Prognostic significance of p27Kip1, p45Skp2 and Ki67 expression profiles in Merkel cell carcinoma, extracutaneous small cell carcinoma, and cutaneous squamous cell carcinoma

AIMS

To compare the immunohistochemical expression of prognostic markers p27(Kip1), p45(Skp2) and Ki67 in Merkel cell carcinoma (primary neuroendocrine carcinoma of the skin, MCC), small cell neuroendocrine carcinoma of lung and urinary bladder (SNC), and cutaneous squamous cell carcinoma (SCC).

METHODS AND RESULTS

Immunohistochemistry was performed using antibodies directed against p27(Kip1), p45(Skp2) and Ki67 on 72 tumour cases: 24 MCC, 25 SCC, and 23 SNC (15 from the lung and eight from the urinary bladder). Percentages of positive cells were determined for each marker and statistically analysed. Expression profiles on MCC and SCC were significantly different for all three markers. MCC and SNC exhibited significant similarities in their p27(Kip1) and p45(Skp2) expression profiles. In contrast, MCC and SNC differed significantly in their Ki67 proliferation indices, which were much higher in SNC. Additionally, MCC cases showed an association between increased proliferation indices and the appearance of local recurrence(s) and/or metastases.

CONCLUSION

The immunohistochemical profile of MCC differs from that of SCC, in spite of their common oncogenesis and the supposed metaplastic origin of MCC, and resembles that of SNC, except for Ki67 levels, which were higher in the latter (characterized by greater biological aggressiveness). High levels of Ki67 also appear to be a prognostic factor in MCC.

Primary biliary tract malignant melanoma: US, CT, and MR findings

We report a case of primary biliary tract malignant melanoma occurring in a 47-year-old male. Ultrasonography and computed tomography showed multiple masses in the gallbladder and distal common bile duct that caused biliary tract dilatation. Magnetic resonance imaging showed that the polypoid masses in the gallbladder and common bile duct were of low signal intensity on T2-weighted images and of high signal intensity on unenhanced T1-weighted images.

Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis

BACKGROUND

Helicobacter pylori-associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients.

AIM

To evaluate H. pylori diagnostic methods in patients with liver cirrhosis.

METHODS

One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13C-urea breath test and faecal H. pylori antigen determination were also carried out.

RESULTS

Sixty-two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immunohistochemistry, 96.2% and 96.7% for body immunochemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13C-urea breath test and 75.4% and 94.1% for faecal antigen.

CONCLUSION

The most reliable tests for H. pylori infection in cirrhotic patients were the 13C-urea breath test and gastric body histology.

Idiopathic pylephlebitis and idiopathic sclerosing peritonitis in a man with protein S deficiency

Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein S deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein S deficiency.

K-ras mutations in nonmucinous ovarian epithelial tumors: a molecular analysis and clinicopathologic study of 144 patients

BACKGROUND

To assess the putative prognostic value of K-ras mutations in nonmucinous ovarian tumors, the authors looked for K-ras point mutations at codons 12 and 13 in 144 nonmucinous ovarian tumors.

METHODS

A series of 144 consecutive, unselected, archival, nonmucinous ovarian tumors (35 benign, 12 borderline, and 97 malignant) were studied. K-ras mutations at codons 12 and 13 were determined by polymerase chain reaction using the restriction fragment length polymorphism method with mismatched nested primers. Extensive clinicopathologic and follow-up data on all patients were evaluated.

RESULTS

The overall prevalence of K-ras mutations at codons 12 and 13 was 30.5% (44/144). In benign tumors, it was 20% (7/35); in borderline tumors, 25% (3/12); and in carcinomas, 35% (34/97). The presence of K-ras point mutations did not correlate with survival. Among the benign tumors, K-ras mutations were detected in three Brenner tumors with a mucinous component.

CONCLUSIONS

These results indicate that K-ras mutations are not initial events in the pathogenesis of nonmucinous ovarian tumors and do not appear to be related to survival.

Fine needle aspiration cytology in pancreatic pathology

OBJECTIVE

To assess the sensitivity and specificity of pancreatic fine needle aspiration.

STUDY DESIGN

Two hundred five fine needle aspirates were obtained from 149 patients over seven years. After excluding 40 patients lacking biopsy or follow-up, 125 aspirates from 109 patients were selected to analyze the accuracy of this method. (male:female ratio, 1.4:1; age range 43-79 years).

RESULTS

The cytologic diagnosis was true positive in 50 studies (45.9%), false positive in 0, true negative in 25 (22.9%), false negative in 19 (17.4%) and suspicious for malignancy in 17 (15.6%); 14 aspirations (12.8%) yielded material unsatisfactory for a diagnosis. Of the 17 suspicious studies, 15 were from patients in whom a malignancy was confirmed later. The other two patients had chronic pancreatitis.

CONCLUSION

The efficiency was 79.8%, sensitivity 72.5%, and specificity and predictive value of a positive result 100%. Cell blocks provided sufficient material in 96.8% of cases and smears in 90.4%. No major complications were reported after fine needle aspiration.

p53 expression in anaplastic carcinomas arising from thyroid papillary carcinomas

AIM

To study the expression of p53 tumour suppressor gene in anaplastic carcinomas arising from thyroid papillary carcinomas.

METHODS

Formalin fixed, paraffin wax embedded tissues from four cases of anaplastic carcinomas associated with thyroid papillary carcinomas were studied by immunohistochemistry with two different p53 monoclonal antibodies.

RESULTS

The anaplastic component showed nuclear immunostaining in two cases, but not in the other two. In all cases the papillary carcinoma component was negative.

CONCLUSION

The results support the hypothesis that p53 stimulates tumour progression in thyroid tumours.