Analytical and Quantitative Cytopathology and Histopathology最新文献

Bladder carcinoma with variant histology is a subject of recent interest, with data suggesting more aggressive behavior when compared with conventional urothelial carcinoma. The timely identification and recognition of these histological variants should avoid their misinterpretation as benign lesions. We emphasize the need to recognize these peculiar morphologic features since some of them may require a different/specific therapeutic approach. Other rare entities such as bladder polyps and myofibroblastic proliferations tend to occur at a younger age and represent specific problems in the differential diagnosis. We describe the salient clinicopathologic features of representative rare entities arising in the urinary bladder.

Apart from the typical acinar morphology observed in more than 90% of prostatic adenocarcinomas, a spectrum of morphological variants and prostate cancer subtypes exists. Two nosologically different groups can be distinguished: the variants of conventional acinar cancer and cancers with histological pattern, which are unusual for the prostate. Variants of conventional prostate cancer (pseudohyperplastic, foamy gland, hypernephroid, atrophic, microcystic, with Paneth cell-like changes, with collagenous micronodules, with glomeruloid formations, oncocytic) do not have any known prognostic significance and are graded according to the Gleason system. Unusual cancer types (ductal carcinoma, mucinous [colloid] carcinoma, mucinous signet ring cell carcinoma, small cell carcinoma, sarcomatoid carcinoma and carcinosarcoma, pleomorphic giant cell carcinoma, squamous and adenosquamous carcinoma, basal cell and adenoid cystic carcinoma, lymphoepithelioma-like carcinoma, primary urothelial carcinoma of the prostate) have mostly a very poor prognosis and are therefore real nosological entities.

Renal cell carcinoma is an aggressive neoplasm, frequently diagnosed incidentally in an advanced stage (local or metastatic). Sunitinib is a small molecule that inhibits multiple receptor tyrosine kinases, mainly directed against the angiogenic pathway. Sunitinib is largely used in first-line treatment, but response varies widely among patients. Thus, there is an urgent need to find predictive factors able to determine whether or not a patient would respond to treatment, thereby avoiding unnecessary toxicities. In this report we review the literature focusing on clinical, pathological, and molecular predictive factors currently being studied and more promising to enter clinical practice.

Nonsurgical therapeutic options for prostatic diseases are divided into androgen action-related, with androgen action inhibition (AAI), or androgen action-unrelated strategies, such as radiotherapy (RT). AAI, achieved by numerous medications with antiandrogen activity, is used for prostatic hyperplasia and carcinoma. Treatment mostly affects secretory epithelial cells, with consequent reduction in prostate volume and diminished amount of cancer. Histologically, AAI changes the morphologic appearance of benign prostatic glands, prostatic intraepithelial neoplasia, and cancer, as well as prostatic stroma. The effects of most AAI drugs are similar, although variable in intensity. Expression of some diagnostic immunohistochemical markers can decline after longtime treatment, requiring careful interpretation of staining results. Patterns of tissue injury after RT for prostate cancer differ from those after AAI. While irradiation has a profound effect on benign prostatic glands, it does not affect immunohistochemistry, which retains its diagnostic value. In order to make a reliable diagnosis in needle biopsies of treated prostate cancer, uropathologists should have all the relevant information on treatment modalities and their duration. As treatment affects the morphology of prostate cancer, Gleason grading is unreliable and therefore not recommended. An overview of treatment effects caused by AAI and RT is herein presented, with discussion on their importance in everyday practice.

The diagnosis of prostate cancer is made based on the architecture of the glandular proliferation and nuclear atypia, but some normal structures (seminal vesicle, Cowper's glands, prostatic central zone) or nonneoplastic proliferative lesions can mimic carcinoma. Of the 3 patterns of prostate cancer--solid, cribriform, and microglandular, the microglandular pattern is the one that imitates carcinoma most frequently on needle biopsy. The demonstration of basal cells can be the best method to identify these prostate cancer mimickers.

Background: Although lung cancer is the solid tumor which most frequently metastasizes to the kidney, metastatic pulmonary adenocarcinoma detected by urine cytology examination is exceedingly rare.

Case: A 52-year-old woman presented with gross hematuria. Urine cytology revealed numerous crowded, overlapped 3-dimensional clusters with occasional papillary and luminal formations. The tumor nuclei were uniformly enlarged with smooth oval contours, regular nuclear membranes, finely granular chromatin, and prominent nucleoli. Numerous clear, intracytoplasmic vacuoles were noted. Urine fluorescence in situ hybridization (FISH) examination was abnormal. Positive immunohistochemical thyroglobulin transcription factor-1 and Napsin-A staining of a renal calyx biopsy confirmed the diagnosis of metastatic lung cancer.

Conclusion: Although rare, metastatic lung adenocarcinoma in urine has characteristic cytomorphologic findings which appear distinct from the more commonly encountered urothelial carcinoma. Differentiation from other metastatic malignancies may be more problematic and will likely require immunohistochemical confirmation. Metastatic lung cancer may also cause abnormal urine FISH results and thus may be misdiagnosed as urothelial cancer. Therefore, this ancillary testing modality must be employed with caution in the setting of metastatic disease.

Objective: To determine the immunohistochemical and histopathological changes in facial skin after exposure to maneb (manganese ethylene bisdithiocarbamate), a fungicidal dithiocarbamate pesticide.

Study design: In the experimental group maneb was administered by inhalation to 10 male Wistar albino rats for 5 days each week for 3 weeks. As a biological control, the control group (n = 10) received distilled water by spray for the same time period. The experiment was terminated after 3 weeks. Sections of rat facial skin were examined histopathologically.

Results: In the experimental group, microscopic examination of facial skin revealed degeneration of the epidermis, detection of mild inflammatory reaction, and vascular dilation in the connective tissue. Hair follicles and degenerative changes were observed in the deeper parts. In the experimental group, dilation of the blood vessels in the dermis and hemorrhage were supported by an increase in CD34 expression. In addition, a reduction in the number of melanocytes (hypopigmentation) was observed in the hair follicles and epidermis, along with a decrease in the expression of CD117.

Conclusion: Epidermal degeneration, intradermal cell infiltration, vascular changes, and reduction in the number of melanocytes in the follicle and content of cytokeratin in both the epidermis and hair follicle keratinocytes were detected after maneb application. These findings may have important implications in the association with main signaling pathways, including keratinocyte proliferation and differentiation. Disruption of these pathways may cause some dermatoses.

Background: Chordoma is a rare, slowly growing tumor arising from notochordal rests and occurring in several anatomical locations with different clinical patterns of presentation. Dedifferentiation or sarcomatous transformation in a chordoma is a known but rarely recorded event.

Case: We report the case of a 58-year-old man diagnosed with chordoma of the clivus who, over the course of 5 years, showed histological and immunohistochemical evidence of progressive dedifferentiation in the tumor.

Conclusion: Sarcomatous transformation in chordomas is seen less frequently in the clival region. A high degree of suspicion and extensive sampling are essential for diagnosis, especially in recurrent tumors.

Objective: To identify morphometric features unique to flat epithelial atypia associated with cancer using digital image analysis.

Study design: Cases with diagnosis of flat epithelial atypia were retrieved and divided into 2 groups: flat epithelial atypia associated with invasive or in situ carcinoma (n = 31) and those without malignancy (n = 27). Slides were digitally scanned. Nuclear features were analyzed on representative images at 20x magnification using digital morphometric software.

Results: Parameters related to nuclear shape and size (diameter, perimeter) were similar in both groups. However, cases with malignancy had significantly higher densitometric green (p = 0.02), red (p = 0.03), and grey (p = 0.02) scale levels as compared to cases without cancer. A mean grey densitometric level > 119.45 had 71% sensitivity and 70.4% specificity in detecting cases with concomitant carcinoma.

Conclusion: Morphometry of features related to nuclear staining appears to be useful in predicting risk of concurrent malignancy in patients with flat epithelial atypia, when added to a comprehensive histopathologic evaluation.