The study of tumor architecture components in prostate adenocarcinoma using fractal dimension analysis.

AIM: The aim of the study is to evaluate the three main components of the tumor architecture in correlation with two different grading systems of prostate adenocarcinoma (PA) using the fractal dimension (FD) analysis. PATIENTS, MATERIALS AND METHODS: 433 fields with different patterns of PA selected from 83 patients with total prostatectomy according to Gleason and Srigley grading systems were selected. Four serial sections were cut and stained in order to assess the following parameters: tumor grading with Hematoxylin-Eosin (H-E), tumor cells architecture (GÖ) with Gömöri technique, tumor stroma architecture (TC) with Goldner's trichrome, and vascular network (VN) architecture with cluster of differentiation 34 (CD34) immunomarker. Images were binarized with variable user-defined empiric threshold for Goldner's trichrome staining and CD34 immunostaining and k-nearest neighbor approach for GÖ staining. The FD was computed for each binary image using a box-counting algorithm. The three computed values were used for clustering and classification, k-nearest neighbor proving to be a good choice with a classification rate, due to the irregular distribution of cases in different patterns. Values tending to "1" had the meaning of a more "Linear type" distribution and values tending to "2" had the meaning of a more "Area type" distribution. RESULTS: Tumor cells architecture had a more ordered smooth ascending trend towards "area-like" type of distribution (with FD>1.5) in Srigley system than in Gleason system. Tumor stroma architecture had almost the same type of distribution - between "linear-like" and "area-like" (FD~1.5) - in both grading systems. VN architecture had a more "linear-like" type of distribution (FD<1.5), with a descending trend towards high-grade patterns in both systems. Tumor cells architecture had a direct correlation with tumor stroma architecture and VN architecture (p-value of Pearson's test <0.001), while tumor stroma architecture and VN architecture proved no correlation (p-value of Pearson's test >0.05), irrespective of grading pattern. CONCLUSIONS: Tumor cell population is remodeling and adapting TC and VN in the same way its architectural disposal evolves. TC and VN develop independently of each other, the former towards "Area type" and the latter towards "Linear type" of architectural disposal as the degree of differentiation is decreasing. FD analysis proved that Srigley system is more accurate in grading PA than Gleason system.

Primary diffuse large B-cell lymphoma of the testis.

Non-Hodgkin's lymphomas are chronic lymphoproliferative disorders, with nodal or extranodal onset, most of which being digestive tract lymphomas. Testicular primitive lymphoma generally affects men; it is rare but aggressive type of lymphoma. We present the case of the only patient diagnosed with testicular lymphoma in Hematology Clinic of Craiova, Romania, in the last 20 years. Histopathological and immunohistochemical exams confirmed the diagnosis of diffuse large B-cell lymphoma, and the stage was IIB. According to International Prognostic Index (IPI) score, the patient was classified as low risk. He received combined treatment consisting of surgery, chemotherapy, central nervous system prophylaxis and radiotherapy. The outcome was very good, the patient achieving complete remission. After 36 months, he is still in complete remission with clinical and biological evaluation performed every three month, and computerized tomography once a year.

Correlations between intratumoral interstitial fibrillary network and vascular network in Srigley patterns of prostate adenocarcinoma.

OBJECTIVE: The study aims to assess the both individual behavior and correlations of stromal fibrillary component (SFC) and vascular density (VD) in relation with Srigley architectural patterns of prostate carcinoma. MATERIALS AND METHODS: Digital images of prostate adenocarcinoma labeled following both Gleason and Srigley systems were acquired with ×20 objective from two serial sections, 340 from the section stained using Gömöri technique for SFC assessment and another corresponding 340 from the section immunomarked with anti-CD34 antibody for assessment of VD. The SFC amount and VD were determined and compared. Srigley patterns were divided in two redefined behavioral groups: "solid" group (Srigley I, Srigley III, Srigley IV) and "necrotizing" group (Srigley II with subdivisions: Gleason 3A, 3C and 5A). RESULTS: SFC mean values had an ascending trend in both "solid" and "necrotizing" groups. VD mean values had an ascending trend in "solid" group but a descending trend in "necrotizing" group towards Gleason 5A pattern. SFC and VD values had a direct, ascending correlation for all determinations (p=0.0006), but also for "solid" (p=0.005) and "necrotizing" (p=0.026) groups. The two stromal elements had different behaviors both individually and in their correlation that seem to be related with their interaction with different tumor cellular populations. CONCLUSIONS: Our results could plead for the hypothesis that the different subtypes of tumor architecture represent steps of a continuous process from well-differentiated status to poorly or undifferentiated status but who is accomplished by two different tumor cells populations with different distinct behavior in their relationship with the stromal microenvironment.