Multicystic peritoneal mesothelioma treated by surgical cytoreduction and hyperthermic intra-peritoneal chemotherapy (HIPEC)

BACKGROUND

Multicystic peritoneal mesothelioma (MPM) is an extremely uncommon lesion with uncertain malignant potential. Multiple recurrences after surgical interventions and transition to aggressive malignancies have been reported. Here, we review our experience with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of MPM.

PATIENTS AND METHODS

Five women with MPM underwent 6 procedures of cytoreduction and close-abdomen HIPEC with cisplatin and doxorubicin. Three patients had recurrent disease after 1, 2 and 4 previous debulkings, respectively.

RESULTS

Optimal cytoreduction (residual tumor nodules < or =2.5 mm) was performed in all the procedures. One grade 4 postoperative complication (NCI/CTCAE v.3.0) and no operative mortality occurred. Median follow-up was 31 months (range 3-102). MPM recurred in two patients: one is presently disease-free after a second cytoreduction with HIPEC and the other is alive with minimal stable disease.

CONCLUSION

Definitive eradication by means of cytoreduction and HIPEC seems a safe and effective therapeutic option for MPM.

Prolonged survival in poor-risk diffuse large B-cell lymphoma following front-line treatment with rituximab-supplemented, early-intensified chemotherapy with multiple autologous hematopoietic stem cell support: a multicenter study by GITIL (Gruppo Italiano Terapie Innovative nei Linfomi)

A prospective multicenter program was performed to evaluate the combination of rituximab and high-dose (hd) sequential chemotherapy delivered with multiple autologous peripheral blood progenitor cell (PBPC) support (R-HDS-maps regimen) in previously untreated patients with diffuse large B-cell lymphoma (DLB-CL) and age-adjusted International Prognostic Score (aaIPI) score 2-3. R-HDS-maps includes: (i) three APO courses; (ii) sequential administration of hd-cyclophosphamide (CY), hd-Ara-C, both supplemented with rituximab, hd-etoposide/cisplatin, PBPC harvests, following hd-CY and hd-Ara-C; (iii) hd-mitoxantrone (hd-Mito)/L-Pam + 2 further rituximab doses; (iv) involved-field radiotherapy. PBPC rescue was scheduled following Ara-C, etoposide/cisplatin and Mito/L-Pam. Between 1999 and 2004, 112 consecutive patients aged <65 years (74 score 2, 38 score 3) entered the study protocol. There were five early and two late toxic deaths. Overall 90 patients (80%) reached clinical remission (CR); at a median 48 months follow-up, 87 (78%) patients are alive, 82 (73%) in continuous CR, with 4 year overall survival (OS) and event-free survival (EFS) projections of 76% (CI 68-85%) and 73% (CI 64-81%), respectively. There were no significant differences in OS and EFS between subgroups with Germinal-Center and Activated B-cell phenotype. Thus, life expectancy of younger patients with aaIPI 2-3 DLB-CL is improved with the early administration of rituximab-supplemented intensive chemotherapy compared with the poor outcome following conventional chemotherapy.

[CK20 expression in the gastrointestinal tract of the embryo and fetus]

A novel type of cytokeratin, cytokeratin 20 (CK20), was added in 1990 to the classic catalog of human cytokeratins, a heterogeneous group of proteins present in almost all epithelia. In man, the expression of CK20 is almost entirely confined to the gastro-intestinal epithelium, to the urothelium and to Merkel cells. Since only few data are available regarding the expression of CK20 in the developing human intestinal mucosa, we studied CK20 immunoreactivity in fetal and neonatal human gut. Immunoreactivity for CK20 was tested in fetuses and newborns, from the twelfth up to the fortieth week of gestation. In each subject, a specimen from the oesophagus, stomach, small intestine, colon, appendix was studied. Tissue samples were routinely processed and paraffin sections were stained with the CK20-specific antibody IT-Ks 20.8. CK20 immunoreactivity was absent in the oesophageal epithelium and it was unevenly distributed in the gastrointestinal mucosa. Three main patterns of immunoreactivity were observed during normal development: the first, found in the stomach and in the small bowel, is characterized by a progressive increase in CK20 expression during gestation; the second pattern, found in the duodenum, shows a progressive decrease in CK20 expression during gestation; in colon and appendix (third pattern), we did not find significant changes in the degree of immunoreactivity for CK20 during gestation. CK20 is unevenly expressed in developing human intestinal mucosa. The degree of positivity for CK20 appears to be related to the epithelial maturation stage only in gastric and small bowel mucosa. Further studies are needed to verify if the uneven CK20 immunoreactivity in the gastrointestinal tract persists even in adulthood.

Is tumour angiogenesis a prognostic factor in patients with colorectal cancer and no involved nodes?

OBJECTIVE

To examine a possible association between tumour angiogenesis and conventional prognostic variables and to assess the prognostic value of the variables examined in patients with colorectal cancer, with no involved nodes.

DESIGN

Retrospective study.

SETTING

University hospital, Italy.

SUBJECTS

119 patients who had had colorectal cancers resected for cure with no involved nodes between 1985-1990.

INTERVENTIONS

The three microscopic fields with the most microvessels were identified by immunohistochemical techniques. 10 high-power fields in each area were used for the microvessel count and the mean values indicated the microvessel density.

MAIN OUTCOME MEASURES

Correlation of microvessel density with conventional prognostic factors, recurrence rates, and survival.

RESULTS

There was a significant correlation between microvessel density and sex, women having a higher density than men (p < 0.05), but no significant correlations between density and recurrence rates or survival. Multivariate analysis did not indicate that microvessel density had a prognostic role.

CONCLUSION

Microvessel density in colorectal cancer without involved nodes does not correlate with conventional prognostic factors and provides no prognostic information.

[Anorexia nervosa ]

The etiopathogenesis of the anorexia nervosa is still unknown although several hypotheses have been postulated. Recently it has been postulated that it may be due to biochemical derangement of the serotonin metabolism. Clinically the anorexia nervosa is characterized by an obsessive fear of gaining body weight and, therefore, by a phobic repulsion for the food. It differs, however from the phobic-obsessive psychoneurosis for the constant presence of the amenorrhea. The treatment requires psychopharmacology as well as psychotherapy.

[Hemospermia: cause, clinical significance and our experience]

The hemospermia is first of inflammatory origin, in the young, where it is due to urethro-prostatitis or orchio-epididymitis, in the old, to benign or malignant prostatic tumours. In 30-70% of the cases it is idiopathic. It can be connected with a prolonged sexual abstinence or with intense sexual activity. Predisposing diseases are prostatitis, epididymitis, urinary stones, gonorrhea, syphilis, tuberculosis, cirrhosis of the liver, blood hypertension, haematologic diseases. Our casistics, 60 patients in 4 years (1987-1990), has showed the hemospermia as isolated episode in 20% of the cases, in 35% associated with urologic symptoms. Juvenile forms, connected with urethro-prostatitis, are often associated with the echographic presence of periurethral calcifications or to a swelling of the seminal vesicles. In 8 patients, the hemospermia was recurrent, and due to a prostatic tumour. In 2 patients, with recurrent hemospermia, a urogenital tuberculosis has been detected.

[The importance of tumor markers in adenocarcinoma of the prostate]

The discovery of the new markers for the diagnosis and therapy of the carcinoma of the prostate, the prostatic acid phosphatase (PAP) and the prostatic specific antigen (PSA), and their correlation has opened new horizons in the field of the neoplastic prostatic pathology. The PAP fails have a rule in the diagnosis of a prostatic tumour in the initial phase, and therefore as a test of screening. It increases considerably only in the bone metastases. The PSA is highly specific, and together with the PAP is very useful in the check of the patients in treatment and in the surveillance of the appearance of metastases. We have considered over a period of 10 months, 70 patients with prostatic pathology. 22 were affected with carcinoma of the prostate. 48 were affected with benign prostatic hyperplasia. In both groups the simultaneous dosage of the PAP and PSA has been carried out with the RIA method. In the patients with BPH the simultaneous dosage of the 2 markers was elevated only in two cases. On the contrary, in the patients with carcinoma of the prostate we have noticed univocal data of increasing of both the markers. In the patients with metastases, the 2 markers behave in a very similar way, and progressively increase with the progressively increase with the evolution of the clinical stage of the tumour. The control after 3 months of treatment with analogues of the LH-RH and flutamide has showed a reduction of the serum levels of the 2 markers varying between 65 and 85% and over.

[The immunopathology of type I diabetes mellitus]

The onset of type I diabetes is preceded by a prodromic phase during which, despite the absence of symptoms, the beta-cell mass decreases as a result of an autoimmune process. In this review we discuss the importance of environmental and genetic factors, and abnormalities of humoral and cellular immunity in the development of autoimmune process toward pancreatic beta cells. The resulting immunological network involves monocytes activation, interleukin-1 secretion, T-lymphocyte activation, secretion of interleukin-2 and other lymphokines which activate cytotoxic cells to induce beta-cell lysis.