Colorectal cancer (CRC) affects more than 1,000,000 people worldwide each year. Recently, the number of young patients with early-onset colorectal cancer has increased, and right-sided colorectal cancer is still often diagnosed only in advanced stages. The TNM classification is not perfect for CRC staging. This study aimed to perform, for the first time, simultaneous analysis of tumor-infiltrating immune cell density, presence of lymphoid follicles, and budding status in CRC tissue. Intraoperative samples of neoplastic tissue were collected from 195 consecutive patients who were admitted to the surgical ward for elective colorectal surgery. Histological parameters were assessed in the tissue samples: tumor budding foci, poorly differentiated clusters and areas of poorly differentiated components. Tumor-infiltrating immune cells (tumor-associated neutrophils and tumor-infiltrating lymphocytes) were detected in five randomly chosen, areas at the tumor center and at the invasive front. Additionally, the presence of lymphoid follicles in CRC tissue was assessed. Tumor budding parameters were positively correlated with colorectal cancer advancement or histologic (mucinous) type of CRC. The number of poorly differentiated clusters was higher in younger patients. Lower densities of CD3 and CD4 lymphocytes were seen in CRC with a greater depth of tumor invasion. Lower densities of CD3 and CD8 lymphocytes were found in CRC with metastases to the surrounding lymph nodes. The lower density of CD8 lymphocytes was observed in CRC with distant metastases. Lower densities of tumor-associated neutrophils and tumor-infiltrating lymphocytes (CD3 and CD8) were revealed in CRC without lymphoid follicles. The number of lymphoid follicles was higher in patients with less advanced CRCs. Three histopathology markers, such as high tumor budding, scanty lymphocyte infiltration, and the poverty of lymphoid follicles, complement each other, appear to be reliable indicators of colorectal cancer progression, and could be useful in everyday medical practice, but their widespread use requires further research. We propose to take into account these markers, in the assessment of colorectal cancer advancement, in addition to the TNM classification.

Introduction:The presence of tumor budding, i.e.,single cancer cells or a nest of poorly differentiated cells at the front of tumor invasion appears to be a new histopathological indicator of increased aggressiveness of colorectal carcinoma. Purpose: The aim of this work was a retrospective evaluation of the invasion front (tumorbudding, vascular invasion,and lymphocytic infiltration) in postoperative biopsies of patients with colorectal carcinoma and analysis of the 5-year survival. Materialsand methods:The study was based on the material received after surgical treatment of 164 patients with colon cancer. Tissue was obtained directly following tumor resection, fixed in 10% formaldehyde and embedded in paraffin blocks using a routine method by melting with paraffin at a temperature of 56º C. These samples were then routinely stained with haematoxylin and eosin and underwent a histopathological evaluation, with particular attention being paid to the invasion front of the tumor. The immunohistochemical expression of cytokeratin 20 was also evaluated using anti-human CK20 monoclonal antibody (clone Ks.20.8, Dako, Poland). Results: Tumor budding was found in 124 out of 164 patients. Statistical analysis showed a correlation between the presence of tumor budding TB and depth of invasion (pT), lymph node metastasis, distant metastasis, lymphocytic infiltration,and vascular invasion. The cumulative five-year survival correlated with the lack of tumor budding and vascular invasion, as well as a decrease in lymphocyticinfiltration.

Introduction. Colorectal cancer (CRC) affects more than 1,000,000 people worldwide each year. Recently, the number of young patients with early-onset colorectal cancer has increased, and right-sided colorectal cancer is still often diagnosed only in advanced stages. The TNM classification is not perfect for CRC staging. This study aimed to perform, for the first time, simultaneous analysis of tumor infiltrating immune cell density, presence of lymphoid follicles, and budding status in CRC tissue. Methods. Intraoperative samples of neoplastic tissue were collected from 195 consecutive patients who were admitted to the surgical ward for elective colorectal surgery.Results. Tumor budding parameters were positively correlated with colorectal cancer advancement, and histologic (mucinous) type of CRC. The number of tumor budding foci was lower in CRC localized in the rectum, and the number of poorly differentiated clusters was higher in younger patients. In the invasive front, a lower number of CD8 lymphocytes was found in CRC with confirmed distant metastases, and lower densities of CD3 and CD4 lymphocytes were seen in deeply invasive CRCs. The density of CD3 lymphocytes was higher in men and older patients. The number of lymphoid follicles was higher in patients with less advanced cancers. Conclusion. Three histopathology markers, such as high tumor budding, scanty lymphocyte infiltration, and the poverty of lymphoid follicles, complement each other, appear to be reliable indicators of colorectal cancer progression, and could be useful in everyday medical practice, but their widespread use requires further research. We propose to take into account these markers, in the assessment of colorectal cancer advancement, in addition to the TNM classification.

Introduction: Whipple’s disease is a chronic systemic infectious disorder with Tropheryma whipplei as an etiologic agent, occurring rarely and affecting numerous organs and systems. The variety of symptoms and a non-typical course make it difficult to establish a proper diagnosis. Purpose: In this study, etiopathogenesis, diagnostics and treatment of Whipple’s disease were presented based on the case report of 60-year-old man diagnosed with Whipple’s disease. Case presentation: Persistent diarrhoea with weight loss, lymphadenopathy in the abdominal cavity and moderate microcytic anemia predominated in the clinical picture. Diagnosis was put based on the clinical picture and macroscopic assessment of the small intestine and the presence of macrophages filled with a PAS-positive substance in the lamina propria. To deepen diagnostics, samples collected were assessed showing macrophages with the damaged mucosa, containing numerous elongated micro-organisms whose ultrastructure corresponded to Tropheryma whipplei. The patient’s clinical conditions improved after antibiotic therapy. Conclusions: It is vital to remember about Whipple’s disease in patients with chronic diseases due to a non-specific clinical picture and difficulties in establishing a proper diagnosis. When the disease is diagnosed unequivocally, proper and effective antibiotic therapy should be instituted immediately.

The most common neck masses in adults are neoplastic in nature, so they should be treated as neoplasms until the diagnosis turns out otherwise.