Konrad Zaręba

Immunohistochemical assessment of apoptosis-associated proteins: p53, Bcl-xL, Bax and Bak in gastric cancer cells in correlation with clinical and pathomorphological factors.

PURPOSE The p53 protein as well as Bcl-2 family proteins such as Bax, Bak and Bcl-xL regulate apoptosis. The study objective was to analyze the expression of p53, Bak, Bcl-xL and Bax in gastric cancer and in healthy gastric mucosa. MATERIAL AND METHODS The study group consisted of 66 patients with gastric cancer, treated surgically in II Department of General and Gastroenterological Surgery, Medical University of Bialystok. The expression of the studied proteins was assessed using the immunohistochemical method. RESULTS Significant differences were found in the expressions of the studied proteins as compared to healthy gastric mucosa. The expressions of p53 and Bax were significantly higher (70% vs 13% and 50% vs 13%), whereas those of Bak and Bcl-xL significantly lower (18% vs 83% and 74% vs 97%) in cancer cells than in normal mucosa (p<0.001). Significant differences were also noted in the expressions of Bax and Bcl-xL in relation to histological type. In the intestinal type (Lauren I), the expressions of Bax and Bcl-xL were higher as compared to the diffuse type (Lauren II) (93% vs 43% and 91% vs 43%). Simultaneously, correlations were noted between changes in the expression of Bax vs Bcl-xL and Bak. High expression of Bax showed a positive correlation with reduced Bak and Bcl-xL (p<0.05). Moreover, positive expression of p53 caused poorer distant survival of patients (p<0.05). CONCLUSION Our study concluded that disturbances in the expression of p53, Bax, Bcl-xL and Bak proteins are associated with their involvement in the process of carcinogenesis in the stomach. It is suggesting that they might appeared in the early phase of carcinogenesis.

Primary splenic angiosarcoma – the same diagnosis yielding two different clinical pictures. case report

Splenic angiosarcoma has been presented as an extremely rare malignant tumour. Amongst the rarest of all neoplasms, primary splenic angiosarcoma comprises 0.14–0.25 of all annually reported cases per one million persons Splenic angiosarcoma was first described in 1879 by T. Langerhans. The clinical symptoms and diagnostic values associated with splenic angiosarcoma are extremely variable. Nonetheless, majority of the patients (75%) complain of abdominal pain, and a quarter to one-third present with rupture of the involved organ. We hereby report our experience with two splenic angiosarcoma cases, which despite being similar in their diagnosis, nonetheless present with an entirely different clinical picture. Our first case, whereby the patient presented with a liver that was also affected by the angiosarcoma of the spleen. In the second case however, although the patient did show evidence of metastasis to the abdominal cavity as well as the liver, she also suffered from primary adenocarcinoma of the colon. To our knowledge, no previous article has made mention of primary splenic angiosarcoma existing independently of another primary neoplasm. Both may be found in common practice, and ought to be highlighted for their significance as such.

Cecal Volvulus as a Rare Cause of Intestinal Obstruction

Caecal volvulus is very rare causa of the intestinal obstruction. It ocures in 1- 1,5% of all intestinal obstructions. It is known that there is only on treatment in this situation which is surgery. It is classified as an obstruction because of strangulation.We present a case of the 46 year old patient, who was operated because of intestinal obstruction. During the operation caecal volvulus has been found, with gangrene of the appendices.

Parenteral nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma.

PURPOSE The aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients. MATERIAL/METHODS The study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase. RESULTS Immediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase. CONCLUSIONS Application of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.

Angiosarcoma of the large intestine - a case report

Hemangioendotheliomas are poorly differentiated neoplasms built from strands of endothelial cells and have a very narrow lumen filled with blood cells. Hemangioendotheliomas are commonly detected during the initial six months of life, concerning mainly soft tissues and skin. It is the most common bening liver cancer in children. In adults, hemangioendotheliomas are very rare findings, being mostly described in the liver, lungs, brain and bones. Hemangioendotheliomas of the large intestine are extremely rare in adults. Cancer developing there is of high degree of malignancy. The authors present the case of 68 year old patient in whom preoperative benign tumor with ulcers were diagnosed. Intraoperative macroscopic picture suggested malignant process. The patient underwent anterior rectal resection with regional lymphadenectomy. The postoperative histopathological evaluation with immunohistochemical studies angiosarcoma was diagnosed. A four year survival free of cancer was obtained, and the patient died due to myocardial infarct. Literature describes the short periods of survival of patients with vascular sarcoma of the colon. The most common reason for decease are metastases with massive haemorrhages. Bleeding tendency results from growing Kasabach-Merritt syndrome. It is characterized by profound thrombocytopenia and coagulopathy. The presented patient is a unique example of angiosarcoma with long period of survival.

Problem of the Insulin Resistance in Surgery

Insulin resistance is the reduced reactivity of peripheral tissues to insulin. Its measure is the ratio of the concentration of insulin acting on the cell to the volume of glucose assimilation, dependent of its concentration. In healthy subjects and normal insulinemia tissues consume 6.5-8 mg of glucose/ body weight/min (1-7). According to another definition, insulin resistance is considered as the condition of impaired biological tissue response to endoand exogenous insulin, considering the metabolism of carbohydrates, lipids, and proteins (1-9). The reasons for the occurrence of clinical manifestations of insulin resistance have not yet been clearly defined. The following factors are considered in the pathogenesis of insulin resistance: – influence of genetic factors (2, 4, 6-12), – influence of environmental factors (11-17), – influence of inflammatory cytokines and adipokines (hormones secreted by adipose tissue) (7, 8, 9, 11-15), – hypersecretion of hormones antagonistically affecting insulin (growth hormone, glucagons, glycocorticosteroids, catecholamines) (3, 6, 7, 8, 11-16, 18, 19, 20). Considering pathophysiology the following types of insulin resistance are distinguished:

p16, p21, and p53 proteins play an important role in development of pancreatic intraepithelial neoplastic

BackgroundDeregulation of cell cycle takes place during the development of many cancers as well as pancreatic ductal adenocarcinoma (PDA), which develops from precursor lesions, most frequently including pancreatic intraepithelial neoplasia (PanIN).AimsThe aim of this study was to evaluate and compare the expression of p16, p21, and p53 proteins taking part in the regulation of the cell cycle in normal pancreatic ducts and pancreatic intraepithelial neoplasia at its various advancing stages.MethodsThe expressions of p16, p21, and p53 were assessed immunohistochemically in 70 patients with different pancreatic diseases (pancreatic ductal adenocarcinoma, pancreatitis, and pancreatic cysts), showing also pancreatic intraepithelial neoplasia. The results correlated with chosen clinicopathological parameters.ResultsOur study revealed a difference in p16, p21, and p53 expressions between normal pancreatic ducts and various stages of PanIN. p16 expression progressively decreased, whereas p21 and p53 increased from normal pancreas to PanIN 1, 2, and 3. The expression of p21 was associated with age, p53 with PanIN location in the pancreas and p16 with the type of primary diseases. Simultaneously, we observed a directly proportional relationship between the expression of p21 and p53 proteins and inversely proportional between the p16 and the p21 and p53 proteins.Conclusionsp16, p21, and p53 proteins play an important role in the deregulation of the cell cycle and participate in the development of pancreatic intraepithelial neoplasia. Immunohistochemical evaluation of their expressions may be helpful in the diagnosis of PanIN.

Large pancreatic pseudocyst penetrating into posterior mediastinum

We report a rare case of a large mediastinal pancreatic pseudocyst compressing the left atrium and the esophagus and causing dyspnea, palpitations, and emesis. Chest radiograph was non-diagnostic, esophagogastroduodenoscopy showed diffuse extrinsic compression of the distal esophagus and gastric corpus, but a definitive diagnosis was confirmed by computed tomography. We decided to perform surgery due to the recurrence of the pancreatic pseudocyst, a history of unsuccessful radiologically guided external drainage a few years earlier, and a very large diameter of the pseudocyst causing acute cardio-pulmonary distress syndrome.

Dysfunctions in the Mature Dendritic Cells Are Associated with the Presence of Metastases of Colorectal Cancer in the Surrounding Lymph Nodes

Dendritic cells play a key role in the antigen presentation and T cell activation. The aim of this study was a detailed analysis of the presence of mature dendritic cells (CD 83 positive) in colorectal cancer in correlation with selected clinicopathological parameters. The presence of mature dendritic cells (mDCs) was determined immunohistochemically using the anti-CD83 antibody. The morphometric analysis of the mDCs was performed in the normal colon wall adjacent to the cancerous tumor as well as in the front of the tumor and in the main mass of the cancerous tumor. Decrease in mDCs in the front and in the main tumor mass was observed. The increase in the number of mDCs in both of these locations was associated with the presence of metastases in the nearby lymph nodes (p < 0.05 and p < 0.01). Furthermore, the increase in the proportion of mDCs in the main tumor mass was associated with the presence of the invasion of tumor cells into the blood and lymph vessels (p < 0.01). The increase in the amount of mDCs in the cancerous tumor is associated with the invasiveness of the tumor and especially with the metastasis to the surrounding lymph nodes.

Own experiences of endoscopic self-expandable stent placement for malignant colorectal ileus

Introduction Acute low neoplasm ileus requires emergency surgery. Nowadays there are increased numbers of patients with comorbidities, which causes higher risk of intra- and postoperative complications. Aim To evaluate the clinical usefulness of endoscopic self-expandable stent placement for malignant colorectal ileus. Material and methods Twenty-one patients (8 women and 13 men), mean age 66.7 years, with low neoplasm obstruction, underwent endoscopic stenting of the stricture. This procedure was performed as a bridge to the surgery especially for high-risk patients. Eight of them had coagulation system impairment, 5 severe metabolic disorders, 4 circulatory insufficiency, 3 severe malnutrition and 1 patient undiagnosed synchronic rectal tumor. In 10 patients cancer was located in the sigmoid colon, in 7 in the rectum, in 2 in the ascending colon, and the transverse and ascending colon was involved in another 2 patients. Results All 21 patients (100%) underwent endoscopic stenting successfully. There were no complications after stent placement. The authors underline that placement of expandable metallic stents for patients with malignant colon obstruction with acute ileus is a safe and effective method. It gives an opportunity for quick balance of fluid, electrolyte, and the coagulation system and improvement of efficiency of the circulatory and respiratory system. Conclusions Endoscopic treatment of ileus helps precisely estimate tumor advancement and gives the possibility of a single stage radical surgical procedure.