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Volume 75 - 2012 - Fasc.2 - Case series

Serrated lesions of the colorectum, a new entity : What should a clinician-endoscopist know about it ?

Serrated polyps of the colorectum have received much attention in recent literature. Several classifications have been proposed and created considerable confusion. Morphology and molecular biology have greatly contributed to the better identification of these entity. The recently published WHO classification, proposed using the term of "serrated polyp" as a generic term and defined sporadic serrated polyps as "a heterogeneous group" of lesions characterized morphologically by a serrated (sawtooth or stellate) architecture of the epithelial com- ponent which include hyperplastic polyps (HP), sessile serrated adenomas/polyps (ssA/P) and traditional serrated adenomas (TSA). With the development of molecular biology, it is now clear that the serrated pathway is one of the new carcinogenic pathways in the colon. There is now strong evidence that some serrated polyps correspond to precursors of some sporadic colorectal cancer (CRC). The aim of this article is to summarize the present data concerning the morphological and molecular characteristics of these serrated lesions and to give some recommendations for the management of such lesions. (Acta gastroenterol. belg., 2012, 75, 197-202).


Familial primary biliary cirrhosis : Like mother, like daughter ?

The reasons underlying why autoimmune diseases overwhelmin- gly affect women more than men are not clear. Nor are the reasons why autoimmune disease is more prevalent in families. This review uses primary biliary cirrhosis (PBC) as a model autoimmune disease to discuss the familial risk, focusing mainly on mother- daughter pairs. PBC is a chronic cholestatic liver disease characte- rised by an immune-mediated inflammatory destruction of the small intrahepatic bile ducts, with fibrosis progressing to cirrhosis and subsequent liver failure. Epidemiological studies have demon- strated that first degree relatives of PBC patients are at higher risk of developing PBC, as well as other autoimmune diseases. This is especially true for the mothers, daughters and sisters of PBC patients. Multiple case reports have highlighted the complexity of mother-daughter pairs in PBC, and the need for follow-up of these individuals when one member of the pair is diagnosed with PBC. It may be the case that diagnosis in one individual may lead to early diagnosis in the other, even if they are asymptomatic. Early management of PBC may improve the prognosis in these patients. This review will examine the literature surrounding PBC in mothers and daughters. (Acta gastroenterol. belg., 2012, 75, 203-209).


Molecular changes in pancreatic cancer : implications for molecular targeting therapy

Pancreatic ductal adenocarcinoma has a high mortality rate, which is generally related to the initial diagnosis coming at late stage disease combined with a lack of effective treatment options. Gemcitabine has been the most commonly used drug over the past decade and is still the cornerstone of therapy in adjuvant and metastatic settings. Intrinsic or acquired resistance of tumours to gemcitabine is, however, a major clinical problem. New therapeu- tic strategies are urgently needed whereas we also need to identify new prognostic and predictive biomarkers. This article focuses on gemcitabine resistance, on the role of chemokines and chemokine receptors in pancreatic carcinoma initiation and progression, and on stellate cells as partners in crime with neoplastic epithelial cells. (Acta gastroenterol. belg., 2012, 75, 210-214).