Lymphoepithelioma-like Gastric Carcinoma (LELGC): A Case Report and Review of Literature

Lymphoepithelioma-like gastric carcinoma (LELGC),  is a rare type of gastric cancer characterized by a carcinoma with intense stromal lymphocytic infiltration. It is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. According to the World Health Organisation classification of tumors of digestive sysytem 2010, LELGC is a rare type of tubular carcinoma. Although this entity is hard to be recognized in the biopsy specimens, pathologists and clinicians should acknowledge this subset of gastric cancer because it generally has a better prognosis than other forms of EBV-associated gastric carcinomas and conventional gastric carcinomas. This might be due to the fact that the patient's inflammatory response may prevent the spread of tumor through the gastric wall and to the lymph nodes or remote organs.(21) In order to gain a detailed understanding of this rare disease, we reviewed the literature and report here a recent case of epithelioid gastric cancer in a 60 year old male patient presented in our Emergency Department. Keywords: Lymphoepithelioma-like Gastric Carcinoma, gastric cancer , Ebstein-Barr virus, prognosi

Gastrointestinal Stromal Tumors, Identification of C-Kit Mutation and Differential Diagnosis

Background: Prior to the recognition of C-Kit mutations, GIST were most commonly classified as leiomyoma, leiomyosarcoma, leiomyoblastoma or Autonomic nervous system gastrointestinal tumor. This is why, for the accurate histologic diagnosis of these tumors, it is necessary to record the C-Kit mutation and to identify some other molecular markers that help in differential diagnosis. C-Kit mutation detection is a criterion for morphologic diagnosis and also it serves as a predictive factor for determining the therapy with Imatinib (Glivec) if it is present in these tumors.Objectives: Evaluation of 49 cases of C-Kit mutations and differential diagnosis assessment by IHC examinations.Material and Methods: The study is a retrospective cohort type. 49 patients was evaluated the C-Kit mutation and further IHC examinations for differential diagnosis with other similar lesions. For this purpose the immunoreactivity for CD117, CD34, Actin, Desmin, S100 was evaluated. In these cases, the proliferative index with Ki67 was also evaluated as a prognostic factor together with the tumor diameter and presence or not of necrosis.Results: In the cases studied the presence of c-kit mutation (CD117 positive) was detected in 97% of the examined cases, CD34 was found positive in 77% of the examined cases, SMA was found positive in 34% of the examined cases, Desmin was found positive in 17% of the examined cases, S100 was found positive in 7% of the examined cases. Ki67 resulted to be on average 17.6% in cases with mitotic index> 5/50 HPF and on average 5.7% in cases with mitotic index <5/50% HPF Conclusions: Most of the mesenchymal tumors in the gastrointestinal system are Gastrointestinal Stromal type. This tumor is diagnosed in most cases if C-Kit mutation (positive immunoreactivity for CD117) is identified. Other immunostains like CD34, SMA, Desmin,  S100, help in the diagnose by differentiating this tumor from other histologically similar lesions. Proliferative index determination by Ki67 serves for the differentiation of these tumors into two prognostic categories. Keywords: GIST, C-KIT mutations, differential diagnosis, malignant behavio

Management Approach to Thyroid Cancer in Albania

Thyroid cancer is a cancer that starts in the thyroid gland. In Albania, thyroid cancer is rare disease, according to available data, which are not solid and up to date data, referred to 2014 to a paper named “Actualities in the Diagnosis and Treatment of Thyroid Cancer in Albania” by D. Gjergji et al., data from Clinic of General Surgery, UHC “Mother Theresa” in Tirana and the Registry of the Department of Pathology during the period 2004 – 2011, there were suspected 262 patients with thyroid tumors and only 42 of them or 16 % were diagnosed with thyroid cancer. Treatment depends on the type of thyroid cancer. Surgery is most often done, the entire thyroid gland is usually removed and if is suspected that cancer has spread to lymph nodes in the neck, these will also be removed. Radiation therapy may be done with or without surgery and it may be performed by; aiming external beam x-ray radiation at the thyroid or taking radioactive iodine by mouth. If the cancer does not respond to surgery or radiation, and has spread to other parts of the body, chemotherapy and targeted therapy are applied. The importance of screening, early diagnosis and there proper treatment possess still challenges in Albania, so better national health  programs must be developed in order to offer a better health care service to this medical problem. Keywords: Thyroid cancer, risk factors, diagnosis, treatmen

Hepato Cellular Carcinoma: Case Report

Hepatoma is a tumoral disease that consists in an abnormal proliferation of the hepatic cells. According to the augmentation of the risks factors such as smoking, alcohol abuse, consuming no healthy food and different types of viral and bacterial infections. Nowadays, this disease is becoming more evident even in the young ages. Here, we present a 63 old female with this disease. Keywords: Hetapoma, tumoral, disease DOI: 10.7176/ALST/78-06 Publication date: March 1st 202

Ectopic Thyroid Tissue and Management Approach: Surgical vs Conservative

From embryology it well known that thyroid gland is the first endocrine gland to develop in the body, starting by the end of third week post conception. The thyroid gland originates from primitive pharynx and the neural crests. Surgeons should have a complete understanding of embryonic development of thyroid and parathyroid gland, as well as knowledge of possible congenital abnormalities of thyroid dysgenesis that is characterized by thyroid ectopia, as may impact medical assessment and the surgical procedures approach and prevention of possible complications. Surgical vs conservative management approach should be well evaluated and proper professional decision upon patient case should be taken, upon patient consensus. Thyroid ectopia is a rare disease, and according to most studies and respective database it is estimated with prevalence about 1 per 100 000–300 000 people, rising to 1 per 4000–8000 patients with thyroid disease. This paper focuses on surgical approach of lingual ectopic tissue of thyroid of a 32 years old women. Keywords: Thyroid, endocrine, location, embryology, ectopic, surgeon DOI: 10.7176/ALST/93-05 Publication date: April 30th 202

Primary Breast Lymphoma

The term “primary breast lymphoma” (PBL) is used to define a malignant lymphoma primarily occurring in the breast in the absence of previously detected lymphoma localizations [1]. PBL is a rare disease, accounting for only 0.4-0.5% of all breast malignancies, 0.38-0.7% of all non-Hodgkin lymphomas (NHL), and 1.7-2.2% of extranodal NHL. The median age of patients with diagnosed PBL ranges from 60 to 65 years [1-12]. The disease occurs almost exclusively in women. Bilateral breast involvement accounts for 11% of all breast lymphomas [13] or 5% according to Ryan et al. [11]. This rare situation is especially observed during pregnancy or postpartum, suggesting that tumour growth is influenced by hormonal stimulation. Breast lymphoid cells probably originate in mucosa-associated lymphoid tissue (MALT) [14]. PBL may also originate from lymphatic tissue present within the breast adjacent to ducts and lobules, or from intramammary lymph nodes [15, 16]. More than 80% of PBL are B-cell lymphomas, mostly CD20+. The most frequent histopathologic types are: diffuse large B-cell lymphoma (DLBCL) which accounts for up to 50% of all PBL, follicular lymphoma (FL) – 15%, MALT lymphoma – 12.2%, Burkitt’s lymphoma (BL) and Burkitt-like lymphoma – 10.3% [17]. Other histological types of PBL include marginal zone lymphoma (MZL), small lymphocytic lymphoma (SLL), and anaplastic large cell lymphoma (ALCL). Diffuse large B-cell lymphoma (DLBCL) is the most common histological diagnosis. These lymphomas have been shown to be of a non-germinal centre B-cell phenotype with a high proliferation index and are thought to be associated with a poor outcome [18]. There is a close association between ALCL and silicone breast implants [19, 20]. Burkitt’s lymphoma is observed particularly in pregnant or lactating women and HIV-seropositive patients. The clinical presentation of PBL and the radiological features are usually no different from those of carcinoma of the breast. PBL is usually classified according to the Ann Arbor staging system. Other diagnostic criteria for PBL were described by Wiseman and Liao in 1972 [21]. According to the last classification, the clinical site of presentation is the breast. A history of previous lymphoma or evidence of widespread disease are absent at diagnosis. There is present close association of lymphoma to breast tissue in the pathologic specimen. Ipsilateral lymph nodes may be involved. This definition of PBL comprises only tumours being in stage I (lymphoma limited to the breast) and stage II (lymphoma limited to the breast and axillary lymph nodes) and not to tumours originating from non-breast sites

Primary Gastric Melanoma

Melanoma represents 1-3% of all malignant cancers and typically appears in sites where melanocytes are commonly found, including the skin, eyes, meninges and anal region, most  commonly  in the rectum and sigmoid colon(1). Most melanomas found in the stomach are metastases from cutaneous sources. According to a clinicopathologic analysis of 652 patients with disseminated disease, 58% demonstrated small bowel metastases upon autopsy, 26% were found to have gastric metastases,but only 1.5% were identified to have any gastrointestinal lesions antemortem³⁴. Primary gastric melanoma is a rare entity with 11 cases reported worldwide(2). Primary gastric melanoma is underdiagnosed, it’s symptoms and signs are nonspecific and specific staining techniques must be used to confirm the diagnosis. Therefore thorough physical examination, laboratory studies and imaging are required to rule out metastatic disease in the setting of metastatic melanoma We have a case of a  man N.K 56 years old, with three fungoid lesions partially ulcerated, irregular shaped in corpus ventriculi, which histologically resulted to be a non epithelial and non lymphoid tumor of the stomach. It was performed also a laparoscopy with frozen biopsy for a lymphnode in the abdomen. The patient had also spleen metastatic lesion. A wide range of antibodies in immunohistochemistry were used in the differential diagnosis. A detailed clinical and radiologic  investigations revealed no primary lesion elsewhere

Alfa Internexin Expression in a Series of 137 Gliomas and its Correlation with Oligodentroglial Morphology IDH1, P53 SYN and EGFR Expression

Background: Distinguishing glial subtypes based on nuclear and cellular morphology alone is subjective,with significant interobserver variability, even among highly experienced neuropathologists. Genetic subtyping of a given histological phenotype and robust biomarkers has improved the diagnostic and prognostic assessment. Recently, IDH1 (more rarely IDH2) mutations have been found in nearly 40% of gliomas and strongly predict lower grade in histology and better outcomes. Aim: To evaluate if the expression of alpha-internexin (INA) can be used a reliable diagnostic, prognostic and cost-effective marker, a proneural gene-coding neurofilament interacting protein significantly correlated with oligodendroglial phenotype, 1p/19q codeletion as well as higher chemosensitivity and better prognosis to our study population. Material: We studied INA expression in 137gliomasand correlated it with pure oligodendroglial histology, IDH1, p53, EGFR and SYN expression by immunohistochemistry.Results: INA was expressed in 72.2% of grade II oligodendrogliomas (n = 22), 62.5% of grade III oligodendrogliomas (n = 16), 57.2% of grade II oligoastrocytomas (n = 7), 66.7% of grade III oligoastrocytomas (n = 6), 66.7% of glioblastomas with oligodendroglial component (n = 12), 0% of grade I astrocytomas (n = 13), 0% of grade II astrocytomas (n = 4), 0% of grade III astrocytomas (n = 12) and 2.5% of glioblastomas and gliosarcomas (n = 40).INA was expressed by 27(71.1%) of pure oligodendrogliomas(n=38) versus 17(17.2%) of no pureoligodentrogliomas(n=99), Chi-square was p < 10-4; Cramer’s V was 0.517; p <10-4, which show a very strong relationship.INA was expressed by 32(45.1%) of gliomas with IDH1 mutation (n=71) versus 12(18.2%) of gliomas without IDH1 mutation (n=66), Chi-square was p < 0.001; Cramer’s V was 0.288; p < 0.001, which show a very strong relationship. INA was expressed by 26(27.4%) of gliomas with P53 mutation (n=95) versus 18(42.9%) of gliomas without P53 mutation (n=42), Chi-square wasp=0.05 which show they were negatively correlated. INA was expressed by 30(50.0%) of gliomas with SYN expression (n=60) versus 14(18.2%) of gliomas without SYN expression (n=77), Chi-square was p < 10-4; Cramer’s V was 0.338; p < 10-4, which show a very strong relationship. INA was expressed by 12(27.3%) of gliomas with EGFR expression (n = 44) versus 32(34.%) of gliomas without EGFR expression (n=44), Chi-square was p=0.05 which show they were negatively correlated. Conclusion: INA expression is a fast, cheap and reliable diagnostic and prognostic marker, which helps identify patients of different prognostic groups in diffuse gliomas and should be used routinely in the pathologic diagnosis of glial tumours.Keywords: Glial tumours, Alpha-internecine, IDH1, P53, Synaptophysin, EGFR protein

Alfa Internexin Expression in a Series of 137 Gliomas and its Correlation with Oligodentroglial Morphology IDH1, P53 SYN and EGFR Expression

Background: Distinguishing glial subtypes based on nuclear and cellular morphology alone is subjective,with significant interobserver variability, even among highly experienced neuropathologists. Genetic subtyping of a given histological phenotype and robust biomarkers has improved the diagnostic and prognostic assessment. Recently, IDH1 (more rarely IDH2) mutations have been found in nearly 40% of gliomas and strongly predict lower grade in histology and better outcomes. Aim: To evaluate if the expression of alpha-internexin (INA) can be used a reliable diagnostic, prognostic and cost-effective marker, a proneural gene-coding neurofilament interacting protein significantly correlated with oligodendroglial phenotype, 1p/19q codeletion as well as higher chemosensitivity and better prognosis to our study population. Material: We studied INA expression in 137gliomasand correlated it with pure oligodendroglial histology, IDH1, p53, EGFR and SYN expression by immunohistochemistry.Results: INA was expressed in 72.2% of grade II oligodendrogliomas (n = 22), 62.5% of grade III oligodendrogliomas (n = 16), 57.2% of grade II oligoastrocytomas (n = 7), 66.7% of grade III oligoastrocytomas (n = 6), 66.7% of glioblastomas with oligodendroglial component (n = 12), 0% of grade I astrocytomas (n = 13), 0% of grade II astrocytomas (n = 4), 0% of grade III astrocytomas (n = 12) and 2.5% of glioblastomas and gliosarcomas (n = 40).INA was expressed by 27(71.1%) of pure oligodendrogliomas(n=38) versus 17(17.2%) of no pureoligodentrogliomas(n=99), Chi-square was p < 10-4; Cramer’s V was 0.517; p <10-4, which show a very strong relationship.INA was expressed by 32(45.1%) of gliomas with IDH1 mutation (n=71) versus 12(18.2%) of gliomas without IDH1 mutation (n=66), Chi-square was p < 0.001; Cramer’s V was 0.288; p < 0.001, which show a very strong relationship. INA was expressed by 26(27.4%) of gliomas with P53 mutation (n=95) versus 18(42.9%) of gliomas without P53 mutation (n=42), Chi-square wasp=0.05 which show they were negatively correlated. INA was expressed by 30(50.0%) of gliomas with SYN expression (n=60) versus 14(18.2%) of gliomas without SYN expression (n=77), Chi-square was p < 10-4; Cramer’s V was 0.338; p < 10-4, which show a very strong relationship. INA was expressed by 12(27.3%) of gliomas with EGFR expression (n = 44) versus 32(34.%) of gliomas without EGFR expression (n=44), Chi-square was p=0.05 which show they were negatively correlated. Conclusion: INA expression is a fast, cheap and reliable diagnostic and prognostic marker, which helps identify patients of different prognostic groups in diffuse gliomas and should be used routinely in the pathologic diagnosis of glial tumours

Diffuse Lipomatosis of Thyroid Gland. Case Report and Review of Literature

Fat tissue is usually not present in normal thyroid glands, orcan only be noted directly under the capsule and along the vessels. Only a few thyroid lesions containing fat tissue have been reported until today. Lipomatosis of thyroid gland is very rare and characterized by infiltration of fat cells into the thyroid tissue. The pathophysiology of thyroid lipomatosis remains unclear. We report the case of a 69-year-old female who was admitted to the Emergency Room of our hospital. She complained of dysphagia, dyspnea, swelling of the neck and loss of weight. Her thyroid panel tests were in normal range. Ultrasound examination displayed with typical appearance of a multinodular goiter. A computed tomography revealed a rightward deviation and compression of the trachea with narrowing the tracheal lumen to more than 50%. The patient underwent total thyroidectomy. The histopathological examination revealed fat tissue which was diffusely distributed throughout the whole thyroid gland. There was no evidence of atypia or mitotic activity. Capsular infiltration or amyloid deposits were not noted as well as no nuclear grooves or intra-nuclear cytoplasmic inclusions. Therefore, diffuse lipomatosis of the thyroid gland was diagnosed.In normal thyroid glands, adipose tissue is distributed only under the capsule and along vessels.It is not usually present within the thyroid gland. Only a few adipose tissue -containing thyroid lesions have been reported to date. Lipomatosis of thyroid gland is very rare condition,characterized by infiltration of adipose tissue in the thyroid gland.The pathophysiology of adipose tissue infiltration in the thyroid gland remains unclear. We report a case of a 69-year-old female who presented in the Emergency Room of our hospital, complaining dysphaghia,dyspnea ,swelling of the neck and weight loss. Her thyroid panel tests were in the range,ultrasound showed the typical appearance of multinodular goiter.A computed tomography revealed a rightward tracheal deviation and compression narrowing the tracheal lumen more than 50%. The patient underwent total thyroidectomy. The histopathological examination revealed that adipose tissue was diffusely distributed throughout the thyroid gland.There is no evidence of atypia or mitotic activity. Capsular infiltration or amyloid deposition were not observed. Nuclear grooves or intranuclear cytoplasmic inclusions were not observed. Accordingly, diffuse lipomatosis of thyroid gland was diagnosed