[Immunoscore and Its Predictive Value for Colorectal Cancer]. / Immunoscore a jeho prediktivní hodnota u kolorektálního karcinomu.

Recent studies suggest that immune  classification (immune-score) in cancer patients has a prognostic value in some cases that seems to be superior to the AJCC/ UICC TNM  classification. The clinical outcome can vary significantly among patients with a particular diagnosis within the same TNM stage. Immunoscore methodology quantifies and detects different types of immune cells in tumor tissue, and also determines the density of their infiltration and localization at the tumor site. Currently within an international collaboration of 23 centers in 17 countries (including our department), immunoscore is being evaluated in more than 7,000 colorectal cancer patients in terms of the tumor microenvironment, focusing on the presence of immune cells both in the tumor tissue and the tumor invasive margin. Immunoscore results are assessed in correlation with: 1. patients response to the treatment, 2. rate of progression, disease prognosis and other immune parameters. It appears that the TNM classification and tumor invasiveness is statistically dependent on the immune response of the patient (there is an inverse correlation between the density of the infiltration of CD8⁺, CD3⁺ lymphocytes and the tumor stage). High densities of T-lymphocytes (CD8⁺, CD3⁺) both in the core and the invasive margin of the primary tumor are associated with longer term asymptomatic survival, overall survival, lower risk of relapse and reduced likelihood of metastases. The project of the international collaboration aims to introduce immunoscore in routine diagnostics.

Histopathological autoptic findings in 8 patients with pandemic influenza A (H1N1) pneumonia.

UNLABELLED: In the years 2009 and 2010 a novel influenza A (H1N1) caused the first influenza pandemic after 41 years. In the Czech Republic it culminated in November and December 2009 and there were 101 laboratory-confirmed deaths. Another few cases occurred later in the year 2010 and at the beginning of 2011. Here we report 8 autoptic cases of patients who died between 2009 and 2011 with confirmed H1N1 influenza and underwent a post mortem examination at the Institute of Pathology, General University Hospital in Prague, Czech Republic. This group differs from the others reported in literature by having a higher age as well as a higher percentage of patients with pre-existing severe comorbidities including malignant diseases. All 8 patients developed atypical pneumonia with subsequent respiratory failure. In this article we present these cases with related clinical data and findings in other organs, but we focus primarily on the findings in the respiratory tract which were shown to be approximately similar to those in the other studies and case reports. Nevertheless there were also some noteworthy variations. The most prominent feature observed was diffuse alveolar damage accompanied by intraalveolar haemorrhage and inflammatory infiltrate of variable extent. Less frequent features included cytopathic changes of pneumocytes and their desquamation, reactive changes of bronchial epithelium, intraalveolar fibrinous exudate, minor necroses, residual necrotizing bronchitis, focal granulation tissue and incipient fibrosis. In one case we found an extraordinary vascular change of uncertain origin. In conclusion, this group of patients is slightly atypical and differ in some features from those in other published studies and case reports concerning novel pandemic influenza. By reporting them we wish to extend the number of described cases, which may contribute to a better understanding of the pathogenesis of novel influenza infection. KEYWORDS: influenza A virus, subtype H1N1 - viral pneumonia - diffuse alveolar damage.

Comparison of the IHC, FISH, SISH and qPCR methods for the molecular diagnosis of breast cancer.

Her2 proto-oncogene amplification and protein overexpression is observed in 20-40% of patients with breast cancer and plays a crucial role in invasive breast cancer and its treatment. In the present study, we investigated samples from 131 patients with invasive breast carcinoma. In all cases, the overexpression/amplification level of Her2 was determined using manual immunohistochemistry (IHC) and/or automatic IHC, fluorescence in situ hybridization (FISH), silver in situ hybridization (SISH) and quantitative polymerase chain reaction (qPCR). Using various methods, we demonstrated candidate methods for Her2 detection and their dependability. Our results demonstrate that these methods are highly comparable for the detection of Her2 overexpression/amplification. It was also revealed that qPCR is a valuable tool for the evaluation of Her2 gene overexpression/amplification. The results from pPCR analysis positively correlated with the results from IHC and FISH analysis. Moreover, in contrast to IHC or SISH/FISH, the results obtained by qPCR were not encumbered with any subjective error on the part of the evaluator.

Intrapericardial teratoma as a cause of fetal death--a case report.

Intrapericardial teratoma is a rare congenital tumor that without treatment leads to cardiac failure in either the prenatal or postnatal period. Early diagnosis and recent surgical advances can, in some cases, delay development of intrauterine symptoms and allow final treatment through a tumor resection. However, a large number of intrapericardial tumors go undetected during prenatal diagnostics, until they are found as a cause of intrauterine death or postnatal cardiorespiratory insufficiency, as in our case report. An abortion was induced in the 23rd gestational week because there was no cardiac activity detected during a routine ultrasound scan in a 35-year old woman. The tumor was found during the postmortem of the fetus.

Study of the effect of neoadjuvant chemotherapy on the status of Her2/neu.

Her2/neu proto-oncogene amplification and protein over-expression is observed in 20-40 % of patients with breast cancer and plays a crucial role in invasive breast cancer and its treatment. A number of studies postulated the stability of Her2/neu gene expression, showing that in most patients the status of expression had not significantly changed after the neoadjuvant treatment. In the present study, we investigated samples from 20 patients with invasive breast carcinoma who had undergone neoadjuvant chemotherapy and subsequent surgery. In all cases, the expression level of Her2/neu was evaluated in both pre-therapeutically obtained tumour tissue by core needle biopsy and from specimens obtained during final surgery using immunohistochemistry. Fluorescence in situ hybridization and quantitative reverse transcription polymerase chain reaction methods were used for verifying the results obtained by immunohistochemistry. Her2/neu status determined by immunohistochemistry remained unchanged in 12 of 20 (60%) patients after neoadjuvant treatment. In six cases (30%) minor changes were observed after the treatment. However, in two cases (10%) we found altered Her2/neu expression from strongly positive in the pre-treatment biopsy to negative in the post-treatment surgery specimen. Moreover, this is the first report describing the changes in Her2/neu status at all protein, RNA and DNA levels by using immunohistochemistry, quantitative reverse transcription polymerase chain reaction and fluorescence in situ hybridization, respectively. By using variable methods we demonstrated possible new ways for Her2/neu detection and their dependability. Improvement in specific molecule detection can prevent the use of tailored targeted therapy in an untargeted manner.