Molecular Pathology
Seyed Amir Miratashi Yazdi; Elham Nazar
Abstract
The etiology of parathyroid carcinoma (PC) is largely unknown. Associations have been made with several inherited syndromes and with specific genetic lesions. The management of PC is challenging for clinicians. The complexity of molecular phenotypes increases with tumor aggressiveness. Lack of parafibromin ...
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The etiology of parathyroid carcinoma (PC) is largely unknown. Associations have been made with several inherited syndromes and with specific genetic lesions. The management of PC is challenging for clinicians. The complexity of molecular phenotypes increases with tumor aggressiveness. Lack of parafibromin on immunohistochemistry staining and HRPT2 mutation present capable consequences in differentiating carcinoma from adenoma. Lack of parafibromin expression, the gene product of HRPT2 is now used as a diagnostic, prognostic and predictive marker for parathyroid carcinoma. The epigenetic alteration, for example, DNA methylation and modifications in the chromatin structure, are known as significant events that are the reason for parathyroid tumorigenesis. We suggest that adjuvant genetic and epigenetic target therapy should be considered in treating PC patients.
Breast Pathology
Sajitha K; Meenakshi Arumugam; Jayaprakash Shetty; Reshma A Shetty; Ritu Asnani; Prashanth Shetty
Abstract
Background & Objective: Breast cancer is the most common cancer in developed and developing countries. This study mainly addresses the issue of an equivocal result in IHC, which then needs further assessment if the patient has to receive targeted therapy. The study aimed to detect the expression ...
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Background & Objective: Breast cancer is the most common cancer in developed and developing countries. This study mainly addresses the issue of an equivocal result in IHC, which then needs further assessment if the patient has to receive targeted therapy. The study aimed to detect the expression of Her2/neu protein in breast cancer by immunohistochemistry (IHC) and Fluorescence in situ Hybridization (FISH) and evaluate concordance and discordance between the two methods. Also, the clinicopathological parameters in these patients were studied in association with ER, PR, HER-2, and Ki-67.Methods: This study was conducted on 34 female carcinoma breast specimens, including core biopsies and mastectomies. Each case underwent histopathological and immunohistochemical studies for (Estrogen Receptor) ER, (Progesterone Receptor) PR, (Human Epidermal growth factor Receptor 2) HER-2, and Ki-67. In addition, FISH was done on all the samples to detect Her2 gene amplification.Results: The overall concordance between the two tests was 79.41% while the concordance between the two tests in equivocal cases, was 14.3%. ER/PR expression and HER-2 amplification were inversely associated. Also, Ki-67 expression was not associated with the side size of the lesion, lymphovascular invasion, and lymph node metastasis. Age less than 50 at presentation and infiltrating ductal carcinoma histological type showed increased proliferation index.Conclusion: The highest concordance between FISH and IHC was noted in IHC positive and negative cases, whereas IHC equivocal cases showed low concordance. FISH accurately determines the assessment of HER2 expressions in equivocal cases.
Breast Pathology
Zeinab Vosough; Shima Golbini; Majid Sharbatdaran; Akramossadat Hosseini
Abstract
Background & Objective: Breast cancer is the most common malignancy in Iranian women and worldwide. Lymphatic vessel invasion (LVI) was found to be an independent prognostic factor in many carcinomas, including invasive carcinoma of the breast. The aim of this study was to compare the hematoxylin ...
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Background & Objective: Breast cancer is the most common malignancy in Iranian women and worldwide. Lymphatic vessel invasion (LVI) was found to be an independent prognostic factor in many carcinomas, including invasive carcinoma of the breast. The aim of this study was to compare the hematoxylin and eosin (H&E) staining method and the use of the immunohistochemistry (IHC) marker, D2-40, for evaluating LVI in breast carcinoma specimens. Materials & Methods: The study was conducted on 50 patients undergone surgery between the years 2010 and 2015 in Rohani Hospital, Babol, Iran with invasive carcinoma of the breast with Census sampling method. LVI was assessed using H&E staining and two IHC markers, i.e., D2-40 and CD31, by two surgical pathologists. Results: LVI was detected in 25 (50%) patients by H&E and in 14 (28%) patients by D2-40. Twelve out of 25 patients with positive LVI in H&E were confirmed by D2-40 and 2 out of 25 patients with negative lymphatic vessel in H&E. Only one case showed weak staining of CD31 proving LVI. These results showed a significant difference between the H&E staining and D2-40 IHC study for LVI detection (p =0.004). Conclusion: The D2-40 IHC marker is helpful in the diagnosis and confirmation of LVI in invasive carcinoma of the breast. CD31 is not suitable for the evaluation of lymphatic vessels.
Breast Pathology
Maryam Kadivar; Fatemeh Aram
Abstract
Background & Objective:Ki-67 evaluation is an essential tool to define luminal A and B breast cancers, which is not yet systematized. The International Ki67 in Breast Cancer Working Group suggests the counting of 500 or 1000 cancer cells, which is a time-consuming process. Therefore, novel methods, ...
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Background & Objective:Ki-67 evaluation is an essential tool to define luminal A and B breast cancers, which is not yet systematized. The International Ki67 in Breast Cancer Working Group suggests the counting of 500 or 1000 cancer cells, which is a time-consuming process. Therefore, novel methods, such as the Eye-10 method and stepwise counting strategy, are proposed to facilitate measurement. Methods:Immunohistochemical staining of Ki67 was performed on 100 hormone-receptor-positive invasive ductal carcinoma specimens. Ki67LI was evaluated for each case, and then results were dichotomized by a cut-off point of 20%. Next, for each sample, an expert pathologist visually assessed percentages of Ki67-positive cells in 10% intervals at a glance (Eye-10 method). Finally, by using a dynamic process with rejection regions, Ki67 was defined so if the estimate belonged to the upper or lower rejection region, the Ki67 status had been determined and if the rejection region could not be reached after counting the maximum number of 400 tumor cells, the specimen was regarded as equivocal (stepwise counting strategy).Results:The comparison between Eye-10 and Ki67LI revealed almost perfect agreement (kappa coefficient =0.889), and the concordance between the stepwise counting strategy and Ki67LI was substantial (kappa coefficient =0.639).Conclusion:Both two methods left some results in the gray/intermediate zone, which is unavoidable. Both methods are much faster and simpler than evaluation of Ki67LI and are also reliable. Regarding the gray zone in both methods, further improvements in the methodology, as well as more analytical studies, are needed.
Dermatopathology
Parvin Rajabi; Mitra Hydarpoor; Ahmadreza Maghsoudi; Fatemeh Mohaghegh; Maryam Dehghani Mobarakeh
Abstract
Background & Objective: Basal cell carcinoma (BCC) is a common skin cancer arising from the basal layer of the epidermis and its appendages. They are locally invasive, aggressive, and destructive of skin and the surrounding structures. β-Catenin is a multifunctional protein located to the ...
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Background & Objective: Basal cell carcinoma (BCC) is a common skin cancer arising from the basal layer of the epidermis and its appendages. They are locally invasive, aggressive, and destructive of skin and the surrounding structures. β-Catenin is a multifunctional protein located to the intracellular side of the cytoplasmic membrane coded by the CTNNB1 gene, which maps to chromosome 3p22.1. It has a critical role in cell-to-cell adhesion by linking cadherins to the actin cytoskeleton and has a central role in transcriptional regulation in the Wnt signaling pathway. We evaluated the diagnostic value of the Beta catenin immunohistochemistry marker in distinction of aggressive and non-aggressive Basal cell carcinoma.Methods: This cross sectional and descriptive-analytical study was done on archived formalin fixed, paraffin embedded tissue blocks in pathology library of Al-Zahra hospital in Isfahan city. We used immunochemistry to determinate the role of β-Catenin in aggressiveness in BCC with higher rate of relapse.Results: A total of 76 samples were evaluated in two groups (aggressive &none aggressive). The mean percentage of cytoplasmic β-Catenin staining in aggressive group was more significant than the other group (sensitivity: 86.8% specificity: 81.6%, PPV: 81.5% and NPV: 86.1%) and the mean percentage of membranous β-Catenin staining in non-aggressive group were significant more than the aggressive group. Intensity of membranous staining in both groups significant less than normal epithelium.Conclusion: Cytoplasmic β-Catenin staining in aggressive BCC is more significant than non-aggressive subtypes, so this indicates that the use of β-Catenin IHC marker maybe helpful in the diagnosis of aggressive BCC.
Adriana Handra-Luca
Abstract
Squamous cell differentiation (SCD) may occur in papillary thyroid carcinoma (PTC) only at metastatic sites. We have studied cytokeratin CK5/6 and P63 along with TTF1 (thyroid transcription factor 1) and B-Raf (V-Raf murine sarcoma viral oncogene homolog B1) immunohistochemical expression in neck ...
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Squamous cell differentiation (SCD) may occur in papillary thyroid carcinoma (PTC) only at metastatic sites. We have studied cytokeratin CK5/6 and P63 along with TTF1 (thyroid transcription factor 1) and B-Raf (V-Raf murine sarcoma viral oncogene homolog B1) immunohistochemical expression in neck lymph node metastases of thyroid PTC showing SCD. The patient (21-years) presented with a neck mass. The check-up revealed bilateral thyroid nodules. Total thyroidectomy and neck lymph node dissection were performed. The diagnosis was that of bilateral PTC with lymph node metastases (pT1N1Mx). The metastases were peculiar by the presence of cystic change and of SCD. The thyroid PTC expressed P63 focally and, TTF1 and B-Raf diffusely. Cytokeratin 5/6 was expressed only in the lymph node metastases, in the metastatic cyst lining and in the SCD foci. The P63+ cells outnumbered those CK5/6+. TTF1 expression was faint in SCD. Metastatic, both classical PTC- and SCD-epithelia expressed B-Raf. The expression patterns of CK5/6, P63, TTF1 suggest a luminal/central-to-abluminal/peripheral direction for SCD development from PTC-epithelia in lymph node metastases. Whether this metaplasia type may reflect a regression to a less aggressive morphotype or a progression-switch to squamous cell carcinoma-type differentiation in a composite tumor remains matter of debate.
Hematopathology
Ali Yaghobi; Payam Azadeh; Behzad Nemati Honar
Abstract
Verrucous carcinoma (VC) is a rare variant of well differentiated squamous cell carcinoma (SCC) which is usually found in oral cavity mucosa. Cutaneous verrucous carcinoma is a rare entity and in this paper we report a 43 years old man with VC superimposed on chronically inflamed skin of ileostomy site. ...
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Verrucous carcinoma (VC) is a rare variant of well differentiated squamous cell carcinoma (SCC) which is usually found in oral cavity mucosa. Cutaneous verrucous carcinoma is a rare entity and in this paper we report a 43 years old man with VC superimposed on chronically inflamed skin of ileostomy site. Previously, he was operated to treat rectal adenocarcinoma and has had ileostomy for six months. The skin lesion was resected totally during surgical operation for ileostomy closure. Histopathologic examination confirmed the diagnosis of cutaneous verrucous carcinoma. Post-operative follow up shows no evidence of recurrence after six months. We suggest patient’s training for follow up visits in order to early detection of osteomy site complications including neoplastic changes.
Dermatopathology
Farahnaz Bidari Zerehpoosh; Soheila Nasiri; Sara Zahedifard; Shahram Sabeti
Abstract
Background:Non-Melanoma Skin Cancer (NMSC), the most prevalent types being Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC), is the most common type of malignancy in human beings. These neoplasms are more frequent in the elderly and fair skinned people and mainly occur on sun-exposed sites ...
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Background:Non-Melanoma Skin Cancer (NMSC), the most prevalent types being Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC), is the most common type of malignancy in human beings. These neoplasms are more frequent in the elderly and fair skinned people and mainly occur on sun-exposed sites of the body. Ultraviolet B (UVB) has a well-known effect in induction and promotion of growth of these cancers. The p53 tumor suppressor gene is believed to be an early target in UV-induced skin carcinogenesis. Aggregates of keratinocytes with p53 protein overexpression are frequently identified in normal human skin and are more prevalent in chronically sun-exposed skin, and have been proposed to play a role in skin cancer pathogenesis. The aim of this study was to clarify the potential role of P53 in the development of NMSC. Methods: Immunohistochemical evaluation of p53 expression in peri-lesional skin of 90 cases of SCC, BCC and melanocytic nevi was performed. Results: The well-delineated compact type of p53 clone, but not the strong dispersed type, was significantly more predominant in SCCs in comparison with BCCs and melanocytic nevi (P value=0.001). The size of p53 clones was also significantly greater in SCCs compared to the BCCs (P=0.003) and melanocytic nevi (P=0.001). There was no significant difference between these neoplasms regarding the frequency of P53 clones (P=0.86). Conclusion: This study suggests the possible relationship of epidermal p53 clones with the pathogenesis of SCC.
Ali Eslamifar; Amitis Ramezani; Kayhan Azadmanesh; Farahnaz Bidari-Zerehpoosh; Mohammad Banifazl; Arezoo Aghakhani
Abstract
Background and Objectives: Breast cancer is the most common malignancy in women throughout the world. There are controversial reports on the role of human papillomavirus (HPV) infection in breast carcinogenesis. The aim of this study was to assess the presence of HPV-DNA in invasive breast carcinoma ...
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Background and Objectives: Breast cancer is the most common malignancy in women throughout the world. There are controversial reports on the role of human papillomavirus (HPV) infection in breast carcinogenesis. The aim of this study was to assess the presence of HPV-DNA in invasive breast carcinoma to determine the association between HPV infection and breast carcinoma. Methods: The study included formalin-fixed paraffin-embedded tissue samples of 100 cases with invasive ductal carcinoma of breast and 50 control tissues of mammoplasty specimens. HPV-DNA was purified and amplified through GP5+/GP6+ and MY09/MY11 primers. Results: All tested carcinomas as well as normal tissues were negative for all types of HPV in PCR assay. Conclusion: Our results do not support the association between HPV infection and breast carcinoma. Further studies involving larger number of cases are required to elucidate the role of HPV infection in breast carcinogenesis.
Priyanka Joseph Koshy; Mijil Anand Justin; Meenakshi Vedavyasan; Thomas Alexander; Renu G’Boy Varghese
Volume 7, Issue 1 , January 2012, , Pages 58-62
Abstract
The presence of a low level of M protein in the peripheral blood <3gm/dl which is below the required cut off for the diagnosis of plasma cell myeloma is known as monoclonal gammopathy of undetermined significance (MGUS). Elevated levels of serum M protein and detection of M band on serum protein electrophoresis ...
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The presence of a low level of M protein in the peripheral blood <3gm/dl which is below the required cut off for the diagnosis of plasma cell myeloma is known as monoclonal gammopathy of undetermined significance (MGUS). Elevated levels of serum M protein and detection of M band on serum protein electrophoresis (SPE) can occur in chronic diseases not related to B cell disorders and not always diagnostic for B cell dyscrasias. It can also be seen in non hematological malignancies as seen in our case. We present a case of MGUS in a 59yr male patient, previously diagnosed and surgically treated for carcinoma prostate and colon. Serum electrophoresis revealed an M Band – monoclonal protein of 1.9 gm/dl. Urine for Bence Jones proteins was negative and his skeletal X-rays did not reveal lytic lesions. Bone marrow aspiration revealed metastatic carcinoma. Plasma cells formed 1% of the bone marrow differential count.
Rajesh Laishram
Volume 5, Issue 4 , September 2010, , Pages 212-215
Abstract
Background: Spontaneous infarction is an uncommon complication of fibroadenoma of the breast. Although infarction following fine needle aspiration (FNA) has been reported in the literature, infarction encountering on first time aspiration is very rare. Lack of knowledge of this entity may lead to an ...
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Background: Spontaneous infarction is an uncommon complication of fibroadenoma of the breast. Although infarction following fine needle aspiration (FNA) has been reported in the literature, infarction encountering on first time aspiration is very rare. Lack of knowledge of this entity may lead to an erroneous diagnosis of inflammatory lesion like mastitis and carcinoma on cytology smears.
Case: We report the cytological and histological findings in partial spontaneous infarction of fibroadenoma in an 18-year-old female and literature reviewed.
Conclusion: In young patients with breast lumps, if the aspirated material is necrotic, the probable diagnosis of spontaneous infarction should always be kept in mind. Viable fibroadenomatous tissue should be searched for in the FNA smears.
Afsaneh Rajabiani; Hossein Vakili
Volume 4, Issue 4 , September 2009, , Pages 190-193
Abstract
Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles epithelial ovarian cancer. Here we introduce a case of tubal carcinoma in a postmenopausal woman. The diagnosis of primary fallopian tube carcinoma is rarely considered preoperatively and is usually first appreciated ...
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Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles epithelial ovarian cancer. Here we introduce a case of tubal carcinoma in a postmenopausal woman. The diagnosis of primary fallopian tube carcinoma is rarely considered preoperatively and is usually first appreciated by the pathologist. Because of low frequency of tubal carcinoma, there are few systemic pathological reports of its mode and extent of spread. Surgical staging and management as the use of chemotherapy follow the concepts used in epithelial ovarian cancer. In contrast to epithelial ovarian cancer, it is the importance of early lymphatic spread in this disease. The earlier diagnosis of primary fallopian tube carcinoma leads to an apparent better survival compared with its ovarian counterpart. However, as with epithelial ovarian carcinoma, stage and residual tumor are the most important prognostic variables. Only with more extensive clinical researches, ovarian carcinoma management principles should be used in clinical practice of this tumor.
Alireza Abdollahi
Volume 3, Issue 4 , September 2008, , Pages 208-213
Abstract
Background and Objective: Non-specific granulomatous prostatitis is an uncommon diffuse inflammatory condition of the prostate. It is important because it may be mistaken for prostatic carcinoma. The aim of the study was to determine the prevalence of non-specific granulomatous prostatitis (NSGP) ...
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Background and Objective: Non-specific granulomatous prostatitis is an uncommon diffuse inflammatory condition of the prostate. It is important because it may be mistaken for prostatic carcinoma. The aim of the study was to determine the prevalence of non-specific granulomatous prostatitis (NSGP) and comparing the results of transrectal ultrasonography, serum prostate specific antigen (PSA) and free prostate specific antigen levels, digital rectal exam (DRE) in NSGP with the prostate carcinoma and benign prostate hyperplasia. Materials and Methods: During a cross-sectional study, the prostate needle biopsy cases with the granulomatosts prostatitis diagnosis that had been referred to one of the largest pathology centers (1 year: 2006) were found and their clinical files were revised from the point of DRE, transrectal ultrasonography (TRUS), FPSA, and PSA. Some clinical and pathology findings such as age, microscopic findings, sonography information and experimental findings that had been necessary for the study were gathered and analyzed using SPSS software. Results: Out of 783 needle biopsies of prostate, 8 (1.02%) cases were non-specific granulomatous prostatitis. The age range of patients was 55-76 years (with a mean of 66.1 years). Mean of PSA level was 19.45 ng/ml and fPSA level was 0.7 ng/ml. In 2 patients, TRUS showed focal hypoechoic areas and in other 2 of these DRE revealed asymmetry and mild nodularity. Conclusion: There is no pattern of clinical, biochemical or ultrasound findings that allows a specific diagnosis of granulomatous prostatitis to be made or differentiate it from prostatic carcinoma and the biopsy is still necessary for the certain disease diagnosis.
Alireza Abdollahi; Issa Jahanzad; Peyman Mansuri Mehrabani
Volume 3, Issue 2 , March 2008, , Pages 88-94
Abstract
Background and Objective: In this study, we explored expression rate, some biomarkers affecting the prognosis of the breast carcinoma, and the relationship between these markers and clinicopathologic features of the disease as well as the relationship between each of these markers through a tissue ...
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Background and Objective: In this study, we explored expression rate, some biomarkers affecting the prognosis of the breast carcinoma, and the relationship between these markers and clinicopathologic features of the disease as well as the relationship between each of these markers through a tissue array technique. Materials and Methods: This study was an observational and cross-sectional study. From 100 breast samples which had been diagnosed as invasive ductal carcinoma, blocks were prepared through a tissue array method and were stained by monoclonal antibodies of the markers. All data were analyzed using SPSS program. Results: The appearance rate of EGF-R marker had a direct relationship with the degree of malignancy (p=0.026), metallothionein marker with the mean number of mitosis (p=0.044), sialyl-Tn marker with the macroscopic size of tumor (p=0.036), the appearance of cyclin B1 marker with the appearance of metallothionein marker (p=0.012), and the appearance rate of EGF-R marker had a reverse relationship with Nm23 (p=0.020). Conclusion: Through investigating the relationship between some biomarkers such as EGF-R and metallothionein and the clinicopathogenic features of tumor or the relationship between each marker and the other parameters, we can assess the state of invasion and metastasis process or the degree of its malignancy or determine its prognosis.
Kajal Kiran Dhingra; Somak Roy; Namrata Setia; Shramana Mandal; Nita Khurana
Volume 3, Issue 1 , January 2008, , Pages 47-49
Abstract
Amoebiasis of the uterine cervix is an extremely rare entity and presentation as carcinoma cervix has only been reported once in the extensively searched English literature. It can clinically simulate cervical malignancy by virtue of surface papillomatous and overall ulcerated and necrotic appearance. ...
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Amoebiasis of the uterine cervix is an extremely rare entity and presentation as carcinoma cervix has only been reported once in the extensively searched English literature. It can clinically simulate cervical malignancy by virtue of surface papillomatous and overall ulcerated and necrotic appearance. We present a case of amoebic cervicitis in a 55-year old female which was suspected to be a squamous cell carcinoma until a punch biopsy disclosed a diagnosis of amoebic etiology thereby preventing unwarranted aggressive management
