Publications by authors named "Alexandra Kalogeraki"

40 Publications

Osteoclast: like giant cell undiferrentiated pancreatic tumor diagnosed by means of EUS guided FNA.

Acta Biomed 2021 05 12;92(2):e2021106. Epub 2021 May 12.

University of Crete, Medical Faculty, Department of Gastrenterology.

Objective: Osteoclast-like giant cell tumours are rare abdominal malignant neoplasms mainly arising in the pancreas. Because of their rarity, clinical and cytopathology reports are very limited, and sonographic features have not been clearly specified ; these tumors are easily misdiagnosed by ultrasound as mucinous cystic tumors (MCTs)  or solid pseudopapillary neoplasms (SPNs).

Case Study: We report a case of osteoclast  like giant cell tumor arising in the pancreas of an 80 year old female patient offered by EUS-FNA cytology on direct and cell block slides. A biphasic pattern composed by a malignant mononuclear cell component and a giant cell component were hallmarks to the diagnosis.

Conclusion: Our case highlights the performance of EUS-FNA in the diagnostic approach of  abdominal tumours and the significance of cell block method in the interpretation of osteoclast-like giant cell pancreatic tumour.
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http://dx.doi.org/10.23750/abm.v92i2.9482DOI Listing
May 2021

Cerebrospinal fluid and intraoperative squash cytology of childhood ependymoma.

Acta Biomed 2021 05 12;92(2):e2021107. Epub 2021 May 12.

PEDIATRICIAN ONCOLOGIST.

Ependymomas are glial neoplasms of central nervous system originated from the ependymal lining of the brain ventricles and spinal cord central canal, and rarely exfoliated into cerebrospinal fluid (CSF). In this case we report the cytomorphological and immunocytomorphological features of ependymoma in CSF and intraoperative squash preparations, confirmed by histology. Case report. The patient  was a nineteen months old female presented at the University hospital of Heraklion, Crete, in a hemicoma, and was intubated. Computed tomography, scanning and magnetic resonance imaging (MRI), were performed and a mass in the posterior fossa was found. A sample of cerebrospinal fluid (CSF) was sent for cytologic evaluation. A diagnosis of ependymoma was rendered, followed by tumor resection, during which intraoperative squash smears for cytologic interpretation were obtained. Cytological consultation disclosed a grade II ependymoma (WHO grade II), with focally anaplastic features (WHO grade III).
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http://dx.doi.org/10.23750/abm.v92i2.9996DOI Listing
May 2021

Determination of prenatal exposure to parabens and triclosan and estimation of maternal and fetal burden.

Toxicol Rep 2021 2;8:808-815. Epub 2021 Apr 2.

Department of Chemistry, University of Crete and Foundation for Research and Technology - Hellas (FORTH-IESL), Heraklion, Crete, GR-71003, Greece.

Background: Parabens (PBs) and triclosan (TCS) are generally used as antimicrobials mostly in personal care products. Their wide prevalence in daily products raised an acute need for the biomonitoring of these contaminants and the investigation of possible health impacts.

Material And Methods: In this study we aimed to quantitatively determine PBs and TCS levels in urine and amniotic fluid samples using a liquid chromatography - mass spectrometry system (LC-MS). Ninety nine (99) pregnant women took part in this research. The samples were collected during the amniocentesis in the early second trimester of their pregnancy. Women of all ages, education, household income and profession were selected. The exposure and the burden of pregnant women and their infants were also evaluated.

Results: The most prevalent compound in urine, among the analyzed, was TCS with 74.7 % positive samples while in amniotic fluid methyl paraben (MePB) with 21.2 % positive samples. MePB was detected at higher concentrations in urine (mean: 378.5 ng/mL) followed by TCS (mean: 55.3 ng/mL), ethyl paraben (EtPB) (mean: 23.2 ng/mL) and butyl paraben (BuPB) (mean: 2.3 ng/mL) while benzyl paraben (BePB) was not detected in any urine sample. Concentrations in amniotic fluid samples were much lower. In particular, the mean concentrations were 6.6 ng/mL for MePB, 9.2 ng/mL for EtPB, 0.4 ng/mL for BuPB, 0.6 ng/mL for BePB and 1.8 ng/mL for TCS. The detected levels of all analytes in urine were correlated with those in amniotic fluid but no statistically significant results arose (p >n0.05). Negative associations were observed between amniotic fluid levels of MePB and maternal age (p = 0.05) while both urinary and amniotic levels of TCS were correlated with maternal BMI (p = 0.04). Somatometric characteristics of the infants showed no statistical significant associations with the detected levels of PBs and TCS.

Conclusion: This study indicated a strong/possible association between exposure of pregnant women to TCS and higher/lower maternal body weight gain during pregnancy. The same trend was observed between amniotic fluid MePB levels and maternal age. However, no statistically significant associations were observed between neonatal somatometric characteristics or health status and PBs and TCS levels.
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http://dx.doi.org/10.1016/j.toxrep.2021.03.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044871PMC
April 2021

Diagnosis and immunocytochemical characterization of an EBV related diffuse B large cell lymphoma of the retroperitoneum from cell block preparations obtained by means of EUS guided FNA.

Rev Esp Enferm Dig 2021 Jun;113(6):470-471

Gastroenterology, Medical Faculty. University of Crete.

Diffuse large B cell lymphoma (DLBCL) in the retroperitoneum has been scarcely reported and the diagnostic workup is challenging due to difficulties in access to tissue. A 73-year-old female presented to the gastroenterology clinic, with recent-onset atypical abdominal pain and alternating constipation and diarrhea.
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http://dx.doi.org/10.17235/reed.2020.7247/2020DOI Listing
June 2021

Carcinogenic, ethanol, acetaldehyde and noncarcinogenic higher alcohols, esters, and methanol compounds found in traditional alcoholic beverages. A risk assessment approach.

Toxicol Rep 2020 21;7:1057-1065. Epub 2020 Aug 21.

Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Crete, Greece.

Greek fermentation and distillation industries produce traditional spirit beverages, such as tsipouro and tsikoudia, consumed both in bottles and bulk quantities by the general population or tourists. The same spirits are also produced by individuals at home since previous centuries, as a part of the local culture but mainly due to the Greek agricultural sector unique characteristics (small cultivation areas with great number of farmers). In this study, the concentrations of carcinogenic compounds: ethanol and acetaldehyde; and noncarcinogenic: higher alcohols (1-propanol, isobutanol, and isoamyl alcohol), esters (ethyl acetate), and methanol were measured to estimate the potential cancer risk and daily intake of these compounds. The margin of exposure (MOE) of carcinogenic compounds was found to be less than 500 (mean value), well below the toxic threshold of 10,000, above which there is not public concern, as suggested by the European Food Safety Authority. Additionally, through risk assessment of noncarcinogenic compounds, we identified two specific compounds in-bulk spirits (produced by individuals), namely ethyl acetate and isobutanol, with health risk index (HRI) greater than 1 (indicating a possibility to induce side effects by consumption of high amounts). Our results indicate that bottled spirits, which are produced in a controlled environment (alcohol industries), showed higher human safety level in terms of both carcinogenic and noncarcinogenic risk assessment studies, comparing to bulk beverages produced by individuals (with out strict regulations).
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http://dx.doi.org/10.1016/j.toxrep.2020.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475172PMC
August 2020

Current and Future Trends in Molecular Biomarkers for Diagnostic, Prognostic, and Predictive Purposes in Non-Melanoma Skin Cancer.

J Clin Med 2020 Sep 4;9(9). Epub 2020 Sep 4.

Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece.

Skin cancer represents the most common type of cancer among Caucasians and presents in two main forms: melanoma and non-melanoma skin cancer (NMSC). NMSC is an umbrella term, under which basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Merkel cell carcinoma (MCC) are found along with the pre-neoplastic lesions, Bowen disease (BD) and actinic keratosis (AK). Due to the mild nature of the majority of NMSC cases, research regarding their biology has attracted much less attention. Nonetheless, NMSC can bear unfavorable characteristics for the patient, such as invasiveness, local recurrence and distant metastases. In addition, late diagnosis is relatively common for a number of cases of NMSC due to the inability to recognize such cases. Recognizing the need for clinically and economically efficient modes of diagnosis, staging, and prognosis, the present review discusses the main etiological and pathological features of NMSC as well as the new and promising molecular biomarkers available including telomere length (TL), telomerase activity (TA), CpG island methylation (CIM), histone methylation and acetylation, microRNAs (miRNAs), and micronuclei frequency (MNf). The evaluation of all these aspects is important for the correct management of NMSC; therefore, the current review aims to assist future studies interested in exploring the diagnostic and prognostic potential of molecular biomarkers for these entities.
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http://dx.doi.org/10.3390/jcm9092868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564050PMC
September 2020

The toxic influence and biodegradation of carbon nanofibers in freshwater invertebrates of the families Gammaridae, Ephemerellidae, and Chironomidae.

Toxicol Rep 2020 28;7:947-954. Epub 2020 Jul 28.

School of Engineering, Far Eastern Federal University Vladivostok, 690950, Russia.

Carbon nanofibers (CNFs) are widely used in consumer products today. In this study, we assessed the effects of CNFs on the digestive system of three freshwater invertebrate species (Gammaridae, Ephemerellidae, and Chironomidae). The aquatic insects sp., , and were incubated with the CNFs at the concentration of 100 mg/L during the 7-days period. Histological examination of the whole specimens and the longitudinal sections revealed no toxic effects of CNFs. However, a noticeable change in the structure of the CNFs accumulated in the intestines of the aquatic insects was found by Raman spectroscopy. The registered decrease in the relative proportion of amorphous carbon included in the CNF sample was found in the intestines of sp. and . The registered effect can indicate a biodegradation of amorphous carbon in the digestive tract of these two insect species. In contrast, the decrease of highly structured carbons and the decrease of G-bonds intensity were registered in the digestive tract of . This observation demonstrates the partial biodegradation of CNFs in the digestive tract of .
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http://dx.doi.org/10.1016/j.toxrep.2020.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415770PMC
July 2020

Cytological diagnosis of primary pineal germ cell tumour with a yolk sac component in cerebrospinal fluid.

Cytopathology 2020 03 21;31(2):153-157. Epub 2020 Jan 21.

Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece.

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http://dx.doi.org/10.1111/cyt.12792DOI Listing
March 2020

Translational Application of Circulating DNA in Oncology: Review of the Last Decades Achievements.

Cells 2019 10 14;8(10). Epub 2019 Oct 14.

I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia.

In recent years, the introduction of new molecular techniques in experimental and clinical settings has allowed researchers and clinicians to propose circulating-tumor DNA (ctDNA) analysis and liquid biopsy as novel promising strategies for the early diagnosis of cancer and for the definition of patients' prognosis. It was widely demonstrated that through the non-invasive analysis of ctDNA, it is possible to identify and characterize the mutational status of tumors while avoiding invasive diagnostic strategies. Although a number of studies on ctDNA in patients' samples significantly contributed to the improvement of oncology practice, some investigations generated conflicting data about the diagnostic and prognostic significance of ctDNA. Hence, to highlight the relevant achievements obtained so far in this field, a clearer description of the current methodologies used, as well as the obtained results, are strongly needed. On these bases, this review discusses the most relevant studies on ctDNA analysis in cancer, as well as the future directions and applications of liquid biopsy. In particular, special attention was paid to the early diagnosis of primary cancer, to the diagnosis of tumors with an unknown primary location, and finally to the prognosis of cancer patients. Furthermore, the current limitations of ctDNA-based approaches and possible strategies to overcome these limitations are presented.
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http://dx.doi.org/10.3390/cells8101251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829588PMC
October 2019

Genotoxic, cytotoxic, and cytopathological effects in rats exposed for 18 months to a mixture of 13 chemicals in doses below NOAEL levels.

Toxicol Lett 2019 Nov 12;316:154-170. Epub 2019 Sep 12.

Department of Immunology, Victor Babes National Institute of Pathology, Bucharest, Romania; Department of Pathology Dept. Colentina Clinical Hospital, Bucharest, Romania. Electronic address:

The present study investigates the genotoxic and cytotoxic effects of long term exposure to low doses of a mixture consisting of methomyl, triadimefon, dimethoate, glyphosate, carbaryl, methyl parathion, aspartame, sodium benzoate, EDTA, ethylparaben, buthylparaben, bisphenol A and acacia gum in rats. Four groups of ten Sprangue Dawley rats (5 males and 5 females per group) were exposed for 18 months to the mixture in doses of 0xNOAEL, 0.0025xNOAEL, 0.01xNOAEL and 0.05xNOAEL (mg/kg bw/day). After 18 months of exposure, the rats were sacrificed and their organs were harvested. Micronuclei frequency was evaluated in bone marrow erythrocytes whereas the organs were cytopathologically examined by the touch preparation technique. The exposure to the mixture caused a genotoxic effect identified only in females. Cytopathological examination showed specific alterations of tissue organization in a tissue-type dependent manner. The observed effects were dose-dependent and correlated to various tissue parameters. Specifically, testes samples revealed degenerative and cellularity disorders, liver hepatocytes exhibited decreased glycogen deposition whereas degenerative changes were present in gastric cells. Lung tissue presented increased inflammatory cells infiltration and alveolar macrophages with enhanced phagocytic activity, whereas brain tissue exhibited changes in glial and astrocyte cells' numbers. In conclusion, exposure to very low doses of the tested mixture for 18 months induces genotoxic effects as well as monotonic cytotoxic effects in a tissue-dependent manner.
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http://dx.doi.org/10.1016/j.toxlet.2019.09.004DOI Listing
November 2019

Contrast-induced nephropathy in an animal model: Evaluation of novel biomarkers in blood and tissue samples.

Toxicol Rep 2019 2;6:395-400. Epub 2019 May 2.

Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece.

Identification of novel biomarkers of contrast-induced nephropathy (CIN) that may more accurately detect renal function changes; reflect kidney damage; assist monitoring; and elucidate pathophysiology attract considerable scientific attention nowadays. To evaluate novel biomarkers of nephrotoxicity in blood/tissue samples of a CIN model, 10 New Zealand white rabbits were divided into group 1 (n = 5; iopromide) and group 2 (n = 5; control). Blood was drawn at 0 h (immediately), 24 h and 48 h after contrast medium (CM) administration. Animals were euthanized at 48 h and kidneys were removed. Serum creatinine (sCr)/symmetric-asymmetric dimethylarginine (SDMA-ADMA) levels were measured. CM genotoxic/cytotoxic effect was investigated 48 h post-CM exposure using micronucleus assay in lymphocytes. Cytological examination was conducted using touch preparation technique (TPT). All animals in group 1 developed CIN: mean sCr levels increased by 68.2% within 48 h. Significant SDMA-ADMA level elevation was observed at 0 h and 24 h with insignificant drop at 48 h in group 1, remaining normal in group 2 at all time-points. Significant increase in bi-nucleated cells with micronuclei and micronuclei frequency was detected in group 1. Cytokinesis block proliferation index was reduced insignificantly in group 1. TPT revealed degenerative lesions/inflammation, cell degeneration, abnormal uterine tubular casts and rubella in kidneys of all animals in group 1. Group 2 presented normal cells.
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http://dx.doi.org/10.1016/j.toxrep.2019.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506864PMC
May 2019

Adverse and hormetic effects in rats exposed for 12 months to low dose mixture of 13 chemicals: RLRS part III.

Toxicol Lett 2019 Aug 16;310:70-91. Epub 2019 Apr 16.

Center of Toxicology Science & Research, Medical School, University of Crete, Heraklion, Crete, Greece; Department of Analytical and Forensic Medical Toxicology, Sechenov University, Moscow 119991, Russian Federation. Electronic address:

The aim of the current study was to evaluate the effects of a mixture of thirteen common chemicals on rats, after a one-year exposure to doses around the acceptable daily intake (ADIs), using blood and urinary tests. The influence of low doses of the mixture on weight gain, water consumption, feed consumption and feed efficiency, biochemistry parameters, haematological parameters, blood lymphocytes subsets, serum inflammation profile and urine parameters was evaluated. Our mixture caused a moderate monotonic increase of the males' appetite and a non-monotonic increase of anabolism and a monotonic increase of appetite for the females. Regarding biochemical parameters, the exposure to the test mixture caused non-monotonic increases of AST and ALT, a decrease of PChE in males and plausibly a monotonic biliary obstruction in both sexes. Monocytes significantly increased in low dose groups of both sexes. A significant decrease of all the lymphocytes subclasses and an increased expression of TNF-α protein associated with an increased expression of IFN-γ protein observed in various groups. It became apparent that after twelve months of exposure very low doses of the tested mixture had both non-monotonic and monotonic harmful effects on different levels on rats.
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http://dx.doi.org/10.1016/j.toxlet.2019.04.005DOI Listing
August 2019

An imazamox-based herbicide causes apoptotic changes in rat liver and pancreas.

Toxicol Rep 2019 19;6:42-50. Epub 2018 Nov 19.

Department of Toxicology & Forensic Sciences, Faculty Medicine, University of Crete, Heraklion, Greece.

We studied the acute toxicity of an imazamox-based herbicide at 12, 24 and 36 mg/kg body (bw) weight imazamox equivalent dose on the liver and pancreatic tissue in Sprague Dawley rats. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, glucose, calcium as well as creatinine, were determined in blood samples, which were collected after 24, 48 and 72 h exposure. Caspase 3 and anti-insulin expression and immunopositivity were evaluated using in situ hybridization and immunohistochemistry, respectively. The imazamox-based herbicide evaluated in this study induced toxic effects even from the lowest dose tested (12 mg/kg bw). The two highest doses caused a statistically significant cytotoxicity on the Langerhans islet cells. Necrotic and degenerative changes were detected in hepatocytes at the two highest doses. Imazamox is considered to be poorly toxic to the liver. Nevertheless, the imazamox-based herbicide formulation tested here reduced the size of the β-islet cells, induced an elevation in serum glucose and calcium. Our data shows that commercial formulations of imazamox containing various co-formulants can have hepatic and pancreatic toxic effects.
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http://dx.doi.org/10.1016/j.toxrep.2018.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289906PMC
November 2018

Schwannoma of right cerebellopontine angle. A cytologic diagnosis.

Acta Biomed 2018 10 8;89(3):411-414. Epub 2018 Oct 8.

UNIVERSITY OF CRETE, GREECE, MEDICAL FACULTY..

Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology- immunohistochemistry.
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http://dx.doi.org/10.23750/abm.v89i3.5437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502132PMC
October 2018

The immunotoxicological pattern of subchronic and chronic benzene exposure in rats.

Toxicol Lett 2017 Jun 17;275:1-5. Epub 2017 Apr 17.

Gazi University, Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey.

Exposure to benzene and its inevitable metabolites can result in deleterious effects on human health, including lymphocytopenia, hematotoxicity and cancer. However, the duration of exposure might alter the effects including immune consequences. The aim of this study was to determine whether benzene could modulate lymphocyte proliferation induced by the T cell mitogen concanavalin A, in rats, at different exposure durations. 386 Wistar rats were assigned into control and treatment groups which were subdivided into groups for 45, 90 and 135days for 0,6mL/kg of drinking water mixed benzene treatment. The percentage of CD3+, CD4+, CD8+ spleen lymphocytes was defined using the flow cytometer. Interleukin (IL)-4, IL-6, IL-10 and interferon-gamma, in supernatants of splenocyte cultures stimulated with Concanavalin A, were assessed by enzyme-linked immunosorbent assay (ELISA) technique. The decrease in the total lymphocyte and T cell counts were associated with increased benzene exposure duration. Th2-type cytokine, IL-4 significantly increased, whereas IL-6, CD4+T cells, CD4+/CD8+ ratio and CD3+ T cells decreased. Despite the positive correlation between benzene toxicity and indicated increased immune responses, 45-day exposure to benzene appeared to be the most sensitive time point for evaluating benzene cytotoxicity.
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http://dx.doi.org/10.1016/j.toxlet.2017.04.006DOI Listing
June 2017

Cytology of Pericardial Effusion due to Malignancy.

Rom J Intern Med 2016 09;54(3):179-183

Background: Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare [corrected]. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date.

Material And Methods: Pericardial effusion specimens from 145 patients collected over a 25 [corrected] year period were studied by cytology [corrected]. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL.

Results: Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients [corrected].

Conclusions: Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important in the diagnostic evaluation.
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http://dx.doi.org/10.1515/rjim-2016-0026DOI Listing
September 2016

Recurrent Cerebellar Desmoplastic/Nodular Medulloblastoma in Cerebrospinal Fluid (CSF) in the Elderly. A Cytologic Diagnosis.

Rom J Intern Med 2016 Apr-Jun;54(2):137-9

Desmoplastic medulloblastoma is a rare subtype of medulloblastoma in childhood and more rare in adults. Cerebrospinal fluid (CSF) occurrence is frequent and important for treatment and prognosis. We report the CSF cytologic features of recurrent desmoplastic/nodular medulloblastoma in a 30-aged male.
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http://dx.doi.org/10.1515/rjim-2016-0018DOI Listing
September 2016

Nephrotoxicity in rabbits after long-term nandrolone decanoate administration.

Toxicol Lett 2016 Sep 23;259:21-27. Epub 2016 Jun 23.

Center of Toxicology Science & Research, Medical School, University of Crete, Heraklion, Crete, Greece. Electronic address:

Among the various side effects of supra-physiological dose of anabolic androgenic steroids that are described, renal toxicity remains the least evaluated. The present study provides evidence that long-term administration of nandrolone decanoate could lead to alterations of renal function and structure in the experimental rabbit model. A pronounced increase in serum urea, creatinine, SGOT and SGPT is observed in the treated animals, with intramuscular administration being more detrimental. Histopathological evaluation of kidneys indicated hyperaemia, fibrosis and focal inflammation. Furthermore, the significantly increased telomerase activity found in the kidneys of the intramuscularly treated animals could possibly represent a counteracting survival mechanism. Oxidative stress markers that were influenced the most were TBARS, indicating lipid peroxidation, and GSH. An interesting finding in our study though, was that while intramuscular administration showed the highest biochemical derangement, oxidative stress markers provided mixed results between intramuscularly and subcutaneously treated rabbits. In conclusion, nephrotoxicity of nandrolone decanoate remains a multi-factorial, partly irreversible effect that involves augmented tissue oxidative status.
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http://dx.doi.org/10.1016/j.toxlet.2016.06.1122DOI Listing
September 2016

EUS - Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review.

Rom J Intern Med 2016 Jan-Mar;54(1):24-30

Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNAB. There are many new applications of EUS using FNAB. Researchers are looking to deliver chemotherapeutics into small pancreatic cancers and cysts. Nerve blocks using EUS/FNAB to inject numbing medicines into the celiac ganglia, a major nerve cluster, are now routinely performed in patients with pain due to pancreatic cancer. The aim of this study is to perform a review of the literature regarding the usefulness of EUS/FNAB in the diagnosis of pancreatic adenocarcinoma.
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http://dx.doi.org/10.1515/rjim-2016-0002DOI Listing
July 2016

Fine Needle Aspiration Biopsy (FNAB) in the Diagnosis of Hepatocellular Carcinoma: A Review.

Rom J Intern Med 2015 Jul-Sep;53(3):209-17

Hepatocellular carcinoma (HCC) is the fifth more common cause of cancer and the third leading cause of cancer deaths worldwide. Despite advances in surgical and non surgical modalities in the treatment of HCC, a number of controversies regarding appropriate diagnostic procedures continue to evolve. A consensus statement from the European Association for the study of Liver Diseases (EASL) has been formulated to help clinicians standardize diagnostic approaches. In nodules greater than 2 cm diameter in size, diagnosis can be made if any 2 imaging studies (ultrasonography, computed tomography, magnetic resonance imaging or hepatic arteriography) show increased vascularity. Alternatively only one imaging study with an Alpha fetoprotein level more than 400ng/mL is diagnostic. Fine needle aspiration biopsy (FNAB) should be performed in cases of indeterminate radiology and in lesions sized between 1 and 2 cm. The aim of this review is to familiarize pathologists in the FNAB diagnosis of HCC in an appropriate and timely fashion.
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http://dx.doi.org/10.1515/rjim-2015-0028DOI Listing
February 2016

THE PROGNOSTIC SIGNIFICANCE OF P53, BCL2 AND MIB1 EXPRESSIONS RELATED WITH OTHER CLINICOPATHOLOGICAL VARIABLES IN SEROUS OVARIAN CARCINOMAS. A CLINICOPATHOLOGICAL STUDY IN PERITONEAL FLUIDS.

Rev Med Chir Soc Med Nat Iasi 2015 Apr-Jun;119(2):454-60

Objective: The first cytological study examining the expression of P53, BCL2 and MIB 1 expressions in correlation with other clinicopathological parameters in ascitic fluids of patients with serous ovarian carcinomas.

Materials And Methods: Fifty women 35-75 years old were diagnosed cytologically and confirmed histologically after operation in the University Hospital of Crete. All carcinomas were serous type and eight(8) of grade I, eighteen (18) of grade II and twenty two (22) of grade III. All carcinomas were staged according to the Figo criteria. Fifteen (15) were of Figo stage III and thirty five (35) were of Figo stage IV. For p53 and bcl-2, staining was evaluated on a semiquantitative scale depending on the number of cells showing positivity. For MIB1, the percentage of positive nuclei was calculated. Main outcome measure(s): The expression of P53, BCL2 and MIB 1 (Ki 67) correlated with tumor grade and Figo stages were estimated by chi-square (χ2).

Results: The expression of P53 and MIB1 were found to be statistically significant (p < 0.005) correlated with Figo stage and tumor grade. A statistical significant correlation was also found between BCL2 expression and tumor Grade ( p < 0.005) but not between BCL2 expression and Figo Stage. The study found a high expression of P53 (64%) and MIB1 (72%) and an expression of BCL2 (48%) in ascitic fluid of patients with ovarian carcinoma. A statistically significant correlation between P53 and MIB1 expression correlated with tumor grade and Figo stage (p < 0.005) and a statistically significant correlation between BCL2 expression and tumor grade but no with the Figo stage was found (p < 0.005). There was a positive correlation between P53 and MIB1. No significant association was found between P53 and BCL2 expression or MIB1 labeling index.

Conclusion(s): Our data show significant differences in the expression of these markers in ovarian tumors and suggest a possible role for these tumor-associated genes as supplemental tools in prognosis and further definition of the biologic potential of these tumors.
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September 2015

Abdominal primary extra-gastrointestinal stromal tumor (EGIST). A cytologic diagnosis in ascitic fluid.

Rev Esp Enferm Dig 2015 Jul 13;107. Epub 2015 Jul 13.

PATHOLOGY-CYTOPATHOLOGY, MEDICAL SCHOOL, GREECE.

Dear Editor, We present a case of a primary abdominal Extra-gastrointestinal stromal tumor (E-GIST) in a75 years old female patient. E-GISTs are rare, non-epithelial, mesenchymal tumors arising from the soft tissues of the abdomen - mesentery and retroperitoneum. These tumors are histologically and cytologically similar to the stromal tumors of gastrointestinal tract, composed of round or fusiform cells or a mixture of both in a myxoid background. The recognition of these tumors is important because of their aggressive biological behavior, the metastatic potential and the high rate of recurrence.
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http://dx.doi.org/10.17235/reed.2015.3598/2014DOI Listing
July 2015

Extra-nodal primary diffuse large B-cell lymphoma of the maxilla. Fine needle aspiration cytology.

Stomatologija 2013 ;15(2):58-60

Department of Pathology-Cytology, Medical Faculty, University of Crete, PO Box1393, Heraklion, 71110 Crete Greece.

A 76-year-old female presented at University hospital of Crete with a large painless mass (d<10 cm) of the left maxilla. The cytologic diagnosis in FNAB smears was of a diffuse large B-cell lymphoma of the maxilla that was confirmed histologically. The fine needle aspiration cytology (FNAC) in conjunction with immunocytochemistry can distinguish between benign and malignant lymphoid infiltrates and support a diagnosis of extra-nodal diffuse large B-cell lymphoma.
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February 2014

Eccrine porocarcinoma: cytologic diagnosis by fine needle aspiration biopsy (FNAB).

Acta Med Port 2013 Jul-Aug;26(4):467-70. Epub 2013 Aug 30.

Departments of Pathology-Cytopathology. Medical Faculty. University of Crete. Heraklion. Crete. Greece..

Introduction: Eccrine porocarcinoma is an uncommon malignant adnexal tumor of the skin. Eccrine porocarcinoma is an adenocarcinoma of the eccrine sweat gland with a propensity to recur locally and gives metastases to regional lymph nodes. This paper presents a cytologic diagnosis by fine needle aspiration of an eccrine porocarcinoma along with histopathology and immunocyto-histochemistry.

Case Report: The cytologic findings of an eccrine porocarcinoma in a 76-year-old female and histologic features of the skin tumor are reported. Cytologically in fine needle aspiration biopsy, the tumor was characterized by atypical malignant cells with basophilic cytoplasm, hyperchromatic nuclei and prominent nucleoli. The cytologic diagnosis was confirmed by histology.

Conclusions: The accurate preoperative diagnosis of eccrine porocarcinoma is crucial to developing a curative surgical plan. Fine needle aspiration cytology provides a convenient, safe and effective approach to solving a challenging differential diagnosis.
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July 2014

Syndecan-2 is a key regulator of transforming growth factor beta 2/Smad2-mediated adhesion in fibrosarcoma cells.

IUBMB Life 2013 Feb 7;65(2):134-43. Epub 2013 Jan 7.

Department of Histology-Embryology, Medical School, University of Crete, Heraklion, Greece.

Fibrosarcoma is a rare malignant tumor originating from fibroblasts. Transforming growth factor beta 2 (TGFβ2) has been established to regulate processes correlated to fibrosarcoma tumorigenesis. In this study, we investigated the possible participation of syndecan-2 (SDC-2), a cell membrane heparan sulfate (HS) proteoglycan on these TGFβ2 functions. Our results demonstrate that the inhibition of SDC-2 expression by short interfering RNA (siSDC2) abolished TGFβ2-dependent HT1080 cell adhesion (P ≤ 0.01). In parallel, the downregulation of SDC-2 significantly inhibited TGFβ2-induced Smad2 phosphorylation (P ≤ 0.01). The immunoflourescence signal of TGF receptor III as well as its protein expression was decreased in SDC-2-deficient cells. The enhancement of adhesion molecules integrin β1 (P ≤ 0.01) and focal adhesion kinase expression, induced by TGFβ2 treatment (P ≤ 0.001), was markedly inhibited in SDC-2-defficient cells (P ≤ 0.01). Conclusively, the obtained data suggest that SDC-2 modulates TGFβ2 transcriptional regulation via Smad signaling to facilitate fibrosarcoma cell adhesion.
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http://dx.doi.org/10.1002/iub.1112DOI Listing
February 2013

Histopathological lesions, oxidative stress and genotoxic effects in liver and kidneys following long term exposure of rabbits to diazinon and propoxur.

Toxicology 2013 May 28;307:109-14. Epub 2012 Nov 28.

Section of Hazardous Substances, Mixtures and Articles, Directorate of Environment, General Chemical State Laboratory of Greece, Athens, Greece.

Purpose: The aim of the present study was to investigate the effects of diazinon and propoxur on liver and kidneys, following long term exposure of rabbits.

Methods: Ten New Zealand white female rabbits were used. The animals were divided into 5 groups, consisting of 2 animals each. Diazinon (groups 1 and 2) and propoxur (groups 3 and 4) were administered at 2 different doses, and group 5 served as the control group. Histopathological lesions in the liver and kidneys, oxidative stress and oxidative DNA damage were evaluated.

Results: Both pesticides induced focal inflammation and fibrosis in the liver and kidneys. The low dose of propoxur induced a significant increase in total antioxidant capacity (TAC), with no difference in reduced glutathione (GSH), while the high dose of propoxur induced an increase in GSH with no change in TAC. For diazinon-exposed animals, the opposite findings were observed. Both diazinon and propoxur induced a statistically significant oxidative DNA damage in the liver and kidneys and a subsequent increase in telomerase activity in these tissues, possibly as a counteracting mechanism. Furthermore, systemic inflammation, as depicted by the dose-dependent increase in telomerase activity in peripheral blood mononuclear cells (PBMCs), was observed in propoxur treated animals.

Conclusions: Histopathological lesions, oxidative stress and genotoxic effects were induced in liver and kidneys following long term exposure of rabbits to diazinon and propoxur.
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http://dx.doi.org/10.1016/j.tox.2012.11.002DOI Listing
May 2013

History of endometriosis may adversely affect the outcome in menopausal recipients of sibling oocytes.

Reprod Biomed Online 2012 Nov 8;25(5):543-8. Epub 2012 Aug 8.

Iakentro, Fertility Centre, Thessaloniki, Greece.

Due to the known adverse effect of endometriosis on gamete quality, it has always been difficult to demonstrate a direct effect of endometriosis on implantation. In order to eliminate these confounding effects, this prospective comparative study studied a population of menopausal recipients with and without endometriosis sharing sibling oocytes coming from the same donor. The aim was to understand the impact of endometriosis on implantation, pregnancy and live birth rates in menopausal recipients. A total of 240 menopausal recipients of donated sibling oocytes, were divided in two groups. Group I consisted of 120 recipients diagnosed with endometriosis and group II consisted of 120 controls. The implantation and pregnancy rates were significantly lower in the endometriosis group compared with the control group (23.81% versus 31.48%, P=0.019; 45.00% versus 58.33%, P=0.039, respectively). In oocyte donation cycles, a recipient's history of endometriosis might have a negative impact on implantation, pregnancy and live birth rates, even in menopausal women. Infertility in endometriosis may be due to poor oocyte quality or embryos with decreased ability to implant due to impaired fertilization. There are no conclusive data on the impact of endometriosis on implantation. The already-known adverse effect of endometriosis on gamete quality makes it more difficult to demonstrate a direct effect of endometriosis on implantation. In order to eliminate these confounding effects we studied a population of menopausal recipients with and without endometriosis sharing sibling oocytes coming from the same oocyte donor. The oocyte donation model was used in an attempt to understand whether the endometrium, the oocytes or both are affected by endometriosis. The aim of the present study was to understand the impact of endometriosis on implantation, pregnancy and live birth rates in menopausal recipients. A total of 240 menopausal recipients of donated sibling oocytes were divided into two groups. Group I consisted of 120 recipients diagnosed with endometriosis and group II consisted of 120 controls. The pregnancy and implantation rates were significantly lower in the endometriosis group compared to the control group (45.00% versus 58.33%, P=0.039) and (23.81% versus 31.48%, P=0.019) respectively. In oocyte donation cycles, a recipient's history of endometriosis might have a negative impact on implantation, pregnancy and live birth rates, even in menopausal women.
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http://dx.doi.org/10.1016/j.rbmo.2012.07.020DOI Listing
November 2012