Turkish Journal of Pathology - 2006; 22(3)

Nuclear morphometry associated with Gleason score in prostatic adenocarcinoma

Sibel BEKTA�, Banu DO�AN G�N, Burak BAHADIR, Ayd�n MUNGAN, ��kr� O�uz �ZDAMAR — 2006-09-01

Quantitative morphometric methods have been tried to develop objective grading system in prostatic adenocarcinoma. In this study morphometric analysis results of the prostatic adenocarcinoma were compared with the Gleason scores of 54 cases; 40 of them (74%) were prostate needle biopsy specimens and 14 (26%) were prostatectomy specimens. For each case, about 150 nuclei were included for the morphometric analysis. After transferring microscopic images to the computer, nuclear area, roundness factor, and form ellipse were automatically measured by an image analysis program. The relationship between Gleason score and these varieties were determined by using correlation analysis. Among all the specimens, Gleason score and mean nuclear areas showed significant moderate correlation (r:0.456, p=0.001). As the needle biopsy group concerned, strong correlation was determined between Gleason score and the mean nuclear area (r:0.752, p=0.001). As a result, in the prostatic adenocarcinoma, mean nuclear area assessment may support to evaluate pathologic status of the disease.

Differentiation in cutaneous adnexal tumors: Immunohistochemical study

Figen BARUT, Banu DO�AN G�N, Burak BAHADIR, ��kr� O�uz �ZDAMAR — 2006-09-01

Cutaneous adnexal neoplasms are rare tumors that display differentiation in different ways. The aim of this study is, to present embryonic developmental properties and to determine the way of differentiation of adnexal neoplasms by evaluating the immunohistochemical expression of various markers. Forty-seven cases with adnexal tumors enrolled in this study. Histopathologic groups of these 47 cases were: 15 (32%) hair follicle tumors, 11 (23.4%) sebaceous tumors, 8 (17%) apocrine tumors, and 13 (27.6%) eccrine tumors. CK5-6, CK6, CK7, CK8, CK10, CK19, GCDFP-15, carcinoembryonic antigen, epithelial membrane antigen and S100 protein expressions were examined by immunohistochemical methods. As a result of this immunohistochemical study it was concluded that the expression of CK5-6 and CK8 carries more importance than other markers in determining certain types of differentiation of hair follicle tumors. It was also determined that, epithelial membrane antigen expression is important for the diagnosis of sebaceous tumors and the markers like CK8, CK10 and carcinoembryonic antigen may aid for the same purpose as well. It was found that, GCDFP-15 as well as CK5-6 expressions are significant for apocrine tumors, and carcinoembryonic antigen reaction as well as CK8 positivity will aid in determining differentiation of eccrine tumors. The presence of similar CK6 expression in all kinds of adnexal tumors has demonstrated that this marker is useless in differential diagnosis.

Synovial sarcoma: Clinicopathologic evaluation of 82 cases

Taner AKALIN, Ye�im ERTAN, G�rdeniz SER�N, G�l�en KAND�LO�LU — 2006-09-01

The current retrospective study examined a relatively large group of synovial sarcoma patients of all ages who were evaluated at a single institution over a 21 year period. There were 42 females and 40 males, whose age ranged from 13 to 75 (median 34 years). The neoplasms measured from 1,5 to 24 cm in greatest diameter (median 8,5 cm). Tumor locations were as follows; lower extremities (53 cases), upper extremities (16 cases), trunk (7 cases) and head-neck (3 cases). One hundred thirty six material belonging to 82 cases were evaluated histologically. Of these cases, 58 were monophasic fibrous type, 18 were biphasic type and 6 were poorly differentiated type synovial sarcoma. Immunohistochemically, monophasic fibrous type and poorly differentiated type synovial sarcoma cases (64 cases) were positive for EMA or cytokeratin. Of these cases, 14 were EMA positive but cytokeratin negative, however six were cytokeratin positive but EMA negative. Follow up was available for 43 patients with a duration of median 47 months. Of the 43 patients, 12 died of disease, nine had metastatic disease, nine had local reccurence and 13 (30%) had no evidence of disease. In conclusion, synovial sarcoma is an aggressive neoplasm and is affected from radiochemotherapy in varying proportions. Most of the synovial sarcoma cases can be diagnosed by the help of morphology and immunohistochemistry (by applying both EMA and cytokeratin).

HPV-DNA testing and Ki-67 immunocytochemistry in liquid based cervical cytology in prostitute women

Esin AT�K, Bar�� OTLU, Meryem �ET�N, Devrim TOK, R�za DURMAZ — 2006-09-01

HPV causes several changes in the function of host genes, and these interactions cause deregulation of the cell cycle manifested by abnormal expression of cell cycle associated proteins, such as Ki-67. The detection of Ki-67 can play a role in screening and diagnosis of HPV infection with risk of progression towards dysplasia and carcinoma. To show this relation in prostitute women, cervical cells were collected in the PapSpin Collection Fluid. A starting volume of 1000 �l for each sample, and a 200 �l cell suspension were used to prepare each sample for thin layer liquid based cytology and then they were stained by Papanicolaou method. The cytological results were classified according to the Bethesda 2001 system. From the remaining cell suspension of 800 �l, a 400 �l sample was used for HPV-DNA detection by PCR, a 50 �l alliquot was used to make thin layer preparations for immunocytochemistry. Single antigen staining was performed with Ki-67 protein. Cells were considered immunopositive if the nuclei were stained. All cells in one high power field (x400) were counted, and the fraction of immunopositive cells on the slide was calculated. This fraction was expressed as the number of positive cells per 1000 cells to facilitate comparisons of differential cell counts. HPV types 6 and 32 in the study, and HPV types 6 and 51 in the control group were detected. The mean Ki-67 values were 2.7�1.2 and 3.6�4.1 in HPV positive and negative cases respectively. There was a positive correlation only with nuclear changes and HPV positivity (x² =28.8, p<0.001). There was not any significant correlation between HPV or Ki-67 and leukocytosis. An association with HPV and contraception, smoking, and concurrent genital infection was not found. The prevalence of HPV types in different geographical locations and races may indicate different etiologies of cervical cancer. Our results suggest that Ki-67 immunocytochemistry is not useful as a surrogate marker for HPV types of 6, 32 and 51.

p53 mutation and the presence of the human papilloma virus in pterygium: PCR and immunohistochemical investigation

2006-09-01

Pterygium is a pathological lesion of bulbar conjunctiva extending to the center of the cornea. There are a lot of agents that have been accused in etiology of pterygium, such as chemical and physical factors, human papilloma virus infection and p53 gene mutation. Human papilloma virus in pterygium was firstly demonstrated by Varinli et al in 1994. Researchers thought that human papilloma virus infection caused p53 gene mutation in the epithelium of conjunctiva and this damage led to uncontrolled cell proliferation which formed pterygium. In this study, p53 mutation and the presence of the human papilloma virus infection in primary and recurrent pterygium were investigated. The p53 tumor suppressor gene mutation was demonstrated by immunohistochemistry, and presence of HPV infection, while HPV-16 and HPV-18 were investigated by polymerase chain reaction method. The p53 tumor suppressor gene mutation was found in 64 (88.8%) of the samples (58 primary, and 6 recurrent pterygium). Human papilloma virus was found in 26 primary, and 2 recurrent pterygium cases (38.9%). Four human papilloma virus positive samples out of 28 were determined as HPV-18, and 8 as HPV-16. Consequently, it has been assumed that HPV and p53 gene mutation play important roles in the etiopathogenesis of pterygium. Patients should be carefully followed-up for recurrences and developing malignancies secondary to human papilloma virus infection.

p53 and bcl-2 expression in testicular germ cell tumors

2006-09-01

To investigate the association between p53 and bcl-2 expressions and morphological and biological features of testicular germ cell tumours, tissue slides from 49 orchiectomy specimens diagnosed as testicular germ cell tumors between 1986-2002 in the Department of Pathology, Ondokuz Mayis University Faculty of Medicine were retrospectively analysed and classified. The p53 and bcl-2 expression were demonstrated immunohistochemically and the intensity of staining was graded semiquantitatively from (+) to (++++). The p53 expression was seen in 24 of 28 (86%) seminoma cases and 12 of 16 (75%) nonseminomatous germ cell tumours. Bcl-2 expression was seen in 2 of 28 (7%) seminoma and 7 of the 16 (44%) nonseminomatous germ cell tumour cases. To explain the role of p53 expression detected in 86% of seminomas and 75% of nonseminomatous germ cell tumours and bcl-2 positivity observed in 44% of nonseminomatous germ cell tumors in the development and prognosis of these testicular tumours, large scale studies with long term follow-up periods are needed.

The identification of mixed pathology laboratory samples by DNA analysis

Ay�im TU�, C�neyt ELMA — 2006-09-01

Formalin-fixed, and paraffin embedded biopsy samples can be useful sources for DNA analysis. In two cases, two tissue specimens taken from patients during total thyroidectomy operations were sent to pathology laboratory in accordance with the routine application. However, from pathology laboratory, results of the three samples belonging to the same patient were reported. Nodular goitre in two, and papillary carcinoma in one sample were diagnosed. Due to the difference of therapies to be applied, genetic matching between tissue samples sent and the patient had been claimed for the determination of whether all the samples do belong to the same patient or not. For each case totally six tissue samples, fixed in formalin (n=3) and embedded in paraffin (n=3) were sent to the DNA laboratory of the department of forensic sciences. When DNA profiles of blood samples and tissue specimens taken from patients were compared, all samples matched perfectly with respect to 16 analyzed genetic loci, and thus it was concluded that the specimens were unmistakably belonged to the respective biopsied patients. Analyses were completed within three days and the results were sent to the related clinics.

Primary gastric choriocarcinoma: A case report

Kemal DEN�Z, Arzu TA�DEM�R, Tahir Ercan PATIRO�LU — 2006-09-01

Primary gastric choriocarcinoma is a highly malignant and very rare tumor. A 44-year-old man was referred to our hospital, with a diagnosis of gastric adenocarcinoma made by histologic examination of the endoscopic biopsies in an other medical center. The patient underwent total gastrectomy and omentectomy. Histological examination of the gastrectomy specimen revealed gastric choriocarcinoma. Postoperative chemoteraphy was performed and the patient died of disease 4 months after operation.

Breast carcinoma metastatic to nasopharynx

2006-09-01

Metastatic breast carcinoma has been described at numerous sites in the head and neck region. Here, we report a case of a 56 year old female patient with invasive ductal carcinoma metastasizing to the nasopharynx. The patient presented initially with liver metastasis followed by metastasis to the nasopharynx. This is the second documented and first proved case of metastatic breast carcinoma to the nasopharynx.

Concomitance of primary insular carcinoid developing in mature cystic teratoma of the ovary and endometrial papillary serous carcinoma

Ayten L�VAO�LU, M. Banu YILMAZ, Ay�im �ZA�ARI, Fevziye KABUK�UO�LU — 2006-09-01

The primary ovarian carcinoid tumor is rare and must be differentiated from metastatic carcinoid tumors. Uterine serous papillary carcinoma is a highly aggressive type of endometrial carcinoma. A 70 year old patient referred to the clinic with the complaint of postmenapousal bleeding. Endometrial biopsy was performed and papillary serous carcinoma was diagnosed. Total hysterectomy and bilateral salpingoopherectomy was performed. Beside the tumor in the uterine cavity, the left ovary was 6x4,5x4 cm in size and had a multiloculated cystic appearance with a mural nodule 1,5 cm in diameter. With histopathologic examination, concomitance of insular carcinoid tumor developing in ovarian mature cystic teratoma and endometrial papillary serous carcinoma was found to be interesting and presented.