Elena Pacella, Francesco Ricci, Maurizio Colecchia, Francesco Boccardo, Antonio Lopez-Beltran, Bruno Spina
Background: Collision metastasis is a rare phenomenon in which metastases of carcinoma from 2 separate primary tumors occur in the same lymph node. We summarize here the clinical course and highlight the histological challenges in the diagnosis of this rare phenomenon.
Case: A biopsy performed due to gross hematuria by endoscopic resection revealed an infiltrative high-grade urothelial carcinoma in a 75-year-old man receiving androgen deprivation therapy due to biopsy-proven high-grade prostate cancer. A radical cystectomy, with regional lymphadenectomy and prostatectomy, was performed. Three nodes appeared to have metastatic foci from both primary tumors: prostatic and urothelial cancer. The presence of the 2 tumor types colliding in the same lymph nodes was confirmed by immunohistochemical stains.
Conclusion: In a patient with simultaneous tumors it is important to remember that a part of lymph node metastases with histological polymorphic appearance may result from a collision metastasis. In light of the important therapeutic consequences, a differential diagnosis is needed, suggesting appropriate immunohistochemical investigations.
{"title":"Prostatic and urothelial metastasis in the same lymph node: a case report.","authors":"Elena Pacella, Francesco Ricci, Maurizio Colecchia, Francesco Boccardo, Antonio Lopez-Beltran, Bruno Spina","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Collision metastasis is a rare phenomenon in which metastases of carcinoma from 2 separate primary tumors occur in the same lymph node. We summarize here the clinical course and highlight the histological challenges in the diagnosis of this rare phenomenon.</p><p><strong>Case: </strong>A biopsy performed due to gross hematuria by endoscopic resection revealed an infiltrative high-grade urothelial carcinoma in a 75-year-old man receiving androgen deprivation therapy due to biopsy-proven high-grade prostate cancer. A radical cystectomy, with regional lymphadenectomy and prostatectomy, was performed. Three nodes appeared to have metastatic foci from both primary tumors: prostatic and urothelial cancer. The presence of the 2 tumor types colliding in the same lymph nodes was confirmed by immunohistochemical stains.</p><p><strong>Conclusion: </strong>In a patient with simultaneous tumors it is important to remember that a part of lymph node metastases with histological polymorphic appearance may result from a collision metastasis. In light of the important therapeutic consequences, a differential diagnosis is needed, suggesting appropriate immunohistochemical investigations.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 2","pages":"139-43"},"PeriodicalIF":0.1,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33378713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To describe the accuracy of the diagnosis of involved excision margins after loop electrosurgical excision procedure (LEEP) in a low-resource setting.
Study design: Cross-sectional study of 176 LEEPs indicated for a cytological report of high-grade squamous intraepithelial lesion (HGSIL). A total of 72 HIV-positive and 104 HIV-negative women with cervical intraepithelial neoplasia (CIN) ≥ 2 on their LEEP histology report with involved excision margins were enrolled in the study. All patients underwent either a repeat LEEP or a hysterectomy. The specimens were evaluated for residual/recurrent CIN ≥ 2 or less.
Results: Persistent/recurrent CIN ≥ 2 was diagnosed in 139 (79.4%) instances and microinvasive squamous cell carcinoma in 6 (3.4%). Thirty (17.2%) showed CIN1. The persistence/recurrence rate was 72.2% and 88.5% in HIV-positive and HIV-negative women, respectively (χ2 = 7.5, p = 0.006).
Conclusion: In > 80% the diagnosis of involved excision margins was confirmed, a positive predictive value of 82.4%. In the absence of more accurate follow-up methods such as HPV testing or co-testing with cytology, a correct diagnosis of margin status, especially when involved, is an important guide to further management and follow-up.
目的:探讨低资源环境下环形电切手术(LEEP)后受累切缘诊断的准确性。研究设计:对176例leep进行横断面研究,以细胞学报告显示高级别鳞状上皮内病变(HGSIL)。共有72例hiv阳性和104例hiv阴性的LEEP组织学报告中宫颈上皮内瘤变(CIN)≥2并伴有切除边缘的妇女被纳入研究。所有患者均接受重复LEEP或子宫切除术。评估标本的残留/复发CIN≥2或更小。结果:139例(79.4%)诊断为持续/复发CIN≥2,6例(3.4%)诊断为微创鳞状细胞癌。30例(17.2%)为CIN1。hiv阳性和hiv阴性妇女的持续/复发率分别为72.2%和88.5% (χ2 = 7.5, p = 0.006)。结论:受累切除边缘的确诊率> 80%,阳性预测值为82.4%。在缺乏更准确的随访方法(如HPV检测或与细胞学联合检测)的情况下,对切缘状况的正确诊断,特别是在涉及的情况下,是进一步管理和随访的重要指导。
{"title":"Involved LEEP excision margins as predictor of residual/recurrent disease in HIV-positive and HIV-negative women in a low-resource setting.","authors":"Louis-Jacques van Bogaert","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To describe the accuracy of the diagnosis of involved excision margins after loop electrosurgical excision procedure (LEEP) in a low-resource setting.</p><p><strong>Study design: </strong>Cross-sectional study of 176 LEEPs indicated for a cytological report of high-grade squamous intraepithelial lesion (HGSIL). A total of 72 HIV-positive and 104 HIV-negative women with cervical intraepithelial neoplasia (CIN) ≥ 2 on their LEEP histology report with involved excision margins were enrolled in the study. All patients underwent either a repeat LEEP or a hysterectomy. The specimens were evaluated for residual/recurrent CIN ≥ 2 or less.</p><p><strong>Results: </strong>Persistent/recurrent CIN ≥ 2 was diagnosed in 139 (79.4%) instances and microinvasive squamous cell carcinoma in 6 (3.4%). Thirty (17.2%) showed CIN1. The persistence/recurrence rate was 72.2% and 88.5% in HIV-positive and HIV-negative women, respectively (χ2 = 7.5, p = 0.006).</p><p><strong>Conclusion: </strong>In > 80% the diagnosis of involved excision margins was confirmed, a positive predictive value of 82.4%. In the absence of more accurate follow-up methods such as HPV testing or co-testing with cytology, a correct diagnosis of margin status, especially when involved, is an important guide to further management and follow-up.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 2","pages":"105-8"},"PeriodicalIF":0.1,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33260138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is an idiopathic nonneoplastic lymphohistiocytic proliferation with variable clinical presentations, sometimes mimicking other disorders including neoplasm. Particularly, intracranial Rosai-Dorfman disease is rare and without well-established optimal treatment modalities.
Case: A 42-year-old man presented with gradually progressive unilateral hearing and vision loss over a two-year period. An MRI of the head showed findings consistent with meningiomatosis. He subsequently underwent a dural biopsy, and histologic examination of the lesion showed sheets of histiocytes positivefor CD68 and S-100 and negative for CD1a within a rich lymphoplasmacytic infiltrate. Some of the histiocytes showed emperipolesis of lymphocytes and plasma cells. These findings were consistent with Rosai-Dorfman disease. Interestingly, EMA-positive meningothelial whorls were seen scattered within the dominantly histiocytic-appearing process, mimicking the appearance of meningioma; these whorls were thought to be reactive in nature.
Conclusion: This case is important as it high-lights unusual clinical and histopathologic features of Rosai-Dorfman disease, thereby adding to the spectrum of manifestations of this entity. Awareness of such features is helpful in averting the misdiagnosis of intracranial Rosai-Dorfman disease with reactive meningothelial hyperplasia as meningiomas.
{"title":"Extranodal (dural) Rosai-Dorfman disease radiologically and histologically mimicking meningioma: a case report.","authors":"Samer Nassif, Fouad Boulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is an idiopathic nonneoplastic lymphohistiocytic proliferation with variable clinical presentations, sometimes mimicking other disorders including neoplasm. Particularly, intracranial Rosai-Dorfman disease is rare and without well-established optimal treatment modalities.</p><p><strong>Case: </strong>A 42-year-old man presented with gradually progressive unilateral hearing and vision loss over a two-year period. An MRI of the head showed findings consistent with meningiomatosis. He subsequently underwent a dural biopsy, and histologic examination of the lesion showed sheets of histiocytes positivefor CD68 and S-100 and negative for CD1a within a rich lymphoplasmacytic infiltrate. Some of the histiocytes showed emperipolesis of lymphocytes and plasma cells. These findings were consistent with Rosai-Dorfman disease. Interestingly, EMA-positive meningothelial whorls were seen scattered within the dominantly histiocytic-appearing process, mimicking the appearance of meningioma; these whorls were thought to be reactive in nature.</p><p><strong>Conclusion: </strong>This case is important as it high-lights unusual clinical and histopathologic features of Rosai-Dorfman disease, thereby adding to the spectrum of manifestations of this entity. Awareness of such features is helpful in averting the misdiagnosis of intracranial Rosai-Dorfman disease with reactive meningothelial hyperplasia as meningiomas.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 2","pages":"144-6"},"PeriodicalIF":0.1,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33378714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate different immunocytochemical protocol variations to find the most effective protocol for the analysis of involucrin, epidermal growth factor receptor (EGFR), and E-cadherin antibodies. Exfoliative cytology is a noninvasive method used to monitor and screen for early changes in the oral mucosa of patients exposed to carcinogens such as tobacco and alcohol. It has been postulated that its association with immunocytochemistry may improve the effectiveness of the screening process.
Study design: Four graduate students from Porto Alegre in southern Brazil had oral smears collected from the border of the tongue using a cytobrush. The following variables were analyzed: cell membrane permeability, antigen retrieval method (microwave oven or water bath), antibody incubation time (overnight or 1 hour), detection system used (Envision or LSAB), and chromogen incubation time (10 seconds or 5 minutes).
Results: Best results were obtained with the following combinations: (1) for involucrin: water bath, 1-hour incubation for primary antibody, Envision, and chromogen incubation for 10 seconds; (2)for EGFR: microwave, overnight incubation, LSAB, and chromogen incubation for 5 minutes; and (3) for E-cadherin: water bath, over-night incubation, Envision, and chromogen incubation for 5 minutes.
Conclusion: Our findings suggest that each antibody requires a specific immunocytochemical protocol to guarantee optimal results with oral smears.
目的:评价不同免疫细胞化学方案的差异,以寻找最有效的方案来分析天花素、表皮生长因子受体(EGFR)和E-cadherin抗体。剥脱细胞学是一种非侵入性方法,用于监测和筛查暴露于烟草和酒精等致癌物的患者口腔黏膜的早期变化。据推测,它与免疫细胞化学的关联可能会提高筛选过程的有效性。研究设计:四名来自巴西南部阿雷格里港的研究生使用细胞刷从舌缘收集口腔涂片。分析以下变量:细胞膜通透性、抗原提取方法(微波炉或水浴)、抗体孵育时间(过夜或1小时)、检测系统(Envision或LSAB)、显色原孵育时间(10秒或5分钟)。结果:(1)天花苷:水浴,一抗、Envision孵育1小时,显色剂孵育10秒;(2) EGFR:微波、过夜孵育、LSAB、显色剂孵育5分钟;(3) e -钙粘蛋白:水浴、过夜孵育、Envision、显色原孵育5分钟。结论:我们的研究结果表明,每种抗体都需要特定的免疫细胞化学方案来保证口腔涂片的最佳结果。
{"title":"Immunocytochemistry associated with oral exfoliative cytology: methodological analysis..","authors":"Alessandra Dutra da Silva, Celina Faig Lima, Bruna Jalfim Maraschin, Natália Koerich Laureano, Natália Batista Daroit, Fernanda Brochier, Manoel Sant'Ana Filho, Fernanda Visioli, Pantelis Varvaki Rados","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate different immunocytochemical protocol variations to find the most effective protocol for the analysis of involucrin, epidermal growth factor receptor (EGFR), and E-cadherin antibodies. Exfoliative cytology is a noninvasive method used to monitor and screen for early changes in the oral mucosa of patients exposed to carcinogens such as tobacco and alcohol. It has been postulated that its association with immunocytochemistry may improve the effectiveness of the screening process.</p><p><strong>Study design: </strong>Four graduate students from Porto Alegre in southern Brazil had oral smears collected from the border of the tongue using a cytobrush. The following variables were analyzed: cell membrane permeability, antigen retrieval method (microwave oven or water bath), antibody incubation time (overnight or 1 hour), detection system used (Envision or LSAB), and chromogen incubation time (10 seconds or 5 minutes).</p><p><strong>Results: </strong>Best results were obtained with the following combinations: (1) for involucrin: water bath, 1-hour incubation for primary antibody, Envision, and chromogen incubation for 10 seconds; (2)for EGFR: microwave, overnight incubation, LSAB, and chromogen incubation for 5 minutes; and (3) for E-cadherin: water bath, over-night incubation, Envision, and chromogen incubation for 5 minutes.</p><p><strong>Conclusion: </strong>Our findings suggest that each antibody requires a specific immunocytochemical protocol to guarantee optimal results with oral smears.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 2","pages":"134-8"},"PeriodicalIF":0.1,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33378712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the expression of 52-kDa FK506-binding protein (FKBP52) in human placentas complicated by preeclampsia (PE) and intrauterine growth restriction (IUGR).
Study design: Case-control study including placentas from 6 PE pregnancies, 6 IUGR pregnancies, and 6 controls. FKBP52 expression was determined by immunohistochemistry and Western blot techniques.
Results: FKBP52 expression was downregulated in PE group placentas compared to control and IUGR group placentas. In IUGR group placentas FKBP52 expression was upregulated compared to control and PE group placentas. FKBP52 expression differences between PE and IUGR group placentas (p = 0.008) and control and IUGR group placentas (p = 0.042) were statistically significant. There was FKBP52 immunoreactivity in decidua, syncytiotrophoblast, villous stromal cells, and vascular endothelium in all groups. Unlike control and PE group placentas, FKBP52 expression was continuous in syncytiotrophoblast of IUGR group placentas.
Conclusion: FKBP52 seems to be disrupted in PE and IUGR pregnancies. Decrease of FKBP52 protein levels in PE and increase in IUGR group placentas might have an importance and be involved in the pathogenesis of PE and IUGR.
{"title":"Expression of 52-kDa FK506-binding protein (FKBP52) in human placenta complicated by preeclampsia and intrauterine growth restriction.","authors":"Nuray Acar, Ismail Ustunel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the expression of 52-kDa FK506-binding protein (FKBP52) in human placentas complicated by preeclampsia (PE) and intrauterine growth restriction (IUGR).</p><p><strong>Study design: </strong>Case-control study including placentas from 6 PE pregnancies, 6 IUGR pregnancies, and 6 controls. FKBP52 expression was determined by immunohistochemistry and Western blot techniques.</p><p><strong>Results: </strong>FKBP52 expression was downregulated in PE group placentas compared to control and IUGR group placentas. In IUGR group placentas FKBP52 expression was upregulated compared to control and PE group placentas. FKBP52 expression differences between PE and IUGR group placentas (p = 0.008) and control and IUGR group placentas (p = 0.042) were statistically significant. There was FKBP52 immunoreactivity in decidua, syncytiotrophoblast, villous stromal cells, and vascular endothelium in all groups. Unlike control and PE group placentas, FKBP52 expression was continuous in syncytiotrophoblast of IUGR group placentas.</p><p><strong>Conclusion: </strong>FKBP52 seems to be disrupted in PE and IUGR pregnancies. Decrease of FKBP52 protein levels in PE and increase in IUGR group placentas might have an importance and be involved in the pathogenesis of PE and IUGR.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 2","pages":"87-95"},"PeriodicalIF":0.1,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33260136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Staging of prostate carcinoma provides a standardized method for tumor classification which is based on involvement of the prostate gland, adjacent local structures, regional lymph nodes, and distant sites. Staging information is therefore crucial for clinicians to be able to assess risk of disease progression, to offer therapeutic choices in the individual patient, and to provide population-based prognostic information. Clinical staging, which is based on data obtained prior to first definitive treatment, relies on tumor determination by digital rectal examination, transrectal ultrasonography, other imaging techniques, and serum PSA level, while pathological staging requires histological identification of tumor extent in prostate gland and surrounding tissues. T1 tumors, denoted to clinically unapparent, not palpable or visible by imaging, are diagnosed by transurethral resection of the prostate procedure or needle biopsy. T2 tumors are confined to the organ, are subdivided by involvement in one or both lobes, and are determined by radical prostatectomy procedure. Stage T3 denotes locally advanced tumors that spread beyond the organ's boundaries, and T4 denotes invasion or fixation to the pelvic organs. Despite wide acceptance of the system as a whole, the current 2010 revision of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node and metastasis (TNM 7) appears to contain some controversies, particularly T2 three-tiered subclassification. This review will cover suggested changes to further TNM editions; these changes have been accumulated in the literature in recent years and include items such as lymph node involvement quantification, "vanishing" carcinoma, Gleason score, resection margin status, pretreatment serum PSA level, as well as difficulties the pathologist may encounter in microscopic examination which may hamper accurate stage assessment.
{"title":"Staging of prostate cancer: a review with reference for further refinement.","authors":"Boris Pospihalj","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Staging of prostate carcinoma provides a standardized method for tumor classification which is based on involvement of the prostate gland, adjacent local structures, regional lymph nodes, and distant sites. Staging information is therefore crucial for clinicians to be able to assess risk of disease progression, to offer therapeutic choices in the individual patient, and to provide population-based prognostic information. Clinical staging, which is based on data obtained prior to first definitive treatment, relies on tumor determination by digital rectal examination, transrectal ultrasonography, other imaging techniques, and serum PSA level, while pathological staging requires histological identification of tumor extent in prostate gland and surrounding tissues. T1 tumors, denoted to clinically unapparent, not palpable or visible by imaging, are diagnosed by transurethral resection of the prostate procedure or needle biopsy. T2 tumors are confined to the organ, are subdivided by involvement in one or both lobes, and are determined by radical prostatectomy procedure. Stage T3 denotes locally advanced tumors that spread beyond the organ's boundaries, and T4 denotes invasion or fixation to the pelvic organs. Despite wide acceptance of the system as a whole, the current 2010 revision of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node and metastasis (TNM 7) appears to contain some controversies, particularly T2 three-tiered subclassification. This review will cover suggested changes to further TNM editions; these changes have been accumulated in the literature in recent years and include items such as lymph node involvement quantification, \"vanishing\" carcinoma, Gleason score, resection margin status, pretreatment serum PSA level, as well as difficulties the pathologist may encounter in microscopic examination which may hamper accurate stage assessment.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 1","pages":"69-74"},"PeriodicalIF":0.1,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33386843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
At least 90% of testicular tumors belong to the group of germ cell tumors (GCTs), which are classified according to the 2004 World Health Organization (WHO) classification. Race is one of the most important etiologic factors in the development of GCTs. White men living in Western industrialized countries show the highest rates of incidence. Known risk factors are cryptorchidism, contralateral GCT, familial association, infertility, testicular atrophy, trauma, surgery, socioeconomic status, environmental factors, and occupational exposure to noxious conditions. For the most part, the morphology of GCTs is well known to pathologists. There are, however, some little-known rare entities like anaplastic type of spermatocytic seminoma. In the group of nonseminomatous GCTs are emerging the somatic-type malignancies (carcinomas, sarcomas) arising in teratomas. Tumors of sex cord/gonadal stroma account for 1.6-6% of adult testicular tumors and are somewhat more frequent in children. Absolutely nothing is known about the epidemiology, histogenesis, and possible etiology of these tumors, which derive from Leydig, Sertoli, granulosa, and theca cells. In the group of "miscellaneous tumors," lymphomas are the most frequent testicular tumors in men older than age 50.
{"title":"Update on the pathology of testicular tumors.","authors":"Gregor Mikuz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>At least 90% of testicular tumors belong to the group of germ cell tumors (GCTs), which are classified according to the 2004 World Health Organization (WHO) classification. Race is one of the most important etiologic factors in the development of GCTs. White men living in Western industrialized countries show the highest rates of incidence. Known risk factors are cryptorchidism, contralateral GCT, familial association, infertility, testicular atrophy, trauma, surgery, socioeconomic status, environmental factors, and occupational exposure to noxious conditions. For the most part, the morphology of GCTs is well known to pathologists. There are, however, some little-known rare entities like anaplastic type of spermatocytic seminoma. In the group of nonseminomatous GCTs are emerging the somatic-type malignancies (carcinomas, sarcomas) arising in teratomas. Tumors of sex cord/gonadal stroma account for 1.6-6% of adult testicular tumors and are somewhat more frequent in children. Absolutely nothing is known about the epidemiology, histogenesis, and possible etiology of these tumors, which derive from Leydig, Sertoli, granulosa, and theca cells. In the group of \"miscellaneous tumors,\" lymphomas are the most frequent testicular tumors in men older than age 50.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 1","pages":"75-85"},"PeriodicalIF":0.1,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33386844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Lopez-Beltran, Rita C Marques, Rodolfo Montironi, Carlos Reymundo, Jorge Fonseca, Liang Cheng
Urothelial dysplasia (low-grade intraurothelial neoplasia) is recognized as a premalignant urothelial lesion in the 2004 World Health Organization (WHO) classification system. Although clarification of the diagnostic criteria of urothelial dysplasia has improved in recent years, there is still a lack of interobserver reproducibility. Active clinical follow-up is mandatory in patients with a diagnosis of urothelial dysplasia since it constitutes a marker of urothelial instability, and disease progression, in up to 19% of cases. The differential diagnosis of urothelial dysplasia is with other flat urothelial lesions with atypia, including flat urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, especially when small amounts of tissue are available, morphologic features alone may not be sufficient for diagnosis. Immunohistochemistry can be of help in selected cases, and a panel of cytokeratin 20, p53, and CD44 may help in the diagnosis. The use of HER2, p16, and Racemase remains as an option pending validation. Herein, we present the pathologic features and clinical significance of urothelial dysplasia and carcinoma in situ with emphasis on differential diagnosis from common flat lesions with atypia.
{"title":"Dysplasia and carcinoma in situ of the urinary bladder.","authors":"Antonio Lopez-Beltran, Rita C Marques, Rodolfo Montironi, Carlos Reymundo, Jorge Fonseca, Liang Cheng","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Urothelial dysplasia (low-grade intraurothelial neoplasia) is recognized as a premalignant urothelial lesion in the 2004 World Health Organization (WHO) classification system. Although clarification of the diagnostic criteria of urothelial dysplasia has improved in recent years, there is still a lack of interobserver reproducibility. Active clinical follow-up is mandatory in patients with a diagnosis of urothelial dysplasia since it constitutes a marker of urothelial instability, and disease progression, in up to 19% of cases. The differential diagnosis of urothelial dysplasia is with other flat urothelial lesions with atypia, including flat urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, especially when small amounts of tissue are available, morphologic features alone may not be sufficient for diagnosis. Immunohistochemistry can be of help in selected cases, and a panel of cytokeratin 20, p53, and CD44 may help in the diagnosis. The use of HER2, p16, and Racemase remains as an option pending validation. Herein, we present the pathologic features and clinical significance of urothelial dysplasia and carcinoma in situ with emphasis on differential diagnosis from common flat lesions with atypia.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 1","pages":"29-38"},"PeriodicalIF":0.1,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33386838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberta Mazzucchelli, Andrea B Galosi, Matteo Santoni, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng, Rodolfo Montironi
Active surveillance (AS) is an alternative strategy that aims to minimize overtreatment by selecting only patients with significant prostate cancer (PCa) tumors for immediate treatment. Patients with favorable tumor characteristics are closely monitored using serum prostate-specific antigen (PSA) levels and serial biopsies of the prostate. In addition, other predictors of tumor progression, such as PSA doubling time, can be used during AS management. AS represents an excellent opportunity to identify molecular biomarkers of PCa behavior and to develop novel therapeutic strategies.
{"title":"Role of the pathologist in active surveillance for prostate cancer.","authors":"Roberta Mazzucchelli, Andrea B Galosi, Matteo Santoni, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng, Rodolfo Montironi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Active surveillance (AS) is an alternative strategy that aims to minimize overtreatment by selecting only patients with significant prostate cancer (PCa) tumors for immediate treatment. Patients with favorable tumor characteristics are closely monitored using serum prostate-specific antigen (PSA) levels and serial biopsies of the prostate. In addition, other predictors of tumor progression, such as PSA doubling time, can be used during AS management. AS represents an excellent opportunity to identify molecular biomarkers of PCa behavior and to develop novel therapeutic strategies.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 1","pages":"65-8"},"PeriodicalIF":0.1,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33386842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The indications of frozen section diagnosis in uropathology are quite specific, and this explains the fact that they amount to a mere 7.3% of the frozen sections performed in general hospitals. Generally speaking, frozen sections are not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) renal masses of a doubtful parenchymal origin or located in the urinary tract, (2) testicular neoplasias, when the possibility of a conservative treatment arises, and (3) determination of the presence of a prostate adenocarcinoma in an organ donor with high serum prostate-specific antigen (but even in these circumstances the need is widely controversial). Intraoperative determination of surgical margins is particularly useful in (1) partial nephrectomies (it may be limited to inspection after dyeing the margin with India ink; bed freezing is very seldom needed) and (2) partial penectomies (always studying the urethral margin and the cavernosal and spongiosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic frozen sections are indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis; frozen section is recommended, particularly of radioisotope-marked sentinel nodes.
{"title":"Value of frozen sections in uropathology.","authors":"Ferran Algaba","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The indications of frozen section diagnosis in uropathology are quite specific, and this explains the fact that they amount to a mere 7.3% of the frozen sections performed in general hospitals. Generally speaking, frozen sections are not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) renal masses of a doubtful parenchymal origin or located in the urinary tract, (2) testicular neoplasias, when the possibility of a conservative treatment arises, and (3) determination of the presence of a prostate adenocarcinoma in an organ donor with high serum prostate-specific antigen (but even in these circumstances the need is widely controversial). Intraoperative determination of surgical margins is particularly useful in (1) partial nephrectomies (it may be limited to inspection after dyeing the margin with India ink; bed freezing is very seldom needed) and (2) partial penectomies (always studying the urethral margin and the cavernosal and spongiosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic frozen sections are indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis; frozen section is recommended, particularly of radioisotope-marked sentinel nodes.</p>","PeriodicalId":55517,"journal":{"name":"Analytical and Quantitative Cytopathology and Histopathology","volume":"37 1","pages":"23-8"},"PeriodicalIF":0.1,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33386837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}