Usefulness of immunohistochemistry as a diagnostic tool for tumors and pseudotumoral bone lesions

Immunohistochemical study for the diagnosis of bone tumors and tumor-like lesions has to be scheduled after an appropriate analysis of clinical data, radiological findings, and results of histology in H-E sections. The value of several markers for osteoblasts is discussed, chiefly for various forms of osteosarcomas. In the same way, the role of S-100 protein as well as anticollagen type II antibody is developed for cartilaginous tumors. The selection of markers in the fields of round cell tumors and spindle cell tumors of bone is also discussed. Some diagnostic problems with the support of immunohistochemistry are described, like chordomas versus chondrosarcomas or bone metastases. Lastly, immunohistochemical study of proliferating factors in the bone tumor field is quoted.     

Utility of immunohistochemistry for alpha-methylacyl-CoA racemase in distinguishing atrophic prostate cancer from benign atrophy

Small atrophic prostate cancers on needle biopsy are rare and difficult to distinguish from benign atrophy on needle biopsy. We report on a study of 23 needle biopsy specimens with small foci of atrophic prostate cancer from the consult service of one of the authors. In 19 cancer cases the atrophic component was pure; in 4 cases it was dominant with a minor (<5%) nonatrophic cancer component. These atrophic cancers and 16 cases of florid benign atrophy on needle biopsy were examined by immunohistochemistry for alpha-methylacyl-CoA-racemase (AMACR). All cases of cancer and atrophy were verified immunohistochemically with antibodies to basal cells (34betaE12 and p63). AMACR staining were scored as 1+ (5% to 25% of glands expressing AMACR), 2+ (26% to 50% of glands expressing AMACR), or 3+ (>50% of glands expressing AMACR). Positive staining was defined as staining above that of surrounding benign glands. AMACR was expressed in 69.6% of atrophic prostate cancers (3+, 11 cases; 2+, 3 cases; 1+, 2 cases); 30.4% (7 cases) of atrophic prostate cancer exhibited no AMACR expression. In the 4 cases with a few glands of ordinary (nonatrophic) prostate cancer, the nonatrophic cancer demonstrated more intense and a greater extent of AMACR staining. Fourteen cases (87.5%) of benign atrophy showed no AMACR expression. In 2 cases (12.5%) of benign atrophy, background immunostaining made it difficult to assess AMACR expression. We conclude that AMACR immunostaining alone is not sufficiently discriminatory in the differential diagnosis of atrophic prostate cancer versus benign atrophy. Atrophic prostate cancers are not as frequently or as strongly positive as ordinary prostate cancer. Using a panel of immunostains including AMACR, 34betaE12 and p63 (positive AMACR immunostaining along with negative basal cell markers) is recommended in the differentiation of atrophic prostate cancer and benign atrophy.     

AgNOR图像定量分析在角结膜缘上皮良,恶性病变中的诊断价值

目的：探讨ＡｇＮＯＲ图像定量分析对角结膜缘上皮良、恶性病变的鉴别诊断价值。方法：应用真彩色图像分析技术对角结膜缘上皮良、恶性病变（其中上皮增生１９例，不典型增生６例，原位癌１４例，鳞状细胞癌１２例）细胞核内ＡｇＮＯＲ进行了定量测定。结果：在不同的病变中，细胞核内ＡｇＮＯＲ颗粒的分布形态、大小及所占平均面积均存在明显差异，且与病变的良、恶性及细胞的分化程度有密切关系。结论：提示ＡｇＮＯＲ图像定量分析对角结膜缘上皮良、恶性病变的鉴别诊断、进一步了解不同病变组织细胞的增殖活性和分化程度提供了一种新的定量指标     

Distinction of basaloid carcinoma of the prostate from benign basal cell lesions by using immunohistochemistry for bcl-2 and Ki-67

The distinction of rare basaloid carcinomas (BC) of the prostate from more common basal cell hyperplasia may be difficult, because basal cell hyperplasia (BCH) may have prominent nucleoli and may appear infiltrative. Using immunohistochemistry, we studied bcl-2 and p53 expression and Ki-67 proliferation index in eight cases of typical BCH, eight cases of BCH with nucleoli, and six cases of BC. Bcl-2 expression (P < .0001) and Ki-67 index (P = .005) were elevated in BC compared with typical BCH or BCH with nucleoli, whereas there was no significant difference between typical BCH and BCH with nucleoli. P53 was not discriminative in separating benign from malignant basal cell lesions of the prostate. Bcl-2 may play a role in the pathogenesis of basal cell lesions of the prostate. Elevated expression of bcl-2 and higher Ki-67 index may aid in the diagnosis of basal cell proliferative lesions of the prostate.     

Gastricsin in the benign and malignant prostate.

An immunoperoxidase (peroxidase-antiperoxidase) method was used to localise the gastric acid proteinase gastricsin in prostate. The enzyme was present, probably as zymogen, in acinar lining cells in 66 (69%) of 96 cases of benign prostatic enlargement; other normal tissues from male genital tract were negative. It was also present in the tumour cells in 21 (39%) of 54 cases of prostatic adenocarcinoma. The findings support the suggestion that the prostate is the source of the gastricsin of normal seminal fluid. It is not yet clear whether its presence in prostatic carcinomas will be of diagnostic use.     

Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer

Benign changes ranging from atrophy and inflammation to high-grade prostatic intraepithelial neoplasia (HGPIN) are common findings on prostate core needle biopsies. Although atrophy and inflammation may be precursors of prostate cancer, only HGPIN is currently recommended to be included in surgical pathology reports. To determine whether these benign findings increase prostate cancer risk, we conducted a case-control study nested within a historical cohort of 6692 men with a benign prostate specimen collected between 1990 and 2002. The analytic sample included 574 case-control pairs comprised of cases diagnosed with prostate cancer a minimum of 1 year after cohort entry and controls matched to cases on date and age at cohort entry, race, and type of specimen. The initial benign specimen was reviewed for presence of HGPIN, atrophy (simple, lobular, and partial) and inflammation (glandular and/or stromal). HGPIN significantly increased risk for prostate cancer (odds ratio (OR)=2.00; 95% confidence interval (CI)=1.25-3.20). Inflammation within the stromal compartment was associated with decreased risk (OR=0.66; CI=0.52-0.84), and diffuse stromal inflammation of severe grade had the strongest inverse association with risk (OR=0.21; CI=0.07-0.62). In a model adjusted for prostate-specific antigen (PSA) level at cohort entry and inflammation, simple atrophy was associated with a 33% increased prostate cancer risk that was marginally significant (P=0.03). Clinicians should consider patterns and extent of inflammation when managing high-risk patients with negative biopsy results. Identifying benign inflammatory processes that underlie high PSA levels would help to reduce the number of unnecessary repeated prostate biopsies.     

干细胞样细胞在乳腺良恶性病变中的数量与分布

目的 探讨乳腺上皮干细胞样细胞(stem-like cells,SIC)在乳腺部分良恶性病变中的数量及分布.方法 使用免疫组化双染法检测了89例乳腺良性病变及36例乳腺浸润性导管癌(invasive ductal carcinoma,IDC)中SLC的密度及分布部位.结果 ①SLC在良性病变中主要分布于乳腺腺管的腔面顶层上皮和肌上皮细胞之间;②在实质增生区SLC密度多于纤维腺瘤及实质减少区(P<0.05);③MUC-/ESA 细胞在IDC中数量差异较大.结论 SLC的数量及分布随病变不同而异.     

Significance of mucin stain in differentiating benign and malignant lesions of prostate

In an attempt to assess the significance of mucin stains in benign and malignant lesions of prostate, 200 prostatic biopsies in the department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak were studied. All the biopsies were subjected to PAS and alcian blue staining along with H&E stain. Neutral mucin (PAS positive) was more frequently observed in benign prostatic lesions (93.3%) as compared to carcinoma (36%) while acid mucin (AB positive) was found more in carcinoma prostate (68%) as compared to benign prostatic lesions (16%). The positivity for acid mucin was more in well differentiating tumour decreasing significantly in high grade malignancies. With both types of mucin, luminal positivity was slightly more as compared to cytoplasmic positivity.     

Palpable lesions as a diagnostic tool in patients with thoracic pathology

Palpable lesion(s) noticed in a patient with thoracic disease may be a useful diagnostic tool and it often gives a clue for further management. In this study, we searched the diagnostic value of palpable lesions in patients with thoracic pathology suspected clinically and/or radiologically. We prospectively examined the correlations of clinical/radiologic and pathologic findings of 72 palpable lesions from 68 patients who presented with suspect for a thoracic disease from two tertiary medical centers. Thirty‐two lesions (44.4%) were diagnosed as malignant either by fine‐needle aspiration (FNA) only or FNA with confirmatory biopsy. The most common malignancy was non‐small‐cell carcinoma (10) followed by adenocarcinoma (6), and small‐cell carcinoma (5). The most common localization of the palpable lesions was cervical region (20.8%) followed by left supraclavicular (13.8%) and anterior chest wall (13.8%). FNA was effective in obtaining an accurate diagnosis in 66.6% of the patients. Tissue confirmation of FNA was performed in 54 patients. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA in distinguishing a malignant lesion from a benign disease for these palpable lesions were 75, 97, 96, and 80, respectively. One false negativity and one false positivity were also found. Abnormal radiologic features were not correlated with having a malignant palpable lesion. Evaluation of the palpable lesions by FNA and tissue biopsy together is effective for initial triage of the patients with suspect for a thoracic pathology. FNA alone is a convenient and easy method for this purpose especially when the material is immediately assessed for specimen adequacy. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

The WISC as a diagnostic tool.

Wechsler's hypotheses for the adolescent sociopath were applied to the WISC under controlled conditions. Groups were separated according to race and sex, while IQ, socioeconomic class, and geographic location were held constant. The criterion for selection of Ss was appearance before a juvenile court. The efficiency of each of Wechsler's signs was determined. Post hoc analysis provided specific signs for each combination of race and sex in the 80-89 IQ range. The need for cross-validation of these signs was stressed. Other methodological issues that may contribute to inconclusive findings with traditional assessment procedures were discussed throughout the study. These included: (1) the need for control of the relevant variables; (2) the problem of poorly defined criteria; (3) the need for analysis of the individual as well as the group data; (4) the importance of a holistic approach; (5) the problem with matching; and (6) the problem of not having an expected distribution with which to compare the frequency of "hits" for Wechsler's indices.     

Distribution of epithelial membrane antigen in benign and malignant lesions of the salivary glands

Summary An antiserum against epithelial membrane antigen has been used to stain a variety of lesions arising in the salivary glands. In normal major and minor glands staining was localised to the ductal systems. There was no evidence of myoepithelial cell staining. The mucous elements of the submandibular and sublingual glands were negative, but in the mucous elements of the minor glands there was focal cytoplasmic positivity. There was no cytoplasmic staining of serous elements in major or minor salivary glands. In pleomorphic adenomas the luminal membrane of ductal elements was strongly positive, with focal cytoplasmic positivity in some myxoid areas. In mucoepidermoid tumours both adjacent cell membranes and cytoplasm were strongly positive. The ductal structure of adenoid cystic carcinomas were clearly delineated while the pseudoducts produced by enclosed areas of stroma were negative. All mesenchymally derived tumours were negative and a tumour previously considered as a chondroma was strongly positive. The results are discussed in relation to phenotypic heterogeneity and the histogenesis of salivary gland tumours.     

Evaluation of AgNOR count in distinguishing benign from malignant mesothelial cells in pleural fluids.

The authors have evaluated in eight reactive and eight malignant pleural effusions the number of intranuclear dots representing the nucleolar associated proteins stained with silver colloid technique (interphase nucleolar organizer regions-AgNORs). The mean number per nucleus in benign reactive effusions was 1.56 (SD 0.77) while in mesotheliomatous effusions it was 2.81 (SD 1.44). The statistical analysis of values, by Mann-Whitney U Wilcoxon Rank Sum W Test, revealed a significant difference of AgNOR counts in the two cytological samples. The variability of AgNOR areas and morphologies in reactive and mesotheliomatous nuclei in pleural fluids is evaluated applying automatic image analysis.     

IGFII and MIB1 immunohistochemistry is helpful for the differentiation of benign from malignant adrenocortical tumours

AIMS: The differentiation of adrenocortical carcinomas from adenomas may be difficult based on morphology alone. Differential expression of insulin-like growth factor (IGF) II and cyclin-dependent kinase (CDK) 4 has recently been described in these tumours. The aim of this study was to investigate the diagnostic usefulness of these markers immunohistochemically. METHODS AND RESULTS: We examined 22 benign and 17 malignant adrenocortical tumours and compared IGFII and CDK4 expression with known immunohistochemical as well as morphological criteria of malignancy. Thirteen of 17 carcinomas showed immunohistochemical reactivity for IGFII, whereas all adenomas but one were negative. Intense CDK4 expression was detected in 11 of 17 carcinomas but was present in only three of 22 adenomas. The MIB1 index was >5% in 14 of 16 carcinomas and was <5% in all adenomas but one. The combination of IGFII immunohistochemistry with MIB1 index led to high sensitivity and specificity in detecting adrenocortical carcinomas. CONCLUSIONS: IGFII and MIB1 are helpful immunohistochemical markers to predict malignancy in adrenocortical neoplasms. These markers can be used in addition to clinical, gross and morphological features to establish a diagnosis in difficult cases.     

Utility of cytomorphologic criteria and p53 immunolocalization in distinguishing benign from malignant cystic squamous-lined lesions of the neck on fine-needle aspiration

We retrospectively examined the cytologic findings of well-differentiated villoglandular adenocarcinoma (VGA) treated in our hospital. Cervical smears of four cases and a touch preparation of another case of VGA formed the materials for the study. The cytologic features were correlated with the histomorphology of VGA. Architecturally, long slender papillae and cohesive branching epithelial sheets with smooth borders and a lack of feathery edge were observed. Crowding and overlapping of nuclei were noted. The nuclei were uniform, small, and round to oval-shaped, with evenly distributed granular chromatin. Nucleoli were absent or inconspicuous. Mitoses were occasionally seen in all but one case. As the features of VGA are distinctive, the diagnosis could be possible on cytological grounds. Examination of cervical smears would be helpful for an early diagnosis of VGA or to suggest the coexistence of other neoplastic components.