Study of the immunoexpression of Bcl-2 by a cutaneous granular cell tumor

BACKGROUND

Cutaneous granular cell tumors have only rarely been examined for Bcl-2, a marker that is expressed by granular cell tumors from other parts of the body.

OBJECTIVE

We retrospectively studied three cases of cutaneous granular tumors from our archives.

METHODS

We immunohistochemically tested for neuron-specific enolase (NSE), CD68 (KP1), Bcl-2, and S-100. In Cases 1 and 3, we also tested for CD34, HMB-45, and melan-A. In Case 3, we additionally tested for smooth muscle actin, CD68-PGM1, cytokeratin AE1-AE3, epithelial membrane antigen, desmin, CD1a, and CD117.

RESULTS

None of our cases presented any of the histological markers traditionally considered to be indicators of potential malignancy in granular cell tumors. All cases strongly expressed S-100, CD68, NSE, and Bcl-2. Case 3 also expressed CD68-PGM1. The rest of the markers were not expressed by the tumors.

CONCLUSIONS

Bcl-2 is expressed by cutaneous granular cell tumors.

[Mucinous adenocarcinoma of the appendix associated with ovarian tumors and pseudomyxoma peritonei. The difficulty in differential diagnosis]

Mucinous adenocarcinoma of the appendix is rare. If there is a concomitant ovarian tumor to determine the primary might be difficult. Histological features are not always determinant, but there are some macroscopic findings that may suggest an origin in the appendix. We report a case of synchronous tumors in appendix and ovaries with pseudomyxoma peritonei. The patient presented with mass sensation in the right lower quadrant, asthenia, anorexia and weight loss. Abdominal ultrasound and CT scan showed a tumor involving cecum, appendix, terminal ileum and pelvis. Findings on colonoscopy and biopsies were inconclusive. At laparotomy, the tumor compressed appendix, cecum and ascendant colon, terminal ileum, ovaries and peritoneum. Histopathological analysis demonstrated a well-differentiated mucinous adenocarcinoma of appendiceal origin with metastasis in ovaries and peritoneum (pseudomyxoma peritonei).

[Amebic liver abscesses with bacterial superinfection in a nonendemic area]

A 26-year-old man was admitted to hospital with asthenia, weight loss, right upper quadrant abdominal pain, diarrhea without blood, and fever. Abdominal ultrasonography showed multiple hypoechoic areas in the left hepatic lobe. On abdominal CT, multiple hypodense areas without contrast capture were consistent with hepatic abscesses. Cultures were obtained and the patient was placed empirically on metronidazole, gentamicin and ampicillin, without improvement in the first 72 hours, and a drain was placed in the largest lesion collecting a purulent material. The abscess culture was positive for group C beta-hemolytic Streptococcus. Entamoeba histolytica serology was positive and colon biopsies revealed trophozoites. Multiple left hepatic lobe abscesses secondary to E. histolytica, with bacterial superinfection, is an unusual presentation of amoebic infection, considering that Spain is not an endemic area.

Chondroid metaplasia in the tunica media of the aorta in dogs submitted to saphenous vein aorto-cava by-pass

We submitted twelve dogs to aorto-superior vena cava by-pass with saphenous vein. Six months later, all dogs had developed areas of chondroid metaplasia in the tunica media of the aorta, near the area of anastomosis. Three dogs also had bony metaplasia. The Foci of metaplasia had no relation to sutures. This lesion begins with a build-up store of glycosaminoglycans in the tunica media. Later, elastic fibers show a fenestration and dissolution, while chondrocytes replace smooth muscle fibres. We suggest that the rupture of the vasa vasorum during operation and the traction and pulsation of the by-pass over the area of suture could be the cause of this direct metaplasia.

[Primary malignant melanomas of the nasal fossae]

Melanoma of the nasal and paranasal sinus mucosa represented less than 1% of all melanomas. Melanoma to be localized commonly in nasal septum and your prognosis is poor. We presented three cases with a mean age of 75 years. The tumor was localized in nose. The melanocytes were presented in only case. All the tumoral cells stained with S-100 and HMB-45. In a case the vascular invasion was presented. Only a patient was treated with surgical excision. Two patients death 8 months after diagnosis.

[Histopathological features of carcinomas of the bladder treated with radiotherapy. Anatomo-clinical correlation]

We evaluated the effects of radiotherapy (total dose 6,100 rads; 1,500 intraoperative and 4,600 external irradiation) on urothelial carcinomas in 16 patients. Tumor response and the histopathological changes were evaluated. All but one of the patients were men. Mean patient age was 58 years. The urothelial tumors were graded from I-III according to the histological features and degree of invasion. Two were classed as grade I, 6 grade II and 8 grade III. The post-irradiation cystectomy specimens revealed no tumor cells in 9 cases (56%); 2 grade II and 7 grade III tumors. All cystectomy specimens revealed histopathological changes following radiotherapy: edema and congestion (16 cases), squamous metaplasia (11 cases), multinucleated giant cells (7 cases), fibroblast proliferation (6 cases), dystrophic calcification (4 cases), macrophages with lipids (3 cases) and osseous formation (1 case). The mean patient follow-up was 18 months. Four patients died (3 from the tumor). Mean patient survival was 12 months. The foregoing findings indicate that radiotherapy appears to be more effective in destroying the more undifferentiated and deeper urothelial carcinoma.

Intraoperative and external beam radiotherapy in invasive bladder cancer: pathological findings following cystectomy

The pathological findings observed following intraoperative radiotherapy (IORT) boost (15Gy) to the whole bladder, external beam fractionated irradiation (46Gy in 5 weeks), and planned radical cystectomy in patients with deep invasive bladder carcinoma are analyzed. Clinical pretreatment stage of disease was T3 (16 cases) and T4 (two cases). No evidence of residual tumor (pT0) was demonstrated in 11 cystectomy specimens (61%) and residual tumor (pT+) was observed in seven (39%). Toxicity and complications related to the treatment approaches were minor and reversible. It is concluded that IORT is a feasible boosting modality in the management of invasive bladder cancer, able to induce high rates of pT0 cystectomy specimens, and might be considered as a valuable technique for organ preservation treatment programs.