Deciphering CHFR Role in Pancreatic Ductal Adenocarcinoma

Checkpoint with forkhead-associated and ring finger domains (CHFR) has been proposed as a predictive and prognosis biomarker for different tumor types, but its role in pancreatic ductal adenocarcinoma (PDAC) remains unknown. The aim of this study was two-pronged: to review the role of CHFR in PDAC and evaluating CHFR as a potential predictive biomarker in this disease. For this purpose, we first explored the CHFR messenger (m)RNA expression and promoter methylation through the TCGA database. Secondly, the CHFR expression and promoter methylation were prospectively evaluated in a cohort of patients diagnosed with borderline (n = 19) or resectable (n = 16) PDAC by immunohistochemistry (IHC), methylation specific-PCR (MSP), and pyrosequencing. The results from the TCGA database showed significant differences in terms of progression-free survival (PFS) and overall survival (OS) based on the CHFR mRNA expression, which was likely independent from the promoter methylation. Importantly, our results showed that in primarily resected patients and also the entire cohort, a higher CHFR expression as indicated by the higher IHC staining intensity might identify patients with longer disease-free survival (DFS) and OS, respectively. Similarly, in the same cohorts, patients with lower methylation levels by pyrosequencing showed significantly longer OS than patients without this pattern. Both, the CHFR expression intensity and its promoter methylation were established as independent prognostic factors for PFS and OS in the entire cohort. In contrast, no significant differences were found between different methylation patterns for CHFR and the response to taxane-based neoadjuvant treatment. These results suggest the potential role of the higher expression of CHFR and the methylation pattern of its promoter as potential prognostic biomarkers in PDAC, thus warranting further comprehensive studies to extend and confirm our preliminary findings.

Squamous cell carcinoma in situ of the endometrium as superficial extension of cervical carcinoma

Squamous cell carcinomas of the endometrium, either primary or secondary extending from the cervix, are rare. We report a 52-year-old woman with squamous cell carcinoma in situ of the cervix associated with squamous cell carcinoma in situ of the endometrium. The patient had received pelvic cobalt therapy 10 years earlier. She presented to the hospital with discomfort in the lower abdomen. Examination revealed vaginal stenosis and pyometra. After cervical cytology and a biopsy showing squamous cell carcinoma in situ, a wide abdominal hysterectomy with bilateral salpingo-oophorectomy (Wertheim modification) was performed. The unusual presentation of cervical carcinoma with a history of previous radiation treatment suggests the need for performing more cytologic and histologic studies on these patients, because of the risk of developing a secondary malignancy.

Pulmonary diffuse amyloidosis and ankylosing spondylitis. A rare association

We report herein the association of primary pulmonary amyloidosis and ankylosing spondylitis. To our knowledge, this rare association has never been reported. This case reemphasizes that not all pulmonary complications that appear in the course of ankylosing spondylitis are related to the seronegative spondyloarthropathy. Primary pulmonary amyloidosis should be considered in patients with interstitial pulmonary disease.

Human growth plate development in the fetal and neonatal period

The development of the normal human upper tibial growth plate was studied at autopsy in 46 stillborns and 79 newborns of 20-41 weeks gestational age. During this time period, the histology of this plate evolves from a highly cellular structure with relatively poor columnar organization and matrix development to the well known structure seen later in postnatal life. The thickness of the growth plate, assessed in the area surrounding the longitudinal tibial axis, decreases continuously from 1.15 mm on the 20th week to 0.6 mm on the 38th week. This decrease results from losses of both matrix and cellular components, mostly of the latter. However, the relative fraction of area occupied by the matrix significantly increased (12%) and matrix area per cell increased 1.5 times over the last half of gestation, indicating a maturation process of the plate towards a more matrix-oriented structure with age. In this maturation process the number of cells per unit area does not change and the average size of the cells appears to decrease. Plate thickness does not decrease further in the final 3 weeks of pregnancy and increases in early neonatal life; this has no apparent influence on the tibial growth rate. In the period under study the relative anatomical participation of the upper tibial growth plate decreases from approximately 4% of the radiographic length of the tibia on the 20th week to less than 1% at term. Present data will provide fetal and neonatal growth plate standards needed to obtain a better understanding of this structure during both normal and abnormal conditions.

Angiolymphoid hyperplasia with eosinophilia of the tongue: report of a case and review of the literature

Angiolymphoid hyperplasia with eosinophilia has been described mainly in the dermis and subcutaneous tissues of the head and neck, and only occasionally in the oral cavity. A case of angiolymphoid hyperplasia with eosinophilia of the tongue in an 82-year-old man with typical morphologic features is presented. The diagnosis criteria and treatment of this lesion reported in the English literature are also reviewed.

Sirenomelia and anencephaly

We report on a monozygotic twin with sirenomelia and anencephaly. This association seems to have been observed only twice before. In addition to these anomalies the patient had cleft palate, rachischisis, and segmentation vertebral anomalies affecting the cervical and the upper thoracic spine. The second twin was a liveborn female infant with a large cystic paraovarian teratoma, and duplication of internal genitalia.

Risk of cancer in patients with gastric dysplasia. Follow-up study of 67 patients

This work is based on the follow-up evaluation of 67 moderate (MD) or severe gastric dysplasias (SD) diagnosed by endoscopic biopsy. Forty-one patients had moderate gastric dysplasia, 22 (53.65%) had regression of MD, 14 patients (34.4%) had persistence, three (7.31%) had progression to SD, and two (4.87%) had transformation in gastric adenocarcinoma. Twenty-six patients were diagnosed with severe gastric dysplasia: in 12 patients (46.15%) gastric lesions regressed to normality (five cases), mild (six cases) or moderate dysplasia (one case); six patients (23.07%) showed persistent histologic changes of SD in the subsequent biopsy specimens; eight patients (30.7%) presented progression of lesions to gastric adenocarcinoma after 1 to 79 months of follow-up evaluation. The authors conclude that moderate and severe gastric dysplasias are preneoplastic lesions and a valuable marker of gastric cancer risk; the risk of gastric cancer after moderate or severe dysplasia is of 9.52%, excluding those cases with short follow-up. The authors claim that these patients may receive a conservative clinical treatment with frequent endoscopic studies until the appearance of either early carcinoma to indicate gastrectomy, or no dysplasia at all or mild dysplasia in specimens from at least two consecutive biopsies.

Risk of cancer in patients with gastric dysplasia. Follow-up study of 67 patients

This work is based on the follow-up evaluation of 67 moderate (MD) or severe gastric dysplasias (SD) diagnosed by endoscopic biopsy. Forty-one patients had moderate gastric dysplasia, 22 (53.65%) had regression of MD, 14 patients (34.4%) had persistence, three (7.31%) had progression to SD, and two (4.87%) had transformation in gastric adenocarcinoma. Twenty-six patients were diagnosed with severe gastric dysplasia: in 12 patients (46.15%) gastric lesions regressed to normality (five cases), mild (six cases) or moderate dysplasia (one case); six patients (23.07%) showed persistent histologic changes of SD in the subsequent biopsy specimens; eight patients (30.7%) presented progression of lesions to gastric adenocarcinoma after 1 to 79 months of follow-up evaluation. The authors conclude that moderate and severe gastric dysplasias are preneoplastic lesions and a valuable marker of gastric cancer risk; the risk of gastric cancer after moderate or severe dysplasia is of 9.52%, excluding those cases with short follow-up. The authors claim that these patients may receive a conservative clinical treatment with frequent endoscopic studies until the appearance of either early carcinoma to indicate gastrectomy, or no dysplasia at all or mild dysplasia in specimens from at least two consecutive biopsies.

Malignant fibrous histiocytoma in a child's hand

A 3-year-old girl had a 4-month history of a tumor in her right hand. The tumor was located in the subcutaneous and soft tissues of the palm and the long, ring, and small fingers. Histologic studies showed a malignant fibrous histiocytoma that was confirmed by the ultrastructural study as having a fibroblastic and histiocytic origin. The long, ring, and small fingers were amputated. The postoperative course was normal, and 18 months later no recurrence or metastases were observed.

Caudal deficiency and asplenia anomalies in sibs

The caudal deficiency and asplenia anomalies have been described separately in children. Two sibs with these two entities are described. Only another similar case, with caudal deficiency and polysplenia anomalies was found in the literature. It is possible that this association could be a new syndromic entity. An autosomal recessive mode of inheritance is suggested.

Malakoplakia of the maxillary sinus

The first case of malakoplakia in the nasal cavities is reported. The patient, a 21-year-old man, presented a polypoid formation in the left maxillary sinus that was removed and studied by light and electron microscopy. The polypoid formation consisted of pseudostratified epithelium surrounding a central myxoid tissue which contained fibroblasts, histiocytes, and small inflammatory infiltrates. The most relevant features were histiocyte accumulations containing 1 to 5-microns diameter granules which displayed a concentric multilayered configuration. Ultrastructural findings revealed three types of lysosomes within the histiocyte cytoplasm: phagolysosomes, intermediate bodies, and Michaelis-Gutmann bodies. Septate junctions between lysosomes were frequent. The etiopathogenesis of this lesion is discussed.