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Glucagonoma as a rare case of neuroendocrine tumor of the pancreas: a case report

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Zińczuk J., Lewoniewska S., Zaręba K., Pryczynicz A., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2019
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vol. 1
169-173
EN
Introduction: Glucagonoma is a rare neuroendocrine tumor with characteristic features such as the presence of the glucagon-producing tumor, diabetes, and necrolytic migratory erythema. Case presentation: the 60-year-old patient was admitted to hospital with periodic pain in the right and middle upper abdominal appearing after eating. Laboratory tests presented a high glucose level and anemia. Tumor of the body and tail of the pancreas passing the organ pouch has been found during the surgery. Diagnosis of glucagonoma was confirmed in histopathological examination in immunohistochemical stainings: a positive reaction was observed with chromogranin, synaptophysin and CEA. The proliferative activity of Ki-67 was less than 1%. Staining for glucagon also was positive so confirmed the presence of neuroendocrine tumor - glucagonoma. Conclusions: Glucagonoma sometimes may occur without characteristic features which may cause delayed diagnosis. Early diagnosis of glucagonoma is important because it increases the chances of successful recovery.
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Assessment of the presence of pancreatic intraepithelial neoplasia in various diseases of this organ

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Zińczuk J., Zaręba K., Konarzewska-Duchnowska E., Guzińska-Ustymowicz K., Kędra B., Kemona A., Pryczynicz A.
Progress in Health Sciences
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2017
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vol. 7(2)
43-49
EN
Purpose: Pancreatic intraepithelial neoplasia (PanIN) is one of the most commonly occurring precancerous lesion in pancreas which leads to development of pancreatic ductal adenocarcinoma (PDAC). We assessed the presence and grade of pancreatic intraepithelial neoplasia in the course of various diseases of the pancreas and its correlations with chosen clinicopathological parameters. null Results: A total of 276 foci of PanIN were identified in 94 patients. The most common lesions were PanIN 1a and PanIN 1b which together constituted 68.2 % of all lesions, whereas the PanIN 2 was present in 21.7% and PanIN 3 in 10.1% of patients. No statistical differences were observed in gender tendency for the development of PanINs. There was correlation between age of patients and degree of PanIN (p=0.034). There is no statistical difference in PanIN frequency among patients with pancreatic ductal adenocarcinomas, neuroendocrine tumors, chronic pancreatitis and pancreatic cysts (p=0.592). Conclusions: Our study showed that important factor in development of pancreatic intraepithelial neoplasia is age and the presence of PanIN in nonneoplastic diseases in older people should be included to the group with increased risk of cancer development.
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Spigelian hernia: a case report

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Martyniuk M., Ustymowicz W., Zińczuk J., Pryczynicz A., Guzińska-Ustymowicz K., Kędra B., Zaręba K.
Progress in Health Sciences
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2019
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vol. 2
53-56
EN
Spigelian hernias constitute a minute fraction of all abdominal hernias. In this monography, we present a case report of this relatively seldom seen phenomenon which some general surgeons never get to see during their medical career.
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Whipple’s disease as a systemic infectious disease – a case presentation

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Maciorkowska M., Ustymowicz W., Zakrzewski M., Pryczynicz A., Markowski A., Romatowski J., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2018
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vol. 8(1)
212-218
EN
Introduction: Whipple’s disease is a chronic systemic infectious disorder with Tropheryma whipplei as an etiologic agent, occurring rarely and affecting numerous organs and systems. The variety of symptoms and a non-typical course make it difficult to establish a proper diagnosis. Purpose: In this study, etiopathogenesis, diagnostics and treatment of Whipple’s disease were presented based on the case report of 60-year-old man diagnosed with Whipple’s disease. Case presentation: Persistent diarrhoea with weight loss, lymphadenopathy in the abdominal cavity and moderate microcytic anemia predominated in the clinical picture. Diagnosis was put based on the clinical picture and macroscopic assessment of the small intestine and the presence of macrophages filled with a PAS-positive substance in the lamina propria. To deepen diagnostics, samples collected were assessed showing macrophages with the damaged mucosa, containing numerous elongated micro-organisms whose ultrastructure corresponded to Tropheryma whipplei. The patient’s clinical conditions improved after antibiotic therapy. Conclusions: It is vital to remember about Whipple’s disease in patients with chronic diseases due to a non-specific clinical picture and difficulties in establishing a proper diagnosis. When the disease is diagnosed unequivocally, proper and effective antibiotic therapy should be instituted immediately.
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Fine needle aspiration cytology in the diagnosis of Sjögren’s syndrome

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Pryczynicz A., Guzińska-Ustymowicz K., Wakulewska A., Ducher M., Lewczuk Ł., Kisielewski W., Ustymowicz A., Zioło M., Famulski W.
Progress in Health Sciences
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2013
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vol. 3
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issue 2
178-182
EN
Introduction: Sjögren’s syndrome is an autoimmune disease belonging to the group of collagenases. It is characterized by lymphocytic infiltration of the exocrine glands, leading to their impairment or complete dysfunction. The inflammatory process usually involves cells of the salivary or lacrimal glands. However, also other organs and systems can be affected. Purpose: The presentation of a Sjögren’s syndrome case. The pathologist’s role in the disease diagnosis. Case presentation: A 63-year-old female patient with the enlarged left parotid salivary gland and symptoms of xerostomia and xerophtalmia was referred for ultrasound imaging and fine-needle aspiration biopsy (FNAB). Ultrasonography revealed inhomogeneous echostructure of the salivary gland with multiple tiny, oval, hypoechoic areas, hyperechoic zones of fibrosis and enhanced vascularization of the gland. The pathological analysis of FNA showed a benign lymphoepithelial lesion, and Sjögren’s syndrome was suggested. Blood serum analysis found anti Ro-52 (SS-A), anti-La (SS-B) and anti-ANA antibodies at 1:1,000 titer. Sjögren’s syndrome was diagnosed based on accessory investigations and the clinical condition of the patient. Conclusions: The pathomorphological analysis of fine-needle aspiration biopsy of the salivary gland contributed to the diagnosis of Sjőgren’s syndrome in the patient.
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Clinical usefulness of MMP-2 and TIMP-2 concentrations in the preoperative serum of patients with colorectal cancer

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Pryczynicz A., Gryko M., Dymicka-Piekarska V., Lewczuk Ł., Wakulewska A., Ozimkiewicz M., Lebelt A., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2016
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vol. 6(1)
32-39
EN
Purpose: To evaluate the clinical significance of MMP-2 and TIMP-2 concentrations in the sera of patients diagnosed with colorectal cancer. Methods: The study group comprised 48 patients with colorectal carcinoma and 24 healthy controls. The serum concentration of MMP-2 and TIMP-2 proteins was evaluated by the ELISA method. Results: The mean level of MMP-2 in the sera of patients with colorectal cancer was 39.4 ng/ml and was significantly lower compared with the control (p<0.001). A decrease in TIMP-2 protein in the sera of patients with colorectal cancer was also observed where its mean level was 132.3 ng/ml. The concentration of MMP-2 and TIMP-2 did not correlated with any clinicopathological parameters, except for the patients’ age. In addition, the concentration of MMP-2 in the sera of patients with CRC correlated negatively with the number of white blood cells in the blood and the prothrombin index. The concentration of TIMP-2 correlated positively with potassium and urea concentration in the blood. Conclusions: The results of our study indicate lack of clinical usefulness of determining the levels of MMP-2 and TIMP-2 in the sera of patients with colorectal cancer. However, these proteins play an important role in the carcinogenesis of colorectal cancer.
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The growth differentiation factor-15 (GDF-15) can be useful in the detection of distant metastases in sera of colorectal cancer patients

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Jakubowska K., Pryczynicz A., Dymicka-Piekarska V., Cepowicz D., Jagodzińska D., Lewczuk Ł., Lebelt A., Ozimkiewicz M., Kiszło P., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2016
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vol. 6(1)
40-48
EN
Purpose: Growth differentiation factor-15 (GDF- 15) protein belongs to a transforming growth factor-β family which determines the growth and differentiation of cells. In cancers, GDF-15 influences on the proliferation, differentiation, viability, migration and invasiveness of cancer cells. The aim of our study was to evaluate the expression of GDF-15 in the tissue and its levels in sera of patients with colorectal cancer. Materials and methods: The level of GDF-15 in the sera of 55 patients diagnosed with colorectal cancer was determined using the ELISA method whereas expression of this protein was performed by immunohistochemical method. Results: The mean value of GDF-15 levels in the sera of patients with colorectal cancer was significantly higher than in healthy control group (p<0.001). The expression of GDF-15 in the tissue was weak, moderate and strong in 23.6%, 15.7% and 60.7% cases, respectively. Statistical analysis showed that the expression of GDF-15 correlated with patients’ age (p<0.005) and non-mucinous type of cancer (p<0.001). The high GDF-15 levels in the serum was associated with tumor size (p<0.01) and distant metastases (p<0.05). Conclusions: According to our results, we postulate that the level of GDF-15 in serum can be use to assess the metastatic behavior of colorectal cancer
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Symptoms of colorectal cancer contributes to its localization and advancement

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Nizioł M., Kostrzewska B., Kamińska D., Domurat M., Zińczuk J., Misiura M., Guzińska-Ustymowicz K., Pryczynicz A.
Progress in Health Sciences
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2019
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vol. 1
76-82
EN
Introduction: Colorectal cancer is one of the most common cancers occurring in Poland. Unfortunately, this cancer is most often diagnosed at the time of great advancement. This is caused by the appearance of specific symptoms only in the late stages of cancer. Also, such low detection of early stages of adenocarcinoma may be caused by disregarding of slight symptoms. Purpose: To analyse symptoms in patients with colorectal cancer and correlate with chosen clinical-pathological parameters. Materials and methods: The study group consisted of 46 patients diagnosed with colorectal cancer. Information on symptoms associated with cancer (subjective and objective) have been selected from patients' medical history. The presence of these symptoms was correlated with the age and sex of patients, tumor location, histological type of cancer, grade of histological malignancy (G), stage of tumor (T stage), presence of lymph node metastases and distant metastases. Results: It has been shown that the presence of pain complaints described by the patient are associated with the occurrence of cancer in the colon. The painfulness and pathological resistance diagnosed by the physician are more often associated with cancer located in the colon. In the case of tumors located in the rectum, faecal admixtures appear more frequently. It has also been shown that the presence of admixtures of blood and mucus in the stool is associated with more advanced local tumors, infiltrating pericolorectal tissues (T3 + T4). Conclusions: Familiarity with clinical symptoms of colorectal cancer could make patients more sensitive to more often screening for cancer. Analysis of these symptoms could indicate to the physician the location or stage of the cancer.
9
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Immunohistochemical Fascin-1 expression correlate with lymph node and distant metastases in pancreatic ductal adenocarcinoma

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Pryczynicz A., Nizioł M., Miniewska K., Kamińska D., Kuczyńska P., Zińczuk J., Zaręba K., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2018
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vol. 8(2)
124-130
EN
Introduction: Pancreatic cancer is characterized by its aggressiveness and poor prognosis. Furthermore, mortality is one of the highest among all types of cancers. It has been observed that the expression of Fascin-1 (the actin-bundling protein which enables the motility of cells) is higher in cancer cells and is correlated with invasiveness and metastasis. Purpose: To investigate the expression of Fascin-1 in histopathological specimens from patients treated for pancreatic cancer and its relationship with histopathological parameters. Materials and methods: The study was performed on a group of 52 patients diagnosed with pancreatic cancer in the Medical University of Bialystok Clinical Hospital. The expression of Fascin-1 was evaluated in tissue samples using the immunohistochemical method and was rated as “present” or “absent”. The analysis of histopathological parameters was performed in correlation with Fascin-1 expression. Results: Fascin-1 expression was observed in the cytoplasm of cancer cells in 42/52 cases (80.8%). Fascin-1 expression occurred more frequently among patients with lymph node metastases (92.6%) than without this type of metastases (68%) (p=0.024). Likewise, the expression of the investigated protein was observed more often with the presence of distant metastases (100%) than without those metastases (74.4%) (p=0.043). There were no statistically significant differences about age, sex, histological type of cancer, grade of histological differentiation, desmoplasia, inflammatory infiltration, foci of hemorrhage, necrosis, and MVD. Conclusion: The expression of Fasicn-1 is correlated with the presence of metastases and can be a useful marker of pancreatic cancer involvement.
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Expression of EpCAM protein in gastric cancer cells may contribute to its histogenesis

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Nizioł M., Kuczyńska P., Misiura M., Zińczuk J., Zaręba K., Ustymowicz W., Ćwiklińska-Dworakowska M., Baszun M., Jelski S., Guzińska-Ustymowicz K., Pryczynicz A.
Progress in Health Sciences
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2018
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vol. 8(1)
74-79
EN
Introduction: EpCAM protein belongs to adhesion molecules of epithelial cells. It mediates in the homophile adhesion cell-cell reactions. EpCAM protein expression can be observed in the majority of healthy normal cells. However, mutations in EpCAM gene may lead to an increased risk of cancer development. The aim of the study was to assess EpCAM protein expression in the correlation with chosen clinical and histological parameters in gastric cancer. Materials and Methods: EpCAM protein expression was evaluated immunohistochemically in 88 patients diagnosed with gastric cancer. Results: An increase in EpCAM protein expression was demonstrated in cancer cells compared to normal gastric mucosa (59.3% cancers with the positive expression of EpCAM protein). The increased EpCAM protein expression was observed in patients with a histological type of adenocarcinoma without a mucinous component than in those with adenocarcinoma with a mucinous component (p=0.028). The higher expression of this protein was observed also in the intestinal type according to the Lauren classification (p=0.037). The expression of the protein was lower in the diffuse type of cancer. Additionally, an increase in EpCAM protein expression was revealed in cancers infiltrating to the blood vessels (p=0.013). Conclusions: A correlation between EpCAM expression and adenocarcinoma without a mucinous component as well as the intestinal type according to the Lauren classification may prove a role of this protein in the histogenesis of gastric cancer. Moreover, its positive expression is related to cancerous cells infiltrating to the blood vessels, which may suggest a role of EpCAM protein in the early stages of gastric cancer metastases.
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Significance of mucin expression in pancreatic intraepithelial neoplasia (PanIN) – precursor lesions of pancreatic ductal adenocarcinoma (PDAC)

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Zińczuk J., Zaręba K., Pryczynicz A., Kuczyńska P., Boroń Z., Ustymowicz W., Maciorkowska M., Ćwiklińska-Dworakowska M., Baszun M., Jelski S., Guzińska-Ustymowicz K.
Progress in Health Sciences
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2018
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vol. 8(1)
63-73
EN
Purpose: To evaluate chosen mucins (mucin 1, 4, 5AC) expression in pancreatic intraepithelial neoplasia, which is a precursor lesion of pancreatic ductal adenocarcinoma. Materials and methods: The study group included 70 patients operated on due to inflammation, cysts and pancreatic ductal adenocarcinoma with pancreatic intraepithelial neoplasia revealed additionally. Mucin 1, 4 and 5AC expression was assessed by immunohistochemical method using polyclonal antibodies. Results: Statistical analysis proved a positive correlation between the expression of mucin 1, 4 and 5AC proteins and the presence and staging of pancreatic intraepithelial neoplasia (p<0.001). Statistically significant correlations were determined between mucin 1, 4 and 5AC and the location of PanIN lesion in the pancreas. Positive correlations were found between mucin 5AC expression and the type of a basic disease (p=0.014). Differences in the expression of MUC 1, 4 and 5AC proteins between healthy pancreatic ducts and various stages of pancreatic intraepithelial neoplasia were statistically significant (p<0.001). Conclusions: Overexpression of mucin 1, 4 and 5AC is related to the presence of pancreatic intraepithelial neoplasia. This suggests that overproduction of mucus is a phenomenon occurring early in the process of carcinogenesis in the pancreas and has its beginning in precancerous lesions of an early stage.
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