Case for the Panel: Filamentous Bodies in a Squamous Cell Carcinoma

A primary hepatic gastrinoma found in a 13-year-old boy was studied by light microscopy, immunohistochemistry, electron microscopy, and immunoelectron microscopy. Results were consistent with a neuroendocrine neoplasm with abundant gastrin-immunoreactive cells. Unlike all previously reported cases of primary hepatic neuroendocrine tumors, which have been endocrinologically asymptomatic, the patient had a Zollinger-Ellison syndrome apparently cured by surgical resection of the tumor.     

锌指转录因子Snai1通过E-钙黏蛋白调控胃癌侵袭及淋巴结转移

目的 探讨锌指转录因子Snai1在胃癌发生发展中的作用,以及胃癌组织中Snai1与E-钙黏蛋白（E-cadherin）表达的关系.方法 收集本院普外科2010年1月至2012年1月收治的65例胃癌患者手术切除的胃癌组织及邻近的正常胃黏膜组织,免疫组织化学检测Snai1和E-cadherin的表达.体外培养人胃腺癌细胞株SGC-7901,分为3组：空白对照组不进行转染,阴性对照组转染不含靶向作用于Snai1的siRNA的空质粒,转染组转染靶向作用于Snai1的siRNA.转染结束后实时定量PCR和免疫印迹法检测3组细胞Snai1和E-cadherin的表达.结果 胃癌组织中Snai1表达阳性率较正常胃黏膜组织明显增高（58.5％比0.0％,P＜0.001）,而E-cadherin表达阳性率明显降低（43.1％比100.0％,P＜0.001）.Snai1阳性和阴性的胃癌组织中E-cadherin表达的阳性率分别为28.9％ （11/38）、63.0％（17/27）.Snai1阳性的胃癌患者较Snai1阴性的胃癌患者淋巴结转移率明显升高（78.9％比40.7％,P＜0.001）.体外细胞实验显示,空白对照组与阴性对照组比较,Snai1和E-cadherin的表达差异无统计学意义（均P＞0.05）;与空白对照组比较,转染组Snai1 mRNA和蛋白表达下调,而E-cadherin mRNA和蛋白表达上调（均P＜0.05）.结论 Snai1可通过抑制E-cadherin表达,促进胃癌发生局部浸润及淋巴结转移.     

A case of blastic plasmacytoid dendritic cell neoplasm: Cytomorphological findings of the touch imprint specimen of lymph node

The patient is a 75‐year‐old man with axillary lymphadenopathy presenting an indurated papule on his buttock. Touch imprint cytology of the biopsied axillary lymph node revealed the monotonous appearance of medium‐sized tumor cells. The nuclei had a slightly irregular contour, finely dispersed chromatin, and a conspicuous nucleolus. Some tumor cells had intracytoplasmic microvacuoles. Immunohistochemistry of the imprint specimens showed that the tumor cells were positive for CD56 and CD123. Histological diagnosis of the lesion was blastic plasmacytoid dendritic cell neoplasm (BPDCN). Epstein‐Barr virus‐encoded RNAs were not detected in the tumor cells. Neither immunoglobulin heavy chain genes nor T‐ cell receptor genes was clonally rearranged. BPDCN should be strongly considered during the differential diagnosis of CD56‐positive neoplasms of the skin. We demonstrated a possible contribution of the cytomorphological and immunohistochemical findings of the touch imprint specimens to the diagnosis of BPDCN. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

肾黏液样小管状和梭形细胞癌临床病理分析

目的：探讨肾黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCC)的临床病理学特征、诊断和鉴别诊断,提高对MTSCC的认识和诊断水平。方法：对2例MTSCC标本进行临床病理分析,并复习相关文献。结果：肿瘤与周围肾组织分界清楚,肿瘤由紧密排列的、小而狭长的小管构成,小管间为淡染的黏液样间质。肿瘤细胞呈立方形和梭形,肿瘤细胞胞质嗜酸性,细胞核圆形或卵圆形,异型性小,核仁不明显,核分裂像少见,在黏液性间质中可见散在淋巴细胞、浆细胞。免疫组织化学显示2例均表达细胞角蛋白(cytokeratin,CK)7,CK18, CK8/18和波形蛋白,Ki-67增殖指数<5%。结论：MTSCC是一种较罕见的低度恶性肿瘤,具有独特的组织学和免疫组织化学特征,明确该肿瘤的形态学特征、诊断和鉴别诊断有重要意义。     

Circumferential Resection Margin Involvement in Stage III Rectal Cancer Patients Treated with Curative Resection Followed by Chemoradiotherapy: A Surrogate Marker for Local Recurrence?

Purpose

Circumferential resection margin (CRM) involvement is a well-known predictor for poor prognosis in rectal cancer. However, the significance is controversial in some studies. Accordingly, this study attempted to examine the prognostic impact of CRM involvement in stage III rectal cancer.

Materials and Methods

Between January 1990 and December 2007, a total of 449 patients who underwent curative resection followed by complete adjuvant chemoradiotherapy for stage III rectal cancer located within 12 cm from the anal verge were selected. Patients were divided into a CRM-positive group (n=79, 17.6%) and a CRM-negative group (n=370, 82.4%).

Results

With a median follow-up of 56.6 months, recurrent disease was seen in 53.2 and 43.5% of the CRM-positive and CRM-negative group, respectively. CRM involvement was an independent prognostic factor for 5-year systemic recurrence-free survival (HR: 1.5, CI: 1.0-2.2, p=0.017). However, no significant difference was observed for local recurrence rate between the two groups (13.0 and 13.5%, respectively, p=0.677).

Conclusion

In this study, local recurrence rate did not differ according to CRM involvement status in stage III rectal cancer patients, although CRM involvement was shown to be an independent poor prognostic factor. Accordingly, validation of the results of this study by further large prospective randomized trials is warranted.     

Immunohistological expression of HIF‐1α, GLUT‐1, Bcl‐2 and Ki‐67 in consecutive biopsies during chemoradiotherapy in patients with rectal cancer

The aim of this study was to describe the dynamics of HIF‐1α, GLUT‐1, Bcl‐2 and Ki‐67 during chemoradiotherapy (CRT) of rectal cancer, and to investigate the fluctuation of these biomarkers in relation to pathological response to CRT. The study included 86 patients with rectal adenocarcinoma receiving preoperative CRT (>50.4 Gy and Uracil/Tegafur). Immunohistological expressions of HIF‐1α, GLUT‐1, Bcl‐2 and Ki‐67 were investigated in biopsies taken before treatment, after 2, 4 and 6 weeks of CRT and in specimens from the operation. Decreasing expressions of HIF‐1α, Bcl‐2 and Ki‐67 were observed during CRT, whereas GLUT‐1 overall was unchanged. No significant changes of the markers were observed in the interval between CRT and surgery. A significant association was observed between the presence of residual carcinoma after 6 weeks of treatment and pathological response to CRT, but no association was seen between the fluctuations of any of the markers and response to CRT. This unique material containing specimens before, after and during CRT for rectal cancer demonstrated biological dynamics in HIF‐1α, Bcl‐2 and Ki‐67, but not GLUT‐1, expression during CRT, and a significant association was seen between the presence of residual carcinoma after 6 weeks of treatment and pathological response to CRT.     

Parietal Cell Carcinoma of Gastric Cardia: Immunophenotype and Ultrastructure

The case is reported of a clinically aggressive parietal cell carcinoma of the gastric cardia in a 67-year-old man. Histologically, the tumor was a poorly differentiated adenocarcinoma with a predominantly solid growth pattern, though with areas exhibiting glandular morphology and with extensive lymphatic invasion. The tumor cells had eosinophilic, finely granular cytoplasm, with focal Alcian blue-positive mucin in the gland lumens. Ultrastructural examination of the pleural metastasis and gastrectomy specimen demonstrated many mitochondria, tubulovesicular profiles of endoplasmic reticulum, and intracytoplasmic lumens, which resembled intracellular canaliculi of parietal cells. Immunohistochemically, there was positive staining of tumor cells for the parietal cell specific antibodies to H/K-ATPase and human milk fat globule-2 (HMFG-2).     

β-catenin and PPAR-γ levels in bone marrow of myeloproliferative neoplasm: an immunohistochemical and ultrastructural study

In accordance with increased proliferation in myeloproliferative neoplasm (MPN), the goal is to evaluate the immunoexpression of: β-catenin, PPAR-γ and Ki67 protein, to compare them with bone marrow ultrastructural characteristics in patients with MPN. Immunoexpression and electron microscopy of bone marrow was analyzed in 30 Ph-negative MPN patients, including per 10 patients with polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). The quantity of β-catenin immunoreactive cells was significantly higher in PV then in ET (p < 0.01) or PMF group of patients (p < 0.01) and also in ET versus PMF group of patients (p < 0.01). Erythroid lineage showed absent β-catenin staining without immunoreactivity in nucleus. In contrast, immunoreactivity for PPAR-γ was localized mostly in megakaryocytes and the highest number of PPAR-γ immunopositive cells was detected in PMF group of patients. In addition, the proliferative Ki67 index was significantly increased in the PMF and PV patients compared to patients with ET. Also, the megakaryocytes showed abnormal maturation in PMF group of patients as determined by ultrastructural analysis. These results indicated that PV dominantly expressed β-catenin and proliferation marker Ki67 in bone marrow, while PMF is linked preferentially to PPAR-γ immunopositive megakaryocytes characterized by abnormal maturation.     

Microsatellite instability and Epstein-Barr virus infection in gastric remnant cancers

Clinicopathological analysis, microsatellite analysis, detection of Epstein-Barr virus (EBV), and immunohistochemistry on p53 protein were performed in 26 cases of gastric remnant cancer (GRC). They were divided into two groups; Group A (n = 14) who had undergone a primary gastrectomy for benign gastric disease, and Group B (n = 12) who had undergone the same operation for gastric cancer. EBV infection was present in 29% of Group A, 8% of Group B and 6% of the conventional gastric carcinoma (CGC) (Group A vs CGC, P = 0.01). Microsatellite instability (MSI) was found in 7% of Group A, 25% of Group B, and 9% of the CGC (Group B vs CGC; P = 0.08). p53 Overexpression was observed in 46% of the GRC and 33% of the CGC. p53 Overexpression was observed in 90% of the intestinal type of GRC, but in only 20% of the diffuse type of GRC (P = 0.002). The cancer stage was a significant factor in the univariate analysis of survival (P = 0.04). In conclusion, GRC is different from CGC in terms of MSI or EBV association. The pathogenetic differences between the two groups require further investigation. EBV infection may have been involved in the carcinogenesis of Group A. MSI may be an important factor in the carcinogenesis of metachronous multiple gastric cancer (Group B).