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Our results indicated that histology might be a useful prognostic marker for both early and advanced GC patients, with intestinal-type associated with a better outcome. This information could be used for stratification purpose in future clinical trials.

Tumour budding is associated with worse survival in stage II CRC, in particular in pT3N0M0 patients. It could therefore potentially be used when deciding whether to administer adjuvant chemotherapy in high-risk node negative CRC patients.

Background/Aim: About 15-20% of colorectal cancers (CRCs) have deficiency in a mismatch repair (MMR) protein. MMR has a high level of microsatellite instability (MSI-H). We have conducted this review and meta-analysis to determine the prognostic role of MSI-H status in stage II CRC. Materials and Methods: We searched PubMed, EMBASE, The Cochrane Library, Web of Science, and SCOPUS for studies reporting data on overall survival (OS) and disease-free or relapse-free survival (DFS or RFS) for MSI-H compared to microsatellite stable (MSS) CRC. Results: A total of 39 studies were analysed, including 12,110 patients. MSI-H status was associated with a significantly reduced risk of death (HR=0.64, 95%CI=0.52-0.8, p<0.01) and relapse (HR=0.59, 95%CI=0.45-0.77, p<0.01) in stage II CRC. Conclusion: MSI-H represents an important prognostic determinant in stage II CRC and may be considered when estimating the risk of recurrence in stage II CRC. Stage II colorectal cancer (CRC) is usually associated with a good prognosis; five-year overall survival (OS) rates range from 75 to 87.5% (1). However, the administration of postoperative 5-fluorouracil (5-FU)-based chemotherapy in this group of patients remains controversial, since it has been shown that survival gain generally does not exceed 5% (2). Several prognostic factors have been evaluated in order to identify a high-risk stage II CRC subgroup, for which adjuvant chemotherapy would have a better indication. High-risk features include an inadequate sampling of lymph nodes (less than 12), extension of primary tumor (pT4), poor differentiation (grade 3), acute onset of the disease with obstruction or perforation, lymph-vascular and perineural invasion, and close, indeterminate or positive resection margins (3). Recently, microsatellite instability status (MSI) has been identified as a reliable prognostic indicator in stage II CRC, with an additional role in predicting the lack of benefit of 5-FU-based adjuvant chemotherapy (4-6). These data have been replicated in the large randomized phase III Quick and Simple and Reliable (QUASAR) trial, where 2,291 patients with stage II CRC were randomized to receive adjuvant chemotherapy with 5-FU and folinic acid or to undergo observation. An analysis performed on these patients found a prognostic role for MMR status, even if it was not shown to be predictive of any benefit from adjuvant chemotherapy (6). Although a number of molecular markers of outcome in CRC has been proposed (BRAF/KRAS), there has been no clear consensus about their role in early stage CRC. Despite that a series of studies have investigated the relationship between MSI status and survival in CRC patients, they often included mixed populations of early (stage II-III) and advanced CRCs (stages IV). The aim of our study was to evaluate the prognostic significance of MMR status in stage II CRC by analyzing all the available data coming from prospective and retrospective studies.

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Background. Ovarian carcinomas may produce human chorionic gonadotropin (HCG) or HCG‐like substances and may even contain syncytiotrophoblast cells, but a true choriocarcinomatous component has not been described in these tumors. Methods. Two cases of poorly differentiated ovarian carcinoma with choriocarcinomatous components are reported. Pathologic findings were correlated with immunohistochemical stains, hormonal effects, and clinical behavior. Results. Each tumor contained a circumscribed, extensively necrotic and hemorrhagic brown nodule. Microscopically, the nodules exhibited a mixture of cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast capped cytotrophoblast and was strongly positive for β‐HCG. In one of the cases, a transformation zone composed of poorly differentiated carcinoma with occasional β‐HCG‐positive cells was observed between a mucinous cystadenoma and the choriocarcinomatous elements. The two cases exhibited activation of the ovarian stroma in the form of condensation and luteinization. Extra‐abdominal metastases developed early in both patients and, despite multiagent chemotherapy, they died shortly post‐operatively. Conclusions. Choriocarcinoma may rarely develop as a result of dedifferentiation of common epithelial ovarian tumors. Recognition of choriocarcinomatous components in ovarian carcinomas is important because of its association with aggressive behavior.

Gastrointestinal stromal tumours are rare tumours of the gastrointestinal tract. We describe the case of a 57-year-old man with a locally advanced gastrointestinal stromal tumour of the rectum. We started Gleevec. The pathological examination documented a complete pathological response. An already described mutation in KIT exon 11 was observed in the gastrointestinal stromal tumour of the rectum. At the same time as the treatment of our patient, his brother received a neoadjuvant therapy for a locally advanced rectal adenocarcinoma. During the surgical procedure, a gastric lesion was excised and the pathological examination showed a low-grade gastrointestinal stromal tumour. We analysed DNA extracted from the tumoral mass and normal tissue of both patients. No mutations, either in KIT or in PDGFRA, were detected in the subserosal stomach gastrointestinal stromal tumour. After 18 months, both patients are free from recurrence. Our clinical case suggests that preoperative imatinib therapy may enable radical surgery in patients with an inoperable disease.