Assessing the hepatoprotective effects of hesperidin on liver-associated disorders in albino rats with experimentally induced obesity and type II diabetes: A histological and biochemical study.

Hesperidin (HSP) has multiple beneficial effects in verities of clinical situations including type 2 diabetes mellitus (T2DM). AIM: Determination of curative effects of HSP on the liver in T2DM rats through biochemical and histopathological studies. METHODS: Animals. Fifty rats were enrolled. 10 rats were fed a normal diet (control group), and the remaining 40 rats received a high-fat diet (HFD) for 8 weeks. The HFD-fed rats were grouped into Group II: 10 rats, and Group III: 10 rats received HSP 100 mg/kg. Group IV: 10 rats received a single dose of streptozotocin (STZ), 30 mg/kg, and Group V: 10 rats received STZ and HSP. Body weight, Blood glucose, insulin level, liver enzymes, lipid profile, oxidative stress, TNF-α, NF-κB, and liver biopsy were estimated. RESULTS: there is improvement in the histological profile of the steatosis in HFD-fed rats treated with HSP either in group III or in group V (received STZ) along with amelioration in blood glucose, insulin, liver enzymes, lipid profile, oxidative profile, TNF-α, and NF-κB. CONCLUSION: HSP in this STZ model revealed an improvement in steatosis, biochemical markers, and histologic findings. By studying these factors, we expected to identify the prospective targets for intervention that could help improve outcomes for individuals with obesity and diabetes-related liver diseases.

Optimal Steps for designing and implementing the extracurriculars through the integrative medical approach.

Extracurriculars are those that fall outside the scope of the academic curriculum. The purpose of the work is to outline the steps of planning extracurriculars, practice these steps in the medical program, and evaluate these steps. Methods: Using Kern's steps with some modifications, we did some extracurricular reforms. Assessment of the current situation/needs and identification of gaps have been occurred by a questionnaire that revealed low students' satisfaction (36.1%) about the current extracurriculars with points of weakness that have been addressed in the improvement plan. A list of extracurriculars was prepared and aligned with modules and learning outcomes. Allocation of resources and implementation of these extracurriculars were performed. The evaluation was done through a questionnaire that was fulfilled by 404 students. Results: Students' satisfaction was 66.8% in the second questionnaire compared to 36% in the initial questionnaire with a significant association. Further analysis of the respondents who revealed satisfaction showed that 95 out of 140 (67.8%) were high-grade achievers, 88 out of 134 (65.7%) for moderate, and 87 out of 130 (66.9%) in low-grade achievers. A comparison of the student's satisfaction in the three phases revealed a significant p-value (0.004), but no significance in students' satisfaction within phases of the program between males and females. Conclusion: Well-structured extracurriculars might contribute to the achievement of the mission, vision, and goals of the program. Extracurricular activities might be flexible and undergo periodic changes related to the nature of the curriculum. Following the cycle of developing extracurricular activities in designing, implementing, monitoring, evaluating, and reporting, the extracurricular activities will be more efficient in enhancing the learning climate and making the learning process more enjoyable, especially in a solid medical integrated curriculum.

The Extent of Expression of Thyroid Transcription Factor 1, Cytokeratin 7, and Anaplastic Lymphoma Kinase in Lung Adenocarcinoma.

Background: New forms of genetic alteration were developed giving a new era of lung adenocarcinoma (AdC) with diverse clinical and pathological features. Aim and Objectives: The aim is to investigate the ALK-rearranged gene as one of these genetic alterations in AdC. The role of TTF-1 and CK7 is to exclude the metastases. Material and Methods: Paraffin-embedded 50 AdC specimens were cut into 4-mm thick sections and stained with the primary antibody, using an anti-TTF-1 antibody, (all at a 1:200 dilution, mouse monoclonal antibody; Dako, Denmark), anti-CK 7 antibody (DAKO, Carpentaria, CA), and the rabbit monoclonal anti- ALK antibody (D5F3) (Ventana, USA). Positive reactivity was considered as brown nuclear immunostaining for TTF-1 and cytoplasmic for CK 7and both cytoplasmic and nuclear for ALK. Results: The median age was 56±2, with male to female ratio 7:3. Forty-four cases revealed a mixed pattern (88%), with focal intraluminal mucin. Forty-one cases (82%) were positive for TTF-1, of these; weak (13; %), moderate (16; %) and strong (12; %). Regarding CK7; 48 cases (96%) were positive; weak (7 cases; 14.5; %), moderate (18 cases; 37.5%) and strong (23 case; 47.9 %) of the positive cases. Regarding D5F3; five cases (10%) were positive; weak (1 case; 20 %), moderate (2 cases; 40 %) and strong (2 cases; 40%) out of the positive cases. Four ALK-positive cases were male and ALK-positive patients ranged from 42-55 years with median 48. Conclusion: Despite the incidence of ALk-AdC is uncommon, it might be suspected in lesions of lower age group especially with mucinous foci.

The Prevalence of Stress Among Medical Students Studying an Integrative Curriculum During the COVID-19 Pandemic.

PURPOSE: Stress is a psychological shift that negatively affects student achievement. We sought to investigate the extent of stress in the medical students at our university. PATIENTS AND METHODS: A total of 337 medical students representing three program phases were represented. Stress was measured using a questionnaire divided into three main parts: 10-question Kessler instruments, 10-questions specific to identifying the causes of stress, and a qualitative component to report additional information. For the Kessler questionnaire, a score of less than 20 was considered negative for stress of any level (alert) and scores of 20-24 were considered mild stress (resistance phase), 25-29 moderate stress (near exhaustion), and 30-50 severe stress (exhaustion). Descriptive studies in the form of mean, standard deviation, and confidence interval (CI) were used in addition to the chi-squared test for estimate significant differences between variables. A P-value of <0.05 was considered significant. RESULTS: The prevalence of stress was 85.5%, with a slight male predominance. The prevalence of stress was seen among the male students during Phase I (88.25%), followed by male students during Phase III (87.7%), female students during phase II (86.5%), male students during phase II (84.5%), female students during phase I (83.3%) and female students during phase III (80.4%). Stress was uniformly high during phase I (86.2%) followed by phase II (85.4%) and phase III (85.1%), and 85% of stress was obtained from the number and content of assessments. CONCLUSION: There is a high level of stress throughout the curriculum. The number of assessments and the number of modules and their content are the primary sources of stress. Student mentorship, including academic, psychic, and social counseling, may help predict and manage stress and improve student performance. Detection of stress among the students is a major issue for program monitoring and development.

Efficacy of expressions of Arg-1, Hep Par-1, and CK19 in the diagnosis of the primary hepatocellular carcinoma subtypes and exclusion of the metastases.

Many conflicts arise using immunohistochemistry of Hepatocellular carcinoma (HCC), some of these conflicts arise from the biliary part within the tumor itself or from liver metastasis. The aim of this study is to investigate the extent of Arg-1, HepPar-1, and CK-19 expressions in the primary HCC subtypes as well as studying of some metastatic cases to find a distinctive immunohistochemical panel utilizing it to differentiate between these entities. MATERIAL AND METHODS: A paraffin-embedded block including 62 cases of primary HCC, and 18 cases diagnosed as metastatic tumors, were subjected for this study using Anti-liver Arginase antibody (ab125134 Cambridge, USA, polyclonal antibody, 3.75 µg/ml), HepPar-1 (polyclonal mouse antibody OCH1E5; 1:600; DAKO, CA, USA), and CK 19 Anti-Cytokeratin 19 antibody (ab15463, rabbit polyclonal antibody; 1:100; Cambridge, USA). The intensity of immunostaining was scored (0 to 3+). Nuclear and cytoplasmic staining with Arg-1 and cytoplasmic for both HepPar-1 and CK 19 are reported. RESULTS: The histopathological patterns were mainly trabecular no= (24, 38.7%), and pseudoglandular (no=14, 22.5%), mixed hepatocellular cholangiocarcinoma was observed in one case (1.6%). Arginase-1 positivity was in 55 cases (88.7%) opposite to 46 (74.19%) and 8 (12.9%) for HepPAr.1% -1 and CK 19, respectively. The intensity of expression was marked in well and moderate differentiation for Arg-1 and HepPar-1and in poorly differentiated for CK 19. Metastatic carcinoma cases revealed two cases positive for Arg-1 (11.1%), 4 cases (22.2%) positive for HepPar-1, and 13 cases (72.2%) positive for CK 19. CONCLUSION: Arg-1 and HepPar-1 are confirmative in the diagnosis of primary HCC in most cases, either separately or collectively but the priority of selection leans more towards Arg-1. Arg-1 and HepPar-1 positive with negative CK 19 expressions give more support to diagnosis of primary HCC while the reverse will support the diagnosis of tumour of biliary origin or liver metastasis.

Efficacy of interleukin-6 in the induction of liver cell proliferation after hemi-hepatectomy: histopathologic and immunohistochemical study.

INTRODUCTION: The function of Interleukin-6 (IL-6) in the regenerative process is not fully understood. The aim was to show the IL-6 role in hepatocyte regeneration by identifying the proliferative rate of hepatocytes following partial hepatectomy. MATERIAL AND METHODS: Eighty male adult Sprague-Dawley rats were categorized into two equivalent groups (n = 40 rats); non-treated, and treated group with IL-6 of 35 µg/100 gm body weight according to lethality study for a four-day observation. Both groups were subjected to 70% hepatic resection. Liver specimens were taken for histo/immunohistochemical studies. Five measures were investigated histopathologically; binucleation, mitoses, thickening of the hepatic plate, ductular reaction, and presence of inflammatory cells. Ki-67 labeling index was evaluated using mouse anti-Ki-67 antibody. RESULTS: In non-treated group; binucleation and multinucleation were noted in 12 cases (30%), bizarre cells with abnormal mitoses 16 cases (42%), and thickening of liver cell plate 18 cases (45%), in contrast to 32 (80%), 30 (75%) and 28 (70%), in treated group. Patches of inflammatory infiltrate were more marked in the treated group. Ki-67 labeling index was higher in the treated group (p-value 0.00001). The degree of Ki-67 reactivity in the treated group was: negative 6 (15%), weak 6 (15%), moderate 16 (40%) and strong 12 (30%) compared with 18 (45%), 13 (32.5%), 6 (15%) and strong 3 (7.5%) in non-treated group. CONCLUSION: IL-6 is valuable in the induction of liver cell regeneration. Correlation with biochemical assay and flow cytometric studies is recommended.

Induction of synthesis of matrix metalloproteinases by interleukin-6; evidence for hepatic regeneration following hemi-hepatectomy.

AIM OF THE STUDY: Interleukin-6 (IL-6) can play a role in hepatic regeneration through many mechanisms, one of which is the induction of synthesis of matrix metalloproteinases (MMPs). The aim of the study is to focus on the significance and role of MMPs in the regenerative process to reveal the correlation between IL-6 and MMPs in rats following partial hepatectomy. MATERIAL AND METHODS: Following hemi-hepatectomy, eighty male rats were divided into a control group and a group treated with IL-6 35 µg/100 gm body weight according to a lethality study. The blood samples were drawn from all animal groups for MMP-9 serum level assessment. For the quantitative determination of MMP-9 an enzyme-linked immunosorbent assay (ELISA) was used (Cytoimmune Science Inc., MD) through the quantitative sandwich immunosorbent assay technique. A monoclonal antibody for MMP-9 was pre-coated onto microplate standards. After washing away the unbound substances, an enzyme-linked polyclonal antibody specific for cytokine was added to the wells and color developed in proportion to the amount of total cytokine (pro and/or active) bound in the initial step. The color development was stopped and the intensity of the color was measured. RESULTS: The liver regeneration rate (%) was significantly higher in the group of rats treated with IL-6 (median value was 49.55% vs. 33.20%), p < 0.001. The MMPs' serum level was significantly higher in the group of rats with resection and treatment (median value was 8.01). CONCLUSIONS: These results give evidence for the vital role of MMPs in the process of hepatic regeneration, the level of which, in turn, has a close relationship with the level of IL-6. MMPs have diverse effects in promoting angiogenesis, remodeling of extracellular matrix and endothelial cell proliferation.

Perception of Pathology of Otolaryngology-Related Subjects: Students' Perspective in an Innovative Multidisciplinary Classroom.

AIM: Multidisciplinary, as a term, is used to define people from different scientific backgrounds working together, each drawing on their field of expertise. Some related terms are frequently used interchangeably, such as interdisciplinary and transdisciplinary, but they are confusing and ambiguous. Introduction of a multidisciplinary teaching method in the early phases of medical curricula is insufficient for effective learning. Here, we aim to implement a multidisciplinary approach in the early phase of medical education and identify outcomes. METHODS: Two groups were evaluated in this study, each representing phases II and III of the Albaha medical curriculum, and including 90 and 86 students, respectively. "Hearing tests and their clinical applications" was selected as a subject to evaluate the understanding of special senses as studied by the phase II group, while "pathology of otolaryngology-related tumors and clinical correlations" was selected as a subject to evaluate the understanding of otolaryngology as studied by the phase III group. These subjects were selected by faculty members from otolaryngology, pathology and physiology departments and taught in successive stations. Teaching sessions were followed by a formative test that included 10 multiple-choice questions and a mini-clinical evaluation exercise (mini-CEX). A questionnaire to evaluate student satisfaction was completed after the exam. RESULTS: Students' satisfaction for the "hearing tests and their clinical applications" and "pathology of otolaryngology-related tumors and clinical correlations" subjects were 80% and 90.5%, respectively. The formative assessment revealed good student performance at 63.28%, and 60.46% of all students in both phases attained scores above 80%. CONCLUSION: Introduction of a multidisciplinary approach early in the medical curriculum improves knowledge and skill acquisition. This is reflected in student performance, especially if evaluated using the mini-CEX format, thus providing rapid feedback to students concerning their performance.

Role of interleukin 6 in liver cell regeneration after hemi-hepatectomy, correlation with liver enzymes and flow cytometric study.

AIM OF THE STUDY: Liver regeneration after hemi-hepatectomy may be affected by several growth factors and cytokines. The aim is to evaluate the importance of interleukin 6 (IL-6) in the induction of liver cell regeneration and find correlations with other parameters such as liver enzymes, and DNA analysis by flow cytometric studies. MATERIAL AND METHODS: 80 adult male Sprague-Dawley rats were obtained and divided into two equal groups (n = 40 rats) to undergo 70% partial hepatectomy: group 1 - untreated (control) group; 40 rats not treated; and group 2 - treated group, 40 rats treated with IL-6 35 µg/100 gm body weight according to a lethality study for a period of 4 days, then hepatic resection was carried out according to the steps of Higgins and Anderson. Assessment of liver enzymes and bilirubin level was done. Flow cytometric study was done using a flow cytometer (FACSCalibur; Becton Dickinson) and DNA content was estimated with CellQuest software (Becton Dickinson). RESULTS: The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly higher in the untreated group of rats with liver resection. A higher value of bilirubin was observed in the treated group. Rat weight at sacrification was significantly lower in the group of rats treated with IL-6 than those without treatment, p < 0.001. Liver weight at sacrification was significantly higher in the group of rats treated with IL-6 (p < 0.001). The percentage of apoptotic cells with hypodiploid DNA content was determined from DNA histograms. Untreated rat resected liver showed a peak pattern that represented liver damage with high damage of 73.4%. CONCLUSIONS: Interleukin 6 is of value in induction of liver cell regeneration after seventy percent hemi-hepatectomy as evident by increased liver cell mass, liver enzymes and flow cytometric analysis.

Study of the Association of Phosphatase and Tensin Homolog and p27 Expressions in Endometrial Hyperplasia and Carcinoma.

INTRODUCTION: Phosphatase and tensin homolog (PTEN) and p27 are commonly mutated gene in endometrial carcinoma (EC) and their association in development of EC has not been fully understood. THE AIM OF THE STUDY: The aim is to clarify the association of PTEN and p27 in EC and their correlation with the histologic grade. MATERIAL AND METHODS: Paraffin-embedded 20 and 50 specimens representing EH and EC were collected, cut into 4 mm thick and stained with H&E stain for histopathological examination. All EC cases were graded according to the percentage of nonsquamous solid pattern into 3 grades. Immunohistochemical (IHC) analyses were done using a rabbit polyclonal anti-PTEN antibody and a rabbit monoclonal anti-p27 antibody. Evaluation of reactivity was categorized: 1+ (weak) = less than 10%, 2+ (moderate) = 11 to 50% and 3+ (strong) = more than 50% tumor. t-test, one way ANOVA and chi-square test were used in the statistical analysis. RESULTS: Loss of PTEN was seen in 7/20 (35%) and 29/50 (58%) of EH and EC cases with significance (P =0.01824), opposite to 17/20 (85%) and 25/50 (50%) of p27 (P = 0.00334). Both antibodies showed significance in EH cases only (P = 0.00019). No correlation with the histological grade for both antibodies. Four major categories were formulated; PTEN+/p27+ (n = 2, 14, 10%, 28%), PTEN+/p27- (n = 5, 7; 25% and 14%), PTEN-/p27+ (n = 1, 11; 5%, 22%) PTEN-/p27- (n = 12, 18; 60%, 36%) cases of EH and EC, respectively with no significant difference obtained. CONCLUSION: Not all cases of PTEN negative EC showing p27 loss and vice versa. Despite many studies reacted with PTEN and p27 expression in EC, none of them is confirmatory to adjust the correlation between them in EC. So, more studies must be done to correlate between the degree of PTEN loss and p27 comprising all subtypes and grading of EC.

The efficacy of self-directed learning versus problem-based learning for teaching and learning ophthalmology: a comparative study.

INTRODUCTION: Self-directed learning (SDL) and problem-based learning (PBL) are fundamental tools to achieve lifelong learning in an integrated medical curriculum. However, the efficacy of SDL in some clinical courses is debated. AIM: The aim of the study was to measure the effectiveness of SDL for an ophthalmology course in comparison with PBL. METHODS: A cross-sectional study was conducted with fifth-year medical students enrolled in an ophthalmology course. SDL comprised four case-based scenarios guided by several questions. PBL comprised three sessions. An ear, nose, and throat (ENT) course was selected for comparison as a control. At the end of the course, 30 multiple-choice questions (MCQs) for both SDL and PBL were assessed and analyzed against their counterparts in the ENT course by an independent t-test. RESULTS: For the SDL component of the ophthalmology course, the number and percentages of students attaining high (n = 6/60, 10%) and moderate (n = 15/60, 28.3%) scores on an MCQs written exam were evaluated. For the PBL component, high scores were seen for 23.3% (n = 14/60), and moderate scores for 33.3% (n = 20/60) of the participants. For the SDL component of the ENT course, the number and percentages of students attaining high (n = 14/60, 23.3%) and moderate (n = 17/60, 28.3%) scores were recorded. For the PBL component, high (16/60, 26.6%) and moderate (17/60, 28%) scores were recorded. Significant p-values were obtained between the results for SDL and PBL in the ophthalmology course (p = 0.009), as well as between SDL results for both courses (p = 0.0308). Moreover, differences between the SDL results of ophthalmology and the PBL results of ENT (p = 0.0372) were significant. CONCLUSION: SDL appears to be less valuable for promotion of self-readiness. Periodic discussions in small groups or by panel discussion are strongly recommended for students to enhance readiness with SDL.

Mapping of pathology curriculum as quadriphasic model in an integrated medical school: how to put into practice?

INTRODUCTION: Integration is the dynamic interconnectedness at multiple levels based on recursive interactions. Pathology teaching strategy in the integrated curriculum has been widely studied, but mapping pathology in the integrated curriculum has not been fully handled. AIM OF THIS STUDY: The aim of this work is to address the pathology teaching experience at Albaha School of Medicine. METHODS: For attaining the well-situated integration of pathology, the quadriphasic model for teaching/learning pathology in the integrated curriculum is fully formulated and well conducted. This model is formed on the basis of the incorporation of pathology foundations at all academic levels in 4 phases: Phase I: the introductory course of the preparatory phase; Phase II: formation of the 7-week principle of disease module: 2nd basic year; Phase III: integration of anatomic pathology into system-based basic science modules; and Phase IV: application of clinical perspectives on the pathological background in clinical years. RESULTS: Inferences acquired through program evaluation as well as student assessment indicate that this model will be of practical use in medical schools. Trivial improvements and changes related to the balance between topics applied and time allocated are extensively needed. Despite the positive feedback obtained, minor pathology topics have been missed or only partially delivered. CONCLUSION: The quadriphasic model is a novel approach to teaching pathology and needs to be more documented and addressed by traditional medical schools that are in the process of shifting toward an integrated system-based learning. Addition of the module that covers the missed topics is highly recommended, and its content must be reformed annually.

Integrated pathology and radiology learning for a musculoskeletal system module: an example of interdisciplinary integrated form.

INTRODUCTION: Many curricula integrate radiology with anatomy courses but none of these curricula adopt integration of pathology with radiology as interdisciplinary form at the undergraduate level. The aim of the current study was to identify the outcome of interdisciplinary integrated course of pathology and radiology in musculoskeletal system module (MSK). METHODS: A comparative interventional study was conducted on 60 students representing a whole class of the third year of level V. MSK and gastrointestinal module (GIT) were selected as study and control module, respectively, as being adopted for the same level/allocated hours, enriched with many subject areas for both fields, and availability of learning resources for both. A planned interdisciplinary integrated course for MSK pathology and radiology was implemented in the pathology lab. The subject area was selected and taught for both fields in consecutive ways by pathology and radiology experts. After teaching, gross/histopathologic specimens and radiology imaging/reports were distributed over benches and the students investigated the same. Conversely, in GIT control module, both fields were delivered separately, and no interdisciplinary form of integration occurred. Students' scores for both fields were filtered from the objective structured practical exam, quiz, and final exam. Students' marks and satisfaction were subjected to multiple comparisons using independent student's t-test. SPSS version 17 was used. RESULTS: Significances were obtained between total marks of students for both modules and between radiology courses for both with P=0.0152 and 0.0199, respectively. Number of students who achieved >80% in MSK was 20 and 26 compared to 15 and 17 in GIT for pathology and radiology, respectively. Student satisfaction was high for interdisciplinary integration in MSK with significant difference obtained between MSK and GIT. CONCLUSION: The integration of both fields augments student performance for both. This experience must encourage curriculum committee to globalize it over all other modules.

Matching medical student achievement to learning objectives and outcomes: a paradigm shift for an implemented teaching module.

INTRODUCTION: Low student achievement in a basic imaging module was the impetus for an assessment of the module. METHODS: A valid, reliable, and structured Likert scale was designed to measure the degree of student satisfaction with the domains of the module, including learning objectives (LO), teaching strategy and tools (TT), assessment tools (AT), and allotted credit hours (CH). Further analysis was conducted of student dissatisfaction to determine the subdomain in which module improvement was to be implemented. Statistical analysis of data among Likert scale domains was conducted. RESULTS: Likert scale data showed the TT domain to be the major reason for low student achievement. Statistical studies revealed 57/117 students (48.6%) were dissatisfied with TT, compared with LO 16/117 (13.6%), AT 54/117 (46.1%), and CH 12/117 (10.2%). Significant P-values were obtained for LO vs TT (P<0.0001), LO vs AT (P<0.0001), LO vs CH (P<0.03), TT vs CH (P<0.0001), and AT vs CH (P<0.0001). No significant difference was observed between TT and AT (P<0.29). Regarding TT, 41/117 (34.9%) students were dissatisfied with lectures (L) compared to hospital-based teaching (HPT) 24/117 (20%), problem-based learning (PBL) 8/117 (6.8%), self-directed learning (SDL) 3/117 (2.5%), and seminars (S) 4/117 (3.4%). Significant P-values were obtained for L vs HPT (P<0.0001), L vs PBL (P<0.0001), L vs SDL (P<0.0001), L vs S (P<0.0001), HPT vs PBL (P<0.002), HPT vs SDL (P<0.0001), and HPT vs S (P<0.0001). Regarding lecture modifications, student satisfaction was 78.3% compared to 52% before modification. A significant P-value (P<0.0001) was obtained between Likert scale domains before and after modification. Lecture modification resulted in a good student response and satisfaction. CONCLUSION: The major reason for low student achievement was the teaching tools, particularly the lectures. Major modifications to lectures improved student achievement. The students and most of the teaching staff were highly satisfied with the modifications, which provided for reciprocal discussion and interaction. These results should encourage and guide other medical schools to investigate the points of weakness in their curriculum.

Comparison Between HER2, Estrogen Receptors and Progesterone Receptors in Primary Breast Carcinomas and Matched Lymph Node Metastases.

OBJECTIVE: In the current work, we compared HER2 by fluorescence in situ hybridization and estrogen and progesterone receptors by immunohistochemistry in matched primary breast carcinomas and their lymph node metastases. MATERIAL AND METHOD: Thirty-nine cases of primary and lymph node metastases were assessed for HER2. Primary tumors of the cases selected were known to be HER2 negative. Also, immunohistochemistry for estrogen and progesterone receptors was performed on 36 cases from the same cohort to assess any discrepancy between the primary tumor and the lymph node metastases. RESULTS: Out of 39 cases, one case was HER2 amplified in lymph node metastasis compared to non-amplified primary tumor. Approximately eight percent of cases (3/36) were estrogen receptor-negative in LN metastasis and 5.55% (2/36) were less strongly positive compared to the positive primary tumors. Nineteen percent (7/36) were progesterone receptor-negative in lymph node metastasis in contrast to the matched positive primary tumors, and 5.55% (2/36) were progesterone receptor-positive in lymph node as compared to their corresponding negative primary tumors. CONCLUSION: While most matched primary breast tumors and lymph node metastases show concordance in HER2, estrogen and progesterone receptor status, we confirmed the multiple reports that identified discordant results in a subset of cases. These results support the newly adopted guidelines that require testing for HER2 on metastatic lesions.

Thyroid, Renal, and Breast Carcinomas, Chondrosarcoma, Colon Adenomas, and Ganglioneuroma: A New Cancer Syndrome, FAP, or Just Coincidence.

We are presenting a case associated with papillary thyroid carcinoma, renal cell carcinoma, invasive mammary carcinoma, chondrosarcoma, benign ganglioneuroma, and numerous colon adenomas. The patient had a family history of colon cancer, kidney and bladder cancers, lung cancer, thyroid cancer, leukemia, and throat and mouth cancers. She was diagnosed with colonic villous adenoma at the age of 41 followed by thyroid, renal, and breast cancers and chondrosarcoma at the ages of 48, 64, 71, and 74, respectively. Additionally, we included a table with the most common familial cancer syndromes with one or more benign or malignant tumors diagnosed in our case, namely, FAP, HNPCC, Cowden, Peutz-Jeghers, renal cancer, tuberous sclerosis, VHL, breast/other, breast/ovarian, Carney, Werner's, Bloom, Li-Fraumeni, xeroderma pigmentosum, ataxia-telangiectasia, osteochondromatosis, retinoblastoma, and MEN2A.

ERα and ERK1/2 MAP kinase expression in microdissected stromal and epithelial endometrial cells.

Our previous published data detected higher expression of total and active mitogen activated protein kinase (MAPK) in the epithelial vs. stromal cells of the endometrium. In the present work we compared the expression of ERK1/2 MAPK and estrogen receptor α (ERα) in epithelial versus stromal cells in benign human endometrial tissues. Laser capture microdissection was used to separate glandular epithelium and stromal cells from six frozen, proliferative phase endometrial specimens. Total and phosphorylated levels for ERK1/2 and ERα were measured by quantitation of signals from Western blots using specific antibodies against the active and total forms of ERK1/2 and against ERα. When the level of the proteins was quantitated and normalized to ß actin from microdissected stroma and epithelium, no significant difference was detected in the levels of these proteins between the two tissue compartments. There was a trend toward higher expression in the stroma vs. epithelium, respectively (active ERK1/2 0.45 ± 0.17 vs. 0.2 ± 0.65; total ERK1/2 0.54 ± 0.35 vs. 0.28 ± 0.23; ERα 0.82 ± 0.28 vs. 0.54 ± 0.18; n=6). These data demonstrate that there are comparable levels of ERα (P=0.41), total ERK1/2 (P=0.18) and active ERK1/2 (P=0.13) in the stroma and epithelium of proliferative phase endometrium with a trend toward higher expression of these proteins in the stromal compartment.