CKS1B overexpression implicates clinical aggressiveness of hepatocellular carcinomas but not p27(Kip1) protein turnover: an independent prognosticator with potential p27 (Kip1)-independent oncogenic attributes?

BACKGROUND

Through data mining the Stanford Microarray Database, the CKS1B transcript was found to be frequently upregulated in hepatocellular carcinomas (HCCs) with low alpha-fetal protein (AFP) expression. Together with SKP2, CKS1B is known to implicate p27(Kip1) protein turnover promoting cell-cycle progression.

METHODS

CKS1B, p27(Kip1), and SKP2 were immunostained in 75 HCCs and correlated with clinicopathological features, local recurrence-free survival (LRFS), and overall survival (OS). Silencing of CKS1B and SKP2 with interference short-hairpin RNA (shRNA) was performed in SK-Hep1 and Hep-3B cell lines.

RESULTS

Immunohistochemically, increased CKS1B and SKP2, and attenuated p27(Kip1) were all associated with tumor multiplicity (P < 0.05) and increasing American Joint Committee on Cancer (AJCC) stage (P < 0.05). Overexpression of CKS1B significantly correlated with advanced Okuda stages (P = 0.048) and SKP2 overexpression (P = 0.047). Neither CKS1B nor SKP2 was inversely related to p27(Kip1), which was reinforced by no alteration in p27(Kip1) abundance in HCC-derived cells with CKS1B or SKP2 silencing. Both CKS1B overexpression (P = 0.0011 and P = 0.0017) and p27(Kip1) attenuation (P = 0.0079 and P = 0.0085) were predictive of OS and LRFS, respectively, while SKP2 overexpression was associated with worse OS alone (P = 0.0043). Combined assessment of CKS1B and p27(Kip1) was able to robustly distinguish three prognostically different groups (P < 0.0001). In multivariate comparison, CKS1B overexpression represented the strongest independent adverse prognosticator [OS, P = 0.0235, hazard ratio (HR): 4.193; LRFS, P = 0.0204, HR: 4.262], followed by p27(Kip1) attenuation (OS, P = 0.0320, HR: 2.553; LRFS, P = 0.0262, HR: 2.533).

CONCLUSIONS

CKS1B protein overexpression in HCCs is implicated in clinical aggressiveness but not in p27(Kip1) turnover, implying presence of p27(Kip1)-independent oncogenic attributes. The combined assessment of CKS1B and p27(Kip1) immunoexpressions effectively risk-stratifies HCCs with different prognoses, which may aid in the management of this deadly malignancy.

Expression of inducible nitric oxide synthase and apoptosis in human lupus nephritis

To understand the expression of inducible nitric oxide synthase (iNOS) and its possible association with apoptosis in human lupus nephritis, 48 renal tissue samples from patients with lupus nephritis were investigated immunohistochemically and by the terminal-deoxynucleotidyl-transferase-mediated dUTP nick end labeling method for the detection of iNOS and apoptosis, respectively. Modulation of apoptosis by p53 and Bcl-2 was also evaluated. This study showed immunohistochemical evidence of iNOS expression, predominantly in the glomerular and tubulointerstitial cells of class-IV lupus nephritis. The frequency of iNOS+ glomeruli was significantly correlated with that of apoptosis+ glomeruli, and the frequency of the latter was also significantly correlated with that of the glomeruli showing p53 overexpression. Bcl-2 was predominantly expressed in the cellular and fibrocellular crescents. This study suggests that induction of iNOS, and thus nitric oxide production, plays a role in the occurrence of apoptosis in the glomeruli of lupus nephritis; and the occurrence of apoptosis might in part be modulated by p53 and Bcl-2-related pathways. The expression of Bcl-2 in predominantly cellular and fibrocellular crescents suggests that Bcl-2 may participate in persistent proliferation of the crescentic cells.

Cytomegalovirus appendicitis in a patient with acquired immunodeficiency syndrome: a case report

Cytomegalovirus (CMV) infection occurs predominantly in immunocompromised hosts. Involvement of the gastrointestinal tract in acquired immunodeficiency syndrome (AIDS) patients is frequent. Nevertheless, CMV appendicitis is exceeding rare. This report describes a patient with AIDS who presented with right lower quadrant abdominal pain, high fever, nausea and vomiting, but without leukocytosis. Diagnosis of CMV appendicitis was confirmed by appendectomy and histopathological examination. Problems related to the diagnosis and therapeutic management of CMV appendicitis in AIDS patients are discussed. The importance of early surgical intervention is emphasized, as is postoperative ganciclovir therapy for treatment of such patients.

Cutaneous Rosai-Dorfman disease manifestating as recurrent breast tumor: a case report

A case of cutaneous Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) manifestating as a recurrent breast tumor is reported. The tumor occurred on the left breast of a 35-year-old woman. Before arriving at the correct diagnosis, four biopsies had been performed with various diagnoses of chronic inflammation, plasma cell mastitis and inflammatory pseudotumor. Numerous typical histiocytes with lymphophagocytosis appeared in the final excised specimen, and a correct diagnosis was made. Ultrastructural examination revealed no evidence of Birbeck granule. The literature concerning Rosai-Dorfman disease manifestating as breast tumor is reviewed. Since the diagnosis is often overlooked in the absence of lymphadenopathy, a high index of suspicion is required to recognize this rare cutaneous Rosai-Dorfman disease.

Primary pleural thymoma

An unusual thymoma is reported in a 32-year-old woman. The tumor presented as diffuse pleural thickening with encasement of the left lung. Computed tomographic scan and pleural biopsy of this pleural-based lesion were interpreted as favoring a diffuse pleural mesothelioma. After pleuropneumonectomy, pathologic examination revealed a characteristic epithelial thymoma. However, neither mediastinal involvement nor a concurrent mediastinal mass was found at surgery or by radiographic examinations. To our knowledge, only six previous cases of thymomas have been reported as pleural-based tumors for which a mediastinal origin could be excluded (namely, primary pleural thymomas). It is emphasized that in clinical and pathologic diagnosis of a pleural-based lesion thymoma should be considered in the differential diagnosis.

Clear cell meningioma: a case report

A case of clear cell meningioma in a 12-year-old male is reported. The tumor was located at the left side cerebellopontine angle, and characterized by sheets of patternless clear cells rich in cytoplasmic glycogen. Vague whorl formation and focal small clusters of typical meningothelial cells were the most important diagnostic features. The tumor cells showed positive immunoreactivity for vimentin, epithelial membrane antigen (EMA), and S100 protein. Cytokeratin and glial fibrillary acidic protein (GFAP) were negative. Ultrastructural features exhibited were abundant cytoplasmic glycogen particles, desmosome-like junctions and tangles of intermediate filaments, while cell membrane interdigitations were few. Clear cell meningioma is rare and is potentially aggressive in that it may recur, spread locally, and even metastasize, despite its bland histologic appearance. There is probably a predilection for younger age group. It is histologically unique but should be differentiated from other mimicking clear cell tumors of the central nervous system, including metastatic renal cell carcinoma, hemangioblastoma, oligodendroglioma, and clear cell ependymoma.