Laila Seada

Solid–pseudopapillary tumor of the pancreas: its origin revisited

Abstract Solid–pseudopapillary tumor of the pancreas (SPT) has distinctive morphologic and biologic features but an unclear origin. It is classified among the pancreatic epithelial tumors, though many are reported to be negative for cytokeratin. Also unclear are its neuroendocrine differentiation, its capability to express alpha-1-antitrypsin (AAT) and, in view of the tumor’s striking prevalence in women, its relationship with the female genital tract. To clarify these issues, the immunoprofiles of 59 SPTs were defined by applying a battery of antibodies against cytokeratin, vimentin, neuron-specific enolase (NSE), synaptophysin, chromogranin A, tyrosine hydroxylase (TH), AAT, LeuM1, Ki-M1P, smooth-muscle actin, CD34, alpha-inhibin, calretinin, placental alkaline phosphatase (PLAP), and progesterone and estrogen receptors. The most consistent markers with the strongest immunoreactivity were vimentin, AAT, NSE, and the progesterone receptor, which were each found in more than 90% of the tumors. Using immunocytochemical methods involving antigen retrieval, cytokeratin was demonstrated in almost 70% of the cases. Synaptophysin was found in 22% of the tumors, while chromogranin was absent and tyrosine hydroxylase was only present in a few tumors. None of the other markers tested were expressed by SPTs. This staining pattern fails to reveal a clear phenotypic relationship with any of the defined cell lineages of the pancreas. In view of the striking female preponderance of SPTs and the known close approximation of the genital ridges to the pancreatic anlage during embryogenesis, it is, however, hypothesized that SPTs might derive from genital ridge/ovarian anlage-related cells, which were attached to the pancreatic tissue during early embryogenesis.

Increased bcl-2 expression is associated with primary resistance to chemotherapy in human epithelial ovarian cancer

OBJECTIVE bcl-2, an anti-apoptotic factor, has a role in the pathogenesis of ovarian cancer as well as in resistance to chemotherapy. DESIGN AND METHODS 20 benign, and 26 malignant epithelial ovarian tissues were analyzed for bcl-2 protein and mutant p53 by enzyme-immunoassay (EIA). Flowcytometric analysis was also performed. Patients of malignant group were followed up to monitor overall survival and primary resistance to chemotherapy. RESULTS bcl-2 was significantly higher in malignant group than benign group (p < 0.001). A cutoff value was determined for bcl-2 (63.8 kU/g protein). At this cutoff, sensitivity is 80.7%, and specificity is 85%. Using chi square analysis, a significant correlation was found between bcl-2 and FIGO stage (p = 0.01), overall survival (p = 0.01), as well as primary resistance to chemotherapy (p = 0.03). By correlation coefficient analysis the relation between bcl-2 and synthetic phase fraction was highly significant (p = 0.002). Bcl-2, p53, and FIGO stage were significantly correlated to poor survival (p = 0.01) in univariate analysis. However, in multivariate analysis, only FIGO stage, and p53 were independent risk factors. CONCLUSION EIA could be a useful tool for investigating the prognostic value of bcl-2, and its possible prediction of platinum resistance in epithelial ovarian cancer. This might help in selecting patients for future anti-bcl-2 therapy.

Expression patterns of transcription factors in progressively transformed germinal centers and Hodgkin lymphoma.

Abstract. The World Health Organization (WHO) classification of Hodgkin lymphoma (HL) distinguishes two types: Classical Hodgkin lymphoma (CHL) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). Both groups have in common that they mostly derive from B cells with rare classical cases originating from T cells. They differ in their histomorphology, immunophenotype, and clinical behavior. One of the subtypes of CHL, designated as lymphocyte-rich classical Hodgkin lymphoma (LRCHL), shares some morphological features with NLPHL. The transcription factors BSAP, BOB.1, Oct2 and MUM1 are sequentially expressed in normal B-cell development. In order to investigate the relationship between the CHL subgroups and NLPHL, we examined the protein expression of these transcription factors using immunohistochemistry in 15 reactive processes and 4 different subtypes of 58 HL cases. Our findings underline the B-cell origin of HL, without evidence, that reactive processes like progressively transformed germinal centers (PTGCs) are precursor lesions of HL. Furthermore, they demonstrate that LRCHL is distinct from NLPHL and that it is closely related to the mixed cellularity CHL (MCHL) in respect of BSAP, BOB.1, and Oct2 expression. It therefore occupies an intermediate position between MCHL and NLPHL. Based on MUM1 staining, LRCHL exhibits a more mature phenotype than NLPHL.

Study of telomerase reverse transcriptase (hTERT) expression in normal, aged, and photo-aged skin.

Background  Telomerase is a ribonucleoprotein enzyme capable of extending chromosome ends with telomeric DNA sequences. It protects the germline and stem cells from senescence by preventing telomere attrition. Cutaneous aging includes intrinsic aging, and photo‐aging. Telomere‐associated cellular senescence contributes to certain age‐related cutaneous disorders, including increased cancer incidence. Premature skin aging in xeroderma pigmentosa (XP) is expected to show increased telomere attrition. We aimed to study human telomerase reverse transcriptase (hTERT) expression in normal, aged and photo‐aged skin and to investigate its possible role in the pathogenesis of aging and photo‐aging.

Heterotopic Ossification in a Colorectal Carcinoma

A 48 years old man presented with subacute intestinal obstruction resulting from an intraluminal colorectal mass. He underwent partial colectomy. Histological diagnosis of mucinous adenocarcinoma with focal areas of heterotopic ossification was made. Although the presence of heterotopic ossification has no known prognostic implication in colorectal carcinoma, however, it is important that both radiologist and pathologist be aware of this phenomenon as distinct from carcinosarcoma that has poorer prognosis. From the available literature reviewed and to the best of our knowledge, this is the first reported case of mucinous colorectal carcinoma with heterotopic ossification in Saudi Arabia.

PREVALENCE OF DIABETIC FOOT AND AMPUTATIONS IN HAIL, KSA

Background and Objectives: Diabetes is a chronic disease that can lead to complications one of which is diabetic foot (DF). The aim of this study is to identify the prevalence of diabetic foot, pattern of amputation, associated diseases and cost effectiveness in Hail region. Results: Among 2765 diabetes cases studies during the period from January 3013- December 2015, 840 (32.92%) patients had diabetic foot. Males were found to have a higher prevalence of DF than females, male to female ratio being 1.4: 1. Most of our patients were among the age group 60-70 years. Hypertension, renal and cardiac diseases were the most common associated diseases. Seventeen patients 17/840 (2.02%) had amputations, above knee being the most common 8/17 (47.1%), followed by toes 6/17 (35.3%), below knee 2/17 (11.7%) and fingers 1/17 (5.9%) respectively. A total management cost of 1, 448,000 SR was calculated. Conclusion: Incidence of diabetic foot (32.92%) and amputations (2.02%) in Hail region are within local and international rates; however, cost expenses are much higher.

Undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma of the larynx with giant cells and myogenic differentiation: a case report

Undifferentiated pleomorphic sarcoma (UPS)/malignant fibrous histiocytoma (MFH) is quite rare in the larynx, with few cases reported. In the present study, we report an UPS/MFH of the larynx arising as a second primary neoplasm. It showed giant cells, spindle areas with vague storiform appearance, and myxoid areas. CD68 was positive in the giant cells and focally in the tumor cells. S100 showed scattered positivity in stellate cells. Desmin and specific muscle actin were negative, whereas h-caldesmon was positive in tumor cells and medium-sized blood vessels, denoting a possible myogenic differentiation. To the best of our knowledge this is one of the rare case reports of UPS/MFH with giant cells in the larynx arising as a second primary neoplasm.