In this paper, we present the successful therapeutic approach of unresectable liver metastases in a patient with rectal cancer.A 63-year-old male underwent endoscopic polypectomy followed by rectosigmoid resection for an adenocarcinoma of the rectum diagnosed in pT2N0 stage. The angio-computed tomography (CT) revealed four metastatic hepatic nodules ranging from 12 to 130 mm in diameter. After one cure of trans-arterial chemoembolization (TACE) with lipiodol and 5-fluorouracil, combined with FOLFOX4 + capecitabine systemic chemotherapy, the diameter of all hepatic nodules decreased to half size, at 6 months after TACE. Further curative surgical hepatic metastasectomy was done and complete pathologic response was obtained. The patient is free of recurrences and metastases after 26 months of follow-up.This representative case shows that an efficient trans-disciplinary approach could lead to successful therapeutic management even in patients with advanced-staged colorectal carcinomas.

Malignant melanoma (MM) is a highly heterogenic tumor whose histological diagnosis might be difficult. This study aimed to investigate the diagnostic and prognostic utility of the conventional pan-melanoma cocktail members (HMB-45, melan-A and tyrosinase), in conjunction with SOX10 and SOX11 immunohistochemical (IHC) expression. In 105 consecutive cases of MMs and 44 of naevi, the IHC examination was performed using the five-abovementioned markers, along with microphthalmia transcription factor (MITF), S100, and Ki67. Correlation with the clinicopathological factors and a long-term follow-up was also done. Survival analysis was performed with Kaplan–Meier curves and compared with TCGA public datasets. None of the 44 naevi expressed SOX11, but its positivity was seen in 52 MMs (49.52%), being directly correlated with lymphovascular invasion, the Ki67 index, and SOX10 expression. HMB-45, SOX10, and tyrosinase, but not melan-A, proved to differentiate the naevi from MMs successfully, with high specificity. Triple MITF/SOX10/SOX11 co-expression was seen in 9 out of 15 negative conventional pan-melanoma-cocktail cases. The independent prognostic value was proved for the conventional pan-melanoma cocktail (triple positivity for HMB-45, melan-A, and tyrosinase) and, independently for HMB-45 and tyrosinase, but not for melan-A, SOX10, or SOX11. As consequence, to differentiate MMs from benign naevi, melan-A should be substituted by SOX10 in the conventional cocktail. Although the conventional pan-melanoma cocktail, along with S100 can be used for the identification of melanocytic origin of tumor cells and predicting prognosis of MMs, the conventional-adapted cocktail (triple positivity for HMB-45, SOX10, and tyrosinase) has a slightly higher diagnostic specificity. SOX11 can be added to identify the aggressive MMs with risk for lymphatic dissemination and the presence of circulating tumor cells.

MULTIPLE COLONIC AND GASTRIC METASTASIS OF ENDOMETRIAL ADENOCARCINOMA -CASE REPORT (Abstract): INTRODUCTION:In the gynecological malignancies endometrial adenocarcinoma is the second most common, giving early hematogenous and lymphatic metastasis to the lungs, brain and bones. CASE REPORT: We present the case of a 71 year old patient who underwent surgery two years ago for endometrial adenocarcinoma and followed postoperatively multimodal oncological treatment. The patient was admitted in January 2013 in the First Surgery Clinic of the Emergency Clinical County Hospital Târgu Mureş, Romania, for chronic anemia, consumptive disease signs and subocclusive syndrome. The preoperative exams (upper and lower gastrointestinal endoscopy, thoracoabdominal computed tomography and ultrasound) found a tumor invading right, transverse and sigmoid colon as well as gastric antrum and spleen. A subtotal colectomy with ileo-rectal anastomosis was then performed associated with distal gastrectomy and splenectomy. The histopathological exams revealed gastric and colonic metastasis from the endometrial serous cancer operated two years ago. The postoperative evolution was uneventful. CONCLUSIONS: Endometrial cancer can metastasize to the colon and stomach even without the presence of endometriosis. Multivisceral resections and preoperative exams of the digestive tract are justified in terms of subjective complaints of an occlusive simptomatology.

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