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BACKGROUND Gastric cancer commonly follows a long-standing inflammation, mainly due to Helicobacter pylori (HP) infection. After resection, the stump develops precancerous alterations. DESIGN Prospective study of patients undergoing endoscopy from April 1, 2000, through March 31, 2006. SETTING University departments of Surgery and Experimental Medicine and Pathology. PATIENTS One hundred eighty-seven patients receiving upper gastrointestinal tract endoscopy many years after surgery for duodenal ulcer or gastric cancer. Ten to 12 postoperative endoscopic biopsy samples were taken from the remnant stomach. MAIN OUTCOME MEASURE The risk of gastric cancer precursor lesions associated with HP infection. RESULTS The gastric cancer precursor lesions were more common in the entire HP-positive population (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.25-4.49; P = .007). However, HP-positive patients undergoing resection for cancer had a higher risk of the precursor lesions compared with HP-negative patients in the same diagnostic group (OR, 4.20; 95% CI, 1.10-15.96) and all patients undergoing resection for duodenal ulcer (OR, 1.59; 95% CI, 0.44-5.73). CONCLUSION The results of this investigation support the role of HP in gastric carcinogenesis and suggest that the HP eradication therapy might prevent the development of metachronous gastric cancer after gastric resection.Arch Surg. 2010;145(10):962-967--

Background The direct extension of advanced tumors from adjacent organs to the bladder is not uncommon. Secondary bladder involvement through hematogenous and/or lymphatic metastases and implant of cells by tumors involving higher urinary tract via the ureter are rare. Therefore, the histological resemblance between primary bladder adenocarcinoma and colorectal adenocarcinoma can be a dilemma for pathologists.Methods A 67-year-old female underwent total right hemicolectomy for ascending colon adenocarcinoma. After a 20-month follow-up the lesion was removed (which was histopathologically similar to the previous colon cancer) and the patient underwent ureteral stenting because of a mass in the right internal iliac nodes with homolateral hydronephrosis. Subsequently intermittent gross hematuria urged on performing cystoscopy detecting a non-papillary mass situated above the right ureteral orifice, previously revealed on ultrasonography and CT scan.Results A TURBT was performed. Histopathologically the mass, partially covered by intact urothelium, consisted of tubular and pseudoglandular structures intermixed with solid foci of mucin-producing signet-ring-cells-type adenocarcinoma, very similar to the original colon cancer. The tumor base was healthy. Immunohistochemically stains for cytokeratin 7 (CK7) and cytokeratin 20 (CK20) presented multifocal positivity, suggesting the colorectal origin of the neoplasm.Conclusions In order to optimize the therapeutic options, it is important to distinguish the primary disease of the bladder from other causes of hematuria, and achieve a correct differentiation between primary enteric-type adenocarcinoma of the bladder and secondary colorectal adenocarcinoma involving the bladder, these entities being morphologically indistinguishable. Therefore, in patients with history of colonic adenocarcinoma, the presence of a subsequent bladder tumor should be considered as an eventuality of a secondary disease.

Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases.A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.

Several letters to the editor are presented in response to articles in the December/January 2007 issue including "If It's Not One Thing, It's Your Mother," by Adair Lara, "Uncovered," by Martha Fay and "The Anatomy of Melancholy," by Meredith Maran.