Snail and E-Cadherin Immunoexpression in Clear Cell Renal Cell Carcinoma.

Renal cell clear cell carcinomas (ccRCC) represent 75% of the malignant renal neoplasias. A critical molecular characteristic in the epithelial-mesenchymal transition (EMT) is the loss of E-cadherin expression, as well as the epithelial-mesenchymal transcription factors, one of the most important of which is Snail. In the current study, we analyzed the immunoexpression of the two markers in 46 cases of clear cell renal cell carcinomas, with reference to the most important prognosis histopathological factors. Our results indicated significant associations between the overexpression of Snail, under expression of E-cadherin and high Fuhrman grade. E-cadherin immunoexpression was high in incipient tumoral stages, and Snail was overexpressed in advanced tumoral stages of ccRCC. Our study supports the importance of this antibody panel in the prognosis of ccRCC.

E-cadherin and Snail Immunoexpression in Colorectal Adenocarcinomas.

Epithelial-mesenchymal transition (EMT) is a fundamental process which governs invasiveness. E-cadherin plays a major role in development, organogenesis and tissue formation, but also in tumor progression. Snail is a transcription factor described as a direct repressor of E-cadherin during development and in carcinogenesis. In this study we analyzed E-cadherin and Snail immunoexpression in 47 cases of colorectal adenocarcinoma (CRC) in comparison with some histopathological prognostic factors. The majority of cases were G2 tumors in stages II and III, with vascular and perineural invasion. All cases showed positive cytoplasmic signal for E-cadherin and Snail. E-cadherin reactions were intense with the highest composite score (CS) values in CRC G1. CS values of E-cadherin decreased with the advancement in tumor stage and the association with vascular and perineural invasion was statistically significant. Snail immunoreaction was intense with the highest values of CS in CRC G3, being more evident with the increase of tumor staging, aspect which was statistically significant. CS and Snail association demonstrated a statistically significant aspect related to vascular invasion. We found a negative linear correlation of E-cadherin and Snail expression. The obtained results indicate the implication of Snail and E-cadherin in EMT of CRC, aspect which is useful in the evaluation and stratification of patients with CRC for the targeted specific therapy.

Low Grade Ovarian Serous Carcinoma - A Clinical-Morphologic Study.

Low grade ovarian serous carcinomas (LGSC) are rare tumors, representing only a small part of all ovarian carcinomas. The study included six LGSC cases for which we followed the clinical-epidemiological and morphological parameters depending on the tumoral stages. The tumors corresponded to stage I in four cases, in one case to stage II and in another case to stage III. The majority of the analyzed histopathological parameters were present in all tumoral stages. The accuracy of the diagnostic and the correct staging of the LGSC affected patients is very important, because the grade and stage of the serous ovarian tumors impose the therapy and the prognosis.

Histopathological and Morphometric Study of Fibrosis and Nuclear Pleomorphism in Dilated Cardiomyopathy.

Histopathological changes associated with dilated cardiomyopathy (CMD) are frequently nonspecific and often only present in the terminal stage of the disease. The study followed the histopathological and morphometric quantification of fibrosis and nuclear pleomorphism in CMD. We analyzed left ventricle myocardial fragments harvested during autopsy, from 35 cases with clinical diagnosis of CMD and 5 cases of normal myocardium. Fibrosis was present in all CMD cases, with higher values compared with control cases. Nuclear pleomorphism was identified in 18 cases (45%), two of the analyzed parameters, respectively the ratio of nuclear diameters and roundness of nucleus, revealing significant differences in CMD compared to the control cases. Myocardial fibrosis present in all cases of CMD represents a major feature of the disease. The nuclear pleomorphism due to the nuclei change in diameters and size was more pronounced in the vicinity of fibrosis areas, possibly related to this alteration.

Assessment of Histopathological Parameters Useful in the Diagnosis of Low Grade Non-Invasive Urothelial Carcinomas.

Urothelial papillary lesions of urinary bladder are frequent lesions in medical practice and sometimes difficult to be histopathologically classified. In this study were included 179 urothelial papillary lesions, represented by low grade non-invasive urothelial carcinomas (LGNIUC), papillary urothelial neoplasms of low malignant potential (PUNLMP) and urothelial papillomas (UP), for which the architectural and cytological histopathological parameters were analyzed in order to determine their usefulness for the classification of lesions. For each parameter, an aggressivity score was set, the sum representing the composite histological score (CHS) for each case. The increase of urothelial thickness, the papillae fusion, the loss of cellular polarity, loss of basal cell palisading and absence of umbelliform cells were commonly associated with diffuse pattern in LGNIUC, were focal/absent in PUNLMP and absent in UP. The nuclear hypertrophy and hyperchromasia, the nucleoli presence and mitotic activity were specific for LGNIUC, rarely associated with PUNLMP and absent/low in UP. CHS values for the three categories of analyzed lesions were superior statistically significant in LGNIUC compared to PUNLMP and UP. The mitotic index and the thickness of cytological atypical epithelial layers support the parameters utility as reproducible criteria for the differentiation of papillary urothelial tumors.

Histopathological Patterns of Microinvasion in Ovarian Serous Borderline Tumors.

Stromal microinvasion in ovarian serous borderline tumors can take various aspects, some of which are difficult to identify. Thus, the identification of stromal microinvasion is relatively simple for typical intracystic papillary proliferations such as serous borderline tumors, but may be difficult for tumors with glandular component. The study analyzed 14 cases of ovarian serous borderline tumors diagnosed in patients with mean age of 47,1 years. Histopathologically all tumors corresponded to typical forms in which we identified only two cases of stromal microinvasion. In one case, microinvasion was of eosinophilic type, and in the other case was observed a glandular and micropapillary pattern, being associated with the noninvasive peritoneal implants.

Proliferative Activity in Basal Cell Carcinomas.

Basal cell carcinomas (BCCs) represent one of the most common human neoplasias. The excellent prognosis of the diagnosed early lesions and the low metastasis rate are particularities that required the investigation of the mechanisms of carcinogenesis on these lesions. In this study we analyzed the proliferation rate for 53 cases of BCC in relation to the clinicopathological parameters of the lesions using Ki67, considered a true indicator of cellular proliferation. The results indicated statistically significant differences in Ki67 immunoexpression related to histological type and lesion stage. The highest Ki67 values were observed in the adenoid and morpheaform subtypes, and in advanced tumor stages. This aspects may be useful for stratification of lesions in terms of tumor aggressiveness.

Morphological Survey of Placenta in Trombophilia Related Hypoperfusion of Maternal-Fetal Blood Flow.

Complex and modern obstetric medical care provides a constant improvement for the pregnancy prognosis. Thus, young women with an undiagnosed pathology become pregnant and, during pregnancy, the previously undiagnosed pathology, without any clinical signs and symptoms, becomes present during pregnancy, having an unfavorable impact on the fetus and the health state of the pregnant woman. The gestational syndromes during pregnancy influence the woman's health state over a long period of time and the quality of the conception product. The recommendation, performance of laboratory tests and imagistic investigations at the right time during pregnancy, as well as a correct interpretation of their results, may prevent the onset of catastrophic occurrences including fetal death in utero and/ or maternal death. We report the case of a 30-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, severe preeclampsia, severe IUGR and thrombophilia.

EGFR Immunoexpression in Malignant Serous and Mucinous Ovarian Tumors.

The epithelial growth factor receptor (EGFR) is involved in various stages of cancer growth such as tumor initiation, angiogenesis and metastasis, being an attractive target for oncogenic therapy. The present study aims to evaluate the EGFR expression in 54 cases of serous and mucinous ovarian borderline tumors and carcinomas. EGFR expression was present in more than half of the investigated tumors, more frequently in carcinomas than in borderline tumors, especially in the serous type. The highest values of the final staining score (FSS) were observed only in serous carcinomas in the advanced stages of the disease. As a result of frequent expression of EGFR in ovarian tumors, it is necessary to monitor EGFR inhibitors for ovarian cancer therapy, but probably after establishing more rigorous selection and stratification criteria for patients.

Immunoexpression of Transforming Growth Factor Beta 3 (TGFß3) and Its Receptor Type III (TGFßRIII) in Basal Cell Carcinomas.

Basal cell carcinomas (BCCs) are malignant tumors with particular biological prognosis and behavior, and the biomolecular investigation of these lesions can provide important therapeutic targets for epithelial neoplasia. In this study we analyzed the immunoexpression of transforming growth factor beta 3 (TGFß3) and its receptor type III (TGFßRIII) for 53 cases of BCC in relation to the main histopathological prognostic parameters. The results indicated statistically significant differences of TGFß3 and TGFßRIII expression related to histological type and lesion stage, the both proteins being higher expressed in adenoid and morpheaform advanced stage tumors. In this study, TGFß3 and TGFßRIII immunoexpression analysis indicated their utility for identifying aggressive BCCs with potential for tumor progression.

Histopathological Prognostic Factors for Colic Adenocarcinoma.

The majority of colorectal carcinomas are adenocarcinomas derived from the colic mucosae cell, more frequently moderately differentiated. The purpose of this study was to determine de incidence of CRC and the relationship between histopathological risk factors in patients with colic adenocarcinomas. The study included 144 cases of CRC diagnosed within the Pathology Laboratory of the Clinical County Hospital of Craiova in the year 2017.The biological material consisted in samples from colectomies and hemicolectomies provided from patients admitted within the surgical clinics of the same hospital, then fixed with 10% buffered formalin and afterwards processed using the classic histopathological technique of paraffin inclusion and staining with hematoxylin and eosin. We observed certain histopathological parameters such as: pattern, grading, stage, vascular invasion and neural invasion. The mean age of diagnostic was 68.6 ± 11.2, and it was predominantly male patients (64.6%). Most cases presented with mucinous pattern (31.9%) and cribriform comedocarcinoma type (29.9%). The majority were classified as stage III B (34%), being moderately differentiated (64.6%) and associated with vascular invasion (47.2%) and perineural invasion (25.7%). Statistical analysis indicated significant relationships between tumor stage and differentiation grade (p<0.01, χ²test), as well as between tumor stage and vascular invasion (p<0.05, χ²test), without including perineural invasion (p<0.05, χ²test).

Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters.

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

Architectural Histopathological Changes in Ovarian Serous Carcinomas.

Ovarian serous carcinomas have a very large spectrum of growth patterns that contrast with the most primitive ovarian carcinomas, in which the morphology varies very much less. Serous carcinomas growth patterns include papillary and glandular aspects, but also cribriform, solid, microcystic and trabecular, some being common to the both high- and low-grade types of ovarian serous carcinomas, others being distinct. The study included 45 cases of ovarian serous carcinomas out of which five cases with low grade and 40 cases with high grade. High grade serous carcinomas were associated with mixed growth patterns, with large complex papillae, glands with irregular shape lined by stratified epithelia, often with areas of extended necrosis. In the case of low grade ovarian carcinomas we observed the association with more uniform growth patterns, micropapillary or glandular, the presence of optically empty slit-like spaces, psammoma bodies, the absence of necrosis and the association with a borderline or benign component. The recognition of the common histopathological aspects, allows a more accurate diagnosis of the ovarian serous carcinoma types and subtypes, which has a great importance in the actual era of personalized therapy.

Study of Histopatological Parameters of Gastric Carcinomas with Micropapillary Component.

Micropapillary carcinoma was recently identified as a carcinoma variant characterized by the presence of small clusters of tumor cells located in optically empty spaces. The study included a number of 14 cases represented by surgical excision specimens diagnosed with gastric carcinoma (tubular, papillary and signet-ring) which associated the micropapillary component in variable proportions. Regarding the low-grade tubular carcinomas, the micropapillary component represented less than 25% of the tumor, while in the high-grade tubular carcinomas and papillary carcinomas it represented 25-50%. Among signet-ring carcinomas, the micropapillary component had a percentage of over 50. The depth of invasion was frequently associated with T3 and T4 categories. Lymph nodes metastasis were found in ten cases and distant metastasis were present in three cases. Recognition of the micropapillary component associated with gastric carcinoma represents an aspect of great importance because it is frequently correlated with unfavorable prognosis parameters.

Histopathological Prognostic Factors in Clear Cell Renal Cell Carcinoma.

Clear cell renal cell carcinoma (CCRCC) are the most frequent type of renal cell carcinoma. Fuhrman grade and tumor stage are prognostic factors with great importance in survival rate. This study was performed on 75 cases of CCRCC diagnosed by the Anatomical Pathology Laboratory of the County Clinical Emergency Hospital of Craiova between 2014 and 2017. The biological material was represented by pieces of nephrectomy. The cases were analyzed on two criteria: epidemiology (age, sex) and histopathology (Fuhrman grade, tumor stage, architectural pattern, sarcomatoid transformation, and necrosis). Statistical analysis was done using Chi Square tests in IBM SPSS software. Average diagnosis age of CCRCC was 58.8±10.2 years, predominantly in male patients (66.7%). Tumor sizes were between 2 and 14cm, with an average of 6.7±2.9cm. Most cases were determined to be tumor stage III (60%) and Fuhrman grade 2 (56%), followed, in order of frequency, by tumor stages I and II (28% and 10.7%) and Fuhrman grades 3 and 1 (21.3% and 20%). High Fuhrman grade CCRCC were significantly associated with advanced tumor stage (p<0.05, χ2 test). Most cases presented a mixed pattern, significantly associated with advanced tumor stages (p<0.05, χ2 test). Even though the presence of sarcomatoid transformation was more frequent in advanced tumor stages, it wasn't significantly linked to them (p<0.05, χ2 test). Conclusions: Analyzed histopathological parameters are useful for determining CCRCC aggressiveness. CCRCC in advanced tumor stages is associated with high Fuhrman grade and mixed architectural pattern.

Histopathological Aspects of the Myocardium in Dilated Cardiomyopathy.

Dilated cardiomyopathy is the most common form of cardiac muscle disease, accounting for approximately 60% of all cardiomyopathies. We proposed to identify histopathological changes of the myocardium in dilative cardiomyopathy. This study comprised a total of 19 cases, represented by myocardial fragments from deceased patients with diagnosis of dilated cardiomyopathy. Histopathological analysis allowed changes to be observed for both myocytes and myocardial interstitial components. We have found a combination of hypertrophic, atrophic and normal myocardocytes, or associated with the presence of hydropic changes. We rarely identified the aspect of myocytosis, cytoplasmic accumulation of lipofuscin pigment or mucinous material, and variable nuclear pleomorphism. At the interstitial level we noticed changes in fibrosis, lipomatosis and rarely the presence of inflammatory infiltrate. Histopathological characteristics of the myocardium in dilated cardiomyopathy are numerous but nonspecific, similar to those in the terminal stages of other cardiac diseases.

P21 Immunoexpression in Actinic Keratosis and Cutaneous Carcinomas.

Actinic keratosis is a precancerous lesion of the skin with variable rates of transformation into non-melanocytic carcinomas. The present study aims to analyze p21 expression in actinic keratosis and cutaneous squamous carcinomas. P21 expression analysis revealed a positive reaction in 63 (71.4%) of the investigated cases. The immunostaining analysis revealed positivity in 82.1% of the studied actinic keratosis cases and in 43.9% of the investigated carcinomas. High scores of immunoreactions were identified only for the well-differentiated and for the carcinomas in initial stages. Association of p21 expression with pre-invasive or well-differentiated invasive lesions in early stages of tumor progression suggests that p21 may be an early event in squamous carcinogenesis.

CD44 Immunoexpression in the Progression of Actinic Keratosis and Cutaneous Squamouscarcinoma.

CD44 seems to confer the needed conditions for malignant neoplasms to grow and progress. The present study aims to investigate the role of CD44 expression in pre-invasive and invasive squamous lesions of the skin. We investigated 89 cases of preinvasive and invasive cutaneous lesions, of which 28 corresponded to actinic keratosis (KIN- keratinocyte intraepithelial neoplasia) with varying degrees of severity and 61 cases of squamous cell carcinoma with variable degrees of differentiation. The statistical analysis of CD44 immunoexpression indicated significantly higher values for KIN I and II compared to KIN III, as well as for KIN lesions in comparison with squamous cell carcinomas. Similar results were observed in well differentiated carcinomas compared to moderate and poorly differentiated lesions. These observations suggest that CD44 expression plays a role in the progression of cutaneous squamous neoplasia.

P53 Immunoexpression in Laryngeal Squamous Cell Carcinoma.

p53 is a marker described in the premalignant lesions with a high risk of malignant transformation for laryngeal cancer. It is a tumor suppressor gene that during the cancer gains also oncogenic activity. We aimed to study the p53 immunoexpression in 38 cases of laryngeal squamous cell carcinomas and the relation with the clinicopathological aspects. We obtained variable p53 expression regarding the differentiation degree and tumor stage. The higher p53 immunotaining values were observed in high grade and advanced stages lesions. P53 may be useful in identifying aggresive laryngeal squamous carcinomas, a useful aspect for better stratification of patients for therapy.

EGFR Immunoexpression in Laryngeal Squamous Cell Carcinoma.

Epidermal growth factor receptor (EGFR) is a tyrosine kinase molecule associated to the initial stages of neoplastic transformation. High expression of EGFR is connected to aggressive tumor behavior and high risk of metastasis and treatment failure. The aim of our study was to analyze the immunohistochemical expression of EGFR in 38 cases of laryngeal squamous cell carcinomas depending on clinicopathological parameters related to prognosis. The EGFR immunoreactions have statistical significant higher values in high grade carcinomas. Although the EGFR values were superior in advanced stages lesions, the aspect was not significant EGFR may be useful in identifying the aggressive laryngeal squamous carcinomas.