Pancreatoduodenectomy for pancreatic cancer in a low volume institution.

PURPOSE: To report the patient morbidity and mortality rates following pancreatoduodenectomy (PD) carried out in our low volume institution, and compare our results with results from other high volume institutions. METHODS: A retrospective analysis was conducted on patients with pancreatic malignancies surgically treated with PD from 2005 to 2010 in our institution. Data were collected with particular emphasis on morbidity and mortality rates. All patients were followed from the date of discharge to the date of death or status at the last follow-up (July 2011). RESULTS: In a period of 5 years 42 patients underwent PD. Morbidity rates were as follows: 11.9% wound infections, 21.4% pancreatic fistulae, 23.8% delayed gastric emptying (DGE), 14.3% hemorrhage, and 7.1% biliary leak. Two patients required re-laparotomy one for delayed hemorrhage and one for sepsis. The mortality rate was 7.1%. The 2-year survival rate was 45.17 percent; and the median survival 22 months. CONCLUSION: PD in our low volume institution had high morbidity and mortality rates compared with results published in the literature. There is a need, however, to establish a policy for referral of patients with pancreatic cancer to other centers with a higher number of resections, in order to decrease morbidity and mortality rates.

Expression of pSTAT3 in human colorectal carcinoma: correlation with clinico-pathological parameters.

PURPOSE: Signal transducers and activators of transcription (STATs) are tyrosine phosphorylated transcription factors activated by the Jak family kinases. Various ligands, including interferons and growth factors induce activation of STATs. STATs are key signaling molecules in malignant transformation and tumor progression. Constitutive activation of the STAT3 has been observed in a wide variety of human malignancies. The purpose of this study was to evaluate the clinical significance of phosphorylated (p) STAT3 expression in human colorectal adenocarcinomas (CRC). METHODS: 135 primary human CRC were immunohistochemically studied, from which 11 were intramucosal and 124 invasive carcinomas. The observed pattern of pSTAT3 immunostaining was nuclear and cytoplasmic. Nuclear pSTAT3 staining was calculated as the number of pSTAT3 positive nuclei divided by the total number of nuclei in at least 10 fields, and then expressed as a percentage. Cytoplasmic positivity of pSTAT3 was measured, depending on the intensity of immunoreactivity and scored as mild, moderate and intense. RESULTS: Positive staining for pSTAT3 immunoreactivity was significantly correlated with the depth of tumor invasion (p<0.001), venous invasion (p<0.05), lymph node metastasis (p<0.05) and advanced Dukes stage (p<0.001). There was no significant correlation between pSTAT3 immunoreactivity and poor differentiation of CRC. CONCLUSION: The expression of pSTAT3 is an important factor related to tumor and vascular invasion, nodal involvement and advanced CRC stage.

Malignant gastrointestinal stromal tumor of the ampulla of Vater presenting with obstructive jaundice.

Malignant gastrointestinal stromal tumor (GIST) consists a rare neoplasm, developing in small intestine and stomach. The presenting manifastations include weakness, weight loss, nausea, melena and anaemia. The present case refers to a 65 years old female patient with a GIST of the ampulla of Vater presenting with obstructive jaundice. Diagnosis was achieved pre-operatively by biopsies collected through diagnostic ERCP. The tumour was locally excised, with preservation of the ampulla. The histological analysis suggested low grade GIST positive for both CD 117 (c-kit) and CD34. Two years after the surgery the patient remains free of disease. Malignant GIST of the ampulla of the Vater is extremely rare as only few similar cases have been described in the literature. This is the first time a GIST being presented as obstructive jaundice ever reported. Despite the unavailability of EUS-FNA, the diagnosis was set preoperatively and the tumor was resected.

Alternative interventional multimodality therapies for the management of liver malignancies.

Primary and secondary liver tumors are highly malignant with a very high morbidity and mortality. Although surgical resection is generally accepted as the mainstay of treatment, only a small number of patients are suitable for curative resection. Interventional multimodality therapies provide an alternative to liver resection with minimal morbidity and mortality and quite promising outcomes. These include transcatheter arterial chemoembolization (TACE), percutaneous ethanol (PEI) or other injection techniques, radiofrequency ablation (RFA), microwave coagulation therapy (MCT), cryoablation and interstitial laser photocoagulation (ILP). Techniques, indications and outcomes are discussed.

Localized unilateral perirenal fibrosis: CT and MRI appearances.

We report a rare case of localized perirenal retroperitoneal fibrosis (RPF) in a woman presenting with anemia. The increased diagnostic capabilities and imaging characteristics of CT and MRI are emphasized. Extensive search through the literature revealed that perirenal distribution of RPF has been reported in eight cases, being unilateral in only three.

Mixed (composite) glandular-endocrine cell carcinoma of the gallbladder.

BACKGROUND: A mixed pattern of glandular and neuroendocrine elements is rare in tumours at any site within the gastrointestinal tract but particularly so in the gallbladder. CASE OUTLINE: A 72-year-old woman presented with abdominal pain and jaundice and was found to have a large mass in the fundus of the gallbladder.The mass was radically excised to include a wedge of liver and the hepatoduodenal lymph nodes. Histopathological examination of the resected gallbladder showed an invasive tumour composed of both adenocarcinoma and endocrine cell carcinoma, with apparent transitions between them. The patient received no further treatment and died two months later. DISCUSSION: There are 14 previous case reports of mixed adeno/endocrine carcinoma of the gallbladder. Histochemical similarities between the two neoplastic components of the present tumour would support their origin from a common precursor cell, but the alternative hypothesis of coincidental neoplastic change in two different cell types cannot be excluded.

Residual nodal disease after excisional biopsy of a palpable, positive node in melanoma.

The medical records of 365 patients with the diagnosis of malignant melanoma who underwent axillary (n = 210) or groin (n = 155) dissection at a cancer referral center were reviewed. Sixty-one patients were referred after excisional biopsy of a palpable, histologically positive node. After node dissection, 75% of these patients were found to have additional, microscopically involved nodes, which confirms the advisability of node dissection after biopsy of a positive regional node.

Expression of HLA class I antigens in sporadic adenomas and histologically normal mucosa of the colon.

The loss of HLA antigens by neoplastic cells is considered important for tumor growth and metastasis, inasmuch as it may allow tumors to escape immune surveillance. We have observed reduced expression of HLA antigens in sporadic colon cancer and adenomas from familial adenomatous polyposis patients. We now studied the expression of HLA class I antigens in patients with sporadic adenomas, which are precursors of colorectal cancer. Expression of HLA class I antigens was studied by immunohistochemistry in (a) sporadic colon adenomas, (b) histologically normal mucosa distant from the adenomas, (c) histologically normal colonic mucosa from patients with history of sporadic colon adenomas, and (d) colonic mucosa from normal subjects. HLA class I antigen expression was moderately reduced in 56% and severely reduced in 44% of the adenomas; this reduction was significant when compared to controls (P < 0.0001). The reduction of HLA class I expression in adenomas was related to the grade of dysplasia of the adenomas. HLA class I expression of normal appearing mucosa was decreased in 76% of patients with adenoma (P < 0.0001) and in 54% of patients with history of adenoma (P < 0.005) compared to normal controls. These changes were antigen specific, inasmuch as the expression of carcinoembryonic antigen, a surface antigen, was not affected. Our findings suggest that reduced HLA class I expression is an early event in the cell transformation process from normal to neoplastic state, preceding in many cases the onset of histological changes. HLA class I could be potentially used as a premalignant marker in the colon.

Influence of cation markers on sulfate distribution in mouse gastrocnemius muscle.

Further studies are reported which examines the influence of fixed negative sites on anion distribution in the interstitium of mouse gastrocnemius muscle. For this purpose, the 35S-sulfate distribution in in vitro muscles was examined in the absence and presence of a number of cations which are thought to bind to the interstitial fixed negative sites. Each of the cation treated muscles gave sulfate space measurements which were statistically greater than the control muscles. Ferritin, spermidine and ruthenium red treatment resulted in muscle sulfate spaces similar to the true morphometric ECV. This study suggests that the fixed negative sites in the interstitium of mouse gastrocnemius muscle exists in sufficient density to influence the distribution of anions in these tissue.