Author: Ruxandra D. Sinescu-Bălțăteanu

The Endocrine Approach of Melanoma: The Puzzle of Estrogen Receptors Expression

Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays.

Anatomic-surgical study on the interparietoperitoneal space from a laparo-endoscopic perspective

The interparietoperitoneal (IPP) space, by a broad definition, is the space between the musculo-fascial walls of the abdomen and the parietal peritoneum. A review of the literature on this subject has been performed through a search in the databases according to the following

Vitamin D status and cholecalciferol supplementation on patients with active Basedow disease: a clinical study

This study aims to analyze the 25-hydroxyvitamin D (25OHD) corelations with TRab (anti-TSH receptor Antibodies) at baseline and after corections of 25OHD deficit. Method: Prospective, interventional, controled, single-centre, clinical study on 62 patients with active Basedow disease (BD), admitted at C.I. Parhon National Institute of Endocrinology, Bucharest, Romania, between 2013 and 2020. Patients were divided into two groups: one group (N=37) received 2000 IU of daily cholecalciferol and a second one (N=25) without vitamin D supplementation, all subjects being under anti-thyroid drugs (standard guideline therapy). 25OHD and TRab levels were assessed at start and after 6, respective 12 months. Results: Initial evaluation confirmed vitamin D deficiency (mean 25OHD of 18.33±6.45 ng/mL). At start, TRab negatively correlates with 25OHD (N=62, r= -0.22, p=0.08). The decrease in TRab was statistically significant higher in group 1 versus group 2 after 6 months (35.84% versus 3.53%, p=0.03). After 12 months, TRab decreased with 56.28% in group 1, respective 27.16% in group 2 (p=0.03). In group 1, inverse correlation between 25OHD and TRab was consistent at 6 and 12 months. Conclusion: In patients with active BD, TRab values were negatively correlated with 25OHD at baseline and during follow-up. Correction of vitamin D deficiency is correlated with the decrease of TRab levels.