Immunoexpression of Bmi-1, CK15, Bcl-2 in different types of basal cell carcinomas.

Introduction: Basal cell carcinoma (BCC) occurs in aggressive and non-aggressive forms. The expression of immunohistochemical markers varies in different types of BCC. Aim: Immunohistochemical analysis of selected proteins in BCCs. Material and methods: The immunohistochemical method was used to examine the immunoexpression of Bmi-1, CK15 and Bcl-2 in 56 cases of BCC divided into four groups. Results: Positive Bmi-1 staining 3-4+ level (nodular type) was seen in 91.3% of samples, 4+ (infiltrative) in 92.3%, 4+ (nodular/infiltrative) - 69.2%, 3+ - 30.8%, in BSC 3+ - 42.8%, and 28.6% each for 2+ and 4+. Low grade positivity (0-1+) in CK15 staining was present in 52.1% of nodular BCC, 46.2% - nodular/infiltrative, 92.3% - infiltrative, and 100% - BSC, but levels 2-3+ in nodular BCC in 47.8%, nodular/infiltrative BCC - 53.8%, infiltrative - 7.7%. Bcl-2 positivity (3-4+) was revealed in nodular BCC in 95.6%, (1-2+) in 100% of BSC, infiltrative and infiltrative/nodular BCC, but the lowest (0-1+) in 76.9% of nodular/infiltrative BCC, 71.4% of BSC, and in 38.4% of infiltrative BCC. Conclusions: Positive Bmi-1 staining was the highest in the aggressive infiltrative subtype of BCCs, whereas the lowest in basosquamous cell carcinomas (BSC). Infiltrative BCC was characterized by a lower level of CK15 expression than nodular BCC and nodular/infiltrative BCC. Differentiation of Bcl-2 expression depended on the type of tumour; the highest level was found in nodular BCC, low grade in nodular/infiltrative and infiltrative BCCs, and BSC.

Effects of electrospun scaffolds of di-O-butyrylchitin and poly-(ε-caprolactone) on wound healing.

BACKGROUND: We sought to determine the usefulness of electrospun dibutyrylchitin (DBC) or poly-(ε-caprolactone [PCL]), in wound treatment. We investigated the mechanisms of action of these polymers on wound healing. METHODS: We synthesized DBC, a newly identified ester derivative of chitin, using a patented method comprising the substitution of butyryl groups at positions C-3 and C-6 in chitin molecules. We confirmed the double substitution by the butyric groups using infrared spectrometry. The fibrous scaffolds were obtained using the electrospinning method. A polypropylene net was implanted subcutaneously in the rat and served as a wound model. RESULTS: Both DBC and PCL increased granulation tissue weight in the wound. In contrast to PCL, DBC did not abolish glycosaminoglycan changes in wounds. The tested samples did not impair total collagen synthesis or induce excessive fibrosis. In both PCL- and DBC-treated wounds, we observed a lower level of soluble collagen (compared with controls). The results show better hydration of the wounds in both the DBC and PCL groups. No induction of large edema formation by the tested materials was observed. These polymers induced almost identical macrophage-mediated reactions to foreign-body implantation. The implants increased the blood vessel number in a wound. CONCLUSION: Both PCL and DBC could be used as scaffolds or dressings for wound treatment. The materials were safe and well tolerated by animals. As DBC did not disturb glycosaminoglycan accumulation in wounds and absorbed twice as much liquid as PCL, it can be considered superior.

CONTEXTE: Nous avons cherché à déterminer l'utilité du dibutyryl-chitine (DBC) ou du poly-(ε-caprolactone [PCL]) électrofilés dans le traitement des plaies. Nous avons étudié les mécanismes d'action de ces polymères sur la cicatrisation des plaies. MÉTHODES: Nous avons synthétisé le DBC, un dérivé ester récemment identifié de la chitine, à l'aide d'une méthode brevetée incluant la substitution des groupes butyryl aux positions C-3 et C-6 des molécules de chitine. Nous avons confirmé la substitution double par les groupes butyriques à l'aide de la spectrométrie infrarouge. Les échafaudages fibreux ont été obtenus grâce à la méthode de filage électrostatique. Un filet en polypropylène a été implanté par voie sous-cutanée dans le rat et a servi de modèle de plaie. RÉSULTATS: Le DBC et le PCL ont tous deux augmenté le poids du tissu de granulation dans la plaie. Contrairement au PCL, le DBC n'a pas supprimé les changements des glycosaminoglycanes des plaies. Les échantillons examinés n'ont pas perturbé la synthèse totale de collagène ni entraîné une fibrose excessive. Nous avons observé un niveau inférieur de collagène soluble (par rapport aux témoins) tant dans les plaies traitées par PCL que par DBC. Les résultats montrent une amélioration de l'hydratation des plaies tant pour les groupes DBC que PCL. Les matériaux à l'étude n'induisaient pas d'œdème étendu. Ces polymères ont induit des réactions macrophagiques presque identiques à l'implantation d'un corps étranger. Les implants ont accru le nombre de vaisseaux sanguins de la plaie. CONCLUSION: Tant le PCL que le DBC pourraient être utilisés comme échafaudages ou pansements pour le traitement des plaies. Les matériaux étaient sécuritaires et ont été bien tolérés par les animaux. Comme le DBC n'a pas perturbé l'accumulation des glycosaminoglycanes des plaies et a absorbé 2 fois plus de liquide que le PCL, il peut être considéré comme étant supérieur.

The predictive value of sonographic images of follicular lesions - a comparison with nodules unequivocal in FNA - single centre prospective study.

BACKGROUND: To determine the diagnostic efficacy of ultrasonographic malignancy risk features (UMRFs) in follicular lesions (FL) in a population with low risk of malignancy in FL and to compare it with a similar analysis in a group of patients with unequivocal cytology (UC): benign lesion (BL) or malignant neoplasm (MN). METHODS: Presence of UMRFs (hypoechogenicity, solid echostructure, taller-than-wide shape, pathological vascularization, irregular margins, microcalcifications and macrocalcifications) and their sets were assessed in 322 FL: 202 follicular lesions of undetermined significance (FLUS) and 120 suspicious for follicular neoplasm (SFN) and 300 nodules with UC: 200 BL and 100 MN, subsequently evaluated histopathologically. RESULTS: Cancers were confirmed in 100% nodules in MN group (89.0% of them were papillary carcinomas - PTC), in 6.4% FLUS nodules (69.2% PTC), and in 10.8% SFN nodules (30.8% PTC). In the UC group all UMRFs occurred more frequently in cancers than in benign lesions. In the FL group only calcifications were found in cancers more frequently - macro and microcalcifications together: 34.6 vs. 11.5% (p = 0.001) and isolated macrocalcifications: 26.0 vs. 6.8% (p = 0.001); the presence of those features increased the basic risk of malignancy in FL more than 2 times. The presence of at least 2 of the following URMFs: hypoechogenicity, solid echostructure, any type of calcifications and suspected shape, additionally improved sensitivity. CONCLUSIONS: Evaluation of UMRFs in FLs is less effective than in nodules with UC, and its effectiveness decreases parallel to the decrease in percentage of PTCs among malignant neoplasms and to the increase of the percentage of adenomas among benign nodules. The presence of macrocalcifications in such FLs significantly increases the basic risk of malignancy in these nodules.

Hypopituitarism and goitre as endocrine manifestation of Langerhans cell histiocytosis (LCH). Case Report.

Langerhans cell histiocytosis (LCH) in adults is a rare disorder of unknown etiology characterized by monoclonal proliferation of Langerhans cells. It belongs to dendritic cell disorders and occurs in 1-2 adults per million. The most common endocrine manifestation of classical LCH is associated with the posterior pituitary, with clinical symptoms of diabetes insipidus. Less than 80 reported cases of LCH involving the thyroid gland have been published so far. We present the case of a 39 years old woman with 10 years history of diabetes insipidus and secondary amenorrhoea, which appeared after second delivery. She was suspected for lymphocytic inflammation of pituitary and she was administered steroid treatment. She was also treated symptomatically with desmopressin, L-thyroxine, estrogen and progestagen replacement therapy due to diabetes insipidus, secondary hypothyroidism and hypogonadotropic hypogonadism. In September 2014, she noticed a painless, firm tumour of the neck. Ultrasound (US) examination demonstrated bilateral, solid, hypoechogenic thyroid nodules. The result of fine-needle aspiration biopsy (FNAB) was not diagnostic. Due to rapid progression and US image of the tumour, she was referred for surgery. In postoperative histopathology tumour cells were positive for CD1a and S-100 protein, therefore diagnosis of LCH was established. Postoperatively, the results of thoracic computed tomography scan, abdominal US and bone scintigraphy revealed no evidence of multifocal disease. We have not observed any disease recurrence in the patient after a year of follow-up in postoperative course. This case illustrates diagnostic and therapeutic difficulties in patient with LCH.

Clinicopathological analysis of recurrent basal cell carcinoma of the eyelid.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common malignant neoplasm of the eyelids and surrounding structures, usually developing in the area of the lower lid and medial canthus. Invasive forms of BCC are connected with a high risk of recurrence, often due to incomplete excision of these lesions. AIM: Clinical and pathological analysis of recurrent BCCs of the eyelids and surrounding structures. MATERIAL AND METHODS: We present clinical and pathological analysis including immunohistochemical reaction to Ki-67 antigen of 19 patients (11 women, 8 men) operated for recurrent BCCs of the eyelids in 2000-2012. RESULTS: In most cases, recurrences were present on the lower lid and in the medial canthus. In 15 patients the histopathological type did not change and in 4 cases it transformed into more invasive forms. The values of Ki-67 index for primary BCCs ranged between 1% and 20%, and for relapsing lesions between 11% and 48%. CONCLUSIONS: Proper clinical and pathological evaluation to determine the risk of relapse in BCCs of the eyelids and surrounding structures should include the analysis of prognostic factors, in particular location and size, histopathological type and radicalness of surgical treatment of primary BCCs. Clinical and pathological analysis of patients with recurrent BCC of the eyelids and surrounding structures should be combined with the evaluation of proliferation index Ki-67, which is essential for prognosis and choice of the appropriate therapeutic method.

Knowledge assessment of women living in the Wielkopolska region concerning risk factors for cervical cancer.

INTRODUCTION: Cervical cancer (CC) is a malignant tumor which for many years has been a serious epidemiological problem in Poland. This issue is important because CC is the second most common type of malignant tumor, after breast cancer, and the second most common cause of death among women. The aim of this study was to assess the knowledge and awareness of women living in the Wielkopolska region (Gniezno district) of risk factors for cervical cancer. MATERIAL AND METHODS: The study used the diagnostic poll method, based on a previously developed survey questionnaire. The study was carried out between March and April 2013. The study group consisted of 100 women, involving schoolgirls from the secondary school in Gniezno (Group I), workers (doctors, nurses and midwives) of two outpatient clinics in the Gniezno district (Group II) and patients of the same clinics (Group III). RESULTS: According to the respondents, the main cause of CC is human papillomavirus (Group II - 36%) and genetic predisposition (Group III - 35%). It is alarming that 26% of women did not know the risk factors for CC. CONCLUSIONS: It is necessary to improve health education, especially concerning the main factors affecting the development of CC, in order to reduce the morbidity and mortality rates related to this cancer.

[Surgical treatment of malignant eyelid tumors]. / Chirurgiczne leczenie zlosliwych nowotworów powiek.

UNLABELLED: Eyelid tumors constitute 5 to 10% of all skin malignancies. They mostly affect the elderly, chronically exposed to sunlight. The primary treatment is radical surgical excision of the tumor. The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of selected reconstructive methods and the evaluation of long-term results of surgical treatment of eyelid tumors. MATERIAL AND METHODS: The study involved 92 patients treated in 2000-2007 for malignant tumors of the eyelids. All patients underwent surgical excision of the tumor with concurrent eyelid reconstruction. The choice of reconstructive method depended on the size and location of the tumor. Histopathological evaluation was carried out specifying the type of cancer and radical surgery. The long-term results were rated on the basis of medical records and patients' examinations. RESULTS: Tumors were located mostly within the lower eyelid 67 (70.5%) and the medial canthus 17 (17.9%). Basal cell carcinoma was found in 83 (87.3%) cases, while in 12 (12.7%) diagnosed with other, less common cancers. Histopathological verification of tumor margins revealed incomplete excision in 14 specimens (14.7%). Reoperations due to recurrent tumor was performed in 11 (15.6%) cases. Good long-term results of functionally-aesthetic reconstruction of the eyelids was observed in 84 (91.3%) patients. CONCLUSIONS: 1. Basal cell carcinoma is the most common malignant tumor of the oculopalpebral region and originate mainly in the lower eyelid. 2. Significantly higher risk of recurrence exists in a more aggressive form of BCC (infiltrative basal-cell carcinoma) and tumors located in medial canthus. 3. The knowledge of multiple reconstruction methods allows the surgeon to choose the most appropriate one, depending on the size and location of the defect formed after excision of the tumor.

The development of squamous cell carcinoma in a patient after kidney transplantation: a case report.

In patients with organ transplantation as compared to the general population the risk of cancer is significantly increased. The most common changes are malignant tumors of the skin, constituting 30-65% of malignant tumors found in recipients. Potential risk factors for skin cancer after a transplant operation are: solar radiation, immunosuppressive therapy, genetic factors, infection with HPV and skin cancer transmission before transplantation. In contrast to the immunocompetent population, skin cancers in transplant recipients are dominated by squamous cell carcinoma, followed by basal cell carcinoma. Squamous cell carcinoma in patients after transplantation is characterized by a strong tendency to give local recurrences and distant metastases. Due to the high risk of developing skin cancer in transplant recipients, preventive oncology plays an important role in the long-term care of patients after transplantation. This includes: sun protection, education, and early treatment of patients with precancerous lesions. It is also stressed that systematic dermatologic studies need to be carried out in patients after transplantation surgery. The paper contains basic information about skin cancers in organ transplant recipients: epidemiology, potential risk factors, treatment and prognosis. The paper presents also a case of patient who developed squamous cell carcinoma of the skin 3 years after renal transplantation.

Single nucleotide polymorphisms of RAD51 G135C, XRCC2 Arg188His and XRCC3 Thr241Met homologous recombination repair genes and the risk of sporadic endometrial cancer in Polish women.

BACKGROUND: The genes RAD51, XRCC2 and XRCC3 encode proteins that are important for the repair of double-strand DNA breaks by homologous recombination. Therefore, genetic variability in these genes may contribute to the occurrence and progression of endometrial cancer. METHODS: The subject of investigation in the reported study was the distribution of genotypes and the prevalence of alleles of the RAD51 G135C, XRCC2 Arg188His and XRCC3 Thr241Met polymorphism in 230 cases of sporadic endometrial cancer; the polymorphisms were determined by polymerase chain reaction-restriction fragment-length polymorphism methods. RESULTS: The obtained results demonstrated a significant positive association between the RAD51 C/C genotype and endometrial carcinoma, with an adjusted odds ratio (OR) of 3.75 (P < 0.0001). The homozygous C/C genotype was found in 72% of endometrial cancer cases and in 19% of the used controls. The variant 135C allele of RAD51 increased the cancer risk (OR = 1.64 [1.28-2.10]P < 0.0001). There were no significant differences between the distribution of G135C, Arg188His and Thr241Met genotypes in the subgroups assigned to histological grades. CONCLUSIONS: The obtained results indicate that the polymorphism of RAD51, but not of either XRCC2 or XRCC3 genes, may be positively associated with the incidence of endometrial carcinoma in the population of Polish women. Further studies, including those on a larger group of patients, are required to further clarify this point.

RAD51 gene polymorphisms and sporadic colorectal cancer risk in Poland.

BACKGROUND: DNA repair processes play an important role in protection against carcinogenic factors. Mutations in DNA repair genes, which code proteins engaged in repair processes, may lead to carcinogenesis and among others also to colorectal cancer (CRC) development. The genetic variability in RAD51 may contribute to the appearance and progression of various cancers including CRC. The aim of the study was to compare the distribution of genotypes of RAD51 135G>C and 172G>T polymorphism between colorectal cancer patients and controls. MATERIAL AND METHODS: Both polymorphisms were evaluated by PCR-RFLP methods in colorectal tissue of 320 colorectal cancer subjects and 320 healthy subjects who served as controls. RESULTS: In the present work we demonstrated a significant positive association between the RAD51 C/C genotype and colorectal carcinoma. Variant 135C allele of RAD51 increased the cancer risk. However, we did not observe any relationship between each polymorphism and colorectal cancer progression assessed by node metastasis, tumour size and Dukes' stage. CONCLUSIONS: Our results suggest that variant genotypes of the 135G>C of RAD51 polymorphism may be positively associated with colorectal carcinoma in the Polish population. Further studies conducted on a larger group are required to clarify this point.

Single nucleotide polymorphisms in the homologous recombination repair genes and breast cancer risk in Polish women.

Genetic polymorphisms in homologous recombination repair genes that can lead to protein haploinsufficiency are generally associated with increased cancer risk. The aim of the present study was to evaluate associations between the risk of breast cancer and single nucleotide polymorphisms in the genes, encoding three key proteins of the homologous recombination repair: RAD51 (the human homologue of the E. coli RecA protein), X-ray repair cross-complementing group (XRCC) 2 and XRCC3. The polymorphisms studied were G135C of the RAD51 gene (c. -98 G>C; rs1801320), Arg188His of the XRCC2 gene (c. 563 G>A; rs3218536), and Thr241Met of the XRCC3 gene (c. 722 C>T; rs861539). Each polymorphism was genotyped by the PCR-RFLP (restriction fragment-length polymorphism) method in 700 Polish female patients with sporadic breast cancer and in 708 cancer-free women, who served as controls. In the present study, we showed the association between RAD51 G135C polymorphism and the incidence of breast cancer (p < 0.0001), but found no significant association with XRCC2 Arg188His or XRCC3 Thr241Met polymorphism. Instead, significant association was identified between XRCC2 Arg188His or XRCC3 Thr241Met polymorphism and breast cancer progression, assessed by the histological grading. However, each of these three polymorphisms was not associated with the tumor size or the lymph node metastases. This study provides evidence that links single nucleotide polymorphisms of RAD51 and XRCC2/3 genes with the risk of breast cancer in Polish women. In conclusion, RAD51 G135C, XRCC2 Arg188His and XRCC3 Thr241Met polymorphisms may be regarded as predictive factors of sporadic breast cancer in female population.

135G>C and 172G>T polymorphism in the 5' untranslated region of RAD51 and sporadic endometrial cancer risk in Polish women.

BACKGROUND: Despite advanced diagnostic and therapeutic procedures, endometrial cancer (EC) is still responsible for high morbidity and mortality of women. The genetic variability in RAD51 may contribute to the appearance and progression of various cancers including EC. AIM: We investigated the association of polymorphisms in the DNA repair genes RAD51 135G>C and 172G>T with endometrial cancer risk. MATERIAL AND METHODS: The genotypes of RAD51 135G>C and 172G>T polymorphism were determined by PCR-RFLP methods in endometrial tissue of 240 cancer subjects and 240 healthy subjects who served as controls. RESULTS: In the present work we demonstrated a significant positive association between the RAD51 C/C genotype and endometrial carcinoma, with an adjusted odds ratio (OR) of 13.0 (p < 0.0001). The distribution of genotypes for 135G>C SNP in endometrial cancer patients vs. controls was: 10% vs. 27% for GG, 13% vs. 58% for GC and 77% vs. 15% for CC genotype, respectively. Variant 135C allele of RAD51 increased the cancer risk (OR = 1.81; 95% CI 0.11-2.93, p = 0.022). The higher risk of EC occurrence was associated with the combined C135C-G172T genotype (OR = 7.69; 95% CI 3.45-17.12). CONCLUSION: The results indicated that the polymorphism 135G>C of the RAD51 gene may be positively associated with endometrial carcinoma in the Polish population. Further studies, conducted on a larger group, are required to clarify this point.

[The practical value of breast cancer molecular classification]. / Praktyczna wartosc molekularnej klasyfikacji raków sutka.

Breast cancer is the most common female cancer in the Western World and the leading cause of cancer death among women. It is a clinically heterogeneous clinical entity. Histologically similar tumors may have different prognosis and may respond to therapy differently. It is believed that these divergences in clinical behavior are due to molecular differences between microscopically similarneoplasmas. Breast cancer is a complex disease of genetic background characterized by accumulation of molecular alterations resulting in an important clinical heterogeneity. Current prognostic factors (including lymph node status, tumor size, histological grade, hormone receptor status, ERBB2 expression and patient age) are insufficient to predict accurately the clinical outcome. Microarray expression profiling classifies breast cancer into five (or six) molecular subtypes: luminal A, luminal B, basal-like, HER2 and normal breast-like (sometime luminal C, too). The different molecular classes of breast cancer not only have different prognoses but also show distinct sensitivities to preoperative chemotherapy. They have specific clinical profiles, as well (reproductive factors, age and race). It means that new, modified prevention strategy for breast cancer is necessary.

Toxicity of penta- and decabromodiphenyl ethers after repeated administration to rats: a comparative study.

Until recently, pentabromodiphenyl (PentaBDE) and decabromodiphenyl (DecaBDE) ethers were commonly used as flame retardants in a wide array of products, mostly in the production of plastics utilized in the electric, electronic and textile industries. The aim of this study was to compare the toxicity of PentaBDE and DecaBDE after their repeated (7-28 days) intragastric administration to rats. The compounds were given at doses of 2, 8, 40 or 200 mg/kg/day (PentaBDE) and 10, 100 or 1,000 mg/kg/day (DecaBDE). The repeated administration of PentaBDE disturbed redox homeostasis, which was manifested by lower total antioxidant status and increased activity of glutathione reductase in serum and higher concentrations of glutathione reduced and malondialdehyde in the liver. The occurrence of these effects was not observed after DecaBDE administration. The results of histopathological examination showed fatty degeneration after administration of the highest dose of PentaBDE. The repeated administration of PentaBDE also caused the increase in relative liver mass, dose-dependent increase in the activity of CYP 1A (EROD) and CYP 2B (PROD), 7-12- and 2-8-fold, respectively, as well as enhanced level of CYP 1A1 (5-30-fold) and CYP 4A (2-4.5-fold). The administration of DecaBDE induced much less pronounced changes: a maximum 2.8-fold increase in the activity of CYP 1A, a twofold increase in CYP 2B, and no alterations in other parameters under study. Contrary to DecaBDE, PentaBDE disturbed redox homeostasis, and induced liver microsomal enzymes. Fatty degeneration in liver caused by this compound was also found.

Immunoexpression and clinical significance of the PTEN and MLH1 proteins in endometrial carcinomas.

Carcinogenesis is a multistep process resulting from mutations in genes controlling the cellular growth, differentiation, apoptosis, and genome integrity maintenance. We investigated relationships between the PTEN and MLH1 immunoreactivity in the cancer cells and the histological subtypes of endometrial carcinoma as well as the survival times of the affected women. The PTEN and MLH1 protein immunoexpression was also examined separately in both clinicopathological groups of endometrial carcinoma. We estimated the practical use of the proteins as diagnostic and predictive markers. The histoclinical analysis was performed on 104 patients. The follow-up in all the cases was well known. To assess the expression of both proteins in the cancer cells we adopted a semiquantitative immunohistochemical analysis. We proved that the incidence of the PTEN and MLH1 nuclear positive cells was significantly higher in the serous type than in the endometrioid one. We also demonstrated a strong correlation between both cytoplasmic and nuclear PTEN immunoexpression and the survival times in the entire cohort. In conclusion, the PTEN and MLH1 immunohistochemical analysis broadens the microscopic diagnosis of the endometrial carcinomas. However, the PTEN and MLH1 antibodies tests cannot determine the recognition of the cancer, and they should not be regarded as independent prognostic factors.

The recurrent goitre unusually located near the hyoid bone.

INTRODUCTION: Recurrent goitre is a significant clinical problem among patients who have been operated due to benign lesions. An atypical localization of recurrent goitre - near the hyoid bone - poses additional difficulties as there are no data available on the clinical significance of such lesions. The aim of this study was to analyze if this unusual localization of recurrence is related to any significant differences in the clinical course, and if it significantly increases the risk of thyroid neoplasm. MATERIAL AND METHODS: The outcomes of ultrasound (US) and cytological examinations of 62 patients presenting with a goitre recurrence localised as a focal lesion near the hyoid bone were analyzed (mean age 59.4 ± 12.4 years). The analysis included the period from the operation to the lesion-revealing US, the lesion's volume, the presence of ultrasound features of malignancy, the volume of residual thyroid tissue in the thyroid bed, the changes in volumes of examined structures, and the outcomes of cytological examinations. RESULTS: The mean period from the surgery to the US confirming the lesion presence was 16 years, the mean volume of lesion was 2.17 cm³, and the mean period of observation was 3.2 years (ranging from 1 to 10). Fine needle aspiration biopsy was performed in 47 (76%) focal lesions. The cytological results were never suspicious or malignant. In 38% of patients in whom control US was done within the observation period, the lesions enlarged by 20% or more, in 21% of them - by 50%, and in 15% - by over 100%. The category of cytological result did not imply any significant change, even in the case of significant isolated increase in volume of the lesion near the hyoid bone. CONCLUSIONS: Focal lesions near the hyoid bone, revealed in patients operated previously for benign goitre, are not related to increased risk of thyroid neoplasm, and their enlargement does not imply their malignancy.

Metastases of breast cancer to the thyroid gland in two patients - a case report.

INTRODUCTION: Metastatic cancer is rarely found in the thyroid (only 2-3% of malignant tumours found in that gland); primary sources usually including breast, kidney, and lung tumours. CASES REPORTS: Two cases of advanced breast cancer with thyroid metastases in female patients are presented. The similarities between these two cases included: 1) postmenopausal age; 2) diagnosis based on result of FNAB (numerous groups of cells with epithelial phenotype strongly implying metastatic breast cancer); 3) thyroid function - overt hyperthyroidism in the first woman and subclinical hyperthyroidism in the second one; 4) the presence of nodular goitre in clinical examination, the occurrence of many nodular solid normoechogenic lesions with calcifications in both thyroid lobes in US; and 5) negative antithyroid antibodies. The main difference was the time of establishing diagnosis; in the first woman - before mammectomy, parallel to diagnostics of breast tumour, and in the second woman four years after mammectomy, during cancer dissemination (with right pleural effusion and lung metastasis). In the first case, mammectomy was followed two weeks later by thyroidectomy. The second patient was disqualified from thyroid surgery due to systemic metastatic disease. CONCLUSIONS: 1. Fine needle aspiration biopsy of the thyroid gland should obligatorily be performed in patients with breast cancer and nodular goitre, even without any clinical data of metastatic disease. 2. The clinical context of cytological findings is of critical value. 3. In patients with breast cancer accompanied by multinodular goitre, we recommend that more punctures be performed during FNAB than is routinely done. (

Primary perivascular epithelioid cell tumor (PEComa) of the liver: report of a case.

PEComa is very rare mesenchymal neoplasm which is formed by perivascular epithelioid cells and is characterized by dual melanocytic and myoid differentiation. Up to now only a very few cases of PEComa of the liver have been described worldwide. We herein present a patient who underwent a right hemihepatectomy for a huge tumor which could not be identified by imaging investigations. A final histopathologic examination revealed a benign epithelioid tumor with a solid growth pattern, abundant vascularity, and frequently dilated vascular channels. Immunohistochemically, the tumor cells were strongly positive for HMB-45, moderately positive for actin, and faintly positive for S-100, respectively. Based on the above findings, a diagnosis of a primary clear cell "sugar" tumor was established. Because the natural history of PEComas is mostly unpredictable, the patient has been closely followed up; however, no recurrence has so far been observed. Immunohistochemical findings play a crucial role in avoiding a misdiagnosis, and a surgical resection with an adequate margin of healthy tissue remains the gold standard of treatment. A long-term periodic follow-up is reasonable in all cases presenting with PEComa.

Immunohistochemical pattern of protein P21, cyclin D1 and cyclin E in endometrial hyperplasia.

PURPOSE: In our research we investigated immunohistochemical expression of cell cycle proteins protein p21, cyclin D1 and cyclin E in physiological endometrium (n = 15), hyperplastic endometrium (n = 61), and post hormone replacement therapy endometrium (n = 24). MATERIAL AND METHODS: We performed immunohistochemical analysis of selected cell cycle proteins in 100 specimens of human endometrium. RESULTS: The average immunoexpression index scores in glandular endometrial cells (GES) and stromal endometrial cells (SEC) were respectively: for p21- GES: 11.8 +/- 17.19%; SEC: 9.31 +/- 17.15%; for cyclin D1- GES: 9.25 +/- 18.41%; SEC: 3.22 +/- 11.46%; for cyclin E: GES: 26.42 +/- 27.47%; SEC: 4.61 +/- 7.90%. Statistical analysis disclosed more intense p21 glandular immunoreactivity among women with endometrial hyperplasia in comparison to other subpopulations. In the case of assessment of cyclin D1 immunoreactivity, there was no statistical correlation between analysed parameters. The average cyclin E immunoreactivity in endometrial glandular cells was significantly higher (p = 0.003) in women with endometrial hyperplasia and correlated with age. CONCLUSIONS: Intensive immunoreactivity of cyclin E in glandular cells is typical for endometrial hyperplasia and can be treated as an objective indicator of this pathological process during histopathological diagnostic procedures. Immunoreactivity index of p21 and cyclin D1 is independent of the morphological pattern of human endometrium, patients' age and gynaecological history of patients.

Number of mitotic figures in microscopic picture of nephroblastoma histologic types--estimation of the value of the oldest known prognostic factor.

There are two main widely accepted prognostic factors in nephroblastoma group of tumors--histological type of tumor and clinical stage of disease. However nuclear anaplasia, one of the elements of Wilms' tumor microscopic picture was found as a new prognostic marker in this group of tumors. Estimation of nuclear anaplasia is an obligatory procedure in currently used therapeutic protocols. In our work we compared another element of nephroblastoma microscopic picture--number of mitoses as the oldest known indicator of activity of tumor cells with prognostic markers estimated in routine histologic examination according SIOP Protocols (histological risk, nephroblastoma type and the presence of diffuse anaplasia) and with CD44 expression--widely known marker of discussed prognostic value. We found statistically important correlation between number of mitoses and all the examined features. We believe that mitotic figure counting may become in future a helpful tool in the qualification of prognosis for individual patients in doubtful cases.