The prognostic value of E-cadherin and Ki-67 compared to standard histopathologic examination in non-muscle invasive bladder cancer

OBJECTIVES

The objectives of this study were to determine the prognostic value of expression levels of selected biomarkers and their statistical analysis in relation to survival and standard histopathologic examination and other clinicopathologic variables in non-muscle invasive bladder cancer (NMIBC).

BACKGROUND

Worldwide, bladder cancer is a frequent malignant disease with rising incidence. Characteristic invasiveness and high recurrence rates call for more diagnostic methods to obtain more accurate information. Prognosis is affected by a significant interpersonal variability of the disease. For this reason, constant search for alternative and better diagnostic methods is essential.

METHODS

We analysed cancer tissue from patients with Ta and T1 bladder cancer. E-cadherin and Ki-67 expression levels were analysed using immunohistochemical staining. The expression levels quantified to a percentual amount were statistically analysed in relation to survival and their frequency distribution in the study group.

RESULTS

E-cadherin and Ki-67 expression levels show high association with tumor stage and grade         (p<0.001), in contrast, the association with recurrence has proven insignificant. Patients with non-aberrant biomarker expression levels have much higher survival rates than the cases with aberrant expression.

CONCLUSION

Low expression levels of Ki-67 and high expression levels of E-cadherin positively affect survival of patients, whereas aberrant expressions pose poorer prognosis (Tab. 2, Fig. 2, Ref. 33).

Bone metastases in neuroendocrine tumors

Neuroendocrine tumors arise from various cells that form a part of the endocrine system and account for a small number of cases encountered by oncologists in clinical practice. The clinical incidence of these tumors used to be low, and newer imaging modalities have now begun to be used for detecting bone metastases at an earlier stage. Bone metastases arising from neuroendocrine tumors are a well-recognized complication. Their presence carries along a poor prognosis. Clinical symptoms are similar to those encountered in other forms of cancer that are complicated by bone metastasis. Over the last decade or so, the clinical detection, diagnostic methods and treatment strategies have changed dramatically, and new treatments are emerging slowly. The indolent course of neuroendocrine tumors and the development of bone metastasis have limited our current knowledge on how to best prevent and manage the condition. Current information available from clinical studies is marred by paucity and small sample sizes, making further clinical trials an absolute necessity. In this review, we discuss the current status in the diagnosis and management of bone metastases arising from neuroendocrine tumors (Fig. 3, Ref. 28).

Detection of circulating tumor cells in metastatic breast cancer patients

OBJECTIVE

The objective of this study was the detection of circulating tumor cells (CTCs) in metastatic breast cancer patients.

METHODS

Since only small numbers of circulating tumor cells (CTCs) are found in peripheral blood, at first we performed immunomagnetic separation as a concentration method suitable for selecting circulating tumor cells in peripheral blood. This was followed by analysis of isolated cells with the aid of laser scanning cytometry (LSC). Twenty eight patients with metastatic breast cancer were enrolled in the study and the control group consisted of 19 clinically healthy women. Six milliliters of peripheral blood was drawn for the analyses, but only in two patients the blood has been drawn twice. Blood samples were taken when no chemotherapy was administered, but hormonal therapy has been allowed.

RESULTS

The positivity for CTCs was found in 20 (50.0 %) patients with metastatic breast cancer patients, while in 6 (31.6 %) healthy controls false positive circulating epithelial-like cells were detected. Because we did not use CD45 staining, we could not distinguish these circulating epithelial-like cells from CTCs. In a majority of metastatic breast cancer patients we found a mixed population of HER-2 gene expressing CTCs. We found that HER2+ CTCs in high numbers are CK19 + CTCs, while almost all HER2-CTCs are CK19- CTCs.

CONCLUSION

The described method was found promising for estimating HER2 status on CTCs from peripheral blood in metastatic breast cancer patients.

Radionavigated detection of sentinel nodes in breast carcinoma--first experiences of our department

INTRODUCTION

Biopsy and histological evaluation of sentinel lymphatic node limits the axillary node dissection only in cases of positive histological finding and decreases the occurrence of postoperative complications related to the axillary node dissection.

METHODS

We used radiotracer SentiScint, Medi-Radiopharma Ltd, Hungary and preoperatively administered blue dye--Blue Patenté V, Guebert, Aulnay-Sous-Bios, France. 11 (18%) patients were subdued to deep peritimorous application of radiotracer, 10 (16.4%) to sub/intradermal application over the lesions and n 40 (65.6%) patients the application was sub/intradermal and periareolar. The patients underwent an operation protocol of corresponding quadrantectomy, radionavigated blue-dye sentinel node biopsy and axillary dissection.

RESULTS AND CONCLUSIONS

From May 2006 to June 2008, we examined 61 patients with breast carcinoma. They underwent radionavigated and blue-dye sentinel node biopsy. We detected 57 (93.4%) sentinel nodes with preoperative scintigraphy, of which only 51 (83.6%) were detected peroperatively and underwent histological evaluation. In six (9.8%) cases, the "frozen cut" histology of the primary lesion had shown a benign lesion; hence no sentinel node biopsy or axillary disection was performed. 12 (19.7%) of 51 histologically evaluated sentinel nodes had metastatic invasion. We retrospectively compared the histological fund in sentinel and axillary nodes in patients with metastatic sentinel nodes. In 6 (16.6%) cases, the sentinel node was positive of metastatic invasion but axillary nodes were histologically negative, in 6 (16.6%) cases the sentinel node and axillary nodes were positive for metastatic invasion. We observed falsely negative findings in 3 (8.3%) patients with negative histological fund in the sentinel node, but positive axillary nodes (Tab. 3, Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Synaptophysin negative central neurocytoma

BACKGROUND

Central neurocytoma is a rare primary brain tumour, mostly localised in the lateral ventricles in relation to the foramen of Monro.

OBJECTIVES

To report a case of a rare central neurocytoma with a complete loss of Synaptophysin expression and provide the differential diagnosis.

METHODS AND RESULTS

We describe a case of a 34-year old man with a headache, unsteady gait and dim vision. MRI demonstrated a tumorous expansion localised in both lateral ventricles. The patient underwent a subtotal resection. Histology showed a picture consistent with central neurocytoma, but tumour was completely negative for Synaptophysin. We describe our approach in such a diagnostically difficult case.

CONCLUSIONS

In the rare case of Synaptophysin-negative central neurocytoma, its neuronal differentiation should be substantiated by electron-microscopic examination. Unfortunately in the routine work, biopsy samples are usually fixed in formalin fixative which does not preserve ultrastructure well. In such situations, an accurate diagnosis is disputable and based on careful assessment of the histological features, exclusion of tumours with similar morphology and detailed correlation with MRI pictures (Fig. 4, Ref. 6). Full Text (Free, PDF) www.bmj.sk.

Chromatin texture, DNA index, and S-phase fraction in primary breast carcinoma cells analysed by laserscanning cytometry

OBJECTIVES

Laser scanning cytometry (LSC) is a slide-based technique capable of measuring a number of biological parameters both in immobilised cell suspensions and in formalin-fixed paraffin-embedded tissue sections.

BACKGROUND

High proliferation rate in surgically removed breast tumours is an unfavourable prognostic factor. In node negative cases it can help distinguish patients with higher risk for distant metastases from those with a lower risk.

PATIENTS AND METHODS

In a prospective study we investigated 140 breast tumours, of which 113 were invasive ductal carcinomas, 11 were invasive lobular carcinomas, and 16 tumours were of other histological types. Cells for LSC investigations were prepared from fresh, surgically removed tumours by mechanical disintegration. After fixation the cells were stained with FITC-conjugated anti-cytokeratin (CK-FITC) to distinguish CK+ tumour cells from CK- stroma, and with propidium iodide to stain DNA.

RESULTS

We identified three S-phase fraction (SPF) groups, with low (30 patients), moderate (54 patients), and high SPF (51 patients). Thirty-seven tumours were diploid, 83 were aneuploid, while 5 tumours had a bimodal distribution of DNA content. Chromatin texture values were increasing in the respective subclasses from the hypodiploid group to the tetraploid/hypertetraploid group.

CONCLUSION

The measurement of DNA content and SPF of tumours by LSC completed by and correlated with other biological properties of the tumour cells may be a useful tool in assessing prognosis and clinical outcome of patients with breast cancer. (Tab. 5, Fig. 4, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

Advanced detection and measurement of cells on membrane from peripheral blood by laser scanning cytometry (LSC) in early stage breast cancer patients

BACKGROUND

The aim of our study was the potential detection of circulating tumour cells (CTCs) in early stage breast cancer patients. Our approach was cell microfiltration through polycarbonate membrane as a concentration method suitable for CTC selection in peripheral blood. The isolated cells on membrane were further analysed by laser scanning cytometry.

METHODS

Sixteen patients were enrolled in the study, of which 13 had early stage breast carcinoma and 3 patients had metastatic breast carcinoma. The analyses were performed from 9 ml of peripheral blood, in one patient blood was drawn twice. Blood samples were taken after adjuvant chemotherapy but prior to adjuvant radiotherapy. The control group consisted of 12 clinically healthy subjects.

CONCLUSIONS

In the control group 3 subjects out of 12 had 1 CTC, the mean CTC numbers being 0.25 +/- 0.45. In the early stage breast cancer patients 0-36 CTCs were detected (mean 13.9 +/- 12.9 CTCs. 10 patients out of 13 had more than 2 CTCs (62%). The detection and measurement of cells on membrane is a simple and reproducible method of detection of CTCs in peripheral blood. Sensitivity of the method is 88.5%. Detection of CTCs seems to be a promising method for the monitoring of adjuvant therapy in early stage breast cancer patients and for the identification of high risk patients in whom elevated numbers of CTCs are persisting following the termination of adjuvant therapy (Tab. 1, Fig. 4, Ref. 35). Full Text (Free, PDF) www.bmj.sk.

Genetic analysis of KRAS mutation status in metastatic colorectal cancer patients

Colorectal carcinoma (CRC) represents a serious problem worldwide: in the Slovak republic are diagnosed about 2600 new CRC cases annually and its incidence is increasing. Colorectal cancer patients may succumb to the disease because of local recurrence or local formation of metastasis. Therefore, it is necessary to modulate therapeutic algorithm with new methods, leading to early diagnostic of CRC or changing the existing therapeutic procedures. Recent progresses have been made in understanding of EGFR pathway involved in CRC carcinogenesis, especially the role of Ras protein. Mutations in KRAS oncogene are frequently found in human cancers, particularly colorectal, pancreatic, billiary tract and lung tumors. The presence of the KRAS mutations in metastatic colorectal cancer patients correlates with lack of response to the certain epidemal growth factor receptor (EGFR) inhibitor therapies, such as Panitumumab and Cetuximab. Consequently, screening for KRAS mutations status may be used as a prognostic marker, because the CRC patients with KRAS positive tumors have a worse prognosis. The aim of our study was to establish the methods for rapid and sensitive detection of KRAS mutation status in formalin fixed paraffin embedded (FFPE) tissues DNA. We applied Real Time PCR analysis (TheraScreen KRAS Mutation Test Kit) and sequencing analysis (optimised for the analysis of FFPE tissues) to detect somatic mutations in codon 12 and 13 of KRAS gene. Both methods were used concurrently in the panel of DNA isolated from 25 colorectal FFPE tissues tumor. The positive or negative results from all 25 samples were identified by both methods independently. The KRAS mutations were presented in 8 of 25 patients (32%). Our results demonstrate that the Real Time PCR analysis can be used for detection of somatic KRAS mutations in FFPE clinical samples. However, we also recognize that the sequencing analysis of approximately 200bp amplicons may be used for mutations status screening, but with care of method sensitivity.

Recurrent malignant epitheloid schwannoma of the lower lip

The authors describe a case of recurrent malignant epitheloid schwannoma of the lower lip. Histologically, the tumor was composed of fibroblast-like spindle cells in compact fascicles and areas of epitheloid growth, combined with demonstration of S-100, GFAP and NF positivity, which is characteristic for this type of tumor. The therapy consisted of a combination of surgery and radiotherapy and the patient was followed-up since the disease was diagnosed. A local re-operation had to follow the first surgical intervention consisting of a radical excision of tumor in the lower lip together with suprahyoid neck dissection six months later. After the first operation, the patient received a radiation therapy with a total dosage of 12 Gy in seven fractions to the tumor area of the lower lip. After the second operation, an external radiotherapy with total dosage of 50 Gy was applied. Despite the complex intensive therapy, the patient died of metastases into lungs, liver and spine 37 months after the initiation of the therapy (Fig. 2, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Laser scanning cytometry (LSC) in pathology--a perspective tool for the future?

Cytometry is becoming a standard method of examination not only in biology but also in various fields of experimental and clinical medicine. While in flow cytometry suspensions of cells are measured, laser scanning cytometers enable both the measurement of cells in single-cell suspensions (after immobilising the cells on a conventional glass slide) and in frozen or paraffin-embedded tissue sections. We discuss the possible fields of utilisation and future perspectives of laser scanning cytometry in medicine with special reference to clinical pathology and cytology (Fig. 3, Ref. 49). Full Text (Free, PDF) www.bmj.sk.

Thyroid tumors: histological classification and genetic factors involved in the development of thyroid cancer

Classification of thyroid tumours and their variants is described with special respect to some recent findings on somatic mutations characteristics which are associated with individual types of malignity. Special attention is paid to the interrelations between thyroid nodules and malignity and predictive risk factors are listed.

Heterotopic pancreas in gastric antrum with macroscopic appearance of gastric polyp

Heterotopic pancreas is a relatively rare clinical diagnosis, not commonly involved in differential diagnostic considerations of GI symptoms. The authors report a case of heterotopic pancreas discovered endoscopically in the gastric antrum. A 60-year-old woman presented with epigastric pain. The patient took alendronate for osteoporosis. The endoscopic examination revealed Helicobacter pylori positive antral atrophic gastropathy and a well delineated hemispherical polyp, 8 mm in diameter, in the antrum of the stomach. Histology showed antral gastritis and the presence of heterotopic pancreas. After dietary measures and Helicobacter eradication, the patient was relieved of symptoms. According to the authors' opinion, the finding of heterotopic pancreas did not necessitate intervention, and was an incidental finding. The authors discuss the significance of heterotopic pancreas with the conclusion that the resection of the lesion is indicated only if consistent symptoms are present. Fig. 3, Ref. 28.)

Serum markers of liver fibrogenesis, and liver histology findings in patients with chronic liver diseases

AIM OF THE STUDY

Investigation of the relationships between the grade and stage of chronic liver diseases irrespective of their etiology using some novel serum markers of liver fibrogenesis, the "classical" serum markers of liver necro-inflammatory injury (such as transaminases), and the histomorphological evaluation of liver biopsies.

METHODS

Markers of liver fibrogenesis: serum metalloproteinase 1 (MMP-1), tissue inhibitor of MMP-1 (TIMP-1), and N-terminal propeptide of the procollagen III (PIIINP); "liver function tests" (LFTs): bilirubin, transaminases ALT, AST; ALP, GMT; and liver morphology findings: necro-inflammatory activity, fibrosis; were studied in the series of 32, 'naive', i.e. yet untreated patients (women/men--11/21) with various CLDs: chronic viral hepatitis B or C 13 (CHB 3, CHC 10), non-alcoholic steatohepatitis 9, liver steatosis 4, primary biliary cirrhosis 5, drug-induced hepatitis. The diagnoses were based on the clinical, laboratory and liver imaging (ultrasonography) findings and confirmed by the liver biopsy.

CONCLUSIONS

Investigation of liver fibrogenesis serum markers (PIIINP, MMP-1, TIMP-1) in patients with various CLDs has shown statistically significant correlations of these parameters with "classical" serum markers of liver necro-inflammation (ALT, AST) and the results of histomorphological evaluation of the necro-inflammatory activity (parameters NAI, MEF) and fibrosis (parameter FI) in liver biopsies. (Tab. 4, Ref. 31.)

Clinical picture of arteriolosclerosis

Arteriolosclerosis is a generalised systemic vascular disease which is characterised by hyalinisation of intima (hyalinosis) as well as proliferation and hypertrophy of the media in the arteriolar part of the arterial system (so-called benign arteriolosclerosis). However, the patients suffering from accelerated and malign hypertension develop also fibrinoid necrosis (so-called malign arteriolosclerosis, arteriolonecrosis). Arteriolosclerosis as well as other similar stenotic (obliterating, obstructive, occlusive) diseases of the arterial system, have one single common consequence--ischemia. Currently, angio-organic ischemic syndromes in the whole world most frequently result from atherosclerosis which, however, is not the only nosologic unit of the group of arterial diseases having the tendency to develop arterial wall sclerosis. The latter group is briefly referred to as arteriosclerosis. In addition to atherosclerosis, this group includes also Mönckeberg's medial arteriosclerosis, diabetic angiopathy and arteriolosclerosis. The authors of this study, on the basis of their analysis of their own large set of patients (71,662 angiologic consultant examinations performed during the period of 25 years of the existence of the Angiologic Department of the Medical Faculty Hospital of Comenius University in Bratislava) attract attention to the fact that the clinical picture of this disease is multiform, and that it occurs frequently in clinical practice. Therefore, angiology is a separate specialisation which is above the structure of internal medicine.

Malignant carcinoid in two brothers

Familial occurrence of malignant carcinoid is rare (about 3%). Authors describe occurrence of the malignant carcinoid in two brothers. In the older one the diagnosis was estimated in 1991. He had multiple intestinal carcinoid tumor with multiple liver metastases histological type III by Soga classification. Patient is intermittently treated with somatostatin analogue--lanreotid and with interferon alfa. By this therapy the disease is stabile. In the younger of brothers the diagnosis was estimated in 1999. The disease had rapid progression and in ten months patient died despite of the therapy. Definitive diagnosis was a malignant neuroendocrine tumor of pancreas-mixed low differentiated carcinoid with calcitonin overproduction. (Fig. 4, Ref. 15.)

Effect of pleuran (beta-glucan from Pleurotus ostreatus) on the antioxidant status of the organism and on dimethylhydrazine-induced precancerous lesions in rat colon

The effect of pleuran (beta-1,3-D-glucan isolated from the oyster mushroom Pleurotus ostreatus) on the antioxidant status of the organism and on the development of precancerous aberrant crypt foci (ACF) lesions in the colon is studied in the male Wistar rat. A diet containing either 10% pleuran or 10% cellulose was compared with a cellulose-free diet and both were found to significantly reduced conjugated diene content in erythrocytes and in liver. Particularly significant was the reduction of conjugated dienes in the colon following pleuran administration. Diets containing cellulose and pleuran reduced glutathione peroxidase (GSH-PX) activity and increased catalase activity in erythrocytes. Pleuran increased superoxide dismutase (SOD) and GSH-PX activity (compared with the cellulose diet), and glutathione reductase activity (compared with the cellulose-free diet) in liver; and both diets reduced glutathione levels significantly in the colon. ACF lesions developed in the colon of all animals fed a cellulose-free diet; however, the incidence was reduced to 64% and 60% following the cellulose and pleuran diets, respectively. The highest average count of the most frequent small ACF lesions--and highest total count--was seen in animals fed a cellulose-free diet. Although ACF lesions were reduced by the cellulose diet, the more significant reduction statistically (>50%) was achieved with the pleuran diet.

Histopathology of mammary tumours in female rats treated with 1-methyl-1-nitrosourea

OBJECTIVE

To induce, evaluate and classify advanced stages of mammary gland tumours induced by MNU.

METHODS

Female Sprague-Dawley rats were injected intraperitoneally with 1-methyl-1-nitrosourea (MNU; 50 mg.kg-1) on the day 33, 40, 47, 54 and 61 of age in the first experiment and on 50th and 113th day in the second experiment. On the 117th day (first experiment) and on the 153rd day of age (second experiment) the rats were sacrificed by decapitation and their mammary glands were evaluated both macroscopically and microscopically for the presence of grossly detectable mammary tumours. Mammary tumours were classified according to Russo et al. (1990).

RESULTS AND CONCLUSIONS

The final incidence of palpable carcinomas was ranging from 60 % to 76 %. All microscopically evaluated tumours were malignant. Among the total number of lesions classified the percentage of invasive tumours ranged from 35 % to 44 %. No metastases were observed in other organs in MNU treated animals.

Effect of oyster mushroom (Pleurotus ostreatus) on pathological changes in dimethylhydrazine-induced rat colon cancer

The effect of 5% of dried oyster mushroom (Pleurotus ostreatus) in the diet on the dimethylhydrazine (DMH)-induced colon carcinogenesis was studied in male Wistar rats. DMH in a dose of 20 mg/kg of body weight was applied to animals once a week during a period of 12 weeks. Mushroom diet was applied either after treatment with DMH for another 21 weeks or during the whole experiment. Mushroom diet reduced significantly the incidence of lymphoid hyperplasia foci when mushroom was supplemented during the whole experiment. Tumour lesions could be characterized either as carcinoma in situ, or as infiltrating adenocarcinoma. Mushroom diet did not affect significantly the incidence of tumours. Nevertheless, a reduction in total number of tumours was observed in both groups of animals fed mushroom diet. A significant reduction of the number of tumour foci of the type carcinoma in situ was observed in animals fed the oyster mushroom during the whole experiment. Also these animals had the significantly lower number of aberrant crypt foci. Mushroom diet reduced the ornithine decarboxylase activity in the colon and in the liver when oyster mushroom diet was administered during the whole experiment.

Histopathological evidence of vitamin C protection against Cd-nephrotoxicity in guinea pigs

The critical organ of chronic cadmium (Cd) exposure are kidneys. Long-term exposure leads to Cd accumulation in kidneys and causes renal tubular dysfunctions. Cd-induced renal changes are irreversible, so the primary prevention by different nutrients can play an important role. In this study, male guinea pigs which, like humans, do not synthetize ascorbic acid (AA) received low (2 mg/animal/day) or high (100 mg/animal/day) dosage of AA and cadmium (1 mg Cd/animal/day) in drinking water for 12 weeks. Characteristic finding in renal morphology of Cd-intoxicated guinea pigs was dilatation of interstitial veins with apparent paravenous lymphatic infiltrates. Histomorphological changes were more evident in Cd-intoxicated guinea pigs with low AA intake. High AA intake apparently reduced in Cd-intoxicated guinea pigs the extent of renal damage. Cadmium significantly increased serum creatinine and urea levels in the group of guinea pigs with low AA intake but not in guinea pigs receiving high concentration of AA. The results showed that AA can be effective in the protection of Cd-induced nephrotoxicity.