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

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

Sebaceous carcinoma in situ as a diagnostic entity. Case report and review of the literature.

The concept of carcinoma in situ was first introduced by Broders in 1932 [1] and has been accepted as a well-established notion and diagnostic category in many organs and systems. However, sebaceous carcinoma in situ (SCIS) has not yet been recognized as a concept and diagnostic entity in general pathology or dermatopathology. Such lesions have been commonly misinterpreted as either a benign neoplasm or sebaceous carcinoma. Tumors that do not necessarily arise in pre-existing sebaceous glands are usually invasive at the time of diagnosis, and like their ocular counterparts, can exhibit pagetoid intraepidermal spread. Cases of purely in- situ extraocular sebaceous carcinoma are extremely rare and yet controversial until now. Recognizing sebaceous carcinoma in situ as a valid concept and diagnostic entity that will certainly help to avoid misinterpretation and subsequently under or over treatment of such lesions. In this article, we provide a case report presentation with histopathological examination and a critical review of the literature

Report of two cases of chordoid meningioma in patients with Castleman syndrome

[No abstract available

The 6th Albanian Congress of Trauma and Emergency Surgery

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together