Primary adrenal NK/T cell lymphoma: a clinicopathologic analysis of six cases / 中华病理学杂志

Objective: To investigate the clinicopathologic features of primary adrenal NK/T cell lymphoma (PANKL). Methods: Six cases of PANKL were collected at Henan Provincial People's Hospital from January 2000 to December 2021. The clinicopathologic features including morphology, immunophenotype, treatment and prognosis were retrospectively analyzed, and relevant literature was reviewed. Results: There were two males and four females. The median age was 63 years (ranged from 57 to 68 years). The tumors involved bilateral adrenal glands in 4 cases and unilateral adrenal gland in 2 cases. The main clinical symptom was low back pain without obvious cause. Serum lactate dehydrogenase (LDH) is elevated in five cases. The imaging feature was rapidly enlarging mass initially confined to unilateral/bilateral adrenal glands. Morphologically, the lymphoid cells were mainly medium-sized with a diffuse growth pattern. Coagulative necrosis and nuclear fragmentation were common. Angioinvasion was seen. Immunophenotypically, the neoplastic cells were positive for CD3, CD56 and TIA-1 while CD5 was negative in 5 cases. All cases were positive for EBER by in situ hybridization with more than 80% proliferative activity by Ki-67. Four cases received chemotherapy, one case underwent surgery, and one case underwent surgery with chemotherapy. Follow-up was done in 5 cases; one case was lost to follow-up. Three patients died with a median survival of 11.6 months (3-42 months). Conclusions: PANKL is rare with highly aggressive clinical presentation and poor prognosis. Accurate diagnosis entails correlation of histomorphology, immunohistochemistry, EBER in situ hybridization and clinical history.

Clinicopathologic analysis of dysembryoplastic neuroepithelial tumor / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, radiologic findings, treatment options and prognosis of dysembryoplastic neuroepithelial tumor (DNT).</p><p><b>METHODS</b>The clinicopathologic and radiologic features were retrospectively analyzed in 10 cases of DNT.</p><p><b>RESULTS</b>Intractable partial seizure was the main presenting symptom in all patients. The tumor was located in temporal lobe (number = 5), frontal lobe (number = 3) or parietal lobe (number = 2). CT scan displayed a hypodense lesion. MRI scan revealed the tumor was non-enhancing T1WI hypointense and T2WI hyperintense, with internal septation and hyperintense ring around the tumor seen on FLAIR image. There was neither peritumoral edema nor mass effect. Histologically, the tumor showed the presence of glioneuronal element, with oligodendrocyte-like cells, floating neurons, astrocytes and associated microcystic changes. Immunohistochemical study demonstrated positivity for NeuN and synaptophysin in the neurons and some oligodendrocyte-like cells. Olig2 and S-100 protein were also expressed in the oligodendrocyte-like cells. Ki-67 index were lower than 1% in all cases. Nine cases were treated by complete surgical excision and the remaining case was subtotally excised. No post-operative chemotherapy or radiotherapy was given. One of the 10 cases recurred on follow up.</p><p><b>CONCLUSIONS</b>Correct diagnosis of DNT requires correlation with clinicopathologic, radiologic and immunohistochemical findings. Complete resection of the tumor and epileptogenic foci is the mainstay of treatment for DNT, with intraoperative EEG monitoring. Post-operative chemotherapy or radiotherapy is not required.</p>

Significance of EphA2 receptor expression in human gliomas / 肿瘤

Objective: To investigate the expression and significance of erythropoietin-producing hepatocellular A2 (EphA2), a receptor of tyrosine kinase in human gliomas and the correlation between EphA2 expression and tumor angiogenesis. Methods: Immunohistochemistry was used to examine the EphA2 expression in 66 surgically resected human glioma tissues, 2 human glioblastoma multiforme (GBM) cell lines(U251 and U87) and 10 normal brain tissues. Next, we performed Western blotting to further investigate the expression of EphA2 in high-grade GBM and normal brain tissues. Microvessels in the glioma tissues were counted after immunostaining for CD34, and the c orrelation between EphA2 expression and microvessel counts (MVCs) in glioma tissues were assessed. Results: Our immunohistochemical analyses demonstrated variable levels of EphA2 expression in 63 of 66 cases examined (63/66, 95.5%). But EphA2 expression was not detected in all 10 normal brain samples and 3 cases of low-grade gliomas (I-II). There was statistical difference in EphA2 expression between human gliomas and normal brain samples (P < 0.01). The positive rate of EphA2 expression was significantly higher in high-grade gliomas (WHO III-IV) than in low-grade gliomas (WHO I-II) (P < 0.01). The specific EphA2 staining was observed in both glioma tissues and U251 cells. The expression level of EphA2 protein was significantly lower in U87 cells than that in U251 cells. It was not detected in normal brain tissues. Microvessel density (MVD) significantly correlated with expression level of EphA2 protein (P <0.01). The MVD was higher in EphA2-strong positive tumor areas. Conclusion: EphA2 is specifically over-expressed in high-grade gliomas, but is not detected in normal brain tissues. EphA2 may be a novel marker of malignant glioma. It can be used as a molecular target for therapeutic intervention against high-grade glioma. EphA2 is involved in angiogenesis and plays an important role in the initiation and progression of glioma.