Turkish Journal of Pathology - 2000; 16(3-4)

THE PROGNOSTIC SIGNIFICANCE OF ATYPICAL EPITHELIAL HYPERPLASIA IN INTRADUCTAL PAPILLOMAS OF THE BREAST

1999-12-01

Intraductal papillomas may rarely contain areas of atypical epithelial hyperplasia and ductal carcinoma in situ. The information about clinical outcome of intraductal papillomas with features of atypical ductal hyperplasia-ductal carcinoma in situ is inadequate. In this study, 59 intraductal papilloma cases belonging to 55 patients were reviewed retrospectively according to archives records and slides. Atypical epithelial hyperplasia was observed in 12 of the fifty-nine intraductal papillomas (20 %). While two of the intraductal papilloma with atypical epithelial hyperplasia developed carcinoma on the same side (16 %), papilloma without atypia developing carcinoma was only 2%. In the patients who had followed-up, recurrence was 13 %. It was thought that intraductal papilloma with atypical epithelial hyperplasia related to recurrence and carcinomatous transformation.

MERKEL CELL CARCINOMA: REPORT OF FIVE CASES

Merkel cell carcinoma is a skin tumor with poor prognosis that may pose differential diagnostic problems with some primary skin tumors as well as metastatic ones. In this report, 5 Merkel cell carcinoma cases were evaluated regarding their clinical and histopathologic findings. Three patients were women and two were men. The mean age was 57,4 (range: 26-79). Tumor size range was 1-13 cm. Positivity for immunohistochemical markers were 5/5 for pancytokeratin, 5/5 for cytokeratin 20, 0/5 for cytokeratin 7, 4/5 for neuron specific enolase, 3/5 for chromogranin and 3/5 for synaptophysin. Dot-like, crescentic or signet-ring type staining patterns were seen for cytokeratin 20. The same pattern was also observed for pancytokeratin, chromogranin and synaptophysin. Three cases were died of their tumor following 10, 24 and 28 months after the initial excision. One of the cases was alive after 26 months, and the last one was lost to follow-up.

EPITHELIOID SARCOMA (CLINICOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL FEATURES IN 5 CASES)

1999-12-01

Epithelioid sarcoma is a soft tissue sarcoma of young adults and the most common locations are fingers, hand and forearm. The tumor is often multinodular showing central necrosis. Epithelioid cells with large, eosinophilic cytoplasm and spindle cells are both seen. Epithelial membran antigen (EMA), cytokeratin and vimentin are always positive. The histogenesis of the tumor is debatable. The tumor has a high potential of local recurrence and metastasis and must be treated with radical excision. Five cases of epithelioid sarcoma were presented. One patient was female. The median age was 28. The tumor locations were finger, hand or forearm. Three cases had died with distant metastasis. One patient had local recurrence. One patient was lost for follow-up. Follow-up ranged from 2 - 5.5 years.

GASTR�K KARS�NO�D T�M�R (�K� OLGU SUNUMU)

Gastric carcinoids are uncommon and have different clinical and morphological features compared with other gastrointestinal carcinoids. Nevertheless more recent studies have demonstrated that they may consttute 10-30% of all carcinoid tumors. The following types have been identified. 1: multiple small body-fundus carcinoids associated with chronic atrophic gastritis 2: sporadic lesions usually solitary type 3: Zollinger-Ellison syndrome / MEN 1 related carcinoids. In this article we present 2 gastric carcinoid tumor cases. Both of them aroused in chronic atrophic gastritis background and were small body-fundus carcinoids. Cases were 53, 68 years of age and female. Immunhistochemical tests were used to detect neuroendocrine activity. In both cases chromogranin A positivity was ascertained.

SOLITARY FIBROUS TUMOR OF THE PLEURA: A CASE REPORT

Solitary fibrous tumor is a rare tumor of the serosal membranes and it is accepted to be originated from submesothelial layer. It is usually located to pleura, mediastinum and lungs but its typical place of settlement is the base of the pleura. Our case was a 65 years old female having long term dispnea. A shadow was seen located to right lower zone at the PA chest x-rays. CT examination revealed circumscribed mass, measuring 8cm. in diameter, at the superior segment of right lung’s lower lobe, adjacent to the pleura. At the operation, a capsulated mass connected with a pedicule to lower lobe superior segment was totally excised. Histopathologically, the tumor was characterized by a proliferation of spindle or oval cells separated by bands of collagen. Immunohistochemically, tumor cells were stained positively for vimentin and CD34 but there was no reactivity for cytokeratin, S-100 and smooth muscle actin. In the light of all these findings, the final diagnosis was a solitary fibrous tumor. At one year follow-up, the patient has no clinical or radiological evidence of recurrence.

QUANTITATIVE HISTOPATHOLOGY AND Ki-67 INDICES IN STAGE IIIA-N2 SQUAMOUS CELL CARCINOMA OF THE LUNG: PROGNOSTIC VALUE OF STEREOLOGIC ESTIMATES OF MEAN NUCLEAR VOLUME AND PATIENT AGE

1999-12-01

The aim of this study was to investigate the relation between Ki-67 index and quantitative parameters detected by stereological methods, and survival in stage IIIA-N2 squamous cell carcinoma of the lung. Twenty eight cases with squamous cell carcinoma of the lung were included in our study group. Sections from paraffin embedded tissue samples were stained histochemically with hematoxylin and eosin and immunohistochemically with Ki-67. In each case by using a projection microscope and a test system, mean nuclear volume, mean nuclear profile area, nuclear profile density , nuclear volume fraction, mitotic profile density and Ki-67 index were determined. Data were evaluated by Kendall’s t test, log-rank test and Cox regression analysis. While Ki-67 index was observed not to be related with clinicopathologic parameters and survival, mean nuclear volume (654�m³ ) and age (57 years) of the patients were found to be independent prognostic factors. Our results show that in stage IIIA-N2 squamous cell carcinoma of the lung mean nuclear volume and patient age are useful parameters that could be used in the determination of the course of disease.

LUTEOMA OF PREGNANCY

Luteoma of pregnancy is an unusual ovarian lesion. It is a hormonally dependent, self-limited process, but can be confused with a neoplasm. Maternal virilization in pregnancy is rare and generally the result of ovarian overproduction of androgens. Luteoma of pregnancy and hyperreactio luteinalis associated with theca-lutein cysts are the two most common benign causes of maternal virilization in pregnancy. Both conditions are thought to regress spontaneously postpartum and not to recur in subsequent pregnancies. Our patients are 19 and 22 years old. One of them applied with complaints of amenorrhoea for 3 months and hirsutism. In pelvic ultrasonography disrupted gestational sac and bilateral hyperechoic cystic ovarian masses were seen. Nineteen years old patient had cesarean section because of postmaturity. Both spesimens were diagnosed as a pregnancy luteoma.

ADULT RHABDOMYOMA LOCATED NEAR THE THYROID GLAND

The adult rhabdomyoma is a rare, benign skeletal muscle neoplasm. The presented case involves a 56 years old patient who applied to hospital with a mass located in the right neck. The lesion was initially misinterpreted as a nodule of the thyroid gland as a result of physical displacement of the right thyroid lobe by a mass determined by ultrasound and CT scan. An adult rhabdomyoma located in close proximity to the thyroid gland and the most important differential diagnoses are discussed.

FEATURES OF CHRONIC INFLAMMATION AT THE GASTRIC CARDIA AND THE RELATIONSHIP WITH HELICOBACTER PYLORI INFECTION AND ESOPHAGITIS

1999-12-01

The etiopathogenesis of chronic inflammation at the gastric cardia is not known exactly. It is suggested that carditis may be a finding of gastroesophageal reflux disease or it may occur as a result of the gastritis caused by Helicobacter pylori infection. The aim of the study was to examine morphological features of carditis, as well as the associations of carditis with Helicobacter pylori gastritis and esophagitis as a marker of gastroesophageal reflux disease. Endoscopic biopsy specimens obtained from esophagus, cardia and antrum of 83 dyspeptic patients were retrospectively evaluated. Carditis was detected in 77 (93%) of the cases. The mean age of the carditis group was 48,5 years and the male-to-female ratio was 1:1. The relation of the carditis with age and sex was not significant (p=0,485 and p=0,145). All cases of the carditis group had concomitant chronic gastritis. In cases with carditis, the chronic inflammation at antrum was significantly more severe than that found at cardia (p<0,001). Degree of neutrophilic infiltration (activity) and H. pylori colonisation were significantly correlated (p=0,005). Intestinal metaplasia was observed in 6 cases (8.0%). Of 28 cases in which chronic esophagitis was detected, 22 cases had features of carditis. Although the number of cases with carditis accompanying H. pylori infection was higher than the ones without infection, there was no significant relationship between the risk factors and carditis. We suggest that this is because of the unsufficient number of cases which do not have carditis.

SUMMARY: VALUE OF THE TRU-CUT BIOPSY IN THE DIAGNOSIS OF SOFT TISSUE TUMORS: 355 CASES

1999-12-01

In tumour centers, the number of tru-cut biopsies performed are increasing over open biopsies in recent years. In this study, we investigated the reliability of tru-cut biopsies based on the experience of 355 cases. According to first tru-cut biopsy results, 135 of the cases were sarcomas, 96 were benign tumours, 48 were non-tumoral lesions, 22 were fibromatosis, 20 were metastases, and 2 were lymphomas. Material was insufficient in 6% of the tru-cut biopsies. Of the cases, 162 resection material were evaluated, malignant fibrous histiocytoma (25%) and liposarcoma were the most frequent sarcomas among 103 primary malignant tumour. Diagnostic accuracy for malignancy was 97%, for the diagnosis of sarcoma sensitivity was 90% accuracy was 94%, sensitivity for grading was 88%, sensitivity for subtyping of sarcomas was 86% with tru-cut biopsy. In conclusion, these findings which are parallel to literature show that tru-cut biopsy is a reliable tool and it may be use instead of open biopsy. But it is good to be cautious while evaluating the tru-cut biopsy because it is difficult to get experience in relatively rare soft tissue tumours. We believe that one should not hesitate to request a rebiopsy or open biopsy if there is any suspicion in evaluating the tru-cut biopsy especially for the points that may cause major changes in the treatment planning such as differential diagnosis between sarcoma and lymphoma or metastasis, and histological grading. On the other hand we think that clinicopathological correlation will decrease possibility of misinterpretation.

PRIMARY CARDIAC ANGIOSARCOMA

Cardiac angiosarcomas are rare and accounting for 8.8 % of primary cardiac tumors. Clinically, incidence is equal in men and women and most patients are in the fourth decade. It classically located in the right atrium. Often, they are diagnosed only at autopsy. Prognose is poor and survival for two years is 17%. The patient, who is 30 years old female was admitted to hospital with following complains; cough for 6 months, chest pain, dispnea and weakness. On physical examination, cyanosis, crepitane rale of the left lobe of lung, hepatomegaly, ascites, pretibial edema were detected. There was no specific finding on laboratory tests. EKG showed low voltage and negative T in all derivations. The patient died from acute cardiac tamponade. Postmortem examination showed that the tumor which was in right atrium had diffuse growth pattern and diffuselly infiltrated the surrounding structures including the pericardial space. Microscopic examination disclosed that the tumor had extensive areas of necrosis and hemorrhage. Lung showed extensive metastases which had peculiar tendency to localize around vessels and also tumor thrombous was observed. By immunohistochemistry tumoral cells were positive for vimentin, FVIII related antigen and negative for cytokeratin. Herein, we discussed the cardiac angiosarcomas in view of the literature.

"PROLIFERATING CENTRAL" NEUROCYTOMA: CASE REPORT

Central neurocytomas are 0.25-0.5% of all intracranial tumors. They occur frequently in young adults and in the intraventricular location. They present a good prognosis if they can be resected totally. It is suggested that when the tumour has a high proliferative index (MIB1-LI>2%) its clinical presentation can be more aggressive and radiotherapy can be required even after total excision. Central neurocytoma which has a proliferative index of more than 2%, may have more aggressive biological behaviour and poor clinical outcome, regardless of the histological atypia. The presented case had MIB1-LI >2% (4.3%) and radiotherapy was applied.

p53 OVEREXPRESSION IN PROSTATE CARCINOMA AND ITS RELATIONSHIP WITH CLINICOPATHOLOGICAL PROGNOSTIC PARAMETERS

1999-12-01

Fifty patients with prostate adenocarcinoma have been examined for p53 overexpression using immunochemistry, between 1993-1998 in L�tfi K�rdar Education and Research Hospital’s Pathology Department. Possible relations between p53 overexpression and different prognostic parameters such as type, histological grade, stage, vascular and perineural invasion have been evaluated. p53 overexpression have been encountered in 22% of all cases. Statistically significant relation between the intensity and distrubution of p53 staining was seen. Tumors in early stages and lower grades did not show p53 overexpression, wheras it was noticed that there is a statistically significant correlation between p53 overexpression and late stage and/or high grade tumors. There was no correlation with vascular and perineural invasion. In eight of 11 p53 positive cases there was nuclear staining in basal and secreting cells of benign neighbouring glands. Our findings support the view that p53 overexpression in prostate cancers are seen less than other organ cancers. p53 overexpression is correlated with Gleason’s grade and stage but is irrelevant with vascular and perineural invasion. Although p53 overexpression, evaluated as a single criterion is not a bad prognostic sign, its detection in latent and early prostate cancer may influence the therapy.

DESMOPLASTIC SMALL ROUND CELL TUMOR: REPORT OF THREE CASES

[Taner |AKALIN|1][G�l�en |KAND�LO�LU|1] — 1999-12-01

Desmoplastic small round cell tumor is a rare and recently described tumor. It has been reported the positivite reaction with epithelial, mesenchymal and neural markers. In this study, we reported three desmoplastic small round cell tumor cases that have follow-up and performed relatively large immunohistochemical panel. Cytokeratin, EMA, desmin, vimentin, NSE and CD15 were positive in each three cases. Synaptophysin (2/3 cases), CD99 (2/3), CD57 (2/3), smooth muscle actin (1/3), Ber-Ep4 (1/3), CA-125 (1/3) were positive in some of the cases and actin was negative. We think that, cytokeratin EMA, desmin, vimentin, NSE and CD15 are useful markers in the diagnosis of desmoplastic small round cell tumor. Of the cases two were died of their disease after 12 months from initial diagnosis and one was alive with disease after 30 months from initial diagnosis reflecting the aggressive clinical course of desmoplastic small round cell tumor.

RECLASSIFICATION OF NONINVASIVE PAPILLARY UROTHELIAL NEOPLASMS ACCORDING TO THE WHO/ISUP CONSENSUS CLASSIFICATION AND EVALUATION OF p53 AND Ki 67 OVEREXPRESSION IN THESE SUBGROUPS

1999-12-01

Objective: In 1998 WHO/ISUP consensus meeting, stage pTa urothelial cell neoplasms of the bladder were classified under the term “non-invasive papillary urothelial neoplasms” and four histomorphologic subgroups were defined. This study evaluate whether p53 and Ki-67 overexpression in these subgroups may be of value in estimating recurrences and prognosis. Materials and Methods: A retrospective review was made of 50 cases who were diagnosed papilloma, grade-II (Mostofi) and stage pTa urothelial cell carcinoma between 1995-99 in Taksim State Hospital. All cases were classified into four subgroups according to the concensus. Samples were stained immunohistochemically for p53 and Ki-67 and correlation was sought between overexpression of p53 and Ki-67 and prognosis. Results: 95% of the bladder carcinomas diagnosed in our laboratory were of �rothelial cell origin and 32% of these were in stage pTa and papilloma grade I-II (Mostofi). 15% of the cases were urothelial papilloma (UP), 33% papillary urothelial neoplasm with low malignant potential (PUN-LMP), 29% low-grade papillary urothelial carcinoma (LG-PUC) and 23% high-grade papillary urothelial carcinoma (HG-PUC). Mean expression levels of p53 and Ki-67 were 0.03 and 0.0380 in urothelial papilloma, 0.0660and 0.080 in papillary urothelial neoplasm with low malignant potential, 0.1999 and 0.1969 in low-grade and 0.3517 and 0.3010 in high-grade papillary urothelial carcinoma, respectively. Conclusion: The study results were consistent with WHO/ISUP concensus classification with respect to recurrence and progression of papillary urothelial neoplasms, with p53 and Ki-67 overexpression levels being compatible with the diagnosis of the subgroups.

GALLBLADDER ADENOCARCINOMA ARISING FROM PAPILLOMATOSIS

Biliary papillomatosis is a lesion characterized by multifocal papillary tumours which has the potential of local recurrence. There is usually cytological atypia. Therefore it is difficult to differentiate it from papillary carcinoma. Sometimes malign transformation occurs. Our case is a sixty eight years old man who had papillomatosis all over the gallbladder and multifocal intramucosal carcinoma and adenocarcinoma that arised from this lesion. We discuss this rare case reviewing the literature.

HISTOLOGICAL EVALUATION OF GASTRIC BIOPSIES ACCORDING TO SYDNEY SYSTEM

1999-12-01

The aim of this study is to evaluate gastric biopsies from cases with gastric ulcer, duodenal ulcer, and non-ulcer dyspepsia according to Sydney system. Biopsy specimens from 450 patients were examined, 378 Helicobacter pylori (Hp) positive cases were classified, and graded histologically according to Sydney system. The overall Hp positivity was 84%. The colonisation rate were 88%, 84%, and 71% in patients with duodenal ulcer, non-ulcer dyspepsia, and gastric ulcer, respectively. Hp associated gastritis was the most common form of chronic gastritis. Hp density was greater in the antrum than the corpus. In Hp associated gastritis atrophy was seen in 58%, and intestinal metaplasia in 17% of the cases. We concluded in our study that the colonisation rate of Hp was higher in our region than developed countries, Hp associated gastritis was the most common form of chronic gastritis and intestinal metaplasia and atrophy were higher in the antrum.