Turkish Journal of Pathology - 2015; 31(3)

Expression of p63, TTF–1 and Maspin in Non-Small Cell Lung Carcinoma and Their Effect on the Prognosis and Differential Diagnosis

Banu YAMAN, Deniz NART, Pervin KORKMAZ EKREN, G�rsel �OK, Ali VERAL — 2015-09-01

Objective: Lung cancer is still the leading cause of cancer mortality. Antiapoptotic genes and protease inhibitors play an important role in the development of lung cancer. Material and Method: p63, TTF-1 and maspin expression and their role in the differential diagnosis, overall survival, progression-free survival and other clinicopathological characteristics of the patients were investigated in 80 surgically-resected non-small cell lung carcinomas. Results: The maximal tumor diameter range was 1.5–11 cm (mean: 4.06�1.8 cm). Forty-five (56.3%) tumors were adenocarcinoma, 23 (28.8%) squamous cell carcinoma, four (5%) large cell carcinoma, six (7.5%) large cell neuroendocrine carcinoma, one (1.2%) sarcomatoid carcinoma while one was (1.2%) both adenocarcinoma and squamous cell carcinoma. The patients with advanced TNM stage and a tumor diameter more than 3 cm had markedly poor survival. Immunohistochemically, p63 staining was present in 87.5% of squamous cell carcinomas, 4.3% of adenocarcinomas, 25% of large cell carcinomas, and 16.7% of large cell neuroendocrine carcinomas. Similarly, maspin was positive in 66.7% of squamous cell carcinomas and 17.4% of adenocarcinomas. The TTF–1 staining rate was higher in adenocarcinomas (84.8%). There was no immunoreactivity in squamous cell carcinomas (p<0.001). We found that p63 and TTF–1 had no significant effect on survival in either tumor group (p>0.05) while maspin has a negative prognostic effect in adenocarcinoma (p=0.048). Conclusion: This study suggests that p63 and TTF–1 are reliable markers in non-small cell lung carcinoma and can be used in differential diagnosis. Maspin has been identified as a prognostic marker in adenocarcinoma. However, more studies are required to elucidate the significance of maspin.

Transition to Virtual Microscopy in Medical Undergraduate Pathology Education: First Experience of Turkey in Dokuz Eyl�l University Hospital

2015-09-01

Objective: Pathology education includes an important visual part supporting a wide range of theoretical knowledge. However, the use of traditional microscopes in pathology education has declined over the last decade and there is a lack of interest for microscopy. Virtual microscopy, which was first described in 1985 and has experienced a revolution since 2000, is an alternative technique to conventional microscopy, in which microscopic slides are scanned to form digital images and stored in the web. The aim of this study was to evaluate the use of virtual microscopy in practical pathology sessions and its effects on our students and undergraduate education at our faculty. Material and Method: Second and third year medical students who were used to conventional microscopes were included in the study. The practical sessions were carried out via virtual slides and the effect of the new technique was investigated by a scale at the end of each session. Academic staff from the pathology department joined sessions to promote discussion and respond to questions. Student ratings were analysed statistically. Results: The evaluation of the ratings showed that the students were easily adapted to the use of virtual microscopy. They found it user-friendly and thought that the opportunity of viewing slides at home was advantageous. Collaboration between students and interactive discussions was also improved with this technique. Conclusion: It was concluded that the use of virtual microscopy could contribute to the pathology education of our students.

The Role of Frozen-Section in the Surgical Management of Patients with Endometrial Intraepithelial Neoplasia

Mehmet Co�kun SALMAN, Derman BA�ARAN, Alp USUB�T�N, Nejat �ZG�L, Kunter Y�CE — 2015-09-01

Objective: Patients with endometrial intraepithelial neoplasia may have concurrent endometrial cancer if managed surgically or develop cancer in time if managed conservatively. Therefore, intraoperative assessment of the uterus may be helpful if a surgical approach is decided on. Our study aimed to investigate the role of frozen-section examination in patients with endometrial intraepithelial neoplasia. Material and Method: Patients with endometrial intraepithelial neoplasia who were subjected to hysterectomy with intraoperative frozen-section assessment were included. Main outcome measures were the rates of concurrent endometrial cancer and concurrent high-risk endometrial cancer as well as the efficacy of frozen-section in the detection of concurrent invasive disease and in the designation of low-risk and high-risk features. Results: The study group consisted of seventy-three patients. Permanent pathology revealed endometrial adenocarcinoma in 19.2% whereas only one patient (1.4%) had high-risk disease necessitating surgical staging. Frozen-section diagnoses were consistent with final pathology in 93.2% of patients in terms of the presence or absence of co-existent carcinoma. When frozen-section reports were further evaluated in terms of the presence or absence of high-risk endometrial carcinoma, consistency with the final pathology was seen in 98.6% of patients. Conclusion: Co-existent endometrial cancer is not uncommon in endometrial intraepithelial neoplasia. Intraoperative frozen-section evaluation should therefore be considered whenever possible. Frozen-section is effective in the detection of coexistent invasive disease and in the designation of low-risk features. Although coexistent high-risk cancer is extremely rare, frozen-section assessment is not successful in determining high-risk features. Therefore, a re-staging surgery may be required on rare occasions.

Significance of Morphometric Parameters in the Categorization of Breast Lesions on Cytology

2015-09-01

Objective: The aim of this study was to assess the utility of the morphometric parameters in cytological aspirates in the categorization of breast lesions. Material and Method: The study was carried out on 50 females presenting with a breast lump for fine needle aspiration cytology. Air-dried smears from the aspirate were stained with Leishman and Giemsa stains while alcohol-fixed preparations were stained with the PAP stain. They were subsequently categorized into benign, borderline and malignant categories on light microscopy. Morphometry was performed on the stained smears. The morphometric parameters studied were mean nuclear area, mean cytoplasmic area, perimeter and nuclear/cytoplasm ratio. Results: Morphometric parameters revealed a progressive and statistically significant increase in values from benign to borderline to malignant cases. On comparing benign with borderline and malignant, all the four parameters were found to be statistically significant with a p-value of less than 0.05 while on comparing borderline with malignant, two of the parameters, i.e. mean nuclear area and mean cytoplasmic area, were statistically significant. Conclusion: This study introduces morphometry as a highly objective tool to supplement the entirely subjective fine needle aspiration cytology in the crucial differentiation of benign from malignant lesions and especially the borderline cases in the gray zone comprising of atypical ductal hyperplasia and ductal carcinoma in situ.

Ocular Diseases Among Pathologists and Pathologists' Perceptions on Ocular Diseases: A Survey Study

Orkun AKMAN, Kemal K�SEMEHMETO�LU — 2015-09-01

Objective: The impact of visual disorders and color vision deficiency on the occupational life has been previously investigated by several studies. In this study, we aimed to evaluate the prevalence of visual disorders among Turkish pathologists and their perceptions on visual disorders. Material and Method: A survey composed of 14 questions about ocular diseases and perceptions to these diseases has been introduced to the volunteering pathologists or pathology residents, participating in the 23rd Congress of Pathology. Results: Ninety-three pathologists or pathology residents participated in the survey. Of the participants, 25 (26.9%) were residents, 30 (32.3%) were pathology specialists, and 36 (38.7%) were academicians. The mean duration for working as a pathologist was 15 years. The vast majority (%93.5) of the participants had at least one type of refractive error; the two most common disorders were myopia (77.0%) and astigmatism (64.4%). Sixty-four of the participants (68.8%) claimed an increase in their refractive error after working in the pathology department. Eyeglasses (56/87, 64.4%), contact lenses (14/87, 16.1%), or both (9/87, 10.3%) were used in order to correct the refractive error; however, only 31 of the participants (33.3%) preferred using eyeglasses during microscopy. While 65 participants (69.9%) never had conjunctivitis, 26 participants (28.0%) had at least one conjunctivitis attack. None of the participants claimed to be color blind. Conclusion: Conjunctivitis and refractive errors are quite prevalent among pathologists. Refractive errors were also found to increase during the pathology practice. Most of the pathologists do not consider visual disorders (mostly refractive errors) as a negative factor during their career decision making, except a color vision defect.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Skin and Superficial Soft Tissue Lesions: A Study of 510 Cases

Abhijit BHOWMIK, Mamata Guha MALLICK (SINHA), Dilip Chandra BARMAN — 2015-09-01

Objective: Diseases of the skin and superficial subcutaneous soft tissues present with a wide array of lesions ranging from nonspecific dermatoses and inflammatory lesions to frank neoplasms. Though cytopathology is an excellent diagnostic tool in routine dermatologic practice, studies relating to histopathological and cytological correlation are sparse. The aim of this study was to analyze the concordance rate between cytological and histopathological diagnosis of skin and superficial soft tissue lesions. Material and Method: We retrospectively studied 510 consecutive fine needle aspiration cytology findings of cases from North Bengal Medical College and Hospital and correlated their diagnoses based upon cytological and histopathological grounds. Results: Out of the 510 cases studied, 253 were non neoplastic lesions and 257 were neoplastic. A high degree of concordance was observed (100% for malignant and 96.15% for benign lesions) when these two diagnostic modalities were compared. Histopathological correlation was possible in all malignant, 52/189 (27.51%) of benign and 27/253 (10.67%) of non-neoplastic lesions. Sensitivity and specificity of diagnoses were 95.31% and 97.6%, respectively. Conclusion: It can be safely concluded that fine needle aspiration cytology is a rapid, reliable and fairly accurate tool for initial triage and treatment of skin and superficial soft tissue lesions.

Dedifferentiated Liposarcoma with Peculiar Meningothelial-Like Whorling and Metaplastic Bone Formation, Case Report

Duygu G�REL, Aydanur KARGI — 2015-09-01

Dedifferentiated liposarcoma represents a both morphologically and biologically fascinating lesion in which transition from low-grade to high-grade nonlipogenic morphology within a well-differentiated liposarcoma is observed. A peculiar form of dedifferentiated liposarcoma characterized by a nonlipogenic component with a meningothelial- like whorling pattern of growth and metaplastic bone formation has been described. A 59-year-old man presented with a pelvic retroperitoneal mass measuring 13x10x8 cm. Histopathologically the mass consisted almost entirely of a dedifferentiated nonlipogenic component with meningothelial-like whorling pattern, metaplastic cartilage and bone. Dedifferentiated liposarcoma with meningothelial- like whorling pattern has rarely been encountered. Here, we report this case because of the problems in differential diagnosis especially for cases that have an extensive dedifferentiated component and the uncertainty of the biological behavior of these tumors.

Symplastic Glomus Tumor

Fevziye KABUK�UO�LU, Hanife �ZKAYALAR, Damlanur SAKIZ, Yavuz KABUK�UO�LU — 2015-09-01

Glomus tumors showing nuclear pleomorphism without any other malignant features have been defined as symplastic glomus tumors. This type of glomus tumor is rarely encountered. Another case of symplastic glomus tumor is described in this study. A 37-year-old woman referred to the hospital with the complaint of a palpable tender nodule on the fourth finger tip of her left hand. The lesion had been present for about a year and aggravation of tenderness upon cold exposure was conspicuous. It was a 0.5 cm well circumscribed lesion with round to cuboidal epithelioid cells showing high grade nuclear pleomorphism. Nests of cells more uniform in shape and showing punched out nucleus representative of typical glomus tumor could also be observed. Immunohistochemical study showed expression of smooth muscle actin, caldesmon and vimentin. Ki-67 labeling index was undetectable. Investment of tumor cells was shown by type IV collagen. In contrast to its atypical cellular morphology, symplastic glomus tumor clinically behaves benign, and it is important to differentiate it from malignant glomus tumor as well as other primary or metastatic malignant tumors.

Synchronous Primary Endometrial Carcinoma and Metastatic Malignant Melanoma in an Ovarian Cystic Teratoma

Mine GEN�, Oya S�VR�KOZ, Berhan GEN�, Sefa KURT, Esin �EL�K — 2015-09-01

Malignant transformation of a benign cystic teratoma of the ovary is only rarely seen. A review of the English literature revealed no reports of a malignant melanoma developing from concurrent primary endometrial carcinoma and ovarian cystic teratoma. We report herein a 54-year-old nulliparous woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for a pelvic mass and was diagnosed by histopathological examination to have a malignant melanoma developing from concurrent primary endometrial carcinoma and ovarian cystic teratoma. No foci of primary malignant melanoma except for the ovary were found upon clinical examination. The patient received postoperative interferon alpha 2B and radiotherapy. She was still asymptomatic at 12 months of follow-up.

Primary Gastric Invasive Micropapillary Carcinoma: A Case Report

Enver VARDAR, Beng� G�NAY YARDIM, Rukiye VARDAR, Mustafa �LMEZ — 2015-09-01

Invasive micropapillary carcinoma is a recently identified neoplasm. A 77-year-old-female was admitted to the hospital due to progressive loss of weight and nausea. Endoscopic biopsy of the antral/prepyloric located mass was diagnosed as moderately differentiated adenocarcinoma. Subtotal gastrectomy and regional lymph node resection were performed. The tumor was composed of moderately differentiated cells arranged in micropapillary structures with only a few poorly formed glandular foci in lamina propria. Immunohistochemically, neoplastic cells of micropapillary and focal conventional adenocarcinoma areas were diffusely positive for pancytokeratin, cytokeratin 7 and epithelial membrane antigen. In micropapillary areas, membranous and peripheral cytoplasmic positivity with epithelial membrane antigen in outside of the cell clusters called “inside-out polarity” pattern that is characteristic for invasive micropapillary carcinoma were seen. Invasive micropapillary carcinoma is very rare in the stomach in the English literature.

Cutaneous Chromoblastomycosis Mimicking Tuberculosis Verrucosa Cutis: Look for Copper Pennies!

Arghya BANDYOPADHYAY, Kaushik MAJUMDAR, Mimi GANGOPADHYAY, Sabyasachi BANERJEE — 2015-09-01

Chromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin. Here in we report a case of chronic cutaneous Chromoblastomycosis in a middle aged woman from north eastern part of India, who was initially misdiagnosed as Tuberculosis verrucosa cutis. In histopathology characteristic brown colored spores of the fungus (also known as copper pennies) were seen within dermal abscess. The organism isolated from culture of the biopsy material was Fonsecaea pedrosoi thus confirming our diagnosis of cutaneous chromoblastomycosis. The patient responded well to oral Itraconazole. The dermatologists and pathologists should be aware of this condition especially when dealing with verrucous lesion of the skin. The pathologists should search for fungal spores in cutaneous lesion with pseudoepitheliomatous hyperplasia and dermal abscess.

M�llerianosis with Intestinal Metaplasia: A Case Report

2015-09-01

Mullerianosis or M�llerian choristomas are developmental alterations that consist of an organoid structure with normal M�llerian tissue. We present a 62-year-old patient diagnosed on ultrasound scanning and on CT scan of bilateral ovarian cysts. During surgery, a left ovarian cyst and retroperitoneal tumor (adhered to sigmoid serous surface) were found. On histological examination, the tumor corresponded with a M�llerian choristoma showing endometrial, endosalpingeal and endocervical epithelium, with foci of intestinal metaplasia, a phenomenon not described in the literature.

Molecular Biology for HPV Typing in Focal Epithelial Hyperplasia

2015-09-01