Biomedical subjects
Publications and source records attributed to A Balaton.
Pancreatic cancer remains the fourth most common cause of cancer death. Surgery remains the only option for cure. Accurate diagnosis and staging are essential for appropriate management of patients with pancreatic cancer. This paper reviews the state of the art for imaging modalities in the diagnosis and staging of pancreatic adenocarcinoma. The crucial role of CT has increased with the new generation of multidetector CT.
CONTEXT: The Standards, Options and Recommendations (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To elaborate practice guidelines for difficult diagnoses in surgical pathology or cytopathology in cancer patients. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: The main recommendations to prevent and reduce the number of difficult diagnoses in surgical pathology or cytopathology are: The main recommendations to detect lesions associated with difficult diagnosis in surgical pathology or cytopathology are: The main recommendations to solve difficult diagnosis in surgical pathology or cytopathology are:
The HER2 proto-oncogene encodes a transmembrane protein, which is considered to function as a growth factor receptor. Overexpression of this protein found by immunohistochemistry in about 20% of infiltrating breast carcinomas, has a predictive value of response to treatment by trastuzumab, an anti-HER2 humanized monoclonal antibody. Search for HER2 gene amplification is necessary to adapt the immunohistochemical technique quality and also in the cases of delicate analysis or weak overexpression. It is usually carried out by Fluorescence In Situ Hybridization (FISH). A more recent hybridization technique, named CISH because of its chromogenic revelation is an alternative method, which gives highly correlated results with FISH. We present details of this technique, which may be more familiar for the pathologists than FISH, because reading analysis is similar to that of immunohistochemical staining.
Primary squamous cell carcinoma of the endometrium (PSCCE) is an exceedingly rare tumor. Rarely are cytological criteria discussed. We report our experience in the cytological diagnosis of a case. A postmenopausal, 64-yr-old woman suffered from pyometria. An endometrial Pap smear displayed some malignant squamous cells. Curettage of the cervix and the uterine cavity only recovered some fragments of atypical squamous epithelium whose origin could not be precisely identified. A hysterectomy with bilateral adnexectomy was decided upon. Pathological study evidenced a primary squamous cell carcinoma in the uterine cavity while the cervix was tumor-free and the lymph nodes were devoid of metastases (pT1, pN0, pM0). The patient died 46 mo PO with multiple pulmonary and renal metastases. The histological feature of PSCCE is identical to that of any tumor of a similar nature, whatever the site, especially the cervix. Confirmation of the primary endometrial nature is only possible on the hysterectomy specimen.
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993 is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for difficult diagnoses in surgical pathology or cytopathology in cancer patients. METHODS: Data were identified by searching Medline and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 71 independent reviewers. RESULTS: The main recommendations to prevent and reduce the number of difficult diagnoses in surgical pathology or cytopathology are: 1) The development of quality insurance programs with use of written procedures in each pathology laboratory (standard). 2) The knowledge of clinical data in order to explain surgical pathology or cytopathology results (standard). 3) The availability of complementary patient informations (radiologic data . . .) can be useful to explain surgical pathology or cytopathology results (option). The main recommendations to detect lesions associated with difficult diagnosis in surgical pathology or cytopathology are: 1) Tumor types known as potential difficult diagnosis in surgical pathology or cytopathology should be reviewed by a second pathologist. 2) The systematic second reviewing for every case is expensive but has to be done when the difficulty is know (sarcoma, lymphoma . . .) by experienced pathologists. The main recommendations to solve difficult diagnosis in surgical pathology or cytopathology are: 1) Block recuts, use of special techniques (immunocytohistochemistry and molecular biology), additional data from clinicians, second opinion by a local pathologist, or new specimen can be required for establishing the diagnosis (options). 2) Outside second opinion by expert pathologist has to be considered once the other steps did not allow to establish surgical or cytopathology diagnosis (recommendations, expert agreement).
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The authors report a case of adenoid cystic (cylindromatous) carcinoma of the endocervical canal associated with an intraepithelial squamous cell carcinoma of the cervical os in a 60-year-old woman suffering from metrorrhagia. Immunohistochemical study demonstrated labeling of cylindromatous cells with anti-actin, anti-vimentin and anti-keratin antibodies. Ultrastructural study provided significant findings to confirm that the hyaline material surrounded by tumor cells was derived from the remnants of the lamina densa of the basement membrane of tumor lobules. These morphological data are similar to those observed in adenoid cystic carcinomas (cylindromas) of salivary glands. They support the hypothesis that adenoid cystic carcinoma of the cervix may develop from the multipotent reserve cells.
Findings are presented from an histological study of 360 skin-snips (from iliac crests, calves, ankles) taken from 30 Ivory Coast onchocerciasis patients before and three days after an oral dose of ivermectin (200 micrograms/kg). This dose causes a nearly complete disappearance of the intralymphatic microfilariae and, surprisingly, of the "extra-vascular" ones. That shows the difficulty to localize the microfilariae on histological sections; these microfilariae are in fact inside the lymphatic pre-capillaries. There was no intensification of acute skin lesions after the treatment, thus showing that, contrary to diethylcarbamazine (DEC), ivermectin does not induce an exit of microfilariae into the extralymphatic connective tissue. Under the influence of ivermectin, paralyzed microfilariae may be carried passively towards the deep sub-cutaneous lymphatics, and then destroyed inside the regional lymph nodes, without producing major changes in the skin.
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In this paper, the authors report two cases of adult type rhabdomyomas of the soft palate. This tumor is composed of striated muscle cells containing striations and intracytoplasmic rod-shaped inclusions. In specimens already fixed in aqueous fixators (formalin...), some tumor cells presented a fixation artefact and displayed the morphology of so-called "spiderweb cells". Adult type rhabdomyoma is a real tumor. Total surgical removal is sufficient to cure the patient of this tumor in most cases.
We report the eleventh illustrated case of primary liposarcoma of the heart in a 28-year-old man. The tumor arose from the mitral valve and the left ventricle and was revealed by a solitary brain metastasis 1 year before. The primary tumor and the metastasis were surgically removed. The cardiac and brain neoplasms were myxoid liposarcoma, as confirmed by histochemical, immunohistochemical, and ultrastructural studies. Although review of the literature points out the poor survival of patients with malignant liposarcoma of the heart, no recurrence or metastasis was observed after a 6-month follow-up.
The authors a rare case of necrotizing sialometaplasia localised in the palate. This case is interesting because of the diagnostic problems raised by the clinical and radiological appearance of the lesion. The case report is completed by a review of the literature.
A case of primary leiomyosarcoma of the ovary in a 35-year-old woman is presented. The tumor was investigated histologically and by histochemistry. Desmin was demonstrated in neoplastic cells. Pertinent literature is reviewed and histogenesis is discussed.
Microwave irradiation of biological specimens produces molecular movement and heat, mainly because dipolar molecules like water are caused to reverse on their axes 2.45 billion times per second. These properties have been used in biology for some years. Using a domestic microwave oven, there is a dramatic decrease of the time needed to perform numerous histological procedures: fixation; dehydration, clearing, impregnation; slide drying; histochemical staining, particularly with metallic impregnation techniques which benefit from an additional improvement in quality; enzyme histochemical reactions; immunohistochemical reactions.
Some metallic impregnations--Fontana-Masson, Warthin-Starry, Grocott's methenamine silver, Grimelius' and Dieterle's stains have been modified to use a microwave oven. Microwave bombardment markedly reduces the staining times and produces a cleaner background.
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A 62 yo man presented with an enlargement of the parotid gland that had accentuated over the past ten months. Results of a needle aspiration cytology were interpreted as consistent with an adenocarcinoma. A surgical investigation was decided. Frozen and paraffin sections of superficial parotidectomy specimen disclosed a malignant melanoma. This specimen also contained an intraparotid lymph node which was free of tumor. Cervical lymph node dissection yielded 4 metastatic adenopathies among 15 lymph nodes. A retrospective search for an anterior melanocytic lesion was negative. The final diagnosis was primary malignant melanoma of the parotid gland. Cervical radiotherapy was applied. 7 months later, the patient died of diffuse metastatic involvement in the skin, brain, lungs and liver. No local recurrence occurred. Review of the medical literature revealed the rarity of malignant melanomas of the parotid gland (0.68%). No significant differences concerning clinical data and pathological aspects were noted in so called primary malignant melanoma and secondary malignant melanoma of the parotid gland. Nevertheless, primary malignant melanoma of the parotid gland is a controversial entity. Pathogenesis is discussed on the light of modern concepts of diffuse neuro-endocrine system. Prognosis remains poor, due to a late diagnosis and to an inherent aggressiveness of this type of tumor.
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