Diagnosis Of Malignant Disease Research Articles

Comparison of the Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in Evaluation of Patients with Obstructive Jaundice

Background: Obstructive jaundice patients need surgical intervention to overcome the biliary obstruction. For planning these complex interventions, the radiologist has to precisely assess the etiology, location, level, and extent of the disease.
 Aim: To compare the diagnostic benefit of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in the evaluation of patients with obstructive jaundice taking histologic tests and anatomical findings after surgical intervention as gold standard.
 Study Design: This prospective study included 72 patients who were referred to DCIMCH radiology department with clinical features of biliary obstructive disease.
 Materials and Methods: All patients were evaluated by Ultrasonography followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP). The results were read by radiologists blinded to other imaging findings. The characteristic histopathological diagnosis / surgical findings (as applicable) were considered as gold standard.
 Results: Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases, MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%).
 Conclusion: MRCP is the best imaging investigation in the pre-operative evaluation for obstructive jaundice patients.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 32-36

Role of cytoblock on pleural effusion for diagnosis of malignant disease.

Thoracocentesis of pleural effusion is a simple technique for pleural fluid examination through cytology. In addition to cytological examination to assess the nature of pleural fluid content, we can also perform more detailed examinations through cytoblocks of residual fluid. These paraffin-embedded cytoblock samples are important because we can perform examinations as in other bioptic samples. In these samples, immunohistochemical and molecular analyses can be performed. Two hundred fifty-five cytological samples from patients with pleural effusion were examined. In cases in which the presence of malignant cells was identified in the cytological examination, as well as cases that were suspicious but not definitive for the presence of a malignant effusion, a cytoblock was prepared. Histological examination and immunohistochemical analysis were performed. Among 255 cases with pleural effusion, 152 had the presence of malignant cells and 6 cases were suspicious, but uncertain for the presence of malignant cells, while 86 cases had inflammatory pleural effusion or other pathologies but were not malignant. After histological analysis of the cytoblock and immunohistochemical analysis, we identified 82 malignant tumors of the lung, 8 malignant tumors of the gastrointestinal tract, 15 malignant tumors of the breast, and 6 malignant tumors of the female genital tract, as well as 24 tumors of undetermined origin. Cytoblocks are important for the diagnosis of the primary nature of malignant pleural effusions. The highest importance is primary lung tumors, as well as those tumors in which the primary site of the tumor cannot be determined clinically.

INFLUENCE OF CANCER NEWS ON QUALITY OF LIFE OF PATIENT'S FAMILIES: AN OBSERVATIONAL STUDY

Malignant disease diagnosis brings great psychological suffering to the patient, and the sickness might have catastrophic ramifications for the relatives. The Objective of this study is to assess influence of cancer news on quality of life of patient's families. This study was prospective cohort study conducted at the oncology department of a tertiary care Hospital, Pakistan for the duration of one year. The quality of life was assessed as per pre-defined questionnaire both from two first degree relatives at each clinical visit during treatment every week and every month for six months after completion of treatment. Data analysis was done by employing SPSS version 21. 180 family members were included. QOL of family members was 1.54±0.57 (p=0.001). Anxiety/depression score of the family members was 1.67±0.64 while in control group it was 1.50±0.64 (p=0.031). The EQ VAS score in control group was 66.5±16.7 whereas in caregivers group, it was 71.3±18.8 (P=0.023). Stress was observed in 98 (54.44%) participants in caregivers group. Moderate-severe depression was observed in 45(25%) vs 21(11.67%) participants in caregivers vs control group, respectively (p=0.041) Our findings reveal that family caregivers of cancer patients face mental health issues and a decline in health-related quality of life. To reduce the effect of caring on the mental health and health related quality of life of family caregivers in Pakistan, culturally suitable caregiver support programs are required.

Needs and Difficulties of Parents with Children Suffering from Malignant Diseases

Malignant diseases are one of the leading causes of death in children in developed countries, although constant progress in therapy is continuously decreasing mortality. The diagnosis of malignant disease is a significant stressor in the life of a child and its family, significantly affecting the quality of life for the entire family. it constitutes the prototype of a stressful situation and a disease with a potentially devastating effect on the child and its family. This paper discusses 50 professional and scientific papers published between 1993 and 2022 that explore the needs and difficulties of parents of children with malignant diseases. To provide adequate help and care, a correct evaluation of the problem and parents’ needs is required. for the parents, the diagnosis of a malignant disease for their child constitutes a psy- chological and existential challenge. To meet the par- ents’ needs, as well as to ease their problems, further research – in most cases also supported by the parents themselves – is needed to help them cope with this extremely stressful and hard part of their lives.

The impact of patient-reported outcomes in cancer patients in Croatia.

e18659 Background: Perception of symptoms is essential for optimal cancer care and improving the quality of life but an inappropriate interpretation may lead to treatment outcomes failure or may leave the patients undertreated. This variation in the perception of adverse events (AEs) can lead to wrong assumptions and potentially unnecessary hospitalizations (H) or emergency room visits (ERV). Methods: Patients considered for inclusion were 18 years of age or older receiving systemic therapy and were able to read and understand questionnaire via tablet computers. All patients had a verified diagnosis of malignant disease of breast (31%), lung (17%), colorectal (16%), hematological (8%) or other site cancers (28%). Patients were asked on the same day as physician assessment, to complete 10 PRO-CTCAE symptoms (including fatigue, pain, nausea, vomiting, diarrhea, dysgeusia, appetite, sleep disturbance, fever, and alopecia). Participants remained on study until discontinuation of cancer treatment, withdrawal, or death. Informed consent was obtained from all patients and the study was approved by the institutional review board of the General Hospital Pula, Croatia. Concordance of symptoms reporting between patients and health care providers at the individual level was compared, and intraclass correlation coefficients were computed by a two way mixed effect model and an absolute agreement definition. Univariate and multivariate COX proportional hazard models adjusted for covariates including age, gender, cancer type and performance status were constructed for unplanned H and ERV. Results: The median age of 308 included patients in this trial was 62 years. Cohen's coefficient of agreement that corrects for chance for AEs gr. 1-5 and AEs gr. 3-4 was 0.115 (95%, CI, 0.15 to 0.02), indicating only slight agreement and 0.320 (95%, CI, 0.428 to 0.448) indicating fair agreement, respectively. Physicians underestimated symptoms at the group level (p < 0.013) for all symptoms. The highest level of agreement was found for pain but fatigue and alopecia were most underestimated. The median times of follow-up were 13 months, and 8,1 % of patients had H or ERV. Female patients had worse PRO scores, with higher levels of pain, fatigue, and alopecia across disease groups. In multivariate analysis, patient symptoms was not predictive, but we noticed trend for higher patient reports of pain (p = 0.05) for unnecessary H or ERV. Conclusions: The failure of the physician to identify a substantial number and severity of symptoms identified by the PRO instrument is not surprising considering the published experience in clinical trials. To our knowledge, this is the first such analysis aimed specifically at examining the reliability of physician identification of AEs in a real world practice in Croatia. The incorporation of PRO measures into routine practice might help to avoid unnecessary hospitalizations and emergency room visits. Clinical trial information: 2019-000855-15.

Safety and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for patients aged 80 years and older.

BackgroundThe safety and efficacy of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in patients aged 70 years and older has been established. However, few studies have evaluated the safety, usefulness, and significance of EBUS‐TBNA in patients aged 80 years and older.MethodsWe retrospectively investigated patients aged 80 years and older who underwent EBUS‐TBNA under local anesthesia. The study period was 10 years; from November 1, 2010 to October 31, 2020. The primary endpoint was the safety of EBUS‐TBNA, which was measured as the incidence of complications associated with the procedure. The secondary endpoints were the overall diagnostic rate, malignant disease diagnosis rate, and malignant disease treatment rate.ResultsA total of 111 patients were enrolled in the study, and the median age was 82 years (range: 80–89 years). The incidence of complications (the primary endpoint) was 5% (5/111) and comprised oversedation in one case, chest pain in one case, hypoxemia in two cases, and arrhythmia in one case. Regarding the secondary endpoints, the diagnostic rate for all patients was 75% (83/111), and the diagnostic rate of malignant disease was 89% (75/84). Of the 75 patients with malignant disease diagnosed with EBUS‐TBNA, 61 (81%) received tumor‐specific therapy in accordance with their diagnoses.ConclusionEBUS‐TBNA can be considered safe and effective even in patients aged 80 years and older.

Influence of Cancer News on Quality of Life of Patients Families: An Observational Study

Background: Malignant disease diagnosis brings great psychological suffering to the patient, and the sickness might have catastrophic ramifications for the relatives. Objective: To assess influence of cancer news on quality of life of patient’s families Methodology: This study was prospective cohort study conducted at the oncology department of tertiary care Hospitals of Peshawar for duration of one year. The quality of life was assessed as per pre defined questionnaire both from two first degree relatives at each clinical visit during treatment every week and every month for six months after completion of treatment. Data analysis was done by employing SPSS version 21. Results: A total of 180 family members were included. In the current study, the quality of life of family members was 1.54±0.57 in view of usual activities (p=0.001). Anxiety/depression score of the family members was 1.67±0.64 while in control group it was 1.50±0.64 (p=0.031). The EQ VAS score in control group was 66.5±16.7 whereas in caregivers group, it was 71.3±18.8 (P=0.023). Based on mental health, stress was observed in 98 (54.44%) participants in caregivers group. Moderate-severe depression was observed in 45 (25%) participants in caregiveres group whereas in contorl group moderate to severe depression was observed in 21 (11.67%) subjects. (p=0.041) Conclusion: Our findings reveal that family caregivers of cancer patients face mental health issues and a decline in health-related quality of life. To reduce the effect of caring on the mental health and health related quality of life of family caregivers in Pakistan, culturally suitable caregiver support programs are required. Key words: Cancer news; Quality of life; Stress; Depression

Photothermal triggered clinical swab point-of-care testing diagnostics: fluorescence-pressure multi-signal readout detection of cervical cancer biomarker

In this protocol, a photothermal triggered multi-signal readout point-of-care testing (POCT) was established in a multifunctional clinical vagina swab for Human papillomavirus type 16 E6 (E6 protein) determination. Particularly, a portable vagina swab was employed as a sensing substrate integrated collection and analysis of samples. The composite probe SiC-CS@Ag with the chitosan (CS) decorated silicon carbide nanoparticles (SiC NPs) as a label was bounded to the swab via competitive reaction. To transfer recognition events into detectable signals, a flexible fluorescence -temperature indicator (FLTI) with thermal-responsive fluorescence capability was assembled on swab surface followed by sealing it into a home-made tiny pressure device and H2O2 as a signal reporter was introduced. Under near-infrared (NIR) laser expose, remarkable photothermal effect from SiC-CS@Ag caused notable temperature elevation, which lead to significant fluorescence (FL) quenching on FLTI. Meanwhile, increased temperature also enhance the catalase-like activity of SiC-CS@Ag toward H2O2 decomposition that cause significant pressure elevation. This bioassay realized sensitive target detection in the linear ranger from 10-6 ng/mL to 1 ng/mL with detection limits of 1.60 × 10-6 ng/mL. Such a photothermal mediated multi-signal readout sensing platform not only provides rapid and precise methodologies for biomarker detection, but also enriches strategies for POCT and boosted its application for early diagnosis of malignant diseases in remote areas.

IgG4 immunoglobulin subclass and related pathological conditions or how to effectively imitate cancer disease.

IgG4 is the least represented subclass of human imunnoglobulines G (IgG) in serum and differs from other antibodies by its unique bio-logical properties. Although its function in the immune response is not entirely clear, it is mainly involved in the regulation of the immune response. It is formed as a result of chronic or strong antigenic stimulation; in such a case, it becomes a predominantly formed IgG subclass. IgG4 play a key role in the immune tolerance in allergies and tumors. The tolerogenic potential of IgG4 is used in the treatment of allergic diseases using the allergen immunotherapy; at the same time, it is also involved in inducing the immunological tolerance in the microenvironment of tumors, which promotes tumor progression. The increase of serum IgG4 is associated with relatively recently described groups of diseases. In addition to the IgG4-autoimmune diseases, it is mainly connected with IgG4-associated diseases (IgG4-RD) where various organs of the human body are affected by the formation of fibrous and sclerosing deposits in this group of the immune-mediated diseases, which leads to specific organ dysfunction. The most commonly affected organs include the pancreas and large salivary glands; moreover, the orbits and lacrimal glands, the biliary tract, the lungs, the kidneys, the retroperitoneum, the aorta, the meninges, and the thyroid gland may also be affected. It is not entirely clear whether these patients have a higher prevalence of cancer than the general population; however, there is also another relationship between IgG4 and cancer. IgG4-RD very often imitate advanced cancer in medical imaging techniques, so its existence should also be considered in the differential dia-gnosis of malignancies. The aim of this article is to draw attention of clinical oncologists to the issue of IgG4-associated diseases group which can mimic cancer condition in various organs in the human body. Therefore, it is necessary to bear them in mind in the differential dia-gnosis of malignant diseases.

Comparison among the Role of Different Imaging Techniques in Diagnosis of Malignant Lesions Causing Obstructive Jaundice

Introduction: The expanding spectrum of therapeutic options for patients with Obstructive /surgical jaundice makes it necessary for the surgeon to precisely assess the etiology, location, level and extent of disease before operation. Aims were to compare the diagnostic accuracy, sensitivity and specificity of different imaging techniques like ultrasonography (USG), Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in evaluation of patients with malignant obstructive jaundice and correlation of histopathological findings after surgical/ therapeutic intervention. Methods: It was a prospective observational study conducted in the Department of General Surgery and Hepatobilliary unit, Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka during January 2015 to December 2015 for duration of one year to find out the role of different imaging techniques in diagnosis of malignant lesions causing obstructive jaundice in 50 cases who fulfilled the inclusion criteria. Initial USG evaluation was followed by CT scan, MRCP and ERCP. The results were read by radiologists blinded to other imaging findings. Surgically fit patients with a stage of resectability should be offered the option of surgical resection for cure. For unresectable malignancies, the choice is between surgical palliation/bypass and ERCP with drainage. The characteristic surgical findings or ERCP features and histopathological diagnosis were recorded methodically as final. Results: Malignant obstructive jaundice is the commonest amongst the males and mean age was 47.56 ± 13.191 and the commonest etiology was Ca head of pancreas (30%). Diagnostic accuracy of MRCP (98%) in the diagnosis of malignant obstructive jaundice was relatively high (98%) as compared to ERCP (89.5%), CT (91.43%), USG (89.97%) in malignant obstructive jaundice respectively. In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to ERCP (89%), CT scan (91.67%) and ultrasonography (78.17%). Regarding specificity MRCP (100%) was the high in comparison among ERCP (94%), CT (90.91%) and USG (96.15%).Conclusion: It is concluded that malignant obstructive jaundice is the commonest amongst the males. Ca head of pancreas was the commonest malignant etiology in malignant obstructive jaundice. MRCP was superior to among USG, CT scan or ERCP in studying the malignant lesions. J Bangladesh Coll Phys Surg 2021; 39: 233-240

Social factors influence the course and prognosis of malignat diseases.

Astatement of the dia-gnosis of malignant disease fundamentally changes the identity of aman. Ahealthy person changes to apatient. Alot of studies analyzed the influence of marital status on the disease development. We present an analysis of interpersonal relationships in connection with oncological diseases. The majority of the authors consider living in acouple as apositive prognostic factor. On the other hand, malignant disease at ayounger age increases the risk of divorce or breakup.

Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including 18F-FDG-PET/CT/MRI-A Rare Case.

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (18F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (18F-FDG-PET/CT/MRI (The imaging modality 18F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same 18F-FDG-tracer dose for both the whole-body 18F-FDG-PET/CT and the regional 18F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased 18F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, 18F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed.

Atypical vessels in hysteroscopy: Usefulness in prediction of malignant diseases in patients treated with tamoxifen.

Tamoxifen (TAM) is widely used in adjuvant endocrine therapy for invasive breast cancer as a selective estrogen modulator, but this treatment has a risk of developing endometrial malignancy. However, hysteroscopic findings during or after TAM treatment are unclear. The aim of this study is to examine the association between hysteroscopic patterns and malignant histological findings during or after treatment with TAM. The subjects were patients who received TAM after surgery for breast cancer and underwent hysteroscopy at our institution from January 2016 to December 2019. Clinicopathological factors and hysteroscopic findings were collected from medical records and investigated retrospectively. Histologically, atypical endometrial hyperplasia, endometrial cancer, and carcinosarcoma were classified as malignant diseases. A total of 26 patients were eligible for the study. Hysteroscopic findings included an irregular surface of the endometrium (n = 3, 11.5%), atypical vessels (n = 10, 38.5%), papillary structure (n = 3, 11.5%), and polypoid structure (n = 18, 69.2%). Histological examination revealed malignancy in six patients (23.0%). The percentage of atypical vessels in patients with malignancies was significantly higher than that in patients with a normal endometrium or benign lesion (100% vs. 20%, p = 0.0009). The sensitivity and specificity of atypical vessels in hysteroscopy for diagnosis of malignant diseases were 100% and 80%, respectively. Hysteroscopic findings of atypical vessels may be useful for prediction of malignant diseases in patients treated with TAM.

MiR-340: A multifunctional role in human malignant diseases.

MicroRNAs (miRNAs) are a class of short non-coding RNAs of approximately 22 nucleotides in length, which function by binding to the 3' UTR sequences of their target mRNAs. It has been reported that dysregulated miRNAs play pivotal roles in numerous diseases, including cancers, such as gastric, breast, colorectal, ovarian, and other cancers. Recent research efforts have been devoted to translating these basic discoveries into clinical applications that could improve the therapeutic outcome in patients with cancer. Early studies have shown that miR-340 may act either as an oncogene or a tumor suppressor by targeting genes related to proliferation, apoptosis, and metastasis, as well as those associated with diagnosis, treatment, chemoresistance, and prognosis. miR-340 has been shown to have a role in other diseases, such as autoimmune diseases, acute stroke, and alcoholic steatohepatitis. Nevertheless, the roles of miR-340 in human malignancies are still unclear, and the associated mechanisms are complex, involving a variety of signaling pathways, such as Wnt/β-catenin and the JAK-STAT pathways. Herein, we review the crucial roles of miR-340 in human cancers through the analysis of the latest research studies, with the aim of clarifying miR-340 function in malignant disease diagnosis, treatment, and prognosis, and to propose further investigations.

Зрелая тератома во время беременности и в послеродовой период

Ovarian tumors are detected in 2-3% of pregnant women. They may cause complications such as torsion of the tumor or appendages, rupture of the capsule, threat of termination of pregnancy or premature birth, obstruction of the birth canal, risk of tumor malignancy. Patients with mature teratomas most often have no or few symptoms, hence complicated diagnostics. The bimanual examination and the ultrasound method are not so effective due to the pregnancy. The tumor markers are not so meaningful in the differential diagnosis of malignant diseases, which complicates the choice of treatment tactics. That is why we present the clinical cases of pregnancies with a mature teratoma. The correct differential diagnosis of complications of ovarian tumors with diseases such as endometritis and other inflammatory diseases are very important.

Cellular DNA based cancer diagnosis using self-internalized plasmonic sensors

The SERS sensing of nucleic acids (DNA) by coating the plasmonic materials with a biocompatible layer and complementary DNA strands developed an entire stimulating area in biomedical applications, specifically for the diagnosis of malignant diseases. However, the labels and coating increase the overall hydrodynamic size of the plasmonic nano-materials, which restricts the internalization inside the nucleus, and DNA sensing stays limited to the sensing of cytoplasmic DNA or isolated DNA strands. To elucidate this, here we introduce the concept of sensing the intracellular DNA in the in vitro environment by using small plasmonic sensors for cancer diagnosis. As far as we know, it is the first attempt to study the native plasmonic sensors for the sensing of intracellular DNA molecules without the need for surface labels and coatings. Here, the plasmonic sensors were able to successfully self-internalize inside the cellular nucleus by diffusion mechanism because of its extremely small size (2.3 nm). Due to the presence of plasmonic sensors inside the nucleus, the DNA signal’s intensity significantly increases by a minimum of 700 folds. The SERS signals resulted in the simultaneous sensing of multiple cellular components, which can be used for the analysis of cancer. Therefore, by using Principal Component Analysis (PCA) and Hierarchical Clustering analysis, we can analyze a significant difference between malignant (lung cancer and pancreatic cancer) and healthy cells. In addition to differentiating between cancerous and healthy cells, we were able to differentiate lung cancer cells from pancreatic cancer cells. The native plasmonic sensors were synthesized by using physical synthesis methods (laser synthesis), which eliminates the need for labels and surface coating, as the sensors are synthesized without residues. This indicates that the physically synthesized sensors can sense the DNA molecules in the in vitro environment without losing signals or distortion. The present study holds a promising potential for developing a new technique for accurate diagnosis of the cancer-based on cell DNA diagnosis.

Occurrence of Seizures Prior to Single-fraction Radiosurgery or Multi-fraction Stereotactic Radiotherapy in Patients With Very Few Brain Metastases.

Seizures represent a major problem for patients with brain metastases. This study evaluated the role of seizures in patients receiving single-fraction radiosurgery (SRS) or multi-fraction stereotactic radiotherapy (FSRT). This retrospective study included 195 patients receiving SRS (n=164) or FSRT (n=31) alone for one to three brain metastases. The prevalence of pre-SRS/FSRT seizures and correlations with pre-treatment factors were investigated. These factors plus pre-SRS/FSRT seizures were assessed in regard to survival. Thirty-three patients had pre-SRS/FSRT seizures (prevalence=16.9%). Seizures were significantly correlated with age ≤61 years. Trends were observed for seizures being more frequent in those with NSCLC and those without extra-cranial metastatic spread. On multivariate analysis, significant associations with improved survival were found for Karnofsky performance score ≥80%, breast cancer, and an interval from diagnosis of malignant disease to SRS/FSRT ≥21 months. Younger age, NSCLC and absence of extra-cranial spread appeared to be risk factors for seizures prior to SRS/FSRT. Having seizures prior to SRS/FSRT showed no association with survival.

Possibilities of per-oral transpapillary cholangioscopy in oncological practice

Relevance. Diagnosis of malignant diseases causing bile duct strictures is a big challenge. At admission, patients with suspected biliary tract stricture, initially undergo endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and treatment method. The morphological diagnosis of bile duct stricture based on ERCP with brush biopsy or intraductal forceps biopsy is limited by their low sensitivity. Consequently, a significant proportion of strictures remains undiagnosed, which led to the development of methods based on cholangioscopy.
 Aim. To determine the role of per-oral transpapillary cholangioscopy (TCS) in a specialized cancer clinic.
 Materials and methods. SpyGlass direct visualization system for per-oral intraductal examination from Boston Scientific was clinically tasted in Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. Using this electronic system, TCS was performed in 4 patients with various malignant diseases.
 Results. In all cases, TCS was successful. In all patients, the diagnosis was confirmed with a forceps intraductal biopsy using Spybite forceps.
 Conclusion. Single-use electronic direct visualization system for per-oral intraductal examination and interventions like SpyGlass can be recommended for use in specialized cancer centers.

Single-cycle rituximab-induced immunologic changes in children: Enhanced in neuroimmunologic disease?

ObjectiveTo investigate the immunologic impact of a single cycle of rituximab (RTX) in children and adolescents with immune-mediated disorders, we evaluated B cells and immunoglobulin levels of 20 patients with neuroimmunologic, nephrologic, dermatologic, and rheumatologic disorders treated under recommended guidelines.MethodsRetrospective study of immunologic changes in children (aged ≤18 years) diagnosed with immune-mediated disorders in which RTX was prescribed between June 2014 and February 2019. Patients were excluded if they had prior diagnosis of malignant disease or primary immunodeficiency. Patients were clinically and immunologically followed up every 3 months. Only patients having received a single cycle of RTX and with a follow-up greater than 12 months were included in the analysis of persistent dysgammaglobulinemia.ResultsTwenty children were included. Median age at RTX treatment was 12.8 years (interquartile range [IQR] 6.6–15.5 years). Median follow-up was 12.6 months (IQR 10.2–24 months). Of the 14 patients eligible for persistent dysgammaglobulinemia analysis (3 had received RTX retreatment, 2 had <12 months post-RTX follow-up, and in 1 data for this time point was missing), 2/14 (14%) remained with complete B-cell depletion, and 5/14 (36%) had dysgammaglobulinemia. Patients with dysgammaglobulinemia were younger (7.8 vs 15.6 years, p = 0.072), had more underlying neuroimmunologic diseases (5/5 vs 0/9, p < 0.001), and had received more frequently concentrated doses of RTX (3/5 vs 1/9, p = 0.05) than patients without dysgammaglobulinemia. Kinetics of immunoglobulins in the 20 patients revealed a decrease as early as 3 months after RTX in patients with neuroimmunologic disorders.ConclusionIn our cohort, single-cycle RTX-induced dysgammaglobulinemia was enhanced in patients with neuroimmunologic diseases. Further studies are needed to confirm this observation.

Role of the Hsp90-Immunophilin Heterocomplex in Cancer Biology

The identification of new factors that may function as cancer markers and become eventual pharmacologic targets is a challenge that may influence the management of tumor development and management. Recent discoveries connecting Hsp90-binding immunophilins with the regulation of signalling events that can modulate cancer progression transform this family of proteins in potential unconventional factors that may impact on the screening and diagnosis of malignant diseases. Immunophilins are molecular chaperones that group a family of intracellular receptors for immunosuppressive compounds. A subfamily of the immunophilin family is characterized by showing structural tetratricopeptide repeats, protein domains that are able to interact with the C-terminal end of the molecular chaperone Hsp90, and via the proper Hsp90-immunophilin complex, the biological properties of a number of client-proteins involved in cancer biology are modulated. Recent discoveries have demonstrated that two of the most studied members of this Hsp90- binding subfamily of immunophilins, FKBP51 and FKBP52, participate in several cellular processes such as apoptosis, carcinogenesis progression, and chemoresistance. While the expression levels of some members of the immunophilin family are affected in both cancer cell lines and human cancer tissues compared to normal samples, novel regulatory mechanisms have emerged during the last few years for several client-factors of immunophilins that are major players in cancer development and progression, among them steroid receptors, the transctiption factor NF-&amp;#954;B and the catalytic subunit of telomerase, hTERT. In this review, recent findings related to the biological properties of both iconic Hsp90-binding immunophilins, FKBP51 and FKBP52, are reviewed within the context of their interactions with those chaperoned client-factors. The potential roles of both immunophilins as potential cancer biomarkers and non-conventional pharmacologic targets for cancer treatment are discussed.