Combined perioperative plasma endoglin and VEGF-A assessment in colorectal cancer patients

Colorectal cancer growth and spread is absolutely dependent on angiogenesis with vascular endothelial growth factor (VEGF) being the most important cytokine involved in the process. Endoglin, a membrane co-receptor for TGF-beta, has recently emerged as a sensitive index of cancer stage. There is now sufficient evidence indicating that microvessel density assessed by endoglin-immunostaining correlates with stage of colorectal cancer and patient survival. An association of a soluble form of endoglin with lymph node and distant metastases has recently been reported in two studies. Both of them used local elaborated immunoassays for endoglin assessment. The aim of our study was to determine the efficacy of plasma endoglin, assessed using a commercial kit, as a marker of tumor spread and distant metastases in colorectal cancer patients. We studied 48 colorectal cancer patients, compared with 22 healthy subjects, using ELISA. We observed that colorectal cancer patients had increased plasma VEGF-A, but not endoglin levels. However, we found an association of plasma endoglin with the stage of malignancy. Endoglin levels were increased in metastasis-positive patients when compared to both metastasis-negative patients and healthy volunteers. Plasma endoglin correlated with VEGF-A, CEA and CA19.9. Endoglin assessment in plasma does not seem useful as a maker of colorectal cancer. Our observations indicate however that it might be helpful in selecting patients with metastatic disease

Matrix metalloproteinase 2 and tissue inhibitor of matrix metalloproteinases 2 in the diagnosis of colorectal adenoma and cancer patients.

The aim of the study was to assess the importance of the measurement of matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of matrix metalloproteinases 2 (TIMP-2) in patients with colorectal cancer (CRC) in relation to clinicopathological features of tumor and patients' survival. Additionally, we determined serum MMP-2 and TIMP-2 in colorectal adenoma (CA) patients and healthy controls and compared them with tumor markers, CEA and CA 19-9. The serum levels of MMP-2 and TIMP-2 in 91 CRC patients, 28 CA subjects and 91 healthy controls were determined by ELISA method, but concentrations of CEA and CA 19-9 using MEIA method. Nonparametric statistical analyses were used. Serum levels of MMP-2 and TIMP-2 were significantly lower in CRC patients than in healthy subjects and decreased with tumor stage. Additionally, MMP-2 concentrations were significantly lower in patients with CRC than in CA group. Diagnostic sensitivity of TIMP-2 (59%) was the highest among biomarkers tested and increased in combined use with CEA (79%). Moreover, the area under ROC curve (AUC) of TIMP-2 was larger than AUC of MMP-2 in differentiation between CRC and healthy subjects, but lower than AUC of matrix metalloproteinase 2 in differentiation between colorectal cancer and adenoma. Our findings suggest clinical usefulness of TIMP-2 as a biomarker in the diagnosis of CRC, especially in combination with CEA. However, further investigation is necessary

Clinical significance of serum levels of matrix metalloproteinase 2 (MMP-2) and its tissue inhibitor (TIMP-2) in gastric cancer

Matrix metalloproteinase 2 (MMP-2) is able to degrade type IV collagen, and thus plays a key role in the migration of tumor cells. MMP-2 activity is inhibited by its tissue inhibitor (TIMP-2). The imbalance between MMPs and TIMPs may facilitate progression of cancer cells. The aim of this study was to compare the clinical importance of MMP-2 and TIMP-2 to that of classical tumor markers, namely carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) in the diagnosis of gastric cancer (GC) by calculating the diagnostic criteria and estimating the levels of MMP-2, TIMP-2, CEA and CA 19-9 in GC patients in relation to clinicopathological features of cancer. We found that serum levels of MMP-2 and TIMP-2 were significantly lower, whereas serum tumor markers were higher, in GC patients than in healthy subjects. Moreover, concentrations of TIMP-2 and CEA correlated with gastric wall infiltration, while CA 19-9 levels correlated with gastric wall infiltration and the presence of nodal metastasis. None of the proteins tested was found to be an independent prognostic factor for GC patients’ survival. The percentage of true positive results of TIMP-2 (61%) was higher than those of MMP-2 (54%) and the classical tumor markers CEA (21%) and CA 19-9 (31%). The highest diagnostic sensitivity was observed for the combined use of TIMP-2 with MMP-2 (77%). The results suggest the greater importance of serum MMP-2 and TIMP-2 than of the classical tumor markers CEA and CA 19-9 in the diagnosis of GC. But this issue requires further investigation. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 1, pp. 125–131

Cytological picture of the oral mucosa in patients with gastric and colon cancer

The incidence of malignant gastrointestinal cancers in Poland has been constantly growing, which hasled to an intensification of the search for new markers of the early clinical stage of this disease. The oral cavity,as the first part of the gastrointestinal tract, has a very important role. The oral cavity presents symptoms of bothtypically stomatological and systemic diseases. Oral cancers, benign or malignant, may originate and grow in anyof the tissues of the mouth, and within this small area they may be of varied clinical, histological and biologicalfeatures. These can be lesions typically observed in the oral cavity, but also characteristic of cases where thesymptoms occur both in the mouth and in other body parts. The aim of this study was to present a cytologicalpicture of the oral mucosa in patients with gastric and colon cancer and to compare the cytological picture withthat obtained from a group of patients with no cancer, using the Papanicolaou classification and the Bethesdasystem. The study was conducted in 126 patients treated surgically in the II General and GastroenterologicalSurgery Clinic between 2006 and 2008. All patients were divided into two groups based on the type of lesions. Inboth of the studied groups, more than half of the patients did not present any abnormalities in the mucosa of themouth, lips and cheeks in the physical examination. None of the patients had erosion, ulceration or lesionstypical of leukoplakia or lichen planus. No malignant cells were detected in either of the studied groups, andthere were no well-defined lesions found in the oral cavity that would distinguish the patients with gastrointestinalcancer. (The incidence of malignant gastrointestinal cancers in Poland has been constantly growing, which hasled to an intensification of the search for new markers of the early clinical stage of this disease. The oral cavity,as the first part of the gastrointestinal tract, has a very important role. The oral cavity presents symptoms of bothtypically stomatological and systemic diseases. Oral cancers, benign or malignant, may originate and grow in anyof the tissues of the mouth, and within this small area they may be of varied clinical, histological and biologicalfeatures. These can be lesions typically observed in the oral cavity, but also characteristic of cases where thesymptoms occur both in the mouth and in other body parts. The aim of this study was to present a cytologicalpicture of the oral mucosa in patients with gastric and colon cancer and to compare the cytological picture withthat obtained from a group of patients with no cancer, using the Papanicolaou classification and the Bethesdasystem. The study was conducted in 126 patients treated surgically in the II General and GastroenterologicalSurgery Clinic between 2006 and 2008. All patients were divided into two groups based on the type of lesions. Inboth of the studied groups, more than half of the patients did not present any abnormalities in the mucosa of themouth, lips and cheeks in the physical examination. None of the patients had erosion, ulceration or lesionstypical of leukoplakia or lichen planus. No malignant cells were detected in either of the studied groups, andthere were no well-defined lesions found in the oral cavity that would distinguish the patients with gastrointestinalcancer.

Neuroendocrine tumors of gastrointestinal tract in own material

Guzy neuroendokrynne należą do rzadkich schorzeń przewodu pokarmowego, które często sprawiają kłopoty diagnostyczne i lecznicze. Celem pracy było opisanie 2 przypadków z guzem neuroendokrynnym przewodu pokarmowego operowanych w 2005 roku w II Klinice Chirurgii Ogólnej i Gastroenterologicznej AM w Białymstoku. U 63-letniej pacjentki, u której wstępnie rozpoznano przerzuty do wątroby guza neuroendokrynnego, nie udało się w badaniach przedoperacyjnych zlokalizować dokładnie ogniska pierwotnego. Dopiero podczas operacji stwierdzono obecność guza neuroendokrynnego w końcowym odcinku jelita krętego z przerzutami do wątroby i sieci większej. Wykonano hemikolektomię prawostronną oraz częściową resekcję segmentów VII i VIII wątroby wraz z guzami przerzutowymi. W przebiegu pooperacyjnym obserwowano zaburzenia neurologiczne o niejasnym podłożu bez zmian ogniskowych w tomografii komputerowej. U 57-letniego chorego operowanego z powodu wznowy węzłowej guza żołądka rozpoznano histopatologicznie rakowiaka. Wycięty 6 lat wcześniej guz żołądka był zdiagnozowany jako Adenocarcinoma G2 pT2N0M0. Po zabiegu limfadenektomii obserwowano u pacjenta rozsiew do wątroby i węzłów chłonnych w jamie brzusznej, potwierdzony oktreoskanem. Rozpoczęto terapię analogiem somatostatyny (oktreotydem LAR). Mimo leczenia nastąpił zgon. Autorzy niniejszej pracy prezentują własne doświadczenia, obrazujące trudności w diagnostyce przedoperacyjnej guzów neuroendokrynnych przewodu pokarmowego. Przedstawiono również nieoczekiwane powikłania neurologiczne w przebiegu leczenia.Neuroendocrine tumors are rare gastrointestinal tract disorders, in which diagnosis and treatment are often difficult. The aim of the paper is to present two cases of patients with neuroendocrine tumor of gastrointestinal tract, who underwent surgical procedure in II Department of General and Gastroenterological Surgery of Medical University of Białystok in 2005. A 63-year-old female patient with primary diagnosis of neuroendicrine tumor metastases in liver was not successfully investigated for primary tumor in the preoperative period. The laparotomy procedure indicated the malignant neuroendocrine tumor in the terminal ileum and metastases to the liver and to the greater omentum. The right hemicolectomy and liver metastatic segment VII and VIII resection were performed. The neurological disturbances of obscure origin were observed in the postoperative period and the patient suddenly died on the 15th day after surgery. A 57-years-old male patient was operated on for lymph node recurrence of gastric tumor. Pathologic examination of tissue sample revealed the diagnosis of carcinoid. The patient underwent subtotal gastric resection for a pyloric ulcer, diagnosed as Adenocarcinoma G2 pT2N0M0 6 years before. Liver and abdominal node metastases, confirmed by octreoscan, were observed after lymphadenectomy, The treatment of somatostatin analogues (LAR octreotide) was used. In spite of therapy the patient died. The authors present their own experiences and show the preoperative diagnostic difficulties in patients with neuroendocrine gastrointestinal tumors. Unexpected neurological complications in the treatment course were described

Dysfunctions in the Mature Dendritic Cells Are Associated with the Presence of Metastases of Colorectal Cancer in the Surrounding Lymph Nodes

Dendritic cells play a key role in the antigen presentation and T cell activation. The aim of this study was a detailed analysis of the presence of mature dendritic cells (CD 83 positive) in colorectal cancer in correlation with selected clinicopathological parameters. The presence of mature dendritic cells (mDCs) was determined immunohistochemically using the anti-CD83 antibody. The morphometric analysis of the mDCs was performed in the normal colon wall adjacent to the cancerous tumor as well as in the front of the tumor and in the main mass of the cancerous tumor. Decrease in mDCs in the front and in the main tumor mass was observed. The increase in the number of mDCs in both of these locations was associated with the presence of metastases in the nearby lymph nodes (p<0.05 and p<0.01). Furthermore, the increase in the proportion of mDCs in the main tumor mass was associated with the presence of the invasion of tumor cells into the blood and lymph vessels (p<0.01). The increase in the amount of mDCs in the cancerous tumor is associated with the invasiveness of the tumor and especially with the metastasis to the surrounding lymph nodes

Comparison between clinical significance of serum proinflammatory proteins (IL-6 and CRP) and classic tumor markers (CEA and CA 19-9) in gastric cancer

Gastric cancer (GC) is a second most common cause of cancer-related death and represents an inflammation-driven malignancy. It has been suggested that interleukin 6 (IL-6) and C-reactive protein (CRP) play a potential role in the growth and progression of GC. The aim of the present study was to compare clinical significance of IL-6 and CRP with classic tumor markers—carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) in GC patients. The study included 92 patients with GC and 70 healthy subjects. The serum concentrations of IL-6, CEA and CA 19-9 were determined using immunoenzyme assays, whereas CRP using immunoturbidimetric method. We defined the diagnostic criteria and prognostic value for proteins tested. In GC patients, the serum concentrations of all the proteins tested were significantly higher than in healthy subjects. The IL-6, CEA and CA 19-9 levels correlated with nodal metastases, while CRP with tumor stage, gastric wall invasion, presence of nodal and distant metastases. Diagnostic sensitivity of IL-6 was higher (85%) than those of other markers (CRP 66%, CA 19-9 34%, CEA 22%) and increased in combined use with CRP or CEA (88%). The area under ROC curve for IL-6 was larger than those of CRP and classic tumor markers (CEA and CA 19-9). None of the proteins tested was independent prognostic factor for the survival of GC patients. Our findings indicate better usefulness of serum proinflammatory proteins—IL-6 and CRP than classic tumor markers—CEA and CA 19-9 in the diagnosis of GC