Aspects regarding nomenclature, classification and pathology of neuroendocrine neoplasms of the digestive system - a review.

Neuroendocrine neoplasms (NENs) of the digestive system are composed of cells with a neuroendocrine phenotype. These tumors produce and secrete peptide hormones and biogenic amines and they are called neuroendocrine neoplasms because of the marker proteins that they share with the neural cell system. The classification and nomenclature used to designate NENs have undergone changes over the past decades due to the accumulation of evidence related to the biological characteristics and their evolution. The European Neuroendocrine Tumor Society (ENETS) proposed a classification system based on the tumor grading and staging according to their localization. The latest internationally recognized NEN classification was published by the World Health Organization (WHO) in 2010. In accordance with the 2010 WHO criteria, the determination of the NEN malignancy potential is based on grading, depending on the mitotic activity and the Ki67 proliferation index, as well as on the tumor TNM stage. It is worth emphasizing that the terms neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC), without reference to grading or differentiation, are inadequate for prognostic assessment or the therapy determination, being inappropriate in pathology reports. The functional status of the tumor is based on the clinical findings but not on the pathological data or immunohistochemically profile. Despite the inability to establish a single system of sites, these are common features to establish the basis of most systems, documentation of these features allowing for greater reliability in the pathology reporting of these neoplasms.

Intraoperative assessment of sentinel lymph nodes in early-stage breast cancer.

The assessment of axillary lymph node (ALN) status provides heavily weighing prognostic indicators in deciding on breast carcinoma treatment. In the 6th and 7th editions of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual are evaluated the nodal metastases based on size and taking into account the number of metastatic cells. According to these Manuals, a positive node is equated to metastasis whose size reaches at least 0.2 mm or amounting to more than 200 tumor cells. The clinical significance and the therapeutic optimum of the presence of a minimal nodal involvement after axillary sentinel lymph nodes (SLNs) biopsy remain controversial. The need for further axillary treatment (ALN dissection or axillary radiation) in clinical N0 patients with early-stage breast carcinoma and SLNs metastases remains unclear. In all likelihood, the delivery of the regular adjuvant treatment in association with systemic treatment and radiation therapy results in survival rates similar to axillary treatment completion. This review also presents several assessment methods related to the SLNs at the surgical stage, such as cytological, histological, immunohistochemical and molecular diagnostic techniques, evaluating the advantages and disadvantages of each of them. More studies including larger groups of breast patients are needed to confirm which of them is the most reliable method for the evaluation of the SLNs.

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.