Opportunistic salpingectomy for prevention of sporadic ovarian cancer — a jump from basic science to clinical practice?

Ovarian cancer is the most malignant and aggressive gynecological cancer. Due to nonspecific symptoms in the early stage and a lack of effective screening methods, it is typically diagnosed at an advanced stage. The high-grade serous cancer (HGSC) represents 75% of all ovarian cancers and accounts for the majority of deaths. Contemporary thought suggests that precursor lesions of HGSC originate in the fallopian tube. The presumed precursor tubal lesion, localized at the fimbrial end of the fallopian tubes, is termed the serous tubal intraepithelial carcinoma (STIC). Thus, removal of the fallopian tubes at the time of pelvic or abdominal surgery for a benign condition (i.e. opportunistic salpingectomy) appears as an attractive option for primary prevention of HGSC. This paper presents the scientific background of opportunistic salpingectomy and discusses controversies regarding the benefits and safety of the procedure

Morphology and physiology of the epiphyseal growth plate.

The epiphyseal growth plate develops from the cartilaginous-orientated mesenchymal cells that express SOX family genes. This multilayer structure is formed by the proliferation and hypertrophy of cells that synthesize the extracellular matrix composed of collagen (mainly type II, IX, X, XI) and proteoglycans (aggrecan, decorin, annexin II, V and VI). The resting zone is responsible for protein synthesis and maintaining a germinal structure. In the proliferative zone, cells rapidly duplicate. The subsequent morphological changes take place in the transformation zone, divided into the upper and lower hypertrophic layers. In the degenerative zone, the mineralization process becomes intensive due to increased release of alkaline phosphate, calcium and matrix vesicles by terminally differentiated chondrocytes and some other factors e.g., metaphyseal ingrowth vessels. At this level, as well as in the primary and secondary spongiosa zones, chondrocytes undergo apoptosis and are physiologically eliminated. Unlike adult cartilage, in fetal and early formed growth plates, unusual forms such as authophagal bodies, paralysis and dark chondrocytes were also observed. Their ultrastructure differs greatly from apoptotic and normal cartilage cells. Chondrocyte proliferation and differentiation are regulated by various endocrine, paracrine, and autocrine agents such as growth, thyroid and sex hormones, beta-catenin, bone morphogenetic proteins, insulin-like growth factor, iodothyronine deiodinase, leptin, nitric oxide, transforming growth factor beta and vitamin D metabolites. However, the most significant factor is parathyroid hormone-related protein (PTHrP) which is synthesized in the perichondrium by terminally differentiated chondrocytes. Secondary to activation of PTH/PTHrP receptors, PTHrP stimulates cell proliferation by G protein activation and delays their transformation into prehypertrophic and hypertrophic chondrocytes. When proliferation is completed, chondrocytes release Indian hedgehog (Ihh), which stimulates PTHrP synthesis via a feedback loop. Any disturbances of the epiphyseal development and its physiology result in various skeletal abnormalities known as dysplasia

Eruption of palmoplantar pustular psoriasis in patient treated with anti-androgen therapy for prostate cancer and aggravation of lesions after statin treatment

Abstract The article focuses on the eruption of palmoplantar pustular psoriasis, which was documented in a 53-year-old man diagnosed with prostate cancer with bone metastases. This clinical finding was made during routine hormone therapy and palliative radiotherapy. The local improvement in skin lesions was achieved following administration of topical ointments and the use of UVA 311 nm radiation therapy. The management of prostate cancer in this subject resulted in malaise, onset of diabetes mellitus and increased concentration of serum lipids. Interestingly, a few days after the statin treatment was initiated, the intensive pustule eruption was observed as well as severe pain and burning sensation in the palms and soles. The dermatological treatment led to significant improvement. The patient is still receiving oncological therapy and is monitored by dermatologists on a regular basis

Left atrial myxoma with concomitant coronary artery stenosis: comprehensive diagnosis and treatment

  A 69-year-old patient was admitted to the Department of Cardiology due to an accidental finding on a chest X-ray, enlarged heart outline, accompanied by worsening of heart failure to NYHA II with LVEF, about 30%. In the X-ray description, an enlargement of the left atrium silhouette with local calcifications. The patient underwent TTE, confirming the presence of a pedunculated tumor of the left atrium attached to the ceiling measuring 3.5x3.5x2.2 cm. Due to the ischemic heart disease manifestation patient uderwent coronarography confirming the presence of single-vessel coronary artery disease with changes in the middle segment of the LAD. Patient was treated with CABG LIMA-LAD surgery and removeal the left atrial tumor. Post operation tissue material prooved the preseance of left atrium myxoma. The postoperative course was uneventful, the patient was discharged home. &nbsp

Neuropilin 1 in uterine leiomyosarcoma. Clinical and pathological analysis

Objectives: The role of angiogenesis in leiomyosarcomas still remains unclear. The aim of this study was to evaluate the NRP1 expression in the leiomyosarcoma tissues and to find the relations between its expression and the clinical features. Material and methods: The study group consisted of 50 patients with diagnosis of the uterine leiomyosarcoma. Clinical and follow up data were collected. Using immunohistochemical methods the expression of NRP1 was detected. Results: The lack of NRP1 expression was found in 14 cases, positive (weak or moderate) expression was noted in 36 cases. The significantly higher expression of NRP1 was observed in more severe clinical stages in comparison to lower stages of the disease. The significantly shorter survival of patients with the positive expression of NRP1 in leiomyosarcoma was observed. Conclusions: The expression of NRP1 is associated with clinical advancement and worse prognosis in uterine LMS. Neuropilin 1 can be widely used as a postoperative survival predictor for the patients suffering from uterine LMS

Ekspresja podoplaniny w raku jasnokomórkowym jajnika

Abstract Introduction: Podoplanin is a transmembrane glycoprotein expressed in endothelial lymphatic cells. It was proven to be a predictive marker in a variety of cancers e.g. mesothelioma and head and neck squamous-cell carcinoma. Ovarian clear cell carcinoma (OCCC) is a rare and unique histopathologic subtype of epithelial ovarian cancer (EOC). The molecular basis of that phenomenon remains unknown. Objectives: The aim of our study was to assess podoplanin expression on the protein level in OCCC. Material and Methods: Immunohistochemistry was performed on paraffin-embedded tissues from 19 patients with diagnosed OCCC. Results: Podoplanin expression was present (moderate or strong) in 52% of OCCC cases (10/19). Nine of eleven (81,2%) postmenopausal and one of eight (12,5%) premenopausal women were podoplanin positive. No differences in podoplanin expression were found in relation to clinical features of the tumor. Conclusion: The incidence of podoplanin expression is higher in ovarian clear cell adenocarcinoma in postmenopausal patients.Streszczenie Wstęp: Podoplanina jest przezbłonową glikoproteiną występującą w komórkach śródbłonka naczyń limfatycznych. Swoje zastosowanie jako marker predykcyjny znalazła w diagnostyce międzybłoniaka czy też w raku głowy i szyi. Jasnokomórkowy rak jajnika (OCCC) jest rzadko występującym i odmiennym histopatologicznym podtypem nabłonkowego raka jajnika. Molekularne podłoże tego zjawiska nadal nie jest znane. Cel: Celem badań była ocena ekspresji podoplaniny na poziomie białka w jasnokomórkowym raku jajnika. Materiał i metody: Ekspresję podoplaniny oceniono metodą immunohistochemiczną z zastosowaniem techniki macierzy tkankowych (TMA) u 19 pacjentek z OCCC. Wyniki: Ekspresja podoplaniny była obecna (średnia lub wysoka) w 52% przypadków OCCC (10/19). Jej ekspresję wykazano u jednej Spośród ośmiu pacjentek przed menopauzą (12,5%) i u 9 spośród 11 (81,2%) po menopauzie. Nie wykryto różnic w ekspresji podoplaniny w odniesieniu do cech klinicznych nowotworu. Wnioski: Częsta ekspresja podoplaniny jest charakterystyczna dla kobiet po menopauzie ze zdiagnozowanym rakiem jasnokomórkowym jajnika

Ectopic pancreas: endoscopic, ultrasound and radiological features

Ectopic pancreas, a rare entity, is defined as pancreatic tissue lying outside its normal location without anatomical or vascular connections with the pancreas proper. Most occurrences of heterotopic pancreas are located in the stomach wall, duodenum, small intestine or anywhere in the gastrointestinal tract. The aim of this study was to describe the endoscopic, endosonographic (EUS) and radiological features of these lesions. Management of the ectopic pancreas remains controversial. The authors describe 12 patients and try to recommend different kind of treatment in the light of the symptoms, location and size of the lesions

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

  Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. Material and methods: The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% — symptomatic uterine fibromas, 12.7% — abnormal uterine bleeding, 8.9% — suspicion of uterine adenomyosis) between January 2011 and December 2015. Pre­malignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. Results: The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. Conclusions: The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.