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Biomedical subjects

S S Banerjee

Publications and source records attributed to S S Banerjee.

At least 55 records · Page 3Linked to original sources

Nodular erythema elevatum diutinum mimicking cutaneous neoplasms.

AIMS: We describe the cutaneous pseudoneoplastic lesions in two patients with nodular erythema elevatum diutinum, a rare chronic disorder in which polymorph nuclear fragmentation (leukocytoclasis) is present within dermal nodules showing spindle cells and fibrosis. In both cases diagnostic difficulty was encountered clinically and pathologically and various benign and malignant neoplasms were considered in the differential diagnosis. METHODS AND RESULTS: Immunohistochemically the spindle cells were negative for CAM5.2, AE1/3, S100 protein and desmin (D33). They were positive for vimentin and focally positive for CD34 and alpha-smooth muscle actin. Some of the spindle cells were positive for Mac 387 and KP1(CD68). By electron microscopy, the lesions were shown to consist of fibroblasts/myofibroblasts and fusiform macrophages. CONCLUSIONS: Increased awareness of the features described will help to avoid misdiagnosis as a neoplastic process.

Adult↗

VS38 immunostaining in neuroendocrine tumours.

VS38 was originally described as a marker of neoplastic and non-neoplastic plasma cells. We recently described its immunoreactivity with melanocytic lesion. The aim of the present study was to investigate the reactivity of VS38 with various neuroendocrine tumours. Using paraffin sections of routinely processed archival tissue we found that 72% of 50 neuroendocrine tumours tested showed immunohistochemical positivity for VS38. A wide spectrum of neuroendocrine tumours were positive. Use of a panel of markers and awareness of the lack of specificity of VS38 will avoid misdiagnosis, particularly when neuroendocrine tumours and other lesions which react immunohistochemically with this antibody are located at unusual sites and exhibit plasmacytoid features.

Antibodies, Monoclonal↗

Prognostic factors for breast recurrence after conservative breast surgery and radiotherapy: results from a randomised trial.

Prognostic factors predicting for breast recurrence following breast conserving surgery and radiotherapy have been identified in a prospective randomised trial comparing two different radiotherapy techniques. The first used megavoltage radiation to encompass the whole breast and regional nodes (WF group). The second used an electron field directed to the tumour bed only (LF group). With a median follow up of 8 years survival in both groups was the same (72%). There was an increased rate of breast recurrence in the LF group: 25%, compared to the WF group: 13% (P = 0.00008), expressed in actuarial terms at 8 years. In a multivariate analysis of factors predicting for breast recurrence, once the difference in treatment technique is allowed for, only two factors were found to be significant: histological grade (P = 0.013) and lymphovascular invasion in the histological specimen (P = 0.037).

Breast Neoplasms↗

Gastrointestinal autonomic nerve tumours: a report of nine cases.

We describe the clinicopathological features of gastrointestinal autonomic nerve tumours in nine patients where the diagnosis was confirmed by electronmicroscopy. Most patients presented with abdominal pain. At laparotomy, large intra-abdominal tumour masses were found which tended to be cystic and haemorrhagic. The predominant histological patterns were nests, sheets and fascicles of spindle and epithelioid cells. Immunohistochemistry showed positive staining for neuron specific enolase (9/9), PGP 9.5 (9/9), NKI/C3 (7/9), vimentin (7/9), alpha-smooth muscle actin (5/9), vasoactive intestinal peptide (3/9) and CD34/QBend10 (2/9). Grimelius staining was positive in two of nine cases. All tumours were negative for CAM 5.2, chromogranin, synaptophysin, Leu 7, neurofilament protein, muscle-specific actin (HHF-35) and desmin (D33). Ultrastructural examination showed cellular processes and dense-core granules in all cases. Three tumours had microtubules and/or intermediate filaments, particularly in cell processes. Skeinoid fibres were seen in three cases. No convincing synapses or small (synaptic-type) vesicles were identified. There was no evidence of epithelial, smooth muscle or nerve sheath differentiation. Two patients died due to tumour, two died of unknown causes and the remainder are alive 2-44 months after presentation. Four of the five survivors have recurrent/residual intra-abdominal tumour. So-called gastrointestinal autonomic nerve tumours are apparently slow-growing malignant tumours showing neuronal differentiation. Four cases arose in the mesentery/retroperitoneum or omentum rather than bowel wall and therefore a more appropriate nomenclature might be intra-abdominal stromal tumour with neuronal differentiation.

Actins↗

Malignant melanoma showing smooth muscle differentiation.

A unique case of a metastatic non-desmoplastic sarcomatoid malignant melanoma in an axillary lymph node showing smooth muscle differentiation in a 54 year old woman is described. The tumour cells exhibited alpha-smooth muscle actin, HHF-35 and desmin positivity but were negative for S100 protein and HMB-45. Ultrastructural examination revealed smooth muscle phenotype and there was no evidence of myofibroblastic differentiation, a feature described previously in desmoplastic melanomas.

Actins↗

VS38 immunostaining in melanocytic lesions.

AIMS: To investigate the immunoreactivity of a range of melanocytic lesions, both benign and malignant, with the monoclonal antibody VS38. This was recently described as a marker of reactive/neoplastic plasma cells and, therefore, is useful in the diagnosis of plasmacytoma/myeloma and lymphomas with plasmacytic differentiation. This study was prompted by the recent observation that a plasmacytoid melanoma arising in the nasal cavity was strongly immunoreactive with VS38, which was therefore a potential source of major diagnostic error. METHODS: The Streptavidin-peroxidase complex technique was used on paraffin wax embedded sections of 167 melanocytic lesions. Diaminobenzidine (DAB) was used as chromogen for non-pigmented or lightly pigmented lesions and nickel/DAB for more heavily pigmented lesions. RESULTS: Positive immunostaining for VS38 was seen in 14.5% (10/69) of benign naevi (including 40% (four of 10) of Spitz naevi), 10.5% (two of 19) of dysplastic naevi/in situ melanomas, 92% (35/38) of primary cutaneous melanomas, 100% (four of four) of primary mucosal melanomas, 91.7% (33/36) of recurrent/metastatic melanomas, and 100% (one of one) of clear cell sarcomas of soft tissues. CONCLUSIONS: VS38 immunostaining is frequently positive in primary and recurrent/metastatic malignant melanoma and is also reactive less commonly with benign naevi. These results should be borne in mind when this recently described marker of normal/neoplastic plasma cells is used to identify tumour lineage, particularly in tumours arising at unusual sites, such as in the nasal cavity. The possibility of malignant melanoma should be actively considered and excluded in any undifferentiated tumour which shows VS38 immunoreactivity.

Aged↗

Focal rhabdomyosarcomatous differentiation in primary liposarcoma.

A unique case of primary myxoid liposarcoma of the thigh, in which focal pleomorphic areas were present containing rhabdomyoblasts, is described. Focal rhabdomyosarcoma in liposarcoma has only rarely been reported previously and only in dedifferentiated liposarcomas of the retroperitoneum. All but one have been recurrences with rhabdomyoblasts being absent in the primary liposarcoma. As rhabdomyoblasts were only focally present, the present case is regarded as liposarcoma with focal divergent rhabdomyoblastic differentiation rather than malignant mesenchymoma.

Aged↗

Malignant peripheral nerve sheath tumour with vascular differentiation: a report of four cases.

Four cases of malignant peripheral nerve sheath tumour showing vascular differentiation are described. One case was associated with neurofibromatosis 1 and contained angiosarcomatous, cartilaginous and rhabdomyoblastic elements. The other cases occurred in patients without neurofibromatosis and showed a spectrum of vascular lesions ranging from lobulated, haemangioma-like structures to angiosarcoma. These are the first recorded examples of this phenomenon not associated with neurofibromatosis. Immunohistochemical examination demonstrated the endothelial nature of the lesions in all cases and revealed cells positive for alpha-smooth muscle actin, probably pericytes, closely apposed to the endothelium.

Adult↗

Olfactory neural tumours--the role of external beam radiotherapy.

Olfactory neuroblastoma is an uncommon tumour arising in the nasal cavity or paranasal sinuses. We report the management of nine cases treated with external beam radiotherapy subsequent to surgery, either attempted definitive removal or biopsy only. Recent refinements in pathological evaluation of these tumours are discussed. Seven cases were deemed classical olfactory neuroblastoma whilst two were classified as neuroendocrine carcinoma. The clinical features, radiotherapy technique and variable natural history are presented. Seven of eight patients treated radically were controlled locally, with a minimum follow-up of two years. Three patients developed cervical lymph node disease and three patients died of systemic metastatic disease. Suggestions are made as to which patients should have en-bloc resection rather than definitive radiotherapy.

Aged↗

Inflammatory pseudotumour of lymph nodes.

AIM: To describe the clinical, histological and immunohistochemical features in four cases of an uncommon benign lymph node lesion which may mimic a neoplastic process. METHODS: Four cases of inflammatory pseudotumour of lymph nodes were studied using conventional staining (haematoxylin and eosin, PAS, Gordon and Sweets reticulin stain, and the Ziehl-Neelsen stain) and with immunohistochemical techniques using a variety of antibodies (CD3, L26, CD15, CD21, CD30, KP1, MAC 387, vimentin, alpha SMA, HHF-35, D33, CD34, and S100). RESULTS: The lesion comprises a proliferation of spindle cells expanding the connective tissue framework of lymph nodes and is associated with a plasma cell and small lymphocyte infiltrate. There are variable numbers of macrophages, neutrophils and eosinophils, and varying degrees of fibrosis. Vascular changes are common but vary in degree and type. CONCLUSIONS: Inflammatory pseudotumour of lymph nodes is an uncommon benign reaction pattern which may be misdiagnosed as a neoplastic or even a malignant process. Increased awareness of its histological features should help prevent such misdiagnoses.

Adult↗

Audit of tumour histopathology reviewed by a regional oncology centre.

AIMS: To analyse the diagnostic differences in reporting tumour histopathology between a district general hospital and a regional oncology centre. METHODS: Tumour histopathology reports (n = 227) extracted from Bolton General Hospital files between 1988 and 1992 were compared with the corresponding Christie Hospital (oncology centre) reports, the same material having been seen at both hospitals. RESULTS: Diagnostic agreement existed in 77% of all cases. The incidence of major discrepancies was 8.37%. Of the diagnoses, 19 (36%) cases involved major discrepancies and 34 (64%) cases minor discrepancies. Most discrepancies occurred in the lymphoma group and involved subclassification of Hodgkin's and non-Hodgkin's lymphoma. Ki1 anaplastic large cell lymphoma and T cell rich B cell lymphoma were problematic diagnoses. The correct grading of follicle centre cell lymphomas using the Kiel classification was another problem area. In 19 cases certain aspects of immunohistochemistry produced discrepancies. In one case an incorrect diagnosis was made at the oncology centre and in another both centres gave an incorrect diagnosis. CONCLUSIONS: Areas of diagnostic difficulty mainly involve the subclassification of lymphomas. Review of tumour pathology by experts is recommended, at least in certain categories, to ensure correct diagnosis and uniformity in subclassification of tumours.

Cancer Care Facilities↗