Showing papers in "Československá patologie in 2016"

Basal cell carcinoma of the skin with mixed histomorphology: a comparative study

Abstract: Basal cell carcinoma (BCC) of the skin exhibits a very heterogeneous histomorphology, on the basis of which it is classified into several subtypes and variants. In many cases, however, a definite categorization remains difficult, because BCC may consist of more than one histopathological subtype. There are limited data exploring the characteristics of these mixed BCCs, since they have not been specifically analysed. The aim of this study was to estimate the prevalence of BCCs with mixed histomorphology observed in a set of primary BCCs and to compare their clinicopathological features with a single type BCC subgroup. A total of 911 histologically proven primary BCCs from 697 patients were investigated. Prevalence of single and mixed type BCCs was 64.9 % and 35.1 %, respectively. In mixed type BCC subgroup, a very heterogeneous histomorphology was found comprising a mixture of two to four different subtypes in various proportions. The most frequent combinations included nodular-infiltrative, superficial-nodular, nodular-trichoepithelial and nodular-micronodular subtype. Comparative analysis of the two given subgroups showed that mixed type BCCs were significantly more frequently localized on the extrafacial regions of the head (30.0 % vs. 20.0 %, p = 0.02) and less often on the face (37.2 % vs. 45.2 %, p = 0.03). There were not convincing differences in the occurrence of single vs mixed type BCCs in other parts of the body. Histologically, mixed type BCCs exhibited an aggressive-growth pattern more frequently (64.6 % vs. 13.0 %, p < 0.0001). Positive surgical margins were significantly more common in mixed type BCC subgroup (17.8 % vs. 12.6 %, p = 0.02). Cutaneous BCCs with mixed histomorphology represented about one third of the cases. It is a common finding in routine pathological practice, probably suggestive of evolution and phenotypic transformation of the cancer. Since mixed type BCCs are frequently composed of aggressive histological subtypes, regardless the personal habits in description or terminology among pathologists, the presence of aggressive-growth component in tumor tissue should always be mentioned in final biopsy report.

Observations of different patterns of dysplasia in barretts esophagus - a first step to harmonize grading.

Abstract: We reviewed a set of cases of early neoplasia (low grade / high grade dysplasia / IEN and mucosal carcinoma) to reach better defined criteria for subtypes of dysplasia/differentiation in the columnar lined (Barretts) esophagus. We discuss criteria that we categorized for recognizing low and high-grade dysplasia and mucosal carcinoma in patterns of neoplasia that we regarded as intestinal, gastric and mixed.

Clinicopathological correlations of the immunoprofile in diffuse large B-cell lymphoma NOS - a single institutions experience.

Abstract: The experimental platform in hematooncology is still searching for more valid prognostic and predictive factors on clinical, morphological and molecular levels. The bridge closer to daily practice is so-called translation medicine and from this point of view we have tried to sort diffuse large B-cell lymphoma not otherwise specified. The applied methodological approaches are morphology, indirect immunohistochemistry on formaline-fixed, parrafin-embeded tissue, Hans classifier sorting, expression of Bcl-2, CD5, CD20, CD30 and NfκB proteins in comparison with the clinical (Ann Arbor stage, IPI, aa-IPI, PFS, OS), laboratory and cytogenetic results (complex and simplex karyotypes). Statistical analysis included Cox regressive analysis, Mann-Whitney and Kruska-Wallis test. The interval of PFS and OS has been assessed according to Kaplan-Meier analysis. According to Hans classifier 11 cases (18.7 %) could not be sorted exactly into GCB/nonGCB- like subgroups. All relapsing cases bear negative expression of CD10 and 28 cases of non-relapsing cases showed positive expression of CD10. The "third" - GCB-like/nonGCB-like unsortable subgroups shared a very similar course of PFS with the nonGCB-like subgroup and a worse clinical course of OS. Statistically nonsignificantly better response to chemotherapy was shown by cases with positive Bcl-2 expression of more than 30 %. Statistically nonsignificantly better OS and PFS was shown by cases with a proliferation index Ki67 more than 70 %. The study detected 17 cases (28.8 %) with a nuclear expression of p50 and one case with nuclear expression of p65 (1.7 %) which may imply the possibility of NfκB signaling pathway activation. A statistically nonsignificant realationship of p50 expression and OS/PFS was indicated.

Poorly differentiated sinonasal tract malignancies: A review focusing on recently described entities.

Abstract: Sinonasal tract malignancies are uncommon, representing no more than 5% of all head and neck neoplasms. However, in contrast to other head and neck sites, a significant proportion of sinonasal neoplasms tend to display a poorly/ undifferentiated significantly overlapping morphology and a highly aggressive clinical course, despite being of diverse histogenetic and molecular pathogenesis. The wide spectrum of poorly differentiated sinonasal epithelial neoplasms with small "basaloid" blue cell morphology includes basaloid squamous cell carcinoma (both HPV+ and HPV-unrelated), nasopharyngeal-type lymphoepithelial carcinoma (EBV+), small/large cell neuroendocrine carcinoma, esthesioneuroblastoma, poorly differentiated carcinoma of salivary type (myoepithelial carcinoma and solid adenoid cystic carcinoma), NUT midline carcinoma, the recently described SMARCB1-deficient sinonasal carcinoma, sinonasal teratocarcinosarcoma and, as a diagnosis of exclusion, sinonasal undifferentiated carcinoma (SNUC). On the other hand, a variety of sarcomas, melanoma and haematolymphoid malignancies have a predilection for the sinonasal cavities, and they occasionally display aberrant cytokeratin expression and show small round cell morphology thus closely mimicking poorly differentiated carcinomas. This review summarizes the clinicopathological features of the most recently described entities and discuss their differential diagnosis with emphasis on those aspects that represent pitfalls.

Submucosal calcifying fibrous tumor of the stomach: A case report.

Abstract: The calcifying fibrous tumor is a rare benign fibrous tumor which occurs in subcutaneous or deep soft tissues in children and young adults, but also is frequently seen in pleural and intraabdominal locations in older people. Gastric involvement has been only sporadically reported in the literature. We present here our experience with this unusual lesion discovered in a 68-year-old woman. Clinically, the tumor was described as a pendulating, submucosally located mass, in the body of the stomach on a lesser curvature. The calcifying fibrous tumor is a histologically distinct lesion composed of dense hyalinized collagen fibers, inconspicuous scattered fibroblasts, a varying amount of psammoma bodies or dystrophic calcifications and foci of lymphoplasmacytic infiltration. In this report we will focus on a brief review and differential diagnosis of this tumor and other more common or not widely known gastric spindle cell lesions.

Hypoglycemia in a solitary fibrous tumor of the liver

Abstract: A 64-year-old patient developed sudden hypoglycemia leading to unconsciousness. Hypoglycemic episodes recurred on several occasions but were not accompanied by unconsciousness. Magnetic resonance imaging revealed a liver tumor in the right lobe sized 20.0 × 14.6 × 19.0 cm. No other masses were detected. Right hemihepatectomy was indicated but could not be performed due to heavy bleeding near the tumor. Histological examination showed a relatively cellular tumor made of elongated bland cells. The mitotic index was fewer than 4 mitoses per 10 HPF. The tumor was without necrosis or hemorrhage. The excised tumor was not encapsulated and showed no signs of invasive growth. On immunohistological examination, the tumor expressed NSE, CD34, CD99, Bcl2 and STAT6; Ki-67 was positive in approximately 20% of the cells. Both the histological pattern and immunophenotype were suggestive of solitary fibrous tumor of the liver. Given its size, cellularity and relatively high expression of the proliferation marker Ki-67, the tumor was classified as potentially malignant. The patient underwent embolization of arteries supplying the tumor with blood. The effect of the procedure on the tumor will only be assessed later. Hypoglycemia has resolved and the patient feels well.

[Oncopathological aspects of BRCA1 and BRCA2 genes inactivation in tumors of ovary, fallopian tube and pelvic peritoneum].

Abstract: Ovarian carcinoma represents a heterogeneous group of malignant epithelial tumors which could be divided into two fundamental groups: Type I (endometrioid carcinoma, clear cell carcinoma, low grade serous carcinoma, mucinous carcinoma and more rare seromucinous carcinoma and malignant Brenner tumor) and type II (high grade serous carcinoma - HGSC). HGSC is the most frequent ovarian carcinoma which may be etiologically linked to inactivation of tumor suppressor genes BRCA1/2 and TP53 and differs from type I carcinomas by higher aggressiveness, tendency to peritoneal spread and worse prognosis. A precursor lesion of HGSC was described as a serous tubal intraepithelial carcinoma (STIC) which is usually localized in fimbria of the fallopian tube from where tumor cells are capable to implant on ovary and pelvic peritoneum. Therefore, HGSC may present itself not only as a tuboovarian tumor but also as a primary peritoneal carcinoma. HGSC constitutes a dominant group within hereditary ovarian carcinomas as a manifestation of hereditary breast and ovarian cancer or site-specific ovarian cancer syndromes which are associated with germinal mutations of BRCA1/2 genes. BRCA1 deficient HGSC show characteristic histological appearance which encompasses SET features (Solid-pseudoEndometrioid-Transitional), significant nuclear atypia and mitotic activity, geographic necrosis, marked lymphocytic infiltration and abnormalities in TP53 expression. Use of immunohistochemistry as a screening method for BRCA1/2 inactivation is questionable at this time. Bilateral adnexectomy is considered to be a standard prophylactic treatment of women affected by germinal BRCA1/2 mutation. In that case, fallopian tubes should be submitted completely for the histological evaluation according to the SEE-FIM protocol (Sectioning and Extensively Examining the FIMbria) due to the risk of STIC or occult HGSC. Tumors with BRCA1/2 inactivation show a better therapeutic response to platinum-based chemotherapeutic compounds and a more favorable prognosis. Inhibitors of poly(ADP-ribose) polymerase (PARP) are the next generation of antitumor agents comprising olaparib which is implemented in clinical practice currently. Germinal or somatic inactivation of BRCA1/2 serves as a predictor for targeted oncologic therapy by PARP inhibitors, therefore evaluation of these genes in ovarian carcinoma patients will be carried out by departments of pathology and clinical genetics. Next generation sequencing seems to be an ideal method for the reduction of the time factor and optimization of BRCA1/2 analysis. Unfortunately, a routine test for the evaluation of homologous recombination functionality and detection of "BRCAness" in sporadic tumors is still not available.

Meningothelial hamartoma of the scalp. A case report

Abstract: We report the case of a 34-year - old male with meningothelial hamartoma. The patient had a subcutaneous tumor of the scalp, clinically diagnosed as a lipoma. Histologically, the tumor consisted of mature connective tissue elements, adipose tissue, blood vessels and clusters of cuboidal or polygonal cells with scant eosinophilic or amphophilic cytoplasm and regular nuclei. Mitoses were absent. Immunohistochemically, these cells showed diffuse positivity for vimentin, epithelial membrane antigen (EMA) and progesterone receptors. Other markers examined, including α-smooth muscle actin, CD34, desmin, cytokeratin AE1/AE3, cytokeratin CAM 5.2, α-inhibin, estrogen receptors, synaptophysin, chromogranin A and S100 protein, were negative. Meningothelial hamartoma is a rare benign lesion known under many synonyms and the exact number of reported cases is difficult to establish.

Clear cell sarcoma of vulva. A case report.

Abstract: We report the case of a 67-year-old female with clear cell sarcoma (CCS) of the vulva. Grossly, the tumor was a partly exophytical vulvar mass, measuring 20 x 15 cm. At the time of presentation, the patient showed metastases to the lung, inguinal and pelvic lymph nodes. Histologically, the tumor consisted of oval or spindle cells with only mild nuclear pleomorphism and rare mitoses (up to 2/10 HPF). The cytoplasm was pale eosinophilic or clear. The tumor cells were arranged in confluent sheets. There were large areas of necrosis and surface ulceration. Immunohistochemically, the tumor cells showed expression of S-100 protein and focal melan A and HMB45 expression. Fluorescent in situ hybridization analysis revealed rearrangement of the EWSR1 gene. To the best of our knowledge, this is the first report of CCS arising in the vulva.

[HPV-associated head and neck cancer: update and recommendations for practice].

Abstract: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) represents a specific clinical and pathological entity among head and neck cancers with more favorable prognosis than corresponding HPV-negative oropharyngeal squamous cell carcinoma (SCC). HPV-OSCC most commonly displays non-keratinzing SCC histology, although number of cases presented variable morphology. Detection of transcriptionally active HPV in oropharyngeal SCCs is of critical prognostic importance, which even supersedes the importance of their formal pathological grading. This article summarizes the current state of knowledge of HPV-positive SCC of oropharynx and of other anatomical subsites of the head and neck and discusses the role of HPV detection in the diagnostics of metastatic SCC lesions of unknown origin.

Skin cell response after jellyfish sting

Abstract: Introduction Jellyfish burning is not commonly part of the professional finding in the central Europe health care laboratory. Holiday seaside tourism includes different and unusual presentations of diseases for our worklplaces. Sea water-sports and leisure is commonly connected with jellyfish burning and changes in the skin, that are not precisely described. Aim Authors focused their research on detection of morphological and quantitative changes of some inflammatory cells in the skin biopsy of a 59-years-old woman ten days after a jellyfish stinging. Because of a comparison of findings the biopsy was performed in the skin with lesional and nonlesional skin. Methods Both excisions of the skin were tested by imunohistochemical methods to detect CD68, CD163, CD30, CD4, CD3, CD8, CD20 a CD1a, to detect histiocytes, as well as several clones of lymphocytes and Langerhans cells (antigen presenting cells of skin), CD 117, toluidin blue and chloracetase esterase to detect mastocytes and neutrophils. Material was tested by immunofluorescent methods to detect IgA, IgM, IgG, C3, C4, albumin and fibrinogen. Representative view-fields were documented by microscope photocamera Leica DFC 420 C. Registered photos from both samples of the skin were processed by morphometrical analysis by the Vision Assistant software. A student t-test was used for statistical analysis of reached results. Results Mean values of individual found cells in the sample with lesion and without lesion were as follows: CD117 -2.64/0.37, CD68-6.86/1.63, CD163-3.13/2.23, CD30-1.36/0.02, CD4-3.51/0.32, CD8-8.22/0.50, CD3-10.69/0.66, CD20-0.56/0.66, CD1a-7.97/0.47 respectively. Generally mild elevation of eosinofils in lesional skin was detected. Increased values of tested cells seen in excision from lesional skin when compared with nonlesional ones were statistically significant in eight case at the level p = 0.033 to 0.001. A not statistically significant difference was found only in the group of CD163+ histiocytes. Conclusion Authors detected numbers of inflammatory cells in lesional skin after the stinging by a jellyfish and compared them with the numbers of cells in the nonlesional skin of the same patient. Statistically significant differences were seen in the level of selected inflammation cells and numerically documented changes of cellularity in the inflammatory focus were caused by a hypersensitivity reaction after jellyfish injury in the period of 10 days after attack.

Histopathology of interstitial lung diseases

Abstract: Diffuse interstitial lung disorders include more than 200 different syndroms affecting the space between epithelial basal membrane and endothelial cells. Histopathological investigation of the lung tissue is one of the crucial parts of the multidisciplinary team approach for the investigation of these disorders. The aim of this review is a brief characterization of the pattern of the main subtypes of lung tissue damage.

[Diffuse tenosynovial giant cell tumor of the cervical spine destroying vertebra C6 - a case report].

Abstract: Presented is a case of 59-year-old woman with longstanding neck pain who has been promptly operated for spinal cord compression. Imaging studies disclosed ill-defined cervical paravertebral soft tissue mass at the level of vertebra C5/6 abutting left-sided intervertebral joint and destroying neighboring both vertebral arch and processus spinosus. Submitted specimen was interpreted as a possible metastatic skeletal process by clinicians and referring pathologist favored diagnosis of giant cell tumor/osteoclastoma of the bone. Microscopic features were consistent with giant cell lesion where uniform mononuclear mosaic stromal component dominated the unevenly distributed loose clusters of osteoclast-like giant cells frequently imparting appearance of peculiar pseudoalveolar spaces. Additionally, alternating geographic xanthomatous and densely hyalinized/ osteoid-like zones with speckled, coarsely granular haemosiderin pigment completed the variegated structural composition. The tumor infiltrated adjacent striated muscles; either original bone structures and/or extracellular matrix deposits were not identified. Immunohistochemical stains with p63, SATB2, desmin, EMA, clusterin and S100protein turned out to be completely negative. FISH analysis revealed no rearrangement of CSF1 gene. The diagnosis of the diffuse tenosynovial giant cell tumor was rendered.