AIMTo study the morphology of the enteric nervous system and the expression of beta-2 adrenergic (B2A) receptors in primary colorectal cancer.METHODSIn this study, we included forty-eight patients with primary colorectal cancer and nine patients for control tissue from the excision of a colonic segment for benign conditions. We determined the clinicopathological features and evaluated the immunohistochemical expression pattern of B2A receptors as well as the morphological changes of the enteric nervous system (ENS). In order to assess statistical differences, we used the student t-test for comparing the means of two groups and one-way analysis of variance with Bonferroni’s post hoc analysis for comparing the means of more than two groups. Correlations were assessed using the Pearson’s correlation coefficient.RESULTSB2A receptors were significantly associated with tumor grading, tumor size, tumor invasion, lymph node metastasis (P < 0.05), while there were no statistically significant associations with gender, CRC location and gross appearance (P > 0.05). We observed, on one hand, a decrease of the relative area for both Auerbach and Meissner plexuses with the increase of the tumor grading, and on the other hand, an increase of the relative area of other nervous elements not in the Meissner plexus or in the Auerbach plexus with the tumor grading. For G1 tumors we found that epithelial B2A area showed an inverse correlation with the Auerbach plexus areas [r(14) = -0.531, P < 0.05], while for G2 tumors, epithelial B2A areas showed an indirect variation with both the Auerbach plexus areas [r(14) = -0.453, P < 0.05] and the Meissner areas [r(14) = -0.825, P < 0.01]. For G3 tumors, the inverse dependence increased for both Auerbach [r(14) = -0.587, P < 0.05] and Meissner [r(14) = -0.934, P < 0.05] plexuses.CONCLUSIONB2A receptors play an important role in colorectal carcinogenesis and can be utilized as prognostic factors. Furthermore, study of the ENS in colorectal cancer may lead to targeted molecular therapies.
The present study aimed to observe and compare the values of microvessel density (MVD), mast cell microdensity (McMD) and macrophage microdensity (MphMD) in intratumoral areas compared with the advancing edges, and to assess any correlations between these values and the degree and stage of the neoplasia. The cases of 52 patients who were diagnosed with endometrial carcinoma between 2003 and 2011 were analyzed, the majority of which were in the first stage of the disease (44 cases). Double sequential immunohistochemistry and the hot-spot counting method were used to assess the MVD (CD105+ MVD), McMD [tryptase+ (Try+) McMD] and MphMD (CD68+ MphMD) densities. The χ2 test, paired Student’s t-test and the Pearson correlation index were used to assess the significance of the results. A weak correlation was observed at the advancing edge only, between CD105+ MVD and Try+ McMD (P=0.039). No significant differences were identified in the analysis of CD105+ MVD, Try+ McMD and CD68+ MphMD, but wide variations in their distribution were observed. Depending on the tumor stage, CD105+ MVD exhibited an intratumoral, indirect correlation with Try+ McMD for stage IA (P=0.026) and II (P=0.013) tumors. CD105+ MVD presented an indirect correlation with CD68+ MphMD in stage IB tumors (P=0.016) and at the advancing edge for well-differentiated tumors (P=0.027). An analysis of the correlation between CD68+ MphMD and Try+ McMD indicated that the intratumoral levels of CD68+ MphMD were directly proportional with the Try+ McMD values in well-differentiated (P=0.005) and stage II (P=0.012) tumors, while at the front of the invasion, this correlation was indirect (P=0.010) in stage II tumors. In endometrioid endometrial carcinoma (EEC), angiogenesis is at its most active at the advancing edge of the tumor, where mast cells play a pro-angiogenic role.
Introduction: Amongst all malignant tumors, cancers of the digestive tract rank first in terms of yearly deaths. Patients above 60 years of age are the most affected, as the diagnosis is frequently made in advanced stages of the disease when therapy is less effective. Our study aimed to evaluate the efficiency of narrow-band imaging (NBI) endoscopy and probe-based confocal laser endomicroscopy (pCLE) in the correct diagnosis of preneoplastic lesions in the upper and lower digestive tract. Patients, Materials and Methods: We included 46 patients with digestive preneoplastic lesions, who underwent either upper or lower digestive endoscopy, followed by NBI and pCLE. We recorded 5-10 frames per each lesion, from different angles and distances during white-light endoscopy and selected frames from full recordings of NBI and pCLE. Usual preparation was used for the endoscopic procedures; pCLE required in vivo administration of 10% Sodium Fluorescein as a contrast agent. Pathology was performed in case of solid tumors. Three medical professionals with different levels of training, blinded to the results, interpreted the data. Results: The experienced physician correlated very well the NBI findings with pathology (0.93, p=0.05), while the resident physician and the experienced nurse obtain lower, albeit still statistically significant, values (0.73 and 0.62, respectively). For pCLE, the experienced physician obtained near-perfect correlation with pathology (0.96), followed closely by the resident physician (0.93). The nurse obtained a modest correlation (0.42). All examiners obtained approximately equal performances in discerning between malignant and benign lesions. Conclusions: Digestive endoscopy in NBI mode proved its effectiveness. Even less experienced endoscopists can achieve good results, while an experienced nurse can positively influence the diagnosis. In the case of pCLE, when available, it can greatly reduce diagnostic times, while requiring higher expertise and specialty training.
Uveal malignant melanoma is a rare malignant tumor comprising less than 5% of melanoma cases. It is nevertheless the intraocular tumor with the highest incidence in adults, that arises from the melanocytes in the uveal tract. The authors present the case of a patient with locally advanced choroidal melanoma: from presentation to diagnosis, treatment, and prognosis. A 63-year-old female patient presented in the Ambulatory of the Emergency County Hospital, Craiova, Romania, on the February 1, 2021, accusing visual acuity drop and photophobia in her left eye for about three weeks. Pathology examination in Hematoxylin-Eosin (HE) staining reveals a dense cell proliferation, with small and medium spindle cells and pigment production. The following immunohistochemical markers were used in our study: human melanoma black 45 (HMB45), Ki67, cyclin D1, B-cell lymphoma 2 (Bcl2), S100, Wilms' tumor 1 (WT1), p16, and p53. Uveal melanoma is a malignant tumor that can arise in all the uveal components: iris, ciliary body, and choroid. Out of the three components, iris melanomas have the best prognosis, while ciliary body melanomas have the worst prognosis. It is mandatory for the patient to respect the follow-up schedule, as follow-ups can provide early diagnosis of eventual metastasis.
Pathological diagnosis of prostate adenocarcinoma often requires complementary methods. On prostate biopsy tissue from 39 patients including benign nodular hyperplasia (BNH), atypical adenomatous hyperplasia (AAH), and adenocarcinomas, we have performed combined histochemical-immunohistochemical stainings for argyrophilic nucleolar organizer regions (AgNORs) and glandular basal cells. After ascertaining the pathology, we have analyzed the number, roundness, area, and fractal dimension of individual AgNORs or of their skeleton-filtered maps. We have optimized here for the first time a combination of AgNOR morphological denominators that would reflect best the differences between these pathologies. The analysis of AgNORs' roundness, averaged from large composite images, revealed clear-cut lower values in adenocarcinomas compared to benign and atypical lesions but with no differences between different Gleason scores. Fractal dimension (FD) of AgNOR silhouettes not only revealed significant lower values for global cancer images compared to AAH and BNH images, but was also able to differentiate between Gleason pattern 2 and Gleason patterns 3–5 adenocarcinomas. Plotting the frequency distribution of the FDs for different pathologies showed clear differences between all Gleason patterns and BNH. Together with existing morphological classifiers, AgNOR analysis might contribute to a faster and more reliable machine-assisted screening of prostatic adenocarcinoma, as an essential aid for pathologists.
Objectives:In normal fetuses the CPR falls after 34 weeks' gestation. However, the cerebroplacental ratio (CPR) is lower in fetuses suffering from fetal growth restriction, and therefore at risk of stillbirth. It is possible that the magnitude or rate of fall could be useful in identifying those fetuses at risk. The aim of this study was to investigate the longitudinal change in small for gestational age (SGA) fetuses that had stillbirth or perinatal death. Methods: A longitudinal study of singleton pregnancies undergoing ultrasound monitoring of fetal biometry and Dopplers. Major structural abnormalities, aneuploidy, genetic syndromes or missing outcomes were excluded. Analysis of repeated measures with multilevel mixed-effects linear model (fixed effects and random effects) was performed. Regression analysis was used to investigate and adjust for potential confounding variables. ROC curve analysis was used to investigate the predictive accuracy. Results: 6906 observations were recorded in 2481 pregnancies: 1546 AGA fetuses, 31 SGA fetuses that had perinatal death, and 903 SGA fetuses that survived. There was a quadratic increase of CPR with GA in the AGA fetuses (p<0.01). CPR values were significantly lower in the SGA compared to the AGA fetuses (p<0.01). Women whose pregnancies were complicated by perinatal death were more likely to be smokers, non-Caucasian, nulliparous and delivered at an earlier GA (p<0.001 for all), compared to those who survived. CPR was significantly associated with the risk of stillbirth and perinatal death (p<0.001 for both). CPR recorded at the initial assessment had AUC 0.77 (95%CI 0.74-0.79; sensitivity 80.7%, specificity 76.6%, PPV 10.5%, NPV 99.1%), while CPR at the last assessment had AUC 0.82 (95%CI 0.79-0.84; sensitivity 80.7%, specificity 81.8%, PPV 13.2%, NPV 99.2%). Conclusions: CPR is a predictor of stillbirth and perinatal death in SGA fetuses, both at the initial and last assessments. Objectives: The purpose of the paper is to present the outcomes and safety of the association between MTX and UAE in patients with EUP. Methods: Retrospective analysis on the results of a protocol that included administration of systemic / local MTX -depending on the gestational age, in association with UAE to manage EUP. Results: Until present, a series of 3 interstitial and 6 cicatriceal EUP complied to the protocol. All the procedures were technically successful. The results of the technique were beneficial in all cases, except one case of cervical pregnancy later diagnosed as choriocarcinoma. OP11: COMPLICATIONS IN EARLY PREGNANCY: USING IMAGING AND BIOMARKERS TO PROVIDE NEW INSIGHTS Conclusions:The availability of the procedure in settings with experienced staff in gynecology and radiology is beneficial. To the best of our knowledge, this report presents some of the rare cases of interstitial pregnancy managed by angiographic uterine artery embolisation in addition to MTX. OP11.02Endometrial thickness and its value in triaging women with a pregnancy of unknown location Objectives: Seru...
Background Spondyloarthritis (SpA) defines a group of interrelated diseases with heterogeneous clinical presentation. Regarding the shared distinguishing features one can mention uveitis as an important extraarticular involvement with a highly suggestive impact on the future evolution of SpA. Objectives To investigate the prevalence of uveitis in patients with recent onset of inflammatory lumbar pain (ILP) which can be suggestive for developing SpA and to assess the interrelation of uveitis with other specific features of SpA patients. Methods We enrolled 49 patients with a reported onset of ILP within a maximum of 3 months prior to the referral. All patients were assessed in the Rheumatology Department over a 3 year period, between 2009-2012. The subjects were included based on their personal evolution into different disease group, they had a mean age of 46.3±5 years aut of which 36 males and 13 females. Patients were monitored and reevaluated every 3 months during the first year and then every 6 months for the final 2. Positive diagnosis of SpA was based on the established criteria such as: the New York modified criteria for ankylosing spondylitis (AS). Uveitis was defined by an ophthalmologic episode diagnosed as such by an ophthalmologist. Data on the baseline functional status, imaging features, and serologic tests were compared in patients with and without uveitis. Factors associated with the presence of uveitis were identified both through univariate and multivariate statistical analysis (logistic regression) Results The prevalence of uveitis at inclusion was 10.2 %. Uveitis was observed after the first episodes of ILP in 40 % of patients. The presence of uveitis was significantly associated (univariate) with pain in the lumbar spine, infection preceding inflammatory disease, a previous positive diagnosis of inflammatory bowel disease (IBD); enthesitis or radiologic evident coxo-femural joint involvement, but we could not certify a relation with the fulfillment of specific classification criteria, HLA-B27, Bath Ankylosing Spondylitis Disease Activity Index or the Bath Ankylosing Spondylitis Functional Index. Stastical multivariate analysis showed a positive association between uveitis and pain in the lumbar spine, infection preceding inflammatory disease, a previous diagnosis of IBD (P < 0.05). Conclusions Our study showed association of ILP with the onset of IBD and infectious episodes which suggests an important role of environmental factors in the incidence of uveitis in SpA. These data stand the ground for a more thorough approach of the patient whom presents with an uveitis episode since they might already be eligible for the inclusion in a SpA category and evaluated accordingly. Disclosure of Interest None Declared
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