Background/Aim. Colorectal cancer (CRC) is one of the most common cancers in the population, often leading to lethal outcome. Myeloid-derived suppressor cells (MDSC) belong to a heterogeneous group of immature cells that are thought to have an immunosuppressive effect that may aid in tumor development and spread. The aim of this study was to analyze the frequency and significance of MDSC like cells at different stages in patients with CRC. Methods. We analyzed a blood samples in 83 patients at different stages of the disease and 12 healthy subjects who made up the control group. MDSC like cells were detected and enumerated in peripheral blood samples of the participants based on the immunophenotypic characteristics of the cells. Results. A statistically significant increase in the absolute and relative number of polymorphonuclear MDSC like cells (PMN-MDSC like cells) in peripheral blood was observed in total patients with CRC compared to the healthy, control group (p <0.0001). No statistically significant increase was observed in mononuclear MDSC like cells (M-MDSC like cells) when analyzed without stage stratification (p> 0.05). Analyzing the relative and absolute number of PMNMDSC like cells according to the stages of CRC disease (TNM classification), a statistically significant difference was observed between the control group and patients in stage III and IV disease (p=0.0005 vs p=0.0003 and p<0.0001 vs p<0.0001, respectively), as well as comparing values in stage I and II patients with PMN-MDSC like cells values in stage IV CRC (p=0.0161 vs p<0.0001 and p=0.0065 vs p<0.0001, respectively). A statistically significant difference in the relative and absolute number of M-MDSC like cells was observed only in patients between stage II and IV disease (p = 0.0014 and p = 0.0002, respectively). The highest number of MDSC like cells were observed in stage IV of the disease according to the TNM classification. Positive correlation between the presence of these cells and the number of organs affected by metastatic changes was observed (p<0.0001 for relative and absolute number of PMN-MDSC like cells and p=0.003 and p=0.0004 for relative and absolute number of M-MDSC like cells). Conclusion. CRC patients had a statistically significant increase in PMN-MDSC like cells compared to healthy controls. The increase in absolute and relative numbers of these cells mostly follows the growth and progression of CRC, while a statistically significant difference in 4 the number of M-MDSC like cells is observed only between stages II and IV of the disease. The absolute and relative numbers of both subtypes of MDSC-like cells correlate with the number of organs affected by CRC metastases.

Introduction. Portal vein (PV) thrombosis (PVT) is a partial or a complete obstruction of blood flow as a result of a thrombus mass in the lumen of PV. In the acute phase, the symptoms are unspecific such as right upper quadrant pain, nausea and fever. Diversity of subacute and chronic symptoms are associated with complications related to PVT and portal hypertension. Case report. We are presenting a case of a 50-year-old female who was admitted in hospital due to acute abdominal cramping pain. The pain lasted for 15 to 20 minutes, and was followed by defecation of normal stool and haematochezia in three occasions. The abdominal pain returned in several hours, again followed by haematochezia and tenesmuses every 10 minutes. After admission a colonoscopy was performed that determined vulnerable, erythematous mucosa of the colon with contact bleeding from lienal flexure to rectosigmoid junction. During the colonoscopy, a biopsy was performed. A computer tomography (CT) scan revealed partial PVT, thrombosis of intrahepatic branches of PV and thrombosis of the inferior mesenteric vein. After conservative treatment with low molecular weight heparin (LWMH), and other supportive measures the digestive bleeding ceased, and defecation became normal. During one month follow up a patient has had no complications and control CT scan revealed normal PV flow without thrombosis. Conclusion: Although is a rare, a non-malignant and non-cirrhotic PVT in differential diagnosis should not be neglected because timely and vigilant therapy with LWMH can lead to complete resolution without serious complication.

Background/Aim. Myeloid-derived suppressor cells (MDSC) represent a heterogeneous group of immature cells of myeloid origin, which have the ability to inhibit both the innate and adaptive immune response. Due to its immunosuppressive effect, MDSC can promote the growth and progression of cancer. Colorectal cancer (CRC) is one of the most common cancers in the general population for whose advanced stages of the disease there is still no good therapy. In addition to contributing to the development and spread of CRC, MDSC could potentially be markers of its prognosis. The aim of the study was to examine the potential prognostic role of peripheral blood MDSC counts in CRC patients. Methods. In a prospective study we analyzed the possibility of using CD16low granulocytes and mononuclear (M-MDSC) like cells as well as neutrophyl to lymphocyte ratio (NLR), lymphocite to monocyte ratio (LMR), CD16hi/CD16low granulocytes ratio and M/MMDSC like cells ratios before starting of the treatment as a biomarker for overall survival (OS) in patients with CRC. Hazards ratios (HRs) with the corresponding 95% confidence intervals (95%CIs) were calculated to evaluate the prognostic role of MDSCs in cancer. Results. The analysis was performed in 47 patients in stage III and IV CRC according to the TNM/AJCC disease classification. Dependable data were obtained in 32 patients. Patients blood samples are taken before the possible start of treatment (surgery, chemotherapy). Increased percentage and absolute values of CD16low granulocytes as well as absolute values of M-MDSC-like cells have been shown to be associated with shorter overall survival (OS) (p < 0.0066, p < 0.0013 and p < 0.0119, respectively). The relationship of CD16hi/CD16low granulocytes ratio and M/M-MDSC like cells ratio with OS indicated the existence of positive correlations between these parameters, which higher value of this relationship indicated longer survival of patients (p < 0.0054 and p < 0.0426, respectively). Relationship between OS and NLR indicators found statistically significant inverse correlation with NLR (p = 0.0349). No statistical significance was found in the relationship between OS and LMR. Conclusion. This study shows that percent and absolute numbers of CD16low granulocytes, as well as absolute number of M-MDSC like cells, CD16hi/CD16low granulocytes ratio, M/M-MDSC like cells and NLR ratio ratio may be reliable indicators of survival in patients with CRC.