[Endoscopic ultrasonography in diagnosis of surgical treatment of pancreas].

Results of endoscopic ultrasonography at 137 patients suspected for pancreas pathology are analyzed. Methodology of endoscopic ultrasonography, semiotics of pancreas surgical diseases, advantages over other diagnostic methods are described. Endosonography is informative method for final diagnosis of different disease of pancreas. Diagnostic value of method and area of its clinical application are described.

Subjective sonographic assessment for differentiation between malignant and benign adnexal masses.

OBJECTIVE: To determine the accuracy of subjective sonographic assessment in distinguishing between benign and malignant adnexal masses. STUDY DESIGN: Cross-sectional descriptive study. METHODS: The patients scheduled for elective surgery due to adnexal masses were recruited into the study. All patients were sonographically examined within 72 hours of surgery were subjectively evaluated by the experienced sonographer, who had no any information of the patients, to differentiate between benign and malignant adnexal masses based on sonographic morphology. The final diagnoses, used as gold standard, were based on either pathological or operative findings. RESULTS: One hundred and fifty-eight patients with 174 adnexal masses, (benign; 108 and malignant; 66) were recruited into the study. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were of 89.7%, 84.9 % and 92.6 %, 87.5% and 90.9%, respectively. CONCLUSIONS: Subjective evaluation of sonographic morphology has high accuracy in differentiating between benign and malignant adnexal masses.

Sonographic morphology scores (SMS) for differentiation between benign and malignant adnexal masses.

OBJECTIVE: To determine the sensitivity and specificity of a scoring system for distinguishing between benign and malignant adnexal masses and to detect threshold scores for prediction of malignant ovarian tumors. STUDY DESIGN: Cross-sectional diagnostic testing. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: A total 158 patients scheduled for elective surgery due to ovarian tumors at Maharaj Nakorn Chiang Mai Hospital between June 16, 2002 and August 8, 2004 were recruited into the study. METHODS: All patients were sonographically examed within 72 hours before surgery by the same sonographer to evaluate the morphology including wall structure, shadowing, septum, echogenicity and score the tumors. The final diagnosis was based on either pathological or operative findings. MAIN OUTCOME MEASURE: Sensitivity and specificity of the best cut-off score. RESULTS: A score of 5 from the receiver operating characteristic curve was found to be the best cut-off score, giving a sensitivity and a specificity of 85% and 70%, respectively. CONCLUSION: Sonographic morphology scores are useful in distinguishing adnexal malignancies from benign lesions in some selected cases.

An immunohistochemical and ultrastructural study of pancreatic microcystic serous cyst adenoma with special reference to tumor-associated microvasculature and vascular endothelial growth factor in tumor cells.

Pancreatic microcystic serous cyst adenomas are rare exocrine tumors composed of small cysts lined by glycogen-rich cells. The disease may be sporadic or present as part of von Hippel-Lindau (VHL) syndrome. Four sporadic cases of pancreatic serous cyst adenoma were examined by conventional histological, immunohistochemical, and ultrastructural methods. In the present study, new findings include the immunohistochemical identification of vascular endothelial growth factor (VEGF) and the lack of PDX-1 (putative master transcriptional factor in pancreatic stem cells) in the epithelial tumor cells. Ultrastructurally, many small blood vessels were intimately associated with epithelial tumor cells and adjacent fibroblastic cells. The observations suggest the possibility that VEGF-containing tumor cells act in a paracrine fashion to stimulate neovascularization; that peripheral blood in the vascular lumen might be filtered or processed by the endothelial and epithelial tumor cells; and that filtrates might therefore be stored as serous inclusions. It is hypothesized that pancreatic serous cyst adenomas might be under the abnormal regulation of the VHL gene, just like VHL disease itself and certain types of renal cell carcinoma, showing the distinctive histology of a rich vascularity intimately related to epithelial lining cells of cysts accompanied by stromal fibroblasts/myofibroblasts and collagenous stroma.

[Assessment of the influence of chemotherapy on the nucleolar organizer regions (AgNORs) count in serous ovarian cancer cells]. / Ocena wplywu chemioterapii na parametry oceny ilosciowej stref organizatorów jaderkowych (AgNORs) w komórkach raka jajnika.

OBJECTIVE: When planning treatment of ovarian cancer, the prognostic factors should be considered. One of them is the amount of nucleolar organizer regions (AgNORs) in cancer cells, which reflects proliferative activity of the tumor. DESIGN: To estimate the influence of chemotherapy on the AgNORs count in serous ovarian cancer cells. MATERIAL AND METHODS: 26 women who underwent surgical procedure and then chemotherapy between 1998-2002 due to serous ovarian cancer were included into the study. During the initial surgery the cancer stage I was detected in 1 case, stage II in 2 cases, stage III in 12 cases, and stage IV in 11 cases. In all cases during second-look laparotomy, which was performed after 6 courses of chemotherapy (paclitaxel, cisplatinum), the persistent disease was found. In 17 out of 26 cases it was disseminated neoplasmatic disease. In all cases the specimens were prepared according to one-step AgNORs method described by Howell and Ploton. In cancer cells the mean number of AgNORs per nucleus (mAgNOR) and the mean percentage of nuclei with five or more AgNORs per nucleus (pAgNOR) were counted. RESULTS: The mAgNOR and pAgNOR mean number before chemotherapy were respectively: 4, 22 +/- 0.94 and 35.62 +/- 19.90. After treatment the mAgNOR and pAgNOR were significantly lower, and the data were respectively: 3.67 +/- 0.91 and 24.15 +/- 19.53. In 4 cases (15.4%) the mAgNOR increased, in 7 cases (26.9%) the change was not significant, and in 15 cases (57.7%) the mAgNOR decreased. In 6 cases (23.1%) the pAgNOR increased, in 5 cases (19.2%) the change was not significant, and in 15 cases (57.7%) the pAgNOR decreased. We did not found any correlation between the tendency to change the number of AgNORs and staging, the amount of persistent neoplasmatic tissue, the range of primary surgery, as well as grading. CONCLUSIONS: The number of AgNORs per nucleus in most cases of ovarian cancer after chemotherapy was lower. The tendency to change the number of AgNORs was not connected with staging as well as grading.

Macrocystic serous adenoma of the pancreas.

Macrocystic serous adenoma of the pancreas (MSAP) is a rare neoplasm. Its preoperative diagnosis by physical examination and imaging studies is challenging, if not impossible. In recent years, a few cases of MSAP with correct cytodiagnosis by transabdominal fine-needle aspiration (TFNA) have been documented. This paper reports two cases of MSAP that were successfully diagnosed by TFNA cytology. Two adult women presented with epigastric discomfort. Abdominal imaging studies revealed a large pancreatic cystic lesion in both cases. TFNAs of the pancreatic lesions were subsequently performed and revealed a clear serous fluid containing small monolayered sheets of benign cuboidal epithelial cells with scant, clear or granular cytoplasm, vesicular nuclei and micronucleoli. The cell cytoplasm stained positively with periodic acid-Schiff (PAS) and negatively with PAS with prior digestion with diastase (PASD). The cytological findings in both cases were similar and suggested a serous cystadenoma. The two pancreatic lesions were removed by Whipple's operation. They showed features of a macrocystic serous adenoma of the pancreas that were characterized by a small number of large cystic cavities lined by a single layer of non-mucus secreting, PAS-positive and PASD-negative cuboidal epithelial cells. By electron microscopy, the epithelial lining cells showed short and aborted apical microvilli, well-formed desmosomes and a large amount of intracytoplasmic glycogen, suggesting a centroacinar ductal cell origin.

[Karyometry of the tumor epitheliocytes in the dysplastic sections of serous tumors and in serous cancers of the ovaries]. / Kariometriia opukholevykh épiteliotsitov v uchastkakh displazii seroznykh opukholei i v seroznykh rakakh iaichnikov.

With the help of Integral-2MT cytoanalyzer, the average area of nuclei and the percentage of epitheliocytes with small, medium and large nuclei at the site of dysplasia of serous cysts and serous ovarian carcinomas have been evaluated. An increase in the degree of dysplasia of tumorous epithelium is associated with an increase in the average area of nuclei and the number of cells with medium nuclei. A decrease in the degree of differentiation of serous ovarian carcinomas is accompanied by increasing percentage of cells with large nuclei. Preoperative chemotherapy does not affect this regularity.

[Nucleolus organizers in the epithelium of serous ovarian tumors]. / Sostoianie iadryshkovykh organizatorov v épitelii seroznykh opukholei iaichnikov.

Morphofunctional state of nucleolar organizers in epithelial cells of benign, and malignant serous ovarian tumours has been studied. A rise in the activity of nucleolar organizers depending upon an increase of the level of malignancy has been revealed.