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.

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).