scholarly journals Lymphovascular Invasion in Micropapillary Urothelial Carcinoma: A Study of 22 Cases

2012 ◽  
Vol 136 (6) ◽  
pp. 635-639 ◽  
Author(s):  
Elizabeth McQuitty ◽  
Jae Y. Ro ◽  
Luan D. Truong ◽  
Steven S. Shen ◽  
Qihui Zhai ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Immunohistochemical Staining ◽  
Vascular Invasion ◽  
Lymphovascular Invasion ◽  
Staining Pattern ◽  
Immunohistochemical Analysis ◽  
Lymphatic Invasion ◽  
Tissue Sections ◽  
Hematoxylin Eosin ◽  
Aggressive Variant

Context.—Micropapillary urothelial carcinoma (MPUC) is a known aggressive variant of urothelial carcinoma. However, the reasons for its aggressiveness remain unclear. Objective.—To investigate the frequency of lymphovascular invasion in 22 cases of MPUC. Design.—Consecutive tissue sections were stained with D2-40 and CD34 to highlight lymphovascular channels associated with MPUC. Spaces containing tumor cells were scored as positive for lymphovascular invasion if the staining pattern on immunohistochemistry was distinct and circumferential. Results.—Of 22 cases, 21 (95%) had lymphovascular invasion on immunohistochemical staining, with 91% lymphatic invasion and 4% vascular invasion. Interestingly, 8 cases were originally signed out as negative for lymphovascular invasion on the basis of hematoxylin-eosin–stained sections; of these, 7 (88%) had focal lymphovascular invasion evident on immunohistochemical staining. Conclusions.—Our results confirm that micropapillary lacunae are not lymphovascular channels. However, nearly all MPUC tumors (95% in this series) have evidence of lymphovascular invasion by immunohistochemical analysis. Our data support the use of micropapillary features as a morphologic marker for lymphovascular invasion and MPUC as an adverse histologic type of urothelial carcinoma.

Vascular Invasion and Herniation by Hepatocellular Carcinoma in Cirrhosis: A Wolf in Sheep's Clothing?

2005 ◽  
Vol 129 (5) ◽  
pp. 639-644 ◽  
Author(s):  
Alberto Quaglia ◽  
Nazanin Etessami ◽  
Rosalind Sim ◽  
John Difford ◽  
A. P. Dhillon
Keyword(s):  
Hepatocellular Carcinoma ◽  
Vascular Invasion ◽  
Thrombus Formation ◽  
Smooth Muscle Actin ◽  
Point Of View ◽  
Factor Xiiia ◽  
Tissue Sections ◽  
Prognostic Feature ◽  
Vascular Structures ◽  
Hematoxylin Eosin

Abstract Context.—Vascular invasion is an important diagnostic and prognostic feature of hepatocellular carcinoma (HCC) in cirrhosis. Intravascular free-floating tumor clusters (IvCs) of HCC are found histologically in the vicinity of HCC. Thrombus formation is not seen morphologically in association with these IvCs, which are usually covered by endothelium. Objective.—Our hypothesis is that these IvCs are the result of a nondestructive form of vascular invasion by HCC, and we tried to define this aspect of microvascular invasion more accurately. Design.—Tissue sections were stained with hematoxylin-eosin, and consecutive sections were stained for fibrin (Martius scarlet blue, fibrinogen), platelets (factor XIIIa), smooth muscle actin, and endothelium (CD34). We studied cirrhotic livers removed at transplantation between 1997 and 1999. Of the livers studied, 35 of 81 consecutive cirrhotic livers contained HCC, and 17 showed microscopic vascular invasion. Five of these 17 cases showed IvCs and were subjected to the study. Main Outcome Measure.—Presence or absence of thrombus formation in association with IvC. Results.—Usually, IvCs were covered by endothelium, and no associated thrombus formation was seen. In 1 case of HCC, thrombus formation was seen focally in association with disruption of the endothelial coating. Conclusions.—We propose that the endothelial-lined trabecular structure of HCC everts, frondlike, via vascular structures within the tumor capsule into peritumoral vascular lumens without destruction of the endothelial coating. This may protect these HCC tumor projections from thrombus formation but may also act as a barrier to tumor extravasation, and this may be exploited from a therapeutic point of view.

The Basement Membranes in Sarcomatoid Carcinomas. An Immunohistochemical Study

1993 ◽  
Vol 79 (2) ◽  
pp. 128-132 ◽  
Author(s):  
Marcello Guarino ◽  
Salvatore Squillaci ◽  
Domenico Reale ◽  
Giorgio Micoli
Keyword(s):  
Immunohistochemical Staining ◽  
Type Iv Collagen ◽  
Immunohistochemical Study ◽  
Staining Pattern ◽  
Complete Loss ◽  
Basement Membranes ◽  
Sarcomatous Component ◽  
Tissue Sections ◽  
Type Iv ◽  
Frequent Finding

Aims Eight sarcomatoid carcinomas from various anatomical locations were investigated by immunohistochemical staining to laminin, type IV collagen and heparan sulfate proteoglycan, to study the characteristics of basement membranes at the interface between carcinomatous and sarcomatous tissues. Methods Paraffin wax embedded tissue sections from representative tumor samples have been stained with specific antibodies, using the peroxidase-antiperoxidase technique. Results In all cases several interruptions or discontinuities of the basement membrane staining pattern were seen. In 4 cases, larger defects or complete loss of staining was also noted. At these places, the boundaries between carcinomatous and sarcomatous tissue were often blurred. Conclusions Disruption and loss of basement membranes at interface between carcinomatous and sarcomatous tissues is a frequent finding in sarcomatoid carcinomas. These changes could be consistent with an epithelial origin of the sarcomatous component in these tumors by means of an epithelial-mesenchymal conversion mechanism.

Evaluation of the Tissue Microarray Technique for Immunohistochemical Analysis in Rectal Cancer

2002 ◽  
Vol 126 (6) ◽  
pp. 702-705 ◽  
Author(s):  
Eva Fernebro ◽  
Michael Dictor ◽  
Pär-Ola Bendahl ◽  
Mårten Fernö ◽  
Mef Nilbert
Keyword(s):  
Rectal Cancer ◽  
Tissue Microarray ◽  
Core Biopsy ◽  
Immunohistochemical Staining ◽  
Immunohistochemical Analysis ◽  
Ki 67 ◽  
Tissue Sections ◽  
Biopsy Specimens ◽  
Tissue Core ◽  
Microarray Technique

Abstract Background.—Immunohistochemical staining for tumor-associated proteins is widely used for the identification of novel prognostic markers. Recently, a tissue-conserving, high-throughput technique, tissue microarray, has been introduced. This technique uses 0.6-mm tissue core biopsy specimens, 500 to 1000 of which are brought into a new paraffin array block, which can be sectioned up to 100 times. Methods.—We evaluated the tissue microarray technique for immunohistochemical analysis in 20 rectal cancers. Immunohistochemical staining was performed for the proliferation marker Ki-67 and the tumor suppressor protein p53 in whole tissue sections and in tissue core biopsy specimens. Results.—The whole tissue sections were assessed by counting all cells in 10 high-power fields (×40), which resulted in a mean fraction of Ki-67–expressing tumor cells of 0.81 (range, 0.54–1.0). p53 expression assessed in whole tissue sections showed nuclear staining in 15 (75%) of 20 rectal carcinomas. For the tissue microarray technique, a median of 3 (range, 3–5) 0.6-mm tissue core biopsy specimens were studied from each of the 20 tumor specimens. The tissue microarray method gave a mean Ki-67 expression of 0.85 (range, 0.50–1.0) in tumor cell nuclei and showed p53 protein expression in the same 15 of 20 tumors as in the whole tissue sections. Conclusion.—We conclude that the tissue microarray technique for immunohistochemical staining in rectal cancer yields staining of good quality and expression data for Ki-67 and p53 comparable to those obtained with whole tissue staining. The feasibility of tissue microarray thus enables time- and tissue-preserving studies of multiple markers in large tumor series.

The neural phenotype in invasive urothelial carcinoma patients: Alternative score detection and prognostic implication.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17037-e17037
Author(s):  
Paolo Andrea Zucali ◽  
Piergiuseppe Colombo ◽  
Camilla De Carlo ◽  
Laura Giordano ◽  
Rodolfo Hurle ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Vascular Invasion ◽  
Immunohistochemical Analysis ◽  
Pathological Stage ◽  
Stage Of Disease ◽  
Non Invasive ◽  
Negative Results ◽  
Invasive Component ◽  
Luminal Type ◽  
Muscle Invasive

e17037 Background: Recent molecular subtyping studies (NGS) identified a subset (5-15%) of muscle invasive urothelial carcinoma (MIBC) with transcriptomic patterns consistent with neuroendocrine (NE) differentiation in the absence of NE histology (NE-like), representing a potentially high risk subgroup of carcinoma which may require a different treatment strategy. We recently set an alternative immuno-phenotypical score (Piescore), to discriminate Luminal from Basal from Neural carcinoma. Aim of this study was to test the ability of Piescore in identifying NE-like cases in a mono-institutional cohort of patients treated with trans-urethral resection and radical cystectomy (RC) and to correlate them with clinical outcomes. Methods: Transurethral resection specimens harbored foci of HG pT2 (MIBC) UC from 116 pts who subsequently underwent RC have been submitted for immunohistochemical analysis, using relevant gene-expression-based markers for Basal type (CD44, CK5/6) and Luminal type (CK20 and pPARg). Piescore divided Basal and Luminal types when at least 3 of the 4 markers were consistent with a specific phenotype; Mixed if two luminal and two basal markers were present simultaneously; NE-like when all four markers were negative. Results: Overall, the Piescore identified Basal phenotypes in 49 patients (42,2%), Luminal in 38 (32,7%), and Mixed in 9 (7,8%). No expression was identified in 20 patients (17,2%): 7 cases with morphological NE differentiation and 13 cases with classical urothelial histology, all consistent with NE-like phenotype. Interestingly, in 10/13 patients the NE-like phenotype was only documented in the muscle invasive component of the tumor whereas in the non-invasive component they retained Luminal phenotype in 9 cases and Basal in one. With a median follow up of 188 months, the pathological stage of disease (pT2 versus ≥pT3 and/or N+) and the tumor vascular invasion (absent versus present) resulted prognostic (Stage: 5-years DFS rate 65% versus 30%, p = 0.038; 5-years OS rate 69% versus 32%, p = 0.017) (vascular invasion: 5-years DFS rate 47% versus 24%, p = 0.020; 5-years OS rate 54% versus 21%, p < 0.001) in all population. No statistically significant differences in terms of pathological stage of disease, vascular invasion, DFS, and OS were observed in NE-like cases compared with non-NE-like cases. Conclusions: The NE-like urothelial carcinoma identified by Piescore immunophenotyping (CD44, CK5/6, CK20 and pPARg) did not show any statistically significant association with worse prognosis.

scholarly journals Increased COX-2 Immunostaining in Urothelial Carcinoma of the Urinary Bladder Is Associated with Invasiveness and Poor Prognosis

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Basim Al-Maghrabi ◽  
Wafaey Gomaa ◽  
Mohammed Abdelwahed ◽  
Jaudah Al-Maghrabi
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Distant Metastasis ◽  
Immunohistochemical Staining ◽  
Lymphovascular Invasion ◽  
Tumor Grade ◽  
Tissue Microarrays ◽  
Clinicopathological Parameters ◽  
Cox 2 ◽  
Muscle Invasion

Background. Urothelial carcinoma of the urinary bladder (UCB) is the commonest bladder tumor. Cyclooxygenase-2 (COX-2) mediates angiogenesis, cell survival/proliferation, and apoptosis. This study investigates the relation of COX-2 immunostaining in UCB to clinicopathological parameters in Saudi Arabia. Methods. The study population includes 123 UCB and 25 urothelial mucosae adjacent to UCB. UCB samples were collected before any local or systemic therapy. Tissue microarrays were designed and constructed, and TMA blocks were sliced for further immunohistochemical staining. Immunohistochemical staining was done using a mouse anti-human COX-2 monoclonal antibody. A cutoff point of 10% was chosen as the threshold to determine low and high COX-2 immunostaining. Results. COX-2 immunostaining is higher in UCB than in the adjacent urothelium (p=0.033). High COX-2 immunostaining is associated with high-grade UCB (p=0.013), distant metastasis (p=0.031), lymphovascular invasion (p=0.008), positive muscle invasion (p=0.017), pT2 and above (p=0.003), and high anatomical stages (stage II and above). High COX-2 immunostaining is an independent predictor of higher tumor grade (p<0.001), muscle invasion (p=0.015), advanced pathological T (p=0.014), lymphovascular invasion (p=0.011), and distant metastasis (p=0.039). High COX-2 immunostaining is associated with lower overall survival rate (p=0.019). Conclusion. COX-2 immunostaining is associated with the invasiveness of UCB which may be used as an independent prognostic marker. COX-2 may be a significant molecule in the initiation and progression of UCB. Molecular and clinical investigations are required to explore the molecular downstream of COX-2 in UCB and effectiveness of COX-2 inhibitors as adjuvant therapy along with traditional chemotherapy.

scholarly journals Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhi-Yi Zhou ◽  
Jie Sun ◽  
Qing Guo ◽  
Hai-Bin Zhao ◽  
Zhi-Hua Zhou
Keyword(s):  
Gastric Cancer ◽  
Risk Factor ◽  
Early Gastric Cancer ◽  
Endoscopic Resection ◽  
Independent Risk Factor ◽  
Lymphatic Invasion ◽  
Clinicopathological Features ◽  
Surgical Operation ◽  
Tissue Sections ◽  
Clinicopathological Significance

Abstract Background Certain gastric cancers exhibit some primitive phenotypes, which may indicate a high malignancy. In histologically differentiated early gastric cancer (EGC), the presence and the clinicopathological significance of the primitive phenotype remain unclear. Methods Using immunohistochemical staining we detected the expression of three primitive phenotypic markers SALL4, Glypican-3(GPC3), and AFP in whole tissue sections of differentiated EGC (gastrectomy specimens, n = 302). For those cases with primitive phenotypes, we analyzed their clinicopathological features and evaluated whether the criteria for endoscopic resection were met. Results We found that 9.3% (28/302) of all differentiated EGC cases have primitive phenotypes, and most of these cases (25/28) exhibit a histomorphology similar to conventional differentiated EGC. Patients with primitive phenotypes had a deeper invasion, a higher rate of ulcer and lymphatic invasion than cases without primitive phenotype. Moreover, patients with primitive phenotypes displayed a significantly higher frequency of LNM than those without (57.1% vs 8.8%, P < 0.001). Multivariate analysis revealed that presence of primitive phenotypes was an independent risk factor for LNM (P = 0.001, HR 6.977, 95% CI: 2.199–22.138). Interestingly, we found 2 cases with primitive phenotypes developed LNM, and they both met the expanded indications of endoscopic resection for differentiated EGC. Conclusions A small number of differentiated EGC have primitive phenotypes, which were closely related to LNM and were an independent risk factor for LNM. Given its highly aggressive behavior, differentiated EGC with primitive phenotypes should be evaluated with stricter criteria before endoscopic resection, or considered to give an additional surgical operation after endoscopic resection.

Renal Oncocytoma With Both Lymphovascular Invasion and Prominent Intracytoplasmic Vacuole-Like Spaces: A Case Report and Review of the Literature

2021 ◽  
pp. 106689692110415
Author(s):  
Xunda Luo ◽  
Christopher Preciado ◽  
Anupma Nayak ◽  
Lauren E. Schwartz ◽  
Thomas J. Guzzo ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Vascular Invasion ◽  
Lymphovascular Invasion ◽  
Renal Tumor ◽  
Renal Oncocytoma ◽  
Review Of The Literature ◽  
Renal Oncocytomas ◽  
Microscopic Features ◽  
Intracytoplasmic Vacuole ◽  
Tumor Entities

Here we report a case of renal oncocytoma in a 68 year-old male. The diagnosis was initially made on a needle biopsy 6 years prior to the partial nephrectomy. The case is unique that in addition to the gross and microscopic features commonly seen in renal oncocytomas, both lymphovascular invasion and prominent intracytoplasmic vacuole-like spaces are also present in this tumor. Although vascular invasion is increasingly recognized as compatible with renal oncocytoma, intracytoplasmic vacuoles are a rare and unusual finding that may lead to diagnostic difficulty. The diagnosis of renal oncocytoma was confirmed after immunohistochemistry was performed to argue against succinate dehydrogenase deficient renal cell carcinoma (RCC) and chromophobe RCC. This case highlights the importance for practicing pathologists to recognize the rare co-occurrence of lymphovascular invasion and large intracytoplasmic vacuole-like spaces in renal oncocytoma. Other differential diagnoses may include emerging renal tumor entities, such as the recently-proposed eosinophilic vacuolated tumor.

scholarly journals Use of immunohistochemical analysis of CK5/6, CK14, and CK34betaE12 in the differential diagnosis of solid papillary carcinoma in situ from intraductal papilloma with usual ductal hyperplasia of the breast

2018 ◽  
Vol 6 ◽  
pp. 205031211881154 ◽  
Author(s):  
Ichiro Maeda ◽  
Shinya Tajima ◽  
Yoshihide Kanemaki ◽  
Koichiro Tsugawa ◽  
Masayuki Takagi
Keyword(s):  
Differential Diagnosis ◽  
Papillary Carcinoma ◽  
Carcinoma In Situ ◽  
Immunohistochemical Staining ◽  
Immunohistochemical Analysis ◽  
Intraductal Papilloma ◽  
Solid Papillary Carcinoma ◽  
Usual Ductal Hyperplasia ◽  
Ductal Hyperplasia

Objectives: The aim of this study was to use immunohistochemistry to differentiate solid papillary carcinoma in situ from intraductal papilloma with usual ductal hyperplasia (IPUDH). Three types of high-molecular-weight cytokeratins (CKs) – CK5/6, CK14, and CK34betaE12 – were targeted. Methods: We studied 17 patients with solid papillary carcinoma in situ and 18 patients with IPUDH diagnosed by at least two pathologists. Immunohistochemical analyses used antibodies to CK5/6, CK14, and CK34betaE12 to make the differential diagnosis of solid papillary carcinoma in situ versus IPUDH. Immunohistochemical staining was scored as 0–5 using Allred score. Results: Immunohistochemistry with CK5/6 and CK14 antibodies produced scores of 0–3 in all patients with solid papillary carcinoma in situ and 2–5 in all patients with IPUDH. Immunohistochemical staining with CK34betaE12 antibody produced scores of 1–3 in all patients with solid papillary carcinoma and 3–5 in all patients with IPUDH. In tissues from patients with IPUDH, significantly more cells were stained with CK34betaE12 than CK5/6 ( p < 0.05) or CK14 ( p < 0.05). Conclusion: The immunoreactivity of CK5/6, CK14, and CK34betaE12 antibodies was useful to differentiate solid papillary carcinoma in situ from IPUDH. CK34betaE12 is especially useful for distinguishing solid papillary carcinoma from IPUDH.

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