Sara Farag

Expression of H1.5 and PLZF in granulosa cell tumors and normal ovarian tissues: a short report

PurposeOvarian granulosa cell tumors (GCTs) typically exhibit an excellent prognosis, but their recurrences are associated with high mortality rates. In the past, immunohistochemistry (IHC)-based approaches have been used to facilitate the distinction between GCTs and other, more frequently occurring, primary or metastatic tumors. The purpose of this study was to assess the added value of H1.5 and PLZF protein expression in the correct delineation of GCTs.MethodsConsecutive 5-μm thick sections from routinely fixed and paraffin embedded tissues from 30 GCTs and 33 benign ovaries were processed for IHC using anti-PLZF and anti-H1.5 monoclonal antibodies. The respective protein staining intensities and distributions were quantified into reported scores for all tissue samples. Student’s t-test and Fisher’s exact test were used to compare the mean scores for each group. A p-value of <0.05 was considered statistically significant. Also, both the sensitivity and the specificity of the two antibodies were evaluated.ResultsA statistically significant difference in the expression of H1.5 between the GCT and normal ovary groups was observed (p < 0.0001). Normal ovarian tissues were found to strongly express H1.5, whereas GCTs were found to weakly express this protein. In contrast, PLZ expression was not found to be significantly different between both study groups.ConclusionsFrom our results we conclude that H1.5 is down-regulated in GCTs compared to normal ovarian tissues. Additional investigations on larger and more heterogeneous study populations, and on the molecular mechanism (s) underlying down-regulation of the H1.5 protein, may further substantiate the use of H1.5 as a diagnostic/prognostic marker and, in addition, provide insight into the pathogenesis of GCTs.

Immunohistochemical Detection of Promyelocytic Leukemia Zinc Finger and Histone 1.5 in Uterine Leiomyosarcoma and Leiomyoma

Objectives: The accurate distinction of leiomyoma from leiomyosarcoma is essential for patient management. However, the distinction can be difficult to make, particularly in tissue biopsy samples. Immunohistochemistry has been established as a useful technique to aid in the diagnosis of malignancies. The advantages of immunohistochemical studies are their ease of use and interpretation. This study is the first to evaluate the utility of the promyelocytic leukemia zinc finger (PLZF) protein and the histone 1.5 (H1.5) protein as potential diagnostic immunohistochemical markers for distinguishing leiomyosarcoma from leiomyoma. Methods: Tissue samples from 21 leiomyosarcomas and 26 leiomyomas were studied. The student t-test and the Fisher exact test were used to calculate the differences in staining between the 2 groups. Results: Statistically significant differences were found in the staining indices of anti-PLZF and anti-H1.5 when comparing benign and malignant tumors (P < .0001 and P < .0001, respectively). The mean H1.5 staining score in leiomyosarcomas was 158.3, compared to 28.3 in leiomyomas. The mean PLZF score in leiomyosarcomas was 1.5 in contrast to 71.5 in leiomyomas. For H1.5 at a score ≥60, the sensitivity and specificity were 90.5% and 84.6%, respectively. For PLZF, a score ≤15 had a test sensitivity and specificity of 100% and 80.8%, respectively. This suggests that staining for H1.5 or PLZF can serve as a good screening test. Additionally, combining the 2 immunostains results in a sensitivity and specificity of 90.5% and 97.5%, respectively, in differentiating between leiomyoma and leiomyosarcoma. Conclusions: We describe immunostaining for PLZF and H1.5 in benign and malignant uterine smooth muscle tumors. Statistically significant differences in staining patterns were found, suggesting utility in distinguishing leiomyosarcomas from leiomyomas.

Clinical Outcomes of Type II Endometrial Cancer in Open Versus Minimally Invasive Staging Surgery.

Demographic data, surgical parameters and histopathology details were analyzed. Intervention: We performed da Vinci robot-assisted radical hysterectomy. The learning curve was evaluated using the cumulative summation (CUSUM) technique. Measurements and Main Results: The mean operating time (273.9 88.5 min) of phase I was significantly longer than phase II (222.0 51.4min) (p = 0.032) and phase III (218.2 50.6 min) (p = 0.015). Significant differences were found among the 3 groups which the number of pelvic autonomic nerve preservation and para-aortic lymph node resection, (p \ 0.005). There were no significant differences between the three groups with respect to lymph node yield and identifying positive lymph nodes, and pathologic outcome. Time to resume voiding function did differ between the three groups, (p \ 0.005). The learning period of da Vinci robotic surgical system for radical hysterectomy to reach a turning point was calculated to be 30 cases. Conclusion: An extended learning period can be required for da Vinci robotic surgical system for radical hysterectomy, during which pathologic outcome of radical hysterectomy may not be adversely affected. As for the surgeons with abundant experiences of laparoscopic surgery for cervical cancer surgery, after about 30 resections, they can overcome the learning curve and master da Vinci robotic surgical system for radical hysterectomy in cervical cancer.