Significance of immunohistochemical expression of p16INK4a in the differentiation of inflammatory and preneoplastic cervical lesions.

INTRODUCTION: Most studies point at the main role of humanpapilloma virus (HPV) in the development of dysplasia and cervical cancer. Due to the low specificity and sensitivity of morphological diagnostic methods it is necessary to find an adequate marker which would be introduced in the screening program for cervical cancer. Most research suggests that p16INK4a is a specific and sensitive marker. OBJECTIVE: The aim of this research was to determine the presence of p16INK4a expression in inflammatory and preneoplastic lesions of the cervix. METHODS: The study was performed on 73 samples of cervical biopsy. In 34 patients a preneoplastic change (dysplasia) in the stratified squamous cervix epithelium was found, and in 39 a non-specific inflammatory process was disclosed. In all samples, immunohistochemical analysis using antibodies to p16INK4a was performed. RESULTS: The expression of p16INK4a was verified in 67.65% of cases in dysplastic cervical lesions and 38.5% of the inflammatory lesions. A statistically significant difference was determined in the presence and grade of expression between dysplastic and inflammatory lesions of the cervix (χ2 = 24.16; p < 0.001). The expression was more frequent and had a higher grade in dysplastic lesions with high grade and showed a statistically significant difference compared to the expression in low-grade dysplasia (χ2 = 21.48; p < 0.001). CONCLUSION: The analysis of the presence of p16INK4a can differentiate non-neoplastic from preneoplastic changes in the cervix. It is recommended to use immunocytochemical and immunohistochemical analysis using p16INK4a in interpreting borderline lesions of the cervix.

[Morphological parameters of prostatic adenocarcinoma].

INTRODUCTION: Prostatic carcinoma is one of the most common malignancies in men and the second most common cause of cancer-related deaths, after lung cancer. However, many of these tumors are latent, of no biologic significance, and are recognized only as an incidental findig at autopsy. PROSTATIC CARCINOMA: HISTOLOGIC FEATURES: Prostatic carcinomas have multiple histologic patterns, which can easily be confused with benign lesions. The following histologic changes are associated with prostatic carcinomas. prostatic acini are close to one another and present with linear infiltrates in the fibromuscular tissue; cells lining the acini often consist of a single layer, and the basal cell layer is absent; prominent large eosinophilic nucleoli are usually present in malignant cells; nuclear hyperchromatism is rare and it depends on the quality of the tissue fixation; perineural invasion is often observed. Today, the Gleason grading system is the most commonly used (Gleason score). Immunohistochemistry is widely used in pathology and clinical diagnosis of prostatic carcinoma, metastases of prostatic origin in staging malignant tumors and in the prognosis.

The management of T1G3 bladder cancer.

INTRODUCTION: The treatment of T1G3 bladder cancer is still a controversial issue. Nowadays, intravesical bacillus Calmette-Guérin (BCG) instillation is considered to be the treatment of choice for patients with high-grade superficial bladder tumour after transurethral resection of all visible tumour. The aim of this retrospective study was to determine the effects and results of this approach, recurrence and progression rates in patients with T1G3 superficial bladder tumours. MATERIALS AND METHODS: 43 patients (28 male, 15 female; mean age 65.5 years, range 21-82) with T1G3 TCC (transitional cell carcinoma) bladder tumour underwent transurethral resection and subsequent intravesical BCG according to Morales protocol, in the period 1993-1998 at our institution. The mean follow-up period was 52.5 (range 30-96) months. RESULTS: After one or more initial courses of therapy, 33 patients were disease-free. Twelve patients (27.90%) had recurrent tumour after a median of 7 (range 3-46) months. After a second course of BCG treatment, 6 patients had no evidence of disease, 3 patients had progression and 3 had recurrence. Progression occurred in 7 (16.27%) patients after a median of 19 (range 3-43) months. Five patients underwent radical cystectomy and the remaining 2 underwent bladder-preserving therapies. Two patients died of TCC and 3 due to disease-unrelated conditions. CONCLUSION: Intravesical BCG instillation can be recommended as treatment modality for responders with T1G3 TCC bladder tumour. The benefit of the second course of intravesical BCG therapy has to be confirmed in further investigations.

[Long term survival of patients with lupus nephritis]. / Dugogodisnje prezivljavanje bolesnika s lupusnim nefritisom.

Lupus nephritis is a clinical manifestation of Systemic Lupus Erythematosus with most prominent influence on the course of the disease. The most predictive parameters for development of renal failure are: type of hystological changes, degree of interstitial inflammation, serum creatinine concentration at the time of diagnosis and therapeutical protocols used in the treatment. Single center experience in a group of 220 lupus patients is presented in this paper. In 130 patients (59%) lupus nephritis was diagnosed by clinical and laboratory tests, while 74 kidney biopsies were performed. Proliferative type of lupus nephritis (class IV in 54% of cases and class III in 18.9%) was more frequent than the other histological types. During a long term follow up (range 1-17 years, mean 7.6 years) renal failure developed in 17 patients (24%), while 11% of patients developed uremia and required dialysis. Development of renal failure was influenced by histological changes with predominance of class IV lupus nephropathy, disseminated disease with more ARA criteria for systemic lupus erythematosus classification present at the time of kidney biopsy, more frequent lupus flares, persistence of low complement levels during the first year of follow-up and even earlier.