Primary acantholytic squamous cell carcinoma of the cecum: a case report

<p>Abstract</p> <p>Background</p> <p>Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of SCC, characterized by marked acantholysis, wherein the tumor cells demonstrate defective cohesion to one another in the cancer nest leading to a pseudoglandular or pseudovascular appearance. The most common site of ASCC is the sun-exposed areas of the skin. Sporadic cases of ASCC have also been reported in various mucosal membranes and organs but to our knowledge this is the first case of primary ASCC of the large bowel.</p> <p>Case presentation</p> <p>A 59-year-old woman underwent right hemicolectomy due to large tumor in cecum and initial part of the ascending colon. Microscopically, the tumor consisted of nests of focally keratinizing large, atypical, squamous epithelial cells. Approximately 70% of the tumor showed acantholytic changes and acantholysis was equally distributed through the entire tumor. Immunohistochemically tumor cells were diffusely positive for cytokeratin (CK) AE1/AE3 and focally positive for epithelial membrane antigen and syndecan 1. All other tested antibodies (CK7, CK 20, CK MNF116, E-cadherin, beta-catenin, p63, p16, CD31, CD34, CEA, estrogen, progesterone) showed negative reaction. Periodic acid Schiff and alcian blue staining showed no intracellular or extracellular mucinous material in the tumor. The diagnosis of acantholytic squamous cell carcinoma of the cecum was suspected and additional examination was recommended to exclude possibility of metastatic carcinoma. Extensive clinical examination which also included whole-body PET/CT scan showed no additional tumors. After the exclusion of possible metastatic disease the diagnosis of primary acantholytic squamous cell carcinoma of the cecum was confirmed. Six months after surgery the metastasis in small intestine and recurrence in the abdominal cavity at the site of surgery appeared and had the same morphological characteristic as the primary tumor in the cecum.</p> <p>Conclusion</p> <p>We report a unique case of ASCC arising in cecum and on this way expands the range of tumors originating in colon. Reports of more cases of colonic ASCC would possibly help to elucidate origin, clinical behavior and therapy of these tumors.</p

Pogoršanje simptoma anularne gušterače uslijed trudnoće

Annular pancreas is a rare embryonal abnormality. Its manifestation in adulthood is often pinpointed with a substantial delay, which is most often attributed to pancreatitis, biliary pathology or dyspepsia. We present a case of a 28-year-old woman who had exacerbating symptoms of high bowel obstruction from 20th week of pregnancy, progressing after premature delivery. Diagnostic work-up revealed partial annular pancreas compressing the duodenum. Despite attempts of conservative treatment, her state deteriorated to such an extent that surgery was indicated and gastrojejunal bypass created. Her postoperative recovery was uneventful. In cases in which symptoms of high bowel obstruction in pregnancy persist and prostration occurs, we suggest close monitoring and a more thorough diagnostic approach. The question remains whether annular pancreas presents a cause of pathologic findings, a cofactor, or a mere accidental diagnosis in the development of superposed pathologies.Anularna gušterača je rijetka embrijska anomalija. Simptomi kojima se javlja u odrasloj dobi pripisuju se pankreatitisu, bilijarnoj patologiji ili dispepsiji, pa se do dijagnoze dolazi sa znatnim vremenskim odmakom. Prikazujemo slučaj 28-godišnje trudnice sa simptomima opstrukcije dvanaesnika koji su se javili od 20. tjedna trudnoće i pogoršali se nakon prijevremenog poroda. Obradom je postavljena sumnja na djelomičnu anularnu gušteraču koja pritišće dvanaesnik. Unatoč konzervativnom liječenju dolazi do pogoršanja općeg stanja i indicira se operacijski zahvat. Postavljena je gastrojejunalna anastomoza. Poslijeoperacijski tijek je protekao bez komplikacija. Kod dugotrajnih simptoma opstrukcije dvanaesnika u trudnoći uz pogoršanje općeg stanja predlaže se pomnije praćenje bolesnica i detaljniji dijagnostički postupak. Ostaje neriješeno pitanje je li anularna gušterača u ovom slučaju bila jedini uzrok, supostojeći čimbenik ili tek slučajan nalaz

Magnetotransport in graphene on silicon side of SiC

We have studied the transport properties of graphene grown on silicon side of SiC. Samples under study have been prepared by two different growth methods in two different laboratories. Magnetoresistance and Hall resistance have been measured at temperatures between 4 and 100 K in resistive magnet in magnetic fields up to 22 T. In spite of differences in sample preparation, the field dependence of resistances measured on both sets of samples exhibits two periods of magneto-oscillations indicating two different parallel conducting channels with different concentrations of carriers. The semi-quantitative agreement with the model calculation allows for conclusion that channels are formed by high-density and low-density Dirac carriers. The coexistence of two different groups of carriers on the silicon side of SiC was not reported before.Comment: 5 pages, 6 figures, accepted for publication in the "IOP Journal of Physics: Conference series" as a contribution to the proceedings of the 20th International Conference on "High Magnetic Fields in Semiconductor Physics", HMF 2

Netraumatski obostrani subduralni hematom uzrokovan antiagregacijskom terapijom: Prikaz slučaja i pregled literature

A 64-year-old female receiving clopidogrel and aspirin antiaggregation therapy after percutaneous coronary intervention for non-STEMI myocardial infarction developed nontraumatic bilateral subdural hematoma with dizziness, vertigo and headache. Craniotomy had to be postponed because of reduced ADP platelet aggregability. Four days after clopidogrel withdrawal and transfusion of 12 platelet concentrate units, ADP aggregation transiently normalized and bilateral trepanation with hematoma evacuation was performed. The procedure was followed by excellent neurologic and clinical recovery; however, decreased platelet aggregability was recorded by postoperative day 12 despite strict clopidogrel and other platelet inhibitor withdrawal. Suspicion of Glanzmann thrombastenia was excluded by flow cytometry. Two weeks after neurosurgery, the right femoral vein thrombosis was detected by color doppler ultrasonography and therapy with fractionated heparin was initiated, followed by warfarin. The risk and incidence of hemorrhagic complications of antiaggregation and anticoagulation therapy are discussed. Caution is warranted on prescribing this potentially harmful therapy to older patients, generally burdened with other chronic comorbidities.U 64-godišnje bolesnice koja je zbog ne-STEMI srčanog infarkta dobivala aspirin i klopidogrel razvio se netraumatski obostrani subduralni hematom praćen smušenošću, vrtoglavicom i glavoboljom. Kod prijma je utvrđena smanjena agregacija trombocita u ADP testu pa je kraniotomija i dekompresija odgođena za 4 dana. Četiri dana nakon prestanka uzimanja klopidogrela i aspirina te uz transfuziju od 12 doza trombocita prolazno se normalizirala agregabilnost trombocita pa je učinjena obostrana trepanacija i uklonjeni su hematomi. Slijedio je odličan neurološki oporavak. Smanjena agregabilnost trombocita bila je prisutna do 12. poslijeoperacijskog dana. Sumnja na Glanzmannovu trombasteniju isključena je protočnom citometrijom. Četrnaestoga poslijeoperacijskog dana nastala je tromboza desne femoralne vene koja je liječena smanjenim dozama heparina i varfarina. Uz prikaz bolesnice analizira se rizik od krvarenja i tromboze u bolesnika koji uzimaju antitrombocitne lijekove. Preporuča se oprez u starijih bolesnika kod kojih su prisutne i druge teške bolesti, što povećava rizik od krvarenja

Biliopankreatično skretanje s gastrektomijom u obliku rukava i antroilealnom anastomozom - prikaz slučaja

Obesity is becoming a major epidemiological problem throughout the world. Current estimate of obesity in Croatia is 25% of males and 24% of females (BMI ≥30 kg/m2). Biliopancreatic diversion combines both restrictive and malabsorptive component of bariatric surgery. It was first described by Scopinaro in 1979 and later modified with sleeve gastrectomy by Marceau in 1993. It is reserved for super obese patients with BMI ≥50 kg/m2 and is sometimes done in two acts, i.e. sleeve gastrectomy first and then biliopancreatic diversion. A 61-year-old female patient with BMI 52.6 kg/m2 and multiple comorbidities is presented. She had previously had many unsuccessful attempts at losing weight with conservative methods. Due to the high BMI and comorbidities, we decided to perform biliopancreatic diversion with sleeve gastrectomy and antroileal anastomosis. On postoperative day 12, the patient was discharged with BMI 49.2 kg/m2, yielding a 12% excess weight loss (EWL). After five weeks, she was rehospitalized for suspected pulmonary embolism and was discharged three weeks later. On regular follow up at three months after surgery, the patient had 112 kg, yielding a 35% EWL.Pretilost postaje jedan od vodećih epidemiološ.kih problema današnjice. Trenutna procjena broja pretilih ljudi u Hrvatskoj je 25% muškaraca i 24% žena (indeks tjelesne mase, BMI ≥30 kg/m2). Biliopankreatično skretanje kombinira i restriktivnu i malapsorpcijsku sastavnicu barijatrijske kirurgije. Prvi ga je izveo i opisao Scopinaro 1979. godine, a kasnije ga je Marceau 1993. godine modificirao izvođenjem gastrektomije u obliku rukava. Danas se ova operacija prvenstveno izvodi kod super pretilih bolesnika s BMI ≥50 kg/m2. Ponekad se izvodi u dva akta: prvo resekcija želuca, a potom biliopankreatično skretanje. Prikazuje se slučaj 61-godišnje bolesnice s BMI od 52.6 kg/m2 i više istodobnih bolesti. Bolesnica je prethodno u više navrata neuspješno pokušala smršaviti konzervativnim metodama. Zbog visokog BMI i drugih bolesti odlučili smo se za biliopankreatično skretanje s gastrektomijom u obliku rukava i antroilealnom anastomozom. Dvanaestog poslijeoperacijskog dana bolesnica je otpuštena kući s BMI 49.2%, što je već bio gubitak prekomjerne tjelesne težine (EWL) od 12%. Nakon pet tjedana bolesnica je ponovno hospitalizirana s kliničkim znakovima plućne tromboze te je tri tjedna kasnije otpuštena kući. Na kontrolnom pregledu tri mjeseca nakon operacije bolesnica je imala 112 kg ili EWL 35%

Pozitivna ekspresija NEDD9 u karcinomima glave i vrata povezana je s boljim preživljenjem

The aim was to determine immunohistochemical expression of NEDD9 protein in head and neck squamous cell carcinoma (HNSCC) and the possible relation of its expression with primary tumor size (T), regional lymph node status (N), stage of disease (TNM) and survival period. A total of 131 patients with primary tumor localization in the area of oropharynx, hypopharynx and larynx, monitored for at least 5 years after initial surgical treatment were analyzed. The study included 128 male and three female patients, median age 62.0 (range 53.0-68.0) years. Of these, 105 (95%) patients showed positive NEDD9 expressed by dyed cytoplasm. There were no significant differences in NEDD9 expression according to TNM tumor status. Patients with positive NEDD9 expression had a significantly higher median (IQR) survival time 51.0 (15.0-60.0) months as compared to 22.5 (9.0-55.0) months in patients with negative NEDD9 expression (p=0.048). NEDD9 negative expression, controlled for the influence of other variables included in the Cox’s proportional hazards model, had a significant hazard ratio (HR) of 2.10 (95% CI: 1.23-3.58; p=0.006). The results of our study showed that NEDD9 expression might be an independent prognostic marker in patients with HNSCC regarding data on overall survival and mortality.Cilj je bio utvrditi imunohistokemijsku ekspresiju proteina NEDD9 i moguću povezanost ekspresije s veličinom tumora (T), statusom regionalnih limfnih čvorova (N), kliničkim statusom bolesti (TNM) i preživljenjem bolesnika s planocelularnim karcinomom glave i vrata. Analiziran je 131 bolesnik s primarnim tumorom lokaliziranim u orofarinksu, hipofarinksu i larinksu, a bolesnici su praćeni najmanje pet godina nakon inicijalnog kirurškog liječenja. Studija je uključivala 128 muškaraca i tri žene, medijan životne dobi od 62,0 (raspon 53,0-68,0) godine. Ukupno je 105 (95%) bolesnika imalo pozitivan NEDD9 vidljiv imunohistokemijskim bojanjem citoplazme. Nije nađeno značajne razlike u ekspresiji NEDD9 u odnosu na status TNM. Bolesnici s pozitivnom ekspresijom NEDD9 imali su značajno viši medijan (IQR) razdoblja preživljenja: 51,0 (15,0-60,0) mjesec prema 22,5 (9,0-55,0) mjeseca kod bolesnika s negativnom ekspresijom NEDD9 (p=0,048). Negativna ekspresija NEDD9 pod kontrolom utjecaja drugih varijabla imala je značajan omjer rizika, uključujući Coxov proporcionalni model rizika (HR) od 2,10 (95% CI: 1,23-3,58; p=0,006). Rezultati naše studije su pokazali da ekspresija NEDD9 može biti nezavisan prognostički biljeg u bolesnika s karcinomom glave i vrata s obzirom na podatke o ukupnom preživljenju i smrtnosti

Structural and photoluminescence studies of erbium implanted nanocrystalline silicon thin films

Hydrogenated amorphous and nanocrystalline silicon thin films deposited by Hot Wire (HW) and Radio-Frequency Plasma-Enhanced (RF) Chemical Vapor Deposition were Er-bium-implanted. Their pre-implantation structural properties and post-implantation optical properties were studied and cor-related. After one-hour annealing at 150ºC in nitrogen atmos-phere only amorphous films showed photoluminescence (PL) activity at 1.54 μm, measured at 5 K. After further annealing at 300oC for one hour, all the samples exhibited a sharp PL peak positioned at 1.54 m, with a FWHM of ~5 nm. Amorphous films deposited by HW originated a stronger PL peak than corresponding films deposited by RF, while in na-nocrystalline films PL emission was much stronger in sam-ples deposited by RF than by HW. There was no noticeable difference in Er3+ PL activity be-tween films implanted with 1x1014 atoms/cm2 and 5x1015 at-oms/cm2 Er doses.FCT for a post-doctorate grant (SFRH/BPD/14919/2004

Recidivi venske tromboze unatoč “optimalne antikoagulantne terapije” antifosfolipidnog sindroma. Mogu li novi peroralni antikoagulansi riješiti problem ?

The aim was to determine the validity of the international normalized ratio (IN R) and prothrombin time (PT ) as a monitor for warfarin therapy in patients with lupus anticoagulants and recurrent thrombosis, and to investigate alternative approaches to monitoring warfarin therapy and new treatment options in these patients. A case is described of a 63-year-old female with antiphospholipid syndrome and recurrent venous thrombosis despite optimal adjusted warfarin therapy. In patients with lupus anticoagulants, the IN Rs obtained while receiving warfarin vary and often overestimate the extent of anticoagulation, while PT without receiving warfarin is often prolonged. In conclusion, lupus anticoagulants can influence PT and lead to IN R that does not accurately reflect the true level of anticoagulation. Optimizing of (warfarin) oral anticoagulation therapy could be achieved by individual monitoring of anticoagulation effect with a test that is insensitive to lupus anticoagulants (chromogenic factor X assay). Emerging oral anticoagulants, direct thrombin inhibitors and direct factor Xa inhibitors, such as dabigatran and rivaroxaban, with a predictable anticoagulant response and little potential for food or drug interactions, have been designed to be administered in fixed doses without coagulation monitoring and could be the treatment choice for these patients.Cilj je bio analizirati uzroke neuspjeha “optimalno doziranog” varfarina kod prevencije recidiva duboke venske tromboze u bolesnika s antifosfolipidnim sindromom. Opisuje se slučaj 63-godišnje bolesnice s antifosfolipidnim sindromom i recidivima venske tromboze tijekom uzimanja varfarina. Vrijednosti IN R bile su u terapijskim granicama. Analizirali su se patofiziološki mehanizmi nastanka tromboze i literaturni podaci. Rezultati su pokazali kako u bolesnika s pozitivnim lupus antikoagulans (LA) testom vrijednost PV -IN R ne daje pravu sliku protuzgrušavajućeg učinka varfarina. Aktivnost PV je zbog interferencije često lažno smanjena, iako u času mjerenja bolesnik ne uzima varfarin ili drugi antagonist vitamina K. Zaključak je kako prisutnost LA može interferencijom lažno smanjiti aktivnost u PV testu i rezultirati nalazom IN R koji ne odražava pravo stanje protuzgrušavajuće aktivnosti izazvane varfarinom. U tom bi slučaju umjesto PV testa trebalo mjeriti aktivnost faktora Xa kromogenom metodom koja je neosjetljiva na LA. Drugo moguće rješenje bi u bolesnika s antifosfolipidnim sindromom bila zamjena varfarina novim lijekovima, oralnim inhibitorima trombina i faktora X. Ovi lijekovi u fiksnoj dozi s predvidivim te o hrani i lijekovima uglavnom neovisnim protuzgrušavajućim učinkom imaju djelotvornost i nuspojave uglavnom slične varfarinu, ali ne trebaju kontrole IN R