Piotr Lewitowicz

Percutaneous Fine Needle Biopsy in Pancreatic Tumors: A Study of 42 Cases

The technological progress within the range of methods of pancreas imaging and their more common accessibility selects a group of patients requiring a microscopic diagnosis. Percutaneous fine needle aspiration biopsy under the control of ultrasonography (PCFNA/USG) is the method commonly used in determining the character of a focal pancreatic lesion. Aim of the Work. An assessment of the accessibility of PCFNA biopsy in the assessment of solid and cystic changes in a pancreas and the correlation of the results of imaging examination, cytological smear and concentration of a serous marker CA19-9. Material and Methodology. In our material we analysed 43 cases of tumors of the pancreas among the patients who were at the average age of 59 ± 10.4 (14 women, 28 men) diagnosed by PCFNA biopsy. Results. In a group we are 23 cases of cancer, 12 cases of inflammation and 7 cases of cellular atypia for which 2 cases of IPMN were included. The sensitivity of the method was 92.5% but specificity was 68%. In our opinion PCFNA/USG is a method of the comparable sensitivity and specificity with fine needle aspiration biopsy with EUS control and its efficiency depends to a considerable degree on experience and interdisciplinary collaboration.

CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up

Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 (p = 0.008) as well as with GLUT-1 (p = 0.014). We noted a strict correlation of GLUT-1 expression with CD63 expression (p = 0.03), which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor.

α-Fetoprotein-Producing Hepatoid Gastric Adenocarcinoma With Osteoclast-Like Giant Cells and Neuroendocrine Differentiation A Case Study With Molecular Profiling

Here we present the case of a 73-year-old woman with an ulcerated, advanced, hepatoid, and α-fetoprotein-producing poorly differentiated (G3) primary gastric adenocarcinoma pT3 N3a M1 with multinucleated cells and evident neuroendocrine component. This tumor was consistent with giant cell tumor type gastric carcinoma with osteoclast-like giant cells (OGCs). The cancer was HER2 and E-cadherin negative, chromogranin A dispersedly and moderately positive, and strongly α-fetoprotein-positive with evident CK AE1/AE3 immunoreactivity, while OGCs expressed CD68. To provide an insight into the molecular background of this peculiar neoplasm, next-generation sequencing (NGS) was performed to analyze the 50 most frequently mutated oncogenes and tumor suppressors. We detected mutations in the primary tumor in the following genes: KIT, EGFR, PTEN, ATM, and RB1. In the liver metastasis, we revealed mutations in 3 genes: PIK3CA, KIT, and CDKN2A.

Comparative analysis of selected scales to assess prognosis in acute pancreatitis

OBJECTIVE To evaluate the utility of selected scales to prognosticate the severity and risk for death among patients with acute pancreatitis (AP) according to the revised Atlanta classification published in 2012. METHODS Prospective data regarding patients hospitalized due to AP were analyzed. The final analysis included a total of 1014 patients. The bedside index for severity in acute pancreatitis (BISAP), Panc 3 scores and Ranson scales were calculated using data from the first 24 h of admission. RESULTS Mild AP was diagnosed in 822 (81.1%) cases, moderate in 122 (12%) and severe in 70 (6.9%); 38 (3.7%) patients died. The main causes of AP were cholelithiasis (34%) and alcohol abuse (26.7%). Recurrence of AP was observed in 244 (24.1%) patients. In prognosticating the severity of AP, the most useful scale proved to be the Acute Physiology and Chronic Health Evaluation (APACHE) II (area under the curve [AUC] 0.724 [95% CI 0.655 to 0.793]), followed by BISAP (AUC 0.693 [95% CI 0.622 to 0.763]). In prognosticating a moderate versus mild course of AP, the CT severity index proved to be the most decisive (AUC 0.819 [95% CI 0.767 to 0.871]). Regarding prognosis for death, APACHE II had the highest predictive value (AUC 0.726 [95% CI 0.621 to 0.83]); however, a similar sensitivity was observed using the BISAP scale (AUC 0.707 [95% CI 0.618 to 0.797]). CONCLUSIONS Scoring systems used in prognosticating the course of the disease vary with regard to sensitivity and specificity. The CT severity index scoring system showed the highest precision in prognosticating moderately severe AP (as per the revised Atlanta criteria, 2012); however, in prognosticating a severe course of disease and mortality, APACHE II proved to have the greatest predictive value.

Role of immunohistochemical and histochemical profiling in H&E-based diagnosis of scrotal leiomyosarcoma of dartos muscle

Histochemical and immunohistochemical methods should often but not always complement standardized histopathologic procedures. Here, we illustrate use of these ancillary techniques in a report of scrotal leiomyosarcoma. 62-year-old male patient presented with a palpable, subcutaneous 2,5 cm wide tumor arising from dartos muscle. The tumor was diagnosed leiomyosarcoma G2 pT1b. Interestingly, the sarcomatous mass was focally strictly attached to convoluted, benign bundles of smooth muscles that were intermingled with tumor mass at peripheral, lateral and superior sides of the lesion. We have used immune- and histochemical methods to confirm histopathological findings based on H&E staining. As expected, in tumor cells smooth muscle actin and desmin were strongly immunopositive similarly as Masson trichrome staining, while S100 and CD34 antigens were immunonegative except for sustained positivity for CD34 in vessels. The auxiliary staining methods can provide additional information on the tumorigenesis of leiomyosarcoma. They can also serve to determine additional features of prognostic significance, since e.g. immunoreactivity of CD34 accurately maps vascular density of tumor and enables a careful assessment of vascular invasion in course of leiomyosarcoma as well.

Tumor Digital Masking Allows Precise Patient Triaging: A Study Based on Ki-67 Scoring in Gastrointestinal Stromal Tumors

Background Technological advances constantly provide cutting-edge tools that enhance the progress of diagnostic capabilities. Gastrointestinal stromal tumors belong to a family of mesenchymal tumors where patient triaging is still based on traditional criteria such as mitotic count, tumor size, and tumor location. Limitations of the human eye and randomness in choice of area for mitotic figure counting compel us to seek more objective solutions such as digital image analysis. Presently, the labelling of proliferative activity is becoming a routine task amidst many cancers. The purpose of the present study was to compare the traditional method of prediction based on mitotic ratio with digital image analysis of cell cycle-dependent proteins. Methods Fifty-seven eligible cases were enrolled. Furthermore, a digital analysis of previously performed whole tissue section immunohistochemical assays was executed. Digital labelling covered both hotspots and not-hotspots equally. Results We noted a significant diversity of proliferative activities, and consequently, the results pointed to 6.5% of Ki-67, counted in hotspots, as the optimal cut-off for low–high-grade GIST. ROC analysis (AUC = 0.913; 95% CI: 0.828–0.997, p < 0.00001) and odds ratio (OR = 40.0, 95% CI: 6.7–237.3, p < 0.0001) pointed to Ki-67 16% as the cut-off for very high-grade (groups 5–6) cases. With help of a tumor digital map, we revealed possible errors resulting from a wrong choice of field for analysis. We confirmed that Ki-67 scores are in line with the level of intracellular metabolism that could be used as the additional biomarker. Conclusions Tumor digital masking is very promising solution for repeatable and objective labelling. Software adjustments of nuclear shape, outlines, size, etc. are helpful to omit other Ki-67-positive cells especially small lymphocytes. Our results pointed to Ki-67 as a good biomarker in GIST, but concurrently, we noted significant differences in used digital approaches which could lead to unequivocal results.

GSTM1, GSTT1, and GSTP1 polymorphisms and colorectal cancer risk in Polish nonsmokers

Glutathione S-transferase (GST) enzymes are responsible for cellular detoxification of many carcinogens and are important anticancer elements. This study assessed potential relationships between GSTM1, GSTT1, and GSTP1 polymorphisms and colorectal cancer (CRC) risk in Polish nonsmokers. We also analyzed the influence of GST gene polymorphisms on CRC clinical and histopathological features. Our study included 197 CRC patients and 104 healthy controls. GSTM1, GSTT1, and GSTP1 polymorphisms were evaluated using qPCR. Polymorphism frequencies observed in our control group corresponded to those in other European populations. The GSTM1 null and GSTT1 null genotypes were observed with similar frequencies in both CRC patients and controls (GSTM1 null: 46.7% vs. 45.2%; GSTT1 null: 15.7% vs. 20.2%). GSTP1 Ile/Ile, Ile/Val, and Val/Val genotype frequencies were respectively 42.1%, 48.2%, and 9.6% in patients and 48.1%, 42.3%, and 9.6% in controls. GSTT1 polymorphism correlated with higher tumor grade in CRC patients, and the GSTM1 null/null genotype was associated with more frequent metastasis to lymph nodes (pN classification). Our results suggest that GST gene polymorphisms may influence CRC tumor grade and stage.

Cardiac malignant peripheral nerve sheath tumours arising from atrial neurofibroma as an unusual complication of neurofibromatosis

Address for correspondence: Alicja Stępień-Wałek, MD, 1st Cardiology Department, Swietokrzyskie Cardiology Centre, ul. Grunwaldzka 45, 25–736 Kielce, Poland, e-mail: magda1100@onet.pl; bw.kaplon@poczta.onet.pl Conflict of interest: none declared Kardiologia Polska Copyright

Conventional colon adenomas harbor various disturbances in microsatellite stability and contain micro-serrated foci with microsatellite instability

Introduction Colorectal cancer belongs to the most frequent occurring malignancies. A prediction of the clinical outcome and appropriate choice of neoadjuvant chemotherapy needs personalized insight to the main driving pathways. Because most CRCs have polyps as progenitor lesions, studying the pathways driving to adenomagenesis is no less important. Goals Our purpose was the evaluation of microsatellite stability status within conventional colon adenomas and also β-catenin, BRAFV600E and p53 contribution. Material and methods The cohort included 101 cases of typical colon adenomas with high grade epithelial dysplasia according to WHO. An immunohistochemistry method was used for the depiction of the expression of targeted proteins, as also their heterogeneity. Results Generally, we noted a 10% frequency of MSI events where MSI-H reached a 5% share occurred within the left colon and rectal polyps. β-catenin nuclear overexpression was noted with a 70% frequency and p53 with close to a 24% frequency. In addition, we found a presence of micro-serration foci more often within tubular adenomas, where focal MSI took place more often. Our results indicate that MSI events occur more often than had been theorized earlier. It results in tumour heterogeneity, more complex underlying pathways and finally ontogenetic molecular-diversity of tumours besides similar occurring histopathological features.