BackgroundSmall bowel tumours are rare and comprise less than 2 % of all primary gastrointestinal neoplasms. Among these tumours, a leiomyosarcoma belonging to soft tissue sarcomas is extremely rare and accounts for about 1 % of malignant mesenchymal lesions in the gastrointestinal tract. Due to its aggressive nature and slow growth, it is often diagnosed at the late stage when curative treatment is impossible. Authors report a first case of leiomyosarcoma with chronic recurrent ileocaecal intussusception and literature review to analyse diagnosis and treatment features of the ileum mesenchymal tumours.Case presentationWe present a case of an 87-year-old Caucasian man suffering from cramp-like abdominal pain for months. Due to lack of clinical signs and unspecific complaints, a diagnosis was delayed. Despite a detailed in-hospital examination, a proper diagnosis was established as late as during an operation. The patient was treated by surgery with good results. An uncommon laparoscopic resection of the small bowel with a tumour was performed. A histopathological investigation confirmed a very rare mesenchymal lesion of the distal ileum. The patient is under control with no recurrence for 1 year of the follow-up period.ConclusionsReported case indicates that a usually asymptomatic tumour can cause uncommon chronic recurrent ileus signs. CT and MRI scans are investigation of choice in such cases, but they are sometimes inconclusive. It might be worth highlighting the good results of laparoscopic leiomyosarcoma lesion resection with a very good outcome.

Pancreatic fistula is one of the most severe complications after pancreatic surgeries. The risk of pancreatic fistula after distal pancreatectomy is up to 60%. Effective methods to prevent pancreatic fistula are still sought. A unified definition of pancreatic fistula, which was introduced in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), has allowed for an easier diagnosis and determination of fistula severity, as well as for a reliable inter-center comparison of data. Furthermore, a number of publications point out the risk factors of pancreatic fistula, which may be classified into patient-related risk factors, such as MBI, gender, smoking tobacco or pancreatic structure; and surgery-related risk factors, such as blood loss, prolonged surgery and non-underpinning of the major pancreatic duct. The analysis of risk factors and the use of different methods for the prevention of pancreatic fistula, including novel surgical techniques, may reduce both, the formation and severity of fistula. This will, in turn, lead to reduced secondary complications and mortality, as well as a shorter hospital stay. We present a literature review on different strategies used to prevent pancreatic fistula. It seems, however, that multicenter, prospective, randomized studies in two large groups of patients after pancreatectomy are necessary to establish clear recommendations for the preventive management.

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophins group which plays a crucial role in brain development and neurogenesis. In the hypothalamus it is described as playing a role in energy metabolism and feeding behaviour. The hippocampal concentration of BDNF is believed to play an important role in learning and memory, it has a protective role in neurodegeneration and stress responses. BDNF is also known to take part in many other processes, e.g. angiogenesis, proliferation, cell migration and apoptosis. With its receptor TrkB, neurotrophins are important agents that playa role in neural diseases, as well as in cardiovascular and metabolic disorders, such as diabetes mellitus or acute coronary syndrome. Over the last few years, BDNF interaction with TrkB has also been found to be involved in cancer development, including brain, breast, urinary and gastrointestinal cancer. TrkB expression itself has been described as an aggressive neural tumour. BDNF/TrkB signalling takes part in promoting tumour growth and metastasis. The presented review focuses on gastrointestinal cancer and presents the current literature concerning influence of BDNF and TrkB receptor in cancer progression. Special attention is also paid to data confirming the possible role of BDNF/TrkB interaction in chemotherapy resistance. This might present the opportunity to assess the BDNF and TrkB pathway as a possible novel target for anticancer therapies.

Background Brain derived neurotrophic factor (BDNF) is a neurotrophin involved in neural and metabolic diseases, but it is also one of the crucial factors in cancer development and metastases. In the current study, we investigated serum BDNF concentrations in patients that underwent surgical treatment for colorectal cancer or pancreatic cancer. Methods Serum BDNF concentrations were measured with standard enzyme-linked immunosorbent assays, before and on the third day after the operation, in 50 consecutive patients with colorectal cancer and 25 patients with pancreatic cancer (tumours in the head of pancreas). We compared pre- and postoperative BDNF levels, according to the subsequent TNM stage, histologic stage, lymph node involvement, neuro- or angio-invasion, and resection range. Results In the pancreatic cancer group, BDNF concentrations fell significantly postoperatively (p = 0.011). In patients that underwent resections, BDNF concentrations fell (p = 0.0098), but not in patients that did not undergo resections (i.e., laparotomy alone). There were significant pre- and postoperative differences in BDNF levels among patients with (p = 0.021) and without (p = 0.034) distant metastases. Significant reductions in BDNF were observed postoperatively in patients with small tumours (i.e., below the median size; p = 0.023), in patients with negative angio- or lymphatic invasion (p = 0.028, p = 0.011, respectively), and in patients with lymph node ratios above 0.17 (p = 0.043). In the colon cancer group, the serum BDNF concentrations significantly fell postoperatively in the entire group (p = 0.0076) and in subgroups of patients with or without resections (p = 0.034, p = 0.0179, respectively). Significant before-after differences were found in subgroups with angioinvasions (p = 0.050) and in those without neuroinvasions (p = 0.049). Considering the TNM stages, the postoperative BDNF concentration fell in groups with (p = 0.0218) and without (p = 0.034) distant metastases and in patients with tumours below the median size (p = 0.018). Conclusion Our results suggested that BDNF might play an important role in gastrointestinal cancer development. BDNF levels were correlated with tumour volume, and with neuro-, angio- and lymphatic invasions. In pancreatic cancer, BDNF concentrations varied according to the surgical procedure and they fell significantly after tumour resections. Thus, BDNF may serve as a potential marker of complete resections in underdiagnosed patients. However, this hypothesis requires further investigation. In contrast, no differences according to the procedure was made in patients with colon cancer.

<b> Introduction:</b> Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Tumor penetration into the inferior vena cava/right atrium is rare, as it occurs only in 3–4% of HCC patients. There are no clear guidelines for the management of this stage of disease. </br></br> <b>Aim:</b> This is a case report of a patient with HCC and tumor thrombus in the inferior vena cava and with advanced coronary artery disease. </br></br> <b> Materials and methods:</b> The patient was qualified for a simultaneous cardiac surgery and liver resection with removal of the tumor thrombus from the inferior vena cava due to a high risk of sudden cardiac death. The first stage involved aortocoronary bypass followed by a right-sided hemihepatectomy with removal of the tumor thrombus from the inferior vena cava (this part of the operation was performed by extracorporeal circulation). The postoperative period was uneventful. Surgical treatment is one of the therapeutic options that offers a chance to radically remove the tumor and extend the patient's life. From a standpoint, these operations are extremely difficult and carry a high risk of perioperative complications (up to 40%). At the same time, the patient is at risk of complications due to cancer, such as pulmonary embolism, tricuspid stenosis, and congestive heart failure, which should be considered when choosing a treatment method. A significant number of patients also suffer from chronic conditions that worsen the prognosis. Cardiac diseases combined with tumor thrombus in the inferior vena cava may cause sudden cardiac death. </br></br> <b>Conclusions:</b> Surgical treatment should be considered in patients with HCC and tumor thrombus in the inferior vena cava, especially in patients with cardiovascular disease burden, as it is not only a chance to prolong life, but also to protect them against life-threatening cardiac complications.

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The incidence of pancreatic cancer has been on the rise. Unfortunately, in most cases this cancer is diagnosed in an advanced stage. In clinical practice, patients with metastases to distant organs such as the liver, peritoneal cavity, lungs and even bones or brain are frequently encountered. On the other hand, skin metastases are very rare. Those that occur in the umbilical area are called Sister Mary Joseph's nodules. Below, we present a patient who, after a long diagnostic process including removal of abdominal skin tumor, was finally diagnosed with pancreatic cancer.