Athanasios Tampakis

Nestin involvement in tissue injury and cancer - a potential tumor marker?

BackgroundIn eukaryotic cells, the cytoskeleton contains three major filamentous components: actin microfilaments, microtubules and intermediate filaments. Nestin represents one of the class VI intermediate filament proteins. Clinical and molecular analyses have revealed substantial information regarding the presence of Nestin in cells with progenitor or stem cell properties. During tissue injury Nestin is expressed in cells with progenitor cell-like properties. These cells may serve as a tissue reserve and, as such, may contribute to tissue repair. Based on currently available data, Nestin also appears to be implicated in two oncogenic processes. First, Nestin has been found to be expressed in cancer stem-like cells and poorly differentiated cancer cells and, as such, Nestin is thought to contribute to the aggressive behavior of these cells. Second, Nestin has been found to be involved in tumor angiogenesis through an interaction of cancer cells and blood vessel endothelial cells and, as such, Nestin is thought to facilitate tumor growth.ConclusionsWe conclude that Nestin may serve as a promising tumor marker and as a potential therapeutic target amenable to tumor suppression and angiogenesis inhibition.

Histone Deacetylase Inhibitors and Colorectal Cancer: what is new?

Colorectal cancer is the third most common cancer in humans. Cancer has always been regarded as a disease of genetic defects such as gene mutations and deletions, chromosomal abnormalities, which lead to the loss of function of tumor-suppressor genes and/or gain of function or hyperactivation of oncogenes. Modifications on chromatin are considered to be the result of the opposing activities of histone acetyltransferases and histone deacetylases, which affect gene expression. Targeting histone deacetylases, histone deacetylase inhibitors are promising agents, as in solid tumors they are characterized by relatively low toxicity profile and antiproliferative activities. In colorectal cancer, the current experience is mainly experimental but promising. Histone deacetylase inhibitors are currently being admitted as monotherapy or combination therapy either with the conventional chemotherapy or with other agents. Valproic acid combined with ionization may enhance tumor response. Vorinostat was the first drug of this group used in clinical trial in combination with conventional chemotherapy and managed to stabilize advanced colorectal cancer. Experimental results show that combination therapy of vorinostat and decitabine (DNA methyl transferase inhibitor) may have optimal results. However, patients with colorectal cancer need to be recruited in randomized clinical trials in order to evaluate the potential efficiency of these agents.

Cabozantinib and Vandetanib in medullary thyroid carcinoma: mitochondrial function and its potential as a therapeutic target towards novel strategies to design anti-CSCs drugs

Ekaterini Christina Tampaki, Athanasios Tampakis, Raoul Droeser, Efstratios Patsouris, and Gregory Kouraklis B Department of Propaedeutic Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; National Organization for the Provision of Healthcare Services, Department of Planning and Monitoring of Medicines Dispensing, Medicines Division, Greece; Department of General and Visceral Surgery, University Hospital of Basel, Switzerland; Institute for Surgical Research and Hospital Management ICFS, Basel, Switzerland; A Department of Pathology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece

Nestin and cluster of differentiation 146 expression in breast cancer: Predicting early recurrence by targeting metastasis?

The purpose of this study was to investigate the relationship between the expression of stem-cell markers nestin and cluster of differentiation 146 with clinicopathological characteristics in breast cancer and to determine whether a prognostic impact of nestin and CD146 expression exists regarding occurrence of disease relapse in breast cancer. A total of 141 patients who were histologically diagnosed with breast cancer and underwent radical operations from November 2006 to October 2013 in Laiko General Hospital, National and Kapodistrian University of Athens, were enrolled in the study. CD146 and nestin protein expression were evaluated using immunohistochemistry. Nestin expression was observed in 18.4% (26/141) of the cases, while CD146 expression was observed in 35.5% (50/141) of the cases. Nestin expression is significantly higher in younger patients with breast cancer. Nestin and CD146 expression were not correlated with the tumor size and the presence of lymph node metastasis. On the contrary, a significantly higher expression of nestin and CD146 was observed with triple-negative cancers (p < 0.0001 for both markers), low differentiated tumors (p = 0.021 for nestin and p = 0.008 for CD146), and increased Ki-67 expression (p = 0.007 for nestin and p < 0.0001 for CD146). The nestin-positive group of patients and the CD146–positive group of patients presented significantly higher rates of disease recurrence (log-rank test, p = 0.022 for nestin and p = 0.003 for CD146) with a distant metastasis, 30 months after the primary treatment. CD146 but not nestin, however, predicted independently (p = 0.047) disease recurrence. Nestin and CD146 are expressed in breast cancer cells with highly aggressive potency. They might contribute to disease relapse in breast cancer by activating the epithelial–mesenchymal transition pathway and assist tumor neovascularization.

A case of cecal volvulus mimicking Ogilvie Syndrome in a hospitalized patient with a pelvis fracture

Introduction Cecal volvulus and ogilvie syndrome are two entities which may display similar clinical presentation but require different treatment approaches. Presentation of case An 84-year old male patient admitted for conservative treatment of a pelvis fracture, complained of abdominal cramps and flatulence on the third hospitalization day. Abdominal radiographs arose suspicion of cecal volvulus. The diagnosis was ruled out on the CT scan but however was later confirmed by an exploratory laparotomy. Discussion The management of cecal volvulus requires prompt (emergency) surgical intervention while Ogilvie syndrome can be principally managed with conservative treatment. Our patients profile was typical for both entities. The absence of air throughout all colonic segments including the rectosigmoid on plain abdominal radiographs seems to be the most important sign in the exclusion of the Ogilvie syndrome diagnosis. Conclusion Cecal volvulus and Ogilvie syndrome display overlapping clinical features at their time of presentation and need to be carefully distinguished. By uncertainty, an exploratory laparotomy should always be performed, in view of the reported high mortality rate of cecal volvulus if surgery is delayed.

Peripheral vs pedicle division in laparoscopic resection of sigmoid diverticulitis: a 10-year experience

PurposeLaparoscopic rectosigmoid resection is the standard surgical treatment for recurrent sigmoid diverticulitis. However, speaking of mesenterium division, no unique standard procedure is actually provided. Surgeons can perform it at the level of either the sigmoid vessels or the inferior mesenteric vessels. The objective of this study was to compare intra- and postoperative complications of both techniques.MethodsFrom a prospective collected database of patients that underwent elective laparoscopic sigmoid resection between January 2004 and December 2014, a retrospective analysis according to the selected operative technique was performed.ResultsA total of 1016 patients were operated, and a pedicle division of the mesenteric vessels was performed in 280 patients (central group 27.6%) while a peripheral division was performed in 736 patients (peripheral group 72.4%). Comparison of these two groups demonstrated no statistically significant difference regarding age or stage of disease. Thirteen patients (1.3%) developed anastomotic leak; among them, nine belonged to the peripheral group (1.2 vs 1.4% p = 0.794). Twenty-four patients (2.4%) developed postoperative rectal bleeding but only in nine cases was a bleeding of the anastomosis confirmed using endoscopy (seven peripheral group vs two central group, 0.95 vs 0.7% p = 0.712). Moreover, postoperative morbidity did not significantly differ between the two groups. A very low mortality rate was observed, with 2 deaths (both in the peripheral group).ConclusionsLigation of inferior mesenteric vessels does not seem to affect anastomotic healing; both surgical techniques presented similar incidence of anastomotic bleeding. In this analysis, we could not identify any significant difference in overall morbidity and mortality.

Crohn’s disease-associated large and small bowel adenocarcinoma with peritoneal carcinomatosis: two case reports

Dear Editor: Small bowel adenocarcinoma (SBA) is a rare entity of gastrointestinal cancers. Only 5 % of gastrointestinal cancers is found in the small bowel. SBAs are predominantly found in the duodenum. The ileum is only affected in about 10 % of all SBAs (Dig Liver Dis. 2014 Feb;46(2):97–104). Well-known risk factors for SBA are inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. In these cases, the ileum is typically affected. The relative risk of developing SBA is found to be up to 20–40 times higher in Crohn’s disease than in the general population. Patients with SBA and CD are generally younger and more likely to be male. As in colorectal cancers it is thought, that SBAs in Crohn’s disease arise from an inflammation-dysplasia-adenocarcinoma sequence given that most of the tumors are found in chronically inflamed regions of the small bowel (Am Surg. 2007 Nov;73(11):1181–7). Patients commonly present with obstructive symptoms due to strictures that fail conservative treatment. Other presenting symptoms are abdominal pain, weight loss, and anemia, which are also seen in active Crohn’s disease. Unfortunately, SBA is frequently not found until pathological examination of the specimen. A preoperative diagnosis based on radiologic findings remains challenging. A differentiation between chronic inflammation and a malignant process is rarely possible based on imaging findings. Despite surgery and adjuvant chemotherapy, the 2-year survival is reported as low as 50 % (Abdom Imaging. Springer US; 2014 Apr 24;:1–8). We present two cases of patients with longstanding Crohn’s disease who were taken to the operating room in an acute setting due to small bowel perforation.

Letter to the editor: a case of an extraadrenal paraganglioma in the sigma in a patient with recurrent sigmadiverticulitis

Dear Editor: Pheochromocytomas (PCH) and paragangliomas (PG) are defined as tumors arising from the chromaffin tissue in the adrenal medulla and extraadrenal ganglia, respectively, which can result in excessive catecholamine secretion and may present with symptoms of hyperadrenergic affect (e.g., tachycardia, headache, sweating) [1]. Extraadrenal paragangliomas are rare tumors, and due to their rarity, they have not fully been classified in every possible anatomic location. We herein describe a case of a patient with an extraadrenal paraganglioma within the muscularis propria of the sigma.