Showing papers in "Československá patologie in 2009"

Mammaglobin immunostaining in the differential diagnosis between cutaneous apocrine carcinoma and cutaneous metastasis from breast carcinoma.

Abstract: The differential diagnosis between cutaneous apocrine carcinoma (CAC) and cutaneous metastases from breast carcinoma is commonly difficult. Many times, clinical information is crucial in the final diagnosis, because help that can be obtained from immunohistochemistry is usually limited concerning this subject. We used the antibody mammaglobin in order to study 10 cases of cutaneous metastasis of ductal breast carcinoma, and 2 cases of CAC. One of the CAC cases showed only scattered positive cells, while the other did not show any positivity. Four cases of metastatic breast carcinoma also showed scattered positive cells. In other five metastatic cases, positive cells were abundant, representing up to 60% of the tumoral cells. One case of metastatic breast carcinoma did not show any expression of mammaglobin at all. Although, more cases of CAC should probably be studied in the future before any categorical conclusion can be obtained, our results seem to indicate that a pattern of immunostaining with expression of mammaglobin in many cells would favor a metastatic origin of the tumor.

Recurrent mucinous carcinoma of skin mimicking primary mucinous carcinoma of parotid gland: a diagnostic pitfall.

Abstract: A case of a 63-year-old man with a swelling lasting 2 years in the left infraauricular area is reported. Examination by fine needle aspiration cytology raised suspicion of mucoepidermoid or adenoid cystic carcinoma of the parotid gland and an excision was recommended. The lateral parotidectomy specimen showed a poorly circumscribed gelatinous tumor measuring 15 mm in diameter within the parotid gland tissue. Microscopically, the lesion featured large pools of mucin containing clusters of tumor cells with little atypia and low mitotic activity. Immunohistochemically, the tumor cells showed expression of epithelial markers and of both estrogen and progesterone receptors. Left lateral neck dissection revealed massive lymphogenous dissemination of the tumor. Retrospective analysis of a skin biopsy from the same anatomic area performed 8 years prior to parotid neoplasm displayed a tumor with identical microscopic appearance and immunohistochemical profile (additionally performed) which was, however, misdiagnosed as a benign lesion. The diagnosis of recurrent primary mucinous carcinoma of the skin infiltrating the parotid gland was established. The patient underwent radiotherapy and has been 3 years free of disease. The differential diagnostics of this rare tumor is discussed.

Thyroid carcinoma in children and adolescents resulting from the Chernobyl accident: possible causes of the incidence increase overestimation.

Abstract: The Chernobyl accident in the nuclear power plant on 26th April 1986 was followed by numerous publications overestimating the medical consequences of the disaster In the publications, interpretations of spontaneous diseases as radiation-induced, indication of radioactivity or dose levels without confrontation with the natural radiation background, or conclusions about incidence increase without comparison with the increase tendencies in larger regions or the whole country, can be found Improved diagnostics after the Chernobyl accident is not always taken into account The high figures could have been caused in some cases by non-random material selection or inadequate morphological assessment of biopsy specimens The application of the linear-no-threshold theory to the inhabitants of contaminated areas contributed to an overestimation of medical consequences of the Chernobyl accident as well The incidence increase of thyroid carcinoma in children and adolescents started in 1990, four years after the accident High tumor expectancy after the accident, in the circumstances of limited technical possibilities and outdated equipment of histological laboratories, contributed to a higher number of registered cases The quality of specimens necessary for the assessment of nuclear criteria of papillary carcinoma was not always achieved at that time The incidence increase of thyroid carcinoma can, at least in part, be explained by improved detection of thyroid nodules with occasional false-positive conclusions about malignancy Besides, latent carcinomas and well-differentiated thyroid tumors of uncertain malignant potential, diagnosed as malignancies, could have additionally contributed to the high figures

[Congenital granular cell epulis: a case report].

Abstract: Congenital granular cell epulis is a rare benign lesion occuring exclusively in newborns as a solitary or multiple swelling of alveolar mucosa of either maxilla or mandible. A case of a female newborn who presented with multiple swellings of both maxillary and mandibular alveolar mucosa measuring up to 10 mm is presented. On 24th postnatal day, the lesions were under general anesthesia excised and sent for microscopic examination, which revealed congenital granular cell epulis. Immunohistochemically, granular cells showed expression of both vimentin and PGP 9.5, whereas the proof of S100 protein and inhibin was negative. The postoperative course was uneventful and follow-up for 8 months showed no local recurrence.

Angiosarcoma of the parotid gland.

Abstract: Angiosarcomas of the major salivary glands are rare tumours. The authors describe a case of the tumour located in the right parotid gland of a 77-year-old woman. Histological examination revealed a poorly differentiated tumour made up of epithelioid and spindle cells. These two types of cells intermingled. In some parts, primitive mutually anastomosing irregularly shaped vascular spaces with atypical endothelial cells were found. The tumour cells were positive for CD31, CD34, EMA and FVIII (focally). Due to the relatively short follow-up period the prognosis of the disease is difficult to estimate.

[Post-radiation dedifferentiation of meningioma into chondroblastic osteosarcoma].

Abstract: We report a case of post-radiation dedifferentiation of meningothelial meningioma into chondroblastic osteosarcoma. The tumor developed in a 61-year-old man, seven years after adjuvant stereotactical radiotherapy of recurring meningioma. Histologically, there was a continuous transition from atypical meningioma into chondroblastic osteosarcoma. The patient died three weeks after the surgery, without additional oncological treatment. To our knowledge, this case represents only the second reported case of post-radiation dedifferentiation of meningioma into osteosarcoma.

[Merkel cell carcinoma--immunohistochemical study in a group of 11 patients].

Abstract: The aim of our work was to confirm an immunohistochemical profile of routine markers of epithelial and neuroendocrine differentiation in eleven cases of Merkel cell carcinoma, as well as to study the expression of two markers of early phases of neuronal differentiation, namely reelin and class III beta-tubulin, markers which have not yet been studied in Merkel cell carcinomas. In all the investigated tumours the characteristic "dot-like" pattern of cytokeratin 20 immunoexpression, as well as negative immunostaining for cytokeratin 7 and thyroid transcription factor 1 (TTF-1) were disclosed; all the tumours showed neuroendocrine differentiation, expressing either neuron specific enolase (NSE) or chromogranin A(CgA), or both. An interesting finding was observed when the anti-cytokeratin monoclonal antibody MNF 116 was used. The characteristic "dot-like" pattern was detected in high proportion of tumours, including two samples of local recurrence of one of the carcinomas, where neoplastic cells have lost the expression of cytokeratin 20. The majority (91%) of Merkel cell carcinomas included in our group showed positive immunodetection of class III beta-tubulin when TU-20 antibody was used, while TuJ-1 immunostaining was surprisingly negative in all the investigated tumours. Detection of reelin was negative in almost all the studied Merkel cell carcinomas except for cases, where neoplastic cells revealed weak focal immunostaining in a minor portion of neoplastic cells.

[Neuroendocrine tumours of the alimentary tract--history and at present].

Abstract: Histological classification of the neuroendocrine tumours ("carcinoids") of the alimentary tract, as well as the opinion on biological behaviour of these tumours, changed rapidly within the last decade. Advances in knowledge of cellular biology of the diffuse endocrine system and in clinical diagnostics and treatment of tumours lead to the creation of a new histological classification of neuroendocrine tumours. This classification, apart from essential histological picture and immunohistological characterisation of the markers of neuroendocrine differentiation, also includes definition of biological properties of tumours based on their site of origin, mitotic and proliferative activity of the tumour cells and clinicopathological correlation, including the size of the tumour and its progression. Exact classification of an individual tumour into a corresponding category is an essential condition to select adequate following diagnostic procedures and optimal therapeutic strategy.

[Retiform hemangioendotelioma in a 8-year-old girl--case report].

Abstract: Retiform hemangioendothelioma (RHE) is a rare vascular tumoriform lesion characterized by rete testis--like vascular structures. RHE belongs to a group of vascular tumors of intermediate malignancy and together with Dabska tumor form a category of so-called hobnail hemangioendotheliomas. Authors present a case of a 8-year-old girl with RHE which was located in right calf and measured 12 x 8 mm. Histologically, the tumor consisted of a net of vessel formations with retiform appearance and prominent endothelial nuclei. Some of vascular channels had intraluminal projections. Other benign and malignant vascular lesions with hobnail cells (hemangioma, angiosarcoma) have to be considered in differential diagnosis.

[Detection of regulatory protein p16/INK4A in the dysplastic cervical squamous cell epithelium is a diagnostic tool for carcinoma prevention].

Abstract: Parallel sections from 423 randomly selected blocks representing biopsies of 178 women with the diagnosis of cervical dysplasia and/or erosion were stained for p16 polypeptide. The p16/INK4A (inhibitory kinase 4) protein is a cellular division regulator, expression of which increases in the presence of oncoprotein E7, encoded by human papillomavirus (HPV). Expression of p16 protein was seen in the nuclei and cytoplasm of dysplastic squamous epithelium cells as well as in carcinoma cells. In 16.6% of erosion cases, the p16 antigen was present in the basal and suprabasal layer of the surrounding squamous epithelium revealing features of CIN I/LSIL. In CIN I/LSIL as classified by HE staining, the p16 antigen was found in 65 out of 80 (81%) cases. The p16 protein was typically seen in dysplastic basal and suprabasal cells encompassing a confluent layer in the lowest third segment of stratified epithelium. In CIN II and CIN III grouped as HSIL, the positive rate of p16 antigen presence was 95% (in 45 cases out of 47) and/or 100% (in each of 27 cases), respectively. The typical sign of p16 antigen distribution in HSIL was its staining over two thirds and/or throughout the whole dysplastic epithelium. Extensive staining for p16 antigen was registered within nuclei as well as cytoplasm of neoplastic cells in all 6 cervical squamous cell carcinomas, which were examined in many sections when being used as positive controls. Based on our experience, we consider the p16 antigen staining a helpful tool indicating dysplastic cells and estimating their extent.

Systemic amyloidoses in renal biopsy samples

Abstract: UNLABELLED The kidneys are one of the most frequent sites of amyloid deposition during systemic AL, AA, and several hereditary amyloidoses. Distinguishing between different forms of amyloids is clinically important because of their different treatment. MATERIAL AND METHODS We present a 5-year retrospective study of amyloidoses diagnosed in renal biopsy samples. The classification of amyloidosis was made by immunofluorescence and immunohistochemical staining with antibodies to kappa and lambda immunoglobulin light chains, and for serum amyloid A protein. RESULTS From January 2003 to December 2007, 996 renal biopsy samples from one centre were evaluated. Amyloidosis was diagnosed in 62 samples (6.2%); 33 (53.2%) were classified as AL and 25 (40.3%) as AA amyloidosis. Four cases have remained unclassified. We did not identify any difference in the distribution of deposits among cases with AL and AA amyloidosis, respectively. The majority of patients underwent the renal biopsy due to severe proteinuria or nephrotic syndrome. Three patients had very low proteinuria, less than 0.5 g/day. Diagnosis of amyloidosis was suspected by nephrologists in 48 patients (77.4%). CONCLUSION Diagnosis of amyloidosis involves detection of amyloid deposits and classification of the amyloid form, which represent the basic step for appropriate therapy. Altogether it is not an easy task for pathologists, and with the emergence of markedly different treatments depending on the specific type of amyloid, the precise typing is of increasing clinical importance and should be performed with great care. Immunofluorescence can be very useful in daily practice for classification of the type of amyloidosis.

New aspects of tumor pathobiology

Abstract: Several biological principles such as epigenetic changes, RNA interference, epithelial-mesenchymal transition, and cancer stem cell formation have been recently connected to the pathobiology of tumors. All these phenomena have, along with genetic changes, a significant impact on the neoplastic transformation and/or tumor progression. Authors report a review of the above mentioned "nongenetic" processes and their effect on the neoplastic transformation, and the appearance, behavior, prognosis, and therapy of tumors. Future diagnostic and therapeutic perspectives are also discussed.

Unusual clinical presentation of hepatic yolk sac tumour in periappendical region. A case report and review of the literature

Abstract: Primary hepatic yolk sac tumour (YST) is a very rare neoplasm The authors present a case of a 20-year-old woman with fever and pain in the epigastrium, clinically resembling acute appendicitis along with high levels of serum alpha-fetoprotein From laparoscopic appendectomy there was bioptically verified a diagnosis of YST Consequently, there was discovered a tumor in the liver and the patient underwent right hemihepatectomy, hemicolectomy and ovariectomy, from which the YST was disclosed in the liver and in the coecum with spread into regional lymph nodes While the gonadal, mediastinal and central nervous system origin of the YST was excluded, the diagnosis of the primary hepatic YST could have been established The exact etiology of primary hepatic YST is still unclear It has been suggested that these YSTs might originate from the germ cells that escaped during migration course from the yolk sac to the genital ridge during embryogenesis with subsequent malignant transformation or from persistent pluripotent embryonic cells in the liver, which escaped from the influence of differentiation during embryogenesis This tumour is aggressive with ability to spread into distant sites, where it can lead to the first clinical presentation

New trends in diagnostics and classification of breast carcinoma

Abstract: Authors report a review of current issues in morphological, immunohistochemical and molecular-genetic diagnostics of breast carcinoma. In particular, classification of tumors based on molecular profiling (luminal, HER-2 positive, triple-negative), frequency of HER-2 positive tumors in population, as well as new approaches and pitfalls in HER-2/neu diagnostics, including current recommendations for performing the tests in the Czech Republic are discussed.

[Our experience in using fluorescence in situ hybridization FISH-Uro Vysion in diagnostics of urothelial carcinoma].

Abstract: UNLABELLED Urothelial carcinoma is a disease at high risk of recurrence after the initial therapy (70-80%) and with the tendency to progression accomplishing the recurrence (30%). Long lasting monitoring of patients with urothelial carcinoma is necessary. Cystoscopy and cytology are currently the primary modalities used to detect and monitor urothelial carcinoma. However, cytology has relatively poor sensitivity especially in well differentiated tumors. Cystoscopy is an invasive and relatively expensive method. Therefore, methods improving detection of urothelial carcinoma from urine specimens are employed. Uro Vysion (Vysis) fluorescence in situ hybridization (FISH) for improved detection of urothelial carcinoma was evaluated. MATERIALS AND METHODS Bladder tumor progression is accompanied by increased chromosomal instability and aneuploidy of chromosomes 3, 7, 17 and loss of locus 9p21. A total of 124 patients were analyzed at Dpts. of Urology and Pathology, Faculty Hospital in Brno. Cytologically analyzed urine specimens were tested by FISH and simultaneously cystoscopy was employed including biopsy for histological examination. RESULTS FISH analysis was positive in 35 cases, including 5 cases with negative biopsy and cytology. Negative FISH result was detected in 24 cases where the malignant status was determined. The sensitivity of FISH in our series was 58.9% and the specificity 88.1%. CONCLUSIONS FISH is a relatively simple, speedy and non invasive diagnostic method. It detects the symptoms of malignity on the molecular level, which leads to earlier diagnosis and therapy and, hence, to potential extended survival. FISH makes it possible to take decision in cases of atypical or unclear cytological finding. The FISH method using the Uro Vysion kit appears as a prospective non invasive method capable of early UK detection, with a higher sensitivity than the standard cytology of urine.