Non-surgical ablative therapies for inoperable benign insulinoma.

PURPOSE: Benign insulinoma is the most common functioning neuroendocrine tumor of the pancreas. The gold-standard therapeutic approach for insulinoma is surgery, which allows for tumor removal, histology and immunochemical analyses. If surgery is not feasible, minimally invasive ablative procedures performed by interventional radiology can lead to partial or complete remission of hormone hypersecretion and tumor control in insulinoma patients. METHODS: We performed a review of existing literature on non-chemotherapeutic/radioactive ablative techniques employed for the treatment of benign, otherwise inoperable, pancreatic insulinoma. For this purpose, feasibility, effectiveness and safety of ablative treatments for pancreatic insulinoma were reviewed from literature data published from 1982 to date. RESULTS: A total of 44 insulinoma cases treated with non-surgical ablative techniques were desumed, and divided as follows: 7 cases of tumor embolization, 26 ethanol ablations, 7 radiofrequency ablations, 2 high intensity focused ultrasound ablation, 1 irreversible electroporation and 1 percutaneous microwave ablation. Most cases involved single insulinoma, predominantly located in the pancreas head and body. In the majority of patients, ablation was chosen instead of surgery due to severe comorbidities. After an average follow-up of 16 months, the overall success rate of non-surgical ablative treatments of insulinoma was 84%, the recurrence/persistence rate was 16%, and transient adverse events were noted in 23% of cases. Adverse events were usually self-limiting and medically manageable. CONCLUSIONS: Non-surgical ablation is a feasible, safe and repeatable procedure in patients with pancreatic insulinoma, who are not candidate to surgery or refuse it. Partial or complete control of symptoms and tumor growth is experienced by the majority of patients.

Placement of port-a-cath through the right internal jugular vein under ultrasound guidance.

PURPOSE: This study was undertaken to demonstrate the effectiveness of ultrasound (US)-guided placement of porta-cath (PC) through the right internal jugular vein (RIJV) by evaluating the onset of early and late complications. MATERIALS AND METHODS: From 30 June 2008 to 30 June 2011, we placed 695 port-a-caths in 694 patients with a mean age of 58 years. Exclusion criteria were active infection, bleeding disorders and life expectancy <6 months. The procedures were performed in the angiography suite under local anaesthesia. After US-guided puncture of the RIJV, the subcutaneous pocket was prepared, followed by tunnelling of the vein and closure of the surgical wound. In order to evaluate pneumothorax (PNX), all patients underwent chest X-ray a few hours after the end of the procedure unless there were clinical indications. We evaluated the technical success of the procedure and the rate of complications. RESULTS: Technical success was achieved in all cases. The device was kept in place for an average of 168 days. There was one case of PNX (0.14%) as shown on chest X-ray and five cases of late complications (0.70%): one case of intracatheter thrombosis (0.14%), two cases of disconnection between the reservoir and catheter (0.28%) and two cases of PC infection (0.28%). CONCLUSIONS: This procedure incurs very small number of complications compared with other positioning techniques using accesses such as the subclavian vein. Complications recorded in our study are comparable, in type and incidence, to those found by other authors, with the most frequent being device infection.

[Analysis of bone marrow angiogenesis in multiple myeloma]. / Analýza angiogeneze v kostní dreni u plazmocytárního myelomu.

The authors studied angiogenesis in trephine biopsy samples taken from the hip bone from a total of 51 patients with an as yet untreated plasma cell myeloma / multiple myeloma (MM). Microvessel density calculated to 1 mm2 was represented by monoclonal antibodies against CD34 and nestin. It was discovered that proliferating vessels labeled with anti-nestin antibody nearly never occur in the interstitial type of infiltration. The amount of proliferating vessels in nodular infiltrates is significantly lower compared to the capillary network labeled with antibodies against CD34. The density of proliferating vessels in nodular infiltrates significantly correlates with the proliferation index Ki67 of myeloma cells, not, however, with the degree of MM differentiation.

[Bone marrow angiogenesis in patients with multiple myeloma as a marker of biological behaviour]. / Angiogeneze v kostní dreni pacientu s plazmocytárním myelomem jako ukazatel biologického chování.

Angiogenesis, the creation of new blood vessels from preexisting vascular nets, plays a major role in the development, progression and dissemination of solid malignant tumors. Research over the last few years has shown a correlation of angiogenesis and the biological behaviour of haematologic malignancies. This study focused on the relation of vasoformation, stage of differentiation of tumour plasmocytes and type of bone marrow infiltration in patients with multiple myeloma (MM) prior to treatment. We evaluated trephine biopsy samples from 55 patients for microvessel density in 1 mm2 field by monoclonal antibody anti CD34. Angiogenesis correlated with the type of infiltration and with stage of morphological differentiation. It was highest in the nodular type of infiltration with a low level of differentiation, and lowest in grade 1 differentiation with an interstitial type of infiltration.

Stereotactic excisional breast biopsy performed by interventional radiologists using the advanced breast biopsy instrumentation system.

The Advanced Breast Biopsy Instrumentation (ABBI) system, which uses surgical cannulas up to 20 mm in diameter, is an alternative to conventional surgical biopsy for the diagnosis of non-palpable breast lesions. Since the need for radiological skill outweighs the surgical content of the technique, we evaluated the feasibility of complete management of the procedure by interventional radiologists. 35 of the 111 patients originally scheduled for the procedure were excluded, three because the lesion could not be visualized and 32 because of insufficient thickness of the compressed breast. The procedure had to be abandoned in one case due to a technical failure. 77 stereotactic excisional breast biopsy procedures were performed using the ABBI system in 75 patients with suspicious non-palpable mammographic lesions. The procedure was carried out under local anaesthesia in the radiology department, using a dedicated Lorad (R) radiographic system. 31 (40%) masses without calcifications, 11 (14%) masses with calcifications and 35 (46%) clusters of microcalcifications without tumour mass were sampled. 43 (56%) benign lesions and 34 (44%) malignant lesions were diagnosed. The overall mean diameter of the lesions was 8.7 mm (range 3-22 mm). All 34 patients with malignancies and lobular carcinoma in situ subsequently underwent surgery, the results of which are reported. Three (4%) haematomas were detected and aspirated percutaneously. Two technical problems occurred: an ABBI cannula malfunction, and a computer failure of the digital imaging system during the procedure. The average procedure time was 80 min and the cost of each procedure was 2,800,000 Italian lire (1555 US$). It is concluded that tissue sampling with the ABBI system can be performed entirely by radiologists without significant problems. The procedure was well tolerated by all patients. The quality of the biopsy specimen was identical to that of a surgical specimen but with the advantages of stereotactic precision for localization of the lesion.

Selective monocellular necrosis of Hodgkin's/Reed-Sternberg cells and their immunoreactivity to human serum antinuclear antibodies in NS- and MC-types of malignant lymphogranuloma.

The selective (apoptotic) necrosis of Hodgkin's cells in malignant lymphogranuloma appears to be etiologically quite different from focal one due to ischemic-vascular causes. The morphology and supposed etiopathogenesis of this cellular lesion, as well as the karyoclastic process-presumably apoptotic in nature-are briefly described and considered as a mechanism leading to cellular regression with subsequent destructuralization and release of DNA-reactive nucleoprotein material in form of free hematoxylin bodies. An original observation of the immunoreactivity of Hodgkin's cells with antinuclear antibodies of human serum in a case of collagenosis is also described.

Mucopolysaccharides in gastric cancer.

The histochemical properties of mucus in 48 diffuse type gastric carcinomas and in 46 intestinal type gastric cancers were investigated. In the diffuse type there was a prevalence of intracellular secretion of mucopolysaccharides with a significantly larger portion of sulfated mucopolysaccharides. Acid mucopolysaccharides occurred in the tumor cells only along with neutral ones. In the intestinal type of this cancer, in turn, extracellular secretion prevailed, along with the occurrence of purely acid mucopolysaccharides and a smaller portion of sulfated ones. The secretion of pure neutral mucopolysaccharides in both types of gastric cancer was very low. In the marginal areas of intestinal type carcinomas, incomplete intestinal type IIb metaplasia was frequently found.

Expression of blood group A and B antigens in gastric cancer examined by monoclonal antibodies.

Fourty-eight patients with gastric carcinoma were histologically examined and classified according to Laurén as intestinal or diffuse type. Employing monoclonal antibodies, in all samples the expression of blood group A and B antigens was studied using the method of indirect immunoperoxidase reaction. In patients with blood groups A and AB the comparison of expression revealed marked differences between the intestinal and diffuse type carcinomas. In the intestinal type, the expression of the blood group antigens was highly heterogenous, while diffuse type carcinomas displayed a homogenous expression. The obtained differences support Laurén's classification. The staining of supranuclear regions of tumor cells by the monoclonal antibody HE 10 (which reacts with antigenic determinants A and H of type 3 and 4) was found more frequently in intestinal type carcinomas. The possible prognostic significance of these findings is discussed.

Expression of Bcl-2 in dysplastic and neoplastic cervical lesions in relation to cell proliferation and HPV infection.

Expression of the bcl-2 gene has been shown to effectively confer resistance to programmed cell death in a variety of tumors. The bcl-2 proto-oncogene is involved in the development of human follicular lymphomas and also in a number of solid tumors such as carcinomas of prostate, breast, lung and GIT. The present study was designed to analyze the role of Bcl-2 expression in cervical intraepithelial squamous neoplasias (CIN) and cervical invasive carcinomas. Special attention was given to the association of Bcl-2 expression with the grade of the lesion, proliferative activity (expression of nuclear antigen of proliferative cells - PCNA) and human papillomavirus (HPV) DNA positivity. We examined tissue samples obtained from 86 women with varying degrees of cervical disease. Bcl-2 and PCNA were investigated using immunohistochemical staining and detection of HPV DNA was performed by hybridization in situ. Increased Bcl-2 expression was observed in advanced degrees of dysplasia and in carcinomas. We found a strong association between the presence of Bcl-2 in pathological epithelium with both the degree of dysplasia and the proliferative activity. We also observed a significant correlation between the amount of Bcl-2 positive lymphocytes infiltrating the lesions and the degree of disease. We, therefore, suggest that Bcl-2 expression in these lymphocytes may influence the antiviral or antitumor immune response. On the other hand we did not detect any significant correlation between the Bcl-2 oncoprotein and the presence of HPV. These results indicate that Bcl-2 may play an important role in the development of cervical cancer.

[Detection and typing of HPV DNA in situ--improvement in diagnosis of lesions of the uterine cervix]. / Prukaz a typizace HPV DNA in situ--príspevek ke zlepsení diagnostiky lézí delozního cípku.

We examined the cervical samples from 63 female patients with various grades of cervical intraepithelial neoplasia (CIN), invasive squamous cell carcinoma (INCA) or inflammation. All the women with the diagnosis of CIN were selected on the basis of cytological prediction of HPV infection (koilocytosis, dyskeratosis). The analysis of human papillomavirus (HPV) genome by DNA hybridization in situ was done in all cases. Simultaneously, the immunohistochemical expression of papillomavirus common antigen (PVCA) and proliferating cell nuclear antigen PCNA/cykline was determined. The results confirm the correlation between high risk HPV types 16, 18, 33 and higher grade of dysplasia (CIN) as well as higher proliferative activity. On the other hand, the detection of HPV DNA does not correlate with PVCA expression or with cytological/histological diagnosis of koilocytosis. This finding shows that common cytological or histological examinations may be unreliable and in particular the significance of koilocytosis must be reevaluated.

[Expression of the blood group antigens A and B in carcinoma of the urinary bladder]. / Exprese krevních skupinových antigenu A a B v karcinomu mocového mechýre.

In 21 patients with transitional cell carcinoma of the urinary bladder expression of A and B blood group antigens was studied by means of monoclonal antibodies on using indirect immunoperoxide reaction. Expression of the investigated antigens was found to be dependent on the degree of histological differentiation of the tumor tissue. In well-defined carcinomas mostly pronounced expression of A and B blood group antigens was observed. Middle and low-differentiated carcinomas were characterized by reduction or even total deletion of expression. The expected favorable prognosis in transitional cell carcinomas expressing A and B blood group antigens failed to be confirmed. The expression of incompatible A-like antigens in 0 and B blood group patients with carcinoma is discussed. (Tab. 3, Fig. 3, Ref. 22.).

[The significance of Laurén's classification of gastric carcinoma]. / K významu Laurénovy klasifikace karcinomu zaludku.

A reclassification of 142 cases of gastric carcinoma was carried out into Laurén's intestinal and diffuse types. It failed to confirm a convincing correlation of the type of carcinoma with sex, age distribution and patients survival.

[Malignant B-monocytoid mantle zone lymphoma]. / Maligní lymfom plást'ové zóny, B-monocytoidní typ.

Three cases of B-monocytoid malignant lymphoma were studied by histology, immunohistology and electron microscopy. Two of them were primarily extranodal (in parotid gland and palatine tonsil), the third was in lymph nodes. All tumours were characterized by patients' long survival without signs of generalization.

[Myocyte transformation in autologous transplantation of colonic smooth muscle in domestic pigs]. / Transformance myocytu autologního transplantátu hladké svaloviny tracníku u vepre domácího.

Autologous gut smooth muscle graft of two piglets was used for creating a ring in sigmoidostomy. The graft was investigated several times by histology and electron microscopy. A sort of myofibroblasts were observed the 7th day in the smooth muscle. Three months later the smooth muscle was completely transformed into a cellular connective tissue comprising myofibroblasts and fibroblasts. The experiment points to possible relation of smooth muscle cell, myofibroblast and fibroblast.

[Differences in the expression of blood group antigens A and B in carcinoma of the stomach in relation to Laurén's classification]. / Rozdíly v expresi krevních skupinových antigenu A a B v karcinomu zaludku s prihlédnutím k Laurénove klasifikaci.

Expression of blood group antigens A and B was studied in a group of 48 gastric carcinomas (classified according to Laurén as intestinal and diffuse types respectively) by monoclonal antibodies in an indirect immunoperoxidase method. Results could be summarized as followings: 1. Significant difference concerned the expression of blood group antigens A and AB. Intestinal type was characterized by striking heterogeneity of expression and more pronounced deletion of antigens. Diffuse type had a homogenous expression and a distinctly smaller deletion. 2. Supranuclear immunoreactivity with monoclonal antibody HE 10 in intestinal type carcinoma may have a prognostic importance. This expression could not be observed in diffuse type carcinoma.

[The final picture of wound healing in CO2 laser scalpel surgery]. / Výsledný obraz reparace rány zpusobené CO2-laserovým skalpelem.

The terminal reparative phase was studied in wounds caused by carbon dioxide laser on rat skin, auricle, striated muscle, liver and spleen. Comparative histology was especially concerned with resorptive granulomas around carbonized tissue remnants. Presence of carbonized residua was connected with a more extensive fibrosis and seemed to lengthen the healing process.

[Expression of A,B and H blood group antigens in urothelial carcinoma of the urinary bladder]. / Exprese krevních skupinových antigenu A, B a H v uroteliálním karcinomu mocového mechýre.

Expression of blood group antigens A, B, and H was studied in transitional carcinoma of the urinary bladder. Positive result was obtained in 16 cases of a group of 21 tumours by indirect immunoperoxidase reaction with monoclonal antibodies. A relation of quantitative expression to histological grading of tumour differentiation was noticed. Well differentiated transitional carcinomas mostly had more conspicuous expression of A, B, and H antigens. However, expected more favourable prognosis in cases of transitional carcinoma with expression of A, B, and H blood group antigens failed to be proved.

[Diagnosis of lymphoproliferative diseases from bone marrow biopsies]. / Zkusenosti s diagnostikou lymfoproliferativních onemocnení v biopsii kostní drene.

The cytological, histological and immunophenotypical markers of lymphoproliferative diseases are evaluated in the collection of 950 trepanobiopsies, and correlated with types of extramedullary malignant lymphoma. The diagnostic significance of tumor infiltrates topography and basic rules of the differential diagnoses of malignant lymphomas in the bone marrow biopsies are discussed.

[Inflammatory stromal reaction in epithelial neoplasia of the uterine cervix in correlation with HPV infection]. / Zánetlivá stromální reakce v epiteliálních neoplaziích delozního hrdla v korelaci s infekcí HPV.

260 cases of women with epithelial neoplasias of the uterine cervix were studied: HPV infection was detected by DNA in situ hybridization and serology, simultaneously structure and intensity of stromal inflammatory reaction (SR) were evaluated (semiquantitatively) as well as standard clinical immunological parametres investigated by serology. Results proved the same character of SR in intraepithelial lesions and invasive carcinomas and the intensity of SR increasing in relation to the gravity of epithelial dysplasia. There was not found any significant difference in SR between cases with detected HPV infection and cases lacking it. Summarized immunological parametres were in limits of normal reference range.