Update on adrenal cortical neoplasia

The adrenal cortex gives rise to a biologically heterogenous group of neoplasms, each with a distinct morphology, antigen expression and molecular profile. Adrenal cortical adenomas have excellent prognosis and are usually cured by surgical resection alone, while adrenal cortical carcinomas are very aggressive tumors with a poor prognosis regardless of therapy. These tumors are rare and often challenging for a pathologist to diagnose, as significant overlap exists between benign and malignant lesions in some cases. In this review, we attempt to summarize most important histologic and clinical features of adrenal cortical adenomas and carcinomas, clarify the use of different grading systems, the use of special stains and the differential diagnosis for practicing pathologists. Most relevant hereditary syndromes associated with adrenal cortical tumors are listed. Updates in molecular alterations in adrenal cortical neoplasms and hyperplastic diseases as well as their clinical significance and potential therapeutic implications are also discussed.     

Fixator-assisted nailing of tibial fractures: New surgical technique and presentation of first 30 cases

Background

Intramedullary nailing is considered a “gold standard” for treatment of tibial shaft fractures. However, some types of fractures are typically considered as “difficult for nailing”. This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.

Influence of tumours on normal cells and optimal chemotherapy regimens: the case of several drugs and toxicity constraints.

Cancer chemotherapy with the application of several drugs is studied. The negative and inhibiting effect of the tumour on normal cells is taken into account. Under certain hypotheses, we determine the optimal regimen that minimizes the tumour burden at the end of a fixed period of therapy while maintaining several normal cell populations above prescribed levels. More precisely, it is demonstrated that the optimal drug administration corresponds to the strategy of intensive chemotherapy.     

Ketoconazole Impairs Early Pregnancy and the Decidual Cell Response via Alterations in Ovarian Function

Ketoconazole (KCZ) is an imidazole antifungal agent that alsoaffects P450 enzymes of the mammalian steroidogenic system.Several steps in the ovarian steroidogenesis pathway are knownto be inhibited by KCZ, but previous work has failed to addressthe ramifications of such inhibition with respect to early pregnancy.In initial studies, Holtzman rats (8–10/group) were administered10–100 mg/kg KCZ during days 1–8 of pregnancy. Onday 9, evaluations revealed a reduction at both 75 and 100 mgKCZ/kg in the number of implantation sites and serum progesteronelevels as well as an increase in ovarian weight The decidualcell response (DCR) was blocked by KCZ in parallel with decreasedserum progesterone and increased ovarian weight, indicatingdirect interference with uterine function. KCZ had no effectwhen given to long-term-ovariectomized rats that were hormonesupplemented to permit the DCR, indicating that the ovary wasat least one site of KCZ action on early pregnancy. Measurementof ovarian progesterone production in vitro from ovaries removedfrom rats treated in vivo with KCZ indicated a decline in progesteroneproduction, suggesting a direct effect of KCZ on ovarian steroidogenesis.These data demonstrate that KCZ can compromise early pregnancyand appears to do so by inhibiting progesterone synthesis inthe ovary.     

Ceruloplasmin activity in blood serum in stomach and duodenal ulcers

An examination of 100 patients with ulcer disease of the stomach duodenum and 20 practically healthy people has shown that the level of extracellular antioxidant enzyme defense (ceruloplasmin) is higher than those in practically healthy people. This dependence was most pronounced in the group of patients requiring surgical interventions. In the process of treatment the level of ceruloplasmin activity gradually decreased, without reaching normal values. The level of ceruloplasmin activity in patients with ulcer disease of the stomach and duodenum are thought to characterize the state of compensatory reactions in these patients.     

Chromosomal imbalances in clear cell ependymomas.

Clear cell ependymoma is a rare and diagnostically challenging subtype of ependymoma, whose genetic features are essentially unknown. We studied 13 clear cell ependymomas (five cases WHO grade II, eight cases WHO grade III) by comparative genomic hybridization (CGH). Chromosomal imbalances were found in 12/13 cases. The most common aberrations overall were +1q (38%), -9 (77%), -3 (31%), and -22q (23%). Clear cell ependymomas of WHO grade II were characterized by -9 (40%), whereas WHO grade III cases mainly showed +1q (63%), and +13q (25%), as well as -9 (100%), -3 (38%), and -22q (25%). In contrast to other ependymal tumors, clear cell ependymomas of WHO grade II showed fewer imbalances than WHO grade III samples (1.4 vs 3.5 per case). Although some of the implicated chromosomes have previously been shown to be involved in other ependymoma variants, the striking frequency of +1q, -9, and -3 suggests that aberrations differ between clear cell and other types of ependymomas, in particular, for loss of chromosome 9 which can be regarded as the molecular hallmark of clear cell ependymomas.     

Study of the molecular structure of ethylene-propylene copolymers obtained with catalysts of different composition

The monomer composition and sequence distribution in ethylene-propylene copolymers (EPCs) obtained with supported titanium/magnesium (TMC) and vanadium/magnesium (VMC) catalysts as well as with titanium trichloride was studied by means of ¹³C NMR spectroscopy. Based on these data ethylene-propylene reactivity ratios were determined. The EPCs obtained on these catalysts are inhomogeneous in composition; the soluble fractions contain larger amounts of propylene. The microstructures of copolymers obtained on TMCs and TiCl₃ are similar. For EPCs obtained on VMCs, propylene “head-to-head” or “tail-to-tail” inversions and a more homogeneous distribution of propylene are observed.     

Angiomyolipoma of the kidneys

59 angiomyolipomas were studied: immunohistochemistry (IHC) was used in 24 cases, electron microscopy (EM) in 6 cases. 57 tumors had a typical structure, 2 did not contain fat component. Premelanosomes were found by EM in one tumor. Smooth muscle actin was found in all tumor cells. Involvement of lymph nodes was observed in 2 patients. Histogenesis of this tumor is discussed.