Aliki Fiska

The CD44+/CD24− phenotype relates to ‘triple-negative’ state and unfavorable prognosis in breast cancer patients

Breast carcinomas have been reported to contain a subpopulation of CD44+/CD24− tumor cells with stem cell–like properties. This study investigates the significance of these two molecules in connection with tumor aggression and prognosis. The phenotypic profile of 139 breast carcinomas was investigated in paraffin sections using markers previously associated with stem cell–like properties (CD44, CD24), the “triple-state” (ER, PR, c-erb-B2), and angiogenesis (CD31). Tumors with >10% of CD44 and CD24 cancer cells were considered positive. The prevalence of CD44+ and CD24+ breast carcinomas in the series was 51.8% and 41.7%, respectively. Patients with the CD44(+)/CD24(−) phenotype had a 10-year lower median age at presentation and harbored tumors with a triple-negative state. They experienced an unfavorable prognosis. Lack of CD44 expression was associated with lymph node involvement, regardless of CD24 status, whereas the lack of both CD44 and CD24 was connected with high histologic grade and unfavorable prognosis which, notably, was the worse among all phenotypes. In multivariate analysis, the CD44(−)/CD24(−) phenotype, the nodal involvement, the vascular density and the ER-/PR-/c-erbB-2-profile were independent prognostic variables. It is concluded that assessment of the CD44/CD24 status may reveal distinct subgroups of breast cancer patients with different clinical behavior. The unsatisfactory response of the triple-negative tumors to current chemotherapy and their intimate link with the CD44(+)/CD24(−) phenotype, makes CD44 targeting an attractive therapeutic alternative for breast cancer patients. The strong association between the CD44(−)/CD24(−) phenotype and prognosis requires further investigation.

Beclin-1 and LC3A expression in cutaneous malignant melanomas: a biphasic survival pattern for beclin-1.

Autophagy is an intracellular pathway for the degradation of long-lived proteins and damaged organelles. It is, in essence, a recycling process allowing cells to survive oxygen and nutrient depletion. The expression of two autophagy-related proteins, beclin 1 and light chain 3A (LC3A) was investigated in 79 nodular cutaneous melanomas. The results were correlated with histopathological factors, vascular density, and hypoxia-related proteins [hypoxia-inducible factors (HIF1&agr; and HIF2&agr;) and lactate dehydrogenase 5]. The reactivity of both autophagy-related proteins was uniformly cytoplasmically diffused. High beclin 1 and LC3A reactivity was related to tumor hypoxia, as this was inferred from the intense expression of HIF1&agr; and lactate dehydrogenase 5, whereas low beclin 1 and LC3A expression was linked with an increased vascular density. In addition, beclin 1 was related to disease-specific survival which, however, exposed a biphasic pattern. A strong beclin 1 expression extending over a tumor area of more than 50% (high) was associated with an increased rate of early deaths, whereas a similarly strong, but less-extensive cytoplasmic reactivity (<10% tumor area; low) defined a sharp fall in the survival 5 years after surgery. Furthermore, the low beclin 1 expression was associated with high Breslows depth, high Clarks level, and ulceration. Low LC3A expression was also related to ulceration, but not to other histopathological features nor prognosis. In multivariate analysis, beclin 1 was an independent prognostic variable. It is concluded that extensive autophagic activity is generated by tumor hypoxia and anaerobic glycolysis, whereas angiogenesis maintains low autophagic activity. Atg6/beclin 1 was proved to be capable of deciphering the prognosis in cutaneous malignant melanoma, but the matter requires further investigation.

Assessment of SOX17 DNA methylation in cell free DNA from patients with operable gastric cancer. Association with prognostic variables and survival.

Abstract Background: DNA methylation represents one of the most common epigenetic changes in human cancer providing important information regarding carcinogenesis. A possible role as a prognostic indicator has also been proposed. The aim of our study was to evaluate the prognostic significance of SOX17 promoter methylation status in patients with operable gastric cancer. Methods: Using methylation-specific PCR (MSP) we examined the incidence and prognostic significance of SOX17 methylation status in cell free circulating DNA in the serum of 73 patients with operable gastric cancer. Fifty-one patients were male (69.9%), their median age was 65 years, 43 patients (58.9%) had regional lymph node involvement and all had a Performance Status (WHO) of 0–1. Results: SOX17 promoter was found to be methylated in 43 out of 73 gastric cancer serum samples examined (58.9%). All 20 control serum samples from healthy individuals were negative. Overall survival (OS) was found to be significantly associated with SOX17 methylation (p=0.049). A significant correlation between methylation status and differentiation (p=0.031) was also observed. No other significant associations between different tumor parameters examined and SOX17 methylation status were observed. Conclusions: SOX17 promoter methylation in cell free DNA of patients with operable gastric cancer is a frequent event and may provide important information regarding prognosis in this group of patients.

Sexual dimorphism of the hip joint in Greeks.

The objective of the present study was to report our measurements of hip bones within the Greek population and review the possible implications of these differences in their health as well as in social life. For this purpose the remains of 100 male and 100 female pelvic and femoral bones were studied. The distance from the pubic tubercle to the anterior rim of the acetabulum, the acetabulum diameter between its rims, their ratio, the depth of the acetabulum, the diameter of the femoral head and the ratio between the femoral head and the diameter of the acetabulum were measured. It was found that in males, in comparison to the females, the distance from the pubic tubercle to the anterior rim of the acetabulum was smaller while the acetabulum diameter and its depth, the diameter of the femoral head and the ratio between femoral head and the acetabulum diameter were larger. The above differences reached strong statistical significance. Of the two ratios used only the first one reached statistical significance. Using this ratio alone offered the best discrimination rate of up to 99% and should be the preferred choice when available.

Multicystic peritoneal mesothelioma.

Summary Background: Multicystic peritoneal mesothelioma is a rare disease. It is not certain if it is a benign or a borderline tumor. Although many therapeutic approaches have been used, complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy has gained acceptance. Case Report: A case of multicystic peritoneal mesothelioma in a 16-year old patient is reported. The patient underwent complete cytoreduction and received intraoperative hyperthermic intraperitoneal chemotherapy. The patient is disease-free one year after surgery. Conclusions: Complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy appears to be a rational therapeutic approach in multicystic peritoneal mesothelioma.

A giant adrenal lipoma presenting in a woman with chronic mild postprandial abdominal pain: a case report.

IntroductionAdrenal lipomas are rare, small, benign, non-functioning tumors, which must be histopathologically differentiated from other tumors such as myelolipomas or liposarcomas. They are usually identified incidentally during autopsy, imaging, or laparotomy. Occasionally, they may present acutely due to complications such as abdominal pain from retroperitoneal bleeding, or systemic symptoms of infection. We report a giant adrenal lipoma (to the best of our knowledge, the second largest in the literature) clinically presenting with chronic mild postprandial pain.Case presentationA 54-year-old Caucasian woman presented several times over a period of 10 years to various emergency departments complaining of long-term mild postprandial abdominal pain. Although clinical examinations were unrevealing, an abdominal computed tomography scan performed at her most recent presentation led to the identification of a large lipoma of the left adrenal gland, which occupied most of the retroperitoneal space. Myelolipoma was ruled out due to the absence of megakaryocytes, immature leukocytes, or erythrocytes. Liposarcoma was ruled out due to the absence of lipoblasts. The size of the lipoma (16 × 14 × 7 cm) is, to the best of our knowledge, the second largest reported to date. After surgical resection, our patient was relieved of her symptoms and remains healthy six years postoperatively.ConclusionPhysicians should be aware that differential diagnosis of mild chronic abdominal pain in patients presenting in emergency rooms may include large adrenal lipomas. When initial diagnostic investigation is not revealing, out-patient specialist evaluation should be planned to enable appropriate further investigations.

Lack of periradicular healing and gradually increasing swelling two years after intentional extrusion of calcium hydroxide into periapical lesion: report of a case.

A 40-year-old female patient with noncontributory medical history presented to the postgraduate clinic of the Department of Endodontology, Aristotle University of Thessaloniki, Greece. Her chief complaint was a gradually increasing swelling in the left side of her maxilla, during the preceding 2 months. After clinical examination, the radiologic and computerized tomographic scan examinations revealed the presence of a radiopaque foreign material in contact with the apex of tooth #22, confined within the limits of a radiolucent area. On dental anamnesis and after communication with her dentist, it was concluded that calcium hydroxide was deliberately extruded for the healing of the large lesion. The patient was scheduled for periapical surgery. The histopathologic features of the lesion revealed the presence of a periapical cyst and the absence of foreign body giant cells. After an observation period of 1 year, healing was uneventful.

Ganglionectomy without Repairing the Bursal Defect: Long-term Results in a Series of 124 Wrist Ganglia

Background Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglions nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. Methods This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglions nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. Results At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. Conclusions This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.

A 20-Year-Old Man with Large Gastric Lipoma - Imaging, Clinical Symptoms, Pathological Findings and Surgical Treatment

A 20-Year-Old Man with Large Gastric Lipoma - Imaging, Clinical Symptoms, Pathological Findings and Surgical Treatment A broad search of the available literature yielded no other report of gastric lipoma of that size (13.5×6.5×4.5 cm) at this early age. The patient (a 20-year-old man with giant lipoma in the anterior gastric wall) presented with haematemesis and melena after excessive alcohol consumption. Gastric resection was performed. At 5-year follow up the patient is healthy and doing well. Epidemiology of gastric lipoma, the differential diagnosis, means of diagnosis and treatment are discussed. Случай двадцатилетнего мужчины с большой липомой желудка. Визуализация, клинические симптомы, патология и хирургическое лечение Не существует других доступных для нас литера-турных данных, представляющих липому желудка подобных размеров и в таком возрасте. Уникальный случай относится к двадцатилетнему молодому мужчине, у кого липома с размерами (13.5 х 6.5 х 4.5 см), локализованная на передней стенке же-лудка, выявленная гематемезисом и меленой после обильной консумации алкоголя. Выполнена была резекция желудка. Пациент здоров после пятилетнего прослеживания его сос-тояния. Эпидемиология желудочных липом, их диффе-ренциальный диагноз, средства для диагностики и лечения обсуждены.

The first medical ethics and deontology in Europe as derived from Greek mythology.

Medical ethics and deontology are mentioned in Greek myths long before 700 B.C. We collected and present information derived from ancient Greek mythology and related to (how) ancient physicians took care of the sick or injured and how they were rewarded for their services.