An unusual mole: an adult case of Dabska tumour.

In 1969 Dabska and her colleagues described for the first time this rare malignant tumour, also later known as a malignant endovascular papillary angioendothelioma of childhood. Overall, depending amongst other factors on its location, it is thought to have a generally favourable prognosis and a wide local excision seems to be the treatment of choice. We here present a very rare and unusual case of a 63 year old woman with a 20 year history of slow-growing right buccal dermatological lesion which resembled a common mole. The histopathological diagnosis of Dabska Tumour was made following the hematoxylin and eosin (H&E) biopsy. The analysis revealed multiple delicate interconnecting vascular channels with papillary plugs, some of which containing hyalinized core, projecting into the lumen lined by atypical plumped endothelial cells.

Expression of MAGE-A and NY-ESO-1 cancer/testis antigens in medullary breast cancer: retrospective immunohistochemical study.

AIM: To immunohistochemically evaluate the expression of MAGE-A1, MAGE-A, and NY-ESO-1 cancer/testis (C/T) tumor antigens in medullary breast cancer (MBC) tumor samples and to analyze it in relation to the clinicopathological features. METHODS: This retrospective study included samples from 49 patients: 40 with typical MBC and 9 with atypical MBC. Tumor specimens were obtained from patients operated on in the University Hospital for Tumors and the Sisters of Mercy University Hospital, Zagreb, Croatia, from 1999 to 2005. Standard immunohistochemistry was used on archival paraffin-embedded MBC tissues. RESULTS: MAGE-A1, MAGE-A, and NY-ESO-1 antigens were expressed in 33% (16/49), 33% (16/49), and 22% (11/49) of patients, respectively. No difference between the groups with and without C/T tumor antigen expression in age at diagnosis, tumor size, axillary lymph node metastasis, adjuvant therapy, and HER-2 expression was identified. Significantly more patients died in the MAGE-A-positive group than in the MAGE-A-negative group (P=0.010), whereas a borderline significance was found between MAGE-A1-positive and the MAGE-A1-negative group (P=0.079) and between NY-ESO-1-positive and NY-ESO-1-negative group (P=0.117). Overall survival, as evaluated by the Kaplan-Meier curves, was lower in MAGE-A1- (P=0.031), MAGE-A- (P=0.004), NY-ESO-1-positive groups (P=0.077). CONCLUSION: Expression of C/T antigens may represent a marker of potential prognostic relevance in MBC.

Immunohistochemical detection of early myocardial damage in two sudden deaths due to intentional butane inhalation. Two case reports with review of literature.

The abuse of household and other commercially available products containing volatile organic solvents is underrecognized. Not infrequently intentional butane inhalation results in high morbidity and mortality. A fatal outcome of butane abuse can be caused by asphyxia, cardiac arrhythmia or trauma. The reported number of cases in which death was the consequence of pure butane inhalation is limited, and in most cases a mixture of propellants was involved. This report covers two cases of sudden death due to the sniffing of a cigarette lighter refill containing butane. Autopsy was followed by toxicological, pathohistological and immunohistochemical analysis. Butane gas was confirmed in samples of blood, urine, brain and lungs by the gas chromatography method - "headspace" technique. Histology showed almost identical changes in the lungs and heart in both cases. The morphology of heart damage on standard H/E stains was of special interest because it displayed all the characteristics of chronic and acute myocardial hypoxia found in the absence of atherosclerotic heart disease. In order to confirm early cardiac death caused by asphyxia due to butane inhalation a panel of immunohistochemical agents was used: Myoglobin, Desmin, Fibronectin, Fibrinogen and CC9.

Immunohistochemical analysis of ER, PR, HER-2, CK 5/6, p63 and EGFR antigen expression in medullary breast cancer.

AIMS AND BACKGROUND: Recent publications of breast cancer classification based on gene expression profile analyses indicate that medullary breast carcinomas (MBC) may be considered part of the basal-like carcinoma spectrum made up of ER-negative, PR-negative and HER-2-negative cells ("triple-negative phenotype"). On the other hand, there are also data showing that a proportion of MBC and atypical MBC (AMBC) is ER, PR and/or HER-2 positive. Therefore, we have decided to immunohistochemically analyze ER, PR, HER-2 and basal/myoepithelial markers CK 5/6, p63 and EGFR expression in our archival paraffin-embedded MBC and AMBC samples from 48 patients. METHODS: Immunohistochemical evaluation of samples which were derived from patients operated on at our two hospitals between 1999 and 2005. RESULTS: Typical MBC was found in 39 patients and AMBC in 9 patients. The patients ranged in age from 32 to 84 years (median 55). Modified radical mastectomy with axillary dissection was performed in 30/48 patients (63%) while breast segmentectomy with axillary dissection was performed in 18/48 patients (37%). Metastases in axillary lymph nodes were observed in 15/48 patients (31%). ER positivity was present in 3/48 patients (6%), PR positivity in 8/48 (17%), and a positive HER-2 reaction was present in 14/48 patients (29%). CK 5/6 was positive in 20/48, p63 in 24/48 and EGFR in 8/48 patients. Adjuvant therapy was applied in all but 2 patients. Alive were 45/48 (94%) of patients. With the exception of PR expression, 39 patients with typical MBC and 9 patients with AMBC were comparable in the analyzed parameters. Positive HER-2 antigen expression in the analyzed sample was not found to be associated to a statistically significant degree with the MBC or AMBC histological tumor type, tumor size, axillary lymph node metastases, ER and PR status nor with patient survival. CONCLUSIONS: The data from our study seem to be generally comparable with the relatively scarce published data on clinicopathological parameters of MBC and AMBC.

[p53, bcl-2 and Ki-67 in the diagnosis of insular thyroid gland cancer. Case report with a review of literature]. / p53, bcl-2 i Ki-67 U dijagnostici inzularnog karcinoma stitnjace. Prikaz bolesnika s pregledom literature.

The report covers the first case of insular thyroid cancer recorded in Croatian medical literature. A 71-year old female patient presented to our hospital with symptoms of inspiratory stridor. Clinical examination disclosed an expansive tumor mass. US guided FNA indicated anaplastic cancer and total thyroidectomy was accordingly indicated. Pathohistological analysis of H/E biopsies disclosed a tumor mass with a characteristic insular growth pattern of monomorphic tumor cells. Immunohistochemical analysis confirmed diagnosis by a diffuse positive reaction to thyreoglobulin, focally to TTF-1, and scant to cytokeratin, while calcitonin, FVIII, CD34 and LCA were clearly negative. P53 and bcl-2 were expressed in 35.9% and 85% of tumor cells, respectively. The proliferation index for Ki-67 was 4.19. According to our survey we suggest a panel of immunohistochemistry for diagnosing insular cancer. Even if partly present, insular cancer should be mentioned in the pathohistological description because of its prognostic meaning.

[Second primary malignant tumors in patients with primary renal cell carcinoma]. / Ucestalost drugih primarnih tumora u bolesnika s primarnim karcinomom bubreznih stanica.

INTRODUCTION: Among multiple primary cancers in the same patient, renal cell carcinoma occurring either synchronously or metachronously is one of the most common. AIM: The aim of the study was to determine the frequency of second primary malignant tumor in patients with primary renal cell carcinoma. MATERIAL AND METHODS: Between 1992 and 2000, 447 patients underwent nephrectomy for primary renal tumor at the Department of Urology, Sestre milosrdnice University Hospital. Out of 447 patients 310 were registered at Cancer Registry of the Republic of Croatia. There were data on 297 patients with renal cell carcinoma, 197 male and 104 female patients, age group 24-91 (mean 59.9) years. RESULTS: Data on 24 (8.1%) patients with second primary malignant tumors were found in Hospital Registry and Croatian Cancer Registry during the study period. There were 13 male patients, age range 47-80 (median 65.1) years, and 11 female patients, age range 51-70 years (median 61.1) years with 26 second primary tumors. One male patient presented with four different primary tumors (kidney, prostate, urinary bladder and colon). The patients most commonly presented with prostate and colon carcinoma. The second malignant primary tumors occurred most commonly as antecedent to renal cell carcinoma, i.e. in 11 (42.3%) cases. CONCLUSION: Our results indicate that during the clinical follow-up of patients treated for primary renal cell cancer, a possibility of second primary cancers should always be considered. In order to upgrade detection of multiple cancer, the quality and completeness of cancer notification and registration from hospitals as well as collaboration between the National Cancer Registry and hospital cancer registries should be improved.

Periacinar retraction clefting in the prostatic needle core biopsies: an important diagnostic criterion or a simple artifact?

The diagnosis of prostatic adenocarcinoma in needle core biopsy is based on major and supportive criteria. One of the supportive criteria is the presence of retraction clefting around neoplastic glands. We analyzed a series of 137 prostatic cancer cases diagnosed by needle core biopsy to determine the frequency, extent and criteria for periacinar retraction clefting. Clefting was analyzed on ten neoplastic and ten normal glands in three different high power fields. One-third or more glands with clefts affecting more than 50% of circumference were significantly more common in tumors (51.8%) than in benign glands (8%) (P<0.0001). A stricter criterion that designated as positive the cases with at least 50% of neoplastic glands (15 of 30) with clefts that affected more than 50% of circumference revealed clefts in only 15.3% of the malignant cases but none in benign cases (0%) (P<0.0001). Regardless of their extension, 15 or more glands with clefts were also more prominent in malignant cases (86.9%) than in benign cases (20.4%) (P<0.0001). We conclude that periacinar retraction clefting represents a reliable criterion for diagnosis of the prostatic adenocarcinoma, especially in cases with clefts affecting more than 50% of circumference in at least 50% of suspicious glands.

[Importance of determination of various histologic components in testicular germ cell tumors]. / Vaznost odredivanja razlicitih histoloskih sastavnica tumora zametnih stanica testisa.

Testicular germ cell tumors represent about 95% of all testicular tumors. They are often composed of many different components. Seminoma usually has a favorable course but the prognosis of mixed germ cell tumors is depending on the type and proportion of different histologic components. The aim of this study was to determine the proportion and histologic type of various components of testicular germ cell tumors diagnosed in the period 1992-2000. In this period there were 131 testicular germ cell tumors with 72 (55.0%) nonseminomatous and 59 (45.0%) seminomatous tumors. Of all nonseminomatous tumors, 4 were composed of one component only, and 68 contained different components. Nonseminomatous tumors contained most commonly embryonal carcinoma (91.7%), teratoma (70.8%) and yolk sac tumor (33.3%) components. The most frequent combination of mixed germ cell tumors was composed of teratoma and embryonal carcinoma in 28 (41.2%) cases. Seminoma was found in 59 cases as pure seminoma and in 19 (26.4%) additional cases represented a component of testicular mixed germ cell tumor. Analysis of deeper sections by means of HE stained slides and immunohistochemistry (cytokeratin, CD30, alpha-fetoprotein, beta-HCG, PLAP and hPL) revealed 20 cases with components that were not described in original biopsy findings. We may conclude that the analysis of many sections using immunohistochemistry is necessary to identify all tumor components.

[Liposarcoma of the spermatic cord: case report and review of the literature]. / Liposarkom sjemenog snopa: prikaz bolesnika i pregled literature.

Liposarcoma of the spermatic cord is rare and is usually discovered during hernia repair operation. We report a 71-year-old patient with spermatic cord liposarcoma. The patient presented with a painless mass in the left scrotum measuring up to 25 cm. The mass had gradually been enlarging during the last 6 months. Clinical examination suggested inguinal hernia and after a routine clinical check-up the patient underwent surgery. During surgery, a large, yellow, lobulated mass adherent to spermatic cord was found. The mass was not spreading to the retroperitoneum, epididymis or testis. Simple orchidectomy was performed. Histopathologic diagnosis was well-differentiated liposarcoma comprising foci of myxoid and dedifferentiated liposarcoma. At present the patient is well and without recurrence 6 months after surgery.