Buerger's disease: clinical and histomorphological study.

There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.

Tumour angiogenesis and C-myc expression in breast carcinomas.

Angiogenesis in tumors has been widely studied and has been considered to be a prognostic factor particularly in breast carcinomas. The myc family of proto oncogenes has shown an amplification in breast carcinomas. The aim of this study was to assess MVD (micro vessel density) and the expression of c-myc in invasive breast carcinomas. Formalin fixed, routinely processed, paraffin embedded tissue was stained with H&E for classification and grading according to the Nottingham modification of Bloom and Richardson criteria. Immunohistochemical staining using primary antibody against F VIII antigen and anti C-myc were carried out. LSAB method was employed with AEC as chromogen and Gill's Haematoxylin as counter stain. Micro vessels were counted and positivity indicated by a cherry red staining in the cytoplasm of the tumour cells. Grades I, II and III showed 12.22 %, 20.9% and 24.5 % positivity of micro vessel density (MVD). Fifty percent of Grade 1, 69.2 % of Grade II and 24.5 % of Grade III tumours expressed c-myc proteins. In our study we found a positive association between tumour grade and micro vessel density, signifying a poor prognosis for tumours with high MVD. C-myc expression also showed a positive association with increasing grade.