Az őrszemnyirokcsomó-áttét kimutatása 4 mm-nél vastagabb melanomában esélyt ad ígéretes adjuváns kezelésre

Bevezetés: Az őrszemnyirokcsomó-biopszia (SNB) jelentősége az előrehaladott – 4 mm-nél vastagabb – melanomák kezelésében eddig vitatott volt a szakirodalomban. Manapság azonban az adjuváns terápiák alkalmazásának előfelté- tele a regionális nyirokcsomók érintettségének szövettani igazolása. Ugyanakkor az SNB szükségességének kritériu- mai Magyarországon sem egységesek, van, ahol jelenleg a vastag melanomák esetén nem végzik el ezt a beavatkozást. Célkitűzés: Klinikánkon az elmúlt években konzekvensen elvégeztük az őrszemnyirokcsomók vizsgálatát 4 mm-nél vastagabb melanomák esetén is, így érdemesnek tartottuk értékelni, hogy ebben a betegcsoportban milyen arányban fordul elő a tájéki nyirokcsomók klinikailag nem, szövettanilag viszont detektálható áttéte. Módszer: A klinikánkon 2007 és 2011 között melanomával diagnosztizált 1133 beteg közül kiválasztottuk azokat a pácienseket, akiknek 4 mm-nél vastagabb primer tumoruk volt, és retrospektíven értékeltük a betegek demográfiai adatait, primer daganatuk klinikai, valamint szövettani jellegzetességeit az őrszemnyirokcsomó szövettani paraméte- reinek függvényében. Eredmények: Az 5 éves időszakban 116 olyan, melanomában szenvedő beteget diagnosztizáltunk, akinél vastag mela- noma került sebészi kimetszésre. 78 páciensnél történt SNB, mely 50 esetben szövettanilag pozitívnak bizonyult. A betegek átlagos életkora közel 58 év volt. Következtetés: Klinikánkon évente tíz olyan, vastag melanomás beteget kezelünk, akinél az őrszemnyirokcsomó szö- vettani pozitivitása alapján igazoltuk a betegség metastaticus stádiumát. Eredményeink és a Nemzeti Rákregiszter adatai alapján akár 100 körülire becsülhető azoknak a pácienseknek a száma Magyarországon, akiknél ezzel a patoló- giai stádiumot meghatározó módszerrel az adjuváns kezelés szükségessége megállapítható. A betegcsoport fiatal életkorát figyelembe véve, hatékony target/immunterápia adjuváns alkalmazásával eredményesebben csökkenthető lehet az elvesztett életévek száma, mint a belszervi metastaticus stádiumban megkezdett kezelésekkel

Expression of growth hormone-releasing hormone receptors in apocrine adnexal tumours and apocrine glands of the skin

Encouraged by our previous finding of growth hormone-releasing hormone receptor (GHRH-R) expression in metaplastic and neoplastic apocrine breast epithelium, we examined a small series of skin adnexal tumours with various degrees of apocrine (oxyphilic) differentiation, as well as normal axillary and anogenital apocrine sweat glands, for the expression of GHRH-R. Sections of formalin-fixed paraffin-embedded tissue blocks were immunostained for gross cystic disease fluid protein-15 (GCDFP-15) and androgen receptor (AR), to prove apocrine differentiation and correlate it with areas of GHRH-R expression. All but one of 19 tumours with apocrine epithelium and all five benign apocrine glands stained with both anti-GHRH-R antibodies used, each labelling a different domain of the receptor. Non-apocrine areas of the tumours and four eccrine tumours without oxyphilic features did not stain, but most sebaceous glands and some eccrine glands were labelled. Our data suggest that anti-GHRH-R antibodies highlight apocrine differentiation at extramammary sites also. Although GHRH-R seems to have a sensitivity comparable to classic apocrine markers such as AR and GCDFP-15, it seems to be inferior in specificity. The GHRH-R labelling of apocrine glands and neoplastic epithelium might also interfere with the emerging anti-GHRH targeted treatment of some malignancies acting on these receptors

Elastic staining does not assist detection of venous invasion in cutaneous melanoma

The aim of the present study was to determine the benefit of orcein elastic staining of primary cutaneous melanoma specimens in detecting venous invasion. Primary cutaneous melanomas in vertical growth phase were assessed for vascular invasion. All tumour blocks were stained with haematoxylin and eosin (H&E) and orcein. The cases were reviewed by two pathologists. Vascular invasion was not identified more frequently on orcein stained slides than on H&E stained ones. Elastosis and periappendiceal elastic fibres interfered with vascular invasion detection with elastic staining. Based on our study, we conclude that elastic stains such as orcein do not improve the detection rate of venous invasion in primary cutaneous melanomas

Incidentally Discovered Diffuse Large B-Cell Lymphoma Limited to the Endocervical Mucosa in a Young Female Patient

Primary high-grade non-Hodgkin lymphoma of the female genital tract is extremely rare. Vaginal bleeding, abdominal pain or urinary complaints might be its most frequent symptoms. We report a 27-year-old multipara who underwent large loop excision of the transformation zone because of the repeated finding of a low-grade squamous intraepithelial lesion identified during routine cancer screening. Incidentally, CD20-positive, primary, diffuse large B-cell lymphoma infiltrating the mucosa of the endocervix was also diagnosed from this specimen. The case is unusual because the patient had no symptoms, specific colposcopic signs or visible mass. R-CHOP 21 immunochemotherapy was introduced and resulted in complete remission without hysterectomy. The patient is without any evidence of disease after 49 months of follow-up. Primary cervical lymphomas are mainly subepithelial initially, and therefore they may be under-recognized due to the inefficiency of smears to diagnose such lesions. Early diagnosis and available targeted treatment allowed a cure in the reported example. (c) 2015 S. Karger AG, Basel

The effect of ionization on the populations of excited levels of C IV and C V in tokamak edge plasmas

The main populating and depopulating mechanisms of the excited energy levels of ions in plasmas with densities <1023-1024 m-3 are electron collisional excitation from the ion's ground state and radiative decay, respectively, with the majority of the electron population being in the ground state of the ionization stage. Electron collisional ionization is predominately expected to take place from one ground state to that of the next higher ionization stage. However, the question arises as to whether, in some cases, ionization can also affect the excited level populations. This would apply particularly to those cases involving transient events such as impurity influxes in a laboratory plasma. An analysis of the importance of ionization in populating the excited levels of ions in plasmas typical of those found in the edge of tokamaks is undertaken for the C IV and C V ionization stages. The emphasis is on those energy levels giving rise to transitions of most use for diagnostic purposes (n≤5). Carbon is chosen since it is an important contaminant of JET plasmas; it was the dominant low Z impurity before the installation of the ITER-like wall and is still present in the plasma after its installation. Direct electron collisional ionization both from and to excited levels is considered. Distorted-wave Flexible Atomic Code calculations are performed to generate the required ionization cross sections, due to a lack of atomic data in the literature. Employing these data, ionization from excited level populations is not found to be significant in comparison with radiative decay. However, for some energy levels, ionization terminating in the excited level has an effect in the steady-state of the order of the measurement errors (±10%). During transient events, ionization to excited levels will be of more importance and must be taken into account in the calculation of excited level populations. More accurate atomic data, including possible resonance contributions to the cross sections, would tend to increase further the importance of these effects