The Value of ER∝ in the Prognosis of GH- and PRL-Secreting PitNETs: Clinicopathological Correlations.

Pituitary neuroendocrine tumors (PitNETs) are divided into multiple histological subtypes, which determine their clinical and biological variable behavior. Despite their benign evolution, in some cases, prolactin (PRL) and growth hormone (GH)-secreting PitNETs may have aggressive behavior. In this study, we investigated the potential predictive role of ER∝, alongside the clinicopathological classification of PitNETs (tumor diameter, tumor type, and tumor grade). A retrospective study was conducted with 32 consecutive cases of PRL- and mixed GH- and PRL-secreting PitNETs (5 patients with prolactinomas and 27 with acromegaly, among them, 7 patients with GH- and PRL- co-secretion) who underwent transsphenoidal intervention. Tumor specimens were histologically and immunohistochemical examined: anterior pituitary hormones, ki-67 labeling index, CAM 5.2, and ER∝; ER∝ expression was correlated with basal PRL levels at diagnosis (rho = 0.60, p < 0.01) and postoperative PRL levels (rho = 0.58, p < 0.001). In our study, the ER∝ intensity score was lower in female patients. Postoperative maximal tumor diameter correlated with Knosp grade (p = 0.02); CAM 5.2 pattern (densely/sparsely granulated/mixed densely and sparsely granulated) was correlated with postoperative PRL level (p = 0.002), and with ki-67 (p < 0.001). The IGF1 level at diagnosis was correlated with the postoperative GH nadir value in the oral glucose tolerance test (OGTT) (rho = 0.52, p < 0.05). Also, basal PRL level at diagnosis was correlated with postoperative tumor diameter (p = 0.63, p < 0.001). At univariate logistic regression, GH nadir in OGTT test at diagnostic, IGF1, gender, and invasion were independent predictors of remission for mixed GH- and PRL-secreting Pit-NETs; ER∝ can be used as a prognostic marker and loss of ER∝ expression should be considered a sign of lower differentiation and a likely indicator of poor prognosis. A sex-related difference can be considered in the evolution and prognosis of these tumors, but further studies are needed to confirm this hypothesis.

The curious case of a forehead metatypical basal cell carcinoma.

The risk of developing basal cell carcinoma (BCC) during lifetime varies between 29-55%, while for squamous cell carcinoma (SCC) varies between 7-11%. Between them, considered to be a BCC, there is a particular histological type, named metatypical basal cell carcinoma (MTC) or basosquamous cell carcinoma (BSCC). In this paper, we presented a rare case of metatypical carcinoma of the forehead with an interesting history of unexpected recurrences, underlining the clinical, therapeutic and histological essential aspects that may come in use to other clinicians in managing this type of cancer. In this case, the last recurrent tumor invaded the external layer of the frontal bone and needed a temporo-parietal flap to cover the large defect, which was previously covered in 2014 using skin grafts. Using Hematoxylin-Eosin (HE) staining, the histological assessment revealed a basosquamous carcinoma (IDO-O 8094/3, according to World Health Organization). In addition to the histological aspects revealed using HE staining, in this case, diffused tumor cells were p63 nuclear positive, which according to Bircan et al. (2006), it is strongly and diffuse reactive in 82.1% differentiated, in 77.8% of superficial and in 72.3% of solid undifferentiated BCCs. The aggressive behavior was revealed by tumor's dimension, local invasion of the frontal bone with high mitotic rate as seen in the van Gieson and HE staining, also by the number of recurrences. The prognosis of this case is reserved due to the number of recurrent tumors, immunohistochemistry anomalies, involvement of the external layer of the frontal bone, tumor site, gender, poor remaining reconstructive procedures in case of a relapse, thus, close follow-up is to be recommended for a period of minimum five years. Recurrent tumors raise treatment difficulties regarding the reconstruction procedure of the defect after wide surgical excision. Therefore, the aggressive behavior of the MTC should be taken into consideration in clinical practice.