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Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

World Journal of Gastroenterology 2017年第24期23卷 4399-4406页

作者： Cosimo Sperti Mario Gruppo Stella Blandamura Michele Valmasoni Gioia Pozza Nicola Passuello Valentina Beltrame Lucia Moletta departments of Surgery Oncology and Gastroenterology3rd Surgical ClinicUniversity of Padua departments of Medicine section of PathologyUniversity of Padua

To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.

关键词： Lymphadenectomy Pancreas Pancreatic cancer Pancreatectomy Lymph node metastasis Para-aortic nodes Survival

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Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature

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World Journal of Gastroenterology 2015年第36期21卷 10468-10474页

作者： Andrea Cacciato Insilla Pinuccia Faviana Luca Emanuele Pollina Paolo De Simone Laura Coletti Franco Filipponi Daniela Campani Department of surgical MedicalMolecular Pathology and Critical AreaDivision of Surgical PathologyUniversity Hospital of Pisa Department of surgical MedicalMolecular Pathology and Critical AreaDivision of Liver Surgery and TransplantationUniversity Hospital of Pisa

Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy,the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2,CK8,CK18,CEA(polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3,CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors(GISTs).The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here,we report the clinicopathological features of our case,along with a review of the few cases present in the literature.

关键词： Lymphoepithelioma Lymphoepithelioma-like Hepatocel

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Counteraction of perforated cecum lesions in rats: Effects of pentadecapeptide BPC 157,L-NAME and L-arginine

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World Journal of Gastroenterology 2018年第48期24卷 5462-5476页

作者： Domagoj Drmic Mariam Samara Tinka Vidovic Dominik Malekinusic Marko Antunovic Borna Vrdoljak Jelena Ruzman Marija Milkovic Perisa Katarina Horvat Pavlov Jerusha Jeyakumar Sven Seiwerth Predrag Sikiric departments of Pharmacology and pathology Medical Faculty University of Zagreb

AIM To study the counteraction of perforated cecum lesion using BPC 157 and nitric oxide(NO) system *** Alongside with the agents' application(after 1 min, medication(/kg, 10 ml/2 min bath/rat) includes: BPC 157(10 μg), L-NAME(5 mg), L-arginine(100mg) alone or combined, and saline baths(controls)) on the rat perforate cecum injury, we continuously assessed the gross reappearance of the vessels(USB microcamera) quickly propagating toward the defect at the cecum surface, defect contraction, bleeding attenuation, MDA-and NO-levels in cecum tissue at 15 min, and severity of cecum lesions and adhesions at 1 and 7 d. RESULTS Post-injury, during/after a saline bath, the number of vessels was significantly reduced, the defect was slightly narrowed, bleeding was significant and MDA-levels increased and NO-levels decreased. BPC 157 bath: the vessel presentation was markedly increased, the defect was noticeably narrowed, the bleeding time was shortened and MDA-and NO-levels remained normal. L-NAME: reduced vessel presentation but not more than the control, did not change defect and shortened bleeding. L-arginine: exhibited less vessel reduction, did not change the defect and prolonged bleeding. In combination, mutual counteraction occurred(L-NAME + L-arginine) or the presentation was similar to that of BPC 157 rats(BPC 157 + L-NAME; BPC 157 + L-arginine; BPC 157 + L-NAME + L-arginine), except the defect did not change. Thereby at day 1 and 7, saline, L-NAME, L-arginine and L-NAME + L-arginine failed(defect was still open and large adhesions present). CONCLUSION The therapeutic effect was achieved with BPC 157 alone or in combination with L-NAME and L-arginine as it was able to consolidate the stimulating and inhibiting effects of the NO-system towards more effective healing recruiting vessels.

关键词： BPC 157 perforated cecum L-arginine L-NAME vessels rats

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A selective approach to the surgical management of periampullary cancer patients and its outcome

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 628-633页

作者： Omar J Shah Irfan Robbani Parveen Shah Sadaf A Bangri Irfan J Khan Mohammad Y Bhat Manmohan Singh departments of surgical Gastroenterology Sher-i-Kashmir Institute of Medical Sciences Srinagar Kashmir India Radiodiagnosis & Imaging Sher-i-Kashmir Institute of Medical Sciences Srinagar Kashmir India pathology Sher-i-Kashmir Institute of Medical Sciences Srinagar Kashmir India departments of surgical Gastroenterology Sher-i-Kashmir Institute of Medical Sciences Srinagar Kashmir India departments of surgical Gastroenterology Sher-i-Kashmir Institute of Medical Sciences Srinagar Kashmir India

BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.

关键词： pancreaticoduodenectomy superior approach technique Whipple's operation

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Nestin:A novel angiogenesis marker and possible target for tumor angiogenesis

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World Journal of Gastroenterology 2013年第1期19卷 42-48页

作者： Yoko Matsuda Masahito Hagio Toshiyuki Ishiwata departments of pathology and Integrative Oncological pathology Nippon Medical SchoolTokyo 113-8602Japan

Abnormal vasculature,termed tumor vessels,is a hallmark of solid *** degree of angiogenesis is associated with tumor aggressiveness and clinical ***,exact quantification of tumor vessels is useful to evaluate ***,selective detection of newly formed tumor vessels within cancer tissues using specific markers raises the possibility of molecular targeted therapy via the inhibition of tumor ***,an intermediate filament protein,is reportedly expressed in repair processes,various neoplasms,and proliferating vascular endothelial *** expression is detected in endothelial cells of embryonic capillaries,capillaries of the corpus luteum,which replenishes itself by angiogenesis,and proliferating endothelial progenitor cells,but not in mature endothelial ***,expression of nestin is relatively limited to proliferating vascular endothelial cells and endothelial progenitor *** expression is also reported in blood vessels within glioblastoma,prostate cancer,colorectal cancer,and pancreatic cancer,and its expression is more specific for newly formed blood vessels than other endothelial cell ***-positive blood vessels form smaller vessels with high proliferation activity in *** of nestin in vascular endothelial cells suppresses endothelial cell growth and tumor formation ability of pancreatic cancers in *** nestin to more accurately evaluate microvessel density in cancer specimens may be a novel prognostic ***,nestin-targeted therapy may suppress tumor proliferation via inhibition of angiogenesis in numerous malignancies,including pancreatic *** this review article,we focus on nestin as a novel angiogenesis marker and possible therapeutic target via inhibition of tumor angiogenesis.

关键词： Nestin Angiogenesis Molecular targeting therapy Gastrointestinal cancer Pancreatic cancer Microvessel density CD34 CD31 Factor VIII

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The omentum

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World Journal of Gastroenterology 2000年第2期6卷 169-176页

作者： Cameron Platell Deborah Cooper John M.Papadimitriou John C.Hall Department of Surgery the University of Western Australia departments of pathology the University of Western Australia

INTRODUCTIONThe word omentum derives from the ancientEgyptians who,when embalming human bodies,used to assess their'omens'by looking at thevariations in what we recognise today as ***(128-199 AD)thought that therole of the omentum was to warm the *** was on the basis of a gladiator who had anomental resection after a stab injury and sufferedgreatly from cold for the rest of his life.A

关键词： omentum peritonitis macrophage neutrophil lymphocytes mesothelium adhesions omentectomy

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Prostate cancer cells metastasize to the hematopoietic stem cell niche in bone

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Asian Journal of Andrology 2011年第4期13卷 622-623页

作者： Evan T Keller departments of UroJogy and pathology University of Michigan Ann Arbor MI 48109 USA

The majority of men with advanced prostate cancer develop bone metastases as opposed to metastases at other sites. It has been unclear why prostate cancer selectively metastasizes to and proliferates in bone. Recently, Shiozawa et al. delineated a mechanism that may account for the establishment of prostate cancer in bone. Specifically, they identified that prostate cancer cells compete with hematopoietic stem cells （HSC） for the osteoblast in the HSC niche of the bone. Defining the mechanisms through which prostate cancer cells establish themselves in bone is critical towards developing effective therapeutic strategies to prevent or target bone metastases.

关键词： Biological sciences Cell biology Microbiology

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Noncoding RNAs as drivers of the phenotypic plasticity of oesophageal mucosa

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World Journal of Gastroenterology 2017年第43期23卷 7653-7656页

作者： Matteo Fassan Sonia Facchin Giada Munari Giuseppe Nicolò Fanelli Greta Lorenzon Edoardo Savarino surgical pathology Unit Department of MedicineUniversity of Padua Gas-troenterology Unit Department of Surgical Oncology and GastroenterologyUniversity of Padua

The histological commitment of the lower oesophageal mucosa largely depends on a complex molecular landscape. After extended inflammatory insult due to gastroesophageal reflux disease,squamous oesophageal mucosa may differentiate into columnar metaplastic mucosa. In this setting,the presence of intestinal metaplasia is considered the starting point of Barrett's carcinogenetic cascade. Aside from secondary prevention strategies for Barrett's mucosa(BM) patients,there are multiple endoscopic ablative therapies available for BM eradication and for the replacement of metaplastic epithelia with a neosquamous mucosa. However,BM frequently recurs in a few years,which supports the notable phenotypic plasticity of the oesophageal mucosa. In recent years,several reports pinpointed a class of small noncoding RNAs,the micro RNAs(mi RNAs),as principal effectors and regulators of oesophageal mucosa metaplastic(and neoplastic) transformation. Because of mi RNAs notable stability in fixed archival diagnostic specimens,expression profiling of mi RNAs represent an innovative diagnostic,prognostic and predictive tool in the stratification of phenotypic alterations in the oesophageal mucosa.

关键词： Barrett's mucosa Biomarkers Noncoding RNAs Micro RNAs Metaplasia

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Immunohistochemical measurement and expression of Mcl-1 in infertile testes

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Frontiers of Medicine 2015年第3期9卷 361-367页

作者： Raafat Hegazy Abdelmonem Hegazy Mustafa Ammar Emad Salem pathology Anatomy and Embryology Urology of departments Faculty of Medicine Zagazig University Zagazig 44159 Egypt

The diagnosis of azoospermia represents a major challenge to andrologists as this condition may occur despite normal spermatogenesis and genital tracts. Myeloid cell leukemia-1 （Mcl-1） is a member of the Bcl-2 family of proteins involved in regulation of apoptosis in various cell types. This study aimed to investigate the immunohistochemical expression of McI-1 in testieular biopsies of subjects with azoospermia. Eighty-six cases with azoospermia were obtained from 509 infertile patients admitted to the Andrology Unit of the Zagazig University Hospitals from January 2010 to December 2011. Biopsies were diagnosed and classified using H＆E-stained slide sections. The specimens were subjected to immunohistochemical staining for Mcl-1 and examined through light microscopy. Forty-five cases of maturation arrest （25 at spermatids and 20 at the spermatocytes）, 31 cases of hypospermatogenesis （20 moderate and 11 severe）, 5 cases of Sertoli cell-only syndrome, 2 cases of basement membrane hyalinization, and 1 case of tubular and peritubular sclerosis were observed. Normal spermatogenesis was detected in 2 cases. A strong positive immunoreaction in Leydig cells was observed among all investigated specimens. A moderate reaction was detected in spermatocytes and spermatozoa in cases of normal spermatogenesis and hypospermatogenesis, but a negative reaction was detected in cases of maturation arrest and germ cell aplasia. Apoptosis was found to be associated with decreased rate of spermatogenesis. High apoptosis rates may result in azoospermia, which can occur despite normal spermatogenesis and absence of duct obstruction.

关键词： spermatogenesis testis Mcl-1 expression immunohistochemical study infertility

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Esophagogastric anastomosis in rats: Improved healing by BPC 157 and L-arginine, aggravated by L-NAME

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World Journal of Gastroenterology 2016年第41期22卷 9127-9140页

作者： Zeljko Djakovic Ivka Djakovic Vedran Cesarec Goran Madzarac Tomislav Becejac Goran Zukanovic Domagoj Drmic Lovorka Batelja Anita Zenko Sever Danijela Kolenc Alen Pajtak Nikica Knez Mladen Japjec Kresimir Luetic Dinko Stancic-Rokotov Sven Seiwerth Predrag Sikiric departments of Pharmacology and pathology Medical Faculty University of Zagreb 10000 Zagreb Croatia

AIM To cure typically life-threatening esophagogastric anastomosis in rats, lacking anastomosis healing and sphincter function rescue, in particular. METHODS Because we assume esophagogastric fistulas represent a particular NO-system disability, we attempt to identify the benefits of anti-ulcer stable gastric pentadecapeptide BPC 157, which was in trials for ulcerative colitis and currently for multiple sclerosis, in rats with esophagocutaneous fistulas. Previously, BPC 157 therapies have promoted the healing of intestinal anastomosis and fistulas, and esophagitis and gastric lesions, along with rescued sphincter function. Additionally, BPC 157 particularly interacts with the NOsystem. In the 4 d after esophagogastric anastomosis creation, rats received medication(/kg intraperitoneallyonce daily: BPC 157(10 μg, 10 ng), L-NAME(5 mg), or L-arginine(100 mg) alone and/or combined or BPC 157(10 μg, 10 ng) in drinking water). For rats underwent esophagogastric anastomosis, daily assessment included progressive stomach damage(sum of the longest diameters, mm), esophagitis(scored 0-5), weak anastomosis(m L H2 O before leak), low pressure in esophagus at anastomosis and in the pyloric sphincter(cm H2O), progressive weight loss(g) and mortality. Immediate effect assessed blood vessels disappearance(scored 0-5) at the stomach surface immediately after anastomosis creation. RESULTS BPC 157(all regimens) fully counteracted the perilous disease course from the very beginning(i.e., with the BPC 157 bath, blood vessels remained present at the gastric surface after anastomosis creation) and eliminated mortality. Additionally, BPC 157 treatment in combination with L-NAME nullified any effect of L-NAME that otherwise intensified the regular course. Consistently, with worsening(with L-NAME administration) and amelioration(with L-arginine), either L-arginine amelioration prevails(attenuated esophageal and gastric lesions) or they counteract each other(L-NAME + L-arginine); with the addi

关键词： Esophagogastric anastomosis L-NAME Aggravation BPC 157 L-arginine Curative treatment Rats

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