Distribution of sul genes and their variants in uropathogenic Escherichia coli isolated from two hospitals of Sabah

Sulphonamides resistant strains are highly prevalent in uropathogenic Escherichia coli (UPEC) isolates. Sul genes encode sulphonamide resistance and are present on transferrable plasmids. Integrons (IGNs) are genetic elements containing integrase gene, attl site and gene cassettes which carry multiple antibiotic resistant genes. Class 1 integrons have been extensively studied because these were most prevalent among clinical isolates. In this study, UPEC isolates were determined for the antibiotic susceptibility patterns to four antibiotics commonly used for urinary tract infections, which include co-trimethoxazole (TMP-STX). Distribution of sul genes and integrase1 gene (intI1) was studied in TMP-STX resistant UPEC isolates by using multiplex polymerase chain reaction (mPCR). Sul genes variants were investigated by DNA sequencing of the whole open reading frame of sul1 and sul2 genes and PCR product of sul3 gene. Sul1, sul2 and sul3genes were prevalent in 37 (24.7%) of 150 UPEC isolates. IntI1 is positive in 22 sul genes positive isolates. Of six isolates positive with sul2 genes, sul2(a) and sul2(b) variants, which were described in the previous study, in the four isolates and the two isolates respectively were observed. This is the first mPCR which investigates the prevalence of three sul genes and intI1 in the UPEC clinical isolates from two hospitals of Sabah

Gliosarcoma of a Brain: A Challenging Diagnosis

Gliosarcoma is a rare primary malignant tumour of the central nervous system. A 28-year-old radiographer without a history of neurological disorder, malignancy or trauma presented with unprovoked seizures. He was symptom-free for 3 years but developed relapsed. Computed tomography of the brain was consistent with anaplastic convexity meningioma which was identical via intraoperative findings. However, the final histology revealed gliosarcoma of the brain. He recovered well postoperatively without any neurological deficit and had completed adjuvant chemoradiotherapy. He was asymptomatic during follow up with no tumour recurrence. Gliosarcoma with predominant sarcomatous component mimicking a meningioma has prolonged survival as compared to a case with predominant glioblastoma component. Hence, the discordance between clinical, radiological, intraoperative and histopathological findings is a challenge in establishing a diagnosis of gliosarcoma

Clinical Significance of BCL2, C-MYC, and BCL6 Genetic Abnormalities, Epstein-Barr Virus Infection, CD5 Protein Expression, Germinal Center B Cell/Non-Germinal Center B-Cell Subtypes, Co-expression of MYC/BCL2 Proteins and Co-expression of MYC/BCL2/BCL6 Proteins in Diffuse Large B-Cell Lymphoma : A Clinical and Pathological Correlation Study of 120 Patients

Background: Clinical significance of germinal center B-cell (GCB) and non-GCB sub-categorization, expression of MYC, BCL2, BCL6, CD5 proteins and Epstein Barr virus encoded RNA (EBER) positivity in diffuse large B-cell lymphoma (DLBCL) remain controversial. Could these biomarkers accurately identify high risk DLBCL patients? Are MYC, BCL2 and BCL6 proteins expression feasible as baseline testing to predict c-Myc, BCL2 or BCL6 gene rearrangements? Aims: To investigate prognostic values of GCB/non-GCB sub-categorization, Double Protein Expression Lymphoma (DPL), Triple Protein Expression Lymphoma (TPL), positivity of CD5 protein and EBER in patients with DLBCL disease. To evaluate correlation between BCL2 , c-Myc and BCL6 gene rearrangements with BCL2, MYC and BCL6 proteins expression. Methods: Diagnostic tissue samples of 120 DLBCL patients between January 2012 to December 2013 from four major hospitals in Malaysia were selected. Samples were subjected to immunohistochemical staining, fluorescent in-situ hybridization (FISH) testing, and central pathological review. Pathological data were correlated with clinical characteristics and treatment outcome. Results: A total of 120 cases were analysed. Mean age of diagnosis was 54.1 years ± 14.6, 64 were males, 56 were females, mean follow up period was 25 months (ranged from 1 to 36 months). Of the 120 cases, 74.2% were non-GCB whereas 25.8% were GCB, 6.7% were EBER positive, 6.7% expressed CD5 protein, 13.3% were DPL and 40% were TPL. The prevalence of c-Myc, BCL2, BCL6 gene rearrangements were 5.8%, 5.8%, and 14.2%, respectively; and 1.6% were Double Hit Lymphoma (DHL). EBER positivity, DPL, TPL, c-Myc gene rearrangement, BCL2 gene rearrangement, extra copies of BCL2 gene and BCL6 gene rearrangement were associated with shorter median overall survival (P0.05). Overall, c-Myc, BCL2 and BCL6 gene rearrangements showed weak correlation with expression of MYC, BCL2 and BCL6 proteins (P>0.05). Fluorescent in situ hybridization is the preferred technique for prediction of treatment outcome in DLBCL patients. Conclusion: c-Myc, BCL2, and BCL6 gene rearrangements, EBER expression, DHL, TPL and IPI score are reliable risk stratification tools. MYC, BCL2 and BCL6 proteins expression are not applicable as baseline biomarkers to predict c-Myc, BCL2, and BCL6 gene rearrangements

Gliosarcoma of a brain: a challenging diagnosis

Gliosarcoma is a rare primary malignant tumour of the central nervous system. A 28-year-old radiographer without a history of neurological disorder, malignancy or trauma presented with unprovoked seizures. He was symptom-free for 3 years but developed relapsed. Computed tomography of the brain was consistent with anaplastic convexity meningioma which was identical via intraoperative findings. However, the final histology revealed gliosarcoma of the brain. He recovered well postoperatively without any neurological deficit and had completed adjuvant chemoradiotherapy. He was asymptomatic during follow up with no tumour recurrence. Gliosarcoma with predominant sarcomatous component mimicking a meningioma has prolonged survival as compared to a case with predominant glioblastoma component. Hence, the discordance between clinical, radiological, intraoperative and histopathological findings is a challenge in establishing a diagnosis of gliosarcoma

Expression distribution of cancer stem cells, epithelial to mesenchymal transition, and telomerase activity in breast cancer and their association with clinicopathologic characteristics

A total of 167 surgically resected primary invasive breast carcinomas and 63 metastatic lymph node lesions were analyzed for immunohistochemical (IHC) localization of the CD44+CD24−low breast cancer stem cell (CSC) markers, epithelial to mesenchymal transition (EMT) markers, and telomerase activity by double-staining IHC technique, in formalin-fixed, paraffin-embedded tissue, the results were validated by double-staining immunofluorescent and flow cytometry techniques. The results showed that CSCs with CD44+CD24−low phenotype were significantly increased in node-positive tumors, high-grade tumors, and ductal carcinoma in situ (DCIS). There was a high incidence of telomerase expression in metastatic lymph node lesion. There were considerably high number of tumor cells with EMT expression in metastatic lymph node lesion, and triple-negative tumor. The occurrence of EMT phenomena was usually accompanied by the co-existence of CSCs of CD44+CD24−low phenotype. There was no association between the existence of CSCs and detection of telomerase activity in tumor cells. Increased numbers of both CSCs of CD44+CD24−low phenotype and cells under-went EMT in DCIS lesion might be an initial step in the stromal invasion and propagation of breast cancer, and occurrence of EMT in the breast tumor associated with high prevalence of CSCs, promoting tumor invasiveness and metastasis

Lymphovascular Invasion is a Significant Prognostic Marker of Distant Metastasis in Breast Carcinoma

Lymphovascular invasion (LVI) is not incorporated in most staging systems although assessment of LVI is now part of the minimum data set for breast carcinoma pathology reporting. This study investigates the correlation between LVI with clinical staging, grading and prediction of patients’ survival in patients with invasive breast carcinoma. This was a retrospective study using data obtained from reviewing archival histological material and patients’ medical records at Queen Elizabeth Hospital, Sabah, Malaysia. Breast carcinoma samples from 117 female patients at all stages of disease were included in this study. Correlation was performed between LVI and staging, grading, lymph node (LN) status and patient’s clinical outcome after five years of diagnoses. LVI showed significant correlation with LN involvement and distant metastasis but no significant correlation between LVI and grading. LVI correlates with clinical staging and is a reliable predictor of outcome in patients with invasive breast carcinoma