Metastatic clear cell renal carcinoma - an unusual response to Temsirolimus in second line therapy.

Renal cell carcinoma (RCC) represents 3% of all cancers, with the highest incidence occurring in the most developed countries and representing the seventh most common cancer in men and the ninth most common cancer in women. The understanding of the tumor molecular biology and the discovery of new drugs that target molecular pathways have increased the arsenal against advanced renal cell carcinoma and improved the outcomes in the patients suffering from these affections. Studying the molecular signaling that controls the tumor growth and the progression has led to the development of molecular therapies targeting the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways, resulting in a significant improvement in the overall survival and quality of life. Sunitinib represents an inhibitor of VEGFR 1-3, c-kit, FLT-3 and PDGFR. We present the case of a patient with metastatic clear cell RCC with a treatment effect following sequential VEGF and mTOR inhibitor treatment. Under sunitinib treatment, the patient had a progression free survival (PFS) of approximately 9 months, similar to the PFS observed in clinical trials. Sunitinib was well tolerated by this patient. Temsirolimus, an mTOR inhibitor, is currently only approved for the first-line treatment of mRCC patients with poor prognosis. This study analyzes a treatment effect of second line temsirolimus in a patient with metastatic renal cell carcinoma (mRCC).

Histopathological Aspects Described in Patients with Hepatic Hydatidosis.

INTRODUCTION: Hydatidosis is a parasitic disease with tumour-like development of a cystic mass. This has specific endemic areas, Romania being amongst them. Our hospital has national addressability and the collaboration between the Departments of Parasitology, General Surgery and Pathology ensures optimal multidisciplinary approach to cases of therapeutic and diagnostic standpoint. The study aims to test the hypothesis that the gallbladder is a hydatid reservoir, to identify signs of biliary fistulas in the pericyst and liver parenchyma; to identify inflammation elements in the pericyst and the gallbladder. MATERIAL AND METHODS: The study is a retrospective observational one, carried out between 2011-2014, on a total of 35 patients operated for hepatic hydatidosis in the General Surgery Department of "Colentina" Clinical Hospital. All the selected patients had sent to the Pathology Department: gallbladder, cyst and pericyst. Statistical analysis of the data was performed using SPSS package Statistics 19. RESULTS: The main results of the study revealed no evidence to confirm the hypothesis that the gallbladder is a hydatid reservoir. Out of the 35 cases, in 16 we observed the tendency to include hepatic biliary ducts in the pericyst or the formation of new canals which lead to the formation of biliary fistulas. Using immunohistochemical techniques with mark of CK19 (cytokeratin 19), have been observed the pattern of fistulization and modification of local architecture through the formation of the pericyst, in 16/35 (45.7%) of cases. CONCLUSION: Although it is a benign pathology, the evolution of hepatic hydatidosis can lead to severe complications and a low quality of life for the patient, both before and after surgery. Better knowledge of the pathology behind the local evolution of the disease can influence the therapeutic approach.

Kyrle's Disease in a Patient with Delusions of Parasitosis.

Acquired perforating disorders are a group of uncommon skin conditions characterized by transepidermal extrusion of altered dermal material, most often associated with diabetes mellitus and chronic kidney failure. Delusional parasitosis is a primary psychiatric disorder in which affected patients have fixed, false beliefs that their skin is infested by parasites, in the absence of any evidence supporting their statements. A 69 year old malepatient addressed the Dermatology Department for a skin eruption consisting of multiple umbilicated keratotic papules with a generalized distribution. The patient believed that the lesions were produced by small parasites entering and exiting his skin. The histopathological examination confirmed the clinical diagnosis of Kyrle's disease. The psychiatric examination established the diagnosis of delusions of parasitosis. This is the first reported case of Kyrle's disease associated with delusions of parasitosis. There is no evidence supporting the hypothesis that delusions of parasitosis might be a predisposing factor for Kyrle's disease. However, we believe that the pruritic dermatosis might have triggered the delusions of parasitosis due to the associated pruritus. On the other hand the constant excoriations and traumatizing of a skin prone to develop idiopathic Kyrle's disease in the attempt to remove the parasites prevented the complete resolution of the lesions.

Single-centre epidemiological study on the incidence of hepatic hydatid cyst.

Echinococcosis is a parasitic disease caused by Echinococcus granulosus tapeworm through its larva infestation. Hydatid cyst has become a health problem interesting by the demographic changes in recent years. If until recently it was a disease of the pastors or breeders and animal lovers in rural areas, the increase in number of the stray animals in the streets of big cities has moved the curve incidence and prevalence of this disease onto the city. Worldwide pathology is prevalent in the Mediterranean, South America and Turkey. The present study examines patients admitted with the diagnosis of hydatid cyst in the surgery department of Colentina Clinical Hospital, Bucharest, across a period of six years. The results demonstrate that the incidence is higher among women (58%) than in men (41.3%). Also, statistical data processing shows that the prevalence/incidence is higher in urban areas compared to rural areas. We want the results of this research to lead to hypotheses that can be demonstrated by analytical studies, because, without fundamental knowledge provided by descriptive studies, it is almost impossible to ask about the aetiology and effects of treatments that can be used in the management of hydatid cyst.

The many faces of triple negative breast cancer.

Triple negative breast tumors are described by the lack of immunohistochemical expression for hormone receptors (ER and PgR) and Her2 neu. The immunophenotype is, in general,associated with young age and high biological aggressiveness,its frequency in the literature ranging from 10 to 20%. In our study we performed a retrospective classification of triple negative breast cancers in order to show the large spectrum of lesions that can embrace this very special phenotype.Clinicopathological parameters evaluated included age, tumorsize and macroscopic appearance, histological subtype and association with in situ component, the degree of tumor differentiation (nuclear pleomorphism, mitosis count, the formation of tubules), presence of lymph nodes or distant metastases. Triple negative breast cancers represent a particular subtype of tumors but their, now famous, aggressiveness applies only to some histological subtypes. It is very important to correlate the histological features and the phenotypical expression.

Biological prognostic parameters in gastric carcinomas.

Gastric cancer is the second leading cause of cancer mortality worldwide. (1) Gastric carcinogenesis involves a variety of factors including diet, habitual factors as well as environmental factors. (2,3) This study aimed to correlate clinicopathological parameters of the cases studied and PCNA and p53 expression using immunohistochemistry. The study group included a total of 32 patients that underwent gastrectomy for gastric cancer.The study parameters were represented by epidemiological aspects (age, sex), clinical characteristics (signs and symptoms),histopathological findings (pTNM staging and degree of differentiation, histological classification, lymph nodes status and presence of vascular invasion) and survival, and immunohistochemical analysis (p53 and PCNA expression) of the study group. Histopathological study showed that most of the cases(26 cases) were of the intestinal type and 6 cases of the diffuse type. Immunohistochemical analysis of p53 protein expression showed an average of 20.75% positive cells, while PCNA expression showed an average of 47.3%. In terms of survival there were 6 cases of death at intervals ranged from 2-189 days,5 cases had subsequent presentations over 12 months, while 8 patients were lost to follow-up. At the time of surgery, 6 patients had distant metastases, while 6 more developed them in a period of 2-12 months after surgery. Identification of biomolecules that highlight potentially aggressive tumors may help modulate the therapeutic approach after surgical resection.

Photodynamic therapy in the treatment of basal cell carcinoma.

Photodynamic therapy (PDT) is a medical procedure based on the activation of the molecules of various exogenous or endogenous chemical substances called photosensitizers by a light source emitting radiation of an adequate wavelength, usually situated in the visible spectrum; photosensitizers are chemical compounds bearing the capacity to selectively concentrate in the neoplastic cells. The energy captured by the molecules of these substances pervaded in the tumor cells is subsequently discharged in the surrounding tissue, triggering certain photodynamic reactions that result in the destruction of the tumor. The procedure is applicable in numerous medical fields. Skin basal cell carcinoma (BCC), the most frequent type of cancer of the human species, is a cutaneous tumor that responds very well to this innovative treatment method. By reviewing numerous recent studies in the field, this article aims to present the role and the indications of photodynamic therapy in the management of basal cell carcinoma, as well as the most important results achieved so far by this therapy in the field of dermato-oncology.

A primary hydatid cyst in the abdominal wall -- case report.

INTRODUCTION: A solitary primary hydatid cyst in the abdominal wall is an exceptional entity, even in countries where the Echinococcus infection has a high rate, being considered an endemic disease. CASE PRESENTATION: We report a case of a 70-year-old Caucasian man who presented to our clinic with a slow-growing painless parietal mass in the abdominal wall, right flank area. The diagnosis of cystic mass was established at the ultrasound exam. There were no findings that could describe a hydatic cyst. The punction at the surgical intervention revealed a "clear, stone liquid like"; due to the high risk of major injury of the abdominal wall, we performed partial resection of the outer cystic wall, proligerous membrane removal and drainage. The patient had an uneventful post-operative recovery. The histopathology confirmed the suspected diagnosis. CONCLUSION: Hydatid cyst should be considered in the differential diagnosis of every abdominal intraparietal cystic mass, especially in regions where the disease is endemic. The best treatment is the total excision of the cyst preserving an intact wall (complete cystectomy). Otherwise, removing the proligerous membrane with partial pericyst's resection (partial pericystectomy) and drainage should be considered.

Giant testicular tumor--a case presentation.

BACKGROUND: Testicular cancer is the most common cancer in men 15 to 35 years old. Histological subtypes are seminoma, non-seminoma and mixed tumours (partly seminoma and partly non-seminoma). Seminomas are more sensitive to radiation therapy and are easier to cure than non-seminomas. The surgical treatment is either orchiectomy, either orchiectomy plus lymph node dissection of the involved ganglia. CASE PRESENTATION: We present the case of a 42-year-old man with scrotal pain, important swelling and erythema admitted into our surgical unit. Clinical exam and ultrasound revealed a testicular augmentation of 6/15 cm. Radical orchiectomy was performed and the patient was further referred to the oncology department. CONCLUSIONS: Even though the common causes of scrotal erythema with local swelling and pain are orchiepididimitis and testicular torsion, a careful examination followed by a precise ultrasound can reveal a developing testicular tumor, which was complicated by inflammation. Moreover, a careful anamnesis hints to the development of a tumor as the patient was operated on for cryptorchidism in childhood. Orchiectomy followed by radiotherapy in seminomas, has a cure rate of 70 to 100%.

Evaluating the treatment of metastatic colorectal cancer with monoclonal antibodies.

The ability to tailor biologic therapy based on the status of tumor biomarkers and monoclonal antibodies has become very important in the last years. The role of tumor biomarkers in treating colorectal cancer, specifically the K-RAS gene, was identified. K-RAS had a higher interest after Lievre and colleagues reported at the 2008 American Society of Clinical Oncology (ASCO) meeting, their analysis of K-RAS mutations in tumors from patients who did not appear to benefit from cetuximab therapy, providing additional data involving K-RAS mutant tumors and their lack of response to cetuximab, as part of first-line therapy for metastatic colorectal cancer. Furthermore, other trials evaluated the K-RAS status and the first-line treatment of metastatic colorectal cancer, the treatment of refractory metastatic cancer and dual-antibody therapy in the first-line treatment of colorectal cancer. Patients with mutant K-RAS colorectal tumors have no benefit from cetuximab, no matter the type of chemotherapy regimen.

Pancreatogenic diabetes pacient selection for pancreatic islet transplantation.

BACKGROUND: recently, insulin-dependent diabetes mellitus, can be treated by pancreatic islet allotransplantation. METHODS: This retrospective study involves 137 patients from the Surgery Department of Colentina Clinical Hospital, Bucharest, in the July 2000 - July 2008 period, who underwent pancreatic resections, the number of patients who developed pancreatogenic diabetes and their selection for the pancreatic islet transplantation. RESULTS: After pancreatectomy, 70 patients are diagnosed with diabetes, and 42 with prediabetic stages (IFG and IGT). 61 of these had average glycemic excursions (MAGE) over the normal, and 31 of the 70 patients diagnosed with diabetes, presented hypoglycemic episodes during treatment. CONCLUSION: The present criteria of patient selection for pancreatic islets transplantation are limited and can be applied to a small number of patients.