Sarcomatoid Squamous Cell Carcinoma of the Penis - a Report of Two Cases.

BACKGROUND: Sarcomatoid (spindle cell) squamous cell carcinoma is a rare, highgrade, aggressive tumor consisting of the squamous cell carcinoma admixed with the malignant spindle cell (sarcomatoid) elements. These tumors are relatively uncommon in the genitourinary system and particularly in the penis. MATERIALS AND METHODS: Two sarcomatoid squamous cell carcinomas of the penis were diagnosed in our hospital between 2012 and 2015. Clinical histories, pathology reports, hematoxylin and eosin-stained and immunohistochemical slides were reviewed. RESULTS: In both cases, the tumors presented as single, pedunculated, extensive masses with surface ulceration; histology study showed a mixture of high-grade squamous cell carcinoma component and spindle cell neoplastic component in different proportions. Immunohistochemical stains of CK AE1/AE3, p63 and CK903 showed positive immunoreactivity in both components in both cases. Vimentin was positive in spindle cell component and negative in squamous cell carcinoma areas. CONCLUSION: Sarcomatoid squamous cell carcinoma of the penis is an uncommon tumor of this site with aggressive behavior and bad prognosis which might be related to the delay in medical examination and diagnosis. A correct and thorough morphological study is of great importance for the staging of the disease, treatment and follow up of patients.

Diagnostic Value of ERG in Prostate Needle Biopsies Containing Minute Cancer Foci.

BACKGROUND: Prostate carcinoma (PC) is the second most diagnosed cancer in men population worldwide. The small amount of the tissue in prostate needle biopsy is often sufficient for the correct interpretation. Novel antibodies, as ERG, could add to the diagnostic value of IHC study in analysing difficult core biopsies. AIM: The aim of the present study was to establish a diagnostic use of ERG in a work-up of prostate needle biopsies containing minute PC, individually and in combination with AMACR/34ßE12. MATERIALS AND METHODS: From total number of 1710 consecutive prostate needle biopsies based on HE stain 114 biopsies containing minute PC. Selected biopsies were incubated with anti-ERG, AMACR and 34ßE12 antibodies using immunohistochemical technique. RESULTS: Among 98 selected biopsies, 57 showed positive and 41 negative ERG staining. AMACR staining was positively expressed in 86 of the cases and completely absent in remaining 12. In 9 of the AMACR-negative cases the final diagnosis was establish by manifestation of ERG expression in the tumour foci. 95 of the biopsies demonstrated lack of 34ßE12 expression and only 3 cases showed weak patchy staining. Among these cases 2 were ERG-positive. CONCLUSION: ERG antibody could be especially helpful in the cases with controversial expression of AMACR and 34ßE12.

Lack of ERG-antibody in Benign Mimickers of Prostate Cancer.

INTRODUCTION: Prostate carcinoma (PC) is the second most diagnosed cancer in men worldwide. Prostate tissue in needle biopsy expresses a wide variety of architectural patterns some of which are difficult to interpret. Immunohistochemical markers, such as AMACR, p63 and 34ßE12 that are currently used in diagnosing prostate cancer, are of great value, but often their interpretation is ambiguous. In 2005 Tomlins et al. identified an emerging marker, erythroblastosis E26 rearrangement gene (ERG), which is a member of the family of genes encoding erythroblast-transformation specific transcription factors (ETS) with frequent expression in PC. AIM: The aim of this study was to investigate the expression of ERG in benign mimickers of PC in needle biopsies and its diagnostic value alone and in combination with AMACK and 34ßE12. RESULTS: Of the selected 46 biopsies, two were eventually diagnosed as PC Gleason score 6 as they were simultaneously ERG and AMACR-positive and 34ßE12-negative. One case was considered atypical. The remaining 43 biopsies were diagnosed as benign cases: simple atrophy in 13 cases, partial atrophy in 11, adenosis in 9, basal cell hyperplasia in 3, post-atrophic hyperplasia in 3, clear cell hyperplasia in 2 and sclerotic adenosis in 2 cases. None of the 43 benign cores showed evidence of ERG expression. CONCLUSION: ERG could be preferably used in diagnosing prostate needle biopsies, lesions that are hard to interpret and controversial expression of AMACR/34ßE12.

Intraepithelial lymphocytes in relation to NIH category IV prostatitis in autopsy prostate.

BACKGROUND: Quantitative analysis of the number, normal and pathologic ratios between lymphocytes and epithelial cells (ECs), and the significance of intraepithelial lymphocytes (IELs) in normal prostatic epithelium, benign prostatic hyperplasia (BPH), and high grade prostatic intraepithelial neoplasia (PIN) in relation to NIH category IV prostatitis (histologic prostatitis: HP) was studied in autopsy prostate. METHODS: IELs were analysed in 59 autopsy prostates, which was routinely embedded in paraffin and immunohistochemically stained for CD3. An average of 300-500 ECs were counted per case. The number of IELs was calculated as the mean/100 ECs. Category IV prostatitis was evaluated using NIH consensus grading system in terms of anatomical localization and grade. RESULTS: In healthy individuals the mean number of IELs/100 ECs was 0.61 ± 0.34% or ≤1 lymphocyte/100 ECs, which is considered as the normal basal level of prostate IELs. In category IV prostatitis, the mean number of IELs/100 ECs was 8.53 ± 3.25% or 5-11 lymphocytes/100 ECs. The number of IELs in both around and inside inflammation areas correlated to the grade and location of HP (P < 0.0001 and P < 0.0003), the presence of acute glandular inflammation (P < 0.0001), the scattered stromal lymphocytes (P = 0.029), and BPH and PIN associated prostatic inflammation (P < 0.0001). CONCLUSION: The study presents the first attempt to examine and score the basic quantitative values of prostatic IELs in normal prostate and in relation to category IV prostatitis. The detected normal upper limit of CD3+ IELs is 1 lymphocyte/100 ECs in the normal prostate epithelium. This is considered as an organ specific characteristic of the prostate-associated lymphoid tissue (PALT). Values >5 IELs/100 ECs indicate the presence of category IV prostatitis. The severity of inflammation correlates to the number of IELs. There is an intimate link between the quantity of the IELs, the degree of the severity and the localization of category IV prostatitis. HP is a chronic and dynamic inflammatory process affecting the whole prostate gland. The increased number of IELs suggests the immune or autoimmune character of category IV prostatitis, BPH and inflammatory preneoplastic (PIN) lesions in the prostatic tumor environment.

Bilateral pheochromocytoma/intra-adrenal paraganglioma in von Hippel-Lindau patient causing acute myocardial infarction.

A 26-year-old male presented to the emergency department complaining of obstipation, severe headache and abdominal pain. An autopsy revealed bilateral pheochromocytoma and acute myocardial infarction. The tumor cells showed positive immunoreactivity of both chromogranin A and synaptophysin and were negative for adrenocortical markers such as SF-1, c17, scc, 3-HSD as well as SDHB, suggesting a germline mutation of the gene SDHB or SDHD. Molecular genetic analyses did not show a mutation in these two genes, but a mutation in the VHL gene, in exon 3: VHL c.499C>T. This is a missense mutation and causes an amino acid change (Arg167Trp).

Immunohistochemical phenotype of colorectal carcinoma in patients with KRAS mutation and mismatch repair status.

INTRODUCTION: Aberrant expression of CK7/CK20/CDX2 is reported in percentage of colorectal carcinomas (CRC).

Granulomatous Cheilitis or Tuberculid?

The granulomatous cheilitis (GC) presents a heterogeneous group of disorders characterised by a granulomatous inflammation/reaction of the lips to various stimuli. Numerous etiologies have been proposed, including genetic, immunologic, allergic and infectious. Among the secondary causes of GC, an infection by Mycobacterium tuberculosis (MBT) should be considered. In such cases, the GC could be the clinical presentation of a tuberculid resulting from a hypersensitivity reaction to an underlying focus of active (ATBI) or latent tuberculosis infection (LTBI). This communication describes an immunocompetent patient diagnosed with GC resulting from tuberculid, who responded well to Isoniazid monotherapy.

Immunohistochemical expression of CK20, CK7, and CDX2 in colorectal carcinoma in correlation with pathomorphological characteristics.

INTRODUCTION: Colorectal carcinoma is the third most common cancer worldwide. The usual immunophenotype of colorectal adenocarcinoma is CDX2 positive, CK20 positive, and CK7 negative. Aberrant expression is reported in a variety of colorectal carcinomas but its relation to morphological variables and survival data is still unclear.

Topical Occlusive Corticosteroid Therapy for the Treatment of Gingival Manifestation of Mucous Membrane Pemphigoid - a Case Report.

Mucous membrane pemphigoid (MMP) is a chronic, autoimmune, subepithelial vesiculobullous disease that very frequently affects the mucous membranes and less often the skin. Oral cavity is the most commonly affected site and desquamative gingivitis (DG) is the most common manifestation. This is the main reason why dentists play a vital role in the diagnosis and managing the oral health of patients. Treatment is usually challenging, however, it only can achieve temporary symptomatic effect. We report a case of desquamative gingivi-tis, manifestation of MMP that was treated successfully with topical corticosteroid. The latter was applied by using of individual made custom trays to improve clinical efficacy.

Paratesticular well-differentiated liposarcoma initially diagnosed as fibrous pseudotumour.

Paratesticular tumours are relatively rare and mostly of the mesenchymal origin. Due to its rarity, general surgical pathologists might have limited experience on the diagnostic entities and relevant differential diagnoses related to mesenchymal paratesticular tumours. This may likely cause diagnostic difficulties in a daily pathology practice. Paratesticular liposarcoma is a highly heterogeneous tumour and may be misdiagnosed as a benign fibromatous lesion. Herein we present a case of well-differentiated paratesticular liposarcoma of the sclerosing type initially diagnosed as a fibrous pseudotumour. Main differential diagnostic considerations are highlighted.

Histological Gingival Assessment after Conventional and Laser Gingivectomy.

BACKGROUND: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. AIM: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments - a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. MATERIALS AND METHODS: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types - as test groups. The following histological parameters were measured: coagulation layer thickness (in µm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. RESULTS: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. CONCLUSIONS: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.