MUC1 and bcl-2 expression in preinvasive lesions and adenosquamous carcinoma of the lung.

BACKGROUND: Adenosquamous carcinoma of the lung involves both adenocarcinoma and squamous cell carcinoma, each comprising at least 10% of the tumor. Atypical adenomatous hyperplasia (ADH), bronchiolar columnar cell dysplasia (BCCD), basal cell dysplasia (BCD), columnar cell dysplasia (CCD), bronchial epithelial dysplasia with transitional differentiation (BEDT) and squamous dysplasia (SD) are preinvasive lesions. The aim of this study is to define the preinvasive lesions and evaluate the role of MUC1, bcl-2, and the preinvasive and invasive components of adenosquamous carcinoma. METHODS: A group of 31 patients with adenosquamous carcinoma of the lung were selected. The ratio of squamous to glandular differentiation, the associated preinvasive lesions, the features of peritumoral tissue, the stroma of the tumor, necrosis, perineural and vascular invasion were analyzed. For the immunohistochemical study, blocks containing squamous cell carcinoma, adenocarcinoma and preinvasive lesions were selected. MUC1 and bcl-2 analyses were performed by the immunoperoxidase method using the avidin-biotin complex. RESULTS: Associated preinvasive lesions amd SD, BCCD, BEDT, AAH and CCD were observed in 24, 6, 3, 1 and 6 cases, respectively. Expression for MUC1 was positive in the squamous component of 30 cases, the adenocarcinoma component of 27 cases and in 34 preinvasive lesions. A strong correlation was found between MUC-1 expression in the squamous component and tumor localization (p = 0,01). The positive expression of Bcl-2 in the adenocarcinomatous component was correlated with the presence of preinvasive lesions (p = 0,01). CONCLUSIONS: Squamous dysplasia was the most frequent preinvasive lesion of adenosquamous carcinomas. MUC1 and bcl-2 expression levels were strongly associated with preinvasive lesions in adenosquamous carcinomas.

Clinical significance of the expression of alpha-methylacyl-CoA racemase in squamous cell carcinoma and adenocarcinoma of the lung.

BACKGROUND: The role of alpha-methylacyl-CoA racemase (AMACR) in pathogenesis and diagnosis of different types of cancer has been investigated during last decade. This study is conducted to investigate AMACR expression in adenocarcinoma and squamous cell carcinoma (SCC) of lung and its correlation with clinical characteristics and survival. METHODS: The clinicopathologic characteristics of 146 patients who underwent a potentially curative surgical resection between June 2000-2009 in our clinic were reviewed retrospectively. The patients who were given adjuvant chemotherapy and/or radiotherapy, with an evidence of residual tumor at resection margin and who died due to postoperative mortality and due to reasons not related to lung cancer were excluded. Data from remaining 67 patients were analyzed for survival. For the correlation between progression and AMACR immunoreactivity, data from 62 patients who had postoperative follow up in our center were analyzed. RESULTS: AMACR immunoreactivity was observed more frequently in adenocarcinoma group than SCC group (p = 0,046). The samples with invasive adenocarcinoma--lepidic predominant pattern also showed high rates of positive staining (73%). We could not show a statistically significant correlation between AMACR immunostaining and degree of differentiation, age, gender, pathologic T status, N status, or stage. We failed to show a statistically meaningful effect of AMACR on overall and progression-free survival. CONCLUSION: Adenocarcinoma had higher rates of positive immunostaining for AMACR than SCC (p = 0,046). But the presence of AMACR expression did not have a statistically meaningful effect on overall and progression-free survival in adenocarcinoma and SCC of lung.

Primary mediastinal haemangiopericytoma--an unusual cause of massive haemoptysis in a young woman.

We report a case of primary mediastinal haemangiopericytoma in a 29-year-old female patient who presented with haemoptysis, cough and dyspnea. Computed tomography showed a 9 x 6 x 5 cm mass in the left posterior mediastinum. Bronchoscopic examination failed to obtain biopsy because of massive bleeding. The patient underwent left thoracotomy. Mediastinal mass and left lower lobe resection was performed despite the persistent bleeding. The lower lobe bronchus had been infiltrated by the tumour. Microscopic examination revealed a highly cellular tumour composed of round to fusiform cells, surrounded by thin walled endothelium lined vascular channels with a staghorn appearance. Immunohistochemical and molecular techniques rule out other soft tissue tumours which have a haemangiopericytoma-like vascular pattern. The patient is alive and free from tumour recurrence 6 months post-operatively.

Ectopic primary B cell lymphoma of the thyroid presenting as an anterior mediastinal mass. A case report.

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has not been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed.

EGFR and PDGFR differentially promote growth in malignant epithelioid mesothelioma of short and long term survivors.

BACKGROUND: Malignant pleural mesothelioma (MPM) is an asbestos related tumour difficult to detect early and treat effectively. Asbestos causes genetic modifications and cell signalling events that favour the resistance of MPM to apoptosis and chemotherapy. Only a small number of patients, approximately 10%, survive more than 3 years. The aim of our study was to assess possible differences within signalling pathways between short term survivors (survival <3 years; STS) and long term survivors (survival >3 years; LTS) of MPM. METHODS: 37 antibodies detecting proteins engaged in cell signalling pathways, enforcing proliferation, antiapoptosis, angiogenesis and other cellular activities were investigated by tissue microarray (TMA) technology. RESULTS: Epidermal growth factor receptor (EGFR) was expressed stronger in LTS whereas platelet derived growth factor receptor (PDGFR) signalling was more abundant in STS. Expression of TIE2/Tek, a receptor for tyrosine kinases involved in angiogenesis, was differentially regulated via PDGFR and thus is more important in STS. Antiapoptosis was upregulated in STS by signal transducer and activator of transcription 1 (STAT1)-survivin and related molecules, but not in LTS. Our study provides novel insights into the regulatory mechanisms of signalling pathways in MPM, which differentially promote tumour growth in LTS and STS. CONCLUSION: We have demonstrated that small scale proteomics can be carried out by powerful linkage of TMA, immunohistochemistry and statistical methods to identify proteins which might be relevant targets for therapeutic intervention.

Utility of intraoperative frozen section examination in thoracic surgery. A review of 721 cases.

AIM: Intraoperative frozen section examination (FSE) is an important tool for determining how extensive a surgical procedure needs to be. In this study we reviewed the indications for FSE, the correlation between FSE and postoperative histopathology, and the contribution of intraoperative FSE in determining the extent of the surgical procedure. METHODS: A total of 744 FSE performed in 721 patients between January 1995 and January 2004 were reviewed retrospectively. The FSE were divided into 7 groups according to the indications of the request for frozen section. False positivity and false negativity were evaluated. RESULTS: The indications for FSE included intraoperative diagnosis of pulmonary masses (311, 41.8%), determination of N2 status with mediastinoscopy and mediastinotomy (153, 20.6%), staging of pulmonary carcinomas during the operation (86, 11.6%), assessment of the margin of bronchial surgical resection following pulmonary resection (54, 7.2%), presence of solitary pulmonary nodules (75, 10.1%), presence of mediastinal masses (39, 5.2%), and pleural thickening (26, 3.5%). When compared to postoperative paraffin sections, FSE was found to have a 1.9% (8) rate of false negatives and a 0.2% (1) rate of false positives (P < 0.001). CONCLUSIONS: Intraoperative FSE in thoracic surgery is a rather reliable method. When FSE indicates malignancy, it is a valuable guide in directing the extent of the ongoing surgical procedure. However, when FSE indicates a benign lesion, surgeons should interpret this in the light of the patient's clinical and radiological features and the lesion's macroscopic nature when deciding how extensive an operation needs to be.

Recurrence Pattern of Pulmonary Langerhans Cell Histiocytosis After Lung Transplantation: A Case Report.

Pulmonary Langerhans cell histiocytosis is an uncommon indication for lung transplantation. The recurrence of the primary pathology after transplantation is rare. Extra-pulmonary involvement of Langerhans cell histiocytosis before transplantation and resuming of smoking after transplantation are risk factors for recurrence. Herein, we present a 48-year-old woman with a recurrence pattern 24 months after bilateral sequential lung transplantation. On thoracic computed tomography, progressive parenchyma infiltrates were present without clinical symptoms. Infiltrations regressed and respiratory status of the patient was improved with steroid therapy. No events had occurred at follow-up of 31 months.

A case of acute fibrinous and organizing pneumonia during early postoperative period after lung transplantation.

Acute fibrinous and organizing pneumonia (AFOP) is a distinct histologic pattern usually classified under the term chronic lung allograft dysfunction. We present a 48-year-old female patient who experienced AFOP during the 2nd week of double lung transplantation for pulmonary Langerhans cell histiocytosis and secondary pulmonary hypertension. During the 8th day after transplantation, fever and neutrophilia developed together with bilateral consolidation. Infection markers were elevated. Despite coverage of a full antimicrobial spectrum, the situation progressed. The patient was diagnosed with AFOP with transbronchial biopsy. The infiltration resolved and the patient improved dramatically with the initiation of pulse corticosteroid treatment. AFOP should be suspected when there is a pulmonary consolidation after lung transplantation, even in the very early post-transplantation period. Several causes, such as alveolar damage and drug reactions, should be considered in the differential diagnosis.

Breast tuberculosis.

Breast tuberculosis is a rare form of tuberculosis. Of all the breast diseases treated surgically, tuberculosis is seen in the range between 0.025% and 0.1%. This ratio is higher in undeveloped countries. We presented five cases with breast tuberculosis. Their ages were between 20 and 63 years. All of them had children and were breastfeeding. The cause of admission to the hospital was swelling in four of them and pain in the remainder. All of the lesions were unilateral. One case had received antituberculosis treatment for pulmonary tuberculosis 10 years ago. AAFB was not detected in sputum, breast discharge, urine and tissue culture in all the cases. Diagnosis was made histopathologically from the excisional biopsy material. Caseating granulomatosis was also found in axillary lymph nodes in three cases. Antituberculosis therapy was planned as 2HRZE/4HR for all of the cases. Three of them completed the therapy without any complaints. One case left the hospital without permission. The last one is now undergoing resistant tuberculosis treatment for pulmonary disease without any complaint of her breast. As a conclusion, although tuberculosis of breast is extremely rare, it should be kept in mind particularly in developing and undeveloped countries.

Acquired pulmonary arteriovenous malformation secondary to hydatid cyst operation.

Pulmonary arteriovenous malformations are abnormal communications between pulmonary arteries and pulmonary veins. The majority of the cases are congenital in origin, and acquired pulmonary arteriovenous malformations are very rare. We present a case here, which - to the best of our knowledge - is the first acquired pulmonary arteriovenous malformation secondary to a hydatid cyst operation in the literature, and we discuss the etiology, clinical presentation, diagnostic modalities and treatment of acquired pulmonary arteriovenous malformations.

Surgical treatment of tracheal hamartoma.

Tracheal hamartoma is a rare tumor and difficult to diagnose. A case is presented in which tracheal hamartoma was misdiagnosed and treated for four years as asthma. The tumor was curatively excised via posterolateral thoracotomy.