Histopathological and immunohistochemical study of laterocervical lymph node metastases of unknown primary origin.

In this study, we examined histopathologically and immunohistochemically 24 cases of laterocervical lymph node metastases with unknown primary origin. For immunohistochemical study, we used a large panel of antibodies represented by CK7, CK19, CK20, CKAE1/AE3, CK34betaE12, TTF1, HBME-1, CEA, MUC5AC and EBV. In the cases studied tumors accompanied by seemingly primitive adenopathies were located in the thyroid, lung, esophagus, stomach, rhinopharynx, hypopharynx, oropharynx and larynx.

Malignant melanoma of nasal cavity.

INTRODUCTION: Malignant melanoma rarely develops in the mucous membranes. Statistical data indicate that rhinosinusal mucosal melanoma was reported in less than 1% of all melanic tumors and in 2-8% of all cancers developed in the nasal fossae and sinuses. Due to reduce and non-specific symptoms and a high degree of invasion away, patients come for a medical expertise in advanced stages of the disease, which is leading to a poor prognosis. The average five-year survival is 20-30%. PATIENT AND METHODS: We present the case of a 65-year-old female patient coming from a rural environment, hospitalized for unilateral nasal obstruction and nasal mucosal changes of a blackish appearance on all of the walls. RESULTS: The endoscopic examination revealed a matter and of a blackish appearance nasal mucosa along the whole length of the left nasal cavity (septum, turbinates, floor, ceiling). Presumptive diagnosis of melanoma led to the excision of inferior and middle turbinate mucosa, floor and ceiling mucosa and the excision of the nasal septum, keeping the columella and the posterior portion. Histopathological and mostly immunohistochemical exams confirmed the diagnosis of malignant melanoma. To determine the phenotype of tumor cells, it was evaluated their immunostaining for HMB-45, Melan-A, S-100, vimentin, cyclin D1 and CD44 markers. The patient followed oncologic treatment and radiochemotherapy, presenting a favorable evolution with the absence of loco-regional recurrence or distant metastasis 24 months postoperatively.

Malignant fibrous histiocytoma of larynx with giant cell: case report and histological-clinical considerations.

INTRODUCTION: Malignant fibrous histiocytoma (MFH) is a tumor which has a mesenchymal origin, and an uncertain histogenesis. MFH with giant cell accounts for 3-15% of all malignant fibrous histiocytomas. OBJECTIVE: To explore the histopathology, the diagnosis and the treatment of MFH with giant cell of larynx. PATIENT AND METHODS: We report a case of a glottic MFH at a 59-year-old male, who has been smoking for 30 years, and was hospitalized in June 2008 at Emergency County Hospital of Craiova. RESULTS: The largely-sized tumor was originated in glottic area, upper a left vocal cord, with no paresis. The tumor determined respiratory failure and dysphonia. Patient underwent surgical excision of the tumor after an emergency tracheotomy. The immunohistochemical techniques proved positive for vimentin, smooth muscle actin, CD68, CD34, bcl2, EGFR, S100, Ki67, and negative for CD117, NFT, chromogranin, c-erbB2, CK34betaE12, MNF116, and p53. CONCLUSIONS: Malignant fibrous histiocytomas (MFH) with giant cell of larynx are very rare mesenchymal neoplasm (this case seems the first reported). The diagnosis of MFH of larynx was difficult and the immunohistochemistry could have been helpful.

Chronic tonsillitis: histological and immunohistochemical aspects.

OBJECTIVES: Chronic tonsillitis represents the most common inflammatory lesions of the pharynx determining numerous local or distant evolutive complications. We decided to study the histological and especially immunohistochemical expression of this pathology. MATERIAL AND METHODS: We have studied 112 surgical samples representing tonsils resected from 56 patients with chronic tonsillitis. The tonsillectomies were performed in the ENT Clinic of the Emergency County Hospital of Craiova, between 01.01.2007--31.12.2007. The processed histological samples were stained using Hematoxylin-Eosin, light green trichromic and argental impregnation. For the immunohistochemical study, we used LSAB method with CD20, CD45 RO, CD68 antibodies in order to reveal and differentiate T- and B-lymphocytes and also the macrophages. RESULTS: In all samples, we found hyperplasia and hypertrophy of the lymphoid follicle with excessive developing of the clear germinal center as a normal reaction to antigens presence. In some cases, we remarked micro hemorrhages and hematic extravasations inside the follicles, probably due to the excessive virulence of the pathogens causing endothelial lesions. The conjunctive stroma was enriched in collagen fibbers, in some cases organized in strong fascicles with an obvious tendency to divide the tonsils in lobules. The young fibroblastic type cells were numerous. The specific reticulin fibbers had a low representation being disorganized. The immunohistochemical study proved that the clear center of the lymphoid follicles was occupied by B-lymphocytes, but the T-lymphocytes were present in the cortical region of the follicles, perifollicles and in the surface epithelium. CONCLUSIONS: In some pathological cases, the predominant cellular population of the clear center was formed by T-lymphocytes.

Clinical, morphological and immunohistochemical aspects in laryngeal premalignant lesions.

OBJECTIVE: We investigated the proliferative activities in premalignant laryngeal vocal chord lesions treated by epithelial stripping in microlaryngoscopy, using immunohistochemical staining with anti-p53, anti-PCNA and anti-Ki-67 monoclonal antibody and we correlated with clinic and morphologic aspects. MATERIAL AND METHODS: The study was made on 32 patients hospitalized in Craiova ENT Clinic in 2005 presenting lesions precursor to vocal cord malignity. The lesion's aspect was observed using suspended microlaryngoscopy, a biopsy was performed and biological tests were examined from a pathological and immunohistochemical point of view, with the investigation of the following immunohistochemical markers: Ki-67, PCNA and p53. RESULTS: 13 cases (41%) presented red hypertrofic cronic laryngitis, seven cases (22%) presented white hypertrofic cronic laryngitis, and 12 cases (37%) presented papillomas with with simple, moderate, severe dysplasia and in situ carcinoma in 62.5%, 22%, 12.5% and, respectively, 3% of the cases. All the dysplasic lesions, no matter the dysplasic degree, have presented alteration of both surface eplitelium and chorion. The expression of Ki-67, PCNA and p53 was correlated with the dysplasia's degree in various proportions. CONCLUSIONS: In clinical practice, morphological grading of dysplasia is difficult to evaluate. The Ki-67 and PCNA markers were correlated with the dysplasia degree; the expression of p53 was present only in 28% cases with moderate dysplasia and in one case with in situ carcinoma.