2008 Summer Meeting - Leeds - The Pathological Society of Great ...

P79Evaluation of survivin expression in testicular tissues ofinfertile malesH Hanout 1 ,SEl Farargy 2 ,HAiad 1 , T Salah 11 Minofyia University, Faculty of Medicine, Dermatology and AndrologyDepartment, 2 Minofyia University, Faculty of Medicine, PathologyDepartmentNormal spermatogenesis represents a precisely regulated balance betweencontinuous cell proliferation and apoptosis. Survivin is one of the inhibitors ofapoptosis. We aimed to examine the testicular survivin expression in infertilemen and to evaluate its possible role in defective spermatogenesis. 55 infertilemale patients were included. Testicular biopsies were taken and were dividedinto 3 groups; normal spermatogenesis (NS), maturation arrest (MA) and sertolicell only (SCO) groups. Immunohistochemical expression of survivin wasdetected in all groups but varied in degree of intensity. Only two specimensfrom SCO group were devoid of survivin expression. Survivin expression wasdetected in the cytoplasm of not only spermatogenic cells but also sertoli cellsand interstitial cells of leydig. Most of patients of NS group (70%) and MAgroup (75%) showed marked survivin expression. In SCO group, 22% showednegative expression, 67% showed mild expression and 11% showed markedexpression. The intensity of survivin expression was significantly higher in NSand MA groups when compared to SCO group (P=0.0198 & P=0.0008)respectively. However, there was no statistical significant difference in intensityof survivin expression between NS and spermatogenic failure (SCO and MA)(p=1). Also, there was no statistical difference between early and late MA(P=1).Conclusion: Survivin expression is not a specific marker for germ cells.Survivin expression is significantly reduced in sertoli cell only patients whencompared to patients with maturation arrest or normal spermatogenesishowever, survivin expression couldn’t correlate with the stage of maturationarrest.P81Urothelial Carcinoma with Rhabdoid Features: A CaseReportJPatel 1 ,SSen 1 , P Chaudhri 11 Lincoln County HospitalExtrarenal rhabdoid tumours have been described in a variety of primary siteswith only rare case reports of urothelial carcinomas with rhabdoid features inthe literature.We describe a rare case of poorly differentiated urothelial carcinoma withrhabdoid features, confirmed on immunohistochemistry. Bladder biopsies fromthree different sites were received from a large solid mass, all of which showedsimilar features. The tumour was poorly differentiated invasive urothelialcarcinoma infiltrating the deep muscle and composed of high gradepleomorphic nuclei with frequent mitosis. Also present was the rhabdoidcomponent composed of large rhabdoid cells with abundant pink cytoplasm,vesicular nuclei, and a prominent nucleolus in a myxoid background. Rhabdoidcells were discohesive and were present singly, in clusters, or in nests.Immunohisotchemical stains for cytokeratin CK7, CK20, CD10, AE1/AE3showed either dotlike positivity or diffuse cytoplasmic staining in the rhabdoidcomponent of the tumours. The tumour cells with the rhabdoid features showedpositivity with desmin and vimentin.Malignant tumours with rhabdoid features in adults in extrarenal locations areconsidered to be phenotypic variants and have aggressive outcome. These havebeen described in all age groups and from multiple sites, including theextremities, brain, liver, mediastinum, orbit, heart, and is now accepted as adiscrete entity. The tumours generally have a histological appearance similar tothat of renal rhabdoid tumours. Immunohistochemical analysis usuallydemonstrates reactivity to vimentin, desmin, and keratin. Extrarenal rhabdoidtumours do not demonstrate skeletal muscle components byimmunohistochemical analysis.P80An Audit of The Staining Patterns of P504S, CK34BE12 andp63 in Benign and Malignant Prostatic Glands.JCumiskey 1 ,MZaba 1 , M Leader 11 Royal College of Surgeons in IrelandAims: To audit and compare staining of prostatic adenocarcinoma with P504S,CK34BE12 and p63 on core biopsies.Methods: Prostatic cores containing adenocarcinoma from 51 patients wereretrospectively reviewed. All had sextant biopsies and 23 patients had >1positive core. Immunohistochemical stains for p63, CK34BE12 and P504S(AMACR) were performed. Staining was recorded as either positive or negativefor CK34BE12 and p63, and either strong, weak or absent luminal orcytoplasmic staining for P504S.Results: P504S showed cytoplasmic and / or luminal positivity in both benignand malignant glands. Forty-five percent of biopsies showed positivity inbenign glands and 90% showed positivity in malignant glands. The sensitivitywas 90%, specificity 55%, and positive predictive value 67%. There was somevariation in staining pattern between benign and malignant glands withmalignant glands more likely to show both luminal and cytoplasmic staining orcytoplasmic staining alone, and benign glands more likely to show luminalstaining alone (p=0.0012 2 ). Cytoplasmic staining was more likely to be‘strong’ in malignant glands (p=0.0134, Fisher’s Exact). There was nosignificant difference in intensity of luminal staining between benign andmalignant glands (p=0.2300).Conclusion: Although the sensitivity of P504S as a marker of prostaticmalignancy is 90%, specificity and positive predictive value are poor. There issome variation in intensity and staining pattern between malignant and benignglands but there is considerable overlap. Used alone, P504S has significantlimitations and it should rather be used as an adjunct to CK34BE12 and p63.P82Tale of Two Urinary Bladder tumours – Myeloid Sarcoma asa Primary manifestation of Acute Myeloid Leukemia andExtranodal Marginal Zone LymphomaJPatel 1 ,SSen 1 , P Chaudhri 1 ,ACoup 1 , C Hunt 11 Lincoln County HospitalCase 1: Myeloid sarcoma (MS) of the lower urinary tract is rare.We describe a 47-year-old man with pyuria, who underwent TURBT for asuspected bladder tumour and was found to have acute myeloid leukemia.Fragments of ulcerated bladder mucosa with underlying distinct monomorphicpopulation of cells with granular and clear cytoplasm were noted.Immunohistochemistry revealed strong expression of myeloperoxidase andweak IRF4(MUM1) positivity. Expression of transcription factor PU-1 wasaccompanied by weak CD45. CD3, CD20, CD138, CD34, CD68, IRF8,MNF116 and Cam5.2 were negative. Blood count after one month was WBC-99.0x10*9/L, with predominant population of leukemic blasts.Case 2: Malignant lymphoma of the bladder can be classified into 3 groups: 1)Primary lymphoma localized to the bladder; 2) Lymphoma in the bladder asdisseminated disease (non-localized lymphoma); 3) Recurrent bladderinvolvement by lymphoma(secondary lymphoma). Primary extranodal marginalzone lymphoma of MALT type of the urinary bladder is rare and generally hasexcellent prognosis. We present a 70 yr female with a newly diagnosed bladdertumour comprising of neoplastic lymphoid infiltrate with focal nodular patternand occasional lymphoid follicles. The focal nodular growth pattern was as aresult of colonization of the germinal centres by the neoplastic lymphoidinfiltrate.Immunohistochemistry showed these lymphoid cells to be CD20, CD79a andbcl-10 positive and CD5, CD43, CD10, cyclin D1 negative. Demonstration oflight chain restriction was not possible. Bone marrow aspirate and trephinebiopsy showed no evidence of lymphoma infiltration.52 Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme