Preporuke za patohistološki pregled i nalaz uzoraka debelog crijeva s karcinomom

In the post-genomic era of medicine, histopathological assessment of colorectal carcinoma specimens plays the key role in the comprehensive management of patients with colorectal cancer. Adequate specimen handling and dissection is a crucial step in obtaining a precise and accurate pathohistologic report. Microscopic analysis must give information on: histological tumour type and differentiation, maximum extent of local invasion (pT stage), grade of tumour regression following pre-operative (neoadjuvant) therapy, resection margins (longitudinal and circumferential margins), lymph node status, venous invasion, MSI status and other abnormal findings. Latest ESMO consensus guidelines for the management of patients with metastatic colorectal cancer emphasize the pathologist’ role in this process. Recently defined molecular subtypes of colorectal cancer will hopefully serve as the basis for future trials.U post-genomskoj eri medicine, patohistološka procjena uzoraka karcinoma debelog crijeva i dalje igra ključnu ulogu u cjelovitom i kvalitetnom pristupu pacijentima oboljelima od ove bolesti. Odgovarajuće postupanje sa samim uzorkom temelj je za dobivaje cjelovitog i svrsishodnog patohistološkog nalaza. Mikroskopska analiza mora dati podatke o: histološkom tipu tumora i gradusu, lokalnoj proširenosti (pT stadij), gradusu regresije tumora nakon neoadjuvantne terapije, resekcijskim rubovima (proksimalnom, distalnom i radijalnom), statusu limfnih čvorova, vaskularnoj invaziji, MSI statusu i ostalim patološkim nalazima ako postoje. U najnovijim ESMO smjernicama, a koje se odnose na upute o postupanju s pacijentima koji imaju metastatski kolorektalni karcinom, naglašena je važna uloga patologa u ovome procesu. Nedavno definirani molekularni podtipovi kolorektalnog karcinoma pružaju bazu za buduća istraživanja

Epitelioidni hemangiom orbite: prikaz slučaja

Epithelioid hemangioma (EH) and Kimura’s disease (KD) were once considered different stages of the same disease, as they share many clinical and histopathologic similarities. Nowadays, they are considered as two different entities, but some authors still confuse these terms. Our objective is to present a case of EH occurring in a very uncommon location and to emphasize the microscopic and clinical differences between EH and KD. We present a case of EH of the orbit in an 83-year-old man diagnosed after histopathologic evaluation of a mass that was surgically removed from the orbit. The tumor showed typical microscopic appearance with pathognomonic epithelioid endothelial cells. The diagnosis was also confirmed by immunohistochemical analysis. Our case clearly illustrates typical appearance of EH and the main differences between EH and KD are thoroughly discussed.Epitelioidni hemangiom (EH) i Kimurina bolest (KD) su zbog mnogih kliničkih i histopatoloških sličnosti smatrani različitim stadijima iste bolesti. Danas se smatraju dvama različitim entitetima, ali neki autori još uvijek poistovjećuju ova dva pojma. Naš cilj je predstaviti slučaj EH koji se pojavio na vrlo neuobičajenom mjestu te naglasiti mikroskopske i kliničke razlike između EH i KD. Predstavljamo slučaj EH orbite koji se pojavio kod 83-godišnjeg muškarca. Dijagnoza EH potvrđena je patohistološkom analizom kirurški uklonjenog tumora iz orbite u kojem su nađene specifične epitelioidne endotelne stanice koje nikad nisu prisutne kod oboljelih od KD. Dijagnoza je potvrđena imunohistokemijskom analizom. Opisani slučaj rijetkog orbitalnog tumora jasno pokazuje značajke specifične za EH, uz podrobno prikazane razlike između EH i KD

Molekularni podtipovi kolorektalnog karcinoma – kratki pregled

The failure of the AJCC/UICC staging system in predicting prognosis in intermediate-stage of colorectal cancers (CRCs) may be overcome by adding tumor budding (TB) in pathology report as the presence of high-grade TB has been consistently associated with negative clinicopathologic parameters in gastrointestinal tumors, especially in CRCs. Over the past few decades, numerous methods of assessing TB in CRC have been proposed, with variations in the area of assessment, cut-off values, and use of standard hematoxylin and eosin (H&E) stained slides vs. cytokeratin immunohistochemistry. This review summarizes previous studies in this scientific area and resulting guidelines. The concept of whether peritumoral budding (PTB) vs. intratumoral budding (ITB), or both, should be assesed is still under discussion. The original studies on TB utilized PTB, or assesment of budding at the invasive front of the CRC, and current guidelines pertain to that. Budding category and tumor grade are not the same and TB has an independent prognostic value and should be taken into account along with other clinicopathological factors in a multidisciplinary setting. TB should be routinely reported in stage II CRC, next to other high-risk factors, in order to aid the decision for adjuvant therapy.Neuspjeh AJCC/UICC staging sustava u predviđanju prognoze u srednjem stadiju karcinoma debelog crijeva i rektuma (KDCR) može se prevladati dodavanjem tumorskog pupanja (TP) u nalaz patologa jer je prisutnost visokog gradusa TP dosljedno povezivana s negativnim klinikopatološkim parametrima u gastrointestinalnih tumora, posebno u KDCR. Tijekom proteklih nekoliko desetljeća predložene su brojne metode procjene TP u KDCR, s varijacijama područja procjene, graničnim vrijednostima i korištenjem standardnih hematoksilin-eozinom obojenih preparata nasuprot imunohistokemiji citokeratinom. Ovaj pregledni članak sažima dosadašnja istraživanja u ovom znanstvenom području i proizašle smjernice. Još uvijek se razmatra koncept treba li se procjenjivati peritumorsko pupanje (PTP) ili intratumorsko pupanje (ITP), ili oboje. Izvorne studije o TP-u koristile su PTP ili procjenu pupanja na invazivnom rubu KDCR, a trenutne se smjernice odnose na to. Kategorija pupanja i stupanj tumora nisu isti, a TP ima nezavisnu prognostičku vrijednost te ga treba uzeti u obzir zajedno s drugim kliničkopatološkim čimbenicima u multidisciplinarnom okruženju. TP bi trebalo rutinski izvijestiti u stadiju II KDCR, pored drugih visokorizičnih čimbenika, kako bi se pomogla odluka o adjuvantnoj terapiji

Patološke promjene bubrežnih arterija u bolesnika s karcinomom bubrežnih stanica [Pathological changes of renal arteries in patients with renal cell carcinoma]

Renal cell carcinoma is the ninth most common cancer in the world. It may have a varied microscopic appear- ance, and the most common histopathological type is clear cell carcinoma. The most common pathological changes of renal arteries are atherosclerosis and fibromuscular dysplasia (FMD). During histopathological evaluation of a kidney specimen containing carcinoma, the renal vein is routinely analyzed, while the renal artery is usually given little attention. Our stud- ies have shown that pathological changes of renal arteries are significantly more frequent in the group of patients with renal cell carcinoma compared with the control group and the group of patients with non-tumor kidney diseases. These relations led us to the conclusion that the onset of renal artery changes is not prior to the carcinoma or non-tumor diseases and that they are formed simultaneously or as a consequence. Further studies should be aimed at determining the incidence of these changes in a larger number of samples and the detection of their possible correlation with renal cell carcinoma

PATHOLOGICAL CHANGES OF RENAL ARTERIES IN PATIENTS WITH RENAL CELL CARCINOMA

Karcinom bubrežnih stanica deveti je prema učestalosti maligni tumor u svijetu. Može imati različit mikroskopski izgled, a najčešći patohistološki tip je svjetlostanični karcinom. Najučestalije patološke promjene bubrežnih arterija jesu ateroskleroza i fibromuskularna displazija (FMD). Tijekom patohistološke obrade bubrega u kojem se nalazi karcinom ­rutinski se analizira bubrežna vena, dok se bubrežnoj arteriji većinom pridaje malo pozornosti. Rezultati nekoliko naših istraživanja pokazali su da su patološke promjene bubrežnih arterija statistički značajno učestalije u skupini pacijenata s karcinomom bubrežnih stanica u odnosu prema kontrolnoj skupini, kao i u skupini bolesnika s netumorskim bolestima bubrega. Utvrđeni odnosi ponajprije upućuju na zaključak da nastanak promjena bubrežnih arterija ne prethodi nastanku karcinoma ili netumorskih bolesti, nego nastaju istodobno s njima ili kao njihova posljedica. Daljnja bi istraživanja trebala biti usmjerena na utvrđivanje incidencije patoloških promjena bubrežnih arterija na većem broju uzoraka, kao i na otkrivanje njihove moguće uzročno-posljedične veze s karcinomom bubregaRenal cell carcinoma is the ninth most common cancer in the world. It may have a varied microscopic appearance, and the most common histopathological type is clear cell carcinoma. The most common pathological changes of renal arteries are atherosclerosis and fibromuscular dysplasia (FMD). During histopathological evaluation of a kidney specimen containing carcinoma, the renal vein is routinely analyzed, while the renal artery is usually given little attention. Our studies have shown that pathological changes of renal arteries are significantly more frequent in the group of patients with renal cell carcinoma compared with the control group and the group of patients with non-tumor kidney diseases. These relations led us to the conclusion that the onset of renal artery changes is not prior to the carcinoma or non-tumor diseases and that they are formed simultaneously or as a consequence. Further studies should be aimed at determining the incidence of these changes in a larger number of samples and the detection of their possible correlation with renal cell carcinoma

Apoptotic markers (P53, Bcl-2 and Bax) expression in renal oncocytoma and chromophobe renal cell carcinoma

Background and Purpose: Renal oncocytoma (RO) and eosinophilic variant of chromophobe renal cell carcinoma (ChRCC) have overlapping morphologic, immunohistochemical, histochemical and ultrastructural features. Their distinction is mandatory since RO is a benign tumor, while ChRCC is a low-grade malignant tumor which has metastatic potential and may undergo sarcomatoid transformation. The aim of this study was to determine expression of P53, Bcl-2 and Bax in ROs and ChRCCs and to explore whether these markers could be useful in differential diagnosis of RO and ChRCC. Patients and Methods: We analyzed 61 cases (28 ChRCCs and 33 ROs) by immunohistochemistry using primary antibodies to P53, Bcl-2 and Bax. The staining percentage and staining intensity scores were multiplied to give immunohistochemical staining index (ISI). Results and Conclusion: All specimens showed positive reaction for Bcl-2 and Bax. There was no significant difference in the ISI for Bcl-2 and P53. Statistical analysis showed significant difference in the ISI of Bax between ROs and ChRCCs. Moreover, cases of ROs had cytoplasmic pattern of reaction for Bax, while the pattern of reaction for Bax in cases of ChRCCs was membranous. Further studies are needed to confirm the possible use of Bax immunostaining in differential diagnosis of RO and ChRCC

Masivna endometrioza koja klinički oponaša tumor – neuobičajen slučaj intususcepcije crvuljka

Appendiceal intussusception is a rare clinical entity that, in women of reproductive age, may be caused by endometriosis. We report a case of a 36-year-old woman presenting with abdominal pain. The patient underwent laparoscopic surgery, during which a suspicion of a cecal tumor was raised. A laparoscopic right hemicolectomy was performed. The patohistological exam showed an intussuscepted appendix, and the cause of the intussusception was massive endometriosis involving the colon, ileum, and appendix. It is important not to mistake appendiceal intussusception and appendiceal endometriosis with other intraabdominal pathologies whose symptoms they can mimic.Intususcepcija crvuljka je rijedak klinički entitet koji u žena reproduktivne dobi može biti uzrokovan endometriozom. U članku je prikazan slučaj 36-ogodišnje žene koja se javila u hitnu službu s bolovima u abdomenu. Učinjena je laparoskopska operacija tijekom koje je postavljena sumnja na tumor cekuma te je napravljena desnostrana hemikolektomija. Patohistološki nalaz je pokazao intususcepciju crvuljka čiji je uzrok bio opsežna endometrioza koja je zahvatila debelo crijevo, ileum i crvuljak. Važno je prepoznati intususcepciju i endometriozu crvuljka, jer ih je lako zamijeniti za drugu intraabdominalnu patologiju, čije simptome mogu oponašati

Sinkroni adenokarcinom rektuma i bilateralni karcinom bubrega tipa svijetlih stanica

A 69-year-old man was admitted for resection of rectal adenocarcinoma diagnosed by colonoscopy. Preoperative computed tomography scan and abdominal ultrasonography revealed bilateral renal tumors measuring up to 2 and 2.8 cm in largest diameter, respectively. Th e patient underwent partial colectomy and bilateral partial nephrectomy. Microscopically, rectal adenocarcinoma penetrated the submucosa, without invasion of the muscularis propria. Both renal tumors were clear cell renal carcinomas of Fuhrmann nuclear grade 2. To our knowledge, this is the first case of synchronous adenocarcinoma of the rectum and bilateral clear cell renal cell carcinoma described in the literature to date.U radu je prikazan slučaj bolesnika kojemu je kolonoskopski dokazan adenokarcinom rektuma. U prijeoperacijskoj obradi kompjutorskom tomografijom su dijagnosticirani obostrani tumori bubrega promjera do 2,8 cm. Bolesnik je podvrgnut lijevostranoj hemikolektomiji, a u istom aktu je učinjena resekcija obaju bubrega. Patohistološki nalaz na oba bubrega je bio karcinom svijetlih stanica. Budući da simultano pojavljivanje karcinoma rektuma i bubrega nije tako rijetko, želimo upozoriti na potrebu proširene dijagnostičke obrade u bolesnika s karcinomom rektuma i/ili bubrega

Connexins Expression in Adenocarcinoma of Nasal Cavity and Paranasal Sinuses

Aim: To investigate the immunohistochemical expression of connexins (Cxn) 30, 32, 37, 43 in patients with adenocarcinoma of the nasal cavity and paranasal sinuses. Methods: This was a retrospecitve study which included patients with adenocarcinoma of the nose and paranasal sinuses operated at the ENT Department of University Hospital Center Sisters of Mercy in an 11-year period (from 2007-2018). Immunohistochemical analysis was performed on a single representative block from 20 cases. We used primary antibodies for Cxn 30, 32, 37 and 43 (Abcam). Material was routinely processed and analyzed under the light microscope. Each section was analyzed in the whole mount two times. The first time under low power (x40) and the second time under high power magnification (x400). Results: All cases showed negative reaction for Cxn 43, moderately positive reaction for Cxn 32 and extremly strong positive reaction for Cxn 30 and 37. Conclusion: The preliminary data of our study showed the absence of the reaction for Cxn 43 and positive reaction of Cxn 30, 32 and 37 in patients with adenocarcinoma of nasal cavity and paranasal sinuses. These findings are in concordance with the results of studies performed on adenocarcinomas of the ovary, prostate, lung and stomach. Further studies are needed to explore the potential prognostic role of Cxn expression in these patients