Evaluation of Microsatellite Instability Molecular Analysis versus Immuno-Histochemical Interpretation in Malignant Neoplasms with Different Localizations

MMR gene germline mutations are considered a major genetic disorder in patients with hereditary nonpolyposis colon cancer (HNPCC) or Lynch syndrome; A total of 15% of sporadic colon carcinomas are MSI-High. MSI has also been observed in other cancers, such as endometrial, gastric, and ovarian cancer. The aim of the current study was to correlate and outline the optimal method between the molecular testing of the instability of microsatellite DNA regions (MSI status) and the loss of protein expression by immunehistochemistry (MMR). A total of 242 paraffin-embedded tissues from gastrointestinal, gynecological, genitourinary, lung, breast, and unknown primary cancer patients were analyzed for the expression of MLH1/MSH2/MSH6/PMS2 by immunohistochemistry, as well as for the molecular analysis of MSI status using PCR-based molecular fragment analysis. A total of 29 MSI-High patients were detected molecularly, while 23 patients were detected by immunohistochemistry, with rates that are comparable according to the literature. Based on the agreement coefficient of the two methods, a substantial agreement emerged (Kappa = 0.675 with standard error = 0.081, p < 0.001). Despite the substantial agreement, both methods ought to be established to determine MSI-H/dMMR status in all cancer types as a first-line screening test.

Clinical performance of Immunoscore in stage III colorectal cancer patients in the SCOT and IDEA-HORG cohorts

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Background: The ESMO clinical practice guidelines recommend consideration of Immunoscore (IS) for risk assessment of early colon cancer patients. IS clinical performance was assessed in the SCOT and IDEA-HORG trials evaluating 3 vs. 6 months (3m vs. 6m) of mFOLFOX6 adjuvant chemotherapy in stage III colorectal cancer (CRC). Methods: 1,002 formalin-fixed paraffin-embedded (FFPE) tumor samples (762 from SCOT;240 from HORG) were collected, of which 851 were eligible for biomarker analysis. Eligible samples were classified into 2 groups using pre-defined cut-offs (IS-Low, IS- High) and the performance of IS to predict 3 year disease-free survival (3y-DFS) was evaluated. Results: IS was successfully assessed in 846 cases (99%). 615 (72.7%) samples were classified as IS-High (311 and 304 in 3m and 6m arm, respectively). No significant association between IS and patients’ gender, age, PS, BMI or primary tumour location was observed. However, a significant difference between IS-High (43.7%) and IS Low (57.1%) was observed in the proportion of high risk (T4 and/or N2) tumours (p=0.001). Patients with IS-High tumors had significantly longer 3y-DFS (79.4%, 95%CI: 75.9%-82.4%) compared to those with IS-Low tumors (65.0%, 95%CI: 58.3%-70.9%); adjusted hazard ratio (HR) 1.9 (95%CI: 1.46-2.46; p<0.0001). Similarly, IS-High was significantly correlated with longer 3y-DFS in both treatment arms: 78.5% (95% CI 73.4%-82.7%) for IS-High and 65.8% (95% CI 56.1%-73.9%) for IS-Low in 3m arm; 80.3% (95% CI 75.3%-84.5%) for IS-High and 64.4% (95% CI 54.8%-72.6%) for IS-Low in 6m arm. The estimated HRs according to treatment duration and IS classification were 1.80 (95% CI 1.25-2.60) in 3m arm, 2.00 (95% CI 1.38-2.92) in 6m arm and 1.89 (95% CI 1.46-2.47) in the total study population; interaction p = 0.687. Conclusions: The results of this study confirm the prognostic value of IS observed in the IDEA-France trial (Pagès F et al 2020). However, this analysis was not powered to determine the predictive value of IS for treatment duration. Similar analysis of patients treated with CAPOX is warranted.

The clinical utility of SPECT/CT hybrid imaging on bleeding Meckel's diverticulum in adults

Technetium-99m pertechnetate planar scintigraphy is the procedure of choice to localize ectopic gastric mucosa. However, single photon emission computed tomography/computed tomography (SPECT/CT) provides precise landmarks and scintigraphic findings. We report a case of an adult patient with Meckel's diverticulum involving an atypical location, within the pelvic region, next to the right margin of the urinary bladder. Imaging characteristics supported the diagnosis of either Meckel's or bladder diverticulum. Single photon emission computed tomography /CT was the key method to obtain definite diagnosis, since the low-dose CT revealed the presence of air within the lesion of radiotracer uptake. This finding was suggestive of an outpouching of the bowel wall.

Cerebrospinal fluid and intraoperative squash cytology of childhood ependymoma

Ependymomas are glial neoplasms of central nervous system originated from the ependymal lining of the brain ventricles and spinal cord central canal, and rarely exfoliated into cerebrospinal fluid (CSF). In this case we report the cytomorphological and immunocytomorphological features of ependymoma in CSF and intraoperative squash preparations, confirmed by histology.

Osteoclast: like giant cell undiferrentiated pancreatic tumor diagnosed by means of EUS guided FNA

Objective:

Osteoclast-like giant cell tumours are rare abdominal malignant neoplasms mainly arising in the pancreas. Because of their rarity, clinical and cytopathology reports are very limited, and sonographic features have not been clearly specified; these tumors are easily misdiagnosed by ultrasound as mucinous cystic tumors (MCTs) or solid pseudopapillary neoplasms (SPNs).

Case study:

We report a case of osteoclast like giant cell tumor arising in the pancreas of an 80 year old female patient offered by EUS-FNA cytology on direct and cell block slides. A biphasic pattern composed by a malignant mononuclear cell component and a giant cell component were hallmarks to the diagnosis.

Conclusion:

Our case highlights the performance of EUS-FNA in the diagnostic approach of abdominal tumours and the significance of cell block method in the interpretation of osteoclast-like giant cell pancreatic tumour. (www.actabiomedica.it)

Toxicity evaluation of an essential oil mixture from the Cretan herbs thyme, Greek sage and Cretan dittany

The importance of herbal extracts on health, which was initially based on ethnopharmacological and traditional knowledge, becomes increasingly well documented by numerous experimental and intervention studies. The daily use of beverages from different aromatic plants which becomes more popular nowadays, has been a tradition in Crete, and a habit that has been linked to the longevity seen in the island. Additionally, a certain combination of aromatic plants has been used against common cold and influenza. Interestingly, when such a mixture of essential oils from Cretan herbs (Cretan Aromatic Plants essential oil, CAPeo, from thyme, Greek sage, and Cretan dittany) was formulated, significant antiviral properties were observed in vitro and a significant reduction in the duration and severity of symptoms of patients with upper respiratory tract infections was found in a clinical study. However, since many plants extracts can exert toxic effects, toxicity issues should be properly addressed. In the present work we present an acute and sub-chronic toxicity evaluation for this mixture of aromatic plants' essential oils in rats. In fact, it is the only toxicity study for Cretan dittany. We report absence of toxicity, rendering the use of the mixture of essential oils from Cretan dittany, Greek sage and thyme as safe.

Estrogen receptor-alpha isoforms are the main estrogen receptors expressed in non-small cell lung carcinoma

The expression profile of estrogen receptors (ER) in Non-Small Cell Lung Carcinoma (NSCLC) remains contradictory. Here we investigated protein and transcriptome expression of ERα wild type and variants. Tissue Micro-Arrays of 200 cases of NSCLC (paired tumor/non-tumor) were assayed by immunohistochemistry using a panel of ERα antibodies targeting different epitopes (HC20, 6F11, 1D5, ERα36 and ERα17p). ERβ epitopes were also examined for comparison. In parallel we conducted a probe-set mapping (Affymetrix HGU133 plus 2 chip) meta-analysis of 12 NSCLC tumor public transcriptomic studies (1418 cases) and 39 NSCLC cell lines. Finally, we have investigated early transcriptional effects of 17β-estradiol, 17β-estradiol-BSA, tamoxifen and their combination in two NSCLC cell lines (A549, H520). ERα transcript and protein detection in NSCLC specimens and cell lines suggests that extranuclear ERα variants, like ERα36, prevail, while wild-type ERα66 is minimally expressed. In non-tumor lung, the wild-type ERα66 is quasi-absent. The combined evaluation of ERα isoform staining intensity and subcellular localization with sex, can discriminate NSCLC subtypes and normal lung. Overall ERα transcription decreases in NSCLC. ERα expression is sex-related in non-tumor tissue, but in NSCLC it is exclusively correlating with tumor histologic subtype. ERα isoform protein expression is higher than ERβ. ERα isoforms are functional and display specific early transcriptional effects following steroid treatment. In conclusion, our data show a wide extranuclear ERα-variant expression in normal lung and NSCLC that is not reported by routine pathology ER evaluation criteria, limited in the nuclear wild type receptor.

Membrane androgen receptors (OXER1, GPRC6A AND ZIP9) in prostate and breast cancer: A comparative study of their expression

Accumulating evidence during the last decades revealed that androgens exert membrane-initiated actions leading to the modulation of significant cellular processes, important for cancer cell growth and metastasis (including prostate and breast), that involve signaling via specific kinases. Collectively, many nonclassical, cell surface-initiated androgen actions are mediated by novel membrane androgen receptors (mARs), unrelated to nuclear androgen receptors. Recently, our group identified the G protein coupled oxo-eicosanoid receptor 1 (OXER1) (a receptor of the arachidonic acid metabolite, 5-oxoeicosatetraenoic acid, 5-oxoETE) as a novel mAR involved in the rapid effects of androgens. However, two other membrane proteins, G protein-coupled receptor family C group 6 member A (GPRC6A) and zinc transporter member 9 (ZIP9) have also been portrayed as mARs, related to the extranuclear action of androgens. In the present work, we present a comparative study of in silico pharmacology, gene expression and immunocytochemical data of the three receptors in various prostate and breast cancer cell lines. Furthermore, we analyzed the immunohistochemical expression of these receptors in human tumor and non-tumoral specimens and provide a pattern of expression and intracellular distribution.

Antagonizing effects of membrane-acting androgens on the eicosanoid receptor OXER1 in prostate cancer

Accumulating evidence during the last decades revealed that androgen can exert membrane initiated actions that involve signaling via specific kinases and the modulation of significant cellular processes, important for prostate cancer cell growth and metastasis. Results of the present work clearly show that androgens can specifically act at the membrane level via the GPCR oxoeicosanoid receptor 1 (OXER1) in prostate cancer cells. In fact, OXER1 expression parallels that of membrane androgen binding in prostate cancer cell lines and tumor specimens, while in silico docking simulation of OXER1 showed that testosterone could bind to OXER1 within the same grove as 5-OxoETE, the natural ligand of OXER1. Interestingly, testosterone antagonizes the effects of 5-oxoETE on specific signaling pathways and rapid effects such as actin cytoskeleton reorganization that ultimately can modulate cell migration and metastasis. These findings verify that membrane-acting androgens exert specific effects through an antagonistic interaction with OXER1. Additionally, this interaction between androgen and OXER1, which is an arachidonic acid metabolite receptor expressed in prostate cancer, provides a novel link between steroid and lipid actions and renders OXER1 as new player in the disease. These findings should be taken into account in the design of novel therapeutic approaches in prostate cancer.

EUS - Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review

Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNAB. There are many new applications of EUS using FNAB. Researchers are looking to deliver chemotherapeutics into small pancreatic cancers and cysts. Nerve blocks using EUS/FNAB to inject numbing medicines into the celiac ganglia, a major nerve cluster, are now routinely performed in patients with pain due to pancreatic cancer. The aim of this study is to perform a review of the literature regarding the usefulness of EUS/FNAB in the diagnosis of pancreatic adenocarcinoma.

Fine Needle Aspiration Biopsy (FNAB) in the Diagnosis of Hepatocellular Carcinoma: A Review

Hepatocellular carcinoma (HCC) is the fifth more common cause of cancer and the third leading cause of cancer deaths worldwide. Despite advances in surgical and non surgical modalities in the treatment of HCC, a number of controversies regarding appropriate diagnostic procedures continue to evolve. A consensus statement from the European Association for the study of Liver Diseases (EASL) has been formulated to help clinicians standardize diagnostic approaches. In nodules greater than 2 cm diameter in size, diagnosis can be made if any 2 imaging studies (ultrasonography, computed tomography, magnetic resonance imaging or hepatic arteriography) show increased vascularity. Alternatively only one imaging study with an Alpha fetoprotein level more than 400ng/mL is diagnostic. Fine needle aspiration biopsy (FNAB) should be performed in cases of indeterminate radiology and in lesions sized between 1 and 2 cm. The aim of this review is to familiarize pathologists in the FNAB diagnosis of HCC in an appropriate and timely fashion.

Angioleiomyoma of the uterus: report of a distinctive benign leiomyoma variant

Angioleiomyoma is a relatively rare type of leiomyoma of the uterus that originates from smooth muscle cells and contains thick-walled vessels. Angioleiomyoma is usually found in the skin of the lower extremities. Uterine angioleiomyoma has similar morphological features to that of the skin. The authors present a case of a 50-year-old woman who was admitted to the present hospital with the complaint of lower abdominal pain. On clinical examination, she was found to have a palpable lower central abdominal mass. Pelvic ultrasound revealed uterine enlargement, multiple small leiomyomas, and a large mass in the myometrium. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy. On histological examination, the mass was diagnosed as angioleiomyoma. Hemangioma, angiofibroma or angiomyofibroblastoma were also included in the differential diagnosis. The treatment of choice for angioleiomyoma is surgical excision, and either angiomyomectomy or simple hysterectomy are proven to be equally effective; the decision depends on the patient's symptoms and her desire to preserve fertility.

Solid neuroendocrine carcinoma of the breast: a rare tumor

Solid Neuroendocrine carcinoma of the breast (SNECB) is a subtype of primary neuroendocrine carcinoma (NEC) of the breast with several distinctive features. In the present study, the authors report a case of 84-year old woman who was admitted in the hospital with a lump in her right breast. Mammography revealed a well-defined nodule in the outer lower quadrant of her right breast. She underwent lumpectomy and sentinel lymph node biopsy, which showed no metastasis. The histological diagnosis was solid neuroendocrine carcinoma of the breast. Microscopically, the tumor is formed from cells arranged in nests or trabeculae and separated by scant connective tissue. Immunohistochemical staining demonstrates strong positivity for NSE, chromogranin, synaptophysin, ER, and PR. The patient is still alive 14 months after diagnosis. Because of the rarity of this disease, there is no standard treatment protocol and a large variety of chemotherapy protocols have been employed in treating this disease.

Gastric calcifying fibrous tumor: a very rare case report

Calcifying fibrous tumor is a very rare benign mesenchymal tumor which shows a predilection for soft tissue, mesentery and peritoneum. Up to date only 7 cases have been reported in the literature confined to the gastric wall. We report a rare case of a calcifying fibrous tumor of the stomach in a 60-year-old man who presented with dyspepsia, flatulence and feeling weight. A clinical and laboratory investigation was performed with normal results. Gastroscopy revealed a bulge in the gastric body measuring 1 cm with normal overlying mucosa, and mucosal biopsies showed chronic gastritis. Endoscopic ultrasound of the gastric bulge showed a 1 × 0.8 cm hypoechoic lesion involving the gastric wall. After the above finding a wedge resection of the stomach was performed. Microscopically the lesion consisted of well-circumscribed hypocellular hyalinized fibrosclerotic tissue with lympoplasmatic infiltrates, lymphoid aggregates and psammomatous calcifications. Lesional cells were positive for vimentin and factor XIII and negative for actin, desmin, S100p, CD117, CD34, CD31 and ALK-1. The lesion involved the muscularis propria with variable submucosal extension. Calcifying fibrous tumor has shown an excellent prognosis with recurrences being rare and showing the same morphology as the primary lesion.

Atypical polypoid adenomyoma of the uterus. A case report and a review of the literature

Atypical polypoid adenomyoma (APA) is a rare, benign lesion. The tumor occurs in nulliparous women aged 22-48 years (average 33 years) and it has been suggested as being related to prolonged estrogenic stimulation. We describe a case of a 72-year-old woman who presented at our hospital with persistent, worsening urinary incontinence and pelvic pain. Physical examination and pelvic ultrasound disclosed uterine enlargement, a mass in the endometrial cavity and multiple small myomas. Total hysterectomy with bilateral salpingo-oophorectomy was performed. The histological diagnosis for the mass of the endometrial cavity was atypical polypoid adenomyoma. APA should be distinguished from endometrial carcinoma and other malignant uterine neoplasms such as adenofibroma, adenosarcoma and malignant mixed mullerian tumor. The immunohistochemical panel which usually includes alpha smooth muscle actin, desmin, Ki67 and recently CD10 is often helpful in establishing the diagnosis. The treatment may vary depending on the patient's age, her desire to preserve fertility, and the severity of her symptoms.

Primary cutaneous apocrine carcinoma of sweat glands: a rare case report

Cutaneous apocrine gland carcinoma, a subtype of sweat gland carcinoma, is a very rare malignancy, and only few cases have been reported in the literature. Many of these carcinomas are indolent and slowly developing, but some are rapidly progressive. The treatment of choice is wide local excision with clear margins, with or without lymph node dissection. We report a case of a 67-year-old man who came to our hospital with an ulcerated nodule in the right axilla measuring 1 × 0.8 cm. Histological evaluation showed features of an apocrine gland carcinoma arising in an area of high apocrine gland density.