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Melanomas of the skin are poorly circumscribed lesions, very frequently asymptomatic but unfortunately with a continuous growing incidence. In this landscape, one can distinguish melanomas originating in the mucous membranes and located in areas not exposed to the sun, namely the vulvo-vaginal melanomas. By contrast with cutaneous melanomas, the incidence of these types of melanomas is constant, being diagnosed in females in their late sixties. While hairy skin and glabrous skin melanomas of the vulva account for 5% of all cancers located in the vulva, melanomas of the vagina and urethra are particularly rare conditions. The location in areas less accessible to periodic inspection determines their diagnosis in advanced stages, often metastatic. Moreover, despite the large number of drugs newly approved in recent decades for the treatment of cutaneous melanoma, especially in the category of biological drugs, the mortality of vulvo-vaginal melanomas has remained almost constant. This, together with the absence of specific treatment guidelines due to the lack of a sufficient number of cases to conduct randomized clinical trials, makes melanomas with this localization a discouraging diagnosis, associated with a very poor prognosis. Our aim is therefore to draw attention to this oftentimes overlooked entity in order to encourage the community to employ various strategies meant to increase research in this area. By highlighting the main risk factors of vulvar and vaginal melanomas, as well as the clinical manifestations and molecular changes underlying these neoplasms, ideally novel therapeutic schemes will, in time, be brought into effect.

Objectives. Local recurrence after distal rectal cancer surgery is a major complication with an increased morbidity and mortality. The therapeutic strategy consists in a complex association of radiochemotherapy with surgical approach that may improve prognosis and quality of life. It is necessary to identify the risk factors for local recurrence and to have a highly-selected patients for oncological radical treatment. Materials and methods. The study included the analysis of 79 patients with middle and lower rectal cancer who were diagnosed and operated at Coltea Clinic Surgical Clinic Hospital, Bucharest, for a period of 4 years. Male patients were more frequent (64.4%). The average age was 65 years old. The surgical strategy included 33 patients (41.8%) who underwent abdominoperineal resection, 36 patients (45.6%) who underwent low anterior resection with stapled colorectal anastomosis and 10 patients (12.75) who underwent ultralow anterior resection. Results. Local recurrence rate was 12.7%. The mean time from surgery until the time of discovery of local recurrence was 14.5 months. Local recurrence was associated with advanced tumor stages T3 (10.1%) and T4 (2.5%). It was also associated with histopathological features related to serous infiltration (100%) and tumor invasion of the radial margins (3.8%). The surgical treatment strategy consisted of abdominoperineal resection, permanent colostoma and R2 resections. Discussion. The radical surgical resection is the most significant prognostic factor. There are a number of other patient-related factors and tumor-related factors that can significantly influence the evolution and overlall survival. Periodic clinical, imaging scans and colonoscopy follow-ups are able to early detect the tumor recurrence and to allow a curative cancer treatment. Conclusions. Local recurrence after mid and lower rectal cancer surgery is a major complication with direct impact on morbidity, mortality, prognosis and quality of life of these patients. The treatment strategy must be established by a multidisciplinary team in order to identify carefully-selected patients to undergo the optimal oncological therapy.

Studies of HIV-1-infected individuals on anti-retroviral therapies and of patients receiving lymphoablating treatments indicate that the thymus retains restorative capacity even in adults. The contributions of the thymic epithelial cells (TECs) to the regeneration of the thymus and the identity of epithelial cell progenitors were evaluated in murine models of transient thymic atrophy followed by a complete regeneration. Using microarray approach, we analyzed the pattern of gene expression in TECs sorted from mice that were depleted of thymocytes by steroid treatment or by irradiation. The initial analysis identified significant increases in the mRNA for cMyc, Trp63 and Tcf3 transcription factors known to be expressed in early epithelial cell progenitors in tissues other than the thymus. Immunohistochemistry showed that in involuted thymuses, the cMyc and Trp63 proteins were expressed in a subset of cortical thymic epithelial cells (cTECs) that were keratin 5 positive (K5+), typifying cTEC precursors. Importantly, confocal microscopy established that epithelial cells with the phenotype of putative TEC progenitors (i.e. K5+K8+) expressed the Trp63 protein and confirmed that K5+K8+ TEC progenitors expanded significantly during atrophy and prior to the thymic regeneration. Thus, our data demonstrated for the first time that critical steps in the recovery of the adult thymus include expansion of TEC progenitors and elevated expression of Trp63, cMyc and Tcf3 transcription factors in the thymic stroma. These results suggest that TEC progenitors could be reactivated in the adult thymus and, therefore, reactivation of TEC progenitors could provide a new approach for thymic reconstitution. [ABSTRACT FROM AUTHOR]