EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY.

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

Chromogranin A-, somatostatin- and serotonin- containing endocrine cells in the corporal gastric mucosa of patients with Helicobacter pylori associated chronic gastritis.

OBJECTIVE: To examine the number and distribution of chromogranin A, somatostatin and serotonin containing endocrine cells (EC) in the corporal gastric mucosa of patients with Helicobacter pylori (HP) associated chronic gastritis. METHODS: In 12 patients (7 males and 5 females, median age 47 years, range 39-59 years) the number of chromogranin A, somatostatin and serotonin containing endocrine cells (EC) in the corporal gastric mucosa was counted after the appropriate histochemical reaction using specific primary antibodies. The gastric mucosal tissue was obtained by endoscopic biopsy from the greater curvature, anterior and posterior walls of the stomach body. The number of EC was determined per 1 mm2 of the lamina muscularis mucosae. RESULTS: The number of chromogranin A, somatostatin and serotonin containing EC in the corporal gastric mucosa in the patients examined was not increased. CONCLUSIONS: The lack of changes in the somatostatin containing cells indicates that they are not directly involved in the development of hypergastrinaemia accompanying the HP infection.

Immunohistochemical detection of collagen type III and IV in relation with transformation of Ito cells in liver sinusoids of patients with reactive biliary hepatitis.

Reactive biliary hepatitis is a defined morphological entity, which is a result of chronic diseases of the gall bladder, biliary ducts or pancreas. The aim of the present study was to describe the morphology of reactive biliary hepatitis and its significance for progression of liver fibrosis, and in particular Ito cell (fat storing cell) transformation and occurrence of collagen type III and IV in the liver. Liver tissue from 19 patients with reactive biliary hepatitis was investigated light microscopically and immunohistochemically. Histologically, the liver showed features of mild to severe portal and lobular inflammation. The number of Ito cells increased periportally and pericentrally. Deposition of collagen type III and IV was increased in portal tracts, septa and perisinusoidal spaces, mainly in periportal zones of the lobules. Ultrastructurally, collagen type III immunoreactive fibrillar networks were found to be increased in the space of Disse around transitional cells. Collagen type IV immunoreactive deposits were detected around newly proliferating bile ducts in portal stroma and in the space of Disse. Ito cells were mainly transformed into transitional and myofibroblast-like cells. We discuss here the role of Ito cells and certain cytokines in the process of fibrosis of the liver in the course of reactive biliary hepatitis. It is proposed that bile acid retention in bile ducts during non-specific reactive inflammation or a gut endotoxin may cause transformation of Ito cells and increased collagen type III and IV in this type of hepatitis.

Results of the treatment of colorectal cancer complicated by obstruction.

654 patients with colorectal cancer were operated on during the period 1982-1993. Acute surgical intervention was performed in 232 cases because of large bowel obstruction, whereby the obstruction tumor was localized in the colon in 160 patients and in the rectum in the remaining 72 patients. 53 of the patients were designated as stage T3,4N-M0 stage, 97 as T3,4N+M0 and 82 as T3,4N+/-M1. Histologically, well- and moderately-differentiated adenocarcinoma was diagnosed in 69%, poorly differentiated and mucinous adenocarcinoma in 29% and squamous cancer in 2% of the cases. The patients were distributed in 4 groups according to the clinical presentation of the obstruction: acute (n = 60), subacute (n = 52), recurring (n = 42) and chronic (n = 78) forms. 122 radical and 110 palliative operations were performed. 34% of the patients had postoperative complications. The overall postoperative mortality was 25% AND it was highest in one-stage operation with a primary anastomosis (p < 0.05). The 5-year survival in patients with obstructive colon and rectal tumours was 32% and 27%, respectively (p = 0.631). The patients with differentiated adenocarcinoma have a better prognosis, as well as those without regional lymph node metastases (p < 0.05). The patients without obstruction operated on during the same period, had a higher 5-year survival for both colon (p < 0.01) and rectal (p < 0.0019) cancer.