Clasificación en subtipos intrínsecos de los carcinomas de mama analizados en un centro de patología de Medellín en el año 2011 / Classification of intrinsic subtypes of breast carcinomas analyzed in a pathology center of Medellin in 2011

Introducción: los carcinomas de mama representan un grupo heterogéneo de tumores, tanto en su comportamiento clínico como pronóstico. El tratamiento oncológico pre y postoperatorio en pacientes con carcinoma de mama está condicionado por el resultado histopatológico, inmunohistoquímico y la expresión de c-erbB2. La clasificación molecular del cáncer de mama ha definido grupos de riesgo y manejos diferentes. Objetivo: clasificar los carcinomas de mama según su tipo histológico y subtipos intrínsecos, estudiados en el Laboratorio de Patología y Citología (LAPACI) de Medellín en el año 2011. Materiales y métodos: estudiamos 114 pacientes con cáncer de mama diagnosticadas mediante biopsia cortante, quienes fueron evaluadas entre enero 1 y diciembre 31 de 2011. Se realizó una evaluación histopatológica e inmunohistoquímica del tumor para receptores de estrógenos, progesterona, HER2, KI-67 y con estos resultados se clasificaron los tumores en cuatro subtipos moleculares: luminal A y B, triple negativo y HER2 enriched. En la evaluación clínico-patológica se consideraron: edad, tipo histológico y grado de diferenciación. Resultados:la edad media de presentación del cáncer de mama fue de 55 años y el tipo histológico más común fue el ductal. Los carcinomas de mama más frecuentes fueron los de tipo luminal A (38,5 %), luminal B (32,4 %), triple negativos (15,8 %) y HER2 enriched (13,1 %). Los carcinomas de mama de tipo luminal mostraron ser, con mayor frecuencia, tumores bien diferenciados y con bajo índice de proliferación (Ki-67). En tanto, los carcinomas de mama de tipo triple negativo y HER2 enriched correspondían a tumores pobremente diferenciados, que expresaban un alto índice de proliferación celular. En los grupos de menor edad los tumores fueron más indiferenciados, siendo el subtipo HER2 enriched el que con mayor frecuencia afecta a mujeres pre menopáusicas (40 %) y a las menores de 34 años.s. Conclusión: los subtipos luminal A y B son los carcinomas que presentan mejor grado de diferenciación, por el contrario los subtipos triple negativo y HER2 enriched son predominantemente mal diferenciados y con altos índices de proliferación celular, a su vez son los que más afectan a las mujeres premenopáusicas, y el subtipo HER2 enriched es el que más se presenta en mujeres menores de 35 años.

Introduction: Breast carcinomas represent a heterogeneous group of tumors, both in their clinical behavior and prognosis. The pre and post cancer treatment in patients with breast carcinoma was conditioned by the results of histopathological, immunohistochemical hormone receptor and the expression of c-erbB2. The molecular classification of breast cancer defined risk groups and different treatments. Objectives: To classify breast carcinomas in intrinsic subtypes by immunohistochemical markers and analyze the histopathological features according to the degree of differentiation, age and rate of cell proliferation of different subtypes studied in the laboratory of pathology and cytology (LAPACI) of Medellín in 2011. Materials and Methods: We studied 114 patients diagnosed with breast cancer by cutting biopsy, seen between January 1 and December 31 2011 It takes a histopathological and immunohistochemical evaluation of tumor for estrogen, progesterone, HER2, Ki-67 expression and these results are classified in four intrinsic subtypes: Luminal A and B, triple negative and HER2 enriched. In the clinical-pathological evaluation were considered: age, histological type, degree of differentiation. Results: The most common breast carcinomas were luminal A (38,5%), luminal type B (32,4%), triple negative (15,8%) and HER2 enriched (13,1%). Breast carcinomas showed luminal type being more well differentiated tumors frequency and low proliferation index (Ki-67). Meanwhile, breast carcinomas triple negative and HER2 enriched corresponded to poorly differentiated tumors expressing a high rate of cell proliferation. In the younger age groups were more undifferentiated tumors, HER2 enriched subtype being the most frequently affected premenopausal women (40%) and under 34 years.. Conclusion: The mean age at diagnosis of breast cancer was 55 years, and the most common histological type was ductal; The luminal subtypes A and B are the carcinomas that have better degree of differentiation, however the triple negative and HER2 subtypes are predominantly enriched poorly differentiated, and high rates of cell proliferation in turn are most affecting women premenopausal and HER2 enriched subtype is the most commonly occurs in women under 35 years.

Research progress and development direction on histological classification system of breast cancer / 实用肿瘤学杂志

Histological classification system ( HCS) is an important system in judging and predicting ma-lignant behaviors of breast cancer .This study is aimed to analyze research progress and development direction of HCS by perusing literatures ,including the origin and development progress of HCS ,contents and deficiencies of Nottingham classification system(NCS),and introduction of novel classification system .HCS of breast cancer has a history of more than one hundred years ,among which NCS is the most widely used ,based on morphological fea-tures of cancer cells .However,there are still some shortcomings about NCS ,such as few indexes incorporation , great evaluation variation and low evaluation efficiency .Recently ,many newly evaluation systems have been devel-oped,including“nucleus+proliferation”classification system ,computer assisted classification system and compre-hensive prognostic classification model .Therefore,the future development directions of HCS on breast cancer is to use high throughput analysis technology to extract and analyze the hidden molecular information in cancer cells and the surrounding tumor microenvironment ,so as to better guide personalized therapy and predict clinical prog-nosis.

Urinary bladder cancer diagnosed by pathologic method / Монголын Анагаах Ухаан

BACKGROUND: Urinary bladder cancer (UBC) ranks ninth in worldwide cancer incidence. It is the seventh most commonmalignancy in men and seventeenth in women. UBC tends to occur most commonly in individuals over 65 orolder men and the male to female ratio are 3:1. The vast majority (over 90%) of bladder cancers are transitionalcell or urothelial carcinoma. Many experts did favor the 1998 World Health Organization/international Societyof Urological Pathology (WHO/ISUP) formulation for urothelial neoplasm. The 2004 WHO had accepted thenomenclature used in 1998, the system is currently used in countries of the world. Histology is the gold standardof typing, grading and staging to determine prognosis of the disease and process tactics of treatment. This newclassification system is not been introduced in our country yet, so UBCs are still formulated with the WHO 1973system. And there are no noted studies for UBC yet in Mongolia, these reasons were the background to determinethe UBC pathology with international classification system and nature of UBC in Mongolians.OBJECTIVE: To classify urinary bladder cancer occurred in Mongolia with the current histological classification and determinesspecific characters of pathology.MATERIALS AND METHODS: In this study we evaluated 138 patients with UBC diagnosed in Urological department of Central UniversityHospital, biopsy materials of these patients are classified with WHO/ISUP(2004) and results were analyzed.RESULT: Of the 108 patients with urinary bladder tumor, 2 patients (2%) were diagnosed with papilloma, 13 patients (12%)with papillary urothelial neoplasm of low malignant potential, 93 patients (86%) diagnosed with UC. Of 93 patientswith bladder carcinoma, majority of patients (91/98%) were diagnosed with urothelial carcinoma, 2 patients (2%)were diagnosed with adenocarcinoma. 74 (79.5%) of study patients were male, 19 (20.5%) were female and themale to female ratio was 3.9:1. Older man (over 50) was 65 (88%). Of UC (91), 1(1%) was carcinoma in situ,38 (42%) low grade papillary carcinoma, 33 (36%) high grade papillary carcinoma, 19 (21%) were no papillaryurothelial carcinoma. Of bladder carcinoma (93), 29 (31%) were superficial cancer (pTa, pTis), 58 (62%) wereinvasive cancer (pT₁₋₄).CONCLUSION: Urinary bladder cancer is in the majority in urinary bladder tumor in our country and transitional cell or urothelialcarcinoma compresses 98%. The male to female ratio in patients with bladder carcinoma is 3.9:1, older men over50 years are overweening affected.

Differences in Expression of VEGF-A, VEGFR-1, VEGFR-2 and Microvessel Density in Colorectal Cancer with Liver Metastasis

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignant neoplasms and is a leading cause of mortality worldwide. Metastasis to the liver is a frequent event in patients with CRC. An essential step in the metastatic cascade is angiogenesis. METHODS: This study included 45 patients who underwent a partial colectomy with hepatic resection for CRC with hepatic metastases. Immunohistochemistry was performed using vascular endothelial growth factor (VEGF)-A, VEGF receptor (VEGFR)-1, VEGFR-2, and CD34 antibodies to examine the relationship between CRC with liver metastases and angiogenesis. RESULTS: CRC showed significantly stronger expression of VEGF-A, VEGFR-1, and VEGFR-2 than liver metastases (p < 0.05). Microvessel density was also higher in CRC than in liver metastases (p < 0.05). CONCLUSIONS: Compared with previous studies, we found a higher expression of VEGF-A, VEGFR-1, VEGFR-2, and microvessel density in CRC than in liver metastases, which could be ascribed to a difference in vessel distribution and blood supply in each organ. Given its profuse blood supply and distinct cell populations, the liver might provide a rich milieu for tumor cell growth with less expression of angiogenesis-inducing agents.

Aspectos histológicos do pólipo rinossinusal / Histological aspects of rhinosinusal polyps

Estudo de coorte contemporânea com corte transversal. As diferenças histológicas dos pólipos nasais e a sua possível implicação clínica são escassas em literatura, apesar de sua importância para um diagnóstico preciso. Os trabalhos existentes classificam amostras de pólipos sem a preocupação quanto à influência de tratamentos prévios, o que influenciaria o resultado obtido. OBJETIVO: Estudar morfologicamente, através da microscopia ótica, as alterações estruturais do pólipo nasal na ausência de qualquer tratamento prévio e classificá-lo, histologicamente, correlacionando com os estudos de literatura. MATERIAL E MÉTODOS: Foram estudados 89 pacientes com polipose rinossinusal sem tratamento prévio. As amostras dos pólipos foram colhidas por biópsia ambulatorial e analisadas através de microscopia ótica após coloração com hematoxilina e eosina. RESULTADOS: As amostras foram classificadas da seguinte forma: pólipo Edematoso ou Eosinofílico: 65 casos (73 por cento); pólipo Fibroinflamatório: 16 casos (18 por cento); pólipo com Hiperplasia de Glândulas Seromucinosas: 06 casos (6,7 por cento) e pólipo com Atipia de Estroma: 2 casos (2,3 por cento). DISCUSSÃO: O padrão eosinofílico predominou nos pacientes com polipose rinossinusal na população estudada. Este padrão assemelha-se com os principais estudos que, no entanto não mencionam sobre tratamentos prévios. CONCLUSÃO: Após análise das características histológicas dos pólipos, observou-se que pólipos não tratados apresentam um padrão predominantemente eosinofílico.

Contemporary cohort cross-sectional study. Introduction: Despite its importance for an accurate diagnosis, histology differences among nasal polyps and its clinical implications are rarely reported in the literature. The existing papers classify polyp samples without concern for prior treatments, which could influence the results attained. AIMS: carry out a morphological study, through light microscopy, of nasal polyps' structural alterations in the absence of any type of prior treatment and histologically classify it in relation to studies published in the literature. MATERIALS AND METHODS: We studied 89 patients with nasosinusal polyps without prior treatment. Polyp samples were collected by outpatient biopsy and analyzed through light microscopy after dyeing with hematoxylin-eosin. RESULTS: Samples were classified in the following way: Edematous or eosinophilic polyp 65 cases (73 percent); fibro-inflammatory polyp: 16 cases (18 percent); Polyp with Sero-mucinose gland hyperplasia: 06 cases (6.7 percent) and polyp with stroma atypia: 2 cases (2.3 percent). DISCUSSION: eosinophilic pattern prevailed in the patients with nasosinusal polyps of the population studied. This pattern is similar to the ones found in the major studies, which, however, do not mention prior treatment. CONCLUSION: after analyzing the polyps' histological characteristics, we noticed that the untreated polyps present a predominantly eosinophilic pattern.

Correlations of Immunopathologic Types with Clinical Manifestations and Histological Classifications in Children with Henoch Schonlein Purpura Nephritis / 实用儿科临床杂志

0.05).Compared with other immunopathologic types,IgA plus IgG plus IgM deposition type had higher proportion of histological grade Ⅲb-Ⅵ(P

Immunohistochemical Study of Calponin, Smooth Muscle Myosin Heavy Chain, Cytokeratin 34E12, and p53 in Papillary Neoplasm of the Breast

BACKGROUND: The most important feature distinguishing intraductal papilloma (IDP) from papillary carcinoma is the presence of uniform myoepithelial cells (MECs) within the lesion. METHODS: Immunohistochemistry (IHC) for calponin, smooth muscle myosin heavy chain (SMMHC), cytokeratin 34E12, and p53 were performed on 37 IDP, 4 intraductal papillary carcinomas (IDPCA), 5 microinvasive papillary carcinomas, and 5 invasive papillary carcinomas (IPCA), respectively. RESULTS: The mean age of the patients was 43 (43.3+/-11.6) years. Cytokeratin 34E12 was expressed in epithelial cells (84%) as well as in MECs (23%) of IDP. The expression of SMMHC was significantly reduced in the intraductal and invasive papillary carcinoma (p=0.001). The expression of calponin was also significantly reduced (P<0.001) as IDP 95%, IDPCA 76%, microinvasive papillary carcinoma 39%, and IPCA 8%, respectively. p53 over-expression was noted in 3 (one IDP and two IPCA) of 51 cases. CONCLUSIONS: Because MECs were significantly reduced with malignant progression, calponin and SMMHC were very useful markers for differentiating between benign and malignancy in the papillary neoplasm. Calponin was more sensitive than SMMHC and was an excellent ancillary test for assessing MECs and for detecting microinvasion.

Immunophenotype of Thymic Epithelial Tumors According to the New World Health Organization Classification

BACKGROUND: To identify the expression patterns and usefulness of various antibodies in making diagnoses and predicting prognoses, an immunohistochemical study was performed on thymic epithelial tumors (TETs). METHODS: Forty-two cases of TETs were reclassified according to the new World Health Organization (WHO) classifications. CD3, CD5, CD79a, CD99, pan-, high- and low-molecular weight cytokeratins, EMA, vimentin, MIB-1 (Ki67) and p53 immunostaining were carried out. RESULTS: There were two, twelve, eight, two, thirteen and one case for type A, AB, B1, B2, B3 and C, respectively. Combined B1/B2 and B2/B3 were 2 cases each. Fourteen cases (33.3%) had myasthenia gravis. CD99 was immunoreactive mainly in cortically derived lymphocytes, while CD3 and CD5 were immunoreactive in medullary-derived lymphocytes. CD5 immunoreactivity was negative in all thymic epithelial cells, except for one case of type B3. MIB-1 indices were highly expressed in cortical lymphocytes and some thymic epithelial cells, but did not show any correlation with grades. p53 in thymic epithelial cells was expressed in 6 (46%) out of 13 cases of type B3 and one case of type C, and it was negative in all other subtypes. CONCLUSIONS: Only p53 was helpful for predicting high grades (B3 and C) (P<0.05). By MIB-1 indices, we could tell how many cortical immature lymphocytes were occupied in TETs, however, grading could not be achieved.

Clinical and Pathological Analysis of 48 Children with Focal Segmental Glomerulosclerosis / 实用儿科临床杂志

Objective To investigate the relationship between the clinical character and pathological variants as well as response to treatment of focal segmental glomerulosclerosis(FSGS) in children.Methods The clinical feature, laboratory data and histological variants of 48 children with idiopathic FSGS proven by renal biopsy were studied retrospectively. Among them,34 were boys;14 cases were girls. The age ranged from 1.75 to 16.0 years.Results Of 48 children with FSGS,nephrotic syndrome in 32(66.7%)was the predominant clinical manifestation. The pathological classification included FSGS not otherwise specified(NOS) in 29 cases(60.42%), perihilar variant in 14 cases(29.17%), tip variant 3 cases(6.25%), cellualr variant 2 cases(4.17%)and no collapsing variant. The different pathological variants had similar rate of segmental sclerosis glomeruli; perihilar variant had a higher global sclerosis glomeruli than FSGS NOS and other variants and there was a statistical significance(P 0.05).Vascular lesions were rarely seen in all kinds of histological variants of children.Conclusions Hypertension and renal insufficiency are less frequently seen in children FSGS, isolated hematuria as unique clinic presentation is common in FSGS. All pathological variants have tubular-interstitial lesions, but vascular lesions are rarely seen. Most FSGS children with nephrotic syndrome are sensitive to steroid at initial stage, and easy to develop frequent relapse gradually, immunosuppressive agent may be helpful to elevate remission rate.