Publications by authors named "Anna Nasierowska-Guttmejer"

72 Publications

Encephalomyelitis associated with rheumatoid arthritis: a case report.

Folia Neuropathol 2021 ;59(1):91-97

Department of Neurology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland.

Encephalitis/encephalomyelitis in the course of rheumatoid arthritis (RA) remains a matter of debate. We present a case of a patient with encephalomyelitis associated with RA confirmed with post-mortem neuropathological examination. A 68-year-old woman with a long-standing, seropositive history of RA presented progressive disturbances of consciousness. Magnetic resonance imaging (MRI) of the brain and cervical spine revealed an increase of signal intensity on T2-weighted and fluid attenuated inversion recovery (FLAIR) images with corresponding restricted diffusion involving cerebral peduncles, pons, medulla oblongata, and cervical spinal cord and mild contrast-enhancement of the right cerebral peduncle. Extensive radiological and laboratory testing, including autoantibodies to paraneoplastic anti-neuronal and neuronal cell surface antigens, were all negative except for elevated rheumatoid factor. Cerebrospinal fluid (CSF) analysis revealed moderate pleocytosis with mononuclear cell predominance, mildly increased protein level, and negative viral PCRs, bacterial cultures, flow cytometry, and neuronal surface antibodies. Despite intensive treatment with corticosteroids, antibiotics, antiviral drugs, and intravenous immunoglobulin the patient died after 3 months of hospitalization. Post-mortem neuropathological examination revealed numerous, disseminated, heterochronous ischaemic lesions, rarely with haemorrhagic transformation, predominantly in the brainstem, and widespread, diffuse microglia and T-cell infiltrations with neuronal loss and astrogliosis, most severe in the frontal and temporal lobes. Mild, perivascular lymphocyte T infiltrations involved particularly small and medium-sized vessels and were associated with brainstem ischaemic lesions. The neuropathological picture confirmed diagnosis of encephalomyelitis, which together with the clinical course suggested association with RA. Concluding, encepha-lomyelitis due to RA remains a challenging, controversial entity that needs further research and the establishment of effective diagnostic and treatment guidelines.
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http://dx.doi.org/10.5114/fn.2021.103805DOI Listing
January 2021

Prognosis of the patients suffered from uterine carcinosarcoma from rural and urban areas.

Ginekol Pol 2021 Apr 29. Epub 2021 Apr 29.

University of Humanities and Economics in Lodz, UHE Satellite Campus in Warsaw, Poland.

Objectives: Uterine carcinosarcoma is a very aggressive neoplasm. Patients' median age at diagnosis ranges from 62 to 67 years. The aim of this study was to compare treatment results and prognostic factors for residents of urban and rural areas suffering from uterine carcinosarcoma.

Material And Methods: Clinical outcomes of 58 uterine carcinosarcoma patients treated in one institution were assessed: 25 residents of rural and 33 of urban areas. All the patients were treated by using surgery followed by chemotherapy (48 pts) or radiotherapy (10 pts). Standard chemotherapy regimen comprised of paclitaxel 175 mg/m² and carboplatin on day one at area under curve (AUC) six every 21 days. Radiotherapy was performed by combined treatment - tele and brachytherapy. External beam pelvic radiation therapy (EBRT) once a day, five days a week with a daily fraction size of 1.8 Gy over five weeks at cumulative dose 50.4 Gy was the first part of adjuvant treatment. High-dose-rate (HDR) brachytherapy at dose 22.5 Gy was the second part of radiotherapy.

Results: A strong correlation between tumor diameter and the presence of lymph node metastasis was observed. Tumor size greater then 4.5 cm correlated with presence of node involvement and this parameter was statistically significant (p = 0.015). There was no significant correlation between other analyzed clinical factors and overall survival. In the period 2004 - 2010 43.5% (10/23) and 50% (14/28) of rural and urban residents, respectively, died due to carcinosarcoma progression.

Conclusion: Uterine carcinosarcoma patients in rural and urban areas seem to have similar outcomes.
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http://dx.doi.org/10.5603/GP.a2021.0067DOI Listing
April 2021

Contemporary principles of diagnostic and therapeutic management in cervical and ovarian neuroendocrine tumors.

Ginekol Pol 2021 Mar 23. Epub 2021 Mar 23.

2-nd Clinic of Obstetrics and Gynecology, Medical University of Warsaw, Poland.

Enhancing knowledge about neuroendocrine neoplasms causes the need to improve management of these tumors. Although these tumors are rare in clinical practice, their biological diversity makes both diagnostics and therapy a challenge for contemporary oncology. The article discusses the latest developments in the diagnostic procedures and methods of treatment of the cervical and ovarian neuroendocrine tumors. Algorithms are presented to understand the differences in therapeutic management in these malignancies.
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http://dx.doi.org/10.5603/GP.a2020.0189DOI Listing
March 2021

COVID-19 Autopsies: A Case Series from Poland.

Pathobiology 2021 30;88(1):78-87. Epub 2020 Nov 30.

Chair of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland.

This paper presents autopsy findings of 3 COVID-19 patients randomly selected for post-mortem from two tertiary referral Polish hospitals. Analysis of macroscopic, histopathological findings with clinical features was performed. All 3 deceased patients were Caucasian males (average age 61 years, range from 56 to 68 years). Using real-time polymerase chain reaction assay, the patients were confirmed (antemortem) to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two patients were obese, and 1 patient had type 2 diabetes mellitus. The medical history of 1 patient included hemorrhagic pancreatitis, gangrenous cholecystitis, Acinetobacter baumanii sepsis, and cholecystectomy. Pulmonary embolism was diagnosed in 2 patients. At autopsy, in 1 case, the lungs showed bilateral interstitial pneumonia with diffuse alveolar damage (DAD), while in another case, interstitial pulmonary lymphoid infiltrates and enlarged atypical pneumocytes were present but without DAD. Microthrombi in lung vessels and capillaries were observed in 2 cases. This study revealed thrombotic complications of COVID-19 and interstitial pneumonia with DAD presence as the main autopsy findings in patients with SARS-CoV-2 infection that was confirmed antemortem with molecular tests. Autopsy studies using tissue sections handled in accordance with SARS-CoV-2 biosafety guidelines are urgently needed, especially in the case of subjects who were below the age of 60.
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http://dx.doi.org/10.1159/000512768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801982PMC
February 2021

Colorectal Adenocarcinomas Harboring ALK Fusion Genes: A Clinicopathologic and Molecular Genetic Study of 12 Cases and Review of the Literature.

Am J Surg Pathol 2020 09;44(9):1224-1234

Surgical Pathology, Holycross Cancer Center.

This study determined the frequency and the clinicopathologic and genetic features of colorectal carcinomas driven by oncogenic fusions of the anaplastic lymphoma kinase gene (ALK). Of the 8150 screened tumors, 12 (0.15%) were immunohistochemically ALK-positive with D5F3 antibody. These cancers harbored CAD-ALK (n=1), DIAPH2-ALK (n=2), EML4-ALK (n=2), LOC101929227-ALK (n=1), SLMAP-ALK (n=1), SPTBN1-ALK (n=4), and STRN-ALK (n=1) fusions, as detected by an RNA-based next-generation sequencing assay. ALK fusion carcinomas were diagnosed mostly in older patients with a 9:3 female predominance (median age: 72 y). All tumors, except a rectal one, occurred in the right colon. Most tumors were stage T3 (n=7) or T4 (n=3). Local lymph node and distant metastases were seen at presentation in 9 and 2 patients. These tumors showed moderate (n=6) or poor (n=3) glandular differentiation, solid medullary growth pattern (n=2), and pure mucinous morphology (n=1). DNA mismatch repair-deficient phenotype was identified in 10 cases. Tumor-infiltrating lymphocytes were prominent in 9 carcinomas. In 4 carcinomas, tumor cells showed strong, focal (n=3), or diffuse programmed death-ligand 1 immunoreactivity. CDX2 expression and loss of CK20 and MUC2 expression were frequent. CK7 was expressed in 5 tumors. Four patients died of disease within 3 years, and 7 were alive with follow-up ranging from 1 to 8 years. No mutations in BRAF, RAS, and in genes encoding components of PI3K-AKT/MTOR pathway were identified. However, 1 tumor had a loss-of-function PTEN mutation. Aberration of p53 signaling, TP53 mutations, and/or nuclear accumulation of p53 protein was seen in 9 cases. ALK fusion colorectal carcinomas are a distinct and rare subtype of colorectal cancers displaying some features of mismatch repair-deficient tumors.
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http://dx.doi.org/10.1097/PAS.0000000000001512DOI Listing
September 2020

HPV genotyping and p16/Ki-67 test significantly improve detection rate of high-grade cervical squamous intraepithelial lesion.

Arch Med Sci 2020 11;16(1):87-93. Epub 2019 Jan 11.

Clinic of Gynecology, Holy-Cross Oncology Centre, Kielce, Poland.

Introduction: Liquid-based cytology allows to apply modern and specific analyses of hrHPV genotyping in p16/Ki-67 test. All of these together could raise accuracy ratio for high-grade squamous intraepithelial lesion above 90%. The purpose of this study was to evaluate the diagnostic accuracy of LBC, hrHPV testing, and p16/Ki-67 testing in diagnosis of high-grade cervical intraepithelial lesions.

Material And Methods: The study consisted of 176 women, out of which 50 presented with HSIL (CIN2) SCC (cervical intraepithelial lesion grade 2 squamous cell carcinoma). 126 women with a negative Pap test were pooled into the second group of the study. All patients were resampled for LBC, HPV genotyping, and for the p16/Ki-67 test. The research was carried out between May and December 2017, and second sampling were taken from 1 to 4 months.

Results: We reported a strong correlation between positive Pap test and hrHPV ( < 0.05) that met accuracy close to 90%. We noted correlations between a positive p16/Ki-67 with a positive Pap test: < 0.001; 66% sensitivity (95% CI: 51.2-78.8%), 87.8% specificity (95% CI: 75.2-95.4%), 76.8% accuracy (95% CI: 67.2-84.7%), and OR 13.9 (95% CI: 4.9-39.2), especially HSIL and HPV16: < 0.001; sensitivity (95% CI) 64.0, specificity (95% CI) 98.4, accuracy (95% CI) 88.6, OR (95% CI) 109.3.

Conclusions: The results of our study indicate hrHPV genotyping as a good biomarker for the triage of patients with an abnormal cytological report. In our opinion, the hrHPV test reaches the highest level of sensitivity, specificity, and accuracy, and should be considered as crucial diagnostic test in cervical screening.
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http://dx.doi.org/10.5114/aoms.2018.80697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963143PMC
January 2019

Rare presentation of eczema-like amelanotic melanoma of the forearm with its dermoscopic differentiation.

Postepy Dermatol Alergol 2019 Oct 12;36(5):635-638. Epub 2019 Nov 12.

Department of Dermatology, Warsaw Medical Institute, Central Clinical Hospital of the Ministry of Defence, Warsaw, Poland.

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http://dx.doi.org/10.5114/ada.2019.89510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906973PMC
October 2019

The Influence of Red Meat on Colorectal Cancer Occurrence Is Dependent on the Genetic Polymorphisms of S-Glutathione Transferase Genes.

Nutrients 2019 Jul 22;11(7). Epub 2019 Jul 22.

Department of Surgery and Surgical Nursery with a Research Laboratory and Genetic Laboratory, Faculty of Medicine and Health Sciences, Jan Kochanowski University, 19, 5-317 Kielce, Poland.

Background: It is postulated that both individual genotype and environmental factors such as diet may modify the risk of developing colorectal cancer (CRC). The influences of gene polymorphism and red meat intake on CRC occurrence in the Polish population were analyzed in this study.

Methods: Genotyping was performed with the qPCR method.

Results: A high frequency of meat consumption was associated with an over 2-fold increase in the risk of colorectal cancer odds ratio (OR) adjusted for sex and age = 2.4, 95% confidence interval (CI); 1.3-4.4). However, after analyzing the genetic profiles, in the absence of polymorphisms of all three analyzed genes, there was no association between a high frequency of meat consumption and the occurrence of CRC. In the case of gene polymorphism, the high frequency of meat consumption increased the risk of CRC by almost more than 4 times (OR adjusted for sex and age = 3.8, 95% CI: 1.6-9.1). For gene polymorphism, a 3-fold increase in CRC risk was observed with a high frequency of meat consumption (OR adjusted for sex and age = 3.4, 95% CI: 1.4-8.1). In the case of gene polymorphism, the increase in risk of CRC was not statistically significant (OR adjusted for sex and age = 1.9, 95% CI: 0.4-8.5).

Conclusions: The frequency of red meat intake in non-smokers increases the risk of colon cancer in the case of gene polymorphisms.
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http://dx.doi.org/10.3390/nu11071682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683097PMC
July 2019

Fibromatosis - immunohistochemical evaluation, differential diagnosis from gastrointestinal tumors, and other mesenchymal tumours.

Prz Gastroenterol 2019 12;14(1):79-85. Epub 2019 Mar 12.

Department of Pathology, Jan Kochanowski University, Kielce, Poland.

Introduction: Fibromatosis is a histologically benign growth of fibroblastic and myofibroblastic cells, with a potential to recur and invade local organs. It can occur as a superficial or deep form. Visceral fibromatosis and superficial fibromatosis are histologically similar. They both have alterations in the WNT signalling pathway, but mutations in the APC or β-catenin gene do not occur in superficial fibromatoses.

Aim: To present four cases of deep fibromatosis and one case of Peyronie's disease, along with immunohistochemical staining analysis and the criteria for differential diagnosis.

Material And Methods: All patients were hospitalised in the Central Clinical Hospital of the MSWiA in Warsaw during the period of 2012-2015. Surgical specimens were examined, and tissue samples were embedded in paraffin blocks.

Results: As the result of the study we present a short algorithm of immunostainings that can be useful in differential diagnosis. When a spindle cell tumour is encountered in the abdomen a gastrointestinal stromal tumor (GIST) should always be excluded; therefore, a CD117 staining is recommended as the first step. When the staining is negative, fibromatosis can be taken into consideration. β-Catenin staining should be done in order to confirm that diagnosis.

Conclusions: The diagnosis of fibromatosis is not always simple; GISTs can easily be mistaken for it. Immunohistochemical staining with CD34 and CD117 antibodies are useful in differential diagnosis. DTF should present negative stainings for S100, CD34, CD99, and bcl-2, which can help to distinguish it from other mesenchymal tumours.
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http://dx.doi.org/10.5114/pg.2019.83429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444105PMC
March 2019

Diagnostic and therapeutic recommendations in pancreatic ductal adenocarcinoma. Recommendations of the Working Group of the Polish Pancreatic Club.

Prz Gastroenterol 2019 12;14(1):1-18. Epub 2019 Mar 12.

Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland.

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts' recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE) All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.
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http://dx.doi.org/10.5114/pg.2019.83422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444110PMC
March 2019

Neuroma (schwannoma). A rare pancreatic tumor.

Pol Przegl Chir 2019 Feb;92(1):48-51

Instytut Medycyny Doświadczalnej i Klinicznej im. M. Mossakowskiego PAN w Warszawie, Klinika Chirurgii Gastroenterologicznej i Transplantacyjnej CSK MSWiA w Warszawie.

Introduction: Neuroma (Schwannoma in Latin) is an encapsulated, mesenchymal tumor arising from Schwann cells surrounded by nerves. Hence it can be located in any area in the body with passing peripheral nerves. The most common location is the head, neck, and extremities. The tumor arising from Schwannoma cells was first described by Stout and Carson in 1935. Pancreatic schwannomas are extremely rare tumors. Until 2017, in English literature 68 cases have been described. Surgical treatment is the most common way of treating pancreatic schwannomas, and postoperative prognoses are good.

Case Report: A 63-year-old patient was admitted to the Clinical Department of Gastroenterological Surgery and Transplantation of the Central Clinical Hospital at the Ministry of Interior and Administration in Warsaw due to pancreatic head cancer. Needle biopsy-both ultrasound-guided and CT-guided as well as open biopsy for lesions in the pancreas did not show tumor cells in any of the collected samples. Abdominal CT in a projection of the uncinate process of the pancreas revealed an oval lesion highly suspected of neoplastic process. Next, diagnostics was extended by abdominal MRI which revealed a retroperitoneal tumorous thick-walled cystic mass filled with fluid. The patient was qualified for surgical treatment. Pancreaticoduodenectomy (Whipple Procedure) was done on August 22, 2017. Material sent for histopathological examination revealed Schwannoma capitis pancreatis. In surgical practice, pancreatic schwannoma occurs extremely rare, but in centers which conduct large numbers of surgical procedures in the pancreas, a case like this may occur.
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http://dx.doi.org/10.5604/01.3001.0012.8558DOI Listing
February 2019

Protein and peptide profiles in neonatal meconium.

J Obstet Gynaecol Res 2019 Mar 21;45(3):556-564. Epub 2018 Dec 21.

Department of Pathomorphology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.

Aim: The proteins accumulated in the meconium reflect the intrauterine environment and are naturally excreted by a neonate. The identification and classification of individual meconium proteins may be a valuable source of information about physiological and pathological processes in utero.

Methods: Proteomic analysis was used to study the protein composition in pooled 50 serial meconium portions from 10 neonates. The proteins were classified based on the gene ontology database. The amounts and relative number of proteins (%) in the identified categories and their subcategories were assessed.

Results: A total of 946 proteins identified in meconium, including 430 represented by two or more peptides were classified into three categories: biological process (n = 401), molecular function (n = 386) and cellular component (n = 422). The highest number of proteins (>25% of the total) was found in the subcategories: developmental processes, signaling, transport, response to stimulus, regulation, metabolic processes, ion binding, extracellular region, membrane and cytoplasm.

Conclusion: The composition of meconium proteins identified in this study may be a rich source of new biomarkers for use in neonatology with a potential to predict later development.
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http://dx.doi.org/10.1111/jog.13888DOI Listing
March 2019

Quality and practical aspects of pathological and molecular diagnostics in metastatic colorectal cancer (mCRC).

Contemp Oncol (Pozn) 2018 30;22(2):75-85. Epub 2018 Jun 30.

Pathology Department, The Jan Kochanowski University in Kielce, Poland.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. In recent years novel therapies targeted at EGFR receptor have been developed. However, this treatment can only be beneficial if no mutation in specific loci of and genes is found in tumour specimen. Therefore, clinically useful pathological diagnosis of CRC in the era of personalised medicine is a multistep procedure, requiring good cooperation between the clinician/surgeon, pathomorphologist, and molecular biologist. Herein we propose the guidelines of colorectal cancer operating material proceedings for clinicians and pathomorphologists, which determines the correct pathomorphological diagnosis, and we discuss the colorectal cancer molecular biology issues useful in the selection of individual molecular targeted therapy. We discuss and stress the importance of each diagnostic phase: from tumour resection and sample collection at preanalytical stage, through proper pathological preparation, evaluation and selection of material for molecular testing, to molecular analysis and finally preparation of a pathological molecular report.
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http://dx.doi.org/10.5114/wo.2018.77047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103235PMC
June 2018

How to standardize the evaluation of tumor regression grading of gastrointestinal cancers after neoadjuvant therapy?

Virchows Arch 2018 08 21;473(2):255-256. Epub 2018 Jun 21.

Central Clinical Hospital Ministry of Internal, Warsaw, Poland.

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http://dx.doi.org/10.1007/s00428-018-2391-4DOI Listing
August 2018

, , and polymorphisms and colorectal cancer risk in Polish nonsmokers.

Oncotarget 2018 Apr 20;9(30):21224-21230. Epub 2018 Apr 20.

Department of Surgery and Surgical Nursery with a Research Laboratory, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.

Glutathione S-transferase (GST) enzymes are responsible for cellular detoxification of many carcinogens and are important anticancer elements. This study assessed potential relationships between , , and polymorphisms and colorectal cancer (CRC) risk in Polish nonsmokers. We also analyzed the influence of gene polymorphisms on CRC clinical and histopathological features. Our study included 197 CRC patients and 104 healthy controls. , , and polymorphisms were evaluated using qPCR. Polymorphism frequencies observed in our control group corresponded to those in other European populations. The and genotypes were observed with similar frequencies in both CRC patients and controls (: 46.7% vs. 45.2%; : 15.7% vs. 20.2%). , , and genotype frequencies were respectively 42.1%, 48.2%, and 9.6% in patients and 48.1%, 42.3%, and 9.6% in controls. polymorphism correlated with higher tumor grade in CRC patients, and the genotype was associated with more frequent metastasis to lymph nodes (pN classification). Our results suggest that gene polymorphisms may influence CRC tumor grade and stage.
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http://dx.doi.org/10.18632/oncotarget.25031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940415PMC
April 2018

Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma. 2018 Update.

Endokrynol Pol 2018 ;69(1):34-74

Nuclear Medicine and Endocrine Oncology Department; M.Sklodowska-Curie Memorial Institute - Cancer Center, Gliwice Branch, Wybrzeze AK 15, 44-100 Gliwice, Poland; Zakład Medycyny Nuklearnej i Endokrynologii Onkologicznej, Centrum Onkologii-Instytut im. Marii Skłodowskiej-Curie, Oddział w Gliwicach, Wybrzeże AK 15, 44-100 Gliwice, Poland.

Significant advances have been made in thyroid can-cer research in recent years, therefore relevant clinical guidelines need to be updated. The current Polish guidelines "Diagnostics and Treatment of Thyroid Carcinoma" have been formulated at the "Thyroid Cancer and Other Malignancies of Endocrine Glands" conference held in Wisła in November 2015 [1].
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http://dx.doi.org/10.5603/EP.2018.0014DOI Listing
July 2018

Conventional cytology vs. immunocytochemistry of intraoperative peritoneal washes in gastric cancer patients subjected to gastrectomy: clinical correlates and association with overall survival.

Minerva Chir 2018 Jun 1;73(3):261-268. Epub 2018 Feb 1.

The Faculty of Medicine and Health Science, The Jan Kochanowski University, Kielce, Poland.

Background: The aim of this study was to verify if positive results yielded with conventional cytology and immunocytochemical analysis of peritoneal washes correlate with established prognostic factors and overall survival (OS) in gastric cancer patients.

Methods: The study included the data of 271 gastrectomized patients. Peritoneal washes of 131 (48.3%) patients were examined by means of conventional cytology, and material from 140 (51.7%) subjects treated surgically after this date was subjected to immunocytochemical analysis.

Results: Free cancer cells (FCCs) were detected significantly less often in patients from conventional cytology group than in those from immunocytochemistry group (4.6% vs. 12.1%). Positive result of immunocytochemical analysis was significantly more often associated with presence of pT3/4 tumor (94.1% vs. 60.2%), lymph node ratio ≥0.2 (82.4% vs. 43.1%) and involvement of blood vessels (64.7% vs. 28.5%). Median OS in patients with immunocytochemical evidence of FCCs in peritoneal washes was significantly shorter than in those without (11 vs. 45 months). Moreover, the two groups differed significantly in terms of 5- (0% vs. 43.1%) and 10-year OS rates (0.0% vs. 29.3%).

Conclusions: In contrast to conventional cytology, immunocytochemically documented presence of FCCs in peritoneal washes correlates with established prognostic factors and OS in gastric cancer patients.
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http://dx.doi.org/10.23736/S0026-4733.18.07529-6DOI Listing
June 2018

Polish Consensus on Treatment of Gastric Cancer; update 2017.

Pol Przegl Chir 2017 Oct;89(5):59-73

Department and Clinic of General, Transplantation and Liver Surgery, Warsaw Medical University, Poland.

The "Polish Research on Gastric Cancer" project has been continued since 1986. The main aim of this project, which is a multicenter and interdisciplinary research, is enhancing the treatment results of gastric cancer patients by developing and promoting the use of optimal methods for diagnosis and treatment, both surgical as well as combined. One of the more important achievements of the project is the development and publication of a document named "Polish Consensus on Treatment of Patients with Gastric Cancer", whose first version was published in 1998. Following versions were updated adequately to changing trends in the proceedings in patients with gastric cancer. A scientific symposium on "Polish Consensus on Treatment of Gastric Cancer - update 2016" was held in 3-4 June 2016 in Cracow. During the symposium a panel session was held during which all authors publicly presented the Consensus assumptions to be discussed further. Moreover, the already mentioned session was preceded by a correspondence as well as a working meeting in order to consolidate the position. It has to be underlined that the directions and guidelines included in the Consensus are not the arbitrarily assumed rules of conduct in a legal aspect and as such every doctor/team of doctors is entitled to make different decisions as long as they are beneficial to a patient with gastric cancer. The Consensus discusses as follows: a) recommended qualifications (stage of advancement, pathological, lymph node topography and the extent of lymphadenectomy, division of cancer of the gastroesophageal junction), b) rules for diagnostics including recommendations regarding endoscopic examination and clinical evaluation of the advancement stage, c) recommendations regarding surgical treatment (extent of resection, extent of lymphadenectomy, tactics of proceedings in cancer of the gastroesophageal junction), d) recommendations regarding combined treatment with chemotherapy or radiotherapy, e) place of endoscopic and less invasive surgery in the treatment of gastric cancer. This publication is a summary of the arrangements made in the panel session during the abovementioned scientific symposium in Cracow in 2016.
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http://dx.doi.org/10.5604/01.3001.0010.5413DOI Listing
October 2017

The importance of the concept and histological criteria of "intraepithelial squamous cell carcinoma" of the esophagus: in comparison between Western and Japanese criteria.

Esophagus 2017 14;14(4):333-342. Epub 2017 Jun 14.

Endoscopy Division and Department of Internal Medicine, Hitachi General Hospital, Hitachi, Ibaraki-ken Japan.

Background: There are differences in the histological diagnostic criteria for early stage gastrointestinal carcinoma between Western and Japanese pathologists. Western histological criteria of carcinoma are "presence of stromal invasion of neoplastic cells", while Japanese criteria are "the degree of cytological and structural abnormality of neoplastic cells, regardless of stromal invasion". The aim of the present study is to clarify and review the present status of the Western and Japanese histological criteria of early stage esophageal squamous cell carcinoma (SCC) and also to clarify their significance and accuracy.

Methods: Twenty-nine Polish, German, and Japanese pathologists participated in this study. A total of 18 histological slides of biopsy, endoscopic submucosal dissection (ESD), and surgical resection of esophageal squamous lesions were diagnosed using a virtual slide system.

Results: Most of noninvasive (intraepithelial) carcinomas diagnosed by Japanese pathologists were diagnosed as high- or low-grade dysplasia (intraepithelial neoplasia) or reactive atypia by the majority of Polish and German pathologists. Diagnoses of not only high-grade dysplasia but also low-grade dysplasia or reactive lesion by Western criteria were given for many biopsy specimens of cases in which the corresponding ESD or surgical specimens showed definite stromal invasion.

Conclusion: There still exist differences in the histological diagnostic criteria for early stage esophageal carcinoma between Western and Japanese pathologists. The Japanese diagnostic criteria could improve agreement of diagnoses between biopsy and resected specimens of esophageal SCC. Moreover, diagnostic approaches using Western criteria may cause delay in the early diagnosis and treatment of esophageal SCC.
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http://dx.doi.org/10.1007/s10388-017-0583-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603644PMC
June 2017

Diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):79-110

Klinika Endokrynologii i Nowotworów Neuroendokrynnych, Katedra Patofizjologii i Endokrynologii, Śląski Uniwersytet Medyczny.

Progress in the diagnostics and therapy of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN), the published results of new randomised clinical trials, and the new guidelines issued by the European Neuroendocrine Tumour Society (ENETS) have led the Polish Network of Neuroendocrine Tumours to update the 2013 guidelines regarding management of these neoplasms. We present the general recommendations for the management of NENs, developed by experts during the Third Round Table Conference - Diagnostics and therapy of gastro-entero-pancreatic neuroendocrine neoplasms: Polish recommendations in view of current European recommenda-tions, which took place in December 2016 in Żelechów near Warsaw. Drawing from the extensive experience of centres dealing with this type of neoplasms, we hope that we have managed to develop the optimal management system, applying the most recent achievements in the field of medicine, for these patients, and that it can be implemented effectively in Poland. These management guidelines have been arranged in the following order: gastric and duodenal NENs (including gastrinoma); pancreatic NENs; NENs of the small intestine and appendix, and colorectal NENs.
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http://dx.doi.org/10.5603/EP.2017.0015DOI Listing
July 2017

Colorectal neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):250-260

Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.
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http://dx.doi.org/10.5603/EP.2017.0019DOI Listing
July 2017

Neuroendocrine neoplasms of the small intestine and appendix - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):223-236

This study presents the revised Polish guidelines regarding the management of patients suffering from neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common location for these neoplasms. Most are well differentiated and slow growing. Their symptoms may be atypical, which can result in delayed or accidental diagnosis. Appendicitis is usually the first manifestation of NEN in this location. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of patients suffering from small intestinal NENs with distant metastases. The main cause of death in patients with carcinoid syndrome is carcinoid heart disease. The most useful laboratory test is the determination of chromogranin A, while concentration of 5-hydroxyindoleacetic acid is helpful in the diagnostics of carcinoid syndrome. For visualisation, ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, double-balloon enteroscopy, and somatostatin receptor scintigraphy may be used. A detailed his-tological report is crucial for the proper diagnostics and therapy of NENs of the small intestine and appendix. The treatment of choice is surgical management, either radical or palliative. The pharmacological treatment of the hormonally active and non-active small intestinal NENs as well as NENs of the appendix is based on long-acting somatostatin analogues. In patients with generalised NENs of the small intestine in progress during the SSA treatment, with good expression of somatostatin receptors, the first-line treatment should be radio-isotope therapy, while targeted therapies, such as everolimus, should be considered afterwards. When the above therapies are exhausted, in certain cases chemotherapy may be considered.
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http://dx.doi.org/10.5603/EP.2017.0018DOI Listing
July 2017

Pancreatic neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):169-197

This article presents updated diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine tumours (PNEN), proposed by the Polish Network of Neuroendocrine Tumours. The guidelines contain new data received in the years 2013-2016, which confirm previous recommendations, and have led to modification of previous guidelines or have resulted in the formulation of new guidelines. Biochemical and imaging (anatomical and functional) tests are of great importance in diagnostics, as well as histopathological diagnosis to determine the management of PNEN patients, but they must be confirmed by an immunohistochemical examination. PNEN therapy requires collaboration among the members a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment in many cases. Further therapy requires a multidirectional procedure; therefore, the rules of biotherapy, peptide receptor radionuclide therapy, molecular targeted therapy, and chemotherapy are discussed.
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http://dx.doi.org/10.5603/EP.2017.2016DOI Listing
July 2017

Gastroduodenal neuroendocrine neoplasms, including gastrinoma - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):138-153

This paper presents the updated Polish Neuroendocrine Tumour Network expert panel recommendations on the management of neuroendocrine neoplasms (NENs) of the stomach and duodenum, including gastrinoma. The recommendations discuss the epidemiology, pathogenesis, and clinical presentation of these tumours as well as their diagnosis, including biochemical, histopathological, and localisation diagnoses. The principles of treatment are discussed, including endoscopic, surgical, pharmacological, and radionuclide treatments. Finally, there are also recommendations on patient monitoring.
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http://dx.doi.org/10.5603/EP.2017.0016DOI Listing
July 2017

Conventional colon adenomas harbor various disturbances in microsatellite stability and contain micro-serrated foci with microsatellite instability.

PLoS One 2017 24;12(2):e0172381. Epub 2017 Feb 24.

Department of Pathology, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.

Introduction: Colorectal cancer belongs to the most frequent occurring malignancies. A prediction of the clinical outcome and appropriate choice of neoadjuvant chemotherapy needs personalized insight to the main driving pathways. Because most CRCs have polyps as progenitor lesions, studying the pathways driving to adenomagenesis is no less important.

Goals: Our purpose was the evaluation of microsatellite stability status within conventional colon adenomas and also β-catenin, BRAFV600E and p53 contribution.

Material And Methods: The cohort included 101 cases of typical colon adenomas with high grade epithelial dysplasia according to WHO. An immunohistochemistry method was used for the depiction of the expression of targeted proteins, as also their heterogeneity.

Results: Generally, we noted a 10% frequency of MSI events where MSI-H reached a 5% share occurred within the left colon and rectal polyps. β-catenin nuclear overexpression was noted with a 70% frequency and p53 with close to a 24% frequency. In addition, we found a presence of micro-serration foci more often within tubular adenomas, where focal MSI took place more often. Our results indicate that MSI events occur more often than had been theorized earlier. It results in tumour heterogeneity, more complex underlying pathways and finally ontogenetic molecular-diversity of tumours besides similar occurring histopathological features.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172381PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325232PMC
August 2017

Viral Nucleic Acids in the Serum Are Dependent on Blood Sampling Site in Patients with Clinical Suspicion of Myocarditis.

Intervirology 2016 13;59(3):143-151. Epub 2017 Jan 13.

Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.

Background: The meaning of viral nucleic acids in the myocardium in many cases is difficult for clinical interpretation, whereas the presence of viral nucleic acids in the serum is a marker of active infection. We determined the diagnostic value of viral nucleic acids in ventricular serum and peripheral serum samples in comparison with endomyocardial biopsy (EMB) specimens in patients with clinically suspected myocarditis.

Methods: The viral nucleic acid evaluation was performed in serum samples and EMB specimens by real-time PCR in 70 patients (age: 47 ± 16 years). The biopsy specimens were examined by histo- and immunohistochemistry to detect inflammatory response.

Results: The viral nucleic acids were detected in ventricular and peripheral serum, and EMB samples of 10 (14%), 14 (20%), and 32 (46%) patients, respectively. Notably, viral nucleic acids of the same virus as in the EMB sample were present more often in ventricular than in peripheral serum (60 vs. 7%, p = 0.01). A significant concurrence was observed between the positive and the negative results of viral nucleic acids present in EMB and ventricular serum (p = 0.0001).

Conclusions: The detection of the same viral nucleic acid type in the myocardium and in ventricular serum being significantly more frequent than in the peripheral serum may suggest that the site of the blood collection is important for more precise and reliable confirmation of the active viral replication in the heart.
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http://dx.doi.org/10.1159/000452834DOI Listing
March 2017

Congenital anomalies of the genitourinary system can help in diagnosis of the primary site of metastatic cancer: a case report and a review of the literature.

Onco Targets Ther 2016 20;9:4435-40. Epub 2016 Jul 20.

Department of Pathology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.

Objective: To analyze whether the presence of congenital anomalies of the genitourinary system that are accompanied by specific types of cancer and predispose patients to many complications, including infection, obstruction, stasis, calculus formation, and impaired renal function, could help in the diagnosis of the primary site of a metastatic tumor.

Case Presentation: We report a case of a 58-year-old man with metastatic adenocarcinoma, in whom congenital anomalies of the genitourinary system proved helpful for the diagnosis of the primary site of cancer originating in the seminal vesicles.

Conclusion: We report an extremely rare case of primary adenocarcinoma arising probably from the left seminal vesicle associated with ipsilateral renal agenesis. The lesion was detected on ultrasound and contrast-enhanced computed tomography and confirmed histologically with ultrasound-guided biopsy. Serum markers, ie, CA19-9 and CA125, were elevated, while prostate-specific antigen and carcinoembryonic antigen were within normal limits. Such a constellation of markers strengthened the diagnosis. Our patient unfortunately presented very late in the course of the disease. Hence, we decided to initiate antiandrogen therapy and best supportive care in a hospice setting. Only early detection seems to be the key factor that may result in improved cure rates for cancer of the seminal vesicles. We also performed a literature search for current concepts related to the diagnosis and clinical management of primary adenocarcinoma of seminal vesicles.
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http://dx.doi.org/10.2147/OTT.S108290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959588PMC
August 2016

Diagnostics and Treatment of Thyroid Carcinoma.

Endokrynol Pol 2016 ;67(1):74-107

Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice.

Revised Guidelines of Polish National Societies Prepared on the initiative of the Polish Group for Endocrine Tumours approved in their final version between November 16th and 28th, 2015 by the Scientific Committee of the V Conference "Thyroid Cancer and other malignancies of endocrine glands" organised between November 14th and 17th, 2015 in Wisla, Poland; called by the following Societies: Polish Endocrine Society, Polish Society of Oncology, Polish Thyroid Association, Polish Society of Pathologists, Society of Polish Surgeons, Polish Society of Surgical Oncology, Polish Society of Clinical Oncology, Polish Society of Radiation Oncology, Polish Society of Nuclear Medicine, Polish Society of Paediatric Endocrinology, Polish Society of Paediatric Surgeons, Polish Society of Ultrasonography Gliwice-Wisła, 2015 DECLARATION: These recommendations are created by the group of delegates of the National Societies, which declare their willingness to participate in the preparation of the revised version of the Polish Guidelines. The members of the Working Group have been chosen from the specialists involved in medical care of patients with thyroid carcinoma. Directly before the preparation of the Polish national recommendations the American Thyroid Association (ATA) published its own guidelines together with a wide comment fulfilling evidence-based medicine (EBM) criteria. ATA Guidelines are consistent with National Comprehensive Cancer Network (NCCN) Recommendation. According to the members of the Working Group, it is necessary to adapt them to both the specific Polish epidemiological situation as well as to the rules referring to the Polish health system. Therefore, the Polish recommendations constitute a consensus of the experts' group, based on ATA information. The experts analysed previous Polish Guidelines, published in 2010, and other available data, and after discussion summed up the results in the form of these guidelines. It should be added that Part II, which constitutes a pathological part, has been available at the website of the Polish Society of Pathologists for acceptance of the members of the Society, and no essential comments have been proposed. The Members of the Group decided that a subgroup elected from among them would update the Guidelines, according to EBM rules, every year. The Revised Guidelines should help physicians to make reasonable choices in their daily practice; however, the final decision concerning an individual patient should be made by the caring physician responsible for treatment, or optimally by a therapeutic tumour board together with the patient, and should take into consideration the patient's health condition. It should be emphasised that the recommendations may not constitute a strict standard of clinical management imposed on medical staff. The data from clinical trials concerning numerous clinical situations are scarce. In such moments the opinion of the management may differ from the recommendations after considering possible benefits and disadvantages for the patient.
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http://dx.doi.org/10.5603/EP.2016.0011DOI Listing
February 2017

The proposed new classification of coronary microcirculation as the predictor of the heart failure progression in idiopathic dilated cardiomyopathy.

Cardiovasc Pathol 2015 Nov-Dec;24(6):351-8. Epub 2015 Aug 8.

Department of Pathology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.

Background: The appropriate condition of the coronary microcirculation is essential for proper cardiac muscle activity. The understanding of the pathological microcirculation changes in different stages of idiopathic dilated cardiomyopathy (IDCM) could provide a reliable background for proper therapeutic decisions and prognosis.

Methods And Results: The study population consisted of 116 patients (86.2% males, mean age 50.4±13.2 years) with IDCM and heart failure. In samples from left ventricular endomyocardial biopsy, the coronary microcirculation was evaluated by staining with hematoxylin and eosin, Masson's trichrome, and anti-CD34 antibody. The microvessel density (MVD) was calculated. Also, the electron microscopic evaluation of the extracellular matrix capillaries was performed. Samples were assigned to one of four types according to the microcirculation condition: 1, normal microvessels (MVs) (18 patients); 2, mostly normal, some MVs with slightly decreased lumen diameter and thickened wall, absent/mild intravascular fibrosis, and MVD decrease (37 patients); 3, MVs with moderately decreased lumen diameter and thickened wall, moderate intravascular fibrosis, and MVD decrease (45 patients); and 4, MVs with significantly decreased lumen diameter and thickened wall, significant intravascular fibrosis, and MVD decrease (16 patients). Taking all types of the proposed classification into consideration, in type 4, clinical (incidence of New York Heart Association 3 and 4, dyspnea on exertion, pulmonary congestion) and echocardiographic (left atrial and right ventricular diameter, left ventricular mass and ejection fraction, tricuspid annular plane systolic excursion, early diastolic mitral annular velocity measured at the interventricular-septal annulus [E'med], ratio of early diastolic mitral inflow velocity to E'med) parameters were worst. Only atrial fibrillation, diabetes, tricuspid annular plane systolic excursion, and the type of the microcirculation significantly correlated with the incidence of cardiovascular hospitalizations in the linear regression models.

Conclusion: The condition of the coronary microcirculation corresponds with the heart failure progression in patients with IDCM.
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http://dx.doi.org/10.1016/j.carpath.2015.08.001DOI Listing
August 2016