Risk of malignancy in adrenal tumors in patients with a history of cancer.

Purpose: Adrenal gland is a common site of metastasis and on the other hand, metastases are the most frequent malignant adrenal tumors. The aim of this study was to estimate the risk of malignancy in suspicious adrenal mass in patients with a history of cancer. Methods: This is a single-center retrospective analysis of patients with adrenal tumors treated previously for different types of cancers. Between 2004 and 2021 a hundred and six such patients were identified. Mean age of patients was 62.6 years (30-78), and mean time from oncologic treatment was 55.8 months (0-274). The most common primary cancer was kidney (RCC): 29 (27.4%), colon/rectum (CRC): 20 (18.9%) and lung (NSCLC): 20 (18.9%). Results: Of 106 patients, 12 had hormonally active (HA) (11,3%) and 94 (88,7%) non active (HNA) tumors In group of patients with HA tumours 4 had hypercortisolaemia and 8 had elevation of urinary metanephrines. In the first group of HA patients pathology confirmed preoperative diagnosis of adrenocortical cancer and no metastasis was found. In all patients from the second group pheochromocytomas were confirmed. Primary (PM) and secondary (SM) malignancies were found in 50 patients (47.2%). In hormone inactive group only SM - 46/94 (48.9%) were diagnosed. The odds that adrenal lesion was a metastasis were higher if primary cancer was RCC (OR 4.29) and NSCLC (OR 12.3). Metastases were also more likely with high native tumor density, and bigger size in CT. The cut-off values for tumor size and native density calculated from receiver operating characteristic (ROC) curves were 37mm and 24, respectively. Conclusion: Risk of malignancy of adrenal mass in a patient with a history of cancer is high (47,2%), regardless of hormonal status. 47,2% risk of malignancy. In preoperative assessment type of primary cancer, adrenal tumour size and native density on CT should be taken into consideration as predictive factors of malignancy. Native density exceeding 24 HU was the strongest risk factor of adrenal malignancy (RR 3.23), followed by history of lung or renal cancer (RR 2.82) and maximum tumor diameter over 37 mm (RR 2.14).

The angiogenic activity of ascites in the course of ovarian cancer as a marker of disease progression.

Ovarian cancer cells are able to create invasive implants in the peritoneum and their growth is directly associated with the angiogenetic potential. This effect is probably stimulated by vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8), which are both found in ascites. The aim of this study was to assess the influence of ascites produced by ovarian cancer on the angiogenesis. Peritoneal fluid was collected from patients with advanced ovarian cancer; cancer cells were separated from CD45+ leukocytes. Angiogenesis was assessed in mice, after intradermal injection of full cellular suspension together with supernatant or phosphate buffered saline, purified cancer cells suspension, or CD45+ leukocytes suspension. The angiogenesis index (AI) was assessed after 72 hours. VEGF and Il-8 were measured in the supernatant and cellular suspension. AI was the highest in the isolated cancer cells suspensions as well in the group stimulated with supernatant. Both VEGF and IL-8 were high in supernatants from ascites rich in cancer cells (>45%). A significant correlation was revealed between IL-8 concentration and AI. We conclude that ascites in patients with advanced ovarian cancer stimulates angiogenesis and this mechanism is dependent mostly on cancer cells activity and enhanced by cooperation with infiltrating leukocytes.

Mast cells and histamine: do they influence placental vascular network and development in preeclampsia?

UNLABELLED: The physiological course of pregnancy is closely related to adequate development of the placenta. Shallow invasion of trophoblast as well as decreased development of the placental vascular network are both common features of preeclampsia. To better understand the proangiogenic features of mast cells, in this study we aim to identify the potential relationship between the distribution of mast cells within the placenta and vascular network development. MATERIAL AND METHODS: Placentas from preeclampsia-complicated pregnancies (n = 11) and from physiological pregnancies (n = 11) were acquired after cesarean section. The concentration of histamine was measured, and immunohistochemical staining for mast cell tryptase was performed. Morphometric analysis was then performed. RESULTS: We noticed significant differences between the examined groups. Notably, in the preeclampsia group compared to the control group, we observed a higher mean histamine concentration, higher mast cell density (MCD), lower mean mast cell (MMCA) and lower vascular/extravascular (V/EVT) index. In physiological pregnancies, a positive correlation was observed between the histamine concentration and V/VEVT index as well as MCD and the V/VEVT index. In contrast, a negative correlation was observed between MMCA and the V/EVT index in physiological pregnancies. CONCLUSIONS: Based on the data from our study, we suggest that a differential distribution of mast cells and corresponding changes in the concentration of histamine are involved in the defective placental vascularization seen in preeclamptic placentas.

Supplementation with hydrocortisone on the 3rd-5th day following dexamethasone premedicated chemotherapy eliminated severe dizziness and postural hypotension.

We present the case of a 60 year-old woman with a stage III fallopian tube cancer submitted to hysterectomy and bilateral salpingo-oophorectomy with partial omenectomy, followed by six courses of chemotherapy and revision surgery. After each course of chemotherapy (paclitaxel + carboplatin) preceded by premedication with dexamethasone, she suffered from side- -effects, of which the most unpleasant was severe dizziness appearing on the third, fourth and fifth day following the listed combination of drugs. It was revealed that dizziness with concomitant sweating and rapid pulse, noted in the standing position, was combined with marked postural hypotension. Considering the possibility of a temporary pituitary-adrenal axis suppression caused by premedication with a very large dose of dexamethasone, during those three days she was supplemented with small doses of hydrocortisone, which caused almost complete disappearance of the mentioned symptoms. Our conclusion is that postural hypotension causing severe dizziness initially linked with chemotherapeutic drugs can be eliminated or markedly reduced by three days supplementation with hydrocortisone applied after the expected wash out of the dexamethasone.

[Mast cells as a source of nitric oxide in the human placenta--morphometric analysis in preeclampsia complicated pregnancy]. / Komórki tuczne jako zródlo tlenku azotu w lozysku ludzkim--analiza morfometryczna w ciazy powiklanej stanem przedrzucawkowym.

UNLABELLED: The aim of the study was to test hypothesis, that in placenta mast cells are significant source of iNOS. MATERIAL: Placentas were collected after term delivery from healthy (control, n=13) and preeclamptic (n=11) women. Mast cells and iNOS expression were detected in obtained samples with monoclonal anti-iNOS and anti-tryptase antibodies. Next, morphometric analysis were performed. There were no significant difference between iNOS expression and number of iNOS-positive cells in normal and preeclamptic placentas. There was a significant increase in mast cells number in preeclamptic placentas (8.32 +/- 1.3 SD vs 5.14 +/- 1.2 SD in control) and decrease in percentage of iNOS positive cells among them (68.1% vs 23.6%). We conclude, that in uncomplicated pregnancies, mast cells are the main source of iNOS in placenta while in preeclampsia they loss their potential to synthetase iNOS.

[Mast cells, histamine and development of the placental vascular network in pregnancies complicated by preeclampsia and intrauterine growth retardation]. / Komórki tuczne. i histamina a rozwój sieci naczyniowej lozyska w ciazach powiklanych stanem przedrzucawkowym i wewnatrzmacicznym zahamowaniem wzrostu plodu.

UNLABELLED: Importance of angiogenesis in proper development of placenta is unquestioned. Abnormalities in vascular development are typical for complications of pregnancy: intrauterine growth retardation (IUGR) and preeclampsia (PE). As mast cells are involved in new vessels sprouting and development we tried to disclose if they can be involved in etiology or pathogenesis of IUGR and/or PE. MATERIAL AND METHODS: Placentas from PE-complicated pregnancies (n=11), IUGR-complicated pregnancies (n=10), and from healthy women--controls (n=13) were obtained after cesarean sections. Histamine concentration was measured and immunohistochemical staining for mast cell tryptase was performed. Microscopic slides of placental tissue were analyzed with morphometric software. RESULTS: We disclosed increased histamine concentration in PE group--227.3 +/- 17.7 (in ng of histamine per 1 g of tissue) and decreased concentration in IUGR group 114.3 +/- 13.5 vs control--178.1+/- 18.9. Histamine concentration corresponded with density of mast cells in examined groups: PE group--8.32 cells/mm2 +/- 1.3, IUGR--3.07 +/- 1.05 and control--5.14 +/- 1.2. The mean area of mast cells identified in PE as well as in IUGR group was smaller than the mean area of mast cells in controls. V/EVT index was decreased in PE and IUGR group in comparison to controls, respectively: 0.15 +/- 0.018; 0.12 +/- 0.014; 0.23 +/- 0.029. CONCLUSIONS: We suggest that differences in mast cells density and corresponding differences in histamine concentration are associated with pathogenesis of PE and IUGR or are consequence of primary cause.