HSP70 In triple negative breast cancer: Prognostic value and clinical significance.

BACKGROUND: Triple-negative breast cancer (TNBC) has the worst prognosis and the highest immunogenic potential of all breast cancer subtypes. It is characterized by a lack of estrogen and progesterone receptors as well as HER2. A major component of the tumor microenvironment (TME) of TNBC is tumor-infiltrating lymphocytes (TILs). A chaperone heat shock protein 70 (HSP70) is involved in several pathways that enable tumour growth and progression, as well as in immune modulation. METHODS: Immunohistochemical analysis of HSP70 expression in immune cells, as well as expression of immunosuppressive markers CTLA4 and PD-L1 and major TILs components: CD8, CD4 and Tregs were analyzed in the superficial and deep tumor layer of primary TNBC and compared with established clinicopathological parameters. Clinical data and surgical tissue samples from 68 TNBC patients who underwent initial surgery were included in the analysis and 36 control samples from benign breast tissue biopsies. RESULTS: A higher expression of TILs, CD4, CD8 and PD-L1 was found in the invasive tumor front (ITF), as compared to the tumor center (TC) (p < 0001). HSP70 positive immune cells (HSP70(+) IC) in TC were associated with adverse clinical and pathological markers: higher stage of disease (P = 0.013), higher grade (P = 0.05) and a higher pN status (P < 0.001). In addition, higher expression of HSP70(+) IC from TC was correlated with the higher expression of FOXP3(+)T cells both in ITF (N = 61, rho=0.42, p < 0.001) and in metastatic tissue from the draining lymph nodes (N = 13, rho=0.61, P = 0.026). CONCLUSION: Correlations between HSP70 immune cells expression and individual TILs components support the hypothesis of its active role in inducing immunosuppression and tumor progression. Routine determination of HSP70 expression, in immune cells of TC, may be of added value in the clinical decision-making process concerning axillary surgery.

Inflammatory Fibroid Polyp of the Small Intestine: A Case Report and Systematic Literature Review.

AIM: Starting from a case presentation, this review aims to present literature data on inflammatory fibroid polyps (IFPs) of the small intestine. METHODS: Case report and systematic review. A comprehensive systematic review of English literature using PubMed was conducted, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The used key words were: "inflammatory fibroid polyp" or "Vanek", including only cases with IFPs localized of the small intestine, published from 1976 to 2019. RESULTS: We present a case of a 38-year old patient with intestinal IFP presenting with acute abdomen due to intussusception diagnosed with ultrasound (US) based on a target sign and visible solid tumor in the small intestine leading to prompt surgical treatment. A diagnosis of IFP was made based on the pathohistological findings. Moreover, a systematic review of small intestine IFPs was conducted which is, to our knowledge, the first comprehensive systematic literature review on this topic. The analysis included 53 case reports or case series concerning 77 cases of small bowel IFPs. The patients were aged from 4 to 75 years (average 45.2), with a female predominance (59.7%). The most common localization was the ileum in 77.9% cases, followed by the jejunum (13%) and the duodenum (6.5%). The most common clinical presentation was abdominal pain due to intussusception (63.6%). Regarding diagnostic methods, computed tomography (CT) was frequently used as primary diagnostic method (26%) followed by exploratory laparotomy (16.9%), endoscopy (7.8%) and US (6.5%). Combination of US and CT contributed to the diagnosis in 9.1% of cases. The majority of cases were treated surgically (92.21%), while only a minority benefited of minimally invasive techniques such as endoscopy. CONCLUSIONS: Small bowel IFPs, ones of the least common benign tumors, are characterized by variable clinical signs and symptoms and can potentially lead to serious consequences for the patient.

Impact of HER2 receptor status on axillary nodal burden in patients with non-luminal A invasive ductal breast carcinoma.

BACKGROUND: Breast cancer (BC) is the most common malignancy in women. AIM: To assess the impact of HER2 status on axillary lymph node (ALN) involvement in patients with invasive ductal carcinoma of no special type (IDC-NST) both at diagnosis and during the 4-year postoperative period. PATIENTS AND METHODS: We retrospectively included 375 women with an early clinical stage of non-luminal IDC-NST who between 2007 and 2013 underwent breast surgery at a clinical hospital. They were divided into phenotype-based groups: HR+HER2-, HR+HER2+, HR-HER2+ and HR-HER2-. Only patients with sentinel lymph node (SLN) macrometastases underwent ALN dissection. If > 3 ALNs were positive, radiotherapy was delivered. All patients were treated with chemotherapy, HER2+ BC patients received trastuzumab, and hormone receptor (HR)-positive BC patients received hormonal therapy. RESULTS: Larger tumor size, higher grade, HR+, HER2+ status, and lymphovascular invasion (LVI) were predictive for ALN metastases at diagnosis. The poorest overall, disease-free, and distant recurrence-free survival (OS, DFS, DRFS) were found in the HR-HER2- group, while the poorest locoregional recurrence-free survival (LRFS) was observed in HR-HER2+ and HR-HER2- groups. HER2 status was not predictor of survival. CONCLUSIONS: HER2+ status was predictive for ALN involvement at diagnosis but had no effect on 4-year LRFS in these patients.

Impact of HER2 receptor status on axillary nodal burden in patients with non-luminal A invasive ductal breast carcinoma / Receptores HER2, compromiso ganglionar axilar y sobrevida en mujeres con cáncer de mama ductal invasivo

ABSTRACT Background: Breast cancer (BC) is the most common malignancy in women. Aim: To assess the impact of HER2 status on axillary lymph node (ALN) involvement in patients with invasive ductal carcinoma of no special type (IDC-NST) both at diagnosis and during the 4-year postoperative period. Patients and Methods: We retrospectively included 375 women with an early clinical stage of non-luminal IDC-NST who between 2007 and 2013 underwent breast surgery at a clinical hospital. They were divided into phenotype-based groups: HR+HER2-, HR+HER2+, HR-HER2+ and HR-HER2-. Only patients with sentinel lymph node (SLN) macrometastases underwent ALN dissection. If > 3 ALNs were positive, radiotherapy was delivered. All patients were treated with chemotherapy, HER2+ BC patients received trastuzumab, and hormone receptor (HR)-positive BC patients received hormonal therapy. Results: Larger tumor size, higher grade, HR+, HER2+ status, and lymphovascular invasion (LVI) were predictive for ALN metastases at diagnosis. The poorest overall, disease-free, and distant recurrence-free survival (OS, DFS, DRFS) were found in the HR-HER2- group, while the poorest locoregional recurrence-free survival (LRFS) was observed in HR-HER2+ and HR-HER2- groups. HER2 status was not predictor of survival. Conclusions: HER2+ status was predictive for ALN involvement at diagnosis but had no effect on 4-year LRFS in these patients.

Antecedentes: El cáncer de mama es el tumor maligno más común en mujeres. Objetivo: Conocer el impacto del estado HER2 sobre el compromiso ganglionar axilar al momento del diagnóstico y durante los primeros cuatro años después de la cirugía en mujeres con carcinoma ductal invasivo de tipo no especial (IDC-NST). Pacientes y Métodos: Incluimos retrospectivamente a 375 mujeres en etapas clínicas iniciales de IDC-NST que fueron operadas en un hospital clínico. Ellas se dividieron en grupos de acuerdo al fenotipo: HR+HER2-, HR+HER2+, HR-HER2+y HR-HER2-. La disección de ganglios axilares se efectuó solo en las pacientes con macrometástasis en el ganglio centinela. Si había más de tres ganglios comprometidos, se efectuó radioterapia. Todas las pacientes se trataron con quimioterapia. Las pacientes HER2+ recibieron trastuzumab y las pacientes HR+ recibieron hormonoterapia. Resultados: Tumores más grandes, de mayor grado de malignidad, HR+, HER2+ y la invasión linfovascular fueron predictivos de la presencia de metástasis axilares al momento del diagnóstico. La sobrevida más baja se observó en pacientes HR-HER2+. La sobrevida libre de recurrencia locorregional más baja, se observó en pacientes HR-HER2+ y HR-HER2-. HER2 no fue predictor de sobrevida. Conclusiones: En estas mujeres, HER2+fue predictor de la presencia de compromiso ganglionar axilar al momento del diagnóstico pero no de la sobrevida a cuatro años.

Secondary torsion of vermiform appendix with mesoappendiceal lipoma.

A torsion of the vermiform appendix with a mesoappendiceal lipoma is a rare condition. It is also a rare cause of acute abdomen, as such, the condition is diagnosed during surgery. This case report presents a 70-year-old male patient with lower right abdominal pain and signs of acute abdomen with an increased peripheral blood leukocyte count. An ultrasound examination revealed a mass of 9.6 cm2, which was suggested to be a perityphlitic abscess. An emergency operation was indicated, as the patient had clinical signs of acute abdomen. Laparotomy via a pararectal incision revealed the cause of the pain to be a torsion of the vermiform appendix caused by a mesoappendiceal lipoma. The apex of the appendix was perforated, which caused circumscript peritonitis. Both an appendectomy and an extirpation of the tumor were performed, and a surgical drain was placed in the wound, yielding an excellent postoperative clinical outcome.

[Analysis of sentinel lymph node in early breast cancer patient - Clinical Hospital Center Rijeka]. / Analiza limfnog cvora cuvara u bolesnica s ranim invazivnim rakom dojke - Klinicki bolnicki centar Rijeka.

Sentinel lymph node (SLN) biopsy is an accurate method for the detection of axillary metastases in early breast cancer patients and is of value as a replacement for axillary dissection. However, variations in the methods and protocols used for the pathological evaluation of SLN exist in everyday practice. Therefore, standardization how to detect, dissect, process, stain, assess and report SNL is required in order to stratify patients into adequate prognostic groups. The aim of this study was to present our experience in SLN analysis in patients with early breast cancer and clinical stage T1-2 and N0. In the period between 2003 and 2011, 1071 consecutive patients or 1915 SLN were analyzed. The protocol included intraoperative analysis of histological frozen sections and cytological imprint, followed by analysis of paraffin sections according to the protocol that included sections of whole SLN with the interval of 250 prm. According to the accepted protocol 75% of SLN were negative. The obtained results were correlated with literature data.

Outcome evaluation of 10,317 laparoscopic cholecystectomies: a 17-year experience at a single center.

BACKGROUND/AIMS: This study is an analysis of the large series of laparoscopic cholecystectomies and compare our results with those reported in the literature concerning complications. METHODOLOGY: From December 1993 to September 2010, 10,317 patients with gallstone disease underwent laparoscopic cholecystectomy. Previously operated patients were also included in the study. We analyzed the successfulness of the results, intraoperative and postoperative complications, conversions in open cholecystectomy, mortality and reoperation rate. RESULTS: We registered 23.28% complications. Intraoperative complications were bleeding in 9.84%, gallbladder perforation in 8.63%, stone loss in 1.37%, common bile duct injury in 0.24% and injury of intraabdominal organs in 0.07% of cases. Postoperative complications were bleeding in 1.12%, wound infection in 0.59%, bile leakage in 0.5%, incisional umbilical hernias in 0.37%, subhepatal collection in 0.33%, residual gallstones in choledocus in 0.09%, urine retention in 0.08% and biliary peritonitis in 0.01% of patients. Conversion to open cholecystectomy was necessary in 2.13%. Reoperation was performed in 0.27%. The mortality rate was 0.019%. CONCLUSIONS: Our results on large number of patients are similar to other series in the newer literature but the rate of complications should be decreased. The incidence of complications decreases with growing laparoscopic experience.

The "round block" surgical technique in the management of multicentric fibroadenomas.

The "round block" surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-Goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the "round block" technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast.

Evaluation of adjuvant chemotherapy in patients with colorectal cancer in Primorsko-Goranska and Istarska County--a twenty years retrospective study.

Colorectal cancer is the second most common malignant disease in developed countries, with about one million new cases worldwide every year, accompanied with high mortality rate. We examined the survival rate and recurrence (occurrence of distant metastases and/or local recurrence) of patients with colorectal cancer in Primorsko-Goranska and Istarska County who received adjuvant chemotherapy, compared to those who did not in the period since 1980. until 1999. This study involves 483 patients with colorectal cancer stages II and III of Primorsko-Goranska and Istarska County, which were underwent curative resections of colorectal cancer at the Clinical Hospital Centre Rijeka, and then treated with chemotherapy (288) or without Chemotherapy (195). We analyzed the five year survival rate and the recurrence of malignant disease in the adjuvant treatment group in comparison with not treated group with chemotherapy, depending on the stage of disease, degree of histological differentiation, patient age and location of cancer (colon or rectum). After follow-up of 60 months died 44.79% (129/288) of patients who received chemotherapy and 53.33% (104/195) of patients who did not receive chemotherapy. The relative risk of death (from any cause) in chemotherapy-treated group versus the group without chemotherapy was 0.82 (p < 0.008). Recurrence of malignant disease in the chemotherapy group was 38.54% (111/288), and in the group without chemotherapy was 46.15% (90/195). The relative risk of recurrence of malignant disease in the chemotherapy group versus the group without chemotherapy was 0.78 (p < 0.001). There was no difference in treatment efficacy regard to the localization of the tumor, but there were differences in efficiency with respect to disease stage, grade and age. Chemotherapy with 5-fluorouracil and leukovorin ameliorate the survival and reduces recurrence and distant metastases in patients with colorectal cancer stages II and III.