Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland.

BACKGROUND In Crohn disease (CD), pharmacotherapy with nutritional support is the treatment of choice. However, complications and a lack of response to drugs are indications for surgery. The aim of this study was to present indications for surgery and methods of surgical treatment of CD and to analyze the postoperative morbidity and mortality risk factors. MATERIAL AND METHODS This was a retrospective analysis of adult patients who underwent surgery for CD between January 2015 and January 2019. Sixty of 457 patients (13%) hospitalized for CD required surgical treatment. The parameters age, sex, body mass index, duration, behavior and location of the disease, pharmacotherapy, indications for surgery, type and duration of surgery, perioperative complications, and laboratory tests results were analyzed. RESULTS Most procedures (90%) were elective. The most common indications for surgery were fistulae and strictures. The most frequently performed procedure was right hemicolectomy (60%). Thirty-two percent of patients had postoperative complications. Perianal disease (P=0.002) and penetrating behavior (P=0.01) were associated with more surgeries. Stricturing and penetrating behavior was more frequent in patients with ileal/ileocecal involvement than in those with CD affecting the colon (P=0.039). Patients with smoking history had a significantly lower age at first surgery (P=0.02). The use of anti-TNF medications appeared to extend time between diagnosis and first surgery (P=0.014). CONCLUSIONS Although the analysis did not reveal any risk factors for perioperative complications, perianal manifestations, penetrating disease type, ileal/ileocecal involvement, and smoking may be associated with risk of earlier surgery or multiple surgeries.

Primary thyroid squamous cell carcinoma presenting as a left-sided neck lump.

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.

A Retrospective Study of Postoperative Outcomes in 98 Patients Diagnosed with Gastrointestinal Stromal Tumor (GIST) of the Upper, Middle, and Lower Gastrointestinal Tract Between 2009 and 2019 at a Single Center in Poland.

BACKGROUND Gastrointestinal stromal tumors (GISTs) arise in the smooth muscle pacemaker interstitial cells of Cajal, or similar cells. The aim of this retrospective study between 2009 and 2019 from a single center in Poland was to assess the selected prognostic factors (location, tumor size, mitotic index, body mass index (BMI), length of hospital stay, age, sex, and coexistent neoplasm) and to investigate postoperative outcomes in 98 patients with GIST of the upper, middle, and lower gastrointestinal tract. MATERIAL AND METHODS Between 2009 and 2019, 98 patients (50 women and 48 men) with an average age of 63.8 years (range from 38 to 90 years) were operated on for GIST in the Department of Gastrointestinal Surgery in Katowice, Poland. Based on the intraoperative and postoperative investigations, the tumor size and mitotic index were determined in each case. RESULTS A statistically significant correlation between age and mitotic index (MI) was found (p=0.02). The higher the MI, the younger the age of the patients. However, regardless of sex, younger patients had a tendency to survive longer. A >60-year-old male patient's probability of survival was around 65% after 40 months. Higher mitotic index was also associated with larger tumor size (p<0.0001). Female patients had a tendency to survive longer than males. CONCLUSIONS The findings from this small retrospective study support the importance of preoperative evaluation and frequent postoperative follow-up for patients with GIST of the gastrointestinal tract, particularly in older male patients, and patients with malignant comorbidities, which are associated with increased mortality.

Serous neoplasms of the pancreas share many, but not all aspects of their microvascular and angiogenic profile with low-grade clear cell renal cell carcinomas.

Similarly to clear cell renal cell carcinomas (CCRCC), serous neoplasms (SN) of the pancreas frequently show inactivation of VHL gene, clear cell histology and abundant microvasculature. Data on the microvascular and angiogenic profile of SN are scarce. Aiming to examine further the striking resemblance of clear cell epithelial neoplasia in pancreas and kidney, we compared the microvascular profile and expression of pro-angiogenic factors in SN and in CCRCC using immunohistochemical stains. SN and CCRCC shared a predominance of differentiated blood vessels, scarcity of lymphatic vessels, presence of CD105 and claudin-5 in tumoral vessels, expression of vascular endothelial growth factor (VEGF)-A, cyclooxygenase-2 (COX-2), carbonic anhydrase IX in tumoral cells, and lack of VEGF-C in tumoral cells. In contrast to CCRCC, SN showed lower pericyte coverage of vessels, lower blood vessel endothelial cell proliferaction fraction, more pronounced VEGF receptor (VEGFR)-2 and glucose transporter-1 expression, higher inducible (iNOS) but lower endothelial nitric oxide synthase (eNOS) expression, as well as presence of VEGFR-3 and D2-40 expression in epithelial cells. In conclusion, we found a significant similarity but not equality of microvascular biology of SN and CCRCC. We recognized VEGFR-2, VEGFR-3, COX-2, iNOS, eNOS and D2-40 as new markers of epithelial cells of SN of the pancreas.

A new protocol for cultivation of predegenerated adult rat Schwann cells.

The purpose of this study was to optimize the methodology of cultivation of predegenerated Schwann cells (SCs). SCs were isolated from 7-day-predegenerated sciatic nerves of adult rats. We applied commercially available culture medium for cultivation of endothelial cells endothelial cell culture medium (EBM-2) instead of Dulbecco's Modified Eagle's Medium commonly used to culture adult Schwann cells. Additionally, cell culture medium was supplemented with factors specifically supporting SCs growth as: bovine pituitary extract (5 µg/ml), heregulin (40 ng/ml) and insulin (2.5 ng/ml). Similarly to the reports of others authors, we did not observe any beneficial effects of Forskolin application, so we didn't supplement our medium with it. Cell culture purity was determined by counting the ratio of GFAP, N-Cadherin and NGFR p75-positive cells to total number of cells. About 94-97 % of cells were confirmed as Schwann cells. As a result, we obtained sufficient number and purity of Schwann cells to be applied in different experimental models in rats. EBM-2 medium coated with fibronectin was the best for cultivation of adult rat Schwann cells.

Precursor lesions of early onset pancreatic cancer.

Early onset pancreatic cancer (EOPC) constitutes less than 5% of all newly diagnosed cases of pancreatic cancer (PC). Although histopathological characteristics of EOPC have been described, no detailed reports on precursor lesions of EOPC are available. In the present study, we aimed to describe histopathological picture of extratumoral parenchyma in 23 cases of EOPCs (definition based on the threshold value of 45 years of age) with particular emphasis on two types of precursor lesions of PC: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMNs). The types, grades, and densities of precursor lesions of PC were compared in patients with EOPCs, in young patients with neuroendocrine neoplasms (NENs), and in older (at the age of 46 or more) patients with PC. PanINs were found in 95.6% of cases of EOPCs. PanINs-3 were found in 39.1% of EOPC cases. Densities of all PanIN grades in EOPC cases were larger than in young patients with NENs. Density of PanINs-1A in EOPC cases was larger than in older patients with PC, but densities of PanINs of other grades were comparable. IPMN was found only in a single patient with EOPC but in 20% of older patients with PC. PanINs are the most prevalent precursor lesions of EOPC. IPMNs are rarely precursor lesions of EOPC. Relatively high density of low-grade PanINs-1 in extratumoral parenchyma of patients with EOPC may result from unknown multifocal genetic alterations in pancreatic tissue in patients with EOPCs.

Discrepancies between two alternative staging systems (European Neuroendocrine Tumor Society 2006 and American Joint Committee on Cancer/Union for International Cancer Control 2010) of neuroendocrine neoplasms of the pancreas. A study of 50 cases.

The aim of our study was to identify and describe potential inconsistencies between two alternative staging systems of pancreatic neuroendocrine neoplasms (pNENs)--the European Neuroendocrine Tumor Society (ENETS) system (2006) and the American Joint Committee on Cancer/Union for International Cancer Control (AJCC-UICC) system (2010). To address this issue, we performed a retrospective clinico-pathological study of 50 cases of pNENs. We found 9 (18%) cases of ENETS/AJCC-UICC discrepancies regarding the primary tumor stage. They included 7 cases of T2/T3 disagreement and 2 cases of T3/T4 disagreement. In addition, we discussed the issue of potential T1/T2 discrepancy (however, we did not observe any such a case). Another inconsistency was related to the application of different stage prognostic groupings between both systems. In conclusion, the discrepancies between ENETS and AJCC-UICC staging systems for pNENs are relatively frequent and heterogeneous. We believe that they should be rigorously recognized. This is necessary for the evaluation of prognostic factors and the effectiveness of therapeutic options used in patients with pNENs.

Serous neoplasms of the pancreas constitute a continuous spectrum of morphological patterns rather than distinct clinico-pathological variants. A study of 40 cases.

Serous neoplasms (SN) of the pancreas account for 1-2% of all pancreatic tumours. Six morphological variants of SN were previously recognized: serous microcystic (cyst)adenoma, serous macrocystic (cyst)adenoma, von Hippel-Lindau-associated serous cystic neoplasm, solid serous adenoma/neoplasm, mixed serous-neuroendocrine neoplasm and serous cystadenocarcinoma. It was recently postulated that SN shows a continuous spectrum of morphological patterns rather than distinct clinico-pathological subtypes. To address this issue, we performed a detailed review of 40 SN cases diagnosed at our institution between 1989 and 2011. We found 11 cases of serous microcystic (cyst)adenoma, 5 cases of serous macrocystic (cyst)adenoma, and a single case of von Hippel-Lindau-associated serous cystic neoplasm. Apart from that, we found 20 cases of SN which showed features of both microcystic and macrocystic (cyst)adenomas, 2 cases of small 'incipient' SN and a single case of a mixed microcystic and solid adenoma. In conclusion, we showed that 'borderline' lesions among SNs truly exist and are not rare. The reason for such a wide diversity of morphological patterns of SN remains unknown.

Childhood pineal parenchymal tumors: clinical and therapeutic aspects.

The aim of our study was to investigate the correlation of the clinical characteristic of pineal parenchymal tumors in children and adolescent with histopathological diagnosis and patient survival. Records of 27 patients with histologically diagnosed pineocytomas (n=16) and pineoblastoma (n=11) consecutively treated between 1991 and 2001 were reviewed retrospectively to identify factors predictive of aggressiveness. Among analyzed epidemiological, clinical, and radiological factors, we found that independent prognostic indicator in patients with childhood pineal parenchymal tumor was the extent of surgical resection.

Age distribution patterns of patients with conventional ductal adenocarcinoma of the pancreas. A single-institution study of 580 cases re-evaluated using current histopathological diagnostic criteria.

There are a few studies concerning epidemiology of pancreatic ductal adenocarcinoma (PDAC) in the Polish population. Analysis of age distribution patterns of patients with different types of cancer may be useful for studying their specific biology. In the present study we aimed to describe age distribution patterns of 580 patients with PDAC diagnosed in one centre during a 25-year period. All the histopathological diagnoses were re-reviewed using current histopathological diagnostic criteria. Age distributions of selected subpopulations of patients (defined based on gender, potential tumour resectability and type of the surgery) were compared using mean values, medians, age frequency density plots and logarithmic plots of age-specific frequencies. The mean and median values of patients' age were 60.8 y and 61.0 y, respectively. Females were approximately 2 y older than males at the time of PDAC diagnosis. Females with non-resectable PDAC were approximately 2 y older than females with resectable tumours. Mean age values of males with non-resectable and resectable PDAC were similar. Patients treated with pancreaticoduodenectomy were approximately 2 y older than patients undergoing other types of resections. Age distribution density plots showed that some subgroups of patients studied were somewhat heterogeneous and might include several yet poorly recognized clinico-pathological entities. Logarithmic plots of age-specific frequencies showed that PDAC epidemiology is in concordance with a multistage theory of carcinogenesis. PDAC is an age-dependent cancer. Single-institutional pathology-oriented cancer epidemiological databases may add some information to population-based cancer registries.

Intraductal oncocytic papillary neoplasms of the pancreas and bile ducts: a description of five new cases and review based on a systematic survey of the literature.

BACKGROUND: Intraductal oncocytic papillary neoplasms (IOPN) are rare tumors of the pancreatic and biliary ductal system. It is not absolutely clear if the molecular and clinicopathologic characteristics of IOPN differ significantly from other related lesions, namely intraductal papillary mucinous neoplasms (IPMN). Therefore it is not clear if it is reasonable to consider IOPN as a separate diagnostic and clinical entity. METHODS: In order to describe the clinicopathologic characteristics of IOPN and to compare them with the IPMN profile, we performed a systematic review of the literature and additionally studied five previously unreported IOPN cases. RESULTS: IOPN differ from IPMN by lack of K-ras gene mutations in all studied cases. Several differences in the clinical and biological profile between IOPN and IPMN exist, but they are of quantitative rather than of qualitative nature. Additionally, pancreaticobiliary or gastric-foveolar IPMN components may coexist with IOPN component within a single lesion, which suggests at least a partial relation of the pathogenetic pathways of IPMN and IOPN. Importantly, the pathogenesis of accumulation of mitochondria and oxyphilic appearance of IOPN remains unknown. CONCLUSIONS: At present, there are no reliable criteria other than histopathological picture and K-ras gene status to differentiate IOPN from IPMN. In particular, no clear differences in optimal treatment options and prognosis between these tumors are known. Further studies are needed to clarify the biology of IOPN and to establish their position in clinicopathologic classifications of pancreatic tumors.

Different approaches to assessment of lymph nodes and surgical margin status in patients with ductal adenocarcinoma of the pancreas treated with pancreaticoduodenectomy.

AIM: To develop a method of gross examination of pancreaticoduodenectomy specimens with pancreatic ductal adenocarcinoma, allowing adequate assessment of the entire pancreatic surface as a surgical margin, which would not affect the lymph node yield. METHODS: We retrospectively compared the R1 rates (i.e., proportions of patients with microscopic residual tumour at surgical margins) and lymph node yield in a series of 67 consecutive cases of pT3 ductal adenocarcinomas diagnosed in pancreaticoduodenectomy specimens during three different periods of time and sampled using three different approaches: (1) period 2006-2007, when the pancreatic surface (except for the transection margin and superior mesenteric artery margin) was not examined; (2) period January-September 2008, when the posterior pancreatic surface (posterior circumferential radial margin) was examined using an improved method based on sampling of 2.0-2.5 mm thick consecutive slices perpendicular to the duodenal axis; and (3) period October 2008 - June 2009, when the whole surface of the pancreatic head was sampled using the approach mentioned above. RESULTS: The R1 rates in three consecutive time periods were 23.5%, 40% and 53.8%, respectively. Median numbers of retrieved peripancreatic lymph nodes were 11.0, 12.0 and 14.0, respectively. CONCLUSIONS: The newly proposed approach allowed adequate assessment of the entire pancreatic head surface as a surgical margin and reduced the risk of under-detection of R1 status. Moreover, this approach did not affect the number of peripancreatic lymph nodes examined.

Colloid carcinoma of the pancreas: review of selected pathological and clinical aspects.

Colloid carcinoma (CC) of the pancreas is a histopathological variant of ductal adenocarcinoma, which is characterised by the presence of large pools of extracellular mucin, containing neoplastic cells. The mucin component comprises at least 50% of CC (according to the definition by the World Health Organization) or at least 80% of the tumour (according to the US Armed Forces Institute of Pathology). In the vast majority of cases, CC develop from pre-existing intraductal papillary mucinous neoplasms, especially those forming intestinal-type papillae and characterised by MUC2 expression. Data concerning the long-term prognosis in patients with CC are discrepant. In this review, the authors present contemporary definitions of CC, issues of its epidemiology, symptomatology, pre-operative diagnostics, histopathology, treatment and prognosis. Special attention has been paid to pathogenesis of CC.

Floret-like multinucleated giant cells in neurofibroma.

This short report discusses a case of neurofibroma containing floret-like multinucleated giant cells. This being the second such case in the literature. Floret-like multinucleated giant cells have been reported in gynaecomastia and neurofibroma in neurofibromatosis type 1. These cells have been reported in uncommon soft tissue tumours including pleomorphic lipoma, giant cell collagenoma, giant cell fibroblastoma and giant cell angiofibroma. We recommend these cells to be interpreted carefully keeping in mind the rare malignant change in neurofibromas. Immunohistochemistry would help in defining the nature of such cells.

Coexistence of gastrointestinal stromal tumors with other neoplasms.

BACKGROUND: The purpose of this study was to assess the prevalence of other neoplasms in patients with gastrointestinal stromal tumors (GISTs) and to compare clinical and histopathological data in patients with a GIST and accompanying neoplasms and in patients with GIST only. METHODS: The analysis encompassed 82 patients with a GIST from among 330 300 patients whose surgical specimens, biopsies, and autopsies were evaluated between January 1989 and June 2006. A subgroup of patients with other types of neoplasms was selected. RESULTS: Other neoplasms in patients with a GIST were diagnosed in 22 of the 82 (26.8%) patients. The most common accompanying neoplasms were colorectal (nine cases) and gastric (four cases) adenocarcinoma, as well as pancreatic adenocarcinoma (three cases). There was a tendency toward more common localization of a GIST in the small intestine in patients with other neoplasms than in patients with a GIST alone (P < 0.09). Tumors with very low risk of aggressive behavior were more frequent in patients with a GIST accompanied by other neoplasms than in the other group (P < 0.05). No phenotypic differences in GIST cells were found between the two groups. CONCLUSIONS: In almost 27% of the study population, GISTs coexisted with other neoplasms. A greater proportion of patients with a GIST localized in the small intestine and/or characterized by a very low risk of aggressive behavior and accompanying other neoplasms, compared with a GIST alone, most likely reflects the fact that in the first group, GISTs tended to be an incidental finding during surgery. The results were affected by patient selection and the type of tissue material available.

Papillary pineocytoma in child: a case report.

BACKGROUND: Papillary pineocytoma is an extremely rare tumor usually with a poor outcome. CASE REPORT: We report a case of a 10-year-old-girl with pineal gland tumor and obstructive hydrocephalus diagnosed using MRI. The child was successful treated by insertion of a ventriculoperitoneal shunt and consecutive tumor resection by supracerebellar-infratentorial approach. Histopathological examination showed a papillary structure of the pineocytoma. As such, tumors are considered to be aggressive the child was subjected to radio- and chemotherapy. CONCLUSION: At six year follow-up after surgery, the patient is symptom-free and the MRI shows no tumor recurrence.

The changes in neurotrophic properties of the peripheral nerves extracts following blocking of BDNF activity.

OBJECTIVES: Retinal ganglion cells (RGCs) of adult rats are unable to regenerate their axons after optic nerve injury and soon after they enter the pathway of apoptosis. They may, however, survive and regenerate new axons in response to application of specific peripheral nerve extracts that presumably contain a range of neurotrophic substances. One of the recognized substances of proven neurotrophic activity is brain-derived neurotrophic factor (BDNF). We have investigated whether blocking the BDNF activity in post-microsomal fractions obtained from 7 day pre-degenerated peripheral nerves would affect its neurotrophic properties towards RGCs after optic nerve transection in adult rats. METHODS: Autologous connective tissue chambers sutured to the distal end of transected optic nerve served as active substances containers. Surviving RGCs were visualized using Dil. The number of myelinated outgrowing fibers within the chambers was evaluated in histologic sections. RESULTS: BDNF and 7 day pre-degenerated nerve extracts, and also extracts with blocked BDNF activity, enhanced RGC fibers outgrowth. The regeneration was significantly weaker in the control group. Blocking the BDNF activity in the 7 day pre-degenerated peripheral nerve extract reduced its neurotrophic effects but the differences were insignificant in comparison with non-blocked extracts. DISCUSSION: The regeneration intensities in groups receiving 7 day pre-degenerated peripheral nerve extracts (PD7) and BDNF were comparable. The number of surviving cells was higher in the PD7 group and there were more regenerating fibers in the BDNF group, which may be explained by the strong BDNF effect on axonal collateralization and sprouting.

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy.

AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS: Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS: Complete regression (ypT0, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging" and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5. No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION: Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients with rectal cancer at the stage of cT3NxM0. There is no unequivocal relationship between "T-downstaging" and TRG and NG. There is some concordance in the assessment of lymph node status with ypT, TRG and NG. TRG and NG are of limited value for the risk assessment of the lymph node involvement.

Primary malignant fibrous histiocytoma of the heart.

A 72-year-old male diagnosed with heart failure and dyspnea was found to have a lesion in his right atrium. Histological examination of the tumor revealed it to be a malignant fibrous histiocytoma. The patient's management and subsequent follow-up are presented.