ah Emilia Tuan Sharif

Incidence of Esophageal Carcinoma Among Malays in North-Eastern Peninsular Malaysia: An Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

BackgroundObesity, gastroesophageal reflux, and Barrett’s esophagus have all been linked to esophageal adenocarcinoma. In addition, the decline in Helicobacter pylori (H. pylori) infection in affluent societies has also been suggested to be a major factor in the recent rise in the incidence of esophageal adenocarcinoma. If H. pylori infection has a protective role, populations with a naturally low prevalence of H. pylori infection such as the ethnic Malays of Northeastern Peninsular Malaysia should have high rates of esophageal adenocarcinoma.AimTo test this hypothesis, we investigated the incidence of esophageal carcinoma among the ethnic Malays of the state of Kelantan in Northeastern Peninsular Malaysia.MethodsThe pathology services in the state of Kelantan are provided by two main hospitals. The histopathological records of both hospitals were systematically examined to retrieve all cases of esophageal carcinoma diagnosed between 2004 and 2008. Incidence rates were determined based on the most recent population census.ResultsThe age-standardized incidence rates (per 100,000 population) of esophageal adenocarcinoma among Malay men and women were 0.75 and 0.69, respectively. The corresponding rates for squamous cell carcinoma of the esophagus were 0.66 and 1.34, respectively.ConclusionsThe low rates of adenocarcinoma and squamous cell carcinoma of the esophagus in the study area, despite the fact that H. pylori infection is virtually absent, does not support the hypothesis that the absence of H. pylori infection is a pivotal factor in the pathogenesis of these cancers.

In human invasive breast ductal carcinoma, tumor stromal macrophages and tumor nest macrophages have distinct relationships with clinicopathological parameters and tumor angiogenesis

Tumor-associated macrophages play a crucial role in breast cancer progression and tumor angiogenesis. However, evaluation of tumor-associated macrophages incorporating their histological locations is lacking. The aim of this study was to clarify whether macrophages in tumor stroma and macrophages in tumor cell nests have distinctive properties in relation to pertinent breast cancer clinicopathological parameters and tumor angiogenesis. In 94 human invasive breast ductal carcinomas, tumor-associated macrophages were immunostained with anti-CD68 antibody and counted or graded according to these histological locations. Microvessels were immunostained with anti-CD34 antibody and counted for microvessel density. We found that the presence of tumor stromal and tumor nest macrophages was closely correlated (p = 0.001). Both tumor stromal and tumor nest macrophages were associated with mitotic count (p = 0.001 and p = 0.037, respectively). However, only higher tumor stromal macrophage grades were associated with higher tumor grades (p = 0.004) and negative estrogen receptor status (p = 0.007). Multivariate analysis showed that tumors with a high mitotic count score (score 3 vs. scores 1 and 2) had a higher tumor stromal macrophage density (Grades III and IV) when adjusted for tumor size, tubule formation, and estrogen receptor status (odds ratio 3.41, p = 0.010). The tumor nest macrophage count significantly correlated with the microvessel density (p < 0.001). These results imply that tumor stromal macrophages and tumor nest macrophages residing in different tumor microenvironments have distinctive roles.

Breast Tumor Angiogenesis and Tumor-Associated Macrophages: Histopathologist's Perspective.

Much progress has been made since the conceptualization of tumor angiogenesis—the induction of growth of new blood vessels by tumor—as a salient feature of clinically significant primary or metastatic cancers. From a practicing histopathologists point of view, we appraise the application of this concept in breast cancer with particular reference to the evaluation of proangiogenic factors and the assessment of new microvessels in histopathological examination. Recently, much focus has also been centered on the active roles played by tumor-associated macrophages in relation to tumor angiogenesis. We review the literature; many data supporting this facet of tumor angiogenesis were derived from the breast cancer models. We scrutinize the large body of clinical evidence exploring the link between the tumor-associated macrophages and breast tumor angiogenesis and discuss particularly the methodology and limitations of incorporating such an assessment in histopathological examination.

Barrett's Esophagus in an Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

Objective. This study was undertaken to gain an insight into the relationship between Helicobacter pylori (H. pylori) infection, Barretts esophagus and reflux esophagitis in an area of exceptionally low prevalence of H. pylori infection. Methods. A total of 1895 consecutive upper endoscopies performed between January 2005 and July 2007 were reviewed. 120 cases of columnar-lined esophagus and endoscopic esophagitis were evaluated. H. pylori infection was determined using the urease test and/or histology. Results. The rate of endoscopic esophagitis was 5.49% (80 Malays, 24 non-Malays) while histological reflux esophagitis was found in 3.75% (56 Malays, 15 non-Malays). Barretts esophagus was present in 0.79% (11 Malays, 4 non-Malays). H. pylori infection was present in 8/120 or 6.67% subjects. Conclusion. The low rate of Barretts esophagus in this population does not support the hypothesis that the absence of H. pylori infection is more than a minor risk factor for Barretts esophagus.

Characteristics of Invasive Breast Ductal Carcinoma, NOS, Diagnosed in a Tertiary Institution in the East Coast of Malaysia with a Focus on Tumor Angiogenesis

BACKGROUND Prognosis of breast cancer depends on classic pathological factors and also tumor angiogenesis. This study aimed to evaluate the clinicopathological factors of breast cancer in a tertiary centre with a focus on the relationship between tumor angiogenesis and clinicopathological factors. METHODS Clinicopathological data were retrieved from the archived formal pathology reports for surgical specimens diagnosed as invasive ductal carcinoma, NOS. Microvessels were immunohistochemically stained with anti-CD34 antibody and quantified as microvessel density. RESULTS At least 50% of 94 cases of invasive breast ductal carcinoma in the study were advanced stage. The majority had poor prognosis factors such as tumor size larger than 50mm (48.9%), positive lymph node metastasis (60.6%), and tumor grade III (52.1%). Higher percentages of estrogen and progesterone receptor negative cases were recorded (46.8% and 46.8% respectively). Her-2 overexpression cases and triple negative breast cancers constituted 24.5% and 22.3% respectively. Significantly higher microvessel density was observed in the younger patient age group (p=0.012). There were no significant associations between microvessel density and other clinicopathological factors (p>0.05). CONCLUSIONS Majority of the breast cancer patients of this institution had advanced stage disease with poorer prognostic factors as compared to other local and western studies. Breast cancer in younger patients might be more proangiogenic.

Pattern of collagen fibers and localization of matrix metalloproteinase 2 and 9 during breast cancer invasion.

Aims and Background Parenchymal cells naturally interact, react and adapt with the environment including stromal components around them in order to maintain tissue architecture and function. However, studies have shown that this spontaneous interaction will become crucial in assisting cancer invasion. The purpose of the study was to analyze the pattern of collagen deposition and localization of matrix metalloproteinase 2 and matrix metalloproteinase 9 in the tumor microenvironment during breast cancer invasion. Methods and Study Design A standard transmission electron microscopy procedure was used together with the immunogold technique with a few modifications. Results The ultrastructure of fibroblasts in the vicinity of cancer cells was thick, elongated and spindle shaped with nuclear indentations. Desmoplasia was present near the cancer cells. Collagen fibers were still arranged parallel to the cancer cells and fibroblasts but were less dense than collagen fibers far from cancer cells and fibroblasts. Collagen fibers were less dense in the pericellular region because of proteolytic enzyme activity, which facilitates the invasion of breast cancer cells. In immunogold localization analysis, matrix metalloproteinase 9 had consistent localization throughout cancer cells, fibroblast and stroma. In matrix metalloproteinase 2 localization, gold conjugates were more heavily deposited in cancer cells and fibroblasts than in the stroma. Conclusions Invasive breast carcinoma is not an independent entity, and its survival depends on the surrounding microenvironment.

Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination: Narrow band imaging

Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow‐band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non‐neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non‐neoplastic colorectal lesions.