Turkish Journal of Pathology - 2015; 31(1)

The Determination of Normal Percentages of Syncytiotrophoblastic Knots in Various Regions of Placenta: Where to Count the Syncytial Knots

2015-01-01

Objective: The marginal, basal and subchorial regions of the placenta are considered to be more hypoxic than other regions. Therefore, it is not recommended to determine the increase in syncytiotrophoblast knots, based on the major morphological change in placental hypoxia, from the samples taken from these regions. However, the normal count of knots at various regions of placenta is not investigated. Material and Method: In this study we have sampled morphologically and clinically normal placenta with eccentric cord insertion from various sites, either close to cord entrance or away from it (marginal, non-marginal basal, non-marginal subchorial, and nonmarginal midparanchymal). The number of knots was calculated on a total of at least 100 villi for each placental sample. The normal amount of knots in different regions and comparison between them were investigated. Twenty-eight placentas with eccentric cord insertion were sampled in the same manner. Hot spots from the above mentioned regions were counted in a total of 100 villi. Results: No significant difference was found between the dual comparison of the mean percentages of different regions (p: 0.148). The variety of hypoxia in different regions of the placenta could not be demonstrated in this study. Conclusion: It is found that there is no difference in perfusion that can be morphologically demonstrated with increase in syncytiotrophoblast knot, between different regions of placenta.

Metastasis-Associated Protein 1 Expression in Oral Squamous Cell Carcinomas: Correlation with Metastasis and Angiogenesis

2015-01-01

Objective: Metastasis-associated protein 1 (MTA1) has been associated with poor prognosis in several carcinomas. Recent investigation has found that in different tumors, MTA1 protein significantly correlates with tumor angiogenesis, suggesting that MTA1 may be a possible angiogenesis-promoting molecule in malignant tumors. Thus, the current study was performed to determine the role of MTA1 protein in the biological behavior of oral squamous cell carcinoma and its relation with tumor angiogenesis. Material and Method: In this study, 44 oral squamous cell carcinomas and 15 normal epitheliums were reviewed by IHC staining for MTA1 and CD105. Results: Frequency of MTA1 expression in SCCs was recorded as 97.7%, which was significantly higher than that of the control group (33.3%). Mean percentage of MTA1 expression in oral squamous cell carcinomas was 76.88 � 25.33% which was significantly higher than that of the control group (22.81 �10.83). Our data showed a correlation between MTA1 expression with lymph node metastasis, tumor size and, stage. Evaluation of the correlation between MTA1 protein expression and micro vessel density showed that high micro vessel density was detected more frequently in tumors with MTA1 protein overexpression than in those without overexpression. Conclusion: In the present study, high expression of the MTA1 protein was seen in oral squamous cell carcinoma, and was closely associated with tumor progression and increased tumor angiogenesis. The findings may indicate that MTA1 protein has clinical potentials as a useful indicator of progressive phenotype, a promising prognostic predictor to identify patients with poor prognosis and may be a potential novel therapeutic target of anti-angiogenesis for patients with oral squamous cell carcinoma.

Diagnostic Power and Pitfalls of Intraoperative Consultation (Frozen Section) in Rhabdomyosarcoma

Olcay KURTULAN, Kemal K�SEMEHMETO�LU — 2015-01-01

Objective: Intraoperative consultation plays an important role in the management of soft tissue sarcomas, such as rhabdomyosarcoma. In this study, we aimed to draw attention to the important points during frozen section interpretation, and analyse the accuracy of frozen diagnosis in rhabdomyosarcoma patients. Material and Method: The cases, both diagnosed as rhabdomyosarcoma or followed with a history of rhabdomyosarcoma, and interpreted with intraoperative consultation (frozen section) between 2000 and 2013 were culled from pathology archives. The diagnoses were confirmed by desmin and myogenin, immunohistochemically. The frozen and final diagnoses were noted of 21 biopsy specimens of 19 patients. Sensitivity and specificity of intraoperative consultation were calculated regarding to the major diagnostic discrepancies leading to a change in surgical management of the patient, after exclusion of the cases deferred to paraffin section. Results: Of the evaluated 21 biopsy material, 3 (14%) were misdiagnosed: Of the 2 false negative embryonal rhabdomyosarcoma cases, sample was not representative of the tumor, and there was chemo/radiotherapy induced changes in the other case. In the only false positively diagnosed case with a known history of rhabdomyosarcoma, inflammatory cells were misinterpreted as small round cell neoplasm. In 5 (29%) of 21 biopsies, a frozen diagnosis could not be given, and the diagnosis was deferred. Six cases (29%) were evaluated with cytological squash or imprint preparation; none of the misdiagnosed cases was evaluated with adjunct cytological preparation. Six of 8 misdiagnosed or deferred biopsies showed morphological changes secondary to radiotherapy and/or chemotherapy. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 85%, 67%, 92% and 50%, respectively. Conclusion: Intraoperative consultation for rhabdomyosarcoma is a reliable tool with high sensitivity and fair specificity. Cases with treatment effect may lead to diagnostic difficulties, especially false negative results. Understanding the diagnostic algorithm of surgeon may prevent misdiagnosis of frozen specimen. Our results also emphasize the diagnostic role of intraoperative cytology as an adjunct to frozen section.

Clinico-Pathological Study to Evaluate Oral Lichen Planus for the Establishment of Clinical and Histopathological Diagnostic Criteria

Santhosh KUMAR S HIREMATH, Alka D KALE, Seema HALLIKERIMATH — 2015-01-01

Objective: Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. Material and Method: In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Out of the 100 cases, 50 were prospective and 50 were retrospective cases. Prospective cases were collected based on the clinical diagnosis of oral lichen planus and oral lichenoid lesion. Retrospective cases were collected based on the histopathological diagnosis of oral lichen planus. Both the clinical and histopathological analyses were performed based on a proposal for a set of modified diagnostic criteria of oral lichen planus and oral lichenoid lesion. A final diagnosis of oral lichen planus was made only after the correlation of the clinical diagnosis with the histopathological diagnosis. Results: The interobserver agreement among three observers for both prospective and retrospective cases in the final diagnosis of oral lichen planus was found to be “good” to “very good” indicating high reproducibility. However, the final diagnoses of true oral lichen planus after clinico-pathological correlation in prospective and retrospective study groups appeared to be 38.0% and 54.0% respectively. Conclusion: The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively.

CXCR-4 and COX-2 Expression in Basal Cell Carcinomas and Well-Differentiated Squamous Cell Carcinomas of the Skin; Their Relationship with Tumor Invasiveness and Histological Subtype

Oya Nermin S�VR�KOZ, Belk�z UYAR, Filiz DA�, Funda TA�LI, Salahattin M. SANAL — 2015-01-01

Objective: Both CXCR-4 and COX-2 are biological markers that play a significant role in several neoplastic processes. We explored the differences in expression of these markers in certain subtypes of basal cell carcinoma, and squamous cell carcinomas in general. Material and Method: In this study, we investigated the differences between 38 patients with basal cell carcinoma (nodular, infiltrative and micro-nodular subtypes) and 24 patients with well-differentiated squamous cell carcinomas with respect to their depth of invasion, tumor location, age, and CXCR-4 and COX-2 expression. Results: Statistically, we found no significant difference between squamous cell carcinomas and basal cell carcinoma in terms of CXCR-4 and COX-2 expression; however, the degree of marker expression became stronger with increasing depth of invasion in both tumors. The expression of both markers was also higher in infiltrative type basal cell carcinoma compared to all the other subtypes. The results were statistically significant (p<0.05). Additionally, a significantly positive correlation also existed between COX2 and CXCR4 expression (p < 0.05). Conclusion: The degree of expression of CXCR-4 and COX-2 is related to invasiveness in both malignancies; thus, infiltrative type of basal cell carcinoma displays the highest degree of CXCR-4 and COX-2 expression among all the subtypes. Furthermore, our results indicate that these two biological markers may both be involved in the process of carcinogenesis and require investigation with further molecular and genetic studies in larger series.

Rare Structural Chromosomal Abnormalities in Prenatal Diagnosis; Clinical and Cytogenetic Findings on 10125 Prenatal Cases

2015-01-01

Objective: The aim of this study was presentation of the ultrasonographic findings and perinatal autopsy of cases with rare chromosomal abnormalities. Material and Method: A total of 10125 prenatal cases over 17 years including 8731 amniocentesis, 973 chorionic villus sampling, and 421 fetal blood sampling cases were evaluated for prenatal cytogenetic diagnosis. Conventional cytogenetic studies, fluorescence in situ hybridization studies, and Array-CGH analysis techniques were used for genetic analysis. Results: A structural chromosomal abnormality was observed in 95 cases. The most frequently observed structural abnormalities were balanced translocations with a frequency of 53.7% (51 cases) followed by unbalanced translocations (16.8%), inversions (11.6%), supernumerary marker chromosomes (8.4%), duplications (4.2%), deletions and ring chromosomes (2.1%) and complex translocation (1.1%). Rare structural chromosomal abnormalities including de novo balanced translocations, unbalanced translocations, inversions, duplications, deletions, ring chromosomes, and supernumerary marker chromosomes were detected in 24 cases. Conclusion: The rate of rare chromosomal abnormalities varies from 2.4% (South East Ireland) to 12.9% (Northern England) in Europe with a total rate of 7.4/10 000 births. In our study, the overall rate of chromosomal abnormality in prenatal cytogenetic diagnosis was 3.7%, similar to South East Ireland. Ultrasonographic and perinatal autopsy findings of the cases with rare structural chromosomal abnormalities are important for proper genetic counseling for further similar cases.

The Impact of Growth Patterns of Retinoblastoma (Endophytic, Exophytic, and Mixed Patterns)

2015-01-01

Objective: To study the impact of the retinoblastoma growth pattern (endophytic vs. exophytic) on the clinical and pathological features after primary enucleation. Material and Method: A retrospective case series of 42 eyes of 41 patients who had pathologically confirmed retinoblastoma. The main outcome measures included demographics, laterality, international intraocular retinoblastoma (IIRC) group, vitreous seeding, neovascular glaucoma, choroid invasion, optic nerve invasion, metastasis, and survival. Results: The median age at diagnosis was 30 months. Nineteen (46%) patients were males, and 17(41%) patients had bilateral retinoblastomas. Eight (19%) eyes were IIRC group C, 20 (48%) eyes were IIRC group D, and 14 (33%) eyes were IIRC group E. Nineteen (45%) tumors were endophytic, 14 (33%) were exophytic, and 9 (21%) were mixed. Choroid invasion was seen in 4 (21%) of the endophytic tumors, 5 (36%) of the exophytic tumors, and 8 (89%) of the mixed tumors (p=0.025). A mixed growth pattern was associated with massive choroid invasion in 5 (56%) of eyes. Neovascular glaucoma was seen in 5 (56%) of the mixed tumors (p=0.0376). Vitreous seeds were seen in 6 (67%) of the mixed tumors (p=0.0448). Optic nerve invasion as well as patients' age at diagnosis, gender, and tumor laterality had no correlation with tumor growth pattern. At a median follow up of 36 months, no single case had metastasis or was dead. Conclusion: Exophytic tumors have higher risk of choroid invasion, while endophytic tumors have higher risk of vitreous seeding. The mixed tumor growth pattern is associated with more advanced IIRC group, more risk of neovascular glaucoma, and more risk of massive choroid invasion.

Vernix Caseosa Peritonitis: Report of Two Cases

2015-01-01

Vernix caseosa peritonitis is a rare complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Most cases occur after cesarean section. We discuss herein two patients, aged 33 and 29 years, who presented with vernix caseosa peritonitis seven to nine days after a cesarean delivery. Laparotomy was performed and it revealed neither uterine rupture nor other surgical emergencies, but cheesy exudates on the serosal surface of all viscera. Appendicectomy was performed. Histopathologic study revealed acute fibrinous serositis and a mixed cellular infiltrate, rich in neutrophils, around fetal desquamated anucleate squamous cells. Patients� recovery was complete. Clinical diagnosis of vernix caseosa peritonitis should be suspected in patients presenting post-cesarean section with an acute abdomen. Distinctive histopathologic findings allow making the correct diagnosis. Vigilant monitoring after diagnosis is essential as delayed morbidities may appear.

Primary Renal Rhabdomyosarcoma: A Case Report

Duygu G�REL, Bur�in TUNA, Kutsal Y�R�KO�LU, G�ven ASLAN — 2015-01-01

Renal sarcoma represents 1-3% of all renal malignant tumours. Primary rhabdomyosarcoma of the kidney is a rare and highly aggressive tumor in the adult population. Here, we report the case of a 50-year-old woman with a large rhabdomyosarcoma of the left kidney and associated adrenal cortical adenoma. Rhabdomyo sarcoma is a very rare tumor in adults but it needs to be considered in the differential diagnosis among undifferentiated malignant tumors.

Oral Focal Epithelial Hyperplasia: Report of Three Cases

2015-01-01

Focal epithelial hyperplasia or Heck's disease is an infrequent asymptomatic condition caused by human papillomavirus types 13 or 32 affecting the mucous membrane of the mouth and is commonly seen in young individuals. Firstly, it was described in Indians and Eskimos, but it exists in various populations. We present three cases of Heck's disease in an Afghan immigrant family group living in Iran that seem to have familial predominance. The disease was identified as oral focal epithelial hyperplasia on the basis of histopathologic and clinical findings. The lesions were reduced significantly after 4 months of good oral hygiene. Dentists should be familiar with the clinical manifestations of these types of lesions that affect the oral cavity. In fact, histopathologic assessment and clinical observation are necessary to establish the diagnosis.

Incidental Bladder Lipoma: A Case Report and Review of the Literature

2015-01-01

Conventional lipoma is the most common benign mesenchymal neoplasm in adults. However, bladder lipoma is a rare tumor. We report an incidental 0.5-cm, mucosal, bladder lipoma in a 75-year-old man, successfully treated with endoscopic excision. The tumor was found during the extension study of a high-grade urothelial carcinoma of the renal pelvis. A review of the published cases, including the present report, yielded a total of 16. Conclusions on this review are presented. The case is being reported because its rarity and to highlight the importance of complete workup to clarify associated disorders that may suggest extension of a malignant process.

Pleuropulmonary Blastoma: A Case Report

2015-01-01

Pleuropulmonary blastoma is rare embryonal tumor of infancy and early childhood and it often arises from lung and more rarely from the parietal pleura. We present this entity which has no systematic data associated with its incidence in order to discuss clinical, histopathological, immunohistochemical features and the differential diagnosis. A three-year-old boy presented with fever showed signs of upper respiratory tract infection. Radiological examination revealed a solid mass filling the right hemithorax. The patient underwent core needle biopsy, wedge biopsy and lobectomy. Biopsy and surgical material were examined histopathologically. The tumor was composed of predominantly solid areas consisting blastemal cells with spindle, polygonal and round nuclei in the myxoid stroma. Immunohistochemical staining of the tumor cells were positive with vimentin and desmin. MIB-1 labeling index was above 90%. Histological diagnosis was pleuropulmonary blastoma type 3. The surgically sampled adjacent diafragma was also infiltrated with the tumor. The patient was treated with chemotherapy and showed no signs of recurrence in the follow-up of 9 months. Pleuropulmonary blastoma is a very rare childhood cancer that needs to be kept in mind in the pathological differential diagnosis of thoracic tumors in the children.

Sinonasal-Type Haemangiopericytoma: A Case Report

Fazilet U�UR DUMAN, Semin AYHAN, Ayd�n ��SA�, G�rkem ESK��ZM�R, Serdar TARHAN — 2015-01-01

Sinonasal-type hemangiopericytomas, which comprise less than 0.5% of all sinonasal neoplasms, arise unilaterally in the nasal cavity as polypoid masses with a mean diameter of about 3 cm. A 34-year-old female patient was admitted due to nasal obstruction and epistaxis. A polypoid mass covered with intact mucosa that originated both from the right inferior concha and lateral nasal wall was detected by nasal endoscopy. The tumor, extending from the oropharynx to the nasopharynx, was measured as 3,5x3x2 cm. Although exhibiting characteristic histopathological features and typical clinical symptoms, this case with unexpected immunohistochemical findings can provide a viewpoint on the nature of this kind of tumors.

Placental Polyp - A Rare Case Report

2015-01-01

Placental polyp is the retained fragment of placental tissue after the parturition or abortion for indefinite period which forms a polypoidal mass in the uterus. It is predominantly composed of necrotic and hyalinized chorionic villi (ghost chorionic villi). We report a case of 26-year-old G2P2 woman presenting with vaginal bleeding. Her last pregnancy had occurred five years ago. Laboratory investigations revealed a positive urine pregnancy test and serum levels of beta-human chorionic gonadotrophin (β-hCG) was elevated. Ultrasonography revealed hyperechoic mass in uterine cavity. She underwent total abdominal hysterectomy and the pathological diagnosis was of a placental polyp.

CAMTA1 Immunostaining is not Useful in Differentiating Epithelioid Hemangioendothelioma from its Potential Mimickers

Viroj WIWANITKIT — 2015-01-01