Can Fibulin-5 Induce Gastrointestinal Stromal Tumor Development?

Özet

Objective: Gastrointestinal stromal tumors are the most common primary mesenchymal tumors of the gastrointestinal tract and show Cajal cell differentiation. Fibulin-5 is a multifunctional extracellular matrix protein that inhibits epithelial and endothelial cell proliferation. Expression of fibulin-5 is down-regulated in various carcinomas. In contrast, fibulin-5 stimulates fibroblast and fibrosarcoma cells. In this study we aimed to investigate the expression of fibulin-5 in Cajal cells and gastrointestinal stromal tumors. Materials and Methods: Immunohistochemical fibulin-5 staining is performed on 34 (22 gastric and 12 small intestinal) gastrointestinal stromal tumors. Fibulin-5 staining intensity was scored in 4 quantitative categories and compared with clinicopathological features of the patients. Results: There was no staining in 4 of the gastrointestinal stromal tumors; weak staining in 20 cases, moderate staining in 6 cases, and strong staining in 4 cases were observed. In 3 cases Cajal cells were detected with fibulin-5 by moderately staining. The relationship between fibulin-5 staining intensity and age and gender of the cases, localization, size, grade, and the risk groups of the tumors wasn’t statistically significant. Conclusion: A great proportion of gastrointestinal stromal tumors show fibulin-5 expression, even if weak, in contrast to the infrequent fibulin-5 expression in Cajal cells. Based on these findings, it can be speculated that the expression of fibulin-5 in Cajal cells can be increase cell proliferation, but it would be useful to conduct new studies with larger series to clarify this issue. There is no correlation between fibulin-5 expression intensity and clinicopathological and prognostic data of gastrointestinal stromal tumors.

Abstract

Background: In this study, our intent was to determine whether serum levels of B12 and folic acid in patients diagnosed with iron deficiency anemia undergo change in response to iron supplements. Methods: In this retrospective study, 202 female patients with iron deficiency anemia and only iron treatment were included. Complete blood count, vitamin B12, ferritin, folate levels of patients at the time of initial presentation and 4-8 weeks after treatment were examined. Results: Overall, significant increases were detected in mean hemoglobin, mean hematocrit, mean mean corpuscular volume, median white blood cell and median serum ferritin levels in all patients treated with iron therapy (both oral and intravenous); significant decreases were observed in post-treatment median platelet, median folate, and median B12 levels in this patient cohort. Conclusions: We conclude that deficiencies in serum levels B12, folate and iron, which are critical factors promoting erythropoiesis may effectively mask one another in a basic clinical assessment of anemia.