Histoprognostic markers role in colorectal cancer.

Malignant tumors with digestive location are, according to the World Health Organization (WHO), a major cause of morbidity and mortality worldwide. In Romania, the constant increase of prevalence and incidence of colorectal cancer awarded it the status of priority public health problem. The study aimed to identify specific aspects of colorectal cancer histoprognosis that may be associated with a higher frequency of the disease. Data were collected from records and registers within Clinic of Medical Oncology, Emergency County Hospital, Craiova, Romania. Were analyzed and associated demographics and epidemiological data, clinical features, anatomotopographical, histopathological and immunohistochemical. The cases studied were adenocarcinomas with a balanced gender distribution and a worrying incidence for Craiova. The age group with the highest incidence was that of 55-64 years. Topographic, rectum and rectosigmoidian junction are the first two locations. More than half of the cases (55.55%) are adenocarcinomas with moderate differentiation and belong to the pT3 category, as extension of colorectal tumor degree. 32.5% of patients were identified with mutations in the K-Ras oncogenes and were found Ki67 positive immunoreacted and heterogeneity of antigen expression in tumor areas studied. Colorectal cancer recorded a worldwide steady increase in the incidence; growth trend in our country is above the European average. Dolj County faces with an increased incidence and mortality rates by this disease. To limit the disease at the population level and pre-malignant diagnosis is necessary to establish histoprognostic value and predictive of tumor markers.

More than 9 years of continuous trastuzumab treatment in metastatic breast cancer without cardiac toxicity: a case report and literature review.

The main concern of long-term use of trastuzumab remains its association with potential cardiac side effects. Although these side effects are real, they are probably overemphasized. We report the case of a woman with metastatic breast cancer, who is currently in complete remission, and who received trastuzumab continuously for more than 9 years, without any significant cardiac toxicity.

Study of the diagnosis and treatment of cancer located in the head and neck and correlation with expression of prognostic markers.

A prospective study made by authors was initiated in 2000 in order to analyze differences in terms of response rate, overall survival and progression free survival for patients with advanced head and neck carcinoma treated with radiotherapy vs. radiochemotherapy, respectively and to analyze the role of modern molecular biomarkers in the prognosis of these patients (p53, EGFR and Ki67). It was detected one significant difference appeared between the two groups for response rate (p<0.0001) and median overall survival [18.8 months in Group A and 17.2 months in Group B, with a hazard ratio for survival of 0.88 (95% CI, 0.75-1.12, p<0.0001]. Progression free survival was not significant different between these two groups [6.9 months for Group A and 7.2 months for Group B, p=0.3179]. Multivariate analysis by sex, age, TNM stage, site of disease, revealed TNM stage and site of disease as clinical phenotypes with predictive value. Also, the molecular biomarkers p53, EGFR and Ki67 have a prognostic significance in head and neck cancer in addition to the established clinical prognostic factors such as the stage, site of the tumor and the type of treatment. Because of material reasons, we decided to carry out the immunohistochemical marking in the group of patients who were radiochemotherapy-treated and the results of multivariate analysis reached statistical significance threshold in terms of response rate to treatment, overall survival and disease-free interval. Furthermore, immunohistochemical examination was not performed for patients with rhinopharyngeal carcinoma with marked radiochemosensibility and reduced tumor aggressiveness reflected in significantly better therapeutic outcomes by treatment response rate, overall survival and disease free interval. In the present study of the 93 cases that underwent immunohistochemical staining for EGFR, the majority (66 cases) showed a positive reaction for this marker, in 36 cases are highly immunohistochemical staining, and in 30 cases were weakly positive. In addition, cell proliferation was intense in 26 cases in which Ki67 index was greater than 45%, p53 protein expression was positive in 18 cases, but the majority (22) of cases showed a positive reaction for this marker; index was greater than 55%, and in the most (22) cases p53 protein was not expressed. Radio/chemoradiotherapy regimen associated with molecular anti-EGFR target therapy is standard therapy in advanced squamous head and neck carcinoma.

Retrorectal dermoid cyst: a rare clinical entity.

The retrorectal space represents the anatomical site at which level we identify the embryologic reminiscents in which it can develop liquid tumors - cysts or solid tumors - neoplasia. These tumors are rare but pose a diagnostic and therapeutic interest. This paper presents the case of a young 18 years-old diagnosed incidentally at a gynecological examination, with a palpable tumor developed, at the retrorectal space. Imaging examinations - transvaginal ultrasound and abdominal - pelvic computer tomographic exam - have supported the presence of a cystic tumor with a maximum diameter of 7.8 cm., in the space retrorectal. The lesion presented surgical indication, so it needed a posterior approach with resection of the coccyx enough for the control and safety of the operation. Histopathological examination revealed a dermoid cyst. Five years after surgery the patient is presented in good general condition, asymptomatic without clinical and imaging signs of local-regional recurrence.

Recent data about the role of human papillomavirus (HPV) in oncogenesis of head and neck cancer.

Human papillomavirus (HPV) is a small circular DNA-virus and the high-risk types 16, 18 is implicated in oncogenesis of head and neck cancer--especially oropharynx (tonsil and base of tongue), poorly differentiated (the basaloid type), locoregional advanced stage, poorly differentiated, at the younger male, non-smokers, non-drinkers, sexual behaviors. The prognostic is favorable of human papillomavirus tumor status for patients with oropharynx squamous cell carcinoma treated with radiotherapy (accelerated fractionation without total dose reduction). The impact of HPV-vaccination (ACIP 2007) decreasing the incidence of oropharyngeal cancer, but that patients HPV-positive, have good prognostic in generally (two-year overall survival: 95%, two-year progression-free survival: 88%), therefore HPV-vaccination in routine practice it is controversy.

Clinical and cytopathological aspects in phyllodes tumors of the breast.

The frequency of mesenchymal breast tumors is very low, being represented mostly by tumors with biphasic proliferation (phyllodes tumors) and less by other types of non-epithelial tumors. From clinical point of view, phyllodes tumors (PT) can mimic a breast carcinoma. Therefore, the preoperative diagnosis by cytological examination on material obtained by fine needle aspiration (FNA) is very important for adequate treatment of these tumors. In current study, we assessed clinical aspects of 79 phyllodes tumors regarding patient's age and localization of the tumors. In 17 out of 79 cases, it has been performed FNA within the tumors with further cytological examination on the smears obtained. The median age of the patients was 46.07-year-old, being progressively higher with grade of the tumors with significant values between benign and borderline tumors (p=0.04954) and between benign and malignant ones (p=0.02890). The distinguish on the smears of stromal fragments and naked stromal nuclei with variable grade of atypia regarding the tumoral type, in detriment of epithelial elements have been conclusive for fibroepithelial lesion as cytopathological diagnosis. The preoperative differentiation between a breast phyllodes tumor and a breast carcinoma is extremely important for avoiding of a useless radical surgery for the patient. If the fine needle aspiration was correctly performed, the accuracy of the cytodiagnosis has been 82% in current study.

Endometrial stromal sarcoma: clinico-pathological report of four cases and review of the literature.

Endometrial stromal sarcoma (ESS) represents a very rare pathological entity occurring as a malignant disease in women genital sphere. Our clinical report is based on a group of four women aged 37, 48, 50 and 70-year-old, that have been histologically diagnosed with endometrial stromal sarcoma. The most common symptom sending the patient to the physician has been the vaginal bleeding, occurring in all patients. Other associated symptoms were the abdominal enlargement and the presence of the pelviabdominal mass generated by the tumor, low to medium abdominal pain or polakiuria. Two patients were diagnosed with ESS after accomplishing a biopsic curettage of the uterus. Total abdominal hysterectomy and salpingo-oophorectomy have been successfully performed for all of the patients. Adjuvant therapy-radiotherapy has been administered to three patients. At this time, none of the patients died of the disease. Our paper also includes a concise review of the literature in order to have an up-to-date conception regarding diagnosis, therapy and outcome for ESS.

Morphopathological changes induced by the Obstetrical Antiphospholipid Antibody Syndrome in fetal adnexa and uterus.

The Obstetrical Antiphospholipid Antibody Syndrome (OAAS) is representing a separate entity of the global Antiphospholipid Antibody Syndrome (APS), focusing the pregnancy morbidity. OAAS is generating morphopathological changes in almost all components of the gestational biologic transitory system (GBTS): placenta, umbilical cord or uterine wall. The most important, serious and lengthened anomalies are occuring in placenta. Our research has been developed on a group of 68 patients diagnosed with OAAS, initially using the Sapporo criteria and later using the "Sydney" ones. There have been morphopathologically examined: placenta, umbilical cord and myometrium. Histological examination revealed on one hand macroscopic modifications: fibrinoid deposits, white or red placental infarctions, intervillous thrombosis, marginal or basal decidual hematoma, calcareous deposits, umbilical cord thrombosis, and on the other hand microscopic findings: placental infarction, fibrinoid necrosis, myometrial thrombosis, degenerative myometrial disorders, focal myometrial necrosis, villous stasis and necrosis, umbilical cord thrombosis. Because of the increased prothrombotic background, in APS, any vessel or organ could be involved, with no exception for GBTS elements. The basis of the pregnancy morbidity from the obstetrical APS is represented by the morphopathological changes occurring in fetal adnexa and uterine structures.

Preliminary study concerning the cytoscreen system importance (liquid based cytology) in gynecologic cytology.

Our study aims to present the principal and the advantage of using the Liquid Based Cytology method by Cytoscreen system, as an alternative to the conventional Babes-Papanicolaou test, by reducing the false negative results frequency due to the poor quality of the smears and the epithelial cell screening by the blood elements, mucus or inflammatory exudates. A set of 1 054 female patients was available to be investigated during 2002-2004 both in the Clinical Gynaecology of The Clinical Hospital Filantropia and the Clinic of Oncology of the Clinical County Emergency Hospital of Craiova; the patients were from the rural and urban places as well; they underwent cytologic screening by Cytoscreen method. We simultaneously performed the cytologic exam by using both the Cytoscreen and the conventional Papanicolaou methods in 220 patients; the rest of them, namely 834 patients, were examined just by Cytoscreen method. The samples were processed in the Laboratory of Pathology and Cytology of the Clinical County Emergency Hospital of Craiova. The smears were fixed in the absolute ethanol for minimum five minutes than was performed the Papanicolaou stain. The diagnosis was according to Bethesda System 2001. Most of the patients (85.87%) were 21-50 aged. For the group of those tested by Cytoscreen, the rate of the "satisfactory smears" was significant increase (82.27% compared to 65.45% of the patients examined by using only the conventional method). The positive results were 5.44% compared to 2.27%. More accurate diagnosis of high degrees squamous intraepithelial lesions (1.36% compared to one case --0.45%), of low degree lesions (4 cases--1.81% compared to 2 cases--0.91%) and the atypical squamous cells with undetermined significance (1.36%Cytoscreen tested compared with 0.91%). Cytologic diagnosis was enforced by biopsy with histopathologic exam for 4 of 10 cases; the rest of the patients did not present for biopsy to be performed. In one case, HSIL diagnosis was false negative as the biopsy result was well-differentiated invasive squamous carcinoma. Both the diagnosis sensitivity and the smears feasibility were significantly improved by using Cytoscreen method.

The value of serum and tissular expression of CA 125 antigen, in evaluation of the response to second line chemotherapy for the relapsed ovarian carcinoma.

PURPOSE: The purpose of this study is to compare the predicted value of the blood levels variations of CA 125 antigen and the imunohistochemical expression of CA 125, with imagistic criteria (The Response Evaluation Criteran in Solid Tumor--RECIST) regarding the survival estimation of female patients with relapsed ovarian carcinoma which undergo to second line chemotherapy. MATERIAL AND METHOD: We included in this study 40 female patients diagnosed with ovarian carcinoma in the Oncology Clinic of the Emergency County Hospital Craiova, in a period of two years (from 2000 to 2002), which have fulfilled the following criteria: ovarian carcinoma IC-IV stage, according to FIGO system, first line treatment represented by the association between paclitaxel and a platinum salt, refractory or recurrent disease, indications for beginning the second line chemotherapy represented by topotecan or paclitaxel and carboplatin. The serial CA 125 antigen was determined in all patients before starting the chemotherapy and after each two sequences of chemotherapy, and the imunohistochemical expression of CA 125 was evaluated from surgery extracts before the second line chemotherapy (11 cases). The imagistic evaluation of the treatment response was done after 4 sequences of chemotherapy. RESULTS: All patients had measurable disease according to RECIST criteria and had high values (at least double) of the CA 125 antigen blood level at the time of diagnosis. The imunohistochemically expression of CA 125 was correlated in most cases with the blood level of CA 125. The evaluation criterion of the CA 125 antigen has been shown to be more efficient in estimation the survival rate compared with the RECIST system. In a various analysis, which included numerous potential prognostic factors, only the variation of blood levels of these antigen and the free disease interval from the finalization of the first line chemotherapy have been identified as predictive factors of survival, while the other variables, including the RECIST criteria, had no impact on the prognosis regarding the survival. CONCLUSIONS: The response evaluation criteria based on the blood levels variations of CA 125 antigen are a better instrument for the estimation of the compared prognosis with the RECIST criteria, for patients on second line chemotherapy for relapsed ovarian carcinoma.