Evaluation of some histochemical and immunohistochemical criteria of round cell tumors of bone

The differential diagnosis of round cell tumors of bone [RCTB], Ewing sarcoma, smallcell osteosarcoma, mesenchymal chondrosarcoma, osteoblastoma, chondroblastoma, primary bone lymphoma, and multiple myeloma still remains a challenge. Given the significant differences in treatment, an accurate diagnosis is crucial. This study aimed to evaluate some histochemical and immunohistochemical criteria of RCTB. Periodic acid-Schiff [PAS], CD99, CD138, osteocalcin, and leukocyte common antigen [LCA] were evaluated in 113 patients with RCTB. PAS was positive in neoplastic cells of all Ewing sarcomas, 27% of osteosarcomas, 92% of chondrosarcomas, all osteoblastomas and chondroblastomas, and the osteoid tissue of all osteosarcomas and osteoblastomas. CD99 was positive in all Ewing sarcomas, in 11, 4, and 11% of osteoblastomas, multiple myelomas, and bone lymphomas, respectively. CD99 was higher in Ewing sarcoma than in other RCTB [Po0.0001]. Osteocalcin was positive in neoplastic cells of all osteosarcomas, osteoblastomas, and 20% of chondroblastomas, 84, and 78% of osteoid of osteosarcomas and osteoblastomas, respectively. CD138 was positive in all multiple myelomas, 12% of Ewing sarcomas, 20% of osteosarcomas, 44% of osteoblastomas, 8% of chondrosarcomas, and 40% of chondroblastomas. CD138 was higher in multiple myeloma [Po0.0001] than in other RCTB. LCA positivity was higher [Po0.01] in bone lymphomas [100%] than in multiple myelomas [73%]. PAS negativity excludes multiple myeloma and bone lymphoma from other RCTB that could be differentiated by LCA and CD138. CD99 positivity confirms the diagnosis of Ewing sarcoma. PAS could detect areas of osteoid in osteosarcoma and osteoblastoma. Osteocalcin suggests an osteogenic tumor origin: osteosarcoma/ osteoblastoma. Double negativity of CD99 and osteocalcin suggests a chondrogenic tumor origin: chondrosarcoma/chondroblastoma

Diagnostic value of HBME-1, COX-2 and CK19 in the differential diagnosis of thyroid lesions

The distinction between benign and malignant thyroid tumors is critical for the management of patients with thyroid nodules. We applied immunohistocmhem1ical stainig for HBMF-1, COX-2 and CK19 to determine their diagnostic accuracy in diagnosis of thyroid lesions. The expression was significantly associated with thyroid carcinoma. The sensitivity was 77.8% with HBME-1, 100% with COX-2 and 100% with CK19 for papillary carcinoma: 80% with HBME-1, 60% with COX-2 and 100%with CK19 for follicular carcinoma. The specificity of these antibodies was 100% for thyroid carcinoma included in this study. Comparing papillary carcinoma with papillary hyperplasia, the three antibodies were significantly expressed in papillary carcinoma. Comparing follicular variants of papillary carcinoma with follicular carcinoma, the expression of CK19 was significantly higher in follicular variants of papillary carcinoma, while COX-2 was higher in follicular carcinoma, comparing follicular carcinoma with follicular adenoma, the expression of COX-2 and HBME-1 was significantly higher in follicular carcinoma, we suggest that: [1] COX-2 and HBME-1 positivity may indicate malignancy in thyroid lesions. [2] Diffuse CK19 positivity can aid in the differential diagnosis of classic papillary carcinoma and follicular variants of papillary carcinomas vs. follicular carcinoma and other benign thyroid lesions mimickers. [3] COX-2 expression may serve as useful molecular marker for cases of follicular carcinoma with diagnostic difficulty

Immunohistochemical evaluation of P53 exprssion in astrocytomas

Alteration of the P53 tumor suppressor gene is implicated in tumorigenesis and in progression of a wide variety of human cancers, including gliomas. Accumulation of P53 protein is used as indicator of alteration in P53 gene. Less is known about P53 expression in reactive non-neoplastic lesions [gliosis]. This work is done to verify, the presence of P53 in astrocytomas through immunohistochemistry as well as correlating its expression with clinicopathological parameters and to detect its role in differentiating gliosis from low grade astrocytomas. Ninety-one astrocyromas and 24 cases of reactive gliosis were retrospectively collected from Pathology Department in Assiut University Hospital and private laboratories. Astrocytomas were classified and graded according to WHO classification [2000] using H and E stained sections from formalin fixed paraffin embedded blocks. P53 was immunohistochemically evaluated in selected 46 cases of astrocytomas and 12 cases of reactive gliosis. Glioblastoma multiforme [WHO grade IV] was the predominant grade of astrocytomas. The mean age of patients with asirocytomas showed upregulation with grade. There was male sex predilection in all grades of astrocytomas. P53 protein was detected in 58.7% of astrocytomas including all grades. The immunoreactivity score showed gradual upregulation with increasing grade. There was positive insignificant correlation between P53 expression and age, cellularity and mitosis and positive significant correlation between its expression and pleomorphism, microvascular proliferation and necrosis. All cases of ghosts except one showed negative P53 immunoreactivity. In P53 protein alteration is an early event in lumarigenesis and progression of astrocytomas and is a useful diagnostic tool in diagnosis of high grade gliomas. P53 provides just one more procedure in differentiation of glios is from low grade astrocyromas

Comparison between TRU cut biopsy and aspiration technique in hepatic focal lesions

This study was carried out on fifty-four patients [thirty-five males and nineteen females with ages ranged from three years to seventy-two years] with normal prothrombin concentration. They had suspicious malignant hepatic focal lesions diagnosed by clinical and sonographic examinations. The sonographic picture of hepatic focal lesions was classified according to site [thirty-seven in right lobe and seventeen in left lobe], echogenicity [forty-seven solid and seven cystic], depth [forty-four deep and ten superficial], size [forty- three large and eleven small] and number of focal lesions [thirty- eight single and sixteen multiple]. Ultrasonically guided tru-cut and fine needle aspiration biopsy was done. Cytological and electromicroscopical examinations of specimens obtained by aspiration and histopathological examinations for TRU-cut specimens were carried out. Fine needle aspiration was done in negative cases. The positive results by aspiration cytology were 81.5% and for core biopsy technique 66.7%. Combining both methods, the positive results could increase up to 90.7%. Positive aspiration cytological results increased in cystic, left lobe, superficial and small lesions in contrast to TRU-cut. Also, repeated aspiration in negative cases increased the positive results. Application of electromicroscopical scanning to cytodiagnosis permitted the assessment of cell surface by which they can differentiate between cancer and non-cancer cells. This study could be used for follow up of cases after surgery, chemotherapy or irradiation. It is less risky than conventional surgical biopsy and is usually done in out-patients clinics with minimal complications

Luteal phase defect with different lines of treatment for induction of ovulation

The prevalence of luteal phase defect [LPD] with different drugs, for induction of ovulation, was studied in 71 infertile women. LPD was diagnosed when an endometrial biopsy, obtained on the 22nd day, showed a histologic lag of 2 days or more. Ultrasound scan [USS] was used for study of follicular growth and prediction of ovulation. Insler cervical score from day -4 to day 0 was done, estradiol [E2] in serum in day 0 and mid-luteal, and progesterone [P] mid-luteal were measured. Prevalence of LPD with antiestrogen, bromocriptine and HMG/HCG was 38%, 15.4% and 22%. Cervical score showed good predictive value for LPD from day -2 to day 0 [F 0.0001]. Neither serum E2 nor P showed predictive value of LPD

Immunohistochemical determination of hormone-receptors in juvenile nasopharyngeal angiofibroma

Immunoperoxidase technique was used for detection of testosterone and oestrogen receptors in tissue sections prepared from 5 nasopharyngeal angiofibromas excised from 5 juvenile boys. None were positive for oestrogen receptors. Testosterone receptors were present in the covering epithelium in all cases and in the tumour tissue only in three. These findings support the view that juvenile nasopharyngeal angiofibroma is an androgen dependent tumour and may explain the variability of the response to oestorgen therapy

Aclinicopathological study of nasopharyngeal masses

177 patients with nasopharyngeal masses were studied. The neoplastic lesions constituted about 48% of the nasopharyngeal masses. 39% were malignant and 8.5% were benign. Nasopharyngeal carcinoma was the commonest malignant tumour of the nasopharynx [55.0%] with a peak age incidence between 40-70 years, and a male to female ratio of 2:1. Malignant lymphoma was the second in order of frequency [34.8%], mainly of the non-Hodghin's variety [87.5%]. The mean age was 42.2 years and the male to female ratio was 1.62:1. The rest of the malignant lesions were diagnosed as rhabdomyosarcoma [4.4%], adenoid cystic carcinoma [2.9%] and fibrosarcoma [2.9%]. In this study, angiofibroma constituted 8.5% of nasopharyngeal masses with a mean age of 14.5 years and was only in males. Adenoids or lymphoid hyperplasia formed about 11.3% with a mean age of 19 years and male to female ratio of 1.2:1. The inflammatory lesions of the nasopharynx constituted about 36.15 of nasopharyngeal masses with a male to female ratio of 3:1. Scleroma of the nasopharynx made 23.9% of the inflammatory lesions. One patient was diagnosed as tuberculous nasopharyngitis, the rest of the inflammatory lesions [70.1%] were diagnosed histologically as chronic non-specific inflammation. The differentiation between benign and malignant nasopharyngeal masses depends upon histological examination and therefore accurate biopsy techniques are essential. Transnasal biopsies using topical anaesthesia invite inadequate sampling of tissue with resultant delay in diagnosis. Early recognition and treatment favorable influence survival. Complaints of pain, epistaxis, trismus or cervical mass are uncommon in patients with benign lesions and should alert the clinician to the probability of malignancy. Clinical symptoms suggestive of malignancy demand prompt and conclusive evaluation

Cytoplasmic estrogen receptors in endometrium after long term use of contraceptive implant Norplant

In this work, endometrial biopsies from 31 ladies who had used contraceptive implants NORPLANT for 5 years were studied for detection of estrogen receptors. The biopsies were taken at the time of removal of the NORPLANT at the outpatient Family Planning Clinic of Assiut University Hospital. Age of patients varied between 28 and 45 years. All were multipara with regular menstruation except for 3 women who had irregular bleeding and one with ammenorrhea. Histochemcial immunoperoxidase staining method was used in formalin-fixed paraffin-embedded tissue sections for detection of cytoplasmic estrogen receptor complexes. Accordign to histopathological paterrn of endometrium our 31 cases were classified into: proliferative endometrium [15 cases], irregular secretory [11 cases] and suppressed endometrium [5 cases]. Serum concentrations of estradiol, progesterone, levonorgestrel and sex hormone binding globulin were measured in all cases. Progesterone serum concentration was higher in cases with both proliferative and suppressed endometrium