[Clinical case of ACTH-ectopic syndrome].
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Biomedical subjects
Publications and source records attributed to L E Gurevich.
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The authors examined 25 patients with prostate cancer (PC) and 36 patients with benign prostatic hyperplasia (BPH). In the group of patients with morphologically verified PC mean serum level of vascular endothelial growth factor (VEGF) was significantly higher than in patients with BPH (p < 0.05). The study demonstrated strong negative association between VEGF and prostate specific antigen (PSA) levels (r = 0.72, p < 0.05) in PC patients. There was no association between VEGF serum level and the stage or malignancy of PC (Gleason score). In benign prostatic glands moderate VEGF expression was observed only in basal cells, whereas in cases of PC all tumor cells displayed active VEGF expression; the difference was significant (p < 0.05). High serum VEGF levels and its active expression in patients with PC suggest an important role of angiogenic factors in the pathogenesis of this disease. The negative association between VEGF and PSA serum levels in PC indirectly confirms antiangiogenic activity of PSA, shown before.
We carried out a retrospective immunohistochemical study of Ki-67, PCNA, Bcl-2, BAX, BclX, and VEGF expression in tumors of two groups of breast cancer patients with favorable and unfavorable course of the disease. Considerably enhanced VEGF expression was detected in tumors of patients with early relapses of breast cancer. High VEGF expression was paralleled by high level of Ki-67 and PCNA expression in tumors. It can be hypothesized that expression of VEGF, Ki-67, and PCNA in primary tumor can be used for predicting the course of breast cancer or detecting the patients at a high risk of early relapses.
Neuroendocrine tumors are the rare pathology. They are characterized by slow growth and favorable prognosis for life. From 1985 to 2000 fifty-two patients with "silent" neuroendocrine tumors were treated. Clinical symptoms in 60% patients were associated with squeezing of the surrounding organs and tissues (gastroduodenal obstruction or cholestasis), in 20% patients tumors were diagnosed within the framework of syndrome of multiple endocrine metaplasia and in 16% cases tumors were revealed accidentally. Fifty-two percent of the tumors located in the head of the pancreas, 23 and 25% - in the corpus and tail of the pancreas respectively. All the patients underwent surgery. Neuroendocrine nature of the tumors was verified during morphologic study. Five-year survival was 51.8, 41.6 and 54.5% when tumor located in the head, corpus and tail of the pancreas, respectively.
Data are described on a retrospective immunohistochemical study of the Ki-67, PCNA, Bcl-2, BAX, BclX and VEGF expression in tumors of two groups of patients with breast cancer (BC) and with the favorable and unfavorable clinical courses. A reliably high level of VEGF expression was detected in tumors of patients with an early BC relapse. Apart from VEGF, higher levels of the Ki-67 and PCNA expression were registered in tumors of the discussed patient's category. It can be suggested that the expression parameters of VEGF, Ki-67 and PCNA in the primary tumor can be made use of in evaluating the BD prognostications or describing the features of high-risk groups with a high probability of early disease relapses.
Our findings indicate that expression of matrix metalloproteinase-2 is an important prognostic marker of invasive potential of pancreatic tumors. Expression of this marker in neuroendocrine tumors (particularly in gastrinomas) can be used as a differential diagnostic criterion characterizing more malignant phenotype of tumors with the presence of ductal component. On the contrary, weak expression matrix metalloproteinase-9 is characteristic of less invasive phenotype of tumor cells (neuroendocrine and solid pseudopapillary tumors, mucinous cystadenomas). Co-expression of matrix metalloproteinases 2 and 9 is an unfavorable prognostic sign.
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Immunomorphological study of the liver in patients died from diffuse peritonitis showed specific changes in the number and morphology of Kupffer cells and endotheliocytes in various zones of the acinus in peritonitis of different origin.
Among 142 patients with islet cell tumor who were admitted to hospital between 1982 and 1999, 15 patients (10.6%) had malignant tumours. The mean age was 45.3 +/- 5.8 years. Islet cell tumors were located in the head and corpus of the pancreas in 26.6% and 26.6% of the patients, respectively, in the tail of the pancreas in 46.8% of the patients. The mean size of the tumor was 2.9 +/- 0.7 cm, in 6 patients (40%) liver metastases were found. US, CT and angiography which sensitivity were 72.7, 100 and 85.7%, respectively, were used for topical diagnosis of the islet cell tumors. 12 patients were operated on (15 operations) and 3 patients were treated conservatively by streptozocin. Surgical procedures included distal pancreatic resection (n = 11), enucleation of the tumor (n = 2), hepatic resection (n = 1), abdominal exploration (n = 1). In 2 patients palliative pancreatic resections were combined with transarterial embolization and devascularisation of the liver metastases and 2 patients were treated by systemic chemotherapy. To reveal malignancy before and during the operation was possible only by evaluation of distant metastases and the adjacent organs infiltration. In other cases to determine the diagnosis was possible only after planned histological identification of the resected specimens. 5-year survival rates after conservative and surgical treatment were 33% and 62.5%, respectively. In patients without distant metastases 5-year survival rate was 100%.
From 1982 to 1998 144 patients (males 31.7%, females 68.3%) with organic hyperinsulinism underwent surgery. Mean age of the patients was 44.2 +/- 4.6 years. The causes of the development of this disease were benign insulinoma (82.6%), malignant insulinoma (6.9%), beta-cells hyperplasia and microadenomatosis (4.2%). In 6.3% of the patients the origin of the disease was not established. The location of the insulinoma in the pancreatic head was detected in 33.8%, in the body--in 35.2%, in the tail--31%. The sensitivity of the used methods of topical diagnosis was the following: US--40.3%, CT--28.6%, angiography (selective celiacography and upper mesentericography)--76.9%, blood samples from the right hepatic vein after intraarterial stimulation of different parts of the pancreas by Ca with measurement of immunoreactive insulin level--87.2%, intraoperative palpation--86.5%, intraoperative US examination--100%. Preoperatively, the authors used combined angiographic examination, the sensitivity of which made up 94.9%, this study being a single one which allows to reveal the region of the lesion of the pancreas in beta-cells hyperplasy. Tumor enucleation (59 patients), distal resection of the pancreas (50), the excision of the insulinoma (25), duodenopancreatic resection (1), explorative laparotomy (9) were made. Postoperative complications rate arose in 43.6% of the patients, mortality rate--7.7%. The best results were achieved in enucleation of insulinoma and distal resection of the pancreas. The authors suggest that in preoperative diagnosis of insulinomas the preferable methods should be US-examination and combined angiographic examination. Intraoperative revision should be made with use of US examination. Depending on the intraoperative findings the preference should be given either to enucleation of insulinoma or to distal resection of the pancreas.
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Morphologic, ultrastructural changes in the epithelial component of the thymus in 41 patients with myasthenia are analyzed. Studies by histochemical, ultrastructural, and immunofluorescent methods revealed that the severity of the clinical course of myasthenia was related to the degree of changes in the epithelial component of the thymus, in its specific structures, Hassal's bodies. Effect of thymic epithelial component on lymphoid immunogenesis-regulating component was detected.
Thymectomy was included in the complex of therapeutic measures in the management of generalized myasthenia in 41 children. Much attention was given to preoperative management in which plasmapheresis was applied along with the traditional methods. As a result, maximum compensation of the myasthenic disorders was achieved and spontaneous respiration was restored in 9 patients who were given artificial ventilation of the lungs before the operation. The authors describe the techniques of thymectomy and the changes found in the thymus during histological study. No complications occurred. All of the children were discharged from the clinic in an improved condition. The late-term results were studied in 38 children in follow-up periods of 6 months to 4 years. Marked stable improvement was recorded in 31 (77.5%) patients.
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