E. Contessini Avesani

Gene expression analysis of early and advanced gastric cancers

Gastric carcinoma is one of the major causes of cancer mortality worldwide. Early detection results in excellent prognosis for patients with early cancer (EGC), whereas the prognosis of advanced cancer (AGC) patients remains poor. It is not clear whether EGC and AGC are molecularly distinct, and whether they represent progressive stages of the same tumor or different entities ab initio. Gene expression profiles of EGC and AGC were determined by Affymetrix technology and quantitative polymerase chain reaction. Representative regulated genes were further analysed by in situ hybridization (ISH) on tissue microarrays. Expression analysis allowed the identification of a signature that differentiates AGC from EGC. In addition, comparison with normal gastric mucosa indicated that the majority of alterations associated with EGC are retained in AGC, and that further expression changes mark the transition from EGC to AGC. Finally, ISH analysis showed that representative genes, differentially expressed in the invasive areas of EGC and AGC, are not differentially expressed in the non-invasive areas of the same tumors. Our data are more directly compatible with a progression model of gastric carcinogenesis, whereby EGC and AGC may represent different molecular stages of the same tumor. Finally, the identification of an AGC-specific signature might help devising novel therapeutic strategies for advanced gastric cancer.

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

Crohn’s disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohn’s disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohn’s disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons.RiassuntoLa malattia di Crohn è una malattia infiammatoria cronica che può coinvolgere qualsiasi segmento del tratto gastroenterico, più frequentemente l’ileo terminale, il grosso intestino e la regione perianale. Le manifestazioni della malattia di Crohn perianale comprendono: alterazioni cutanee, emorroidi, ulcere anali, stenosi ano-rettali, ascessi e fistole perianali, fistole retto-vaginali e cancro della regione perianale. Le manifestazioni perianali della malattia sono una delle principali fonti di disagio per il paziente ed uno degli aspetti della malattia di Crohn più difficili da trattare. La gestione della malattia perianale richiede un’integrazione fra differenti metodiche di imaging e una stretta collaborazione fra gastroenterologi e chirurghi dedicati.