ABSTRACT
<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics of atypical fibrous histiocytoma (AFH), with emphasis on differential diagnosis.</p><p><b>METHODS</b>The clinical and pathologic features were reviewed in 24 cases of AFH (from 2007 to 2012). The follow-up data were analyzed. Immunohistochemical study using EnVision method was carried out.</p><p><b>RESULTS</b>There were 10 males and 14 females with age at presentation ranging from 8 to 67 years (mean = 41 years and median = 39 years). The tumor occurred in the extremities (number = 14), trunk (number = 8) or head and neck region (number = 2). Apart from one case, all were located in the dermis. The clinical appearance was similar to those of classic fibrous histiocytoma. Histologically, the tumor was characterized by various number of hyperchromatic bizarre cells scattered in the background. Mitotic figures including atypical ones were noted, especially in the more cellular areas. Immunohistochemical study showed that the tumor cells expressed vimentin. Focal positivity for alpha-smooth muscle actin was demonstrated in some cases. Follow-up information was available in 14 cases. Three of them suffered local recurrence. None of these cases had distant metastasis.</p><p><b>CONCLUSIONS</b>Atypical fibrous histiocytoma represents a pleomorphic variant of fibrous histiocytoma. Although the tumor exhibits worrisome features, it usually pursuits a relatively benign course. Nevertheless, rare cases may recur, especially after incomplete excision. AFH is sometimes mistaken as atypical fibroxanthoma. A distinction between the two entities is warranted as they represent two different entities.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Actins , Metabolism , Back , Pathology , Diagnosis, Differential , Extremities , Pathology , Follow-Up Studies , Histiocytoma, Benign Fibrous , Metabolism , Pathology , General Surgery , Neoplasm Recurrence, Local , Retrospective Studies , Skin Neoplasms , Metabolism , Pathology , General Surgery , Vimentin , Metabolism , Xanthomatosis , PathologyABSTRACT
<p><b>OBJECTIVE</b>To study the association of positive expression of nucleotide excision repair cross complementary group 1 (ERCC1) in the tumor tissues with platinum resistance of the tumor cells and the clinical outcomes of neo-adjuvant chemotherapy in elderly patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>ERCC1 expression was detected immunohistochemically in the tumor tissues from 113 elderly patients with NSCLC, of which 58 patients received platinum-containing neo-adjuvant chemotherapy, and the impact of ERCC1 expression on the outcomes of neo-adjuvant chemotherapy was analyzed.</p><p><b>RESULTS</b>The total positivity rate of ERCC1 expression was 35% in these patients. The positivity rates was significantly higher in the patients receiving neo-adjuvant chemotherapy than in the control group (46.7% vs 21.05%, χ² = 3.770, P = 0.048). In the 39 patients positive for ERCC1, the response rate to treatment was 53.85%, as compared to the rate of 51.35% in the 74 ERCC1-negative patients. After neoadjuvant chemotherapy, the median survival time (MST) was 53 months in ERCC1-negative patients, as compared to 37 months in the positive patients. The ERCC1-negative and ERCC1-postivie patients showed similar 3- and 5-year survival rates (48.3% vs 44.4%, χ² = 0.033, P = 0.856; 22.5% vs 18.5%, χ² = 0.096, P = 0.757). Multivariate COX regression analysis showed that ERCC1 expression level in the tumor tissue and TNM stages were independent factors that affected the prognosis of the patients (P < 0.05).</p><p><b>CONCLUSION</b>Neoadjuvant chemotherapy can induce ERCC1 expression in the tumor, and the objective response rate of neoadjuant chemotherapy can be low in NSCLC patients with high ERCC1 expression. ERCC1 expression is an independent factor affecting the prognosis of elderly patients with NSCLC receiving neoadjuant chemotherapy.</p>