[The importance of pre-operative MRI-detected extramural vascular invasion in the treatment of rectal carcinoma]. / Význam predoperacne zjistené extramurální vaskulární invaze v lécbe karcinomu rekta.

INTRODUCTION: Extramural vascular invasion (EMVI) is associated with a poor prognosis in patients with rectal carcinoma. Patients with proven vascular invasion have a shorter progression-free survival and overall survival. Until recently, vascular invasion had been identified primarily by pathologists. Currently, EMVI can be detected preoperatively by magnetic resonance imaging used for rectal cancer staging. Our study aimed at verifying the effect of pre-operative EMVI detection on PFS after resection and comparing this interval (PFS) to the group of patients with vascular invasion identified and confirmed by pathologists. METHODS: Patients who underwent surgery for rectal carcinoma at our Surgical Department in the years 20122016 were included in the group and were followed for local recurrence or systemic progression of the disease. The median follow-up was 36 months. In this group, we then retrospectively evaluated MR EMVI and at the same time the presence of tumor vascular invasion from the resected specimen. The relationship of both prognostic markers to PFS was compared. RESULTS: Tumor vascular invasion as well as positive extramural vascular invasion on MRI found preoperatively in our group had a statistically significant negative effect on the progression-free survival compared to the group without evidence of EMVI or vascular invasion. CONCLUSION: Positive extramural vascular invasion found on MRI during rectal cancer staging is associated with a poor prognosis. It is one of the prognostically negative factors and referral of these patients for outpatient care should receive special attention because even after radical resection with a negative resection line there is a risk of early progression of the disease.Key words: rectal carcinoma extramural vascular invasion - progression-free survival.

Extensive Al amyloidosis presenting with recurrent liver hemorrhage and hemoperitoneum: case report and literature review.

BACKGROUND: Spontaneous hepatic bleeding is a rare but potentially life-threatening complication of primary systemic amyloidosis. Although the liver is a common site of amyloid deposition, clinical presentation is usually mild or absent. CASE: We report a case of a female patient, who had been repeatedly surgically revised because of liver rupture and hemoperitoneum. Initially, the computed tomography finding was interpreted as liver hemangioma. However, based on liver biopsy, the diagnosis had to be changed to primary systemic amyloidosis, and the patient was referred to our hematooncology department. Due to a considerably advanced disease, the patient was eligible only for palliative chemotherapy with cyclophosphamide and dexamethasone, which could not deflect the course of rapidly progressing liver destruction. CONCLUSION: The cause behind ruptured and bleeding liver does not always need to be hemangioma but rather amyloidosis. In cases of advanced disease and in patients with contraindications for aggressive treatment, the outlook for complete hematological and organ treatment response is very limited. An early diagnosis is of utmost importance. Although liver biopsy brings the definite results, screening for monoclonal protein in serum or urine, leading to a search for AL amyloidosis, may be sufficient for diagnosis. The presence of some of the warning signs (B-symptoms such as fevers or subfebrile temperatures, fatigue, weight loss; and paraneoplastic laboratory findings such as elevated C-reactive protein and erythrocyte sedimentation rate) should raise suspicion of a lymphoproliferative disease.

[Molecular biological diagnostics of KRAS and BRAF mutations in patients with colorectal cancer - laboratory experience]. / Molekulárne biologická diagnostika mutací genu KRAS a BRAF u pacientu s kolorektálním karcinomem - zkusenosti laboratorního pracoviste

BACKGROUND: Targeted biological therapy based on blocking growth factor receptors and inhibition of cancer-inducing signaling pathways is a new treatment facility for patients with colorectal cancer (CRC). Therapeutic agents are monoclonal antibodies targeting epidermal growth factor receptor (EGFR). Gene aberrations in the EGFR-induced pathways are negative predictors of therapeutic response. Determination of -non-mutated KRAS is a requirement for the indication of targeted anti-EGFR therapy in the present time, BRAF mutation analysis is recommended. Comparison of our results with published data and verification of routine laboratory methods in relation to diagnostic kits were the purposes of this study. PATIENTS AND METHODS: In addition to routine methods based on PCR, direct sequencing as well as two diagnostic kits for KRAS (codon 12 and 13) and BRAF (codon 600) mutation analysis were used for 132 patients. RESULTS: KRAS mutations were detected in 45 patients (34%), V600E mutation of the BRAF gene in 9 patients (7%). Both mutations simultaneously were not detected. Tissues from primary tumor and metastases were available from 33 patients. KRAS mutation was detected in 13 cases of this group. KRAS mutations in tumor and metastasis were of the same type in 9 patients; types of mutation in both tissues were different in one case. KRAS mutation only in one tissue was detected in 3 cases. BRAF mutation in both tissues was detected in the 4 patients. A low percentage of tumor cells in 17 patients specimen did not allow performance of routine analysis and diagnostic kit was used. CONCLUSION: The frequency of KRAS and BRAF mutations in our cohort of patients corresponds to published data. The suitability of metastatic tissue analysis due to tumor heterogeneity was confirmed. KRAS analysis requires a comprehensive methodological approach with regard to reduced DNA quality and different percentage of tumor cells in tissue. For this reason, commercial diagnostic kits constitute a suitable supplement to standard methods.

[The detection of p16 protein in uterine cervix lesions]. / Stanovení proteinu p16 u lézí delozního hrdla.

OBJECTIVE: The detection of p16 in oncocytology and in the surgical pathology of the uterine cervix. SETTING: Department of Pathology and Department of Gynaecology and Obstetrics, University Hospital Brno. METHODS: An imunocytochemical and immunohistochemical analysis of formalin-fixed, paraffin embedded samples of the uterine cervix (included knips biopsies) and liquid based smears was performed. The bioptic database included 7 cases of CIN II-III, 5 cases of reactive epithelial changes and 3 cases of atrophic epithelium. 36 liquid based smears, 25 cases of CIN III and 11 cases of uterine cervix without a dysplastic lesion. RESULTS: Nuclear and cytoplasmatic p16 positivity was found in 22 cases of CIN III in liquid based smears. Diffuse and intensive p16 expression was in 5 cases of knips biopsies CIN III. CONCLUSION: The detection of p16 seems to be a valuable tool in surgical pathology of the uterine cervix: possible evaluation of the surgical margins, differential diagnosis regarding reactive atypia, and it is also prospective in oncocytologic diagnosis regarding differential diagnosis of the ASCUS, or can be used in monitoring of the uterine cervix dysplasia.