Focal neuroendocrine differentiation in prostatic gland carcinoma with basaloid pattern

Introduction. Prostatic gland basal cell proliferations exhibit morphological continuum ranging from basal cell hyperplasia to basal cell carcinoma. In the following report, we described clinical features, morphological spectrum, neuroendocrine differentiation and histogenesis of prostatic gland basal cell carcinoma in our patient. Case report. Hematoxylin- eosin (HE), Alcian blu-periodic acid schiff (ABPAS) at pH 2.5 stained sections and the avidin-biotinperoxidase complex (ABC), were performed on prostate gland paraffin-embedded tissue. Monoclonal antibodies directed against cytokeratin (34βE12) which selectively stains basal cells, prostate specific antigen (PSA), chromogranine A, neuron-specific enolase (NSE), synaptophysin and CD56, were used. Basal cell proliferations exhibited a morphological continuum ranging from basal cell hyperplasia to prostatic gland carcinoma. In these prostatic lesions, positive reactivity was demonstrated for 34βE12 and CD56. These findings indicate that the basaloid cells of basal cell hyperplasia, florid basal cell hyperplasia, atypical basal cell hyperplasia and basal cell carcinoma are derived from basal cells of the normal prostate gland suggesting a continuum in the progression of hyperplasia to benign and then malignant neoplasia. The presence of CD56 protein in the discovered lesions may be related to their neuroendocrine differentiation. Conclusion. The fact, that our patient was well six years after the radical prostatectomy supports the belief of some authors that basal cell carcinoma represents a low grade carcinoma with an excellent prognosis

Clinical, histopathological and immunohistological study of lymphoid disorders in the parotid gland of patients with Sjögren's syndrome

Bacground/Aim. Sjögren's syndrome is a chronic autoimmune systemic disease characterized by polyglandular tissue destruction, leading to keratoconjunctivitis sicca and xerostomia. These patients have 44-fold increased risk of developing salivary gland lymphoma, of which 80% are marginal zone (MALT) type. Having in mind that criteria for distinguishing benign lymphoepithelial lesions from MALT lymphoma are obscure, the aim of this study was to provide practical information that could be integrated into diagnostic practice. Methods. Among 32 parotidectomies, 27 cases were identified as having benign lymphoepithelial disorders and 5 cases low grade MALT lymphoma. Histological sections were stained routinely with hematoxylin and eosin (H&E and special stains. Immunohistochemical study was performed by LSAB2 method, by using primary antibodies for CD20, CD3, Kappa and Lambda light chains and Cytokeratin (Dako Denmark). Results. The 27 patients with Sjögren's sialoadenitis (22 women and 5 men), and 5 patients with MALT lymphoma (only women) were included in this analysis. According to the Ann Harbor Classification, all patients with MALT lymphoma had stage IE. Both groups of patients had an indolent clinical course, except permanent, rapid parotid enlargement in the patients with MALT lymphoma. Histologically, the periductal lymphoid infiltrate, gradually extended to the acini, completely replacing them by a sea of polyclonal lymphocytes, immunoblasts, germinal centers and plasma cells (confirmed immunohistochemically), but sparing the ducts and preserving lobular appearance. The histological feature of salivary gland MALT lymphoma included heterogeneous B-cell infiltrate that totally or subtotally had effaced the normal glandular structure. Malign lymphoepithelial lesions, representing infiltration of the ductal and epithelial structures by monoclonal neoplastic Bcells, positive for CD20, were highlighted by antibody to cytokeratin. Conclusion. The optimal diagnosis of salivary gland MALT lymphoma requires careful integration of clinical, morphological and immunohistochemical results

MORPHOMETRIC CHARACTERISTICS OF JUGULAR FORAMEN AND SIGMOID SINUS GROOVE: THEIR POSSIBLE CONNECTIONS WITH HIGH JUGULAR BULB PRESENCE

High jugular bulb represents very important variation in neurosurgery. The aim of our research was to measure certain characteristics of jugular foramen and surrounding bony structures in order to evaluate their possible significance in high jugular bulb detection. Thirty seven dried human skull sagittal sections were used as material. Sigmoid sinus groove width and depth, jugular fossa height and exocranial opening mean diameter were measured with vernier caliper. Internal auditory canal height and the distance between its inferior margin and superior margin of petrous bone, jugular foramen endocranial opening area and sino dural angle were measured with ImageJ. Cluster analysis with jugular fossa height as classification parameter was used for the classification of the analyzed skull sagittal sections. Classification analysis showed the presence of two groups: the first with predominantly low height of jugular fossa dome, the second with significantly higher values of jugular fossa dome, sino-dural angle and mean diameter of jugular fossa exocranial opening. This group predominantly included right skull sagittal sections. In addition, sigmoid sinus groove width and depth, jugular foramen endocranial opening area and jugular fossa exocranial opening mean diameter were significantly higher on the right in relation to the left side. So, it can be concluded that high jugular fossa dome is more frequently associated with sigmoid sinus groove anterior position, high values of mean diameter of jugular fossa exocranial opening and sigmoid sinus groove width and depth, especially on the right side

Serum Level of HMGB1 Protein and Inflammatory Markers in Patients with Secondary Peritonitis: Time Course and the Association with Clinical Status

Background: Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods: In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results: Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions: HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis.Journal of Medical Biochemistry (2017), 36(1): 44-5

The association between NOTCH3 expression and the clinical outcome in the urothelial bladder cancer patients

Disrupted NOTCH activity is a driving event in urothelial bladder cancer (UBC). After activation by hypoxia, the NOTCH3 receptor participates in tumor cell proliferation, acquisition of the epithelial-mesenchymal transition phenotype, and angiogenesis. The aim was to analyze the association of NOTCH3 expression with histopathological and clinical parameters, and to determine its predictive impact on the clinical outcome in UBC patients. The present research included 614 UBC samples incorporated in paraffin tissue microarrays, evaluated by immunohistochemistry for NOTCH3 expression. The accrual period was four years, while the follow-up period was two years. The membranous expression was semi-quantified (0-3), and the mean degree was 1.81±0.94. Criteria for semi-quantification the NOTCH3 expression were the intensity of the staining and the percentage of positive cells. The samples with negative (0) and weak (1) NOTCH3 immunohistochemical (IHC) score were considered negative, while the samples that showed moderate (2) and strong (3) expression were considered positive. Higher degree of positivity was associated with higher risk of cancer-specific mortality (p<0.001). Independent predictors for cancer-specific mortality were NOTCH3 expression and high stage (p<0.001). NOTCH3 expression was not a statistically significant predictor of recurrence-free survival (p=0.816). This study indicated that NOTCH3 is a predictor of poor outcome, suggesting that the NOTCH3 could be potentially reliable IHC marker for selecting the UBC patients that would require more intensive follow-up, especially if they diagnosed in higher stage, with divergent differentiation in pathological report, and without recurrences which would lead them to more frequent medical assessments

A retrospective review of 139 major and minor salivary gland tumors

Aim To describe demographic and histomorphological characteristics of 139 patients with epithelial salivary gland tumors in the Southeastern Serbia population. Methods A total number of 139 patients with epithelial tumors arising in major and minor salivary glands in the period 2010-2012 was evaluated. After standard tissue proceeding, the routine haematoxylin-eosin (HE) and histochemical alcian blue-periodic acid-Schiff (AB - PAS) methods were used for histomorphological examination. Results Among 139 patients, 102 (73.38%) had benign, and 37 (26.62%) malignant tumors. The majority of tumors were localized in the parotid gland, in 117 (84.17%) patients. Among benign tumors there were 50 (49.02%) pleomorphic adenoma, 48 (47.06%) Warthin’s tumor, two (1.96%) myoepithelioma, and two (1.96%) oncocytoma. In the group of malignant tumors the most common was mucoepidermoid carcinoma, in 12 (32.43%) patients, carcinoma ex pleomorphic adenoma in six (16.22%), adenoid cystic carcinoma in five (13.51%), and oncocytic carcinoma in three (8.11%) patients. Conclusion Benign tumors were more common than malignant ones, with predominance of pleomorphic adenoma. Malignant tumors are less common than benign in the large salivary glands, and more common in the minor salivary glands. Histochemical AB-PAS method helps in the diagnosis of mucinous salivary gland carcinoma

HISTOPATHOLOGY, IMMUNOHISTOCHEMISTRY AND THE MALT LVMPHOMA THERAPY

Most of the MALT-lymphoma of the stomach is generated in the antrum and it is macroscopically characterized by unclear boundaries, mucosa thickening or its ulceration. The MALToma generation is a many-phase process and it is a consequence of the chronic infection Helicobacter pylori. At an early stadium, the tumor is limited to the stomach mucosa while its growth depends on the immunological stimulation through H. pylori while the regression starts after the eradication of this bacterium. However, the tumor can progress into an aggressive phase invading deeper layers of the gastric wall and, along with the dissemination into the local lymph nodes, into distant places as well. At an advanced stage, the stomach MALT lymphomas do not depend upon the H. pylori mediated stimulation; thus, they do not respond to the H. pylori eradication therapy. Finally, the boundary MALT lymphomas can be transformed into aggressive tumors of a high degree of malignity. Immunological and genetic factors intervene into the genesis of gastric MALT lymphomas, often synergetic in their effects. The immune response of the host to H. pylori induces the activity of the B-cell population.During this chronic inflammatory disease, the genome becomes unstable; thus, it is possible that the genetic abnormalities like trisomy should develop in the B cells. The changed B cell clone is subjected to clone expansion gradually forming the MALT lymphoma. Further genetic developments such as complete inactivation of the tumor suppressant genes (p53 and pl6) and possible activation of c-wyconcogene by trans location or other disturbances can lead to the transformation of the MALT lymphoma into the MALT lymphoma of a high malignity level