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Atypical and malignant meningiomas; the importance of micronecrosis as a prognostic indicator
TRAINEE PROFFERED PAPERS MALIGNANT MENINGIOMAS; THE MICRONECROSIS AS A PROGNOSTIC
UMBILICAL CORD STRICI1JRE AND FETAL INTRAUTERINE DEATH
ATYPICAL AND IMPORTANCE OF INDICATOR.
Yuntian Sun", Susan Arbuckle**, Glenn Hocking" and Virginia Billson* * Department of Anatomical Patfwlogy, The Royal Women's Hospital, Melbourne ** Department of Anatomical Pathology, The Royal Hospital for Women, Sydney
·C.A Mclean" D. Jolley', E Cukier, G. Giles" M.F Gonzales ' . 1. Department of Anatomical Pathology, The Royal Melbourne Hospital, Parkville, Victoria 3050 2. Anti-Cancer Council, 1 Rathdowne Street, Cartlon, 3053
Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. There has been considerable speculation as to whether the condition is real or a post mortem artefact during the last five decades. In this study 25 cases reported since 1925 in the literature are reviewed and 6 new cases are described. Clinically, a decrease of fetal movements is usually the only symptom during the second or third trimester of pregnancy and fetal death occurs soon after. The women's age, health and previous history have shown no link with this condition but a higher incidence is noted in twin pregnancy. Successive pregnancies complicated by cord stricture also reported in this study. Morphologically, most infants are macerated and an extremely narrow segment of umbilical cord is usually seen at the fetal end of the cord and rarely at the placental end or in multiple sites. Absence of Wharton's jelly, stenosis or obliteration of cord vessels at the narrow segment and cord thrombosis are the major pathological features. The findings of this study support the view that the condition can cause fetal death and alerts both pathologists and clinicians to the important features identifying this cause of perinatal wastage.
Twenty-eight patients with a diagnosis of either atypical or malignant meningioma, according to the WHO classification, were followed up to relate histopathological features with time to recurrence and death. The meningiomas were selected from a total of 2031 meningiomas notified to the Australian Brain Tumour Registry between 1986-1990. Of the 133 atypical/malignant meningiomas, the 28 chosen for the study had been completely resected. Two sets of Kaplan-Meier survival analyses were performed. The first analysis was from diagnosis to first recurrence and the second from recurrence to death. Additional analyses were stratified by the presence or absence of one of five histopathological features. These were; pleomorphism, prominent nucleoli, brain invasion, micronecrosis and mitotic activity. A second series of meningiomas were subsequently randomly selected from the residual 1898 to determine the proportion of benign meningiomas with micronecrosis. Five year disease free survival was 41 % with a median of 27 months. Micronecrosis was the only histopathological feature that was associated with an increased risk of recurrence (rate ratio 3.73). At 36 months, 32% of patients with micronecrosis were alive compared to 71 % of patients without micronecrosis. Brain invasion was not associated with disease free survival. After recurrence, median survival was 7 months and was not correlated with any histopathological feature. The prevalence of micronecrosis in the random samples from benign, atypical and malignant meningiomas was 8%, 42% and 71 % respectively. Brain invasion is currently the main distinguishing feature between atypical and malignant meningiomas in the WHO classification. We conclude that foci of micronecrosis and not brain invasion are a more important histopathological prognostic indicator. Presenter; Or C.A Mclean, Anatomical Pathology, RMH
p53 EXPRESSION IN ASTROCYTOMAS: AN IMMUNOHISTOCHEMICAL STUDY.
r. Tomlinson*. S. Carrello. H. Dawkins. P. Jacobsen and P. Robbins Department of Histopathology, Sir Charles Gairdner Hospital, NEDLANDS, Western Australia. Immunohistochemical analysis of p53 protein was evaluated in a series of 97 astrocytomas. The reactions were studied in 96 formalin fixed paraffin embedded tissue sections and 32 fresh frozen sections. immunostaining was observed in 27% of the formalin fixed cases and was found in all grades of astrocytoma (4/17 cerebellar pilocytic, 4/20 grade ll, 4/19 grade HI, 14/39 grade IV). immunostaining was present in 63% of cases examined in frozen sections. 23/32 were grade IV astrocytomas, of which 16 (70%) were positive. Staining in formalin fixed and frozen sections was able to be compared in 29 cases, 23 of which were grade IV astrocytomas. Overall there was positive staining in both paraffin and frozen sections in 7/29 cases. However, in 11/29 cases, positive staining was only present in the frozen sections. These findings indicate that immunostaining in frozen sections may be a more sensitive means of detecting p53 mutations, and that alterations in the p53 gene are involved in the initiation and progression of some astrocytic tumours.
ZYGOMYCOTIC INFECTIONS - A THREE YEAR REVIEW R. Norton * Division of Clinical Microbiology, Institute of Medical and Veterinary Science, Adelaide, S.A. 5000. A retrospective review was made of Zygomycetes isolated from clinical specimens submitted to this laboratory over a three year period. A total of nine patients were identified. In five of these there was histological evidence of fungal invasion of tissue. Two patients had rhinocerebral disease, two had burns and one had pulmonary disease. There were two deaths in this group. There were four other patients from whom zygomycetes were isolated but histological confirmation of tissue invasion was not sought. The significance of these isolates remains unclear and highlights the importance of finding evidence of tissue invasion. The majority of isolates were Rhizopus species. Predisposing clinical factors included diabetes, alcoholism, immunosuppression and extensive soft tissue damage. The pathogenesis of this condition is not fully understood but includes defective phagocytic mechanisms and iron metabolism. Liaison between the clinician, microbiologist and histopathologist is essential for optimal patient management. Clinical management generally requires adequate surgical debridement and antifungal chemotherapy.
UMBILICAL CORD STRICI1JRE AND FETAL INTRAUTERINE DEATH
ATYPICAL AND IMPORTANCE OF INDICATOR.
Yuntian Sun", Susan Arbuckle**, Glenn Hocking" and Virginia Billson* * Department of Anatomical Patfwlogy, The Royal Women's Hospital, Melbourne ** Department of Anatomical Pathology, The Royal Hospital for Women, Sydney
·C.A Mclean" D. Jolley', E Cukier, G. Giles" M.F Gonzales ' . 1. Department of Anatomical Pathology, The Royal Melbourne Hospital, Parkville, Victoria 3050 2. Anti-Cancer Council, 1 Rathdowne Street, Cartlon, 3053
Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. There has been considerable speculation as to whether the condition is real or a post mortem artefact during the last five decades. In this study 25 cases reported since 1925 in the literature are reviewed and 6 new cases are described. Clinically, a decrease of fetal movements is usually the only symptom during the second or third trimester of pregnancy and fetal death occurs soon after. The women's age, health and previous history have shown no link with this condition but a higher incidence is noted in twin pregnancy. Successive pregnancies complicated by cord stricture also reported in this study. Morphologically, most infants are macerated and an extremely narrow segment of umbilical cord is usually seen at the fetal end of the cord and rarely at the placental end or in multiple sites. Absence of Wharton's jelly, stenosis or obliteration of cord vessels at the narrow segment and cord thrombosis are the major pathological features. The findings of this study support the view that the condition can cause fetal death and alerts both pathologists and clinicians to the important features identifying this cause of perinatal wastage.
Twenty-eight patients with a diagnosis of either atypical or malignant meningioma, according to the WHO classification, were followed up to relate histopathological features with time to recurrence and death. The meningiomas were selected from a total of 2031 meningiomas notified to the Australian Brain Tumour Registry between 1986-1990. Of the 133 atypical/malignant meningiomas, the 28 chosen for the study had been completely resected. Two sets of Kaplan-Meier survival analyses were performed. The first analysis was from diagnosis to first recurrence and the second from recurrence to death. Additional analyses were stratified by the presence or absence of one of five histopathological features. These were; pleomorphism, prominent nucleoli, brain invasion, micronecrosis and mitotic activity. A second series of meningiomas were subsequently randomly selected from the residual 1898 to determine the proportion of benign meningiomas with micronecrosis. Five year disease free survival was 41 % with a median of 27 months. Micronecrosis was the only histopathological feature that was associated with an increased risk of recurrence (rate ratio 3.73). At 36 months, 32% of patients with micronecrosis were alive compared to 71 % of patients without micronecrosis. Brain invasion was not associated with disease free survival. After recurrence, median survival was 7 months and was not correlated with any histopathological feature. The prevalence of micronecrosis in the random samples from benign, atypical and malignant meningiomas was 8%, 42% and 71 % respectively. Brain invasion is currently the main distinguishing feature between atypical and malignant meningiomas in the WHO classification. We conclude that foci of micronecrosis and not brain invasion are a more important histopathological prognostic indicator. Presenter; Or C.A Mclean, Anatomical Pathology, RMH
p53 EXPRESSION IN ASTROCYTOMAS: AN IMMUNOHISTOCHEMICAL STUDY.
r. Tomlinson*. S. Carrello. H. Dawkins. P. Jacobsen and P. Robbins Department of Histopathology, Sir Charles Gairdner Hospital, NEDLANDS, Western Australia. Immunohistochemical analysis of p53 protein was evaluated in a series of 97 astrocytomas. The reactions were studied in 96 formalin fixed paraffin embedded tissue sections and 32 fresh frozen sections. immunostaining was observed in 27% of the formalin fixed cases and was found in all grades of astrocytoma (4/17 cerebellar pilocytic, 4/20 grade ll, 4/19 grade HI, 14/39 grade IV). immunostaining was present in 63% of cases examined in frozen sections. 23/32 were grade IV astrocytomas, of which 16 (70%) were positive. Staining in formalin fixed and frozen sections was able to be compared in 29 cases, 23 of which were grade IV astrocytomas. Overall there was positive staining in both paraffin and frozen sections in 7/29 cases. However, in 11/29 cases, positive staining was only present in the frozen sections. These findings indicate that immunostaining in frozen sections may be a more sensitive means of detecting p53 mutations, and that alterations in the p53 gene are involved in the initiation and progression of some astrocytic tumours.
ZYGOMYCOTIC INFECTIONS - A THREE YEAR REVIEW R. Norton * Division of Clinical Microbiology, Institute of Medical and Veterinary Science, Adelaide, S.A. 5000. A retrospective review was made of Zygomycetes isolated from clinical specimens submitted to this laboratory over a three year period. A total of nine patients were identified. In five of these there was histological evidence of fungal invasion of tissue. Two patients had rhinocerebral disease, two had burns and one had pulmonary disease. There were two deaths in this group. There were four other patients from whom zygomycetes were isolated but histological confirmation of tissue invasion was not sought. The significance of these isolates remains unclear and highlights the importance of finding evidence of tissue invasion. The majority of isolates were Rhizopus species. Predisposing clinical factors included diabetes, alcoholism, immunosuppression and extensive soft tissue damage. The pathogenesis of this condition is not fully understood but includes defective phagocytic mechanisms and iron metabolism. Liaison between the clinician, microbiologist and histopathologist is essential for optimal patient management. Clinical management generally requires adequate surgical debridement and antifungal chemotherapy.