Colorectal cancer in patients with type 2 diabetes mellitus: a single-center experience.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC). The aim of the study is to evaluate the prevalence of CRC in a cohort of Caucasian patients with T2DM and the association with other variables previously known to be related with increased risk of CRC. We retrospectively evaluated the data of 741 consecutive Caucasian patients with T2DM who underwent colonoscopic screening in our tertiary referral center. A control cohort of 333 patients with thyroid disease was selected to evaluate the difference in the incidence of CRC. At a median follow-up of 132.5 months (range 33.3-175.7), 67 cases of cancer (prevalence 9%) occurred; among these, 14 cases of CRC were reported (prevalence 1.88%) among the diabetic patients, while only two case (one of these was a CRC) (overall prevalence 0.006%, prevalence of CRC 0.003%) occurred in the control group; the difference between the prevalence of CRC was statistically significant (chi-square 4.21, p=0.04). The median duration of T2DM to CRC diagnosis was 168 months (range 12-768). At the univariate analysis, older age (p=0.001, r 0.138) and diabetes duration (p=0.001, r 0.138) were related to higher risk of cancer, while metformin seems to be protective towards cancer (p=0.07, r -0.098). In the subset of patients with CRC, the age (RR = 2.25; 95% CI: 0.30 - 17.31; p less than 0.001), the diabetes duration (RR = 1.93; 95% CI: 0.25 – 14.77; p = 0.001) and the sulphonylureas treatment (RR = 2.33; 95% CI: 0.78 – 7.38; p = 0.007) were independently correlated with CRC. In our study, the prevalence of CRC in the cohort of patients with T2DM was higher compared to that from the National Tumor Register in 2010 (0.5%). Furthermore, we could speculate that sulphonylureas may play a role in CRC carcinogenesis impairing the physiological insulin secretion.

Histological findings in direct inguinal hernia : investigating the histological changes of the herniated groin looking forward to ascertain the pathogenesis of hernia disease.

BACKGROUND: The study is focused on recognizing the histological changes of the structures close to and around the hernia opening in patients having direct inguinal hernia. METHODS: In 15 patients with primary bilateral direct inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, tissue specimens from the abdominal wall surrounding a direct hernia border were excised for histological examination. These findings in patients with direct inguinal hernia were compared with tissue specimens excised from the fossa inguinalis media of cadavers without hernia. RESULTS: Significant degenerative modifications such as fibrohyaline degeneration and fatty substitution of the muscle fibers were seen in the biopsy samples. Inflammatory infiltration with lympho-histiocitary elements, artery sub-occlusion and vascular congestion were also constantly identified. Noteworthy injuries of the nervous structures such as edema, degenerative fibrosis and atrophy were also detected. No comparable tissue damage was witnessed in the control samples. CONCLUSION: Presence of inflammatory infiltration, vascular damage and regressive nerve lesions, as well as fibrohyaline degeneration and fatty dystrophy of the muscle fibers are the features seen within the examined structures surrounding the direct hernia opening. These findings could represent a reason for a structural and functional weakening of the inguinal region. Consequently, the described results lead the authors to depict these changes as a plausible cause of direct inguinal hernia protrusion.

Cavernous haemangioma of the external auditory canal: clinical case and review of the literature.

Although benign vascular lesions are frequent in the head and the neck region, clinical evidence of cavernous haemangioma of the external auditory canal is extremely rare; when present, the lesion invades the middle ear space. Herein, a rare case of a soft mass filling the external auditory canal, not involving the tympanic membrane, in a symptomatic 59-year-old male is described. Clinical and audiological characteristics, imaging studies and surgical treatment with histological evaluation are reported, which led to a diagnosis of a cavernous haemangioma. This is only the seventh case described in the literature, to date, not involving the tympanic membrane and the middle ear space. In addition, a review has been made of the relevant literature with respect to epidemiology, presentation, evaluation, pathology, and management options for haemangiomas arising in the external auditory canal.

[Breast cancer less than 1 cm: bio-morphologic characterization with ER, PgR, Ki67, Her-2/Neu, MDV, MAGS, p53, EGF-R]. / Carcinoma della mammella con diametro inferiore ad 1 cm. Caratterizzazione bio-morfologica: ER, PgR, Ki67, Her-2/Neu, MDV, MAGS, p53, EGF-R.

Breast carcinoma is the most common malignant tumour and the main cause of carcinoma death in women. There has been a sharp increase in the detection of breast carcinoma, although mortality is still unvaried. In the last ten years the incidence of breast cancer measuring less than 1 cm, corresponding to pT1a, pT1b in TNM stadiation, has greatly increased. The present study describes the biologic characterisation of small breast carcinomas. The Nottingham/Tenovus Primary Breast Cancer Study stated that tumour size is a significant, independent factor for breast cancer prognosis. Cases were selected among formalin-fixed, paraffin-embedded tissues from 360 ductal breast cancers. In one-half of cases, the tumour was less than 1 cm in diameter, pT1a- pT1b; in the other half the tumour size was greater than 1 cm, but less than 2 cm, pT1c. Histological grading was assessed with the Scarff-Bloom-Richardson method, without Nottingham grade. Immunohistochemical determinations for ER, PgR, Ki-67, Her-2/Neu, CD34, p53, EGFR were done with an automated method. From the above analyses, it was demonstrated that the tumour size is indeed an important prognostic factor, particularly in cases without lymph node metastasis (N0). In particular, we observed significant differences between pT1a-b and pT1c cases, confirming that tumour size is an important criterion for prognostic valuation in ductal breast cancer without lymph node metastasis.

Collagen IV, laminin, fibronectin, vitronectin. Comparative study in basal cell carcinoma. Correlation between basement membrane molecules expression and invasive potential.

AIM: Basal cell carcinoma (BCC) is a malignant carcinoma arising by cells of epidermal basal layer and adnexal epithelium. It appears intimately connected with a stromale component that holds a relevant role for tumour's evolution. It occurs frequently on sun-exposed regions, and is considered as low potential for metastasis, whereas its local invasion, destruction and recurrence are well known. METHODS: Particularly formalin-fixed, paraffin-embedded tissue from 40 cases of BCC, 20 recurring and 20 not recurring, had been studied, with immunohistochemical techniques to value the distribution of intrinsic and extrinsic components of basal membrane. RESULTS: The immunohistochemical examination showed collagen IV and laminin continuous positivity in peripheral cells, seating around neoplastic nests of 62.5% not recurring BCC. The same antigens exhibited discontinuous positivity in cells with non distinguished borders, seating around nests of 85% micronodular recurring BCC. The valuation of fibronectin and vitronectin could have a more significant prognostic value. Fibronectin in fact appeared hyper-expressed in peritumoral stroma of 80% recurring BCC, vitronectin appeared less expressed than normally in peritumoral stroma of 95% recurring BCC. CONCLUSION: A correlation between basal membrane's break and carcinoma's recurrence has been noticed. This shows the utility of other prognostic factors helping the valuation of malignant progression.

CD1a down-regulation in primary invasive ductal breast carcinoma may predict regional lymph node invasion and patient outcome.

AIMS: CD1a is a molecule belonging to the highly conserved group of CD1 proteins. Its expression in dendritic cells is related to the presentation of tumour-derived glycolipid antigens to T cells and, consequently, the development of a successful antitumour response. The aim was to investigate the presence of CD1a+ cells in both primary tumours and lymph nodes (LN) of a series of 35 invasive ductal carcinomas by both immunohistochemistry and reverse transcription-polymerase chain reaction. METHODS AND RESULTS: CD1a antigen was more expressed in N0 than N1 breast cancer (P < 0.0001) in both primary lesions and LN metastases and correlated positively and significantly with oestrogen (ER) (P = 0.0025) and progesterone (P = 0.0226) receptor (PR) status, as well as CD4+ and CD8+ T-lymphocyte infiltration. CONCLUSIONS: This is the first report to show a link between CD1a+ mononuclear cells in breast cancer and in paired LN metastases. The positive and significant correlations between the number of CD1a+ cells and positivity of the primary tumour for ER and PR suggest a possible role for CD1a as a prognostic marker for breast cancer, raising the possibility that hormone receptor-positive breast cancer patients may have a better prognosis in the presence of greater dendritic cell infiltration.

Atrial natriuretic peptide and CD34 overexpression in human idiopathic dilated cardiomyopathies.

Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease of unknown cause characterized by ventricular chamber enlargement with impaired contractile function. In familial forms of IDCM, mutations of genes coding for cytoskeletal proteins related to force transmission, such as dystrophin, cardiac actin, desmin, and delta-sarcoglycan, have been identified. Here, we report the data of a retrospective investigation carried out to evaluate the expression of atrial natriuretic peptide (ANP), CD34, troponin T and nestin in the myocardium of patients affected with IDCM. Formalin-fixed and paraffin-embedded consecutive tissue sections from the ventricular wall of 10 human normal hearts (NH) following forensic autopsy and 22 IDCM (living explanted hearts) were studied using primary monoclonal antibodies against ANP, CD34, troponin T and nestin by immunohistochemistry. Myocardial fibers were counted independently by three pathologists. Statistics included analysis of variance, log-rank test for Kaplan-Meier analysis, and kappa assessment for intra- and inter-observer variability. ANP and CD34 were significantly overexpressed in IDCM compared to NH (p<0.05). Conversely, troponin T and nestin expression levels did not show significant variation. Inter-observer kappa statistics showed a value of 0.87 and intra-observer kappa statistics a value of 0.98. Evaluation of the marker distribution in the myocardium of patients with IDCM CD34 expression curve was similar to that of troponin T (p<0.0001), although two groups could be identified. Patients with a difference of more than 20 myocardial fibers in expression of CD34 and troponin T had a somewhat less favorable survival although the difference was not significant. The analysis of cells positive for troponin T resulted in a similar number of cardiac fibers between NH and IDCM. This is in agreement with cardiac enlargement present in IDCM, which is due to ventricular dilatation rather than increased number of myocytes. Moreover, the expression of nestin, a marker of activation of myocardial precursors, did not change either, and this may confirm that there are no hyperplastic phenomena in the IDCM pathogenesis. The increase in ANP-positive cells in IDCM could be a consequence of neurohormonal activation due to a decline in the impaired myocyte contractility. Furthermore, since it was already shown that ANP could be important in the control of vascular remodeling, we postulated that the increase in CD34-positive cells might be functionally correlated with the increase in ANP production. Differential expression of CD34 and troponin T might be used in future studies to evaluate their prognostic value.

[The reevaluation of neoangiogenesis indices in cutaneous melanoma]. / La rivalutazione degli indici di neoangiogenesi nel melanoma cutaneo.

The melanoma today represents one of more diffuse malignant neoplasm and known, object of numerous studies and you debate yourself, topic more and more puts into effect them, observed and estimated under more it varies aspects to you. Our study has been lead taking in consideration the process of neoangiogenesis, fundamental stage in the progression graduates them of the malignant melanoma, than it comes true through the release of VEGF and many other angiogenic molecules from part of the same neoplastic cells. The evolution of such process represents a critical moment for the development of whichever neoplasm, but in particular way in the melanoma it is in charge of the transition from the phase of horizontal increase to that one of vertical increase. We have therefore place the attention on the appraisal of objective indices of the vascularization as factor I prognosticate of the melanoma; particularly way we have correlated the indices of vascularisation in 54 cases of melanomas, all to III the level of Clark, and have obtained of turns out to you that confirm the possibility to insert between the prognostic factors determinants also those.

Polyamine-modulated expression of c-myc plays a critical role in stimulation of normal intestinal epithelial cell proliferation.

The nuclear protein c-Myc is a transcription factor involved in the control of cell cycle. Our previous studies indicated that cellular polyamines are absolutely required for cell proliferation in crypts of small intestinal mucosa and that polyamines have the ability to stimulate expression of the c-myc gene. The current study went further to determine whether induced nuclear c-Myc plays a role in stimulation of cell proliferation by polyamines in intestinal crypt cells (IEC-6 line). Exposure of normal quiescent cells after 24-h serum deprivation to 5% dialyzed fetal bovine serum (dFBS) increased both cellular polyamines and expression of the c-myc gene. Increased c-Myc protein formed heterodimers with its binding partner, Max, and specifically bound to the Myc/Max binding site, which was associated with an increase in DNA synthesis. Depletion of cellular polyamines by pretreatment with alpha-difluoromethylornithine (DFMO) prevented increases in c-myc expression and DNA synthesis induced by 5% dFBS. c-Myc gene transcription and cell proliferation decreased in polyamine-deficient cells, whereas the natural polyamine spermidine given together with DFMO maintained c-myc gene expression and cell growth at normal levels. Disruption of c-myc expression using specific c-myc antisense oligomers not only inhibited normal cell growth (without DFMO) but also prevented the restoration of cell proliferation by spermidine in polyamine-deficient cells. Ectopic expression of wild-type c-myc by recombinant adenoviral vector containing c-myc cDNA increased cell growth. These results indicate that polyamine-induced nuclear c-Myc interacts with Max, binds to the specific DNA sequence, and plays an important role in stimulation of normal intestinal epithelial cell proliferation.