Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle biopsy: case report.

Hodgkin lymphoma (HL) is an uncommon malignancy usually limited to the lymph nodes and lymphatic system while extranodal involvement is much less common than in non-Hodgkin lymphoma. The current report presents an unusual case of primary classical HL (cHL), nodular sclerosis type with mixed cellularity in buttock soft tissue of 78-year old man. Primary lymphoma of the gluteal muscle is a rare disease and primary cHL is even rarer. In addition, to this unusual extranodal presentation, the present case highlight a diagnostic challenge in fine-needle biopsy masquerading a low grade sarcoma, primarily myxoinflammatory fibrosarcoma or an inflammatory lesion. However, surgical biopsy and immunohistochemistry guided correct diagnosis that was of major interest for further successful treatment.

Expression of matrix metalloproteinase 9 in primary and recurrent breast carcinomas.

The matrix metalloproteinases (MMPs) comprise a family of zinc-dependent endopeptidases that are secreted as inactive precursors, which are activated by cleavage of an N-terminal pro-peptide. Their basic mechanisms of action include cancer cell growth, differentiation, apoptosis, migration and invasion, and the regulation of tumour angiogenesis and immune surveillance. The expression of MMP2 and MMP9 has been associated with high potential of metastasis in several human carcinomas including breast cancer. The 29 female patients, 9 premenopausal and 20 postmenopausal, aged from 37 to 79 years were included in this study. Tissue samples were examined in 29 primary and 48 recurrent carcinomas using the tissue microarrays which included 102 cores of primary breast carcinomas and 96 of recurrent breast carcinomas. Immunohistochemistry determined a pattern of expression for MMP9. The staining was diffuse cytoplasmic, strong, moderate, faint/weak and negative. The majority of the breast carcinomas stained homogenously for MMP9 on tumor cells. Statistically significant correlation was found for the expression of MMP9 between primary and recurrent breast carcinomas in general (p < 0.001) and in tumors that were grouped as recurrence before (p = 0.039) and after 24 months (p < 0.001). Strong expression of MMP9 was observed in primary tumors that recurred after 24 months, median: 162.5 (score range 0-300) and those tumors that recurred before 24 months of the initial diagnosis, median: 102.5 (score range 0-250) (p = 0.026).

Prognostic significance of vascular endothelial growth factor expression in clear cell renal cell carcinoma.

The purpose of this investigation was to analyze and correlate the immunohistochemical pattern of vascular endothelial growth factor (VEGF) expression with the average of microvessel density (MVD) and other clinicopathologic parameters in clear cell renal cell carcinoma (CCRCC) in order to determine its prognostic significance. Surgical specimens of 93 CCRCC were immunohistochemically analyzed for VEGF expression, MVD with anti-CD31, and Ki 67 proliferative index. VEGF expression was recorded as the percentage of positive tumor cells (<75% and >75%) and as diffuse or perimembranous VEGF expression according to cytoplasmic distribution. Sixty-three (68%) RCC had <75% and 30 had (32%) >75% of VEGF expression. A diffuse cytoplasmic pattern of VEGF expression was found in 61(66%) RCC and a perimembranous one in 32 (34%) RCC. Statistical analysis showed that tumors with >75% of VEGF expression were characterized by lower MVD value (p=0.034), higher nuclear grade (p=0.018), and higher Ki 67 proliferation index (p=0.023). Moreover, a higher nuclear grade of tumor cells was characterized by diffuse cytoplasmic VEGF distribution (p=0.005). This tumor model did not confirm the postulated simple relationship between VEGF overexpression and angiogenesis through high microvessel count. However, the study results indicated that overexpression of VEGF was a worse histologic prognostic parameter in CCRCC.