- Email: [email protected]
The utility of MDM2 and CDK4 immunohistochemistry in the diagnosis of lipomatous tumours and correlation with fluorescence in situ hybridisation
S60
Pathology (2012), 44(S1)
PATHOLOGY 2012 ABSTRACT SUPPLEMENT
Results: The sample had median age of 51.5 and slight preponderance of females with a ratio of 1.13:1 to males. Fifty-two cases were solid subtype and more common in females. Out of 10 cavernous and venous subtypes, 7 were males. Fifty-two cases (83.8%) were in the lower extremities and <2 cm in diameter. Between 5% and 30% of smooth muscle cells in 20 females and 17 males reacted positively with progesterone receptors although only 5% of cells in two records showed weak positivity with oestrogen receptors. MRI findings will ensue. Discussion: Angioleiomyoma should be considered as a differential diagnosis of tumours occurring in lower extremities of middleage patients.1,2 Weak positivity for progesterone receptors may suggest its influence in development of angioleiomyomas.3 MRI technique can contribute to more accurate diagnosis of angioleiomyomas.4 References 1. Freeman AM, Meland NB. Anioleiomyomas of extremities: report of a case and eview of the Mayo clinic experience. Plast Reconstr Surg 1989; 83: 328–31. 2. Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma. A clinicopathologic reappraisal of 562 cases. Cancer 1984; 54: 126–30. 3. Marino G, Marchese-Ragona R, Fernandez S, et al. Progesterone receptor expression in angioleiomyoma of the nasal cavity. Acta Otolaryngol 2002; 122: 408–12. 4. Yoo HJ, Choi JA, Chung JH, et al. Angioleiomyoma in soft tissue of extremities: MRI findings. AJR 2009; 192: 291–4.
THE UTILITY OF 16S RRNA GENE PCR AND SEQUENCING IN ENDOCARDITIS: AN 8 YEAR REVIEW Mary De Almeida, Jill Faulkner, Indira Basu, Deborah Williamson, Joshua Freeman, Sally Roberts Department of Microbiology, LabPlus, Auckland City Hospital, New Zealand Background: Up to 31% of patients with infective endocarditis (IE) have negative blood cultures, often due to prior antibiotic therapy or fastidious organisms. In surgically treated patients, 16S rDNA PCR applied to excised heart valve tissue is a useful tool for determining the bacterial aetiology of endocarditis. We sought to evaluate the clinical utility of this technique by reviewing data over the last 8 years. Methods: Patients who underwent cardiac surgery and had valve specimens submitted for 16S rDNA PCR at Auckland City Hospital between January 2004 and July 2011 were retrospectively reviewed. Clinical records and laboratory databases were used to classify each patient according to modified Duke criteria and to record whether PCR determined the bacterial aetiology and impacted on antibiotic management. Results: PCR was applied to 50 excised valve specimens from 40 patients. Twenty-four patients (60%) were PCR positive. For 13 of 40 patients (33%), the aetiology of IE was determined by valve PCR alone. In seven patients, this PCR result lead to a modification in antibiotic therapy to target the pathogen identified. Conclusions: 16 s rDNA PCR of excised valves from patients with suspected IE has had substantial clinical utility in our setting and should be considered for patients with blood culture negative endocarditis whose valves are culture negative. THE UTILITY OF MDM2 AND CDK4 IMMUNOHISTOCHEMISTRY IN THE DIAGNOSIS OF LIPOMATOUS TUMOURS AND CORRELATION WITH FLUORESCENCE IN SITU HYBRIDISATION B. Dessauvagie1, B. Tie1, J. Peverall2, L. Baker2, Michael Platten1, B. Amanuel1
1
Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, 2Department of Cytogenetics, PathWest Laboratory Medicine, Nedlands, WA, Australia
Introduction: Lipomas are characterised by balanced chromosomal rearrangements of 12q13–15 whilst well-differentiated liposarcoma/atypical lipomatous tumour (WDLPS/ALT) and dedifferentiated LPS (DDLPS) have ring and giant chromosomes composed of amplified 12q13–15 sequences. The amplified gene products, (MDM2 and CDK4), detected by fluorescence in situ hybridisation (FISH) or immunohistochemistry (IHC), can help distinguish lipoma from WDLPS/ALT, and DDLPS from other soft tissue tumours (STT). Objective: To determine the utility of MDM2 and CDK4 IHC in the above scenario and compare IHC results with FISH. Methodology: 61 lipomatous tumours and mimics were reviewed and subject to MDM and CDK4 FISH and IHC. Cases with MDM2 and/or CDK4/CEP12 signal ratio >1.5 were considered as FISH amplified and positive IHC was defined as strong nuclear staining of >1 cells/HPF (400) or moderate staining of >10% cells. Results: 13 tumours were reclassified as lipoma, WDLPS or DDLPS from their original diagnoses. The sensitivity/specificity of MDM2 and CDK4 IHC for WDLPS versus lipoma was 0.80/ 0.91 and 0.40/1.0, respectively, and for DDLPS versus STT was 1.0/0.75 and 0.67/0.83. In three of 20 WDLPS cases and in one of six DDLPS, IHC was positive but FISH was negative. MDM2 and CDK4 IHC and FISH had 87% and 95% concordance, respectively. Discussion: IHC and FISH sensitivity and specificity for MDM2 and CDK4 were comparable to those published in the literature.1– 3 MDM2-IHC had better sensitivity but lower specificity than CDK4-IHC in the WDLPS versus lipoma group. Both were found complementary to each other and best results were obtained when IHC was used in conjunction with FISH. A similar trend was observed in the DDLPS versus STT group. References 1. Binh MB, Sastre-Garau X, Guillou L, et al. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol 2005; 29: 1340–7. 2. Aleixo PB, Hartmann AA, Menezes IC, et al. Can MDM2 and CDK4 make the diagnosis of well differentiated/dedifferentiated liposarcoma? An immunohistochemical study on 129 soft tissue tumours. J Clin Pathol 2009; 62: 1127–35. 3. Sirvent N, Coindre JM, Maire G, et al. Detection of MDM2-CDK4 amplification by fluorescence in situ hybridization in 200 paraffin-embedded tumour samples: utility in diagnosing adipocytic lesions and comparison with immunohistochemistry and real-time PCR. Am J Surg Pathol 2007; 31: 1476–89.
UTILITY OF AN IMMUNOHISTOCHEMICAL PANEL INCLUDING TTF-1, NAPSIN A, P63, AND CK5/6 FOR SUBCLASSIFICATION OF POORLY DIFFERENTIATED NON-SMALL CELL LUNG CARCINOMAS Mahtab Farzin, Loretta Sioson, Adele Clarkson, K. T. George, Anthony Gill Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia Aim: The availability of more targeted therapies has created a need for more precise subtyping of non-small cell lung carcinomas (NSCLCs), particularly to separate adenocarcinoma (AC) from squamous cell carcinoma (SCC). The aim of this study was to assess the utility of immunohistochemical markers performed on small biopsies to predict the final histology in excision specimens.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2012), 44(S1)
PATHOLOGY 2012 ABSTRACT SUPPLEMENT
Results: The sample had median age of 51.5 and slight preponderance of females with a ratio of 1.13:1 to males. Fifty-two cases were solid subtype and more common in females. Out of 10 cavernous and venous subtypes, 7 were males. Fifty-two cases (83.8%) were in the lower extremities and <2 cm in diameter. Between 5% and 30% of smooth muscle cells in 20 females and 17 males reacted positively with progesterone receptors although only 5% of cells in two records showed weak positivity with oestrogen receptors. MRI findings will ensue. Discussion: Angioleiomyoma should be considered as a differential diagnosis of tumours occurring in lower extremities of middleage patients.1,2 Weak positivity for progesterone receptors may suggest its influence in development of angioleiomyomas.3 MRI technique can contribute to more accurate diagnosis of angioleiomyomas.4 References 1. Freeman AM, Meland NB. Anioleiomyomas of extremities: report of a case and eview of the Mayo clinic experience. Plast Reconstr Surg 1989; 83: 328–31. 2. Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma. A clinicopathologic reappraisal of 562 cases. Cancer 1984; 54: 126–30. 3. Marino G, Marchese-Ragona R, Fernandez S, et al. Progesterone receptor expression in angioleiomyoma of the nasal cavity. Acta Otolaryngol 2002; 122: 408–12. 4. Yoo HJ, Choi JA, Chung JH, et al. Angioleiomyoma in soft tissue of extremities: MRI findings. AJR 2009; 192: 291–4.
THE UTILITY OF 16S RRNA GENE PCR AND SEQUENCING IN ENDOCARDITIS: AN 8 YEAR REVIEW Mary De Almeida, Jill Faulkner, Indira Basu, Deborah Williamson, Joshua Freeman, Sally Roberts Department of Microbiology, LabPlus, Auckland City Hospital, New Zealand Background: Up to 31% of patients with infective endocarditis (IE) have negative blood cultures, often due to prior antibiotic therapy or fastidious organisms. In surgically treated patients, 16S rDNA PCR applied to excised heart valve tissue is a useful tool for determining the bacterial aetiology of endocarditis. We sought to evaluate the clinical utility of this technique by reviewing data over the last 8 years. Methods: Patients who underwent cardiac surgery and had valve specimens submitted for 16S rDNA PCR at Auckland City Hospital between January 2004 and July 2011 were retrospectively reviewed. Clinical records and laboratory databases were used to classify each patient according to modified Duke criteria and to record whether PCR determined the bacterial aetiology and impacted on antibiotic management. Results: PCR was applied to 50 excised valve specimens from 40 patients. Twenty-four patients (60%) were PCR positive. For 13 of 40 patients (33%), the aetiology of IE was determined by valve PCR alone. In seven patients, this PCR result lead to a modification in antibiotic therapy to target the pathogen identified. Conclusions: 16 s rDNA PCR of excised valves from patients with suspected IE has had substantial clinical utility in our setting and should be considered for patients with blood culture negative endocarditis whose valves are culture negative. THE UTILITY OF MDM2 AND CDK4 IMMUNOHISTOCHEMISTRY IN THE DIAGNOSIS OF LIPOMATOUS TUMOURS AND CORRELATION WITH FLUORESCENCE IN SITU HYBRIDISATION B. Dessauvagie1, B. Tie1, J. Peverall2, L. Baker2, Michael Platten1, B. Amanuel1
1
Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, 2Department of Cytogenetics, PathWest Laboratory Medicine, Nedlands, WA, Australia
Introduction: Lipomas are characterised by balanced chromosomal rearrangements of 12q13–15 whilst well-differentiated liposarcoma/atypical lipomatous tumour (WDLPS/ALT) and dedifferentiated LPS (DDLPS) have ring and giant chromosomes composed of amplified 12q13–15 sequences. The amplified gene products, (MDM2 and CDK4), detected by fluorescence in situ hybridisation (FISH) or immunohistochemistry (IHC), can help distinguish lipoma from WDLPS/ALT, and DDLPS from other soft tissue tumours (STT). Objective: To determine the utility of MDM2 and CDK4 IHC in the above scenario and compare IHC results with FISH. Methodology: 61 lipomatous tumours and mimics were reviewed and subject to MDM and CDK4 FISH and IHC. Cases with MDM2 and/or CDK4/CEP12 signal ratio >1.5 were considered as FISH amplified and positive IHC was defined as strong nuclear staining of >1 cells/HPF (400) or moderate staining of >10% cells. Results: 13 tumours were reclassified as lipoma, WDLPS or DDLPS from their original diagnoses. The sensitivity/specificity of MDM2 and CDK4 IHC for WDLPS versus lipoma was 0.80/ 0.91 and 0.40/1.0, respectively, and for DDLPS versus STT was 1.0/0.75 and 0.67/0.83. In three of 20 WDLPS cases and in one of six DDLPS, IHC was positive but FISH was negative. MDM2 and CDK4 IHC and FISH had 87% and 95% concordance, respectively. Discussion: IHC and FISH sensitivity and specificity for MDM2 and CDK4 were comparable to those published in the literature.1– 3 MDM2-IHC had better sensitivity but lower specificity than CDK4-IHC in the WDLPS versus lipoma group. Both were found complementary to each other and best results were obtained when IHC was used in conjunction with FISH. A similar trend was observed in the DDLPS versus STT group. References 1. Binh MB, Sastre-Garau X, Guillou L, et al. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol 2005; 29: 1340–7. 2. Aleixo PB, Hartmann AA, Menezes IC, et al. Can MDM2 and CDK4 make the diagnosis of well differentiated/dedifferentiated liposarcoma? An immunohistochemical study on 129 soft tissue tumours. J Clin Pathol 2009; 62: 1127–35. 3. Sirvent N, Coindre JM, Maire G, et al. Detection of MDM2-CDK4 amplification by fluorescence in situ hybridization in 200 paraffin-embedded tumour samples: utility in diagnosing adipocytic lesions and comparison with immunohistochemistry and real-time PCR. Am J Surg Pathol 2007; 31: 1476–89.
UTILITY OF AN IMMUNOHISTOCHEMICAL PANEL INCLUDING TTF-1, NAPSIN A, P63, AND CK5/6 FOR SUBCLASSIFICATION OF POORLY DIFFERENTIATED NON-SMALL CELL LUNG CARCINOMAS Mahtab Farzin, Loretta Sioson, Adele Clarkson, K. T. George, Anthony Gill Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia Aim: The availability of more targeted therapies has created a need for more precise subtyping of non-small cell lung carcinomas (NSCLCs), particularly to separate adenocarcinoma (AC) from squamous cell carcinoma (SCC). The aim of this study was to assess the utility of immunohistochemical markers performed on small biopsies to predict the final histology in excision specimens.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.