RESUMEN
Background: prostatic adenocarcinoma is characterized by diverse architectural growth patterns and can be confused with some benign prostatic lesions. The most common pseudoneoplastic lesions in the prostate that can mimic low-grade prostatic adenocarcinoma are post-atrophic hyperplasia [PAH], atypical adenomatous hyperplasia [AAH] and sclerosing adenosis of the prostate [SAP]
Objective: this study aimed to evaluate the histopathological and immunohistochemical features of some pseudoneoplastic lesions of the prostate that could potentially be confused with low-grade prostatic adenocarcinoma [small gland pattern]
Material and Methods: 100 specimens of prostatic lesions were enrolled in this study and analyzed retrospectively [50 needle biopsy specimens and 50 transurethral resection of prostate [TURP] specimens]. All cases had atypical foci that required further workup. Four slides per specimen were cut, one slide for hematoxylin and eosin stain [Hand E] and the other 3 slides for immunohistochemical [IHC] staining by antibodies against 34beta E12 cytokeratin, p63 and alpha methyl acyl coenzyme A racemase [AMACR]
Results: histological examination [prior to IHC staining] revealed provisional histological diagnosis of 35 cases of PAH, 12 cases of AAH, 13 cases of SAP and 40 cases of low grade prostatic adenocarcinoma. Immunohistochemical results revealed immunopositivity to 34beta E12 in a discontinuous pattern in 13 out of the 35 cases of PAH [13/35], immunopositivity to 34beta E12 and p63 in a continuous basal pattern in 17 cases [17/35] and negativity for all markers in 5 cases [5/35]. 29 cases out of the 40 prostatic carcinomas showed immunopositivity for AMACR and negativity for 34beta E12 and p63 [29/40], 5 cases were negative for all markers [5/40] and 6 cases were positive to p63 and negative for AMACR and 34beta E12 [6/40]. 8 out of the 12 cases diagnosed as AAH showed immunopositivity to 34beta E12 and p63 in a discontinuous pattern and negative to AMACR [8/12], 2 cases were positive to AMACR and negative to basal cell markers [2/12] and 2 cases were negative to all markers. All the 13 cases diagnosed histologically as SAP showed immunopositivity to 34beta E12 and p63 and immunonegativity to AMACR
Conclusion: immunohistochemistry [IHC] can be contributive in the diagnosis of prostatic adenocarcinoma if used with care and experience. No single marker can establish a diagnosis on its own, but interpretation must always be in conjunction with Hand E morphology
RESUMEN
Background: Polycystic ovary syndrome [PCOS] is a common complex genetic condition of women in the reproductive age. PCOS is a heterogeneous syndrome characterized by clinical/biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin therapy has been proved to improve fertility in patients with PCOS, inducing not only high ovulation and pregnancy rates, but also reducing the incidence of miscarriages
Aim of the Work: This study was aimed to evaluate the effects of metformin therapy on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors [AR], in patients with PCOS
Patients and Methods: 100 patients with PCOS were included in this study. Each investigated case was submitted to detailed medical history, clinical examination that included body hair distribution, body weight, height and body mass index [BMI], transvaginal ultrasound, laboratory investigations [included fasting insulin, free testosterone, LH and FSH levels]. Endometrial pipelle samples were taken for histopathological evaluation and assessment of androgen receptor expression. These investigations were done before and after three months of metformin treatment
Results: A significant decrease of BMI of the investigated cases after metformin therapy was observed [P value <0.003]. There was a significant decrease of LH level after metformin therapy from 9.17 +/- 2.84 Miu/ml to 6.18 +/- 3.6 Miu/ml and of fasting insulin level from 14.3 +/- 4.3 to 8.2 +/- 5.9. Insignificant increase of FSH level from 3.87 +/- 1.8 to 4.85 +/- 2.6 and also insignificant decrease of free testosterone level from 1.58 +/- o.83 to 1.38 +/- 1.4 were also observed. Histopathological results of the endometrial specimens before metformin therapy revealed histologic features of early proliferative endometrium in 64 cases, 20 cases with a late proliferative endometrium and examination of the remaining 16 cases revealed features of simple endometrial hyperplasia. Among the 64 cases diagnosed as early proliferative endometrium before the therapy, 60 cases showed features of a late proliferative endometrium after treatment and the remaining 4 cases showed no histomorphologic changes. Among the 20 cases diagnosed as a late proliferative endometrium before therapy, 6 cases showed features of early secretory phase after therapy, 6 cases showed features of mid-secretory endometrium while the remaining 8 cases showed a late secretory endometrium that indicate successful ovulation after therapy. Regression of hyperplasia after therapy was noted in 6 of the 16 cases diagnosed as simple endometrial hyperplasia. Immunohistochemical [IHC] results revealed marked increase in endometrial AR expression in patients with PCOS compared to the normal fertile controls [p<0.004]. Also, a significant decrease of AR expression in endometrial epithelial and stromal cells after metformin administration in patients with PCOS was noted [p<0.003]
Conclusion: Metformin therapy restores normal menstrual cyclicity in patients with PCOS, induces ovulation and showing significant decrease in endometrial AR expression
RESUMEN
Background: The classification of molar pregnancies into a complete and a partial hydatidiform mole and the differentiation from hydropic abortions are usually accomplished by histomorphologic features alone, but sometimes may be inaccurate or inconclusive. Immunohistochemical staining techniques have been reported as a good diagnostic method complementary to the histologic diagnosis. One of the advantages of this technique is the ability to apply it retrospectively to sections of formalin fixed/paraffin embedded tissue and therefore, there is no need for expensive or sophisticated techniques
Aim of the Work: This study aimed to determine if immunohistochemical expression of p53, p63, p57 and Ki67 could aid in differentiating molar from non molar pregnancies on one hand and complete mole from partial mole on the other hand
Materials and Methods: A total of 180 placental specimens were enrolled in this study including 60 non molar placental specimens with hydropic changes [HA] and 120 molar specimens [60 complete hydatidiform moles [CHMs] and 60 partial hydatidiform moles [PHMs]. The studied cases were examined histologically and immunohistochemically for expression of p53, p63, p57 and Ki67
Results: There was a significant difference in p57 expression between HA and PHM [P value < 0.05], HA and CHM [P value < 0.0001] and also between PHM and CHM [P value < 0.003]. There was a significant difference in Ki67 expression between HA and PHM [P value < 0.03], PHM and CHM [P value < 0.01] and between HA and CHM [P value < 0.009]. There was no significant difference in P63 expression between HA and PHM [P value .0.8], PHM and CHM [P value .0.5], and also between HA and CHM [P value .0.2]. A significant difference in p53 expression between HA and CHM [P value < 0.007] was noted, also between PHM and CHM [P value <0.005], while no significant difference between HA and PHM in expression of p53 [P value .0.8]