Tumor budding is a prognostic factor linked to epithelial mesenchymal transition in pancreatic ductal adenocarcinoma. Study report and literature review.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a devastatingly poor prognosis. Surgical resection is undertaken in only 20% of patients. Most of well-known prognostic factors reflect tumor stage more than its biology. So it is important to identify new biological indicators related to survival in order to develop new therapies. OBJECTIVE: To determine the relation between tumor budding and Epithelial Mesenchymal Transition (EMT) and to evaluate their impact on survival for patients after resection of PDAC. METHODS: We herein report a retrospective study of 50 patients with resected PDAC. Tumor budding, immunohistochemical expression of vimentin and other standard factors were correlated with survival using the Kaplan-Meier method and Cox multivariable survival analysis. For tumor budding assessment, an inter-observer variability study was performed using 100 images of tumor slides stained with Hematoxylin & Eosin and Pan-Cytokeratin. RESULTS: Tumor budding was present in all tumors. A substantial agreement between six pathologists was established in distinguishing high-grade from low-grade budding (κ = 0.6 and 0.73 for H&E and PCK images respectively). High-grade budding was identified in 56% of tumors (28/50). It was an adverse prognostic factor independent of tumor size, resection margins status, nodal status and vascular invasion (p = 0.008). Tumor budding was significantly associated with vimentin expression (p = 0.002). CONCLUSIONS: The association of tumor budding with vimentin expression supported the idea that EMT is a key process in PDAC responsible for progression and drug resistance. Consequently, the elucidation of EMT molecular biology and development of new targeted therapy may improve disease outcome.

Papillary thyroid tumors: Diagnostic value of CD56 and Cytokeratin 19.

INTRODUCTION: Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features (NIFTP) is a tumor composed exclusively of follicles lined by cells having nuclear characteristics of papillary carcinoma. Morphological diagnosis is often difficult especially in the cases in which these nuclear abnormalities are focal. AIM: To investigate the contribution of the immunohistochemical study with anti CD56 and anti cytokeratin 19 in the positive diagnosis of NIFTP. METHODS: This is a diagnostive, retrospective study of 40 thyroid specimens including 15 NIFTP, 10 classical form papillary carcinoma (CPC) and 15 vesicular adenomas (AV), collected over a period of eighteen months (December 2013-May 2015). RESULTS: Negativity with anti-CD56 was noted in 16 cases: 9 cases of NIFTP and 7 cases of CPC. A diffuse staining was noted in 14 cases of AV. Positivity with anti-Cytokeratin19 was noted in 38 cases: 14 NIFTP, 10 CPC and 14 AV. For the diagnosis of NIFTP, the sensitivity of CD56 was 60% and specificity of 100%. The sensitivity of the Cytokeratin 19 was 93,3 % and specificity of 33,3%. CONCLUSIONS: Considering the good sensitivity and specificity of the CD56, it is possible to apply immunohistochemistry for definitive diagnosis of NIFTP and to differentiate it from adenoma. The cytokeratin 19 does not have a big contribution to distinguish between benign and malignant lesions.

Intracranial grade I meningiomas: Confrontation between histological examination and magnetic resonance imaging.

INTRODUCTION: Meningiomas are tumors derived from arachnoid cells. More than 90% of cases have a benign clinical course and are classified as grade I according to the World Health Organization. A confrontation between radiologic findings and pathological examination is necessary to predict the grading of meningiomas. OBJECTIVES: To study the radiological presentation by magnetic resonance imaging (MRI) and pathological features of intracranial meningiomas grade I. METHODS: This was a retrospective descriptive study of a series of 35 cases of grade I meningiomas. A review of MRI images was performed in this study. RESULTS: Our series consisted of 25 female and 10 male patients with a mean age of 49.2 years.The tumor was localized at the base of the skull in 20 cases (57.14%). The average size was 49 mm. At MRI, all meningiomas were solid showing enhancement after injection of contrast agent. This enhancement was homogeneous in 21 cases and heterogeneous in 14 cases. The edema was broad and extended in 15 cases, reduced in 8 cases and absent in 12 cases. The mean minimum apparent diffusion coefficient was 0.77 and the mean maximum average diffusion coefficient was 0,8. On histological examination, the meningioma was of meningotheliomatous type in 23 cases (65.7%), fibroblastic in 8 cases (22.9%), transitional 3 cases (8.6%) and angiomatous in one case (2,8%). CONCLUSION: Although the final diagnosis of meningioma is mainly based on pathological examination, comparison with imaging is also important to orient the pathologist.

Neuroendocrine differentiation in basal cell carcinoma.

Basal cell carcinoma (BCC) is the prototypical basaloid tumor of the skin. It may show various patterns simulating other cutaneous tumors due to its pleomorphism. It may have an unusal pattern of differentiation such as squamous, sebaceous, apocrine, eccrine, pilar, and endocrine differentiation. In order to establish the relative frequency of neuroendocrine differentiation in BCC, we performed a retrospective study of 33 consecutive BCCs using conventional immunohistochemistry with two neuroendocrine antibodies: Chromogranine A and synaptophysine. The age of the patients ranged from 17-83 years with mean of 65 years. The male to female ratio was 16:17. In immunohistochimestry, Chromogranine A was seen in 72.2% (24/33) while Synaptophysine was positive in 9.09% (3/33). Their expression was cytoplasmic and membranous and was seen in the periphery of these tumors in the overlying cells. Positive staining of chromogranine A was high (75-100% of tumors cells) in 9%, intermediate (25-75% of tumors cells) in 33% of cases and relatively low (<25%) in 30.3% of cases.

Gastrointestinal neuro-endocrine tumors: retrospective study of 36 cases.

BACKGROUND: Neuroendocrine tumors (NETs) of the gastrointestinal tract are a heterogeneous group of tumors which have different malignant potential and evolution. The World Health Organization (WHO) has set up a new classification of gastrointestinal NETs in 2010. However, it does not evaluate the risk of malignancy for each tumor. AIM: To evaluate the prognostic impact of the WHO classification in 2010 by reclassifying the tumor according to new recommendations and to identify histoprognostic factors to better predict changes. METHODS: This is a descriptive retrospective study of 36 cases of gastrointestinal NETs, collected at the pathological anatomy department in Rabta hospital, over a period of 11 years from 2003 to 2013. RESULTS: Our series included 11 NETs of Appendix, nine of the pancreas, seven of the small bowel, four of the stomach, three of the rectum, one of the colon and one of the esophagus. The mean age of patients across all sites, was 50.3 years old and the sex ratio was 0,44. The tumors were classified according to the 2010 WHO classification. They were divided into: G1 in 27 cases (75%); G2 in three cases (8.3%); G3 small cell carcinoma in two cases (5.6%); G3 large cell carcinoma in one case (2.8%) and mixed adeno-neuroendocrine carcinoma in three cases (8.3%). CONCLUSION: Our study has shown limits of the latest 2010 WHO classification of NETs. The prognosis of these tumors could be better predicted by the evaluation of other histoprognostic factors and by the improvement of criteria defining histological degrees including tumor size.

Prognostic value of Ki67: comparison of the proliferation index between meningiomas with and without infiltration of glial tissue.

BACKGROUND: Although generally considered benign, meningiomas can cause significant morbidity and mortality.  Histologic grade is the most useful morphologic predictor of recurrence. OBJECTIVES: To compare Ki67 labeling index between meningioma grade I and meningioma grade II with brain invasion. METHODS: We analyzed 20 primary meningioma, 10 of which were grade I and 10 of which were grade II. Ki67 proliferative indices were determined in all cases. RESULTS: The patient population consisted of 9 males and 11 females with mean age of 60 years. For meningioma grade I, the Ki67 labeling index varied between 1 and 15% with an average of 3.1%. A diagnosis of gradeII meningiomas was made solely on the basis of brain invasion. The immunohistochemical study noted that the Ki67 index varied between 1 and 20% with an average of 6,8%. CONCLUSION: The Ki67 labeling index shows a significant increase from grade I to grade II.  It may provide useful prognostic information.

Agressive infection following a dental extraction in a diabetic patient :Rhinocerebral mucormycosis.

Mucormycosis is a rare and acute fungal infection which is frequently lethal, usually observed in non-controlled diabetic patients. The infection usually begins in the nose but it can invade the lung, the digestive tract, and the skin. Rhinocerebral mucormycosis accounts for 40 to 49% of mucormycosis cases. We report the case of a 44-year-old diabetic man, presenting with rhinocerebral mucormycosis. Our patient was treated by an association of amphotericin B and surgical debridement.

Malignant transformation of nasal inverted papilloma into sarcomatoid carcinoma.

A 57 year-old, male presented with a chronic unilateral nasal obstruction and epistaxis. Intranasal endoscopy showed multiple polypoid lesions. The computed tomography exam revealed a heterogeneous mass that occupied the right nasal cavity with osteolysis of the middle and lower cone causing fluid retention of the right maxillary sinus. He underwent resection of these lesions. Pathological examination revealed malignant transformation of nasal inverted papilloma into sarcomatoid carcinoma. This case report highlights the importance of considering malignant transformation in the differential diagnosis of polypoid lesions.

A Challenging Cutaneous T-Cell Lymphoma.

Cutaneous peripheral T-cell lymphomas not otherwise specified (CPTL-NOS) are rare neoplasms accounting for just 2% of cutaneous peripheral T-cell lymphomas (CPTL). Only very few case series have been reported. They represent a phenotypically and prognostically heterogenous group of CPTL that do not fit into any of CPTL well-defined subtypes. The authors report a case of a 64-year-old man with simultaneous plaque-like lesions and disseminated nodules growing rapidly on the face, trunk, and extremities over a 6-month period. There was no a history of preceding patches, erythematous plaques, rash, or pruritic lesions. These lesions were extending over 80% of the skin surface. Histopathologic analysis revealed dense diffuse infiltrates composed of mostly medium-sized to large lymphoid cells throughout the entire dermis without epidermotropism. Neoplastic cells were atypical with markedly pleomorphic nuclei. Immunohistochemistry showed that the tumor cells were positive for CD3, CD4, and CD5 with a loss of CD7. They were negative for CD20, CD8, CD56, CXCL13, PD1, TIA-1, granzyme-B, perforin, CD25, and CD30. The proliferative fraction was low, with MIB-1 labeling less than 10% of cells. The authors diagnosed the patient with primary CPTL-NOS. Despite the rarity of these tumors, clinicians as well as dermatopathologists and pathologists should be familiar with these rare CPTL especially because most of these lymphomas have an aggressive behavior and exhibit an unfavorable prognosis.

Secondary xanthogranulomatous hypophysitis mimicking a pituitary macroadenoma: a case report.

Hypophysitis is an extremely rare inflammatory disease that can mimic the clinical and radiological features of a pituitary adenoma. In this case report, we describe a 45-year-old woman with secondary xanthogranulomatous hypophysitis (XGH) who presented with signs of a pituitary macroadenoma. The patient complained of headaches, visual impairment, and amenorrhea-galactorrhea syndrome. Her physical examination was normal. Laboratory investigation revealed corticotropin, thyrotropin, and gonadotropin deficiencies. She also had low visual acuity in her right eye and an altered visual field. Pituitary magnetic resonance imaging revealed an intra and suprasellar mass measuring 13 × 11 × 16 mm, with hemorrhagic necrosis, that was having a discrete mass effect on the patient's optic chiasm and pituitary stalk. The patient was treated with hydrocortisone and levothyroxine, and then transferred to the Neurosurgery department for total transsphenoidal resection of the mass. Histological examination of the tumor permitted a diagnosis of XGH of a remodeled Rathke's pouch cyst to be made. Systemic conditions such as tuberculosis, sarcoidosis, and other granulomatous diseases were excluded. The etiopathogenesis of XGH remains poorly characterized, but it may be a progressive form of lymphocytic hypophysitis or a remodeled Rathke's pouch cyst. Screening for autoimmune pathology and systemic diseases is essential to guide appropriate management.

[Vasculitis in Sweet's Syndrome]. / Vascularite au cours du syndrome de Sweet.

BACKGROUND: Also called acute febrile neutrophilic dermatosis, Sweet's syndrome is non-infective dermatoses that exhibit a predominantly neutrophilic inflammatory infiltrate. Absence of vasculitis is a histologic criterion for diagnosis. However, recent reports suggest that vasculitis should not exclude the diagnosis. AIM: To describe their clinical, pathological and therapeutic characteristics. METHODS: We report a series of 47 cases of Sweet's syndrome, collected in our institution between 1997 and 2011. RESULTS: The patient population consisted of 11 males and 36 females. The mean age was 47 years (28-74). An associated disease process was seen in 10 patients: inflammatory disease (3 cases), inflammatory bowel disease (2 cases), tuberculosis (3 cases) and diabetes (3 cases). One case of pregnancy was observed. In the prodromal phase, functional symptoms were reported in 38 cases (80.8%). Cutaneous lesions consisted of erythematous plaques or nodules. Lesions were located mainly on the upper or lower extremities. All biopsy specimens demonstrated a dermal infiltrate composed predominantly of neutrophils. Fibrinoid necrosis and intramural inflammation were observed in 8 cases. CONCLUSION: The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's diseases which requires careful surveillance.