The role of multidetector computed tomography enterography in the evaluation of localized malignant small intestinal lesions: retrospective radiological and pathological experience.

PURPOSE: Our purpose is to present our experience in using multidetector computed tomography (MDCT) enterography in the evaluation of localized malignant small intestinal lesions with pathological correlation. MATERIAL AND METHODS: We retrospectively evaluated 53 patients of pathologically proven malignant localized small intestinal tumours, who underwent multidetector CT enterography. RESULTS: In this study, the mean age was 51.39 ± 17.4 years. The most commonly affected age group was from 50 to 59 years. The commonest clinical complaint was abdominal pain. The ileum was the most commonly affected anatomical region, showing 25 lesions (47.16%). Radiologically irregular/asymmetric wall thickening was detected in 42 cases(79.24%). Pathologically the most common malignancy was small intestinal adenocarcinoma, followed by carcinoid tumour, lymphoma, and gastrointestinal stromal tumours (GIST). We found that there was a statistically significant association between the pathological lymphadenopathy (p = 0.005) and absent proximal intestinal dilatation (p = 0.01) with intestinal lymphoma. Also, there was a statistically significant association between the extra-intestinal mesenteric fat changes with carcinoid tumours (p = 0.001). Irregular/asymmetric wall thickening was detected in 14 cases of small intestinal adenocarcinoma with a statistically significant association (p = 0.001) while exophytic pathological mass formation was statistically significant associated (p ≤ 0.001) with small intestinal GIST. CONCLUSIONS: Multidetector CT enterography is a non-invasive and accurate method in the evaluation of focal and localized small intestinal malignant lesions. The accurate detection of these lesions depends to some degree on the experience of the radiologist, lesional size, site and pattern of enhancement, as well as adequate intestinal distension.

Expression of pRb, Ki67 and HER 2/neu in gastric carcinomas: Relation to different histopathological grades and stages.

Gastric carcinoma is one of the aggressive malignancies with poor prognosis. The expression of pRb, Ki67, Her-2 in relation to tumor grade and stage in gastric carcinoma still needs more exploration. This study was performed aiming to study the immunohistochemical expression of altered retinoblastoma encoding protein (pRb), Ki67 and Her-2 in gastric carcinoma and to investigate their clinical and pathological significance. We studied tumor tissue specimens from 48 patients with gastric carcinoma. Paraffin sections were submitted for immunohistochemistry using pRb, Ki67 and Her-2. Statistical analysis was performed for clinical and pathological data of all studied cases. Altered pRb was expressed in 79% of the studied tumors, inversely correlated with tumor invasion and stage with no significant relation with tumor grade, age, and gender and tumor size. Ki67 LI was significantly associated with tumor grade and stage but not related to sex, age, tumor size, site, depth of invasion and lymph node metastasis. Her2 was expressed in 75% of studies tumors with significant association with tumor grade, the depth of invasion, lymph node metastasis and higher tumor stage. However, there was no significant association between Her-2 expression and gender, tumor site and size. In conclusion, altered pRb is frequently expressed in gastric carcinoma, inversely correlates with tumor invasion and tumor stage suggesting an early event in gastric carcinogenesis. Ki67 expression in gastric carcinoma is directly correlated with the tumor grade and depth of invasion. Her2 expression is significantly correlated with tumor grade, depth of invasion and stage.

Programmed death ligand 1 expression in diffuse large B cell lymphoma: correlation with clinicopathological prognostic factors.

BACKGROUND: The prognostic value of the level of programmed death ligand 1 (PD-L1) expression in non-Hodgkin lymphoma (NHL) is still debatable. This study examined the effect of the level of PD-L1 expression on the clinicopathological characteristics and prognosis of diffuse large B cell lymphoma (DLBCL). METHODS: A retrospective study was conducted on formalin-fixed paraffin-embedded tissue blocks of one hundred de novo DLBCL patients diagnosed from 2013 to 2016. PD-L1 expression was defined by a modified Combined-Positive Score (CPS) and their medical records were reviewed to collect their clinical, laboratory and radiological data, treatment, and outcome. RESULTS: The included patients were aged from 23 to 85 years and treated by rituximab- cyclophosphamide, doxorubicin, oncovin, prednisone (R-CHOP); 49% were males; 85% of the cases were presented at Ann Arbor stages III, IV; 33% of patients were seropositive for HCV and 87% of cases were presented with intermediate and high IPI. All included cases expressed PD-L1 using modified CPS. 27% of patients showed low PD-L1 expression (≥ 5% to < 50% of total tumor cellularity) while 73% of patients showed high PD-L1expression (≥ 50% of total tumor cellularity). High PD-L1 expression is statistically correlated with advanced stage (p 0.01), high IPI score (p 0.017), high incidence of stationary and progressive disease (p 0.002) and high incidence of relapse (p value 0.01). Five-year disease-free survival (DFS) was 29% for patients with high PD-L1 expression compared with 84.8% for patients with low PD-L1 expression (p 0.001). CONCLUSIONS: This study suggests that high PD-L1 expression in DLBCL is associated with aggressive clinicopathological features and a decreased response to R-CHOP. The level of PD-L1 expression could be an independent predictor of DFS of DLBCL. More research is mandatory to standardize the cutoff value and scoring methods.

Prognostic Role of Tumor Microenvironment in DLBCL and Relation to Patients' Clinical Outcome: A Clinical and Immunohistochemical Study.

Diffuse large B cell lymphoma is the most common type of lymphoma in Egypt with an unfavorable prognosis. The tumor microenvironment is rich in immune response either T cells or macrophages. The current study is aimed at testing CD4, CD8, CD68, and MMP9 immunohistochemistry of DLBCL activities with the prognosis of the tumor. The results showed no positive relation between T cell and macrophage reaction to the tumor prognosis suggesting that this reaction is part of the tumor process and not a defense mechanism from the surrounding stroma.