Turkish Journal of Pathology - 2014; 30(1)

Atypical Teratoid Rhabdoid Tumor in Childhood, 15 Cases of a Single Institute Experience

Maysa AL-HUSSAINI, Noreen DISSI, Usama AL-JUMAILY, Maisa SWAIDAN — 2014-01-01

Objective: Atypical teratoid rhabdoid tumor is a rare neoplasm with a distinct cytogenetic profile that predominates in infancy. Many cases show predominance of small cells with scanty rhabdoid cells, making recognition of this tumor difficult. We aim at describing our experience with atypical teratoid rhabdoid tumor cases diagnosed over a 6-year period. Material and Method: Clinicopathologic features and immunohistochemical staining of atypical teratoid rhabdoid tumor cases diagnosed between 2006 and 2011 are presented. Results: Fifteen cases were identified including 9 males with a median age of 26 months. The most common presenting symptom was recurrent vomiting with a mean duration of 6 weeks. Nine cases (60%) were infratentorial and cerebrospinal fluid was positive in 2 cases (13.3%) at time of diagnosis. The median overall survival of the group was 9.5 months. All cases except one showed admixture of rhabdoid and/or small round blue cells in variable proportions. Only 5 out of fourteen referred cases (35.7%) were correctly diagnosed. Three cases showed unusual growth patterns. In 2 cases, nodular medulloblastoma-like growth pattern predominated, with loss of INI-1/BAF47 staining both within the nodules and the inter-nodular areas. The third case contained scattered individual and small groups of large cells with abundant acidophilic cytoplasm and eccentric nuclei, reminiscent of rhabdomyoblasts that were positive for GFAP and desmin, and retained nuclear staining for INI-1/BAF47, consistent with reactive gemistocytes. Conclusion: Pathologists should be aware of the various, and unusual histopathologic patterns of atypical teratoid rhabdoid tumor. INI-1/ BAF47 immunostain should be performed on all central nervous system embryonal tumors, especially in infants and young children.

Editorial

Alp USUB�T�N — 2014-01-01

Editorial

Alp USUB�T�N — 2014-01-01

The Diagnosis of Thoracic Malignant Mesothelioma: Practical Considerations and Recent Developments

Maxwell SMITH, Thomas COLBY — 2014-01-01

Pleural biopsies for the evaluation of malignant mesothelioma can be some of the most challenging cases faced by the practicing surgical pathologist. We review the epidemiology, clinical presentation, and imaging studies in patients with malignant mesothelioma, and then present a practical approach to the diagnosis using the cytologic features for malignancy and whether there is an epithelioid or spindled morphology; four main scenarios are discussed. The pertinent immunohistochemical work-up is reviewed for each scenario. Following this general overview, more unusual histologic patterns are compared and unusual presentations are discussed. Brief mention of grading systems for malignant mesothelioma and the use of electron microscopy and molecular studies is made. Practical considerations in the diagnosis of malignant mesothelioma are made throughout.

Abnormal Cervical Cytology Risk Factors in the Western Black Sea Region and the Importance of Health Insurance

2014-01-01

Objective: To evaluate the prevalence of abnormal cervical cytological findings in the Western Black Sea Region and investigate an association between socio-demographic risk factors and the presence of cytological abnormalities. Material and Method: The reports of 11,539 cervical smears diagnosed according to Bethesda System 2001 version in the Pathology Department between January 2011 and December 2012 were reviewed retrospectively from the hospital records and cytopathology reports. Repeated smear results, unsatisfactory smear results, patients with known gynecologic malignancy history, smear results of patients with hysterectomy and smear results of patients whose socio-demographic information could not be obtained were excluded from the evaluation. The results of 7,740 patients who met the criteria for the study were evaluated. Results: The prevalence of cervical cytological abnormalities was 1.8 % in general. The prevalence rates for atypical squamous cells with undetermined significance (ASC-US), atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells (AGC) were 1.16%, 0.11%, 0.29%, 0.15%, and 0.03% respectively. The prevalence of cytologically diagnosed cervical invasive neoplasia was 0.025%. Advanced age, low education level (primary school or less) and not having health insurance were found as to be risk factors for preinvasive and invasive lesions. Women who had a high school education and previously had a smear test had decreased risk for developing preinvasive and invasive lesions. Conclusion: This study shows prevalence of abnormal cervical cytology findings and associoted risk factors in the Western Black Sea Region of Turkey. The most important risk factor was identified as not having health insurance.

Are Mammaglobin and Gcdfp-15 Sensitive Markers for Diagnosis of Metastatic Basal-Like Triple Negative Breast Carcinomas?

Nasser RAKHSHAN�, Arash DARYAKAR — 2014-01-01

Objective: There are small studies on expression of mammaglobin and GCDFP-15 for detection of basal-like triple negative breast cancer. This type of cancer has shorter survival and higher mortality rate. There must be reliable markers for detecting this type of tumor especially in metastatic cases with unknown origin. Material and Method: In this study we assessed 66 paraffin blocks of breast cancers previously diagnosed as triple negative subtype in Mehr hospital (Tehran, Iran) by tissue microarray and immunohistochemistry technique for expression of mammaglobin and GCDFP-15. Results: GCDFP-15 was positive in 12 cases (18.2%) and the other 54 (81.8%) cases remained negative. Mammaglobin was positive only in 6 cases (9.1%) and the remaining 60 (90.9%) cases were negative. Conclusion: According to recent studies and our findings, there is no useful immunohistochemical marker for detection of breast source in cases of metastatic triple negative breast cancer with unknown origin and we must try hard to discover more accurate immunohistochemical markers for these highly metastatic breast cancers.

Well-Differentiated Pediatric Glial Neoplasms with Features of Oligodendroglioma, Angiocentric Glioma and Dysembryoplastic Neuroepithelial Tumors: A Morphological Diagnostic Challenge

Hande KESER, Michael BARNES, Gregory MOES, Han Sung LEE, Tar�k T�HAN — 2014-01-01

Objective: Oligodendrogliomas are rare in the pediatric population, and most oligodendroglioma-like tumors in this age group may belong to other entities. In addition, accurate diagnosis and grading of such lesions using criteria developed for adult oligodendrogliomas prove difficult, and often controversial. Material and Method: During a study of tumors previously diagnosed as pediatric oligodendroglioma, we identified four tumors displayed features of that resembled oligodendroglioma, angiocentric glioma and dysembryoplastic neuroepithelial tumor but could not be classified as either one of these entities. Ther clinical, histological and immunohistochemical features of these cases were investigated in this study. Results: Two male (both 9 years old) and two female (ages 4 years and 20 months) patients presented with new onset of seizures. All patients were treated surgically, and two required reoperation. Histologically, the tumors were well-differentiated glial neoplasms with focal angiocentric pattern, delicate vascularity, diffuse growth, infiltrative margins, cortical nodules, focal myxoid areas, and leptomeningeal extension. Immunohistochemical studies showed diffuse nuclear positivity with Olig-2 and GFAP antibodies, whereas staining with neuronal markers, EMA, p53, and IDH1 were negative. Fluorescent in-situ hybridization analysis demonstrated intact 1p/19q in all tumors, and there was no ultrastructural evidence of ependymal differentiation. All patients were alive with disease with a mean follow-up of 112 months. Conclusion: These four cases illustrate the morphological diversity of well-differentiated, oligodendroglioma-like glial neoplasms and the uncertainty in their classification among pediatric tumors.

Correlation of Survivin and MMP9 Expressions with Prognosis and Clinicopathological Parameters in Surface Epithelial Ovarian Carcinomas

2014-01-01

Objective: Pathological stage is the most important prognostic factor in ovarian carcinomas, and many studies have been carried out to predict prognosis. In our study, we searched the expression of survivin, which prevents apoptosis and matrix metalloproteinase-9 (MMP-9), which promotes the metastasis of the tumour by splitting up the basal membrane in primary epithelial ovarian carcinomas. We aimed to observe their effects on prognosis by comparing clinicopathological parameters. Material and Method: 60 cases diagnosed with epithelial ovarian carcinoma between 2003 and 2008 and treated and followed up at the oncology clinic were included in the study. 42 patients were serous, 11 endometrioid, 5 mixed type, 1 was clear cell and 1 was undifferentiated adenocarcinoma. Survivin and MMP-9 expression was evaluated in each tumour and assosication with clinicopathological parameters (age, tumour diameter, localisation, histological type of tumour, grade, stage, recurrence and metastasis) were searched and also overall survival and disease free of survival were evaluated. Results: Survivin was statistically insignificant within the clinicopathological parameters. The correlation between the tumour grade and the staining density of MMP-9 in epithelial cells (p=0.028) and the correlation between disease free of survival and MMP-9 expression in stromal cells (p=0.0326) was significant. When the stage was compered with clinocopathologic parameters; recurrence (p=0.005) and death rates (p<0.001) were significantly increased but overall survival (p=0.0269) was significantly decreased in advanced-stage patients. Conclusion: In the present study, the stage was found to be an important prognostic parameter in surface epithelial ovarian carcinomas and an association was found between MMP-9 stromal staining and survival.

Comparison of Cervical Cytological Screening Results Between Postmenopausal and Elderly Women

B�lent �AKMAK, Do�an Re�id K�SEO�LU — 2014-01-01

Objective: There is insufficient data on geriatric period cervical cytology screening in our country. The aim of this study was to compare the cervical cytological results among elderly women and women aged between 45-64 years. Material and Method: A comparison of cervical cytological results of 273 women aged over 65 years and 388 women aged between 45-64 years from January 2010 to June 2013 was performed for presence of cytological abnormalities. Adequacy was assessed according to the criteria of the 2001 Bethesda System. Cervical cytological abnormalities were classified as follows: atypical squamous cell of undetermined significance (ASCUS), cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SSC). Results: Overall, the prevalence of cytological abnormality was 3% and the prevalence of ASCUS, ASCH, LSIL, and HSIL was 1.8%, 0.3%, 0.6% and 0.3%, respectively. Cytological abnormalities were detected to be higher in the geriatric group in comparison to the postmenopausal group (%5.1 vs. %1.5) (p=0.008). ASCUS was detected to be 3.7% in the geriatric group and 0.5% in the postmenopausal group (p=0.005). There was no statistically significant difference between the groups in means of other cytological anomalies. The reactive inflammatory changes were detected more in the postmenopausal group and atrophic changes in the geriatric group (p<0.001). Conclusion: It should not be forgotten that although the cervical screening follow-up program is discontinued in elderly women, squamous intraepithelial lesions can still be encountered in this group even if the rate is low.

Prognostic Significance of Bcl-2, C-Myc, Survivin and Tumor Grade in Synovial Sarcoma

2014-01-01

Objective: We aimed to determine the prognostic value of bcl-2, c-myc and survivin in synovial sarcoma cases and to evaluate the relationship between the conventional morphological findings with prognosis. Material and Method: In this study, we evaluated 81 synovial sarcoma cases referred to our tertiary tumor center during a period of 20 years. We applied bcl-2, c-myc and survivin immunohistochemically and investigated the relationship with prognosis for those 65 cases with follow-up. The relationship between the conventional morphological findings (mitosis, necrosis, grade) with prognosis was also investigated. Results: Five-year disease free survival rate was 44% and ten-year progression free survival rate was 38%, reflecting the aggressive behavior of synovial sarcoma. Tumor grade (according to FNCLCC) was the most significant prognostic input in this study. We obtained a significant difference between grade II (40 cases) and grade III (24 cases) group regarding progression-free survival and overall survival (p<0.001 and p<0.001 respectively). Grade II was divided into two groups according to mitotic index and necrosis (grade IIa and IIb) and there was a significant difference between them regarding prognosis (p=0.013 for progression free survival, p=0.003 for overall survival). There was a significant relationship between bcl-2 negative plus focally weak positive cases (9 cases) and focally strong cases (21 cases) and diffuse strong cases (35 cases) (p=0.042 and p=0.016 respectively). There was a significant relation between c-myc negative cases (25 cases) and nuclear positive cases (17 cases) regarding overall survival (p=0.043) and between c-myc negative cases and cytoplasmic positive cases (23 cases) regarding progression free survival (p=0.05). The relation between survivin and prognosis was not significant. Conclusion: Tumor grade was the most significant prognostic parameter in this study. The grade IIa group (with less than 10 mitoses in 10 HPF, without necrosis) had a better prognosis than both the grade IIb and III groups. The grade IIb group was closer to grade III regarding the prognosis. Bcl-2 and c-myc (nuclear and/or cytoplasmic) immunohistochemical positivity had prognostic value but this finding has to be confirmed by large series.

Malignant Pilomatricoma: Two New Observations and Review of the Relevant Literature

Mohamed ALLAOUI, Elie HUBERT, Jean-Jacques MICHELS — 2014-01-01

Malignant pilomatricoma or pilomatrical carcinoma is a rare malignant hair follicle neoplasm. This tumor is locally aggressive with increased tendency to recur, but a low metastatic potential. Its histopathological diagnosis is difficult and based on a detailed evaluation of the infiltrative nature, the importance of the mummified and necrotic cell component, atypical mitoses, and perineural or vascular invasion. Surgical wide resection is the recommended treatment. It reduces the risk of focal recurrence by 50%. Here we report two new cases including one that occurred on a lesion initially diagnosed as benign pilomatricoma.

Seminoma Presenting as a Polypoid Bladder Mass: A Case Report

2014-01-01

We report a case of extragonadal seminoma presenting as a polypoid mass in the urinary bladder. The patient presented with two months history of hematuria. Evaluation by CT scan and cystoscopic examination revealed a polypoid mass in the base of the bladder. Biopsy of the mass revealed a classical type of seminoma. The diagnosis of seminoma was supported by strong immunostaining of the tumor cells for C-Kit and placental alkaline phosphatase. Thorough physical examination and radiologic imaging of other organ systems failed to reveal any other tumor. Both testes were found to be normal on examination and on ultrasound imaging. Patient responded well to chemotherapy. This case is unique because to the best of our knowledge there are no previously reported cases in the literature with seminoma presenting as a bladder mass.

Soft Tissue Giant Cell Tumor of Low Malignant Potential of the Neck: A Case Report and Review of the Literature

2014-01-01

Giant cell tumor of soft parts is a rare tumor that is clinically and histologically similar to giant cell tumor of the bone. We present a 53-year-old female with a giant cell tumor of low malignant potential arising from the neck. The clinicopathological features and the importance of immunohistochemistry in the differential diagnosis with other giant cell rich tumors was discussed.

A Giant Primary Sclerosing Lipogranuloma of the Scrotum

Sevdeg�l MUNGAN, Ersagun KARAG�ZEL, Celaleddin TURAN, Abdulkadir RE�S — 2014-01-01

Sclerosing lipogranuloma is a rare, benign disease that can affect several organs, particularly of genitourinary system in males. The majority of the cases are secondary to exogenous foreign bodies. The masses are composed of granulomatous tissue formed around an either exogenous or endogenous lipomatous substance. We describe a 47-year-old male patient who presented with a growing, painless scrotal mass on physical examination. The mass was in 20 cm diameter and the laboratory findings were in normal limits. Pathologic evaluation confirmed the diagnosis of scrotal sclerosing lipogranuloma. To the best of our knowledge, this is the biggest scrotal sclerosing lipogranuloma case in the literature. We aimed with this presentation to keep in mind this benign lesion and also to assist the algorithmic approach.

Cytohistopathological Correlation of a Case of Squamous Cell Carcinoma of Gallbladder with Lymph Node Metastasis

Indranil CHAKRABARTI, Amita GIRI, Nilanjana GHOSH — 2014-01-01

Primary carcinomas of the gallbladder are rare malignancies and adenocarcinoma is the more common subtype. Primary squamous cell carcinoma of the gallbladder has rarely been diagnosed by aspiration cytology. Here, we present a case of a 62-year old female patient suffering from abdominal complaints who underwent ultrasound-guided fine-needle aspiration cytology and was diagnosed as keratinizing squamous cell carcinoma of gallbladder. The diagnosis was confirmed on subsequent histopathological examination that also revealed metastasis in the cystic lymph node. Histogenesis and biological behavior of squamous cell carcinoma of gallbladder remains a matter of debate but the role of aspiration cytology in diagnosing these lesions cannot be undermined.

Analysis of High Risk Hpv Subtypes Associated with Cervical Intraepithelial Neoplasia: A Single Centre Retrospective Study in the Mediterranean Region of Turkey

Bet�l �NAL, Cem SEZER — 2014-01-01