An unusual enhanced Doppler vascular profile of a rare uterine tumor: PEComa

PEComas represent a rare class of mesenchymal tumors, with different primary locations. There are less than 100 cases of uterine PEComas published in English literature until now and information considering imaging features of these PEComas is very limited, focusing on CT and MRI and not as much on ultrasounds (US). The authors present here a case of rapidly growing uterine PEComa, with local invasive potential and recurrence, and the review of literature on US characteristics of PEComas. Harboring a hyperechogeneous heterogeneous aspect with no clear separation from the adjacent uterus on the whole boundary, with an extremely rich central vascular network, with low impedance and a rapidly growing profile, this tumor does not show the classic US appearance of malignant PEComas, which are generally easily confused with leiomyomas. However, even if this pattern did not allow the authors to anticipate the histopathological result, it offered clear clues about its invasiveness potential.

Epidemiology and pathology of parotid tumors five-year retrospective study

AIM

To retrospectively analyze the epidemiological, clinical and pathological data of parotid tumors.

MATERIAL AND METHODS

Reassessment of the histologic diagnosis of parotid tumor in the patients admitted to the Oral and Maxillofacial Surgery Unit of the Iasi "Sf. Spiridon" University Emergency Hospital during 2009-2013. Data on gender, age, place of residence, location, size, surgical procedure type and histopatological type were recorded.

RESULTS

The risk of developing pleomorphic adenonma is 7.40 times higher in women and 4.08 times higher before the age of 50 years. The risk of Warthin tumor is 16.47 times higher in male patients and 3.58 times higher in urban patients. People older than 50 years have a 7.14 times higher risk of developing malignancy and rural people have a 2.41 times higher risk of developing cancer. Diabetes, obesity and systemic hypertension were not important risk factors in our study.

CONCLUSIONS

According to this study age and the place of residence could be important predictors for parotid gland tumors. Since in Romania there are few epidemiological data regarding the parotid gland pathology, further cohort studies are needed for a better understanding of their clinical and pathological behavior.

Paraganglioma of the carotid body: case report

With an incidence of 0.03% of all tumors, carotid body tumors (CBTs) are extremely rare. We present the case of a 63 year old female patient with an asymptomatic right sided neck mass of 3 cm diameter. Doppler ultrasound and contrast-enhanced CT confirmed the clinical suspicion of carotid body tumor. The patient underwent complete surgical excision of the Shamblin group II tumor and an adjacent lymph node, without preoperative embolization. The histopathological examination diagnosed a benign CBT. There were no postoperative complications at 1 and 6 months follow-ups.

The value of PAX8 and WT1 molecules in ovarian cancer diagnosis

PAX8 and WT1 are transcription factors, each of them with distinct roles in organogenesis, morphogenesis, cell growth, and differentiation. Recently, their expression was also confirmed in a variety of malignancies, being included in the antibodies panel recommended for the female genital tract pathology. The aim of our study was to evaluate PAX8 and WT1 in different types of ovarian cancer (OC) with focus on (i) the completion of evidences of the Müllerian origin and (ii) the establishment of primary ovarian tumor status vs. metastasis. The study group consisted of 86 cases, with histopathological diagnosis covering the main subtypes of OC (low- and high-grade serous, low- and high-grade endometrioid, clear cell, mucinous, malignant Brenner tumor, malignant mixed Müllerian tumor, undifferentiated, and borderline). The investigation was based on immunohistochemical examination, performed by using specific antibodies applied on blocks obtained through Tissue MicroArray technique, and interpreted by scores assessing the nuclear positivity of tumoral cells. One case was not valuable due to technical difficulties. PAX8 expression was positive in 70 (81.39%) cases, the remaining 15 (17.44%) negative cases suggesting a non-Müllerian origin. WT1 expression was positive in 61 (71%) cases, mainly expressed in serous carcinoma, regardless of their differentiation degree, and negative in 24 (27%) cases. Our study provide supplementary evidences to support the association of PAX8 and WT1 immunostaining in the investigation of the complex biology of OC, PAX8 confirming the ovarian primary and WT1 allowing the refinement of the diagnosis in phenotype overlapping cases.

[Histopathologic and immunohistochemic changes in Helicobacter pylori colonised gastric mucosa]

Helicobacter pylori (H. pylori) colonize gastric mucosa causing both inflammatory changes, premalignant lesions and malignant tumors, including gastric lymphoma and carcinoma. In this study, our propose was to evaluate the histopathological changes corellated with immunohistochemical results demonstrating the types of cellular infiltration and proliferative activity of gastric mucosa infected with H. pylori.

MATERIAL AND METHOD

Gastric endoscopic examinations was performed in 468 patients with anti-H. pylori antibodies and dispeptic phenomena. Snippets harvested endobiopsic stomach were fixed in formalin and processed by paraffine inclusion. Histological sections were stained with hematoxylin-eosine and Giemsa. In 65 cases of endobiopsic fragments (36 deep chronic gastritis with intestinal metaplasia, glandular atrophy and intraepithelial neoplasia and 29 carcinomas) immunohistochemical reactions were performed by applying reagents for evidence of H. pylori colonies, of T lymphocytes (CD3) and macrophages (CD68) and Ki-67 reagent for proliferating nuclear antigen labelling.

RESULTS

Endobiopsic specimen found in all H. pylori or by Giemsa staining or by anti-H. pylori antibodies when they were in small numbers. Histologically, were diagnosed : 463 superficial and deep chronic gastritis associated with premalignant lesions, 29 carcinomas, 2 non-Hodgkin's lymphoma and an adematous polyp. Immunohistochemically, inflammatory infiltrate consisted of numerous T lymphocytes, macrophages and lymphoid follicles. Foveolar cell nuclei, in areas of intraepithelial neoplasia and carcinomatous cells were intensely stained with Ki-67, demonstrating increased proliferation.

CONCLUSIONS

In gastric infection with H. pylori, inflammatory infiltrat is composed of abundant macrophages and T lymphocytes. Ki-67 was absent or minimal in chronic gastritis, while in areas of intraepithelial neoplasia was positive in both foveolar and coating epithelium. Anti-H. pylori antibodies in human serum remains one of the simplest methods to detect H. pylori, therefore it plays an important role in practice. Medical eradication of bacteria may cancel inflammatory changes, metaplasia and proliferation of gastric mucosa and thus it prevents the cascade of carcinogenesis.

[Liver hemosiderosis study in chronic viral hepatitis]

In chronic viral hepatitis the histopathological exam can reveal the presence of liver iron deposits in 10 to 73% of patients. Iron deposits are usually found in Kupffer cells, in endothelial cells and portal macrophages, and extremely rarely in hepatocytes.

AIM

To evaluate the incidence of hepatic hemosiderosis in chronic viral hepatitis.

METHODS

549 morphopathological features of liver biopsy specimens performed in the Gastroenterology and Hepatology Institute IaSi, between January 1 2003 and December 31 2007 have been analyzed. Semiquantitative assessment of the degree of hepatic iron overload was performed and the localization of haemosiderin deposits: at the level of hepatocytes, the reticuloendothelial system or mixedly. The same anatomopathologist examined the blades and interpreted the results.

RESULTS

The medium age of patients who underwent liver biopsy was 45.08 years +/- 10.045. Positive iron staining was found in 22.8% of cases, more frequently in males (31%), and in 91.82% of cases iron deposits were grade 1-2. The association of alcoholic etiology did not influence the incidence of hemosiderosis: 23% in patients with hepatitis and no ethanol exposure vs 25% in cases of strictly viral etiology. Deposits of haemosiderin were more frequent in viral hepatitis B (38.6%) than in viral hepatitis C (26.9%). In 34% of cases stainable iron was found only in reticuloendothelial system and in 46% of cases both in Kupffer cells and hepatocytes.

CONCLUSION

Almost a quarter of chronic viral hepatitis cases are associated with liver deposits of haemosiderin, with features of secondary iron overload (deposits localized in the mesenchymal areas or mixedly). There is a higher risk of hemosiderosis in men, especially for those between 30 and 50. Liver iron overload levels in chronic viral hepatitis are, in most cases, low or medium, and the association with an alcoholic etiology does not influence the incidence of hemosiderosis in chronic viral hepatitis.

[Immunohistochemical evaluation of topoisomerase IIalpha as proliferation factor in gastric lymphoma]

Topoisomerase IIalpha is a nuclear enzyme essential for DNA replication, with presumed prognostic value in various tumors.

MATERIAL AND METHODS

Study group included 34 gastric lymphomas. Tissue samples, formalin-fixed, paraffin-embedded, were investigated by immunhistochemistry using monoclonal antibodies anti Ki67 and anti topoisomerase IIalpha.

RESULTS

The 34 gastric lymphomas were previously diagnosed as follows: 14 MALT lymphoma and 20 aggressive lymphoma (17 diffuse large B-cell lymphoma, 2 diffuse large B-cell lymphoma with minor MALT component and 1 peripheral T-cell lymphoma). Both markers (Ki67 and topoisomerase IIalpha) were positive in 2-31% of tumor cells in MALT lymphoma, while in aggressive lymphoma up to 46-98% of tumor cells showed a positive expression.

CONCLUSION

Similar expression of Ki67 and topoisomerase IIalpha recommends the utilization of topoisomerase IIalpha in determining the proliferation fraction in gastric lymphomas. In addition, we suggest that it might be possible to use topoisomerase II inhibitor agents in high grade gastric lymphomas.

[PSA variations in persons with latent prostate cancer]

The introduction and common use of serum PSA (Prostate Specific Antigen) has been demonstrated a useful index on latent prostate cancer diagnostic but in the same time has increased surgical intervention on histological forms with no eventual future evolution. Benign comportment of latent carcinomas being well known in advance, we correlated in vitro serum PSA from latent tumors, with the samples from a control group (prostates without signs of malignization). Levels of PSA were slightly elevated compared to age norms, mainly in cases with a large coexistent hypertrophy. Our reduced sample does not stand any statistic analysis, but this observation could eventually explain increased diagnostic and hyper-treatment of non-important carcinomas from a clinical point of view.

[Gastric lymphoma. Morphological and immunohistochemical study]

Most of extranodal lymphomas are localized in gastrointestinal tract, gastric lymphoma representing more than 50% of them. The role that Helicobacter pylori (H. pylori) plays in pathogenesis of gastric lymphoma has changed the therapeutic approach.

AIMS

Description of morphological features and immunohistochemical pattern of gastric lymphomas from patients admitted in University Hospital "Sf. Spiridon" Iaşi.

MATERIAL AND METHODS

Thirty four gastric lymphomas were investigated using routine histopathological technics and immunohistochemical staining based on a large panel of antibodies: CD3, CD5, CD20, CD79á, CD23, CD30, cyclin-D1, BCL2, BCL6, ALK1, Ki67, CK-cocktail, anti-H. pylori.

RESULTS

All gastric lymphomas were localized in the antrum, most of them being solitary and large-sized tumors. Ninety-seven percent were B-cell lymphomas, 41.17% were mucosa-associated lymphatic tissue lymphomas (MALT lymphomas), and the remaining were high grade lymphomas. Only one case was classified as peripheral T-cell lymphoma. Cytokeratin cocktail immunostaining improved the detection of typical lymphoepithelial lesions, which characterized exclusively the MALT lymphomas. The sensibility for H. pylori detection in gastric lymphoma cases was increased by 22% using anti-H. pylori antibodies.

CONCLUSIONS

Immunohistochemistry is a diagnostic method for gastric lymphomas, being useful in identification of lymphoepithelial lesions, detection of H. pylori infection, and is mandatory for lymphomas classification according to WHO criteria.

[Colorectal polyps: clinical, endoscopic, and histopathologic features]

AIM

To evaluate the prevalence of colorectal polyps in a population from North- Eastern Romania, which underwent colonoscopic examination and to identify their clinical, endoscopic and histopathologic characteristics.

METHODS

A retrospective prevalence study of subjects aged 18-95 years, with no personal or familial history of familial adenomatous polyposis and inflammatory bowel disease, who underwent a colonoscopy. The number, size, gross endoscopic appearance, histopathological examination, and the anatomic location of colorectal polyps were analyzed, as well as the associated diseases.

RESULTS

Enrolled were 1001 patients (647 men, 354 women), aged 18-95 years (mean: 62.8 +/- 11.4 years) who were diagnosed with colorectal polyps. Overall, there were 1.534 colorectal polyps, and the majority of them (83.0%) were present in patients over the age of 50 years, from urban area (73.9%) and most of the patients were men (63.8%), and had solitary polyps (61.1%). Three-quarters of polyps were distal (rectum, sigmoid, and descendent colon) in location, and most of them (75.8%) had a size less than 10 mm. Over half of all polyps (54.7%) were pedunculated. Based on the histological structural configuration, 76.5% of all polyps were adenomas, and of these 62.6% were tubular adenomas; malignant polyps have been diagnosed in 82 (5.4%) patients. Associated hemorrhoids, diverticulosis, colorectal cancer, and angiodysplasia were identified in 9.6%, 10% and 1.3%, respectively.

CONCLUSION

The prevalence of colorectal polyps in our geographical area is in the range with that observed in other regions of our country. Most of polyps were identified in patients older than 50 years, predominantly men, located in distal colon, had a tubular adenoma histological structure, and frequently associated with hemorrhoids and diverticular disease.

Features of pathological assessment in rectal cancer

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

Early gastric carcinoma diagnosed on endobiopsic and surgical specimens

Early gastric carcinoma (EGC) is difficult to diagnose without a screening program.

AIMS

In this study, we reveal the importance of endobiopsy in EGC diagnosis.

MATERIAL AND METHODS

We examined multiple gastric endobiopsies from 1,201 patients with or without symptoms and endoscopical aspect for gastric carcinoma. All specimens were fixed in 15% buffered neutral pH formaldehyde and paraffin embedded. Histological sections were stained using current techniques: Hematoxylin-Eosin, trichromic van Gieson, Giemsa (for Helicobacter pylori) and Alcian blue, pH 1 and 2.5 (for acid and sulfated mucins). We used Laurén histological classification with two main types of gastric carcinoma: intestinal and diffuse.

RESULTS

From 1,201 gastric endobiopsies, we diagnosed gastric carcinoma in 257 patients (21.3%) and only four of them were EGCs, although their endoscopical examination was negative for gastric tumor. Among these malignant proliferations, three cases showed intestinal type EGC and one case was diffuse type EGC. The additional endobiopsies fragments presented chronic atrophic gastritis with H. pylori infection, intestinal metaplasia and dysplasia.

CONCLUSIONS

EGC had an incidence of 0.34%, which is very low because the lack of an endoscopical screening program favors the diagnosis of gastric cancer in advanced stages. Both histological types--intestinal and diffuse, were present in EGC, associated with H. pylori chronic gastritis, intestinal metaplasia and dysplasia. The presence of dysplasia recommends the endoscopical surveillance of these patients.

[New methods in cancer research--tissue microarray]

Cancer research advances imperiously requested for a new reliable method for biomarker tissue localization study, with standardized experimental conditions, reproducible, fast and at low-prices. Tissue Microarrays technique is the most important discovery in histopathology techniques in the last decade. It mainly consists in bringing and precisely organizing in a single paraffin block of hundreds of micro-cylinders from different blocks. Sections from this new block may be processed using almost all analyses (immunohistochemistry, in situ hybridization). The clear sightedness of those who developed this technique is proved by its rapid acceptance and integration in basic research, prognostic factors oncology and drugs discovery, reflected in hundreds of publications.

[Metachronous primary cancers of the colon and stomach]

We report herein a case of 69 years old woman who, in the course of 11 years, developed two cancers: carcinoma of the colon fistulization in duodenum and adenocarcinoma of the stomach. No polyposis has been found. This patient successfully underwent a right hemicolectomy with pancreaticoduodenectomy (Traverso-Longmire procedure). A decade later, she suffered a total gastrectomy with distal pancreatectomy for gastric adenocarcinoma. The patient made an uneventful postoperative recovery. Although patients with primary multiple cancers are not common, it is nonetheless important for clinicians to consider the possibility of metachronous cancers in patients who were treated for a primary malignant tumor.

[Anal squamous cell carcinoma synchronous with rectal adenocarcinoma]

Most often colorectal carcinoma occurs single; synchronous multiple carcinomas usually develop at widely disparate sites. We report the case of a 75-year-old male, accusing rectal bleeding, disturbances in bowel transit and weight loss. The rectoscopy examination revealed a fungating, bleeding tumor located 5 cm from anal verge. Pathological diagnostic of the endo-biopsy was ulcerated moderate differentiated adenocarcinoma. Patient underwent surgical amputation of the rectum with lymphadenectomy. Microscopical examination of the surgical specimens confirmed the presence of the adenocarcinoma adjacent to a squamous cell carcinoma, moderate differentiated, with reduced keratinization, infiltrative. Also, 2 from the 7 lymph nodes presented squamous cell carcinoma metastases. The most important differential diagnostic is a rectal adenosquamous carcinoma. Prognostic depends on stage of the disease, generally being worse than of the corresponding adenocarcinoma, and can be improved by radio- and chemotherapy.

[ASCUS of metaplastic type. Cyto-histopathological correlations]

We evaluated the cytopathological changes and the prognostic significance of atypical squamous metaplastic cells in cervical smears. 50 ASCUS cases were divided in two groups: 25 cases in different settings and 25 of metaplastic type. All cases were re-evaluated after 6 months and when necessary, verified by biopsy. The second cytological diagnosis was: group I--13 normal, 2 LSIL, 40 ASCUS; group II--6 normal, 2 LSIL, 2 HSIL and 15 ASCUS. The HPV was positive in 5 cases in group I and in 9 cases in group II. In ASCUS persistent cases the biopsy revealed: in group I--3 CIN 1 and 1 CIN 2 cases; in group II--1 CIN 1, 2 CIN II, 2 CIN III and one case of microinvasive carcinoma. In conclusion, atypical metaplastic cells are more frequently involved in serious cervical lesions.

[Diagnosis of gastric cancer on endobiopsies using the WHO classification]

Gastric cancer (GC), one of the most frequent malignancies can be early detected on endobiopsies. Our aim was to evaluate histologically the GC on endobiopsies, using WHO 2000 and Lauren classifications. The study included 2424 gastric endobiopsies, routine processed; sections stained with HE, Giemsa, PAS and AB. GC was diagnosed in 451 cases (19%), mostly in men (311 cases--69%). The highest incidence was in 60-69 year-old aged patients (34%). Using Lauren classification, 279 cases were included in diffuse type (62%), 167 intestinal-type (37%) and 5 (1%) mixed type. Each of these three types were also histologically analyzed considering the WHO classification. We pointed out that GC can be diagnosed histologically on endobiopsy specimens, although it is difficult to diagnose the GC--mixt type, due to reduced size of endobiopsies. Lauren classification (including the two major types: diffuse and intestinal) is very useful, especially if correlated with histological criteria of WHO classification.

[The morphopathological aspects at autopsy of HIV infection in children]

Aspects of HIV infection and AIDS in childhood have been reported since 1982. Pathological features are due to direct action of HIV, opportunistic infection and some tumoral processes. This report presents our own experience resulted from 27 cases of necropsy of patients diagnosed with AIDS or seropositive for HIV. Emphasize is placed on microscopic changes in different systems and organs (central nervous system, heart, lung, gastrointestinal tract, liver, lymphoid organs, kidney), by comparing our results with those described in literature.