Michael Stamatakos

Gastrointestinal stromal tumor

BackgroundGISTs are a subset of mesenchymal tumors and represent the most common mesenchymal neoplasms of GI tract. However, GIST is a recently recognized tumor entity and the literature on these stromal tumors has rapidly expanded.MethodsAn extensive review of the literature was carried out in both online medical journals and through Athens University Medical library. An extensive literature search for papers published up to 2009 was performed, using as key words, GIST, Cajals cells, treatment, Imatinib, KIT, review of each study were conducted, and data were abstracted.ResultsGIST has recently been suggested that is originated from the multipotential mesenchymal stem cells. It is estimated that the incidence of GIST is approximately 10-20 per million people, per year.ConclusionThe clinical presentation of GIST is variable but the most usual symptoms include the presence of a mass or bleeding. Surgical resection of the local disease is the mainstay therapy. However, therapeutic agents, such as Imatinib have now been approved for the treatment of advanced GISTs and others, such as everolimus, rapamycin, heat shock protein 90 and IGF are in trial stage demonstrate promising results for the management of GISTs.

Cell cyclins: triggering elements of cancer or not?

Cyclins are indispensable elements of the cell cycle and derangement of their function can lead to cancer formation. Recent studies have also revealed more mechanisms through which cyclins can express their oncogenic potential. This review focuses on the aberrant expression of G1/S cyclins and especially cyclin D and cyclin E; the pathways through which they lead to tumour formation and their involvement in different types of cancer. These elements indicate the mechanisms that could act as targets for cancer therapy.

Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases

PurposeMirizzi syndrome is a rare complication of long standing cholelithiasis. The purpose of this study is to retrospectively estimate the diagnostic and treatment methods applied in patients with Mirizzi syndrome.Materials and methodsOur experience with 27 cases with Mirizzi syndrome is presented. They were diagnosed either by imaging techniques, or during surgical operation. All of the patients were managed surgically.Results8 patients were diagnosed preoperatively and the rest intraoperatively. Morbidity rate after surgery was 18,5%, and mortality rate was zero. The patients presented free of symptoms three months after surgery during the follow-up.ConclusionMirizzi syndrome is rarely diagnosed preoperatively and US proved inadequate for this purpose. Surgery is the only therapy and usually provides additionally definitive diagnosis.

Breast cancer incidence in Greek women in relation to ABO blood groups and Rh factor

AimTo investigate the correlation between breast cancer in Greek women and ABO blood groups.Material-methodsIn 166 female patients with breast cancer factors such as blood group, histological type, family history, presence or absence of nodal and/or distant metastases were examined. These patients had similar demographic, clinical, surgical, immunohistochemical, laboratory, and follow-up data and this group is representative of general population of women in Greece.ResultsThe ductal type of breast cancer was differentially distributed in blood groups Rh (+) (P ≤ 0.001). In patients with A (+) blood group the ductal type of breast cancer was present in 49.6% of cases, in relation to the other blood groups and in AB blood group the same type occurred rarely (3.6%). Rh (+) women with positive family history were more often found in A blood group. The relative risk of metastasis in Rh (-) patients was 4.2 times higher than that in Rh (+) patients. Among Rh (+) patients, the relative risk of metastasis was 1.29 times higher in A blood group than in other blood groups.ConclusionBlood group A is often associated with ductal breast cancer (49.6%), in contrast to the other blood groups and particularly to blood group AB (3.6%). Blood group A and, particularly, A (-) has the worst prognosis of all.

Sentinel lymph node biopsy in breast cancer: a systematic review.

Lymphatic mapping and sentinel lymphadenectomy have become an important tool for axillary lymph node staging in women with early-stage breast cancer. Many issues such as indications, usefulness, or best method of performing a sentinel node biopsy need to be addressed. Multiple studies now confirm that sentinel lymphadenectomy accurately stages the axilla and is associated with less morbidity than axillary dissection. Blue dye, radiocolloid, or both can be used to identify the sentinel node, and several injection techniques may be used successfully. Many patient factors previously thought to affect accuracy of the procedure have now been shown to be of limited significance. This paper’s main purpose is to present the pros and cons of the sentinel lymph node biopsy, and to elucidate all questions regarding to the matter by reviewing the current medical literature.

Successful pregnancy after breast cancer therapy: dream or reality?

BackgroundNowadays, more breast cancer patients want to have children after the diagnosis of cancer. The purpose of this study is to review the possibility and risks of giving birth among women with breast cancer previously treated by chemotherapy.Case presentationTwo young women aged 28 and 34 respectively, were treated in our clinic for breast cancer, the first (negative hormonal receptors) by surgery, chemotherapy and radiotherapy and the second (positive hormonal receptors) by surgery, radiotherapy and tamoxifen. They both became pregnant, 1 and 8 years after completion of the therapy respectively.ResultsLaboratory testing during pregnancy was negative in both cases and after an uneventful course each woman gave birth to a perfectly healthy child. The first patient breastfed her baby for three months, while the second one did not breastfeed her baby at all.ConclusionWomen undergoing chemotherapy for breast cancer can maintain their fertility and get pregnant. Previous chemotherapy for breast cancer does not present any supplementary risks for the childs mental or physical health.

Phylloides tumor of the breast: a rare neoplasm, though not that innocent

BackgroundCystosarcoma phylloides (CP) is an extremely rare form of breast cancer with an unpredictable clinical course. The histological characteristics of this neoplasm have not proved to offer much in the estimation of prognosis of these patients.Patients and methodsIn our clinics, in a time period of 38 years, 22 patients with cystosarcoma phylloides were treated. There were 5 cases of malignancy, 15 cases with benign tumors, and two cases histologically characterized as borderline neoplasia. Metastases were manifested in one patient. All patients were on a 5-year follow-up, except in five cases, one operated three years ago and four operated within the last two years.Results16 of 22 patients did not present any signs of local recurrence or metastases. There were three patients that manifested local recurrence and underwent supplementary ongectomy or mastectomy and are free of recurrence ever since. One patient with metastatic CP died.ConclusionIndependently of its histopathological behavior, CP is a tumor difficult to be treated. Meticulous follow-up is mandatory in order to manage possible recurrence of the neoplasm.

Management of the rare entity of primary pancreatic cystic neoplasms

Primary cystic neoplasms of the pancreas constitute a rare entity and are composed of a variety of neoplasms with a wide range of malignant potential. Approximately 90% of these lesions are serous cystic neoplasms or mucin‐producing neoplasms. In contrast to serous cystadenomas which are nearly always benign, the mucinous cystic neoplasms represent a more diverse, heterogenous spectrum of related neoplasms. Intraductal papillary mucinous neoplasms manifest a much greater latent or overt malignant potential than other cystic neoplasms of the pancreas. The various subgroups of cystic neoplasms of the pancreas are evaluated and compared through a review of current literature. No symptoms or signs are pathognomonic for the cystic pancreatic neoplasms. While identification of a cystic tumor is relatively easy, the identification of the specific tumor type may be difficult. Most investigators agree that accurate differentiation of benign from malignant neoplasms can be made only at histopathologic examination of the entire resected segment of the pancreas. Because of the low mortality and low postoperative morbidity, surgical resection is indicated in all patients with cystic tumors.

Recapitulation of Ras Oncogene Mutations in Breast Cancer

Several human breast cancer cell lines have been shown to contain mutational activation of Ras oncogenes. The goal of this review is to clarify the physiology and biochemical pathways of Ras family oncogenes in order to understand thoroughly the mechanisms behind Ras gene mutations. Ras genes are involved in the early stages of mammary oncogenesis through augmented expression of the normal p21 protein. Recognition of the mechanisms resulting in aberrant expression of Ras, as well as unveiling the influence of the Ras family gene activation in the Ras signaling pathway, should have a major impact on clarifying the oncogenetic process, possibly offering candidate therapy and prevention strategies.

Rectourethral fistula: A challenging management problem

AimTo describe the problems and management of rectourethral fistulas.BackgroundRectourethral fistula constitutes a rare entity that poses a challenging management problem. The condition is either congenital or acquired. The clinical findings suggestive of RUF include pneumaturia, faecaluria, and urine leakage per rectum.MethodsThis study was based on English research literature, mainly by searching PubMed bibliographic database.ResultsDiagnosis of a rectourethral fistula is difficult and often based on history alone. In rare cases, non-operative management has been successful, but the majority of patients require surgical intervention. A wide variety of procedures have been described for RUF repair.ConclusionRectourethral fistula represents a complex management problem for any surgeon. Surgical treatment of RUF is technically demanding and requires collaboration with rectal surgeons.