Immunohistochemical evaluation of protein expression in membranous glomerulopathy

It is now well established that morphological change of podocytes is closely correlated to the development of proteinuria. AIM: The aim of this study was to investigate the role of podocalyxin, a major podocyte protein, in the pathogenesis of glomerulopathies associated primarily with the nephrotic syndrome. Method: Immunohistochemical expression of podoxalyxin has been evaluated in 44 renal biopsies, including normal controls, patients with podocytopathies (minimal change disease/MCD, focal segmental glomerulosclerosis/FSGS) and membranous glomerulopathy (MG). A computerized image analysis program has been used. Statistical analysis was performed using ANOVA and Bonferroni tests. Results: Immunohistochemical expression of podocalyxin has been observed within the podocytes of normal controls. In MCD podocalyxin expression was globally reduced despite the normal appearance of the glomeruli. In FSGS, podocalyxin loss was observed in both the segmental sclerotic and the non-sclerotic areas as well, being more prominent in the former. Discussion: Reduction of podocalyxin in MG was demonstrated for the first time immunohistochemically. Both the stained area% and the “intensity x area%” were statistically significant higher in the controls than in both pathological groups. However, between the two pathological groups (podocytopathies- MG) there was not statistically significant difference. This is one of the few studies investigating podocalyxin immunohistochemical expression in glomerulopathies associated with nephrotic syndrome. The observed reduction in podocalyxin expression suggests that it constitutes a target molecule in nephrotic syndrome pathogenesis regardless of the underlying cause. Especially in MG, it is worth being further examined if abnormal podocalyxin might uncover putative antigenic targets contributing to the aggregation of immunocomplexes.Στην παθογένεια του νεφρωσικού συνδρόμου εμπλέκονται ποικίλες ιστολογικές μορφές σπειραματοπαθειών με προεξάρχουσες τις ποδοκυτταροπάθειες και τη μεμβρανώδη σπειραματοπάθεια. Σκοπός της παρούσας μελέτης είναι η ανάδειξη του ρόλου μιας ποδοκυτταρικής πρωτεΐνης, της ποδοκαλυξίνης στις σπειραματοπάθειες με πρώτη κλινική εκδήλωση το νεφρωσικό σύνδρομο. Υλικό και μέθοδος: Συγκριτικά με μία ομάδα ελέγχου αξιολογήθηκε ανοσοϊσοχημικώς η έκφραση της ποδοκαλυξίνης σε δείγματα 44 νεφρικών βιοψιών προερχομένων από ασθενείς με ποδοκυτταροπάθειες (νόσο των ελαχίστων αλλοιώσεων, εστιακή τμηματική σπειραματοσκλήρυνση) και μεμβρανώδεις σπειραματοπάθειες σταδίων Ι και ΙΙ. Η αξιολόγηση της ανοσοϊστοθετικότητας έγινε ποσοτικώς με σύστημα ανάλυσης εικόνας μέσω ηλεκτρονικού υπολογιστή. Αποτελέσματα: Η σπειραματική έκφραση της ποδοκαλυξίνης παρατηρήθηκε πρωτίστως κατά μήκος του περισπλαχνίου πετάλου της Βωμάνειας κάψας αφορώντας κυρίως στα ποδοκύτταρα και εν γένει στην εξωτερική επιφάνεια της σπειραματικής βασικής μεμβράνης . Τόσο η έκταση που καταλαμβανόταν από θετική χρώση, όσο και το γινόμενο αυτής της έκτασης επί την ένταση της χρώσης απέβησαν στατιστικώς σημαντικά υψηλότερα στην ομάδα των υγιών μαρτύρων εν συγκρίσει με τα παθολογικά δείγματα, ενώ μεταξύ των υποομάδων των παθολογικών δειγμάτων δεν προέκυψαν σημαντικές διαφορές. Συμπέρασμα: Στις σπειραματοπάθειες με πρώτη κλινική εμφάνιση το νεφρωσικό σύνδρομο, η βλάβη στα ποδοκύτταρα λόγω μείωσης της ποδοκαλυξίνης φαίνεται να είναι κοινή, ανεξάρτητα εάν ο εν λόγω κυτταρικός πληθυσμός αποτελεί τον κύριο παθογενετικό στόχο της νόσου, όπως συμβαίνει στις ποδοκυτταροπάθειες, ή όχι όπως πιθανολογείται ότι συμβαίνει στις μεμβρανώδεις σπειραματοπάθειες. Στις τελευταίες, ανοσοσυμπλεγματικής αιτιοπαθογένεσης σπειραματοπάθειες, η εναπόθεση ανοσοσυμπλεγμάτων φαίνεται να επιδρά και στην πρωτεϊνική ακεραιότητα του ποδοκυττάρου γεγονός που οφείλει να συνεκτιμηθεί στην παθογένεση του νεφρωσικού συνδρόμου σε αυτές

Highly Differentiated Follicular Carcinoma of Ovarian Origin: A Systematic Review of the Literature

(1) Background: Highly differentiated follicular carcinoma of ovarian origin (HDFCO) is an extremely uncommon neoplasm, associated with struma ovarii. There are scarce cases reported in the literature and, subsequently, no reliable conclusions on its pathophysiology, treatment, and prognosis can be drawn. The goal of this study is to enrich the literature on the topic by adding our own experience with a case, and simultaneously accumulate all cases published up to date. (2) Methods: The present review was performed in accordance with the guidelines for systematic reviews and meta-analyses (PRISMA). PubMed (1966–2022), Scopus (2004–2022), and Clinicaltrials.gov databases were screened for relevant articles published up to July 2022. (3) Results: Twenty patients with HDFCO were identified. The included patients were aged 47.15 years (range 24–74). The predominant origin was ovarian (60%) and extraperitoneal spread was confirmed in 15% of the cases. Surgical treatment varied from conservative to radical (35.3% vs. 41.2%, respectively) and the administration of supplementary therapy and thyroidectomy was not universal. Combined thyroidectomy/radioactive iodine therapy was applied in just 62.5% of the reported cases. There was one patient who demonstrated disease recurrence and lives with the disease. No disease related morbidity was reported. (4) Conclusions: HDFCO represents a low-grade malignant tumor, whose rarity does not allow for reliable conclusions. Standard treatment including complete surgical excision and supplementary treatment seems to offer a favorable prognosis in selected cases

Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs

Nationwide Real-World Data of Microsatellite Instability and/or Mismatch Repair Deficiency in Cancer: Prevalence and Testing Patterns

Determination of microsatellite instability (MSI)/mismatch repair (MMR) status in cancer has several clinical implications. Our aim was to integrate MSI/MMR status from patients tested in Greece to assess the prevalence of MSI-high (MSI-H)/deficient MMR (dMMR) per tumor type, testing patterns over time and concordance between MSI and MMR status. We retrospectively recorded MSI/MMR testing data of patients with diverse tumor types performed in pathology and molecular diagnostics laboratories across Greece. Overall, 18 of 22 pathology and/or molecular diagnostics laboratories accepted our invitation to participate. In the 18 laboratories located across the country, 7916 tumor samples were evaluated for MSI/MMR status. MSI/MMR testing significantly increased in patients with colorectal cancer (CRC) and other tumor types overtime (p < 0.05). The highest prevalence was reported in endometrial cancer (47 of 225 patients, 20.9%). MSI-H/dMMR was observed in most tumor types, even in low proportions. Among 904 tumors assessed both for MSI and MMR status, 21 had discordant results (overall discordance rate, 2.3%). We reported MSI-H/dMMR prevalence rates in patients with diverse cancers, while demonstrating increasing referral patterns from medical oncologists in the country overtime. The anticipated high rate of concordance between MSI and MMR status in paired analysis was confirmed