Clear Cell Carcinoma of the abdominal wall

Background: Clear cell carcinoma in scars after cesarean section is extremely rare, with only 22 cases reported in the literature. Management of this condition needs to be further explored. Here, we report of a patient with clear cell carcinoma of the abdominal wall that developed 35 years after cesarean section. Case Report: The material of the study was a group of 61 patients divided into two groups. Group I – 35 deaf or with profound sensorineural hearing loss children (the pupils of the deaf and hard of hearing school), aged 5–17 years (average 9,2 years), 14 males, 21 females, II – control group comprised 26 normal hearing patients, aged 5–16 years (average 10,4 years), 14 males, 12 females (patients of Department of Pediatric Otolaryngology, Audiology and Phoniatrics, Medical University of Lodz). In both groups, exon 2 sequencing of GJB2 gene was performed. Results. A 58-year-old woman was admitted to our department due to abdominal pain and a progressively growing mass in the abdominal wall. Based on biopsy, a preliminary diagnosis of clear cell carcinoma was made. A wide surgical excision of the tumor with clear margins, hysterectomy with bilateral salpingo-oophorectomy, and abdominal wall reconstruction using synthetic mesh were performed. The patient was discharged in good condition after fifteen days of hospitalization. The patient remained recurrence-free 6 months after the treatment. Conclusions: T Lack of standardized management of rare malignant transformations hinders patient care. Due to a growing number of cesarean deliveries, we can expect clear cell carcinoma prevalence of the abdominal wall to increase. Therefore, patients and clinicians should attend to any pain, itching, or change in the size of abdominal wall scars.

The Influence of Intraoperative Factors and Histopathological Staging on the Performance of Sentinel Node Biopsy in Colon Cancer

BACKGROUND

The aim of this study was to assess sentinel node biopsy (SNB) results in colon cancer (CC) regarding intraoperative staging of the disease and pathological cancer features.

MATERIAL AND METHODS

The study was conducted on the basis of 132 SNBs in CC. The elements of intraoperative staging of the disease and pathological cancer features were compared with accuracy, sensitivity and false negative results of SNB in CC by means of ROC curves and the tests for population proportions.

RESULTS

ROC curve analysis did not reveal any statistical significance for tumour measurements (all p > 0.05). Statistically significantly worse results in sensitivity (not in accuracy) were achieved for T3 tumours in comparison with T2 tumours (83% vs 89%, p = 0.0066). Statistically significantly worse results in accuracy (not in sensitivity) of the method were obtained in the cases of involved lymph nodes (78% vs 100%, p < 0.0001), infiltration of the lymph node capsule (80% vs 97%, p = 0.0023) and infiltration of the perinodal tissue (73% vs 97%, p = 0.0002). The analyses of SNB sensitivity and accuracy in combination with other features showed no statistical significance (all p > 0.05).

CONCLUSIONS

The sensitivity of the method is significantly worse for tumours with deeper infiltration of intestinal wall. The presence of nodal metastases, lymph node capsule and perinodal invasion significantly affects the accuracy results of SNB in CC. The problem of qualifying patients for the procedure in regard to the other analysed features, however, remains open and requires further analysis.

The pharmacokinetics of oral oxycodone in patients after total gastric resection

OBJECTIVE

Oxycodone is a semi-synthetic opioid with a stronger analgesic effect than morphine and codeine. The efficacy of this opioid in the treatment of postoperative pain has been proved in different groups of patients. The drug has a favourable adverse reaction profile, which encourages doctors and patients to use it more and more widely. The drug is also used in the patients who underwent an abdominal surgery, e.g. stomach resection. Gastrectomy leads to pathophysiological changes within the gastrointestinal tract, which may cause changes in the drug absorption. In consequence this leads to a change in the pharmacokinetics and effect of the drug. The aim of the research was an analysis of the pharmacokinetics of oxycodone from prolonged release tablet in patients after total gastrectomy.

PATIENTS AND METHODS

The research was carried out on patients after gastrectomy with Roux-en-Y reconstruction. The patients (n=24; mean [SD] age, 67.6 [9.8] years; weight, 69.1 [13.6] kg; and BMI, 25.2 [4.0] kg/m(2)) received oxycodone in a prolonged release tablet in a single orally administered dose of 10 mg. Blood samples were collected within 12 h after the drug administration. The plasma concentrations of oxycodone and noroxycodone were measured with validated high-pressure liquid chromatography coupled with triple tandem mass spectrometery method.

RESULTS

The main pharmacokinetic parameters for oxycodone in men (n = 14) and women (n = 10) were as follows: Cmax, 14.40 (3.76) and 11.54 (6.98) ng/ml (p = 0.2066); AUC0-∞, 157.87 (56.89) and 106.44 (61.31) ng´h/ml (p = 0.0460); tmax, 2.18 (0.58) and 2.15 (0.58) h (p = 0.8008), respectively.

CONCLUSIONS

Total gastrectomy did not affect the pharmacokinetics of oxycodone administered in prolonged release tablets, but the exposure to the drug was significantly lower in women.

Breast cancer sentinel lymph node mapping using near infrared guided indocyanine green and indocyanine green--human serum albumin in comparison with gamma emitting radioactive colloid tracer

AIMS

Recently, a novel method of using near infrared (NIR) guided indocyanine green (ICG) and ICG conjugated with human serum albumin (ICG:HSA) for sentinel lymph node biopsy (SLNB) of breast cancer patients has shown true potential. The aim of this study was to compare the usefulness of NIR guided ICG and ICG:HSA against the gamma emitting radiocolloid (RC).

METHODS

A group of 49 consecutive breast cancer patients underwent SLNB using RC. From this group, the first 28 patients were compared against ICG, while the next 21 patients were compared against ICG:HSA. The number of patients with visible fluorescent path was recorded. Furthermore, the number of SLNs detected by fluorophores percutaneously and total number of intraoperative SLNs detected by fluorophores and/or RC was noted.

RESULTS

NIR guided real time lymphatic flow was observed in 47/49 patients (96%). In all cases except one, SLNs detected by the RC tracer were also detected by their respective fluorophore. Additionally, ICG detected 10 additional SLNs in 8 patients, while 3 additional SLNs were detected by ICG:HSA in 3 patients. Statistical analysis revealed no difference between the number of SLNs detected between ICG versus ICG:HSA and RC versus ICG:HSA. However, a significant statistical difference was observed between RC and ICG (p=0.0117), as well as between the combined NIR guided and RC method (p=0.0033).

CONCLUSIONS

In conclusion, the use of either ICG or ICG:HSA with RC to obtain SLNB seems to be an effective alternative. Compared to RC alone, the use of ICG:HSA, more so than ICG alone, may provide additional benefits.

Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence

BACKGROUND

Sentinel lymph node (SLN) biopsy with radioisotope and blue dye has been used successfully for axillary staging in breast cancer. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping and SLN biopsy.

METHODS

Thirty women with breast cancer had a periareolar injection of ICG for fluorescence detection of SLN using a near-infrared camera. Twenty also received (99m)Tc-labelled sulphur radiocolloid for SLN scintigraphy. All patients underwent axillary lymph node dissection. Detection rate and sensitivity of both methods were the study endpoints.

RESULTS

Visualization of lymphatic vessels by fluorescence detection depended on the dose of ICG. ICG imaging identified SLNs in 29 of 30 women (detection rate 97 per cent). Nineteen of 21 patients had metastatic SLN involvement (sensitivity 90 per cent) with false-negative results in two. Among the 20 patients who had both methods, ICG fluorescence and radiocolloid identified SLNs in 20 and 17 patients respectively. Metastatic lymph nodes were diagnosed in 12 and ten of 13 patients (sensitivity 92 and 77 per cent). False-negative rates were 8 and 23 per cent respectively.

CONCLUSION

ICG fluorescence allowed transcutaneous imaging of lymphatic vessels and SLN detection, thus combining the advantages of radioisotope and blue dye methods.

Evaluation of the sentinel node biopsy in colorectal carcinoma including the results of immunohistochemical examinations

AIM

To evaluate the method and results of sentinel node biopsy including immunohistochemical examinations in resectable colorectal cancer.

MATERIAL AND METHODS

From April 2004 to April 2005, sentinel node biopsy was carried out with the dye method in 27 patients operated on for colorectal cancer. The standard examination of sentinel nodes consisted in the evaluation of individual H&E-dyed specimens from bisection of the node. The negative sentinel nodes were examined with the use of immunohistochemistry against cytokeratins AE1/AE3.

FINDINGS

The sentinel node was identified in 25 patients (92.6%). In a routine histopathological examination it included metastases in 3 cases. The sentinel node was clean in one patient whereas other regional nodes resected "en bloc" with the tumour included metastases. The sensitivity of the method was 75%, and the number of falsely negative results was 25%. Metastases (micrometastases) in the sentinel node were found in 2 other patients (8%) in the immunohistochemical examination. This examination did not change the results of the analysis in the patient with positive non-sentinel nodes and with the negative sentinel node in H&E dyeing. Nevertheless, the sensitivity of the method rose to 83.3% and the number of falsely negative results dropped to 16.7%.

CONCLUSIONS

1. The sentinel node biopsy using the dye method is a safe and relatively easy technique showing a high success rate (92.6%). 2. Low sensitivity of the method, as reflected in the literature, may result from lack of extended histopathological examinations performed on the sentinel node (e.g. immunohistochemistry). 3. Further research is necessary to determine the role and importance of the sentinel node biopsy in colorectal cancer.

[Cases of carcinoid tumor in stomach and retroperitoneal space]

Authors present two cases of carcinoid localized in stomach and retroperitoneal space. Diagnosis was based on clinical examination, endoscopy, CT and histopathological evaluation. The case of gastric carcinoid was an early lesion (penetrated only mucose and submucose layer of gastric wall). In opposition, second patient had inoperable large tumor localized in retroperitoneal space with multiple metastases to the liver.

[A case of primary lymphangiomyomatosis in retroperitoneal space and lungs]

Authors present a rare case of primary lymphangiomyomatosis. Diagnosis was based on histopathological evaluation. Diagnostic difficulties were caused by lack of pathognomonic symptoms in clinical examination, ultrasonography and CT. The patient has been treated with hormonal medicines (Provera, Megace) since 1997. Now she is in a good condition, She hasn't got any symptoms of progression disease.