Clinico-pathological and radiological correlation of CNS tumors along with role of Ki 67 proliferative index in grading Astrocytoma and Meningiomas

Background: CNS neoplasms are a heterogenous group contributing to <2% of all the malignant neoplasms. Imaging and histopathology play a great role in diagnosing these lesions. Aim of the study is to correlate radiological findings with that of histopathology and evaluate the role of Ki 67 proliferative index in various grades of Astrocytomas and MeningiomasMethods: This is an observational study for a period 2 years from July 2015 to June 2017 in Department of Pathology Andhra Medical College. The total number of specimens of CNS tumors received during this period were126. The specimens were routinely processed and stained with H&E. The tumors were classified based on WHO 2016 classification. In total 71 cases-45 cases of meningiomas and 26 cases of astrocytomas, the expression of Ki 67 labelling index was recorded in various grades of these tumors and results tabulated.Results: Among 126 cases, tumors predominantly encountered were of meningeal origin accounting to 45 cases (35.71%) followed by tumors of neuroepithelial origin 35 cases (27.78%). Tumors were seen in all age groups, but common was among 41-50 years of age group with metastatic tumors being seen in >60 year group. Tumors were more common in males with male: female ratio being 1.25:1. Ki 67 proliferative index increased as the grade of tumor increased in both astrocytomas and meningiomas.Conclusions: Grading of meningiomas and astrocytomas are very much essential with reference to prognosis and therapy. Histopathology plays a great role in grading these lesions but Ki 67 proliferative index adds as an adjunct and helps in confirmation and predicting the recurrence of these lesions.

Ameloblastic Carcinoma: A Case Report And Update On Classification System Of Odontogenic Malignancies

Ameloblastic carcinoma is a rare malignant lesion with characteristic behaviour that dictates a more aggressive surgical approach than that of a simple ameloblastoma. However, due to less number of cases reported till now in the literature and scarcity of documentations, reliable evidence of its biologic activity is currently unavailable. Because the lesion is usually found unexpectedly after an incisional biopsy of diagnosed case of Ameloblastoma or after the removal of a cyst, a guide to differential diagnosis is not usually useful. Most ameloblastic carcinomas are presumed to have arisen de novo with a few cases of malignant transformation of ameloblastomas. Although rare, these lesions have been known to metastasize, mostly to the regional lymph nodes or lungs. Here we reported a case of 62year old male and his clinical, radiographical and histological features has been discussed with an insight on the classification systems of odontogenic malignancies.

Low grade follicular lymphoma with high proliferation index; diagnostic and management issues.

Follicular Lymphoma (FL) is the second most common B-Non Hodgkin Lymphoma after diffuse large B cell lymphoma (DLBCL). Low grade FL is known for its indolent behavior; however, one subset of FL behave aggressively and may require intensive therapy. One of the diagnostic issues in FL is to identify this subgroup of cases. Proliferation index can have prognostic importance in this subset of cases. We discuss one case of low grade FL with a paradoxically high proliferative index. A 63 year male presented with generalized lymphadenopathy of one year duration, which was gradually increasing in size. On examination, patient had bilateral cervical, axillary and inguinal nodes. Biopsy of the left cervical lymph node was reported as FL - Grade 2, with high proliferative Index (60%). The patient was put on CHOP regimen targeted for high grade lymphomas, and had complete remission. High proliferative index in FL is a poor prognostic factor irrespective of the histologic grade. So, proliferative index should be assessed in all cases of FL as an adjunct to histologic grading.

Aggressive Vestibular Schwannomas Showing Rapid Growth after Surgical Resection; Clinicopathological Analysis of 15 Cases

OBJECTIVE: Vestibular schwannomas(VS) are known to be relatively slow growing tumors. Some VS, however, rapidly regrow or recur after surgical resection. Our objective is to investigate clinicopathological characteristics of these tumors and to elucidate factors, which can predict a rapid regrowth or recurrence after surgical resection. METHODS: Twenty-nine patients with VS underwent reoperation for regrowth or recurrence at the Department of Neurosurgery in Seoul National University Hospital between 1978 and 2000. Among these, 15 VS regrew or recurred rapidly(annual growth rate larger than 15mm/year). To compare morphology and proliferative activity, 15 cases of VS were randomly selected among consecutive operative cases between 1991 and 1999 with tumor size more than 4cm. As pathological parameters, cellularity, pleomorphism, mitosis, necrosis, invasion to adjacent tissue, and microvascular proliferation were examined. Proliferative indices(Ki-67 index) were also evaluated. Statistical analysis was performed using Fischers exact test and ANOVA test. RESULTS: The mean ages at a diagnosis were respectively 40.6(range 21-63), and 49.7(range 35-67) [p=0.438]. Male to female ratio was respectively 7:7, and 5:10[p=0.462]. In radiological findings, aggressive group at initial presentation had more lobulating contour than CG(7/13 cases vs 3/15 cases, p=0.001). In pathologic findings, cellularity and pleomorphism were significantly higher than those of control group(p=0.001). Proliferative index(Ki-67 index) was higher in aggressive group than control group [2.28(range 0.1-8.6) vs 0.59(range 0-1.5), p=0.034]. CONCLUSION: Vestibular schwannoma presented with lobulating contour, high proliferative index(Ki-67 index), and high cellularity or pleomorphism should be frequently investigated radiologically during follow-up for early detection of regrowth or recurrence.

Apoptosis and Proliferative Activity of Non-Hodgkin's Lymphoma: Correlation with Bcl-2 and P53 Protein Expression / 대한방사선종양학회지

PURPOSE: Tumor growth in a given neoplasm is the net result of cell proliferation and cell loss, and apoptosis is the most significant component of continuous cell loss in most tumors. In this study, we examined non-Hodgkin's lymphoma (NHL, n=67) immunohistochemically for the presence of Bcl-2 oncoprotein and P53 protein and compared apoptotic indices (AIs) and Ki-67 proliferative indices (percentages of Ki-67 positive cells). MATERIALS AND METHODS: 67 patients with NHL were evaluated : 3 low-grade and 64 intermediate-grade. The phenotype was determined in 65 cases : 47 (70%) were B cell type and 18 (27%) were T cell type. AIs and Ki-67 proliferative indices were determined immunohistochemically and the overexpression of P53 and Bcl-2 protein were also evalutated. RESULTS: The overexpressions of Bcl-2 protein and P53 protein were found in 40% (26/65) and 31% (20/ 65). The AI ranged from 0% to 15% (mean 2.16, median 1.2). Cellular Bcl-2, which counteracts apoptosis, was significantly ( p=0.005) associated with AIs. Ki-67 proliferative indices ranged from 1% to 91% (mean 55.4), and P53 was significantly ( p=0.000) associated with Ki-67 proliferative indices. A positive correlation between AIs and Ki-67 proliferative indices was revealed ( p=0.012) in Bcl-2 positive patients. CONCLUSION: In NHL, we observed a correlation between AIs and Bcl-2 expression, between Ki-67 proliferative indices and P53 expression, and between AIs and Ki-67 proliferative indices in Bcl-2 positive patients. Our results suggest that cell apoptosis may be inseparable from cell proliferation during tumor growth.

Expression of cyclins in ductal hyperplasia, atypical ductal hyperplasia and ductal carcinoma in situ of the breast

Cyclin/cdc complexes are known to function in cell-cycle regulation. Cyclin D1/cdk4 and -6 complexes, which functions as a G1-S checkpoint and cyclin B1/cdc2 complexes, a G2-M checkpoint are essential for DNA synthesis and mitosis, respectively. Thus, dysregulated overexpression of cyclins appears to be involved in uncontrollable cell proliferation and early tumor development. We investigated the expression and proliferative index of cyclin D1 (PIcyclin D1), cyclin B1 (PIcyclin B1) and Ki-67 (PIKi-67) using immunohistochemical staining on 15 cases of ductal hyperplasia (DH), 26 cases of atypical ductal hyperplasia (ADH) and 43 cases of ductal carcinoma in situ (DCIS) of the breast in order to evaluate whether these cyclins are associated with abnormal cell proliferation and play a role in tumor development from ADH to carcinoma. Furthermore, we investigated whether the expression and proliferative index of the cyclins and Ki-67 are correlated with the histologic grade according to the Van Nuys classification and with the histologic subtype according to traditional classification. Finally, we estimated the correlation coefficient among PIcyclin D1, PIcyclin B1, PIKi-67 and estrogen receptor in ADH and DCIS. The expression of cyclin D1 was detected in 39.5% of DCIS and 7.7% of ADH cases. In the DH cases, expression of cyclin D1 was not found. Expression of cyclin B1 was also detected in 69.7% of DCIS, 50.0% of ADH and 93.3% of the DH cases. The PIcyclin D1 was significantly different among these three groups. Moreover, the PIcyclin D1 and PIKi-67 were differed significantly between the low grade DCIS and ADH cases. However, PIcyclin B1 only appeared to be significantly different between the total DCIS and ADH. Results of the correlation coefficient among PIcyclin D1, PIcyclin B1 and PIKi-67 were positively correlated with each other. No significant correlation was found between the expression of ER and cyclin D1 in ADH and DCIS. In summary, our results support the hypothesis that a cyclin D1 and cyclin B1 protein aberration, along with Ki-67, may act as a relatively early event in the tumor development from ADH to carcinoma.

Metabolic Ratio of FDG-PET and Histologic Grading in Cerebral Gliomas

To assess the degree of malignancy in cerebral gliomas at the time of diagnosis, we compared the metabolic ratio using 18F-fluorodeoxyglucose(FDG)-Positron Emission Tomography(PET) with histologic grading and proliferative index(Ki-67) of cerebral gliomas. Materials for this study were histologically-examined 21 gliomas and they were divided into glioblastomas as group 1, anaplastic gliomas as group 2, and low-grade gliomas as group 3. The visual analysis of FDG-PET images showed hypermetabolic lesions in 14(87.5%) out of 16 high-grade gliomas (glioblastomas and anaplastic gliomas), and hypometabolic lesions in 4(80%) out of 5 low-grade gliomas. Tumor to cerebellum ratio(T/Cbll) in FDG-PET was used as metabolic ratio and the values of T/Cbll in each group were 1.30+/-0.10, 0.73+/-0.07, 0.70+/-0.07, respectively. In comparision of T/Cbll between group 1 with remaining two groups, differences were statistically significant(p=0.0002, p=0.0002, respectively), however, there was no statistical difference between group 2 and group 3. The values of Ki-67 were 24.16+/-5.66 in group 1, 8.10+/-2.70 in group 2, 5.46+/-1.23 in group 3, and differences were statistically significant between group 1 and group 2, 3(p=0.015, p=0.015, respectively), but there was no statistical difference between group 2 and group 3. The correlation between T/Cbll and Ki-67 was good and statistically significant(p=0.0047). In conclusion, the visual and semiquantitative analysis of FDG-PET would be helpful in determining the degree of malignancy in cerebral gliomas.

Correlation of Histologic Findings of Ovarian Epithelial Tumors with Expression of Proliferating Cell Nuclear Antigen and Flow Cytometric DNA Analysis

The prognosis of malignant ovarian tumor is poorer than that of borderline malignant ovarian tumor, Therefore an accurate diagnosis and estimation of the biologic behavior of the tumor are necessary for proper management of the patient. The histologic investigation of the tumor may provide information on the estimation of the malignant potential of tumor cells, but it may be a questionable method because of the subjective determination of tumor grade. Quantification of proliferative activity of tumor cells may play a role as an objective method to provide an estimation of the malignant potential of tumor cells. An evaluation of histologic findings was done on 84 cases of ovarian mucinous and serous tumors that were surgically resected and diagnosed during the period from January 1981 through July 1992. The proliferating cell nuclear antigen (PCN A) labelling index estimated from the immunohistochemical stain for PCN A and the Sphase fraction and porliferative index obtained from flow cytometric DN A analysis were assessed each other with histologic findings. The results are as follows: The presence of aneuploidy in malignant tumors was statistically significant as compared with benign tumors. The borderline malignant tumors showed no significant difference between the number of diploidy and aneuploidy. The PCNA labelling index, S-phase fraction and proliferative index tended to increase as the histologic grade of tumors went up. They were higher in malignant tumors than in others. The PCN A labelling index, S-phase fraction and proliferative index were higher in tumors with aneuploidy than in those with diploidy. In contrast to borderline malignant tumors, the PCNA labelling index in malignant tumors revealed a significant relation with the mitotic index. The S-phase fraction and proliferative index showed, in malignant tumors, a close correlation with the architectural grade and nucleolar grade, but not in borderline malignant tumors. Considering these results, the presence of aneuploidy, PCNA label.