanced esophageal cancers by chemotherapy is mentioned; and although the overall prognosis of a patient with esophageal cancer still remains poor, earlier diagnosis, the advent of supervoltage therapy, careful surgery and cautious chemotherapy at the optimum time may help to bring the ultimate survival rate of esophageal cancer patients close to that of patients with other malignancies.

Impact of age and sex on survival after curative resection for carcinoma of the esophagus

Background. The impact of age and sex‐related changes in the endogenous hormonal milieu on survival after curative resection for esophageal epithelial cancer is explored. Adami et al. have suggested that the event of puberty has a favorable impact on survival after treatment of epithelial cancers.

Immune dysfunction in non-Hodgkin's lymphoma.

Immune dysfunction seems to be more common in lymphoproliferative disorders wherein the malignant cells originate from the immune system itself. The reactions of Dinitrochlorobenzene (DNCB) and six recall antigens were found to be diminished in patients with non‐Hodgkins lymphomas as compared to control subjects (P < 0.005). The skin reactivity was lost in increasing order in well differentiated, poorly differentiated, and histiocytic types. The depression in delayed hypersensitivity was greater with generalized as compared to localized disease. In angioimmunoblastic lymphadenopathy (AIL), skin tests also showed negative response in 7 of 8 patients. This T‐cell dysfunction in a preneoplastic condition (AIL) suggests early appearance of immunodeficiency and probably a prerequisite for the development of a lymphoma. The serum immunoglobulin levels failed to show any relation with respect to histology or extent of disease. Presumably, the alteration of IgG is secondary to a malignancy.

Intrathoracic anastomosis after oesophageal resection for cancer.

Cervical anastomosis has been advocated to avoid the pulmonary complications and life‐threatening anastomotic disruptions following intrathoracic oesophagogastric anastomosis. This is a retrospective review of 111 oesophageal resections followed by an intrathoracic anastomosis. These resections were performed between September 1993 and August 1994 within a residency training program. The left thoracoabdominal approach was used for distal tumours and the Ivor Lewis technique for more proximal tumours. Squamous cell carcinoma accounted for 72% patients (n = 80), adenocarcinoma for 25% (n = 28), and others for 2.7% patients (n = 3). Of the patients, 69% had pathologic Stage III tumours. Operative mortality rate was 1.8% (two patients). Perioperative complications occurred in 39 patients, including anastomotic leak in 10 patients and myocardial infarction in 2 patients. In the absence of a leak, there were no major pulmonary complications requiring intensive care or ventilatory support. Of those patients with anastomotic disruption, 89% were salvaged by early clinical diagnosis and appropriate treatment. We conclude that transthoracic oesophagectomy with an intrathoracic anastomosis is a safe procedure that can be performed with low mortality and acceptable morbidity.

Dermatofibrosarcoma protuberans metastatic to the lung. A case report.

A case is presented of dermatofibrosarcoma protuberans of the gluteal region with metastasis to the lung appearing 7 years after wide excision of the primary lesion. The world literature is reviewed. The clinical and pathologic features of dermatofibrosarcoma are reviewed and treatment is discussed, with the aim of emphasizing the need for long-term follow-up examination of lymph nodes and for metastases following wide excision of these lesions.