A rare adult case of primary uterine rhabdomyosarcoma with mixed pattern: a clinicopathological & immunohistochemical study with literature review.

BACKGROUND: Rhabdomyosarcomas are aggressive tumors that comprise a group of morphologically similar but biologically diverse lesions. Owing to its rarity, Mixed pattern RMS (ARMS and ERMS) constitutes a diagnostic and therapeutic dilemma. CASE: Herein is presented a very rare case of mixed alveolar & embryonal rhabdomyosarcoma in the uterus of a 68-year-old woman. The wall of the uterine corpus & cervix was replaced by multiple whitish-yellow, firm nodules, measuring up to 12 cm. Microscopically, the tumor was predominantly composed of round to polygonal cells arranged in nests with alveolar pattern intermingled with hypo- & hypercellular areas of more primitive cells with scattered multinucleated giant cells seen as well. Extensive sampling failed to show epithelial elements. Immunohistochemical staining showed positive staining for vimentin, desmin, myogenin, CD56 & WT-1. However, no staining was detected for CK, LCA, CD10, ER, SMA, CD99, S100, Cyclin-D1 & Olig-2. Metastatic deposits were found in the peritoneum. The patient received postoperative chemotherapy and radiotherapy but died of systemic metastases 3 months after surgery. CONCLUSION: The rarity of this histological tumor entity and its aggressive behavior and poor prognosis grab attention to improving recognition and treatment modalities in adults.

Expression of CD74 in invasive breast carcinoma: its relation to Nottingham Prognostic Index, hormone receptors, and HER2 immunoprofile.

PURPOSE: To study the immunohistochemical expression of CD74 in series of invasive breast carcinomas classified according to their estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) immunoprofile and explore its correlation to Nottingham Prognostic Index (NPI) and tumor pathologic stage to determine if it has a prognostic value. METHODS: A total of 160 cases of mammary carcinoma were classified broadly according to their ER, PR, and HER2 expression into luminal, HER2-positive, and triple-negative groups. The NPI was calculated and pathologic stage was recorded for each individual case and cases were classified into different prognostic groups. The CD74 expression was evaluated immunohistochemically and correlated to different prognostic variables. RESULTS: The CD74 immunohistochemical expression in invasive breast carcinoma was significantly higher in triple-negative tumors, higher tumor grades, presence of lymph nodal metastasis, higher tumor stages, and higher NPI scores. CONCLUSIONS: The CD74 might be a useful prognostic indicator predicting poor outcome of patients with breast carcinoma. Its consistent expression in triple-negative breast carcinomas points to the need of further studies to test the possibility if it can be targeted in treatment of breast carcinoma, especially in such groups.

Mammary serine protease inhibitor and CD138 immunohistochemical expression in ovarian serous and clear cell carcinomas.

This study aims to investigate the immunohistochemical expression of mammary serine protease inhibitor (maspin) and CD138 in primary ovarian high-grade serous carcinomas (HGSC) as compared to low-grade serous carcinomas (LGSC) and clear cell carcinomas and investigate if the studied markers have a correlation to International Federation of Gynaecology and Obstetrics (FIGO) stage, Ki67 proliferation index, and to each other. Maspin cellular location varied significantly between studied groups with only nuclear expression seen in 46.7 % of LGSC group, mixed nuclear and cytoplasmic in 13.3, 28.6, and 20 % of LGSC, HGSC, and clear cell carcinoma, respectively, and was only cytoplasmic in 26.7, 71.4, and 80 % of LGSC, HGSC, and clear cell carcinoma, respectively. Mean maspin and CD138 counts were significantly higher in HGSC and clear cell carcinoma compared to LGSC. Both maspin and CD138 scores varied significantly between studied groups and were positively correlated with adverse prognostic factors in studied carcinomas including FIGO stage and Ki67 proliferation index. Besides, both maspin and CD138 had significant correlation to each other. These findings suggest that epithelial cytoplasmic expression of maspin and CD138 may have a significant role in tumorigenesis in ovarian high-grade serous carcinomas and clear cell carcinomas; these markers may regulate tumor cell proliferation, and their significant correlation to each other may suggest that CD138 probably induces maspin expression to protect tumor growth factors from being lysed by proteolytic enzymes.

Immunohistochemical expression of Fas ligand (FasL) and neprilysin (neutral endopeptidase/CD10) in keratoconus.

Recent evidence demonstrated a correlation between apoptosis and neprilysin expression. The aim of this study was to investigate the immunohistochemical expression of Fas ligand (FasL) and neprilysin in keratoconic corneas in comparison to normal cadaver corneas to evaluate if such molecules play a role in the pathogenesis of keratoconus. We studied the expression of FasL and neprilysin in corneal specimens removed during penetrating keratoplasty in 15 cases with keratoconus and compared them with 5 normal cadaver corneas. In keratoconus, FasL was expressed in epithelium, endothelium and sub-Bowman's stroma only, while neprilysin was expressed in epithelium, endothelium and all stromal layers. All normal corneas showed weak expression of both markers in basal epithelial layer only. In keratoconus, corneal epithelium with higher expression of FasL may evoke apoptosis in keratocytes, while neprilysin could prevent possible rescue of keratocytes from apoptosis.

Weapons ovarian epithelial tumors may use in immune escape: an immunohistochemical correlational study.

Investigate FasL and survivin expression in a series of primary ovarian surface epithelial tumors, correlate their expression with each other, and characterize the presence of CD3+ T-lymphocytes in studied tumors and determine whether their presence correlates with FasL or survivin expression in malignant cases. FasL and survivin expression was assessed in 54 ovarian epithelial tumors. The results were compared between different tumor types and grades. Correlation between both markers' expression in all studied tumors was done. Either marker's expression was compared to the mean CD3+ T-lymphocytes per HPF in the studied malignant tumors. Either FasL or survivin expression was significantly higher in malignant versus benign ovarian epithelial tumors (p < 0.001 for both) and both markers were strongly correlated to each other (r = 0.877 & p < 0.001). Malignant tumors show significantly higher mean CD3+ T-lymphocytes than benign and borderline tumors. The mean CD3+ T-lymphocytes decrease significantly on increasing malignant tumor grade (p = 0.019) and expression of both FasL and survivin (r = -0.729, -0.582, respectively & p < 0.001 for both). The higher expression of FasL and survivin in malignant as compared to benign ovarian tumors suggest that they have a significant role in pathogenesis of ovarian carcinoma. Both markers are strongly correlated to each other and may contribute to immune escape of ovarian carcinoma as their higher expression is associated with decreased number of CD3 + T-lymphocytes.

Immunophenotyping of dendritic cells in lesional, perilesional and distant skin of chronic plaque psoriasis.

Psoriasis affects 2.7% of the world's population. The sequence of these events remains controversial. Because antigen presenting is necessary for T-cell activation, dendritic cells may be involved in the pathogenesis of psoriasis. To investigate their role, we examined immunophenotyping of different dendritic cells and their distribution and numbers in psoriasis patients. Immunohistochemistry of CD1a, CD11c, CD86 and BDCA2 were performed using paraffin-embedded tissue obtained from a total of 45 patients with psoriasis. Samples were taken from the lesion, perilesional and distant skin and normal skin obtained from 10 control cases. There were marked increase in the number of positive CD1a, CD11c, CD86 and BDCA2 cells in perilesional and the psoriatic skin when compared to the distant skin and they were the least in the normal control skin. So different dendritic cells subsets have a very important role in psoriasis pathogenesis especially in initiation of the plaque in the perilesional skin.

Immunohistochemical expression of topoisomerase II alpha and Her-2/neu in prostatic carcinoma and benign prostatic hyperplasia.

BACKGROUND AND PURPOSE: Topoisomerase II a (Topo II a) and Her-2/neu are two important targeted therapeutic molecules. The immunohistochemical expression of both of them has not been widely studied in prostatic carcinoma and benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the immunohistochemical expression of Topo II a and Her-2/neu in prostatic carcinoma and BPH and compare the expression patterns of both genes in cases of prostatic carcinoma in relation to Gleason score and hormonal status. MATERIAL AND METHODS: Paraffin blocks of 30 cases of prostatic carcinoma (categorized by Gleason score and hormonal status) and 5 cases of BPH presented to the Department of Pathology, Faculty of Medicine, Tanta University during the period from 2005 to 2008 were retrieved from the files. The immunohistochemical expression of Topo II a and Her-2/neu antibodies in the above-mentioned diagnostic categories was investigated and compared. The percentage of nuclei staining for Topo II a was semiquantitated; overexpression was defined as >or=5% nuclear staining. Her-2/neu immunoreactivity was scored from 0 to 3 + depending on membrane staining intensity and pattern. RESULTS: The expression of Topo II a varied significantly among the different studied groups (p<0.001). Topo II a expression increased significantly with increased Gleason score in prostatic carcinoma (p=0.001). Its expression in both moderately and poorly differentiated carcinomas was significantly higher than in BPH (p=0.005 and 0.002 respectively); however the difference between its expression in well-differentiated carcinoma and in BPH was statistically insignificant (p=0.171). Her-2/neu expression was higher in prostatic carcinoma than in BPH, however the difference did not reach the level of statistical significance (p=0.084). Also, the increase in its expression within prostatic carcinoma cases with increased Gleason score was statistically insignificant (p=0.100). There was a significant correlation between Topo II a and Her-2/neu expression (p=0.008, r=0.478). Hormone resistant carcinomas showed higher expression of Topo II a and Her- 2/neu than carcinomas with no hormone treatment, however, the differences were statistically insignificant (p=0.594 and 0.667 respectively). CONCLUSIONS: Topo II a expression was significantly higher in poorly differentiated and moderately differentiated prostatic carcinoma compared to BPH. There was a significant increase in Topo II a expression with increased Gleason score. Her-2/neu expression was higher in prostatic carcinoma than in BPH, however the difference did not reach the level of statistical significance and the increase in its expression with increased Gleason score was also statistically insignificant. Topo II a and Her-2/neu were co-expressed significantly. Hormone resistant carcinomas showed higher expression of both markers, however, the differences were statistically insignificant. The latter finding may have important therapeutic implications, however, further large scale studies are required for confirmation. KEYWORDS: Topo II a - Her-2/neu - Prostatic carcinoma - BPH.