One patient—two aneurysms—one etiology

Abstracts / Annals of Diagnostic Pathology 11 (2007) 392–394 frequent complications are thrombosis of the profound veins of the lower limb and pulmonary embolia, this case proves that it is possible to have other localizations for thrombosis, for example, the superior mesenteric vein. Another conclusion is that women older than 35, using birth control pills, especially if they are smokers, presenting in the emergency room with an alteration of the general state through hypovolemic shock and severe abdominal pain, should be suspected also for venous enteromesenteric infarction. doi:10.1016/j.anndiagpath.2007.05.012

Detection of human telomerase reverse transcriptase expression (hTERT) in superficial high-grade (T1G3) bladder cancer before and after BCG instillations: a potential adjunct to urine cytology? Zachos Ioannisa, Vandoros Gerasimosb, Repanti Mariac, Papatsoris Athanasiosd, Chrisofos Michalisd, Podimatas Thomasa, Deliveliotis Charalamposd a Hospital, Urology, Patras, Greece b Hospital, Pathology, Egion, Greece c Hospital, Pathology, Patras, Greece d University, Urology, Athens, Greece Introduction and objectives: Telomerase is a ribonucleoprotein complex mainly composed of a reverse transcriptase catalytic subunit (human telomerase reverse transcriptase; hTERT gene) that copies a template region of its RNA subunit to the end of the telomere. Although its expression in urine is well studied in bladder cancer, there are scant and controversial data regarding its immunohistochemical expression in malignant and normal urothelium. We assessed the immunostaining of hTERT in superficial (stage T a-1), high-grade (G3) bladder cancer before and after BCG instillations and its correlation with urine cytology. Materials and methods: After transurethral resection of bladder cancer (TURBT), standard immunohistochemical method was performed on paraffin sections of 20 patients with superficial (Ta-G1) high-grade (G3) bladder cancer in order to detect hTERT. All patients underwent cold cup biopsies of the TURBT scar and urine cytology one month after the last of six BCG standard instillations. Study controls consisted of healthy bladder mucosa of the same patients, obtained with cold cup biopsies during TURBT. The mouse monoclonal antibody HTERT (Vector, USA) was used in a 1:50 dilution. In excised bladder tumor tissue, the expression of hTERT was clearly evident in the majority of nucleoli of cancer cells. The percentage of positive cells was graded according to the following score system: 1: 1-25% of cell population, 2: 25-50%, 3: 50-75%, 4: 75-100%. Immunostained sections were assessed by a semiquantitative method based on a three-level scale. Immunopositivity was graded according to the intensity of the staining: negative, weak, intermediate, and strong. Results: Positive strong hTERT immunostaining, in the 75-100% of cell population (4), was demonstrated in 16 patients (80%) with bladder cancer before BCG instillations, and in 3 patients (15%) after BCG treatment. Intermediate staining, in the 25-75% of cell population (2, 3), was revealed in 3 patients (15%) with bladder cancer, and in 6 patients treated with BCG. Weak hTERT immunostaining, in the 1-50% of cell population (1, 2), was demonstrated in 1 patient (5%) before, and in 11 patients (55%) after BCG instillations. Negative immunostaining was revealed in all the control specimens. Urine cytology was positive for 3 patients who also had strong intensity of staining in the 75-100% of cell population (4). Of the 3 patients with positive cytology, histologic recurrence was confirmed on biopsy in one case (1 pt. with T1G3) and invalided in the other two cases. These last two patients had recurrence within 1 year (one with T1G3 and the other with T2G3). Conclusions: Positive hTERT immunostaining was demonstrated in all patients with superficial high-grade bladder cancer, especially in cases of T1G3 tumors. Standard BCG instillations resulted in weaker hTERT immunostaining. In the literature, the sensitivity of urine cytology for the recurrence of high-risk tumors after BCG treatment is a parameter that varies from 56% to 87%. Otherwise, the interpretation of urine cytology findings after BCG treatment is difficult and requires an experienced pathologist. Although the number of cases in this study was small, the results indicate

393

that urine cytology combined with immunostaining on scar tissue material may provide better additional information concerning examination sensitivity and individual patient prognosis. doi:10.1016/j.anndiagpath.2007.05.013

Expression and prognostic role of angiogenic and cell-cycle markers in serous ovarian carcinomas Engels Knut a, Harter Philippb, Moll Peterc, du Bois Andreasb, Kommoss Friedrichd, Fisseler-Eckhoff Annettee, Kaufmann Manfred f, Loibl Sibyllef a Uniklinikum Frankfurt/M., Institut Für Pathologie, Frankfurt/M, Germany b Dr. Horst Schmidt Klinik, Klinik für Gynäkologie und gynäkologische Onkologie, Wiesbaden, Germany c Uniklinikum Frankfurt/M., Zentrum für Frauenheilkunde und Geburtshilfe, Frankfurt/M, Germany d Institut für Pathologie, A 2/2- 68159 Mannheim, Germany e Dr. Horst Schmidt Klinik, Institut für Pathologie und Zytologie, Wiesbaden, Germany f Uniklinikum Frankfurt/M., Zentrum für Frauenheilkunde und Geburtshilfe, Frankfurt/M, Germany Background: Expression of angiogenic and cell-cycle markers (VEGF-A, COX-2, I-NOS, p53, HIF-1a) and their prognostic role in ovarian cancer are still under discussion. Methods: 112 patients with primary serous ovarian carcinomas treated in Frankfurt or Wiesbaden between 1999 and 2004 were examined. Primary surgery was followed by a platinum and taxane-based chemotherapy in all patients. Expression of i-NOS, COX-2, VEGF-A, HIF-1a was analysed immunohistochemically using tissue microarrays (TMAs) of the primary tumour samples. Results were scored according to staining intensity and percentage of positive tumour cells resulting in an immune-reactive score (IRS) from 0 to 12. Vascularity was assessed using the Chalkley-Eye-Grid method after highlighting vessels with CD34 antibodies in whole tissue sections. These results were correlated with classical prognostic factors and survival. Nonparametric correlations were performed using Spearman's rho, correlations were significant at the .05 level (2-tailed). Results: The median age at the time of surgery was 63 years (33–89 years). The majority of the patients (85.6%) had advanced disease (FIGO III-IV). Tumour grading was G1 in 1.8%, G2 in 37.5%, and G3 in 59.8%. Expressions were as follows: i-NOS, 68.7% positive (IRS ≥4); COX-2, 51.1% positive (IRS ≥5); VEGF-A, 77.9% positive (IRS ≥4); HIF-1a, 5.1% strong (IRS ≥7), 22.2% moderate (IRS 4-6), 57.6% weak (IRS 1-4), 15.2% negative (IRS = 0); p53, 33.3% weak (IRS ≥4), 66.7% strong (IRS N4); Chalkley count representing vascularity ranged from 2.0 to 12.3 and was graded into low (≤5, 50%), moderate (6–9, 46.7%), and high (N9, 3.3%). For computation of the correlation coefficients the noncategorized values were used. I-NOS correlated positively with COX-2 (P = .045), while COX2 correlated positively with VEGF-A (P b .01). Grading correlated significantly with vascularity (P = .04). Univariate analysis did not show any significant prognostic role in our cohort. Conclusions: The investigated proteins are commonly expressed in serous ovarian cancer. We could not detect any significant prognostic impact in patients treated with standard first-line therapy. Future studies, as the ongoing phase III trial AGO-OVAR 11 evaluating bevacizumab, should provide further insight, if markers like VEGF-A are of any predictive value for treatment options with VEGF-inhibitors. doi:10.1016/j.anndiagpath.2007.05.014

One patient—two aneurysms—one etiology Janzen Jana, Schoenhoff Florianb, Geisen Martinb, Carrel Thierryb Department of Pathology, Institute of Pathology, Bern, Switzerland b Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland a

394

Abstracts / Annals of Diagnostic Pathology 11 (2007) 392–394

A case of two nonatherosclerotic aneurysms localised in the ascending aorta (diameter: 5.0 cm) and in the pulmonary trunk (diameter: 5.3 cm) is presented. The patient underwent replacement of the ascending aorta, the aortic arch and the main pulmonary artery. Histopathologically, a severe granulomatous inflammation affecting the whole aneurysm wall was documented, and steroid treatment was started. To the best of our knowledge, it is the first-ever documented case of simultaneous occurrence of aneurysms in the aorta and the pulmonary artery. doi:10.1016/j.ann.diagpath.2007.05.015

Specificity and sensitivity of differentiation antigens in superficial soft tissue tumors: comparison of SMA, calponin, h-caldesmon, c-kit, PLAP and HPL Comunoglu Nila, Comunoglu Cemb, Durak Haydarc, Guven Ayseld, Meryem Cam, Dervisoglu Sergulene a Yeditepe University School of Medicine, Pathology, Istanbul, Turkey b Turkish Cancer Institute, Pathology, Istanbul, Turkey c Istanbul University, Pathology, Istanbul, Turkey d Duzce University School of Medicine, Histology and Embriology, Duzce e Istanbul University, Cerrahpasa School of Medicine, Pathology, Istanbul, Turkey

We examined the expression pattern of smooth muscle actin (SMA), hcaldesmon (HCD), calponin (CALP), placental alkaline phosphatase (PLAP), and human placental lactogen (HPL) in benign and malignant spindle cell superficial soft tissue tumors in order to determine the role of these markers in differential diagnosis. Archival tissue from 38 patients with superficial smooth muscle cell and so-called fibrohistiocytic tumors (8 benign fibrous histiocytomas [BFHs]), 6 dermatofibrosarcoma protuberans [DFPT], 9 malignant fibrous histiocytomas [MFHs], 9 leiomyomas [LMs], and 6 leiomyosarcomas [LMSs]) were immunostained with antibodies against SMA, HCD, CALP, PLAP, and HPL. SMC tumors showed significantly high immunopositivity for HCD than that of so-called fibrohistiocytic tumors (P is less than or equal to .05) but 1/3 of DFPT and MFH cases and half of BFH cases also showed HCD immunopositivity; thus, this difference is debatable and not highly discriminative as expected. All tumor groups showed 100% immunopositivity for CALP. SMC tumors displayed significantly stronger and more widespread immunostaining pattern for PLAP than so-called fibrohistiocytic tumors (P is less than or equal to .05). Superficial soft tissue tumors did not express c-kit. In conclusion, HCD and PLAP can be used as ancillary immunomarkers in differential diagnosis of SMC tumors. doi:10.1016/j.anndiagpath.2007.05.016