Fluorescent in situ hybridization (FISH) in the differential diagnosis of ground-glass opacities in the lung.

Computed tomographic (CT) screening for lung cancer has increased the detection rate of nodules manifesting as ground-glass opacities (GGOs). The natural history of this new entity it is not well known nor is the factors that influence the growth, progression and malignant potential. This genetic study was performed in order to identify molecular markers with possible diagnostic and prognostic significance to differentiate lesions with malignant or benign profiles. Ten pure GGO fresh samples and 5 specimens of normal lung tissue were cytogenetically investigated using a direct method and short-term cultures, and molecular analysis was performed using the 4-target FISH LAVysion kit for the detection of non-small cell lung cancer (NSCLC). Interestingly, all the karyotypes turned out to be normal both with the direct method and cultured cells, while in 3 out of 10 GGOs FISH analysis was abnormal for all the targets and in 2 cases only c-MYC amplification was observed. Karyotypes and FISH performed on the normal tissue samples gave normal results. Two of three FISH positive patients died, one had a relapse of the disease and at the last follow-up showed lung and bone metastases. Despite the small sample due to the rarity of pure GGOs, these preliminary results indicate that interphase FISH analyses are more informative than metaphase studies and might contribute clinically relevant information about the nature of these lesions.

Rectal squamous cell carcinoma treated with chemoradiotherapy: report of six cases.

PURPOSE: Squamous cell carcinoma (SCC) of the colon and rectum is a rare pathologic entity. From May 2006 to August 2008 six consecutive patients with SCC of the rectum were treated at our institution. A retrospective analysis of these cases was performed in order to evaluate the role of chemoradiotherapy as an alternative to surgery. METHODS: All tumors were locally advanced and the clinical stage was T3N0M0 in three cases, T3N1M0, T4N1M0 and T3N2M1 in the other three cases. All patients received primary chemoradiation reserving surgery for unresponsive or recurrent tumors except in one of complete responders. Radiation treatment was given to standard pelvic volume up to 50.4 Gy in 28 fractions, with a boost to the primary tumor up to 59.4 Gy in two patients. RESULTS: A complete clinical response with a negative endoscopic biopsy was achieved in four patients and a partial response in two. Surgery as a part of the primary treatment was performed in the non-metastatic patient with partial response and in the first patient with complete response. At a median follow-up of 39 months (range, 24-41) from the end of chemoradiotherapy, five out of six patients remain alive and free of recurrence, three of them without having undergone surgery. CONCLUSION: Our data, though from a small series, give support to the hypothesis that concomitant chemoradiation may be considered a safe and effective therapeutic approach for patients with rectal SCC.

Sampling variability of computer-aided fractal-corrected measures of liver fibrosis in needle biopsy specimens.

AIM: To assess the sampling variability of computer-aided, fractal-corrected measures of fibrosis in liver biopsies. METHODS: Samples were derived from six to eight different parts of livers removed from 12 patients with clinically and histologically proven cirrhosis undergoing orthotopic liver transplantation. Sirius red-stained sections with a thickness of 2 mum were digitized using a computer-aided image analysis system that automatically measures the surface of fibrosis, as well as its outline perimeter, fractal surface and outline dimensions, wrinkledness, and Hurst coefficient. RESULTS: We found a high degree of inter-sample variability in the measurements of the surface [coefficient of variation (CV) = 43% +/- 13%] and wrinkledness (CV = 28% +/- 9%) of fibrosis, but the inter-sample variability of Hurst's exponent was low (CV = 14% +/- 2%). CONCLUSION: This study suggests that Hurst's exponent might be used in clinical practice as the best histological estimate of fibrosis in the whole organ, and evidences the fact that biopsy sections, which are fundamental for the qualitative diagnosis of chronic hepatitis, play a key role in the quantitative estimate of architectural changes in liver tissue.