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Simple Summary: Adenocarcinomas of the esophagogastric junction and stomach pose significant morbidity and mortality burdens for patients worldwide. Neoadjuvant treatments are increasingly being utilized before the performance of radical surgeries, with varying degrees of response. We attempted to describe how lymph nodes regress after neoadjuvant chemotherapy in comparison to primary tumors. We performed an analysis of tumor-infiltrating lymphocytes on pathology slides of esophagectomy and gastrectomy patients from a single-institution cohort. Our research suggests that tumor-infiltrating lymphocytes correlate differently with the degree of response of lymph nodes versus the degree of response of primary tumors, suggesting that different biologic processes are involved. We investigated the impact of neoadjuvant chemotherapy, namely the FLOT regimen, on lymph node regression and its correlation with tumor-infiltrating lymphocytes. Background/Objectives: Adenocarcinomas of the esophagogastric junction and stomach present clinical entities with significant cancer-related morbidity and mortality, often requiring multimodal treatments. Preoperative chemotherapy, mainly the FLOT regimen, is increasingly being utilized in the neoadjuvant setting for the treatment of these malignancies, with varying degrees of tumor response. Methods: We conducted a retrospective, single-institution review on 75 patients operated on for adenocarcinoma of the esophagogastric junction and stomach after neoadjuvant FLOT. We investigated whether tumor response correlates with disease response in lymph nodes examined on surgical specimens. We also investigated the role of tumor-infiltrating lymphocytes (TILs) in correlation with primary tumor response and disease response in lymph nodes on pathological specimens. Results: Our results suggest that TILs correlate in a differential manner with regards to primary tumors versus lymph nodes, thus suggesting that there are different biologic processes in place. Conclusions: Our results provide unique evidence on tumor-infiltrating lymphocytes in the adenocarcinoma histology of the esophagogastric junction and stomach and might be important for further studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Perioperative FLOT (5-fluorouracil, oxaliplatin and docetaxel) is a standard of care for patients with locally advanced gastro-oesophageal adenocarcinoma (GEA) in Western guidelines, but its use is limited in Asian patients. The aim of our retrospective study was to assess the safety and efficacy of perioperative FLOT in Asian patients from a single centre with routine granulocyte colony-stimulating factor (GCSF) prophylaxis. We demonstrate similar tolerability and efficacy for FLOT to that reported in Western populations but with lower rates of grade 3 to 4 neutropenia. Elderly patients ≥ 65 years old had similar outcomes to those under 65. However, patients of lower socioeconomic status were more likely to experience severe AEs, highlighting the need to proactively support vulnerable groups during treatment. Background: Perioperative FLOT (5-fluorouracil, oxaliplatin and docetaxel) is a standard of care for patients with locally advanced gastro-oesophageal adenocarcinoma (GEA) in Western guidelines, but its use is limited in Asian patients. We report outcomes from a single Asian centre of perioperative FLOT with concomitant granulocyte colony-stimulating factor (GCSF) prophylaxis. Methods: A retrospective analysis of all 56 stage II to III GEA patients treated with perioperative FLOT at the National Cancer Centre Singapore between June 2017 and February 2024 was performed. All patients were discussed at a multidisciplinary tumour board, underwent preoperative laparoscopic staging, and received prophylactic GCSF with perioperative FLOT. Surgery was performed across four partner institutions. The primary endpoints were the tolerability of FLOT and pathological complete response (pCR). A univariate analysis of factors associated with survival and adverse events was also performed. Results: Overall, 33 patients (58.9%) completed eight cycles of pre- and postoperative FLOT, and 92.9% underwent resection. The commonest grade 3 to 4 adverse events (AEs) were diarrhoea (10.7%) and neutropenia (5.6%). The 30- and 90-day postoperative mortality rates were 0% and 1.9%, respectively. In resected tumours, the pCR was 15.4%. The median DFS was 27.5 months, but the median OS was not reached. The values for 1-, 2-, and 3-year DFS were 74.6%, 61.0%, and 46.5%, respectively. The values for 1-, 2-, and 3-year OS were 85.0%, 67.4%, and 61.0%, respectively. In the univariate analysis of patients who underwent resection, an ECOG status of 0 was associated with better DFS, while ypN0, R0 resection, and pathological stages 0-II were associated with better DFS and OS. Patients ≥ 65 years benefited from FLOT similarly to those <65 years in terms of DFS (HR 1.03; p = 0.940) and OS (HR 1.08; p = 0.869), with similar rates of grade 3 to 4 AEs. Patients with a higher housing index (HI) were less likely to experience ≥grade 3 AEs compared to those with a lower HI (OR 0.16, p = 0.029). Conclusions: This study presents a unique real-world Asian experience of perioperative FLOT with prophylactic GCSF use, with low rates of G3 to 4 neutropenia. The tolerability of FLOT was similar to that reported in Western populations. Furthermore, similar survival and rates of grade 3 to 4 AEs were observed in elderly patients. Patients of lower socioeconomic status were more likely to experience severe AEs, highlighting the need to proactively support vulnerable groups during treatment. [ABSTRACT FROM AUTHOR]

Xpert MTB/RIF is recommended for the diagnosis of tuberculosis (TB) in children. We determined the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children. The characteristics of children influencing Xpert MTB/RIF positivity were explored. Children aged <15 years with symptoms suggestive of pulmonary TB were prospectively enrolled from 2013 to 2019. Two sputum/early morning gastric aspirate specimens were collected for examination by smear (fluorescence microscopy), Xpert MTB/RIF, and culture [Mycobacteria growth indicator tube (MGIT)/Lowenstein–Jensen (LJ) medium]. Diagnostic performance of Xpert MTB/RIF was evaluated using LJ and or MGIT culture positivity as the reference standard. Sensitivity, specificity with 95% confidence interval (CI) were calculated. Stratified analysis was done; P  < .05 was considered statistically significant. Of the total 1727 enrolled children, 1674 (97%) with complete results for at least one sputum/gastric aspirate sample were analyzed. The sensitivity of Xpert MTB/RIF was 68.5% in sputum and 53.6% in gastric aspirate while the specificity was 99% for both. The sensitivity compared to smear was 68.5% vs. 33.7% (P  < .001) and 53.6% vs. 14.5%; (P  < .001) in sputum and gastric aspirate, respectively. The sensitivity of Xpert MTB/RIF was 23.9% with decision to treat as reference standard. Xpert MTB/RIF positivity was significantly influenced by sex, age, nutritional status, chest X-ray abnormality, TB infection status, and symptoms suggestive of TB. Xpert MTB/RIF as an upfront test compared to smear improves diagnosis of pulmonary TB in children yet the sensitivity is suboptimal. Newer TB diagnostic tools with improved sensitivity is warranted in children. [ABSTRACT FROM AUTHOR]

This article discusses the misdiagnosis of synaptophysin-expressing gastric glomus tumors as gastric neuroendocrine tumors. The authors present two cases of patients with gastric glomus tumors that were initially misdiagnosed due to the expression of synaptophysin. The article emphasizes the importance of using a comprehensive panel of immunomarkers, including chromogranin, CD56, and keratin, to differentiate between neuroendocrine tumors and glomus tumors. The authors also highlight the potential diagnostic pitfalls and implications of synaptophysin expression in visceral glomus tumors. [Extracted from the article]

Gastric adenocarcinomas have been sporadically reported in camelids. This report describes a primary gastric adenocarcinoma and subsequent peritoneal carcinomatosis in a 20-year-old female Bactrian camel (Camelus bactrianus). Numerous metastases were present throughout the omentum, liver, abdominal lymph nodes, intestinal serosa, kidneys and lungs. The primary tumour macroscopically resembled an ulcerated crater and originated from the distal four-fifths of the C3 compartment, an anatomical region with naturally prominent gastric rugae and true glands. Moderate numbers of Helicobacter spp colonies were present within gastric pits and necrotic areas of C3. Ménetrier's disease has previously been implicated as a predisposing condition for the development of gastric adenocarcinoma in another camel, but no evidence of this premalignant disorder was found in this case. This camel also suffered from a chronic skin wound of the hump and severe degenerative joint disease of the xiphisternum, the latter of which was presumably associated with excessive pressure on the sternum. Gastric adenocarcinoma with subsequent peritoneal carcinomatosis in a Bactrian camel (Camelus bactrianus). The star in image c depicts the location of the primary tumour, which presented as an ulcerated crater in the distal C3 (image d). [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The clinico-oncological outcomes of precursor epithelial subtypes of adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) are limited to small cohort studies. Differences in recurrence patterns and response to adjuvant chemotherapy between A-IPMN subtypes are unknown. Methods: Clincopathological features, recurrence patterns and long-term outcomes of patients undergoing pancreatic resection (2010–2020) for A-IPMN were reported from 18 academic pancreatic centres worldwide. Precursor epithelial subtype groups were compared using uni- and multivariate analysis. Results: In total, 297 patients were included (median age, 70 years; male, 78.9%), including 54 (18.2%) gastric, 111 (37.3%) pancreatobiliary, 80 (26.9%) intestinal and 52 (17.5%) mixed subtypes. Gastric, pancreaticobiliary and mixed subtypes had comparable clinicopathological features, yet the outcomes were significantly less favourable than the intestinal subtype. The median time to recurrence in gastric, pancreatobiliary, intestinal and mixed subtypes were 32, 30, 61 and 33 months. Gastric and pancreatobiliary subtypes had worse overall recurrence (p = 0.048 and p = 0.049, respectively) compared with the intestinal subtype but gastric and pancreatobiliary subtypes had comparable outcomes. Adjuvant chemotherapy was associated with improved survival in the pancreatobiliary subtype (p = 0.049) but not gastric (p = 0.992), intestinal (p = 0.852) or mixed subtypes (p = 0.723). In multivariate survival analysis, adjuvant chemotherapy was associated with a lower likelihood of death in pancreatobiliary subtype, albeit with borderline significance [hazard ratio (HR) 0.56; 95% confidence interval (CI) 0.31–1.01; p = 0.058]. Conclusions: Gastric, pancreatobiliary and mixed subtypes have comparable recurrence and survival outcomes, which are inferior to the more indolent intestinal subtype. Pancreatobiliary subtype may respond to adjuvant chemotherapy and further research is warranted to determine the most appropriate adjuvant chemotherapy regimens for each subtype. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a network meta-analysis to compare the diagnostic efficacy of diverse novel endoscopic techniques for detecting gastric Helicobacter pylori infection. Methods: From inception to August 2023, literature was systematically searched across Pubmed, Embase, and Web of Science databases. Cochrane’s risk of bias tool assessed the methodological quality of the included studies. Data analysis was conducted using the R software, employing a ranking chart to determine the most effective diagnostic method comprehensively. Convergence analysis was performed to assess the stability of the results. Results: The study encompassed 36 articles comprising 54 observational studies, investigating 14 novel endoscopic techniques and involving 7,230 patients diagnosed with gastric H. pylori infection. Compared with the gold standard, the comprehensive network meta-analysis revealed the superior diagnostic performance of two new endoscopic techniques, Magnifying blue laser imaging endoscopy (M-BLI) and high-definition magnifying endoscopy with i-scan (M-ISCAN). Specifically, M-BLI demonstrated the highest ranking in both sensitivity (SE) and positive predictive value (PPV), ranking second in negative predictive value (NPV) and fourth in specificity (SP). M-I-SCAN secured the top position in NPV, third in SE and SP, and fifth in PPV. Conclusion: After thoroughly analyzing the ranking chart, we conclude that M-BLI and M-I-SCAN stand out as the most suitable new endoscopic techniques for diagnosing gastric H. pylori infection [ABSTRACT FROM AUTHOR]

There is currently limited pharmacokinetic data for the use of famotidine in goats for treatment and prevention of abomasal ulceration. The objective of this study was to determine the pharmacokinetic parameters after a single intravenous administration of famotidine (0.6 mg/kg). Famotidine was administered to six healthy goats and plasma samples were collected over a 24‐h period. The famotidine concentration was measured using reverse phase high‐performance liquid chromatography (HPLC). Non‐compartmental analysis was then used to determine the pharmacokinetic parameters. The maximum plasma concentration was estimated at 5476.68 ± 1530.51 ng/mL and elimination half‐life was estimated at 18.455 ± 13.26 min. The mean residence time was determined to be 19.85 ± 12.14 min with the apparent volume of distribution being estimated at 321.924 ± 221.667. The area under the curve was determined to be 54230.08 ± 24947.6 min*ng/mL. Total exposure and elimination half‐life were less than what has been reported in cattle and horses. Future research evaluating the pharmacokinetics of subcutaneous administration and looking at the pharmacodynamics of famotidine in goats is needed to determine the effectiveness of famotidine on raising pH levels of the abomasum. [ABSTRACT FROM AUTHOR]

Opinion Statement: Gastric neuroendocrine neoplasms (G-NENs) are a heterogeneous group of tumors that broadly fall into two groups. The first group, driven by oversecretion of gastrin, are generally multifocal, small, and behave indolently with a low (but non-zero) risk of progression and metastatic spread. They are conventionally categorized into type 1, with endogenous gastric-based overproduction of gastrin, and type 2 G-NEN, with overproduction of gastrin from an extra-gastric gastrin-secreting tumor. The second group, termed type 3 G-NEN, occur spontaneously and are potentially more aggressive, having a clinical course analogous to other neuroendocrine tumors of the gastrointestinal tract. Type 1 G-NEN can be managed with endoscopic surveillance and resection of visible lesions with great success, reserving surgery for the rare high-risk lesion, whereas surgical resection of the causative gastrin-secreting tumor in type 2 G-NEN is usually curative. Type 3 G-NEN is usually managed with formal surgical resection but there is growing evidence that limited surgery or even endoscopic resection in appropriately selected patients with low risk is both safe and effective. A novel subtype of G-NEN, associated with long-term proton pump inhibitor usage, is increasing in incidence. The pathophysiology seems to parallel type 1 G-NEN. In the setting of metastatic disease, which can occur in any subtype but is most common by far in type 3 G-NEN, the lack of trial data unique to G-NEN results in extrapolation of strategies and agents for treatment of non-gastric neuroendocrine disease. The rapid pace of development in this area is likely to benefit the metastatic G-NEN patient as well. As treatment is predicate on type of G-NEN, establishing the etiology of the lesion is crucial but growing knowledge of G-NEN pathophysiology and close collaboration between pathologists, gastroenterologists, radiologists, surgeons, and oncologists have enabled a growing trend towards de-escalation and less-invasive treatment paradigms. [ABSTRACT FROM AUTHOR]

Abstract The immune cellular landscape from the gastric mucosa remains largely unknown despite its relevance in several inflammatory conditions. Human gastric biopsies were obtained from the antrum, body and incisura from 10 individuals to obtain lamina propria mononuclear cells that were further characterized by spectral cytometry. Phenotypic hierarchical analyses identified a total of 52 different immune cell subsets within the human gastric mucosa revealing that T-cells (> 60%) and NK cells (> 20%) were the main populations. Within T-cells, CD4+ and CD8+ were equally represented with both subsets displaying mainly a memory and effector phenotype. NK cells, on the contrary, were largely of the early phenotype. No regional differences were observed for any subsets among the 3 locations. Following unsupervised analysis, a total of 82 clusters were found. Again, no differences were observed amongst locations although a great degree of inter-individual variability was found, largely influenced by the presence of H. pylori infection and dyspepsia. We have unraveled the human gastric immune cellular subset composition and a unique interindividual immune fingerprint with no inter-regional variations.

Gastric cancer remains a disease with an ominous prognosis, while early gastric cancer has a good-to-excellent prognosis, with 5-year survival rates of up to 92.6% after successful endoscopic resection. In this context, the accurate identification of patients with established gastric precancerous lesions, namely chronic atrophic gastritis and intestinal metaplasia, is the first step in a stepwise approach to minimize cancer risk. Although current guidelines advocate for the execution of random biopsies to stage the extent and severity of gastritis/intestinal metaplasia, modern biopsy protocols are still imperfect as they have limited reproducibility and are susceptible to sampling error. The advent of novel imaging-enhancing modalities, i.e., high-definition with virtual chromoendoscopy (CE), has revolutionized the inspection of gastric mucosa, leading to an endoscopy-based staging strategy for the management of these premalignant changes in the stomach. Nowadays, the incorporation of CE-targeted biopsies in everyday clinical practice offers not only the robust detection of premalignant lesions but also an improvement in quality, by reducing missed diagnoses along with mean biopsies and, thus, the procedural costs and the environmental footprint. In this review, we summarize the recent evidence regarding the endoscopic grading and sampling of gastric precancerous lesions.

Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease. [ABSTRACT FROM AUTHOR]

Background: Gastric gastrointestinal stromal tumors (GISTs) represent a subset of gastrointestinal tumors predominantly found in the stomach. Despite their rarity, these tumors carry significant implications for patient health and management. GISTs are potentially malignant tumors with unpredictable progression. They originate from the interstitial cells of Cajal, which are positioned between the intramural neurons and the smooth muscle cells of the digestive tract. These tumors are characterized primarily by mutations in the c-Kit gene, as well as other mutations such as those in the platelet-derived growth factor receptor alpha (PDGFRA) gene. Methods: Our comprehensive search across five databases initially yielded 2976 articles. After eliminating 197 duplicates, we screened the titles and abstracts of 2779 articles, excluding 2692 for not meeting the inclusion criteria. During the full-text screening, 16 more articles were excluded. Ultimately, 71 papers met the inclusion criteria and were included in our analysis. Results: Due to differences in study designs, inclusion criteria for patients, and reported outcomes, a meta-analysis was not conducted. The accurate diagnosis of GIST is established through histopathological examination and immunohistochemistry. Histopathologically, GISTs are classified into three main types: spindle cell, epithelioid, and mixed. The therapeutic management of GIST involves surgery, endoscopic treatment, and chemotherapy. Conclusions: The prognosis for GIST patients depends on various factors, including risk category, disease stage, applied treatments, and recurrence post-treatment. A significant recent advancement comes from artificial intelligence, which can be increasingly involved in both the diagnosis and treatment of this tumor. [ABSTRACT FROM AUTHOR]

Gastric cancer remains a disease with an ominous prognosis, while early gastric cancer has a good-to-excellent prognosis, with 5-year survival rates of up to 92.6% after successful endoscopic resection. In this context, the accurate identification of patients with established gastric precancerous lesions, namely chronic atrophic gastritis and intestinal metaplasia, is the first step in a stepwise approach to minimize cancer risk. Although current guidelines advocate for the execution of random biopsies to stage the extent and severity of gastritis/intestinal metaplasia, modern biopsy protocols are still imperfect as they have limited reproducibility and are susceptible to sampling error. The advent of novel imaging-enhancing modalities, i.e., high-definition with virtual chromoendoscopy (CE), has revolutionized the inspection of gastric mucosa, leading to an endoscopy-based staging strategy for the management of these premalignant changes in the stomach. Nowadays, the incorporation of CE-targeted biopsies in everyday clinical practice offers not only the robust detection of premalignant lesions but also an improvement in quality, by reducing missed diagnoses along with mean biopsies and, thus, the procedural costs and the environmental footprint. In this review, we summarize the recent evidence regarding the endoscopic grading and sampling of gastric precancerous lesions. [ABSTRACT FROM AUTHOR]

Simple Summary: Neoadjuvant chemotherapy (NT) followed by radical surgery is the standard treatment for locally advanced gastric cancer (GC). The impact of NT on body composition was analyzed in locally advanced GC patients undergoing gastrectomy. During chemotherapy, GC patients experienced loss of muscle mass and fat, leading to an increased incidence of pre-surgical sarcopenia. Neoadjuvant chemotherapy (NT) followed by radical surgery is the standard treatment for locally advanced gastric cancer (GC). The incidence of sarcopenia in upper gastrointestinal tract malignancies is very high, and it may be increased after NT. This study aimed to evaluate the impact of NT on body composition. A retrospective study of patients with locally advanced GC undergoing gastrectomy who had received NT in a tertiary hospital between 2012 and 2019 was conducted. CT measured the skeletal muscle index, total psoas area, and visceral and subcutaneous adipose tissue before and after NT. Of the 180 gastrectomies for GC, 61 patients received NT. During NT, changes in body composition were observed with a decrease in the skeletal muscle mass index (SMMI −2.5%; p < 0.001), and these changes were significantly greater in men (SMMI −10.55%). Before surgery, patients who received NT presented 15% more sarcopenia than those without NT (p = 0.048). In conclusion, patients with locally advanced gastric cancer who receive NT have significant changes in body composition during chemotherapy. These changes, which are at the expense of a loss of muscle mass, lead to an increased incidence of pre-surgical sarcopenia. [ABSTRACT FROM AUTHOR]

Objective: Data regarding Helicobacter pylori (H. pylori)‐associated mucosa‐associated lymphoid tissue (MALT) lymphoma in children are lacking. We aimed to characterize the diagnosis, management, and outcome of H. pylori‐associated MALT lymphoma in pediatric patients. Study Design: A retrospective multicenter case series of the pediatric patients with H. pylori‐associated MALT lymphoma who were diagnosed during 2010–2022. Results: Five children, of them three females, were identified. The mean age at diagnosis was 14.6 ± 2.4 years. The clinical presentation included abdominal pain (5/5), nausea (3/5), weight loss, night sweats, recurrent fever (1/5), and iron deficiency anemia (2/5). Endoscopic findings in both the stomach antrum and body included a fragile and hyperemic mucosa, large ulcers, extensive nodularity, and exudate. All the biopsies from the gastric mucosa were consistent with MALT lymphoma, and positive for H. pylori (by Giemsa stain). All the patients received triple therapy (amoxicillin, nitroimidazole, or a macrolide, and a proton pump inhibitor, for 14 days), and achieved H. pylori eradication. All had complete resolution of histological findings at the last follow‐up. In one patient, the histology of MALT lymphoma persisted 12 months after H. pylori eradication, and only the 18‐month‐biopsy was free of residual disease. Conclusions: In this series of pediatric MALT lymphoma, complete resolution of disease occurred in all the patients, yet histological remission was delayed in one. This supports the importance of endoscopic follow‐up. [ABSTRACT FROM AUTHOR]

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Introduction: Despite the numerous studies demonstrating gut microbiota dysbiosis in obese subjects, there is no data on the association between obesity and gastric microbiota. The aim of this study was to address this gap in literature by comparing the composition of gastric microbiota in obese patients and a control group which included normal weight volunteers diagnosed with functional dyspepsia (FD). Methodology: A total of 19 obese patients, and 18 normal weight subjects with FD and normal endoscopy results were included in the study. The gastric tissue samples were collected from participants in both groups by bariatric surgery and endoscopy, respectively, and profiled using 16S ribosomal RNA gene sequencing. Results: There was no significant difference in the α-diversity scores, while distinct gastric microbial compositions were detected in both groups. Significantly lower levels of Bacteroidetes and Fusobacteria, and higher Firmicutes/Bacteroidetes ratio were recorded in the obese patients. A total of 15 bacterial genera exhibited significant difference in gastric abundance with Prevotella_7, Veillonella, Cupriavidus, and Acinetobacter, present in frequencies higher than 3% in at least one subject group. Conclusions: Our study suggests a significant association between obesity and gastric microbiome composition. Future studies with larger sample size and gastric samples from subjects without any gastrointestinal complications are required to confirm our conclusions. [ABSTRACT FROM AUTHOR]

Foregut duplication cyst is most commonly seen in the posterior mediastinum without communication with adjacent organs or presence of other malformations and typically shows ectopic gastric or respiratory epithelium. The finding of ectopic pancreatic tissue is extremely rare. A 15-year-old female patient presented with elevated blood pressure, intermittent right flank pain for 18 months. An abdominal MRI revealed a 4 cm right cystic retroperitoneal mass, initially thought to arise from the right adrenal gland. Intraoperatively, the mass was centered in the retroperitoneum between the right adrenal gland and kidney, without attachments to these organs and no communication with other structures, and it was completely excised. Gross examination revealed a 3.5 cm well-circumscribed solid and cystic mass with orange–white cut surface and cloudy fluid surrounded by variable amounts of adipose tissue. On microscopic examination, the cysts were lined by respiratory and gastric antral/oxyntic-type mucosa, surrounded by muscularis mucosae, submucosal tissue, muscularis propria, and perienteric tissue. Within the muscular propria, exocrine pancreatic tissue was also noted. The patient is well with 7-months of follow up. This case is the first one reporting gastric, respiratory, and pancreatic epithelia. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) of the stomach is rare. Moreover, it is usually found in pediatric patients with systemic diseases and may be associated with a poor prognosis. Solitary gastric LCH in adults is extremely rare and is often misdiagnosed or missed. The aim of our study was to review cases of gastric LCH and explore the characteristics of the disease further. A retrospective study of all patients admitted with solitary gastric LCH was conducted between 2013 and 2023. Clinical manifestations, endoscopic and pathological features, immunophenotypes, and molecular changes were collected from medical records. We examined four cases (one female, three males) of gastric LCH. The affected patients were between 33 and 70 years of age. Endoscopically, three patients presented with a solitary polyp or elevated lesions, whereas one patient showed no abnormalities. Under a microscope, all cases showed abnormal proliferation of histiocytoid cells infiltrating in a nested or sheet-like fashion. The tumor cells were medium-sized, with a slightly eosinophilic cytoplasm, irregular or renal-shaped nuclei, folded nuclear membranes, visible nuclear grooves, and the infiltration of inflammatory cells in the background. Immunohistochemically, all lesions expressed CD1a, S-100, langerin, and cyclinD1. One case showed diffuse BRAF V600E positivity. Follow-up data were available for all patients from 4 to 36 months, and all patients were alive without recurrence or progress at the time of manuscript preparation. Combined with previously reported data, solitary adult gastric LCH is more common in male patients, most of whom are asymptomatic or exhibit only mild gastrointestinal symptoms, with a good prognosis. Endoscopy often reveals solitary polyps or protruding lesions; rare cases may progress to multifocal/multisystem lesions, necessitating long-term close follow-up. [ABSTRACT FROM AUTHOR]

Medication administration via enteral feeding tubes (EFT) is a necessary practice for patients unable to swallow oral dosage forms due to a medical condition or treatment that affects the ability to swallow or the function of the gastrointestinal tract. Off-label administration of oral drug products via EFT raises concerns for pharmaceutical sponsors, regulators, and healthcare practitioners (HCPs) because of the potential risks this practice introduces to both the patient and the caregiver. These risks can be mitigated by generating data-supported instructions that patients and HCPs can use to ensure safe and accurate administration of oral drug products via EFT. This commentary presents an industry perspective on the testing that should be conducted to enable development of product-specific instructions in the labeling to support or advise against administration of oral drug products via enteral feeding tube. The proposal outlined in this commentary takes a risk-based approach, addressing recommendations from both regulatory agencies as well as considerations for expanding this testing to address needs specific to neonatal and pediatric populations. [ABSTRACT FROM AUTHOR]

Incisional hernias represent a far more common complication after midline incisions than previously estimated. Patients with upper gastrointestinal tract malignancies represent a group of patients at increased risk for incisional hernia formation after undergoing major surgery. Our prospectively designed study included 50 patients who underwent onlay synthetic mesh augmentation of their midline closure along with closure using the small bites technique. At a 12-month follow-up, no incisional hernias were documented. A significant decrease compared to historical controls was achieved, with few minor complications. Mesh augmentation of midline closure in patients with upper gastrointestinal tract malignancies can significantly reduce subsequent incisional hernia formation.

Background: Gastrointestinal stromal tumour (GIST) is a rare entity. The diagnosis, treatment and follow-up pose a challenge in our environment. We describe the presentation, diagnosis, treatment, and long-term follow-up of a patient with a localized, large exogastric GIST. Method: The case notes of a 51-year-old woman who presented with a one-year history of upper abdominal swelling with no associated symptom was reviewed. Result: On examination, an oval intraperitoneal mass at the epigastrium measuring 16 x 14cm which was freely mobile, smooth, firm, non-tender with dull percussion notes was found. She subsequently had resection of a large exogastric mass with a histologic diagnosis of GIST. Following tumour resection with a wide margin of gastric wall, she has done well so far for ten (10) years. Conclusion: Wide margin gastric resection may suffice in the treatment of a large localized gastric GIST when it is exogastric.

Mucormycosis is an opportunistic fungal infection that typically affects patients with diabetes mellitus or immunosuppression. The fungus invades nearby blood vessels, leading to thrombosis and organ necrosis. While Mucorales can infiltrate any organ in the body, the gastrointestinal system is an uncommon site for infection. Gastric mucormycosis is a rare but potentially lethal fungal infection resulting from the invasion of Mucorales into the gastric mucosa, exhibiting angioinvasive characteristics. It can lead to high mortality rates due to the increased risk of complications in immunocompromised patients. Common predisposing factors include diabetes mellitus, neutropenia, iron overload states, malnourishment, and other immunocompromised conditions. Mucormycosis is a fatal infection, necessitating prompt intervention to ensure survival. In this case report, authors present a 42-year-old man with a history of chronic alcoholism and chronic kidney disease who presented with complaints of abdominal pain and vomiting for six months, significant weight loss, and loss of appetite for one month. Initially suspected clinically and radiologically as a malignant gastric ulcer, an endoscopy was performed, and a gastric biopsy was sent for Histopathological Examination (HPE). Histological analysis of the gastric biopsy revealed multiple fragments of gastric mucosa with areas of ulceration, neutrophilic abscess, and numerous broad aseptate obtuse-angle fungal hyphae resembling Mucorales. The presence of the organisms was confirmed through special stains for fungus. Very few cases of invasive gastric mucormycosis associated with uncontrolled diabetes, alcoholism, and chronic kidney disease have been reported in the literature.

Gastric perforation in neonates is a rare and serious issue. The condition usually occurs within the first week of life. Due to the high fatality rate, early diagnosis and prompt surgical intervention are required. Here, we describe two newborns who underwent emergency laparotomies for gastric perforation at the ages of 5 and 10 days, respectively. The first case did have sepsis during the recovery time, but it was successfully managed. The second neonate had stature disruption and biliary peritonitis. She eventually developed multi-organ failure syndrome and succumbed on the fourth day after the second laparotomy.

Upper gastrointestinal bleeding is following gastrojejunostomy due to stromal ulceration, marginal ulcer bleeding from anastomotic site, remnant cancer. Gastrojejunostomy done for benign gastric outlet obstruction has many complications. Jejunogastric intussusceptions (JGI) is a rare complication of gastrojejunostomy surgery (

Helicobacter pylori colonizes half of the world's population and is responsible for a significant disease burden by causing gastritis, peptic ulcers, and gastric cancer. The development of host inflammation drives these diseases, but there are still open questions in the field about how H. pylori controls this process. We characterized H. pylori inflammation using an 8-month mouse infection time course and comparison of the wild type (WT) and a previously identified mutant lacking the TlpA chemoreceptor that causes elevated inflammation. Our work shows that H. pylori chronic-stage corpus inflammation undergoes surprising fluctuations, with changes in Th17 and eosinophil numbers. The H. pylori tlpA mutant changed the inflammation temporal characteristics, resulting in different inflammation from the wild type at some time points. tlpA mutants have equivalent total and gland colonization in late-stage infections. During early infection, in contrast, they show elevated gland and total colonization compared to those by WT. Our results suggest the chronic inflammation setting is dynamic and may be influenced by colonization properties of early infection.

Background: Although Huntington's disease (HD) is usually thought of as a triad of motor, cognitive, and psychiatric symptoms, there is growing appreciation of HD as a systemic illness affecting the entire body. Objectives: This review aims to draw attention to these systemic non‐motor symptoms in HD. Methods: We identified relevant studies published in English by searching MEDLINE (from 1966 to September 2023), using the following subject headings: Huntington disease, autonomic, systemic, cardiovascular, respiratory, gastrointestinal, urinary, sexual and cutaneous, and additional specific symptoms. Results: Data from 123 articles were critically reviewed with focus on systemic features associated with HD, such as cardiovascular, respiratory, gastrointestinal, urinary, sexual and sweating. Conclusion: This systematic review draws attention to a variety of systemic and autonomic co‐morbidities in patients with HD. Not all of them correlate with the severity of the primary HD symptoms or CAG repeats. More research is needed to better understand the pathophysiology and treatment of systemic and autonomic dysfunction in HD. [ABSTRACT FROM AUTHOR]

Summary: The annual meeting of the American Society of Medical Oncology (ASCO) was held as usual in Chicago, while the meeting focused on gastrointestinal tumors, ASCO-GI, was held in San Francisco. In particular, ASCO-GI included many phase III trials, the data of which have the potential to change the practice in the near future for tumors of the upper gastrointestinal tract (upper-GI), including tumors of the esophagus, gastroesophageal junction, stomach, and pancreas. Interestingly, ASCO and also the European Society for Medical Oncology (ESMO) offer the virtual plenary sessions under the motto "Today's Science Can Wait." As more physicians and scientists become comfortable with online tools in the post-pandemic era, presenting potential practice-changing data outside of annual meetings appears feasible. Here we present a summary of upper-GI tumor abstracts from two major ASCO meetings including virtual plenary series. [ABSTRACT FROM AUTHOR]

Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications. [ABSTRACT FROM AUTHOR]

Background. Ganglioneuroblastoma is a borderline tumor of sympathetic origin that is considered a childhood disease, with the majority of patients occurring in children less than five years old and few patients occurring in adults. There are no treatment guidelines for adult ganglioneuroblastoma. Here, we report a rare patient of adult gastric ganglioneuroblastoma that was completely resected by a laparoscopic approach. Case presentation. A 73-year-old man presented with dull pain in the upper abdomen along with abdominal distension for one month. Gastroscopy examination revealed chronic gastritis and submucosal tumors of the gastric antrum. Endoscopic ultrasonography showed a hypoechoic mass in the gastric antrum arising from the muscularis propria. An abdominal computed tomography scan revealed an irregular soft tissue mass in the gastric antrum with heterogeneous enhancement in the arterial phase. The mass was completely resected by laparoscopic surgery. Postoperative histopathology revealed that the mass contained differentiated neuroblasts, mature ganglion cells and ganglioneuroma components. The pathological diagnosis was ganglioneuroblastoma intermixed, and the patient was determined to be in stage I. The patient received no adjuvant chemotherapy or radiotherapy. At his two-year follow-up, the patient was doing well and showed no signs of recurrence. Conclusion. Despite the rarity of gastric ganglioneuroblastoma as a primary site of origin, it should be considered in the differential diagnosis of gastric masses in adults. Radical surgery is sufficient for the treatment of ganglioneuroblastoma intermixed, and long-term follow-up should be performed. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of gastric atrophy is highly subjective, and we aimed to establish a model of gastric atrophy based on pathological features to improve diagnostic consistency. Methods: We retrospectively collected the HE-stained pathological slides of gastric biopsies and used CellProfiler software for image segmentation and feature extraction of ten representative images for each sample. Subsequently, we employed the Least absolute shrinkage and selection operator (LASSO) to select features and different machine learning (ML) algorithms to construct the diagnostic models for gastric atrophy. Results: We selected 289 gastric biopsy specimens for training, testing, and external validation. We extracted 464 pathological features and screened ten features by LASSO to establish the diagnostic model for moderate-to-severe atrophy. The range of area under the curve (AUC) for various machine learning algorithms was 0.835-1.000 in the training set, 0.786-0.949 in the testing set, and 0.689-0.818 in the external validation set. LR model had the highest AUC value, with 0.900 (95% CI: 0.852-0.947) in the training set, 0.901 (95% CI: 0.807-0.996) in the testing set, and 0.818 (95% CI: 0.714-0.923) in the external validation set. The atrophy pathological score based on the LR model was associated with endoscopic atrophy grading (Z=-2.478, P=0.013) and gastric cancer (GC) (OR=5.70, 95% CI: 2.63-12.33, P<0.001). Conclusion: The ML model based on pathological features could improve the diagnostic consistency of gastric atrophy, which is also associated with endoscopic atrophy grading and GC. [ABSTRACT FROM AUTHOR]

Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy, which has been the most widely performed bariatric surgery since 2013. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss. However, as the incidence of sleeve gastrectomy rises, recent data have revealed a risk of exacerbation of pre-existing GERD or the development of de novo GERD following sleeve gastrectomy. We performed a detailed review of GERD post-sleeve gastrectomy, including its overall incidence, pathophysiology and current treatment paradigms. [ABSTRACT FROM AUTHOR]

Background and aims: With the continuous development of endoscopic technology, endoscopic resection (ER) has gradually become an optional method for the treatment of gastric gastrointestinal stromal tumors (GISTs). However, studies with a large sample or a long follow-up are lacking. Therefore, this research aims to evaluate the efficacy and safety of ER for gastric GISTs in the real-world setting with more than 300 enrolled patients and a follow-up period longer than 45 months. Methods: From January 2013 to February 2023, 409 patients with a pathological diagnosis of GISTs after ER were retrospectively enrolled in this study. After excluding 86 patients with non-gastric GISTs, we assessed 323 patients with gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. Results: There were 194 (60.06%) females and 129 (39.94%) males, and the median age of the included patients was 58 years (51, 63). The median tumor size was 15.0 (10.0, 20.0) mm. According to the modified NIH criteria, 246 (75.85%) patients were classified as very low risk, 62 (19.20%) were classified as low risk, 12 (3.72%) were classified as moderate risk, and 3 (0.93%) were classified as high risk. A total of 287 (88.85%) patients achieved en bloc resection, and 287 (88.85%) also achieved complete resection. Only one patient showed residual and no recurrent lesions were noted during the follow-up. Regarding complications, three patients had complications, with a complication rate of 0.93%, and no severe complications requiring surgical intervention occurred. Conclusion: ER is an appropriate alternative method for the treatment of gastric GISTs, with an en bloc resection rate of 88.85% and a complication rate of 0.93%. No recurrence was noted during follow-up, even for GISTs with piecemeal resection. [ABSTRACT FROM AUTHOR]

Many bacteria and archaea rely on chemotaxis signal transduction systems for optimal fitness. These complex, multiprotein signaling systems have core components found in all chemotactic microbes, as well as variable proteins found in only some species. We do not yet understand why these variations exist or whether there are specific niches that favor particular chemotaxis signaling organization. One variation is in the presence/absence of the chemotaxis methylation adaptation enzymes CheB and CheR. Genes for CheB and CheR are missing in the gastric pathogen Helicobacter pylori but present in related Helicobacter that colonize the liver or intestine. In this work, we asked whether there was a general pattern of CheB/CheR across multiple Helicobacter species. Helicobacter spp. all possess chemotactic behavior, based on the presence of genes for core signaling proteins CheA, CheW, and chemoreceptors. Genes for the CheB and CheR proteins, in contrast, were variably present. Niche mapping supported the idea that these genes were present in enterohepatic Helicobacter species and absent in gastric ones. We then analyzed whether there were differences between gastric and enterohepatic species in the CheB/CheR chemoreceptor target methylation sites. Indeed, these sites were less conserved in gastric species that lack CheB/CheR. Lastly, we determined that cheB and cheR could serve as markers to indicate whether an unknown Helicobacter species was of enterohepatic or gastric origin. Overall, these findings suggest the interesting idea that methylation-based adaptation is not required in specific environments, particularly the stomach. IMPORTANCE Chemotaxis signal transduction systems are common in the archaeal and bacterial world, but not all systems contain the same components. The rationale for this system variation remains unknown. In this report, comparative genomics analysis showed that the presence/absence of CheR and CheB is one main variation within the Helicobacter genus, and it is strongly associated with the niche of Helicobacter species: gastric Helicobacter species, which infect animal stomachs, have lost their CheB and CheR, while enterohepatic Helicobacter species, which infect the liver and intestine, retain them. This study not only provides an example that a chemotaxis system variant is associated with particular niches but also proposes that CheB and CheR are new markers distinguishing gastric from enterohepatic Helicobacter species.

Burkitt lymphoma is a highly aggressive and rapidly growing B cell non-Hodgkin lymphoma with heterogeneous pattern of manifestations. We present a rare case of a 39-year-old immunocompetent male with double localization of Burkitt lymphoma: gastroduodenal and ileal tract. The gastric location is extremely rare, and the association with another site is unusual with only few reports in the literature. Imaging modalities play a crucial role in correct diagnosis as it can manifest as a focal mass or as segmental wall thickening.Radiologists should recognize common and uncommon presentations and sites of Burkitt lymphoma given the urgency of potential treatment, in order to improve the patient's prognosis.

Abstract Background Inflammatory myofibroblastic tumor (IMT) is a unique, rarely metastatic tumor composed of myofibroblasts and fibrous spindle cells with inflammatory cell infiltration that can affect any organ in the human body. By reviewing the relevant literature on PubMed, we found that this is the first case report of IMT with both gastric and cardiac involvement. Case presentation A 57-year-old male patient was admitted to the hospital with complaints of malaise, poor appetite, and epigastric pain with black stools. We found a mass in the patient’s stomach and left atrium by contrast-enhanced computed tomography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and other tests. The patient underwent laparoscopic Billroth II subtotal gastrectomy and Braun’s gastrointestinal reconstruction under general anesthesia. On the 46th day following stomach surgery, the cardiac tumor was removed under general anesthesia. The patient has treated with doxorubicin 70 mg of D1 chemotherapy two months after cardiac surgery. Postoperative pathological immunohistochemistry of the mass confirmed the diagnosis of an IMT. His review three months after the cardiac surgery suggested the progression of the left atrial mass, but he declined further treatment and finally died one month after the review. Conclusions As a unique class of tumors that rarely metastasize, IMTs have an unknown etiology and pathogenesis, and distant metastasis is primarily observed in patients with negative activin receptor-like kinase (ALK) expression. The preferred treatment for IMT is complete surgical resection, and the effectiveness of adjuvant therapy for patients with distant metastases is still being determined. The clinical presentation of IMT lacks specificity and is often related to the location of tumor growth, which poses a diagnostic challenge. Pathological immunohistochemistry is the only way to confirm the diagnosis at present. Our case report reminds clinicians that a category of ALK-negative IMT with a tendency toward distant metastasis should not be ignored.

Gastric necrosis is a very rare surgical emergency in a previously healthy child. A 13-year-old boy with abdominal pain and coffee-ground vomiting was admitted to the emergency department. Physical examination revealed signs of peritonitis and septic shock. The patient underwent a laparotomy. Gastric necrosis and discoloration of the lower esophagus and duodenum due to ischemia were present. Distention of gastric and duodenum was also seen. Total gastrectomy and Roux-en-Y esophagojejunostomy were done. The patient underwent a chest computed tomography (CT), and patchy ground-glass opacity was observed in both lungs. Consolidation was seen in the lower lobe of the lung. The polymerase chain reaction (PCR) for coronavirus was tested two times. The first time was negative, and the second time was positive. The patient was discharged in good condition. During the follow-up period, severe anastomotic strictures occurred. In our case, gastric necrosis and positive coronavirus were reported. [ABSTRACT FROM AUTHOR]

Mucormycosis is an opportunistic fungal infection that typically affects patients with diabetes mellitus or immunosuppression. The fungus invades nearby blood vessels, leading to thrombosis and organ necrosis. While Mucorales can infiltrate any organ in the body, the gastrointestinal system is an uncommon site for infection. Gastric mucormycosis is a rare but potentially lethal fungal infection resulting from the invasion of Mucorales into the gastric mucosa, exhibiting angioinvasive characteristics. It can lead to high mortality rates due to the increased risk of complications in immunocompromised patients. Common predisposing factors include diabetes mellitus, neutropenia, iron overload states, malnourishment, and other immunocompromised conditions. Mucormycosis is a fatal infection, necessitating prompt intervention to ensure survival. In this case report, authors present a 42-year-old man with a history of chronic alcoholism and chronic kidney disease who presented with complaints of abdominal pain and vomiting for six months, significant weight loss, and loss of appetite for one month. Initially suspected clinically and radiologically as a malignant gastric ulcer, an endoscopy was performed, and a gastric biopsy was sent for Histopathological Examination (HPE). Histological analysis of the gastric biopsy revealed multiple fragments of gastric mucosa with areas of ulceration, neutrophilic abscess, and numerous broad aseptate obtuse-angle fungal hyphae resembling Mucorales. The presence of the organisms was confirmed through special stains for fungus. Very few cases of invasive gastric mucormycosis associated with uncontrolled diabetes, alcoholism, and chronic kidney disease have been reported in the literature. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding is following gastrojejunostomy due to stromal ulceration, marginal ulcer bleeding from anastomotic site, remnant cancer. Gastrojejunostomy done for benign gastric outlet obstruction has many complications. Jejunogastric intussusceptions (JGI) is a rare complication of gastrojejunostomy surgery (<0.1% of cases), yet requires an urgent diagnosis. Mortality rates range from 10% to 50% based on delay in diagnosis and surgical intervention. Vomiting, abdominal pain, and hematemesis are the most common symptoms. We report a 53-year-old man admitted to the emergency department, complaining of epigastric pain and recurrent hematemesis for 3 days. Abdominopelvic computed tomography scan also showed a target sign in favor of jejunal intussusception. Midline emergency laparotomy was done and the gangrenous jejunum was resected with reconstruction Roux en Y loop was done. The patient was discharged without any further complications. In patients presented with hematemesis and abdominal pain and a history of gastrojejunostomy, JGI must consider a possible cause because early diagnosis and treatment are necessary to prevent further complications. [ABSTRACT FROM AUTHOR]

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended. [ABSTRACT FROM AUTHOR]

Background: Inflammatory myofibroblastic tumor (IMT) is a unique, rarely metastatic tumor composed of myofibroblasts and fibrous spindle cells with inflammatory cell infiltration that can affect any organ in the human body. By reviewing the relevant literature on PubMed, we found that this is the first case report of IMT with both gastric and cardiac involvement. Case presentation: A 57-year-old male patient was admitted to the hospital with complaints of malaise, poor appetite, and epigastric pain with black stools. We found a mass in the patient's stomach and left atrium by contrast-enhanced computed tomography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and other tests. The patient underwent laparoscopic Billroth II subtotal gastrectomy and Braun's gastrointestinal reconstruction under general anesthesia. On the 46th day following stomach surgery, the cardiac tumor was removed under general anesthesia. The patient has treated with doxorubicin 70 mg of D1 chemotherapy two months after cardiac surgery. Postoperative pathological immunohistochemistry of the mass confirmed the diagnosis of an IMT. His review three months after the cardiac surgery suggested the progression of the left atrial mass, but he declined further treatment and finally died one month after the review. Conclusions: As a unique class of tumors that rarely metastasize, IMTs have an unknown etiology and pathogenesis, and distant metastasis is primarily observed in patients with negative activin receptor-like kinase (ALK) expression. The preferred treatment for IMT is complete surgical resection, and the effectiveness of adjuvant therapy for patients with distant metastases is still being determined. The clinical presentation of IMT lacks specificity and is often related to the location of tumor growth, which poses a diagnostic challenge. Pathological immunohistochemistry is the only way to confirm the diagnosis at present. Our case report reminds clinicians that a category of ALK-negative IMT with a tendency toward distant metastasis should not be ignored. [ABSTRACT FROM AUTHOR]

Background: Sleep quality is a notable factor of well-being. It also may play a role in the development and progression of chronic diseases and cancers. Therefore, this study was performed to investigate poor sleep quality and its influencing factors among Iranian patients with esophageal and gastric cancer. Methods: In this cross-sectional study, a total of 312 Iranian adult patients who suffered from esophageal and gastric cancers were employed from a gastrointestinal cancer-based cohort study conducted in a referral hospital in Tehran between 2015 and 2018. Persian version of the Pittsburg Sleep Quality Index (PSQI) was used to measure poor sleep quality. Univariate and multiple logistic regression models were applied to determine the related factors to poor sleep quality. Results: Of the participants, 203 (65.06%) were men, and 75.96% had gastric cancer. The mean age was 63.13 ± 12.10 years. The results demonstrated that more than 62% of the patients had poor sleep quality. 148 (62.44%) patients out of 237 patients with gastric cancer had poor-quality sleep. Also, 46 (64.38%) patients out of 237 patients with esophageal cancer had poor-quality sleep. Based on the results of multiple logistic regression models, marital status has a negative association with poor sleep quality (odds ratio [OR] = 0.32, P = 0.015). In addition, having chronic disease (OR = 2.16; P = 0.028) and wealth index (OR = 3.11, P = 0.013; OR = 3.81, P = 0.003; OR = 3.29, P = 0.009; OR = 3.85, P = 0.003 for rich, moderate, poor, and poorest subgroups, respectively) had a positive association with poor sleep quality. Conclusion: The findings showed that about two-thirds of the patients studied were poor sleepers. Also, it was observed that marital status, chronic disease, and wealth index were important factors associated with poor sleep quality. [ABSTRACT FROM AUTHOR]

Coronavirus is a new virus that has affected human life on a large scale; it has infected millions of people and killed hundreds of thousands of people. In contrast, among cancers, stomach neoplasia is the most common cancer of the upper gastrointestinal (UGI) tract. COVID-19 disease has disrupted the optimal management of patients with cancer. Metastasis, deterioration of the patient's nutritional status, UGI bleeding, and increased surgical complications are all consequences of delayed treatment of patients with gastric cancer. However, there is still insufficient evidence on the immunogenicity of the vaccine and the protection provided by coronavirus vaccines in patients with cancer, especially those with immunodeficiency or those who are treated for certain types of cancers. Also, as part of the prevention and control of COVID-19 disease, nutritional support for patients with gastrointestinal cancer is particularly important, and the psychological and physiological limitations caused by the disease duration are hurting the well-being of patients. Therefore, the assessment of the impact of the coronavirus on cancer should be treated as an important issue, and healthcare professionals should be prepared to deal with the long-term effects of the coronavirus disease. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is an invasive cancer, which is usually diagnosed in advanced stages. However, the markers affecting its progression, and invasion are of great importance in its diagnosis and treatment. The current research aimed to study the correlation of genes that contributed to epithelial-mesenchymal transition (EMT), Mest1, and GjA1, with some clinicopathological specifications in gastric cancer patients to better comprehend the functions of these genes in this tumor. Materials and Methods: RNA was extracted from the tumor, and normal tissues and cDNA were synthesized. Then, by designing specific primers for Gja1 and Mest1 genes, their expressions were studied by RT-PCR. The data was analyzed by GraphPad Prism 8 software. Results: Significant differences among the expressions of mentioned genes associated with clinicopathological variables of gastric cancer patients, including tumor size, grade, stage, metastasis, and lymphatic invasion were seen. Conclusion: The obtained data showed the important role of EMT-related genes, Gja1 and Mest1 in the clinical progression of the tumor. Further studies with larger sample sizes are required to confirm these genes as biomarker candidates for detecting gastric cancer. [ABSTRACT FROM AUTHOR]

Purpose: We recently showed that low microsatellite instability (MSI-L) is associated with a good response to platinum/5-fluorouracil (5-FU) neoadjuvant chemotherapy (CTx) in gastric cancer. The purpose of this study was to characterize the instability pattern and to investigate an association of MSI-L tumors with mutations in genes of DNA repair pathways and with total tumor mutation burden (TMB). Methods: MSI patterns were compared between 67 MSI high (-H) and 35 MSI-L tumors. Whole-exome sequencing was performed in 34 microsatellite stable (MSS) and 20 MSI-L tumors after or without neoadjuvant CTx. Results: Of the 35 MSI-L tumors, 33 tumors had instability at a dinucleotide repeat marker. In the homologous recombination (HR) pathway, 10 of the 34 (29%) MSS and 10 of the 20 (50%) MSI-L tumors showed variants (p = 0.154). In the DNA damage tolerance pathway, 6 of the 34 (18%) MSS and 7 of the 20 (35%) MSI-L tumors had variants (p = 0.194). The HR deficiency score was similar in both tumor groups. TMB was significantly higher in MSI-L compared to MSS tumors after CTx (p = 0.046). In the MSS and MSI-L tumors without CTx no difference was observed (p = 1.00). Conclusion: MSI-L due to instability at dinucleotide repeat markers was associated with increased TMB after neoadjuvant CTx treatment, indicating sensitivity to platinum/5-FU CTx. If confirmed in further studies, this could contribute to refined chemotherapeutic options including immune-based strategies for GC patients with MSI-L tumors. [ABSTRACT FROM AUTHOR]