Has the diversity of clinical and biological manifestations of systemic lupus erythematosus a correspondent in the diversity of immune mechanisms? Observations based on a Rowell's syndrome case associated with arthritis and nephritis

This paper draws attention to the relationship between the clinical and biological picture of SLE and the immune mechanisms of this disease. The presence, in the same patient, of erythema multiforme-like skin lesions and erythemato-squamous lesions specific for SLE together with a characteristic immune picture (speckled antinuclear antibodies (ANAs), positive anti-Ro antibodies, positive rheumatoid factor) raise the question of a relationship between the immune mechanisms in SLE and the clinical picture. A case of Rowell's syndrome is discussed: systemic lupus erythematosus diagnosed on the occasion of an erythema multiforme-like rash. Starting from this case, we analyse if the clinical and biological picture in SLE is an expression of the immune mechanisms involved in this disease. Our patient presented with speckled antinuclear antibodies, positive rheumatoid factor, anti-Ro antibodies, suggestive of Rowell's syndrome. The patient manifested rheumatoid-like articular pain and high titer rheumatoid factor. Clinically, we found erythema multiforme-like and erythemato-squamous lesions. The patient developed nephrotic syndrome (proteinuria 11.8g/24h), and renal failure (creatinine 3.08 mg/dl). The renal biopsy showed mesangial proliferative glomerulonephritis class II (ISN/RPS). Under treatment with prednisone the nephrotic syndrome evolved into remission (traces of proteinuria) and serum creatinine declined (1.03 mg/dl). The cutaneous syndrome had a spectacular evolution, too. The question is raised of the existence in Rowell's syndrome of immune mechanisms commonly encountered in SLE and a subset associated with the cutaneous erythema multiforme-like rash and pseudo-rheumatoid arthritis manifestations.

[Thyroid cancer--the malignant lesions in the contralateral lobe]

AIM

This study analysed the frequency of the malignant lesions in contralateral thyroidian lobe after completion thyroidectomy for malignant lesions in the ipsilateral lobe, in order to establish which patients have indication of total thyroidectomy.

MATERIAL AND METHOD

There were studied retrospectively 228 patients which had completion thyroidectomy after histological confirmation of the thyroid cancer in the ipsilateral lobe.

RESULTS

Thyroid cancer in contralateral lobe was found in 94(41.2%) patients. One (4.7%) of patients with cancer < 1 cm in ipsilateral lob had malignant lesions in the contralateral lobe. In patients with ipsilateral lobe cancer > 1 cm, the frequency of malignant lesions was between 42.8% and 47.6%.

CONCLUSION

The very high frequency of malignant lesions in the patients with ipsilateral thyroid cancer > 1 cm impose total thyroidectomy in these cases.

Granular cell tumor of the penis shaft: case report and literature review

INTRODUCTION

Granular cell tumors (GCT) are uncommon soft tissue neoplasms of presumed neural origin that rarely involve the male external genitalia. Penile lesions are distinctly uncommon with less than 20 cases reported till now.

OBJECTIVE

In the present paper we describe the clinicopathological and immunohistochemical findings in a case of GCT of the penis shaft in a 31-years-old man.

RESULTS AND CONCLUSIONS

On physical examination the patient was found to have a small ovoid mass, 20 x 10 mm in diameter, at the left postero-lateral area of the penis' base. The mass was firm on palpation with no fixation on the neighboring tissues. The lesion was completely excised under loco-regional anesthesia. The surgical specimen was an ovoid, gray-white, elastic mass, of 10 x 5 mm. Microscopically, the tumor was moderately cellular and was composed of polygonal-shaped cells with abundant granular eosinophilic cytoplasm. Tumor cells were disposed in nests, cords, and trabeculae and showed perineural invasion. The tumor presented bland cytological features with only focal slight nucleo-megaly. Mitotic activity was undetectable. The tumor cells showed diffuse immunohistochemical expression for S100 protein. At 6 month after surgery the patient was free of persistent/recurrent disease or metastatic spread of the tumor. We discuss the clinical, histo-immunohistochemical and therapeutical features of this unusual penile tumor, the single one encountered in the Department of Pathology from Timisoara County Hospital and, to our knowledge, the only one reported in the Romanian medical literature.

[An unusual splenic tumor. Littoral cell angioma]

Littoral cell angioma is a rare splenic tumor which develops from specialised endothelial cells of the splenic red pulp. Numerous papers published since 1991 when the tumor was firstly described till now were focused on the radiologic characteristics of the lesion. This paper presents the clinical, imaging and morpho-immunohistochemical features of a littoral cell angioma diagnosed in a 51 year - old woman, to our knowledge, the first documented case in the Romanian medical literature. The lesion might be suspected on the basis of the clinical and imaging signs, but the diagnosis of certitude is provided by the gross and microscopic examination supplemented with immunohistochemical methods.

The expression of p53 protein in salivary gland carcinomas

The p53 suppressor gene is the most frequently altered gene in solid human malignancies. It is located on the short arm of chromosome 17 in the region 17p13 and encodes a 53kD nuclear phosphoprotein containing 393 amino acids with specific DNA binding properties and a short life span. The wild p53 protein has been classified as a tumoral suppression gene with a determining role in controlling cellular proliferation and differentiation and can be inactivated through mutation in the protein sequence encoding the gene, leading to neoplastic transformation. In this study we analyzed the expression of p53 protein in a variety of salivary gland malignant tumors fixed in formalin and included in paraffin, using the method of immunohistochemical coloring with the anti-p53 DO-7 antibody. The evaluation of the immunoreactivity with p53 proved a significantly more intense coloring in salivary gland high-grade malignant tumors and the observed immunomarking of over 50% of the tumoral cells is correlated with the weak differentiation of the tumors, giving a predictive factor for the evolution of the disease.

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.

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.

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.