P-675 Clinical importance to distinction of B3 thymoma from othertumor types in the WHO histological classification of thymoma

Posters I ~ 7 2 ~ C o r r o l a t l o n betwesn high-resolution CT findings and hletopathologlcel findings of small pulmonary adenocarclnomas H Saito ~ K Yamada 1, N Hamanaka ~, Y Mizutani 1, F Oshita 1, H Nakayama ~. Y Kameda 2. K Noda ~ 1Department of Thoracic Oncd/ogy, Kanagawa Cancer Center, Yokohama, Japan 2Departrnent of Thoracic Pathology, Kanagawa Cancer Center, Japan Backgrounds: Previously. we reported that small pulmonary adenocercinomas (tumor clameter 20 mm or lass) could be classified according to attenuation on high~-asolut]en CT (HRCT) imagos as either 'air~,,ontaining type' (='air typo~ or 'solid
type ~-i

Classification of histological parletal pleural Invasion at adhesion sltss with surgical specimens of NSCLC and Implications for prognos|s

Y Satoh 1'2 Y Ishikawa ~. K Inamura I . H Ninemlya ~. T Inagaki 2. Y Matsui 2. M. Hiramatsu 2. S. Okumura 2. K. Ken N~agawa ~. E. Tsuchlya ~. ~Departrnent

of Pathology, Cancer institute, Japan, ~Departmant of Chest Surgery, Cancer lnst]tuta Hospital, Japan, 3Research thstJtuta, Kanagawa Cancer Center, Japan Objective: Panetal pleural invasion of non-small cell lung cancer (NSCLC) is a factor for poor prognosis and a tumor of any size that invades the parietal pleura is classified as T3 However. the UICC TNM elassificet]on includes little detail on histological pleural invasion in its definitions. In contrast, the Japan Lung Cancer Society classifies visceral pleural invasion based upon histological e0(aminat]ons. With microscopio invasion beyond elastic fibers of the visceral pleura but no penotTat]on to the panetal pleura at tight adhesion s~tos (we term ttls pl-3), class~fieat]on as to the T factor is undoaan Moreover. the current Japan Lung Cancer Sooety and UICC TNM classifications do not take this condition into account. Since unequivocal parietal pieural invasion is diagnosed as T3. the quast]on adses as to whether invasion beyond the visceral pleura at tight adhesion sites (e0(cluding intedobar invasion) should also be considered in the same way To clarify this point, a series of rasected NSCLCs with invasion histologically demonstrated pl 3 status were studied Methods: Among 1698 consecul~ve patients with NSCLCs who underwent ourative surgery between 1980 and 2003. 24 wore in this category Here a comparison was made with subgroups of p-stages lB. I1. and IliA. with regard to histology, ploural invasion, and survival rates. To maximize the power of assessing prognost]o potential, we sot the significance level at 0.10. one sided. Histologically. ploural invasion was evaluated by elastic fiber staining. During operation, the limits of chest wall invasion and the state of the mediast]nal lymph nodes were e0(plored to ascertain operability and to define

Pathology

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the disease free margins of resection for the parietal pleura, diaphragm, nb and pericardium Results: The pl 3 condition sites of the 24 cases wore the padetal pleura for 21 cases and the pericardium, claphragm, and chest wall for one each of the remainder The b-year survival for these pl 3 pafients was 74%. and these for patients with Stage lB. IIA. liB. and Ilia were 71%. 72%. 60%. and 47%. respectively Significa'lt dif~rencos were observed between pl 3 and Ilia groups (p 0 064) Although the 5-year survival did not significantly ciffer between p1-3 w~h NO (n = 17) and T3N0 or unequrvoeal T3 subgroups (percent surviving. 58%). the prognosis of p l - 3 wtth NO patients (percent surviving. 67%) was rather better than that of T3 and pract]eally identical to T2 (percent surviving. 71%). Among five cases with N2 disease in the p l - 3 group, two remain alive without evidence of disease, one alive with ~seaso. and two died of other diseases, which suggest a relatively good prognosis. COrlCluslorls: it was demonstrated that ploural invasion w~h p l - 3 is not a factor warranting T3 classificafion for NSCLCs ExtTapleural resection of the chest wall with the lung can thus be recommended as the procedure of choice to obtain complete tumor removal Considering the prognosis, pl 3 tumors should be managed as T2 disease for the present Cydooxygsnass-Z expression In non-small cell lung cancer:. Relation to expressions of p53. Bed-Z, Bax, tumor cell proliferation, and survival B. Sis ~. A. Kargi I . C. Ulukus I . I. Oztop 2. A. Akkoclu 3, A. Sanli 4. A. Onen 4.

l Dokuz Eylul University School ~ Medicine, Department of Pathology, tzmir, Turkey, 2Dokuz Eylul Umverstty School ot Medicine, Department ot tntemal Medicine Division of Hematology-Oncology, Turkey, ~Dokuz Eylul University Sohool ct MeeJcine Department of Pulmonary Dtseases, Turkey, 4Dokuz Eylul Untverstty School ot Medicine Department ct Thoracic Surgery, Turkey Background: Cydeexygonaso (COX) 2 overoxpresslen has been detected in a variety of human malignanaas including lung cancer, and COX 2~argeted therapy options are under development. However. the precise mechanisms by which COX 2 expression involves in carcinogenesis are poody understood. Therefore. we aimed to invest]gate COX 2 ~press~en in non small cell lung cancer (NSCLC) and to define any correlation with e~(pressions of p,53. Bd-2. Bax. tumor cell proliferation, and overall survival Methods: In total. 63 NSCLC specimens were e0(amined for e0(pressions of COX-2. p53. Bcl-2. Bas. and K i l t labeling i n d ~ by immunohistochemistTy COX-2 e0(preasion was related to Ki~7 labeling inde=, e0(pressions of p,53. Bcl-2. Bax. conventional clinicopathoiogicel pregnost]c factors, and survival Results: Fifty two (82 ,5%) cases were positive for COX-2 with a granular st;~rlng in tumor cell cytoplasms. COX2 expression was significantly associated with p53(+)iBcl 2() phenotype (p=0.04). and was inversely correlated with Bcl 2 expression (p = 0.01. R=O.296). The mean Bcl 2/Bax ratio was 0.69-1-1.27 for COX 2 pos~vo cases and 1.9-~-1.76 for COX 2 nogatrve cases (p= 0.03). No significant relat]enships were found between COX 2 expression and Bax expression. Ki87 labeling inde0(, and clinicopathelogic Ibatures (p>0.05). By Kapian Meier analysis. Ki 67 labeling index (p ~<0.001). tumor size (p 0 02). lymph node metastasis (p 0 03). and TNM stage (p 0 001) were associated with survival, whereas COX-2 was not (p>0 05) In mulfivanate analysis, only TNM stage emerged as independent pregnost]c factor 03 O O0~ Conclusions: COX-2 expression in NSCLC is related to p53(+)/Bel-2(-) status and low Bd-2/Bax rafios, and is inversely correlated with Bcl-2 e~(prassion The findings suggest a role for COX-2 expression in the regulation of tumor cell apoptosis, but it does not appear to be a significant prognostic factor. [ P ~ 5 ] Clinical Importance to distinction of B3 thymorna from o ~ a r tumor types In ~ a WHO histological classification of thymoma S. Sonobo. H. Mlyamoto. H. Izumi. Y. S ~ a o . T. Futagawa. Y. Anami. A. Yamazaki. T. Oh. R. Fukai. Y. S;~to. Department ot Genera/ Thorac/c

Surge~ Juntendo Umverstty School of Medtcme, Tokyo, Japan Background. Rosai et al. published the Wodd Health Organization (WHO) dassificet]on of thymic op4tholial tumors in 1999. and its clincel usefulness seems to be established. It is for our tils purpose to find a clinically impotant point in the WHO Histological Classificat]on of Thymoma. Methods: Thymomas surgically removed from consecutive 100 patients at Juntendo University Hospital between October 198.3 and February 2002 were dassified according to the WHO histological dassification We assessed overall survival and recurrence-flee rate calculated for each tumor type in the WHO dassificefion compared with those of tumors classified bytbe Masaoka system Results: The thymic epithelial tumors in this senea comprised 10 type A. 1,5 type AB. 18 type Bl. 21 type B2. 33 type B3. and 3 type C tumors according to the WHO classification. Based on the Masaoka system, the disease was stage I in 53 pat]ants, stage II in 30. stage III in 15. and stage IV in 2. The l ~ y o a r recurrence free rate was 100% for type A. AB and BI. while the rates for types B2 and B3 were 66.7% and 54.5%. respectively The 10 year recurrence free rate was 66.7% for type C. The 15 year recurrence flee rate of the 64 patients

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Posters / Pathology

with type A. All. B1. and B2 thymomas was s~gnlficantly higher from that of the 33 palJents with type B3 thymoma (p 0 0026) Conduslon: When using the WHO classificat]on, it is cr~cel to dist]nguish type B3 thymoma from other tumor types P ~ 7 6 I Solitary fibrous tumor of pleura - 39 cases dudng 10 years J Sto{sic. D Jovanm/ic D Mandaric. R Jakovic. M Ercagovac. Z Spasic. J. RadoJicic. lns~tuta for Lung Dtsaases and Tuberculosis, Be/grade, Yugeslavta Background: Solitary fibrous tumor (SFT) was a pleural mesenchimal tumo[ SFT was a derival~on of fibroblastic cells from submasothelial pleural fibrous tissue The aim of the study was to evaluate tumor size. weight, cellularity and mitol~c act3vity as prognostic factors Methods: We analyzed 39 SFTs clagnosad during last 10 years On 16 percutaneous needle biopsies preoperat]vely ware diagnosed mesonchimal tumor with or without cellular pleomorphism and mitotic activity. Macro scopicaly, in all cases we measured tumor s=e. weight, possible tumor penetrat]on of capsula and infilb'ation in surrounding structures. Microscopicely. after routine haomatoxylin~osm stains and pathohistolugical examination we applied monoclonal ant]bodies to cenfirm diagnosis of SFT: vlmentin. CD34 and bcl 2. Also. we evaluated tumor morphology, callularlty, mitot]c activity, degree of necrosis, possible tumor involving of capsula and infiltTation of surrounding structures

Results: Tumors measured 30 mm to 300 mm in the largest diameter ] h e largest SFT showed only compressive symptoms, without evidence of invasion in surrounding structures ] h e most heavy SFT measured 4gO0g. involving the whole right hemithorax and almost whole dght lung Microscopicely. primitive fibreblastic cells differentiated into haemangioma- and neurofibromalike morphological pattern. Spindle tumor cells expressed viment]n. CD34 and bcl 2 in all SFTs. Cellularity vaned from hypocellulanty accompanied with myxoid areas and hyalinisation to hypercellularlty Six SFTs were hypercallular. with mild to moderate cell pleomorphism and mitotic act]v~ with or without necros~s. Tumors involved or only tumor capsula or surrounding st]-uctures: lung. meclastinum or pencard. Pat]ants with malignant SFT had fatal outcome. The rest 33 wall encapsulated SFTs without hypercallularl~ and prominent mitol~c act3vity were without local recidlve and metastasis

solitary metastatic colorectal carcinoma to the lung. a partial lung re,section is feasible On the other hand. if the turner is a primary lung carcinoma. a Iobectomy and a dissect]on of regional lymph nodes are necessary as the racicel resect]on Immunchistochemical markers serve an important role in the differenlJal diagnosis between primary and metastat]c lung lesions Recently. immunohistochemical analysis of the e~(pression of oftokeratin (CK') 20. as well as CK7 and tTanschption factor-1 (3-r-F-I) has been used to ciscern primary from metastatic adenocaroinomas in lung in many laboratories ]he CK20+/CK7 pattem is known as typical of celorectal adenocarcinomas. However. CK 20 expression is recognized in approximately 8% of lung adenocarolnomas. CDX2. is a recently cloned homeobos gene enco~ng an intestine specific transcription factor, and has been reported to have speafic and sensitive expression in colorectal carolnomas. Although several reports have shown CDX identified almost all cases of celorectal carcinoma metastatic to the lung. they have analyzed using the resected specimen. not the preoperatNe biopsy specimen Clinically preoperatNe diagnosis is mere important We evaluated the CDX2 immunohistochemicel examinat]on of biopsy specimen and rasected specimen as a high potent]al marker of metastatic colorectal edenocaroinoma to the lung Methods: A series of 40 censecutJve colorectal adenoceroinoma metastases to the lung. presenting between February 1994 and September 2004 in our hospitals, were used for the present study Two of them were not definitively distinguished from primary lung adenocarolnoma morphologically by Homatoxylin~_osin staining, but ware clinically diagnosed as metastatic celorectal ca~noma. Unsolected cases of 10 primary lung adenoca~nomas with preoperattve biopsies and 10 celorectal adenocarclnomas were used as cent]-ols. Fourteen specimens ext]'acted from preoperative or intraoperatrve biopsy were also used for this study. All specimens ware stained with the ant]body against CDX2. Results: Forty (100%) resacted specimen and 14 (100%) biopsy specimen of metastat]c tumors, and 10 (100%) colorectal tumors expressed CDX2 In centTast, no (0%) resacted specimen or biopsy specimen of primary lung edenocaroinoma e0(pressad CDX2 Conclusions: Our results suggest that CDX2 is a potential marker for cistingulshing primary lung adenocercinoma from metastatic colorectal adenocarcinoma to the lung. not oily using resacted specimen but using biopsy specimen. Adequate surgery could be provided by the preoperat]ve CDX2 immunohistochomical examinat]on of lung biops~as.

15% SFTs were malignant r

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[ P ~ 8 ] U.=e of automated Irnaga cytornetry In dlagflo.=l.= of lung cancer from bronchial wa.=hlngs

33 benign SFTs • 6 mahgnantSFTs

M. Tercell ~. M. Jerse. G. Gavanski. A. Doudkine. IUntversrty Mod/ca/

Clinic, Ljubljana, S/ovenia, 2Institute for Pathology, MeScal School University, Lju~jana, S/oven/a, 3Peroaptrentx Medrcal Inc., Vancouver, Canada

85% 15%

Conclusion: All malignant SFTs. despite tumor s=e. had infilt]-atlve grewth pattem, ware bybercellular, with moderate and marked cellular atypia and mitolJc activity ]hey involved tumor capsula, penetrated it and infiltrated lung 1issue. pedcerd or mediast]nal stuctures, suggesting their malignancy Benign SFTs e0(hiblted hypo- to hypercellular areas with no prominent cell pleomorphism and mitot]c act3vity and without tumor capsula invasion ] h e sampling of SFT mandated its extensiveness for microscopicaly determination of their clinical course

Pathology Wednesday, 6 July :2005

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in ldletlngulehlng [ • adenccarclnoma U e eof CDX2 ffromumetastatic n colorectal e e prlrnary s lung adsnocerdnorna S. Tan;~kaI K. Saitoh 2. Y. Ishibashi I . T. Yoshida ~. T. Itoh ~. K. TaJima2. A. Mogi 2 . Y. Shitara ~. T. Sano 4. H. Kuwano I . ~Department ot Genera/

Surgmal Scmnce, Gunma Graduate School of MeCtcme, Maebash~, Japan; 2Department ~ Surgery, Fujioka Municipal Hospital, Japan, 3Department ot Surge~ /sesalo Mumclpal Hospital, Japan, 4Department ct Tumor Surgery, Gunma Graduate School of Medmme, Japan Background: The lung is one of most frequent target organ of metastatic tumors Colorectal carcinomas are often metastasized to the lung as a solitary nodule. Distinguishing primary lung adenocarclnoma from metastat]c celoroctal carolnoma to the lung is often difficult on histological examinat]on alone. However. the preoperative or intraoperat]ve ident]ficat]on is very important. because the therapeutic strategy of each disease is different. If the tumor is a

Background: Diagnosis of lung cancer from bronchial washings by means of conventional cytology remains a sedoos challenge A summary of publications on the subject (1) des. its average sons~vity of 48% for centrally located les~ons and 43% for penferal lesions (washings and BAL). In this study we invest]gated Automated Image Cytomet]-y performed on bronchial washing samples stained with quant]tatWe DNA stain as a tool for more accurate and repeatable diagnosis We used ClearCyte -M Image Cytometer produced by PerceptTohix Mecicel Inc (Vancouver. Canada) Methods: we analysed samples from 102 high risk palJents who underwent clagnostic bronohoscopy procedure 3,5 patients were comflrmed of having lung cancer by histopathology, while 67 had negative histological results. Bronchial washing samples ware taken dunng brenchoscopy, placed into cellect]on jars with fixat]ve and than processed and deposited on microscope slides using Cytospin 4 centnSJge (Therm(~Shendon). Pittsburgh. PA). Three slides from each sample ware stained with Hematexillin and Eosln and underwent convent]anal cytology assessment. Another three stides from each sample were stained with the DNA spoc~fic and sto~chiometnc Feulgen ]hionin stain and scanned uslug Clear'Cyte TM system. The system consists of base microscepic with automated XYZ stage, automated slide loader, high~-asolut]on CCD camera and computer with monitor. The images of relevant cell nuclei ware acquired and separated from debris by an automated (algorithmic) process and the normalized DNA amount (pioldy) and nuclear morphology faatures of the cells were calculated. Images of measured cells with aneuploid DNA content were displayed on the computer monitor for manual review. Cytologist subsequently cleaned suspicious cell galleries of the remaining debris and raviowed diagnoslJc cells cirectly under the ClearCyte microscope: the program allows any desired call to be automat]cally pos~oned under the cross,air of the microscope by a press of the mouse button Results: in our study, conventional cytology demonst]-ated high sensitivity of 71 4% at specifita of 100% when identifying carcinoma in sltu and cancer cesas: only 4 samples out of 102 were rejected as inadequate Analysis of samples using automated c,~/tometerwith subsequent review of atypical cells by q/tologist produced sensitivity of 88.5% at s p e c l ~ of 97%; all 102 samples ware determined ware determined adequate. Corlcluslons: Automated cytometer performs highly reproducible analysis of thousands of images of call nuclei in a matter of minutes. It performs objective