The presence of Helicobacter pylori in laryngeal squamous cell carcinoma

A definitive relationship between Helicobacter pylori (HP) and upper respiratory tract disorders has not been established. In this case-control study, we investigated the relationship between HP and laryngeal carcinoma by real-time PCR method in Turkey. 74 subjects were enrolled from patients who were admitted to the Otolaryngology Department. Formalin-fixed-paraffin-embedded tissue samples with laryngeal cancer were used and all samples were evaluated by real-time PCR method. Our study population included 72 males and 2 females with a mean age range of 62.7 years. Helicobacter Pylori was detected in only one case. The positive case was also investigated with histopathologic evaluation and HP immunohistochemistry. However, we could not detect HP in this case with both methods. This study revealed that HP might not contribute to the pathogenesis of laryngeal carcinoma. A definitive relationship between HP and upper respiratory tract disorders has not been established.

Hyperammonemic encephalopathy in a patient with primary hepatic neuroendocrine carcinoma

A 53-year-old male patient was admitted to our hospital with abdominal pain in the right upper quadrant. There was no change in laboratory investigations other than a slight increase in serum levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT). Computed tomography (CT) of the abdomen showed multiple hepatic nodular lesions in the liver. Tru-cut biopsy of the lesions was reported as well-differentiated neuroendocrine carcinoma. The patient received sandostatin treatment. After a few days, the patient was hospitalized in the intensive care unit with disturbance of consciousness and clinical features suggestive of encephalopathy. Serum ammonia level was found highly elevated. After the treatment with L-ornithine-L-aspartate, a remarkable improvement in the level of patient's sensorium occurred as well as a reduction in serum ammonia level within a few days. Transarterial chemoembolization (TACE) was performed one week later. The patient's condition began to worsen along with increase in serum ammonia level and he died because of hyperammonemic encephalopathy. There are case reports of hyperammonemia with some malignancies such as multiple myeloma, plasma cell leukemia, and leiomyosarcoma, or in some patients who have received chemotherapy. This case may suggest an association between hyperammonemia and neuroendocrine tumors.

Myxoid neurofibromas of the breast: mammographical, sonographical and MRI appearances

Neurofibromas arise from elements in the peripheral nervous system and are rarely detected in the breast. Neurofibromatosis is a phakomatosis that displays a wide spectrum of clinical expression with neurocutaneous abnormalities and involvement of multiple organ systems. Neurofibromas are more common in neurofibromatosis Type 1. They can show variable amounts of myxoid change, which affect their radiological findings. In this paper, we present a patient with neurofibromatosis Type 1 with mammographical, sonographical and MRI findings of myxoid neurofibromas in her left breast.

Objective risk definition for endometrial lesion spectrum: A diagnostic algorithm

OBJECTIVE

Investigations for risk definition in endometrial lesion spectrum still go on. In this study, molecular, morphometric, immunohistochemical techniques were combined with conventional morphology to realize whether an algorithm is definable for risk assessment to progress an invasive carcinoma in endometrial glandular lesion spectrum is possible.

METHODS

The study was carried out on 20 benign endometria, 35 hyperplasias, and 20 adenocarcinoma cases. Clonality of glandular cells, the volume percent of endometrial stroma (VPS), PTEN inactivation, and proliferative index (PI) were evaluated. Statistical analysis was evaluated to set an objective algorithm.

RESULTS

All benign tissues had polyclonal (PC), whereas all malignant tissues had monoclonal (MC) glandular epithelium. Of hyperplasias, 19 were MC, and 16 were PC. VPS value of 55% had 100% sensitivity, and 80% specificity (n=67) to distinguish MC from PC. Neither PTEN nor PI data augmented the specificity or the sensitivity of clonal distinction.

CONCLUSION

Clonality and VPS values were found to be significant in differential of endometrial lesions. With this rationale, a diagnostic algorithm for endometrial risk lesions was set. This algorithm is based on HE morphology, VPS and clonality findings, and has 100% sensitivity and specificity to discriminate neoplastic endometrium from hyperplasia.

Increased expression of matrix metalloproteinases 2 and 9 and tissue inhibitors of metalloproteinases 1 and 2 correlate with poor prognostic variables in renal cell carcinoma

PURPOSE

Matrix metalloproteinases (MMPs) degrade components of the extracellular matrix and are implicated in tissue remodeling and tumor infiltration. Tissue inhibitor of metalloproteinases (TIMPs) inhibit enzymes of the MMP family and preserve stromal integrity, thus inhibiting tumor migration. Although numerous studies on several human carcinomas have demonstrated a role for MMPs in tumor metastasis and patient survival, their prognostic role in patients with renal cell carcinoma (RCC) has not been well defined. More importantly, the recently documented paradoxical functions of TIMPs have not been characterized in these neoplasms.

EXPERIMENTAL DESIGN

Five-microm, formalin-fixed, paraffin-embedded tissue sections from 153 RCCs were immunostained using specific antibodies against MMP2, MMP9, (Novocastra, Burlingame, CA) TIMP1, and TIMP2 (NeoMarkers, Fremont, CA) proteins. Immunostaining was semiquantitatively scored based on intensity and distribution, and results were correlated with histological and prognostic variables.

RESULTS

The rates of increased expression of MMPs and TIMPs in RCC were as follows: MMP2, 67%; MMP9, 43%; TIMP1, 46%; and TIMP2, 73%. Each of these four markers individually correlated with histological tumor type with a vast majority of papillary and sarcomatoid RCCs expressing these proteins as compared with clear cell tumors (P range, 0.0001-0.003). Significant coexpression of MMPs and TIMPs was observed (P = 0.0001). Increased immunoreactivity for each of these proteins correlated with high tumor grade (P range, 0.0001-0.01). On univariate analysis, expression of each of these markers correlated with shortened survival (P range, 0.004-0.05). On multivariate analysis, including tumor grade, stage, and all four markers, only advanced stage (P = 0.047) and increased TIMP1 expression (P = 0.007) independently predicted shortened survival.

CONCLUSION

Increased expression of MMP2, MMP9, TIMP1, and TIMP2 proteins in RCCs correlate with poor prognostic variables including shortened patient survival. The paradoxical poor prognostic implication of TIMP overexpression complements the recently documented dual function of TIMPs and warrants further investigation.