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Background and objective: The immune system plays an important role in non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the infiltration patterns of CD4+ and CD8+ T cells in NSCLC and to analyze their relation to COPD, smoking status and other clinicopathologic variables. Materials and methods: Lung tissue specimens from 50 patients who underwent surgery for NSCLC (stages I–III) and 10 control group subjects were analyzed immunohistochemically. Results: NSCLC patients had a greater number of CD4+ and CD8+ T cells infiltrating the lung tissue than the control group (P = 0.001) with predominant infiltration in the tumor stroma. We found a significant association between the number of total and tumor stroma-infiltrating CD4+ and CD8+ T cells, and smoking status (P &lt, 0.05). There were more CD8+ T cells in the tumor stroma and fewer in the tumor islets in NSCLC patients with COPD as compared to NSCLC patients without COPD (P &lt, 0.05). However, there was no such association between CD4+ T cells and COPD status. A high level of CD8+ T cell infiltration in the tumor stroma was independently associated with the coexistence of COPD in multivariate analysis (P &lt, 0.05). Conclusions: According to our data, COPD but not smoking seems to be associated with higher infiltration of CD8+ T cells in the tumor stroma of patients with NSCLC. It allows us to hypothesize that NSCLC patients with coexisting COPD may have a more favorable outcome due to anticancer properties of stromal CD8+ T cells.

Surgery remains the main treatment modality for gastric cancer. Adjuvant radiochemotherapy and adjuvant chemotherapy are becoming more and more popular in the treatment of advanced gastric cancer. Early postoperative intraperitoneal chemotherapy as one of the methods of adjuvant chemotherapy is currently being extensively investigated. The aim of the present study was to evaluate the toxicity of early postoperative intraperitoneal chemotherapy and its impact on postoperative complications as well as long-term survival.A prospective study including 46 patients with gastric cancer who underwent radical resection was carried out during 2004-2005. Fourteen patients who received early postoperative intraperitoneal chemotherapy with 5-FU (EPIC group) were compared with 32 patients not receiving intraperitoneal chemotherapy (control group). All patient, except one patient in the EPIC group, received adjuvant radiochemotherapy or adjuvant chemotherapy. The toxicity of early postoperative intraperitoneal chemotherapy was evaluated using the WHO scale, and survival was estimated by the Kaplan-Meier method.The rate of postoperative complications was similar in both the groups (14.3% in the EPIC group vs. 12.5% in the control group). Four patients (28.6%) in the EPIC group developed grade III toxicity. There was no difference in survival comparing the EPIC group with the control group (median survival, 30 months and 34 months, respectively; P=0.500).Early postoperative intraperitoneal chemotherapy with 5-fluorouracile demonstrated acceptable toxicity and was relatively simple to perform. No survival benefit was documented combining early postoperative intraperitoneal chemotherapy with adjuvant radiochemotherapy or adjuvant chemotherapy.

To assess the prognostic significance and impact of p53 protein and human epidermal growth factor receptor 2 (HER2) overexpression on 5-year survival in young patients with stage II breast cancer (aged less than 50 years).Material from medical records and archived tumor tissues from 34 young women diagnosed with stage II breast cancer and obtained between 2001 and 2003 was analyzed retrospectively. Twelve (35%) patients died from breast cancer. Using archived tumor tissues, p53 protein and HER2 over-expression was determined immunohistochemically. Using medical records, and adjuvant chemotherapy, adequacy of anthracycline dose, and hormonotherapy administered for the patients were analyzed.p53 protein and HER2 overexpression was documented in 20.6% and 26.4% of women, respectively. Kaplan-Meier survival analysis showed that patients with tumors positive for p53 protein and negative estrogen receptors, and treated with an inadequate dose of anthracyclines died within shorter period after diagnosis (log-rank P=0.016, log-rank P=0.027, log-rank P=0.013, respectively). There were no significant associations between HER2 overexpression and 5-year survival in this population (log-rank P=0.51). Multivariate analysis revealed that an inadequate dose of anthracyclines (P=0.028) was the only independent factor for poor outcome.p53 protein overexpression, negative estrogen receptors in tissue samples, and inadequate chemotherapy with anthracyclines were associated with reduced overall survival in young women with stage II breast cancer. Inadequate adjuvant therapy with anthracyclines was the only independent prognostic factor.

Leiomyosarcoma is a rare tumor of mesenchymal origin usually affecting the inferior vena cava. Early diagnosis is essential before surgical resection, which is the only therapeutic modality that prolongs patients' survival. Ultrasonography, computer tomography, and magnetic resonance imaging are the main imaging modalities in this case. Combined with guided biopsies, they form the mainstay of reliable diagnosis. We report a case with retroperitoneal tumor arising from the middle segment of the inferior vena cava. Radiological examination revealed retroperitoneal tumor and helped to choose surgical treatment. Histopathological examination confirmed the diagnosis of leiomyosarcoma of the inferior vena cava.

Mucinous adenocarcinoma in association with chronic anal fistula is a rare case in clinical practice. The aim of this article was to report a rare case of anal gland mucinous adenocarcinoma in a patient who was treated in the Hospital of Kaunas University of Medicine. Case report. A 70-year-old male was treated for anorectal fistula in the surgical department. Four operations were performed for perineal abscess during the period of 15 years. During the period of 15 years, the patient complained of purulent secretion from the perineal abscess. After the last operation, anorectal fistula developed. Multiple biopsies and scrapings of the fistulous track were taken for histological examination. Histological examination revealed mucinous adenocarcinoma, G2. Subsequently, the patient underwent endoanal ultrasound, computed tomography scan, and colonoscopy. The computed tomography scan did not show pathology in the abdomen, but showed soft tissue induration at the site of anorectal fistula. Colonoscopy investigation did not show any pathology in the rectum and bowels. Endoanal ultrasound findings showed soft tissue induration at the site of anorectal fistula, no tumor in the rectum wall. The patient underwent abdominoperineal resection. Histological examination after abdominoperineal resection revealed anal duct mucinous adenocarcinoma pT2 N0 L0 V0 R0, G2. Metastases to the mesenteric lymph nodes were not detected. On the eight day after abdominoperineal resection, the patient was discharged from the hospital for follow-up. Summary. Mucinous adenocarcinoma in anorectal fistula is a rare condition. If surgical treatment for perineal abscess or anorectal fistula is not successful for a long time, mucinous adenocarcinoma should be suspected.

Cadmium is a known human lung carcinogen, although some studies indicate a link between cadmium exposure and human breast cancer. The objective of this study was to assess cadmium concentration in breast tissue samples of patients with breast cancer and benign breast tumor. Material and methods. The concentration of cadmium was determined in breast tissue samples of 21 breast cancer and 19 benign tumor patients. Two samples of breast tissue from each patient, i.e. tumor and normal tissue close to tumor, were taken for the analysis. Cadmium was determined by atomic absorption spectrometry (Perkin-Elmer, Zeeman 3030). Results. In patients with breast cancer, the mean cadmium concentration was 33.1 ng/g (95% CI, 21.9– 44.4) in malignant breast tissue and 10.4 ng/g (95% CI, 5.6–15.2) in normal breast tissue (P=0.002). In patients with benign tumor, the corresponding values were 17.5 ng/g (95% CI, 8.4–26.5) and 11.8 ng/g (95% CI, 5.1– 18.5) (P=0.3144). There was a statistically significant difference in cadmium concentration between malignant and benign breast tissues (P=0.009). Conclusion. The data obtained show that cadmium concentration is significantly higher in malignant breast tissue as compared with normal breast tissue of the same women or benign breast tissue. Further studies are necessary to determine the association between cadmium concentration in malignant breast tissue and estrogen receptor level, and smoking.

The epicardiac neural ganglia of the adult human heart are distributed in the seven neural ganglionated subplexuses. The aim of the present investigation was to determine the distribution of the epicardiac ganglia in human fetuses of different age, because intrinsic cardiac nervous system of the human fetus has not been enough investigated so far.In the present study seventeen human fetus hearts were investigated, in which epicardiac neural ganglionated plexus was visualized by histochemical method for acetylcholinesterase.Analysis of the total hearts preparations showed that: (1) the epicardiac neural ganglionated plexus of the fetus at fifteen weeks of gestation has already differentiated into seven ganglionated subplexuses, structure of which is typical for the adult human heart; (2) the epicardiac plexus of fetuses at 15-40 weeks of gestation contains on average 865+/-40 epicardiac ganglia, that may widely range in number from 644 to 1193; (3) the largest number of the neural ganglia is concentrated on the posterior surface of both atria, where up to 76% of all ganglia maybe located; (4) the difference between the number of epicardiac ganglia in the human fetuses at the early (15-25 weeks) and late (26-40 weeks) stages of fetogenesis is not statistically significant (p0.05). In conclusion, both the distribution and the number of the epicardiac ganglia of fetuses ranging from 15 to 40 weeks of gestation are not age-dependent but varied substantially from heart to heart.

Gliomas are the most common type of primary intracerebral neoplasm. They carry a dismal prognosis. The main prognostic factors are patient age, performance status and malignancy grade. Because patients with the same histologic diagnosis have variable outcomes, there is a need to develop better prognostic markers with the aim of predicting tumor behaviour and response to therapies. This paper reviews different morphological, genetic, molecular factors and their association with survival. Tumor associated morphological features such as predominant cell type, cellularity, cytological atypia, proliferation activity, microvascular proliferation, necrosis and apoptosis are discussed in some detail.

Preoperative adjuvant radiation combined with chemotherapy is a recent development in the management of patients with rectal cancer invading perirectal tissue and regional lymph nodes. This study was performed to assess the impact of preoperative adjuvant therapy in patients judged by endorectal ultrasound to have extramural invasion of rectal cancer and/or regional lymph node involvement on tumor regression in bowel wall T and lymph nodes N. The predictive value of ultrasound in staging wall penetration and lymph node involvement after preoperative adjuvant therapy was also assessed.Fifty-one patients were selected by ultrasound to have preoperative irradiation (40-50 Gy over 5-6 weeks). In 29 patients this was combined with 5-fluorouracil chemotherapy. Assessments of ultrasound were compared with pathologic findings in the resected specimen in all patients.Partial downstaging was seen in 37 (72.5%) patients with wall invasion T and in five (9.8%) of 51 patients with lymph node involvement N. Complete downstaging was achieved in one (2.0%) patient with wall invasion T and in 20 (39.2%) of 51 patients with lymph node involvement N. Positive predictive values of ultrasound after irradiation were 47 (92.2%) and 45 (82.2%) for wall penetration and lymph node status, respectively. Negative predictive values of ultrasound after irradiation were rare 3.9% and 5.9%, respectively.In the majority of patients with rectal cancer invading perirectal tissues or lymph nodes, lesions downstages by preoperative chemo radiotherapy. Endorectal ultrasound examination before and after chemo radiotherapy for rectal cancer is one of the most recommended in staging rectal cancer.

The factors influencing failure of pancreaticojejunostomy following pancreatoduodenectomy are still ill-defined. Our previous study showed that age of patient, bilirubinemia or malignant nature of peripancreatic tumor had no impact on pancreas-related morbidity following pancreatoduodenectomy. The hypothesis is that it could be influenced by the level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function. Aim of the study was to analyze the impact of morphologic and physiologic peculiarities of pancreatic remnant on development of pancreas-related morbidity after Whipple procedure.We have analyzed retrospectively clinical data of 122 patients who have undergone pancreatoduodenectomy in the Department of Surgery of Kaunas University of Medicine Hospital during 1995-2001. Fibrosis of pancreatic parenchyma, diameter of main pancreatic duct, and preoperative exocrine function were evaluated. Pancreas-related morbidity was determined as either peripancreatic sepsis or pancreatic fistula. Fibrosis of pancreatic remnant was determined by computer-aided morphometric analysis. The exocrine pancreatic function was tested the day before surgery by Pancreatic Elastase-1 Stool test.One hundred twenty two patients have undergone pancreatoduodenectomy during 1995-2001. Pancreas-related morbidity was encountered in 27 (22.13%) cases, pancreatic fistula in 13 (10.65%) and peripancreatic sepsis in 14 (11.47%). Univariate analysis shows that diameter of main pancreatic duct and level of postoperative amylasemia were significantly different between the groups with and without pancreatic complications (p=0.001 and p=0.002, respectively) as well as there was significant difference of pancreatic exocrine function and fibrosis between the groups of patients who developed pancreas-related complications and who did not (p=0.003 and p=0.026, respectively). When logistic regression analysis was applied on those 4 variables, only one independent risk factor - exocrine pancreatic function at the cut-off of stool Elastase 100 micro g/g was revealed (odds ratio 21.6). The sensitivity of the Stool Elastase-1 test was 0.86, specificity 0.78, positive predictive value - 0.55 and negative predictive value - 0.95.The level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function mainly influence pancreas-related morbidity following pancreatoduodenectomy. Exocrine pancreatic function measured by Stool Elastase-1 test is helpful for the detection of the group of patients with minimal risk for pancreas-related morbidity after pancreatoduodenectomy.

The aim of the present study was to compare the accuracy of transrectal ultrasound in staging rectal carcinoma. 30 consecutive patients with rectal carcinoma proven pathomorphological were staged transrectal ultrasound and computed tomography imaging, and then underwent radical surgery. The data of preoperative staging were compared with pathomorphological findings of the specimens according to Surgical excised the TNM classification system. Transrectal ultrasound showed better results than computed tomography in evaluating N (sensitivity 45.2%, specificity 45.2%), because the parameters of sensitivity and specificity were high enough (76.6%). Computed tomography has limited usefulness in staging rectal tumors because the layers of the rectal wall are not resolved by computed tomography. In T staging transrectal ultrasound sensitivity and specificity ranges 87.54% and 94.82% respectively and that enables to perform adequate surgical procedure.