Lymphoepithelioma-Like Carcinoma of the Urinary Bladder: A Case Report and Review of the Literature.

Lymphoepithelioma-like carcinoma of the urinary bladder is a rare variant of infiltrating urothelial carcinoma. Diagnostic and therapeutic manipulations are not yet standardised, due to the rarity of the tumour, with surgery and chemotherapy being reported as potential therapeutic options. We report on a case of lymphoepithelioma-like carcinoma of the bladder in a 93-year-old female patient and discuss the pathological features and therapeutic options of the neoplasm. Due to her increased age and associated comorbidities such as hypertension, diabetes mellitus and ischemic heart disease, the patient was treated with transurethral resection of the tumour and subsequent cisplatin-based chemotherapy but unfortunately died of chemotherapy-related complications.

New considerations for colorectal cancer screening based on the demographic profile of colorectal cancer in a Greek population.

Colorectal cancer screening has long been recommended for middle age and older individuals. Recent evidence indicates increasing incidence and mortality among young adults. Therefore, the present study re-examined the current recommendations using an asymptomatic average-risk population screened by colonoscopy. A total of 716 participants of a wide age range were prospectively enrolled in an open-access endoscopic screening program based on self-referral. Comparisons between different age, gender and location groups, and receiver operating characteristic curves (ROC) curves for best age selection for detection of lesions were employed. Increased incidence of advanced lesions was observed in adults <50 years old. Although the polyp size was <1 cm in 85% of the cohort, a significant number of participants harbored advanced lesions. A disturbing incidence of lesions in women 30-49 years was located mainly in the left colon. One-third of the important pathology resides exclusively in the right colon. ROC curves demonstrated that with the current starting age of screening at 50 years, 92% of polyps and 95% of adenomas could be detected by colonoscopy, but a number of potential precancerous lesions will appear at an earlier age and therefore will be missed. The present study supported the notion that it is critical to reduce screening initiation below the currently accepted age of 50 years. Colonoscopy is a suitable method for addressing the increased prevalence of proximal lesions and the meticulous resection of smaller polyps.

Left Lateral Cervical Mass with Draining Sinuses.

The aim of the present study is to describe an uncommon case of tuberculous lymphadenitis (TL) in a symptomless 89-year-old male smoker patient, who presented at the emergency department of our hospital with left lateral cervical swelling with draining sinuses. No other clinical symptoms or physical findings were observed at admission. An elevated erythrocyte sedimentation rate (ESR) and a small calcified nodule in chest CT were the only abnormal findings. Pus samples from sinuses were examined and confirmed tuberculosis which was in agreement with surgical pathology of lymph nodes. A four- (4-) drug antituberculous regimen was administered. After an initial remission of his symptoms, the patient presented an exacerbation of the cervical swelling with draining sinuses necessitating addition of oral steroids. TL can be symptomless presenting a paradoxical reaction during treatment. The uniqueness of our case lies in the patient's advanced age, which is uncommon with cervical lymphadenopathy as a form of extrapulmonary tuberculosis, as well as in the administration of oral steroids to resolve the neck's clinical deterioration. The patient had a complete recovery and was free of disease after completion of his six-month antituberculous chemotherapy.

Right Upper Lobe Shadow and Tracheobronchopathia Osteochondroplastica Confined to Right Main Bronchus: A Case Report and Literature Review.

Tracheobronchopathia osteochondroplastica (TO) is a well documented benign entity of endoscopic interest. We describe a case of 76-year-old patient who presented with fever, cough, purulent sputum during the past four days, and presence of an ovoid shadow in right upper zone of his chest X-ray. Medical history included diagnosis of colon diverticuli identified by colonoscopy 3 months ago. Chest CT revealed a compact elongated lesion containing air-bronchogram stripes. Bronchoscopy showed normal upper airways and trachea but presence of unequal sized mucosal nodules, protruding into the lumen, along the entire length of the right main bronchial mucosa. No other abnormal findings were detected. Moreover, brushing and washing smears from the apical segment of right upper lobe (RUL), where the compact lesion was located, were negative for malignancy. Biopsy from the mucosal nodules of right main bronchus showed presence of cartilaginous tissue in continuity through thin pedicles with submucosal cartilage. This finding posed the diagnosis of TO while RUL lesion was cleared by antibiotic treatment. Case is reported because, to our knowledge, it represents a unique anatomic location of TO which was confined exclusively in the right main bronchus mucosa without affecting trachea.

MCM proteins as diagnostic and prognostic tumor markers in the clinical setting.

Minichromosome maintenance (MCM) proteins are essential for the process of DNA replication, functioning as license components for the S-phase of cell-cycle initiation and further exerting weak helicase activity to unwind DNA from its supercoiled state at replication forks. The requirement for MCM proteins in cycling cells and their absence in quiescent ones supports evidence for their potential clinical application as cell proliferation markers. In the last few years, aside from their utility as cell proliferation markers, the assessment of MCM expression levels in diverse human malignancies has been the focus of extensive research in an aim to facilitate tumor diagnosis and prognosis in clinical settings. The present article aims to review the available data so far concerning the clinical significance of MCM protein expression in human neoplasia in comparison to conventional proliferative markers. A review of the literature revealed that MCM expression is associated with important clinicopathological parameters for patient management and also exhibits significant diagnostic and prognostic value in several malignancies. MCMs are characterized by higher specificity and sensitivity than the conventional proliferative markers, such as Ki-67 and PCNA, and are thus considered as diagnostic and prognostic tools of greater clinical significance in several types of human malignancy.

Acute limb ischemia in a patient with cardiac amyloidosis: a case report.

INTRODUCTION: Cardiac amyloidosis is a manifestation of several systemic diseases known as amyloidoses. Arterial thromboembolic complications have not been reported to occur frequently, although the pathophysiology of cardiovascular amyloidosis would theoretically predispose to such manifestations. CASE PRESENTATION: We present the case of a 52-year-old woman, who suffered from cardiac amyloidosis and was admitted to our hospital for left acute limb ischemia. An urgent embolectomy was performed, improving her clinical condition and the pathologoanatomic examination of the embolus revealed deposition of amyloid. CONCLUSION: Peripheral arterial thromboembolic events in patients with amyloidosis are rare. An antiplatelet treatment is recommended in such patients with cardiac amyloidosis for the prevention of embolism.

Heat Shock Protein-27, -60 and -90 expression in gastric cancer: association with clinicopathological variables and patient survival.

BACKGROUND: Heat shock proteins (HSPs) are ubiquitous, highly conserved proteins across all the species and play essential roles in maintaining protein stability within the cells under normal conditions, while preventing stress-induced cellular damage. HSPs were also overexpressed in various types of cancer, being associated with tumor cell proliferation, differentiation and apoptosis. The aim of the present study was to evaluate the clinical significance of HSP -27, -60, and -90 expression in gastric carcinoma. METHODS: HSP -27, -60, and -90 proteins expression was assessed immunohistochemically in tumoral samples of 66 gastric adenocarcinoma patients and was statistically analyzed in relation to various clinicopathological characteristics, tumor proliferative capacity and patients' survival. RESULTS: HSP-27, -60, -90 proteins were abundantly expressed in gastric adenocarcinoma cases examined. HSP-27 expression was significantly associated with tumor size (pT, P = 0.026), the presence of organ metastases (pM, P = 0.046) and pStage (P = 0.041), while HSP-27 staining intensity with nodal status (pN, P = 0.042). HSP-60 expression was significantly associated with patients' sex (P = 0.011), while HSP-60 staining intensity with patients' age (P = 0.027) and tumor histopathological grade (P = 0.031). HSP-90 expression was not associated with any of the clinicopathological parameters examined; however, HSP-90 staining intensity was significantly associated with tumor size (pT, P = 0.020). High HSP-90 expression was significantly associated with longer overall survival times in univariate analysis (log-rank test, P = 0.033), being also identified as an independent prognostic factor in multivariate analysis (P = 0.026). CONCLUSION: HSP-27, -60, and -90 were associated with certain clinicopathological parameters which are crucial for the management of gastric adenocarcinoma patient. HSP-90 expression may also be an independent prognostic indicator in gastric adenocarcinoma patients.

Expression and clinical significance of focal adhesion kinase in the two distinct histological types, intestinal and diffuse, of human gastric adenocarcinoma.

Focal adhesion kinase (FAK), a non-receptor tyrosine kinase protein, acts as an early modulator of integrin signaling cascade, regulating basic cellular functions. In transformed cells, unopposed FAK signaling has been considered to promote tumor growth, progression and metastasis. The aim of this study was to assess the clinical significance of FAK expression in the two distinct histological types of human gastric neoplasia. FAK expression was assessed immunohistochemically in tumoral samples of 66 gastric adenocarcinoma cases, 30 intestinal and 36 diffuse type, and was statistically analyzed in relation to various clinicopathological characteristics, tumor proliferative capacity and patients' survival. In intestinal type carcinomas, enhanced FAK expression was significantly associated with increased tumor proliferative capacity (P = 0.012). In diffuse type carcinomas, FAK staining intensity was significantly correlated with tumor size (P = 0.026) and disease stage (P = 0.024), presenting also a borderline association with nodal status (P = 0.053). In diffuse type carcinomas, enhanced FAK expression was significantly associated with longer overall survival times (log-rank test, P = 0.014), being also identified as an independent prognostic factor in multivariate analysis (Cox regression, P = 0.016). In contrast, patients with intestinal type tumors and enhanced FAK expression were characterized by shorter overall survival times, without though reaching statistical significance (log-rank test, P = 0.092). The current data support evidence that FAK protein may be considered as a diagnostic and prognostic marker in gastric neoplasia. Further studies conducted on larger clinical samples and highlighting on the distinct impact of the two histological types are warranted to delineate the clinical significance of FAK protein in gastric neoplasia.

Immunohistochemical evaluation of immune response in invasive ductal breast cancer of not-otherwise-specified type.

We investigated endotumoral and peritumoral lymphocytic subsets [natural killer cells (NK), B-cells and cytotoxic/suppressor (CD(8)+) T-cells], and expression of MUC1 and MUC6 glycoprotein with regard to various clinicopathological parameters in invasive breast cancer tissues. The study population consisted of 64 female patients with invasive ductal breast cancer of not-otherwise-specified type. Thirty-five women with benign breast lesions served as controls. High-grade carcinomas exhibited higher numbers of endotumoral NK cells and B-cell aggregates than the rest of the tumors examined (P=0.0003 and 0.027, respectively). Cases with more than three positive lymph nodes and with tumors over 2 cm in diameter exhibited higher numbers of endotumoral NK cells (P=0.047 and 0.023, respectively). Increased numbers of peritumoral CD(8)+ T-cells were detected in cases with lymph node metastases (P=0.045). MUC1 was expressed with weaker staining intensity in the control group than in the group with breast cancer (P=0.011). Grade III carcinomas exhibited significantly stronger expression of MUC6 glycoprotein (P=0.001) than the control group. In conclusion, tumors with markers of poor prognosis exhibited increased numbers of lymphocytic infiltrates, and of NK cells in particular, and stronger MUC1 and MUC6 glycoprotein immunoreactivity than did the other tumors.