[Soft tissue sarcoma--problems of diagnosis and treatment]. / Sarcoamele de parti moi--probleme de diagnostic si tratament.

Soft tissue sarcomas are a rare group of cancers compromising 1% of all malignancies and there has been a slight increase in incidence. We present 3 cases of soft tissue sarcomas (the tumors were located to the right axilary region, perianal and dorsale face of the left leg) hospitalized in 2nd Surgical Clinic of Emergency Hospital of Craiova and we discuss the difficulties of diagnosis and treatment. The classification and characterization of soft-tissue sarcomas have evolved as the information supplied by histologic analysis has been supplemented with that provided by immunohistochemical analysis. Surgical resection involving wide margins, with or without radiotherapy, offers the best chance of cure in the absence of metastatic disease. There is little evidence that local recurrence increases the likelihood of metastatic spread, although debate on this point continues. Except for rhabdomyosarcomas and Ewing's sarcomas, the use of adjuvant chemotherapy generally does little to influence the natural history of the disease. In conclusion surgical treatment is mainstay of treatment for soft-tissue sarcomas and is usefull the prompt diagnosis for decrease the risk of local recurrence and metastatic disease.

Histopathological Study on Conservatively Operated Breast Carcinomas.

In this histopathological study we looked at 303 cases of breast carcinomas, managed though conservative breast surgery and later analysed with the help of a classical histopathological technique, paraffin embedding. The carcinomas were assessed in terms of tumor size, lymph node status, histological type, correlation between invasive tumors and an situ carcinoma component, resection margins, grading and patients age. Following assessment, we looked at associations between above morphological and clinical parameters and ipsilateral local recurrences. We concluded that more than half of our cases were carcinomas, measuring between 2 cm and 5 cm, with no associated lymph node involvement, in keeping with pTNM criteria for stage II. By far, in our study, the most frequent histopathological type was type NOS (63.37%) followed by invasive lobular carcinoma (10.56%) and mixed ducto-lobular invasive carcinoma (6.27%). Other types of invasive carcinoma were rarer, each representing less than 4% of cases. In regards to in situ carcinomas we noted the most common histological types to be both cribriform intraductal carcinoma and comedocarcinoma, each identified in 1.65% of cases. Amongst invasive breast carcinomas, infiltrating ductal carcinoma not otherwise specified (NOS) was found to be most commonly associated with in situ ductal carcinoma lesions. This was seen in 34.9% of cases, and was the only type associated with an extensive in situ component. Analysing the grading of mammary carcinomas in our study showed that the vast majority of cases (63.04%) were grade 3 tumors. In regards to surgical resection margins, ¾ of cases were noted to have negative margins. Tumor recurrences were noted in 12 cases. These cases were most commonly noted to reoccur following initial poorly differentiated, infiltrating ductal carcinomas, not otherwise specified (NOS), with positive resection margins, measuring less than 2 cm. Patiens tended to be under the age of 40 and had positive lymph nodes. The emergence of local recurrences after conservative surgery for early breast cancer is singnificantly linked to poorly differentiated primary tumors (p <0.05) but not correlated with histological type, presence of extensive intraductal carcinoma component, size of primary breast tumor or lymph node status ( p> 0.05). In terms of increasing the risk of ipsilateral recurrence the most important aspect highlighted in our sudy was the status of the resection margins. Patients with positive resection margins had a significantly high risk to develop recurrences after the conservative surgery, compared to those with negative margins (p <0.001).

Current Role of Endoscopic Ultrasonography in Rectal Cancer Evaluation During Multidisciplinary Therapy.

We report the case of a patient presenting in the Gastroenterology Department with intermittent rectal bleeding during the past year. A diagnosis of a low rectal adenocarcinoma was based on colonoscopy examination with biopsies, and staging procedures included transrectal endoscopic ultrasonography and magnetic resonance imaging of the abdomen and pelvis (cT2N0M0). Consequently the patient was referred for pre-operative chemoradiotherapy, achieving a complete clinical response as documented by repeated EUS and MRI examinations. Transanal endoscopic microsurgery with pathological assessment of the resected specimen revealed residual adenocarcinoma, highlighting the limitations of current imaging methods, and the constant need of technological improvements.

Endomicroscopy with Fluorescent CD105 Antibodies for "In Vivo" Imaging of Colorectal Cancer Angiogenesis.

The aim of this case report was to evaluate the feasibility of in vivo acquisition of microscopic images using fluorescent CD105 antibodies for molecular imaging in human colorectal cancer. After excluding the presence of tissue autofluorescence, the antibody solution was topically administered through a spray-catheter. The targeted area was analyzed by eCLE and images were recorded. The fractal dimension of tumor vessels and the vessel density were determined using ImageJ software. Immunohistochemistry was used as a gold standard. In vivo CLE analysis of CD105 expression enabled the study of tumor vascular network, revealing a chaotic structure.

Clinical and Pathological Analysis of Two Cases of Cutaneous Malignant Melanoma.

The purpose of this study was the clinical and histo-immunohistochemical analysis of two cases: a cutaneous pigmented facial malignant melanoma and a lumbar congenital nevus with malignant transformation. A series of clinical elements raised the suspicion of some malignant melanocytic lesions and the histopathological analysis through the paraffin embedding technique confirmed the clinical suspicion. The immunohistochemical analysis using the streptavidin-biotin-peroxydase method of the facial malignant melanoma showed: S100 protein intense and diffuse positive, Tyrosinase diffuse positive, HMB45 strong and focal positive, Cyclin D1 positive in approximately 40% and Ki-67 positive in almost 70% of the tumor cells. The malignant melanoma developed on the nevocellular nevus displayed: S100 protein intense and diffuse positive, both in the nevus cells and in the malignant melanocytes as well, Tyrosinase intense and diffuse positive in the malignant melanocytes, poor and focal positive in the nevus cells and HMB45 intense and focal positive in the malignant cells and positive in the isolated nevus cells. Cyclin D1 was positive in about 70% of the malignant cells, but negative in the nevus area and Ki-67 was found positive in relatively 30% of the malignant melanocytes, also in less than 1% of the nevus cells. The pattern and the intensity of the Tyrosinase and HMB45 immunoexpression are important in the differentiation of the nevus cells from the malignant melanocytic cells. The immunoexpression of Cyclin D1 does not correlate directly with the proliferating activity of the malignant melanocytic cells in all types of malignant melanomas.

Value of immunohistochemistry in confirming undifferentiated ovarian carcinomas.

The present immunohistochemical study was carried out on ten cases of ovarian tumours diagnosed with usual staining as undifferentiated ovarian carcinomas. A panel of antibodies was chosen in order to confirm the epithelial origin of these tumours and to eliminate some possible ovarian metastasis. The cytokeratin AE1/AE3, EMA and BerEP4 positivity supported their epithelial origin even if thirty per cent of the cases co-expressed cytokeratin and vimentin. Even if there is not a specific marker to confirm the ovarian origin of the tumours, the CA125 and CEA positivity suggested that these carcinomas might represent a serous or a mucinous dedifferentiation. Associated with these antibodies, the calretinin, CK7 and CK20 stainings allowed the separation of these tumours from peritoneal mesotheliomas with ovarian extension and from ovarian metastasis originating in the gastrointestinal tract. The evaluation of the PCNA labelling index confirms the high degree of cell proliferation and the aggressiveness of these tumours.

Histopathologic aspects in microglandular hyperplasia of endocervix.

In this study we analysed 373 cases of microglandular hyperplasia of endocervix belonging to patients from the III-VII decades of life. Most of the lesions had the typic aspect of proliferation of small glandular lumen lined by endocervix type epithelium, with or without areas of basal proliferation or immature squamous metaplasia. In 8 cases the growing patterns were peculiar, with mucinous or florid aspects, three of the cases rising differential diagnosis problems with cervical carcinoma.

Histologic and immunohistochemical study of the vascular and perivascular structures in patients with chronic obstructive bronchopneumopathy (COBP).

Histologic and immunohistochemical changes of the lung vascular and perivascular structures in 37 clinical and paraclinical COBP diagnosed were studied. We noted the deterioration of an important part of the pulmonary capillary network because of the destruction of interalveolar septae, with an intense vascular congestion within restant capillaries. The venules and arterioles have had a fibrosis wall by the replacing of the elastic and muscular fibers with inextensible fibers of collagen. The perivascular stroma was infiltrated by fibroblasts, macrophages, lymphocytes and plasma cells.

Cutaneous leiomyosarcoma - Case report.

Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumor arising from the dermis or subcutaneous tissue in the skin. Superficial leiomyosarcoma originates in the superficial dermis or subcutaneous tissue and represents about 3% of the soft tissue sarcomas. CLM presents in persons of all ages but with a peak between 60-70 years old. It may also occur anywhere on the body; the existing cases reported it on the face and trunk. The clinic of leiomyosarcoma consists in a firm dermal nodule, which can be painful, pruritic or paresthestic. The tumor is of 1-3 cm in diameter and can often be seen as a solitary formation. We report one case of a cutaneous leiomyosarcoma arising in the chest region of a 79- year-old male. Leiomyosarcoma is a rare entity whose clinical presentation may appear nonspecific, making diagnosis difficult. Primary tumor excision with wide oncological safety margins is considered, when suitable case, the most appropriate method. Other therapeutic methods, such as radio- or chemotherapy are described as without significant benefits. Despite the claims of radical surgical treatment, due to recurrence rates, the prognosis remains poor. We recommend long-term follow-up of patients to capture a subsequent malignant disease progression.