The histopathologic type of the periampullary tumors. Is it important for survival?

BACKGROUND: The ampulla of Vater is a junction with four histologic epithelial types: ampullary, duodenal, pancreatic and biliary. The tumors of this region are named periampullary adenocarcinomas, but the histologic type of these malignancies seems to have an important significance for survival. AIM: Our purpose is to determine whether the histologic type of the resectable vaterian adenocarcinomas is a prognostic factor. METHODS: We reviewed the medical records of 38 patients who underwent RO-R1 pancreatoduodenectomy for periampullary adenocarcinomas between 1998 and 2007 in one single surgical center. The histopathologic reports and the microscopic samples were reevaluated independently by two senior pathologists. Using our database we assessed the overall survival based on histologic type, tumor stage, lymph nodes involvement, tumor size and the level of differentiation. RESULTS: The histologic type of the adenocarcinomas was intestinal in 23 cases (60.5%) and pancreatobiliary in 15 cases (39.5%). The median overall survival was significantly higher in patients with well differentiate intestinal-type in T1-T2 stage without nodes involvement. In a multivariable Cox regression analysis the regional lymph nodes involvement and the differentiation degree remained significant prognostic factors. CONCLUSION: The intestinal type of periampullary adenocarcinomas has a long survival, but the lymph nodes involvement and the lower degree of differentiation are associated with a high risk of death in these malignancies.

The future of cytopathology in Europe. Will the wider use of HPV testing have an impact on the provision of cervical screening?

The emphasis of the EFCS Congress held in Venice in October 2006 was on the future of Cytopathology in relation to events in Europe. Much of the discussion centred on the role of human papilloma virus testing and its impact on the provision of cervical screening. The following is a transcript of the discussion that took place at the Advisory Board Meeting for the journal Cytopathology, with some additional written comments received prior to the meeting. A brief summary has been provided as a conclusion by Dr A. Herbert.

[The histopathological study of the bronchopulmonary carcinoma]. / Studiu histopatologic în carcinomul bronhopulmonar.

PURPOSE: The aim of the study is to reveal the predominant histological types of the bronchopulmonary carcinomas diagnosed at the Pneumology Hospital in the period of 1st January 1996-December 31 1998. MATERIAL AND METHODS: The study enclosed 196 cases of CBP, representing 174 men and 22 women with ages between 31 and 78 of years. The studied specimens were pieces of bronchoscopical and surgical biopsies, material obtained from the pneumological clinic. RESULTS AND DISCUSSIONS: The histological analysis revealed the increasing number of the bronchopulmonary carcinoma, mainly to men with mean age of sixty and the predominance of the epidermoid carcinoma (137) and a reduced number of cases of adenocarcinomas (31) and undifferentiated carcinomas (28). The knowing of the histological type of the CBP is very important in the calculation of the prognosis. CONCLUSIONS: Our study demonstrate the predominance of CBP at men (174), with ages between 55 and 65 years (127 cases) and similar incidences for all histological types of CBP comparative with other territories.

[Castleman's disease. Discussion related to case report]. / Boala Castleman. Discutii în relatie cu un caz clinic.

Castleman's disease, also called angiofollicular hyperplasia was first described as a distinct entity by Castleman et al in 1956. Now there are described two forms, a localised and a multicentric one. All forms of disease share the same histopathological features with a highly characteristic angiofollicular lymphoid hyperplasia which is either hyalinovascular or plasmocytic. The clinical and biological signs are varied and heterogeneous. The disorder is of unknown origin, but interleukin 6 plays a central part in this disease. Despite the benignity of this "prelymphoma state", an aggressive course with poor prognosis occur usually in the multicentric form. We report a case of Castleman's disease, multicentric variant. This case provides the opportunity for discussing many aspects of this atypical lymphoproliferative disorder.

Therapeutical aspects of the plasmocytoma localized at the level of head and neck.

The authors present a study on 7 cases of extramedullary plasmocytoma localized in E.N.T. area, hospitalized and solved in the E.N.T. Department of the the "Sf. Spiridon" Universitary Hospital, in the last 15 years, between 1983-1997. We insist on the last solved case, presenting a double isolated localization, a laryngeal and a rhinosinusal one. We consider that the most indicated treatment in the isolated extramedullary plasmocytoma, is the radiosurgical therapy with a good rate of survival.

[An immunohistochemical study of the steroid hormone receptors in endometrial hyperplasia]. / Studiul imunohistochimic al receptorilor hormonilor steroizi în hiperplaziile endometriale.

AIM: Evaluation of the estrogen and progesterone receptors (ER and PR) in different degrees of endometrial hyperplasias. METHODS: 10 cases of each degree of endometrial hyperplasia (simple, complex and atypical) were analyzed using the avidin-biotin-peroxidase technique and monoclonal antibodies applied to formalin-fixed, paraffin-embedded tissue. RESULTS: We found similar, high level of both ER and PR in simple and complex hyperplasias and a significant decrease of these in atypical hyperplasia. CONCLUSIONS: Endometrial hyperplasias develop in a setting of estrogen excess. This explains the high level of endometrial receptors and the response to progesterone in typical hyperplasia. In atypical hyperplasia, the decrease of steroid receptors results in a low sensibility of this lesion to progestative therapy, but there are cases with high receptor levels which could have a chance for hormonal therapy.

[p53 and steroid receptors support double endometrial carcinogenesis]. / p53 si receptorii steroizi sustin o dubla carcinogeneza endometriala.

AIM: This study investigated the p53 positivity correlated with the receptor status, in different grades and stages of endometrial carcinoma. METHODS: The study included 88 endometrioid-type carcinomas and 5 non-endometrioid-type carcinomas. Paraffin sections were used for the ordinary histological diagnosis and for immunohistochemical diagnosis by avidin-biotin-peroxidase technique. RESULTS: p53 positivity was identified in 10 endometrioid-type carcinomas (11.4%) and 3 non-endometrioid type carcinomas (60%). Most of the p53 positive cases were receptor negative and observed in advanced stages and histological grades. No associated endometrial hyperplasia was p53 positive, while a positive intraepithelial non-endometrioid carcinoma was identified. CONCLUSIONS: p53 positivity is most frequently identified in non-endometrioid type, receptor negative adenocarcinomas, even in a precursor lesion as it is intraepithelial carcinoma, while in endometrioid, receptor positive carcinomas it appear in late stages of development, never being identified in precursor lesions.

[The rejection of a hepatic graft]. / Rejetul de grefa hepatica.

Hepatic graft rejection is an epiphenomenon of liver transplantation. Despite the immunosuppressive therapy, nowadays a level of 30-50% of acute rejection and 5-15% chronic rejection is always persisting. Graft rejection prophylaxis essentially represents the result of a subtle equilibrium of the chronic immunosuppression. This study presents the essential data concerning the graft rejection, such as: prevalences, classifications, clinical presentation and diagnostic, both anatomopathological and differential. Modern therapy of hepatic graft rejection is also presented.

Ultrastructural aspects of the alveolar wall in SIDS.

The aim of this study is to make a comparative analyse between light and ultrastructural lesions of the alveolar wall in SIDS. The study was made on lung specimens collected from autopsy of infants with sudden unexplained death. There were studied histopathologically 10 cases of sudden death. Only in 3 cases were made electron microscopically studies. At light microscope, there were put in evidence interstitial and intra-alveolar oedema and the presence of many parietal and intra-alveolar macrophages. There is a good correlation between light and ultrastructural aspects.

New trends in "mystery SIDS" research.

The aim of this study is to suggest some new trends of research in SIDS, leaving from the pathologist's observations of the presence of unusual lesions in SIDS. The histopathological study was made on 27 cases of SD, representing 1996 SIDS cases registered to hospital. There were put in evidence the oesophageal inflammation, the hyperplasia of submucosal laryngeal glands, different grades of bronchiolar mucous hypersecretion and reducing of elastic lung tissue and the hypertrophy of muscular lung small arteries. This lesions are frequently encountered to SIDS cases.

Histological study of Hodgkin disease (HD), an immunohistochemical identification of the cells surrounding Sternberg-Reed cells.

In this study, we analyze histological types of 77 cases H.D. and examine immunohistochemically the reactive cells surrounding Reed-Sternberg cells (40 cases). On the current techniques sections of lymph nodes were def ned H.D. types after the new criteria (Bennett & col., 1985, Buttler, 1992). Immunologic marker studies were performed on paraffin sections of H.D. tissue utilizing the avidin--biotin peroxidase complex technique with limited panel of monoclonal antibodies OKT3, OKB1, OKM1. On histopathologic grounds we established the diagnosis of lymphocytic predominance type in 6 cases--8%, nodular sclerosis type in 36 cases--47%, from which first degree--24 cases and second degree--12 cases, mixed cellularity type in 28 cases--36% and lymphocytic depletion type in 7 cases--9%. Immunohistochemically, in our 40 H.D. cases, the number of T. lymphocytes in all H.D. types, was highly variable, ranging from a minority to a vast majority of cells directly surrounding the Reed-Sternberg cells. These lymphocytes were positive for OKT3, which were more in tissue involved by nodular sclerosis or mixed cellularity types than in the lymphocytic predominance type. Thus, in our few cases of lymphocytic predominance type, the reactive proliferation was consisted of B. cells along side with a few T cells. Also the OKM1 positive mononuclear cells were few. In conclusion, our data support the necessity to extend of several immunohistochemical investigations used for distinguishing H.D. disease from benign hyperplasia and from non-lymphoid malignancies, and for concerning the functional lymphocytic composition and the role of monocyte-macrophage system in the immunological alteration in H.D.

[Liver transplantation. I. Its history. The indications. Clinical efficacy]. / Transplantul hepatic. I. Istoric. Indicatii. Eficienta clinica.

The aim of this study is to present the actual indications of the liver transplantation in adult as well as in children patients. A multicenter comparative study based on the already published reports in Europe and in the United States has been done in order to analyse the survival rates for different liver diseases subjected to liver transplantation, as well as the prevalence of these nosologic entities in different hepato-biliary centers. Such an analysis is badly needed in Romania, where the prevalence of liver diseases is relatively high, and in the context of the initiation of transplantation in our country.

An immunohistochemical study of P53 protein on colorectal carcinomas.

AIMS: To investigate the frequency of immunohistochemical expression of p53 protein in colorectal carcinomas; to evaluate the correlation between p53 alterations and the histopathological parameters; to determine the prognostic significance of this tumor marker. PATIENT POPULATIONS: Fourty patients with colorectal carcinomas. METHODS: Paraffin embedded normal and tumoral tissues, stained, with HES, PAS, PAS-Alcian Blue stains. For detecting the p53 protein, a three step (streptavidin-biotin immunoperoxidase) immunohistochemical method was used. RESULTS: 28 out of 40 (70%) colorectal carcinomas were positive for p53. The identification of nuclear accumulations of p53 protein in the present study was significantly correlated with the anatomic site and tumor stage. CONCLUSIONS: The mutational pattern observed in this study was substantially as expected. The p53 overexpression is present in advanced stage, thus demonstrating the prognostic value of this marker.

Flow-cytometry DNA index of colorectal carcinomas.

The authors investigated the relationship between flow cytometric DNA index (D.I.-defined as the ratio of the DNA content of malignant cells to that of normal cells) and other prognostic factors (grade, stage of the disease, anatomical site, patients' sex and age) of 20 patients with colorectal cancer. The entire material was obtained from 20 unselected and previously untreated patients. This material consists of fresh tumoural or normal tissues taken after radical colectomy for the flow-cytometric analysis. A normal diploid DNA content was found in six tumours, the other fourteen being founded to be aneuploid. All non malignant tissue samples showed normal diploid DNA content. In the current series of cases we have found that DI was significantly associated with stage but not with grade, anatomical site or other prognostic factors. Our data indicates that cytometrically evaluated DI values have probably an independent predictive power for the clinical outcome of colorectal cancer patients.

Lennert's lymphoma.

Four cases (3 M, 1 F) of Lennert's lymphoma were presented. The age (38-76 years), the clinical aspect and the morphopathological features were characteristic. Despite an intensive chemotherapy, 3 of the 4 patients died between 2 and 16 months (mean survival time 7 months). The controversies about the nosological delimitation and the cellular nature of Lennert's lymphoma are presented. Because of the poor prognosis, it should be considered as a high-grade malignant non-Hodgkin lymphoma.

Morphometry in evaluating large cell malignant lymphomas in lymph node biopsies.

The values of some morphometric cell parameters were analysed in 12 cases of large cell non-Hodgkin's lymphoma (centroblastic and immunoblastic lymphoma and histiocytic sarcomas) in order to test the utility of the morphometric method as an additional element to the histologic diagnosis and to its further accuracy. The nuclear and nucleolar area, the number of nucleoli per nuclear cross section and the nucleus to nucleolus ratio were investigated. The morphometric data were obtained on histograms using the Giemsa stained sections. Mean values and standard deviations were calculated and statistically analyzed. Statistical evaluation of data showed significant differences in the three groups. Our results proved the usefulness of the morphometric method as a helpful technique of differentiating the large cell malignant lymphomas.