Introdução / Objetivos: O prognóstico do adenocarcinoma ampular pode ser influenciado por fatores como estadiamento e variáveis histopatológicas, como o padrão intestinal ou pancreatobiliar. O diagnóstico do padrão histopatológico pode ser auxiliado pela expressão de citoqueratinas, CK, 7 e 20 e do gene homeobox CDX2. O objetivo do estudo foi analisar associações entre características histopatológicas e sobrevida, e entre padrão histopatológico e expressão de CK7, CK20 e CDX2. Método: Estudo de coorte retrospectivo desenvolvido no Hospital de Clínicas de Porto Alegre entre 2000 e 2011. Foram avaliados dados histopatológicos, estadiamento pTNM, padrão histopatológico e expressão imunoistoquímica e sobrevida. Resultados: A amostra constou de 65 carcinomas ampulares (n = 65). Foi observado padrão intestinal em 46, pancreatobiliar em 16 e outros em três. Sobrevida em cinco anos após duodenopancreatectomia (n = 47) foi de 27%. Associaram-se à menor sobrevida na análise univariada: dois ou mais linfonodos metastáticos, razão de linfonodos, RL, maior ou igual a 20%; estágio IIB em relação a inferiores; tumor de alto grau; invasão linfovascular. Na análise multivariada, metástase linfonodal e RL ≥ 20% influenciaram sobrevida. Conclusões: O pior prognóstico foi associado à metástase linfonodal. Não foi observada associação entre padrão histopatológico e expressão imunoistoquímica. / Background / Objectives: The prognosis of patients with ampullary adenocarcinomas can be influenced by such factors as pTNM stage and histopathological variables, such as intestinal or pancreatobiliary patterns. The characterization of these patterns can be facilitated by the expression of cytokeratins 7 (CK7) and 20 (CK20) and caudal-related homeobox gene 2 (CDX2). The aim of the present study was to analyze the association between the histopathological characteristics and the survival of patients with ampullary adenocarcinomas, as well as the association between the histopathological patterns and CK7, CK20 and CDX2 expression. Methods: This retrospective cohort study was performed at the Clinics Hospital of Porto Alegre between 2000 and 2011 and examined the histopathological data, pTNM stage, histopathological patterns, immunohistochemical expression patterns and survival of patients with ampullary adenocarcinomas. Results: The sample patient population consisted of 65 ampullary carcinomas. Of these carcinoma samples, an intestinal pattern was observed for 46, a pancreatobiliary pattern was observed for 16 and other patterns were observed 3 of the samples. The 5-year survival rate for patients following pancreaticoduodenectomy (n = 47) was 27%. From the univariate analysis, the following variables were associated with shorter survival times: the presence of 2 or more metastatic lymph nodes; positive lymph node ratio (LR) ≥ 20%; stage IIB or greater; high-grade tumors; and lymphovascular invasion. From the multivariate analysis, lymph node metastases and a LR ≥ 20% were shown to influence survival significantly. Conclusions: Lymph node metastases were associated with poor patient prognoses, although no association was found between the histopathological pattern and immunohistochemical expression.

Introdução / Objetivos: O prognóstico do adenocarcinoma ampular pode ser influenciado por fatores como estadiamento e variáveis histopatológicas, como o padrão intestinal ou pancreatobiliar. O diagnóstico do padrão histopatológico pode ser auxiliado pela expressão de citoqueratinas, CK, 7 e 20 e do gene homeobox CDX2. O objetivo do estudo foi analisar associações entre características histopatológicas e sobrevida, e entre padrão histopatológico e expressão de CK7, CK20 e CDX2. Método: Estudo de coorte retrospectivo desenvolvido no Hospital de Clínicas de Porto Alegre entre 2000 e 2011. Foram avaliados dados histopatológicos, estadiamento pTNM, padrão histopatológico e expressão imunoistoquímica e sobrevida. Resultados: A amostra constou de 65 carcinomas ampulares (n = 65). Foi observado padrão intestinal em 46, pancreatobiliar em 16 e outros em três. Sobrevida em cinco anos após duodenopancreatectomia (n = 47) foi de 27%. Associaram-se à menor sobrevida na análise univariada: dois ou mais linfonodos metastáticos, razão de linfonodos, RL, maior ou igual a 20%; estágio IIB em relação a inferiores; tumor de alto grau; invasão linfovascular. Na análise multivariada, metástase linfonodal e RL ≥ 20% influenciaram sobrevida. Conclusões: O pior prognóstico foi associado à metástase linfonodal. Não foi observada associação entre padrão histopatológico e expressão imunoistoquímica. / Background / Objectives: The prognosis of patients with ampullary adenocarcinomas can be influenced by such factors as pTNM stage and histopathological variables, such as intestinal or pancreatobiliary patterns. The characterization of these patterns can be facilitated by the expression of cytokeratins 7 (CK7) and 20 (CK20) and caudal-related homeobox gene 2 (CDX2). The aim of the present study was to analyze the association between the histopathological characteristics and the survival of patients with ampullary adenocarcinomas, as well as the association between the histopathological patterns and CK7, CK20 and CDX2 expression. Methods: This retrospective cohort study was performed at the Clinics Hospital of Porto Alegre between 2000 and 2011 and examined the histopathological data, pTNM stage, histopathological patterns, immunohistochemical expression patterns and survival of patients with ampullary adenocarcinomas. Results: The sample patient population consisted of 65 ampullary carcinomas. Of these carcinoma samples, an intestinal pattern was observed for 46, a pancreatobiliary pattern was observed for 16 and other patterns were observed 3 of the samples. The 5-year survival rate for patients following pancreaticoduodenectomy (n = 47) was 27%. From the univariate analysis, the following variables were associated with shorter survival times: the presence of 2 or more metastatic lymph nodes; positive lymph node ratio (LR) ≥ 20%; stage IIB or greater; high-grade tumors; and lymphovascular invasion. From the multivariate analysis, lymph node metastases and a LR ≥ 20% were shown to influence survival significantly. Conclusions: Lymph node metastases were associated with poor patient prognoses, although no association was found between the histopathological pattern and immunohistochemical expression.

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23566号 / 医博第4780号 / 新制||医||1054(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 佐藤 俊哉, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Thesis (M.Sc. (Physiology))--Mahidol University, 1982.

Esophageal and biliary stents are indwelling devices used in the treatment of selected gastrointestinal and biliary disorders. Stenting is accepted as a standard procedure for palliation of malignant obstruction of the esophagus and biliary system. Review of the early and late complications associated with these devices is made with emphasis on the clinical and radiographic features. A suggested approach to diagnosis and treatment recommendations are made for each complication that the emergency department physician may encounter.

No / Background Effective and tolerable chemotherapy with gemcitabine and cisplatin for advanced biliary tract cancer (BTC) has been established recently. However, overall prognosis is still poor, and additional therapeutic approaches are needed for patients with locally advanced, irresectable and/or pretreated tumors. Hepatic arterial infusion (HAI) of chemotherapy represents a safe and well-established treatment modality, but data on its use in patients with BTC are still sparse. Methods Patients with irresectable BTC predominant to the liver were included in a prospective, open phase II study investigating HAI provided through interventionally implanted port catheters. Intraarterial chemotherapy consisted of biweekly oxaliplatin (O) 85 mg/m2 and folinic acid (F) 170 mg/m2 with 5-FU (F) 600 mg/m2. Results Between 2004 and 2010, 37 patients were enrolled. A total of 432 cycles of HAI were applied with a median of 9 (range 1–46) cycles. Objective response rate was 16 %, and tumor control was achieved in 24 of 37 (65 %) patients. Median progression-free survival was 6.5 months (range 0.5–26.0; 95 % CI 4.3–8.7), median overall survival was 13.5 (range 0.9–50.7; 95 % CI 11.1–15.9) months. The most frequent adverse event was sensory neuropathy grade 1/2 in 10/14 patients. Conclusions Using a minimal invasive technique, repetitive HAI with OFF is feasible and results in clinically relevant tumor control with low toxicity in patients with liver predominant advanced BTC.

Introduction: Intraperitoneal tumor seeding is a common form of recurrence after surgery for GI tumours. Early diagnosis and treatment may influence the course of disease. Hypothesis and objectives of the work The finding of free tumor cells and / or elevation of tumor markers in peritoneal fluid predicts intraperitoneal tumor recurrence. The results of these tests can be used to indicate HIPEC. Aim of this work is to determine the sensitivity and specificity of cytology and tumor markers levels and importance of these tests for early diagnosis and prognosis of recurrence. Another objective was to confirm the applicability of RT PCR for identification of free tumor cells. Patients and methods . Materials are sourced both during initial surgery (220 patients) and by the dispensary controls (25 patients). The peritoneal fluid was examined cytologically and biochemically too. 50 samples was exemined by RT PCR. Results Elevation of tumor markers or finding of free intraperitoneal tumor cells predicts recurrence. The prognosis of these patients corresponds to stage IV TNM classification, regardless of other parameters TNM. Low sensitivity of these tests (34% for cytology, 53% for tumor markers) does not allow its use as an indicator of HIPEC. Due to degradation of RNA we did not confirm the value of RT...