Η έκφραση του συνδέτη του μορίου προγραμματισμένου κυτταρικού θανάτου PD-L1 (programmed cell death ligand-1) στον κολο-ορθικό καρκίνο

Εισαγωγή: Η εισαγωγή νέων φαρμάκων που στοχεύουν στο ανοσοποιητικό σύστημα φαίνεται να αλλάζει το τοπίο στην αντιμετώπιση του καρκίνου. Πέντε ανοσολογικά σημεία ελέγχου έχουν εντοπιστεί ως πιθανοί στόχοι της ανοσοθεραπείας: το μόριο του προγραμματισμένου κυτταρικού θανάτου PD-1 (programmed cell death), ο συνδέτης του PD-L1 (PD ligand), η πρωτεΐνη 4 σχετιζόμενη με τα κυτταροτοξικά Τ-λεμφοκύτταρα CTLA4 (cytotoxic T-lymphocyte associated protein 4), το γονίδιο ενεργοποίησης των λεμφοκυττάρων LAG-3 (lymphocyte activation gene) και η διοξυγενάση της ινδολαμίνης IDO (indoleamine 2,3-dioxygenase). Στόχος: Να μελετηθεί η έκφραση του μορίου PD-L1 σε παθολογοανατομικά δείγματα από γαστρικό και κολο-ορθικό καρκίνο. Μέθοδος: Η έκφραση του μορίου PD-L1 μετρήθηκε με ειδική ανοσοϊστοχημική μέθοδο και βαθμονομήθηκε σε ένα σύστημα τριών επιπέδων: α) έκφραση < 1% (απουσία έκφρασης), β) έκφραση 1-49% (χαμηλή έκφραση) και γ) έκφραση > 50% (υψηλή έκφραση). Όλα τα δείγματα γαστρικού καρκίνου ήταν αρνητικά για έκφραση του μορίου PD-L1, οπότε και δεν συμπεριλαμβάνονται στη μελέτη. Αποτελέσματα: Μελετήθηκαν 32 δείγματα ασθενών με κολο-ορθικό καρκίνο, 16 άνδρες και 16 γυναίκες, με μέση ηλικία 71,4 έτη (45-93). Ιστολογικά, τα περισσότερα νεοπλάσματα ήταν μέτριας διαφοροποίησης (24) και λιγότερα χαμηλής διαφοροποίησης (8). Η έκφραση του μορίου PD-L1 ήταν απούσα σε 21 ασθενείς (65,6%), χαμηλή σε 5 (15,6%) και υψηλή σε 6 ασθενείς (18,75%). Σε όλους τους ασθενείς με υψηλή έκφραση του PD-L1 ανευρέθηκε υψηλή μικροδορυφορική αστάθεια (MSI-high). Συμπεράσματα: Η έκφραση του μορίου PD-L1 ανευρίσκεται συνήθως αυξημένη στην υπο-ομάδα των ασθενών με κολο-ορθικό καρκίνο που έχει μικροδορυφορική αστάθεια.Introduction: The development of new therapeutic agents aiming at pathways of the immune system seem to change the treatment of several cancers. Five immune check-points have been found as possible targets of immunotherapy: the programmed cell death molecule PD-1, its ligand PD-L1, cytotoxic T-lymphocyte associated protein 4 (CTLA4), the lymphocyte activation gene (LAG-3) and indoleamine 2,3-dioxygenase (IDO). Aim: To study the expression of PD-L1 in histological specimens of gastric and colorectal cancers. Methods: The expression of PD-L1 was measured with a standardized immunohistochemical method and was categorized in three levels: a) expression < 1% (absence of expression), b) expression 1-49% (low expression), and c) expression > 50% (high expression). All specimens of gastric cancers were negative for expression of PD-L1 and were not included finally in this study. Results: Thirty-two (32) specimens of patients with colorectal cancer were studied, 16 males and 16 females, with a medium age of 71,4 years (45-93). Histologically, most cancers were moderately differentiated (24) and the remaining (8) were poorly differentiated. Expression of PD-L1 was absent in 21 patients (65,6%), low in 5 (15,6%) and high in 6 patients (18,75%). All patients with a high expression of PD-L1 expressed high microsatellite instability (MSI-high). Conclusion: High expression of PD-L1 is usually associated with high microsatellite instability in patients with colorectal cancer

Adenocarcinoma of the third portion of the duodenum in a man with CREST syndrome

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Safety and effectiveness of outpatient laparoscopic cholecystectomy in a teaching hospital: a prospective study of 110 consecutive patients

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the safety and efficacy of outpatient laparoscopic cholecystectomy (OLC) in a day surgery unit in a teaching hospital. OLC was offered to patients with symptomatic cholelithiasis who met the following established inclusion criteria: ASA (American Society of Anesthesiology) physical status classification class I and II; age: 18 - 70 years; body mass index (BMI) < 30 kg/m²; patient acceptance and cooperation (informed consent); presence of a responsible adult to accompany the patient to his residency; patient residency in Athens. The primary study end-point was to evaluate success rates (patient discharge on the day of surgery), postoperative outcome (complications, re-admissions, morbidity and mortality) and patient satisfaction. A secondary endpoint was to evaluate its safe performance under appropriate supervision by higher surgical trainees (HSTs).</p> <p>Findings</p> <p>110 consecutive patients, predominantly female (71%) and ASA I (89%) with a mean age 40.6 ± 8.1 years underwent an OLC. Surgery was performed by a HST in 90 patients (81.8%). A mean postoperative pain score 3.3 (range 0-6) occurred in the majority of patients and no patient presented postoperative nausea or vomiting. Discharge on the day of surgery occurred in 95 cases (86%), while an overnight admission was required for 15 patients (14%). Re-admission following hospital discharge was necessary for 2 patients (1.8%) on day 2, due to persistent pain in the umbilical trocar site. The overall rate of major (trocar site bleeding) and minor morbidity was 15.5% (17 patients). At 1 week follow-up, 94 patients (85%) were satisfied with their experience undergoing OLC, with no difference between grades of operating surgeons.</p> <p>Conclusions</p> <p>This study confirmed that OLC is clinical effective and can be performed safely in a teaching hospital by supervised HSTs.</p

Esophagopericardial fistula as a rare complication after total gastrectomy for cancer

<p>Abstract</p> <p>Background</p> <p>Esophagopericardial fistula is a rare but life-threatening complication of benign, malignant or traumatic esophageal disease. It is most commonly associated with benign etiology and carries a high mortality rate which increases with delay in diagnosis.</p> <p>Case presentation</p> <p>We present a case of an esophagopericardial fistula as a rare complication in a 53-year-old male patient, 7 months after total gastrectomy for an adenocarcinoma of the esophagogastric junction.</p> <p>Conclusion</p> <p>The prognosis of esophagopericardial fistula is poor, especially when it is associated with malignancy.</p

Colon Cancer Perforation Presenting as a Strangulating Ventral Hernia

Colorectal cancer remains the second leading cause of death from malignant disease. Despite improvements in the treatment modalities offered to patients, more than half of the operated patients die from the disease. The most common presenting symptoms of colonic carcinoma are changes in bowel habits, bleeding, abdominal pain, abdominal mass, stools mixed with mucus or not, weight loss, anorexia, and other characteristics related to metastasis. Here, the case of a 74-year-old female patient with colon cancer perforation presenting as a strangulating ventral hernia and a mini-review of the current literature are presented

Nonepiphyseal Giant Cell Tumor of the Rib: A Case Report

A case of a 32-year-old female patient with a giant cell tumor originating in the middle part of the left 10th rib is presented. On X-rays and CT, the tumor caused a well-defined osteolysis with nonsclerotic borders. On MRI, it exhibited intermediate signal intensity on T1 sequences and central high signal and peripheral intermediate signal on T2 sequences. On contrast-enhanced MR images both central and peripheral-periosteal enhancement was noted. Thanks to its small size (2 × 1.3 cm), the lesion was easily resected en bloc with a part of the affected rib. The patient is free of recurrence for 3 years after the operation

Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

<p>Abstract</p> <p>Backround</p> <p>Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall.</p> <p>Case presentation</p> <p>A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0) sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided.</p> <p>Conclusion</p> <p>Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.</p

Malignant potential of intrahepatic biliary papillomatosis: a case report and review of the literature

BACKGROUND: Biliary papillomatosis (BP) is a rare disease entity with a strong malignant potential. It is characterized by multiple papillary adenomas involving both the intrahepatic and extrahepatic biliary tree. BP was considered in the past to be a disease with low malignant potential. However, a current review of the English literature revealed a high rate of malignant occurrence of approximately 41% and histological analysis along with the expression pattern of mucin core proteins (MUC) and mucin carbohydrate antigens suggests that BP is a borderline or low grade malignant neoplasm with a high malignant potential. CASE PRESENTATION: A 68 year-old male patient was referred to our hospital due to the presence of sudden right upper quadrant abdominal pain, nausea and dark urine. Imaging workup demonstrated dilatation of the left hepatic duct without the presence of a space-occupying lesion. A left hepatectomy and cholecystectomy were carried out and histological analysis revealed a moderately to poorly differentiated carcinoma of the left hepatic duct in the background of biliary papillomatosis. Postoperative course was uneventful. Unfortunately, two years after initial diagnosis the patient rapidly deteriorated and died from multiple pulmonary secondary deposits. CONCLUSION: BP should not be considered to be a benign disease. The clinical behavior, the high recurrence rate and the even higher malignant transformation occurrence, as well as the presence of carcinogenetic indicators (K-ras mutation, overexpression of p53, MUC and Tn antigens) strongly support that BP is a low-grade neoplasm with high malignant potential

Aggressive treatment of metastatic squamous cell carcinoma of the rectum to the liver: a case report and a brief review of the literature

BACKGROUND: Rectal squamous cell carcinoma (SCC) is a rare tumor. The incidence of this malignancy has been reported to be 0.25 to 1 per 1000 colorectal carcinomas. From a review of the English literature 55 cases of SCC of the rectum have been published. In this study we report a rectal metastatic SCC to the liver, discussing the efficacy of aggressive adjuvant and neo-adjuvant therapies on survival and prognosis. CASE PRESENTATION: A 39-year-old female patient with a pure SCC of the rectum diagnosed endoscopically is presented. The patient underwent initially neoadjuvant chemo-radiotherapy and then abdominoperineal resection with concomitant bilateral oophorectomy and hysterectomy, followed by adjuvant chemo-radiotherapy. Five months after the initial operation liver metastasis was demonstrated and a liver resection was carried out, followed by adjuvant chemotherapy. Eighteen months after the initial operation the patient is alive. CONCLUSION: Although prognosis of rectal SCC is worse than that of adenocarcinoma, an aggressive therapeutic approach with surgery as the primary treatment, followed by combined neo- and adjuvant chemo-radiotherapy, may be necessary in order to improve survival and prognosis