Clinico-pathological Features of Patients with Melanoma and Positive Sentinel Lymph Node Biopsy: A Single Institution Experience

ABSTRACT Sentinel lymph node biopsy (SLNB) is an established method for the assessment of tumor aggressiveness in patients with primary cutaneous melanoma (PCM). To improve the criteria for the selection of SLNB candidates, the aim of our study was to determine clinico-pathohistological parameters that can serve as predictors of metastatic progression. We retrospectively evaluated all available clinico-pathohistological parameters in 844 patients with PCM diagnosed between January 1, 2005 and December 31, 2010. SLNB was conducted in 484 (57.3%) patients, 122 (14.5%) of whom had a positive node. The association between predictors and SLNB outcomes (positive SLNB and metastatic development) was tested using logistic regression analysis. The main predictors of positive SLNB were Breslow thickness (adjusted odds ratio (AOR)=1.22; 95% confidence interval (CI)=1.11-1.33), Clark levels (AOR=1.78; 95% CI=1.31-2.40), ulceration (AOR=3.1; 95% CI=1.65-5.81), microsatellitosis, gender, and tumor localization. The predictors of metastatic spread were Breslow thickness (AOR=1,69; 95% CI=1.51-1.89), Clark level (AOR=3.59; 95% CI=2.79-4.62), nodular type of melanoma (AOR=8.21; 95% CI=1.70-39.53), ulceration, mitotic rate, microsatellitosis, gender, and tumor localization. It seems that these parameters should be taken into consideration when selecting patients for SLNB since tumor thickness is not a sufficient predictor of SLNB outcome, particularly in case of very thin lesions. KEY WORDS: primary cutaneous melanoma (PCM); sentinel lymph node biopsy (SLNB); metastases

Periacinar clefting and p63 immunostaining in prostatic intraepithelial neoplasia and prostatic carcinoma

The aim of the present study was to correlate the presence and extent of retraction clefting and the expression of p63 in neoplastic glands and glands with prostatic intraepithelial neoplasia (PIN) in needle core biopsies. We analyzed needle core biopsies from 28 patients with PIN and 41 patients with adenocarcinoma. Neoplastic glands and those with PIN were analyzed on high power field (400x) and classified in three groups according to the extent of clefting. Immunohistochemical staining was performed following Microwave Streptavidin ImmunoPeroxidase (MSIP) protocol on DAKO TechMate Horizon automated immunostainer. Periacinar retraction clefting was significantly more prominent in prostatic carcinoma compared to PIN (p<0.0001) and nonneoplastic glands (p<0.0001). There was no difference between normal glands and PIN regarding clefting (p=0.8064). p63 was positive around the whole circumference in 12 out of 28 cases with PIN, and discontinuously positive in remaining 16 PIN cases suggesting initial disruption of the basal cell layer. p63 immunostaining was also positive in all nonneoplastic glands, and negative in all carcinomas. We conclude that retraction clefting was associated with cancer and lack of basal cells, but not with PIN. The relationship between clefting and p63 immunostaining in prostatic cancer should be further analyzed

Intraoperacijska biopsija: zahtjevan dijagnostički postupak na odjelu za kiruršku patologiju

Frozen section (intraoperative biopsy) is one of the most important and most difficult procedures that a pathologist performs during his/her practice. It is performed daily at most pathology departments and requires experience, the capacity to make quick decisions under pressure, the knowledge of clinical medicine, and awareness of the limitations of the method. The aim of the study was to determine the number of frozen sections according to surgical departments and diagnoses at Surgical Pathology Division of the Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital in Zagreb, during the 1998-2004 period. Data were retrieved from the Thanatos program for data archiving, analyzed and divided according to departments (ENT, general surgery, neurosurgery, urology, gynecology, and others) and diagnoses (benign tumor, malignant tumor, other conditions and description). During the 1998-2004 period, the relative frequency of frozen sections rose steadily from 6.25% in 1998 to 7.78% in 2004 (p<0.001). A statistically significant increase was noticed in the number of intraoperative biopsies from the departments of neurosurgery (p<0.001), urology (p<0.001), gynecology (p<0.01) and other departments (p<0.001), while the number of intraoperative biopsies from the surgical department decreased significantly (p<0.001). The difference in the number of intraoperative biopsies from ENT department was not significant. The diagnosis of benign tumors was significantly more frequent in 1998 than in 2004 (p<0.05), and so was the diagnosis of metastases (p<0.001). The number of descriptive answers was significantly higher in 2004 (p<0.001), but the difference in the number of diagnosed malignant tumors and other conditions was not significant. The number of samples examined on frozen section ranged from 1 to 14, the mean number of samples being 1.2 to 1.8. The number of routine, paraffin embedded biopsies that rose through the analyzed period was followed by the increased number of frozen sections. The significant increase in the relative frequency of descriptive diagnoses could mainly be attributed to the intraoperative examination of lymph nodes that proved to be free from tumor.Intraoperacijska biopsija je jedan od najvažnijih i najtežih dijagnostičkih postupaka koje patolozi poduzimaju tijekom svog rada. Na većini odjela za patologiju ona se izvodi svakodnevno. Cilj rada bio je utvrditi broj intraoperacijskih biopsija i na njima postavljenih dijagnoza na Kliničkom zavodu za patologiju «Ljudevit Jurak», Kliničke bolnice «Sestre milosrdnice» u Zagrebu, tijekom razdoblja od 1998. do 2004. godine. Za analizu podataka uporabljen je program za pohranjivanje i obradu podataka iz patologije «Thanatos». Podaci su podijeljeni s obzirom na kirurški odjel (ORL, opća kirurgija, neurokirurgija, urologija, ginekologija i ostali) te s obzirom na postavljenu dijagnozu (dobroćudni tumor, zloćudni tumor, ostala stanja, metastaze i opis). Tijekom razdoblja od 1998. do 2004. broj intraoperacijskih biopsija se neprekidno povećavao, s relativnom učestalošću od 6,25% u 1998. do 7,78% u 2004. godini (p<0,001). Značajan porast broja intraoperacijskih biopsija je opažen s neurokirurgije (p<0,001), urologije (p<0,001), ginekologije (p<0,01) te ostalih odjela (p<0,001), dok se broj intraoperacijskih biopsija s odjela opće kirurgije značajno smanjio (p<0,001). Razlika u broju intraoperacijskih biopsija s odjela ORL između 1998. i 2004. godine nije bila značajna. Dijagnoza dobroćudnog tumora postavljena je 1998. značajno češće nego 2004. (p<0,05), kao i dijagnoza metastaza (p<0,001). Broj opisnih dijagnoza u 2004. je bio značajno veći, no razlika između broja dijagnoza zloćudnog tumora i ostalih stanja nije bila značajna. Broj rutinskih biopsija u proučavanom razdoblju bio je praćen povećanim brojem intraoperacijskih biopsija

Thoracic Intramedullary Sarcoidosis Mimicking an Intramedullary Tumor

Sarcoidosis is a chronic, systemic granulomatous reticulosis of unknown origin, characterized by formation of hard tubercles and noncaseating granulomas1. Since other infectious diseases such as berylliosis, mycobacterium and fungal infections may present with a noncaseating granulomas, histological diagnosis of sarcoidosis is made using the elimination method. Central nervous system manifestations of sarcoidosis may be present in 5–10% of the cases2–5 involving cranial nerves, leptomeninges and third ventricle respectively. Any part of the central nervous system can be affected. Involvement of spinal cord in sarcoidosis is extremely rare and presents with only 0.3–0.4% in patients with systemic sarcoidosis2. Intramedullary sarcoidosis is a rare first manifestation of the disease and it can mimic an intramedullary tumor, which is often manifested with symptoms that initiate from spinal cord compression, resulting in paraparesis, sensory disorders and sphincter dysfunction6–11. We present a case of intramedullary sarcoidosis that mimics a tumor of the thoracic spinal cord. Clinical features, neuroradiological, pathohistological findings, laboratory analysis and surgical treatment of such a rare entity are being discussed

Stupnjevanje invazivnih stanica - pregled

Pathohistologic diagnosis plays a pivotal role in therapeutic modalities for cancer, and acts as a prognostic factor. The histologic grade is a numeric expression of tumor differentiation and is linked to patient outcome. Broders\u27 scoring system is still widely used in scoring squamous cell carcinomas. New data suggest that in the most invasive parts of a malignant tumor, the morphology and biologic behavior differ from the central and superficial areas of the same tumor. A new invasive cell grading system has been proposed as a better prognostic factor in the multifactorial diagnostic and therapeutic approach to the patient with malignant tumor. Numerous studies performed to date have provided sufficient evidence to propose the invasive cell grading system to be introduced instead of the "old" Broders\u27 scoring system.Patohistološka dijagnoza igra ključnu ulogu u terapijskom pristupu raku te djeluje i kao prognostički čimbenik. Histološki stupanj je brojčani izražaj diferencijacije tumora i vezan je uz prognozu tumorske bolesti u pojedinog bolesnika. Danas je u širokoj uporabi Brodersov sustav histološkog stupnjevanja u karcinomima pločastog epitela. Noviji podatci ukazuju na to da se morfologija i biološko ponašanje stanica u invazivnim dubokim dijelovima malignog tumora razlikuju od središnjih i površinskih dijelova istoga tumora. Novi sustav ICG (invasive cell grading . stupnjevanje invazivnih stanica) predložen je kao bolji prognostički čimbenik u složenom dijagnostičkom i terapijskom pristupu bolesniku s malignim tumorom. Brojna su istraživanja potvrdila da se novi sustav ICG može s dovoljnom sigurnošću rabiti u patohistološkom stupnjevanju malignih tumora umjesto "starog" Brodersovog načina

C-myc Expression in the Microvessels of Medulloblastoma

The increased expression of c-myc is related to neoplastic transformation and angiogenesis. Therefore, the assessment of expression of c-myc in endothelial cells and neovascularization could help to determine the biological behavior of the tumor. We analyzed neovascularization and c-myc expression in 36 medulloblastoma specimens. The results were shown by determining immunohistochemical staining index (ISI), the sum of staining intensity (SI) and the percentage of positive cells (PPC) in the blood vessels endothelium of the tumor. We also performed the microvessel count (MVC) in 10 high-power fields (400X) with the most prominent vascularization and expressed it as microvessel density per mm2 (MVD). C-myc immunostaining intensity index in blood vessel endothelium is grouped into four groups, 0 – no reaction, I – weak reaction (ISI = 1 or 2), II – moderate reaction (ISI = 3 or 4), III – strong reaction (ISI = 5 or 6). Statistically significant differences (p=0.0214) have been found between groups 0 and 1 compared to groups 2 and 3. A higher percentage of positive cells has been found in male patients than in female ones (p=0.0483). C-myc PPC 0 or 1 has on the average smaller density of blood vessels per mm2 than c-myc PPC 2 or 3, but the difference is not statistically significant. C-myc ISI 0 or 1 has, on the average, smaller density of blood vessels per mm2 than c-myc ISI 2 or 3, but the difference is not statistically significant.We concluded that c-myc staining intensity was associated with higher microvessels density