Abstract. VEGF is a potent mitogen for endothelial cells and also acts in an autocrine and paracrine manner for development of tumor cells in breast cancer. Correlations between VEGF and some clinicopathologic findings were largely studied but results were controversial. Our purpose was to find if VEGF could be used as individual prognostic factor in invasive breast carcinoma. We included in our study 35 cases of invasive breast carcinoma, which were immunostained for VEGF using monoclonal antibodies anti-VEGF clone VG1. The assessment of VEGF expression used a scoring system, which included an intensity parameter correlated with percent of positive tumor cells. We found positive correlation between ductal invasive carcinoma type of breast cancer and VEGF expression. In addition, presence of inflammation associated with breast malignancies had a significant correlation with VEGF positive staining. Because of these correlations found in our study, we concluded that VEGF could not be used as individual prognostic factor in invasive breast carcinoma.
Keywords: invasive breast carcinoma, immunohistochemistry, prognosis, VEGF.
Abstract. Plasmoblastic lymphoma (PBL) is a subtype of the diffuse large B-cell lymphoma, typically present as extranodal disease associated with human immune deficiency virus (HIV) infection. PBLs are often the initial manifestation of AIDS. Here we present a case of PBL concerning the oral cavity. A 34-year-old woman presented a tumor in the oral cavity that involved the maxilla and gingiva (confirmed by CT-scan). The gingival biopsy showed a massive infiltration by large lymphoid cells with round, vesicular nuclei, prominent nucleoli, fine chromatin and an significant amount of basophilic cytoplasm which express CD79a, CD138, cytoplasmic lambda light chain and LCA, without staining for CD20, CD38, CD3 and CTK. Serological analysis confirmed HIV positivity. PBLs lack most B-lineage markers, but many express CD79a in at least some of the cells, therefore generate difficulties in differential diagnosis. Overall assessment and correlation of the histopathological and immunohistochemical features with the clinical findings and serology investigation are the most helpful diagnostic tools and can lead to the final diagnosis.
Keywords: extranodal PBL, immunohistochemistry, B-lineage markers, HIV.
Abstract. This study was undertaken to assess several histopathological and immunohistochemical markers regarding some lesional aspects of ischemically and hypoxically damaged myocardium in sudden cardiac death. Tissue samples of myocardium from 17 middle age and young patients with sudden cardiac death, following acute or chronic cardio(myo)pathies, were analyzed using standard HE stain and indirect tristadial ABC peroxidase immunohistochemical method, for a panel of 12 antibodies grouped in three categories: antibodies involved in programmed cell death (bcl-2, p53, Fas/CD95, Fas-L, bax, caspase 9), muscular markers (Myo-D1, myogenin, desmin, actin) and growth factor receptors (b-FGF, VEGF, NGF). Myogenin was more sensitive in identifying the ischemic perilesional myocardic fibers than Myo-D1, but less specific, while desmin had a greater sensitivity than myogenin and Myo-D1 taken separately, but with no specificity for myocardic fibers. Fas-L, caspase 9 and bax were expressed in more than 75% of cases in perilesional residual cardiomyocytes, correlating to each other (r = 0.45, respectively r = 0.6, p<0.05). b-FGF, VEGF and NGF had a focally variable expression in subendocardial and subepicardial cardiomyocytes and were statistically independent. Even if there was a polymorphic expression of antibodies in the studied batch, our findings indicate that some parameters (Fas-L, b-FGF, Myo-D1) might be independent markers for predicting sudden cardiac death in patients with previously damaged myocardium.
Keywords: sudden death, predicting parameters, immunophenotype.
Abstract. Recent studies revealed that CD105 is intensively expressed in tumor vasculature, and may be an important prognostic indicator for the outcome in a number of malignancies. The aim of our study was to evaluate the CD105 expression and microvessel density in oral squamous cell carcinoma (OSCC). Nineteen surgical specimens with OSCC were immunohistochemical analyzed with CD105 (Endoglin). We determined the microvessel density (MVD) by "hot spot method". Endoglin was intensively expressed in vessels from the inner and invading front of all investigated OSCC. The highest value of MVD, about 30.89+/-22.4, were record in peritumoral area of OSCC, since intratumoral MVD average was about 10.18+/-4.7. We did not observe any significant association of MVD with age, sex, primary tumor's location, clinical stage or differentiation grade. In conclusion, CD105 expression is up-regulated in OSCC, and has a significant role in the development of such malignancies.
Keywords: angiogenesis, CD105, microvessel density, oral squamous cell carcinoma.
Abstract. Ovarian cancer is a disease difficult to detect in early stages due to nonspecific symptoms and has a rapid progression with frequent relapses after radical surgical procedure. For these reasons, ovarian cancer generally represents the fourth cause of death through cancer in females, while in our country it is surpassed only by cervix cancer. The reduced survival is associated with the absence of symptoms, especially in early stages. Therefore, the diagnosis is delayed, when the metastases are already present and the prognosis is poor. While the etiology of the ovarian cancer is less understood, the histopathological studies and experiments regarding ovarian cancer development suggest that the majority of the tumors refined to the surface epithelium, a cuboidal layer that lays the ovary. It is still unclear if the molecular changes in this layer generate a neoplastic precursor that can be used for establishing an early diagnosis. None of the changes of the involved genes (p53, k-Ras, Her-2/neu, c-Myc, etc.) does seem to follow certain steps. We analyzed histological and immunohistochemical a group of 60 female patients admitted during January 2004 and January 2005 in Surgery Clinic of "Sf. Ioan" Emergency Hospital, Bucharest. Our study reveals that a high percent (68.33%) of females had a correct diagnosis at admission, only five patients (8.33%) being diagnosed with other diseases. In 86.66% of cases, total hysterectomy with bilateral anexectomy has been made, in two cases (3.33%) tumor resection was the only needed therapy and in 19 cases (31.66%) peritoneal implants were found. More than 75% were serous tumors, 20% mucinous carcinoma and 5% borderline ovarian tumors. We found three cases of borderline tumors (5%) that histopathological proved to be serous tumors. The analysis of hormone receptors showed estrogen receptors in 32 cases (71.1%) of serous ovarian adenocarcinoma, in seven cases (58.33%) of mucinous adenocarcinoma, all three cases (100%) of borderline tumors and in four cases (21.05%) of the 19 with peritoneal implants. Progesterone receptors were found in 27 cases (60%) of serous carcinoma, five cases (41.66%) of mucinous carcinoma, one case (33.33%) of borderline tumors and five cases (26.31%) with peritoneal metastases. Immunohistochemical study of CerbB-2 showed positively only in 37 cases (82.22%) of serous carcinomas, five cases (41.66%) of mucinous carcinomas, one case (33.33%) of borderline tumor and eight cases (42.10%) with peritoneal metastases. All tumor types presented positives for CA125 (91.1% in serous tumors, 83.33% in mucinous tumors, 33.33% in borderline tumors and 73.68% in tumors with peritoneal implants. The investigated proliferative factors p53 and Ki-67 demonstrated correlation with tumor aggressiveness. Lack of positivity in borderline tumors and strong positivity in serous and mucinous carcinomas shows correlations with literature. This study outlines that an immunohistochemical analysis of certain antibodies cannot offer useful data regarding the prognosis or the screening for ovarian cancer.
Keywords: ovarian carcinomas, immunohistochemistry, prognosis and screening markers.
Abstract. Aims: Since Toker cell (TC) was first described in 1970, many interpretations concerning their origin have been offered in literature. We tried to investigate the histology of Toker cells in horizontal sections of the nipple. Material and methods: We have studied horizontal sections of the nipple in 10 cases from mastectomy specimens due to ductal carcinoma. We used conventional Hematoxylin-Eosin stains, as well as immunohistochemical staining for cytokeratin 7 in each case. Immunostaining for EMA, CEA and S-100 were also used in the three cases in which TCs were more numerous. In three cases, we made serial sections of the nipple. Results: We evidenced TC in 80% of our cases in the immunohistochemical study. The three cases that were studied with additional antibodies showed a phenotype CEA-, S-100-. While one of the cases was EMA+, the other two were EMA-. Conclusions: The location of TCs, together with the findings in the cases that were seriated, suggests a physical relation between TCs and the sebaceous glands. This latter hypothesis would also explain the immunophenotype of TCs that has been widely studied in literature, and partially corroborated by the current study.
Keywords: Toker cell, Paget disease, nipple, folliculo-sebaceous-apocrine unit, CK7.
Abstract. The actin regulatory proteins Ena/VASP (Enabled/Vasodilator stimulated phosphoprotein) family is involved in the control of cell motility and adhesion. They are important in the actin-dependent processes where dynamic actin reorganization it is necessary. The deregulation of actin cycle could have an important role in the cells' malignant transformation, tumor invasion or metastasis. Recently studies revealed that the human orthologue of murine Mena is modulated during the breast carcinogenesis. In our study, we tried to observe the immunohistochemical expression of mammalian Ena (Mena) in the colorectal polyps and carcinomas. We analyzed 10 adenomatous polyps (five with dysplasia) and 36 adenocarcinomas. We used the indirect immunoperoxidase staining. BD Biosciences have provided the Mena antibody. We observed that Mena was not expressed in the normal colorectal mucosa neither in polyps without dysplasia, but its expression was very high in polyps with high dysplasia. In colorectal carcinomas, Mena marked the tumoral cells in 80% of cases. In 25% of positive cases, the intensity was 3+, in 60% 2+ and in the other 15% 1+. The Mena intensity was higher in the microsatellite stable tumors (MSS) and was correlated with vascular invasion, with intensity of angiogenesis marked with CD31 and CD105 and with c-erbB-2 and p53 expression. This is the first study in the literature about Mena expression in colorectal lesions.
Keywords: colorectal carcinomas, Mena immunostain, microsatellite instability, angiogenesis.
Abstract. Interstitial cells of Cajal (ICC) are pacemakers that generate electric waves recorded from the gut and are important for intestinal motility. The aim of the study was to evaluate the distribution of interstitial cells of Cajal in colon specimens from patients with idiopathic chronic pseudo-obstruction and other non-tumoral colon disorders as compared with samples from normal colon. The distribution pattern of ICC in the normal and pathological human colon was evaluated by immunohistochemistry using antibodies for CD117, CD34, and S-100. In two cases with intestinal chronic idiopathic pseudo-obstruction we found a diffuse or focal reducing number of Cajal cells, the loss of immunoreactivity for CD117 being correlated with loss of immunoreactivity for CD34 marker. Our study revealed that the number of interstitial cells of Cajal also decrease in colonic diverticular disease and Crohn disease (p<0.05), whereas the number of enteric neurones appears to be normal. These findings might explain some of the large bowel motor abnormalities known to occur in these disorders. Interstitial Cajal cells may play an important role in pathogenesis and staining for CD117 on transmural intestinal surgical biopsies could allow a more extensive diagnosis in evaluation of chronic intestinal pseudo-obstruction.
Keywords: Cajal interstitial cells, bowel motility, CD117.
Abstract. Introduction: Hodgkin's lymphoma study by immunohistochemical expression of Bcl-2 in Hodgkin and Reed-Sternberg cells can precise these cases evolutive way. Material and methods: Sixty-three cases of classical Hodgkin's disease, hospitalized into the Hematology Department of the No. 1 Emergency County Hospital Timisoara, were studied. Histopathological diagnostic was performed using common staining methods, and for revealing the tumoral developments immunohistochemical staining was performed Bcl-2. Results and discussion: In our study, the results were noticed a direct relation between the rise of tumoral proliferation index expressions of Bcl-2 and progression of the disease (p<=0.001). For I and II stages Bcl-2 expression does not overcome (-/+) category while the III and IV stages, all the cases are situated in (+/-) and (+) categories. No connection we can be noticed between the histological type and Bcl-2 expression although the classic Hodgkin's lymphoma with lymphocyte depletion is considered the most aggressive histological type (p<=1). In our study, we found this correlation very important because the main cause of relapses is inadequate staging. In some cases, this staging is difficult; some little lymph nodes could be overlooked because they can be placed in less accessible areas and cannot be evidenced by the most imagistic methods. Conclusions: All the cases were Bcl-2 expression higher than (+/-) and are staged as I and II stages should be reinvestigated and restaged. This immunohistochemical reaction, although less used in Romania, is very accurate. That is very important because the therapeutically attitude is different in advances stages compared to earlier stages.
Keywords: Bcl-2, Hodgkin's lymphoma, clinical stage.
Abstract. Colorectal cancer is one of the most frequent malignant diseases with a raising incidence in Romania. Survival at 5-years even was improved in the last decade, remains low especially because of delayed diagnosis. Many clinical-biological and pathological factors have demonstrate a good prognostic value over the time but there are not a wide consensus in this field. The aim of our study is to evaluate the accepted pathological prognostic factors of survival for colorectal cancer in relation to management adopted in a general surgical clinic. We included in our study 273 patients with colon and rectal cancers admitted in Surgical Clinic of Military Hospital of Craiova in which we evaluate the clinical-pathological features, location of the distant metastasis, postoperative staging, curability and survival. We established correlations, inside of a same stage of the disease, for pathological features (characters of the tumors, differentiation grade and location) and survival rate. Our results showed that curative resection is one of the most important factors that could improve survival. Tumor differentiation is correlated with survival only for the patients with stage II and III of the disease, perineural invasion and pathologic N stage representing important predicting factors for a shorter survival. Peritoneal washing for cytology prior to surgery is correlated with the stage of the disease and not with tumor differentiation.
Keywords: colon and rectal cancer, histopathological predictors.
Abstract. Introduction: The mechanisms by which COX-2 contributes to the carcinogenesis are not known until present. It seems that the COX-2 enzyme stimulates the cell proliferation, inhibits the apoptosis, increases the malignant cells' invasiveness and induces the angiogenesis by elaborating some angiogenic factors. Material and methods: In the present study, we intend to evaluate the immunohistochemical expression of COX-2 in gastric carcinomas, keeping track of the correlations between the clinicopathologic factors, the tumor angiogenesis (evaluated by microvascular density - MVD - determination and by VEGF expression) and the patients' survival. In addition, we have tracked the immunoreactions' positivation in the peritumoral mucosa with various lesions, with the purpose to establish the contribution of COX-2 to the gastric carcinogenesis during the pre-invasive stages. A prospective study was realized, regarding the evolution and aggressiveness of the gastric cancer, with a duration of five years, 61 patients operated of gastric cancer being included. Results: The COX-2 immunoreactions have been significantly more frequent noticed in the gastric carcinomas included in the study (57.4%) and in the epithelial dysplasia areas adjacent to the carcinomas of intestinal type (35.5% of the cases), than in the normal peritumoral mucosa (4.9%) (p<0.001 ES). The COX-2 immunoreactions have turned positive more frequently in gastric carcinomas of intestinal type (68.4%), in comparison to the carcinomas of diffuse type (29.4%) (p<0.001 ES). The COX-2 expression is significantly correlated with the invasion level, the presence of the metastases in the regional lymph nodes and the pTNM stage, but without influencing the prognosis of the gastric cancer patients. The negative VEGF carcinomas have turned positive for COX-2 only for 19% of the cases. Different from those, the positive VEGF carcinomas have associated COX-2 immunoreactivity in 77.5% of the cases. Conclusions: The results obtained are suggestive for the predominant expression of COX-2 in the carcinomas of intestinal type and its precursory lesions. Our results show a tight correlation between the immunohistochemical expressions of COX-2 and VEGF in gastric carcinomas (r = 0.562, p<0.001 ES) and also a MVD average value significantly higher in the positive COX-2 carcinomas, suggesting an intense angiogenesis activity in that group of tumors (p<0.001 ES).
Keywords: COX-2, gastric cancer, tumor angiogenesis, survival.
Abstract. Objectives: Chronic tonsillitis represents the most common inflammatory lesions of the pharynx determining numerous local or distant evolutive complications. We decided to study the histological and especially immunohistochemical expression of this pathology. Material and methods: We have studied 112 surgical samples representing tonsils resected from 56 patients with chronic tonsillitis. The tonsillectomies were performed in the ENT Clinic of the Emergency County Hospital of Craiova, between 01.01.2007-31.12.2007. The processed histological samples were stained using Hematoxylin-Eosin, light green trichromic and argental impregnation. For the immunohistochemical study, we used LSAB method with CD20, CD45 RO, CD68 antibodies in order to reveal and differentiate T- and B-lymphocytes and also the macrophages. Results: In all samples, we found hyperplasia and hypertrophy of the lymphoid follicle with excessive developing of the clear germinal center as a normal reaction to antigens presence. In some cases, we remarked micro hemorrhages and hematic extravasations inside the follicles, probably due to the excessive virulence of the pathogens causing endothelial lesions. The conjunctive stroma was enriched in collagen fibbers, in some cases organized in strong fascicles with an obvious tendency to divide the tonsils in lobules. The young fibroblastic type cells were numerous. The specific reticulin fibbers had a low representation being disorganized. The immunohistochemical study proved that the clear center of the lymphoid follicles was occupied by B-lymphocytes, but the T-lymphocytes were present in the cortical region of the follicles, perifollicles and in the surface epithelium. Conclusions: In some pathological cases, the predominant cellular population of the clear center was formed by T-lymphocytes.
Keywords: chronic tonsillitis, immunohistochemistry, tonsil's hypertrophy.
Abstract. Establishing the newborn and fetus age by taking into account of cervical vertebral bony parts dimensions is useful in anthropology and anthropometry as well. In the present study, we tried to determine some morphometric indices of fifth bony part's cervical vertebral arch in both fetus and newborn. We analyzed their correlation with the age of the subjects studied. We used a set of five newborn and five fetuses of six-seven months. We removed the fifth right cervical vertebral hemiarch from each subject. Images of vertebral bony parts hemiarches were acquisitioned, processed and measured by a morphometric Lucia M specialized soft. We measured the bony parts surface area, we traced the hemiarch frame triangle, and we measured the angles, the sides and the frame-triangle surface area, for each hemiarch. By analyzing the data we succeeded in revealing that the ratio between the anteromedial angle value and the opposite side length of that angle correlates to the fetus and newborn ages. Therefore, we consider this ratio as being an anthropometric index useful in deciding upon the fetus and newborn age.
Keywords: fetus, newborn, cervical vertebra, morphometry.
Abstract. Schwannomas of the lip are rare, benign neoplasms which vary in size. The diagnosis is typically made at the time of surgery following biopsy and surgical resection is the mainstay of treatment. We present one case of lip schwannoma: the patient was 25-year-old and he has presented to otorhinolaryngologist for a non-dolorous tumor on the mucosal side of his inferior lip, which was increasing in size for the last six months. The tumor had a superficial ulceration and infection. Initially it was suspected to be a papilloma. The tumor was radically removed, and the sections were stained with Hematoxylin-Eosin. The tumor was encapsulated and showed two different pattern of growth. Antoni A areas displayed spindle cells closely packed together with palisading of nuclei. Verocay bodies, which were presented in Antoni A areas, are whorled formations of palisading tumor cells. The cells of neoplasm were monotone. Only few spindle cells were moderately pleomorphic, but mitotic figures were unusual. In addition, immunohistochemical labeling was performed for S-100 protein, vimentin, GFAP and NSE and confirmed the diagnosis. This report describes a case of lip schwannoma, which was correctly diagnosed by routine staining and confirmed by immunohistochemical staining for S-100 protein, vimentin, GFAP and NSE.
Keywords: schwannoma, neurilemmomas, neurinoma, immunohistochemistry, S-100, vimentin.
Abstract. Dissection of a 65-year-old male cadaver revealed bilateral anomalous facial artery. The right facial artery taking origin from the external carotid artery did not make any loop in the submandibular region, entered the face by winding round the lower border of mandible, and terminated as the inferior labial artery. The upper part of the right side face in this case was supplied by various branches of transverse facial artery, infra orbital artery and dorsal nasal artery. The origin, course and branching pattern of the left facial artery was normal except the inferior labial artery was missing from it. The venous drainage of the face was normal on both sides. This case may provide useful information for clinical applications in different fields of oral and maxillofacial surgery.
Keywords: facial artery, external carotid artery, inferior labial artery.
Abstract. Ganglioglioma with a glioblastomatous component and high-grade atypia of neuronal cells are extremely rare findings. In this paper, we report the case of a 60-year-old man who presented with a tumor of the left temporal lobe. Hematoxylin-Eosin stained slides revealed a complex tumor with features of glioblastoma and marked atypia of neuronal cells. Glial cells were highlightened by antibodies to GFAP and neuronal cells by chromogranin and synaptophysin markers. There was an accumulation of p53-positive cells. There was a high Ki-67 labelling index (19%).
Keywords: ganglioglioma, glioblastomatous component, neuronal atypia.
Abstract. We present a case of an anomalous accessory iliacus muscle in the iliac fossa which gets originated from the iliac crest and inserting along with iliopsoas, and appear to compress the L4 root of femoral nerve. During the routine dissection of a male cadaver aged 58 years, we found an accessory iliacus muscle. The L2 and L3 nerve roots joined the L4 root distal to the accessory iliacus muscle. The L4 root of the femoral nerve supplied accessory iliacus muscle. Accessory iliacus muscle might cause tension on the femoral nerve resulting in referred pain to the hip and knee joints and to the lumbar dermatome L4. The clinical significance of this variant muscle and its importance in the femoral nerve entrapment has been discussed.
Keywords: accessory iliacus, femoral nerve entrapment, muscular variations, iliopsoas muscle.
Abstract. During routine cadaveric dissection, we encountered multiple muscular anomalies in a 58-year-old embalmed male cadaver. All the variations were encountered on the flexor compartment of right upper limb. The anomalies include an axillary arch (Aa) in the axilla, a third head of biceps brachii (Thb) in the arm, a reverse palmaris longus (Rpl) and a Gantzer's muscle (Gm) in the forearm and an unusually large palmaris brevis muscle (Pbm) in the palm. Anatomical description is achieved by measuring the length, width and attachments of the above-mentioned variants. The morphological and clinical significance of the anomalous muscles are discussed.
Keywords: anomalous muscles, axillary arch, third head of biceps brachii, reverse palmaris longus, palmaris brevis.
Abstract. We report an unusual case of carpal coalition between trapezium and trapezoid in a 54-year-old man who was diagnosed after a pain in left wrist following a night's sleep. The patient was otherwise asymptomatic.
Keywords: congenital fusion, trapezium, trapezoid.
Abstract. An abnormal communication between an artery and a vein is known as arteriovenous malformation (AVM) or arteriovenous fistula (AVF). The AVM or the AVF might be congenital in origin or even acquired. The arteriovenous communications are usually surgically made in patients undergoing repeated hemodialysis, while suffering from any chronic renal disease. The abnormal arteriovenous communications may be asymptomatic in nature. The arteriovenous communications might be an incidental finding during any anatomical dissections or medico-legal autopsies. The present study reports the presence of BBC on both sides of a 54-year-old male cadaver who died of road traffic accident. There was a communication between the brachial artery and the brachial vein, 11.5 cm above the medial epicondyle. The oblique communicating channel measured 1.5 cm in length and connected the brachial artery to the brachial vein. A detailed histological study of the communication showed the presence of thick tunica media. Knowledge of arteriovenous communications may be beneficial for any academic studies and equally important for vascular surgeons and radiologists performing angiographic studies.
Keywords: arm, anatomy, brachial, artery, vein, arteriovenous malformation, arteriovenous fistula.