Palliative treatment of the advanced gastric cancer by means of surgery and HIPEC.

OBJECTIVES: We demonstrate a case report of the patient who suffered from advanced gastric cancer and was treated by means of surgery and HIPEC. BACKGROUND: Gastric cancer is a therapeutic challenge in the European countries due to late diagnosis, advanced stages of the disease in time of diagnosis and early recurrence in cases where a radical surgery is possible. METHOD: The patient with an advanced gastric cancer (pT3N2M1 - peritoneal and ovarian metastases) was treated by means of radical surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). Surgical treatment was followed by a standard chemotherapy. Due to recurrence, there was the second look surgery one year later again with HIPEC procedure. RESULTS: Patient survived 32 months after diagnosis and despite intraperitoneal recurrence she never developed clinically significant ascites and she never suffered from intestinal obstruction. CONCLUSION: This case demonstrate a potential benefit of new oncosurgical approach -radical surgery + HIPEC + EPIC in the treatment of gastric cancers (Tab. 2, Fig. 6, Graph 4, Ref. 18). Text in PDF www.elis.sk.

Changes in expression of some apoptotic markers in different types of human endometrium.

The maintenance of tissue homeostasis and highly balanced counteraction of cellular proliferation and apoptosis are essential for tissue integrity. In our study, we evaluated the expression of apoptosis- regulating proteins Bcl-2, Bax and PARP, and executive apoptotic enzyme caspase-3 in normal, atrophic, hyperplastic and cancerous endometrium. Endometrial samples were obtained from patients who underwent curettage, hysteroresection or hysterectomy. The protein levels were quantified by immunoblotting. We observed a higher level of important apoptotic enzyme pro-caspase-3 and its active form in hyperplastic and cancerous endometrium, when compared to normal endometrium. The value of Bcl-2/Bax ratio, which reflects cellular resistance to apoptosis, was determined as > 1 for cancerous, normal, and atrophic endometrium. Thus, the effort to eliminate pre-neoplastic and neoplastic cells by apoptosis indicated by high pro-caspase-3 and caspase-3 levels seems to be overcome by a greater proliferative adjustment suggested by higher Bcl-2/Bax ratios in the samples examined. The PARP levels did not vary significantly among the groups. The levels of all examined proteins were significantly lower in atrophic endometrium. Our results suggest that pre-neoplastic and neoplastic states of human endometrium are not influenced simply by changes in apoptosis, but may also be affected by cellular proliferation. A high Bcl-2/Bax ratio as observed in cancerous endometrium can point to deregulation of apoptotic programmes. Thus, the onset and progression of endometrial malignancy could be linked to increased cellular proliferation with defects in apoptotic control.

[Significance of hysteroscopic resection in diagnostics of endometrial cancer]. / Význam resektoskopie v diagnostice karcinomu endometria.

OBJECTIVES: Endometrial cancer is the second most common malignancy of the female genital tract. Its incidence in the Czech Republic is 32/100 000 women and year with a permanent increasing tendency. In comparison with incidence, its mortality remains relatively low, with mortality ratio of 6.7 per 100,000 women and year. The decrease in mortality might be explained predominantly by early diagnostics. The most controversial issue is the potential risk of microscopic extrauterine dissemination of cancerous cells within the peritoneal cavity and circulation during hysteroscopy, and the question if the relatively high pressure of distension medium used during hysteroscopies may or may not multiply the risk. DESIGN: Retrospective study. MATERIALS AND METHODS: Totally, 400 endometrial biopsies were collected during years 2007-2009 at our clinic. In 56 patients, endometrial cancer was diagnosed. Afterwards, 44 women underwent surgery, during which peritoneal washing (lavage) and cytological examination were done. RESULTS: Fifty-six patients with histologically verified endometrial carcinoma were studied. The samples examined in the study were classified by grading as follows: G1 n=34, G1-2 n=10, G2 n=10, G3-4 n=2. In 44 cases that underwent radical surgery, no cancerous cells in peritoneal washings were found. Only in 1 case, the cytology obtained from peritoneal washing was considered to be suspicious. In 9 cases, carcinoma on the base of the polyp was detected, and in 2 cases, no residuum of cancer was observed after hysterectomy. CONCLUSION: In accordance with contemporary literature and based on our study, we suggest that hystero-resectoscopy does not increase the risk of dissemination of malignant cells within the peritoneal cavity and does not worsen the prognosis of the disease. On the contrary, the samples taken under visual control provide more precise and earlier diagnostics of endometrial cancer.

[Breast cancer cell populations and its changes relation to therapy]. / Populace bunek karcinomu prsu a její zmeny v závislosti na protinádorové lécbe.

This review summarizes the data from published studies that dealt with observation of various bioparameters changes in cancer population dependant on used therapy. Critically evaluating these studies and looking for relations among separate results we are trying to estimate prognostic value of these parameters (likelihood of recurrence, overall survival, ...) and also their value for prediction of tumor response to cytostatic, hormonal or other treatment. The aim is selection of such tumor population characteristics the testing of them would enable better patient stratification in postoperative adjuvant systemic therapy.

[Metastases in peripheral lymph nodes as the first sign of anaplastic skeletal plasmacytoma--2 case reports]. / Metastáza v periferní lymfatické uzline jako první projev skeletálního anaplastického plazmocytomu--popis dvou prípadu.

The paper discusses two unusual cases of solitary skeletal plasmacytoma and multiple myeloma presenting clinically as a metastatic disease in cervical lymph nodes. The pathology report of lymph node plasmacytoma initiated an extensive clinical search for eventual discovery of skeletal disease in both patients. We are not aware of any report in the literature dealing with this issue (Medline 1970-2000). The early involvement of lymph nodes by plasmacytoma with the appearance of undifferentiated neoplasm is challenging and poses great difficulties in correct diagnosis; this is almost impossible from hematoxylin eosin slides. The problem is that one has to think about the rare possibility of metastasing plasmacytoma in differential diagnosis of anaplastic tumors in lymph nodes. Immunohistochemistry and clinical records are very helpful in making a final diagnosis.