Claudia Cicchini

Early stage human colorectal cancer: prognostic value of nm23-H1 protein overexpression.

Nm23 gene codifies for a nucleoside diphosphate kinase allowing the intracellular transduction of the signals. In colorectal cancer nm23 protein expression seems related to the progression of the disease. By immunohistochemistry we have studied the intracytoplasmatic nm23 H1 protein expression in 20 patients affected by colorectal cancer at initial stage. In 12 cases it resulted elevated and in four the disease recurred. The overexpression was not correlated with other prognostic factors. Nm23 H1-positive patients affected by colorectal cancer at initial stage could be considered at risk for disease recurrence and included in a more frequent follow-up protocol.

Duodenal Pancreatic Heterotopy Diagnosed by Magnetic Resonance Cholangiopancreatography : Report of a Case

Abstract We describe herein the case of a heterotopic pancreas that caused stenosis in the second portion of the duodenum. A 46-year-old man presented with upper abdominal pain and a 12-month history of intermittent vomiting. There was no history of melena, hematochezia, hematemesis, clay-colored stools, jaundice, or hepatitis and he did not describe any food dyscrasias, although fatty foods and alcohol seemed to make the symptoms worse. No specific medication or change in position relieved the pain. An initial diagnosis of chronic pancreatitis with multiple pseudocysts was made on the basis of elevated serum amylase and lipase levels, and abdominal ultrasonography and computed tomography (CT) findings. Medical treatment with octreotide was given for 8 weeks, but without any marked effect. Double-contrast barium examination and esophagogastroduodenoscopy were not diagnostic. Magnetic resonance (MR) cholangiopancreatography revealed findings indicative of cystic dystrophy of a heterotopic pancreas (CDHP), and an endoscopy supported this diagnosis. A pancreatoduodenectomy was performed and pathological examination confirmed a diagnosis of CDHP. In our opinion, MR cholangiopancreatography is the diagnostic tool of choice when CDHP is suspected.

Vascular endothelial growth factor C and microvessel density in gastric carcinoma: correlation with clinicopathological factors. Our experience and review of the literature.

Vascular endothelial growth factor (VEGF) has been reported to promote lymphangiogenesis and its overexpression may be related to lymph node metastasis in gastric carcinoma. Microvessel density (MVD) has been investigated as a promoting factor for angiogenesis with conflicting results about its relation to survival. The study aims to investigate the expression of one subtype of VEGF, vascular endothelial growth factor C (VEGF-C), and MVD in gastric carcinoma specimens and their relation with clinicopathological factors. Specimens from 72 patients who underwent gastric resection for gastric carcinoma were analyzed by immunohistochemistry for the VEGF-C study and by monoclonal antibodies for the study of MVD. The VEGF-C and MVD expressions were related to clinicopathological features. High MVD was significantly related to the T stage (p = 0.036); VEGF-C expression was significantly higher in N positive patients (p = 0.047). No relation was found between MVD and VEGF-C expression. An extensive review of the literature was made and data were compared to ours. VEGF-C and MVD resulted to have significant relation with cliniico-pathological features. Further studies are required to determine whether these factors may be used in clinical practice in order to define the relationship with prognosis and to better characterize the biologic features of gastric carcinoma.

An unusual late radiotherapy-related complication requiring surgery in anal canal carcinoma

We herein describe an unusual late radiation‐related complication requiring surgery in a 60‐year‐old male affected by anal epidermoid carcinoma. The patient presented with obstructed defecation and ulcerated perianal lesions. The perianal biopsies were positive for anal squamous carcinoma. Transanal diagnostic investigations could not be performed because of anal stenosis. Computed tomography detected left inguinal lymphadenopathy and a nonhomogeneous presacral mass, infiltrating the rectal wall, the coccyx, and the sacrum. The patient underwent a colostomy, infusion of cisplatin and 5‐fluorouracil, and irradiation of the pelvis, perianal region, and inguinal lymph nodes. In June 1997 the patient complained of the onset of continuous pain at the genitalia, and for penis necrosis he underwent penis amputation. The histologic examination was conclusive for postradiotherapy thrombosis. This complication could strengthen the hypothesis of vasculoconnective damage as the origin of long‐term effects of radiotherapy. Probably the minimal dose in transit volume could not be achieved. Careful evaluation in choosing the treatment scheme is necessary if different options are available. J. Surg. Oncol. 2000;74:167–170.

nm23-H1 protein expression in anal canal carcinoma: Does it correlate with prognosis?

Anatomic extent is not the sole axis of classification of tumors and of tumor patients relevant to treatment planning and estimation of prognosis. This results in the need to demonstrate an improvement in prognostic assessment and choice of therapy achieved by consideration of factors other than TNM. nm23 protein does prevent tumor from metastasizing and may also play a role in the control of growth and development. The purpose of this study was to elucidate the clinical significance of nm23 expression in human anal canal carcinoma and to evaluate its influence on the outcome of patients after surgery or radiochemotherapy.

Localization of a Colovesical Fistula Using a Retrograde Guide-Wire: Report of a Case

We describe an unconventional method of localizing a colovesical fistula by using a guide-wire, successfully carried out in a 45-year-old man with recurrent dysuria, pneumaturia, and suprapubic tenderness. First, we performed a cystoscopy to establish the fistulous tract in the bladder and passed the guide-wire through it. Next, we performed a colonoscopy, and the guide-wire was identified and brought out through the anus. This created a wire loop through the fistula. The transparietal cathether enabled us to detect the exact fistulous tract at laparotomy, making it possible to resect the inflamed colon and identify and resect the fistulous opening on the vesical wall. This technique allowed for a safer resection and a shorter operation time.

Coexistence of anal and genital human papilloma virus infection in patients with anal canal carcinoma

Abstract: The aim of the study was to identify the coexistence of human papilloma virus (HPV) infection in anal carcinoma and in the cervix and glans penis in a population at low risk of sexually transmitted diseases. DNA samples from 14 biopsies of anal carcinoma were analysed by polymerase chain reaction for HPV 6–11, 16, 18, 31–33. The same was done for cervical or glans penis scrapings of the same patients. Among the 9 HPV positive anal squamous carcinomas (64.3%) 6 were HPV 16 positive (42.9%) and 3 were HPV 31–33 positive (21.4%). All the HPV 31–33 positive anal squamous carcinomas were also HPV 31–33 positive in the cytological samples obtained by cervical or glans penis scrapings. In 2 cases (14.3%) HPV 16 was observed both in the anal canal and in the cervix. These data suggest the usefulness of contemporaneous anal and genital evaluation by means of anoscopy and colposcopy with biopsies or scraping as a screening method to identify the presence of HPV without restricting it exclusively to those patients affected by dysplastic lesions of the genital apparatus, sexually transmitted diseases, or to homosexual patients.