Asli Cakir

A comprehensive morphological study for basal-like breast carcinomas with comparison to nonbasal-like carcinomas

BackgroundBreast carcinomas can be classified into five subtypes based on gene expression profiling or immunohistochemical characteristics. Among these subtypes, basal-like breast carcinomas (BLBCs) are one of the most studied group, due to their poor prognosis. The aim of this study was to investigate the prevalance, morphological and immunohistochemical features of BLBCs, in Turkish population.MethodsFive hundred invasive breast carcinomas were reviewed for several morphological features and immunostained for oestrogen and progesterone receptors, c-ERB-B2, cytokeratin5/6, cytokeratin14, vimentin and epidermal growth factor receptor (EGFR). Basal-like breast carcinoma was defined as a triple negative tumor with cytokeratin5/6 and/or EGFR positive.ResultsThe prevalance of BLBC was 9.6%. All medullary carcinomas and 55.6% of metaplastic carcinomas showed basal-like immunophenotype. Patients with BLBC were younger (p=0.04) and had higher-grade tumors (p<0.0001). Morphologic features associated with BLBC included increased mitosis, nuclear pleomorphism, presence of geographic and/or central necrosis, pushing margin of invasion and stromal lymphocytic response (p<0.0001). Presence of prominent nucleoli and vesicular nuclear chromatin were the cytological features correlated with basal-like phenotype (p<0.0001). On multivariate analyses, BLBCs were associated with high mitotic number (p<0.0001), the presence of vesicular chromatin (p=0.004), high tubular grade (p=0.011), lymphocytic response (p=0.031) and the absence of carcinoma insitu (p=0.039). Vimentin was positive in 53.2% of BLBCs, while cytokeratin14 was less frequently expressed (27.7%).ConclusionsBLBCs have some distinctive, but not pathognomonical, morphological features. Paying attention to these features and adding cytokeratin14 and vimentin to the immunohistochemical panel can help the definitive diagnosis of BLBCs.Virtual slidehttp://www.diagnosticpathology.diagnomx.eu/vs/5962175467857400

Investigation of diagnostic utility and expression profiles of stem cell markers (CD133 and CD90) in hepatocellular carcinoma, small cell dysplasia, and cirrhosis

The aim of this study was to investigate the expression rates of CD133 and CD90 in cirrhosis-dysplastic nodule-HCC (Crh-DN-HCC) sequence related to the etiologic background. Thirty-five HCC, 8 small cell dysplasia (SCD), and 63 cases of cirrhosis having different etiologies were collected. Immunohistochemical expressions of CD133 and CD90 were evaluated. CD133 positivity was higher in HCC cases with chronic hepatitis B and CD90 with chronic hepatitis C. The highest staining rate was seen in poorly differentiated HCC cases. Only one SCD case and almost half of the cirrhotic cases which were stained for CD133 were associated with hepatitis B; none was stained for CD90. Increased CD133 expression indicated a significantly shorter overall survival rate. No significant relationship was detected between the expression rates of CD133 or CD90 and other parameters. In this study, which investigates the immunohistochemical expression profiles of CD133 and CD90 through Crh-DN-HCC sequence, the highest staining rate was detected in HCC. It is rational to try to elucidate the earliest events in hepatocarcinogenesis by studying SCD. It is important to be aware of this issue in daily practice, which will provide a deeper insight into the understanding of the effects of CSCs in the progression and management of HCC.

Intracystic papillary carcinoma of the breast: one of the youngest patient in the literature

A 29-year-old premenouposal women presented with bloody nipple discharge and mass in her left breast. Ultrasonography showed periareolar two solid and two cyctic masses in the ductal tract. Excisional biopsy was performed. Macroscopically, the size of the cyctic lesion was 1 9 1 cm in diameter and pathological examination showed intracystic papillary carcinoma (IPC) and intraductal carcinoma where IPC was in continuity in the 8 mm area. After excisional biopsy, left mastectomy and sentinel lymph node dissection (SLND) were performed. On pathological examination 0.5 cm residuel IPC was determined (Fig. 1). Immunohistochemical staining showed estrogen and progesteron receptor were positive Her2/neu was 2?, confirmed by the fluorosein in situ hybridization (FISH). There was no metastasis in sentinel lymph nodes. According to the TNM classification, the postoperative stage was T2N0M0 as stage IIA. After mastectomy we planned adjuvant endocrine therapy in this case. IPC is a non-invasive papillary carcinoma variant and accounts for 0.5–1% of all breast cancer. Although IPC was reported non-invasive carcinoma, generally associated with ductal carcinoma in situ (DCIS) around the main tumor or invasive carcinoma [1–4]. Papillary carcinomas were classified as invasive and non-invasive forms. The non-invasive form was divided into the diffuse form and the localized form. We present a case of IPC accompanying intraductal carcinoma. IPC generally occurs in older women, around 60–70 years as against other breast carcinomas [5, 6]. Although IPC commonly diagnosed in older women, our case is very young woman who is one of the youngest women in the literature. Our review of the literature, more than 1200 women and 50 men that affected IPC. The median age of these patients was 69 (range 27–99 years). There are no clear guidelines on how to treat the tumor [7]. Generally, IPC shows no invasive growth outside of the cyst and is treated similarly to DCIS [8, 9]. Several studies have shown IPC’s prognosis is excellent and recurrence rates low [3–5, 10–13]. In the present case, we performed mastectomy and SLN biopsy after excisional biopsy that confirmed histological diagnosis of cystic papillary carcinoma. After surgery she has been using adjuvant endocrine therapy. Surgical excision is the form the basis of treatment of IPC. Breast-conserving surgery and mastectomy have been used in the treatment. All interventions were not show differences than the other and all procedurs with a good prognosis [4, 7, 13]. The surgical management of IPC appears to parallel that of invasive ductal carcinoma, with a lower rate of breast conservation in older studies [4]. In addition to surgical excision, several studies have reported on the use of adjuvant radiation and/ or endocrine therapy in the management of IPC [4, 7, 13]. There is no consensus as to the role of axillary staging procedures for IPC [14]. Although many authors have suggested that IPC, be treated similar to DCIS it has been reported that, like IPC, DCIS with microinvasion has an 8– 14% incidence of axillary lymph node involvement. Therefore, sentinel lymph node biopsy has been recomended for these patients [15–17]. In conclusion, IPC is the most common appear in older women, however can also determined in younger women M. Baykara U. Coskun (&) U. Demirci R. Yildiz M. Benekli S. Buyukberber Department of Medical Oncology SD, Gazi University Medical School, Besevler, Ankara 06500, Turkey e-mail: ugurcos@hotmail.com

Synchronous testicular liposarcoma and prostate adenocarcinoma: a case report

Prostate adenocarcinoma is the most common malignancy and the second leading cause of cancer related deaths in men. Testicular liposarcomas are uncommon soft tissue neoplasms. We report coexistence of prostate cancer and testicular liposarcoma in a 69 year-old-man because while orchiectomy endications are decreasing day by day, these second malignancies should not be missed.

Adult hepatic epitheloid haemangioendothelioma presenting with Kasabach-Merrit syndrome: a case report.

Kasabach-Merrit syndrome (KMS) is a serious consumptive coagulopathy with thrombocytopenia, associated with benign or malignant vascular tumours or malformations. Although it is generally reported with childhood vascular tumours, there is limited data about adult vascular tumours associated with KMS. Hepatic epithelioid haemangioendothelioma (HEHE) is a rare vascular neoplasm of the liver with intermediate malignant potential. In adult patients, HEHE associated KMS has reported in several case reports. A 39-year-old male patient with epitheloid haemangioendothelioma in the liver and KMS is described here. He presented with multiple bilobar liver metastasis and severe thrombocytopenia, anaemia and coagulopathy. Immunohistochemistry showed diffuse cytoplasmic staining with CD34 and vimentin; thus the diagnosis of epitheloid haemangioendothelioma was confirmed. It is believed that this patient is the third case with adult HEHE associated with KMS reported in the literature. Hepatic epitheloid haemangioendothelioma (HEHE) is a rare vascular neoplasm of the liver with low malignant potential.1 Kasabach–Merrit syndrome (KMS) is serious coagulopathy and is rarely associated …

GATA3 expression and its relationship with clinicopathological parameters in invasive breast carcinomas

GATA3, as a transcription factor, is associated with estrogen receptor (ER) expression and necessary for luminal cell differentiation in mammary glands. Association of GATA3 expression with clinicopathological parameters, molecular subtypes of tumors, disease free survival (DFS) and overall survival (OS) for breast carcinoma patients were evaluated in this study. We immunohistochemically stained GATA3, CK5/6, EGFR, CK14 and vimentin on tissue microarray blocks of 457 invasive breast carcinomas. Tumors are sub-classified as luminal A, luminal B, HER2 expressing, basal-like and null type according to their hormonal status with cerbB2, CK 5/6 and EGFR expressions. Follow-up data for 254 cases were obtained. 215/457 (47%) tumors were GATA3 positive. GATA3 expression was inversely correlated with mitotic count (p<0.0001), nuclear grade (p=0.001), histological grade (p=0.001), tumor necrosis (p=0.001), stromal lymphocytic response (p<0.01), nipple invasion (p=0.01), metastasis (p=0.03), vimentin (p=0.0003), EGFR (p=0.015) and CK14 (p=0.001) expressions; and directly associated with ER (p<0.0001) and progesterone receptor (PR) (p<0.0001) expressions. Luminal A carcinomas had the highest frequency for GATA-3 (140/245), however basal-like carcinomas had the lowest (1/42) (p<0.0001). None of the medullary and metaplastic carcinomas expressed GATA3. GATA3 was associated with good DFS and OS (p=0.001 and p=0.0009) and was an independent prognostic factor for OS. GATA3 expression, regardless of the subtype, may have a prognostic significance for breast carcinomas through its ability to promote the differentiation of luminal progenitor cells.

Clinicopathological Significance of the Proliferation Markers Ki67, RacGAP1, and Topoisomerase 2 Alpha in Breast Cancer

Objectives. The aims of this study are to evaluate expressions of Ki67, RacGAP1 (MgcRacGAP) and topoisomerase 2 alpha (TOP2a), the markers related with cell proliferation that have been proposed to affect the prognosis in the literature and correlate the results with clinicopathological parameters of breast cancer patients. Methods. Ki67, RacGAP1, and TOP2a antibodies were applied immunohistochemically to the tissue micrarray blocks of 457 female breast cancer patients. The results were correlated with clinical, prognostic, histopathological features, and other immunohistochemical findings (estrogen receptor [ER], progesterone receptor [PR], HER2, cytokeratin [CK]5/6, CK14, epidermal growth factor receptor [EGFR] and vimentin), statistically. Results. Ki67 expression demonstrated direct correlation with TOP2a expression, mitotic count, tumor grade, geographic necrosis, basal-like phenotype. RacGAP1 expression was directly correlated with TOP2a expression, nipple invasion, and number of metastatic lymph nodes, and it was inversely correlated with PR expression. TOP2a expression was directly correlated with vimentin and Ki67 expressions, mitotic count, tumor grade, and geographic necrosis, and nipple invasion, and negatively correlated with ER and PR expressions. Higher TOP2a and Ki67 expressions were correlated with shorter overall survival. Higher TOP2a expression and RacGAP1 positivity were directly correlated with shorter disease-free survival. Conclusion. This study showed that the overexpressions of Ki67, RacGAP1, and TOP2a affect the prognosis adversely, thus to develop target therapies against RacGAP1 and TOP2a as well as using Ki67 as a part of routine pathology practice might be beneficial in breast cancer therapy and prediction of prognosis.

Bilateral breast cancer in a survivor of acute lymphoblastic leukemia: a case report

Although breast cancer is the most common disease for women, bilateral breast cancer is a rare situation. Development of a second malignancy which is the most frightening side effect, may be related with genetic predisposition or cancer treatment. Because our case is a survivor of acute lymphoblastic leukemia, development of bilateral breast cancer which occurs rarely in early ages, is discussed with the help of literature.