Clinical significance of P-glycoprotein immunohistochemistry and histomorphologic factors in patients with osteosarcoma

Osteosarcoma is the most frequent highly malignant bone tumor with a peak incidence in the second decade of life. Although survival rate increased up to 60-70% within the last 10 years, the problem of unresponsiveness to chemotherapy remains. In this study, we sought to determine the prognostic significance of P-glycoprotein as a tumor marker for osteosarcoma. In a retrospective study, we correlated P-glycoprotein immunostaining with clinicopathologic and histomorphologic features of the tumor and the patient outcome in 30 cases with primary, non-metastatic, highgrade osteosarcoma who were homogeneously treated. P-glycoprotein positivity was found in 14 of 30 cases and was significantly associated with a higher incidence of adverse events and relapse rate. No relationship was found between p-glycoprotein immunostaining and clinicopathologic features such as age, sex, tumor site, histologic subtype, osteoid content, osteoid pattern, pretreatment necrosis, pleomorphism of the cells, and presence of prominent nucleoli, except for mitotic activity per 10 HPF. P-glycoprotein positivity in immunohistochemistry should be taken into consideration to identify a subgroup of osteosarcoma patients with poor outcome at the time of diagnosis. So it might be an important marker in planning innovative chemotherapeutic regimens

Osteosarcoma arising from a solitary osteochondroma of the tibia

We present a case of osteosarcoma arising from an osteochondroma of the right tibia in a 71 year old man. The radiographic studies were suggestive of a malignant lesion. Histologic examination showed a conventional osteosarcoma that eroded the cartilagenous cap. The patient received postoperative chemotherapy with no evidence of metastasis until three years following the operation. The occurrence of osteosarcoma out of osteochondroma is an extremely rare event and very few cases have been reported

[Comparison between light and electron microscopic findings in 30 patients with lupus nephritis]

The kidney biopsy specimen is used for initial diagnosis of patients with SLE who at the time of biopsy lack either diagnostic clinical manifestation and or serological markers. Another role is evaluation of renal dysfunction in transplanted patients when lupus has occurred in renal allograft. The aim of this study is correlating the findings of light, immunofluorescent and electron microscopy in thirty patients with lupus nephritis. The kidney biopsies of thirty patients with SLE were studied for purpose of correlating the findings of light, immunofluorescent and electron microscopy. We studied 30 parameters in light microscopy sections, 5 parameters in semi -thin and EM sections, and IgG, IgM, IgA, C3, C4 and fibrinogen in different structures of specimens by immunofluroscent microscopy. The P value and measurement of agreement of kappa was calculated. In 25 cases LM and EM correlated completely including lupus nephritis class, activity and chronicity indices and presence or absence of immune complex deposition. In 5 cases discrepancy between Light Microscopy and Electron Microscopy diagnosis was found. Three cases were classified as class three according to LM and class two by EM. LM reevaluation of all three cases showed focal and segmental endocapillary cell proliferation with neutrophilic infiltration. We found that LM study is cornerstone in the focal lesions because of the limited inclusion of glomeruli in EM. One case of class four by LM, in EM shows massive [grade three] sub-epithelial depositions and grade one sub endothelial deposition and was classified it as Class five + six. In LM, findings cellular crescent in six glomeruli, severe endocapillary cell proliferation with activity index of [16/24] were detected. So the correct diagnosis was Class five + six. The last case classified as four in LM classification and revealed moderate mesangial cell proliferation with obliteration of lumens. In EM, we had three glomeruli which all showed mesangial cell proliferation, grade two mesangial deposition, with one focus of small [grade one] sub endothelial deposition. According to the above-mentioned findings the EM class of patient was class two. We found that there is agreement between EM and semi-thin sections for detection of exact site of depositions as well as their grading. Study of semi-thin sections by LM can demonstrate the deposits that are observed on EM

Polyclonal Ki-67 expression in transitional cell carcinoma of the bladder

Current methods of predicting prognosis in transitional cell carcinoma [TCC] of the bladder fail to provide consistently reliable information about future tumor behavior. The polyclonal antibody Ki-67 recognizes a nuclear antigen exclusively present in cells in the cell cycle. The Ki-67 reactivity has been shown to correlate with conventional prognostic indicators in several tumors.We studied the proliferative activity of 40 cases of transitional cell carcinomas of the bladder using polyclonal Ki-67 and determined the proportion of cells undergoing active division. A significant correlation was observed between cells with activated DNA [Ki-67], histological grading and staging [P< 0.0001]. The differences of mean Ki-67 index in the grade Ila versus lib [using Pauwell classification] was also significant [P<0.044]. Those cases which were limited to epithelial layer [stage Ta] show lower Ki-67 positivity than those infiltrating the lamina properia or deeper layers [stage Tl, T2, T3 and T4][P< 0.05]. The differences between stage Tl versus T2 and T3 versus T4 were not statistically significant [P>0.05]. The tumors with lymphatic and vascular invasion showed greater Ki-67 positivity than non-invasive tumors [P<0.01] These results suggest that the immunohistochemical assessment of the proliferative activity of transitional tumors of the bladder, using polyclonal antibody Ki-67 correlates with higher tumor stage and grade. Ki-67 staining provides an easy method of determining tumor cell turnover that might provides additional prognostic information. The results also indicate that the number of Ki-67 positive cells in grade II tumors may be useful aid in separating grade II TCC with favorable prognosis [Ila] from those with a poor clinical outcome [lIb]

[Accuracy of fine needle aspiration in bone lesions]

To determine the accuracy of Fine Needle Aspiration [FNA] cytology in the diagnosis of bone lesions, fifty bone lesions after clinical and radiographic correlation were evaluated by FNA. The results were compared with the histopathology of the open biopsis. Accuracy rates of 75% and 88% were achieved by FNA of non-malignant and malignant bone lesions respectively. Chondrosarcoma and non-malignant lesions such as unicameral bone cyst gave the greatest diagnostic difficulties. Osteosarcoma, Ewing's sarcoma and metastasis could be easily identified when interpreted with clinical and radiographic findings. FNA plays an important role in early diagnosis of most of the malignant bone lesions. Cytologic evaluation together with clinical and radiographic findings has a high accrucy rate for diagnosis of bone lesions

Metastatic ewing's sarcoma of the parotid gland, dagnosed by FNA cytology

Ewing's sarcoma can metastasize to many parts of the body, including bone, lungs, liver and lymph nodes. Metastasis to parotid gland, however, is unusual and has not been reported so far. This report describes clinical and cytological findings of Ewing's sarcoma, metastasizing to the parotid gland

Exfoliative cytology in the esophageal carcinoma

In this study, the results of endoscopic biopsy and exfoliative cytology in the diagnosis of esophageal carcinoma, are compared. Among one thousand cases clinically suspicious of, or at risk for esophageal carcinoma, 20 proved to be malignant on surgical specimen. Brushing cytology was positive in eighteen and biopsy, in seventeen cases. All of the negative cases [30] were diagnosed correctly by both cytology and biopsy [no false positive]. False negative cases in biopsy [3] were diagnosed by cytology and false negative cases in cytology [2 cases] were correctly diagnosed by biopsy. All benign and malignant cases were, therefore correctly diagnosed by combined cytology and biopsy. It is concluded that performing both esophageal biopsy and brushing cytology will improve the diagnostic accuracy without adding inconvenience to patient