Zbigniew Lorenc

Potential role of human papilloma virus in the pathogenesis of gastric cancer

AIM To demonstrate the presence and biological activity of human papilloma virus (HPV) in gastric cancer (GAC) tissues. METHODS The study involved 84 surgically treated patients with gastric adenocarcinoma, regardless of the clinical stage of the disease. The presence of HPV DNA of high oncogenic risk types in formalin-fixed, paraffin-embedded tumor samples was determined using quantitative polymerase chain reaction analysis. A stringent protocol of prevention of cross- and environmental contamination was applied during DNA isolation, and amplification, as well as confirmation of the biological activity of the virus in tumor cells, was implemented. The study utilized the Real-time High Risk HPV test, which detects the DNA of 14 HPV subtypes that are considered to have high oncogenic potential. The overexpression of the p16(INK4a) protein assessed immunohistochemically was considered confirmation of the HPV infection. RESULTS Among the 89 patients initially included in the study group, diagnostic results were obtained for 84 individuals. In five cases, either the histopathological material was too scant to isolate the necessary amount of DNA, or the isolated DNA was significantly degraded, resulting in the failure of internal control amplification within the predefined number of 35 cycles. Those patients were excluded from further analysis. The amplification of HPV DNA was demonstrated in none of the 84 tissue samples; thus, all cases were considered to have a negative DNA status of highly oncogenic HPV subtypes. Immunohistochemical staining provided diagnostic results for all of the examined tissue samples, and excluded the accumulation of the p16(INK4a) protein in tumor cells, thus confirming the lack of active HPV infection in all of the individuals. CONCLUSION The study does not confirm the presence or biological activity of HPV in tumor tissues. Thus, the relationship between GAC and HPV infection, in the Central European population seems doubtful.

Assessment of PI3K/AKT/PTEN signaling pathway activity in colorectal cancer using quantum dot‑conjugated antibodies

In certain patients with advanced colorectal cancer, loss of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) activity is observed. PTEN is a major gatekeeper gene of the AKT serine/threonine kinase (AKT) signaling pathway responsible for the proliferative activity of cells. The assessment of AKT activity may be a prognostic factor or a predictor of response to the targeted therapies against particular signaling proteins. To precisely identify the cause and the place of the pathway deregulation, it is necessary to identify phosphorylation states and concentrations of several proteins located at different levels of the regulatory cascade. In the present study, we propose the simultaneous use of specific antibodies conjugated with different quantum dots to highlight the nature of AKT/PKB cascade deregulation in patients with colorectal cancer and the loss of PTEN expression in tumor tissue. Fifty patients with colorectal cancer of no specific location were enrolled in the study. The expression of the PTEN protein, and concentrations of phosphorylated/activated forms of 3-Phosphoinositide-dependent kinase 1 (PDK1) and AKT were assessed using quantum dot-conjugated antibodies. In patients with a diminished or complete loss of the PTEN expression in the tumor tissue increased levels of activated/phosphorylated forms of PDK1 (Phospho-PDK1-Ser241) and AKT (Phospho-AKT-Thr308) proteins were found, which are responsible for the permanent activation of the phosphoinositide 3-kinase/AKT/PTEN signaling pathway in certain cases of colorectal cancer.

Profile of Expression of Genes Encoding Matrix Metallopeptidase 9 (MMP9), Matrix Metallopeptidase 28 (MMP28) and TIMP Metallopeptidase Inhibitor 1 (TIMP1) in Colorectal Cancer: Assessment of the Role in Diagnosis and Prognostication

Background Studies on the pathomechanism of colorectal cancer (CRC) expansion indicate a significant role of metalloproteinases and their inhibitors in the extracellular matrix. The results of the analysis of a profile of transcriptional activity of genes encoding metalloproteinases were the basis of the hypothesis indicating changes in the expression of genes encoding MMP9, MMP28, and TIMP1 as an additional diagnostic and prognostic marker of CRC. Material/Methods The material consisted of samples obtained from resected tumors and healthy tissue samples from 15 CRC patients (aged 46–72 years) at clinical stages (CSs) I and II–IV. Gene expression analysis was done using microarrays. Microarray data analysis was done using the GeneSpring 11.5 platform. The results were validated using the qRT-PCR technique. Results We found high levels of expression of MMP9 at each CS, as well as in the tissues at the early stage of CRC. Additionally, we observed high levels of expression of TIMP1 and low levels of MMP28 genes in CS II–IV. No statistically significant differences based on the stage of CRC were observed. Conclusions MMP9 gene profile may be a complementary diagnostic marker in CRC. The results suggest a crucial role of MMP9 at the early stage of carcinogenesis in the large intestine. The increase in MMP9 and TIMP1 mRNA concentration and the decrease in MMP28 in the large intestinal tissue may be a confirmation of cancer, but it may not indicate the advance of CRC.

Expression Level of Genes Coding for Cell Adhesion Molecules of Cadherin Group in Colorectal Cancer Patients.

Background Colorectal Cancer (CRC) is one of the most frequently diagnosed neoplasms and also one of the main death causes. Cell adhesion molecules are taking part in specific junctions, contributing to tissue integrality. Lower expression of the cadherins may be correlated with poorer differentiation of the CRC, and its more aggressive phenotype. The aim of the study is to designate the cadherin genes potentially useful for the diagnostics, prognostics, and the treatment of CRC. Material/Method Specimens were collected from 28 persons (14 female and 14 male), who were operated for CRC. The molecular analysis was performed using oligonucleotide microarrays, mRNA used was collected from adenocarcinoma, and macroscopically healthy tissue. The results were validated using qRT-PCR technique. Results Agglomerative hierarchical clustering of normalized mRNA levels has shown 4 groups with statistically different gene expression. The control group was divided into 2 groups, the one was appropriate control (C1), the second (C2) had the genetic properties of the CRC, without pathological changes histologically and macroscopically. The other 2 groups were: LSC (Low stage cancer) and HSC (High stage cancer). Consolidated results of the fluorescency of all of the differential genes, designated two coding E-cadherin (CDH1) with the lower expression, and P-cadherin (CDH3) with higher expression in CRC tissue. Conclusions The levels of genes expression are different for several groups of cadherins, and are related with the stage of CRC, therefore could be potentially the useful marker of the stage of the disease, also applicable in treatment and diagnostics of CRC.

Polish Consensus Statement On The Protective Stoma

Department of General and Colorectal Surgery, Bielański Hospital in Warsaw1 Department of Rehabilitation, J. Piłsudski University of Physical Education in Warsaw2 Z Katedry i Kliniki Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej Department of General and Endocrinological Surgery and Gastroenterological Oncology, Medical University in Poznań, H. Święcicki Teaching Hospital in Poznań3 Department of General and Colorectal Surgery, K. Marcinkowski Medical University in Poznań4 Department of General and Colorectal Surgery, Military Medical Academy University Teaching Hospital, Central Veterans’ Hospital in Łódź5 2nd Department of General, Gastroenterological and Gastrointestinal Tumour Surgery, Medical University in Lublin, Independent Public Teaching Hospital No 1 in Lublin6 Department of Oncological Surgery, Oncology Centre, M. Skłodowska-Curie Institute in Cracow7 Department of General and Colorectal Surgery and Multi-Organ Trauma with Surgical Nursing Unit, Silesian Medical University, Provincial Specialist Hospital No 5 in Sosnowiec8 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow9 Department of General Surgery, Solec Hospital in Warsaw10 Department of General, Oncological and Gastrointestinal Surgery, Medical Centre of Postgraduate Education in Warsaw11 Department of Oncological Surgery, Gdańsk Centre of Oncology, Polish Red Cross Maritime Hospital in Gdańsk12 Department of General and Oncological Surgery, Pomeranian Medical University, Independent Public Teaching Hospital No 2 in Szczecin13 Department of General, Oncological and Endocrinological Surgery, Provincial Hospital Complex in Kielce14 Department of Oncological Surgery, Professor F. Łukaszczyk Oncological Centre in Bydgoszcz15 Department of General and Oncological Surgery, University Teaching Hospital in Wrocław16 Department of General, Oncological and Chest Surgery, Central Teaching Hospital of the Ministry of National Defence, Military Medical Institute in Warsaw17 Department of General, Gastroenterogical and Oncological Surgery, L. Rydygier Collegium Medicum in Bydgoszcz, L. Rydygier Provincial Complex Hospital in Toruń18 Department of Surgery, Military Institute of Aviation Medicine in Warsaw19 Department of General, Oncological and Vascular Surgery, Provincial Specialist Hospital in Słupsk20

Multiannual abdominal pain complicated by obstruction of the gastrointestinal tract in the course of cystic form of mesenteric lymhangioma of the small intestine

Lymphangiomas constitute a group of very rare diseases and occur with a frequency of 1/250,000 to 1/20,000 of hospitalizations. Even though they are benign lesions, their complications may turn into a life-threatening condition. They usually occur in children (90%), they are either congenital or they appear before the childs second birthday. Occassionally they are found in adults. Lymphangiomas are usually localized around neck, but also near armpits and in the groin area. Less than 1% of lymphagiomas are detected in the retroperitoneal space and intestinal mesentery. Vascular lesions derived from lymphatic vessels can be divided into ordinary ones, usually known as capillary, cavernous, and cystic. The cystic tumor (lymphangioma mesenteri) is the least common. It occurs mostly in the retroperitoneal space, mesentery of the colon, or extremely rarely in the mesentery of the small intestine. Preoperative diagnosis is difficult due to non-specific clinical symptoms and noncharacteristic image in the diagnostic tests. Lymphangioma complications, such as intestinal obstruction or perforation, and persistent pain, are the cause of exploratory laparotomy. Final diagnosis requires microscopic examination of material collected during an operation. This article presented the case of a 40-year-old female, operated due to the obstruction of the gastrointestinal tract, in whose case the lymphangioma was recognised in postoperative histopathological examination of the tumor from the jejunal mesentery. Since patients with these tumors have good chances of complete recovery - if there are no serious complications - it appears that the optimal therapeutic procedure should be early surgery, which reduces the possibility of complications.

Primary Duodenal Carcinoma - Case Report

Duodenal carcinoma is a rare tumor of the gastrointestinal tract of an insidious and secretive course, often diagnosed during the advanced stage of the disease. The study presented a case of a female patient diagnosed with duodenal carcinoma, subjected to two-staged surgery. The initial surgical intervention consisted in the implementation of a gastrointestinal anastomosis, followed by radical surgery by means of Whipples method performed after three years.

Calcifying fibrous tumor of the small bowel mesentery in a 27-year old male patient - case report.

Calcifying fibrous tumor is a rare disease entity, usually concerning the soft tissues of the limbs, neck, trunk, or scrotum. Cases of the above-mentioned pathology have also been reported considering the pleural and peritoneal cavity, and small bowel mesentery. The essence of the disease, whose etiology and pathogenesis remains unclear, is the fibrous tissue infiltration and diffuse inflammation with focal calcifications. The study presented a case of a 27-year old male patient subjected to surgical intervention, due to an abdominal cavity tumor. The tumor was radically removed, and its character and definitive diagnosis were established postoperatively. After a seven-year follow-up period, recurrence was not observed.

Changes in the Occurrence of Abdominal Complaints in Surgically TreatedPatients due to Cholecystolithiasis

Introduction: The post cholecystectomy syndrome is defined as the maintenance or the occurrence of digestive tract symptoms after cholecystectomy due to extra hepatic biliary duct disorders. The introduction of a laparoscopic approach has revolutionized the procedure in the treatment of cholecystolithiasis. Laparoscopic cholecystectomy is less invasive for patients as compared to the classic surgical procedure. Aim: Determination of the frequency and the intensity of abdominal symptoms occurring after laparoscopic surgery and classic cholecystectomy related to the post cholecystectomy syndrome. Material and methods: The study group consisted of 105 patients of the Clinical Department of Surgery of the Regional Specialist Hospital in Tychy, Poland. Patients were divided into two groups: patients who underwent laparoscopic (n=83) or classic (n=22) cholecystectomy. The assessments were performed preoperatively, 1 month and 6 months postoperatively, using the “Gastric Symptom Questionnaire”. Results: The results were compared using statistical methods. Results: The symptoms of the syndrome were observed in 32 (30.5%) patients from the study group. Symptoms related to the post cholecystectomy syndrome included abdominal pain, flatulence, nausea, vomiting, movement difficulties, loss of appetite or diarrhea. These symptoms occurred more frequently after classic cholecystectomy as compared to the laparoscopic approach, 1 month and 6 months after cholecystectomy. Conclusions: The post cholecystectomy syndrome may occur in 1/3 of patients after cholecystectomy. The symptoms occur less frequently in laparoscopically treated patients. In a large number of patients the syndrome may be related to the treatment method.

Anastomotic leaks in gastrointestinal surgery and their prevention

Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.