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20TH LJUDEVIT JURAK INTERNATIONALjuraks@kbsm.hr ABSTRACTS |
| Main topics Pathology of the Male Genital Tract |
PATHOLOGICAL MORPHOLOGY OF THE HUMAN AND ANIMAL DISEASE
FEATURES OF PROSTATE NEEDLE BIOPSY CORES AS
PROGNOSTIC FACTORS OF PSA RECURRENCE AFTER RADICAL PROSTATECTOMY
B. Spajić
University
Department of Urology,
The aim of the
study was to determine whether the percentage of carcinoma in needle biopsy and
percentage of positive biopsy specimens as well as the localization of
carcinoma in the prostate could be used as reliable predictors of biochemical
relapse (BCR) in patients having undergone radical prostatectomy. The study
included 340 patients that underwent radical prostatectomy at University
Department of Urology,
INTERPROFESSIONAL
MEDICAL EDUCATION AND ROLE OF COMPARATIVE PATHOLOGY
S. Tkalčić
Western University
of Health Sciences, Pomona, CA, USA
Interprofessional education is a fairly recent trend in medical education and
practice with the goal to provide the most efficient and comprehensive approach
to quality medical service and quality patient care. In this context,
comparative pathology provides good support and common grounds to involve basic
medical science in this process. Information explosion in medicine and
biotechnology in the last few decades warrants the need for multiprofessional
involvement and collaboration in medical diagnosis and patient care. Medical
education is the first to introduce and start pilot programs to implement this
trend into medical curricula worldwide.
Small group settings with a Problem-Based Learning (PBL) approach are a good
model for this effort. Many non-clinical and clinical competencies evolve from
small group exercises in PBL, and in the same time, many learning issues
generated from a given clinical scenario bring students from different
backgrounds to contribute their expertise into collaborative efforts of case
development. Different aspects of comparative pathology can bring students into
the consideration of evidence based medicine in this process, by looking into
mechanisms of disease, basic research using animal models, advances in
pharmacology and clinical research, but also in consideration of public health
and food safety issues in lieu of medical and veterinary pathology.
THE
IMPACT OF 5-AZACYTIDINE ON CELL HOMEOSTASIS IN MAMMALIAN MALE GONAD
A. Katušić1,
E.G. Van Donselaar2, A. J. Verkleij2, F. Bulić-Jakuš1,
M. Vlahović1, Lj. Šerman1,
N. Sinčić1, F. Paić1, G.
Jurić-Lekić3
1Department of Biology, School of Medicine,
University of Zagreb, Zagreb, 2 Cellular Architecture and
Dynamics, Electron Microscopy and Structural Analysis, Faculty of Sciences,
Utrecht University, The Netherlands, 3Department of Histology and
Embryology, School of Medicine, University of Zagreb, Zagreb, Croatia
The anticancer agent 5-azacytidine (5azaC, Vidaza) is a cytosine-based analog which causes
DNA hypomethylation. As DNA methylation is an important mechanism of regulation
of gene expression in gametogenesis, several studies
have shown a severe, dose-dependent disruption of spermatogenesis in
5-azaC-treated adult animals. We investigated the effect of 5azaC treatment on
fetal development of male gonad. 5azaC in a dose of 5 mg/kg was given to female
Fisher rats by a single intraperitoneal injection on day 13, 14, 15 or 16 of
pregnancy. On day 20, fetal testes were isolated and processed for routine
histology or electron microscopy. Immunolabeling was
done using two apoptotic markers, i.e. antibody against cleaved caspase-3 (Asp175) (Cell Signaling Technology)
and antibody against early apoptotic marker γ-H2AX (Cell Signaling
Technology), on semi-thin Tokuyasu cryosections. Light and electron microscopy revealed gonocytes in various stages of apoptosis in testes of all
experimental groups. The highest incidence of apoptotic cells was detected in
tubules of the group treated on day 15. However, less γ-H2AX positive
cells were found, with the characteristic γ-H2AX foci in the nucleus and
the early-to-middle apoptotic stage morphology. Testes of control fetuses were
negative for the presence of apoptotic cells or any apoptotic marker. It was
concluded that 5-azaC disturbed cell homeostasis in fetal rat gonad by causing
apoptosis. Day 15 of pregnancy seemed to be the most sensitive period for the
action of 5-azaC.
DNA methylation status during experimental
mouse teratocarcinoma development
1Department of Medical
Biology, School of Medicine, University of Zagreb, Zagreb, Croatia, 2Epigenetics
Group, International Agency for Research on Cancer, Lyon, France
Normal embryonal development and cancer development are regulated by the epigenetic mechanism of DNA methylation. Experimental mouse teratocarcinoma contains differentiated tissues and undifferentiated embryonal carcinoma (EC) cells. The aim of this study was to determine DNA methylation pattern of several genes possibly involved in teratocarcinoma development such as Brca1, Stat3, PRSS21 and SCGB3a1 and stemness genes Oct4, Sox2 and Nanog. In this experiment, 7.5-day-old C3H embryos were transplanted under the kidney capsule of syngeneic adults. Teratocarcinomas were isolated and weighed after 4 weeks and 8 weeks. DNA was isolated. After bisulfite conversion and PCR amplification, DNA methylation was analyzed by pyrosequencing. After 4 weeks, teratocarcinomas were much smaller than those obtained after 8 weeks. DNA methylation of transcription factor and tumor-suppressor genes was similar in the embryo and in both groups of teratocarcinomas, thus probably not being involved in embryonal cell transformation and growth of experimental teratocarcinoma. On the other hand, stemness genes were less methylated in the embryo than in teratocarcinoma. We can speculate that DNA methylation reprogramming of the mentioned genes during cancer development is due to cell differentiation of the teratoma component within teratocarcinoma. Further intensive growth of teratocarcinoma after 4 weeks is probably the consequence of established stability of DNA methylation statuses between undifferentiated EC component and already differentiated cells allowing EC cells intensive proliferation without differentiation.
ANTIOXIDANT
PBN AMELIORATES THE TERATOGENIC EFFECT OF 5-AZACYTIDINE IN RAT
1Department of Biology, 2Department of Histology and
Embryology, School of Medicine, University of Zagreb, Zagreb, Croatia
The effect of the antioxidant N-tert-butyl-α-phenylnitron (PBN) on teratogenesis induced by the DNA demethylating agent 5-azacytidine (5azaC) was investigated in rat. On days 12 and 13 of gestation, Fisher rats were pretreated by an i.v. injection of PBN (40 mg/kg) and one hour later treated by an i.p. injection of 5-azaC (5 mg/kg). On days 15 and 20 of gestation, fetuses were isolated and their development compared. PBN treated fetuses developed with no difference from untreated controls. PBN significantly improved survival in combination with 5azaC, although this survival was still significantly worse than in controls. On day 15 of gestation, embryo weight was similar in controls, PBN and PBN/5azaC treated embryos, whereas 5azaC treated embryos were significantly smaller. On day 20, embryos were significantly smaller also in the PBN/5azaC treated group, although their weight was significantly higher than in the 5azaC treated group. Similar results were also obtained for crown-rump lengths, which were longer after PBN pretreatment on both days 15 and 20. Limb malformations were found in all fetuses treated with 5azaC, even in those pretreated with PBN. However, after PBN pretreatment, the number of adactyly in front- and hind-limbs was significantly smaller and of oligodactyly significantly higher as compared with only 5azaC treated group. In limb-buds, cell proliferation (Nv PCNA) was significantly lower in 5azaC treated group than in controls and slightly higher in PBN pretreated group. PBN significantly improved most of developmental parameters when used as a pretreatment to 5azaC, which can lead to a conclusion that the teratogenic impact of 5azaC could at least partially depend on the activation of oxidative stress pathways.
4-HYDROXYNONENAL
IN HUMAN AND ANIMAL CHRONIC LIVER DISEASES
M. Ćorić1, Ž. Grabarević2,
M. Štroser3, L. Andrišić3, G. Waeg4,
L.
Brčić5, N. Žarković3
1Clinical
Department of Pathology and Cytology, Zagreb University Hospital Center,
Zagreb, 2Veterinary Faculty, University of Zagreb, Zagreb, 3Ruđer
Bošković Institute, Zagreb, 4Institute
of Molecular Biosciences, Graz, Austria, 5School of Medicine, University
of Zagreb, Zagreb, Croatia
The aldehyde
4-hydroxynonenal (HNE), a peroxidation product of polyunsaturated fatty acids,
is considered the most reliable indicator of endogenous lipid peroxidation in vivo. Lipid peroxidation is an
autocatalytic mechanism leading to oxidative destruction of cellular membranes.
Oxidative stress is an epiphenomenon of hepatitis and a pathogenic factor of
liver cirrhosis, while HNE acts as a growth regulating factor and signaling
molecule. The aim of the study was to investigate the presence of HNE-modified
proteins in human and animal cirrhotic liver by immunohistochemistry. Thirty fixed paraffin-embedded cirrhotic liver
samples were retrospectively selected for the study.
There were 4 cases of
cardiac liver cirrhosis in dogs and 30 cases of various human chronic liver
diseases in the stage of cirrhosis. There were 15 cases of chronic hepatitis C
and B, 4 cases of hemochromatosis, 4 cases of Wilson's disease, and 3 cases of
alcoholic cirrhosis. Slides of paraffin-embedded tissue were prepared for
immunohistochemistry with monoclonal antibodies to HNE-histidine
conjugate. Positive immunohistochemical reaction to HNE was analyzed
semi-quantitatively. Intracellular HNE adduct localized in hepatocyte cytoplasm
was detected in 25 of 30 cases (83%). The strongest
staining was noticed in cases of Wilson’s disease, hemochromatosis, alcoholic
liver diseases and cardiac liver cirrhosis in dogs. Weak staining was observed in
cases of chronic hepatitis C and B. The results of the
study indicated that HNE could be detected in several chronic human and animal
liver diseases. Therefore,
detection of lipid peroxidation could be used in predicting development of
fibrosis and cirrhosis in chronic liver diseases.
REINKE'S
V. Kozina1, Lj. Banek1,
1Department of Histology and Embryology,
School of Medicine, University of Zagreb, 2Division of Molecular
Biology, Ruđer Bošković Institute, Zagreb, Croatia
Reinke's crystals are normal constituents of Leydig cells in humans but their nature
and function are poorly understood. The crystals resemble hexagonal prisms of
variable size (around 3 μm). They are composed
of parallel 10-nm filaments and do not have a unit membrane. Sometimes the
crystals cause deformity of the nucleus and infolding of the nuclear membrane
of Leydig cells. In some cases, Reinke's crystals are
observed like tiny rods within the nucleus. The aim of the study was to
investigate the properties of Reinke's crystals in
healthy and cryptorchid men. We used 20 biopsies from patients with
cryptorchidism and 6 biopsies from men with normal spermatogenesis (age 20-30
years). Tissue was fixed in Gendre, embedded in
paraffin and serially sectioned into 7-µm thick sections. After staining with
modified Masson's method, specimens were observed and stereologically
analyzed. To get closer look of the shape and placement of crystals we used Leica confocal microscope.
Stereological analysis revealed a significant increase in the number of Reinke's crystals within cryptorchid testes in comparison
with controls. The images obtained on confocal
microscope showed a hexagonal form of the crystal. Placement of the crystals
was not restricted to Leydig cells only, since the crystals could be found
within the rest of the interstitial compartment.
THE
INCIDENCE AND PROGNOSTIC VALUE OF HISTOLOGIC CHANGES IN BONE MARROW BIOPSIES
FROM PATIENTS WITH NON-HODGKIN'S LYMPHOMA
G. Petrusevska1, A. Stojanovic2,
L. Cevrevska2,
1Institute of Pathology, 2University
Department of Hematology, School of Medicine, Skopje, R. Macedonia
The aim of the study was to evaluate histologic changes in the bone marrow of patients diagnosed with non-Hodgkin's lymphoma (NHL) and to determine their prognostic value. The study included 189 patients diagnosed with NHL in nodal and extranodal tissue and undergoing bone marrow biopsy for staging of the disease. The patients were followed-up for nine years, with a minimal follow up period of 4 months. Clinical data were obtained from patient histories. Standard histochemical and immunohistochemical staining was done on decalcified, formalin fixed and paraffin embedded bone marrow biopsies. Histologic analysis of bone marrow biopsy specimens showed the presence of lymphomatous infiltration in 79 (41.8%) cases, which yielded no significantly different influence on survival between the groups. The presence of tumor myelopathy was found in 117 (61.9%) cases, associated with worse survival than the rest of study patients. The patients with osteolytic and osteoporotic changes (14.3% and 35.4%, respectively) had worse survival than those with osteosclerotic (5.8%) and normal bone trabecules (44.4%). The probability to survive was better in the group of patients with normal cellularity than in those with aplastic bone marrow and hypercellular marrow spaces. The presence of dysplasia in the three cell lines was an unfavorable prognostic factor: 32.8%, 29.8% and 29.1% of patients with dysplasia survived for 36 months of the disease onset; at longer period these percents fell down to 10.9%, 9.9% and 9.7%. The increased number of eosinophils had no influence on survival. Changes in the stromal tissue had no significant effect on survival in patients with NHL.
TRANSMISSIBLE
VENEREAL TUMOR IN MALE DOGS IN THE
S. Tkalcic1, M. Blauvelt2, R. E. Moreland2
Transmissible venereal tumor (TVT) is a
round cell tumor primarily of the mucous membranes and skin of the external
genitalia in dogs of both sexes. TVT is a typically sexually transmitted neoplasia that can also occur on different sites of the
body due to patterns of sexual behavior. They can spontaneously regress, and
can be managed either by surgical excision and/or chemotherapy (Vincristine),
depending on the location and extent of the disease. In this study, we analyzed
Antech diagnostics database for a 3-year period to
establish recent trends in the occurrence and distribution, as well as the incidence
of this tumor in male dogs across the USA. During the 2006-2008 period, of a
total of 224 recorded male dog cases submitted for cytology and biopsy that
matched the search for diagnosis of TVT, 108 carried a definitive diagnosis of
TVT. In these cases, the predominant location of tumor occurrence included
penis and prepuce. Distant sites included nostril, nasal cavity and anus. In
the remaining 116 cases, the tumor was diagnosed as a round cell tumor and TVT
was considered one of the main differential diagnoses, along with histocytoma, amelanotic melanoma,
plasmacytoma, or a mast cell tumor. In these cases, the
tumor was less differentiated and excised from various locations of the body.
Comparative
study of peritubular tissue in human and rat aging testEs
I. E. Plesea1, O.
T. Pop1, S. D. Enache2, E. Mandache3, M.
Gherghiceanu3, B. Stanoiu1, A. Butaru1
1University of Medicine and Pharmacy,
Craiova, Romania, 2Emergency County Hospital, Craiova, Romania, 3Victor
Babes National Institute, Bucuresti, Romania
The thickness of peritubular
tissue (PT) of human and rat aging testes was assessed and compared. The study material consisted of testicular tissue samples from 28 cases with orchiectomy for prostate
adenocarcinoma and from 12 Wistar rats. Tissue samples were
processed by the classic histologic technique and stained, on serial slides,
with hematoxylin-eosin, Goldner trichrome
and immunomarked for smooth muscle actin. Images were acquired and measured with image
analysis software. The assessed parameter was thickness of PT (PT-Th). Thirty seminiferous tubules (ST) were randomly
selected for each case with X40 objective and 5 random determinations for each
ST were performed. The mean PT-Th (M-PT-Th) for each ST, case and age group was calculated.
Regression line (RL), slope (m) and slope significance test (P) were calculated
for comparison between human and rat PT-Th. Human M-PT-Th was 6.6
µm, with discretely decreasing RL and statistically non-significant P
value. The internal LP layer quite commonly revealed areas of collagen focal
denseness, with frequent foci of hyaline degeneration, occasionally showing circumferential,
collar-like distribution around the ST. Rat M-PT-Th was around
2.5 µm, with no significant trend of variation with
age. PT revealed a simpler architectural pattern than the human one and no
morphological changes were observed in different age groups. In conclusion, human
PT underwent degenerative changes with aging, especially in its internal layer,
with a "mosaic", focal distribution and no tendency to advance with
aging. In contrast, rat PT showed no morphological changes with aging. Neither human
nor rat PT showed any variation in thickness with age.
UROTHELIAL
CARCINOMA OF URINARY BLADDER WITH SQUAMOUS, OSTEOSARCOMATOUS AND PLASMACYTOID
DIFFERENTIATION: A CASE REPORT
Z. Marušić1, G. Krajačić-Jagarčec2, D. Trnski3, B. Krušlin1
1Ljudevit Jurak
University Department of Pathology, Sestre
milosrdnice University Hospital, Zagreb, 2Zabok County Hospital, Zabok,
3University Department of Urology, Sestre
milosrdnice University Hospital, Zagreb, Croatia
Urothelial carcinoma has a propensity for divergent histologic
differentiation. Divergent differentiation frequently parallels high grade and
high stage urothelial cancer. Sometimes a broad
spectrum of bladder cancer variants can be encountered in a single bladder
tumor specimen. The most common differentiation pattern is the squamous one,
which is defined by the presence of intercellular bridges or keratinization and occurs in 21% of urothelial
carcinomas of the bladder. Other variants include nested, microcystic,
micropapillary, lymphoepithelioma-like,
lymphoma-like, plasmacytoid, sarcomatoid,
giant cell and undifferentiated variant. We report a case of an 83-year-old man
with urothelial carcinoma of the urinary bladder
harboring plasmacytoid and osteosarcomatous
foci along with a more common pattern of squamous differentiation. According to
the literature, the most common heterologous element in the sarcomatous
variant is osteosarcoma. It is important to emphasize
that divergent differentiation must be noted, as it usually carries a worse
prognosis, in part probably due to the fact that it parallels high grade urothelial cancer. Squamous differentiation seems to be an
unfavorable prognostic factor, being predictive of a poor response to radiation
therapy and possibly also to systemic chemotherapy.
FOLLOWING
THE FOOT-PRINTS OF LJUDEVIT JURAK
M. Mlinac-Lucijanić1, T. Bujas1, I. Pavić2
1Department
of Pathology and Forensic Medicine, Karlovac General
Hospital, Karlovac, 2Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
„Show me the manner in which a nation or community
cares for its deads and I will measure with
mathematical exactness the tender sympathies of its people, their respect for
the laws of the land and their loyalty to high ideals“. Gladstone
Since the days of Professor Ljudevit Jurak who is the honest
man skilled in forensic medicine and death investigation in Katyn
Forest Massacre in Poland, until today, investigations of mass death and
skeletal remains remain an imperative for providing physical evidence of the
crimes committed. Forensic science is a fundamental transitional justice issue
as it is an imperative for providing physical evidence of the crimes committed
and a framework for interpreting evidence and prosecuting violations according
to the International Humanitarian Law (IHL). The evaluation of evidence
presented in IHL trials and the outcomes of various rulings by such courts, the
accuracy and validity of the methods to be applied in future investigations are
necessary to ensure scientific quality. Accounting for biological and
statistical variation in the methods applied across population and the ways in
which such evidence is used in various judicial systems are important because
of the increasing amount of international forensic casework being done
globally. The excavation of graves, examination of their contents, and analysis
of the remains have an additional purpose, i.e. to collect forensic evidence
that would permit prosecution of those responsible for mass graves, crimes
against humanity and international human rights violation. Yet, the numbers of
unidentified victims remain high due to the lack of ante mortem medical and
dental records, or simply because of unavailability of more expensive methods
of identification. Answers to these issues are essential to promote
reconciliation and justice, give the rights to the dead, and provide moral and
emotional satisfaction to the living at any time possible.
NEUROENDOCRINE
TUMOR IN LARGE BOWEL BIOPSY
I. Veliki-Dalić1, I.
Pavić2, A. Demirović2, D. Baličević2
1Department
of Pathology, University Hospital for Tumors, Zagreb, 2Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
Large intestinal carcinoid
tumors account for approximately 6% of all neuroendocrine
tumors (NETs), with an equal sex distribution and
incidence of 0.07-0.11 to up to 0.21 cases per
100,000 population per year. It is reported at any age from 9 to 83 years, at 64 to 66
years of age on an average. We analyzed gastrointestinal endoscopic biopsies
for carcinoid with respect to histopathologic particularities.
In this retrospective cross-sectional study, 6500 gastrointestinal endoscopies
routinely performed at Department of Gastroenterology from January 1, 2008 till
March 31, 2009 were analyzed. The diagnosis was established according to a set
of typical histological findings with standard hematoxylin and eosin staining
and immunohistochemistry (synaptophysin, chromogranin). Of all gastrointestinal biopsies analyzed,
there were 5 (0.08%) cases of neuroendocrine tumor.
Three of these 5 cases were found in the stomach, and one in the duodenum and
colon each. In addition, five carcinoids from our
database were diagnosed after wide intestinal resection, where one specimen was
from the small intestine, two specimens were from the ascending colon, one from
the appendix, and one was located in the rectosigmoid.
Colonic neuroendocrine tumor is associated with worst
prognosis among all gastrointestinal carcinoid tumors,
with an overall 5-year survival of 33% to 42%. The features such as tumor size
and microinvasion tend to be less useful on assessing
the prognosis of colonic carcinoid than in other
gastrointestinal locations, because at the time of presentation the tumor
exceeds
PROSTATE-SPECIFIC ANTIGEN AND GLEASON
GRADING OF PROSTATE CANCER: REVIEW OF COMPUTER DATABASE 1994-2007
M. Mlinac-Lucijanić1, T. Bujas1,
D. Katušin2
1Department of Pathology, 2Department
of Urology, Karlovac General Hospital, Karlovac,
Croatia
Adenocarcinoma of the prostate is one of the most common malignant tumors in men over 50 years of age. It is characterized by an aggressive clinical course and heterogeneous multimodal histomorphological changes. Prostate-specific antigen (PSA) is the most reliable serum marker in the diagnosis and observation of prostate carcinoma, while Gleason scoring system is a generally accepted method to determine histological grade. The aim of the study was to analyze cases of prostate carcinoma in biopsy material obtained during a 14-year period and to compare PSA level and Gleason score in patients that underwent radical treatment. We used computer database of Departments of Urology and of Pathology, Karlovac General Hospital, for the period from January 1, 1994 to December 31, 2007. During the study period, prostate cancer was diagnosed in 603 patients at Department of Urology, Karlovac General Hospital. Tumors were classified as localized (T1-2N0M0) in 238 (39.5%), locally advanced (T3-4N0-1M0) in 244 (40.5%), and metastatic (T1-4N1M1) in 121 (20.0%) patients. Radical treatment was used in 115 (19.1%), hormonal therapy in 445 (73.8%), and watchful waiting was recommended in 43 (7.1%) patients. This non-controlled study included data on 115 patients with adenocarcinoma located in the prostate that underwent prostate biopsy. All these patients received radical treatment, i.e. radical prostatectomy in 64 (55.7%) and external beam irradiation with curative intent in 51 (44.3%) patients. We compared Gleason score, PSA and pathological features of surgical specimens.
The mean patient age was 65.0 (range 51-75)
years in the surgically treated group and 69.2 (range 59-77) years in the
radical radiotherapy treated group. T-stage was lower, but not significantly in
the surgical group (p=0.07), with 53 (82.8%) cases classified as pT1-2
and 11 (17.2%) cases as pT3-4. Among irradiated patients, 34 (66.7%)
were classified as cT1-2 and 17 (33.3%) as cT3-4.
Positive lymph node was found in 4 (6.2%) surgically treated patients during
pelvic lymph node dissection. The radical prostatectomy group patients were
significantly younger and had lower PSA value, while there was no significant
difference between the radical prostatectomy group and radiotherapy treated
group according to pathological grade (Gleason score). In surgically treated
patients, Gleason score 2-6 was found in 49 (76.5%) and Gleason score 7-
COMPARISON OF MAGE-A3/4 AND NY-ESO1 EXPRESSION WITHPROGNOSTIC MARKERS IN CHROMOPHOBE RENAL CELL CARCINOMA AND RENAL ONCOCYTOMA
J. Slipac1, L. Stemberger1,
A. Demirović1,
H. Čupić1
1Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, 2Department of Pathology, Dubrava University Hospital, 3Andrija
Štampar School of Public Health, School of Medicine, Zagreb, Croatia
The cancer-testis family of antigens is
expressed in a variety of malignant tumors. They are not expressed in normal
human tissues, except for the testis. Expression of two genes from this family,
MAGE-A3/4 and NY-ESO1, has been described in different malignant tumors such as
melanomas, germ cell tumors, and uterine neoplasm. To our knowledge, there are
no studies on the expression of these genes and their proteins in renal tumors.
The aim of this study was to investigate the expression of MAGE-A3/4 and
NY-ESO1 in renal oncocytomas (RO) and chromophobe renal cell carcinomas (CRCC) detected by
immunohistochemistry and to compare the expression of MAGE-A3/4 and NY-ESO1
with other prognostic markers (size, grade) in CRCC. A total of 35 patients (17
RO and 18 CRCC) treated at
However, significant correlation was found
between the expression of MAGE-A3/4 and NY-ESO1 antigens in both tumors: r=0.87
(P=0.0003) for RO and r=0.93 (P=0.0001) for CRCC. This study demonstrated
a statistically significant difference in the expression of MAGE-A3/4 and
NY-ESO1 antigens between RO and CRCC. Study results also showed the expression
of MAGE-A3/4 and NY-ESO1 antigens not to correlate with other prognostic
markers in CRCC, however, additional research is needed to explore their potential
diagnostic and therapeutic implications.
MORPHOMETRIC
ANALYSIS OF CAPSULE IN CHROMOPHOBE RENAL CELL CARCINOMA AND RENAL ONCOCYTOMA
S. Cesarec1, A. Demirović1,
1Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, 2Department of Pathology, Dubrava University Hospital, 3Andrija
Štampar School of Public Health, School of Medicine, Zagreb, Croatia
Renal cell
carcinoma (RCC) accounts for approximately 3% of adult malignancies
and 90%-95% of neoplasms arising from the kidney. These epithelial malignant
neoplasms are subclassified in five main types:
conventional or common RCC, including clear and eosinophilic
cell carcinoma, chromophobe RCC, papillary (or chromophilic)
RCC, collecting duct carcinoma, and RCC unclassified.
Chromophobe RCC is the third most common carcinoma of renal tubular epithelium
and accounts for 5% of cases. This variant of RCC must be differentiated from
oncocytoma, which shares a common cellular origin. Renal oncocytoma is an epithelial tumor, considered as
benign. It comprises about 2%-5% of renal cell neoplasms. Oncocytoma is usually
isolated and unilateral, well circumscribed, non-encapsulated. Pathologic
differentiation between an oncocytoma and chromophobe RCC may sometimes be
difficult. However, the distinction is essential, due to different biological
behavior. The aim of this study was to analyze morphometric parameters of
capsule in chromophobe RCC and oncocytoma. The files from Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University Hospital and Department of
Pathology, Dubrava University Hospital, were searched
for cases of histologically confirmed chromophobe RCC and oncocytoma. Eighteen
chromophobe RCC (8 male and 10 female) and 19 oncocytomas (7 male and 12
female) slides, stained by hematoxylin and eosin, were analyzed. Attention was
directed to capsular characteristics, i.e. presence or absence of the capsule
and its thickness. Morphometric measurements of capsule were done by a
computerized morphometry system with digital camera and microscope. For each
tumor one measurement of capsular thickness was made under higher magnification
(X200). Statistical analysis was performed using χ2-test,
Spearman's correlation test, Fisher exact test and
Mann-Whitney test. The level of statistical significance was set at P<0.05.
The presence of capsule showed a statistically highly significant difference
between the two tumor types observed; the capsule was present in 12 (66.7%)
chromophobe RCC cases and only 2 (10.5%) oncocytomas. The mean capsule
thickness was 337.7 μm in chromophobe RCC and 115.4 μm in
oncocytomas. Although the capsule was less thick, if present, in oncocytomas
than in chromophobe RCC, the median was not statistically significant due to
the small number of cases. The correlation between tumor size, grade and
capsule thickness in chromophobe RCC was not significant. Considering age,
patients with oncocytoma were significantly older. The distribution of these
two tumor types revealed no significant sex differences. In conclusion, making
a correct histological diagnosis of chromophobe RCC and oncocytoma may
occasionally be difficult due to the overlapping morphological characteristics.
Distinguishing renal oncocytoma from chromophobe RCC is essential, knowing that
oncocytoma is a benign tumor, while chromophobe RCC has a potentially malignant
biological behavior. The aim of this study was to determine the presence of the
capsule in chromophobe RCC as a potential diagnostic tool. Although a statistically
significant difference in the presence of capsule between chromophobe RCC and
oncocytoma was evident, this study was in part limited by the small number of
cases; therefore, studies in a larger number of cases are needed.
LYMPH VESSEL DENSITY IN PROSTATIC CANCER AND ADJACENT
NONTUMOROUS TISSUE
M. Ulamec, D. Tomas, H. Čupić,
M. Vučić, B. Krušlin
Ljudevit Jurak
University Department of Pathology, Sestre milosrdnice University Hospital and School of Medicine, University of Zagreb, Zagreb, Croatia
According to some
authors, lymphatic invasion in radical prostatectomy specimens is an
unfavorable prognostic factor in clinically localized prostatic cancer.
Lymphangiogenesis within tumor has been associated with lymphatic invasion and
lymph node metastases. In this preliminary study, we analyzed density of lymph
vessels in prostatic carcinoma and in adjacent prostatic tissue. Neoplastic
glands were analyzed in 25 paraffin sections from radical prostatectomy
specimens with prostatic adenocarcinoma diagnosis. Specimens were taken from
the archive at the Ljudevit Jurak Department of Pathology,
PERITUBULAR
CLEFTING – A MORPHOLOGICAL
CRITERION OF INVASION IN BREAST CANCER?
L. Labinac-Peteh1, T.
Leniček2,
1Department of Pathology and Forensic Medicine, Pula
General Hospital, Pula, 2Ljudevit Jurak
University Department of Pathology, Sestre
milosrdnice University Hospital, Zagreb, Croatia
Microscopic analysis of histologic
specimens has the most important place in the diagnosis of breast cancer.
Because of many different forms of ductal invasive breast carcinoma, along with
the existing ones, additional morphological criteria are needed to distinguish
carcinoma from benign breast changes that may resemble cancer. In the presence of tumor cells, surrounding
stroma changes, and this become topic of many different cancer studies. There
are only few studies on clefting in breast cancer. Stromal change is visible by light microscopy and by clear
spaces around tumorous glands named peritubular
clefts. Transformation of stroma is necessary for local and distant spread of
tumor cells, so analysis of this change may have diagnostic and prognostic
significance. Thirty cases
of breast carcinoma and thirty cases of benign changes (ten cases of fibroadenoma, fibrocystic mastopathy
and sclerosing adenosis
each) were analyzed by light microscopy
at X400 magnification. We analyzed thirty glands in each cancer specimen
and thirty glands in each specimen of benign breast changes, i.e. 900 glands in
either patient group. The expression of peritubular
clefts was classified according to gland circumference into three gland groups:
0 – without cleft; 1 – cleft to up to 50%; and 2 – cleft >50% of gland
circumference. The presence of peritubular clefting differed
between the groups of breast cancer and of benign breast changes (p<0.05).
Correlation of the results on the presence of peritubular clefting with patient
age, histologic grade of tumor, and expression of hormonal receptors and
HER2/neu protein in the cancer group yielded no statistical association (P>0.05).
We believe that peritubular clefts occur as the result
of interaction between tumor cells and stroma that enables local and distant
dissemination and metastasizing.
NEPHROGENIC
ADENOMA OF URINARY BLADDER: A CASE REPORT
K. Tomić1, I. Mahovne1, D. Dittrich2, I. Prvulović1, T. Jakovina1, Lj. Fuštar-Preradović1
1Department of Pathology and Cytology, 2Department
of Urology, Dr. Josip Benčević
General Hospital, Slavonski Brod, Croatia
Nephrogenic adenoma, also known as nephrogenic metaplasia or adenomatous metaplasia, is a relatively rare condition mostly affecting
adult men with a history of urogenital surgery,
trauma, calculi, or renal transplant. Most cases occur in urinary bladder, but the
condition may also be found in the ureter or renal pelvis. Histologically, the
main differential diagnosis is adenocarcinoma. A 65-year-old man presented with
hematuria. Cytologic analysis revealed atypical
urothelial cells suspect of malignancy. Magnetic resonance revealed only
slightly thickened wall of the urinary bladder. Histologically, the lesion
consisted of small tubular and cystic spaces lined with bland, cuboidal and hobnail epithelial cells with no mitosis. The
lesion extended into the lamina propria. On immunohistochemistry, tumor cells
were CK7 positive and CEA negative. One year after the surgery, the patient is
well, without symptoms and with normal cytologic report. The case is presented for
being rare and to emphasize the need for an increased awareness of the
condition, thus to make an accurate diagnosis and to introduce appropriate treatment.
EXPRESSION OF GST-π IN HUMAN PROSTATIC CARCINOMAS
AND NONTUMOR TISSUES
E. Lovrić1, Z. Gatalica2, E. Eyzaguirre3,
B. Krušlin4
1Department
of Pathology and Cytology, Čakovec County Hospital, Čakovec, Croatia,
2Department of Pathology, Creighton University Medical Center, Omaha, Nebraska, USA, 3Department of
Pathology, The University of Texas Medical Branch,
Galvestone, Texas, USA, 4Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, Zagreb, Croatia
Glutathione-S-transferase-π
(GST-π) is an enzyme with tumor suppressor function playing role in
eliminating toxins and carcinogens from the body. Polymorphisms in glutathione-S-transferases
(GST) could predispose to prostate cancer through a heritable deficiency in
detoxification pathways for environmental carcinogens. The
aim of this study was to analyze the expression of GST-π in basal, luminal
and stromal cells of human tumor and nontumor samples of prostatic tissues. Formalin fixed,
paraffin embedded needle core and transurethral resection prostatic biopsies
from 42 patients (34 with carcinoma, Gleason scores ranged from 4 to 9, median
age 63 years, and 8 with normal prostate gland, median age 65 years) were
evaluated with rabbit polyclonal anti-GSTπ
(A8000, Oncor) and anti-cytokeratin antibody clone
34ß E12, DAKO). Standard, automated immunohistochemical procedures were used
(LSAB2, DAKO). GSTπ was strongly expressed in
basal cells in every case of normal prostatic glands, and was also weakly
expressed in luminal cells in a number of cases. GSTπ
was also detected in stromal cells (fibroblasts and
smooth muscle) of normal prostate. Only one case of 34 prostatic carcinomas
showed positivity for GSTπ. Stromal
cells surrounding carcinomas expressed GSTπ
similarly to the normal stromal cells. Basal cells
were identified by strong staining with 34ß E12, while prostatic carcinomas
were consistently negative, and it was used as a control and for comparison
with GSTπ results. In conclusion, GSTπ is expressed strongly and predominantly in basal
cells of human normal prostatic glands. This finding is consistent with its
proposed role as a tumor suppressor in malignant transformation of prostatic
epithelium. However, rare prostatic carcinomas showed cytoplasmic GSTπ expression. Follow up studies are needed to
address the prognostic significance of GSTπ
aberrant expression in prostatic carcinomas.
UROTHELIAL
CARCINOMA WITH AN INVERTED GROWTH PATTERN: A REPORT OF 3 CASES
G. Krajačić-Jagarčec1,
T. Džombeta2, O. Kraus3, B. Ružić3, B.
Krušlin2,4
1Department of Pathology, Zabok General Hospital, Zabok, 2Department
of Pathology, School of Medicine, University of Zagreb; 3University
Department of Urology and 4Ljudevit Jurak
University Department of Pathology, Sestre
milosrdnice University Hospital, Zagreb, Croatia
Urothelial (transitional cell) tumors account for about 90% of all bladder
tumors. Their presentation varies from benign lesions that rarely recur to
highly malignant tumors. While biological behavior of tumor determines its
treatment and prognosis, it is very important to differentiate these variable
forms. Inverted (endophytic) growth pattern in urothelial carcinoma is particularly difficult to distinguish
from inverted papilloma. Morphological criteria alone are not enough and
immunohistochemical assessments must also be done, especially in cases of small
size biopsy material or transurethral resections. We present a recent series of
three patients diagnosed with a low grade urothelial
carcinoma with an inverted growth pattern. All patients were male, aged 37, 61
and 69 (mean 55.6) years. The patients presented with painless hematuria. Histologically, the tumors formed nests of
atypical urothelial cells. Very few or no mitotic
figures were observed. Invasion of lamina propria was
present in two specimens. Immunohistochemically,
positive staining for p53, cytokeratin (CK) 7 and CK 20 was observed in all
three cases. Proliferative activity was assessed using Ki-67 antibody. The
percentage of positive stained tumor cells was 5%, 7% and 12%.
Immunohistochemical staining for CK 7, CK 20, p53 and Ki-67, which is positive
in most carcinomas but not in papillomas, can help us
make the right diagnosis. Urothelial carcinoma with an inverted growth pattern and inverted papilloma
have similar morphological features but their biological behavior,
treatment and prognosis are different. In order to avoid the urothelial carcinoma to be misdiagnosed as a benign papilloma,
we find it very important to make additional investigations besides
conventional histology.
UNUSUAL
MIXED GERM CELL TUMOR OF THE TESTIS CONSISTING OF RHABDOMYOSARCOMA, MATURE
TERATOMA AND YOLK SAC TUMOR: A CASE REPORT
E. Lovrić1, D. Bobonj-Hižak2, M. Perić-Balja3, T. Leniček4, B. Krušlin4
1Department of Pathology and Cytology, Čakovec County Hospital, Čakovec,
2Department of Pathology, Bjelovar General
Hospital, Bjelovar, 3Department of
Pathology, University Hospital for Tumors, Zagreb, 4Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
Testicular mixed germ cell tumors account
for 32%-54% of all germ cell tumors. The various types of germ cell tumors can
occur in any combination. The most common combination is teratoma and embryonal
carcinoma, and also a variant of embryonal carcinoma, yolk sac tumor and
syncytiotrophoblastic cells. Unusual cases of rhabdomyosarcoma arising in
mature teratoma and rhabdomyosarcoma arising in mediastinal teratoma have been
reported in the literature. We present an unusual case of testicular tumor in a
32-year-old man who complained of left testicular swelling and pain. Physical
examination, ultrasonography and CT revealed a tumor in the left testis.
Macroscopically, it was a grey, well circumscribed tumor measuring 4.5x7x6 cm
in size, showing soft and yellow cut surface. There were white and firm areas,
and parts of cartilage, with only marginally visible testicular tissue. Also, there
was a nodule of
TESTICULAR PLACENTAL SITE TROPHOBLASTIC TUMOR
N. Knežević1, S. Nađ-Škegro1, T. Kuliš1, M. Čačić2, M. Ćorić2, Z. Kaštelan1
1University Department of Urology, 2University
Department of Pathology and Cytology, Zagreb University Hospital Center,
Zagreb, Croatia
Placental site trophoblastic tumor (PSTT)
has been sporadically described in male genital tract. Although it is
relatively rare, it has been listed in the last WHO classification of germ cell
testicular tumors. Firstly, it was identified as a trophoblastic tumor in the
uterus. Most of the knowledge regarding its clinical behavior is based on its
appearance in female genital tract. It is considered as an infiltrative tumor
with malignant potential and variable response to chemotherapy. To our
knowledge, we report on the third case of PSTT in male. A 24-year-old man
presented with right testicular enlargement. Preoperative serum levels of tumor
markers included elevated ß-hCG (7.0 mIU/mL) and
normal AFP (2.29 ng/mL). After radical orchiectomy, serum levels of tumor
markers were normalized. Histopathologic examination revealed mature teratoma
65% and PSTT 35%. The PSTT component showed high proliferative activity (Ki 67 index in more than 90% of PSTT component), indicating
high DNA replication and proliferation. Furthermore, PSTT component was HPL,
cytokeratin and inhibin positive, while ß-hCG and AFP were negative. Computerized tomography of the retroperitoneum did not show enlarged retroperitoneal lymph
nodes. We decided to do laparoscopic retroperitoneal lymphadenectomy (RPLND)
and tumor was not found in 15 lymph nodes. During the 3-year follow up, the
patient has been free from recurrence or metastatic disease. Given the
potentially malignant behavior of PSTT, unknown course of disease in male and
primary histopathologic finding, we opted for RPLND. RPLND is a safe and
successful method with low morbidity and mortality, and we think it should be
considered in patients with PSTT component of testicular tumor with normal
postoperative tumor markers and computerized tomography. In patients with PSTT
component in whom chemotherapy was performed for retroperitoneal metastasis, we
believe that post-chemotherapy laparoscopic retroperitoneal lymphadenectomy
should be considered due to the variable PSTT response to chemotherapy.
LIPOID-CELL
VARIANT OF UROTHELIAL CARCINOMA: A REPORT OF TWO CASES
S. Bulimbašić1,
1Department of Pathology, Dubrava University Hospital, Zagreb, 2Department
of Pathology and Cytology, Čakovec County
Hospital, Čakovec, Croatia
Urothelial carcinomas tend to show unusual morphological appearances. Most urothelial carcinomas exhibit papillary or solid histologic
growth pattern, which does not pose diagnostic problem. However, in some
variants histological features differ significantly from the usual patterns.
Case 1: a 56-year-old man developed painless macroscopic hematuria.
Cystoscopic examination revealed a bulky papillary
tumor on the posterior bladder wall. Transurethral bladder resection was
performed. Case 2: a 75-year-old man with microscopic hematuria
developed unilateral obstructive changes. Radiologic studies revealed
infiltrative lesion in the lower third of the left ureter. Radical left nephroureterectomy was performed. Gross examination
revealed a
THE
ROLE OF ELECTRON MICROSCOPY IN THE EVALUATION OF RENAL TUMORS
S. Bulimbašić, A. Racar-Pačić, A. Bauer-Šegvić, D. Ljubanović
Department of
Pathology, Dubrava University Hospital, Zagreb,
Croatia
Renal tumors comprise a heterogeneous group
of neoplasms derived from the renal tubular epithelium, renal mesenchyma or urothelial layer of
the renal pelvis and calyces. Most of them, including the most common "clear-cell"
type of renal carcinoma, are easily recognizable by single use of light
microscopy. However, to diagnose certain variants of renal tumors, it is necessary
to perform additional diagnostic tests. The aim of the study was to evaluate the
contribution of ultrastructural analysis in achieving
the diagnosis of renal tumors. Furthermore, the reasons for ultrastructural
analysis and types of tumors submitted for electron microscopy were analyzed. Data
on cases of renal tumors ultrastructuraly analyzed
during the period from March 2004 to March 2009 were obtained from the files of
the Department of Pathology, Dubrava University
Hospital. For the purpose of this study, archived microphotographs and digital
images of tumor ultrastructure and hematoxylin-eosin slides
of all tumors and immuno stains where available were
reviewed. Ultrastructural analysis was performed on a
Philips EM400T (March 2004-March 2007) and Jeol JEM
1400 (March 2007-March 2009). All photographs and slides were reviewed by two
pathologists (S.B. and D.LJ.) and the original diagnoses were confirmed, or
modified according to the latest WHO classification. Results of ultrastructural analysis were classified into four
categories: "A" inadequate material (poorly
preserved, necrotic, etc.); "B" preserved but non-diagnostic
material, inconclusive; "C" supportive features; and "D"
specific features. During the 2004-2009 period, a
total of 37 renal tumors were evaluated by electron microscopy. This cohort
included 12 oncocytomas (RO), 10 chromophobe carcinomas (CHRCC), 5 clear-cell
renal carcinomas (CCRCC), 2 papillary renal carcinomas (PRCC), 2 urothelial carcinomas (UC), 2 medullary fibromas,
1 neuroendocrine tumor, 1 angiomyolipoma
(AML), and 2 "loopomas" (MTSCTK). The reasons
for ultrastructural analysis were: electron
microscopy as a routine part of diagnostic algorithm in 22, ambiguous
immunohistochemistry results in 4, educational purposes and scientific interest
in 10 cases, and confirmation of the neuroendocrine
differentiation in one case. Results grouped in "A" and "B"
categories, where ultrastructural analysis did not
contribute to the diagnosis, comprised 5.4%, while results in the "C"
(supportive) and "D" (specific) categories comprised 29.6% and 65% of
all analyzed cases, respectively. The best results were seen in the oncocytoma
and chromophobe carcinoma subgroups (22/22). Our study has confirmed that
electron microscopy is a useful technique for the diagnosis of selected types
of renal tumors, especially those with specific ultrastructural
features. It may also help solve real diagnostic difficulties where the diagnosis
has been narrowed but not achieved by use of immunohistochemistry.
RENAL
METASTASES OF PANCREATIC MEDULLARY CARCINOMA: A CASE REPORT.
A. Krvavica1, M. Ulamec2,
L. Pažanin2, C. Lež3, H. Čupić2
1Department of Pathology, Zadar General Hospital, Zadar,
2Ljudevit Jurak University Department of Pathology,
Sestre milosrdnice University Hospital, Zagreb, 3Department of
Pathology, Zabok General Hospital, Zabok, Croatia
Medullary carcinoma of the pancreas has been recently described as a distinct subtype of ductal adenocarcinoma that may have a unique pathogenesis and clinical course.
We report on a 69-year-old woman with a tumorous mass in the tail of the pancreas. Fifteen years before, the patient underwent mastectomy for bilateral breast carcinoma. Thirteen years later, bilateral adrenal metastases were found and surgically removed. Two years later, follow-up computer tomography revealed pancreatic tumor. The tumor progressed in three months, resulting in kidney metastases and enlarged para-aortal lymph nodes. Partial pancreatectomy with partial nephrectomy and removal of para-aortal lymph nodes was performed. Histopathologic analysis revealed pancreatic medullary carcinoma with neuroendocrine component and metastatic spread to the left kidney and lymph nodes. Although medullary carcinomas are grouped together with poorly differentiated ductal adenocarcinomas, some authors suggest a distinct pathogenetic course and clinical features. Accordingly, recognition of the medullary variant of pancreatic adenocarcinoma is of high clinical relevance.
PRIMARY
INTRACRANIAL PLEOMORPHIC LEIOMYOSARCOMA WITH RHABDOID FEATURES: A CASE REPORT
A. Jakovčević1, S.
Dotlić1, K. Žarković1, J. Paladino2
1University Department of Pathology and
Cytology, 2University Department of Neurosurgery, Zagreb University
Hospital Center, Zagreb, Croatia
Primary intracranial leiomyosarcomas
are uncommon tumors. The origin of such neoplasm could be smooth muscle cells
of the vessels, pluripotent mesenchymal cells or
embryonic rests from the inner layers of the arachnoid
and pia. They are more common in immunosuppressed and
HIV infected patients. In this case, the tumor was not associated with AIDS or
immunosuppression. A 58-year-old man presented
with a one-month history of headaches and changing mental status. Magnetic
resonance images revealed expansive tumor mass
SPLENIC
LITTORAL CELL ANGIOMA
A. Demirović, T. Leniček, M. Ulamec, D. Tomas
Ljudevit Jurak University
Department of Pathology,
Littoral cell angioma
(LCA) is a rare primary tumor of the spleen arising from normal endothelial cells
lining venous sinuses of the splenic red pulp
(littoral cells). Although considered as benign, LCA has recently been shown to
exhibit malignant potential and it may also be associated with other visceral
malignancies. Clinical presentation of LCA ranges from asymptomatic to
presenting with a constellation of symptoms such as abdominal pain, splenomegaly and hypersplenism. A
78-year-old woman was admitted on routine follow up examination one year after
hysterectomy and adnexectomy due to primary extraovarian serous cystadenocarcinoma.
Computed tomography of the abdomen disclosed multiple hypodense
lesions in the spleen and splenectomy was performed. Grossly, the spleen
measured 15x15x5 cm and had a nodular surface. Cut sections showed multiple
spongy, soft, brownish nodules ranging in size from 0.8 to
IMMUNOHISTOCHEMICAL
EXPRESSION OF TUMOR ANTIGEN SSX IN PROSTATE CANCER
Lj. Hlupić1, T. Hudolin2, Ž. Kaštelan2
1University Department
of Pathology and Cytology, 2University Department of Urology, Zagreb
University Hospital Center, Zagreb,
Croatia
The aim of the study was to investigate
immunohistochemical expression of SSX, a cancer testis antigen, in prostate
carcinoma. The study included 53 prostate samples from patients undergoing
surgery at University Department of Urology,
PATHOLOGIC
FINDINGS IN PROSTATE CANCER PATIENTS SUITABLE FOR ACTIVE SURVEILLANCE THAT WERE
TREATED WITH RADICAL PROSTATECTOMY
I. Tomašković1, D. Trnski1,
O. Kraus1, B. Ružić1, B. Spajić1, A.
Reljić1, J. Katušić1, D. Tomas1, H.
Čupić1
1University Department of Urology
, 2Ljudevit Jurak University
Department of Pathology,
Active surveillance is a valid treatment
option for low risk, localized prostate cancer. There are several definitions
of low risk prostate cancer. We tested most stringent criteria for active
surveillance in our cohort of patients that were treated with retropubic radical prostatectomy. Study population included
586 patients treated with retropubic radical
prostatectomy between January 2003 and January 2008. Among them, 106 were
eligible for active surveillance according to combined preoperative criteria
set by van den Bergh and Carter. These criteria include clinical stage T1c-T2,
PSA <10 ng/mL, PSA density <0.20 ng/mL/mL, Gleason score ≤3+3,
≤2 positive biopsy cores, and ≤50% of any core involved with
cancer. We analyzed the rate of adverse pathologic findings defined as advanced
disease; extracapsular extension (ECE), positive
surgical margins (+SM), seminal vesical involvement (+SV),
positive lymph nodes (PLN), and intermediate and high Gleason score (7-10). Out
of 586 patients treated with radical retropubic
prostatectomy, 106 were suitable and could have been selected for active
surveillance according to the above criteria. Among them, ECE, +SM and SVI were
recorded in 6.6%, 8.4% and 1.8%, respectively. Gleason score 7 was recorded in
39 and Gleason score 8-