Imunohistokemijska izraženost estrogenskih receptora beta u papilarnom karcinomu štitnjače [Immunohistochemical expression of estrogen receptor beta in papillary thyroid carcinoma]

Papillary thyroid carcinoma occurs more frequently among women of reproductive age, who additionally make up the best prognostic group. The obtained data suggest a relation between estrogen and papillary carcinoma. Direct proliferative effect of estrogen on papillary carcinoma cells has already been proven in vitro, and seems to be mediated by estrogen receptors (ER). The biological importance of ER beta (ER β) remains unclear, but recent research point to its possible prodifferentiative and antiproliferative role. This study has examined the immunohistochemical expression of ER beta in papillary thyroid carcinoma. Specimen from 104 patients with papillary carcinoma has been obtained. The data on age, sex, tumor size and histological subtype, presence of benign thyroid disease, lymphocytic infiltrate, lymph node metastases, and intraglandular dissemination were obtained from patient records and pathology reports. The aforementioned parameters were compared with immunohistochemical reaction to ER β. The expression of ER β was present in both nuclei and cytoplasms of carcinoma cells. Nuclear positivity was more expressed in women younger than 50 years, and cytoplasmic positivity was more expressed in patients older than 50, irrespective of sex. The conclusion is that ER beta expression in papillary carcinoma is related with age and menopausal status in women, which suggests its possible prognostic relevance. Consequently, further investigations should be made

Citologija u dijagnozi raka jajnika

Cytology has so far been underutilized as a modality for the primary diagnosis of ovarian cancer. Lately the outlookon fi ne needle aspiration cytology (FNAC) has greatly shifted. With the availability of modern techniques, USG and CT guided FNAC is becoming an optimum modality for the diagnosis of primary and metastatic ovarian neoplasms and evaluation of recurrent malignant tumors, which consequently has a great impact on patient management. The most common indication for peritoneal washing cytology is staging or upstaging of ovarian carcinomas (First - look). Second - look procedures nare performed in patients previously treated by surgery, radiotherapy and/or chemotherapy to determine the presence of residual or recurrent ovarian cancer. In both procedures cytology has proven itself as a useful diagnostic method.Kao dijagnostička metoda, citologija je do nedavno bila nedovoljno uključena u primarnu dijagnostiku raka jajnika. No, u novije se vrijeme stav prema aspiracijskoj citologiji tankom iglom jasno mijenja. Uz dostupne suvremene tehnologije, ultrazvukom i CT-om vođena citološka punkcija postaje optimalna metoda za dijagnozu primarnih i metastatskih novotvorina jajnika, te za rano otkrivanje relapsa maligne bolesti. Time se citologija izravno upliće i u management liječenja pacijenta. Citološka pretraga ispirka trbušne šupljine najčešće je indicirana u određivanju stadija karcinoma jajnika (tz v. „prvi pogled“). Zahvati tz v. „drugog pogleda“ izvode se na bolesnicima koji su prethodno tretirani kirurški, zračenjem i/ili kemoterapijom da bi se odredila ostatna bolest ili recidiv karcinoma jajnika. U oba navedena slučaja („prvi i drugi pogled“) citologija se dokazala kao korisna dijagnostička metoda

Uloga citologije u otkrivanju i liječenju tumora dojke

Fine-needle aspiration cytology (FNAC) is an established, highly accurate, and cost-eff ective method for diagnosing lesions in the breast. The method is minimally invasive without unwanted side efect. FNAC forms part of the triple assessment of breast lesions and has a high accuracy and sensitivity in dedicated centres. Method as a part of triple assessment has provide its value in describing the fi ndings most accurately. The diagnostic impact depends on experience of the operator, quality of preparation and diagnostic skills of the cytopathologist. Inadequate sampling with FNAC is particulary seen in collagenous lesions and in submitt ed specimens sampled by physicians lacking experience with the FNAC procedure. The highest accuracy is achived at centres with multidisciplinary approach. The majority of European countries use similar reporting system for breast FNAC (C1-C5), in keeping with European guidelines for quality assurance in breast cancer screening and diagnosis. A clear reporting system ensures that an unequivocal cytological diagnosis of malignancy is reliable, and in cases where mammography/ultrasonography and clinical examination are in agreement with FNAC, frozen section examination is unnecessary. The issue of optimal sampling to obtain adequate cell material in suffi cient quantity is of paramount importance when assessing the accuracy of FNAC. The inadequate rates in FNAC from diff erent sources are lowest when FNAC is performed by a cytopathologist and highest when done by a non-cytopathologist. The multidisciplinary approach is necessary to amplify FNAC quality and to reduce its diagnostic limits. Only when this model of activity is not available, the role of FNAC is less eff ective and the addition of core biopsy (CB) to FNAC should be considered. CB as an alternative diagnostic modality should be used advisedly, in situations where it is more likely to yield diagnostic information, e.g., in the diagnosis of impalpable masses, microcalcifi cations or a clinically apparent malignancy where preoperative chemotherapy is planned. CB should not be used as a substitute for poor performance at FNAC. The methods are not mutually exclusive.Aspiracijska citologija tankom iglom (FNAC) je utemeljena, visoko pouzdana i jeftina metoda u dijagnostici lezija dojke. Metoda je minimalno invazivna bez neželjenih nuspojava. Sastavni je dio tzv. trojnog pristupa u dijagnostičkoj obradi lezija dojke, te u specijaliziranim centrima ima visoku pouzdanost i senzitivnost. Također je unutar trojnog pristupa dokazala svoju vrijednost mogućnošću da izrazito pouzdano okarakterizira promjene. Dijagnostički učinak ovisi o iskustvu liječnika koji izvodi postupak, kvaliteti obrade materijala te dijagnostičkim vještinama citopatologa. Neadekvatni uzorak se najčešće susreće u kolagenoznim lezijama,komplex sklerozirajućim promjenama te u oskudnosti primljenih materijalima od strane liječnika koji izvode punkciju, a nemaju dovoljno iskustva s procedurom. Najviša razina pouzdanosti postiže se u centrima s multidisciplinarnim pristupom. Većina europskih zemalja koristi isti sustav pisanja citoloških nalaza vezanih za dijagnostiku dojke (C1-C5), koristeći se smjernicama za osiguravanje kvalitete u probiru i dijagnostici karcinoma dojke. Jasni sustav pisanja nalaza time osigurava pouzdanost nedvojbene citološke dijagnoze maligniteta, te u slučajevima kada je ona u skladu s radiološkim nalazima (mamografijom/ultrazvukom), kao dio trojnog pristupa nije potrebna hitna, introperativna patohistološka dijagnostika. Optimalno prikupljanje materijala radi dobivanja adekvatno celularnog uzorka je od ključne važnosti za pouzdanost aspiracijske citologije ( FNA). Nivo neadekvatnog materijala je najniži kada postupak izvodi citopatolog, a najveći kada ga izvode liječnici drugih specijalnosti. Multidisciplinarni pristup je neophodan za povećanje kvalitete metode te za reduciranje njenih dijagnostičkih ograničenja. Samo u slučajevima kada ovakav model pristupa nije dostupan, uloga citologije (FNA) je manje učinkovita te se treba uzeti u obzir biopsija širokom iglom (CB). CB je alternativni dijagnostički modalitet, te se treba koristiti ciljano, u situacijama kada je izvjesnije da će omogućiti bolju dijagnostičku informaciju, npr. u slučajevima kada se radi o nepalpabilnim promjenama, mikrokalcifi katima, te u slučajevima klinički jasnog malignog procesa gdje se planira preoperativna kemoterapija. CB se ne treba koristiti kao alternativa slabo izvedenoj citološkoj punkciji, te se navedene dvije metode međusobno ne isključuju

Slabo diferencirani sinovijalni sarkom – prikaz slučaja

We report a rare case of primary poorly differentiated synovial sarcoma (SS) in axillary region confirmed by histology. SS accounts for 5-10% of soft tissue sarcomas. Approximately 20% of the cases have poorly differentiated appearance, most often characterized by undifferentiated round cell morphology resembling Ewing’s sarcoma. The differential diagnosis includes ES/PNET family of tumors, rhabdomyosarcoma, desmoid fibromatosis, and malignant melanoma. A 46-year-old female presented to our hospital complaining of a 10 cm slightly painful mass in the right axillary region of a 2-month duration. Clinical examination (CT, ultrasound ) showed an expansive tumor mass. Cytological analysis showed the diagnosis of suspected sarcoma. Surgical treatment was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of poorly differentiated SS. In spite of additional methods as immunocytochemistry, the poorly differentiated variant of SS can be easily mistaken for numerous other tumors in cytological smears due to its complex, overlapping morphology and still limited experience of cytopathologists in the field of rare soft tissue tumors. Nevertheless, recognition of this variant of SS is of a major concern for its worse prognosis.U radu prikazujemo rijedak slučaj primarnog slabo diferenciranog sinovijalnog sarkoma (SS) aksilarne regije čija je dijagnoza potvr|ena patohistološkom analizom. Sinovijalni sarkom čini 5-10% mekotkivnih sarkoma. Oko 20% slučajeva ima sliku slabo diferencirane varijante, malih okruglih stanica podsjećajući na Ewingov sarkom. Diferencijana dijagnoza uključuje ES/PNET skupinu tumora, rabdomiosarkom, desmoidnu fibromatozu i maligni melanom. Četrdesetšestogodišnja pacijentica primljena je u našu ustanovu žaleći se na lagano bolnu 10 cm veliku tumorsku masu u desnoj aksilarnoj regiji u trajanju od dva mjeseca. Klinički pregled (CT; UZV) potvrdili su ekspanzivnu tumorsku masu, a citološka analiza upućivala je na dijagnozu sarkoma te je učinjen operativni zahvat. Histološka i imunohistokemijska analiza potvrdila je dijagnozu slabo diferenciranog SS. Unatoč primjeni dodatnih metoda citološke analize, poput imunocitokemije, slabo diferencirana varijanta sinovijalnog sarkoma može se lako, zbog kompleksne, preklapajuće morfologije kao i ograničenog iskustva citologa na polju rijetkih tumora mekih tkiva, zamijeniti s drugim tumorima. Ipak prepoznavanje ove varijante SS od važnosti je zbog njegove lošije prognoze

Fine Needle Aspiration Cytology in Diagnosing Rare Breast Carcinoma – Two Case Reports

In this paper, we are presenting the two cases of very rare tumors: breast sebaceous carcinoma, which has been described for the first time in Croatian medical literature, and pure breast squamous carcinoma. First case, sebaceous carcinoma, is still quite unknown regarding its morphological characteristics and biological behavior. In the second case, squamous carcinoma, also very rare, was found in a patient who previously had a number of diagnosed head and neck skin carcinomas, and was diagnosed as primary squamous breast carcinoma. As a first case we present a 85-year-old female with a two months history of swelling of the left breast under the mammilla. The second one, a 69-year-old female presented to our hospital in January 2008 with a two months history of a lump in the lower outer region of the left breast and enlarged lymph nodes in left axillary region. Fine needle aspiration cytology (FNAC) of the breast was performed in order to diagnose the exact type of both tumours. This methodology was found important in diagnosis, but in both cases showed certain limitations in diagnosing such rare tumors. The final diagnoses were determined after carefully synthesizing the histological findings and clinical data. Careful and accurate classification of these tumors is necessary. A detailed analysis of their biological behavior and response to the therapy is necessary in order to formulate definite recommendations in managing these patients/diseases

Hodgkin’s Lymphoma Variant of Richter’s Syndrome

Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant lymphoprolipheration, that has tendency to conwert to a higher-grade neoplasam over time. More common is the development of a diffuse large cell lymphoma or transformation into prolymphocytic cell population. In rare cases, 0.1–0.5% of patients develop multiple myeloma or Hodgkin’s disease. We present 65-year old female with Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological, hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed. The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of the enlarged lymph node on the neck was performed. The diagnosis was Hodgkin’s disease. Immuno-hystological studies of the lymph node was consistent with type I Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and radiotherap

Hodgkin’s Lymphoma Variant of Richter’s Syndrome

Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant lymphoprolipheration, that has tendency to conwert to a higher-grade neoplasam over time. More common is the development of a diffuse large cell lymphoma or transformation into prolymphocytic cell population. In rare cases, 0.1–0.5% of patients develop multiple myeloma or Hodgkin’s disease. We present 65-year old female with Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological, hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed. The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of the enlarged lymph node on the neck was performed. The diagnosis was Hodgkin’s disease. Immuno-hystological studies of the lymph node was consistent with type I Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and radiotherap

Kolorektalni karcinom - patohistološki standardi

Colorectal carcinoma is the third most common cancer site in Croatia, according to the data published by the The Croatian National Cancer Registry. In the last decade, the knowledge about pathogenesis and molecular background of colorectal carcinoma has increased dramatically. More than 90% of colorectal carcinomas are adenocarcinomas originating from epithelial cells of the colorectal mucosa. Tumor staging is the most important prognostic predictor of clinical outcome for patients with colorectal carcinoma. The TNM classification has nowdays replaced other classification systems (Dukes, Astler-Coller) and serves as golden standard in everyday practise.In 2012, 5th Croatian Congress for Pathology resulted in uniform standard for pathologic reporting for all cancer sites. The future for colorectal cancer prognosis and therapy is to discover new molecular subtypes of colorectal cancer which represents the future of personalized oncology and will guide drug-development strategies.Prema podacima Registra za rak karcinom kolorektuma je treće najčešće tumorsko sijelo u Hrvatskoj. U zadnjih deset godina imamo brojna nova saznanja o patogenezi i molekularnim karakteristikama karcinoma kolorektuma. Više od 90% kolorektalnih karcinoma su adenokarcinomi po histološkom tipu, porijekla epitelnih stanica kolorektalne mukoze. Stadij tumora je najbitniji prognostički čimbenik za pacijente s tom bolešću. U današnje je vrijeme TNM klasifikacija zamijenila druge klasifikacijske sustave (Dukes, Astler-Coller) i koristi se kao zlatni standard u svakodnevnoj praksi. 2012. na Hrvatskom kongresu patologa, doneseni su standardi za sva tumorska sjela, koje mora zadovoljavati svaki patohistološki nalaz. Budućnost prognoze i terapije kolorektalnog karcinoma je otkriće novih molekularnih podtipova prema kojima bi se određivala personalizirana onkološka terapija te odredile nove strategije liječenja

Immunohistochemical expression of estrogen receptor beta in papillary thyroid carcinoma

Papilarni karcinom štitnjače se učestalije pojavljuje u žena tijekom reprodukcijske dobi, kod kojih ima i najbolju prognozu. Navedeni podaci ukazuju na povezanost estrogena s papilarnim karcinomom. Izravni proliferacijski učinak estrogena na stanicama papilarnog karcinoma je već dokazan in vitro,a najvjerojatnije se odvija posredstvom jezgrinih estrogenskih receptora (ER). Biološka uloga estrogenskog receptora β ( ER β ) još uvijek nije jasna, no dosadašnja istraživanja ukazuju na prodiferencijacijsko i protuproliferacijsko djelovanje. U ovom smo radu na uzorcima tkiva 104 bolesnika s papilarnim karcinomom iz patohistoloških nalaza i povijesti bolesti izdvojili dob, spol, veličinu i histološki podtip tumora, prisutnost benignih promjena u štitnjači,limfocitnog infiltrata, metastaza u limfne čvorove, te intraglandularne diseminacije. Navedene parametre smo usporedili s imunohistokemijskom reakcijom na ER β koju smo učinili na dodatnom rezu uzorka papilarnog karcinoma. ER β bio je pozitivan i u jezgrama i u citoplazmama papilarnog karcinoma. Jezgreni pozitivitet bio je češći u žena mlađih od 50 godina, dok je citoplazmatski pozitivitet bio češći u bolesnika starijih od 50 godina, bez obzira na spol. Zaključak je da je izraženost ER β u papilarnom karcinomu povezana s dobi i menopauzalnim statusom u žena, što upućuje na njegovu moguću prognostičku ulogu. U tom smislu potrebna su daljnja istraživanja.Papillary thyroid carcinoma occurs more frequently among women of reproductive age, who additionally make up the best prognostic group. The obtained data suggest a relation between estrogen and papillary carcinoma. Direct proliferative effect of estrogen on papillary carcinoma cells has already been proven in vitro, and seems to be mediated by estrogen receptors (ER). The biological importance of ER beta (ER β) remains unclear, but recent research point to its possible prodifferentiative and antiproliferative role. This study has examined the immunohistochemical expression of ER beta in papillary thyroid carcinoma. Specimen from 104 patients with papillary carcinoma has been obtained. The data on age, sex, tumor size and histological subtype, presence of benign thyroid disease, lymphocytic infiltrate, lymph node metastases, and intraglandular dissemination were obtained from patient records and pathology reports. The aforementioned parameters were compared with immunohistochemical reaction to ER β. The expression of ER β was present in both nuclei and cytoplasms of carcinoma cells. Nuclear positivity was more expressed in women younger than 50 years, and cytoplasmic positivity was more expressed in patients older than 50, irrespective of sex. The conclusion is that ER beta expression in papillary carcinoma is related with age and menopausal status in women, which suggests its possible prognostic relevance. Consequently, further investigations should be made