Evaluation of concordance of Gleason score between prostate biopsy and radical prostatectomy.

BACKGROUND: Histological Gleason score grading is a main determinant of prostate cancer treatment. However, the final histological examination may reveal that concordance rates between biopsy and pathological Gleason sums are inadequate. AIM: To evaluate the concordance of Gleason score between prostate biopsy and radical prostatectomy specimen and to study factors predictive of up-grading of Gleason score at radical prostatectomy. METHODS: We conducted a descriptive and retrospective study including cases of patients who underwent  prostatectomy between 2008 and 2015. We proceeded to a histological examination of 30 cases of radical prostatectomy and 17 corresponding biopsies. The data of the remaining 13 prostate biopsies, not performed in our hospital, have been picked from detailed histological reports. RESULTS: Our results showed that the concordance in the Gleason score was 43% (kappa = 0.11, poor agreement).Gleason score was upgraded in 54% of the cases. At radical prostatectomy, it increased by two  points in one case and by one point in 14 cases. The Gleason score was under-graded on prostatic biopsies in an only 1 case. Using the new classification ISUP 2014, the concordance rate was 26% (kappa = 0.04,  very poor agreement). Gleason score was upgraded in 78% of the cases for Group 1 (SG 3 + 3) and 63% for group 2 (SG 3 + 4). The concordance rate was highest for Group 4 (4 + 3). Variables as age, serum PSA (prostate specific antigen) , numbre of cores, percentage of positive cores, or prostate volume were not significant predictors of upgrading of Gleason score on radical prostatectomy specimen. CONCLUSION: Thus, the high rate of discordance of Gleason score between prostate biopsy and radical prostatectomy specimen implies an understanding of factors predictive of discordance of this score allowing urologists, pathologists and oncologists to support patients in a more suitable way, choosing the appropriate therapeutic modality for each patient.

Supplementation of grape seed and skin extract to orlistat therapy prevents high-fat diet-induced murine spleen lipotoxicity.

Spleen is the largest lymphoid organ and obesity is related to an elevated risk of immunity dysfunction. The mechanism whereby fat adversely affects the spleen is poorly understood. This study was designed to assess the effectiveness of grape seed and skin extract (GSSE) and orlistat (Xenical, Xe) on high-fat diet (HFD)-induced spleen lipotoxicity. Obese rats were treated either with GSSE (4 g/kg body weight) or Xe (2 mg/kg body weight) or GSSE+Xe and monitored for weight loss for 3 months. Animals were then sacrificed and their spleen used for the evaluation of lipotoxicity-induced oxidative stress and inflammation as well as the putative protection afforded by GSSE and Xe treatment. HFD induced body weight gain and glycogen accumulation into the spleen; ectopic deposition of cholesterol and triglycerides and an oxidative stress characterized by increased lipoperoxidation and carbonylation; inhibition of antioxidant enzyme activities, such as catalase, glutathione peroxidase, and superoxide dismutase; depletion of zinc and copper; and a concomitant increase in calcium. HFD also increased plasma pro-inflammatory cytokines, such as interleukin (IL)-6, IL-17A, tumour necrosis factor alpha, and C-reactive protein, and decreased plasma IL-10 and adiponectin. Importantly, GSSE counteracted all the deleterious effects of HFD on spleen (i.e., lipotoxicity, oxidative stress, and inflammation) and the best protection was obtained when combining Xe+GSSE. Combining GSSE with Xe prevented against fat-induced spleen lipotoxicity, oxidative stress, and inflammation; this combination may be beneficial in other diseases related to the spleen.

Paratesticular Angiomyofibroblastoma-Like Tumor: Unusual Case of a Solidocystic Form.

The angiomyofibroblastoma-like tumor of the male genital tract is a rare benign tumor. A total of 34 cases have been reported in the literature. We herein report an exceptional case of solidocystic form in its paratesticular location, in a 79-year-old man. Clinical examination objectified a right testicular induration. Macroscopic examination of the orchidectomy objectified a paratesticular solidocystic tumor formation. Microscopically, the solid area was composed of vessels with small caliber and turgidity of endothelial cells. These vessels were surrounded by clusters of epithelioid cells, sometimes having the appearance of giant cells. They were associated with spindle cells. The cystic area was uncoated. Immunohistochemically, the fusiform cells expressed Desmin and Smooth Muscle Actin. Endothelial cells and clusters of cells surrounding large vessels expressed CD34. The expression of receptors for estrogen and progesterone was negative. To our knowledge, this is the second solidocystic case of angiomyofibroblastoma-like tumor of male genital tract.

Digestive neuroendocrine tumors: reclassifying of 26 cases according to 2010 who classification.

BACKGROUND: The classification of digestive neuroendocrine tumors is difficult due to their heterogeneity and rareness. AIMS: Reclassify the digestive neuroendocrine tumors according  to  the  WHO-2010 classification .  Methods: A retrospective study included   26 patients having digestive neuroendocrine     tumors ,  is achieved  in our  Pathology  Laboratory  of the Military Hospital of  Tunis between 2000 and 2013. RESULTS: The mean age of patients was 49.64 years. The Sex ratio was  1.36. It was 6 gastric tumors, 5 small intestine tumors , 5 pancreatic tumors, 5  appendix tumors , one hypatic tumor, one  gall bladder  tumor , one rectal tumor and one colon tumor. According to the WHO -2000 classification, tumors are categorised into 11 well differentiated  endocrine tumors, 13 well differentiated  endocrine carcinoma  and 2 poorly differentiated carcinoma . According to the WHO -2010 classification, tumors were re-evaluated as  16 neuroendocrine tumors grade 1, 6 neuroendocrine tumors grade 2 and 4 neuroendocrine carcinoma . CONCLUSION: There was a concordance between the two classifications in 93% of cases. The WHO -2010 classification may allow a  better classification for the digestive neuroendocrine tumors, however there are some histological categories that remained difficult to classify.

Intraosseous hibernoma: a case report and review of the literature.

Intraosseous hibernoma is a rare benign bone tumor, with only 4 cases reported in English literature. CASE REPORT: In this report, we describe a 42-year-old man with  no past medical history and right chest pain. Imaging studies showed an osteolytic lesion with fat attenuation lesion in the right fourth rib. The lesion was completely resected and microscopic study showed mildly thickened bone trabeculae and multivacuolated brown fat cells replacing the normal white fat and hematopoietic elements. The diagnostic of intraosseous hibernoma was made. CONCLUSION: Although it is rare, hibernoma should be included in the differential diagnosis of lipomatous  tumors.

Digestive neuroendocrine tumors: reclassifying of 26 cases according to 2010 who classification.

BACKGROUND: The classification of digestive neuroendocrine tumors is difficult due to their heterogeneity and rareness. AIMS: Reclassify the digestive neuroendocrine tumors according  to  the  WHO-2010 classification .  Methods: A retrospective study included   26 patients having digestive neuroendocrine     tumors ,  is achieved  in our  Pathology  Laboratory  of the Military Hospital of  Tunis between 2000 and 2013. RESULTS: The mean age of patients was 49.64 years. The Sex ratio was  1.36. It was 6 gastric tumors, 5 small intestine tumors , 5 pancreatic tumors, 5  appendix tumors , one hypatic tumor, one  gall bladder  tumor , one rectal tumor and one colon tumor. According to the WHO -2000 classification, tumors are categorised into 11 well differentiated  endocrine tumors, 13 well differentiated  endocrine carcinoma  and 2 poorly differentiated carcinoma . According to the WHO -2010 classification, tumors were re-evaluated as  16 neuroendocrine tumors grade 1, 6 neuroendocrine tumors grade 2 and 4 neuroendocrine carcinoma . CONCLUSION: There was a concordance between the two classifications in 93% of cases. The WHO -2010 classification may allow a  better classification for the digestive neuroendocrine tumors, however there are some histological categories that remained difficult to classify.

Intraosseous hibernoma: a case report and review of the literature.

Intraosseous hibernoma is a rare benign bone tumor, with only 4 cases reported in English literature. CASE REPORT: In this report, we describe a 42-year-old man with  no past medical history and right chest pain. Imaging studies showed an osteolytic lesion with fat attenuation lesion in the right fourth rib. The lesion was completely resected and microscopic study showed mildly thickened bone trabeculae and multivacuolated brown fat cells replacing the normal white fat and hematopoietic elements. The diagnostic of intraosseous hibernoma was made. CONCLUSION: Although it is rare, hibernoma should be included in the differential diagnosis of lipomatous  tumors.

Reclassification of gastrointestinal mesenchymal tumors.

BACKGROUND: Gastrointestinal stromal tumors - commonly called GISTs - are rare; yet, they represent an important type of mensenchymal tumors arising within the gastrointestinal tract. The acronym GIST was introduced in 1998 to define a well established pathological entity which bears a highly specific marker called KIT (CD117). Scientific interest for these tumors in recent years is mainly due to the progress in identification by immunohistochemistry and the advent of targeted molecular therapy. AIM: To reclassify mesenchymal tumors of the digestive tract using advanced immunophenotyping. METHODS: We examined the digestive tissue tumors operated at the Principal Military Hospital of Instruction of Tunis over a 19-year period from 1992 to 2011. RESULTS: We collected 22 cases of benign mesenchymal tumors of the digestive tract. Tumors were initially diagnosed as leiomyomas (4 cases), schwannomas (2 cases), gastrointestinal stromal tumors (14 cases), a leiomyoblastoma and a mesenchymal tumor with fusiform cells. The immunohistochemical study has allowed to correct some diagnoses and, in one case, the block has been exhausted. In total, we selected 18 cases of gastrointestinal stromal tumor, a tumors. The final diagnosis of GIST was confirmed by the positivity of C-kit or DOG1. CONCLUSIONS: The combined use of C-kit and DOG1 ensures accurate diagnosis of GIST. The DOG1 has allowed us to detect the 3 stromal tumors negative for C-kit. This antibody has achieved a diagnostic gain of 15 %. The rate of GIST tumors labeled increased from 71 % to 86 % among mesenchymal tumors.

[Prognostic value of markers of aggressiveness of urinary bladder tumours evaluated by immunohistochemistry]. / Valeur pronostique des marqueurs d'agressivité des tumeurs vésicales évalués par immunohistochimie.

BACKGROUND: The study of some immunohistochemical markers provides an objective and reproducible prognostic evaluation of urinary bladder tumour. aims: study the expression of the following immunohistochemical markers in Tumours of the bladder: Proliferating Cell Nuclear Antigen (PCNA), Ki67 antigen (MIB1), the C-erbB2 proto- antigene, the tumor suppressor gene p53, the receptor for epidermal growth factor (EGF-R), the apoptosis suppressor gene bcl2, the carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). methods: Study of retrospective series of 30 patients having tumours of the urinary bladder. results: The expression of PCNA with a cut-off value of 14% is correlated with recurrence (P = 0.010). The expression of PCNA with a cut-off value of 1% is correlated with tumour stage (P = 0.003). The expression of MIB1 with a cut-off value of 47% is correlated with recurrence (P = 0.010). The expression of MIB1 with a cut-off value of 47% is correlated with the tumour progression in stage and\or in grade (P = 0.007). The expression of C-erbB2 with a cutoff value of 28% is correlated in the tumour grade (P = 0.007). The other antibodies didn't demonstrate a prognostic value. CONCLUSION: MIb1 and PCNA being correlated with recurrence, they can be useful with the decision of the rhythm of the endoscopy. The correlation of C-erbB2 with the tumour grade could serve to better graduating bladder tumours.

A rare cause of a scrotal mass: primary leiomyosarcoma of epididymis.

Most masses encountered within the scrotal sac are neoplastic and occur within the testis; however a subset (2-3%) of these tumours is extra-testicular and usually arises from paratesticular tissue. Although uncommon, these tumours have a high incidence of malignancy reaching 30%, mainly represented by sarcomas (90%). Tumours occurring in the paratesticular region may be clinically indistinguishable from testicular tumours, thus resulting in initial misdiagnosis. In addition, the clinical findings are by no means specific to a tumour type and cannot distinguish between a benign and a malignant tumour, which results in difficulty in diagnosis and management. All paratesticular tumours are amenable to adequate surgical resection. Definite diagnosis is determined by histological evaluation.Leiomyosarcoma, the second most common paratesticular sarcoma after liposarcoma, is represented in the literature primarily as case reports. We report a case of LMS arising from the epididymis and focus on clinical presentation and differential diagnosis of such tumours.