Sabato 27 ottobre 2012 - Pacini Editore

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In ductal carcinoma the cytologic smears are characterized
by high celluarity, and the presence of relatively pure neoplastic
cellular component. Major criteria of malignancy are
considered: the presence of nuclear crowding and overlapping,
the irregular chromatin distribution and the irregular
nuclear contour, whereas minor criteria are the nuclear
enlargement, the presence of single malignant cells, necrosis
and mitosis.
In the biopsy interpretation of a primary pancreatic lesion
eight features are proposed as particularly helpful in the
differential diagnosis with chronic pancreatitis: the loss of
lobular architectural, resulting in a hazard distribution of
glands, the variation in nuclear area greater than 4 to 1 from
cell to cell, prominent and multiple nucleoli, the presence of
incomplete glands, intraluminal necrosis, glands immediately
adjacent to muscular artery, perineural invasion by glands and
vascular invasion.
Endocrine Neoplasms. The smears are hypercellular with
a clean background, except for high grade neoplasia. The
cells can be individually dispersed or arranged in clusters.
The nuclei are frequently uniform, round to oval, with a salt
and pepper pattern (coarse, finely distributed chromatin) but
sometimes they can be pleomorphic and hyperchromatic.
Acinar Cell Carcinoma. The loosely cohesive groups of cells
show the typical acinar differentiation with a cytoplasm filled
with deeply eosinophylic granules. The cells show signs of
Marcatori predittivi morfo-molecolari in
oncologia
C. Doglioni
U.O. Anatomia Patologica, Istituto Scientifico San Raffaele, Università
Vita-Salute, Milano
Estrogen Receptor represented in the early eighties the first
predictive morpho-molecular marker utilized by Pathologists
in helping Oncologists to select the appropriate therapy in
breast cancer patients; it is still the most frequently assessed
marker in pathology labs. The identification of gene alterations
as molecular targets of several new drugs has prompted
the introduction of new molecular diagnostic tests in our labs,
most of which do not necessitate a morphological approach.
However morphology based techniques, including immunohistochemistry
and FISH, still have and they will maintain
an important role in this scenario. FISH is a morphological
technique and it is the gold standard for evaluating several
relevant molecular targets i.e HER2, ALK1, ROS1. Mutation
specific antibodies are new tools for evaluating specific mutations
by immunohistochemistry in the tissue context; they can
couple specificity and sensitivity at the single cell level. Examples
of these mutation specific antibodies are EGFR E746-
A750 del, EGFR L858R, IDH1 R132H, BRAF1 V600E: they
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Sabato, 27 ottobre 2012
Sala Botticelli – 08.30-10.30
Fattori predittivi
Moderatore: Marco Chilosi (Verona)
atypia, with prominent nucleoli and mitoses; necrotic debris
are frequently found.
To avoid the most frequent pitfalls, the pathologist should know
in first instance all the clinical and radiological relevant features.
The most important technical informations he has to know differ
in solid and cystic lesions. In solid lesions the most important
differential diagnosis is between ductal carcinoma and chronic
pancreatitis, especially the tumor-forming pancreatitis, like the
autoimmune pancreatitis. In cystic lesions, the most important
bias are sampling errors. The recognition of gastric and duodenal
epithelial contamination is the most important elements to be
considered in the EUS-guided FNA cytology, especially in the
differential diagnosis of mucin-secreting low grade neoplasia.
The overdiagnosis of carcinoma has to be avoid in the presence
of cellular atypia due to gastritis or duodenitis.
The immuncytochemical features of ductal adenocarcinoma,
are the expression of MUC1 and the lack of MUC2. MU-
C5AC, normally expressed by the gastric mucous surface
cells, are expressed in gastric type Intraductal papillary mucinous
neoplasms.
In endocrine neoplasms, the diagnosis may be confirmed by
the immunohistochemical demonstration of endocrine markers
such as chromogranin A and synaptophysin and the detection
of hormone production.
In acinar cell carcinoma, the most informative immunihistochemically
stain is the acinar marker trypsin.
represent an useful complement to mutation analysis and they
could also, in selected case, surrogate molecular testing.
Morpho-molecular predictive markers in nSCLC
M. Chilosi, M. Brunelli
Anatomia Patologica, Department of Pathology, University of Verona
The introduction of new therapeutic strategies in the clinical
management of lung carcinoma has significantly changed
the diagnostic approach to non-small cell lung carcinoma
(NSCLC), and an increasing number of molecular tests with
predictive significance that can be obtained using different
approaches (immunohistochemical analysis, FISH, sequencing,
etc.) are currently under investigation. Pathologists are
requested to provide precise information regarding the histotype
as defined by up-dated WHO classification, since the
predictive role of histology has been clearly defined, and a
generic diagnosis of NSCLC is not sufficient. The precise distinction
of lung adenocarcinoma from squamous carcinoma
is mandatory in all cases, also when very small amount of
tissue is available (e.g. on cytological preparations and small
biopsies). The search for an optimal immunophenotypic panel
has been the matter of several studies and different marker
combinations and protocols have been proposed to define a