Fotios Seretis

The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study

BACKGROUND Preoperatively elevated neutrophil/lymphocyte ratio (NLR) is a negative prognostic factor of survival in various types of cancers. A retrospective study was conducted to examine if preoperative elevation of NLR is associated with higher risk for incidental papillary thyroid microcarcinoma (PTMC). METHODS The study sample consisted of 26 patients with benign goiters, 31 patients with incidental PTMC, 26 patients preoperatively diagnosed with thyroid cancer, and 26 healthy controls. NLRs were compared regarding thyroidal pathology. RESULTS The mean preoperative NLR was significantly elevated in patients with PTMC and thyroid cancer. In addition, the third and fourth quartiles of NLR included only patients with either PTMC or thyroid cancer. No significant differences in NLR occurred between patients with multifocal and unifocal PTMC. CONCLUSIONS NLRs were significantly elevated in patients with incidental PTMC and thyroid cancer. The findings of this pilot study indicate that NLR should be considered an easily accessible biomarker for detecting incidental PTCM; nevertheless, further studies are required to confirm these preliminary results.

Is Red Cell Distribution Width a Novel Biomarker of Breast Cancer Activity? Data From a Pilot Study

Background Red cell distribution width (RDW) is a parameter of the standard full blood count tests, measuring the size variability of erythrocytes. Recently, its elevation has been proven to reliably reflect the extent systematic inflammation, mainly in cardiometabolic diseases. Up to date, its association with solid malignancies has been scarcely investigated. Methods We performed a retrospective study, in order to examine if RDW values comparing elevation is correlated with the histopathological parameters of breast cancer (tumor size, grade, lymphatic spread, overexpression of hormonal receptors and HER2 protein), as well as to assess the existence of any differences in RDW comparing two age-matched groups of patients with benign and malignant breast lesions respectively. Results RDW was significantly higher in patients with breast cancer, when compared to the enrolled patients with fibroadenomas. Moreover, in the breast cancer group, RDW elevation was significantly correlated with larger primary tumors, higher number of infiltrated axillary lymph nodes and HER2 overexpression, while it was inversely associated with the tumor grade. Conclusions Our pilot study demonstrated tha Red cell distribution width may be a novel biomarker of the activity of breast cancer. Although our preliminary findings need to be evaluated by studies with larger samples of patients, based on commonly accepted pathophysiological principles, we presume that they will be applicable not only in breast cancer, but also in other types of solid cancers, providing a simple and cost-effective biomarker of cancer surveillance.

Metaplastic Changes in Chronic Cholecystitis: Implications for Early Diagnosis and Surgical Intervention to Prevent the Gallbladder Metaplasia-Dysplasia-Carcinoma Sequence

Background Metaplastic features of the gallbladder epithelium are considered to be the precursors of gallbladder cancer. Considering the possible role of chronic inflammatory changes in the development of these lesions and the rationale for performing an early prophylactic cholecystectomy, we performed a retrospective study to assess the prevalence of gallbladder metaplasia in patients who underwent cholecystectomy due to underlying cholelithiasis. Methods We reviewed the routine histopathology reports of 86 patients with chronic cholecystitis, who underwent elective cholecystectomy, to assess the prevalence of gallbladder metaplasia in the course of chronic cholecystitis. We further attempted to evaluate the existence of any correlations between the presence of the gallbladder metaplasia and the type of lithiasis, as well as the gallbladder wall thickness. Results The overall prevalence of metaplastic features in the resected specimens was 25.6%. Dysplastic changes were more frequent in gallbladder specimens with concurrent metaplasia. Moreover, in presence of metaplastic changes, we observed an increase of the average gallbladder wall thickness. Finally, metaplastic and dysplastic changes were associated with the presence of micro-lithiasis rather than macro-lithiasis. Conclusions Gallbladder metaplastic changes appear to be more frequent in cases of micro-lithiasis and seem to be associated with a chronic thickening of the gallbladder wall. Taking into account the usually sub-clinical course of this group of patients, when compared to patients with macro-lithiasis, further studies are needed to evaluate a possible role of prophylactic cholecystectomy in this population to prevent the long term evolution of these early changes to cancerous lesions.

Enhancing the Accuracy of Platelet to Lymphocyte Ratio after Adjustment for Large Platelet Count: A Pilot Study in Breast Cancer Patients

Background. The objective of our study is to investigate the potential effect of adjusting preoperative platelet to lymphocyte ratio, an emerging biomarker of survival in cancer patients, for the fraction of large platelets. Methods. A total of 79 patients with breast neoplasias, 44 with fibroadenomas, and 35 with invasive ductal carcinoma were included in the study. Both conventional platelet to lymphocyte ratio (PLR) and the adjusted marker, large platelet to lymphocyte ratio (LPLR), were correlated with laboratory and histopathological parameters of the study sample. Results. LPLR elevation was significantly correlated with the presence of malignancy, advanced tumor stage, metastatic spread in the axillary nodes and HER2/neu overexpression, while PLR was only correlated with the number of infiltrated lymph nodes. Conclusions. This is the first study evaluating the effect of adjustment for large platelet count on improving PLR accuracy, when correlated with the basic independent markers of survival in a sample of breast cancer patients. Further studies are needed in order to assess the possibility of applying our adjustment as standard in terms of predicting survival rates in cancer.

Multidisciplinary approach to synchronous prostate and rectal cancer: current experience and future challenges.

The management of synchronous prostate and rectal cancer is a challeging task for the general surgeons and urologists, due to the complex anatomy of the pelvis and the sequential significant effects on the patient’s functional independency and quality of life. As both rectal and prostate cancers still remain leading causes of death in the male population, along with the increase of the average life expectancy, it is certain that synchronous prostate and rectal cancer will be a clinical scenario that the clinicians of the future will encounter more frequently. Our aim is to perform a comprehensive review on the management of this oncological entity, focusing on the significance of multidisciplinary approach which will enable the formation of an accurate strategy plan, having at all times the patient in the center of desicion-making.

Appendicectomy and Clostridium Difficile Infection: Is There a Link?

Clostridium difficile infection (CDI) is a gradually emerging healthcare problem in the western world, occurring predominantly from the de-arrangement of the gut microbiota and the widespread use of antibiotics. Recently, it has been proposed that the presence or absence of the appendix could be a factor influencing the occurrence and/or the severity of CDI. We performed a review of the literature, aiming to identify and interpret in an accumulative way the results of the published clinical studies which addressed the issue of a possible association between prior appendicectomy and the features of CDI. A total of five suitable studies were retrieved, which were all conducted retrospectively. Although the results were conflicting regarding the impact of prior appendicectomy in the occurrence and relapse of CDI, it appears that the presence or absence of the appendix is not associated with the clinical severity of CDI. Based on the current evidence and considering the effects of the widespread use of antibiotics in the clinical practice, it appears that an in situ appendix does not have a definitive impact on the development and severity of CDI. Further observational studies are warranted to clarify any potential association.

Calcium channel blockers and esophageal sclerosis: should we expect exacerbation of interstitial lung disease?

Esophageal sclerosis is the most common visceral manifestation of systemic sclerosis, resulting in impaired esophageal clearance and retention of ingested food; in addition, co-existence of lung fibrosis with esophageal scleroderma is not uncommon. Both the progression of generalized connective tissue disorders and the damaging effect of chronic aspiration due to esophageal dysmotility appear to be involved in this procedure of interstitial fibrosis. Nifedipine is a widely prescribed calcium antagonist in a significant percentage of rheumatologic patients suffering from Raynaud syndrome, in order to inhibit peripheral vasospasm. Nevertheless, blocking calcium channels has proven to contribute to exacerbation of gastroesophageal reflux, which consequently can lead to chronic aspiration. We describe the case of severe exacerbation of interstitial lung disease in a 76-year-old female with esophageal sclerosis who was treated with oral nifedipine for Raynaud syndrome.

Metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract. Management and literature review.

Multifocal soft tissue sarcoma is a rare clinical entity occurring in 1% of patients with extremity soft tissue sarcoma and in 4.5% of patients with liposarcoma. Multifocal disease may arise either synchronously or metachronously and has been associated with poor prognosis. Herein, we have described a rare case of metachronous multifocal myxoid liposarcoma involving the gastrointestinal tract that developed 14 months after the resection of a myxoid buttock liposarcoma. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that multifocal myxoid liposarcoma is a rare clinical entity that usually represents metastatic disease with poor prognosis. A thorough imaging and careful physical examination are essential in the preoperative evaluation and postoperative follow-up of patients with myxoid extremity liposarcomas, as these tumors are known to have a tendency to spread toward extrapulmonary sites, frequently without pulmonary metastases.

Immuno-PCI: a proposal for the implementation of "seed and soil" concept in the treatment of peritoneal carcinomatosis from colorectal cancer.

The advent of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has revolutionized the approach to peritoneal carcinomatosis of colorectal cancer origin in appropriately selected cases. However, the high postoperative morbidity and mortality following the procedure underlines the need for optimizing the patient selection criteria, finally aiming to establish a patient-tailored approach. The introduction of tools enabling the quantification of the peritoneal spread of the metastatic deposits has been of paramount importance in the decision-making and the estimation of the prognosis. However, we believe that it is high time to attempt a further evolution of the current practice, by incorporating in the above mentioned quantification scores parameters indicative of the immune-response against the disease progression, fact which will probably reflect more accurately the dynamics of cancer progression and will sequentially be a crucial step towards individualized treatment of peritoneal carcinomatosis.

Primary Prevention of Colorectal Neoplasias: Ample Evidence, Lack of Guidelines

Colorectal cancer (CRC) is the third most commonly diagnosed type of malignancy in males and the second in females, with over 1.2 million new cancer cases and 608,700 deaths estimated to have occurred in 2008 [1]. Sporadic CRC accounts for 75% of the total CRC cases, with colorectal adenoma regarded as the precursor lesion (adenoma-carcinoma sequence) [2]. Despite the major advances in the screening methods, treatment options and follow-up frameworks, there is ample evidence highlighting the preventability of colorectal neoplasias by the implementation of appropriate lifestyle modifications, with the most extensively studied parameters being the effects of physical activity, specific dietary patterns, smoking and alcohol consumption [3]. Moreover, the chemoprevention of colorectal neoplasias is an area of ongoing research, focusing on the potentially preventive role of certain drugs and micronutrients [4]. Although there is now solid evidence regarding the clear protective role of lifestyle modification in terms of preventing colorectal neoplasias, there is lack of specific guidelines from the leading health organizations and professional bodies, with the currently available guidelines providing general rather specific frameworks for establishing national preventive policies. Herein, we attempt to pinpoint in a best evidence topic frame the key findings in the field of primary prevention of colorectal neoplasias, underlining the necessity of a qualitive turn towards setting specific lifestyle modification targets instead of general guidance.