Peritoneal and retroperitoneal lesions: preliminary results

Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, RomaniaIntroduction. Lesions of the peritoneal and retroperitoneal cavities are heterogeneous and include vascular disorders, inflammations and tumors. Aim of the study: To present the preliminary results regarding the types of peritoneal and retroperitoneal lesions. Material and methods. The clinicopathological aspects were examined in all consecutive cases diagnosed in 2015 at Department of Pathology of Clinical County Emergency Hospital of Tirgu Mures, Romania. Results. From the 672 cases, 491 were diagnosed with peritonitis, 125 with tumor lesions, 54 with vascular disorders and two patients presented hydatic cysts. Our of 125 tumors, 116 were metastatic (92.80%) and 9 (7.20%) were diagnosed as primary tumors. In 19 out of 125 tumors, ascites was associated. Metastases were predominantly diagnosed in women (n = 69; 59.48%) with a median age of 64.17±13.05 years, whereas peritonitis mostly affected the male gender (n=281; 57.23%) with a median age of 39.53±26.54 years. Conclusion. The type of peritoneal and retroperitoneal lesions are related to the patients’ gender: peritonitis is more frequent in males, whereas metastases predominantly affects females in their pre-menopausal or menopausal period. Ascites does not always occur in patients with peritoneal carcinomatosis

Colorectal cancer: an update upon the diagnostic and therapeutic transdiciplinary approach

Scop: Prezentarea unor date actualizate referitoare la rolul ONCOTEAM în diagnosticul și terapia pacientului cu cancerului colorectal (CRC). Material și metode: În perioada 2018-2023, 147 de pacienți cu CRC au beneficiat de un abord individualizat. Evaluarea imagistică preoperatorie cu CT-scan/MRI cu difuzie a fost urmată de o descriere de tip ”hartă” a informațiilor pe baza cărora s-a efectuat intervenția chirurgicală și procesarea histopatologică conform metodologiei descrise anterior de echipa noastră în jurnalelel Diagnostics (DOI: 10.3390/diagnostics11020314) și Journal of the Belgian Society of Radiology (DOI: 10.5334/jbsr.3186). Examinările genetice au fost efectuate la indicațiile oncologului iar terapia post-operatorie a luat în considerare profilul molecular al celulelor tumorale. Rezultate: Utilizând acest protocol adaptat, am obținut un număr mediu de 15±2.23 limfonoduli prelevați per caz. Numărul depozitelor tumorale a fost, de asemenea, crescut și a dus la o supra-stadializare a 15% din cazuri. Utilizând o valoare a ”lymph node ratio” de 0.15, am obținut valori superioare celor obținute la abordarea clasică a 120 cazuri examinate anterior (p=0.002). Determinările genetice efectuate în timp au dus la o începere rapidă a terapiei oncologice individualizate și, deși profilul genei BRAF V600E este dificil a fi evaluat în țesuturi incluse în parafină, extracția ADN și determinările PCR au fost adecvate în toate cazurile examinate. Concluzii: Abordarea transdiciplinară a CRC poate fi efectuată doar dacă fiecare membru al echipei este implicat conștiincios în fiecare pas al diagnosticului sau terapiei. Costurile determinărilor au fost parțial acoperite în cadrul proiectelor PCCF 20/2018 și 10127/13/2021.Aim: To present an update regarding the role of the ONCOTEAM in the diagnosis and therapy of colorectal cancer (CRC). Materials and methods: During 2018-2023, 147 patients with CRC have benefited by an individualized approach. Preoperatively evaluation was done with CT-scan/diffusion-weighted MRI and a lymph node station map was typed. The next step consisted on surgical removal, based on the indications included in the map. Histopathological examination was based on the methods described by our team previously (DOI: 10.3390/diagnostics11020314; DOI: 10.5334/jbsr.3186). Genetic examinations were done based on the indications of the oncologist and the post-operative therapy was performed according to the molecular profile. Results: Based on the in-house adapted protocol, the median number of harvested lymph nodes per case was 15±2.23. The number of identified deposits was also significant and up-staged the tumors in 15% of the cases. The lymph node ratio value, using a cut-off of 0.15, was also superior to the classic approach of other 120 cases (p=0.002). The genetic examinations proved to be useful for an earlier start of post-operative therapy, without any cost for the patients. As regarding pre-analytical factors, although BRAF V600E gene profile is hard to be detected from paraffin-embedded tissues, the DNA extraction and PCR examinations were succesful in all of the cases. Conclusions: A proper transdiciplinary approach can be done only if any member of the team is attentively involved in each step of the diagnosis and therapy. The costs were partially supported by the projects PCCF 20/2018, and 10127/13/2021

Rare cause of digestive hemorrhage – synchronous gastrointestinal stromal tumor of jejunum – case report

Clinica Chirurgicală II Tg-Mureş, Departamentul de Anatomie PatologicăTumora gastrointestinală stromală este o neoplazie malignă rară, reprezentând 0,1-3% din neoplaziile gastrointestinale. Tumora interesează cel mai frecvent stomacul (50-70%), intestinul subţire (20-30%) şi colonul – mai puţin de 10%. Descriem cazul unui pacient de sex masculin în vârstă de 61 ani internat cu anemie severă, datorate unei hemoragii digestive grave prin tumoare stromală gastrointestinală sincronă jejunală cu ulceraţie dublă a mucoasei intestinale. Gastroscopia, colonoscopia şi irigografia nu poate preciza sursa hemoragiei. Computer tomografia evidenţiază îngroşarea marcată a peretelui jejunal (21 mm). Se intervine chirurgical constatându-se intraoperator două tumori jejunale, prima la 30 cm de unghiul Treitz aderent de o ansă ileală şi epiplon, iar a doua la 30 de cm distal de prima tumoră. S-a practicat rezecţie segmentară de jejun şi ileon ”en bloc” cu anastomoză jejuno-jejunală şi ileo-ileală. Evoluţia postoperatorie a fost favorabilă, cu externarea pacientului în ziua a 6-a postoperatorie. Rezultatul examinării histopatologice: tumori stromale gastrointestinale maligne, pleomorfe sincrone, CD117 pozitiv. Concluzii: tumorile stromale gastrointestinale pot fi evidenţiate prin explorări imagistice; rezecţia chirurgicală completă ”en bloc” constituie terapia în cazul tumorilor rezecabile.Gastrointestinal stromal tumor is a rare malignant neoplasia, representing 0,1-3% of gastrointestinal cancers. This tumor appeares most frequently in the stomach (50-70%), small bowel (20-30%) and colon – less than 10%. We describe here the case of a 61 years male patient who was admitted in our surgical department for severe digestive hemorrhage by jejunal gastrointestinal stromal tumours with synchronous double ulceration of intestinal mucosa. Gastroscopy, colonoscopy and irigography did not specify the source of bleeding. Computer tomography shows marked wall thickening of jejunum (21 mm). Intraoperatively we found two jejunal tumors, first at 30 cm from the angle of Treitz joint to the ileon and epiplon and the second at 30 cm from the first tumor. We performed “en bloc” segmental jejunal and ileal resection with jejuno-jejunal and ileo-ileal anastomosis. The postoperative outcome was favorable; the patient was discharged on day 6 after surgery. The histopathological examination showes: pleomorfe synchronous malignant gastrointestinal stromal tumors, CD117 positive. Conclusions: gastrointestinal stromal tumors can be revealed by echo and CT ; “en bloc” surgical resection is the therapy of choice for resectable tumors

Subcellular Expression of Maspin in Colorectal Cancer: Friend or Foe

In this review the authors aimed to emphasize the practical value of nuclear expression of the mammary serine protease inhibitor (maspin), also known as serpin B5 protein, in colorectal carcinoma (CRC), from pre-malignant disorders to carcinogenesis and metastasis. As the role of maspin is controversial and not yet understood, the present update highlights the latest data revealed by literature which were filtrated through the daily experience of the authors, which was gained at microscopic examination of maspin expression in CRCs and other tumors for daily diagnosis. Data regarding the subcellular localization of maspin, in correlation with the microsatellite status, grade of tumor dedifferentiation, and epithelial-mesenchymal transition (EMT) phenomenon of the tumor buds were presented with details. An original observation refers to the maspin capacity to mark the tumor cells which are “at the point of budding” that were previously considered as having “hybrid EMT phenotype”. It refers to the transitional status of tumor cell that is between “epithelial status” and “mesenchymal status”. The second original hypothesis highlights the possible role of maspin in dysregulating the intestinal microbiota, in patients with idiopathic inflammatory bowel diseases (IBD) and inducing IBD-related CRC. The dynamic process of budding and EMT of tumor buds, possible mediated by maspin, needs further investigation and validation in many human CRC samples. The histological and molecular data reveal that synthesis of maspin-based therapeutics might represent a novel individualized therapeutic strategy for patients with CRC

From Dukes-MAC Staging System to Molecular Classification: Evolving Concepts in Colorectal Cancer

This historical review aimed to summarize the main changes that colorectal carcinoma (CRC) staging systems suffered over time, starting from the creation of the classical Duke’s classification, modified Astler–Coller staging, internationally used TNM (T—primary tumor, N—regional lymph nodes’ status, M—distant metastases) staging system, and ending with molecular classifications and epithelial–mesenchymal transition (EMT) concept. Besides currently used staging parameters, this paper briefly presents the author’s contribution in creating an immunohistochemical (IHC)-based molecular classification of CRC. It refers to the identification of three molecular groups of CRCs (epithelial, mesenchymal and hybrid) based on the IHC markers E-cadherin, β-catenin, maspin, and vimentin. Maspin is a novel IHC antibody helpful for tumor budding assessment, which role depends on its subcellular localization (cytoplasm vs. nuclei). The long road of updating the staging criteria for CRC has not come to an end. The newest prognostic biomarkers, aimed to be included in the molecular classifications, exert predictive roles, and become more and more important for targeted therapy decisions