[Correlation of size of the primary tumor and axillary node status with the p53 tumor suppressor gene in carcinoma of the breast]. / Korelacija velicine primarnog tumora i aksilarnog nodusnog statusa sa tumor supresornim genom p53 kod karcinoma dojke.

Correlation of standard pathomorphological prognostic parameters, primary tumor size and axillary nodal status with new prognostic factor in breast carcinoma: tumor suppressor gene p53 was analyzed. The studied sample included 65 women who underwent surgery for breast carcinoma at the Surgical Clinic of Clinical Center Banja Luka, from January 1st 1997 till January 1st 1999. Statistical data analysis was performed and correlation of prognostic factors was determined. The majority of authors in this field agree that the primary tumor size and axillary nodal status are the two most important prognostic factors. These factors are the best predictors of prognosis and survival of women who had the tumor and were operated on. Tumor markers were immunohistochemically determined in the last ten years and, according to the majority of authors, are still considered the additional or relative prognostic factors in breast carcinoma. Their prognostic value and significance increase almost daily. Most frequently determined tumor markers are bcl-2, pS2, Ki-67 and p53. There was a positive, directly proportional relationship between primary tumor size and tumor suppressor gene p53, but there was no positive correlation between the axillary nodal status and tumor suppressor gene p53. Significance of determination of new tumor markers as the prognostic factors was emphasized. These markers represent a powerful tool in the early detection and prevention of breast carcinoma.

[Multicystic mesothelioma of the peritoneum]. / Multicisticnih mezoteliom peritoneuma.

Benign multicystic mesothelioma (MCM) of the peritoneum is a rare lesion that occurs predominantly in middle aged women with previous history of pelvic surgery. We report a case of MCM of the peritoneum in a 25-year-old man in whom cystic masses were twice surgically removed in an interval of 1.5 year. Ultrasonography and computer assisted tomography of the abdomen revealed a multicystic abdominal and pelvic mass. At first laparotomy, a multiple, thin-walled cysts ranging 0.5-7 cm in diameter were found involving the abdominal and pelvic peritoneum. After removal of all visible cysts we made histopathological diagnosis of the multilocular cavernous lymphangioma, without immunohistochemical examinations. The recurrent tumor was clinically and pathologically identical, but the final diagnosis, established upon immunohistochemical staining, was MCM: the tumor cells were strongly positive for cytokeratin, weakly positive for vimentin, and negative for Factor VIII. Management of the MCM surgical excision, unfortunately not always curative, since there is a high recurrence rate.

[Correlation between the clinical and pathohistologic diagnosis in "small biopsies" of the lung]. / Korelacija klinickih i patohistoloskih dijagnoza na "malim biopsijama" pluca.

INTRODUCTION: During the last 20 years routine application of various methods of multiple "small biopsies" of the lungs such as forceps, transbronchial, trucut percutaneous and so on, has significantly increased the efficacy of diagnostics of bronchopulmonary and pleural diseases. Tissue samples, not bigger than 3-4 mm, in which diagnostic pathological changes are expected on the basis of previous clinical, radiological and bronchoscopic examinations, can be the basis for making a definite therapeutical decision only if a skillful surgeon has performed the biopsy by correct instruments and from the right place and sent it for histological analysis with other important clinical information. This study is a comment on quality, significance and possibilities of improving clinical-pathological cooperation in this field of clinical pathology. MATERIAL AND METHODS: By correlation of clinical and histological diagnoses we analyzed the diagnostic efficiency of microscopic examinations of "small biopsies" of the respiratory tract in 319 patients (175 bronchial forceps biopsies, 31 transbronchial biopsies, 22 percutaneous needle pleural biopsies and 91 combined forceps and transbronchial biopsies) in whom biopsies were performed during 1996 in the Specialized Hospital for Lung Diseases Brezovik. RESULTS: Overall concordance between the clinical and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out of 135 clinically "obvious" neoplasms, the histopathological examination confirmed existence of malignant tumor: squamous cell carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in 5.6% of patients. In other patients it was not possible to perform a more precise classification. Endoscopic specimens of 29 patients (9.1%) were not representative. CONCLUSION: The level of diagnostic efficiency (73.3%) of definitive histopathological verification of bronchopulmonary lesions, which have been clinically diagnosed as malignancies, is rather high, but the increase of diagnostic efficiency requires application of more sophisticated histological diagnostic methods (immunohistochemical) and more frequent utilization of bioptic procedures which are more convenient for detection of peripheral pulmonary lesions (transbronchial and percutaneous fine needle aspiration biopsies of the lungs).

Stereologic parameters of nuclear ultrastructure as markers of the steroid receptor status in breast cancer epithelium.

The nuclear specific surface density (Sv/Vv), mean nuclear area (A) and numerical density (Nv) of tumor cell nuclei from 30 primary invasive female breast carcinomas with known concentrations of estrogen and progesterone receptors (ER and PR), were morphometrically analyzed at the ultrastructural level. It was found that carcinomas with concordant positive ER and PR status contained significantly higher number of smaller nuclei per volume unit of epithelium (mean Nv = 1.5 x 10(6) mm-3, mean A = 27 microns 2), than carcinomas of negative concordant receptor status (mean Nv = 0.8 x 10(6) mm-3, mean = 37 microns 2). Tumor cell nuclei of the former frequently displayed an elliptic shape (mean Sv/Vv = 1.16 microns-1), and had deeply invaginated surfaces, whereas nuclei of the latter were more frequently ball-shaped and exhibited a smooth-surface (mean Sv/Vv = 0.88 microns-1). The numerical density Nv (NUC/EPI) of tumor cell nuclei turned out to be a most reliable morphological marker of the concordant ER and PR status (overall efficiency = 84%, p < 0.01). The nuclear surface and volume ratio and mean nuclear area also appear to be reliable markers for terminal stages of the biochemical differentiation of breast carcinoma (overall efficiency = 79%, p < 0.05).

Individual differences between nuclear parameters of normal and malignant breast epithelium.

This study attempts to estimate the status of estrogen and progesterone receptors (ER and PR) in tissue of invasive breast carcinoma. Identical stereologic parameters of nuclear ultrastructure, of normal and malignant epithelium in the same breast were compared. Samples of normal and malignant epithelium of 30 surgically amputated breasts were analysed morphometrically. The concentration of ER and PR in the malignant epithelium was estimated by means of the dextran-coated charcoal (DCC) method. We measured the mean nuclear area (A), nuclear specific density (Sv/Vv) and nuclear numerical density (Nv) of epithelium. The comparison of such models of normal and malignant epithelium nuclear ultrastructure of the same breast demonstrated: a) the difference between Sv/Vv of nuclei very sensitively and specifically marks the ER status in malignant tissue (overall efficiency = 80%, p < 0.01), and b) the difference between A, Sv/Vv and Nv marks the concordant ER and PR status with identical overall efficiency. Minimal individual differences in size, surface structure and shape, observed between nuclei of malignant epithelium of positive concordant ER and PR status and nuclei of normal epithelium demonstrated that the highest morphological similarity is associated with biochemical similarity of cells exposed to the identical media of steroid hormones.

[Relation of epithelial metaplasia and calcification with epithelial proliferation in fibrocytic breast disease]. / Odnos epitelne metaplazije i kalcifikacija sa proliferacijom epitela u fibrocisticnoj bolesti dojke.

By semiserial microscopic investigation of the complete tissue of 65 surgical excised fibrocystic lesion of female breast we have found that there exist (a) the high frequency (58.5%) of the apocrine metaplastic epithelium, predominantly located in lobules and topographically widely distributed (mean 9 focuses on a sample), (b) the rare occurrence (3%) of lobular and ductal squamous metaplasia and (c) the high frequency (40%) of sparse (mean 3 focuses on a sample) lobular calcifications. Statistically, apocrine metaplasia and calcifications were significantly (p < 0.001 and p < 0.01) more frequent in the samples of proliferative fibrocystic lesions. The level of the positive spacial correlation (O = 0.512) of proliferative and apocrine metaplastic epithelial changes, as well as a common stratification and papillation of the apocrine epithelium indicate indirectly a possible influence of a steroid hormonal unbalance in the promotion of the apocrine epithelial metaplasia.