P16-CD8-Ki67 Triple Algorithm for Prediction of CDKN2A Mutations in Patients with Multiple Primary and Familial Melanoma

Melanoma, a malignant neuroectodermic tumor originating from the neural crest, presents a growing global public health challenge and is anticipated to become the second most prevalent malignancy in the USA by 2040. The CDKN2A gene, particularly p16INK4a, plays a pivotal role in inhibiting the cell cycle via the cyclin D/CDK2-pRb pathway in certain tumors. In familial melanomas (FM), 40% exhibit CDKN2A mutations affecting p16INK4a, impacting checkpoint G1, and stabilizing p53 expression. This study aims to establish a scoring system using immunohistochemical antibodies, providing a cost-saving approach to classify multiple primary melanomas (MPM) and FM patients based on their mutational status, thus mitigating genetic testing expenses. This retrospective study included 23 patients with MPM and FM, assessing the p16, CD8, and Ki67 immunohistochemical status. Analyses of each parameter and associations between their value intervals and genetic CDKN2A status were conducted. A total score of at least 9 out of 10 points per tumor defined melanomas with homozygous CDKN2A deletions, exhibiting a sensitivity of 100% and specificity of 94.11%. In conclusion, p16, CD8, and Ki67 individually serve as valuable indicators for predicting melanoma evolution. The algorithm, comprising these three immunohistochemical parameters based on their prognostic and evolutionary significance, proves to be a valuable auxiliary diagnostic tool for cost-effective prediction of mutational status in detecting multiple and familial primary melanomas with CDKN2A homozygous deletion.

Immunophenotypic p14 and p16 correlations with CDKN2A mutations in primary multiple and familial melanoma: An observational study

Melanoma represents an aggressive malignant tumor, encapsulating frequent loss of differentiation markers, with familial melanoma constituting a relatively commonly encountered entity, in direct relationship with cyclin-dependent kinase inhibitor 2A (CDKN2A). The present study aims to identify the association between the immunohistochemical p14-p16 profile, the molecular CDKN2A findings and clinically diagnosed familial or multiple primary melanomas (MPM). We conducted a 5-year retrospective cross-sectional study, on patients diagnosed with familial or MPM. P14 and p16 immunohistochemical staining has been applied on the selected surgical specimens simultaneously with the performance of fluorescence in situ hybridization (FISH) CDKN2A testing. 13 out of the 23 included cases displayed p14 and/or p16 immunohistochemical absence and the main positive relationships were encountered between CDKN2A homozygous deletion and p14 ± p16 negative immunoreactions. Cases with exclusive p16 absent reaction (n = 7) were more frequently associated with the presence of distant metastases (85.71%), while samples with exclusive p14 immunohistochemical loss exhibited more favorable histopathological prognostic markers. The average percentage of p16-stained nuclei in the superficial dermis and the deep dermis were equal (29.54% for each), therefore infirming its potential predictive and/or prognostic utility. The present study is the first of its type to approach the clinical, evolutionary and immunophenotypic correlations between p14-p16 immunohistochemical testing, CDKN2A molecular biology pattern, familial melanoma and spontaneous MPM in a cohort of Romanian patients. This analysis highlighted the value of singular p16 immunohistochemical absence as a predictor for aggressive biological behavior and unfavorable prognosis in familial melanoma and/or MPM, in comparison with the exclusive loss of p14, indifferent to the histopathological subtype. The present study emphasizes the utility of immunohistochemistry as a less expensive method of complementing the current testing arsenal and could represent the starting point for the elaboration of tailored diagnostic and therapeutic algorithms, based on the discovered p14-p16-CDKN2A significant correlation.

CD8-Lymphocytic Phenotype Significance in Primary Multiple and Familial Melanoma with Various CDKN2A Mutational Status

Background and Objectives: In the realm of the rising incidence of cutaneous and mucous melanoma, CDKN2A mutations characterize familial and multiple primary melanoma cases. The involvement of tumor-infiltrating lymphocytes (TILs) is interconnected with survival rates, but may extend even further. The aim of this study is to verify the accuracy of the classical "naked eye" count of CD8-positive T cells comprised within the tumoral population and peritumoral infiltrate versus that obtained via a special software run by the aid of artificial intelligence (AI), used to determine the percentage of CD8-positive TILs. Materials and Methods: The present retrospective cross-sectional study conducted over a period of 5 years (2018-2022) focused on patients diagnosed with mucous and/or cutaneous melanoma, with a positive family history for melanoma, or personal antecedents of primary malignant melanocytic lesions. The 23 selected cases were diagnosed histopathologically, tested for CDKN2A mutations through fluorescent hybridization in situ, and CD8 immunohistochemistry was performed. The included slides were evaluated both manually (naked-eye examination) and automatically (via QuPath platform) for quantifying the CD8-positive TILs. Results: The number of CD8-positive TILs in melanoma samples has been more accurately identified through the use of an AI-mediated software as compared to the human-eye evaluation performed by experimental pathologists. A higher percentage of CD8-positive intratumoral lymphocytes versus stromal lymphocytes was positively associated with more numerous metastatic sites. Conclusions: The CD8 lymphocytic phenotype harbors major significance in the context of familial and multiple primary melanoma and may comprise a cost-effective investigation meant to help in the establishment of melanoma prognosis and response to immunotherapy.

Assessment of programmed death-ligand 1 receptor immunohistochemical expression and its association with tumor-infiltrating lymphocytes and p53 status in triple-negative breast cancer

Breast cancer (BC) is the second most frequent type of cancer for both sexes combined, after lung cancer. Triple-negative BC (TNBC) molecular subtype is characterized by lack of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) immunoexpression or amplification and represent 10–20% of all BC cases. The issue of the present study was to analyze the associations between programmed death-ligand 1 (PD-L1) immunoexpression and distribution of stromal tumor-infiltrating lymphocytes (stTILs) combined with clinico-morphological features of patients with TNBC. Secondly, our research evaluated PD-L1 immunoexpression as a prognostic factor and its correlation with p53 immunoexpression. Thirty cases with primary TNBC without prior neoadjuvant therapy were included in this research. stTILs were identified in all cases, most of them with low distribution (66.7%). A positive immunoreaction for PD-L1 was observed in 40% of cases. The PD-L1 immunoexpression was statistically significant associated with age, pathological tumor size, lymphovascular invasion, stTILs level, the presence of cluster of differentiation 8-positive (CD8+) TILs and p53 immunoexpression. In the present study, a positive PD-L1 immunoexpression was associated with a worse distant metastasis free survival (DMFS). We also found not only that high stTILs level were associated with a better DMFS but also that there was a statistically significant association between stTILs level and PD-L1 immunoexpression. Our results bring new insights to the fine connections between tumor microenvironment and molecular changes of TNBC. It helps us to better understand these aggressive tumors to identify the more useful biomarkers for predicting the response to adjuvant therapy and can represent a method for selecting the most suitable patients for immunotherapy.

The diagnostic value of miR-92a, -143, and -145 expression levels in patients with colorectal adenocarcinoma from Romania

MicroRNAs (miRNAs) refers to a small, short non-coding RNA of endogenous class. They have shown to have an increasingly altered expression in many types of cancer, including colorectal cancer (CRC).In the present study, miRNA TaqManMGB and qRT-PCR was used to quantify the expression and clinical significance of 3 mature human miRNA in 82 pairs of colorectal adenocarcinoma tissues and normal adjacent tissue samples (NATS) collected from patients of the south-east part of Romania. Differences between CRC and NATS were analyzed using Wilcoxon test, while correlations between miRNAs expression levels and clinicopathological features were examined using non-parametric tests. In addition, the ability of selected miRNAs to function as biomarkers and, as potential indicators in CRC prognosis was also examined.When the miRNA expression was compared in CRC related NATS, miR-143, and miR-145 were significantly underexpressed (4.99 ± -1.02 vs -5.66 ± -1.66, P < .001; -4.85 ± -0.59 vs -9.27 ± -1.51, P < .001, respectively), while the pattern of miR-92a was significantly overexpressed (-5.55 ± -2.83 vs -4.92 ± -2.44, P < .001). Moreover, the expression levels of selected miRNAs were identified to be correlated with gradual increases in fold change expression with the depth of tumor invasion, lymph node invasion, and maximal increases with distant metastasis. Furthermore, the receiver operating characteristic analysis demonstrated that potential diagnostic of miR-143, miR-145, and miR-92a in discriminating CRC from NATS, with the area under the curve of 0.74, 0.85, and 0.84 respectively. The Kaplan-Meier and the log-rank test showed that a high level of miR-92a and low levels of miR-143 and miR-145 predicted poor survival rate in our cohorts.In conclusion, we can summarize that miR-145 and miR-143 are decreased, while miR-92 is increased in CRC compared to NATS, and associated with different stages of CRC pathogenesis. Thus, the expression of selected miRNAs can represent potential diagnostic and prognostic tools in patients with CRC from Romania.

Molecular expression profiles of selected microRNAs in colorectal adenocarcinoma in patients from south-eastern part of Romania

MicroRNAs (miRNAs) are endogenous, non-coding class of RNAs with functions in the regulation of genes expressions. Dysregulated expressions of miRNAs play important roles in carcinogenesis and cancer progression by targeting various oncogenes and tumor-suppressor genes. miRNAs represent a new field for molecular diagnosis and prognosis of colorectal cancer (CRC) due to their high tissue specificity, their stability, and their dysregulated expression in tumor development.This study aimed to investigate using the qRT-PCR method the expression profile and prognostic value of 11 mature miRNAs in a cohort of 82 Romanian patients diagnosed with CRC. The relationship between the expression levels of selected miRNAs and clinicopathologic features were evaluated using ANOVA and Pearson test. In addition, the receiver operating characteristic (ROC) and area under the curve (AUC) were used to assess the diagnostic values of the miRNAs to discriminate cancerous from non-cancerous states of the samples.The expression levels of miR-30c, miR-144, miR-375, miR-214, and miR-195 in CRC tissue were significantly downregulated (all P < .05; Paired T-Test) than that in normal adjacent tissue sample (NATS), while the expression of miR-141, miR-182, miR-183, miR-21, and miR-370 in CRC tissue were significantly upregulated (all P < .001) than that in NATS. Moreover, the expression levels of miR-182, miR-183, miR-141, and miR-21 were demonstrated to be associated with a gradual increase in fold change expression with depth of tumor invasion (all P < .05), lymph node invasion (all P < .001), and maximal increase with distant metastasis (all P < .001). Moreover, the analysis of ROC curves revealed that AUC (95% CI) of miR-182, miR-183, miR-141, and miR-21 in diagnosis of CRC was 0.76 (0.66-0.87), 0.85 (0.78-0.94), 0.77 (0.62-0.92), 0.83 (0.73-0.90), respectively. The univariate and multivariate Cox-proportional hazard regression for all variables revealed that the nodal status, distant metastasis, miR-21, miR-141, miR-182, and miR-183 were independent prognostic markers of CRC.In conclusion, altered expressions of miR-21, miR-141, miR-182, and miR-183 in CRC varies at different stages of CRC development and may serve as potential diagnosis molecular biomarkers in Romanian patients with CRC. Further investigations are needed to confirm our findings.

A rare case of a double high-risk gastrointestinal stromal tumor of jejunum with KIT-negative∕PDGFRA-positive immunophenotype

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that represent the second most common type in the gastrointestinal system, but clinical outcomes vary due to complex molecular changes. The aim of our study is to highlight a unique case of a 5th decade male, presenting a double primary GIST of the jejunum, associated with a rare immunophenotype and with a high risk of malignancy. Ancillary studies were performed using several biomarkers [cluster of differentiation (CD) 117∕c-kit, discovered on GIST1 (DOG1), desmin, S-100, vimentin, cytokeratin 7 (CK7), Ki67, actin, platelet-derived growth factor receptor alpha (PDGFRA) and CD34], in order to confirm the diagnosis and to evaluate prognostic and predictive factors. A KIT-negative∕PDGFRA-positive immunophenotype was obtained in our case and it was associated with a poor prognosis. Its unfavorable clinical evolution was sustained by recurrence as malignant (GIST) with dedifferentiation and metastases developed in less than one year after the initial diagnosis. Clinico-morphological features of GISTs with an impact on survival must be identified and a tailored therapy should be applied for each case.

ETHICAL AND GENETIC ASPECTS REGARDING PRESYMPTOMATIC TESTING FOR NEURODEGENERATIVE DISEASES

Neurodegenerative diseases, such as Alzheimer's dementia, Huntington's chorea, Parkinson's disease or spinocerebellar ataxia, manifests into adulthood with an insidious onset, slowly of progressive symptoms. All of these diseases are characterized by presimptomatic stages that preceded with many years of clinical debut. In Parkinson's disease, more than half of the dopaminergic neurons of the black substance are lost before the advent of motor characteristic manifestations. In Huntington's chorea, the progressive neurodegenerative disease could be diagnose prenatal and presymptomatic by analyse of the number of CAG repeats in exon 1 of the huntingtin gene. A similar mechanism represented by expansion of trinucleotide repeats during hereditary transmission from parents to children was identified in fragile X syndrome, spinocerebellar ataxia, spinal muscular and bulbar atrophy, or myotonic dystrophy. Presymptomatic diagnosis in all these progressive diseases raise many ethical issues, due to the psychological impact that can cause the prediction of a disease for which there is currently no curative treatment. Therefore, a positive result can produce serious psychological trauma and major changes in the lifestyle of the individual, instead, a negative result can bring joy and tranquillity. But the problem arises if presymptomatic testing in these neurodegenerative diseases brings greater benefits compared to the possible psychological damage, which can add the risk of stigmatization or discrimination.

Gastric primary non-Hodgkin lymphoma: a case report and literature review

Non-Hodgkin malignant lymphomas represent a heterogeneous group of monoclonal tumors developing from cells belonging to the immune system. Primary gastric lymphomas are defined as those malignant limphoproliferative diseases whose initial symptoms are located in the stomach or tumor mass located in the stomach. This paper aims to present a new case of primary gastric non Hodgkin lymphoma diagnosed by histologic and immunohistochemical examination of a partial gastrectomy specimen. The patient is a 51-years old man with a history of smoking, hospitalized for asthenia, hematemesis and melena. Microscopically the tumor consisted of mature small lymphocytes admixed with plasmocitoid lymphocytes and mature plasmocytes. Some of the tumoral cells showed citoplasmatic pas positive inclusions. Immunohistochemical stains were strongly positive for CD20 and 30-40% positive for Ki67.Based on the clinical and histological findings, a diagnosis of gastric primary non-Hodgkin lymphoma was established.

Morphometric Characterization of Marginal Zone Lymphoma

The morphometry in histopathology is used to characterize cell populations belonging to different tissues and to identify differences in their parameters with prognostic implications. To achieve morphometric examination were selected 6 of 8 cases identified as marginal zone lymphoma. For each case analysis was done on five fields, for each field measuring the parameters of 20 cells. The studied parameters were for cytoplasm: cytoplasmic area, maximum and minimum cytoplasmic diameter, cytoplasmic perimeter; for nucleus were measured: nuclear area, minimum and maximum nuclear diameter, nuclear perimeter, nuclear contour index, nuclear ellipticity index, nuclear irregularity index. Also the nucleo-cytoplasmic ratio was calculated in all studied cases. Marginal zone lymphoma is characterized in terms of morphometric parameters by small cytoplasmic and nuclear area, and small nucleo-cytoplasmatic ratio of about 1:1. Nuclear contour index is small, accompanied by a large ellipticity index and an small index of nuclear irregularity. Standard deviations for measured morphometric parameters are variable, having high values for cytoplasmic and nuclear area, highlighting the polymorphic nature of the cells. Morphometric aspects, with corresponding microscopic aspects of large and small lymphocyte proliferation with cleaved and uncleaved nuclei, fit this form of lymphoma in terms of clinical outcome in indolent lymphomas category.

Laryngeal primary malignant melanoma: a case report

Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary lesion. We present a new case of primary laryngeal malignant melanoma diagnosed by histological examination of an excisional biopsy specimen. The patient was a 53-year-old man with a history of smoking and hoarseness but without any clinical evidence of other cutaneous malignant melanocytic lesions. Microscopically, the tumor consisted of polygonal-epithelioid cells admixed with more elongated, spindle-shaped cells. Some of the tumoral cells demonstrated dark brown cytoplasmic and nuclear melanin. Despite significant ulceration and disruption of the epithelium, in situ malignant melanocytes were recognized within the remaining epithelium. Immunohistochemical stains were strongly positive for S-100 protein, HMB-45 and Melan-A. On the other hand, cytokeratin stains were negative. Based on the clinical and histological findings, a diagnosis of primary malignant melanoma of the larynx was established.

Morphometric Characterization of Small Cell Lymphocytic Lymphoma

The morphometry in histopathology is used to characterize cell populations belonging to different tissues and to identify differences in their parameters with prognostic implications. To achieve morphometric examination were selected 6 of 24 cases identified as small cell lymphocytic lymphoma. For each case analysis was done on five fields, for each field measuring the parameters of 20 cells. The studied parameters were for cytoplasm: cytoplasmic area, maximum and minimum cytoplasmic diameter, cytoplasmic perimeter; for nucleus were measured: nuclear area, minimum and maximum nuclear diameter, nuclear perimeter, nuclear contour index, nuclear ellipticity index, nuclear irregularity index. Also the nucleocytoplasmic ratio was calculated in all studied cases. Small cell lymphocytic lymphoma is characterized in morphometric terms having a small cytoplasmic area (average 29.206) and also a small nuclear area (mean 28.939) having a nucleo-cytoplasmic ratio appearance suggestive for adult lymphocyte. A nuclear contour index small value (3.946), ellipticity index value also small (3.521) and small nuclear irregularity index (3.965). Standard deviations, in any of the studied morphometric categories, is around or below 1 suggesting monomorphic cell appearance. These morphometric and microscopic features characterized mainly by a small population of adult lymphocytes, monomorphic, with rounded hipercromic nuclei, dense chromatin, support the framing into indolent lymphoma group in terms of clinical outcome.

Clinico-pathological and molecular subtypes of male breast carcinoma according to immunohistochemistry

INTRODUCTION

Male breast carcinoma is a rare condition, but with a trend of increase frequency. In our study, we investigate the clinico-pathological features and overall survival at 35 male cases of primary invasive breast carcinoma correlated with molecular subtypes defined by immunohistochemical profile.

METHODS

Based on immunohistochemical expression profiles of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2) and Ki67, EGFR and CK5/6, the male breast cancers were classified into the following molecular subtypes: Luminal A, Luminal B, HER2+, triple negative and unclassified.

RESULTS

In our study, we identified 65.7% as Luminal A subtype and 28.6% as Luminal B subtype. The difference was represented by two (5.7%) cases of triple negative subtype, but due to low number of patients, no correlations or prognostic significance could be assessed in these cases. No HER2 or unclassified subtypes were identified.

CONCLUSIONS

Luminal A tumors are the most frequent subtype in MBC, with a better outcome than Luminal B subtype. We recorded high levels of ER and PR expression, which predict a better response to adjuvant hormonal therapy. At the time of diagnosis, most of the patients were aged and with an advance clinical stage, this requiring implementation of screening programs and increase education of population in order to an early detection.

Morphological characteristics of a mucinous adenocarcinoma of the prostate: differential diagnosis considerations

Mucoid adenocarcinoma of the prostate is a very rare variant, account less than 1% of prostatic adenocarcinomas. In this respect, the most common histopathological type of prostate cancer is acinar adenocarcinoma. Diagnosis of this variant is very important due to peculiarities: aggressive biologic behavior, poor response to radiotherapy. Although these tumors are not as hormonally responsive as acinar adenocarcinomas, some of them respond to androgen withdrawal. Before making a diagnosis of primary mucinous adenocarcinoma, is necessary to exclude an extraprostatic malignant neoplasia, especially from the bladder or bowel. We present the case of a male patient who suffered a transurethral prostatic resection surgery. Histopathological examination revealed malignant tumor cells floating in a pool of mucus or even acini mixed with signet ring cells. A particular aspect is that floating mucus cells have a non-papillary pattern similar to colloid carcinoma of the breast. The use of monoclonal antibody revealed positive immunoreaction of malignant cells for prostatic specific markers and excluded neoplastic invasion of the bladder or bowel carcinoma.

Morphologic and immunohistochemical features of breast nevi

A large number of publications recognize that there are melanocytic lesions with microscopic features similar to melanoma, related to their location. Those locations are represented by the ear, the milk lines (axillary, breast, periumbilical and inguinal regions), palms, soles, and flexural regions. Starting from Rongioletti F et al. study in 2004, we measured 10 histological parameters on 96 nevi (39 from the breast) and notes with 0 if absent or impossible to evaluate and with 1 if present. The score for each lesion ranged from 0 to 7 and we compared the features of the breast nevi with the nevi from the control sites and found that breast nevi present more atypical features than the nevi from the other sites (absence of demarcation of melanocytes at lateral margins, nests and dyscohesive pattern and melanocytic atypia). We also performed immunohistochemical examination on lesions that presented three or more of the examined histological parameters, but the results were nor suggestive. The conclusion of this study is that the atypical features of the breast nevi are only site related atypias and have no hormonal influences.

The prognostic value of the immunohistochemical aspects of tumor suppressor genes p53, bcl-2, PTEN and nuclear proliferative antigen Ki-67 in resected colorectal carcinoma

This study aim was to identify the relations between tumor suppressor genes (p53, bcl-2, PTEN), nuclear proliferative antigen Ki-67 and epidemiologic, morphologic and histologic patient related factors, in colorectal cancer.

MATERIALS AND METHODS

Twenty-two prospectively collected colorectal cancer resection specimens were histologically prepared, using standard paraffin-embedded and Hematoxylin-Eosin staining method; for immunohistochemical study, the Streptavidin-Biotin (sABC)/Horseradish Peroxidase (HRP) method was used.

RESULTS

P53 was positive in 86.36% of cases, more intense (>50%) in rectal cancer and in women 59.16 ± 9.49-year-old; the G1/2 adenocarcinoma was dominant. Bcl-2 was positive in 18.18% of the cases, in distal colorectal cancer, only in men, 63.5 ± 13.2-year-old. PTEN was positive in 95.45% of the cases; intense positivity was recorded in 12 men and six women, 61.47 ± 11.67-year-old, in rectal topography. Ki-67 was positive in 86.36% of the cases, more intense in four men and four women, 63.45 ± 12.22-year-old, in proximal and advanced colorectal cancers (pT3N1/2 - 62.5%).

CONCLUSIONS

Tumor suppressor genes mutations are often present in colorectal cancer; the intensity of the expression of these mutations varies, which could explain the different prognosis for these patients.

Pulmonary alveolar lipoproteinosis associated with emphysematous areas

Pulmonary alveolar lipoproteinosis, described for the first time in 1958 by Rosen SH, Castleman B and Liebow AA, is a rare pathological condition characterized by alveolar accumulation of lipoproteinaceous material. It is the result of macrophages impairment to rid the alveolar spaces of spent surfactant. This condition involves a restrictive function of pulmonary tissue, reflected in gas exchange impairment and respiratory symptoms of variable severity. Until now, about 410 cases have been reported in the literature. From these cases, 90% were represented by primary type of pulmonary alveolar lipoproteinosis. We present the case of 37-year-old male patient admitted in the Department of Internal Medicine, Emergency County Hospital, Constanta, Romania, with progressive exertional dyspnea, dry cough and perioral cyanosis. The clinical symptoms started three months before hospital admission. Based on clinical findings and imaging features, the primary pulmonary alveolar proteinosis diagnosis has been suspected. Uncharacteristic serous aspect of fluid resulting from bronchoalveolar lavage required open lung biopsy. Pathologic examination of pulmonary slice revealed features consistent with the diagnosis of pulmonary alveolar lipoproteinosis associated with emphysematous foci. The peculiarity of this case lies in the association of two pathological conditions, each of them requiring different pathways.

Atypical adenomatous hyperplasia of the prostate mimicking adenocarcinoma lesion: case report and literature review

The diagnosis of prostate cancer is challenging because of the existence of lesions that mimic adenocarcinoma. Such a lesion is atypical adenomatous hyperplasia (AAH) or adenosis, which represents a proliferation of crowded, small to medium glands with basal cell layer invariably present, but often inconspicuous on routine stains. The importance of the lesion lies in the potential for being misdiagnosed as low-grade adenocarcinoma (Gleason 1 or 2). We present the case of a male patient, who suffered a transurethral prostatic resection surgery. Histopathological examination showed benign prostatic hyperplasia with a focus of crowded glands with a nodular appearance. The presence of basal cell was assessed using high molecular-weight cytokeratin (HMWCK), clone 34βE12 and p63 immunostaining, which revealed discontinuous positive immunostaining. In adenocarcinomas, the basal cell layer is absent. This case highlights the usefulness of 34βE12 antibodies, avoiding a false positive diagnosis of cancer, with negative consequences on the patient's psychological condition and treatment costs. We recommended the follow-up of the patient.

Differential diagnosis of a gastric stromal tumor: case report and literature review

Gastrointestinal stromal tumors account for 0.1-3% of all gastrointestinal neoplasms and are characterized by features that overlap with those of other mesenchymal tumors. We expose the case of a 58-year-old male patient who complained of abdominal pain, weakness and melena. Microscopic examination of surgically resected gastric tumor revealed a neoplastic proliferation composed of spindle cells with eosinophilic cytoplasm, elongated nuclei with rounded ends, palisadic disposition and intracytoplasmic perinuclear vacuoles, low cyto-nuclear polymorphism, mild atypia and mitotic activity of 3-5÷50 HPF. Some histopathological features requested differential diagnosis with schwannoma and tumors of myocytary origin, based on immunohistochemical techniques, which have established a final diagnosis of spindle cell gastric stromal tumor. We also reviewed the GIST-related literature and evaluated the possible methods of preoperative diagnosis of GISTs based on endoscopic biopsy. Proper classification of GISTs based on histopathological criteria and immunohistochemical techniques has a great prognostic and therapeutic utility. Future development of endoscopic biopsy methods will refine the management of gastrointestinal stromal tumors.

Morphological and immunohistochemical characteristics of a gastric amphicrine tumor: differential diagnosis considerations

Gastric amphicrine tumors, lesions in which dual epithelial and neuroendocrine differentiation occurs in the same cell, represent neoplasms with a very low incidence. We present the case of a male patient, who suffered a subtotal gastrectomy. Histopathological examination showed a malignant proliferation with glandular, solid and trabecular pattern, composed of round/polygonal, monomorphic cells admixed with scattered signet ring cells. The use of monoclonal antibodies revealed positive immunoreaction of malignant cells for epithelial and neuroendocrine markers. These characteristic features plead for the final diagnosis of amphicrine tumor, based on the co-expression of both epithelial and neuroendocrine markers in the same cells. Differentiation of this entity must be done with collision tumor and with composite tumor, with distinct histopathological features. Rigorous interpretation of dual immunohistochemical expression of neoplastic cells of amphicrine tumor is useful in distinguishing this entity from others with similar morphological characteristics, in order to assure an adequate targeted therapy.

Urothelial carcinoma of the renal pelvis associated with cystic disease of the kidney

Primary tumors of the renal pelvis and ureter account for about 8% of all urinary tract tumors. More than 90% of them are urothelial carcinomas. On the other hand, unilateral multicystic renal disease is an uncommon pathologic condition that may be mistaken for unilateral autosomal dominant polycystic kidney disease, multilocular cystic nephroma or cystic neoplasm. We present the case of a 54-year-old male known with arterial hypertension, admitted in the Second Surgery Department of Emergency County Hospital, Constanta, with intense right flank and right lumbar pain. This symptom started one month before hospital admission. Based on clinical features and imaging evaluations we established a presumptive diagnosis of unilateral autosomal dominant polycystic kidney disease. For these reasons, total right nephrectomy was performed. Pathologic examination of the nephrectomy specimen revealed high-grade urothelial carcinoma of the renal pelvis associated with unilateral multicystic renal disease. The particularity of this case lies in the uncommon association between two rare renal pathological conditions diagnosed by pathological examination.

Etio-pathogenic and morphological correlations in congenital hydronephrosis

Hydronephrosis, "distension in varying degrees of pelvis and calyces, accompanied by progressive atrophy of renal parenchyma due to obstruction in urinary flow", is an apparently simple reno-urinary disease, but, in reality, by association of its own characters with those conferred by causative lesions, becomes of a significant complexity. The purpose of this paper is to demonstrate the plurivalent character of this entity on a batch of cases with congenital hydronephrosis, by identification of lesional features correlated with cause of disease. The etiology of hydronephrosis in analyzed cases was characterized by heterogeneity: polar inferior artery, horseshoe kidney, extrarenal pelvis, transverse valves of pelviureteral junction (PUJ), adhesion of ureter to PUJ, intrinsic stenosis of PUJ, vesico-ureteral reflux, posterior urethral valves, stenosis of urethral meatus. The way of intervention of urinary obstruction and the uni- or bilateral character of damage were definitory for the macroscopical appearance of the hydronephrotic kidney, renal pelvis demonstrating its role of expansion room for kidney protection. In analyzed cases of congenital hydronephrosis, correlation specific cause-pelvic lesion evidenced histopathological differences related to etiology. Anatomical preparations obtained by injection followed by corrosion have revealed that renal vessels appear elongated, distanced from each other and even reduced in density, which explains the appearance of ischemia accompanying pathogenetic changes of obstructive uropathy. Regardless of etiology, all cases of congenital hydronephrosis were characterized by varying degrees of fibrosis in chorion of renal pelvis, accompanied by active chronic inflammation, observation that support the idea of connection between the two pathological changes.

The importance of monitoring protocols in cervical carcinoma screening

Romania has supremacy in terms of European statistical indicators of cervical cancer, a fact attested by the studies made by international organizations. The present study is based on cytological evaluation of a group of 9269 cervico-vaginal smears, segregated in various groups that were monitored by standard diagnostic and therapeutic protocols, attitude based on an excellent collaboration with the gynecologist. This cooperation led to the elaboration of a set of protocols for follow-up of patients assessed by Babes-Papanicolaou test, in order to assure an adequate management for all cervical lesions. An important feature of this study is that histopathological examination of cases cytologically designated as HSIL showed, along with changes of HSIL-CIN2 and HSIL-CIN3, also carcinoma in situ and invasive squamous cell carcinoma lesions, emphasizing the importance of the pathologic diagnosis of certainty. This idea is also supported in cases of glandular cell atypia, whose microscopic evaluation identified premalignant and malignant lesions, both in endometrial and endocervical site. A particular aspect of the analyzed batch consists in the description of a subgroup of false-negative cytodiagnostic results associated with cervical carcinoma, highlighting the causes and the possibilities to avoid further errors. Overall analysis of results reveals major involvement of the pathologist in providing the sequence from cytology to histopathological diagnosis and to establish diagnostic continuity.

Nuclear comparative morphometric study between DCIS and normal resting mammary gland tissue

Ductal carcinoma in situ (DCIS) is the malignant epithelial cell proliferation that affect only ducts, including lobular, without basement membrane interruption. Benign or malignant cell phenotype is defined by nuclear appearance. Morphometric analysis could provide quantitative information about nuclear profile in several lesions. In this study, we assess nuclear morphometric features of mammary epithelial cells in DCIS compared to normal resting mammary gland tissue. For morphological evaluation, we included two groups of mammary gland tissue. The first group comprised breast tissue from 20 women surgically treated and histopathologically confirmed with DCIS. The second control group was represented by normal resting mammary tissue obtained from another 20 women surgically treated for fibroadenoma. Evaluated morphometric parameters were: nuclear area (NA), nuclear perimeter (P), maximum diameter (Dmax), minimum diameter (Dmin), elongation factor (E). Morphometric assessment of DCIS nuclei showed significant higher values than normal resting breast tissue. Morphometric analysis gave information about tumor aggressiveness, invasion tendency and disease prognostic.

The correlation of genetic markers with anatomoclinical and histopathological forms in Hirschsprung's disease

Hirschsprung's disease is a birth defect that affects about one out of 5000 newborns. It is one of the most common causes of intestinal obstruction at the babies. The objectives of this study are to evaluate the characteristics of Hirschsprung's disease in Dobrogea area, test of genetic markers in families and single cases, estimate the value of the test in the diagnosis and for evolution. We made a case-control study for the period 1995-2006 and analyzed 21 cases of Hirschsprung's disease, which were treated in the Emergency County Hospital, Constanta. The diagnostic methods comprised clinical and paraclinical examination. The chromosomal markers used in the study are represented by four categories of chromosome abnormalities: Trisomy 21, Del 10q, Del 13q, Del 17q. The molecular markers investigated by us are represented by: RET, EDNRB and EDN3. We made the correlation of genetic markers with the anatomopathological and histopathological forms, by measuring the level of association, expressed by the calculated relative risk (OR) and using the correlation index f. Based on data obtained from the group investigated, we found that the indices of association and correlation are consistently higher compared to DNA-markers with chromosomal markers, both for anatomopathological forms as well as histopathological. We noticed that no chromosomes markers were recorded with indices of correlation with negative values, which means that these chromosomal abnormalities are involved with a particular quota to the release of disease.

Differential diagnosis issues in a case of gastric carcinoma associated with leukemoid reaction

Gastric tumors share many characteristics, making a definitive diagnosis challenging. Gastric adenocarcinomas represent 90% of malignant stomach tumors, meanwhile the frequency of gastric lymphoma range between 1-5% of all gastric cancers. Gastric carcinoma bears resemblance with particular forms of non-Hodgkin's lymphoma of the stomach, not only in morphological presentation, but also in clinical configuration and laboratory tests. We report a case of gastric carcinoma with abnormal hematological picture dominated by leukemoid reaction and peculiar histopathological aspect. Pleomorphism of neoplastic cells and distinct arrangement of these give rise to the need of differentiation between a carcinoma and a non-Hodgkin's lymphoma of the stomach. On immnohistochemical grounds, we succeeded in our action of segregation between the two lesional entities and we establish as definitive diagnosis that of poorly differentiated gastric adenocarcinoma. Additionally, leukemoid reaction proved to be a manifestation of a bone marrow metastasis from gastric cancer.

[Preliminary results for intraperitoneal chemotherapy in abdominal cancers]

The paper presents a review of the the last 20 years experience of some important oncologic and surgical centers all over the world on IntraPeritoneal Hyperthermic Chemotherapy (IPHC) applied by well known specialists in this domain: Sugarbaker P. (SUA), Takeshi S. (Japan, Elias D. (France), Deraco M. (Italy) and others. Then 20 cases of abdominal cancers with or without peritoneal metastases are presented, in which IPCH was applied using a Romanian apparatus of drainage - lavage with hyperthermic solutions of 5 Fluorouracil, alone or combined with cisplatin, over a 3 years period. The results are encouraging although the follow-up of this group is in progress.

Classical testicular seminoma in young man

A 29 year old man was admitted in Urology Department of County Hospital of Constanta for left testicular increased size in last six months, without other symptoms. Testicular tumor was palpated and visualized by ultrasound. Computed tomography did not revealed metastatic lymph nodes. Beta-human chorionic gonadotropin and alpha-fetoprotein were within the normal range. We diagnosed the case as a left testicular tumor and performed high orchiectomy. Histological examination revealed typical seminoma. Subsequently, the patient was given two courses of systemic chemotherapy (bleomycin, etoposide, cisplatin) as an adjuvant therapy. The patient has remained free of disease six months after discharge.

[Preliminary data on post-pancreatectomy diabetes mellitus treated by islet-cell autotransplantation]

The present study describes the first islet autotransplant program in Romania, and the first 3 cases of subtotal pancreatectomy for chronic pancreatitis combined with islet autotransplant. The primary objective was to pain relief by pancreatic resection, but also to preserve the endocrine function by islet autotransplant. Extensive distal pancreatectomy is effective in relieving pain, but should be limited to patients with small duct disease, in whom more conservative methods have failed, because of severe metabolic consequences. Islets were prepared by Liberase digestion of the excised pancreas, and infused unpurified into the portal vein in one case and in the omental pouch and peritoneum in two cases. All patients were relieved of pain, have achieved insulin independence, and positive C peptide levels, but one patient died of a acute bronchopneumonia 60 days post-transplantation. The mean islet yields were 2100 islet equivalents/Kg body weight. Islet autotransplantation can be considered a useful therapeutic option serving to prevent the occurrence of surgically-induced diabetes. The results have indicate that the omental pouch is a viable site for islet autotransplantation, that can accommodate a large tissue volume, is easy to access to implant, and the IBMIR (instant blood mediated inflammatory reaction) may be less severe.