Plasticity of neuropeptidergic neoplasm cells in the primary and metastatic Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous carcinoma with characteristics of neuroendocrine tumor. We performed immunohistochemical analysis to demonstrate the presence of various neuropeptides within cells of MCC resected from a 75-year old woman. The cells of primary tumor of cheek were compared with the cells of regional right submandibular metastatic tumor which was found eight months later. A double- staining IHC for the pan-neuronal marker, PGP 9.5, and selected neuropeptides in the tissue material obtained from both locations was performed. Single multipolar cells in the main mass of primary tumor stained positively for PGP 9.5 and such neuropeptides as GAL, VIP, PACAP, NPY and CGRP. Moreover, we demonstrated for the first time the presence of neuropeptides in metastatic MCC cells. In the metastatic tumor, cells showing the co-localization of PGP-9.5 and neuropeptides were more numerous, mostly of oval shape, and significantly smaller than in the primary tumor. Thus, the progression of MCC may be associated with the acquisition by its cells of new morphological and biological features

Complete pathological remission after palliative therapy with sorafenib in hepatocellular carcinoma — case report

Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver cancer. The five-year overall survival (OS) in men diagnosed with HCC does not exceed 9%. Patients (pts) with advanced disease are treated with sorafenib (multikinase inhibitor). In randomised trials the OS advantage was within the range of three months for sorafenib. Stabilisation of disease was achieved in 71% of patients, and no case of CR was reported. We present a case of 60-year-old patient with locally advanced cT3aN0M0 (stage IIIA according to seventh TNM) bifocal HCC (12 × 10 cm and 10 × 8 cm). The diagnosis was confirmed by pathologic examination. Due to the clinical stage, palliative treatment with sorafenib was administered from January 2016 to February 2017. A clinical partial response (cPR) enabled surgery. In May 2017, left-sided liver bisegmentomy and resection of residual lesion in segment 6 were performed. The pathological report revealed ypCR. Subsequently, pathology verification changed the primary diagnosis to PR. In September 2017 thermoablation of lesion in segment 5 of the liver was performed. The increased AFP (alpha-fetoprotein) level at baseline was normalised during treatment. The sorafenib therapy was completed after one year. The patient remains in follow-up with no evidence of relapse. Treatment with sorafenib in the presented case enabled radical therapy, so the palliative treatment turned out to be an induction treatment. Clinical CR (especially pCR) in advanced non-operable solid tumours after systemic treatment is quite rare (3–15%), and even less common in HCC. So far, only a few cases of achievement of CR during sorafenib therapy in HCC have been described

Całkowita remisja potwierdzona patomorfologicznie po leczeniu paliatywnym sorafenibem w raku wątrobowokomórkowym — opis przypadku

Rak wątrobowokomórkowy (HCC) jest najczęstszym pierwotnym nowotworem złośliwym wątroby. Pięcioletnie przeżycie całkowite (OS) u mężczyzn z rozpoznaniem HCC nie przekracza 9%. Chorzy na zaawansowanego i nieoperacyjnego HCC są kwalifikowani do leczenia sorafenibem (inhibitor wielokinazowy), który jest pierwszym lekiem o udowodnionym wpływie na OS — zastosowanie sorafenibu w prospektywnym badaniu z randomizacją wydłużyło medianę OS u chorych na HCC o 3 miesiące, 71% pacjentów osiągnęło stabilizację choroby, ale nie odnotowano żadnego przypadku całkowitej remisji (CR). W obecnej pracy przedstawiono przypadek 60-letniego chorego z pierwotnie nieoperacyjnym dwuogniskowym (12 × 10 cm i 10 × 8 cm) HCC, potwierdzonym w badaniu histologicznym, o zaawansowaniu klinicznym cT3aN0M0 (IIIA według 7. edycji klasyfikacji TNM), którego leczono paliatywnie sorafenibem w okresie od stycznia 2016 roku do lutego 2017 roku. W związku z uzyskaniem radiologicznej częściowej odpowiedzi (cPR) chorego zakwalifikowano do operacji. W maju 2017 roku wykonano bisegmentomię lewoboczną wątroby z resekcją zmian resztkowych segmentów 2 i 3 oraz resekcję segmentu 6. W pooperacyjnym badaniu patomorfologicznym nie znaleziono komórek raka — opisano cechę ypCR. Ponowna weryfikacja materiału podważyła pierwotne rozpoznanie i ostatecznie opis zmian pooperacyjnych zakwalifikowano jako ypPR. We wrześniu 2017 roku wykonano termoablację ogniska widocznego w badaniach obrazowych w segmencie 5 wątroby. Uzyskano normalizację stężenia markera nowotworowego alfa-fetoproteiny (AFP). Po zakończeniu leczenia sorafenibem chory pozostaje pod obserwacją bez cech nawrotu choroby. W opisywanym przypadku sorafenib umożliwił przeprowadzenie radykalnego postępowania, a leczenie w założeniu paliatywnym stało się leczeniem indukującym odpowiedź. Odpowiedzi całkowite (szczególnie potwierdzone patomorfologicznie — pathologic complete response, pCR) w zaawansowanych nieoperacyjnych nowotworach litych po leczeniu systemowym są dość rzadkie (3–15%), a w przebiegu HCC występują wyjątkowo rzadko. Dotychczas opisano zaledwie kilkanaście przypadków CR u chorych z HCC w trakcie stosowania sorafenibu, jednak pCR stwierdzono zaledwie w kilku przypadkach na świecie

Ruptured ectopic pregnancy diagnosed with computed tomography

Background: The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. Case Report: A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient's lifethreatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8th week of gestation) was found. Conclusions: Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material

Galanin Receptors (GalR1, GalR2, and GalR3) Expression in Colorectal Cancer Tissue and Correlations to the Overall Survival and Poor Prognosis of CRC Patients

Colorectal cancer (CRC) is the second most common cause of cancer in women and the third in men. The postoperative pathomorphological evaluation of patients with CRC is extremely important for future therapeutic decisions. Although our previous studies demonstrated high galanin (GAL) presence within tumor tissue and an elevated concentration of GAL in the serum of CRC patients, to date, there is a lack of data regarding GAL receptor (GalR) protein expression in CRC cells. Therefore, the aim of this study was to evaluate the presence of all three types of GalRs (GalR1, GalR2 and GalR3) within epithelial cells of the human colon and CRC tissue with the use of the immunohistochemical method and to correlate the results with the clinical-pathological data. We found stronger immunoreactivity of GalR1 and GalR3 in CRC cells compared to epithelial cells of the unchanged mucosa of the large intestine. No differences in the GalR2 protein immunoreactivity between the studied tissues were noted. We also found that the increased immunoexpression of the GalR3 in CRC tissue correlated with the better prognosis and longer survival (p n = 55). The obtained results suggest that GalR3 may play the role of a prognostic factor for CRC patients. Based on data from the TCGA-COAD project deposited in the GDC Data Portal, we also found that GalR mRNA in cancer samples and the adjacent normal tissue did not correlate with immunoexpression of the GalR proteins in CRC cells and epithelial cells of the unchanged mucosa

Thrombosis of the deep dorsal penile vein and corpora cavernosa of the penis as the first symptoms of colon cancer. Case report and literature review

The case describes an 86-year-old man with thrombosis of the deep dorsal vein and corpora cavernosa of the penis who developed symptoms 4 months before hospitalisation. An accurate imaging diagnostics supplemented with a biopsy of the corpus cavernosum confirmed the initial diagnosis. Moreover, an adenocarcinoma of the hepatic flexion of the colon with numerous metastatic lesions, including those to the crus of penis were found. Diagnostic and therapeutic difficulties were described and the results obtained were discussed in the context of available literature

Endoscopic ultrasound for differential diagnosis of malignant pancreatic cystic lesions: case report and review of literature

A 63-year-old female patient was admitted to the hospital for an in-depth diagnosis of accidentally found pancreatic cystic lesion. The lesion was detected by computed tomography scan and magnetic resonance imaging of the abdomen and identified as potentially malignant mucinous cystic neoplasm (MCN). Endoscopic ultrasound-guided fine-needle aspiration biopsy with the analysis of the fluid from the cyst was performed as well and it confirmed the malignancy of the cystic lesion. The patient was qualified for surgery and the final diagnosis based on histopathological examination of the surgical material confirmed MCN with the accompanying invasive pancreatic adenocarcinoma

Wartość prognostyczna biomarkerów stanu zapalnego powiązanych z limfocytami w potrójnie ujemnym raku piersi

The aim was to evaluate inflammatory biomarkers as prognostic factors in patients with triple negativbreast cancer. We have collected data from 143 patients and evaluated using Chi-Squared test, Wilcoxon–Mann–Whitney test and Cox regression. We found a relationship between high neutrophil- to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index and local advancement features: tumor (T3/T4) (P = 0.0001, P = 0.0198, P = 0.0001), positive regional lymph nodes (P = 0.0014, P = 0.0075, P = 0.0206). In the multivariate analysis metastatic disease, worse performance status and high NLR (Hazard ratio: 4.48 [2.05–9.80], P=0.0002; 2.23 [1.24–4.03], P=0.0010; 2.23 [1.24–4.03], P=0.0075) were adverse prognostic factors. High neutrophil-to-lymphocyte ratio with worse performance status turned out an adverse independent prognostic factors.Celem pracy było określenie wartości prognostycznej markerów stanu zapalnego u pacjentów z potrójnie ujemnym rakiem piersi. Zebrano dane dotyczące 143 chorych i oceniono używając testu chi-kwadrat, testu Wilcoxon–Mann–Whitney oraz regresji Coxa. Stwierdzono związek między wysokim poziomem stosunku neutrofilów do limfocytów, płytek do limfocytów, wskaźnikiem ogólnoustrojowej reakcji immunologiczno-zapalnej a miejscowym stopniem zaawansowania: guz (T3/T4) (P=0.0001, P=0.0198, P=0.0001), dodatnie regionalne węzły chłonne (P=0.0014, P=0.0075, P=0.0206). Wielowymiarowa analiza wykazała, że choroba rozsiana, gorszy stan sprawności oraz wysoki stosunek neutrofilów do limfocytów (Hazard ratio: 4.48 [2.05-9.80], P=0.0002; 2.23 [1.24-4.03], P=0.0010; 2.23 [1.24-4.03], P=0.0075) stanowią negatywne czynniki prognostyczne. Wysoki stosunek neutrofilów do limfocytów oraz gorszy stan sprawności stanowią niezależne negatywne czynniki prognostyczne