Turkish Journal of Pathology - 2008; 24(3)

Diagnostic utility of cytokeratins 7, 10 and 20 in renal cell carcinoma and oncocytoma

Saba K�REM�T��, �zden TULUNAY, S�mer BALTACI, Orhan G�� — 2008-10-01

Renal cell carcinoma is the most frequent renal epithelial tumor having various subtypes differing in their prognosis and therapeutic response. In most cases it is possible to distinguish subtypes on the basis of histology alone, however, there are diagnostic difficulties for the tumors having granular/eosinophilic cells which create morphologic similarities not only between the subtypes of renal cell carcinoma, but also, between a benign tumor and renal oncocytoma. To achieve correct diagnosis, immunohistochemical analysis focused on cytokeratin (CK) proteins has been used increasingly. We examined the diagnostic utility of CK7, CK10, and CK20 in the classification of renal epithelial tumors based upon an immunohistochemical analysis. The study included tissue macroarray (4 mm) blocks of 83 renal cell carcinomas (62 clear cell, 6 chromophobe, 13 papillary, 2 unclassified subtype), and 6 renal oncocytomas. Fuhrman nuclear grade of the tumors, divided into low (grades 1, 2) and high nuclear grade (grades 3, 4) was negatively correlated with CK7 expression (p=0.001). Diffuse and significantly higher CK7 expression was found in “non-clear cell” (chromophobe and papillary) subtypes than in clear cell renal cell carcinomas (p=0.001). Of 6 renal oncocytomas, 4 was focally positive for CK7. The results demonstrate that, diffuse and strong CK7 immunoreactivity supports the diagnosis of “non-clear cell” subtype versus clear cell renal cell carcinoma and renal oncocytoma. Seldom CK20 reactivity of the tumors did not show any significance, and the tumors were totally unreactive to CK10 which eliminates diagnostic utility of CK20 and CK10 in the classification of renal epithelial tumors.

CD44 and MMP-2 expression in urothelial carcinoma

2008-10-01

Aim: CD44, one of the adhesion molecules, is thought to play an important role in cell-cell and cell-matrix interactions. Matrix metalloproteinases are degradative enzymes that remodel extracellular components. In this study the relation of MMP-2 and CD44 expressions with the histologic classification and the pathologic stage of urothelial carcinoma was revealed using immunohistochemistry. Material and Methods: Thirty-nine patients with urothelial carcinoma of the bladder were studied. The histological classification was performed according to WHO criteria. Patients were grouped as infiltrating urothelial carcinoma, low grade non-invasive papillary urothelial carcinoma, and high grade non-invasive papillary urothelial carcinoma. The pathological staging was done according to the TNM classification. Immunohistochemical staining using CD44 and MMP-2 antibodies was performed on tissue blocks. Results: CD44 immunoreactivity was detected in 77% (30/39) of the tumours which was significantly higher in non-invasive papillary urothelial carcinomas, low grade non-invasive papillary urothelial carcinomas, high grade infiltrating urothelial carcinomas (p≥0.05). MMP-2 expression was observed in 69% (27 of 39) of the tumours. There were no significant differences in MMP-2 expression between various histologic subtypes and noninvasive and infiltrative tumours. Conclusion: In conclusion, higher expression of CD44 is inversely correlated with infiltrative potential of urothelial carcinoma. These results should be supported by further studies.

Fine needle aspiration cytology in salivary gland masses

Sibel BEKTA�, Figen BARUT, Burak BAHADIR, Fikret �INAR, ��kr� O�uz �ZDAMAR — 2008-10-01

Aim: In this study, contribution of fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland diseases forming mass was presented by correlation with biopsy diagnoses. Material and Methods: FNAC materials of salivary glands from 43 cases and excision materials from 19 cases evaluated between 2004 and 2007, in our department were reviewed. Results: FNAC diagnosis were as follows; 32 (74.4%) benign, 5 (11.6%) suspicious for malignancy, 2 (4.7%) malign and 4 (9.3%) insufficient for evaluation. When cytological and histopathologic diagnosis of 19 (44%) cases with excision material were compared, histopathologic diagnosis of 13 cases with benign cytology were as follows: 7 cases of pleomorphic adenoma, one of Warthin's tumor, one of myoepithelial neoplasm with malign potential, one of mucoepidermoid carcinoma, one of intraparotid lymph node and two of inflammatory process. One of the four cases cytologically diagnosed as suspicious for malignancy by FNAC was malign lymphoma and other three cases were diagnosedas squamous cell carcinoma. One of the two cases described as insufficient in FNAC was diagnosed as pleomorphic adenoma and the other as inflammatory process. We found that the diagnostic accuracy, sensitivity and specificity were 88%, 66.6% and 100%, respectively. Conclusion: FNAC is an easily applicable method with high diagnostic value for salivary glands masses.

Comparison of ThinPrep and conventional smears in head and neck fine needle aspiration cytology

Fulya K�YBA�IO�LU, Binnur �NAL, G�l�in G�ler ��M�EK, Demet YILMAZER, �nsal HAN — 2008-10-01

Aim: The ThinPrep Processor has gained popularity as a collection and preparation technique for fine needle aspiration cytology in addition to Papanicolaou smear test. The aim of this study was to compare the various cytologic features of ThinPrep and conventional smear in head and neck masses. Material and Methods: We reviewed 71 consecutive fine needle aspiration cytology specimens and the conventional smear and ThinPrep slides diagnosed without knowledge of histopathologic diagnosis. Statistical analysis was performed by ANOVA test on SPSS program. Results: There was no statistical difference between the two groups as regard to the presence of monolayer cells, cell architecture, and nuclear details (p>0.05). Cellularity, informative background and cytoplasmic details were statistically significant in conventional smear group (p<0.05). However, in ThinPrep preparations there were no blood and necrosis masking the findings (p<0.05). Conclusion: Combined use of conventional smear and ThinPrep preparation provides the best results for fine needle aspiration cytology.

The distribution of lymphoproliferative diseases among tonsillar malignancies

G�l�ah KAYGUSUZ, Cevriye CANSIZ, I��nsu KUZU, Serpil D�ZBAY SAK — 2008-10-01

Aim: We aimed to determine the type and distribution of pathological conditions and lymphoproliferative disorders in examined tonsillectomy specimens, and to review our results in view of the literature findings. Material and Methods: The pathology reports of 491 tonsillectomy specimens diagnosed between January 2000-May 2008 were screened. Results: Totally 58 cases showing malignant infiltration in the tonsil composed of lymphoma (n:33-6%), squamous cell carcinoma (n:22-4%), plasmacytoma (n:1-1%) and malignant melanom (n:2-1%). The most common type of lymphoma in our series was diffuse large Bcell lymphoma (n:22-66%). Conclusion: In contrast to other findings, lymphomas were the most common malignant neoplasms in the tonsillar region in our series. Diffuse large B-cell lymphoma was the most frequent type of lymphoma. We think that tonsillectomy specimens of the patients who have known clinical risk factors should be examined histopathologically, especially in adults.

Three cases of combined small cell lung carcinoma with review of the literature

2008-10-01

Combined small cell lung carcinoma is an uncommon entity and constitutes 1-3% of all cases with small cell lung carcinoma (SCLC). We reported three cases of combined small cell lung carcinoma. All the cases were male (ages: 77, 60 and 55 years, respectively) with a history of heavy smoking and presented with lung masses. Additionally, first case had been a history of asbestos exposure for 5-6 years. Histopathological examination of biopsy specimens revealed a rare variant of small cell lung carcinoma ie combined small cell lung carcinoma. In addition to histological evidence of small cell lung carcinoma, the first biopsy specimen also contained areas of squamous cell carcinoma and the other two biopsy specimens revealed adenocarcinomatous cells. Immunohistochemical findings supported the diagnosis. Combined small cell lung carcinoma is very rare, but is nevertheless a well described diagnostic category among lung cancers. In this case report, because of the rarity of these tumors, we discussed combined small cell lung carcinoma in view of the literature.

Lichen scleroatrophicus in combination with generalized morphea

Nurdan CEYLAN, Mehmet Salih G�REL, �mm�han K�REM�T��, Cuyan DEM�RKESEN — 2008-10-01

Localized fibrosing disorders form a spectrum of rare conditions that frequently begin in childhood. These diseases are characterized by circumscribed fibrotic areas involving different levels of the dermis, subcutis and sometimes underlying soft tissue. Although some cases of morphea and lichen scleroatrophicus coexistence are reported in the literature, this is a rare condition. We present a case of a 20-year-old girl with a 8-year history of brown-white discoloration, thickening of skin on the extremities and trunk and thinning of right leg who was diagnosed as lichen scleroatrophicus which coexisted with generalized morphea.

Mediastinal granulocytic sarcoma

Bahar AKKAYA, Esin �ZEL, �hsan KARADO�AN, H�seyin BEK�Z, G�lten KARPUZO�LU — 2008-10-01

Granulocytic sarcoma is an unusual variant of myeloid malignancy in which there is an extramedullary tumor mass composed of myeloblasts or myeloblasts and more mature neutrophils. It rarely occurs in mediastinum and clinically may resemble a mediastinal lymphoma. We report a patient who was initially diagnosed as malignant lymphoma based on the previous biopsy specimen. The diagnosis of granulocytic sarcoma is not difficult with careful histopathologic evaluation and immunohistochemical staining.

Incidental serous papillary ovarian carcinoma diagnosed on endometrial biopsy

�i�dem H�MMETO�LU, Alp USUB�T�N, Ali AYHAN, T�rkan K��KAL� — 2008-10-01

We present a case of incidental locally advanced serous papillary ovarian carcinoma in a 43-year-old women on endometrial biopsy. On endometrial biopsy, findings of serous carcinoma besides normal endometrial tissue caused diagnostic confusion. However, by thorough clinical investigation, we were able to detect bilateral ovarian masses, which were proved to be serous papillary cystadenocarcinoma. The possibility of a locally advanced ovarian carcinoma should always be kept in mind especially when trying to identify a serous papillary carcinoma in an endometrial biopsy with no endometrial involvement.

A negligible diagnosis: Rhabdomyomatous mesenchymal hamartoma

G�lden D�N�Z, Muharrem AKG�NER, Rag�p ORTA� — 2008-10-01

Rhabdomyomatous mesenchymal hamartoma is a rare lesion of the dermis and subdermal tissue. It was first described in 1986 as “striated muscle hamartoma”. It has been usually reported in newborns. Until recently, there were only 34 reported cases in the literature. We herein report a three-month-old boy with a congenital skin tag in the middle of the chin. Physical examination revealed no congenital abnormalities or other dermal lesions. Histopathological examination showed a mixed tissue collection of subepidermal disorganized skeletal muscle fibers, adipose, fibrous and neural tissues, and abundant folliculosebaceous structures. Clinically, the differential diagnosis of rhabdomyomatous mesenchymal hamartoma includes skin tag, accessory tragus and soft fibroma. If the presence of striated muscle fibers has been ignored, there is microscopic resemblance between all of these lesions. Because of the absence of recurrence or malignant degeneration, this lesion may be accepted a negligible diagnosis. But for as many as 30% of the reported cases with rhabdomyomatous mesenchymal hamartoma have several congenital anomalies; the differential diagnosis of this lesion is important.

Pathology of malignant gliomas: Challenges of everyday practice and the WHO 2007

Tar�k T�HAN, Ay�a ER�EN — 2008-10-01

The recent revision of the “2007 World Health Organization Classification of Tumours of the Central Nervous System” introduces a series of new entities and variants in addition to bringing more clarity to existing ones. It is critical for the practicing surgical pathologist to be aware of these changes, especially those relating to common primary tumors such as malignant gliomas. This study presents a critical review of the changes and attempts to provide practical insights for the surgical pathologist. The morphological spectrum of malignant gliomas is quite diverse, and with definition of newer variants and patterns, there is an increasing need to be more specific on the type and the grade of these aggressive neoplasms. The added value of special stains, immunohistochemistry and molecular/genetic analysis is expected to gradually increase in everyday practice. Thus, the surgical pathologist must be in tune with the progress in these fields and must be in a position to apply and interpret these techniques. Appropriate management of the patients and the correct interpretation of the disease always depend on effective, direct communication of the neuropathologist, neuroradiologist and the neurosurgeon, coupled with the application of carefully chosen ancillary techniques. The combination of collaborative efforts and special techniques is certain to be more critical in the future, and effective utilization of all these elements will better characterize these neoplasms and improve patient management.