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

Amelanotic metastasing melanoma mimicking lung cancer

Lung is one of the most common site of metastasis in patients with malignant melanoma. We report a 64 year old man, who was submitted to our hospital. He complained of increasing intensity of shortage of breath, cough, and loss of weight within the last weeks. Serum analysis was normal. X-ray and CT images displayed a circumscribed density in the lower left lung, suspicious for lung cancer. Bronchoscopy and biopsy indicated a non differentiated malignancy which could not be further classified. Excision of the lower left lobe and of mediastinal lymph nodes was performed. The post surgical definite histological diagnosis revealed an amelanocytic epithelioid melanoma (positive for HMB-45, S-100). Pathologists, pulmonologists and thoracic surgeons should be aware of different cell types of intrapulmonary malignancies although primary lung cancer contributes to the outstanding majority of large and solid lung lesions