Procalcitonin in patients with colorectal cancer.

PURPOSE: Bacterial translocation (BT) is common in colon cancer patients and may be associated with increased occurrence of septic complications as well as with adverse oncologic outcomes. The aim of the present study was to correlate the BT detectable through peritoneal lavage culture or identified by abnormal inflammatory parameters with the clinicopathologic parameters and the short-term prognosis in a prospective series of patients. METHODS: Fifty-four consecutive patients with histologically proven colorectal cancer were included in this prospective study. White blood cells (WBC), erythrocyte sedimentation rate (ESR) and serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined and cultures from peritoneal lavage were collected immediately after laparotomy. RESULTS: Positive PCT was detected in 31 (55.3%) patients while positive cultures were obtained in 6 (11%) patients. Significant positive correlation of PCT with inflammation markers was noticed. Patients with distant metastases had higher serum PCT levels than patients without distant metastases (p=0.01). Borderline statistical significance was found between PCT and tumor grade (p=0.09). PCT was not correlated with the cultures of the lavage or the outcome. CONCLUSION: PCT is an adequate inflammatory marker, able to preoperatively discriminate patients with bacterial systemic inflammatory reaction due to BT. However, the clinical consequence of BT may be minimal as is shown by the lack of association of PCT or positive peritoneal lavage cultures with time to discharge, complications and short-term survival.

Analysis of clinical and molecular associations of triple negative breast cancers in node-negative patients.

INTRODUCTION: Therapeutic modalities in node-negative breast cancer patients remain a matter of controversy. Various prognostic factors have been proposed to help select those patients that would most likely benefit from adjuvant therapy. In view of this notion the triple negative phenotype (hormone receptors and HER2 negative tumors) has gained increasing attention. AIM: To evaluate the clinicopathologic characteristics of triple negative (TN) tumors in node-negative invasive breast carcinomas. METHODS: We retrospectively analyzed the archival pathology tissues of 160 patients with node-negative invasive carcinomas, diagnosed and treated in two surgical departments in Greece from 1999 to 2006. Statistical analysis was used to examine the association between TN tumors and other clinicopathological factors. RESULTS: Triple negative breast cancers correlated with higher histologic grade, mitotic activation index and Ki-67 expression (p < 0.05). Moreover TN tumors were correlated with negative staining for bcl-2 (p < 0.05). CONCLUSION: In node-negative breast cancer patients, triple negativity is associated with aggressive biologic behavior. Further studies are required to better understand the clinical implications of these findings.

Differences in colorectal cancer patterns between right and left sided colorectal cancer lesions.

PURPOSE: Colorectal carcinomas that arise proximal (right) or distal (left) to the splenic flexure exhibit different clinical and biological characteristics. Although various hypotheses have been proposed to explain these differences, their origin remains unclear. In this study we investigated the clinicopathologic differences between left and right colon tumors and comment on the possible explanatory theories behind them. METHODS: This study included a total of 388 retrospectively collected cases of colorectal cancer, surgically treated from 1999 to 2004. Differences of patients' demographic data and tumor micro- and macroscopic characteristics between left and right-sided tumors were investigated and analysed. RESULTS: Patients with right-sided colon cancer were significantly older (mean age 70 vs. 68 years; p<0.05) and had more lymph nodes examined than patients with left colon tumors (mean number of nodes 18.9 vs. 12.6; p<0.05). There was a lower proportion of T1 stage right-sided tumors (3.1 vs. 5%) and a higher proportion of stage T2-4 (96.9 vs. 95%) compared with left-sided tumors (p<0.001 for x2 test of all T stages). Furthermore, right-sided tumors had a higher mean width and depth (4.3 vs. 3.8 cm and 1.8 vs. 1.6 cm, respectively; p<0.05). Finally, there was a higher percentage of poorly differentiated right colon tumors (41.4 vs. 17.5%; p<0.001). CONCLUSION: Right-sided colon tumors affect older patients and are diagnosed at more advanced disease stages. The underlying mechanisms that provoke these differences remain unclear. Further studies are needed in order to better understand the true nature of these differences and their possible clinical implications.

The value of proliferation indexes in breast cancer.

INTRODUCTION: During the past several years, the Ki-67 antigen has gathered great interest in its role as a prognostic marker. Nevertheless, despite the large number of published papers, the role of Ki-67 in clinical practice remains controversial. AIM: To evaluate the association between Ki-67 immunoreactivity and other clinicohistopathological parameters. METHODS: We retrospectively analyzed the archival pathology tissues of 356 patients, diagnosed and treated in our department, from 2002 to 2006. Statistical analysis was used to examine the association between Ki-67 expression and other clinicopathological factors. RESULTS: The expression of Ki-67 was correlated with the mitotic count, tumor grade and size and p53, HER2 and EGFR expression. Furthermore Ki-67 expression was significantly related with nodal status and inversely associated with hormonal expression. Moreover, invasive carcinomas appeared to have greater proliferation values than in situ carcinomas, while invasive ductal carcinomas were correlated with higher Ki-67 expression compared to lobular cancers. CONCLUSION: The expression of Ki-67 appears to be a valuable method of proliferation measurement that could prove helpful in clinical practice. Further research is warranted in order to standardize the methodology and to reach uniformity in regard with the optimal cut-off value.

The role of sonography in the diagnosis of cystic lesions of the breast.

INTRODUCTION: Breast sonography is appropriate in the initial assessment of a women younger than 30 years with a palpable lump and in the adjunctive evaluation of mammographic masses, and palpable abnormalities not seen mammographically. MATERIAL AND METHODS: A total of 269 patients underwent breast examination with ultrasound due to the presence of bilateral or unilateral palpable lesions. Women under 40 years old were submitted to US examination only while patients older than 40 years underwent US breast assessment and conventional mammography. RESULTS: Mammography had an accurancy of 57.3% and confirmed diagnosis in 113 out of 197 patients; in 57 patients (28.4%) it identified the lesion but could not determine the diagnosis. False-positive results for malignancy were detected in 23 patients (11.7%) and there were no false-negative results. Ultrasound assessment had an accuracy in diagnosis reaching 87.3%, 172 cases out of 196. (87.3% vs 57.3% p < 0.05); false-positive results were identified in 17 cases (8.6%). CONCLUSION: Sonography demonstrates a better diagnostic significance than mammography in the early detection of cystic breast carcinoma.

Primary hydatidosis of the gluteus muscles: report of three cases.

BACKGROUND: Hydatid disease caused by the tapeworm Echinococcus granulosus is a worldwide problem especially in sheep and cattle raising countries. AIMS: Muscle involvement is most commonly encountered as recurrence of previously treated disease or concurrently with primary lesions of the liver or lung. Furthermore, the rarity of muscle hydatidosis has unique implications in diagnosis and management. METHODS: We report on three cases of primary echinococcus of the gluteus muscles presented in our clinic during a 10-year period. RESULTS: We have administered albendazole for one cycle of 28 days in two of our patients based on the size and appearance of the cyst. All patients underwent total pericystectomy without cyst rupture. We have not found any recurrences after minimum follow up of 12 months. CONCLUSIONS: Muscle echinococciasis respond well to surgical intervention. Complete and intact removal of the cyst in primary muscular hydatidosis should be considered curative.

Primary insular carcinoid of the ovary.

Primary ovarian carcinoids are very rare tumors that account for less than 5% of all carcinoids and 0.1% of all ovarian malignancies. We present a rare case of a primary, non-functioning, insular carcinoid of the left ovary in a 44-year-old woman originating from the outer surface of a mature cystic teratoma. After an uneventful unilateral salpingo-oophorectomy, the patient had no sign of recurrence with computed tomography and 5-HIAA evaluation at 3-year follow-up. Although rare, primary ovarian insular carcinoid tumors that are confined to the ovary and treated with surgery are expected to have an excellent overall outcome.

Metastatic breast carcinoma initially presenting as acute cholecystitis: a case report and review of the literature.

INTRODUCTION: The gallbladder is an infrequent site of metastatic malignant disease. Although malignant melanoma, renal cell and cervical carcinoma have been documented, breast carcinoma has rarely been reported to metastasize in the gallbladder. CASE REPORT: We describe such a case that manifested as acute cholecystitis and was incidentally recognized after cholecystectomy, in an otherwise disease-free 46-year-old female who had undergone mastectomy for breast cancer two years before. The patient was subjected to adjuvant chemotherapy, but unfortunately died just a year after diagnosis because of generalized peritoneal seeding of the tumor. DISCUSSION: Metastatic gallbladder involvement is rare, especially in cases of primary breast carcinoma, usually leading to symptoms of abdominal pain, mimicking acute or chronic cholecystitis. Thus, abdominal pain in a patient with a previous history of breast carcinoma should raise suspicion of gallbladder metastasis.

A prospective comparison of ampullectomy with pancreaticoduodenectomy for the treatment of periampullary cancer.

Local surgical treatment of periampullary neoplasms seems attractive in the context of the reduced morbidity and mortality than the more radical treatment options. The aim of our study was to compare local excision (LE) of the ampulla with standard pancreaticoduodenectomy (PD) for the treatment of periampullary cancer in terms of overall survival. Inclusion criteria were primary tumor < or = 2 cm with no evidence of lymph node involvement or distant metastasis on abdominal computed tomography (CT). Between January 2000 and January 2004, 23 patients were enrolled onto this study (9 in the LE group and 14 in the standard PD group). The two groups were homogeneous with respect to age and gender as well as the size and origin of the primary neoplasm. There was no correlation of the survival with age, gender, presence of lymph node metastasis, size of the primary tumor, type of surgery or histologic grade (x(2), p >0.05). However, the origin of the tumor had major impact on survival, with pancreatic tumors having the worst prognosis. Hospital stay was significantly reduced in the LE treated patients. Our results showed that LE for periampullary tumors is a viable option and is well suited for medically unfit patients or those who refuse more radical treatment options.

Intact germinal layer of liver hydatid cysts removed after administration of albendazole.

BACKGROUND: Hydatid disease is a common health problem especially in Mediterranean and sheep-farming countries, caused by infection with the metacestode stage of the tapeworm Echinococcus. The liver is the most frequent primary site of Echinococcus granulosus infection in humans. Surgery remains the main treatment modality for cystic hepatic hydatid disease, with complete resection of the germinal layer being of major importance for recurrence. Perioperative administration of albendazole has been reported to improve surgical outcome but the results are controversial. We report here our observations on the usefulness of preoperative chemotherapy in surgical outcome in terms of morbidity and recurrence. METHODS: Five patients with complex liver hydatid cysts received 28 days of albendazole prior to partial cystectomy. Radiological examinations with computed tomography and ultrasound and surgical outcome were used to assess the efficacy of the regimen. RESULTS: Three patients underwent a complete removal of the germinal layer of the cyst and there were no cases of biliary fistula in these patients. There were no relapses in any of the patients at 12 months' follow-up. CONCLUSIONS: Preoperative use of medical therapy consisting of albendazole facilitates complete resection of the germinal layer by detaching it from the laminar layer, thus reducing not only the recurrence rates but also the postoperative complications, especially bilious fistulas.

Parecoxib vs. lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial.

BACKGROUND AND OBJECTIVE: Non-steroidal anti-inflammatory drugs are considered as an effective treatment of postoperative pain after laparoscopic cholecystectomy. COX-2 inhibitors are newer drugs having less adverse effects. Data supporting their efficacy postoperatively in comparison to older non-steroidal anti-inflammatory drugs are scarce. Our study is a prospective, randomized, double-blinded, placebo-controlled trial comparing the efficacy of lornoxicam vs. parecoxib for the management of pain after laparoscopic cholecystectomy. MATERIALS AND METHODS: We enrolled 76 patients, ASA I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive before induction parecoxib 40 mg i.v., lornoxicam 8 mg i.v. or placebo. Pain at rest and on movement was assessed using a visual analogue scale at 0, 6, 12 h postoperatively. Total meperidine consumption and adverse effects were also recorded. RESULTS: At 12 h, visual analogue scale scores at rest and on movement were significantly lower with parecoxib and lornoxicam compared with control ( P = 0.047). The percentage of patients needing meperidine and the average dose of meperidine administered was significantly lower with parecoxib and lornoxicam compared with control (P < 0.001 and P = 0.018). There was no difference between parecoxib and lornoxicam. One patient receiving lornoxicam vomited. CONCLUSIONS: Parecoxib 40 mg i.v. and lornoxicam 8 mg i.v. were equianalgesic and both were more efficacious than placebo for the management of pain after laparoscopic cholecystectomy.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary with synchronous invasive lobular breast cancer: case report.

Malignant transformation of a mature ovarian cystic teratoma is the most serious complication of this relatively common neoplastic lesion. While any constituent tissue of the teratoma can undergo malignant transformation, squamous cell carcinoma represents approximately 80% of those malignancies. Furthermore, the synchronous occurrence of a second malignancy in that setting is extremely rare. Preoperative diagnosis of malignant transformation within a mature cystic teratoma is extremely difficult and poses a great challenge to current clinical surgical practice. The particularly aggressive behavior of this rare tumor, also poses significant surgical managing dilemmas. We present a case report of a premenopausal woman with an invasive squamous cell carcinoma arising in a mature cystic teratoma and a synchronous invasive lobular carcinoma of the breast.

Endovascular obliteration of a ruptured right gastric artery aneurysm.

Aneurysms of the right gastric artery are extremely rare lesions. They constitute less than 0.001% of reported visceral artery aneurysms. A unique case of a ruptured right gastric artery aneurysm is presented. Angiographic diagnosis and endovascular treatment by right gastric artery embolization proved safe and efficacious, resulting in complete obliteration of the aneurysm with no adverse sequelae.

Inguinal dermoid cyst of the round ligament. A case report and review of the literature.

INTRODUCTION: Dermoid cysts are rarely located in extraovarian sites, representing an extremely uncommon lesion of the round ligament. The differential diagnosis of an inguinal lesion that proved to be a dermoid cyst deriving from the round ligament is presented with a review of the literature. CASE REPORT: A case of a 27-year-old female with a dermoid cyst arising from the round ligament and lying inside the inguinal canal, which was tender and palpable, is reported. DISCUSSION: Underlining their origin, clinical manifestation, gross appearance and pathology, we differentiate dermoid cysts mainly from epidermoid cysts and mature cystic teratomas, analyzing the importance of such a distinction to the possibility of malignant degeneration and recurrence of a dermoid cyst in the round ligament.