Tumor-to-Tumor Metastases Involving Clear Cell Renal Cell Carcinomas: A Diagnostic Challenge for Pathologists Needing Clinical Correlation.

Tumor-to-tumor metastasis is a rare event which it is specifically up to pathologists to bring to light correctly. The histological identification of such tumor-to-tumor cases is simple when the respective histologies are different but can be problematic if the case includes two carcinomas with similar cytoarchitecture viewed one inside the other under the microscope. We report four cases of this condition in which clear cell renal cell carcinoma is involved, either as a receptor or as a donor, and remark on the difficulties in recognizing some of them. Appropriate clinical-pathological correlation, including a review of the patient's antecedents and radiological exams, would be a great help in routinely identifying tumor-to-tumor metastases.

CD44 induces FOXP3 expression and is related with favorable outcome in breast carcinoma.

We studied the relationship between CD44 and Forkhead box P3 (FOXP3) gene expression in cell lines and breast carcinomas and their association with clinicopathological variables and patient outcome. We assessed messenger RNA (mRNA) expression of CD44 and FOXP3 by quantitative real-time PCR and determined the number of FOXP3+ Tregs by immunohistochemistry in 264 breast cancer specimens. CD44 was stimulated with hyaluronan treatment, and the accompanying changes in FOXP3 mRNA expression in breast cancer cell lines representing breast cancer subtype were assessed. We found that lower CD44 expression correlated with the presence of necrosis, lymph-vascular invasion, grade 3 tumors, and aggressive phenotype (HER2 and basal-like). FOXP3 mRNA correlated positively with CD44 mRNA expression and Treg content. Moreover, stimulation of CD44 expression by hyaluronan in cell lines increased FOXP3 expression, which supports that their regulation is associated. Survival analysis revealed that low CD44 expression is associated with higher frequency of recurrence. Our findings indicate that CD44 has a regulatory role in FOXP3 expression and is associated with good prognostic factors in breast cancer.

Analysis of Lynch Syndrome Mismatch Repair Genes in Women with Endometrial Cancer.

OBJECTIVE: Endometrial cancer is the second most frequent neoplasm in women with Lynch syndrome (LS). We sought to assess whether analyzing women with endometrial cancer would identify families with LS not identified with current clinical criteria. METHODS: We included women diagnosed with endometrial cancer younger than 50 years and also older if they had a family cancer history associated with LS. In blood samples obtained, we analyzed mutations in mismatch repair (MMR) genes, as well as protein expression by immunohistochemistry and microsatellite instability (MSI) in tumour tissue. RESULTS: A total of 103 patients were enrolled. We detected 14 pathogenic mutations and 4 genetic variants of unknown clinical significance in MMR genes. We found MSI in 41.66% of the women with a pathogenic mutation. In this group, 76.92% showed loss of at least one MMR protein. Women with mutations were younger at diagnosis, but all of them had a family history compatible with LS. CONCLUSIONS: Analysis of the MMR genes, in particular MSH6, seems to be appropriate in women with endometrial cancer and a family history of tumours associated with LS.

Osteopontin Regulates VEGFA and ICAM-1 mRNA Expression in Breast Carcinoma.

OBJECTIVES: To analyze the regulatory role of osteopontin on biomarkers associated with cell survival, invasiveness, and angiogenesis mechanisms in a clinical series and breast cancer cell lines. METHODS: We analyzed by quantitative real-time polymerase chain reaction the messenger RNA (mRNA) expression of osteopontin, Bcl2, intercellular adhesion molecule 1 (ICAM-1), and vascular endothelial growth factor A (VEGFA) in several breast cancer cell lines and in 148 breast carcinomas classified into intrinsic subtypes. RESULTS: We found coexpression of osteopontin, Bcl2, ICAM-1, and VEGFA in triple-negative MDA-MB-468 and MDA-MB-231 cell lines. Furthermore, osteopontin silencing by small interfering RNA inhibited ICAM-1 and VEGFA expression and cell proliferation in MDA-MB-468 cells. In breast cancer specimens, we found a positive correlation between osteopontin, ICAM-1, and VEGFA mRNA expression, especially in triple-negative/basal-like tumors. Among patients with osteopontin-overexpressing tumors, VEGFA remained an independent prognostic indicator for recurrence (hazard ratio, 2.95; 95% confidence interval [CI], 1.48-5.87; P = .002) and death (hazard ratio, 3.25; 95% CI, 1.48-7.11; P = .003) (multivariate analysis, Cox regression). CONCLUSIONS: Our results support that osteopontin regulates ICAM-1 and VEGFA expression mainly in triple-negative/basal-like breast carcinomas, suggesting a relevant role in the pathogenesis and tumor progression of this molecular subtype. Moreover, VEGFA mRNA levels showed an independent prognostic value in patients with breast cancer.

Association of increased osteopontin and splice variant-c mRNA expression with HER2 and triple-negative/basal-like breast carcinomas subtypes and recurrence.

Osteopontin, a secreted phosphoglycoprotein, promotes tumor progression through binding to integrins and CD44 cell receptors. Its overexpression has been correlated with metastasis and adverse outcome in several neoplasms. In breast carcinoma, osteopontin mRNA and its splicing variant-c, a suggested marker for transformed cells, have not been extensively analyzed. Immunohistochemistry was performed in 415 breast carcinomas to examine total osteopontin and osteopontin-c protein distribution. RNA was extracted and retrotranscribed to cDNA from 309 tumors classified into immunophenotypes and in six cell lines representing the breast cancer subtypes. Total osteopontin and osteopontin-c mRNA levels were measured by quantitative RT-polymerase chain reaction. The median fold change of total osteopontin mRNA was higher in HER2-positive (fold-change = 14.7) and triple-negative/basal-like (fold-change = 14.7) tumors, whereas osteopontin-c mRNA was elevated in triple-negative/basal-like subtype (fold-change = 2.8). Total osteopontin levels were increased in SK-BR-3 (HER2-positive) and MDA-MB-468 (triple-negative/basal-like) cell lines. Higher total and osteopontin-c mRNA levels were seen in tumors of high grade, with necrosis, positive nodal status and high Nothingam Prognostic Index score. Disease-free survival was significantly shorter for patients whose tumors overexpressed total osteopontin (67% vs 73%). Moreover, increased osteopontin-c stratified subgroups of patients at higher risk of recurrence among immunophenotypes, especially in triple-negative/basal-like subtype (70% vs 83%). By multivariate analyses for disease-free survival, osteopontin-c emerged as a significant predictor of relapse. In summary, our data showed an association of osteopontin with poor prognostic factors, aggressive subtypes HER2 and triple-negative/basal-like, and higher risk of recurrence.

Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome.

BACKGROUND: Surfactant (SF) instillation may produce acute deleterious effects on gas exchange and both systemic and cerebral hemodynamics. Our aim was to compare the effects of aerosolized SF (SF-aero) with those of bolus SF (SF-bolus) administration on gas exchange, lung mechanics, and cardiovascular function in premature lambs with respiratory distress syndrome (RDS). METHODS: Fourteen preterm lambs (85% gestation) were randomly assigned to receive SF-aero or SF-bolus. Oxygenation index (OI), PaCO2, cardiovascular parameters, carotid blood flow (CBF), lung compliance (mean dynamic compliance), and tidal volume (VT) were measured every 30 min for 6 h. Biochemical and histological analyses were performed. RESULTS: After delivery, lambs developed severe RDS (inspiratory fraction of oxygen: 1; pH < 7.15; PaCO2 > 80 mm Hg; PaO2 < 30 mm Hg, mean dynamic compliance < 0.08 ml/cm H2O/kg). By 60 min after treatment, both groups showed an improvement in OI, PaCO2, mean dynamic compliance, and VT that was maintained until the end of the experiment. PaCO2 and CBF increased significantly in the SF-bolus group during the first 15-30 min, without concomitant changes in cardiovascular parameters, whereas in the SF-aero group, PaCO2 and CBF decreased gradually. SF-aero induced less alveolar hemorrhage and inflammation. CONCLUSION: SF-aero produced improvements in gas exchange and lung mechanics similar to those produced by bolus administration but with less lung injury and fewer cerebral hemodynamic changes.

Altered peptidase activities in thyroid neoplasia and hyperplasia.

BACKGROUND: Papillary thyroid carcinoma (PTC), follicular thyroid adenoma (FTA), and thyroid nodular hyperplasia (TNH) are the most frequent diseases of the thyroid gland. Previous studies described the involvement of dipeptidyl-peptidase IV (DPPIV/CD26) in the development of thyroid neoplasia and proposed it as an additional tool in the diagnosis/prognosis of these diseases. However, very little is known about the involvement of other peptidases in neoplastic and hyperplastic processes of this gland. METHODS: The catalytic activity of 10 peptidases in a series of 30 PTC, 10 FTA, and 14 TNH was measured fluorimetrically in tumour and nontumour adjacent tissues. RESULTS: The activity of DPPIV/CD26 was markedly higher in PTC than in FTA, TNH, and nontumour tissues. Aspartyl aminopeptidase (AspAP), alanyl aminopeptidase (AlaAP), prolyl endopeptidase, pyroglutamyl peptidase I, and aminopeptidase B activities were significantly increased in thyroid neoplasms when compared to nontumour tissues. AspAP and AlaAP activities were also significantly higher in PTC than in FTA and TNH. CONCLUSIONS: These data suggest the involvement of DPPIV/CD26 and some cytosolic peptidases in the neoplastic development of PTC and FTA. Further studies will help to define the possible clinical usefulness of AlaAP and AspAP in the diagnosis/prognosis of thyroid neoplasms.

The impact of peptidase activity on clear cell renal cell carcinoma survival.

Several studies have proposed that protease expression and activity may have a predictive value in the survival of clear cell renal cell carcinoma (CCRCC). Most efforts on this issue have been focused on the analysis of matrix metalloproteinases (MMP) and very little on the role of other proteases, such as peptidases. The catalytic activity of 9 peptidases (APN, APB, ASP, CAP, DPP-IV, NEP/CD10, PEP, PGI, and PSA) was quantified by fluorometric methods in a series of 79 CCRCC patients, and the results obtained were analyzed for survival (Kaplan-Meier curves, log-rank test, and Cox multivariate analysis). CCRCC patients with higher activity levels of membrane-bound APN and soluble APN, DPP-IV, and CAP had significantly shorter 5-yr survival rates than those with lower levels. By contrast, higher soluble APB activity significantly correlated with longer survival. Our data suggest the involvement of peptidases in the biological aggressiveness of CCRCC and support the usefulness of measuring these proteases to assess the prognosis of patients with CCRCC.

Increased prolyl endopeptidase activity in human neoplasia.

Prolyl endopeptidase (EC 3.4.21.26) (PEP) is a serine peptidase that converts several biologically active peptides. This enzyme has been linked to several neurological, digestive, cardiovascular and infectous disorders. However, little is known about its involvement in neoplastic processes. This study analyzes fluorimetrically cytosolic and membrane-bound PEP activity in a large series (n=122) of normal and neoplastic tissues from the kidney, colon, oral cavity, larynx, thyroid gland and testis. Cytosolic PEP activity significantly increased in clear cell renal cell carcinoma, urothelial carcinoma of the renal pelvis and head and neck squamous cell carcinoma. Both cytosolic and membrane-bound PEP activity were also increased in colorectal adenomatous polyps. These data suggest the involvement of PEP in some mechanisms that underlie neoplastic processes.

La médula renal normal y patológica / The normal and abnormal renal medulla

Antecedentes: La médula renal constituye un intrincadosistema de túbulos, vasos sanguíneos e intersticio pococonocido por la mayor parte de los patólogos generales.Métodos: Amplia revisión de la literatura sobre la médularenal y de archivo de toda su patología. Resultados: Se pormenorizandatos de interés para el patólogo sobre el desarrollonormal y patológico, la anatomía microscópica, histologíae inmunohistoquímica, la fisiología, la patología dela diferenciación medular (displasia renal multiquística,enfermedades poliquísticas renales autosómicas dominantey recesiva, enfermedad quística medular) la patología inflamatoria(pielonefritis xantogranulomatosa, malacoplaquia),las displasias, y las neoplasias (oncocitoma, tumor oncocíticoatípico, carcinoma renal de células cromófobas, carcinomade los túbulos colectores, carcinoma urotelial, otros carcinomas,fibroma renomedular y tumores metastáticos) deesta topografía. Conclusiones: El conocimiento compendiadode la génesis, del funcionamiento y de la patologíamedular renal, tanto del desarrollo, como inflamatoria yneoplásica, redundará en un mayor interés por esta zona delriñón que habitualmente pasa desapercibida para el patólogoasistencial(AU)

Background: The renal medulla is composed of a complexsystem of tubules, blood vessels and interstitium,which the general pathologist often are unfamiliar with.Methods: An in depth review of the literature and of materialfrom our archives related to the pathology of the renalmedulla was made. Results: Interesting data on normal andabnormal development, microscopic anatomy, histology,immunohistochemistry, physiology, and pathology, includingrenal medulla differentiation disorders (multicysticrenal dysplasia, adult and infantile type polycystic diseases,cystic medullary disease), inflammatory diseases (xanthogranulomatouspyelonephritis, malakoplakia) and neoplasias(oncocytoma, atypical oncocytic tumour, chromophoberenal cell carcinoma, collecting duct carcinoma, urothelialcarcinoma, other carcinomas, renomedullary fibroma andmetastatic tumours), was reviewed. Conclusions: A comprehensiveknowledge of the genesis, function, and pathologyof the renal medulla would result in a greater interestbeing taken in an area often ignored by pathologists(AU)

Displasia y carcinoma en papilomas schneiderianos nasosinusales. Estudio de 4 casos / Dysplasia and carcinoma in sinonasal schneiderian papillomas. A study of 4 cases

Se revisa en este trabajo la existencia de displasia y/ocarcinoma en una serie de 65 papilomas schneiderianosnasosinusales diagnosticados en nuestro centro en un periodode 17 años. Los papilomas se tipifican como fungiformes,invertidos, y oncocíticos de células cilíndricas,siguiendo las clasificaciones al uso. Se demuestran cambiosdisplásicos y/o carcinoma en 4 casos, todos ellos varones.En éstos, se estudian las características clínicas, incluyendoel seguimiento posterior al tratamiento, e histológicas. Porúltimo, se revisa la literatura existente sobre la asociaciónde papilomas nasosinusales con cambios neoplásicos o preneoplásicosen su epitelio

The presence of dysplasia and/or carcinoma in a seriesof 65 sinonasal schneiderian papillomas diagnosed in ourInstitution along a 17 year period is reviewed. The caseshave been typified as fungiform, inverted, and oncocyticwith cylindrical cells following current classifications.Dysplastic changes and/or carcinoma were demonstrated in4 cases, all of them male patients. Clinical data, includingpostreatment follow up and histological features of the caseswere analysed. Also, the literature concerning schneiderianpapillomas associated with dysplasia or carcinoma wasreviewed

Tumor de células de Sertoli esclerosante / Sclerosing sertoli cell tumor

Se trata de un varón de 28 años de edad que acude alurólogo por presentar un leve aumento de volumen del testículoderecho. El estudio ecográfico muestra un tumor sólidointratesticular de aproximadamente 1 cm de diámetro. Lapieza de orquiectomía radical muestra un tumor con un grancomponente de fibrosis estromal en el que aparecen cordonesde células cuboideas sin atipia citológica ni mitosis, quemuestran positividad para citoqueratinas, vimentina y calretinina.El tumor de células de Sertoli es una neoplasia muypoco frecuente en el testículo. La variedad esclerosante, queha sido descrita recientemente, es aún más rara y comportadiferente pronóstico. En este trabajo se revisa los criteriosmorfológicos diagnósticos y las peculiaridades clínicasrecogidas recientemente en la literatura

Background: Sertoli cell tumor is an unfrequent neoplasmof the testis and the recently reported sclerosingvariant is even rarer, and seems to have a different prognosis.Patients and Methods: A 28 year-old man consultedthe urologist because of a slight increase in right testicularvolume. Echographic examination revealed an intratesticularsolid tumor, 1 cm in diameter. Radical orchiectomy showedan intratesticular sclerotic tumor composed by sheetsand cords of cuboidal benign appearing cells. Immunostainingsfor cytokeratins, vimentin, and calretinin were done.Atypia and mitoses were not found. An analysis of diagnosticmorphological criteria and clinical peculiarities describedin previous recent reports was done