Turkish Journal of Pathology - 2004; 20(1-2)

PROF. DR. MUHARREM K�KSAL

[�lhan |TUNCER|1] — 2003-12-01

THE RELATIONSHIP BETWEEN p53, bcl-2, c-myc OVEREXPRESSIONS WITH PROGNOSTIC PARAMETERS IN COLORECTAL POLYPS AND CARCINOMAS

2003-12-01

30 cases of colorectal carcinoma and 20 cases of colorectal polyp including 15 neoplastic(adenomatous) had been evaluated immunohistochemicaly for overexpression of p53, bcl-2, c-myc oncogenes at Doctor Lutfi K�rdar Training and Research Hospital Pathology Department. Relationships between p53, bcl-2, c-myc overexpression and differentiation, stage, lymph node metastasis, vascular invasion, local extension of carcinomas and between polyp type and dysplasia of colorectal polyp cases were evaluated. The ratio of overexpression of p53 was found 77% in adenocarcinoma cases, whereas bcl-2 overexpression was 70%, and c-myc also was 70%. There was no significant statistical correlation between p53, bcl-2, c-myc immunoreactivity and prognostic parameters of carcinomas. In colorectal polyps, p53 overexpression ratio was 35%, bcl-2 overexpression was 45% and c-myc 50%. There was no correlation between polyp types and degrees of dysplasia and p53, bcl-2, c-myc immunoreactivity. In our retrospective study, due to low number of cases and short term follow up, we were not able to comment on the prognostic significance of these markers. However our findings of high immunoreactivity of all three oncogenes with both carcinomas and adenomatous polyps suggested that these biomarkers might be mutated at the early stage of carcinogenesis and play an active role during the transition from adenoma to carcinoma.

INVASIVE MICROPAPILLARY CARCINOMA OF THE BREAST: CLINICOPATHOLOGICAL FEATURES AND COMPARISON WITH INVASIVE DUCTAL CARCINOMA

[Seyran |Y��T|1][Sinem |AYDIN ERGUN|1][Asl� |KAHRAMAN|1] — 2003-12-01

Recently described, invasive micropapillary carcinoma of the breast has a poor prognosis and is defined as a variant of invasive ductal carcinoma. In this study, 166 cases with a diagnosis of invasive ductal carcinoma and 10 cases with a diagnosis of invasive micropapillary carcinoma (pure and mixed) were compared in view of their clinicopathologic features at Izmir Ataturk Education and Research Hospital during a period lasting from January 2001- July 2003. In our study, invasive micropapillary carcinoma cases were younger than invasive ductal carcinoma cases and the tumors of the invasive micropapillary carcinoma cases were larger. In invasive micropapillary carcinoma, there was no case whose histological and nuclear degree was I. The presence of ductal carcinoma insitu component, vascular invasion and lymph node metastases rate were higher in cases with invasive micropapillary carcinoma. All these findings support that invasive micropapillary carcinoma has worse prognostic features compared to invasive ductal carcinoma. p53, ER, PR, cerb-B2 results were not significant in statistical analysis in comparison of two groups of tumors. In conclusion, we suggest that, if invasive micropapillary carcinoma is present even focally in a breast carcinoma, it should be clearly emphasized in pathology reports.

THE EFFECT OF ANGIOGENESIS TO THE PROGNOSTIC FACTORS IN INVASIVE CERVIX CARCINOMAS

Association among angiogenesis, survival and clinicopathologic parameters in invasive cervical carcinoma was evaluated. 55 patients who had been diagnosed as cervical carcinoma, from 1995 to 2000, were included in the study. Punch biopsies were performed in 11 (20%) of the cases and Wertheim operation was performed in 44 (80%) of the patients. Factor VIII-related antigen expression was examined using immunohistochemistry. The area with the most intensified microvasculature was determined under low-power (x100) magnification, and the count of this area under high-power (x400) magnification was determined as microvessel density (MVD)of the tumor.The value of MVD was grouped as high, middle and low. Statistical analysis was performed. There was positive correlation between MVD increase and lymph node metastasis (p<0.05). There were no differences between MVD and age, dimension of the tumor, histopathological type, grade and clinical stage. No significant difference was established between the groups with low, moderate and high MVD. In conclusion, we agree that in cervical carcinomas, increased angiogenesis is associated with lymph node metastasis and it can be a beneficial prognostic parameter in predicting metastatic potential of cervical carcinoma.

FINE NEEDLE ASPIRATION FINDINGS OF GASTROINTESTINAL STROMAL TUMOR: REPORT OF TWO CASES

2003-12-01

In this report, we aim to discuss the cytomorphological features of gastrointestinal stromal tumors, which are the most common mesenchymal tumors of the gastrointestinal canal. We also point out the role of cytopathology in the diagnostic approach to these tumors and review the literature. We present two patients, one of which admitted to the hospital with metastatic liver masses and the other with an intrathoracic mass. Both cytological findings in the fine needle aspiration materials and histological features in the resection materials were assessed in detail for comparison.

METAPLASTIC (LIPOMATOUS) MENINGIOMA: REPORT OF TWO CASES

[Ferah |KARAYEL|1][B�ge |�Z|1][Murat |�NAN|1][B�lent |CANBAZ|1] — 2003-12-01

Lipomatous meningiom has been first described by Bailey et al. The name ‘Lipomatous Meningiom’ is a descriptive term, probably representing a predominantly lipocytic differentiation of the meningotheliomatous cells. Microscopically, the tumor composed of typical meningothelial cells with vesicular nuclei, inconspicious nucleoli and syntitial eosinophilic cytoplasm. In the tumor, vacuolated cells with either single or multipl vacuoles often resembling signet-ring cells were seen. Mitoses, necrosis and brain invasion were not seen. In the more classic meningotheliomatous areas, tumor cells were focally EMA and MAC-387 positive. The lipomatous areas were negative for these angitens. Meningioms may undergo particular forms of metaplasia, such as osteoid or chondroid. Diagnosis of metaplastic meningiomas is important in differential diagnosis, of more agressive tumors with different treatment and prognosis.

TESTICULAR TUBULAR SEMINOMA: REPORT OF TWO CASES

Classical seminoma is the most frequent malignant germ-cell tumor of the testis. Generally, diagnosis is quite easy because of its characteristic cytomorphology and typical architectural pattern. Sometimes when the tumor does not manifest its classical features, diagnostic difficulties may arise. ‘Tubular seminoma’, which is a rare variant, is discussed here with its histomorphological and immunohistochemical characteristics in two cases.

AMNIOTIC FLUID EMBOLISM AS A CAUSE OF SUDDEN DEATH: A CASE REPORT

2003-12-01

Amniotic fluid embolism is a serious but uncommon complication of labor and immediate postpartum period. It has a mortality rate which exceeds 80% and as other obstetric complications (e.g., eclampsia, pulmonary embolism, hemorrhage, infection) have been rather controlled, amniotic fluid embolism has become an important cause of maternal mortality. A thirty six years old woman who died after normal spontaneus delivery has been autopsied. The lungs were edematous in appearance. On microscopic examination we found congestion, edema and many squamous cells in capillaries and arterioles. In conclusion, the case is presented as an uncommon and fatal complication of pregnancy.

MINIMALLY INVASIVE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS : A CASE REPORT

Intraductal papillary mucinous neoplasms of the pancreas are rare. Morphologically the spectrum ranges from adenoma to carcinoma. They can be differentiated from the common pancreatic tumors by their intraductal development, clinical features and pancreatographic apparence. Prognosis depends upon the spread of the invazive component. We report a case of a minimally invasive intraductal papillary mucinous neoplasm iwith emphasis on the clinical and morphological features.

CONGENITAL/INFANTILE FIBROSARCOMA: A CASE REPORT

Congenital / infantile fibrosarcoma is a rare tumor in the paediatric age group. It occurs mainly in children below the age of five years and commonly involves the extremities. Its biologic behavior is better than that of adult fibrosarcoma. In this report a case of congenital /infantile fibrosarcoma in a one year old male is presented.

FRASER SYNDROME: A CASE REPORT

[Nusret |AKPOLAT|1][H�sn� |�EL�K|2][�zgen |ARSLAN SOLMAZ|1] — 2003-12-01

Fraser syndrome is an autosomal recessive multiple malformation syndrome. It was first described by Fraser in 1962. It is characterized by cryptophthalmos, syndactyly, malformation of the larynx and genitourinary tract, kraniofacial dysmorphisms, orofacial clefting, mental retardation, and musculoskeletal anomalies. In the ultrasonographic examination, intrauterine ex fetus with left renal agenesis and abdominal cyst formation was detected in 36th gestastional week. In the autopsy, cryptophthalmia, abnormalities of ear and nose, syndactyly on both feet and on the left hand, anal atresia, ambiguous genitalia, hydrometrocolpos, laryngeal stenosis and unilateral renal agenesis was detected. In this report we present a case with Fraser syndrome. Our aim was to discuas this case which had multiple organ anamalies in the light of the literature.

LOW-GRADE ENDOMETRIAL STROMAL SARCOMA ARISING ON THE BACKGROUND OF ENDOMETRIOID CYST OF THE OVARY: A CASE REPORT

Malignant transformation on a background of endometriosis is rare and the primary site of the tumor is ovary in most of the cases although rare extragonadal cases have also been reported. The most common histopathologic tumor type is endometrioid carcinoma while sarcomas develop much more rarely. A case of low-grade endometrial stromal sarcoma arising on a background of endometrioid cyst of the ovary is presented in this paper. An adnexial mass was detected in a 52-year-old woman presenting with pelvic pain and surgical excision was performed. Macroscopically, the resected specimen was composed of a cystic mass measuring 15x10x10 cm and a histerectomy material 7x6x3 cm in dimentions. In addition, three solid masses, the biggest 4 cm in diameter were excised. Histerectomy specimen was unremarkable. Microscopic examination of the cystic and solid masses revealed a highly vascular tumor composed of diffusely arranged cells with oval or spindle-shaped nuclei. Less than 3 mitotic figures were counted on ten high-power-fields. Strong nuclear immunoreactivity in all of the tumoral cells was observed on the immunohistochemical staining for estrogen and progesteron receptors. The case was diagnosed as “Low-grade endometrial stromal sarcoma arising on a background of endometrioid cyst of the ovary”. No tumor was detected within the contralateral ovary, endometrium, myometrium or cervix. Differential diagnosis between extrauterine endometrial stromal sarcomas and the other spindle-cell tumors at the same localization may be difficult as the former are rare. The co-occurence with foci of endometriosis, similar histopathologic and immunohistochemical findings to their uterine counterparts help to make the diagnosis.

MULTIPLE PRIMARY MALIGN NEOPLASMS: A CASE REPORT

2003-12-01

Synchronous and /or haphazardly multiple primary malign neoplasms are etiologically due to chemical, genetical and immunological multiple factors. We present a case who was seventy eight years old and had four different malign tumours at different times. He had dealed with painting and chemicals such as acrylic, derlyn, urea, melamin and bacalyte. He presented to the urology clinic of Taksim’s State Hospital. He was diagnosed as prostatic aciner adenocarcinoma. On the follow-up of the patient, small lymphocytic lymphoma, renal cell carcinoma and thyroid papillary carcinoma were diagnosed at different times. The clinicopathologic features and etiology are discussed with the literature.