Sabato 27 ottobre 2012 - Pacini Editore

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392 was smooth. Both ovaries were involved enterely by white solid, firm, yellow, grey tissue. Histologically, booth ovarian tumor were composed of uniform spindle cells arranged in sheets and intersecting fascicles. The stroma showed loose areas as well as more fibrous areas containing intercellular collagen. In some areas, thick hyaline fibrous plaques could be observed. The nuclei were bland and slim with pointed ends and indistinct nucleoli. The neoplastic cells were positive for vimentin. S100, desmin, h-caldesmon, C10, HMB45, muscle-specific actin, estrogen, progesterone receptors, CD31, and c-KIT were negative. The mitotic count varied from 4 to 6 per 10 HPF (Fig. 2). The Ki-67 proliferation index was low (< 1%). No significant atypia or necrosis could be observed. Eighteen months after the surgery, no sign of new recurrence was noted. Discussion. The histologic criteria of ovarian FTs are controversial. In 1981, Prat and Scully 1 proposed histologic criteria for the distinction of cellular fibromas (CFs) from fibrosarcomas (Fs). These authors found that mitotic activity was the most important factor in diagnosing the sarcomas, and that nuclear grading with cellular pleomorphism was not so much reliable. CFs were characterized by densely cellular proliferations of fibroblasts with mild to moderate nuclear atypia, a mitotic count of 3 or fewer mitotic figures (MFs) per 10 HPFs, and a low malignant potential 1 . In contrast, Fs usually exhibited moderate to severe nuclear atypia, mitotic counts of 4 or more MFs/10 HPFs, and a clinically malignant course in most cases 1 . After the first study published by Prat and Scully 1 a number of ovarian Fs with a benign clinical course have been reported in the literature in which the diagnosis was based on a mitotic count of 4 or more mitotic figures/10HPFs 2 . The Atlas of Tumor Pathology, published by Armed Forces Institute of Pathology and the World Health Organization Classification of Tumours are the textbooks of choice consultation for pathologists in the diagnosis of tumour. Scully et al. 3 believe that pure Fs are among the most common forms of ovarian sarcoma. Microscopic examination shows a densely cellular neoplasm with moderate to severe nuclear atypia and an average mitotic count of 4 or more per 10 HPFs. Abnormal mitotic figures and areas of necrosis and hemorrhage are common 3 . In the Chapter “Sex cord-stromal tumours” of the World Health Organization Classification of the Breast and Female Genital Organs, Tavassoli et al. 4 considered ovary F as a rare fibroblastic tumour that typically has 4 or more mitotic figures per 10 high power fields as well as significant nuclear atypia. Irving et al. 5 believe that cellular FT with bland nuclear feaures and mitotic count of ≥ 4 MFs/10 HPFs should be considered a mitotically active cellular fibroma of the ovary (MACF) rather than an ovarian F. The latter term should be reserved for fibroblastic tumors that exhibit a combination of moderate to severe atypia and a usually high mitotic rate. Conclusions. Our cases may be classified as Fs according to Prat and Scully 1 histological criteria of and as MACFs of the ovary according to Irving et al. 5 criteria. Because of the controversial diagnostic criteria, we prefer the terminology ovarian fibromatous tumours of uncertain biological potential when an average mitotic count of 4 or more per 10HPFs are found and nuclear atypia and necrosis are absent. This term reflect the controversial prognosis of these tumors. The management of choice of these lesions consist of exclusive strict radiological follow-up, in order to monitoring recurrences or metastases. references 1 Prat J, Scully RE. Cellular fibromas and fibrosarcomas of the ovary: a comparative clinicopathologic analysis of seventeen cases. Cancer 1981;47:2663-70. 2 Gultekin M, Dursun P, Ozyuncu O, et al. Primary ovarian fibrosarcoma: a case report and review of the literature. Int J Gynecol Cancer 2005;15:1142-7. 3 Scully RE, Young RH, Clement PB. Tumors of the Ovary, Maldeveloped Gonads, Fallopian Tube, and Broad Ligament. Published by the CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012 Armed Forces Institute of Pathology, Washington, D.C. 3rd series. Fascicle 23, p. 197. 4 Tavassoli FA, Mooney E, Gersell DJ, et al. “Sex cord-stromal tumours” of the World Health Organization Classification of the Breast and Female Genital Organs. Edited by Fattaneh A. Tavassoli & Peter Devilee. Lyon: IARCPress 2003, p. 151. 5 Irving JA, Alkushi A, Young RH, et al. Cellular fibromas of the ovary: a study of 75 cases including 40 mitotically active tumors emphasizing their distinction from fibrosarcoma. Am J Surg Pathol 2006;30:929-38. InTErESSE GEnErALE P16 and CK20, immunocytochemical double staining in urinary cytology: method optimization R. Rapezzi, B. Selmi, G. Ferro, P. Crucitti, S. Negri, A. Bondi U.O. Anatomia, Istologia Patologica e citodiagnostica, Ospedale Maggiore, Azienda USL di Bologna Background. Every year more than 7000 patients attend to Anatomic Pathology Unit (UO) of Maggiore Hospital in Bologna to perform an urine cytological test. Since 2009 access to this service has been progressively increased by introducing a new procedure for sample collection by addiction of alcohol based fixative capable of retaining cellular elements well preserved and stable for 7 days at least. The urinary cytology test has an important role in the follow up of patients treated for urothelial cancer, with a high specificity (95- 100%) but low sensitivity (38-60%) due to difficulty to correctly distinguish between florid benign lesions from well-differentiated carcinomas. Therefore immunocytochemical investigations may be useful in the follow-up of cystectomized patient or evaluation of hyperplastic lesions. Loss of heterozygosity at chromosome 9, where houses the regulation of p16 synthesis, is an aberration found in urothelial cell carcinoma of all stage and grade as well as in dysplastic urothelium, possibly representing an early event in urinary bladder carcinogenesis.. The expression of P16 protein represents an indirect estimate of the most common genetic alteration found in bladder cancer and an indication of its ability to replicate. P16 INK4a is not found in non-neoplastic urothelium, while is expressed in 50% of urothelial carcinoma, increasing to 80% in high-grade carcinomas. CK20 is a high molecular weight cytokeratin little or not expressed in normal urothelium, while it is clearly present in transitional carcinomas. Materials and methods. In our laboratory, samples are obtained by simultaneous and complete filtration of 3 samples by a filtration system with a vacuum pump of about 25 mmHg average pressure and a polycarbonate membranes of ø 5 microns pore. For each patient a single glass is set up, stained with Papanicolaou, and produces a single diagnosis. The same analyzed material is then used for immunocytochemical investigations. P16 analysis was performed by a CINtec antibody into the Ventana BenchMark XT. Initially the detection system used was Phosphatase Red Detection Kit, where positivity is shown by nucleus / cytoplasm red staining. CK20 analysis was performed by an antibody anti-CK20 also into the Ventana BenchMark XT. Initially the detection system used was UltraView Universal DAB Detection Kit and positivity was detectable as a brown cytoplasmic staining. However CK20 positivity, revealed by DAB, completely masked P16 positivity revealed by Red. Having a single slide, we developed a double immunocytochemical staining: P16 has been detected in brown with diaminobenzidine (DAB) increasing incubation times and with an amplification system and CK20 was detected in Red, after appropriate reduction of time and incubation temperature of primary antibody.
PoStER Results and conclusion. We achieved a good improvement in performance by developing P16 with DAB and CK20 with Red. Now differentiation between the two antibodies is good, easily interpretable and used in diagnostic practice. references 1 Rosenthal D, Raab SS. Cytologic Detection of Urothelial Lesions. Springer 2005. 2 Planz B, Jochims E, Deix T, et al. The role of urinary cytology for detection of bladder cancer. Eur J Surg Oncol 2005:31:304-8. 3 Alameda F, Juanpere N, Pijuan L, et al. Value of p16(INK4a) in the diagnosis of low-grade urothelial carcinoma of the urinary bladder in urinary cytology. Cancer Cytopathol 2012 Mar 14. doi: 10.1002/ cncy.21193 4 Tauber S, Brunken C, Vierbuchen M. Expression of the tumormarker p16INK4a in cytology specimens of the urinary bladder. A new means for early recognition and surveillance of urothelial cancer. Urologe A 2011;50:1130-3. 5 Melissourgos ND, Kastrinakis NG, Skolarikos A, et al. Cytokeratin- 20 immunocytology in voided urine exhibits greater sensitivity and reliability than standard cytology in the diagnosis of transitional cell carcinoma of the bladder. Urology 2005;66:536-41. 6 Lin S, Hirschowitz SL, Williams C, et al. Cytokeratin 20 as an immunocytochemical marker for detection of urothelial carcinoma in atypical cytology: preliminary retrospective study on archived urine slides. Cancer Detect Prev 2001;25:202-9. 7 Bhatia A, Dey P, Kumar Y, et al. Expression of cytokeratin 20 in urine cytology smears: a potential marker for the detection of urothelial carcinoma. Cytopathology 2007;18:84-6. 8 Eble JN, Sauter G, Epstein JI,et al., eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press: Lyon 2004. The practical use of pagoda red stain in the detection of splenic eosinophilia in immediate anaphylactic death N. Trani1 , C. Palmiere2 , E. Duzzi1 , E. Mattioli1 , M. Lupi1 , L. Maccio1 , G. Barbolini1 , L. Reggiani Bonetti1 1 Dipartimento Integrato di Laboratori, Medician Legale e Anatomia Patologica; Struttura Complessa di Anatomia, Istologia e Citologia Patologica, Azienda Ospadaliero-Universitaria Policlinico di Modena; 2 University Center of Legal Medicine, Geneva-Lausanne Background. The anaphylaxis is an abnormal allergic reaction following to inhalation, ingestion, contact or inoculation of specific allergens. Anaphylaxis related deaths are an infrequent event that is difficult to objectify during autopsies. Beside the clinical and laboratory data, the main forensic findings include upper airways edema and erythematous skin-rush. Isolated studies in literature have been reported increased mast cells and eosinophils in different organs including spleen. Materials and Methods. The aim of this study is to evaluate the presence of eosinophils in the spleen, in a collection of 10 cases of death by anaphylaxis (7 male and 3 female), selected from the Archives of the Department Pathology and Forensic Medicine of the Policlinico Hospital of Modena (University of Modena and Reggio Emilia) and from the University Center of Legal Medicine Geneva-Lausanne. Twenty controls (16 male and 4 female) were selected, including cases of immediate non-anaphylactic death (car-crash, fall). From all cases, representative spleen samples were collected and 8 sections were obtained. Conventional histology (Hematoxylin-Eosin staining – H&E) and Pagoda Red staining (performed in Pathology and Forensic Medicine of the Azienda Policlinico of Modena, section of Histochemistry) were performed in all cases. The counts of eosinophils, mast cells and degranulated mast cells were performed by 3 different observers at 40 high power field (HPF) of magnification, valuing a mean of 10 different fields for slide. Results. The mean age of the patients was 60 y.o. (range: 12- 74). In 9 cases the immediate anaphylactic death followed the 393 intramuscular injection of antibiotics (different types of penicillin or cephalosporin) and other drugs, while in 1 case it occurred consequently to a bee sting. The clinical and laboratory findings provided an increased serum level of tryptase in all cases of anaphylaxis. Autopsy examinations revealed upper airways edema in 7 cases and erythematous skin-rush in 4. In 60% of the cases, the spleen was large and heavy. All spleens showed evident increases in eosinophils (a mean of 3-4 cells/HPF), mast cells (a mean of 4-5 cells/HPF) and degranulated mast cells (1-2 cells/HPF), the latter mainly located in spleen sinuses. The use of Pagoda Red staining clearly identified these cells wherever the routinely H&E stain was clouded. No increased number of mast cells or eosinophils was detected in the controls. Conclusion. Spleen seems to be a marking organ in the anaphylaxis, becoming as the possible shock-organ in human. Pagoda Red staining represents a rapid and low-cost method to prove it. MAMMELLA PI3K/P-AKT pathway phenotypic alterations represents an adverse biologic profile in early stage breast cancer patients A. Di Benedetto, F. Novelli, E. Bria, E. Melucci, C. Ercolani, B. Antoniani, C.A. Amoreo, V. D’Alicandro, V. Dimartino, I. Sperduti, L. Perracchio, P. Vici, C. Nisticò, A. Fabi, E. Pescarmona, M. Mottolese Regina Elena National Cancer Institute, Rome, Italy Background. Akt, a serine/threonine protein kinase, is a target of phosphoinositide-3-OH kinase (PI3K) and this pathway plays a pivotal role in regulating the signalling of many fundamental biological processes as apoptosis and cell cycle progression 1 . p-Akt regulates cell proliferation modulating the function of numerous substrates, such as the cyclin-dependent kinase inhibitors (CDKI), p21/Waf1/Cip1 and p27/Kip2. In particular, p27 interacts with cyclin E/Cdk2 complex inhibiting the cell cycle progression from G1 to S phase and it also acts as a tumor suppressor gene. Akt-mediated phosphorylation of p27 impairs its nuclear import leading to cytoplasmic p27 accumulation, functionally inactivating the growth inhibitory properties of p27 and favoring the proliferation of cancer cells 2 . Most authors found that Akt activation is associated with a worse outcome among endocrinetreated breast cancer (BC) patients 3 . Therefore, the PI3K/Akt pathway is attracting considerable attention as a new target for therapeutic strategies. In this study we analyzed a retrospective series of 133 early stage BC patients homogeneously treated with cyclophosphamide/ metotrexate/5-fluorouracil (CMF) aimed to investigate the impact of PI3K/Akt pathway alterations on disease progression. In addition, we evaluated the relationship between p-Akt, PI3K and consolidated bio-pathologic parameters (Hormonal Receptors, HER2, KI67, T, N, G). Materials and methods. Patients: our series of 133 stage I, IIa, and IIb BC patients were treated at the Regina Elena Cancer Institute between 1997 and 2002. They were submitted to quadrantectomy and received 12 courses of CMF-based adjuvant therapy. Fifty-three of the 133 (39.8%) patients received hormonal maintenance therapy. Immunohistochemistry: sections were incubated with the anti-ER-α Monoclonal Antibody (MoAb) (Menarini, Florence, Italy) 6F11, the anti-PgR MoAb 1A6 (Menarini), the anti-HER2 PAb (A0485, Dako, Milan, Italy), the anti-Ki67 MoAb MIB-1 (Dako), the anti-p53 MoAb DO7 (Menarini), the anti-Bcl2 MoAb 124 (Dako), the anti-PI3K (clone 4, BD Transduction, SIAL, Rome, Italy), the anti-p27 (Dako), and the anti-p-Akt (Ser473) (Cell Signaling, EuroClone, Milan, Italy). Positive and negative controls were included for each Ab.
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212 Key words: EGC, Prognosis, Trea
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COmuNiCaziONi ORali Solitary T-cell
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COmuNiCaziONi ORali Tab. I. CYTOLOG
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Page 175 and 176: PoStER Fig. 1. Kaplan-meier surviva
Page 177 and 178: PoStER believed the use of atypical
Page 179 and 180: PoStER references 1 Goepel JR. Beni
Page 181 and 182: PoStER MALT lymphoma of the rectum:
Page 183 and 184: PoStER 3 Ciulla A, Castronovo G, To
Page 185 and 186: PoStER for protein expression of PA
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Page 189 and 190: PoStER Grossly, an irregular villou
Page 191 and 192: PoStER Expression of ror-1 in pancr
Page 193 and 194: PoStER (see Fig. 1) placental site
Page 195 and 196: PoStER Tissue were fixed in 10% for
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Page 199 and 200: PoStER bination chemotherapy the pr
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Page 209 and 210: PoStER Fig. 1. ductal invasive Brea
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Page 221 and 222: PoStER Results. At gross examinatio
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Page 227 and 228: PoStER Introduction. Angiosarcoma i
Page 229 and 230: PoStER 9 Klein KA, Stephens DH, Wel
Page 231 and 232: Pathologica 2012;104:421-423 InDICE
Page 233: iNDicE DEgli aUtoRi Orsaria M., 319
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