The clinical importance of PD‑L1 and PD‑1 expression in diffuse large B cell lymphoma

Introduction. The target pathway programmed cell death‑1 (PD‑1)/ programmed death‑ligand 1 (PD‑L1) shows clinical efficacy in solid tumors, but also in Hodgkin’s and non‑Hodgkin’s lymphoma. PD‑L1 expression most often correlates with a poor prognosis and a PD‑1 regulatory factor that mediates immunosuppression. The presence of an increased number of tumor‑infiltrating lymphocytes (TILs) PD‑1 + is a favorable prognostic factor in patients with diffuse large B cell lymphomas (DLBCLs) and follicular lymphomas, while the low number of TILs PD‑1 + is associated with an increased risk of histological transformation. In DLBCLs, TILs PD‑1 + may not reflect the depletion of T‑mediated tumor cells but may be an indicator of lymphoid cell origin. Objectives. The objective of this study was to describe the correlation between PD‑1 and PDL‑1 with survival in patients with the diagnosis of diffuse large B cell lymphoma. Material and methods. We have studied 80 patients and we have analyzed DLBCLs according to the Hans algorithm; in addition, we analyzed PD‑1 and PD‑L1 in tumor cells and in immune cells and we correlated this data with patient’s survival. Results. We found that there is a tendency of decreased survival and therapeutic response in DLBCL patients, with both an intense and weak PD‑L1 positivity in tumor cells. PD‑1 low positivity was associated in higher percentage with relapse and treatment unresponsiveness. Conclusions: Our data suggested that PD‑L1 expression correlates with a poor clinical response although it is not an independent prognostic marker and PD‑1 represents a favorable prediction factor for survival

High-grade versus low-grade serous carcinoma of the ovary – current differential diagnosis and perspectives

Introduction. Serous carcinoma is responsible for 47% of all ovarian cancers, and from these cases, only 5% are represented by low-grade serous carcinoma, the rest of them accounting for high-grade serous carcinoma. Objective. The aim of this study is an observational approach of the differences and similarities of the two types of serous carcinoma of the ovary, that must be seen as different forms of cancer and rendered with care. Methods. We performed a retrospective study using three cases of ovarian high-grade serous carcinoma and three cases of ovarian low-grade serous carcinoma, diagnosed at the University Emergency Hospital Bucharest. We analyzed patients’ age, clinical symptoms, macroscopic and microscopic features together with immunohistochemistry tests. Results. Mean age for HG carcinoma was 71.3 years old and for LG carcinoma 47.6 years old. Average tumor diameter was with 5.67 cm higher for LG carcinoma. The most encountered stage for HG tumors was pT2a and for LG tumors was pT1a. Mean value for Ki67 was with 36.33% higher for HG carcinoma. AR expressed diffuse positivity in two cases of LG and only focal positivity in two cases of HG. CD44 expressed focal positivity in all cases of LG and had different patterns in HG. Conclusions. We found considerable differences between patients’ mean age, macroscopic and microscopic features, together with immunohistochemistry expression for Ki67, AR, CD44

Bilateral breast carcinoma – a study of patients admitted in a university emergency hospital

Introduction. Breast carcinoma represents the leading cause of oncologic mortality among women worldwide. Bilateral breast carcinoma is a distinct pathologic entity, with particular prognostic and therapeutic implications. Objective. The objective of the study was to determine the histologic and immunohistochemical characteristics of patients with bilateral breast carcinoma admitted in a university emergency hospital from Bucharest, Romania. Materials and methods. We analyzed breast carcinoma specimens registered as bilateral in the Department of Pathology of the University Emergency Hospital, Bucharest, Romania, between 2015‑2017, and studied their histologic and molecular features in the clinical context obtained from our hospital database. Results. All the analyzed patients were postmenopausal women. The extent of time between the diagnosis of the first and second tumor varied in metachronous cases from 8 months to 7 years. In the majority of cases, the bilateral breast lesions shared histologic, grading and hormone expression similarities. Conclusions. Bilateral breast carcinoma is a rare entity that needs more histologic parameters to be defined as primary or metastatic

Clinico‑morphological aspects and new immunohistochemistry characteristics of ovarian high‑grade serous carcinoma

Introduction. High‑grade serous carcinoma of the ovary is an aggressive form of cancer, with unknown precursor lesions and often delayed diagnosis because of non‑specific, mild symptoms. Objective. We performed a clinical‑pathological study of ovarian high‑grade serous carcinomas, in order to evaluate morphological and new immunohistochemistry characteristics of this malignancy. Methods. This is a retrospective study of 10 cases of ovarian high‑grade serous carcinoma. We evaluated patients’ age, symptoms at presentation, macroscopic aspects, bilateral involvement, microscopic features: papillary/solid areas, mitotic index, psammoma bodies, tumoral extension, lymph node metastasis, immunohistochemistry markers: CD44, ER, AR, Ki67 index. Results. Mean age was 56.9 years old. Tumors were bilateral in 50% of cases. Only 30% were limited to the ovary. Maximum tumor diameter was 16 cm. Solid component in a proportion of 50‑95% was more characteristic. Most tumors had a mitotic index of 30‑50 mitosis/10HPF (70% of cases). 20% of cases contained psammoma bodies. 2 cases out of 7 had lymph node metastasis. We noticed one case with pleural metastasis (M1). We observed AR80% was noticed in 30% of cases. CD44 was positive in 50% of cases and one case had diffuse positivity of CD44 in corpus luteum cells near the tumoral bed. Conclusions. The majority of patients with ovarian high‑grade serous carcinomas presented with extraovarian extension and were characterized by high mitotic index, rare presence of psammoma bodies, AR expression <10%, novel marker CD44 positive in 50% of cases and curious positivity in corpus luteum cells associated with the tumor

BETA-CATENIN – AN IMPORTANT IMMUNOHISTOCHEMICAL TOOL IN STRATIFYING ENDOMETRIAL CARCINOMAS?

Introduction. Recent research has demonstrated that the immunohistochemical nuclear -catenin expression is a valid surrogate for CTNNB1 exon 3 mutation in endometrial carcinomas (ECs). This mutation is an independent prognostic factor which identifies a subgroup of low-grade endometrial carcinomas that have a tendency for recurrence and worse prognosis. The objective of the study was to evaluate nuclear -catenin expression in different molecular subgroups of E Cs. Material and methods. We tested immunohistochemical nuclear -catenin expression in 50 cases of endometrial carcinomas diagnosed in two clinical institutions. Statistical analysis was performed between -catenin expression and various clinical, demographic, pathological and immunohistochemical parameters (age, myometrial invasion, FIGO grade, histopathological subtype, hormone receptors – ER, PR etc). Additionally, we analysed what molecular subgroup of ECs (MSS, MSI, p53wt, p53abn) revealed the most frequent cases with -catenin expression. Results. Our study indicated that ECs with nuclear -catenin positivity were observed in cases with higher FIGO grade (p=0.02), in endometrioid carcinomas (p=0.04) and in cases with lympho-vascular invasion (p=0.05). ER and PR were frequently expressed in the positive -catenin subgroup (p=0.03, p=0 .02). Our results show that ECs which express nuclear -catenin correlate with parameters that are already considered unfavourable. Conclusions. mmunohistochemical -catenin nuclear expression is an excellent replacement for the CTNNB1 exon 3 mutation in ECs and helps to stratify and predict prognosis in certain cases of ECs. We believe that future research will include this marker as part of the routine immunohistochemical panel for ECs

Endoscopic management of a rare case of obstructive giant duodenal Brunner’s gland hamartoma

Introduction. Brunner’s gland hamartomas are very uncommon. They are small, benign lesions, frequently located in the bulb of the duodenum. Usually found incidentally during routine esophago-gastro-duodenoscopies, these lesions are frequently asymptomatic, but some patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Surgical excision is required, especially if the lesion has large dimensions. The pathological examination is the most important in confirming the diagnosis.Case presentation. We report a case of a 64-year-old female patient, who presented to the emergency room for vomiting partially digested food, without blood. Upper digestive endoscopy revealed a polypoid mass, with a 1 cm stalk, located in the duodenal bulb. The polyp was successfully endoscopically resected and the pathological diagnosis was of Brunner’s gland hamartoma. Histologically, this polyp consisted of the components of Brunner’s gland cells, as well as glandular, adipose and muscle cells. Conclusions. Brunner’s gland hamartomas are rare duodenal tumors occurring in middle-aged patients that present either with gastrointestinal hemorrhage, obstructive symptoms or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable. The particularity of our case is given by the fact that this lesion was very large, it caused symptoms such as vomiting and was managed solely by endoscopic resection

Histopathologic infiltration pattern predicts metastasis and progression better than pT-stage and grade in well-differentiated pancreatic neuroendocrine tumors: A proposal for an infiltration-based morphologic grading system

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Histopathologic infiltration pattern predicts metastasis and progression better than pT-stage and grade in well-differentiated pancreatic neuroendocrine tumors: A proposal for an infiltration-based morphologic grading system

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