Analytical and Quantitative Cytopathology and Histopathology最新文献

Objective: To elucidate the role of toll-like receptor 2 (TLR2) in the pathogenesis of acne vulgaris through its immunohistochemical localization in inflammatory and noninflammatory lesions of this disease entity.

Study design: Using standard immunohistochemical techniques, we examined 30 acne cases (involved and noninvolved skin) and the normal skin biopsies of 30 sex- and age-matched, healthy subjects representing the control group.

Results: All examined cases showed positive TLR2 expression in epidermis, pilosebaceous units and dermal inflammatory infiltrate. There were statistically significant differences between acne-involved skin and normal skin and between acne-involved and noninvolved skin regarding TLR2 expression intensity in pilosebaceous units (p < 0.001 for both) and dermal inflammatory infiltrate (p < 0.001 for both). Intense TLR2 expression was in favor of inflammatory acne lesions in pilosebaceous units (p = 0.03) and dermal inflammatory infiltrate (p < 0.05). Intense TLR2 expression was also in favor of severe acne lesions in pilosebaceous units (p = 0.0002) and dermal inflammatory infiltrate (p = 0.001).

Conclusion: TLR2 is involved in the pathogenesis of inflammatory and noninflammatory acne lesions. This occurs through Propionibacterium acnes-mediated activation with the resultant release of inflammatory cytokines.

Objective: To describe the morphology of focal prostatic atrophy and propose a comprehensive histologic classification for a proper diagnostic recognition.

Study design: A broad immunohistochemical study was performed as an adjunct to its recognition as well as a contribution to pathogenesis.

Results: A morphologic continuum was seen on needle biopsies. Chronic inflammation was present only in complete atrophy. Immunohistochemical findings in partial atrophy are similar to normal acini. Luminal compartment in complete atrophy shows aberrant expression of 34betaE12 favoring an intermediate phenotype. ERG negativity in all variants of atrophy may have value in the identification of the lesion.

Conclusion: The morphologic findings favor a continuum probably partially preceding complete atrophy. Chronic inflammation may be a secondary phenomenon seen only in complete atrophy. Overexpression in complete atrophy of glutathione S-transferase pi relates to oxidative stress possibly related to chronic ischemia, of c-Met favors the concept that intermediate cells may be target for carcinogenesis, and of CD44 may be related to the recruitment of inflammatory cells.

While the prime goal of the needle biopsy is to diagnose prostatic adenocarcinoma (PCa), once PCa is detected further descriptive information regarding the type of cancer, amount of tumor, and grade in prostate needle cores forms the cornerstone for contemporary management of the patient and to assess the potential for local cure and the risk for distant metastasis. This review gives an update on selected pathology-related issues on routine workup of prostate biopsy with special references to adequate histologic sectioning necessary to maximize cancer yield, tumor extent measurements and methodologies, specimen orientation, and the role of immunohistochemistry in the evaluation of the prostate. Multiple factors influence the diagnostic yield of prostate biopsies. Many of these factors are fixed and uncontrollable. Other factors are controlled by the urologist, including number of cores obtained, method and location of biopsy, and amount of tissue obtained. The yield of cancer is also controlled by the pathologist and histotechnologist. It is necessary to report the number of cores submitted and the number of positive cores, thereby giving the fraction of positive cores. The percentage involvement by carcinoma with or without the linear extent of carcinoma of the single core with the greatest amount of tumor should also be provided. Using the marking technique, we can add a new pathological parameter: pathological orientation. Cancer or atypical lesions can be accurately located within the biopsy specimen and integrated to biopsy approach. Probably the most common use of immunohistochemistry in the evaluation of the prostate is for the identification of basal cells, which are absent with rare exception in adenocarcinoma of the prostate and in general positive in mimickers of prostate cancer. If a case is still considered atypical by a uropathology expert after negative basal cell staining, positive staining for alpha-methylacyl-CoA-racemase can help establish in 50% of these cases a definitive diagnosis of cancer.

Objective: To examine the efficiency of scanning electron microscopy (SEM) and atomic force microscopy (AFM) in investigating structural anomalies of thalassemic erythrocytes.

Study design: Erythrocytes or red blood cells (RBCs) separated from blood samples of 35 healthy and 42 thalassemic individuals were processed for SEM and AFM imaging, respectively. SEM images were taken after erythrocytes fixed on cover slips were coated with gold. Alterations in both 2D and 3D surface features of erythrocytes were examined with AFM in tapping mode. Fractal dimension was used to estimate erythrocytes surface roughness from SEM and AFM images.

Results: SEM and AFM images showed that healthy erythrocytes were uniform, exhibiting a typical circular and biconcave shape. Thalassemic erythrocytes were notably smaller and the central part was swollen, resulting in irregularity. In the case of SEM images it was observed that there was significant increase (p < 0.001) in roughness of thalassemic erythrocytes. Surface roughness parameters of thalassemic erythrocytes in AFM images were significantly higher (p < 0.001) as compared to healthy ones.

Conclusion: Surface characteristics of erythrocytes are important determinants for distinguishing thalassemic RBCs. Both SEM and AFM images revealed morphological deformities of thalassemic erythrocytes. AFM proved to be a powerful technique for topographical characterization of abnormal erythrocytes.

Background: Sarcomatoid urothelial cell carcinoma of the urinary tract has a poor prognosis. Most of the reported cases of sarcomatoid urothelial cell carcinomas are those from the urinary bladder. A limited number of these tumors originate from the ureter.

Case: We describe a ureteral sarcomatoid urothelial carcinoma in a 63-year-old man who underwent nephroureterectomy with bladder cuff. The malignant epithelial elements consisted of undifferentiated polygonal cells and areas of glandular formation. Urothelial carcinoma in situ was present in the overlying mucosa. The mesenchymal components were pleomorphic spindle cells and atypical chondrocytes within lacunae with multinucleation and mitoses. The tumor extended beyond the muscularis into the periureteral adipose tissue. The tumor recurred after 6 months in the retroperitoneum and presacral area. The patient received chemotherapy and radiotherapy but died 16 months after the initial diagnosis.

Conclusion: Sarcomatoid urothelial carcinoma of the ureter is uncommon. Even rarer is the presence of malignant heterologous elements such as chondrosarcoma. The case described here underscores the aggressive nature of these neoplasms.

Objective: To compare basal-like breast carcinoma (BLBC) gene expression profiles to normal mammary epithelium in order to determine the characteristic gene expression patterns associated with the tumor.

Study design: The gene expression profiles of 12 cases of BLBC were analyzed using a human mRNA genome expression profiling chip containing 48,804 probes in an attempt to characterize molecular mechanism involved in the carcinogenesis of BLBC.

Results: The identified 99 genes were upregulated more than fourfold fold-change (FC) value over their levels in normal mammary ductal epithelial cells, and 43 genes were downregulated to less than fivefold FC value compared to normal epithelial cells. Verification of selected genes by semiquantitative reverse transcription polymerase chain reaction was performed to confirm the expression data obtained by microarray analysis. Most of the abnormal expressed genes were related to DNA binding, transcription and its factor, cell receptors, cell signals and transmitted proteins, metabolism-related proteins, and protein synthesis-related genes.

Conclusion: The difference of gene expression profiles might be of benefit for selecting the relative genes of the basal-like carcinoma as the therapy target and to further the understanding of the development of BLBC.

Background: Osseous metaplasia within bladder cancer is extremely rare and, to our knowledge, has not been previously reported within a urothelial bladder carcinoma (UBC) nodal metastasis.

Case: A 78-year-old man underwent radical cystoprostatectomy because of high-grade pT2 UBC. Pathology revealed a high-grade pT4aN2 UBC with osseous metaplasia into a massively metastatic lymph node but not into the primary bladder tumor.

Conclusion: Based independently on its location, this finding warrants a careful differential diagnosis with sarcomatoid bladder tumors and is likely to be a marker of tumor aggressiveness, thus recommending aggressive treatment.

Objective: To describe the usefulness of endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC) in pancreatic lesions.

Study design: During a 5-year period (2007-2011) a total of 391 patients with pancreatic lesions have been studied using EUS-FNAC, with 43 of them having cytohistological correlation with core biopsy or surgical specimens. The diagnostic performance of this technique with and without the pathologist in the endoscopy room has been compared.

Results: On the cytological smears, adenocarcinoma was diagnosed in 13 (30.2%) cases and neuroendocrine neoplasm in 2 (4.6%). Six (13.9%) cases were considered suspicious for malignancy, 2 (4.6%) were solid pseudopapillary tumors, and 20 (46.5%) were negative. There were no mucin-producing cystic neoplasms in the cytological diagnostic approach. After the cytohistological correlation, 23 (53.5%) cases were true positive, 11 (25.5%) were true negative, and 9 (21%) were false negative. There were no false positive cases in the series. Diagnostic precision was 79%, sensitivity 71.18%, specificity 100%, positive predictive value 100%, and negative predictive value 55%. The diagnostic performance of this technique is significantly higher (p < 0.015) when the pathologist is present in the endoscopy room.

Conclusion: Our data support the usefulness and reliability of EUS-FNAC in the diagnosis of pancreatic lesions. In our experience, significantly better results are obtained when the pathologist takes an active part in the procedure.

Objective: To investigate the role of mast cells and vascular endothelial growth factor (VEGF) as a mediator of angiogenesis to promote wound healing in surgical and pathological scars.

Study design: The study was carried out on 40 patients who presented with active scar lesions. They were subdivided into 4 groups. They included granulation tissue (10 cases), surgical scar (10 cases), hypertrophic scar (10 cases), and keloid scar (10 cases). Also 10 healthy volunteers of the same age and sex were selected as a control group. Skin biopsies were taken from the patients and the control group. Skin biopsies from clinically assessed studied groups were processed for routine histology and embedded in paraffin. Four sections were prepared from each paraffin block. The first section was stained with hematoxylin and eosin for histological evaluation. The second and third sections were processed for immunostaining of mast cells that contain chymase (MCCs) and mast cells that contain tryptase (MCTs). The fourth section was processed for immunostaining of VEGF.

Results: MCCs exhibited mild expression in normal tissue, granulation tissue, and surgical, hypertrophic and keloid scars. MCTs exhibited mild expression in normal tissue, granulation tissue and keloid, whereas moderate expression was exhibited in hypertrophic and surgical scars. VEGF expression was absent in normal tissue, mild in keloid, surgical and hypertrophic scars, and moderate in keloids and granulation tissue.

Conclusion: Mast cell expression variation among different scar types signals the pathological evolution of the lesion, and hence may guide the need for therapeutic intervention.

Background: The published literature on primary prostatic extragastrointestinal stromal tumor (EGIST) is limited to several isolated case reports. No long-term follow-up is currently available for these patients in order to determine if the biologic behavior of prostatic gastrointestinal stromal tumor is different from those occurring in other sites.

Case: A 40-year-old man presented with symptoms of benign prostate hyperplasia. Magnetic resonance imaging revealed a huge prostatic mass restricted to the organ's capsule. After a complete resection and histopathologic study of the specimen, primary high-risk EGIST of the prostate was confirmed. The patient underwent adjuvant chemotherapy with imatinib. He has been observed for 32 months and is in good condition with no recurrence or metastasis.

Conclusion: Primary EGIST of the prostate is an extremely rare entity. It should be carefully distinguished from other spindle cell lesions. Complete surgical resection and chemotherapy with imatinib are important strategies of treatment.