Evaluation of microsatellite instability in routine examinations of surgical samples

CONTEXT

Approximately 20%-30% of colon cancer cases have a hereditary basis. The genetic defect may involve mismatch repair (MMR) genes, which results in microsatellite instability (MSI). MMR-deficient colorectal cancer may occur due to germline mutation (Lynch syndrome) or be a sporadic one. A tumor's histological features, supported by a panel of immunohistochemistry stains, enables pathologists to assess the MMR status, which in turn has beneficial effects on clinical management.

AIMS

We aimed to show the relations between histopathological features identified during routine examinations and MMR genes' mutations.

METHODS AND MATERIAL

We reviewed retrospectively the material of the Department of Pathology fulfilling the revised Bethesda Guidelines.

STATISTICAL ANALYSIS USED

We used Chi-square test, Spearman test, and epidemiological analysis.

RESULTS

For the PMS2 gene, the positive predictive value (PPV) indicates that 91% of cases neither present any histological lesions nor have genetic abnormalities. The negative predictive value (NPV) indicates that only 50% of cases have both histological and genetic changes. For the MSH6 gene, the PPV indicates that 85% of tumors without specific histological features do not have genetic abnormalities.

CONCLUSIONS

We advise universal staining for MLH1, MSH2, MSH6, and PMS2 in every newly diagnosed colon cancer, but due to costly analyses we suggest a protocol for the selection of cases for MMR examinations.

Primary neuroendocrine carcinoma of the breast - a report of four cases

Breast neuroendocrine tumours are rare, accounting for up to 5% of all breasts tumours and approximately 1% of all neuroendocrine tumours. In most cases, breast neuroendocrine tumours are histologically and moderately well differentiated. Neuroendocrine breast tumours lack characteristic imaging patterns. The histopathological assessment of these tumours is difficult, and in most cases the correct diagnosis is made after proper examination of the postsurgical specimen.

Clear cell carcinoma derived from an endometriosis focus in a scar after a caesarean section--a case report and literature review

Endometriosis is defined as the occurrence of endometrial glands and endometrial stromal cells outside their typical localization within the uterus. Malignant transformation of endometriosis foci in a scar after a caesarean section (cc) is very rare--until 2013 (in a span of 40 years), about 40 such cases have been described. In our article, we describe a case of a 42-year-old woman with a tumour localized in a scar after a caesarean section. The tumour was diagnosed as clear cell carcinoma derived from an endometriosis focus. The long time interval--17 years in average (from 3 to 39 years) between the surgery (cesarean section in most cases) and the tumor diagnosis is characteristic. In the case we describe, the patient was diagnosed 16 years after the endometriosis focus in the scar had arised. Even though endometriosis is a benign lesion, it has many features distinctive for invasive carcinoma; it may itself undergo a malignant transformation as well as increase the risk of endometrial carcinoma or clear cell ovarian carcinoma. Maybe in future, more exhaustive studies will allow establishing a therapeutic protocol in patients with extra-ovarian malignant transformation of endometriosis foci.

Inflammatory myofibroblastic tumor of the bladder - an unexpected case coexisting with an ovarian teratoma

Inflammatory myofibroblastic tumors (IMTs) mainly occur in children and young adults, usually in the first two decades of life. IMT-type tumors belong to neoplasms of an intermediate biologic potential with considerable rate of local recurrence and in some cases that able to create metastases. Presented case is the first IMT coexisting with the other neoplasm. In our paper we are going to present a peculiar case of an IMT of the bladder coexisting with an ovarian teratoma, and to discuss its pathogenesis, histological picture and differential diagnosis. A 19-year-old female was admitted to the Gynecological Department and during the surgery, two independent, non-adjacent tumors were found. To settle the diagnosis, a FISH examination with the ALK1 break apart probe was carried out. It confirmed the rearrangement of the chromosome 2p23. Morphologic and immunophenotypic similarities between an IMT and other malignant tumors of the bladder may lead to diagnostic errors and an unnecessary radical cystectomy as a result. The therapy of choice is only total excision of the tumor.

VIRTUAL SLIDES

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1937487606122622.

An atypical leiomyoadenomatoid tumor of the uterus--a case report and literature review

In this study, we describe morphological and immunohistochemical features of a mixed tumor (atypical leiomyoadenomatoid tumor - LMAT) localized in the body of the uterus.

AIM OF STUDY

LMAT-type tumors are very rare and only 5 cases have been described in the literature so far therefore this case report seems particularly noteworthy.

MATERIALS AND METHODS

A 57-year-old patient was admitted to the Gynecology and Obstetrics Unit, Brothers of Mercy Hospital in Katowice for hysterectomy with bilateral salpingo-oophorectomy due to uterine myomata. The macroscopic examination of the surgical material revealed a polycystic tumor 5 cm in diameter with gelatinous contents and grey fibrous areas. The patient was discharged on postoperative day 4, in good general condition. A histological diagnosis of an atypical leiomyoadenomatoid tumor was established on the basis of the tissue material.

Ozone Therapy in Induced Endotoxemic Shock. II. The Effect of Ozone Therapy Upon Selected Histochemical Reactions in Organs of Rats in Endotoxemic Shock

Mitochondria and lysosomes were evaluated by assessment of changes in activity of selected enzymes: lactate dehydrogenase (LDH), succinate dehydrogenase (SDH), adenosinetriphosphatase (ATPase), acid phosphatase (AcPase) and beta-glucuronidase (BG) in rats under profound hypoxia induced by endotoxemic shock. The study was conducted on adult male Wistar rats. The animals formed the following four groups of 15 rats each: control animals (C);-rats receiving intraperitonally O(2)/O(3) (CO), rats receiving of Escherichia coli toxin (LPS) (CL); rats receiving LPS plus oxygen-ozone mixture (OL). Histoenzymatic examinations of liver, kidney, lungs, and heart muscle were performed. Lipopolysaccharide suppressed activities of all the enzymes except for LDH, the activity of which as high as a fourfold increase. The results demonstrated potent, stabilizing and regenerative effects of ozone therapy on body enzymatic processes in course of induced endotoxemic shock in rats, which might prove to be of clinical significance.

[Analysis of adrenocortical tumors morphology as regards their structure and potential malignancy]

INTRODUCTION

A consequence of diagnosis of adrenocortical carcinoma (ACC) is introduction of pharmacological therapy, precise monitoring of the patients and in some cases re-operation. The aim of the study is to analyse morphology of adrenocortical tumours as regards their malignancy by use of criteria proposed by Weiss.

MATERIAL AND METHODS

110 adrenocortical tumours in 107 patients were analysed (M 27.1%, F 72.9%; age 32 to 77 years, mean 55.2 +/- 9.7). Conn syndrome was diagnosed in 16 patients (14.9%), Cushing syndrome in 12 (11.2%), and virilisation in 3 (2.8%). In 76 patients (71.0%) biochemical tests did not reveal hormonal hyperactivity of the tumour.

RESULTS

In routine histopatological examination ACC was diagnosed in 6 tumours (5.4%), adrenocortical adenoma (ACA) in 92 (83.6%) and adrenocortical hyperplasia in 12 (10.9%). Nuclear grade III or IV was observed in 8 tumours (7.3%), mitotic rate > 5/50 high power fields in 6 (5.4%), atypical mitoses in 5 (4.5%), clear cells constituting < 25% of the tumour in 10 (9.1%), diffuse architecture in 8 (7.3%), necrosis in 16 (14.5%), veins infiltration in 4 (3.6%), sinusoids infiltration in 7 (6.3%), and tumour capsule infiltration in 5 (4.5%). Among ACC tumours 4-9 features of malignancy were present, among ACA--0-3 features. Statistical analysis revealed correlation between number of criteria proposed by Weiss and maximal tumour size (p < 0.05).

CONCLUSION

The structure and cell arrangement in adrenocortical adenoma are heterogeneous. Application of criteria proposed by Weiss in histopathological examination of adrenocortical tumours can be useful in differentiating adrenocortical adenoma from carcinoma.

[Primary cardiac malignant fibrous histiocytoma in 47-year-old woman]

A case of pleomorphic malignant fibrous histiocytoma of the right atrium and right ventricle is presented. Primary cardiac malignant fibrous histiocytoma (MFH) is extremely rare and its etiology and clinical course are not precisely known. We treated a 47-year-old female patient with persistent fever and cough, shortness of breath and anasarca. The patient died after eight months with symptoms of cardiac shock. Autopsy revealed a big soft yellow tumor in the right heart. Microscopically, atypical fibroblast-like cells, pleomorphic and multinucleated giant tumor cells with eosinophilic cytoplasm were observed within the myxoid and fibrous stroma. Immunohistochemically, tumor cells were positive for alfa-1-antitrypsin and partially positive for CD68 and vimentin. According to histopathologic and immunohistochemical features we diagnosed pleomorphic MFH.