Precursor Lesions of the Vocal Cord: a Study on the Diagnostic Role of Histomorphology, Histometry and Ki-67 Proliferation.

The precise typing of precursor lesions of squamous cell carcinoma of vocal cord is of vital importance since it determines the line of therapy and prognosis. The aim of the present study is to evaluate the possible value of the types of dyskeratosis, histometry and cell proliferation rate in discriminating these lesions. The present retrospective study was based on 145 patients, classified according to the updated 2017 WHO system and included: Low-grade dysplasia (24 cases), high -grade dysplasia (53 cases), carcinoma insitu (33 cases) and microinvasive carcinomas (35 cases). Cell proliferation was assessed by immunoreactivity to Ki-67. For histometry and quantitation of Ki-67 proliferation rate, an image analysis system was used (Leica LAS, Wetzlar, Germany). Epithelial pearls (cell nests) were commonly observed in microinvasive carcinoma (82.9%) than high-grade dysplasia (5.9%). The median epithelial thickness, as well as, proliferation rate showed a significant increase according to the grade of the lesion. It is concluded that dyskeratosis pattern, histometry and Ki-67proliferation rate are valuable parameters to characterize precursor lesions. The presence of epithelial pearls, thickness > 450 µm and Ki-67 > 40% denote high risk lesions that require adequate excision and/or radiotherapy.

Evaluation of bone marrow in 143 lymphomas: the relative frequency and pattern of involvement, secondary myelopathies, pitfalls and diagnostic validity.

UNLABELLED: The aim of the present study is to assess the frequency of bone marrow (BM) involvement by both bone marrow aspirate and biopsy (BMA and BMB, respectively) procedures in established cases of lymphomas at initial presentation, and to study the relative frequency of marrow disease in relation to lymphoma types, patterns of infiltration and the 2ry associated changes, as well as the diagnostic challenges. Moreover, the diagnostic validity of BMA is tested taking the results of the BMB as the true test results, in order to determine the role of each procedure in the diagnostic approach of marrow infiltration. PATIENTS AND METHOD: This is a retrospective study carried out on 143 nonconsecutive Egyptian patients with lymphomas obtained from a private series during the years 2005 to 2008. Criteria of inclusion included the availability of full medical records and material (medical and pathological), patient consent, nodal disease with no therapy prior to BM sampling, except in 7 patients who had another 2nd BMB following therapy. BMA and BMB were performed as part of the routine workup for diagnosis and staging of lymphoma. The patients had a male to female sex ratio of 2.6:1 and a wide age range from 4 to 74 years. RESULTS: In the present series, 64 cases out of the 143 lymphoma patients studied (44.8%) had a BM disease. Involvement was mostly bilateral (80%). Patients older than 40 years showed higher incidence of bone marrow involvement. There was complete concordance (100%) between both diagnostic procedures in the detection of 76 marrow disease-free lymphoma patients. BMA showed no false positive results and a low rate of deference that makes of it an ideal screening test. Three deferred smears of CLL for BMB diagnosis were all positive for involvement. However, in a total number of 64 BMB positive patients, aspirates could only identify lymphoma involvement in 42 lymphoma patients and missed 22 patients with a BM disease, with an overall sensitivity rate of 65.6%. BMB had a high diagnostic viability and is an easily applied reproducible procedure for diagnosis of BM involvement based on a more detailed informative analysis of both architectural and individual cytomorphologic changes. CONCLUSION: The relatively high level of BM involvement in Egyptian lymphoma patients was directly proportional to high-risk factors. The diagnostic validity of BMB is higher than that of BMA. However, BMA serves as a good positive test in screening lymphomas for marrow disease. A negative BMA does not exclude involvement. Thus, smears should be taken as a complimentary procedure.

Intra-operative diagnosis of breast mass-lesions: comparison of the validity of touch smear preparation and frozen section techniques.

BACKGROUND: A reliable intra-operative pathological diagnosis is a mandatory before proper surgery of breast cancer. So far, The Frozen Section Technique (FS) is the standard technique with a relatively high level of validity. However, when the special facilities of FS are unavailable, Touch Smears Preparation technique (TSP) could be alternatively adopted. OBJECTIVE: Our objective is to compare the validity of TSP in the intraoperative diagnosis of breast mass lesions, with that of FS technique. An additional aim is to determine the special advantages of both techniques. PATIENTS AND METHODS: The study was conducted on 130 breast mass lesions, obtained from operable cases, requesting intra-operative diagnosis at the Pathology Department at the National Cancer Institute (NCI), Cairo University, during the years 2004-2007. The specimens were subjected to the two diagnostic techniques, namely: FS and TSP. Then both were examined separately, by two different observers. The results were expressed as: positive for malignancy, negative for malignancy or deferred diagnosis. The validity of each FS and TSP is tested by using the validity statistical formulas and then results of both were compared. Paraffin section was the golden standard for the true diagnosis. RESULTS: The accuracy of FS was found to be higher than TSP (100%). Thus, a sensitivity of 100% and a specificity of 100%. Whereas, TSP had a sensitivity of 92.99%, a specificity of 93.33% and an overall accuracy of 92.5%. TSP had also a negative predictive value of 80% and the positive predictive value was 97.65%. The rate of deferred diagnosis was lower in FS (1.5%) than TSP (6.2%). CONCLUSIONS: The study concluded that The FS is much superior to TSP in intra-operative the diagnosis of breast mass. However, when the special FS equipment is lacking, TSP could be a reliable alternative provided that an experienced cytopathologist is available. Analysis of predictive value rates revealed that a positive cytological report is more reliable than a negative one. Moreover, TSP could also be an adjuvant to FS.

Pediatric Non Metastatic Non Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTSS): Five Years Experience from NCI-Egypt.

PURPOSE: Evaluation of demographic, pathological, and clinical patterns in addition to treatment outcome of pediatric NRSTS patients treated at the NCI, Egypt. PROCEDURE: 21 pediatric patients of NRSTS between 2001 and 2006 were included. Clinical and pathological diagnosis and subtyping verification were done. Patients' cohort formed of 3 treatment groups. (1) Patients who underwent complete surgical resection with no adjuvant therapies. (2) Patients who received chemotherapy and complete surgical resection, and group (3) Patients with localized unrersectable tumors for whom systemic chemotherapy only was given. Demographic, clinicopathological variables, and treatment modalities were statistically evaluated and compared with the outcome. RESULTS: Tumors of unknown histiogenesis followed by MPNST and myxofibrosarcoma were the most frequent tumor subtypes. Low tumor grade was in favor of better outcome. With a median follow up of 2-years; respectively 100% and 81.1% of patients who had complete surgical resection of a localized disease with or without chemotherapy entered in CR (p=0.01). Local failure rate was 27.2% among CR patients (n=17). Two patients suffered local recurrance and one had distant disease metastasis. CONCLUSIONS: Complete surgical resection with or without chemotherapy is the mainstay of therapy for localized NRSTS. Tumor grade and surgical resection of NRSTS are 2 important predictors of prognosis. KEY WORDS: Nonrhabdomyosarcoma - Soft tissue sarcoma - Pediatric.

Bilharziasis and bladder cancer: a time trend analysis of 9843 patients.

OBJECTIVE: To explore any changes in bladder carcinoma during 37 years period, in regard to: its frequency, bilharzia association, histological profile and demographic data. PATIENTS AND METHODS: This is a retrospective study on 9843 patients treated at the National Cancer Institute (NCI), Cairo University, during the years 1970-2007. Three groups were selected: series (A) included 3212 patients during 1970-1974, series (B) 3988 patients during 1985-1989 and series (C) 2643 patients during 2003-2007. For statistical analysis, data of series (A), (B) and (C) were compared to determine the significance of difference (p value 0.005). RESULTS: A significant decline of the relative frequency of bladder cancer was observed from 27.63% in the old series to 11.7% in the recent series. Bilharzia association dropped from 82.4% to 55.3%. There was a significant rise of transitional cell carcinomas from 16.0% to 65.8%, becoming at present the most common tumor type, with a significant decrease in squamous cell carcinomas from 75.9% to 28.4%. There was an increase in the median age of patients from 47.4 years to 60.5 years and a decrease of male: female (M/F) ratio from 5.4 to 3.3. CONCLUSIONS: The decline in the relative frequency of bladder cancer is associated with a decline in bilharzia egg positivity in the specimen and is probably related to better control of bilharziasis in the rural population in Egypt. This was accompanied by a change in the histological profile of tumors, with significant predominance of transitional cell carcinoma and an increase in the age of patients, a pattern rather similar to that in western reports.

Evaluation of MIB-1 and p53 overexpression as risk factors in large cell non-Hodgkin lymphoma in adults.

BACKGROUND: Improvement of current results of therapy for large cell non-Hodgkin lymphoma patients can be achieved by optimization of initial treatment or application of risk-adapted therapy. The international prognostic index ( IPI), introduced to identify high-risk patients, was recently criticized because it was based on clinical risk factors only, ignoring important tumor molecular risk factors and it fails to identify a sector of high-risk patients, who ultimately relapse. OBJECTIVE: The aim of this study is to evaluate the value of two tumor biomarkers:MIB-1 and p53 as potential risk factors in diffuse large cell lymphoma. MIB-1 measures tumor cell proliferation, whereas p53 is related to tumor progression and response to chemotherapy. PATIENTS AND METHODS: The study was done on 69 adult patients with diffuse large cell NHL ( 58 B-phenotype and 11 T-phenotype). Clinical risk assessment was determined by the IPI and patients with a score of 3 or more were considered high-risk. Expression of MIB-1 and p53 was determined by immunohistochemistry and nuclear staining was quantitated by image analysis. Immunoexpression was considered high for MIB-1 nuclear count 50% and p53 counts 20%. Evaluation included both response to chemotherapy ( mostly CHOP), as well as 2- year overall survival analysis. RESULTS: The IPI was the only clinical variable which had a significant impact on survival. Overexpression of both MIB-1 and p53 was associated with poor response to treatment, as well as unfavorable survival. Combined risk factor analysis revealed that only MIB-1 was an independent variable. MIB-1 could also identify some high-risk patients previously categorized in the IPI lowrisk group. CONCLUSIONS: MIB-1 is an independent biologic risk factor for large cell NHL. In order to optimize risk assessment of these patients, it is recommended to construct a new prognostic index by adding MIB-1 overexpression to the other clinical factors of standard IPI. This may allow better identification of high-risk patients and help to guide planning of effective initial treatment. Key Words:NHL - MIB-1 - p53 - CHOP - Risk factors.

A comparative study of rectal and colonic carcinoma: demographic, pathologic and TNM staging analysis.

OBJECTIVE: The aim is to determine the relative frequency of rectal carcinoma in a large recent surgical series. In addition, rectal carcinoma is compared with colonic carcinoma with regard to demographic data, histological types and TNM stages. PATIENTS AND METHODS: A retrospective pathologic study was conducted on 215 patients with colorectal carcinomas, all treated by radical surgery during the years 2003-2005. Tumors of unfavorable histology included: Mucinous carcinoma, signet-ring carcinoma and undifferentiated carcinoma. For tumor staging, the international TNM staging system was adopted. RESULTS: The mean age was 51 years and male to female ratio was 1.1. Rectal tumors contributed only 27% of cases, contrary to much higher previous reports from Egypt. Tumors of unfavorable histology constituted 24.2% of cases. Patients presented at advanced stages (78.6% stages II and III) with 46.5% lymph node metastases. Patients with rectal carcinomas were younger, with more risk of suboptimal distal surgical margins. CONCLUSIONS: Egyptian patients with rectal carcinoma are younger than those with colonic carcinoma. Otherwise, patients with rectal carcinoma are similar to colonic carcinoma with regard to sex distribution, histological types and TNM stages.