Combination therapy application of Abemaciclib with Doxorubicin in triple negative breast cancer cell line MDA-MB-231

Due to lack of clinical biomarkers, Triple Negative Breast Cancer (TNBC) is more likely to have spread to other tissues at time of diagnosis and therapy planning generally involves use of cytotoxic chemotherapy agents, such as Doxorubicin. We aimed to investigate possible advantages of using combination strategy using Doxorubicin alongside Abemaciclib. After determining the IC50 values for Doxorubicin (DOX) and Abemaciclib (ABE); CompuSyn and ComBenefit software were used to reveal the effect resulting from the combination of two drugs. Following the determined effect, cell death was revealed by fluorescence microscopy and a colony forming assay was performed to see the potential of even a single cancer cell with adhesive character to survive over time and form a clone of itself. Detection of changing antioxidant activity following DOX, ABE and DOX+ABE combination therapy in MDAMB231 cells was determined by measuring MDA, SOD and GSH activities. The expression of Cleaved Caspase 3, PARP, Cleaved PARP, Cdk2 and Bax, which changed as a result of DOX, ABE and DOX+ABE application, was shown by Western Blotting.Cyclin-dependent kinase inhibitors appear as promising agents in therapy planning for breast cancer due to their prominent role in cell cycle regulation, where the number of studies interrogating its efficiency in the treatment of cancer such as TNBC is limited. For this reason, in this study, we aimed to determine the impact of the combined use of the CDK4/6 inhibitors ABE and DOX on the cytotoxicity, apoptotic homeostasis, alterations in antioxidative mechanisms, and the molecular pathways that they utilize. Our results showed that when used in combination, Doxorubicin and Abemaciclib showed a synergistic effect on TNBC cell line MDA-MB-231.

BRAF V600E Mutation: A Significant Biomarker for Prediction of Disease Relapse in Pediatric Langerhans Cell Histiocytosis

Langerhans cell histiocytosis (LCH) is a rare disease presenting with usually a localized disease but sometimes a widespread aggressive disorder especially in children. Among the somatic mutations in RAF-MEK-ERK pathway, especially BRAF mutation has been detected so far in LCH. We aimed in this study to investigate the prognostic significance of the mutations of target genes playing a role in the RAF-MEK-ERK pathway in pediatric LCH. Mutation analyses were performed on tumor DNA extracted from formalin-fixed paraffin-embedded biopsy specimens of 38 pediatric LCH cases using a direct sequencing technique for BRAF, ARAF, MAP2K1, and MAP3K1 genes. The mutational status was correlated statistically with survival, clinical progression (disease relapse), and the established clinical prognostic parameters of LCH such as age, gender, localization, multisystem disease, central nervous system risk lesions, and risk organ or special-site involvement. BRAF V600E mutation was detected in 14 cases (36.8%), whereas ARAF mutation was found in only 1 case. No mutations were identified for MAP2K1 and MAP3K1 genes. The association of BRAF V600E mutation was significant in children with multisystem disease, younger age (<2 years), skin, and special organ involvement. BRAF V600E mutation was an independent predictive parameter for disease relapse. We therefore conclude that BRAF V600E mutation may be a significant marker for predicting disease progression in LCH and a candidate for targeted therapy for children with disease relapse and multisystem disease.

Abstract P4-13-09: Clinical effectiveness of everolimus and exemestane in advanced breast cancer patients from Asia and Africa: First efficacy and updated safety results from the phase IIIb EVEREXES study

Background

BOLERO-2 phase III trial established the efficacy of everolimus (EVE) plus exemestane (EXE) for the treatment of postmenopausal patients with hormone receptor (HR)-positive, HER2-negative, advanced breast cancer (aBC). However, in this study only a minority (&lt;10%) of patients were recruited from African and Asia Pacific countries. Considering the potential effects of ethnic and cultural differences on treatment effectiveness, it remains compelling to confirm the safety and efficacy profile of EVE+EXE in these populations.

Methods

EVEREXES is an open-label phase IIIb, single arm, multi-center trial, which from March 2013 to October 2014 enrolled 232 post-menopausal, HR-positive and HER2-negative, aBC patients previously treated with aromatase inhibitors, across 13 countries in Asia Pacific, Middle East, North and South Africa, with a significant majority of patients being of Asian ethnicity (196, 84.5%). Its primary objective was to investigate the safety and tolerability profile of EVE+EXE. Secondary objectives were the evaluation of efficacy (assessed by PFS, ORR, and CBR based on RECIST 1.1 criteria) and change in ECOG performance status.

Results

At data cut off of 31st of January 2015, at a median follow up of 11.7 months, median PFS for the ITT population was 9.5 months [9.2-11.6 months], based on local assessment, with the observation of 1 (0.4%) CR and 35 (15.4%) PR. Regarding safety and tolerability, a majority (81.1%) of grade (G) 1/2 adverse events (AEs) was reported. In particular, the following pattern was observed in terms of % of patients who developed G1/G2/G3 mTOR-inhibition induced AEs: stomatitis (36.1, 13.7, 10.6), rash (21.6/6.2/0), fatigue (10.6, 4.4, 2.2), hyperglycemia (6.2, 11.5, 7.0), weight decrease (7.5, 7, 0.9), pneumonitis (5.7, 7, 0.9). No Grade 4 AEs related to EVE+EXE treatment were observed, with exception of one case of non infectious pneumonitis (0.4%). Median dose intensity of everolimus was 9.2 mg/day.

Conclusions

Efficacy and safety results from EVEREXES trial further confirm the role of EVE+EXE for the treatment of HR+/Her2- advanced BC patients in Eastern countries. Results were consistent with data previously reported in BOLERO-2 trial.

Citation Format: Im Y-H, Uslu R, Lee KS, Nagarkar R, Sohn J, Sevinc A, Altundag K, Chang Y-C, Abdel-Razeq H, Im S-A, Jeong J, Park HY, Arpornwirat W, Bastick P, Le TH, Ocak Arikan O, Xue HL, Canatar A, Valenti R, Kim S-B. Clinical effectiveness of everolimus and exemestane in advanced breast cancer patients from Asia and Africa: First efficacy and updated safety results from the phase IIIb EVEREXES study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-09.

Abstract P6-08-08: Expression and role of ING3 gene in breast cancer

Background: Inhibitor of growth (ING) tumor suppressor gene family has been discovered over the past decade and five different genes have been identified from ING1 to ING5. They have some functions like cell transcription regulation, cell cycle control, DNA repair and apoptosis. Because of the fact that ING3 gene expression has not been studied in breast cancer so far, we aimed to determine whether there was a relationship between ING3 gene expression and breast cancer prognostic factors.

Methods: 46 female breast cancer patients in different stages were enrolled to our study. ING3 gene expressions obtained from tumoral and healthy breast tissue samples of patients were evaluated together with pathological and histological parameters.

Results: The median age of the patients was 49 years. ING3 expression rate has been significantly higher in the tumor tissue compared to normal tissue and was statistically significant (p=0.001). In estrogen receptor (ER) and progesterone receptor (PR) positive patients, gene expression ratio was significantly higher than negative ones (p&lt;0.001 and p&lt;0.001, respectively). ING3 expression in tumor tissues of the patients with advanced disease (stage 3-4) was detected higher than ones with early stage disease and it was found to be statistically significant at the border (p=0.048). Moreover, there were no significant changes when ING3 gene expressions were compared with c-erbB2 (Receptor tyrosine-protein kinase erbB-2) status and tumor grade (p&gt; 0.05).

Conclusions: This study was the first study on ING3 gene expression in breast cancer. ING3 gene expression has been shown to be associated with the receptor positivity and advanced stage disease. Further studies should be conducted on the prognostic significance of ING3 gene in breast cancer.

Citation Format: Kalender ME, Cakir M, Ergun S, Oztuzcu S, Cengiz B, Ulasli M, Sevinc A, Camci C. Expression and role of ING3 gene in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-08-08.

Sequential adjuvant docetaxel and anthracycline chemotherapy for node positive breast cancers: a retrospective study

PURPOSE

Anthracyclines and taxanes are the most active agents in the adjuvant treatment of breast cancer (BC). They can be used simultaneously or sequentially. The optimal schedule and duration for their administration is unknown. We analyzed the efficacy of sequential adjuvant anthracycline and docetaxel administration in node positive BC patients.

METHODS

Node positive BC patients (N=539) from 6 medical oncology centers in Turkey who received sequential adjuvant anthracycline-based regimens and taxane chemotherapy were included in this study between 2006 - 2010. One-hundred and thirty-eight (25%) patients received 3 cycles of anthracycline-based chemotherapy followed by 3 cycles of docetaxel (3+3) and 401 (75%) patients received 4 cycles of anthracycline-based chemotherapy followed by 4 cycles of docetaxel (4+4). Prognostic factors analyzed were estrogen receptor (ER), progesterone receptor (PR), HER2, tumor grade, and nodal status in relation to disease free survival (DFS) and HER2 status in relation to overall survival (OS).

RESULTS

The patient median age was 48 years (range 18-79). Most common grade 3-4 toxicities were neutropenia, mucositis and arthralgia. No treatment-related toxic deaths were seen. With a median follow up of 26 months (range 1-115) 61 (11.3%) recurrences and 11 (2%) deaths were registered. Three-year DFS was 81% and OS 96% for all patients. There was no statistically significant difference between 3+3 and 4+4 groups in terms of survival (3-year DFS 88% and 79% [p=0.28] and OS 97% and 95% [p=0.60), respectively).

CONCLUSION

Sequential chemotherapy with 4+4 cycles of anthracycline and docetaxel every 3 weeks is an acceptable regimen for adjuvant treatment of node positive BC patients. Duration of chemotherapy should be planned depending on prognostic factors. In this study there was no difference between 3+3 and 4+4 groups in DFS and OS despite the presence of good prognostic factors in the 3+3 group.

Abstract OT1-1-08: Clinical outcomes among ErbB2+ MBC patients treated with lapatinib-capecitabine after trastuzumab progression: Role of early switch to lapatinib (TYCO study)

Background: Lapatinib in combination with capecitabine is a standard of care treatment for ErbB2+ metastatic breast cancer (MBC) patients who have progressed after anthracyclines, taxanes and trastuzumab treatment. Results from the lapatinib pivotal trial showed that the addition of lapatinib to capecitabine increased median time to progression (TTP) even among heavily pre-treated patients (median of 4 prior lines of therapy). A post-hoc exploratory sub-group analysis of this trial suggested that earlier administration of lapatinib-capecitabine in MBC patients who progress after trastuzumab may produce better clinical outcomes. The TYCO study was designed to evaluate if early initiation of lapatinib-capecitabine in patients with ErbB2+ MBC who have progressed on trastuzumab-containing regimen improves TTP in comparison with a delayed start of the therapy.

Trial design: TYCO is an international, multicenter, prospective, observational study in 269 ErbB2+ MBC patients whose disease has progressed after treatment with trastuzumab in the metastatic setting. Two cohorts will be compared; Group 1: patients receiving lapatinib-capecitabine just after the first trastuzumab progression, and Group 2: patients receiving lapatinib-capecitabine after two or more lines of treatment after first trastuzumab progression. The study duration is of 12 months with data collection at baseline and approximately every 3 months thereafter.

Major Eligibility Criteria: 1. Females ≥18y with confirmed ErbB2+ MBC who have progressed after a previous trastuzumab-containing regimen,2. Pts eligible for standard therapy with lapatinib-capecitabine at approved conventional doses, as per local approved label.3. Pts eligible to start standard treatment with Lapatinib-capecitabine at conventional doses, or receiving standard treatment with Lapatinib-capecitabine at conventional doses, for no longer than 10 weeks from the start of the treatment to the date of inclusion in the study;

Aims: Primary objective of this study is to determine if early switch to lapatinib-capecitabine in patients with ErbB2+ metastatic breast cancer who have progressed on trastuzumab containing regimen improves time to disease progression as determined by treating physician either clinically or radiologically. Secondary objectives include overall response rate and overall survival.

Statistical Methods: Kaplan-Meier plots will be used to describe the median TTP after start of lapatinib-capecetabine. Cox proportional hazard model will be developed to estimate the adjusted hazard ratio (and 95% confidence intervals) comparing TTP for the two treatment group using propensity score methods (trimmed sample, adjustment for the continuous propensity score measure, and doubly robust adjustment) to adjust for potential confounding by indication that may arise due to the non-randomised design.

Present and Target Accrual: Enrollment began in February 2010, and as per May 2012, 266 patients have been included from Turkey, Venezuela, Argentina, Saudi Arabia and Colombia.

Mitomycin-C in combination with fluoropyrimidines in the treatment of metastatic colorectal cancer after oxaliplatin and irinotecan failure

PURPOSE

To retrospectively evaluate the efficacy and tolerability of mitomycin-C (MMC) in combination with fluoropyrimidines as salvage 3rd -or 4th-line therapy in metastatic colorectal cancer (MCRC) patients.

METHODS

All patients in this study had previously failed oxaliplatin and irinotecan-based chemotherapy. Patients were treated with MMC (6 mg/m(2) intravenously/i.v.) on day 1 in combination with either oral UFT (500 mg/m(2)) and oral leucovorin (LV) (30 mg) on days 1-14 every 3 weeks (group A) or infusional 5-fluorouracil (5-FU) by deGramont regimen with i.v. LV (200 mg/m(2)) on days 1 and 2, every 2 weeks (group B).

RESULTS

Thirty-nine MCRC patients were analyzed. Twenty-two of them were in group A and 17 in group B. Thirty-three were evaluable for clinical efficacy. The clinical benefit in the intent-to-treat (ITT) population was 30.8%. Median progression free survival (PFS) was 6 months (95% confidence interval/ CI 4-8) and median overall survival (OS) 9 months (95% CI 6.5-11.5). Median PFS was 3 months (95% CI 2.4-3.6) in group A and 7 months (95% CI 5.1-8.9) in group B (p=0.009). Median OS was 7 months (95% CI 4.3-9.7) in group A and 12 months (95% CI 5.4-18.6) in group B (p=0.422). The combination of MMC and fluoropyrimidines was generally well tolerated. The most common severe toxicities were nausea and vomiting, neutropenia, hepatotoxicity and diarrhea.

CONCLUSION

MMC in combination with fluoropyrimidines is safe and active in heavily-pretreated MCRC patients. This combination remains a viable option in these patients. However, better therapies are urgently needed.

Association between the Thr431asn Polymorphism of the Rock2 Gene and Breast Cancer

Background: The objective of this study was to analyze the genotype distributions and allele frequencies for Threonine431Asparagine (Thr431Asn) and Arginine83Lysine (Arg83Lys) polymorphisms of the Rho kinase2 (ROCK2) gene among the breast cancer patients.Material and Methods: In this case-control study, 223 patients with breast cancer were recruited and divided into two groups according to metastases (n=128) and without metastases (n=95). Genomic DNA from the patients and the control cases (n=150) was analyzed by real-time PCR using a Light-Cycler.Results: Neither genotype distributions nor the allele frequencies for the Arg83Lys polymorphism showed a significant difference between the groups. Although no marked changes was observed with no metastasis group, a statistically significant association was found between the control and metastatic group for the Thr431Asn polymorphism of the ROCK2 gene. Further analysis revealed that there were marked associations of this polymorphism with bone, liver, and lung metastases. Homozygous carriers of the Thr431Thr genotype were more frequent among the metastatic patients (39.8%) than among controls (26.0%; P =0.0485). There was also an increase in Thr431 allele (60.5% in patients vs 51.7% in controls) and decrease in Asn431 allele frequencies (48.3% in control vs 39.5% in patients) in metastatic groups (P =0.0356). Progesterone and estrogen receptor negativity was more frequent among metastatic patients carrying a Thr431 allele when compared to the nonmetastatic group.Discussion: Our resulsts are the first to demonstrate that Thr431Asn polymorphism of the ROCK2 gene could be a risk factor for the metastases of the breast cancer, and may help in predicting the prognosis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3038.

Depression-anxiety and quality of life and the use of complementary and alternative medicine among breast cancer patients in Turkey

Abstract #3130

Purpose: Breast cancer is the most common cancer type among women. The aim of this study was to examine the association between the use of complementary and alternative medicine (CAM) and quality of life, and anxiety and depression, and demographic characteristics of Anatolian women with breast cancer.&#x2028; Methods: Quality of life was measured with European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ-C30, version 3.0) and anxiety and depression was measured with Hospital Anxiety and Depression Scale (HADS). The demographic characteristics of patients were filled by patient to a standard form.&#x2028; Results: Totally 122 patients with breast cancer were enrolled, and 50% (n=61) of patients reported that they were using CAM. The most commonly used CAM methods were stinging nettle (57%) and prayer and spiritual healing (49%). The statistical analysis showed that, there was a meaningful correlation between CAM usage and education level (p=0.031) and radiotherapy (p=0.002). There was no relationship between use of CAM and patients age, time since diagnosis, stage of cancer, chemotherapy using, smoking and residence. Analysis of patients showed a positive correlation between CAM and RF2 (Role Functioning) (p=0.014) and FI (Financial Difficulties) (p=0.011) and negative correlation between CAM and EF (Emotional Functioning) (p=0.033). There was no correlation between use of CAM and anxiety and depression scale. The RF2 (p=0.02), EF (p=0.047), FA (Fatigue) (p=0.038), PA (Pain) (p=0.043) and depression results (p=0.008) were better at patients with high education level. We analysed CAM using in patients living in rural or urban area, and the EF (p=0.006), CF (Cognitive Functioning) (p=0.027), PA (p=0.025), DY (Dyspnoea) (p=0.045) and DI (Diarrhoea) (p=0.000) results were better in urban area.&#x2028; Conclusions: According to the various studies in the literature, 20-83.3% of breast cancer patients were using CAM and the CAM methods are different in different countries and cultures. Our results suggest that the use of CAM among Anatolian women with breast cancer is popular. This study findings showed no correlation between anxiety and depression and CAM usage. There is a tendency to CAM usage in patients with financial problems. Emotional functioning was also worse in those patients. The study results showed that the use of CAM is more common among breast patients with bad emotional status and poor financial status.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3130.

Adrenomedullin expression does not correlate with survival in lung cancer

It is suggested that adrenomedullin (AM) plays a role in lung carcinogenesis although, to confirm this suggestion, further clinical studies are needed to determine its relationship with prognosis in lung cancer. Archived 50 paraffin-embedded tumor samples of the lung were retrospectively evaluated for AM expression by immunohistochemistry and analyzed for a possible correlation with patient characteristics and survival. Quantitation of immunoreactivity was accomplished using an immunohistochemical scoring system. The pulmonary resection specimens contained 22 squamous cell carcinomas, 15 adenocarcinomas, and 13 small cell carcinomas. Non-small cell carcinomas of the lung were more likely to express AM than small cell carcinomas of the lung. Ninety-one percent of squamous cell carcinomas and 87% of adenocarcinomas expressed AM at a moderate to strong level and grade2-4 (30-100%), which were significantly higher from the non-neo-plastic lung tissue. Twenty-three percent of small cell carcinomas of lung expressed AM. Interestingly, AM immunoreactivity was essentially weak and grade 1 (<%30) in this group. AM expression is upregulated in non-small cell carcinomas of the lung, whereas it is downregulated in small cell carcinomas and non-neo-plastic lung tissues. AM expression did not show any correlation with the differentiation of the tumor, the stage of cancer, and the overall survival of patients. These results did not support the role of adrenomedullin as an independent survival factor for lung cancer. However, AM inhibition in conjunction with other anti-angiogenic agents may be useful in the prevention and treatment of malignancies.

Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto's disease) mimicking systemic lupus erythematosus: a review of two cases

Kikuchi-Fujimoto's disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited lymphadenitis commonly found in young women. It often shares clinical features with systemic lupus erythematosus (SLE), such as arthralgias, fever and leukopenia. The etiology of KFD remains unknown and controversial. Clinical course is favorable, with spontaneous remission in less than four months in almost all cases. Herein, we present two cases. The former is a 53-year old woman presenting with cervical lymphadenopathy, arthralgia, pancytopenia and positive antinuclear antibody (ANA). Lymph node biopsy revealed histopathological features compatible with Kikuchi-Fujimoto histiocytic necrotizing lymphadenitis. The latter patient was a 20-year old woman presenting with left cervical lympadenopathy, a butterfly rash that was reminiscent of SLE, and a positive antinuclear antibody. Based upon clinical, histological and laboratory findings, the diagnosis of SLE was excluded. Careful attention should be paid to differentiating between KFD and SLE, because of their similar presentations, yet different clinical courses and therapeutic requirements.

A case representing coexistence of acute myeloblastic leukemia and dedifferentiated liposarcoma: the possible role of chemotherapy in triggering dedifferentiation

Acute myelogenous leukemia (AML) is a hematological disorder that is characterized by an abnormal proliferation of immature myeloid cells. Dedifferentiated and well-differentiated liposarcomas are the two pathological subtypes of liposarcoma, based on the WHO classification. Transition from well-differentiated to dedifferentiated liposarcoma is a well-recognized phenomenon. Well-differentiated tumors are known to have low malignancy grade. However, when dedifferentiation occurs, the tumor acquires the aggressive features of a fully malignant lesion. This process largely is believed to progress in a time-dependant manner; however, time is not the only factor of importance. The potential roles of other factors in this transition are still unclear. To date, the coexistence of AML and liposarcoma has not been reported in the literature. In this paper, we report on a case of coexistence of AML and liposarcoma, and on the unusual behavior of a well-differentiated tumor after dedifferentiation occurs.

The evaluation of the Turkish version of the Well-being Questionnaire (WBQ-22) in patients with Type 2 diabetes: the effects of diabetic complications

OBJECTIVE

Psychopathological conditions including depression and anxiety are important in patients with diabetes due to their negative effects on the quality of life, treatment and glycemic control. The specially designed questionnaire for diabetics, the Well-being Questionnaire (WBQ-22), was used to determine the psychological well-being in Turkish diabetic patients.

METHOD

A total of 100 patients, 45 males and 55 females, were included in the study. Patients completed WBQ-22 questionnaire.

RESULTS

Sex, in-patient follow-up, age, duration of diabetes, form of treatment, diabetic microvascular complications, diabetic foot, and increased number of complications were the factors detected to have an effect on the scores of general well-being or its subscales. Scores of depression and general well-being were 7.10 +/- 3.82 and 39.74 +/- 12.27 in females, and 4.20 +/- 3.48 and 48.84 +/- 11.45 in males (p<0.05). Anxiety score was found to be 5.70 +/- 3.71 in the outpatient clinic, and 7.28 +/- 4.38 in the inpatient clinics (p<0.05). General well-being score was 49.40 +/- 8.83 in patients having a diabetes duration of 1 yr or less and 33.70 +/- 8.83 in patients with 20 yr or more (p<0.05). Patients treated with insulin had depression score of 7.02 +/- 4.07 whereas patients treated with diet had 4.50 +/- 3.27 (p<0.05). The increasing total chronic complication points were also found to have a negative effect on WBQ-22 scores. General well-being score was 51.08 +/- 9.84 in patients with no complications and 34.50 +/- 14.14 in patients with 4 complications (p<0.05).

CONCLUSIONS

Psychosocial support should be provided to Type 2 diabetic patients by studying the psychological well-being with WBQ-22 questionnaire.

Cutaneous metastasis of endometrial carcinoma with hemorrhagic nodules and papules

BACKGROUND

Endometrium cancer is the fourth most frequent malignancy in women. However, skin metastasis from endometrium cancer is a very rare entity.

CASE

A 58-year-old multiparous woman postmenopausal for ten years presented with multiple metastatic, nodular, hemorrhagic skin lesions located at the initial surgery and radiotherapy site 14 months after the original diagnosis was made. Combination chemotherapy was instituted, but the patient died after the second cycle of chemotherapy.

CONCLUSION

Although endometrial cancer is one of the most frequent malignancies in women, skin metastasis from endometrial cancer is very rare. In reported cases metastasis from endometrial cancer has been most commonly noted at the initial surgery and radiotherapy site. Therefore, the initial surgical and radiotherapy site must be examined carefully for skin metastasis.

The effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines

The endocrine and immune changes associated with surgery are well documented, but the interaction between them has not been fully evaluated. We, therefore, investigated the possible effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. Thirty-five patients were enrolled in the study (26 females and 9 males, aged 42.4 +/- 16.9 yr, who were admitted to General Surgery Clinic for laparascopic cholecystectomy). Serum C-reactive protein, cortisol, thyroid stimulating hormone, free tri-iodothyronine, free thyroxine, tumor necrosis factor-alpha, interleukin-1beta, soluble interleukin-2 receptor, interleukin-6, and interleukin-8 levels were evaluated 6 h before and after the operation. Postoperative cortisol (p=0.02), TSH (p=0.034), tumor necrosis factor-alpha (p=0.003), soluble interleukin-2 receptor (p=0.004) were found to be significantly higher than their corresponding preoperative levels. However, postoperative serum free thyroxine (p=0.011), and free tri-iodothyronine levels (p=0.001) were decreased when compared with preoperative levels, respectively. No significant difference was observed in C-reactive protein, interleukin-1beta, interleukin-6, and interleukin-8 levels. C-rective protein levels did not change in the early period of the surgical stress. Cytokine responses observed in the early period were found to be conflicting. Cortisol is an important marker of surgical stress which also has close relationship with thyroid functions.

Blastic natural killer cell leukaemia with skin involvement: a case report

Natural killer cell leukaemia is generally accompanied by extramedullary involvement. CD4+ natural killer cell leukaemia frequently manifests with cutaneous involvement. The disease pursues a very aggressive course with no long-term survivors reported. We present a patient with CD4+ natural killer cell leukaemia with skin, bone marrow and peripheral blood involvement who is still on remission at the end of 2 years.

Metastatic bone marrow tumours: a report of six cases and review of the literature

Bone marrow aspirations and biopsies are now employed in the investigation of many disorders in haematology, oncology, and internal medicine. In this paper, clinical, laboratory, and pathological findings are presented of patients with bone marrow metastases of solid tumours (n = 6). Anemia was detected in four cases (66.6%), thrombocytopenia in five cases (83.3%), leukopenia in three cases (50%), diffuse bone pain in four cases (66.6%), elevated serum alkaline phosphatase levels in four cases (66.6%). and hypercalcaemia in two cases (33.3%). In conclusion, bone marrow aspiration and biopsy examinations are effective, practical, and cheap in detecting solid tumour metastasis to bone marrow in a selected group of patients.

The prevalence of hepatitis G virus in cancer patients

Hepatitis G virus (HGV) is transfusion-transmissible and has a global distribution. However, its frequency and clinical impact have not been well established in extrahepatic cancer patients. In this study, we determined the prevalence of HGV RNA positivity, and its relationship with history of transfusion, amount of transfusion, age and sex in patients with hematological and solid malignancies in Southeastern Turkey. Sixty-one patients (35 males and 26 females) followed up for various malignancies and 60 healthy subjects were included in the study. HGV RNA was investigated by the reverse transcription polymerase chain reaction. HGV RNA was detected in none of the patients with cancer (0%) and only one person (1.6%) in the control group. There was no difference between the groups. This observation indicates that the prevalence of HGV is very low in cancer patients and healthy people in our geographical area. In addition, the role of HGV in the pathogenesis of extrahepatic malignancies seems insignificant.

Isolated thrombocytopenia: the presenting finding of typhoid fever

Thrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed.

Role of liver-produced prostaglandins in experimental intra-abdominal sepsis

Background

While the cyclo-oxygenase (Cox) 1 pathway has physiological effects such as maintaining endothelial integrity, Cox-2 also has pathological effects. The role of liver-produced prostaglandins and their specificity were studied in an experimental sepsis model.

Methods

Some 28 male Wistar rats were divided into five groups. In all groups intra-abdominal sepsis was created by caecal ligation and puncture. Group 1 (IASG) comprised five rats and all had intra-abdominal sepsis only. In group 2 (MG; n = 5) all rats received meloxicam 5 mg kg−1. Group 3 (NG; n = 5) received nimesulid 2 mg kg−1. In group 4 (APG; n = 5) antiplatelet activating factor (PAF) agent was administered. Group 5 (MAPG) received meloxicam and anti-PAF. Following 24 h of intra-abdominal sepsis, all rats underwent reoperation. Peritonitis was confirmed pathologically and liver biopsies were performed. The levels of prostaglandin (PG) E2 and PGF2α as prototypic end-products of the Cox-1 and -2 pathway were measured in the biopsy specimens.

Results

The mean PGF2α levels were 539·2, 17·8, 194·4, 341·0 and 229·2 pg per mg liver tissue protein in groups 1–5 respectively. The respective mean PGE2 levels were 422·6, 438·0, 272·6, 331·4 and 205 pg mg−1. PGF2α values in MG were significantly different from those in all other groups (P &lt; 0·001), and those in NG and MAPG were different from those in IASG and APG. On the other hand, PGE2 levels were significantly lower in NG, MAPG and APG than in IASG and MG. Liver tissue PAF was also detected in all groups except NG. Mean PAF levels in IASG, MG, APG and MAPG were 44·4, 33·2, 12·2 and 14·6 pg per mg tissue protein respectively.

Conclusion

(1) PAF is an important mediator in intra-abdominal sepsis. (2) Liver PGF2α may play a role in intra-abdominal sepsis independently from PAF. (3) Anti-PAF agent alone may help healing in peritoneal sepsis, but the main therapeutic agents are PGF2α blocking agents.

Plasma lipid peroxidation products and antioxidant enzyme activities in patients with type 2 diabetes mellitus

Diabetes is associated with a significant increase in thiobarbituric acid reactive substances (TBARS) which are considered as an index of endogenous lipid peroxidation. The human body has a complex antioxidant defense system that prevents the initiation of free radical chain reactions. We measured plasma TBARS levels, superoxide dismutase (SOD) and catalase (CAT) activities and compared their relation to the metabolic control of diabetes and diabetic microangiopathy. Sixty-four patients (19 men), aged 52.35+/-9.31 years with type 2 diabetes mellitus were included in the study. Thirty-six healthy subjects (12 men), aged 51.02+/-7.01 years formed the control group. TBARS levels and SOD activity were elevated in the diabetic group when compared with the control group ( p<0.001 and p<0.00001, respectively). However CAT activity was significantly decreased in the diabetic group when compared with the control group ( p<0.00001). Patients with diabetic nephropathy and retinopathy, but not neuropathy, had elevated TBARS levels but there was no statistically significant difference when compared with diabetic patients without microangiopathy ( p>0.05). There was a positive correlation between plasma TBARS levels and SOD activity (r=0.770, p=0.0001) and a negative correlation between plasma TBARS levels and CAT activity (r=0.482, p=0.0001). There was also a negative correlation between SOD and CAT activities (r=-0.609, p=0.0001). We found significantly elevated TBARS levels in diabetic patients. We did not observe any correlation between TBARS levels and blood glucose and HbA(1c) levels. Elevated TBARS levels and SOD activity and decreased CAT activity may be due to a compensation mechanism of the body.

The triad of weight loss, fever and night sweating: isolated bone marrow tuberculosis, a case report

Extrapulmonary tuberculosis is known to be the infection in an organ with or without pulmonary involvement. The infection in extrapulmonary tuberculosis is insidious and the symptoms and signs are generally nonspecific. We describe a 56-year-old male patient complaining of weight loss, fever, and night sweats. Although there were no signs and symptoms attributable to pulmonary tuberculosis, polymerase chain reaction (PCR), microscobical and cultural examination of bone marrow aspirate revealed isolated bone marrow tuberculosis. A treatment protocol of isoniazid, rifampicin, pyrazinamide, and streptomycin was administered. After 9 months of treatment, re-examination of the bone marrow revealed no signs of tuberculosis. Tuberculosis should be kept in mind especially in endemic areas and bone marrow should be examined in case of suspected tuberculosis infection.

Gemcitabine-induced erysipeloid skin lesions in a patient with malignant mesothelioma

Gemcitabine is a nucleoside analogue that has shown to have antineoplastic activity in different solid tumours (lung, pancreas, bladder, colon, ovarian, and breast cancer) and malignant mesothelioma. The toxic effects of gemcitabine include myelosuppression, flu-like syndrome, altered liver function tests, bronchospasm, rash, itching, and fever. However, gemcitabine-induced erysipeloid skin reaction was reported in a small number of patients with previous history of radiotherapy or lymphedema. We reported a male patient who developed erysipeloid skin reaction following gemcitabine treatment in the absence of radiotherapy and lymphedema.

Non-invasive imaging methods before fine-needle aspiration in the diagnosis of cervical masses

A carotid body tumour is a vascular tumour usually located at or around the bifurcation of the carotid artery and originating from the tunica adventitia. Carotid body tumours, which are generally non-functional and asymptomatic, grow slowly, which is why diagnosis can be delayed. Because of the vascular structures, fine-needle aspiration biopsy may be dangerous and impractical. Efficient and reliable methods of diagnosis, such as colour Doppler ultrasound, magnetic resonance imaging, computerised tomography and arteriography, can be useful. We report on a 58-year-old woman with diarrhoea, flushing and a cervical, hard, non-tender, fixed mass. An unsuccessful diagnostic fine-needle aspiration biopsy was performed after palpation of the cervical mass. A carotid body tumour was finally diagnosed. We concluded that non-invasive imaging methods should be evaluated before fine-needle aspiration in cervical masses. It should also be kept in mind that asymptomatic cervical masses may be related to non-local symptoms.

Brucellosis in the etiology of febrile neutropenia: case report

Brucellosis is one of the leading diseases in the differential diagnosis of fever of unknown origin in some parts of the world. It can lead to treatment failure because of slow growth in blood cultures and late appearance of signs and symptoms in patients with febrile neutropenia who were unresponsive to empirical antibiotic treatment. During the last year in our oncology unit adjuvant chemotherapy was given to 3 patients with breast (n=1) and stomach cancer (n=2) and febrile neutropenia was seen after the first course of chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, etoposide, Adriamycin, and cisplatin) in all 3 patients. Cefepime and amikacin were commenced but the fever continued. Prior to antifungal treatment, the patients were re-evaluated because of the history of unpasteurized milk ingestion without overt signs and symptoms. Serum agglutination tests of brucellosis were performed and were 1:640 in two patients and 1:320 in the third. Brucella melitensis was identified only in one case although multiple blood cultures were taken from all 3 patients. Empiric antibiotic treatment was stopped and streptomycin 1 g/day (10 days), doxycycline 200 mg/day (28 days), trimethoprim 320 mg and sulfamethoxazole 1600 mg/day (28 days) were given. Although neutropenia continued, fever subsided in 3 days. Due to high incidence of brucellosis in some geographic areas, especially in the Middle East, brucellosis should be kept in mind in the differential diagnosis of febrile neutropenia.

The frequency of gallbladder stones in patients with pernicious anemia

BACKGROUND

Ineffective erythropoiesis and intramedullary hemolysis are the two important results of pernicious anemia. Hemolysis is one of the risk factors in the formation of gallbladder stones.

PATIENTS AND METHODS

The frequency of gallstones was searched in 59 patients with pernicious anemia and in 54 healthy subjects.

RESULTS

Nineteen (32.2%) patients in the pernicious anemia group and three (5.5%) patients in the control group were detected to have gallstones. Pernicious anemia patients with and without gallbladder stones were also compared for mean corpuscular volume, hemoglobin, unconjugated bilirubin, lactic dehydrogenase, and vitamin B12 levels but no statistically significant difference was encountered.

CONCLUSION

Apart from other risk factors, pernicious anemia itself increases the frequency of gallbladder stones. Should patients with pernicious anemia develop upper-abdominal pain or other symptoms referable to biliary tract disease, a high index of suspicion for gallstone-related disease should be maintained.

The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology

BACKGROUND/AIMS

Clinical usage of tumor markers is being limited due to low specificity. Elevated plasma levels of tumor markers may be seen in diseases other than malignancy, i.e., kidney, liver or circulatory disturbances.

METHODOLOGY

In our study, we studied serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, CA 15-3 levels in patients with chronic liver disease, spontaneous bacterial peritonitis, malignancy, tuberculous and congestive heart failure in a total of 76 patients.

RESULTS

The sensitivity and specificity for ascites fluid alpha-fetoprotein levels were 28.5% and 100%, for serum alpha-fetoprotein levels 28.5% and 98.1%, for ascites fluid carcinoembryonic antigen levels 38.0% and 98.1%, for serum carcinoembryonic antigen levels 57.1% and 90.0%, for ascites fluid CA 19-9 levels 19.0% and 94.5%, for serum CA 19-9 levels 33.3% and 21.8%, for ascites fluid CA 15-3 levels 28.5% and 92.7%, and for serum CA 15-3 levels 47.6% and 81.8%, respectively.

CONCLUSIONS

In conclusion, the sensitivity of serum and ascites fluid tumor markers was found to be low. High specificity may be due to low number of study participants. Serum and ascites fluid tumor markers are not found to be useful in the differential diagnosis of ascites etiology.

The efficacy of acetazolamide on visual functions in a patient with choroid metastasis of breast carcinoma

Breast carcinoma is the most frequent cancer in women and is the second leading cause of death. Choroid metastasis of breast carcinoma can be found either at presentation or in remission. It is frequently encountered in disseminated breast cancer with multiple organ metastasis. It has been proposed that the oedema-reducing effect of acetazolamide is due to stimulated ion and fluid removal from the retina to the choroid. A 40-year-old female patient on adjuvant chemotherapy for breast cancer was found to have an isolated choroid metastasis. Clinical and radiological remission was achieved after orbital radiotherapy, chemotherapy and acetazolamide treatment. In this case report, we emphasise the possible beneficial effect of acetazolamide in patients with choroid metastasis.

Serum and ascites fluid cytokine levels in patients with chronic heart failure

OBJECTIVE

Cytokines that are capable of modulating cardiovascular function were reported to be elevated in patients with advanced heart failure. We evaluated the diagnostic importance of cytokines both in the serum and ascites.

MATERIAL AND METHODS

We determined serum and ascites fluid TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels in 14 patients with congestive heart failure (group 1) and in 15 patients with chronic liver disease (group 2).

RESULTS

Ascites fluid IL-8 and soluble IL-2 receptor levels were found to be significantly elevated in group 1 when compared with group 2 (p = 0.014 and p = 0.005). There were no statistical differences in serum TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels and ascites fluid TNF-alpha, IL-1beta, and IL-6 levels. Ascites fluid/serum IL-1beta and IL-8 ratio was lower in group 1 when compared with group 2 (p = 0.001 and p = 0.005). Ascites fluid/serum IL-2 and IL-6 ratio was higher in group 1 when compared with group 2 (p = 0.035 and p = 0.025).

CONCLUSION

Cytokine levels in ascites fluid, but not in serum, are important in congestive heart failure. Ascites fluid/serum cytokine level ratios were detected to be more conclusive and valid in the diagnosis work-up of ascites aetiology.