Diagnose von Weichteiltumoren in der Zytologie

Zusammenfassung: Weichteilschwellungen sind das Symptom einer Vielzahl von neoplastischen und nichtneoplastischen Veränderungen. Sarkome gehören zu den selteneren Ursachen. Die Feinnadelpunktion hat sich in der Abklärung von Tumorrezidiven und Karzinommetastasen als minimal-invasive, kostengünstige und zuverlässige Methode bewährt. Auch in der Abklärung von Weichteiltumoren kann sie zu einer präzisen Diagnose führen. Voraussetzung ist eine enge multidisziplinäre Zusammenarbeit unter Einbeziehung klinischer, radiologischer und morphologischer Befunde. Für die zytologische Befundung sind Alter und Geschlecht sowie Topographie, Größe und Wachstumsgeschwindigkeit des Tumors wichtige Parameter. Reifungsgrad und Form der Zellen sowie Vorhandensein und Ausdifferenzierung der bindegewebigen Matrix bieten erste differenzialdiagnostische Hinweise und sind der Ausgangspunkt für immunzytochemische und molekularbiologische (FISH, RT-PCR) Zusatzuntersuchen. Diese Untersuchungen werden an Direktausstrichen, an mittels Zellblockmethode eingebettetem und an tiefgefrorenem Punktionsmaterial ausgeführ

Zytologische Sarkomdiagnostik

Zusammenfassung: Weichteilschwellungen sind das Symptom einer Vielzahl neoplastischer und nichtneoplastischer Veränderungen. Sarkome gehören zu den selteneren Ursachen. Die Feinnadelpunktion (FNP) hat sich in der Abgrenzung zu entzündlichen Prozessen sowie in der Abklärung von Tumorrezidiven und Karzinommetastasen als minimal-invasive, kostengünstige und zuverlässige Methode bewährt. Auch in der Abklärung von Weichteiltumoren kann sie zu einer präzisen Diagnose führen. Voraussetzung ist eine enge multidisziplinäre Zusammenarbeit unter Einbeziehung klinischer, radiologischer und morphologischer Befunde. Für die zytologische Befundung sind Alter und Geschlecht sowie Topographie, Größe und Wachstumsgeschwindigkeit des Tumors wichtige Parameter. Reifungsgrad und Form der Zellen sowie Vorhandensein und Ausdifferenzierung der bindegewebigen Matrix bieten erste differenzialdiagnostische Hinweise und sind der Ausgangspunkt für immunzytochemische und molekularbiologische (FISH, RT-PCR) Zusatzuntersuchungen. Diese Untersuchungen werden an Direktausstrichen, an mittels Zellblockmethode eingebettetem und an tiefgefrorenem Punktionsmaterial ausgeführ

Late solitary bone metastasis of a primary pulmonary synovial sarcoma with SYT-SSX1 translocation type: case report with a long follow-up

Primary synovial sarcoma outside its classical presentation in para-articular soft tissue of young patients is rare but regularly reported. One of the rarest primary locations is the lung. We describe a 73-year-old female patient who presented with a solitary malignant bone tumor 8years after the resection of a lung neoplasm. The bone tumor was classified as an osteosarcoma and the lung tumor as an atypical carcinoid tumor at their first respective diagnostic work-ups. The resection of the affected humerus with allograft and endoprosthesis implantation followed. Reevaluation of the tumor samples at the time of the local recurrence of the bone tumor 6years following the initial symptoms of the bone tumor lead to the reclassification of both specimens as synovial sarcomas. Both neoplasms contained the SYT-SSX1 type of the diagnostic translocation t(X;18) as detected by the reverse-transcription polymerase chain reaction analysis. The patient died 14years after the resection of the primary synovial sarcoma of the lung and 6years following the occurrence of the bone metastasis. This prolonged clinical course is uncommon for the SYT-SSX1 translocation, which, in other locations, is usually associated with an unfavorable prognosi

Management of Cytological Material, Pre-Analytical Procedures and Bio-Banking in Lymph Node Cytopathology

The range of pathologies that Lymph Node (LN) Fine-Needle Cytology (FNC) may deal with is extremely wide and ancillary techniques, in addition to traditional smears, are generally required to reach reliable cytological diagnoses. For this purpose, in the pre-analytical phase of LN-FNC, using the most effective vials, fixatives and supports is essential, since they may perform differently with different ancillary techniques, and even in different pathologies. Moreover, storing part of the cytological material may be useful or necessary for molecular testing. The main difficulties concern the generally small size of the sample and the different ways of acquisition of LN-FNC. Therefore, the pre-analytical phase is extremely important for LN-FNC. This study investigates the management of LN-FNC material, vials, technical supports and main ancillary techniques in order to assess their optimal application, taking into account the different diagnostic needs and cell storage. This article is protected by copyright. All rights reserved

Targeting αvβ3 and αvβ5 integrins inhibits pulmonary metastasis in an intratibial xenograft osteosarcoma mouse model

Osteosarcoma is an aggressive bone cancer that has a high propensity for metastasis to the lungs. Patients with metastatic disease face a very poor prognosis. Therefore, novel therapeutics, efficiently suppressing the metastatic process, are urgently needed. Integrins play a pivotal role in tumor cell adhesion, motility and metastasis. Here, we evaluated αvβ3 and αvβ5 integrin inhibition with cilengitide as a novel metastasis-suppressive therapeutic approach in osteosarcoma. Immunohistochemical analysis of αvβ3 and αvβ5 integrins expression in a tissue microarray of tumor specimens collected from osteosarcoma patients revealed that αvβ5 integrin is mainly found on tumor cells, whereas αvβ3 is predominantly expressed by stromal cells. In vitro functional assays demonstrated that cilengitide dose-dependently inhibited de novo adhesion, provoked detachment and inhibited migration of osteosarcoma cell lines. Cilengitide induced a decline in cell viability, blocked the cell cycle in the G1 phase and caused anoikis by activation of the Hippo pathway. In a xenograft orthotopic mouse model cilengitide minimally affected intratibial primary tumor growth but, importantly, suppressed pulmonary metastasis. The data demonstrate that targeting αvβ3 and αvβ5 integrins in osteosarcoma should be considered as a novel therapeutic option for patients with metastatic disease

Worse prognosis of osteosarcoma patients expressing IGF-1 on a tissue microarray

BACKGROUND It is hardly possible to define osteosarcoma (OS) patients at greatest risk for non-response to chemotherapy, metastasis and short survival times. Our goal was the investigation of local expression of insulin-like growth factor (IGF-1) with regard to survival time of OS patients using a tissue microarray (TMA). MATERIALS AND METHODS Tumor tissue specimens from surgical primary tumor resections were collected from patients with OS. A TMA was composed, sections were stained with rabbit anti-IGF-1 and grading was performed. Statistics involved Kaplan-Meier curves and the log-rank test. RESULTS We analyzed immunohistochemical expression of local IGF-1 on a TMA based on surgical primary tumor resections of 67 OS patients. The mean clinical follow-up time was 98 months. Twenty-two (33%) OS patients stained negatively and 44 (66%) OS patients stained positively for IGF-1. Significantly shorter survival was detected with expression of IGF-1 (p=0.007). The 5-year survival rate for patients expressing IGF-1 was 63% compared to 92% in patients without expression of IGF-1. Non-responders to chemotherapy and patients with metastasis, who also stained positively for IGF-1 manifested a significantly (p=0.002 and p<0.0001, respectively) shorter survival. CONCLUSION Expression of local IGF-1 in primary tumor tissue appears to significantly affect the aggressiveness of OS, may predict survival time and, above all, may discriminate patients with non-response to chemotherapy and metastasis. This represents the basis for successful patient selection with regard to the decision process for or against chemotherapy and the choice of the most effective therapeutic drug. It may be a more important marker of tumor progression and indicator of prognosis than serum IGF-1. Novel tumor markers and therapeutic agents targeting the local IGF-1 pathway may increase the likelihood of therapeutic success

Unlocking the Power of Benchmarking: Real-World-Time Data Analysis for Enhanced Sarcoma Patient Outcomes

Benchmarking is crucial for healthcare providers to enhance quality and efficiency, notably for complex conditions like sarcomas. Multidisciplinary teams/sarcoma boards (MDT/SBs) are vital in sarcoma management, but differences in their processes can affect patient outcomes and treatment costs, despite adherence to international guidelines. To address this issue, this study aimed to compare two MDT/SBs and establish an interoperable digital platform, Sarconnector$^{®}$, for real-time-world data assessment and automated analysis. The study included 983 patients, 46.0% of whom female, with a median age of 58 years, and 4.5% of patients presented with metastasis at diagnosis. Differences were observed in the number of first-time presentations, follow-up presentations, primary sarcomas, biopsies and chemotherapy indications between the two MDT/SB. The results highlight the importance of benchmarking and utilizing a harmonized data approach, such as the RWT approach provided by the Sarconnector$^{®}$, to standardize and evaluate quality and cost metrics. By identifying areas of improvement and making data-driven decisions on the meta-level, healthcare providers can optimize resources and improve patient outcomes. In conclusion, benchmarking with the RWT harmonized data approach provided by the Sarconnector$^{®}$ can help healthcare providers improve the overall effectiveness of the healthcare system and achieve better outcomes for their patients in terms of both outcomes and costs

Response of pulmonary artery intimal sarcoma to surgery, radiotherapy and chemotherapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pulmonary artery intimal sarcoma is a rare disease with no characteristic symptoms. It is difficult to diagnose early and is frequently misdiagnosed as a pulmonary embolism.</p> <p>Case presentation</p> <p>Here we report a case of pulmonary artery intimal sarcoma in a 54-year-old woman presenting with complaints of shortness of breath on exertion. Echocardiography and a computed tomography scan showed that the right pulmonary artery trunk was blocked by a low-density mass. The patient was diagnosed with pulmonary artery intimal sarcoma by pathology and a complete mass resection was performed. After experiencing 10 months of disease-free survival, she was re-admitted because of the recurrence and metastasis of the tumor. Radiotherapy and chemotherapy were performed; however, only limited success was achieved. The patient died 15 months after the initial onset of symptoms.</p> <p>Conclusion</p> <p>Some patients with intimal sarcoma of the pulmonary artery can benefit from radiotherapy and chemotherapy as well as surgery.</p

Podoplanin-positive cells are a hallmark of encapsulating peritoneal sclerosis

Background. Encapsulating peritoneal sclerosis (EPS) and simple peritoneal sclerosis are important complications of long-term peritoneal dialysis (PD). Podoplanin is expressed by mesothelial cells and lymphatic vessels, which are involved in inflammatory reactions in the peritoneal cavity. Methods. We studied 69 peritoneal biopsies from patients on PD (n = 16), patients with EPS (n = 18) and control biopsies taken at the time of hernia repair (n = 15) or appendectomy (n = 20). Immunohistochemistry was performed to localize podoplanin. Additionally, markers of endothelial cells, mesothelial cells, myofibroblasts (smooth muscle actin), proliferating cells, and double labelling for smooth muscle actin/podoplanin were used on selected biopsies. Results. Podoplanin was present on the endothelium of lymphatic vessels in the submesothelial fibrous tissue and on mesothelial cells. In patients on PD and in biopsies with appendicitis, the mesothelial cells demonstrated a cuboidal appearance and circumferential podoplanin staining, with gaps between the cells. The number of lymphatic vessels was variable, but prominent at sites of fibrosis. In patients with EPS, a diffuse infiltration of podoplanin-positive cells with a fibroblastic appearance was present in 15 out of 18 biopsies. This pattern was focally present in 3 out of 16 on PD and none in the 35 controls. The podoplanin-positive cells did not express the endothelial marker or the mesothelial marker (calretinin). Conclusions. EPS is characterized by a population of podoplanin and smooth muscle actin double-positive cells. Podoplanin might be a suitable morphological marker supporting the diagnosis and might be involved in the pathogenesis of EP