Malignant peripheral nerve sheath tumour with perineurial differentiation and hyaline eosinophilic globules (thanatosomes): A rare tumour

@#Malignant peripheral nerve sheath tumour (MPNST) with perineurial differentiation is a rare variant of MPNST. The pathological features and clinical significance of this variant remain to be characterised. We reported the clinicoradiological and pathological features of a case of recurrent right arm mass related to the ulnar nerve in a 42-year-old female patient. On pathological examination, the tumour showed dual features of conventional and perineurial MPNST which was proven by positive immunostaining for S-100 and EMA. The pathological diagnosis was MPNST with perineurial differentiation. In addition, a peculiar and rare finding of intracytoplasmic eosinophilic hyaline globules (thanatosomes) within tumour cells is reported. We document a rare tumour with hybrid features between conventional and perineurial MPNSTs. Further studies are needed to establish its biological behaviour.

Pre-operative chemo-radiotherapy followed by surgery compared to surgery alone in patients with stage II and III esophageal cancer

Current primary treatment options for esophageal cancer are surgery only or concomitant chemo-radiotherapy [CRT] and the long-term survival of patients with locally-advanced disease is rare. Pre-operative concomitant CRT seems to be beneficial, mostly in patients who achieve a complete pathologic response [pCR] after CRT. In this study the efficiency and toxicity of pre-operative CRT in patients with locally-advanced esophageal cancer was analyzed as well as the influence of CRT on the survival. Thirty patients with stages II and III esophageal cancer were randomly assigned to surgery alone and another 30 patients were assigned to surgery after 80 mg/m[2] cisplatin on day 1, 800 mg/m[2] fluorouracil on days 1 - 4, with concurrent radiotherapy of 45 Gy given in 22 fractions over 4.5 weeks. The primary end-point was progression-free survival and the secondary end-points were overall survival, tumor response, toxic effects, patterns of failure and quality of life. Progression-free survival and overall survival did not differ between both groups [PFT P=0.16, Median survival P=0.34]. The chemo-radiotherapy and surgery group had more complete resections with clear margins than did the surgery alone group [24 of 30 [80%] versus 14 of 30 [47%], P= 0.001], and had fewer positive lymph nodes [11 of 30 [37%] versus 20 of 30 [67%], P= 0.012]. Neo-adjuvant chemo-radiation [NCRT] followed by surgery is associated with a small non-statistically significant improvement in the overall survival. Whether this benefit is sufficient to warrant the considerable expense and risk associated with NCRT should be the subject of further larger randomized trials

study of expression of matrix metalloproteinase-1 [MMP-1] and tissue inhibitor of metalloproteinase-1 [TIMP-1] in inflammatory bowel disease

Extracellular matrix [ECU] degradation and remodeling are major features of inflammatory bowel disease [IBD]. Matrix metalloproteinase-1 [MMP-1] is an important enzyme in ECM degradation. Its activity is controlled by tissue inhibitor ofmetalloproteinase-1 [TIMP-1]. To study the expression of MMP-1 and TIMP-1 in intestinal biopsies of patients with IBD and to determine its correlation with the endoscopic and histological scores of inflammation. Immunohistochemistry was used to study the expression of MMP-1 and TIMP-1 in 30 patients with IBD [16 patients with ulcerative colitis [UC] and 14 patients with Crohn's disease [CD]]. In addition, a control group of 10 non inflamed intestinal biopsies from these patients was studied. A semi-quantitative [ordered] method based on both the degree of staining and the percentage of positive cells was used to score immunohistochemical results. 76.67% and 90% of the studied cases of IBD showed positive staining for MMP-1 and TIMP-1 respectively. The mean staining scores of both MMP-1 and TIMP-1 were significantly higher in IBD [3.27 +/- 2 and 3.6 +/- L61 respectively] than control [0.8+0.92 and 1.9+ and .88 respectively] [p=0.001 and p-0.004 respectively]. A significant correlation was found between MMP-1 and TIMP-1 expression [p<0.001]. The expression of both MMP-1 and TIMP-1 was higher in UC [3.38 +/- 1.93 and 3.63 +/- 1.71 respectively] than CD [3.14+2.14 and 3.57 +/- 1.56 respectively], yet the difference was not significant [p=0.8 and p=0.9 respectively]. A significant correlation was detected between both MMP-1 and TIMP-1 expression and each of histological score [p<0.001] and endoscopic score [p < 0.001] of inflammation. MMP-1 and TIMP-1 are overexpressed in the affected mucosa of IBD and their expression correlates with the endoscopic and histological scores of inflammation. Thus, MMP-1 and TIMP-1 are likely to play a major role in the process of tissue destruction and remodeling in IBD. MMP-1 inhibitor therapy may prove useful in modulation of mucosal inflammation and promotion of healing in IBD