Gangaraju C. Raju

Inhibition of histone deacetylase 2 increases apoptosis and p21Cip1/WAF1 expression, independent of histone deacetylase 1.

Histone deacetylases (HDACs) 1 and 2 share a high degree of homology and coexist within the same protein complexes. Despite their close association, each possesses unique functions. We show that the upregulation of HDAC2 in colorectal cancer occurred early at the polyp stage, was more robust and occurred more frequently than HDAC1. Similarly, while the expression of HDACs1 and 2 were increased in cervical dysplasia and invasive carcinoma, HDAC2 expression showed a clear demarcation of high-intensity staining at the transition region of dysplasia compared to HDAC1. Upon HDAC2 knockdown, cells displayed an increased number of cellular extensions reminiscent of cell differentiation. There was also an increase in apoptosis, associated with increased p21Cip1/WAF1 expression that was independent of p53. These results suggest that HDACs, especially HDAC2, are important enzymes involved in the early events of carcinogenesis, making them candidate markers for tumor progression and targets for cancer therapy.

Immunohistochemical study of granular cell tumour

&NA; Immunoperoxidase studies were performed on 8 granular cell tumours using various intermediate filament proteins, as well as lysozyme, S‐100 protein, and lectins. All the lesions gave negative results to cytokeratin, vimentin, desmin, myoglobin, neurofilament protein, glial fibrillary acidic protein and lysozyme. One was positive for alpha‐1‐antitrypsin and alpha‐1‐antichymotrypsin. S‐100 protein and lectins (Concanavalin ensiformis and Triticum vulgaris) were uniformly positive in all the lesions. S‐100 protein positivity would indicate that granular cell tumours are of neural or neuroectodermal origin, although the cell type involved is not clear. There is no obvious explanation for the lectin‐binding properties of granular tumour cells. It is hoped that further studies will evaluate the usefulness of lectin histochemistry in defining the nature of granular cell tumours.

Adrenal leiomyosarcoma: a case report and literature review

&NA; Leiomyosarcoma of the adrenal gland is a very rare tumour. We report a case of this rare tumour and review the previous case reports. The patient, a 68‐year‐old woman, presented with a 1‐week history of right loin pain and fever associated with loss of weight and appetite. Computerised tomography and ultrasound scans showed the presence of a right adrenal gland tumour, which was subsequently surgically removed. Histological examination of the 12.5‐cm tumour revealed a leiomyosarcoma of the adrenal gland. The patient was alive and well with no evidence of recurrent disease 1 year later.

Xanthomatous pseudotumor. An unusual postchemotherapy phenomenon in breast cancer.

Neoadjuvant chemotherapy has become an integral part of the treatment for locally advanced breast cancer. It facilitates tumor resectability and also provides an opportunity for the assessment of therapeutic response and prognosis. We report a case in which a large primary breast carcinoma was significantly reduced in size clinically and replaced by a mass lesion that was composed almost entirely of foamy histiocytes. This peculiar phenomenon is described in detail, together with a brief review of the other known postchemotherapy histologic features that include tumor necrosis, tumor cell cytoplasmic vacuolation and marked nuclear atypia, accompanying chronic inflammatory cellular infiltrate, fibrosis, and ductal-lobular atrophy.

Proximal epithelioid sarcoma of the vulva: A case report and review of current medical literature

Proximal‐type epithelioid sarcoma (PES) of the vulva is an exceedingly rare soft tissue tumor with an unpredictable symptom pattern and frequent recurrences. Information on management is limited. This report describes a 51‐year‐old woman with proximal‐type epithelioid sarcoma of the vulva which was resected surgically and reviewed the current medical literature regarding the diagnosis and management of this disease.

An immunohistochemical study of p53 protein in cervical intraepithelial neoplasia and squamous cell carcinoma

&NA; p53 mutations are known to occur frequently in human cancers where they are considered to be an important event in the step‐wise progression towards malignant transformation. It is therefore interesting to compare p53 expression in the uterine cervix for non‐neoplastic/metaplastic squamous epithelium, cervical intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma. One hundred and nineteen biopsied and resected specimens of the uterine cervix were stained with an anti‐human p53 protein monoclonal antibody by the streptavidin‐biotin immunoperoxidase method. Histologically these could be categorized into non‐neoplastic/dysplastic conditions, including condyloma (34 cases), CIN 1‐3 (66 cases) and invasive squamous cell carcinoma (19 cases). Fifty eight per cent (11/19) of the invasive squamous cell carcinomas and 11% (7/66) of the CIN stained positively for p53. Except for 3 cases of invasive squamous cell carcinoma, there was only sporadic intranuclear staining of less than 5% of the cells. No staining was observed in all non‐neoplastic/metaplastic squamous epithelial cells. The pattern of p53 staining is significantly different for all 3 categories. However it is undetermined as to whether the positive immunoperoxidase staining is a direct consequence of p53 gene mutation or otherwise.

HLA–DR antigen expression in colonic adenomas and adenocarcinomas

&NA; Previous studies have shown that malignant transformation is sometimes associated with the aberrant expression of HLA class II antigens. The functional significance of such aberrant expression is not known. Since HLA‐DR antigen is expressed in normal colonic mucosa, it would be interesting to see if malignant transformation could result in the aberrant suppression of this antigen. Sixteen colonic adenocarcinomas, 29 colonic adenomatous polyps and 23 samples of normal colonic mucosa, including 9 cases of colonic mucosa adjacent to carcinoma, were stained immunohistochemically for HLA‐DR antigen. The intensity and distribution of the antigen staining in the cytoplasm and luminal surface of the epithelial elements were analysed semiquantitatively. The lymphoplasmacytic infiltrate in the lamina propria was also evaluated. Cytoplasmic HLA‐DR antigen expresion was found to be significantly diminished in moderately and poorly differentiated adenocarcinomas but not in adenomas or well‐differentiated adenocarcinomas. This suggests that the change in HLA‐DR expression is not intrinsic to the neoplastic process but may merely be due to the fact that malignant cells, as they become less differentiated, tend to show alterations in their antigenic phenotype.

Mushroom bezoar: a rare cause of small intestinal obstruction

Sir, Bezoars or masses of entangled material in the gastrointestinal tract are uncommon causes of intestinal obstruction. They are broadly of two types: phytobezoar, composed of plant material; and trichobezoar, composed of a tangle of hair. Mushrooms are a distinctly unusual type of bezoar, with only two cases being previously described in the German literature. We report an additional case of such a bezoar in the terminal ileum, presenting with small intestinal obstruction, and briefly review the literature. The patient was a 64-year-old Chinese man with a history of chronic obstructive lung disease who presented with abdominal pain and distension of 1 day’s duration. Bowel sounds were positive and there were no signs of peritonitis. An abdominal X-ray showed dilated small bowel loops consistent with small bowel obstruction. He was treated conservatively with intravenous fluids and naso-gastric suction but showed no improvement after 2 days. A colonoscopy showed cecal diverticulosis but no other identifiable large bowel lesion. A laparotomy was carried out and an intraluminal bolus mass was found in the terminal ileum about 1 m from the ileo-cecal valve. After an unsuccessful attempt at milking the bolus mass through to the cecum, an ileal enterotomy was performed and the bolus mass removed. The patient’s post-operative recovery was uncomplicated. Grossly, the specimen was a soft mass measuring 66562 cm and weighing 26 g, with a whitish central portion on the cut surface (Fig. 1). Histologically, the sections featured a poorly stained mesh of elongated cellular structures that were PAS and GMS positive. These structures showed branching and were septated (Fig. 2A, B). There were areas of gill formation, the surface of which disclosed a lining row of crowded cells (Fig. 3). Together with the corroborative staining properties, these were all features of a mushroom bezoar. The clinical features of bezoars are expectedly nonspecific. They may cause anorexia, weight loss, gastrointestinal bleeding, obstruction or perforation. Common sites of impaction are the gastric outlet, the terminal ileum as well as segments of pre-existing gastrointestinal stenosis of various aetiologies. Predisposing factors include a high fibre intake, inadequate chewing, gastric hyposecretion and hypomotility, previous gastrectomy and vagotomy. The usual culprits of bezoar formation are vegetable and fruit material, with citrus fruits and persimmons being especially implicated. Trichobezoar is another important Fig. 1 Gross appearance of the mushroom bezoar.