Histological and immunohistochemical study on sentinel lymph node in colorectal cancer - values and limitations.

Colorectal cancer is currently one of the most common malignancies in both men and women. Surgical resection remains the essential element in the local control of the disease but the development of novel diagnostic and therapeutic tools can enhance the results of radical surgery. The indication for adjuvant treatment majorly depends on a correct pathological assessment of the surgical specimen - a correct pTNM staging. For patients diagnosed with stage III disease (characterized by the presence of lymph node metastases), adjuvant chemotherapy increases the survival rate, while in stage II disease, in most cases, the chemotherapy is contraindicated, due to increase morbidity without real benefit. This is why an accurate pN stage becomes essential. It is proven that classic pathological exam sometimes fails to identify lymph node micrometastases or isolate tumor cells, which might explain local or distant relapses in stage II patients. In our study, we evaluated a total of 39 surgical specimens of cTNM stage II patients operated for colon or rectal cancer. In the attempt to enhance the accuracy of pTNM staging we used ex vivo lymph node mapping combined with sentinel node analysis on serial sections in both classical histological and immunohistochemical (IHC) staining. We have demonstrated that the IHC staining on sentinel lymph node can improve the accuracy of pTNM staging, when used as a complementary diagnostic test, by identifying micrometastases and isolated tumor cells.

A particular case of a "captive forceps" in the esophagus.

We present a particular case of a "captive" forceps in the esophagus in an attempt to remove a foreign body in a patient with previous esophageal post-caustic stenosis. The mechanism of incarceration and the surgical therapeutic option consisting of open thoracic surgery are detailed and argumented. Postoperative course was favorable, though the patient developed a small esophageal fistula visible at radiology without any clinical expression. This case emphasizes the difficulties that may occur but in the management of esophageal foreign bodies in patients with esophageal post-caustic stenosis, which may lead finally to open surgery.

Collision tumor of recto-sigmoidian junction - case presentation.

Collision tumors of the colon are rare. A 64-year-old man was referred on Emergency County Hospital, Craiova, Romania for the evaluation of intestinal obstruction. Colonoscopy demonstrates the presence of about 9/5 cm sized mass in the rectosigmoid junction. After surgical resection, the rectosigmoid lesion was histopathologically composed of two distinct lesions: mucoid adenocarcinoma in the superficial layer and poorly differentiated neuroendocrin carcinoma in the deeper layer. A rectosigmoid tumor showed two distinct tumors with no admixture or transposition of two neoplastic components. A lymph node metastatic deposit contained both tumors. Immunohistochemical stainings were consistent with mucinous adenocarcinoma and neuroendocrine carcinoma of the two neoplasms. We report this case of colonic collision tumor (mucoid adenocarcinoma and neuroendocrine carcinoma) and review of the literature.