Emilio Álvarez-Fernández

Micropapillary lung adenocarcinoma: a distinctive histologic subtype with prognostic significance. Case series

The aims of the present work were to evaluate the prognostic significance of the micropapillary pattern of lung adenocarcinoma and determine whether there are differences in the behavior of this type of tumor according to its immunohistochemical profile. A series of 191 consecutively resected pulmonary adenocarcinomas were divided into those with (n = 62) and those without (n = 129) micropapillary components. The disease was stage I in 38 and 54 patients, respectively. The 5-year survival rates of patients with and without micropapillary components were 54% and 77%, respectively (log rank P = .03). In multivariate survival analysis, the micropapillary component proved to be an independent prognostic factor (hazard ratio, 3.2). Five autopsy cases were used to investigate the immunohistochemical profile. The percentages of cases positive for various markers were 56.7 for p53, 94 for Ki67, 85.1 for c-myc, 2.9 for Bcl-2, 35.8 for epidermal growth factor receptor, 43.3 for cyclin D1, and 46.3 for Bax. The prognostic value was evaluated according to the expression of the different markers in micropapillary carcinomas in stage I. In univariate analysis, only cyclin D1 expression and Bax expression were associated with significantly worse survival (log rank P = .03 and P = .02, respectively). We conclude that it is important to recognize the micropapillary growth pattern in lung adenocarcinoma. Moreover, cyclin D1 and Bax seem to be markers of a poor prognosis.

Malignant fibrosarcomatous mesothelioma and benign pleural fibroma (localized fibrous mesothelioma) in tissue culture: a comparison of the in vitro pattern of growth in relation to the cell of origin.

Two cases of fibrous mesothelioma are presented. The first is a malignant tumor containing bundles of spindle‐shaped cells with a dense reticulin network and nests of epithelial‐like cells. The second is a benign tumor made up of spindle‐shaped cells arranged in bundles with abundant reticulin and collagen fibers. Tissue culture in the first case revealed plaques similar to those formed by epithelial tumors. The second case had a fibroblastic pattern with single isolated spindle‐shaped cells. These findings confirmed the mesothelial nature of fibrosarcomatous mesothelioma and supported the view that the so‐called localized fibrous mesotheliomas could be fibroblastic neoplasms derived from the submesothelial connective tissue.

Intracytoplasmic fibrillary inclusions in bronchial carcinoid

A case of bronchial carcinoid with filamentous aggregates is described. The cytoplasmic inclusions were clearly demonstrated by means of Massons trichrome stain in Bouins fixed tissue, and the neoplastic cells showed a spontaneous green fluorescence with ultraviolet light. Electron microscopic examination showed that the inclusion bodies were composed of aggregates of filaments measuring 10Å. They were located in the juxtanuclear region in close relation with mitochondria and the cisternae of the Golgi system. There were many neurosecretory granules inside the aggregates of filaments, some showing alterations in the dense core. From this data, we concluded that the aggregates seemed to represent an active rather than an involutional phenomenon and that their relation with hypoxemia and humoral influences needs further study. Cancer 46:144–151, 1980.

Monophasic mesenchymal synovial sarcoma: its identification by tissue culture.

Tissue cultures from a series of spindle cell soft tissue sarcomas allowed the identification of five cases in which the neoplastic cells grew as polygonal elements, forming plaques in the same way as epithelial tumors. The similarity of this behavior in vitro to that of normal pleura and synovium, and to monophasic malignant pleural mesothelioma, allowed these tumors to be classified as monophasic synovial sarcomas. None of the five tumors showed specific light‐optical features, being composed of fusiform cells with a tendency to form slits in two cases. No true epithelial differentiation was found. The topographic distribution and the response to therapy of the neoplasms were also similar to that found in the usual biphasic tumors.

Prognostic significance of synaptophysin in stage I of squamous carcinoma and adenocarcinoma of the lung

The prognostic significance of the presence of a neuroendocrine marker (synaptophysin, SY) was analyzed in stage I of squamous carcinoma and adenocarcinoma of the lung.

Tumor fibroso solitario pleural: características clinicopatológicas de una serie de casos y revisión de la bibliografía

Hemos evaluado las caracteristicas clinicopatologicas del tumor fibroso solitario pleural en una serie de 30 casos. El 70% de los pacientes eran mujeres. El promedio de edad fue de 58,39 anos. El 45% de los casos fueron asintomaticos. La localizacion mas frecuente fue la pleura visceral (70%). En el 20% de los casos se observaron tumoraciones multiples y se asociaron a localizacion intrapulmonar (p El tumor fibroso solitario pleural es una neoplasia poco comun de comportamiento biologico impredecible, por lo que el seguimiento debe centrarse en la deteccion precoz de la recurrencia o de metastasis.

Clinicopathological Features of Solitary Fibrous Tumors of the Pleura: a Case Series and Literature Review

We assessed the clinicopathological features of solitary fibrous tumors of the pleura in a case series comprising 30 patients (20 women, 66.6%) with a mean age of 58.39 years. Forty-five percent of the cases were asymptomatic. In 70% of the cases the tumors arose in the visceral pleura. Twenty percent presented multiple tumors, a finding that was associated with intrapulmonary localization and malignant behavior (P<.0001) Histology revealed low cell density in 15% of the cases, moderate density in 50%, and high density in 35%; further findings showed atypia in 45% of the cases, necrosis in 25%, and hemorrhage in 15%. More than 4 mitoses per 10 high-power fields were noted in 30% of the cases. Immunohistochemistry results were positive for vimentin in all cases; cells were CD34+ in 85% of the cases, BCL2+ in 65%, and CD99+ in 40%. Findings for keratin and protein S100 were negative in all cases. Malignant biological behavior (local recurrence and metastasis) was observed in 4 cases, 2 of which were CD34-. Solitary fibrous tumors of the pleura are uncommon neoplasms with unpredictable biological behavior; follow-up should therefore be based on early detection of recurrence or metastasis.

Intrapulmonary mesotheliomas: Their identification by tissue culture

Two cases of primary intrapulmonary spindle-celled sarcomas unrelated to the pleura have been studied by electron microscopy, tissue culture and histochemistry. Ultrastructurally both tumors showed some desmosomial unions. The first case showed cytoplasmic filaments, nuclear inclusions, prominent rough endoplasmic reticulum and abundant collagen in the interstitium. The second tumor showed scanty organelles and a paucity of interstitial connective tissue fibers. In spite of their spindle morphology both tumors showed a similar pattern in vitro, growing as an epithelial plaque in the same way as previously described mesotheliomas and related tumors, such as synovial sarcomas. Histochemistry of the tumor mass allowed the identification of most of the cavities which were engulfed alveoli and bronchioli. Both neoplasm were classified as intrapulmonary mesotheliomas. Their relationship to other pulmonary lesions is discussed.

Influencia pronóstica de la pérdida de la expresión del antígeno del grupo sanguíneo A en el carcinoma no microcítico de pulmón en estadio I patológico

INTRODUCTION In the scientific literature, contradictory results has been published on the prognostic value of the loss of expression of blood group antigen A (BAA) in lung cancer. The objective of our study was to analyze this fact in our surgical series. PATIENTS AND METHODS In a multicenter study, 402 non-small-cell lung cancer (NSCLC) patients were included. All were classified as stage-I according to the last 2009-TNM classification. We analyzed the prognostic influence of the loss of expression of BAA in the 209 patients expressing blood group A or AB. RESULTS The 5-year cumulative survival was 73% for patients expressing BAA vs 53% for patients with loss of expression (P=.03). When patients were grouped into stages IA and IB, statistical significance was only observed in stage I-A (P=.038). When we analyzed the survival according to histologic type, those patients with adenocarcinoma and loss of expression of BAA had a lower survival rate that was statistically very significant (P=.003). The multivariate analysis showed that age, gender and expression of BAA were independent prognostic factors. CONCLUSIONS The loss of expression of blood group antigen A has a negative prognostic impact in stage I NSCLC, especially in patients with adenocarcinoma.

Prognostic Value of ERBB2 Amplification and Protein Expression in Small Cell Lung Cancer

OBJECTIVE Our objective was to evaluate ERBB2 oncogene amplification using fluorescence in situ hybridization (FISH) and protein overexpression using immunohistochemical techniques, and to explore their possible prognostic value in a series of patients with small cell carcinoma. PATIENTS AND METHODS Included in the study were 99 patients with small cell tumors, classified in 2 broad groups: patients with limited locally advanced disease and patients with disseminated disease. Material for study was obtained in 97% of the cases (96/99) by means of endoscopic biopsy and by tomography-guided needle biopsy in the remaining 3% (3/99). Survival was analyzed using the Kaplan-Meier method. RESULTS The 92 men (92.9%) and 7 women (7.1%) in the study had a mean (SD) age of 62.9 (10.4) years (range, 36-81 years); 39.4% (n=39) and 60.6% (n=60) of the subjects had limited and disseminated disease, respectively. ERBB2 protein overexpression was observed in 26.3% of the patients (n=26), 15.4% (n=4) of whom had limited disease and 84.6% (n=22) of whom had disseminated disease (P=.005). Although mean survival was slightly longer for patients who were negative for ERBB2 protein overexpression, the difference was not statistically significant. FISH identified gene amplification in 6.3% (1 in 16) of the studied cases (ratio, 2.3). CONCLUSIONS The protein product of the ERBB2 oncogene is overexpressed in 33.3% of small cell lung carcinomas and is associated with the presence of disseminated disease. Further studies are necessary to evaluate the possible benefits of specific treatment.