pag. 216-318 - Siapec

250
COMUNICAZIONI E POSTER
Bibliografia
1
Montgomery E, Abraham SC, Fisher C, et al. CD44 loss in gastric
stromal tumors as a prognostic marker. Am J Surg Pathol
2004;28:168-77.
Immunohistology of some Aquaporins in
hyperplastic and neoplastic hepatic lesion
D. Villari, D. Maisano, P.A. Nicòtina
Dipartimento di Patologia Umana, Policlinico Universitario
“G. Martino”, Messina, Italia
Recent experimental evidences have been provided that special
water channel proteins, such as Aquaglyceroporins 8 and
9 (AQP-8 and -9), are expressed in hepatocyte membrane
and cytoplasmic vesicles. AQP-8 and AQP-9 are known to
allow the selective passage of glycerol and other solutes, including
urea, monocarboxylates, polyols, carbamides, and
nucleosides. Hepatic AQP-8 has been related with the structure
of bile canaliculi and bile secretion. AQP-9 was reported
to be common in the hepatocyte and developmentally regulated,
depending on metabolic states, as a channel protein
for glycerol influx and urea efflux. AQP-1, assisting transmembrane
water flow in extra-hepatic sites, is regarded as a
critical reabsorption factor. On this basis, such AQP s
have
been investigated in hyperplastic and neoplastic hepatic lesions,
including focal nodular hyperplasias (FNH s
) and hepatocellular
carcinomas (HCC s
), classified by current systems.
Excised lesions from 18 patients (11 men and 7
women) with a mean age of 61.5 years, were 2 FNH s
, 2 well
differentiated HCC s,
8 moderately differentiated HCC s
(including
5 lesions with a glandular-like pattern) and 6 poorly
differentiated HCC s
. As controls, needle biopsies from 4
HCV hepatitis-affected subjects were also investigated. Control
immunohistology showed: a) AQP-1 staining in biliary
epithelium and endothelial cell membrane of the non-sinusoidal
blood vessels; b) AQP-8 positive reaction decored as
hepatocyte cytoplasm as apical membrane of biliary epithelial
cells; c) AQP-9 outlined the hepatocyte cell-membrane
facing sinusoids, in centrolobular areas. In the study lesions,
AQP-1 was immunolocalized in capillarized sinusoids of the
FNH s
and of both the well- and moderately-differentiated
HCC s.
AQP-1 labelling also profiled the apical border of biliary
epithelium, as in the FNH s
as in tubule-forming cells of
the moderately differentiated HCC s
. AQP-8 was absent in the
FNH s,
but it occurs in glandular-like HCC s
. AQP-9 positivity
was confined to paraseptal and perivascular FNH-hepatocytes,
in well-differentiated HCC s
, but it was lacking in moderately/poorly
differentiated HCC s.
The described AQP-1 in
liver is unprecedented. It is a critical reabsorption factor of
capillary endothelium and assists bile secretion in hepatic
FNH and no-high-grade HCC. Coherently, AQP-8 and AQP-
9 may be related to differentiation rate and secretion of the
newly formed hepatocytes.
A new enzymo-histochemical diagnosis kit
for Hirschsprung Disease
F. Venerucci 1 , A. Favre 2 , G. Martucciello 3
1
Bio-Optica, Milano; 2 Istituto G. Gaslini; Chirurgia Pediatrica,
Genova; 3 IRCCS Policlinico San Matteo; Divisione di
chirurgia pediatrica, Pavia
Hirschsprung Disease (HD) is a neurocristopathy that occurs
at an approximate rate of 1 case per 5000 newborns in all the
world. It is a rectal innervation intrinsic disorders, characterized
by a congenital absence of ganglion cells in the distal
colon resulting in a functional obstruction, appearing with severe
constipation.
The diagnosis is performed on rectal suction biopsy specimens
taken 2 to 10 cm above the pectinate line. Acetylcholinesterase
(AChE), Lactic Dehydrogenase (LDH), and
NADPH-diaphorase (NADPH-d) histochemical techniques
were performed on serial cryostatic sections, following
Scharli and Meier-Ruge criteria (1981)
The basic treatment is to remove the poorly functioning
aganglionic bowel and create an anastomosis to the distal
rectum. For this reason the surgeon performs intraoperative
seromuscular biopsies of the rectum and colon to assess the
lenghth of the aganglionic and ipoganglionic portion with enzymo-histochemistry.
The most common complication of HD are related to problems
of misdiagnosis. These are:
– False positive diagnosis in Pseudo-HD.
– False negative diagnosis in true HD with risk of occlusion,
enterocolitus and death.
– Non-radical treatment with persistent aganglionosis.
– Too radical treatment with risk of extensive resection of
a long segment of normoganglionic intestine.
The gold standard techniques for this pathology are:
– AChE: to assess the infiltration of cholinergic fibers in
the lamina propria of the gut, the criterion standard of
HD, in the pre-operative mucosal biopsies; and the
– ANE technique: useful for intraoperative examination to
determine the anastomosis level, where the ganglion cells
begin to appear.
In the pathology laboratories it is often very difficult to prepare
the incubation media within a limited time, by technicians.
The Bio-Optica presents here a new enzymo-histochemical
diagnosis kit for pathologists, produced with a lyophilization
technologie. The kit, ready for use, can be easy purchased at
room temperature and stored at +4°C, for several months. It
contains AChE and ANE lyophilized reagents for preoperative
diagnosis and for intraoperative examinations on criostatic
sections.
The kit has to provide different synergic enzyme-histochemical
techniques. In a near future also Succinic Dehidrogenase
and NADPH-diaphorase will be added to the kit.
References
Scharli AF, Meier-Ruge W. Localized and disseminated forms of neuronal
intestinal dysplasia mimicking Hirschsprung’s disease. J Pediatr
Surg 1981;16:164-70.