Expression of E-cadherin and syndecan-1 in axillary lymph node metastases of breast cancer with and without extracapsular extension.

BACKGROUND: Extracapsular extension of axillary lymph node (ECE) has significantly increased the risk of locoregional and distant recurrence in breast cancer patients. OBJECTIVE: Identify markers with high biological aggressiveness since it may serve as a prognostic indicator or adjunct to standard treatment. MATERIAL AND METHOD: The authors immunostained 115 axillary lymph nodes of invasive ductal carcinoma with syndecan-1 and E-cadherin. RESULTS: The presented data shows a significantly higher number of positive lymph node (8.48 vs. 4.15; p < 0.0001) and larger primary tumor size (3.53 vs. 2.79; p = 0.0029) in ECE patients. Sixty-one cases had node positive and without evidence of ECE, 54 cases had ECE. Syndecan-1 was found to be of significantly high expression (p = 0.001). There was no significant difference in the expression of E-cadherin during progression into extracapsular area (p = 0.12). CONCLUSION: E-cadherin displays high expression in nodal breast cancer metastases that may have re-expression and has coordinate function with syndecan-1 while invading to the surrounding fatty tissue. The protein is, therefore, likely to play a role in the invasiveness and aggressiveness.

RET proto-oncogene expression of papillary thyroid carcinomas in Thai patients.

BACKGROUND: Ret proto-oncogene activation has been found in papillary thyroid carcinoma with different frequencies according to geographic location. The rate of expression ranges from 0-100 percent in the literature. This gene expression has also been studied in many Asian countries but it has never been studied in Thailand. OBJECTIVE: To study the frequency of the RET expression and their roles in predicting prognosis of papillary thyroid carcinoma among Thai patients treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: One hundred and one cases of papillary carcinomas were studied with immunohistochemistry for RET antibodies. All slides with routine staining were reviewed to classify cell variants and record other prognostic parameters such as size, multicentricity, extrathyroid invasion. The clinical data such as age and sex were also included for analyses. RESULTS: Forty-seven of the total 101 cases (46.5%) showed positive RET protein staining. The mean age among patients with RET negative neoplasms was 43.9 years compared with 39.8 years in RET positive group (p = 0.16). The average size of the tumors without RET expression was 2.5 cm, slightly larger than the RET positive tumors (2.1 cm)(p = 0.26). Extrathyroid invasion of the RET-positive tumors was found to be 33.2 percent while the RET negative neoplasms had 38.8 percent of this feature (p = 1). According to AMES score, the RET positive cases had only 11 percent of high-risk tumors, whereas the RET negative group comprised 23.1 percent of high-risk malignancies (p = 0.20). There was no significant difference in RET expression among cell variants (p = 1). CONCLUSION: The study of 101 papillary thyroid carcinomas at the King Chulalongkorn Memorial Hospital disclosed high frequency of RET expression (46.5%) and this is the only data among Thai patients that has ever been documented in the literature. Although, the gene expression in the tumor tends to be associated with good prognostic features but it was not distinct enough to be statistically significant.

Expression of CyclinD1, p27kp-1, and bcl-2 in plexiform neurofibroma with and without malignant transformation in neurofibromatosis type 1.

Plexiform neurofibroma (PNF) has a low potential to undergo malignant transformation. Identification of markers associated with tumor progression is important since it may serve as prognostic indicators or adjuncts to standard pathological examination. In the present study, the authors immunostained 20 neurofibromatosis type I-associated PNFs with cyclinD1, p27kip-1, and bcl-2. Six of the cases had progressed into malignant peripheral nerve sheath tumor (MPNST), and the transitional area of each sample was also stained separately in order to identify protein(s) associated with tumor progression. Cyclin D1 was found to be significantly increased in the transitional zone, compared to the ordinary PNF (p = 0.007). The protein is, thus, likely to play a role in the malignant transformation. There was no significant difference in the expression of p27kip-1 and bcl-2 during the malignant progression of PNF.

Paraurethral leiomyoma: a case report.

A paraurethral leiomyoma is a rare benign hormone-dependent tumor of mesenchymal origin. A 43-year-old woman presented with a palpable mass near the urethral opening with no abnormal urinary symptom. Simple excision was performed Histopathological diagnosis was paraurethral leiomyoma with confirmation by immunohistochemical study. Further hormonal study of the tumor yielded positive estrogen and progesterone receptor expression, suggesting conservative treatment with gonadotropin-releasing hormone (GnRH) agonist or antagonist may have a role as an alternative treatment in an inoperable case.

Integrated criteria of fine-needle aspiration cytology and radiological imaging for verification of breast cancer in nonpalpable lesions.

OBJECTIVES: To evaluate the accuracy of using radiologic, cytologic and integrated radiologic and cytologic criteria in diagnosis of nonpalpable breast lesions. MATERIAL AND METHOD: From January 2003 to May 2004, a prospective study of performing fine-needle aspiration biopsy (FNAB) was carried out at King Chulalongkorn Memorial Hospital on female patients with nonpalpable or vaguely palpable lumps that needed ultrasound localization for the direction and depth. RESULTS: There were 162 lesions from 150 patients, consisting of 29 malignant neoplasms (17.9%) and 133 benign lesions (82.1%). Of the 107 classified as subcentimeter focal lesions (< 1 x 1 cm2 in size), two of radiological malignancy were false and two others were falsely negative by cytology. While the 23 large/ill-defined lesions (> 1.5 x 1.5 cm2 in size), one hiding malignant lesion adjacent to a prominent intraduct papilloma was missed. Two others had falsely negative cytologic diagnosis. The integrated criteria achieved accuracy and sensitivity of 97.5% and 93% compared with the cytology, 96.3% and 82.8% and the better scenario of radiology, 95.7% and 82.8% respectively. CONCLUSION: The integrated criteria provide the most accuracy rate and sensitivity rate for detection of malignancy in nonpalpable breast lesions.

The correlation of Tc-99m MIBI scintigraphy and histological response in determining the percentage of tumor necrosis in osteosarcoma after preoperative chemotherapy.

PURPOSE: The most important prognostic factor of osteosarcoma is the percentage of tumor necrosis. Only well trained and experienced musculoskeletal pathologists can count and assess the percentage of tumor necrosis from the resected specimens. The purpose of the present study was to characterize the correlation of Tc-99m MIBI scintigraphy for assessing the percentage of tumor necrosis using postoperative histology as a gold standard. MATERIAL AND METHOD: During September 2002 to August 2004, nine consecutive patients with the diagnosis of conventional osteosarcoma were included in the present study. The osteosarcoma protocol comprises 3 courses of doxorubicin and cisplatin preoperatively followed by wide resection of tumors and another 3 courses of postoperative chemotherapy. The Tc-99m MIBI scintigraphy examination was carried out before commencing chemotherapy and after completing preoperative chemotherapy. The tumor uptake was measured using the tumor to the background ratio (TBR). Comparison of TBR before and after preoperative chemotherapy was used to calculate the alteration ratio which was reported in terms of percentage. All of the resected specimens were sent to the pathological department. The histological assessment of the response to chemotherapy was performed using the standard technique according to the current practice of osteosarcoma from the Mayo Clinic. The percentages of tumor necrosis from histology were also reported. RESULTS: The analysis of the correlation between the reduction of tracer uptake and the postoperative histological response was performed. The correlation and linear regression analysis showed that the two methods had a significant correlation (R = 0.75) regression coefficient (1.172) with p = 0.020 and 0.043, respectively. CONCLUSION: The present study showed that Tc-99m MIBI scintigraphy had a significant correlation with percentage of tumor necrosis from histology. This technique can be used to predict the response of osteosarcoma after preoperative chemotherapy.

Angiomatoid fibrous histiocytoma with pain in a child.

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor with low-grade malignancy which occurs chiefly in children and young adults. Mostly, the tumor develops in the extremities or the trunk. The tumor has a relatively rare metastasis and its overall clinical outcome is excellent. The authors present a case of AFH of the subcutis on a left elbow of an 11-year-old boy. Clinically, the tumor appears as a cutaneous nodule with slow growth. Pain and adjacent lymphadenopathy are leading symptoms of the patient. Histological examination shows the classical morphological features of AFH with focal cellular atypia. The tumor has immunoreactivity to vimentin and CD68 but negative to CD34, desmin, CD117 and S-100 protein. Because of its rarity, we report a case with an uncommon clinical presentation in a Thai patient.

The association of co-expression of CD44v4/MMP-9 with different nodal status in high-grade breast carcinoma patients.

BACKGROUND: Breast carcinoma is one of the most common tumors in female patients, and its metastasis is a major cause of death. An experimental model has recently found the association of CD44 with MMP-9 that facilitates tumor cell invasion and metastasis. MATERIAL AND METHOD: The CD44v4 and MMP-9 were performed on tissue in paraffin blocks of 50 cases of high-grade breast carcinoma with node positive and 50 cases with node negative. RESULTS: Increased expression of MMP-9(60%) significantly observed in high-grade breast carcinoma patients with node positive (p = 0. 004), whereas CD44v4 displays no significant difference between the two groups (p-value = 0.81). Significant co-expression of CD44v4+ / MMP-9+ (46%) was observed and correlated with node-positive patients whereas the CD44v4+ / MMP-9- (54%) express in node-negative patient (p-value = 0.01). CONCLUSION: The solely expression of CD44v4 does not associate with node status. MMP-9 plays an important role to enhance breast carcinoma cell invasion and associates with lymph node metastasis. The combined expression of CD44v4 (overexpression) and derangement of MMP-9 expression was significantly associated with nodal status.

Round cell liposarcoma of scrotum with indolent course in young adult.

Myxoid/Round cell liposarcoma accounts for one-half of all liposarcomas and occurs as the second most common subtype. Both myxoid and round cell types share clinical, histological features and are accepted to represent a spectrum of lesions ranging from pure myxoid to near completely round cell liposarcoma. Round cell liposarcoma is highly metastatic and is classified as high grade and poorly differentiated myxoid sarcoma. Typical non-round cell myxoid liposarcoma is less metastatic and has more favorable prognosis. Karyotypic study of myxoid and round cell liposarcomas reveal a characteristic reciprocal translocation t (12;16)(q13;p11) resulting in the fusion of CHOP gene with TLS gene in more than 90% of cases. Most masses within the scrotal sac arise from the testis proper, and less likely from the extratesticular tissue. Liposarcoma represents approximately 20% of malignant extratesticular neoplasms, with the well differentiated subtype being the most common. Myxoid/round cell liposarcoma and round cell liposarcoma are rarely encounter in extratesticular soft tissue. We reported a rare case of round cell liposarcoma (high grade myxoid liposarcoma) of extratesticular tissue. To our knowledge, this is the first case of a large size (> 5cm) round cell liposarcoma arising from soft tissue within the scrotal sac of young adult with indolent course. Simple excision or enucleation are inadequate therapies and wide excision of the hemiscrotum including inguinal soft tissue and nodes is recommended. The role of retroperitoneal lymph node dissection and adjuvant chemotherapy remains controversial.

Congenital nasopharyngeal immature teratoma: a first case report in Thailand.

The authors report the very rare case of a congenital immature teratoma arising from the nasopharyx in a full term female neonate. The tumor also extended to the oral cavity, particularly the right tonsillar fossa without intracranial involvement leading to upper airway obstruction and secondary Escherichia coli pneumonia. The immature part of the tumor in the head and neck region is not a poor prognostic indicator and chemotherapy is useless. In the presented case, the mass was widely excised without postoperative complications. To the best of our knowledge, this is the first reported case in Thailand.

Neurological deficit from metastatic low grade liposarcoma.

Myxoid liposarcoma is a malignant soft tissue tumor with a relatively indolent natural history. It commonly occurs in the extremities with extrapulmonary metastatic potential. Round cell liposarcoma, recently, is widely agreed to be the aggressive counterpart of the myxoid liposarcoma, mostly arising in adverse, local recurrence, and metastatic lesions. Metastatic liposarcoma with pure myxoid element is unusual. The authors report an extremely rare case of a 47-year-old Thai male patient having a metastatic pure myxoid liposarcoma to the thoracic vertebrae, one year after primary tumor documented on the left thigh. Histology of the primary and metastatic sites shows only myxoid pattern. Round cell feature was not documented. To the best of the authors' knowledge, this is the second case report of metastatic myxoid liposarcoma without round cell morphology.

Hydatid disease of the liver: the first indigenous case in Thailand and review of the literature.

The authors describe the first indigenous case of hepatic hydatid disease in Thailand. A 58-year-old female presented with progressive right upper quadrant abdominal discomfort over a 6-month period. Ultrasonography and computed tomography showed a solitary cystic lesion 11 x 12 x 13 centimeter in size at the left lobe of the liver. She had never been abroad and had no livestock exposure. The first operation was complicated by spillage of the parasite which required a combination of albendazole and praziquantel and a second operation for intracystic instillation of hypertonic saline solution. Unfortunately, uncontrolled generalized seizures developed due to severe hypernatremia. She never regained consciousness and expired 3 weeks after admission. In addition, the authors also reviewed previous reports of hydatid disease in Thailand. To date, only 9 cases have been reported since 1932.

Recurrent epistaxis from an intranasal glomus tumor: the 22nd case report.

The case of a 66-year-old Thai woman who was treated at King Chulalongkorn Memorial Hospital due to recurrent epistaxis for two years is presented. Her physical examination revealed a 0.7-cm tumor mass on the right nasal septum. A biopsy was subsequently done and the tissue was sent for pathological examination. The lesion was then diagnosed as "glomus tumor of the nasal septum". Histologically, the tumor was rather well-circumscribed and located in the submucosal region. The neoplastic cells were uniform, round to ovoid in shape and contained bland-looking, finely chromatic nuclei and moderate amount of cytoplasm with ill-defined cell borders. These cells were intervened by tortuous vascular structures. Immunohistochemically, the tumor cells were strongly reactive to smooth muscle actin and negative to cytokeratin and S-100 protein. A glomus tumor is rare in the sinonasal region. So far, there have been only 21 reported cases in the literature. Almost all cases of sinonasal glomus tumor are benign and are usually cured by complete excision.

Comparison of tissue reaction and osteointegration of metal implants between hydroxyapatite/Ti alloy coat: an animal experimental study.

BACKGROUND: One important clinical application of hydroxyapatite (HA) is coating on metal implants to stimulate osteo-integration thus enhancing fixation of the implant to bone, especially plasma-sprayed HA coating applied on Ti alloy substrate. The poor bonding strength between HA and Ti alloy has been of great concern to orthopedists. The biocomptable coat such as Ti alloy (TiO2) coat is one method to improve adhesive strength. OBJECTIVE: The objective of this study was to detect and analyze possible differences in bone formation, bone integration and tissue reaction between group I (uncoated Titanium), group II (Hydroxyapatite coated Titanium), and group III (Hydroxyapatite/TiO2 coated Titanium) implant specimens when embedded into bony hosts. METHOD: Rectangular specimens were implanted into the femoral bone of adult dogs in randomly different sites including: proximal left, proximal right, distal left, distal right. The tailor-made implant specimens were inserted in 5 x 5 mm preprepared sockets. Radiographic evaluation was taken at 0, 1, 3 and 6 months. All animals were sacrificed at 3 and 6 months post implantation. The femoral bone containing implants were dissected and then prepared to be further investigated. The bone-implant interface was analyzed by H&E surface staining, radiography and scanning electron microscopy. Data concerning percentage of osteointegration and adhesiveness of hydroxyapatite layer from different kinds of implants along the entire length of each implants were collected and analyzed for evaluation of any significant differences. RESULTS: No osteo-integration was noted in Group I, but there was 25.57 per cent osteointegration in Group II and 28.63 per cent in Group III. No statistically significant differences were observed between Group II and Group III. However, the coating layer in Group II was found to have detached, in some area, from the metal substrate. Histologically, no adverse tissue reaction was found around any kind of implant. CONCLUSION: Biocompatable bond coat is one of the methods to improve adhesive strength of hydroxyapatite coated implants. In the present study it could be concluded that, besides the improvement in adhesiveness, the intervening TiO2 coating layer had no negative effect concerning bone formation and integration and also showed no adverse surrounding soft tissue reaction.