The Immunoscore in the Clinical Practice of Patients with Colon and Rectal Cancers.

In the fine balance between tumor invasion and our defensive systems, the role played by the adaptive immune response at the tumor site is critical. Beyond the fact that all the immune components of the innate and adaptive response can be observed to varying degrees in the tumor microenvironment, it appears that a high density of T cytotoxic and memory lymphocytes, in a context of Th1 immune orientation in the tumor and its invasion front, provides a prognostic marker of paramount importance for colorectal cancer and more generally all solid tumors. The understanding of the role of immunity in cancer, tailored during one century of intensive research, has led to a complete paradigm shift.based on a sharp dissection In order to show the major impact of this conceptual revolution, we herein retrace through the example of colorectal cancer, how an effective immune test, namely the "Immunoscore", has been developed. We also provide up to date data demonstrating the capacity of the Immunoscore to prognosticate with a better accuracy than the TME classification clinical outcomes and to guide therapeutic strategies.

Porocarcinoma: a rare cause of lateral cervical tumor.

Porocarcinoma is a rare tumor of the eccrine sweat glands that usually disseminates to the regional lymph nodes, but it can also develop distant metastasis. Case presentation: We report the case of a 67 year-old female patient who underwent wide surgical resection of a left cervical cutaneous tumor in a primary care center, for which the histology exam of the specimen was mixed basal cell and squamous cell carcinoma. She was referred to our hospital's oncology clinic and histologic re-evaluation changed the diagnosis to eccrine porocarcinoma (EPC). Computer-tomography (CT) revealed cervical lymphadenopathies for which the patient underwent 4 cycles of chemotherapy, without regression. She subsequently underwent a left upper anterior jugular lymphadenectomy (group IIa) with all nodes being negative and, three months later, she developed a unique adenopathy under the parotid gland that was excised and confirmed to be metastatic. Postoperative external radiotherapy was administered with a good outcome on CT scan. Nine months after her last surgery, the patient did not show any sign of recurrence or distant metastasis. Conclusion: EPC is a challenge, both diagnostically and therapeutically. In the absence of consensus regarding the indications and extent of lymphadenectomy and adjuvant therapy, patients with EPC should be referred to an experienced multidisciplinary team in a tertiary center.

Colon cancer at the molecular level--usefulness of epithelial-mesenchymal transition analysis.

Colorectal cancer (CRC) is the third form of cancer in both men and women. In Romania, the incidence of CRC in 2000 is 17.74 %ooo, in 2002 becoming the second cause of death. We reviewed a series of studies that are related to colon cancer and studied the epithelial-mesenchymal transition at the front of tumor invasion (EMT). Cellular phenotypic changes characteristic of EMT can be induced by the absence of transition cofactor (p300) involved in cellular regulation. Loss of syndecan-l marker is associated with local tumor stage and metastasis. Modulators of protein kinase resistance was associated with changes in genes involved in EMT (including vimentin hyperexpression) and genes involved in invasion (N-cadherin) with a decrease expression of genes involved in epithelial cell adhesion (E-cadherin). Progression in colon cancer is characterized by activating mutations in Ras genes and tumor growth factor action. Vimentin expression associated with EMT initiates molecular program. One of the characteristics of EMT is the loss of E-cadherin. TGF-p (transforming growth factor beta) induces epithelial-mesenchymal transition in colon cancer cell lines with the microsatellite stability, inducing cell invasion and migration. EMT is a critical early event involved in invasion and metastasis of colorectal cancer, characterized by the presence of markers specific to each phenotype, epithelial or mesenchymal. Multiple biomarkers involved in the induction of EMT may represent future therapeutic target in the treatment of colonic neoplasia.

[Low anterior resection of the rectum with total mesorectal excision--immediate results]. / Rezectia anterioara joasa de rect cu excizie totala de mezorect. Rezultate imediate.

AIM: this study was aimed at analyzing the immediate postoperative course in rectal cancer patients who underwent a low anterior resection of the rectum with total mesorectal excision. MATERIAL AND METHODS: A retrospective study was carried out on a series of 75 patients operated between January 1, 2004 and December, 31 2010 at the 1lrd Surgical Unit of the Iasi "St. Spiridon" Hospital,. Low anterior resection of the rectum with total mesorectal excision was performed in all the patients. Data from medical files regarding the immediate postoperative course were analyzed. RESULTS: Neoadjuvant therapy was instituted in 32 patients. There were 28 mechanical colorectal anastomoses and 47 manual anastomoses. Protective ileostomy was performed in 46 cases, including I manual anastomosis and 35 mechanical anastomosis cases. Anastomotic fistulas occured in II patients (6 with manual suture and 5 with stapler). Wound complications were identified in 5 cases, while retraction of ileostomy in 2. Two patients died from anastomotic fistula causing abdominal sepsis and multiple organ failure. In both cases ileostomy was performed at the reintervention, concomitantly with drainage of the abdominal abscesses. CONCLUSIONS: Healing of the colorectal anastomosis remains the major problem with low anterior resection of the rectum. Protective ileostomy reduces the risk of serious complications in the event of anastomotic fistula.