Sabato 27 ottobre 2012 - Pacini Editore

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334 sensitive and early marker of the possibility of developing humoral rejection in those cases with donor-specific antibodies, in which deposits of C4d are not found. Its importance in addressing a humoral immunity component in those cases where the biopsy shows characteristic findings of other mechanisms of rejection (cell-mediated acute rejection, chronic graft nephropathy, etc.) is still a matter of debate, as not infrequently a combination of these features is reported. references 1 Meier-Kriesche HU, Schold JD, Kaplan B. Long-term renal allograft survival: have we made significant progress or is it time to rethink our analytic and therapeutic strategies? Am J transplant 2004;4:1289-95. 2 Sellarés J, de Freitas DG, Mengel M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant 2011;12:388-99. 3 Solez K, Colvin RB, Racusen LC, et al. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 2008;8:753-60. Macrophage related markers expression in MITF/TFE family renal translocation carcinoma, melanotic Xp11 translocation renal cell carcinoma and pure epithelioid pecoma (so called epithelioid angiomyolipoma of the kidney) C. Zampini, D. Segala, E. Munari, M. Pea, S. Gobbo, M. Brunelli, F. Bonetti, C. Ghimenton, O. Hes, P. Camparo, S. Pedron, C. Pastena, M. Chilosi, J.N. Eble, P. Argani, G. Martignoni University of Verona, Verona, Italy; Ospedale Orlandi, Bussolengo, Italy; Ospedale Civile Maggiore, Verona, Italy; Charles University and University Hospital, Plzen, Czech Republic; Hopital Foch, Suresnes, Paris, France; Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins Medical Institutions, Baltimore, MD Introduction. Cathepsin K is a lysosomal protease recently described in MITF/TFE family of translocation renal cell carcinomas (tRCC) 1 2 , and angiomyolipoma of the kidney both classic and epithelioid (pure epithelioid PEComa (PEP)) 3 . Both tRCC and angiomyolipoma are neoplasms expressing MITF/TFE family transcription factors 4 5 . Moreover t(6;11) TFEB+ tRCC and PEP constantly immunostain for the melanogenesis markers HMB45 and MART1 such as melanotic Xp11 tRCC, a neoplasm exihibiting a unique histologic feature and a distinct immunoprofile, different from other Xp11 tRCC with identical chromosome translocations involving TFE3 gene 6-8 . These three tumors can show overlapping morphological and immunohistochemical features and their differential diagnosis can be challenging 9 10 . In this study we investigated the expression of macrophage markers (CD68-PGM1, CD68-KP1, cathepsin K, CD163) in a series of tRCC, PEP and melanotic Xp11 tRCC, in order to assess their utility to distinguish them. MAMMELLA Implant-related breast angiosarcoma: report of a case and brief review of the literature L. Alessandrini1 , A.L. Tosi2 , M.C. Montesco2 1 Anatomical Pathology Unit, Department of Medicine, University of Padua, Italy; 2 Pathology Unit, Oncological Institute of Veneto, Padua, Italy Introduction. A large number of women have received breast CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012 Venerdì, 26 ottobre 2012 Sala Michelangelo – ore 17,00-18,30 Materials and methods. We studied the immunohistochemical expression of CD68-PGM1, CD68-KP1, cathepsin K and CD163 in 21 tRCC (including 9 PRCC TFE3+ tRCC and 12 t(6;11) TFEB+ tRCC), 5 melanotic Xp11 tRCC and 13 PEP. Results. All PEP, all t(6;11) TFEB+ tRCC, and all but two PRCC TFE3+ tRCC express strongly and diffusely cathepsin K whereas the 5 melanotic Xp11 tRCC were weakly positive. CD163 resulted positive in 3 out of 7 PEP and in none of 4 t(6;11) TFEB+ tRCC, 4 PRCC TFE3+ tRCC and 1 melanotic Xp11 tRCC. CD68-KP1 was expressed in all 22 tested tumors (4 PRCC TFE3+ tRCC, 4 t(6;11) TFEB+ tRCC, 1 melanotic Xp11 tRCC, 13 PEP) whereas CD68-PGM1 immunostained all 13 PEP, but none of the other neoplasms. Conclusions. 1) Cathepsin K is consistently expressed in PRCC TFE3+ tRCC, t(6;11) TFEB+ tRCC, melanotic Xp11 tRCC and PEP; 2) CD68-PGM1 is a useful tool for the differential diagnosis between PEP and all the other tRCC, including the HMB45 positive t(6;11) TFEB+ tRCC; 3) the CD68-PGM1 negativity in melanotic Xp11 tRCC seems to relate this tumor more closely to tRCC rather than PEP. references 1 Martignoni G, Pea M, Gobbo S, et al. Cathepsin-K immunoreactivity distinguishes MiTF/TFE family renal translocation carcinomas from other renal carcinomas. Mod Pathol 2009;22:1016-22. 2 Martignoni G, Gobbo S, Camparo P, et al. Differential expression of cathepsin K in neoplasms harboring TFE3 gene fusions. Mod Pathol 2011;24:1313-9. 3 Martignoni G, Bonetti F, Chilosi M, et al. Cathepsin K expression in the spectrum of perivascular epithelioid cell (PEC) lesions of the kidney. Mod Pathol 2012;25:100-11. 4 Chang KL, Folpe AL. Diagnostic utility of microphthalmia transcription factor in malignant melanoma and other tumors. Adv Anat Pathol 2001;8:273-5. 5 Martignoni G, Pea M, Reghellin D, et al. Perivascular epithelioid cell tumor (PEComa) in the genitourinary tract. Adv Anat Pathol 2007;14:36-41. 6 Pea M, Bonetti F, Zamboni G, et al. Melanocyte-marker-HMB-45 is regularly expressed in angiomyolipoma of the kidney. Pathology 1991;23:185-8. 7 Argani P, Ladanyi M. Translocation carcinomas of the kidney. Clin Lab Med 2005;25:363-78. 8 Argani P, Olgac S, Tickoo SK, et al. Xp11 translocation renal cell carcinoma in adults: expanded clinical, pathologic, and genetic spectrum. Am J Surg Pathol 2007;31:1149-60. 9 Argani P, Aulmann S, Karanjawala Z, et al. Melanotic Xp11 translocation renal cancers: a distinctive neoplasm with overlapping features of PEComa, carcinoma, and melanoma. Am J Surg Pathol 2009;33:609- 19. 10 Chang IW, Huang HY, Sung MT. Melanotic Xp11 translocation renal cancer: a case with PSF-TFE3 gene fusion and up-regulation of melanogenetic transcripts. Am J Surg Pathol 2009;33:1894-901. implants (800.000 to 1 million by 1989) either for cosmetic reasons or for reconstruction following cancer surgery. In the last years great attention has focused on long-term complications of breast prostheses, such as cancer. Mesenchymal tumors of the breast associated with implants are rare neoplasias that can be subdivided into two groups: fibromatoses and sarcomas. The latter group, less common than fibromatoses, is characterized by a higher histological grade and a longer latency period. Angiosarcomas are about 0.05% of all primary malignancies of the breast. They can arise de novo or secondary to arm lymph-
COmuNiCaziONi ORali edema following radical mastectomy (Stewart Treves syndrome) or to local radiotherapy. Only three cases of post-implant angiosarcoma are reported in literature. Case report. In 2003 a 53-year-old woman underwent simple bilateral mastectomy because of an invasive ductal carcinoma with nodal involvement and she subsequently had silicone protheses. Radiotherapy was not done. Seven years later, the patient developed an erythematous plaque on breast skin. A incisional biopsy was performed. The histological examination demonstrated a skin lesion composed of intercommunicating vascular channels, lined by plump endothelial cells with hyperchromatic nuclei intermixed with spindle cell solid areas, displaying a high mitotic activity. The neoplasia was characterized by an infiltrative growth pattern, with dissection of dermal collagen fibers and involvement of subcutaneous tissue. Immunohistochemistry showed a strong and diffuse reactivity for Factor VIII, CD31 and CD34. The morphological and immunhistochemical features were suggestive of angiosarcoma. Given the invasive aspect and the malignant potential of the lesion, a wide excision was performed. At gross examination, the surgical specimen measured 17x13x3.8 cm and showed on its cut surface a spongy, haemorragic ill defined mass of 11x7.3 cm. The lesion was multicentric and consisted of rudimentary anastomosing vascular channels, displaying invasion of fatty tissue and surrounding the prosthetic capsule. The microscopic and immunohistochemical features of this neoplasia were very similar to those observed in the biopsy and, thus, consistent with the diagnosis of spindle cell angiosarcoma of the breast. Conclusion. Angiosarcomas affecting the breast could be divided into two main categories: primary angiosarcomas and angiosarcomas associated with prior radiation therapy or with upper limb lymphedema. Due to the increased number of conservative treatment for breast carcinoma and the improvement in surgical techniques, the incidence of Stewart-Treves syndrome seems to have declined; on the contrary, radiation-induced angiosarcomas are a well-known iatrogenic problem, whose incidence has risen in the last years. Primary neoplasias arise mainly within breast parenchyma with secondary involvement of the overlying skin, whereas iatrogenic angiosarcomas affect primarily the skin. In this case, the lesion occurred around the implant capsule and there was no previous radiotherapy. Thus, prosthetic material could be addressed as a possible trigger for this neoplasia. However, considering the widespread use of artificial breast implants and the rarity of primary breast angiosarcomas, it has been difficult to unequivocally establish the presence or absence of a causal association between implants and mesenchymal neoplasias. On one side, an epidemiologic analysis based on National Cancer Institute’s SEER data for the years 1973-1990 concluded that there was no evidence of an increased risk of breast sarcomas associated with the use of silicone implants 8 . On the other side, the hypothetic causal relationship between angiosarcomas and breast prostheses is supported by a work providing evidence of angiosarcomas arising in proximity of foreign bodies (shrapnel, Dacron grafts, sponge, bullet) retained for prolonged periods in humans 9 . Although extremely uncommon, different histological types of sarcoma associated with a variety of foreign body arising in different body sites are reported. Thus, the foreign material is not supposed to be tumorigenic inherently by a chemical interaction, but a solid-state tumorigenesis should be proposed as an oncogenetic mechanism, common to all substances. It is hypotesized that the foreign material gives rise to granulation tissue that, under unknown conditions and after an adequate latency, undergoes neoplastic transformation. In this case, 3 years after implant placement, two samples of fibrous peri-prosthetic tissue were removed, showing microscopically foci of foreign body granulomatous reaction. An experimental animal model, in which a high incidence of mesenchymal tumors 335 were found in 25,8% of the implantation sites of a commercially available biomaterial (including silicone) after two years, contributed to validate the association between breast implants and angiosarcomas. Nevertheless, some authors recommend, before defining a sarcoma as implant-related, to establish that: 1 patients with implants have a higher risk for developing sarcomas than age-matched controls; 2 other well-known causes of sarcoma (i.e. radiation) have been excluded; 3 the tumor develops in the immediate site of the biomaterial after an appropriate latency. Primary breast angiosarcomas are uncommon neoplasms: if related to breast implants, they are extremely rare. This clinicopathologic entity needs further studies to definitely determine whether a causal link between implant and angiosarcomas exists or not and eventually by which mechanisms the neoplasia develops. references 1 Cook RR, Delongchamp RR, Woodbury M, et al. The prevalence of women with breast implants in the United States-1989. J Clin Epidemiol 1995;48:519-25. 2 Balzer BL, Weiss SW. Do biomaterials cause implant-associated mesenchymal tumors of the breast? Analysis of 8 new cases and review of the literature. Hum Pathol 2009;40:1564-70. 3 Drijkoningen M, Tavassoli FA, Magro G, et al. Mesenchymal tumors. In: Tavassoli FA, DevileeP (eds). Pathology and genetics. Tumours of the breast and female genital organs. Lyon: IARC 2003:89-98. 4 Roncadin M, Massarut S, Perin T, et al. Breast angiosarcoma after conservative surgery, radiotherapy and prosthesis implant. Acta Oncologica 1998;37:209-11. 5 Cuesta-Mejias T, de Leon-Bojorge B, de la Pena J, et al. Breast angiosarcoma in a patient withmultiple surgical procedure and breast implant. Report of a case. Ginecolgia y Obstetricia de Mexico 2002;70:76-81. 6 Saunders ND, Marshall JS, Anderson RC. A case of chest wall angiosarcoma associated with breast implants. J thorac cardiovasc surgery 2007;134:1076-7. 7 Nascimento AF, Raut CP, Fletcher CD. Primary angiosarcoma of the breast. Clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol 2008;32:1896-904. 8 Engel A, Lamm SH, Lai SH. Human breast sarcoma and human breast implantation: a time trend analysis based on SEER data (1973- 1990). J Clin Epidemiol 1995;48:539-44. 9 Jennings, Peterson I, Axiotis CA, et al. Angiosarcoma associated with foreign material: a report of three cases. Cancer 1998;62:2436-44. 10 Kirkpatrick CH, Alves A, Kockler H, et al. Biomaterial-induced sarcoma: a novel model to study preneoplastci change. Am J Path 2000;156:1455-67. Clinical decision-making in breast cancer: role of the multidisciplinary team meeting D. Andreis1 , V. Zanoni1 , C. Foroni1 , L. Bazzola1 , G. Allevi1 , M. Alberio1 , N. Ziglioli1 , P. Bottini1 , L. Olivetti2 , M. Bodini2 , R.A. Bottini1 Istituti Ospitalieri di Cremona, Cremona, Italy, 1 U.O. Multidisciplinare di Patologia Mammaria e Lab. di Oncologia Molecolare Senologica, 2 U.O. Radiologia, 3 U.O. Anatomia e Istologia Patologica e Citodiagnostica, 4 5 U.O. Radioterapia e Medicina Nucleare, U.O. Chirurgia Generale, 6 Direzione Strategica Background. Multidisciplinary team (MDT) meeting has become a best practice for treatment decision in breast cancer (BC) patients. MDT offers the best outcome for patients, enabling a team of specialists to plan, optimise and provide care tailored to each patient’s needs. However, data regarding meeting frequency, composition and procedures are still limited. This study examines work processes of our BC MDT, to assess concordance between meeting recommendations, evidence-based guidelines and final treatment implementation.
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Periodico bimestrale - POSTE ITALIA
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202 gli attuali approcci multidimen
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204 of Florence, University of Pisa
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206 rare tumors with various biolog
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208 died of disease. Incomplete res
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210 were included in order to explo
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212 Key words: EGC, Prognosis, Trea
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214 Tab. VI. univariate analysis: 5
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216 the surgeons perform a pancreat
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218 Tab. I. RB-ILD DIP LCH olitis (
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220 ciation of Medical Oncology (AI
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222 and CD56 are the best immunosta
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224 by the general pathologist [1.8
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226 na illuminazione, da un vulvolo
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228 9 Lynch PJ, Moyal-Barocco M, Bo
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230 Procedure di analisi del linfon
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232 are classified as G1 NETs, foll
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234 31 Nugent SL, Cunningham SC, Al
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236 mas and leukemias, whereas the
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238 Patobiologia della parete aorti
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240 10 Luo BH, Carman CV, Springer
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242 zienti asintomatici, la sede pi
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244 Anatomia patologica e citopatol
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246 Fig. 1 logico o cell-blocks, co
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248 In ductal carcinoma the cytolog
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250 techniques have resulted in the
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252 Predictive factors in colorecta
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256 Quanto ai mediatori, in caso di
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258 L’incidenza media complessiva
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260 Anatomia Patologica scegliere q
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patHOlOGiCa 2012;104:267-358 COMUnI
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COmuNiCaziONi ORali Solitary T-cell
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COmuNiCaziONi ORali differences in
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COmuNiCaziONi ORali Tab. I. CYTOLOG
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COmuNiCaziONi ORali BrAF mutation a
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COmuNiCaziONi ORali The aim of the
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COmuNiCaziONi ORali Tab. I. R-MSFTs
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COmuNiCaziONi ORali Fig. 1. skin us
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Page 107 and 108: COmuNiCaziONi ORali Conclusions. Sp
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Page 169 and 170: Pathologica 2012;104:359-420 POSTEr
Page 171 and 172: PoStER references 1 Gerber DE, Minn
Page 173 and 174: PoStER In our case the endofibrotic
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Page 179 and 180: PoStER references 1 Goepel JR. Beni
Page 181 and 182: PoStER MALT lymphoma of the rectum:
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Page 191 and 192: PoStER Expression of ror-1 in pancr
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PoStER Tissue were fixed in 10% for
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PoStER invaded focally adjacent tun
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PoStER bination chemotherapy the pr
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PoStER 21 to 55 years in age, the l
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PoStER Results and conclusion. We a
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PoStER Identification of cancer ste
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PoStER Epidemiological and biomolec
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PoStER Fig. 1. ductal invasive Brea
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PoStER Fig. 2. Fig. 3. Fig. 4. Conc
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PoStER monly develops in elderly ad
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PoStER haematoxylin and eosin and V
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PoStER Fig. 4. High mitotic rate (a
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PoStER Fig. 6. focal sebaceous and
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PoStER Results. At gross examinatio
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PoStER strated that HPV is present
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PoStER Fig. 1. EE primary intestina
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PoStER Introduction. Angiosarcoma i
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PoStER 9 Klein KA, Stephens DH, Wel
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Pathologica 2012;104:421-423 InDICE
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iNDicE DEgli aUtoRi Orsaria M., 319
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