Rectal Neuroendocrine Tumour with an Aggressive Behaviour.

Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics which can make the diagnosis and treatment questionable, and, which in general, have a good prognosis. In recent decades, the incidence of rectal neuroendocrine tumors has increased due to the accessibility of colonoscopy and the introduction of screening programs for colorectal tumors. We present the case of a 55-year-old patient who presented for rectal bleeding started 6 months before. At the moment of the hospital admission, the general state of the patient was good, and the clinical and paraclinical examination confirmed the diagnosis of stage IV rectal tumor. The pathology examination could not distinguish between a non-differentiated carcinoma and a neuroendocrine tumor. The diagnosis of Rectal neuroendocrine tumor with an aggressive behaviour was established via immunohistochemistry (ki 67 index of 75-80%, G3 grading). Due to the high aggressiveness of the tumor, the patient had a rapid evolution towards a severe state and the onset of liver failure did not allow the systemic anti-tumor treatment. In conclusion, we can state that in the case of rectal neuroendocrine tumors, the stage of the disease and the ki67 index have an important prognostic value, and it is crucial for both the diagnosis and tumor aggressiveness to have an immunohistochemical examination. Even though, in general, they are small well-differentiated tumors with a rather good prognosis, there are forms with tumors of greater dimensions and with metastases and severe prognosis.

The Value of C Reactive Protein and the Leukocytes in the Peritoneal Fluid in the Predicting Postoperative Digestive Fistulas.

Anastomotic fistulas in digestive surgery are a severe complication of the patient. The identification of paraclinical laboratory investigations which would allow an early diagnosis of fistulas would lead to the optimization of patient's management. We have performed a retrospective study on 100 cancer patients, with digestive tract surgeries, between May 2016 and December 2017, in the First Clinic of General surgery and Surgical Oncology from the Bucharest Oncology Institute. The postoperative follow-up included: the testing of the C reactive protein (CRP ), and also the monitoring of the number of leukocytes (Ld) from the abdominal cavity, with probes taken from the drainage tube, all in association with the number of leukocytes in the blood (Ls) in all patients (with or without digestive fistula). By calculating the values of these tests and comparing them always with the clinical evolution of the patients, and sometimes with other tests as well, one would confirm an early diagnosis of fistula. The data obtained have shown that in patients with digestive fistulae there is a rapid growth and maintaining of increased values of serum PCR and of the leukocytes from the peritoneal cavity, values to which we associated also an increase in blood leukocytes. The modifications appear with approx. two days before the appearance of clinical signs or their confirmation through imagery (ultrasound, computed tomography). The regular and standardized follow-up in days 1, 3 and 5 postoperatively of the PCR value in blood, of the number of leukocytes in the abdominal cavity and of the serum leucocytosis, increasing the value of these parameters, could allow the early identification of the patients with a risk of fistula and the rapid selection of those which need supplementary investigations and/or surgical intervention.

The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer.

Introduction: In gastric cancer there are multiple local and general risk factors for the occurrence of postoperative fistulas. In the present study, we proposed to analyse the role of the preoperative nutritional state and nutritional therapy along with the disease stage, the age and the sex of patients in the occurrence of fistulas. Material and method: This retrospective study included 158 patients operated for gastric cancer in Surgery Department of Bucharest Oncology institute between January 2010 and December 2016 in which we analysed the incidence of anastomotic fistula according to the nutritional status, disease status, age and sex of the patients. Results: The global incidence of fistulas was of 11%, out of which 8 % were fistulas of the duodenal stump and 3.19% fistulas of the eso-jejunal anastomosis. Out of the 30 patients with weight loss and parenteral nutrition in the preop period, we had 4 fistulas (13%), and out of the 36 patients with weight loss and nutritional measures in the postop we had 5 fistulas (14%), also, out of the 24 patients with weight loss and without nutritional intervention, we had 5 fistulas (21%), finally, out of the 68 patients without weight loss we had fistulas in 4 patients (6%).. The incidence of fistulas was 5% in patients with stage I, II and III and 24% in stage IV patients. The distribution of fistulas according to the age of the patients showed a much higher incidence of fistulae in patients over 70 years old. Conclusions: The number of postoperative fistulas was higher in the advanced stages of the disease (p=0.027) and in patients over 70 years old (p=0.047) and the differences were statistically significant. The difference between the number of fistulae occurred in patients who had weight loss but did not receive nutritional support from those who received this support was not statistically significant (p 0.001).

A Rare Case of a Testicular Teratoma Associated with a Neuroendocrine Tumour.

Introduction: We report a rare case of testicular teratoma combined with a neuroendocrine tumour, emphasizing the difficulty of the following aspects: the clinical and laboratory diagnosis, the treatment options and the evolution of patients suffering from this disease. Case presentation: The patients with testicular neuroendocrine tumours represent a rarity, considering that as of 2017, only 22 cases had been reported in the literature. The case operated on in our clinic presents an association between a testicular teratoma and a neuroendocrine tumour. A 39-year-old patient was admitted in our Department for a non-painful abdominal tumour and concomitant testicular tumour. The serum tumour markers (-human chorionic gonadotropin, -phetoprotein and lactate dehydrogenase) were within normal limits. Lung and bone metastases were diagnosed CT scan. The histopathological diagnosis consisted of immunohistochemical study of the orchidectomy specimen as well as of the bioptic material from bone marrow puncture. Conclusions: The diagnosis of testicular carcinoids is based on immunohistochemistry study. Radical orchidectomy is the only potentially curative treatment for this type of malignancy. Adjuvant chemotherapy determined size reduction of the lung and bone metastases and the disappearance of the lymph node metastases.

Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection.

Introduction: The risk of digestive fistula in patients operated for gastric neoplasm is increased due to biological imbalances generated by the cancer's progression, by diagnosis in advanced stages, and by the scale of intervention. Under these circumstances the use of some technical means to protect digestive sutures in these patients is useful. AIM: To analyse the efficiency of technical means to protect the digestive sutures in patients operated in various stages of development of gastric cancer. Material and Methods: We conducted a retrospective study on a group of 130 patients operated for gastric cancer in the 1st General Surgery and Oncology Clinic of the Bucharest Institute of Oncology, between 2010-2014. Results: 38.46% of the patients in the study group presented stage IV cancer with multiple complications and biological imbalances. 52 total gastrectomies and 40 gastric resections were carried out, while in 34 patients palliative "tumour excisions" or other types of palliative surgery were performed. In 15 of the cases with gastric resection a duodenal decompression probe was used, while in 13 of the patients with total gastrectomy an oeso-jejunal aspiration probe together with an oeso-jejunal feeding probe were used as additional technical measures to prevent fistula formation. The incidence of duodenal stump fistula was 7.69%, that of oeso-jejunal anastomosis fistula was 2.3%, with an overall mortality of 3.07% and that of gastro-jejunal anastomosis fistula was 0.76%. CONCLUSION: Given the risk of fistula development in patients with gastric cancer, as well as the increased risk in advanced stages of cancer development, we consider that the use of technical means of protection of digestive sutures is beneficial and opportune, lowering the incidence of fistulas, reducing their output, pathophysiological effects, and mortality.

Preliminary study of some of the main intratumor stroma components in gastric carcinomas.

AIM: The relationship between stromal compartment and tumor behavior in gastric carcinomas is still poorly understood and defined. Therefore, the authors started, with this preliminary study, an analysis of stromal compartment morphology and behavior in tumors arising from gastric mucosa epithelium. MATERIALS AND METHODS: The study group included 75 patients operated for gastric carcinoma. Five parameters describing tumor morphology and behavior and eight parameters describing tumor stroma (TS) morphology were assessed. Histopathological examination included six serial sections of formalin-fixed, paraffin-embedded tumor tissue samples, stained with three classical stains and three antibodies to reveal the different parameters. For data comparison, Pearson's correlation test and the chi-squared (χ²) correlation test were used. RESULTS: Studied tumors were, usually, infiltrating, undifferentiated∕diffuse type, invasive in subserous spaces and with a Ki67 index higher than 20%. Collagen fibers dominated the stromal components, with a predominance of mature type and an average fibrillary index of 2.7. The whole amount of stromal components accounted for around one quarter of the tumor area. Mature collagen fibers were in opposite correlation with their immature counterpart, and both were in opposite correlation with smooth muscle fibers and expressed an opposite trend of correlation with components of vascular compartment. The whole amount of stromal components had divergent behavior with the components of vascular compartment. The latter expressed generally an opposite trend of correlation with individual fibrillary stromal components. We found only isolated relationships statistically significant between stromal components and tumor characteristics. CONCLUSIONS: TS is in a continuous remodeling process in relation to the evolution of tumor parenchyma, tumors less differentiated proving to have an immature stroma, with newly formed collagen fibers and higher vascular density. Further studies are required.

Clinical-morphological profiles of esophageal carcinoma's main types.

AIM: The purpose of the study was to define and then to compare particularly the morphological profiles of the main morphological types of esophageal carcinoma (EC). PATIENTS, MATERIALS AND METHODS: The studied group included 46 operated EC patients. Few parameters were clinical (gender and age). The rest of them described both gross and histological features of the entire group and of the two main histological types of carcinoma (lesion' site, lateral extension, lesion dimensions, gross aspect, and histological type, and tumor grade, and stage). Stratification scales of cases were defined according to each parameter in order to compare the data and a statistical apparatus [Student's t-test and χ² (chi-squared) test] was used. RESULTS: The studied tumors were encountered mostly in mature adult and elderly men, usually in the lower segments of the esophagus. Many of them had between five and ten cm in the long diameter and produced stenosis. Most of them had infiltrating appearance combined often with protruding or∕and ulcerated aspects. Usually, the tumors were poorly differentiated and in stage III. The two main histological types of EC showed different morphological profiles. Data from the literature revealed sometimes wide ranges of variation for the studied morphological parameters. Our results were within these ranges of variation. CONCLUSIONS: ECs proved to be aggressive and late diagnosed tumors in general, with distinct morphological and behavioral profiles for the two main histological types. Comparisons with literature data confirmed many of our observations regarding the clinical and morphological aspects of both ECs as a whole and its histological types.