Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2007
|
| Schriftenreihe: | Gastroenterology clinics of North America
36,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIII S., S. 775 - 995 zahlr. Ill., graph. Darst. |
| ISBN: | 9781416050735 1416050736 |
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| adam_text | CONTENTS VOLUME 36 ? NUMBER 4 • DECEMBER 2007
Preface xi
Robert D. Odze
Neoplastic Precursor Lesions in Barrett s Esophagus 775
Jason L. Hornick and Robert D. Odze
Barrett s esophagus, currently defined as endoscopically apparent
columnar metaplasia of the esophagus with histologic documentation
of goblet cells, is the precursor to esophageal adenocarcinoma.
However, not all patients with this disorder require intensive
surveillance. Padiologic diagnosis and grading of dysplasia in mucosal
biopsies remains the best and most widely used method of determining
which patients are at highest risk for neoplastic progression. The task of
diagnosing dysplasia suffers from considerable interobserver variability.
Therefore, consultation with expert gastrointestinal pathologists to
confirm the diagnosis of dysplasia before definitive management is
highly advisable. Adjunctive methods to improve reproducibility, such
as immunostaining for alpha-mediylacyl-CoA racemase, show promise
but require confirmation in larger studies. This article focuses on
dysplasia in Barrett s esophagus in terms of its classification, pathologic
diagnostic criteria, limitations, natural history, and treatment.
Squamous Dysplasia and Other Precusor Lesions
related to Esophageal Squamous Cell Carcinoma 797
Michio Shimizu, Shinichi Ban, and Robert D. Odze
Squamous cell carcinoma is the most common tumor of the esophagus
worldwide, and it is believed to develop through a sequence of
dysplastic precursor lesions, which can be detected both endoscopically
and microscopically. There are no published guidelines regarding
treatment for dysplasia; however, most authorities recommend
increased endoscopic surveillance, with biopsies, for patients with flat
low-grade dysplasia and endoscopic mucosal resection, endoscopic
submucosal dissection, or esophagectomy for patients with high-grade
dysplasia. Future studies are needed to define appropriate endoscopic
surveillance frequencies for patients widi premalignant lesions of the
esophagus. This article discusses squamous dysplasia in detail, which is
the most important and well-described risk factor for squamous cell
carcinoma of the esophagus.
Gastric Preneoplastic Lesions and Epithelial Dysplasia 813
Gregory Y. Lauwers and Amitabh Srivastava
The incidence of gastric cancer is declining; however, it remains the
second most common cause of cancer-related deaths worldwide. This
article describes gastric preneoplastic lesions and epithelial dysplasia.
The possible role of Helkobacter pylori infection is emphasized.
Precursors to Pancreatic Cancer 831
Ralph H. Hruban, Anirban Maitra, Scott E. Kern,
and Michael Goggins
Infiltrating ductal adenocarcinoma of the pancreas is believed to arise
from morphologically distinct noninvasive precursor lesions. These
precursors include the intraductal papillary mucinous neoplasm, the
mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia.
Intraductal papillary mucinous neoplasms are grossly visible mucin-
producing epithelial neoplasms that arise in the main pancreatic duct or
one of its branches. The cysts of mucinous cystic neoplasms do not
communicate with the major pancreatic ducts, and these neoplasms are
characterized by a distinct ovarian-type stroma. Pancreatic intra¬
epithelial neoplasia is a microscopic lesion. This article focuses on the
clinical significance of these three important precursor lesions, with
emphasis on their clinical manifestations, detection, and treatment.
Endocrine Hyperplasia and Dysplasia in the
Pathogenesis of Gastrointestinal and Pancreatic
Endocrine Tumors 851
Guido Rindi and Enrico Solcia
Non-neoplastic proliferative lesions of endocrine cells have been
described throughout the gastrointestinal tract and pancreas. A
multistep continuum from hyperplasia and dysplasia to neoplasia
originally was identified and systematically defined for histamine-
producing enterochromaffin-like (ECL) cells of the gastric corpus. More
recently, a similar classification system was devised for gastrin (G)- and
somatostatin (D)-producing cells in the duodenum. Preneoplastic
lesions of the endocrine pancreas still lack a solid and widely accepted
definition of a multistep growth process. Similarly, in spite of reports of
carcinoid-associated endocrine cell hyperplasia, there is no systematic
definition of nonneoplastic lesions of the endocrine cells of the ileum,
appendix and colorectum.
Hepatic Precancerous Lesions and Small
Hepatocellular Carcinoma 867
Prodromos Hytiroglou, Young Nyun Park, Glenn Krinsky,
and Neil D. Theise
Precancerous lesions that may be detected in chronically diseased,
usually cirrhotic livers, include: clusters of hepatocytes with atypia and
increased proliferative rate (dysplastic foci) that usually represent an
incidental finding in biopsy or resection specimens; and grossly evident
lesions (dysplastic nodules) that may be detected on radiologic
examination. There are two types of small hepatocellular carcinoma
(HCC) (defined as HCC that measures less than 2 cm): early HCC,
which is well-differentiated and has indistinct margins; and distinctly
nodular small HCC, which is well- or moderately differentiated, and is
usually surrounded by a fibrous capsule. Precise diagnosis of pre¬
cancerous and early cancerous lesions by imaging methods is often
difficult or impossible. Detection of a dysplastic lesion in a biopsy
specimen is a marker of increased risk for HCC development, and
warrants increased surveillance. High-grade dysplastic nodules and
small HCCs should be treated by local ablation, surgical resection, or
liver transplantation.
Neoplastic Precursors of the Gallbladder and
Extrahepatic Biliary System 889
N. Volkan Adsay
Premalignant lesions of the gallbladder and extrahepatic bile ducts have
been poorly studied compared widi their counterparts in die remainder
of the gastrointestinal tract. Some of the problematic issues, such as the
subjectivity of grading and determination of the relative risk of cancer,
are challenging. Although the understanding of the biology of these
lesions has improved in the past several years, there are still many
issues that can only be addressed by close collaboration between
gastroenterologists, radiologists, hepatobiliary surgeons, oncologists,
and pathologists.
Neoplastic Precursor Lesions Related
to the Development of Cancer in
Inflammatory Bowel Disease 901
Noam Harpaz
Dysplasia is an intermediate stage in the progression from inflammation
to cancer in patients with inflammatory bowel disease. Clinically.
dysplasia is used to define appropriate endpoints for colectomy in high-
risk patients undergoing endoscopic surveillance. Surveillance is
currently the only credible alternative to prophylactic colectomy for
high-risk patients. The success of surveillance can be maximized by
adherence of gastroenterologists to recommended procedural guide¬
lines, adherence of pathologists to standardized histological criteria and
nomenclature, and a joint commitment to close clinical-pathological
communication. Technical enhancements to conventional endoscopy
hold promise of improved efficiency and accuracy. Molecular-based
testing may have a future role for risk stratification and early detection
of neoplasia in inflammatory bowel disease.
Gastrointestinal Polyposes: Clinical, Pathological
and Molecular Features 927
Jeremy R. Jass
This article focuses mainly on noninflammatory epithelial polyposes,
particularly the diagnostically important morphological and molecular
features of the more recently recognized and/or more poorly under¬
stood conditions. One of the most important, but often neglected, of
these is hyperplastic polyposis.
Hyperplastic and Serrated Polyps of the Colorectum 947
Michael J. O Brien
The serrated polyp pathway is a histopathological sequence tfiat begins
in a hyperplastic polyp, or precursor serrated aberrant crypt focus, and
has the potential to end in a colonic adenocarcinoma that is CIMP-high
and, in most cases, also MSI. An activating mutation of the BRAF
oncogene is a marker for this pathway. There is evidence that aberrant
CpG-island methylation is the molecular engine that drives the
progression Arough sequential steps of the padiway, from hyperplastic
polyp to a form of atypical hyperplastic polyp (termed sessile serrated
adenoma) to dysplastic serrated polyp and, ultimately to serrated
carcinoma. A second serrated pathway, identified by mutations of
KRAS in serrated adenoma, is delineated less completely. Its endpoint is
a colorectal carcinoma that is CIMP-low and MSS, and both the
advanced serrated adenoma and carcinoma stages of this pathway show
molecular genetic and morphologic features that overlap with those of
the conventional APC carcinogenic pathway. Clinical studies are
needed to elucidate the natural history of serrated neoplasia, and
provide evidence-based guidance for risk assessment and surveillance of
individuals discovered to harbor its various serrated polyp precursors.
Anal Intraepithelial Neoplasia and Other
Neoplastic Precursor Lesions of the Anal Canal
and Perianal Region 969
Neil A. Shepherd
Anal cancer is rare and this helps to explain why anal pre-neoplastic
conditions are poorly understood, especially with regard to their natural
history and management. Anal intraepithelial neoplasia is closely linked
to human papillomavirus infection and is particularly common in
homosexuals and in immunosuppressed patients, especially those with
HIV/AIDS. The high regression rates of low-grade anal intraepithelial
neoplasia may simply reflect inconsistent pathologic reporting. Higher
grades of anal intraepithelial neoplasia may remain static for long
periods of time in immunocompetent patients, but those with HIV/
AIDS show early and rapid malignant transformation. In general, most
anal pre-neoplastic conditions are best diagnosed by biopsy and treated
by surgical excision, although local recurrence is a problem. In anal
Paget s disease, it is important to ascertain, at the time of diagnosis,
whether it is due to a primary in-situ apocrine-type of neoplasia of the
anus or if the disease is secondary to an invasive primary carcinoma of
the rectum.
Index 989
|
| adam_txt |
CONTENTS VOLUME 36 ? NUMBER 4 • DECEMBER 2007
Preface xi
Robert D. Odze
Neoplastic Precursor Lesions in Barrett's Esophagus 775
Jason L. Hornick and Robert D. Odze
Barrett's esophagus, currently defined as endoscopically apparent
columnar metaplasia of the esophagus with histologic documentation
of goblet cells, is the precursor to esophageal adenocarcinoma.
However, not all patients with this disorder require intensive
surveillance. Padiologic diagnosis and grading of dysplasia in mucosal
biopsies remains the best and most widely used method of determining
which patients are at highest risk for neoplastic progression. The task of
diagnosing dysplasia suffers from considerable interobserver variability.
Therefore, consultation with expert gastrointestinal pathologists to
confirm the diagnosis of dysplasia before definitive management is
highly advisable. Adjunctive methods to improve reproducibility, such
as immunostaining for alpha-mediylacyl-CoA racemase, show promise
but require confirmation in larger studies. This article focuses on
dysplasia in Barrett's esophagus in terms of its classification, pathologic
diagnostic criteria, limitations, natural history, and treatment.
Squamous Dysplasia and Other Precusor Lesions
related to Esophageal Squamous Cell Carcinoma 797
Michio Shimizu, Shinichi Ban, and Robert D. Odze
Squamous cell carcinoma is the most common tumor of the esophagus
worldwide, and it is believed to develop through a sequence of
dysplastic precursor lesions, which can be detected both endoscopically
and microscopically. There are no published guidelines regarding
treatment for dysplasia; however, most authorities recommend
increased endoscopic surveillance, with biopsies, for patients with flat
low-grade dysplasia and endoscopic mucosal resection, endoscopic
submucosal dissection, or esophagectomy for patients with high-grade
dysplasia. Future studies are needed to define appropriate endoscopic
surveillance frequencies for patients widi premalignant lesions of the
esophagus. This article discusses squamous dysplasia in detail, which is
the most important and well-described risk factor for squamous cell
carcinoma of the esophagus.
Gastric Preneoplastic Lesions and Epithelial Dysplasia 813
Gregory Y. Lauwers and Amitabh Srivastava
The incidence of gastric cancer is declining; however, it remains the
second most common cause of cancer-related deaths worldwide. This
article describes gastric preneoplastic lesions and epithelial dysplasia.
The possible role of Helkobacter pylori infection is emphasized.
Precursors to Pancreatic Cancer 831
Ralph H. Hruban, Anirban Maitra, Scott E. Kern,
and Michael Goggins
Infiltrating ductal adenocarcinoma of the pancreas is believed to arise
from morphologically distinct noninvasive precursor lesions. These
precursors include the intraductal papillary mucinous neoplasm, the
mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia.
Intraductal papillary mucinous neoplasms are grossly visible mucin-
producing epithelial neoplasms that arise in the main pancreatic duct or
one of its branches. The cysts of mucinous cystic neoplasms do not
communicate with the major pancreatic ducts, and these neoplasms are
characterized by a distinct ovarian-type stroma. Pancreatic intra¬
epithelial neoplasia is a microscopic lesion. This article focuses on the
clinical significance of these three important precursor lesions, with
emphasis on their clinical manifestations, detection, and treatment.
Endocrine Hyperplasia and Dysplasia in the
Pathogenesis of Gastrointestinal and Pancreatic
Endocrine Tumors 851
Guido Rindi and Enrico Solcia
Non-neoplastic proliferative lesions of endocrine cells have been
described throughout the gastrointestinal tract and pancreas. A
multistep continuum from hyperplasia and dysplasia to neoplasia
originally was identified and systematically defined for histamine-
producing enterochromaffin-like (ECL) cells of the gastric corpus. More
recently, a similar classification system was devised for gastrin (G)- and
somatostatin (D)-producing cells in the duodenum. Preneoplastic
lesions of the endocrine pancreas still lack a solid and widely accepted
definition of a multistep growth process. Similarly, in spite of reports of
carcinoid-associated endocrine cell hyperplasia, there is no systematic
definition of nonneoplastic lesions of the endocrine cells of the ileum,
appendix and colorectum.
Hepatic Precancerous Lesions and Small
Hepatocellular Carcinoma 867
Prodromos Hytiroglou, Young Nyun Park, Glenn Krinsky,
and Neil D. Theise
Precancerous lesions that may be detected in chronically diseased,
usually cirrhotic livers, include: clusters of hepatocytes with atypia and
increased proliferative rate (dysplastic foci) that usually represent an
incidental finding in biopsy or resection specimens; and grossly evident
lesions (dysplastic nodules) that may be detected on radiologic
examination. There are two types of small hepatocellular carcinoma
(HCC) (defined as HCC that measures less than 2 cm): early HCC,
which is well-differentiated and has indistinct margins; and distinctly
nodular small HCC, which is well- or moderately differentiated, and is
usually surrounded by a fibrous capsule. Precise diagnosis of pre¬
cancerous and early cancerous lesions by imaging methods is often
difficult or impossible. Detection of a dysplastic lesion in a biopsy
specimen is a marker of increased risk for HCC development, and
warrants increased surveillance. High-grade dysplastic nodules and
small HCCs should be treated by local ablation, surgical resection, or
liver transplantation.
Neoplastic Precursors of the Gallbladder and
Extrahepatic Biliary System 889
N. Volkan Adsay
Premalignant lesions of the gallbladder and extrahepatic bile ducts have
been poorly studied compared widi their counterparts in die remainder
of the gastrointestinal tract. Some of the problematic issues, such as the
subjectivity of grading and determination of the relative risk of cancer,
are challenging. Although the understanding of the biology of these
lesions has improved in the past several years, there are still many
issues that can only be addressed by close collaboration between
gastroenterologists, radiologists, hepatobiliary surgeons, oncologists,
and pathologists.
Neoplastic Precursor Lesions Related
to the Development of Cancer in
Inflammatory Bowel Disease 901
Noam Harpaz
Dysplasia is an intermediate stage in the progression from inflammation
to cancer in patients with inflammatory bowel disease. Clinically.
dysplasia is used to define appropriate endpoints for colectomy in high-
risk patients undergoing endoscopic surveillance. Surveillance is
currently the only credible alternative to prophylactic colectomy for
high-risk patients. The success of surveillance can be maximized by
adherence of gastroenterologists to recommended procedural guide¬
lines, adherence of pathologists to standardized histological criteria and
nomenclature, and a joint commitment to close clinical-pathological
communication. Technical enhancements to conventional endoscopy
hold promise of improved efficiency and accuracy. Molecular-based
testing may have a future role for risk stratification and early detection
of neoplasia in inflammatory bowel disease.
Gastrointestinal Polyposes: Clinical, Pathological
and Molecular Features 927
Jeremy R. Jass
This article focuses mainly on noninflammatory epithelial polyposes,
particularly the diagnostically important morphological and molecular
features of the more recently recognized and/or more poorly under¬
stood conditions. One of the most important, but often neglected, of
these is hyperplastic polyposis.
Hyperplastic and Serrated Polyps of the Colorectum 947
Michael J. O'Brien
The serrated polyp pathway is a histopathological sequence tfiat begins
in a hyperplastic polyp, or precursor serrated aberrant crypt focus, and
has the potential to end in a colonic adenocarcinoma that is CIMP-high
and, in most cases, also MSI. An activating mutation of the BRAF
oncogene is a marker for this pathway. There is evidence that aberrant
CpG-island methylation is the molecular engine that drives the
progression Arough sequential steps of the padiway, from hyperplastic
polyp to a form of atypical hyperplastic polyp (termed sessile serrated
adenoma) to dysplastic serrated polyp and, ultimately to serrated
carcinoma. A second serrated pathway, identified by mutations of
KRAS in serrated adenoma, is delineated less completely. Its endpoint is
a colorectal carcinoma that is CIMP-low and MSS, and both the
advanced serrated adenoma and carcinoma stages of this pathway show
molecular genetic and morphologic features that overlap with those of
the conventional APC carcinogenic pathway. Clinical studies are
needed to elucidate the natural history of serrated neoplasia, and
provide evidence-based guidance for risk assessment and surveillance of
individuals discovered to harbor its various serrated polyp precursors.
Anal Intraepithelial Neoplasia and Other
Neoplastic Precursor Lesions of the Anal Canal
and Perianal Region 969
Neil A. Shepherd
Anal cancer is rare and this helps to explain why anal pre-neoplastic
conditions are poorly understood, especially with regard to their natural
history and management. Anal intraepithelial neoplasia is closely linked
to human papillomavirus infection and is particularly common in
homosexuals and in immunosuppressed patients, especially those with
HIV/AIDS. The high regression rates of low-grade anal intraepithelial
neoplasia may simply reflect inconsistent pathologic reporting. Higher
grades of anal intraepithelial neoplasia may remain static for long
periods of time in immunocompetent patients, but those with HIV/
AIDS show early and rapid malignant transformation. In general, most
anal pre-neoplastic conditions are best diagnosed by biopsy and treated
by surgical excision, although local recurrence is a problem. In anal
Paget's disease, it is important to ascertain, at the time of diagnosis,
whether it is due to a primary in-situ apocrine-type of neoplasia of the
anus or if the disease is secondary to an invasive primary carcinoma of
the rectum.
Index 989 |
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| spelling | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system guest ed. Robert D. Odze Philadelphia [u.a.] Saunders 2007 XIII S., S. 775 - 995 zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gastroenterology clinics of North America 36,4 Gastrointestinal system Diseases Odze, Robert D. edt Gastroenterology clinics of North America 36,4 (DE-604)BV000613725 36,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016289541&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system Gastroenterology clinics of North America Gastrointestinal system Diseases |
| title | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system |
| title_auth | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system |
| title_exact_search | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system |
| title_exact_search_txtP | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system |
| title_full | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system guest ed. Robert D. Odze |
| title_fullStr | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system guest ed. Robert D. Odze |
| title_full_unstemmed | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system guest ed. Robert D. Odze |
| title_short | Pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system |
| title_sort | pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract liver and pancreaticobiliary system |
| topic | Gastrointestinal system Diseases |
| topic_facet | Gastrointestinal system Diseases |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016289541&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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