Another case of coincidental Giardia infection and pancreatic cancer.

Until now, few cases of coincidental giardiasis and pancreatic tumors have been described. Among these cases, three described giardiasis cases coincided with confirmed pancreatic cancer. We present another case of Giardia infection coexisting with pancreatic cancer in a 67-year-old man who suffered from stenosis of the distal ductus choledochus combined with a hypoechoic mass in the head of the pancreas. The diagnostic conclusion of suspicious adenocarcinoma was based on endoscopic ultrasound fine-needle aspiration (EUS-FNA) biopsy and confirmed by a partial duodenopancreatectomy. On bloody cytology smears prepared from the EUS-FNA specimen, trophozoites of Giardia intestinalis accompanying an inflammatory background and features that fulfilled the morphological criteria of malignancy were observed. In histological sections from the duodenopancreatectomy specimens, the parasites were observed attached to the epithelium, but individual Giardia parasites were also observed beneath the epithelial lining. According to conventional genotyping, the infecting Giardia belonged to sub-assemblage AII.

NOD2/CARD15 mutations and the risk of reoperation in patients with Crohns disease.

INTRODUCTION: Three NOD2/CARD15 gene variants (3020insC, R702W, G908R) have been identified as genetic risk factors for Crohns disease patients. However the diagnostic and therapeutic relevance for clinical practice remains limited. The aim of this study was to evaluate the association between these variants, the risk of reoperation and disease phenotype. METHODS: In 76 Crohns disease patients (41 female, 35 male) with a minimum 5 year follow-up, three polymorphisms of the NOD2/CARD15 gene (R702W, G908R, 3020insC) were tested. Detailed clinical and medical history including surgical procedures and reoperations were obtained by reviewing the medical charts and completed prospectively. Association between the need for reoperation, disease phenotypes and gene variants were analyzed. RESULTS: 24 patients (32%) showed at least one NOD2/CARD15 mutation. 25 patients (33%) required reoperation, 51 (67%) represented the control group. The expected trend that patients with NOD2/CARD15 variants have a higher frequency of reoperations was not confirmed to a level of statistical significance (p=0.2688). Two of the four patients (50%) with the 3020insC variant required further surgery. We did not confirm any association between NOD2/CARD15 mutations and age at diagnosis (p=0.4356), behavior (p=0.6610), or localization (p=0.4747) according to the Montreal classification. CONCLUSION: NOD2/CARD15 polymorphisms did not significantly affect the reoperation rate. Homozygosity for the 3020insC variant in the NOD2/CARD15 gene is associated with a high risk of reoperation. NOD2/CARD15 gene variants are not significantly associated with specific disease phenotypes.

Differentiating autoimmune pancreatitis from pancreatic cancer.

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer can be very difficult. The main clinical symptoms in patients with autoimmune pancreatitis are jaundice, weight loss, abdominal pain and new onset of diabetes mellitus. Unfortunately, the same symptoms could be observed in patients with pancreatic carcinoma too. Imaging methods as computed tomography (CT) scan, magnetic resonance imaging (MRI) and endosonography (EUS); together with serological examination (IgG4 and Ca 19-9) play the important role in differentiation autoimmune pancreatitis from pancreatic cancer. Extrapancreatic findings are distinctive in patients with autoimmune pancreatitis. In some cases the pancreatic biopsy is indicated, mainly in patients with focal or multifocal form of autoimmune pancreatitis. Response to steroids (decreased pancreatic or extrapancreatic lesion or damage) is distinctive to AIP. In clinical practice, CT scan seems to be the most reasonable tool for examining the patients with obstructive jaundice with or without present pancreatic mass. Stratification the patients with possible AIP versus pancreatic cancer is important. In patients with AIP it may avoid pancreatic resection, as well as incorrect steroid treatment in patients with pancreatic carcinoma.

Coincidence of chronic lymphocytic leukaemia with Merkel cell carcinoma: deletion of the RB1 gene in both tumors.

The authors report a case of a 64-year-old man with chronic lymphocytic leukaemia (CLL) diagnosed 5 years ago. Recently, the patient was admitted with a tumour of the skin in the left lumbar region. Histological and immunohistochemical examinations established the diagnosis of Merkel cell carcinoma (MCC). Electron-microscopic examination revealed the formation of spherical aggregates of intermediate-sized filaments in the perinuclear region. The coincidence of MCC and CLl is rather rare and in published cases, no cytogenetic examinations were performed. We examined the RB1 gene using the interphase FISH method. A biallelic deletion in CLL tumour cells was detected; in MCC tumour cells, biallelic deletion was found in 33% of the cells and monoallelic deletion in 57% of the cells. In addition, chromosome 6 trisomy and 1p36 deletion were detected. Examination of non-neoplastic cells of the patient's skin showed a biallelic presence of the RB1 gene. According to the relevant literature, examination of the RB1 gene in CLL has informational value as a prognostic factor. The relationship between deletion of the RB1 gene and prognosis in MCC has not yet been determined and needs more research.

A molecularly genetic determination of prognostic factors of the prostate cancer and their relationships to expression of protein p27kip1.

Loss of a part of chromosome 8p22, containing the gene LPL and amplifications of the field 8q24 comprising the c-myc oncogene are the most frequent chromosomal aberrations in prostate cancer. We aimed to find the frequency of these chromosomal abnormalities and assess their relationship to the prognosis of prostate cancer patients in relation to Gleason score and expression of p27Kip1. We chose a subgroup of 17 monitored patients who had died during five years following diagnosis, and a group of 31 surviving patients whose Gleason score exceeded 5 (Group of Gleason score 2-3). Owing to lack of tumor cells in puncture biopsies, we made hybridizations in situ and objectively evaluated the result in 35 patients out of 48. Amplification in the field for oncogene c-myc was found in 19 cases (54.2%), in 15 of these (78.9%) polyploidy of the chromosome 8 was also confirmed. Deletion of a part of chromosome 8p22 was found in 21 cases (60%). Normal findings were shown in 8 cases (22.8%) and genetic abnormalities were revealed in 27 patients (77.2%). A Chi-squared test showed the dependence of Gleason score on amplification of the c-myc gene in nonmetastasing prostate cancer. In the case of a Gleason score of group 3, abnormalities in amplification of c-myc were statistically more significant than a Gleason score of group 2 using significance according to the Fisher Exact Probability test (p=0.039). We showed that the level of expression of protein p27 Kip1 was related to abnormality of amplification of the c-myc gene. We also came to the conclusion that decreased expression of protein p27 Kip1 is related the c-myc amplification.

[The molecular genetic assessment of prognostic factors in carcioma of the prostate: a pilot study]. / Problematika molekulárne genetického stanovení prognostických faktortu u karcinomu prostaty: pilotní studie.

The loss of the 8p22 chromosome part and amplification of the 8q24 region (c-myc oncogene region) are the most frequent chromosomal aberrations observed in prostate carcinoma. We aimed to demonstrate the frequency of these chromosomal abnormalities and to assess how they correlate with the prognosis in patients with prostate carcinoma. From a set of 130 patients, we selected a group of 17 who died within five years after the diagnosis had been determined. Due to the lack of tumor cells in puncture biopsies, we managed to carry out in situ hybridization and assess the result objectively for 9 patients only. In seven cases, amplification of the region for c-myc oncogene was found; however, in five of them, polyploidy of chromosome 8 was manifested simultaneously. Deletion of the 8p22 chromosome part (region for the LPL gene) was found in five cases. A normal finding was detected in two cases. However, the analysis was carried out on a small number of cells gained from paraffin slices, so it was impossible to meet the requirement to examine 300 interphase cell nuclei. Therefore, we recommend to always determine whether the material taken is representative enough for this methodology and whether the tissue fixation is not inadequate or insufficient.

[Immunohistochemical detection of HER2 protein and its evaluation in breast carcinoma: comparative study of two methods (HercepTest DAKO versus the routine immunohistochemical approach with the DAKO polyclonal antibody) and the results from two laboratories]. / Imunohistochemický (IHC) prukaz HER2 proteinu a jeho hodnocení u nemocných s karcinomy mlécné zlázy: srovnávací studie dvou pracovních postupu (HercepTest DAKO versus bezný IHC postup s polyklonální protilátkou DAKO) a výsledku dvou pracovist.

Routine assessing of HER2 status is necessary for successful treatment of carcinoma of breast by Herceptin. Our results prove comparability of well standardized semiquantitative method by Hercep Test DAKO: both negative findings (73.4% in laboratory A, and 77.4% in laboratory B) and positive findings (26.6% in laboratory A, and 22.6% in laboratory B) corresponded both with each other and with the DAKO's reference data. The study also testifies to problems with interpretation of the IHC data (primary antibody c-erbB-2-oncoprotein DAKO). The problems concern particularly the processing standards, the dilution of antibodies, the application of IHC automatic machine, and probably also the detection system. It is suggested that each laboratory develops a standardized IHC protocol, in coordination with other laboratories. Thus, standardization of both processing and evaluation of the results will be achieved. As the indication for treatment by Herceptin is connected with HER2 overexpression, it is suggested to follow the algorhythm of HER2 examination presented by Nenutil at the ROCHE Satellite symposium.