Expression of phenotypic markers of mast cells, macrophages and dendritic cells in gallbladder mucosa with calculous cholecystitis.

The study aimed at quantitative analysis of expression involving markers of mast cells (tryptase), monocytes/macrophages (CD68 molecule) and dendritic cells (S100 protein) in gallbladder mucosa with acute and chronic calculous cholecystitis. Routinely prepared tissue material from the patients with acute (ACC) (n = 16) and chronic calculous cholecystitis (CCC) (n = 55) was evaluated. Three cellular markers were localized by immunocytochemistry. Their expression was quantified using spatial visualization technique. The expression of tryptase was similar in acute and chronic cholecystitis. CD68 expression in ACC was significantly higher than in the CCC group. Expression of S100 protein was significantly higher in CCC as compared to the ACC group. No significant correlations were disclosed between expression of studied markers and grading in the gallbladder wall. A weak negative correlation was noted between expression of CD68 and number of gallstones in the CCC group. The spatial visualization technique allowed for a credible quantitative evaluation of expression involving markers of mast cells (MCs), monocytes/macrophages (Mo/Ma) and dendritic cells (DCs) in gallbladder mucosa with ACC and CCC. For the first time mucosal expression of S100 protein-positive DCs was evaluated in calculous cholecystitis. The results point to distinct functions of studied cell types in the non-specific immune response in calculous cholecystitis.

Pouchitis may increase the risk of dysplasia after restorative proctocolectomy in patients with ulcerative colitis.

AIM: Dysplasia of the pouch mucosa after restorative proctocolectomy is rare. The aim of this study was to establish whether there is a correlation between pouchitis and dysplasia. METHOD: A group of 276 patients treated for ulcerative colitis by restorative proctocolectomy between 1984 and 2009 was analysed. The presence or absence of pouchitis and dysplasia within the pouch was evaluated. RESULTS: Inflammation was diagnosed in 66 (23.9%) patients, low-grade dysplasia in five (1.8%), high-grade dysplasia in three (1.1%), and cancer in one patient (0.4%). The prevalence of low-grade dysplasia was significantly higher in patients with inflammation than in those without (P < 0.04). High-grade dysplasia was significantly more frequent in pouchitis than in non-inflamed pouches (P < 0.01). Logistic regression analysis suggested that the occurrence of mucosal inflammation increased the risk of low grade dysplasia. CONCLUSION: Patients with chronic pouchitis are at risk of dysplasia and require surveillance of the pouch.

Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy.

BACKGROUND AND PURPOSE: The aim was to verify whether preoperative conventionally fractionated chemoradiation offers an advantage in sphincter preservation in comparison with preoperative short-term irradiation. PATIENTS AND METHODS: Patients with resectable T3-4 rectal carcinoma without sphincters' infiltration and with a lesion accessible to digital rectal examination were randomised into: preoperative 5x5Gy short-term irradiation with subsequent total mesorectal excision (TME) performed within 7 days or chemoradiation to a total dose of 50.4Gy (1.8Gy per fraction) concomitantly with two courses of bolus 5-fluorouracil and leucovorin followed by TME after 4-6 weeks. Surgeons were obliged to base the type of operation on the tumour status at the time of surgery. RESULTS: Between 1999 and 2002, 316 patients from 19 institutions were enrolled. The sphincter preservation rate was 61% in the 5x5Gy arm and 58% in the radiochemotherapy arm, P = 0.57. The tumour was on average 1.9 cm smaller (P < 0.001) among patients treated with chemoradiation compared with short-term schedule. For patients who underwent sphincter-preserving procedure, the surgeons generally followed the rule of tailoring the resection according to tumour downsizing; the median distal bowel margin was identical (2 cm) for both randomised groups. However, in the chemoradiation group, five patients underwent abdominoperineal resection despite clinical complete response. CONCLUSIONS: Despite significant downsizing, chemoradiation did not result in increased sphincter preservation rate in comparison with short-term preoperative radiotherapy. The surgeons' decisions were subjective and based on pre-treatment tumour volume at least in clinical complete responders.

[45 years of experience in surgical treatment for cancer of the large intestine]. / 45 lat doswiadczen w chirurgicznym leczeniu raka jelita grubego.

The aim of the study was to evaluate the results of surgical treatment of colorectal cancer during 45 years of existence of the Department. In this time 1478 cases of rectal cancer and 1008 cases of colon cancer were operated on. Most commonly the diseases occurred between the sixth and seventh decade of live (32.8%). Histology revealed tubular adenocarcinoma in 83.3% of the cases, mucinous adenocarcinoma in 13.5% and other types in 3.2%. The choice of the surgical procedure was based on the individual characteristics of each case, including: localisation of the tumor, histological type, clinical staging, sex of the patient, obesity and overall operative risk. The tumor was localised less then 10 cm above the anal verge in 70% of the patients with rectal cancer. Well differentiated carcinomas (G1) were seen in 32% of the patients, moderately differentiated carcinomas (G2) in 57% and poorly differentiated (G3) in 11%. Curative resections were performed in 64.7% of the patients (1608 cases) and palliative procedures in 35.3% of the patients (878 cases). The mortality rate after curative surgery was 6% and after palliative procedures 5%. The use of combined therapy consisting of surgical treatment and chemo- or radiotherapy allowed for obtaining five years survival rate of 57.4%, local recurrences were seen in 21% of patients. Analysing our own material we evaluated the radicality of different types of operations and the possibility of preserving the sphincter apparatus.

[Combined treatment of large bowel cancer]. / Skojarzone leczenie raka jelita grubego.

During the years 1989 to 1994, in the Department of General Surgery we performed surgery on 800 cases of large bowel cancer. The cases comprised 412 men (51.5%) and 388 women (48.5%), aged 25 to 85, the most numerous age group ranging from 50 to 70 (60%). Radical surgery was carried out on 501 cases (62.7%) and palliative surgery on 299 cases (37.3%). In cases with histopathological evaluation pTNM-T1N0M0 or T2N0M0 we refrained from chemo- and radiotherapy. In cases of rectal cancer with advanced staging T3N1M0 or T4N2M1 we applied radiotherapy, whereas in cases of cancer localized on other parts of large bowel we had recourse to chemotherapy as combined treatment. Radiotherapy was applied irrespective of grading, whereas chemotherapy was applied in cases of cancer with grading G2 and G3. Radiative energy was used in 65 cases and chemotherapy in 120 cases. Postoperational mortality amounted to 6%. Five years survival after radical surgery achieved 57.4%. Local recurrence took place in 21% of the cases. The control group consisted of the cases subjected to surgery in the years 1984-1989 when only surgery was performed and 5-years survival after radical surgery amounted to 48% and local recurrence was found in 30% of the cases.

Tumor specificity of monoclonal antibodies to carcinoembryonic antigen. Immunohistochemical analysis.

The tumor specificity of twelve different monoclonal antibodies (Mabs) against carcinoembryonic antigen (CEA) was assessed by immunohistochemistry. The Mabs had previously been classified into three specificity groups (I-III) on the basis of their reactivity with purified CEA-related antigens by ELISA. Mabs belonging to specificity group III (n = 4) did not cross-react with any CEA-related antigen, including normal cross-reactive antigen of 160 kD molecular weight (NCA-160 = meconium antigen). All Mabs, except one, gave positive immunohistochemical staining of 75-100% of individual tissue samples of colorectal carcinomas and gastric adenocarcinomas. However, when tested against different normal adult tissues, the Mabs displayed marked differences in reactivity. Group III Mabs stained normal colon epithelium, but not parenchymal cells in other organs or, with one exception, cells belonging to the granulocyte and/or macrophage series. Group I and II Mabs, in contrast, stained parenchymal cells in normal colon, submandibular salivary gland, placenta, and pancreas (group I Mab only). They also stained infiltrating and circulating granulocytes and/or macrophages. Lack of cross-reactivity with NCA-160 is the single-best criterion for selecting anti-CEA Mabs with a high degree of tumor specificity. To ensure tumor specificity, CEA-positive, NCA-160-negative Mabs should be checked by immunohistochemistry against cryostat sections of colorectal carcinoma, normal pancreas, submandibular salivary gland, spleen, and liver and for reactivity against circulating granulocytes.