Livin is a new member of the inhibitor of apoptosis proteins family of proteins that interacts with downstream caspases, such as caspase-3, caspase-7, and caspase-9, however, its role in human ampullary carcinoma has not been clearly defined. Immunohistochemistry was used to evaluate tissue samples from patients with ampullary carcinomas (n=71) using antibodies against livin, Ki-67 (a proliferation marker), and caspase-3. Livin was detected in 33/71 cases (in the cytoplasm of all and in the nucleus of only 2 cases). High livin expression correlated with cell differentiation, tumor-node-metastasis stage, and lymph node metastasis (P=0.001, P<0.001, and P=0.028, respectively). Caspase-3 and Ki-67 expression were significantly associated with differentiation (P<0.001, P=0.008, respectively). There was a significant negative correlation between livin and caspase-3 (r=-0.575, P<0.001), and a positive correlation between livin and Ki-67 (r=0.308, P=0.009). Survival of patients with high livin expression was shorter compared with that of patients with low livin expression (P=0.001). Expression of caspase-3 was not associated with overall survival in this cohort (P=0.335). Livin expression was an independent prognostic factor (hazard ratio 2.693, P=0.017), as was lymph node metastasis (hazard ratio 4.959; P<0.001). In this study livin expression significantly correlated with the proliferation marker Ki-67, but was negatively correlated with caspase-3 expression. These data suggest that livin may be a valuable prognostic factor for human ampullary carcinoma.
Extragastrointestinal stromal tumors (EGISTs) are neoplasms located outside the gastrointestinal tract in sites including the omentum, mesentery and retroperitoneum. EGISTs of the transverse mesocolon are rarely noted in the literature. Herein, we describe a rare case of giant EGIST concomitant with gastric cancer in a 78-year-old male who presented with upper abdominal pain and a palpable mass. The patient underwent en bloc resection of the tumor with a distal gastrectomy, with a D2 lymphadenectomy for the gastric cancer, accompanied with resection of a segment of the transverse colon. The patient received targeted therapy (imatinib 400 mg, daily) and adjuvant chemotherapy with FOLFOX (six cycles). Neither recurrence nor metastasis was observed after 24 months of follow-up.
Concomitant primary sarcomatoid hepatocellular carcinoma (SHC) with gallbladder carcinoma is a rare type of hepatobillary disease. To the best of our knowledge, this coexistence has rarely been reported. An 80-year-old male presented with right-sided epigastric pain and a low fever. Computed tomography (CT) imaging revealed a hypodense lesion in the right lobe of the liver and a regular intraluminal polypoid mass in the gallbladder. The patient underwent a partial hepatectomy of the right lobe of the liver and a cholecystectomy. Following pathological examination, the patient was diagnosed with SHC combined with gallbladder adenocarcinoma. The patient and his family refused post-operative adjuvant chemotherapy and radiation therapy. The patient succumbed to intrahepatic and lung metastases at six months post-surgery. In conclusion, concomitant gallbladder carcinoma and SHC may occur. Surgery-based multimodal treatment is the preferred strategy for compound tumors. Adjuvant chemotherapy or radiotherapy may be necessary for the high risk hepatobiliary malignancies.
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