Diffuse familial adenomatous intestinal polyposis in childhood: current state of the problem and case report

OBJECTIVE

Aim: To explore the prevalence, clinical characteristics, and diagnostic aspects of diffuse familial adenomatous polyposis in childhood. This objective is accomplished through an extensive review of recent literature, and the presentation of case report from our clinical practice.

PATIENTS AND METHODS

Materials and Methods: We analyzed 75 scientific papers, the findings of which have been documented in the PubMed database. Our search criteria included keywords such as ≪diffuse familial adenomatous intestinal polyposis,≫ ≪children,≫ and ≪diagnosis.≫ Then we conducted a second-stage analysis that involved a detailed review of a practical case - the medical records of inpatient Kh.V. who had been diagnosed with familial adenomatous polyposis.

CONCLUSION

Conclusions: The analysis of the literature data is consistent with the findings from our clinical observations of familial adenomatous polyposis in a patient with complicated family anamnesis. It is worth noting that clinical features do not significantly differ across various types of polyposis. In cases of suspected familial adenomatous polyposis in adolescents, genetic testing is crucial.

AN INTEGRATED APPROACH TO THE MORPHOLOGICAL DIAGNOSIS OF DIFFERENT TYPES OF PLEOMORPHIC ADENOMAS OF THE SALIVARY GLAND: LONG-TERM RESEARCH RESULTS

OBJECTIVE

The aim: To describe an integrated approach to the morphological diagnosis of different types of pleomorphic adenomas of the salivary gland.

PATIENTS AND METHODS

Materials and methods: Surgical and biopsy material from 30 patients with pleomorphic adenomas of epithelial, mixed and mesenchymal variants was studied using histological, immunohistochemical, genetic, morphometric and statistical methods.

RESULTS

Results: The results of research allowed us to identify methods for determination the pleomorphic adenomas types. The first method requires an immunohistochemical reaction with a monoclonal antibody to human papillomavirus type 16, followed by counting the percentage of positively stained cells in the tumor. Thus, the mesenchymal variant of the tumor is diagnosed when the percentage of positively stained cells is < 40%. In the mixed variant, this indicator is ≥ 40%, but ≤ 70%, and in epithelial variant - > 70%. The second method was based on the multivariate discriminant analysis. Three formulae were derived to determine the tumor types (Fmesenchymal = - 41.03 + 4.96Х1 + 1.11Х2, Fepithelial = - 22.27 + 3.46Х1 + 0.85Х2, Fmixed = - 122.25 + 5.63Х1 + 3.2Х2, here Х1 - number of vessels, Х2 - specific volume of parenchyma).

CONCLUSION

Conclusions: The authors identified several methods for determining the histological variants of pleomorphic adenomas. These methods will improve the morphological diagnosis of pleomorphic adenomas variants in the preoperative and postoperative periods.

CURRENT APPROACHES TO DIAGNOSIS AND TREATMENT OF HIRSCHSPRUNG DISEASE IN NEWBORNS AND INFANTS (LITERATURE REVIEW AND FIRST-HAND EXPERIENCE)

OBJECTIVE

The aim: To analyze the current state of the issue of Hirschsprung disease in newborns and infants on the basis of literature data and first-hand experience.

CONCLUSION

Conclusions: 1. Hirschsprung disease should be suspected in all newborns with late meconium passage. 2. The main methods of diagnosing Hirschsprung disease in newborns and infants are the assessment of anamnestic data, clinical manifestations and features of the clinical course of the pathology, contrast enema, morphological examination of rectal biopsies and immunohistochemistry for ACE. 3. The presence of enterocolitis in newborns and infants should raise suspicion of Hirschsprung disease. 4. Low intestinal obstruction, perforation of the cecum, ascending or terminal small intestine, and peritonitis in the first days of a child's life may be complications of Hirschsprung disease. 5. In newborns and infants, early diagnosis of Hirschsprung disease and timely surgical correction by one-stage surgery help improve treatment outcomes.

FEATURES OF THE COMORBID COURSE OF CHRONIC PANCREATITIS AND ARTERIAL HYPERTENSION

OBJECTIVE

The aim: To investigate the clinical features of the chronic pancreatitis (CP) clinical course in patients with concomitant arterial hypertension.

PATIENTS AND METHODS

Materials and methods: 100 patients with PD were investigated. In 60 patients, the course of CP and AH was combined - the main group, the comparison group - 40 patients with CP without concomitant pathology.

RESULTS

Results: In 52 patients (86.7%) with CP and AH abdominal pain was recorded versus 24 (60.0%) with CP (p<0.01). Correlation analysis revealed weak relationship between the intensity of pain acc. Visual analogue scale (VAS) of pain and the degree of steatorrhea (τ = 0.40, p <0.01), the degree of amilorrhea (τ = 0.39, p <0.01) and the average strength of the relationship with creatorrhoea (τ = 0.60 , p <0.01). Dyspepsia was revealed in CP and AH: flatulence in 55 (91.7%) compared with 26 (65.0%) with CP, diarrhea in 52 (86.7%) patients in the main group versus 23 (57.5%) in the comparison group, nausea in 52 (86.7%), vomiting in 45 (75.0%) in the main group versus 18 (45.0%) and 12 (30.0%) patients from the comparison group (p<0.01 in all comparisons). Asthenia is expressed in patients with CP and AH: weakness in 50 (83.3%) patients versus 6 (15.0%), psychoemotional lability in 44 (73.3%) versus 3 (7.5%), headache in 47 (78.3%) versus 6 (15.0%), sleep disorders in 45 (75.0%) compared with 1 (2.5%) patients with CP (p<0.01 in all comparisons).

CONCLUSION

Conclusions: The negative effect of concomitant hypertension on the clinical course of CP has been established. AH contributes to increased pain syndrome, dyspepsia, asthenia.

Perspective for evaluation of microrna in plasma and bile for differential diagnosis of obstructive biliary tract disease

OBJECTIVE

Introduction: Cholelithiasisis diagnosed in 10-25% of the adult population. The manifestation of cholelithiasis in the form of acute cholecystitis, cholangitis, jaundice etc. occurs with a probability of 2-3% or more per year depending on the risk factors. Most often, it manifests it self as acute calculous cholecystitis. Up to 20% of such patients have additional calculi in extrahepatic bile ducts requiring simultaneous surgical intervention. Currently, the algorithm for diagnosis of concomitant choledocholithiasis in acute cholecystitis is multilevel and it needs to be simplified and improved. Conventional non-invasive diagnostic techniques have low specificity and sensitivity. A new safe diagnostic test is needed for the diagnosis of choledocholithiasis in cholecystitis in order to improve the results of surgical treatment of patients. The aim of the study - to determine the prospects for diagnosis of microRNA for differential diagnosis of obstructive diseases of the biliary tract on the basis of the literature data.

PATIENTS AND METHODS

Materials and methods: The analysis of the selected international literature in the period of 1991-2018 concerning the studies of microRNA in cholestatic liver diseases was carried out. The search for literature was conducted using Google Scholar and PubMed search engines for the following keywords: microRNA, cholestasis, choledocholithiasis, acute cholecystitis, biliary obstruction in their various combinations.

RESULTS

Review: MicroRNA is a specific post-transcriptional regulator of gene expression in all organs and systems of the body. There are specific types of miRNAs for different tissues. The most studied type of liver miRNA is miR-122. The studies showed better sensitivity and specificity of the detection of miR-122 both in the plasma and in the bile for the diagnosis of pathological liver conditions compared with conventional liver tests (aminotransferase, alkaline phosphatase, gamma-glutamyltransferase). Regarding the cholestatic hepatocyte injury occurring in choledocholithiasis, the following types of miRNA were identified: 122, 21, 29, 125, 222, let-7, 98 etc. Their concentrations in plasma and bile can be used as a diagnostic test for the presence of concomitant benign cholestasis in acute cholecystitis. Moreover, these markers can be used for the differential diagnosis of cholestasis of different etiology.

CONCLUSION

Conclusions: Quantitative and qualitative characteristics of microRNA in bile and plasma can be used as an additional non-invasive method for diagnosis of cholestasis induced by choledocholithiasis in acute calculous cholecystitis. Further studyis needed to identify the most optimal algorithm for the administration of microRNA in clinical practice.

[Seminal vesiculoscopy: Past, status quo, and prospects]

Seminal vesiculoscopy is a new technology in uro-andrology developed in recent 10 years, which is a set of clinical operational techniques for observing the ejaculatory duct, seminal vesicle, ampullar region of the vas deferens and their surrounding structure, determining the cause, location and degree of the disease, and accomplishing such treatment procedures as irrigation, resection, incision, fulguration, hemostasis, expansion, drainage, and removal of hematocele, stones or obstruction in the distal seminal duct region. Therefore, it is not only an etiologically diagnostic technique, but also a minimally invasive surgical approach to the management of common diseases of the distal seminal duct region. Seminal vesiculoscopy has irreplaceable advantages of safety, effectiveness, minimal invasiveness, rapid recovery, and few complications.

[Clinicopathological features of primary seminal vesicle adenocarcinoma: A report of 4 cases and review of the literature]

OBJECTIVE

To investigate the clinicopathological characteristics, diagnosis, and treatment of primary seminal vesicle adenocarcinoma (SVAC).

METHODS

We analyzed the clinical data and clinicopathological characteristics of 4 cases of primary SVAC treated in the Department of Urology of the Second Hospital of Tianjin Medical University and reviewed relevant literature.

RESULTS

All the 4 patients were treated by open radical resection of the seminal vesicle and prostate and pathologically diagnosed with SVAC. Preoperative prostatic biopsy had shown 1 of the cases to be negative, while preoperative CT and transrectal ultrasound had revealed a huge pelvic cystic neoplasm in another patient. Immunohistochemistry manifested that the 4 cases were all negative for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and cytokeratin 20 (CK20), but positive for cancer antigen 125 (CA125) and CK7. All the patients recovered smoothly after surgery and experienced no recurrence or metastasis during 154, 41, 20, and 12 months of follow-up.

CONCLUSIONS

Primary seminal vesicle carcinoma is extremely rare and presents in an advanced stage. Immunohistochemistry plays a valuable role in its differential diagnosis. Various combinations of radical surgery, radiotherapy, androgen-deprivation therapy, and chemotherapy are recommended for the treatment of the disease.