De Winter's pattern: an uncommon but very important electrocardiographic sign in the prompt recognition of spontaneous occlusive coronary artery dissection in young patients with chest pain (a case report).

Chest pain is a clinical symptom for immediate consultation, and electrocardiogram (ECG) is a valuable diagnostic tool for use in the emergency room. Although the ST- elevation myocardial infarction (STEMI) requires urgent management, there are other ECG high-risk findings which are associated with adverse outcomes or imminent acute myocardial infarction (AMI). This is a case of STEMI equivalent pattern such as de Winter. As this ECG pattern is uncommon, it may be misinterpreted in the emergency department. We report a misinterpretation of de Winter's pattern (dWp) in a young woman referred to the emergency department for chest pain, feeling of suffocation and hemodynamic instability who undergone reteplase treatment with the suspicion of acute massive pulmonary embolism but developed cardiogenic shock as a result of extensive myocardial infarction due to spontaneous dissection of the left anterior descending coronary artery. A prompt diagnosis of de Winter's pattern and early angiography to detect the underlying cause of clinical manifestation can be lifesaving.

The Stromal Overexpression of CD10 in Invasive Breast Cancer and its Association with Clincophathologic Factors.

BACKGROUND: Breast carcinoma is the most common non-skin malignancy in women. More recently, it has been suggested that extracellular proteinase has also regulated growth factors and cytokines that might contribute to tumor progression. CD10 is a 90-110kd cell surface zinc-dependent metalloproteinase. Since CD10 is structurally similar to matrix metalloproteinase and stromelysin, it might facilitate cancer cell invasion and/or metastasis. The aim of this study was investigation the rate of CD10 expression in the stromal cells of invasive ductal breast carcinomas, Immunohistochemical aspects, then any other aspects to be able to clarify its correlation with other clinicopathological factors of this disease. METHODS: One hundred patients with histopathologic diagnosis of invasive ductal carcinoma and 50 patients with fibroadenoma of breast (as the control group) have selected, then 150 paraffin blocks have obtained. The stained slides by immunohistochemistry method for CD10 marker have examined separately by two pathologists, and discrepancies have reviewed in common session to get the final result. RESULTS: Stromal CD10 has detected in 28% of the IDC. No kind of immunoreactivity has identified in the stromal cells of normal breast. Stromal CD10 expression in IDC has significantly correlated with increasing tumor size (p<0.001), increasing histologic grade (p<0.001), the presence of nodal metastases (p<0.001) and estrogen receptor negative status (p=0.003). CONCLUSION: Stromal CD10 expression in IDC has closely correlated with invasion and metastasis and it might play an important role in the pathogenesis of IDC.