Ki-67 expression in squamous intraepithelial lesions of the uterine cervix

BACKGROUND: Uncontrolled cell proliferation and malignant transformation are the basic elements in the development of malignant disease including cervical cancer and its precursors. The aim of this study was to investigate the proliferative activity by using Ki-67 proliferative marker according to CIN grade. METHODS: We used immunohistochemical methods to study the expression of the proliferative marker Ki-67 in the specimens of 5 patients with normal cervical epithelium, 7 with CIN1, 13 with CIN2, and 25 patients with CIN3 grade of the cervical intraepithelial lesions. RESULTS: All cases with normal cervical epithelium and all those with CIN1 changes had negative proliferative Ki-67 index. Ki-67 positive proliferative index was found in 5 (38.46%) and 17 (68%) of patients with CIN2 and CIN3 changes respectively. There was a clear trend for increasing number of cases with positive Ki-67 index with increasing CIN grade. High significant difference of Ki-67 expression was found between patients with CIN1 and CIN2 lesions (t=2.9; p<0.01). Ki-67 positive cells were distributed only in the lower third of the epithelial layer in CIN1 cases. Seven (53.8%) and 13 (52%) of patients with CIN2 and CIN3 changes respectively, had Ki-67 positive cells in the lower and middle third of the epithelial layer, while 3 (23.1%) and 10 (40%) of cases with the same dysplastic changes had Ki-67 positive cells distributed in lower, middle and upper third of the epithelium. Difference of the Ki-67 positive cells distribution was highly significant between patient with CIN1 and CIN2 epithelial changes. CONCLUSION: The present study shows that there is statistically significant relation between proliferative activity, distribution of Ki-67 positive cells, and CIN grade. Ki-67 antigen could be a tool to identify women who are at higher risk for progression and/or recurrence of cervical squamous precancerous lesions

Minute pulmonary meningothelial-like nodules simulating a metastatic lung adenocarcinoma: A case report

Minute pulmonary meningothelial-like nodules (MPMNs) are relatively rare lesions that located at the pleura or parenchyma of the lung. They are usually found incidentally at autopsy or in surgical specimens. We presented a case of asymptomatic 47-year-old woman with an abnormal shadow in the right upper lung field found by a routine chest X ray. A computed tomography (CT) scan of the thorax revealed a hyperdense subpleural mass, which histologically conformed to adenocarcinoma. A resection of the right upper lobe discovered preponderance of small multiple lesions under the pleura. Microscopically, they were an interstitial nodular proliferation of oval or spindle-shape cells arranged in a zellenballen nesting pattern near small veins. Immunohistochemical and cytological analyses confirmed the diagnosis of MPMNs. Coexistence of multiple MPMNs and lung adenocarcinoma can be a differential diagnostic problem due to suspected metastasis of the primary carcinoma. To obtain an accurate diagnosis, the clinical findings should completely conform to histological, immunohistochemical, and cytological ones

Metastatic spread of mucinous cystadenocarcinoma of the ovaries into abdominal wall

Epithelial ovarian cancer belongs to the most common and most deadly of all types of ovarian carcinomas. Ovarian cancer affects women in the age group 65 years and older more frequently than younger women. Approximately 75% of cases will have spread beyond the ovaries at the time of diagnosis. Twenty-two year old patient was treated at the Institute of Oncology Sremska Kamenica, in the period from 1998 until 2000. In 1993, she underwent left salphingo-oopherectomy; histopathological finding was mucinous cystadenoma of the ovaries. In 1994, mucinous papillary cystadenoma with borderline malignancy confirmed by histopathological findings was found after abdominal hysterectomy with right salpingo-oopherectomy and total omentectomy. The patient was well until 1998 when she palpated a tumor mass in the front abdominal wall with pain in that region. Tumor was extirpated and final histopathological finding was mucinous adenocarcinoma in fibrous tissue. The patient received with chemotherapy (carboplatin and cyclophosphamide) and external-beam radiotherapy. Recurrence free survival rate was 20 months but in April 2000, patient came back with recurrence of the disease. It was the same spread into abdominal wall. Rectus abdominis muscle was resected and plastic surgery of abdominal wall was performed. After operation patient received second line chemotherapy according to the same protocol. However, during the treatment the disease spread into abdominal cavity and affected small intestine and liver

Factors correlating with lymph node metastases in patients with T1 ductal invasive breast cancer

BACKGROUND: Identification of reliable predictors of axillary lymph node metastases (ALNM) may be useful in selecting appropriate management for patients with T1-size breast cancer. This study was undertaken to determine the association between ALNM and several variables, including age, tumor size, grade, estrogen receptor status, progesterone receptor status, p53 and c-erbB2 protein expression, and Ki-67 proliferative index. METHODS: In a retrospective study, 74 patients with pT1b and pT1c ductal invasive breast carcinoma and with known nodal status were analyzed. The size of the infiltrating tumor was microscopically evaluated. The histological grading was performed using the modified criteria of Bloom and Richardson, as described by Elston and Ellis. The immunophenotype of the tumor was determined as: the expression of estrogen (ER) and progesterone (PR) receptors, p53, c-erbB2 and Ki-67. The patients were grouped by age as follows: <50, 50-70, and >70 years old. RESULTS: Twenty six patients (35%) were node positive. Tumor size was related directly to nodal positivity. Nodal positivity was significantly related to negative PR status, p53 protein overexpression and high Ki-67 index (p<0.05). No significant association was found between nodal positivity and patient age, tumor grade, ER status, and c-erbB2 expression. CONCLUSION: These data suggest that PR status, Ki-67 proliferation index, and p53 protein expression might provide additional information to the lymph node status in T1 ductal breast carcinomas

Multisystem Langerhans cell histiocytosis coexisting with metastasizing adenocarcinoma of the lung: A case report

Introduction. Langerhans cell histiocytosis (LCH) is an uncommon disease of unknown etiology characterized by uncontrolled proliferation and infiltration of various organs by Langerhans cells. Case report. We presented a 54-year-old man, heavy smoker, with dyspnea, cough, hemoptysis, headache and ataxia, who died shortly after admission to our hospital. On the autopsy, tumor was found in the posterior segment of the right upper pulmonary lobe as well as a right-sided occipitoparietal lesion which penetrated into the right ventricle resulting in internal and external hematocephalus. Histologically and immunohistohemically, the diagnosis of primary lung adenocarcinoma with brain metastasis was made (tumor cells showed positivity for CK7 and TTF-1 which confirmed the diagnosis). In the lung parenchyma around the tumor, as well as in brain tissue around the metastatic adenocarcinoma histiocytic lesions were found. Light microscopic examination of the other organs also showed histiocytic lesions involving the pituitary gland, hypothalamus, spleen and mediastinal lymph nodes. Immunohistochemical studies revealed CD68, S-100 and CD1a immunoreactivity within the histiocytes upon which the diagnosis of Langerhans' cells histiocytosis was made. Conclusion. The multisystem form of LCH with extensive organ involvement was an incidental finding, while metastatic lung adenocarcinoma to the brain that led to hematocephalus was the cause of death

Evaluation of clinical, morphological and pathohistological characteristics of thymomas: Our ten year experience

Background. Thymomas are rare neoplasms arising from tissue elements of the thymus. The objective of the study was to analyse clinical characteristics of patients with thymoma, as well as morphological and patohistological features of neoplasms. Methods: Retrospectively we studied 41 medical records and patohistological material of patients referred to the Institute for pulmonary diseases of Vojvodina between the January 2005 and December 2014. Results: Patient age at presentation ranged from 19 to 77 years. A slight female preponderance was detected, with 24 (58.5%) females and 17 (41.5%) males being affected. All types of thymoma more often occurred in males, accept subtype B1. Patients with type A thymoma and subtype B1 were mainly asymptomatic, while patients with subtype B2 and type AB presented with dyspnea, dysphagia, pain and cough. Myasthenia gravis often was associated with type A (40%). The most common histologic type was subtype B1. Twenty three (56%) patients had a tumor diameter between 5 and 10 cm. Five patients had malignant thymoma, and the most common types of thymoma that showed signs of capsula invasion or pleural and pericardial implants were type AB (60%) and subtype B2 (50%). Biopsies of suspected tissue were obtained through a sternotomy, video-assisted thoracoscopy surgery, and video-assisted mini thoracotomy, and after setting a diagnosis on ex tempore analysis, the lesions were removed by thymectomy or extirpation of the tumor mass. Conclusion: Thymomas have variable clinical presentations. Clinical outcome correlates with histological type, size and clinical stage, as well as the ability to achieve complete tumor resection

Diagnostic relevance of fine needle aspiration cytology in nodular thyroid lesions

Background/Aim. Fine needle aspiration cytology (FNAC) of the thyroid gland has been used as an initial investigative procedure of thyroid nodule(s) in the Department of Pathology at the Institute of Oncology of Vojvodina for more than 20 years. This procedure is rapid, inexpensive and technologically simple, yet it has found only limited, albeit increasing acceptance in medical practice in Serbia. The aim of the study was to evaluate our FNAC findings by correlating cytological results with histological diagnosis and to define the sensitivity, diagnostic accuracy and positive predictive value of FNAC. Methods. A total of 266 patients with thyroid swellings were aspirated in one year investigated period at our Institute out of whom 69 underwent surgery between May 2008 and May 2009. The cytological results correlated with clinical features, ultrasound investigations (US) and subsequent histopathological examination of the resected tissue. Results. By the use of cytology we found out thyroid carcinoma in 10 patients, and by histopathological examination in 12. We obtained 83% sensitivity, 100% specificity and 97% of diagnostic accuracy of FNAC. Conclusion. The obtained results confirm the importance of FNAC in preoperative assesment of thyroid nodule

Significance of punch biopsy and endocervical curretage in diagnostics of cervical intraepithelial lesions

Background/Aim. Diagnostic procedures during the detection of cervical intraepithelial lesions (CIN) are a combination of cytology, colposcopy, punch biopsy and endocervical curretage. An optimal therapeutic approach according to the distribution, size and grade of cervical lesions is the result of this diagnostic protocol. This study was carried out to assess reliability of the punch biopsy and endocervical curretage in diagnostics of cervical intraepithelial lesions. Methods. Fifty patients undergoing cervical conization were studied retrospectively to evaluate the correlation between the grade of preoperative punch biopsy and endocervical curretage, and the grade of the dysplastic epithelial changes in the cone biopsy. CIN grade was established according to the WHO/ISGYP classification and comparation of the results was performed after that. Results. Out of the total number of patient, 89.36% of them with dysplastic epithelial changes on cone biopsy had also dysplastic changes in the preoperative punch biopsy. An exact correlation between CIN grades was identified in 56% of the cases, 20% in CIN2, and 36% in CIN3 cases. There were 24.14% patients with negative endocervical curretage, while only in one case the cone biopsy was negative, too. Among the remaining 22 patients with CIN changes in endocervical curretage specimens, only one had a negative cone biopsy. An exact correlation of CIN grade was identified in 37.93% of the cases, 13.79% of CIN2, and 24.14% of the CIN3 cases. Conclusion. There was a positive cor relation between the CIN grades in punch and cone biopsy, as well as between the grade on the endocervical curretage and cone biopsy specimen, but with the lower degree than previous

Gastric sarcoidosis

Introduction. Sarcoidosis is a systemic disease with a 90% predilection for the lungs, but any organ can be involved. Gastric sarcoidosis may be a component of a generalized process, while isolated gastric sarcoidosis is very rare. Case Outline. We describe a rare case of biopsy-proven gastric sarcoidosis in a 45-year-old woman with pulmonary sarcoidosis in remission, and highlight the importance of gastroscopy and biopsy to confirm the diagnosis. Her optimal response to anti-acid therapy required no alternate (glucocorticoid) therapy. We briefly review the clinical, diagnostic, and therapeutic aspects of gastric sarcoidosis. Conclusion. Glucocorticoids remain the cornerstone of the sarcoidosis treatment, although it has been insufficiently documented by clinical trials. The decision to treat sarcoid patients with systemic glucocorticoids is largely based upon the severity of symptoms. The anti-acid therapy may be an alternative in milder cases, as demonstrated in our patient

Large cell lung carcinoma with rhabdoid phenotype: Case report

Large cell carcinoma of the lung with a rhabdoid phenotype is very rare. We report a 62-year-old male patient admitted to our hospital due to chest pains and hemoptysis. The computed tomography scan of the lungs revealed a massive consolidation of the parenchyma in the upper right lobe. The right upper lobectomy and mediastinal lymph node sampling were carried out. The microscopic appearance suggested a large cell carcinoma with a rhabdoid phenotype, with no foci of any other carcinomatous components. The tumor cells had eosinophilic cytoplasmic globules and eccentric nuclei. Immunohistochemically, vimentin was diffusely positive. The epithelial membrane antigen and neuron-specific enolase were focally positive. We expect a good outcome for this patient because the diagnostic procedure and successful operation were performed in the early stage (IA-T1aN0) of the disease