Retrospective study which included 133 patients with uterine cervical cancer with or without neoadjuvant therapy based on prognostic factors and correlations between NLR and MNM values, markers that were analyzed as continuous variables. This study aimed to establish the critical value of hematological markers. NLR is significantly lower for preoperative stages I and II (p = 0.0004). There is a significant association between NLR and lymph node metastasis (p = 0.016), parametrial invasion (p = 0.035), lymphovascular space invasion (p = 0.0151) and tumor size (p = 0.0017). Correlational analysis showed that there is a significant association between MNM and lymph node metastasis (p = 0.020), parametrial invasion (p = 0.00010), lymphovascular space invasion materially affecting the value MNM (p = 0.0018), tumor size more than 4 cm (p = 0.0314). NLR and MNM were significantly lower in patients with complete response to neoadjuvant treatment. The results of this study outlines the importance of hematological panel and parameters that can be easily used at no extra cost to establish further evolution of patients to treatment.

Gastroenteropancreatic neuroendocrine carcinomas (GEP-NENs) represent a heterogeneous group of rare tumors. The incidence of GEP-NENs has increased worldwide over the past decades, with the small intestine, rectum, and pancreas as the most common tumor locations. The epidemiological characteristics, pathogenesis and treatment have raised many questions, and some of them are still being debated. Here, we report a case of gastric collision tumor with large-cell neuroendocrine carcinoma and adenocarcinoma. A 73year-old male patient with a history of gastric resection performed 30 years ago, with no medical records revealing the type of resection or the reconstructive way, presented with epigastric pain. The endoscopy revealed a solid, ulcerated mass at the gastrojejunal anastomosis site from which a tissue biopsy was taken, which was reported as adenocarcinoma. For staging, the patient underwent an abdominal CT scan, which showed the thickening of the gastric wall adjacent to anastomosis and perilesional adenopathy. The patient underwent a subtotal gastrectomy and regional lymphadenectomy. A diagnosis of large-cell neuroendocrine carcinoma developed on the gastric stump associated with isolated foci of moderately differentiated tubular adenocarcinoma pT3N1G3 was made. Immunohistochemical analysis is essential for the diagnosis and classification of the lesion. To confirm the diagnosis, Chromogranin A and Synaptophysin are needed, and for prognostic evaluation the identification of Ki-67 and mitotic figure count are required.

The efficiency of neoadjuvant therapy in cervical carcinoma has been well demonstrated, although the cellular mechanisms of different response to this treatment have not been thoroughly investigated. The present study consists of 24 patients with cervical cancer, including 12 patients in stages IB-IIIB with first-line surgical treatment and 12 patients in stages IIB-IIIB, with neoadjuvant therapy followed by radical hysterectomy. The aim of our study was to assess the correlations between the alterations in E-cadherin and CD44v6 immunoexpression in cervical carcinoma, as a tool of evaluation the response to neoadjuvant therapy and its prognostic significance. The intensity of CD44v6 immunoexpression was higher in more aggressive tumors and E-cadherin immunoexpression was approximately constant among the cases with neoadjuvant therapy. Our results demonstrate that the evaluation of CD44v6 immunoexpression in cervical carcinomas is useful for the assessment of tumor response to neoadjuvant therapy and of tumor aggressiveness. The high level of Ecadherin immunoexpression in tumors with neoadjuvant therapy reflects its involvement in the prevention of HPV oncoproteins action, with benefits on the outcome. A larger group of patients and a panel of antibodies, including CD4 and COX2, could provide a better characterization of the tumor response to neoadjuvant therapy, with a positive prognosis impact.

IntroductionIn the early 1990s, the laparoscopic approach in uterine cervical cancer has started to become quite popular among oncologist surgeons in order to minimize postoperative morbidity. When a new surgical technique is taken into consideration or suggested, it is compared with the standard therapy hitherto. Important issues to be taken into account include the feasibility and applicability of the new technique, intraoperative and postoperative complications and in oncological cases, survival and risk of recurrence.Gold standard for uterine cervical cancer in the early stages was abdominal radical hysterectomy with pelvic lymphadenectomy for more than 100 years. This technique, described for the first time Wertheim, Meigs subsequently underwent some changes. The first laparoscopic hysterectomy was performed and published in 1989 [1], but the first laparoscopic radical hysterectomy with pelvic and paraaortic lymphadenectomy in a patient with cervical cancer stage IA2 was performed by Nezha et al. in June 1989 and reported in 1992 [2]. Since then, it has been reported in the literature over 1000 cases [3]. Laparoscopic Surgery versus Open Surgery in Uterine Cervical CancerInitially used for diagnostic, laparoscopy has become a method of treatment in the field of gynecological surgery, but also in many other field. The results of laparoscopic surgery are now comparable with those obtained by laparotomy in benign and malignant pathologies. The most important advantages of the laparoscopic technique include more pleasing cosmetic appearance, or minimum parietal infectious complications, low incidence of adhesion formation, low cost associated with hospitalization and recovery period smaller resumption of daily activities in a shorter period [4]. In a study comparing the two surgical techniques, the results show an average of operating time with significant differences statistically 231.7 minutes for cases treated laparoscopically and 207 minutes to classical surgery, which can be explained by the fact that laparoscopic hysterectomies implemented quite recently requires a learning curve. The surgeons will become more familiar with laparoscopic procedure; the operative time is expected to become shorter. Intraoperative blood loss was lower in the laparoscopy (161.1 ml) compared with the traditional method (394.4 ml), with blood transfusions in 3 patients. Postoperative complications, represented mostly wound infections were recorded only in the group that received radical abdominal hysterectomy. The hospital stay was less in laparoscopic interventions (mean=2.9 days) compared with the second procedure (mean=5. A randomized, multicenter study including 116 patients demonstrated that laparoscopic assisted vaginal hysterectomy can be performed in a similar operating time classic surgery with intraoperative blood loss less and a relatively shorter period of hospitalization (p<0.01). Postoperative pain, another important parameter discussed, is lower for the first 3 days of laparoscopy versus open surgery (p<0.5) [7]....

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Introduction: Neuroendocrine tumors of the gastro-entero-pancreatic system have a variety of components, clinical manifestations and prognostic indices according to their anatomical site. Therefore, their diagnostic and management strategies differ a great deal. Prognosis concerning NETs can be poor due to the degree of differentiation, early metastasizing and the high degree of invasiveness. Material and Methods: For the present study, the patient files were evaluated and the parameters of interest were followed. Results: Over the course of 6 years there were 37 patients diagnosed with and treated for NETs, regardless of primary tumor site. There were 9 patients with NETs of the primite mid-and hindgut thusly: 5 cases with colorectal NETs and 4 cases of small bowel NETs. 6 patients benefited from radical surgical treatment, 2 cases with palliative procedures and only one patient with tumor biopsy. The tumors were evaluated according to the 2010 WHO classification based on the number of mitoses and the Ki67 proliferation index. Adjuvant treatment was adapted according to staging and histopathological parameters. Conclusions: Despite recent progress in managing NETs, there are still many controversial aspects regarding the management of these cases, mainly about timing the right sequence of therapy.

Metastatic breast cancer has a very poor prognosis, considering the lack of reliable curative medical or surgical approaches. Patients with stage IV breast cancer usually undergo palliative surgical procedures and symptomatic treatment. In a 5-year period, 1258 patients with breast cancer were treated in our surgical oncology unit. For the current study, we have selected 19 (1.43%) female patients with intraabdominal metastases (peritoneal, hepatic, ovarian etc.) derived from breast cancer, which received at least one surgical procedure in our unit. We compared our data with up-to-date reports and guidelines in order to establish the role and further directions of surgery, and (most importantly) the necessity of surgery itself in the management of this therapeutically disadvantaged patient-group. Even if current guidelines do not recommend surgical treatment of intraabdominal metastases derived from breast cancer, several oncology centers (including our unit) did not discard surgery, especially in patients with solitary metastasis.

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