An immunohistochemical study on the expression of sex steroid receptors, Ki-67 and cytokeratins 7 and 20 in feline endometrial adenocarcinomas

Radiomics nomogram in aiding preoperatively dilatation and curettage in differentiating type II and type I endometrial cancer

AIM

To established a radiomics nomogram for improving the dilatation and curettage (D&C) result in differentiating type II from type I endometrial cancer (EC) preoperatively.

MATERIAL AND METHODS

EC patients (n=875) were enrolled retrospectively and divided randomly into a training cohort (n=437) and a test cohort (n=438), according to the ratio of 1:1. Radiomics signatures were extracted and selected from apparent diffusion coefficient (ADC) maps. A multivariate logistic regression analysis was used to identify the independent clinical risk factors. An ADC based-radiomics nomogram was built by integrating the selected radiomics signatures and the independent clinical risk factors. Decision curve analysis (DCA) was conducted to determine the clinical usefulness of the radiomics nomogram. The net reclassification index (NRI) and total integrated discrimination index (IDI) were calculated to compare the discrimination performances between the radiomics nomogram and the D&C result.

RESULTS

Receiver operating characteristic (ROC) curves showed that the clinical risk factors, the D&C, and the ADC based-radiomics nomogram yielded areas under the ROC curves (AUCs) of 0.70 (95% CI: 0.64-0.76), 0.85 (95% CI: 0.80-0.89), and 0.93 (95% CI: 0.90-0.96) in the training cohort and 0.64 (95% CI: 0.57-0.71), 0.82 (95% CI: 0.77-0.87) and 0.91 (95% CI: 0.87-0.95) in the test cohort, respectively. The DCA, NRI, and IDI demonstrated the clinically usefulness of the ADC based-radiomics nomogram.

CONCLUSION

The ADC-based radiomics nomogram could be used to improve the D&C result in differentiating type II from type I EC preoperatively.

Metastatic Uterine Adenocarcinoma in a Sable Antelope (Hippotragus niger)

Simple Summary

A female sable antelope with a history of gradual loss of body condition was found dead by the owner. Macroscopic examination revealed an enlarged spleen and liver that were covered in white-to-cream-coloured nodules. The uterus also showed a few small, white-to-cream-coloured nodules, with similar nodules present in other parts of the body. Microscopic analysis of sections of the uterus revealed tumour cells with an appearance that was similar those seen in sections of the other tissues. Critically, tumour cells were seen in the lymphatics within the lungs. The tumour cells in the uterus showed positive staining for cytokeratin as did the tumour cells in the sections of other tissues, confirming they were of epithelial origin. In addition, electron microscopy of the uterus and liver showed tumour cells arranged in groups with junctions present between the cells. This confirmed that the tumour cells seen in the liver were the same as those seen in the uterus and were of epithelial origin. Thus, a diagnosis was made of uterine adenocarcinoma with widespread metastasis. This is the first report of uterine adenocarcinoma in a sable antelope.

Abstract

A nine-year-old intact female sable antelope (Hippotragus niger) with a six-week history of gradual loss of body condition was found dead by the owner and presented for autopsy. Macroscopic examination revealed an enlarged spleen and liver with the hepatic and splenic parenchyma showing extensive infiltration with firm, white to cream-coloured nodules. The uterus showed a few small, firm, well-demarcated, white-to-cream-coloured nodules in the uterine body. Similar nodules were present in the mediastinum, parietal pleura, heart, and marrow cavity of the femur. Histological analysis of the uterus revealed densely cellular neoplastic proliferations, forming nests, tubules, and acini within an abundant fibrovascular stroma. The samples from the other tissues revealed neoplastic cells with a similar appearance to those seen in the uterus, also forming nests and acini in a fibrovascular stroma. Importantly, multiple neoplastic cells were also seen in the peribronchiolar lymphatic vessels. The neoplastic cells in the uterine sections showed positive immunohistochemical labelling for cytokeratin, as did the neoplastic cells in the sections of liver and parietal pleura, confirming they were of epithelial origin. In addition, transmission electron microscopy of the uterus and liver showed neoplastic cells arranged in groups surrounded by basement membranes and interspersed with collagen fibres. Junctions were present between the cells, and junctional complexes could be seen at some cell surfaces. This confirmed that the neoplastic cells seen in the liver sample were the same as those seen in the uterine sample and were of epithelial origin. Thus, a diagnosis was made of uterine adenocarcinoma with widespread metastasis. This is the first report of uterine adenocarcinoma in a sable antelope.

Hormone receptor expression, clinical and histopathological analysis in feline injection site sarcomas

Feline injection site sarcomas (FISS) are aggressive, with high recurrence and rarely metastasising. The objective of this study was to evaluate, by immunohistochemistry, the expression of oestrogen (ER) and progesterone (PR) receptors in FISS and correlate them with clinical and histopathological aspects. This was a retrospective study with 51 cases of FISS. Immunohistochemistry was performed to detect vimentin, ER, PR and Ki67 expression. Clinical, histopathological and immunohistochemical characteristics were predictor variables and the expression of ER and PR were the dependent ones. Twenty-eight (55%) of the 51 FISS cases were female and 23 (45%) male with 10.7 ± 4.2 years and median tumour size of 3 cm (2.0-5.4). The trunk was the most affected site, with 38 cases (84%). Histological grade III was observed in 57% of the cases, considering differentiation score, necrosis and mitotic index. ER expression, positive in 64% of cases, was associated with the mitotic index (P = .05) and degree of pleomorphism (P = .04). PR was not associated with the variables and 63% of cases were negative for this receptor. Thus, ER expression can affect tumour growth. The knowledge on the FISS hormonal expression is important to clarify the pathophysiological mechanisms. Further studies are needed to predict the value of ER expression in the prognosis of FISS.

Amelioration of estrogen-induced endometrial hyperplasia in female rats by hemin via heme-oxygenase-1 expression, suppression of iNOS, p38 MAPK, and Ki67

Although heme oxygenase-1 (HO-1) is part of an endogenous defense system implicated in the homeostatic response, its role in cell proliferation and tumor progression is still controversial. Endometrial hyperplasia (EH) is associated with high risk of endometrial cancer (EC). Therefore, we aimed to evaluate the effect of hemin, a HO-1 inducer, against EH. Thirty-two female rats (60-70 days old) were divided into 4 groups treated for 1 week: vehicle control group, hemin group (25 mg/kg; i.p. 3 times/week), estradiol valerate (EV) group (2 mg/kg per day, p.o.), and hemin plus EV group. Sera were obtained for reduced glutathione level. Uterine malondialdehyde, superoxide dismutase, total nitrite/nitrate, and interleukin-1β levels were estimated. HO-1 and p38 mitogen-activated protein kinase expressions were obtained in uterine tissue. Uterine histological and immunohistochemical assessment of iNOS and Ki67 were also done. Results demonstrated that upregulation of HO-1 expression in hemin plus EV rats led to amelioration of EH which was confirmed with histological examination. This was associated with significant decrease in oxidative stress parameters, p38 mitogen-activated protein kinase expression, and interleukin-1β level. Also, uterine iNOS and Ki67 expressions were markedly suppressed. In conclusion, upregulation of HO-1 expression via hemin has ameliorative effect against EH through its antioxidant, anti-inflammatory, and antiproliferative actions.

Difference in Diffusion-Weighted Magnetic Resonance Imaging and Diffusion Tensor Imaging Parameters Between Endometrioid Endometrial Adenocarcinoma and Uterine Serous Adenocarcinoma: A Retrospective Study

OBJECTIVE

This study aimed to elucidate the difference in diffusion-weighted magnetic resonance imaging (DWI) and diffusion tensor imaging (DTI) parameters between endometrioid endometrial adenocarcinoma (EEA) and uterine serous adenocarcinoma (SA).

METHODS

Data of patients with pathologically confirmed EEA or SA who underwent DWI and DTI scanning between May 2013 and July 2016 were retrospectively analyzed. Apparent diffusion coefficient (ADC) value from DWI and ADC from DTI (ADC) map and fractional anisotropy (FA) values from DTI were analyzed and compared statistically. The correlation between ADC and ADC was analyzed by Pearson correlation analysis. Apparent diffusion coefficient, ADC, and FA between the 2 groups were compared using independent t test. The effect of ADC, ADC, and FA in distinguishing EEA and SA was evaluated by receiver operator characteristic curve.

RESULT

Thirty-three patients were enrolled into the study, including 13 cases of SA and 20 cases of EEA. Pearson correlation analysis suggested that the value of ADC was highly related with ADC in both the SA group (r = 0.812, P = 0.001) and the EEA group (r = 0.858, P < 0.001). The value of ADC and ADC in the SA group was significantly lower than that in the EEA group; FA was significantly higher than that in the EEA group. Receiver operator characteristic curve analysis showed that ADC and ADC have high sensitivity and specificity; FA has low sensitivity and high specificity.

CONCLUSIONS

We suggest that both DWI and DTI could be used in distinguishing EEA from SA. Apparent diffusion coefficient and ADC possess potential diagnostic value with high sensitivity and specificity.

Morphological characteristics of endometrium in patients of reproductive age with viral hepatitis type C

AIM

The purpose of the study was to investigate the morphological features of endometrium in patients with viral hepatitis type C.

MATERIALS AND METHODS

A morphological survey was conducted involving endometrium sections stained with hematoxylin and eosin and Van Gieson's picrofuchsin collected from 140 women of reproductive age, among them 70 patients were diagnosed with chronic hepatitis type C (CHC) infection with minimal (40 patients) and moderate activity (30 patients), and 70 women suffered from endometrial proliferative diseases without viral hepatitis (comparison group). In addition, 36 women with CHC and 36 women without CHC underwent immune histochemical test (IHC) of paraffin sections aimed at investigating the expression level of estrogen (ERα) and progesterone (PR) receptors and proliferation marker Ki-67. Endometrial biopsy samples were collected on the 10th to 14th day and the 15th to 18th day of the menstrual cycle.

RESULTS

Focal changes of endometrium in the form of uneven entering of the endometrium into the next phase of the menstrual cycle with the dominating proliferative phase were found in chronic hepatitis C patients. The number of patients having proliferative activity in the endometrium combined with inflammation increased as viral hepatitis became more active. Immune histochemical test showed the prevalence of the expression levels of ERα and PR receptors in the endometrial stroma. Increased expression of Ki-67 was observed mainly in the glandular epithelium and accrued together with the increment in the CHC activity.

CONCLUSION

Endometrial pathology in patients of reproductive age with chronic hepatitis type C is characterized primarily by proliferative forms with the increasing mismatch between the nature of structural changes and mucous phase of the menstrual cycle prompting suggestions that direct effect of hepatitis C virus on endometrium is possible.

Changes in c-erbB-2 Immunoexpression in Feline Endometrial Adenocarcinomas

Human epidermal growth factor receptor type 2 (c-erbB-2), an oncoprotein with potential prognostic marker and therapeutic use, is overexpressed in several human and animal tumours. But information regarding this molecule in feline tumours is scarce. This study aimed to assess the changes in the immunohistochemical expression of c-erbB-2 in feline endometrial adenocarcinomas (FEA) compared to normal endometrium. An immunohistochemistry assay using a specific antibody against c-erbB-2 was performed in FEA samples (n = 34) and in normal endometrium in the follicular (FS; n = 12) and luteal (LS; n = 11) stages. In FEA, the c-erbB-2 immunoexpression was assessed in neoplastic epithelial cells whilst in normal endometria it was individually evaluated in the surface and the superficial and deep glandular epithelia (SE, SGE and DGE, respectively). In FS and in LS, all the epithelia were positive for c-erbB-2; positivity was higher in the SE and the SGE than in DGE. Twenty of the 34 FEA samples (58.8%) were positive for c-erbB-2 immunolabelling. Nevertheless, its expression was higher in all the epithelia in the FS compared to FEA (p ≤ 0.0001) or the LS (p = 0.016). The results presented herein suggest that c-erbB-2 molecule is differently expressed in the feline endometrium through the oestrous cycle and though it may also be involved in feline endometrial carcinogenesis, a question remains unanswered on the importance of additional pathways of epithelial proliferation in the neoplastic changes in feline endometrium.