Comparative Pathology
Zagreb, Croatia
June 6-7, 2008
juraks@kbsm.hr
BONE
MARROW CELL APOPTOSIS IN A PATIENT WITH MONOCYTIC LEUKEMIA
Lj. Vrbanus, M. Sučić, M. Marković-Glamočak, S. Ries, K. Gjadrov-Kuveždić, B. Labar
Division of Cytology, Clinical Department of Pathology and Cytology; Division of Hematology, University Department of Internal Medicine, Zagreb University Hospital Center and Zagreb University School of Medicine, Zagreb, Croatia
The aim
is to report on a patient with monocytic leukemia and
excessive bone marrow cell apoptosis. Cytomorphology of bone marrow (BM) and
peripheral blood (PB) smears was analyzed after standard Pappenheim and
cytochemical staining. Flow cytometry immunophenotyping and cytogenetic
analysis of BM were also performed. A 76-year-old man with heart disease was
admitted to the hospital for progressive weakness and fever. BM fine needle
aspiration (FNA) was done after the finding of leukocytosis and
thrombocytopenia in PB. BM cytomorphological analysis revealed excessive
apoptotic cells (almost 99%) with only few cytomorphologically preserved cells.
In PB there were 80%-90% of monocytic cells (46% monoblasts, 29% promonocytes
and 11% monocytes). Cytochemistry confirmed the monocytic cell lineage while
almost all monocytic cells in PB and apoptotic cells in BM were esterase
positive. These findings pointed to acute monocytic leukemia M5b type. BM flow
cytometry immunophenotyping revealed apoptotic cells with no specific lineage
cell antigens. FISH was negative for t(9;22) and 11q23. Because of the
patient's age and heart disease reduced-dose cytostatic therapy was introduced,
which led to clinical improvement and reduction of leukocytosis in PB. In
conclusion, cytomorphology and cytochemistry of PB point to proliferation of
immature monocytic cells in patients with BM apoptosis. Apoptosis is increased
in myelodysplastic syndromes but some reports have indicated Fas (CD95) and
LAIR-1 mediated apoptosis in M4 and M5 AML types.
GLOSSAL
ANGIOMYOMA: CASE REPORT
T. Bujas1, V. Štitić1,
M. Mlinac-Lucijanić1, S. Anzić1,
1Department of Pathology and Forensic Medicine, ENT Department, Karlovac General Hospital, Karlovac; 2Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
Angiomyoma is an uncommon, benign, soft
tissue tumor characterized by bundles of smooth muscle cells intermixed with
numerous vascular spaces, which usually develops in lower extremities. Most
oral cases occur in the lips and tongue, the latter being quite a rare site. A
58-year-old man was examined at ENT Department,
TRAFFIC
ACCIDENT VICTIMS IN KARLOVAC DISTRICT DURING ELEVEN-YEAR PERIOD
T. Bujas, M. Mlinac-Lucijanić, V. Štitić
Department of Pathology and Forensic
Medicine,
Vehicle accidents in
AUTOPSY
AS A FUNDAMENTAL PART OF QUALITY ASSURANCE IN THE INTENSIVE CARE UNIT
I. Pavić1, D. Ivanović1,
A. Demirović1, P. Radulović1, L. Stemberger2, D.
Baličević1
1Ljudevit
Jurak University Department of Pathology,
The role and number of autopsies performed in
hospitals have declined over the last decades. An increasing number of
retrospective studies analyzed tried to establish the role of autopsy as a fundamental
part of progress in medical knowledge. Intensive care unit (ICU) data pointed
to major discrepancies between clinical and autopsy diagnoses in 10%-25% of
cases. The aim of this study was to assess the correlation between clinical
diagnosis and subsequent autopsy findings in adult patients and to identify the
types of errors in the diagnosis to help upgrade the quality of care at ICU. We
retrospectively reviewed medical records and final autopsy reports of patients
admitted to surgical and non-surgical ICU at our hospital from January 1, 2001
until December 31, 2005, classifying clinical and pathological diagnoses
according to the International Classification of Diseases 10th revision
(1994). In order to compare discrepancies between premortem and postmortem
diagnoses, we used modified classification of Goldman, which divides diagnoses
into 5 classes: class I and II discrepancies were termed major, class III and
IV as minor if clinically diagnosable or not, and class V as non-discrepant
diagnosis. This study addressed class I: a discrepant primary diagnosis with
adverse impact on survival (e.g., unrecognized treatable infection diagnosed as
inoperable tumor mass); and class II: a discrepant primary diagnosis with
equivocal impact on survival (e.g., pulmonary embolus diagnosed and treated as
acute myocardial infarction). During the study period, there were 5133 hospital
deaths, including 2760 (53.7%) and 722 (15.0%) patients that died at internal and
surgical departments, respectively. The total number of autopsies (n=1415) performed
accounted for a minor part (27.6%) of the total number of patients that died at
internal (n=970; 68.5%) and surgical (n=122; 8.6%) departments. The share of autopsy
at internal department ICU was 37.4% (363 of 970) and at surgical ICU 69.7% (85
of 122). Out of 448 ICU autopsies analyzed, 109 (24.3%) were classified as
Goldman class I and 43 (9.6%) as class II. There was no significant sex
difference. The most common discrepant cause of death was cardiovascular
disease (46.6%). The share of pulmonary embolism (up to 40%) was the leading
misdiagnosed cause of death in both classes (I and II). It is concluded that even
in the era of modern diagnostic technologies, pertinent information on
autopsies performed is one of the fundamental parts of diagnostic methods that can
improve future management of ICU patients.
GENDER
AND TRISOMY 21 ANALYSIS ON ABORTED FETUS TISSUE
P. Korać, R. Lasan-Trčić, M. Dominis
Department of Pathology and Cytology,
Amniocentesis examination showed a female
fetus with trisomy 21 suggesting Down syndrome. After medical pregnancy
termination, administrative mistake took place and the fetus was regarded as
male. The only materials left were the heart and femur stored in formalin.
Amniocentesis results could only be confirmed by the available tissue examination.
The heart was submitted to formalin fixation and embedded in paraffin following
standard procedure. The femur needed to be decalcinated for a longer period
than standard bone marrow trephine biopsy and then was submitted to formalin
fixation and embedded in paraffin. FISH technique was performed on sections
from both tissues using probes for chromosomes X and Y, and a probe for
chromosome 21. Results showed two signals that represented X chromosome and
three signals that represented chromosome 21. The data suggested that final
description of the aborted fetus was an administrative mistake indeed. It was a
female fetus that had Down syndrome.
Wnt signal transduction pathway is targeted in
meningioma
M. Zeljko1, N. Pećina-Šlaus1,2 , T. Nikuševa-Martić1,2, D. Tomas3, H. Čupić3, V. Beroš
1Laboratory of Neurooncology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb; 2Department of Biology, School of Medicine, University of Zagreb; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital;
4University
Department of Neurosurgery,
The molecular mechanisms and candidate genes involved in the development of meningiomas still need investigation and elucidation. In the present study, 33 meningiomas were analyzed for genetic changes of the tumor suppressor gene adenomatous polyposis coli (APC), a component of the Wnt signaling. Gene instability was tested by polymerase chain reaction/loss of heterozygosity (LOH) using the restriction fragment length polymorphism (RFLP) method. RFLP was performed by two genetic markers, Rsa I in APC exon 11 and Msp I in APC exon 15. Results of the analysis showed altogether 15 samples with LOH of the APC gene out of 32 heterozygous patients (47%). Seven patients had LOHs at both exons, while 4 LOHs were exclusively found on exon 11 and exon 15 each. According to histopathologic grade, the changes were distributed as follows: LOH was found in 46% of meningotheliomatous, 33% of fibrous, 75% of mixed (transitional) and 75% of angiomatous meningiomas. One LOH was found in a single case of psammomatous meningioma. None of the LOHs was found in atypical and anaplastic cases. Immunostaining showed that samples with LOHs were characterized by the absence of APC protein expression or presence of mutant APC proteins (c2=13.81; df=2; p<0.001). We also showed that nuclear localization of beta-catenin correlated with APC genetic changes (c2=21.96; df=2; p<0.0001). The results of this study suggest that genetic changes of APC gene play a role in meningioma formation.
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Analysis of E-cadherin and beta-catenin genes in germinoma and teratoma
cases
N. Pećina-Šlaus1,2, T.
Nikuševa-Martić1,2, M. Zeljko1, D. Tomas3
1Laboratory of Neurooncology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb; 2Department of Biology, School of Medicine, University of Zagreb; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital,
Genetic basis and the mechanisms of development of germ cell tumors of the central nervous system (CNS) are still unexplained. Changes of E-cadherin (CDH1) and beta-catenin (CTNNB1) genes in two CNS germ cell tumors are reported. Both gene products are components of adherens junctions, but are also involved in the Wnt signaling pathway. A case of germinoma of the CNS and a case of spinal channel teratoma were tested for loss of heterozygosity (LOH) of E-cadherin gene by PCR amplification of tetranucleotide polymorphism (D16S752). Changes of beta-catenin were tested by heteroduplex method. Both germ cell tumors analyzed demonstrated LOH of the CDH1 gene. Analysis of exon 3 of the CTNNB1 gene showed additional band in the germinoma, suggesting that this sample harbored mutation in beta-catenin gene. Immunostaining showed that LOHs in our samples were accompanied by the absence of E-cadherin protein. We also investigated E-cadherin expression in another four germinomas, of which three were negative and one was mildly positive. Our findings may contribute to better understanding of the germ cell tumor genetic profile.
DEVELOPMENT
OF THE RAT EPIGLOTTIS
S.
Marinović-Kulišić1,2, G. Jurić-Lekić2, F. Bulić-Jakuš3,
V. Radujković2, G. Grahovac2, M. Vlahović3, A.
Katušić3,
1University Department of Dermatology and
Venereology, Zagreb University Hospital Center; 2Department of
Histology and Embryology; 3Department of Biology, School of Medicine,
University of Zagreb, Zagreb, Croatia
The ability for differentiation of various undifferentiated embryonic cells and tissues has been extensively investigated for regenerative medicine purposes, i.e. replacement of tissues or organs damaged by trauma or disease. Although epiglottis was used for palpebral reconstruction in human medicine, there are almost no data on the early development of this organ in the rat or its ability to differentiate in a transplant. Moreover, the adult rat epiglottis has not yet been subjected to TEM analysis. Fisher rat epiglottises were microsurgically isolated under a dissecting microscope from 17-day-old Fisher rat embryos and fixed or transplanted under kidney capsules of adult rats where they were left for 14 days. The DNA demethylating agent 5-azacytidine (5azaC) (5 mg/kg) was injected intraperitoneally to the experimental group over the first three days. Adult rat epiglottises were explanted from 3-month-old rats and fixed. Classic histologic and TEM analysis as well as immunohistochemical detection of the Proliferating Cell Nuclear Antigen (PCNA) and quantitative sterological analysis of its expression (numerical density Nv) were performed. PCNA was expressed in almost all cells of the 17-day-old epiglottis, while in transplants its expression was restricted to undifferentiated cartilage and epithelial cells. Differentiation of the cartilage and epithelia in transplants proceeded well but did not reach the stage of differentiation in adult epiglottis because they lacked elastic fibers and stratified squamous epithelium. 5azaC increased PCNA expression (Nv) in transplants. This investigation provided some new data on the rat epiglottis development.
5-AZACYTIDINE
SEEMS NOT TO DISTURB ODONTOGENESIS IN RAT EMBRYONIC MANDIBLE TRANSPLANTS TO
ECTOPIC SITE
I. Turković1, G. Jurić-Lekić1,
F. Bulić-Jakuš2, V. Lokošek1, V. Radujković1,
M. Vlahović2, A. Katušić2, Lj. Šerman2,
1Department of Histology and Embryology; 2Department of
Biology,
In this study, differentiation of the rat embryonic mandibular tooth germs under the influence of the DNA demethylating drug 5-azacytidine (5azaC) was investigated. The 13- and 14-day-old Fisher rat embryonic mandibles were microsurgically isolated under a dissecting microscope. Adult male rats of the same strain were anesthetized and the mandibles were transferred by the braking pipette to the subcapsular kidney space. 5azaC (5 mg/kg) was applied intraperitoneally over three days to the experimental group of animals while controls were treated by PBS. After two weeks, transplants were fixed for routine histology, embedded in paraffin and sectioned. In both experimental and control group of animals, transplants were surviving well. Dental germs developed to the bell stage of tooth development and, apparently, no differences were found in odontogenesis of the experimental and control group of transplants. Because it is known that 5azaC can cause changes in gene expression and disturb development, further studies are to be done to investigate whether odontogenesis in this system is really less susceptible to this DNA demethylating agent.
CARTILAGINOUS
CHORISTOMA OF THE TONGUE IN A 16-MONTH-OLD FEMALE
L. V. Batelja1,
B. Marn2, S. Seiwerth1
1Department
of Pathology,
Cartilaginous choristomas are a rare group
of distinctive tongue tumors. They are usually seen in adults, very rarely in
infants. So far, 28 cases of cartilaginous choristomas have been published
since
EXPRESSION
OF HYPOXIA-INDUCIBLE FACTOR 1-ALPHA (HIF-1ALPHA) AND VASCULAR ENDOTHELIAL
GROWTH FACTOR (VEGF) IN NEPHROBLASTOMA
A. Pajić1, P. Radulović2,
A. Čizmić1, M. Župančić1, M. Bastić1, B.
Krušlin2
1Children's
Hospital Zagreb; 2Ljudevit Jurak University Department of Pathology,
Angiogenesis has an important role in the progression
of solid tumors and is crucial for tumors larger than 1 to
CYTOLOGIC
FEATURES OF MEDULLOBLASTOMA IN CEREBROSPINAL FLUID: REPORT OF TWO CASES
E. García-Ureta, O. Robles Veiga, R. Álvarez
Rodríguez, J. Pombo Otero, P. Vázquez Bartolomé
Citologia Servicio De Anatomía Patológica Hospital Universitario Juan
Canalejo,
Although medulloblastoma is the most common malignant tumor of the brain in children, to the authors’ knowledge there are limited data on the respective cytologic findings. We report on two cases where cerebrospinal fluid (CSF) studies indicated the presence of malignant cells. CSF was obtained by lumbar puncture and examined by cytology for cellularity, percentual differential recount and presence of malignant cells. Cytologic extensions were prepared by cytocentrifugation and stained using the PAP and MGG techniques. In both cases, cytologic examination of CSF revealed abnormal cells. The cells were arranged either individually or in small groups. The cells showed round to oval nuclei, coarse chromatic clumping and scant cytoplasm. The diagnosis of malignancy is quite easy. However, cytologic characterization of these tumors is difficult because of the lack of specific cytologic criteria. Morphologically, the tumor cells are indistinguishable from other anaplastic small-cell tumors.
FINE
NEEDLE ASPIRATION CYTOLOGY (FNAC) IN THREE CASES OF PLEOMORPHIC ADENOMA IN
CHILDREN
E. García-Ureta, O. Robles Veiga, R. Álvarez
Rodríguez, J. Pombo Otero, P. Vázquez Bartolomé
Citologia Servicio De Anatomia Patologica Hospital Universitario Juan Canalejo,
Pleomorphic adenoma is the most common salivary gland neoplasm in children. However, only a few cases of pleomorphic adenoma with cytologic diagnosis have been reported in literature. Here we present cytologic features of three patients. We assessed the cytologic aspect in 3 male patients aged 5, 6 and 7 years. The puncture technique and handling of the aspirated material were performed under normal conditions. Smears were stained using both Papanicolaou and MGG methods. The level of cellularity ranged from moderate to abundant in all three cases. The combined presence of epithelial and mesenchymal elements was recorded in all patients. Epithelial cells were relatively small, uniform in size, had round or oval eccentric nuclei, a bland, granular chromatin, and moderate amounts of densely stained cytoplasm. One of them showed abundant cells with a plasma-like appearance. Red-stained intercellular material (MGG) was seen in all three cases. With these findings, the cytologic diagnosis of pleomorphic adenoma was made and verified by histologic studies. The main differential diagnosis is adenoid cystic carcinoma. Fine needle aspiration cytology is a valuable method to reach an accurate diagnosis in children with clinical presentation of a suspect mass in the parotid gland.
EXPRESSION
OF C-MYC AND CD31 IN MEDULLOBLASTOMA
T. Džombeta¹,
¹School of Medicine,
Medulloblastoma is a highly malignant brain
tumor of neuroectodermal origin. Changes in cell physiology that determine
malignant phenotype are, among others, self-sufficiency in growth signals and
angiogenesis. C-myc is a protooncogene and CD 31 is an adhesion molecule highly
expressed on endothelial cells. The increased expression of c-myc is related to
neoplastic transformation and angiogenesis. We retrospectively reviewed 11
cases of medulloblastoma in children, in which we analyzed the expression of
CD31 and c-myc. Formalin-fixed, paraffin embedded tumor tissue was
immunostained. Immunohistochemical analysis was performed following microwave
streptavidin immunoperoxidase (MSIP) protocol on a DAKO TechMate™ Horizon
automated immunostainer (DAKO). The intensity of staining for c-myc was graded
semiquantitatively in 1 high-power field (HPF) and denoted as (-) for no
immunostaining, (+) for weak staining, (++) for moderate staining and (+++) for
intense staining. CD 31 was assessed as microvascular density (MVD) per 1 HPF and results were expressed
semiquantitatively as 1 for up to 20 blood vessels per HPF, 2 for >20 to 40 blood vessels per HPF and 3 for more than 40 blood vessels per HPF. Most (n=6) medulloblastomas showed weak (+) c-myc
expression. MVD was
Lipofibromatosis
in a TEN-year-old girl
Z. Marušić1, C. Lež2, B. Krušlin1, D.
Tomas1
1Ljudevit Jurak University
Department of Pathology, Sestre milosrdnice University Hospital, Zagreb; 2Department
of Pathology, Zabok General Hospital, Zabok, Croatia
Lipofibromatosis
is a rare pediatric fibrofatty tumor proposed as a distinct entity in 2000, previously
designated as infantile fibromatosis or fibrous hamartoma of infancy. It has
been reported exclusively in children, mostly males (male to female ratio 2:1),
from infancy to the early second decade of life, with a predilection for
extremities. Some of the cases were congenital. We report a case of plantar
lipofibromatosis in a 10-year-old girl who had experienced plantar pain for
several months prior to excision. She had not previously had any similar
symptoms or surgical procedures for soft tissue tumor. The tumor was
yellowish-white in color, measuring up to
GLANDULAR
PAPILLOMA OF THE BRONCHUS: REPORT OF A CASE AND REVIEW OF THE LITERATURE
D. Kolenc1, Š. Križanac1,
M. Golemac1, D. Baričević2,
1Department
of Pathology,
Glandular (or columnar cell) endobronchial
papilloma is a very rare neoplasm and only eight cases have been described. The
WHO defines glandular papilloma as a papillary tumor lined by ciliated or
non-ciliated columnar cells, with a varying number of cuboidal cells and goblet
cells. We report a case of glandular papilloma on the right upper lobe bronchus
in a male patient. A 74-year-old man was admitted to the hospital because of
dyspnea, cough, loss of weight and dysphagia. The patient was suffering from
hypertension and chronic obstructive pulmonary disease. The patient had an
infiltrative lesion of the lower left pulmonary lobe, which was cytologically
diagnosed as squamous cell carcinoma. Fiberoptic bronchoscopy demonstrated an
irregular polypoid lesion arising from the superior segment of the right upper
bronchus and biopsy was performed. The resected tissue measured up to
REINKE'S
D. Ježek1, V. Kozina1,
L. Kubinova2, B. Drakulić1, K. Šemanjski1, Lj.
Banek1, G. Jurić-Lekić1,
1Department of Histology and Embryology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Biomathematics, Institute of Physiology, Academy of Sciences, Prague, Czech Republic; 3University Department of Urology, Zagreb University Hospital Center, Zagreb, Croatia
Reinke's crystals are a unique feature of human Leydig cells. They could be occasionally found within the cytoplasm and nucleus of these cells. The crystals are composed of 10-nm thick filaments that are believed to be of protein structure. Our aim was to determine the number of crystals in control, azoospermic and cryptorchid testes. In addition, we tried to visualize the crystal 3-D structure. Testicular biopsies were obtained by an “open biopsy” method. Tissue was fixed in Gendre, dehydrated and embedded in paraffin. Serial sections were stained by H&E and a modified Masson's method. So far, the numerical density of crystals was measured in 10 biopsies from azoospermic patients (without history of cryptorchidism), 10 testicular samples from patients with cryptorchidism and 3 control specimens. For 3-D reconstruction of Reinke's crystal, confocal microscopy and the Ellipse 3D software (ViDiTo, Slovakia) were used. Preliminary results indicate an increase in the number of crystals in cryptorchid testes and a slight decrease in azoospermic patients when compared to controls. Preliminary 3-D analysis of the crystal confirmed its biocrystalline nature. Further morphometric investigation of the crystal is in progress.
ECTOMESENCHYMAL
CHONDROMYXOID TUMOR OF THE TONGUE: A CASE REPORT
M. Perić-Balja1, P. Radulović2,
Z. Marušić2,
1Department of Pathology, University Hospital for Tumors; 2Ljudevit Jurak University Department of Pathology; 3University Department of ENT, Sestre milosrdnice University Hospital, Zagreb, Croatia
Ectomesenchymal chondromyxoid tumor of the
tongue was first described as an entity in 1995. To date, only 27 cases have
been reported in the literature. Clinically, this benign neoplasm presents as a
solid, painless, slowly growing mass that typically involves the anterior
dorsal tongue. We report an additional case. We present a case of a 53-year-old
female patient with a solid, slowly growing, painless mass on the anterior
dorsal tongue that had appeared 2 months before. A segment of the tongue with a
mildly elevated tumor of yellowish solid cut surface, measuring
CYCLOSPORINE
INDUCED BIOCHEMICAL REMISSION IN CHILDHOOD AUTOIMMUNE HEPATITIS
O. Žaja-Franulović, M. Požgaj-Šepec, Z. Jurčić
University Department of Pediatrics,
Autoimmune hepatitis (AIH) is a rare inflammatory disease of the liver that may progress to cirrhosis. Currently used immunosuppressive therapy with prednisone and azathioprine fails to induce remission in a significant percentage of patients. We report our experience in AIH pediatric patients treated with cyclosporine (Cys; Neoral) as first-line immunosuppression. During the 1999-2007 period, eight children with AIH, diagnosed according to the established international criteria were recruited. Two were withdrawn from the study because Cys therapy had just been initiated for several months. According to the suggested protocol, Cys was administered orally in 2 divided doses (3-5 mg/kg/d), adjusted to maintain therapeutic serum Cys levels of 200-300 ng/mL. After 3 months, when transaminase activity tended to normalize, oral dose of Cys was adjusted to achieve serum concentration of 100-200 ng/mL. Conversion to low dose of prednisone (0.3-0.5 mg/kg/d) and azathioprine (1-2 mg/kg/d) was started after 6 months, with gradual tapering of Cys dose, and discontinued over a period of 2 weeks. Six patients, age range 4.0-17.7 years (10.56±5.51), initially had elevated transaminases and gamma globulin, with proven inflammatory/necrotic process in 5/6 patients that underwent liver biopsy. Serum ANA/SMA autoantibodies were positive in all but one patient with positive LKM1 serologic marker. In all patients, complete or near normalization of transaminase activity in serum occurred within the first 3-6 months of therapy and there was no relapse after Cys withdrawal. During the follow up, biochemical relapse occurred in one patient after discontinuation of minimal prophylactic corticosteroid doses. Immune mediated extrahepatic disease was present or developed in two patients, i.e. ulcerative colitis and hemolytic anemia in one each. Side effects of Cys were minimal and well tolerated. Data on the use of Cys in children with type 1 and 2 AIH are limited. Our results indicate that Cys given as first-line therapy is able to induce complete biochemical remission in children with AIH.
HID-AB
MUCIN HISTOCHEMICAL ANALYSIS IN GOBLET AND NON-GOBLET BARRETT ESOPHAGITIS
I. Pavić, D. Ivanović, A. Demirović, P. Radulović, D. Baličević
Ljudevit Jurak University Department of
Pathology,
The syndrome of peptic ulceration of the esophagus arising in the gastric type epithelium associated with an esophageal stricture described by Barrett in 1950 was considered, incorrectly, to be due to congenitally short esophagus. Since then, the syndrome has been called Barrett's esophagus; however, replacement of squamous epithelium by columnar epithelium, resembling gastric or intestinal mucosa, has been described later, mostly due to reflux esophagitis. Recently published studies that used various mucin histochemical stains in observed specimens to identify neutral mucins and acid mucins (sialomucins and sulfomucins) indicate that the intestinal type does not necessarily resemble normal small intestine. It is presumed that the diagnosis of Barrett's esophagus is not forced only by histologic findings of goblet cells but also of acid mucin-positive non-goblet columnar cells (NGCC) in the surface epithelium of biopsy specimens. However, the significance of the acid mucin-positive NGCC finding in the surface epithelium from the distal esophagus/gastroesophageal junction (GEJ) in the absence of goblet cells (GC) remains unknown. The aim of the study was to assess the prevalence of sulfomucins in endoscopic biopsies of patients with a columnar lined (Barrett's) esophagus. We compared histopathologic features of biopsy specimens in the surface, foveolar and glandular epithelium taken from the distal esophagus/GEJ diagnosed as Barrett's esophagus in the presence of special columnar epithelium with and without goblet cells. We randomly selected biopsy specimens of 33 patients from our database from the 2000-2008 period. The specimens were stained with alcian blue/periodic acid-Schiff stain (AB-PAS) and high-iron diamine/alcian blue (HID-AB) dividing results into two groups: Barrett's esophagitis with and without GC. Out of 33 stained specimens, 21 were of special columnar intestinal metaplastic (IM) type (type I = 0, type II = 10, type III = 11) with 9:12 male/female ratio, and 12 were NGCC (type I = 0, type II = 7, type III = 5) with 8:4 male/female ratio. In the GC and NGCC group, acid-mucin (sulfomucin)-positive cells were detected in 11 (52%) and 5 (42%) cases, respectively. In the lack of classic special columnar epithelium (with goblet cells) in the esophagus, the presence of metaplastic junctional type of mucosa may quite probably be considered as an initial step towards transformation to the classic Barrett's mucosa, most of all because of the definition of Barrett as a precancerous condition for esophageal adenocarcinoma. As Barrett's esophagus is a precancerous lesion, additional research is needed to evaluate whether the neoplastic progression is related to its mucin profile or the detection of acid-mucin (sulfomucin)-positive non-goblet cells is an early form of intestinal metaplasia, thus deserving attention and follow up.
COMPOSITE
GLANDULAR-ENDOCRINE CELL CARCINOMA OF THE STOMACH
L. Stemberger1, J. Slipac1,
A. Demirović2,
1School
of Medicine,
Composite glandular-endocrine cell
carcinoma, also called adenocarcinoid, is recognized as a special type of
gastric tumor composed of ordinary adenocarcinoma and neuroendocrine tumor. The
existence of composite tumors poses nosologic, histogenic and diagnostic
problems. Adenocarcinomas containing endocrine cells appear to be as
biologically aggressive as the usual adenocarcinomas of the stomach. This type
of tumor in the stomach is a very rare finding and, to our knowledge, there are
only few reports in the literature, without specific numbers to describe its incidence.
We report on a rare case of gastric collision tumor composed of adenocarcinoma
and carcinoid. A 63-year-old-man complained of inappetence and weight loss
within the previous 2 weeks, with nausea after meal and occasional vomiting. He
had epigastralgia on pressure and while coughing. Physical examination showed
icterus and
BILATERAL
WILMS' TUMOR IN A NEWBORN WITH TRISOMY 18
M. Kos, T. Leniček, M. Ulamec
Ljudevit Jurak University Department of
Pathology,
Wilms’ tumor is the most common malignant
renal tumor in children. It is bilateral in 4%-13% of affected children. Five
percent of bilateral Wilms’ tumor cases have synchronous presentation and are
often associated with the presence of nephrogenic rests, congenital
malformations or predisposing syndromes. We present a case of bilateral Wilms’
tumor found on autopsy in a newborn with trisomy