Turkish Journal of Pathology - 2014; 30(2)

Lymphatic Vascularization in Primary Breast Cancer: HER2 Overexpressing Tumors Contain More Lymphatics than Steroid Receptor Positive, Triple-Positive and Triple Negative Breast Carcinomas

Savelina POPOVSKA, Ivan IVANOV — 2014-05-01

Objective: The aim of this study was to examine the relationship between the immunohistochemical subtypes of invasive breast cancer and lymphatic vascularization. Material and Method: One hundred and seventy nine cases of randomly selected invasive breast cancer patients, surgically treated between 2004 and 2007, were retrospectively studied. These were classified into steroid receptor positive (steroid receptor positive/ HER2 negative), triple positive (steroid receptor and HER2 positive), triple negative (steroid receptor and HER2 negative) and HER2 overexpressing (steroid receptor negative /HER2 positive) carcinomas. Appropriate immunostaining and in-situ hybridization techniques were applied and results were statistically analyzed. Results: The median intra-tumor lymphatic vascular density and the median intra-tumor relative lymphatic vascular area were found to differ significantly among the studied groups of breast cancer (KW =49.8611; p<0.0001 and KW =21.5122; p=0.0001 respectively). There was no significant difference in the incidence rate of axillary node involvement among the studied groups of breast cancer (χ² =1.66; Df=3; p=0.6460). Conclusion: The present study indicates that HER2 overexpressing breast carcinomas have a consistent increase of intra-tumor lymphatic vessel counts as compared to all other subtypes. It is suggested that the newly formed vessels are probably not the only essential factor for lymphogenic spread of HER2 overexpressing breast carcinomas as they are not related to an increased incidence of lymph node metastases compared to the other studied subgroups.

Ba�yaz�

Alp USUB�T�N — 2014-05-01

Editorial

Alp USUB�T�N — 2014-05-01

In Situ Hybridization Analysis of Invasive Breast Carcinomas with Immunohistochemically Negative Her-2 Status (A National Multicenter Study)

2014-05-01

Objective: The aim of this study was to determine the rate of Her-2 gene amplification in breast cancer cases with a previous negative Her-2 result as determined by immunohistochemistry (score 0 or 1). Material and Method: 552 cases of invasive breast carcinoma were assessed with the contribution of 9 centers. Previous immunohistochemistry score was either 0 or 1+ in all cases. These cases were re-tested by Her-2 silver in situ hybridization in the central laboratory. Her-2 gene amplification was defined as Her-2/CEP 17 ratio of more than 2.2. Cases with a ratio between 1.8 and 2.0 were defined as equivocal and cases with a ratio of less than 1.8 were defined as negative. Results: Re-testing of the 552 cases with silver in situ hybridization showed a total of 22 cases with Her-2 gene amplification, of which 11 (3.2%) were found to be score 0, and 11 were found to be score 1+ (5.3%) by immunohistochemistry previously. Her-2 gene amplification rate of cases (score 0 and 1+) ranged from 0% to 10.48% among the centers. Polysomy was found in 28 (8.1%) of the score 0 cases and 25 (12.1%) among the score 1+ cases. Five (9.4%) of the cases with polysomy were found to be amplified, and 48 (90.6%) were not. Conclusion: The results of the study show that a group of cases (3.98%) with a potential to benefit from anti-Her-2 therapy may be missed with the immunohistochemical method. This indicates the importance of quality assurance, especially in central laboratories with many breast cancer cases in daily practice.

Caveolin-1 Expression in Odontogenic Cysts and Ameloblastomas

2014-05-01

Objective: The aim of this study is to evaluate the caveolin-1 expression in a group of odontogenic cysts and tumors. Material and Method: In this cross-sectional study, the expression of caveolin-1 was evaluated immunohistochemically in 75 samples including 18 cases of dentigerous cyst, 18 odontogenic keratocysts, 3 orthokeratinized odontogenic cysts, 2 calcifying odontogenic cysts and 34 ameloblastomas (solid and unicystic). Results: Positive immunohistochemical reaction was found in 100% of odontogenic cysts and this was significantly more than both unicystic (65%) and solid (55%) ameloblastomas. Conclusion: The present study showed the expression of caveolin-1 in all odontogenic cysts and more than ameloblastomas. The results suggested that absence of caveolin-1 might enhance aggressiveness of odontogenic lesions and could be a useful marker for distinguishing ameloblastomas from other odontogenic lesions.

Morphological Aspects and Distribution of Interstitial Cells of Cajal in the Human Upper Urinary Tract

2014-05-01

Objective: The mechanism by which the ureter propels urine towards the bladder has a myogenic origin, through peristaltic contractions. This pyeloureteral autorhythmicity is generated by specialized, electrically active cells, the interstitial cells of Cajal, located in the proximal regions of the upper urinary tract. The aim of this study was to describe the exact location and the distribution of interstitial Cajal cells in the human upper urinary tract and to analyze their normal number and morphology. This is a preliminary study, which will allow the study of these cells in different urinary tract pathologies. Material and Method: Urinary tract fragments were sampled at different levels, from 13 autopsy cases. Cases with clinical evidence of renal disease, and with histological changes in the kidney or in the urinary tract tissue samples, visible in hematoxylin-eosin staining, were excluded. The interstitial Cajal cells were highlighted with anti-CD117 antibody, immunohistochemically. Results: Cajal cells were indirectly highlighted by the presence of a finely granulated cytoplasm indicating immunoreactivity. These cells were spindle-shaped or stellate, with cytoplasmic extensions at one or both poles of the cell and large oval nucleus. We found that interstitial Cajal cells were located at all upper urinary tract levels, with a higher predominance in the calyces and pyelon. Interstitial Cajal cells were observed mostly between the two layers of the muscularis, but also between the muscle bundles. Most often, these cells were parallel to the muscle fibers. Conclusion: Our study describes the method of detection of interstitial Cajal cells in normal human urinary tract. These results can be used to analyze the number, morphology and the location of these cells in different congenital pathologies, such as vesicoureteral reflux, pyeloureteral junction obstruction or primary obstructive megaureter.

Interobserver Agreement Among Histological Patterns and Diagnosis in Lung Adenocarcinomas

2014-05-01

Objective: The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. Material and Method: A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. Twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. Results: The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p<0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). None of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p<0.001). Conclusion: The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization.

Histopathological and Genetic Features of Patients with Limb Girdle Muscular Dystrophy Type 2C

2014-05-01

Objective: In this study, it was aimed to describe the clinical, histopathological and genetic features of 20 patients with gamma sarcoglycanopathy confirmed by muscle biopsies and genetic analysis. Material and Method: We retrospectively reviewed 20 patients from whom muscle biopsy specimens were obtained between 2007 and 2012. All patients were clinically diagnosed as muscular dystrophy and biopsy materials were collected from five different centers of neurological disorders. All DNAs were extracted from muscle tissues or blood samples of patients and genetic tests (mutation analyses for gamma sarcoglycan gene and deletion-duplication analyses for all 4 sarcoglycan genes) were performed. Results: The mean age of the patients was 7.6 years (2 -21 years). Only one case (5%) was older than 14 years. The mean CPK level was 10311 U/L (1311 � 35000 U∕L). There were 4 siblings in these series. Expression defects of gamma sarcoglycan staining were determined in (15 males, and 5 females) all patients with muscle biopsy specimens. But only in 9 of them, disease-causing defects could be determined with genetic analyses. Conclusion: The present study has demonstrated that both examination of muscle biopsy specimens and DNA analysis remain important methods in the differential diagnosis of muscular dystrophies. Because dystrophinopathies and sarcoglycanopathies have similar clinical manifestation.

A Study on Distribution of Cancer Cases Diagnosed in �orum

2014-05-01

Objective: In order to help obtain accurate knowledge and to contribute to the establishment of data for regional tumor statistics, we aimed to determine the frequency distribution of cancer cases that was diagnosed in �orum province. Material and Method: In this descriptive study, we retrospectively reviewed the archive records of the pathology departments� of one university hospital and two private hospitals serving in the province of �orum. A total of 138,973 recorded pathology reports were reviewed. Metastatic cancers with a known primary source were excluded. A total of 2184 cases with a diagnosis of cancer were recorded by gender, age, and system/organ and classified to 10 most frequent types of cancer both in general and in terms of gender distribution. Results: The male to female ratio was 1.44 and the mean age was 64.26 years. The cancer is most commonly encountered between 70 and 79 years of age (35.27%) in males whereas the second most common interval was 60 to 69 years of age (23.88%). In females, the cancer is most commonly encountered between 70 and 79 years of age (24.16%) whereas the second most common interval was 60 to 69 years of age (22.60%). The top five cancers were skin (33.60%), prostate (13.87%), stomach (9.07%), urinary bladder (8.61%) and breast (7.88%). Conclusion: Distribution of organ/system involvement of cancer cases that were diagnosed in �orum is quite different from the data regarding Turkey in general. Development of cancer registry centers, upgrading to an active registry system and having all cancer data from health institutions unified in a single organization are mandatory to achieve reliable data.

Metastatic Squamous-Cell Carcinoma of the Lung Arising in a 12-Year-Old Boy with Juvenile Recurrent Respiratory Papillomatosis of Neonatal Onset

2014-05-01

Juvenile recurrent respiratory papillomatosis is the most common benign neoplastic disease of the larynx in children, characterized by numerous squamous papillomas caused by Human Papilloma Virus type 6 and 11. HPV is thought to be acquired at the time of vaginal delivery from maternal genital condylomas. Juvenile recurrent respiratory papillomatosis can be protracted by surgical interventions performed to avoid airway obstruction and extend below the vocal cords as far as the main stem bronchi. Lung involvement in Juvenile recurrent respiratory papillomatosis seems to be more prevalent than non-systematic reviews have reported until now and progression to cancer occurs in a significant proportion of these cases at a younger age than previously reported. This would suggest that closer attention should be paid to these children. We report a case of malignant transformation in a 12 year-old boy followed-up since the birth for an invasive juvenile recurrent respiratory papillomatosis with pulmonary involvement. The presence of HPV 6/11 was demonstrated by PCR analysis performed on material obtained from a metastatic vertebral lesion.

Osteosarcoma Arising from a Haemangioma: Case Report and Review of the Literature

2014-05-01

To create awareness of the benign lesions from which osteosarcoma may arise. Osteosarcoma is a rare tumour of bone the etiology of which is poorly understood, but it may arise from benign lesions. Malignant transformation in hemangiomas, in the absence of prior radiation, is exceedingly rare and the resulting neoplasm is usually an angiosarcoma. We report the case of a 30-year-old woman where investigation for thigh pain revealed a distal femoral hemangioma. She represented with pain and mass 18 years later, leading to a confirmed diagnosis of osteosarcoma at the same site. Osteosarcomas may arise from a variety of benign lesions. In this article we report the case of a histologically confirmed hemangioma which subsequently underwent malignant change into an osteosarcoma.

Idiopathic Eosinophilic Cholecystitis with Cholelithiasis: A Report of Two Cases

2014-05-01

Eosinophilic cholecystitis is a rare entity diagnosed on the basis of classical presentation of cholecystitis with presence of more than 90% eosinophilic infiltration within the gall bladder. The etiology of eosinophilic cholecystitis still remains obscure. However it is frequently associated with other more severe diseases like hypereosinophilic syndrome, eosinophilic-myalgia syndrome, parasitic infestations, few herbal medicines and certain drugs. We report two cases who presented with gall stone disease, which on histopathological evaluation was diagnosed as eosinophilic cholecystitis. Retrospective analysis of their case histories and investigation did not reveal any known etiology. These cases are being reported because of their rarity and to highlight the importance of complete workup to rule out other associated disorders that may be a manifestation of a more severe disease.

Tumor-Like Cystic Endosalpingiosis in the Myometrium: A Case Report and a Review of the Literature

Seyran Y��T, Yelda DERE, Hakan YET�MALAR, Demet ET�T — 2014-05-01

Endosalpingiosis is a disorder of the Mullerian system characterized by benign glands lined with tubal type epithelium and involves the peritoneum, subperitoneal tissues and retroperitoneal lymph nodes. Myometrial endosalpingiosis is very rare. A 44-year-old female presented to the hospital complaining of menorrhagia. Gynecological and radiologic examination revealed a pelvic mass 7.5 cm in diameter, suggestive of a leiomyoma with secondary cystic changes. The gross examination showed an intramural large cyst within the right fundic wall of the uterus. Microscopically, the cyst consisted of multiple micro-macro cysts lined with benign tubal epithelium. With these findings, the diagnosis was cystic endosalpingiosis. In this report, the clinicopathologic features of a cystic endosalpingiosis case located in the myometrium was presented with a review of the literature.

Squamous Cell Carcinoma of Lung with Osteo-Cartilaginous Metaplasia – A Case Report and Review of the Literature

2014-05-01

Calcification and ossification are very rare in primary squamous cell carcinoma of the lung. We report a 55-year-old male with primary squamous cell carcinoma of the lung who on histopathological examination was seen to have extensive calcification and ossification. Squamous carcinoma of the lung rarely presents with osteocartilaginous metaplasia. The case is presented here for its unique presentation.

Pemphigoid Gestationis: Light Microscopic and Direct Immunofluorescense Findings

G�len G�l N�FL�O�LU, Banu LEBE — 2014-05-01

Pemphigoid gestationis is a rare vesiculobullous dermatosis of pregnancy and puerperium. It is commonly seen in second or third trimester. Skin lesions are characterized by pruritic, urticarial plaques with the development of tense vesicles and bullae. Histopathology demonstrates a subepidermal eosinophil-rich vesiculation. Direct immunofluorescence microscopy reveals linear complement 3 and immunoglobulin G deposition along the basement membrane. We present a rare case of pemphigoid gestationis occurring in a 33-year-old pregnancy woman with symptom of generalized pruritis. Pemphigoid gestationis should be kept in mind in the differential diagnosis of vesiculobullous dermatitis of pregnancy.

Rethinking about Tubulocystic Carcinoma of the Kidney after Taking into Account the Existence of Tubulocystic Chromophobe Renal Carcinoma

Dilek ERTOY BAYDAR — 2014-05-01