Al Diffalha, Sameer

Abstract Globally, gastric adenocarcinoma is the fourth leading cause of cancer mortality and a major cancer disparity in the United States. Chemoprevention strategies are lacking for high-risk individuals with gastric premalignant conditions (GPMC). Curcumin, the principal curcuminoid in turmeric, exerts immunomodulatory effects in the epithelium and against Helicobacter pylori, and studies suggest chemoprevention potential. We conducted a double-blind, phase IIa randomized controlled trial in high-risk populations in Puerto Rico and Honduras. We investigated the utility of a bioavailable formulation of curcumin (Meriva) among individuals with H. pylori–negative GPMC, specifically, multifocal atrophic gastritis (MAG) or gastric intestinal metaplasia (GIM). Patients were 1:1 randomized to 1,000 mg Meriva daily or placebo for a 6-month intervention with endoscopy at baseline and 6 months. Outcomes included assessment of epithelial cytokine and chemokine levels, histology, and DNA damage as assessed by γ-H2AX phosphorylation IHC. Of the 110 subjects screened, 50 participants were randomized, and 48 completed the trial. A significant reduction in gastric mucosal IL1β levels from baseline in the gastric body, the primary endpoint, was observed in the Meriva group (P = 0.032). Changes in epithelial IL8, TNFα, and inducible protein 10 levels and gastric mucosal histology and DNA damage (secondary endpoints) were similar between arms. Curcumin (Meriva) was safe, well-tolerated, and showed potential as a curcuminoid chemoprevention agent in H. pylori–negative patients with GPMC. A potential reduction in gastric inflammation as measured by gastric mucosal IL1β levels was observed. Further studies are warranted, including studies in H. pylori–positive individuals, based upon the curcuminoid direct effects on H. pylori. Prevention Relevance: Gastric adenocarcinoma is a leading cause of cancer mortality worldwide. Chemoprevention candidates for GPMCs are limited. This randomized phase IIa trial evaluated a bioavailable curcumin formulation in high-risk individuals with MAG and GIM. The results support further study of curcuminoids for gastric cancer risk reduction. See related Spotlight, p. 387 See related article by Morgan et al., p. 391

Ectopic liver is a rare congenital anomaly characterized by the presence of liver tissue outside the normal liver without any direct connection to it. These lesions are usually detected incidentally during clinical evaluation for other issues. However, they sometimes mimic neoplastic lesions both clinically and radiologically, which poses diagnostic challenges. Here, we present 5 patients with ectopic liver, 4 of which mimicked neoplastic lesions. The first was a 54-year-old woman diagnosed with multiple liver lesions and an enlarged gastro-hepatic lymph node, suspected to be a primary hepatic neoplasm with metastasis. Upon resection, it was found to be a hepatocellular adenoma in the liver and intraabdominal ectopic liver tissue with a small hepatocellular adenoma. Patient 2 was a 36-year-old woman presenting with palpitations and shortness of breath. An echocardiogram revealed a right atrial mass, which was identified as ectopic liver upon microscopic examination. The third patient was a 57-year-old woman with intermittent abdominal pain who underwent cholecystectomy. Microscopy revealed ectopic liver tissue on the gallbladder's serosal surface, along with chronic cholecystitis. The fourth was a 36-year-old woman with a gallbladder polyp, which on microscopy revealed ectopic liver tissue with no other abnormalities in the gallbladder. The fifth patient was a 57-year-old woman presenting with shortness of breath, weakness, and right atrial mass, which was confirmed as ectopic liver. These patients illustrate varied presentations of ectopic liver, sometimes mimicking neoplasia. Hepatocellular adenomas arising in ectopic liver and ectopic liver in intracardiac locations are extremely rare and can be a diagnostic pitfall, as they can clinically, radiologically, and pathologically mimic serious conditions like neoplasia.