[Recurrent thyroid neoplasm with Hürtle cells-- case report]

The thiroidian tumor with Hürtle cells represents a rare clinical form of thyroid neoplasia and has a particular biological behavior. Tumors included in this category are those in which more than half of the cell population is made up of Hürtle cells. We present the case of a 58 years old woman with a recidivant oncocitic adenoma, four years after a subtotal bilateral thyroidectomy. The pathological examination using HE, van Gieson, AgNOR stains, the positive imunoreaction for thyreoglobulin LSAB and the ultrastructural examination established the definitive diagnosis. The surgical treatment is the main therapeutic measure and must be performed under oncological curative principles: lobectomy for the benign forms and total thyroidectomy for the malignant ones. The malignant potential is higher than for other well differentiated thyroidian carcinomas.

Correlation between p53 expression and other prognostic factors in breast cancer

p53 suppressor tumoral gene codifies the nuclear proteins which suppress the cellular proliferation by preventing the entrance of the cells in the division cycle. The loss or inactivation of this protein, by destruction or gene mutation, or by its link to viral oncoproteins, annuls the growths restrictions and favours the malignant transformation. The immunohistochemical determination of the p53 protein accumulation seems to be an efficient mean of selecting breast neoplasias. p53 immunostaining is positive at the level of malignant cells nuclei and negative for normal cells. For this study there were selected 30 patients with breast cancer, treated in the surgical clinics of the County Hospital from Timişoara, during 1993-1995. Immunohistochemical determination of p53 protein was performed on tissular samples formalin fixed and paraffin embedded, using mouse monoclonal antibody DAKO--p53 DO 7 p53 human antiprotein. From the 30 carcinomas studied, 9 (30%) expressed p53 protein, as found in literature. The presence of this protein was more frequent noticed in the infiltrative lobular carcinoma, comedocarcinoma and in medullary carcinoma. Five patients whose tumours presented p53 protein were postmenopausal; in 7 cases (77.7%) the tumoral differentiation degree was G1 or G2.

Immunohistochemical expression of prostate specific antigen (PSA) in benign and malignant tumors of the prostate

The immunohistochemical (IHC) expression of PSA in tissue fragments has been analysed in 25 patients with benign prostatic hypertrophy (BPH) and in 50 patients with prostatic carcinoma. The fragments were obtained by transurethral resection and transvesical adenomectomy. Morphology was studied by hematoxylin-eosin and Gömöri's trichrome staining. For immunohistochemical study anti-PSA monoclonal antibodies (DAKO, EPOS) were used. In BPH cases a positive reaction in the cytoplasm of secretory luminal cells was noticed; the reaction was negative in basal and urothelial cells, in foci of squamous metaplasia and in the cells of mucous gland metaplasia. All the classic types of prostatic carcinoma, regardless of the degree of differentiation showed positive reaction with various intensity and distribution. A positive focal reaction was noticed in two ductal carcinomas of endometrioid type. The reaction was negative in transitional, epidermoid and small cell carcinoma. Though less useful in differentiating benign from malignant lesions, this method may contribute to the differential diagnosis of particular forms of prostatic tumors.

Immunohistochemical markers in the morphological diagnosis of lung carcinoma

Conventional histopathological criteria based on light microscopy are used in pulmonary oncologic pathology in order to establish the diagnosis of tumor, but most frequently they are insufficient, accurate diagnosis requiring ultrastructural and immunohistochemical investigations. The method of immunostaining allowed some molecular marker to be evaluated. Some of them seem to be important in carcinogenesis as a general process, while others have high specificity for lung tumors. Estimation of EGFR and c-erbB-2 protein immunoreactivity showed a significantly stronger staining with NSCLC and was correlated to the poor differentiation of the tumors, undergoing an aggressive biological behavior and an unfavorable prognosis. The expression of p53 protein was found in 19 cases by immunostaining with DO-7 antibody. Immunotracing of more than 50% of the tumoral cells was a predictive factor for the progression of the disease. The growing rate of tumoral proliferative activity was evaluated by immunotracing technique (MIB-1), allowing the Ki-67 index of labeling to be calculated.

Histologic criteria for the diagnosis of gastric low-grade malt lymphoma

Low-grade B cell lymphoma of the stomach have the features of mucosa-associated lymphoid tissue (MALT) and is characterised by lymphoid hyperplasia and infiltrations of lymphocytes into glandular epithelium or lymphoepithelial lesions. It may be difficult to distinguish low-grade lymphomas from benign inflammatory lymphoid infiltrates. Nine primary gastric lymphomas and 20 benign lymphoid hyperplasia were investigated for the type of tumour cells, lymphoepithelial lesions. Dutcher bodies, cytologic atypia, the density of lymphoid infiltrates, invasion of the muscularis mucosae, germinal centers, reactive epithelial atypia and acute inflammation. Our results suggest that B cells proliferation, lymphoepithelial lesions, cytologic atypia and Dutcher bodies are very important for the diagnosis of low-grade MALT lymphoma. None of these was seen in inflammatory infiltrates. The presence of germinal centers, acute inflammation and reactive epithelial atypia does not exclude a diagnosis of low-grade gastric lymphoma.

Carcinoid tumor with uterine location. Case report

A carcinoid is defined as a tumor arising from endocrine cells with neurosecretory characteristics belonging to the APUD system. These cells are most frequently observed in the digestive tract and lungs. Uterine location is rare. This paper presents the case of a 21-year old patient with uterine carcinoid tumor. In order to establish the histopathologic diagnosis of the carcinoid tumor, we used optical microscopy examination in haematoxylin-eosin, argentic impregnation in Fontana-Masson staining and an immunohistochemical reaction using monoclonal antibody to the S100 protein. Due to the intracytoplasmatic granulations shown in Fontana-Masson staining and in the immunohistochemical reaction to S100 protein which confirm the neurosecretory character of the tumoral cells, we included this tumor in the group of tumors with neuroendocrine differentiation.

Significance of the expression of hormone receptors and of p53 protein in breast carcinomas

A certain proportion of breast cancers contain hormone receptors--specific proteins with high affinity and capacity of selective tie of these hormones. There were selected 30 patients presenting breast cancer, treated at the surgical departments from the County Hospital of Timişoara between 1993 and 1995. The identification of hormone receptors was done on 10% formalin-fixed and paraffin-embedded tissue specimens. As anti-hormone receptors, monoclonal and polyclonal antibodies were used. The immunohistochemical identification of positive to hormone receptors cancer cells was obtained, by nucleus staining. Immunohistochemical assay of the accumulation of p53 protein seems to be an efficient means of selecting breast neoplasms. p53 immunostaining is positive at the level of malignant cells' nuclei and negative for normal cells. From the 30 breast carcinomas, 19 (63.3%) were ER+ and 15 (49.9%) were PR+, resulting an increase of the frequency of ER+ tumors together with the age of the patients; 9 cases (30%) expressed p53 protein, harmonizing with the data in the literature.

Expression and significance of tumoral suppressor p53 gene in lung adenocarcinomas

The mutations of p53 tumoral suppressor gene are the most frequent genetic modifications identified till now in lung cancer, suggesting that these alterations represent critical stages in malignant cellular transformation of respiration ways. Conformational changes induced by these mutations are associated with stabilisation of the product of p53 gene and the accumulation of the mutant protein in malignant cells' nuclei, in quantities that can be immunohistochemically detected: immunohistochemistry can be used as an indirect indicator of the genome alteration. Eight cases of lung adenocarcinoma were immunohistochemically analysed (formalin-fixed and paraffin-embedded specimens), in order to find the p53 suppressor expression. The overexpression of p53 protein was detected using an antigenous system and Monoclonal Mouse Anti-Human p53 protein, and it was detected in 5 (62.5%) of the 8 examined adenocarcinomas. In the examined cases, p53 overexpression was limited only to neoplastic cells, the nuclear staining being considered specific. p53 high level was correlated to: histological differentiation degree, smoking, the stage of the tumor and to the survival rate of the patients. The association of smoking with p53 overexpression suggests that p53 gene is a target of specific mutagenes in smokers.

Prognostic significance of neuroendocrine differentiation in carcinoma of the prostate

Biopsies taken by core-needle biopsy and/or transurethral resection to 68 patients with prostatic neoplasia stage III and IV, were studied morphohistochemically. Morphological observations showed high incidence of mixed histopathological forms. The Churukian-Schenk and Garvey silver impregnations were used in order to identify associated neuroendocrine differentiations. Three cases presented monomorphic small cell proliferation which contained numerous argyrophilic cytoplasmic granulations. The prognosis in these cases was poor--the patients died because of neoplastic extension within 5 to 9 months following diagnosis. Neuroendocrine cells were identified in 15 cases, 6 of which presented a malignant pattern. Taking into consideration the hormonal resistance of malignant cells with argyrophilic granulations, the necessity of chemotherapy associated to hormonotherapy is discussed.

Intestinal metaplasia and dysplastic modifications in H. pylori gastritis

Certain studies regarding modifications of gastric mucosa in the presence of infections produced by H. pylori add a new element in the pathology of gastric lesions with a high malignancy potential. From the certain premalignant lesions, a special place is occupied by intestinal metaplasia and by gastric dysplasia, because of their high frequency. This study is based upon the interpretation of 130 gastric biopsies in which the identification of H. pylori was pursued (by HE staining, Giemsa), o intestinal metaplasia and their types (by PAS-Blue Alcian ph 2.5 staining and High Iron Diamine-Blue Alcian ph 2.5) and the presence of neoplastic lesions. Particular aspects of our study are given by the association of H. pylori infection with certain types of intestinal metaplasia, with moderate or severe dysplastic lesions and with gastric carcinomas (especially the "intestinal" type).

Researches on viral hepatitis markers correlated with pathomorphological and clinical aspects in chronic hepatitis

A number of 112 patients hospitalized for chronic hepatitis and liver cirrhosis were investigated. According to the results of the pathomorphological examinations of liver biopsies, 29 (25.8%) were cases of persistent chronic hepatitis (PCH), 39 (34.8%) cases of active chronic hepatitis (ACH), and 44 (39.2%) cases of liver cirrhosis. The prevalence of the female sex was observed in PCH (61.6%) and ACH (64.7%) cases, whereas in liver cirrhosis the sex distribution was more balanced (53.3% patients were males). The patients' mean age ranged from 34 to 38 years in PCH cases, from 44 to 46 years in ACH cases and from 50 to 57 years in liver cirrhosis. The postviral cirrhosis was three times more frequent in the female sex (77%), while the alcoholic and mixed cirrhoses (of an associated alcoholic and viral etiology) were prevalent in males (63.2%, respectively 72.2%). Serological tests for detection of the serological markers of hepatitis viruses B (HBV), C (HCV) and Delta (HDV) were performed for the purpose of studying the correlations between the pathomorphological findings and the viral markers. Among the 39 patients with ACH, HBV markers were detected in 13 cases (33.3%), anti-HCV antibodies in 10 (25.6%), and associated HBV-HCV, respectively HBV-HDV infections in 9 (23%) cases (6, respectively 3 patients). In the remaining 7 cases (17.9%) of ACH, there were no serological markers in the three hepatitis viruses. Of the 29 patients with PCH, 17 cases (58.6%) displayed HBV markers, 4 (13.7%) anti-HCV antibodies, in one patient (3.4%) an associated HBV-HCV infection was present, and in 7 patients (24.1%) markers of none of the three hepatitis viruses could be identified. Of the 44 patients with liver cirrhosis, HBV markers were detected in 17 cases (38.6%), anti-HCV antibodies in 9 (20.4%) and associated HBV-HCV and, respectively, HBV-HDV infections in 11 cases (25%) (9, respectively 2 cases). In 7 (15.9%) of the 44 patients with cirrhosis, markers of none of the three hepatitis viruses could be identified.

[Early cirrhosis, an early modality of the evolution of acute hepatitis. The clinico-biological, immunological and morphological aspects]

A group of 12 patients with recent acute hepatitis (8/86 with HVB and 4/22 with alcoholic hepatitis) had a rapid evolution (under 2 years) towards hepatic cirrhosis (early H.C.). The clinical-biological, immunological and morphological study made evident several characteristics, which became predictive markers of the early cirrhotic evolution of acute hepatitis. Clinically, a persistence of dyspeptic disorders and appearance of several systemic manifestations is noticed. Biologically, the maintenance of some increased transmainases, variable bilirubinemia and decrease of serinemia. Immunologically, the transfer of IgM towards increased IgM, the decrease of the total T lymphocyte and of T1 substrate, the increase of the active B and T lymphocyte. The morphologic exploration is decisive for specification of the diagnosis in the early hepatic cirrhosis.

[Cat-scratch disease. Comments on a clinical case]

The authors present a clinical case of cat's scratch disease, with lymphadenitis and inoculation pustule. A series of observations are made on the importance of anamnesis, histopathologic examination, elimination of other clinical entities with lymphadenopathic manifestations, for determining the diagnosis. The recent investigations are aimed at identifying the etiologic agent. The treatment of the disease is symptomatic.

Hepatic fibrosis in alcoholic steatosis. Morphologic aspects and evolutive tendencies

Alcoholic hepatic steatosis, considered for a long time as a reversible "harmless" disease, is now re-evaluated according to the concept of cirrhosis without cell necrosis and inflammation. The study of 166 biopsies from alcoholic hepatic steatosis has demonstrated the presence of fibrotic process in 25 (15%) of the cases. Histologic and electron microscopic examination have supplied data on the distribution of this fibrosis (perivenous, perisinusoidal and extensive) as well as on the cells involved in collagen synthesis; myofibroblasts, fat storing cells (Ito cells) and the hepatocyte itself. Peritoneoscopy revealed aspects of incipient portal hypertension in some of the cases. Follow-up in time with reiteration of morphologic exploration at intervals of 2 to 3 years has shown the possible evolution toward cirrhosis in cases of steatosis with fibrosis when ethanol consumption is continued. Detection of early fibrosis, in patients with alcoholic steatosis, by means of morphologic or biochemical methods would be necessary for its therapeutic implication: possible reversibility by abstinence from alcohol and antifibrogenic therapy.

Persistent acute hepatitis, an evolutive modality of the acute viral hepatitis, with high cirrhogenic potential

An early detection of the progress to chronic stages of the acute diseases has particular pathogenic and therapeutic implications in hepatology. A complex clinical, biologic and morphologic study has been carried out in 86 patients with persistent acute hepatitis, recently released after 4-8 weeks of hospitalization for acute viral hepatitis, who were submitted to sequential investigations and follow up for a mean period of 16 months (range 2-24 months). All the patients have shown signs of activity of the liver injury, more than three months after the viral hepatitis onset (GOT/GPT 134 +/- 41 KU/219 +/- 59 KU, gammaglobulins 24.2 +/- 2.4%) and a characteristic immune pattern. In some cases, the morphologic investigations (endo-histologic and infrastructural) have revealed elements of acute and chronic active hepatitis. In 70% of the case the disease had a favourable course, while 30% of them showed a tendency to chronicization and even to cirrhosis, within a period of two years.

Morphological markers with predictive-evolutive value in liver diseases

A morphological, endoscopic and bioptic (histologic and electron microscopic) study carried out in 86 patients with acute persisting hepatitis (APH) and 240 patients with noncirrhogenous alcoholic hepatitis (AH) allowed the observation of some aspects with predictive-evolutive value in liver diseases. In APH the endoscopic observation of a change of colour from bright red to variegated and the appearance on histologic examination of portal infiltrate with invasive tendency as well as of collagen spurs penetrating in the portal spaces, suggest the onset of the chronicity. In AH the changes with predictive value present in both AH and hepatic steatosis are, the alterations of the liver surface, and especially perivenular and perisynusoidal fibrosis.

Structural and ultrastructural changes of lymph nodes in primary lymphoedema

Optical and electronmicroscopic investigations of the inguino-iliac lymph nodes and lymphatic vessels of the lower limb suggested a pathogenic role of lymph node structural alterations in primary lymphoedema. Most of the investigated lymph nodes showed an extensive fibrosis frequently associated with lipomatosis ectasy of medullary sinuses, a.o., estimated as primary lesions appearing on a genetically propensic ground or by developmental anomalies. Alteration of the lymphatic vessel intima, proliferation, muscle hypertrophy, subintimal fibrohyalinosis, a.o., occurred in consequence of the impeded lymphatic drainage by the primary lymph node fibrosis.

Lympho-nodal fibrosclerosis in primary lymphedema. Part one: Considerations on lympho-nodal fibrosclerosis in primary lymphedema

Segments of an inferior inguinal ganglion and of an external iliac (upper inguinal) ganglion were microscopically examined in 46 cases of bilateral primary lymphedema and 26 cases of unilateral primary lymphedema. The examination was performed bilaterally and comparatively to a set of ganglions unaffected by lymphedema, during the years 1974-1978. In all the lymph nodes originating from the patients with lymphedema important morphopathological alternations were noticed, chiefly consisting in fibrosis, fibrosclerosis, fat loading, hyalinization processes, giganto-cellular responses, etc., leading even to an aspect of cirrhosis, lympho-nodal pseudo-cirrhosis. These alterations were also found on the healthy side of the patients with unilateral primary lymphedema at the time of the microscopical examination. In the same patient clinical edema appeared in the following years. The degree of the morphopathological alterations was greater in the side of the greater edema and more peculiar in the cases of bulkier edema.

Lympho-nodal fibrosclerosis in primary lymphedema. Part two: Consequences of lympho-nodal fibrosclerosis on lymph stasis in primary lymphedema

The inguinal-iliac lympho-nodal fibrosclerotic processes appearing in female patients with primary lymphedema bring about an obvious tendency of reduction of the circulatory flux in the afferent lymphatics at some distance from the lympho-nodal area: at the foot or at the shank. The inguinal lympho-nodal morphopathological alterations (examined in 72 cases of primary lymph-edema) were followed, by distal lymph stasis at the level of the foot and of the leg, without sensibly affecting the lymph flow in the thigh. These aspects of the lymph stasis adjacent to the lympho-nodal areas are striking in the patients with secondary lymphedema.

Study of gastroesophageal reflux by determination of endoesophageal pH using the Heidelberg telemetering capsule

Gastroesophageal reflux (GER) was determined by recording the endoesophageal pH using the Heidelberg telemetering capsule in 60 patients with various esogastroduodenal diseases. Gastroesophageal reflux was found present in 29 patients (48.3%). The nature (acid in 27 cases, alkaline in 2 cases) as well as the degree of reflux (score 1-6.5) could also be determined by this method. Radiologically reflux could only be detected in 12 out of the 29 patients (41.6%) of whom 9 with hiatal hernia. Only 62% of the GER cases were symptomatic, this being in agreement with the high scores and with the presence of esophagitis confirmed histologically. In chronic ethanol consumers (24 cases) the incidence of GER was increased (70.8%) suggesting the role of alcohol in the relaxation of the lower esophageal sphincter. In conclusion this method proved useful for the detection and quantification of GER.