Use of Elastic Stain Technique to Detect Histologically Occult Vascular Invasion in Resected Colorectal Carcinomas at Danbury Hospital

Introduction/Objective Colorectal carcinoma (CRC) represents a leading cause of cancer related death in the western world and is by far the most common malignancy of the gastrointestinal tract. Vascular invasion (VI), in particular extramural VI by tumor is recognized as a feature of colorectal cancer progression, and the latter is an independent prognostic indicator of disease recurrence and survival in colorectal carcinoma. The purpose of this study is to detect VI in resected colorectal tumor samples and compare sensitivity of elastic staining to routine H&E staining at Danbury Hospital. Methods/Case Report A total of 50 colorectal cancer specimens from segmental colon resection or endoscopic polypectomy performed at Danbury Hospital over a 3-year period were included. Histologic sections of each tumor were assessed for the presence of VI by routine H&E staining. Superficial recuts of each tumor were subjected to elastic Von Giesen staining and reassessed for the presence of vascular invasion. Sensitivity of routine H&E staining for the detection of VI was calculated with elastic stain serving as the “gold standard”. Results (if a Case Study enter NA) In this study, VI by carcinoma was identified by H&E stain and/or elastic stain in 17 (34%) out of 50 cases. H&E stain and elastic stain detected VI in 12 (24%) and 16 (32%) out of 50 cases, respectively. There was a single case for which H&E stain showed vascular invasion that was not confirmed by elastic stain, representing a false negative for the H&E technique. Elastic staining detected VI in 5 cases for which the corresponding H&E stain was falsely negative for VI. Overall, vascular invasion status (absent or present) was concordant in 44 (88 %) of the 50 cases. With elastic stain deemed the “gold standard” for VI detection, the sensitivity, specificity, negative predictive value, and positive predictive value of H&E stain were found to be 68.7%, 97.0%, 86.8%, and 91.6%, respectively. Conclusion Although H & E staining of colorectal carcinoma tissue sections have a very good specificity and positive predictive value for the detection of VI, this technique suffers from a suboptimal sensitivity. For these reasons, we agree with previously published literature reports that the use of elastic stain as a supplement to H & E staining should be strongly considered for the proper evaluation and prognostication of colorectal carcinoma specimens.

Dual-Block Elastic Stain Significantly Increasing Visceral Pleural Invasion(VPI) Positivity and Analysis of Potential Predictors of VPI in Peripheral Non-Small Cell Lung Cancer

Background: Visceral pleural invasion (VPI) is a critical component in the staging of peripheral non–small cell lung carcinoma (NSCLC). Single tumor tissue block for elastic stain is conducive to identifying pleural invasion in routine pathologic examination. We aim to investigate whether dual-block elastic stain increase VPI positivity compared with single-block elastic stain, further analyze the potential predictors of VPI status.Methods: Resected 8419 consecutive peripheral NSCLC cases including tumor size≤3cm 6008 patients were retrospectively reviewed. Total cases were divided into a cohort using one tumor tissue paraffin block (single-block group, n=5184) and a cohort using dual tumor tissue paraffin blocks (dual-block group, n=3235) for elastic stain. Each case was performed with Victoria-blue van Gieson staining to assess VPI status. The clinicopathologic features of patients were collected from the electronic medical record system.Results: The overall incidence of VPI was 12.4% (1047/8419) in peripheral NSCLC patients. The VPI positivity detected by dual-block elastic stain was significantly higher than that by single-block elastic stain (17.7% (573/3235) v.s. 9.1% (474/5184), P＜0.001). The presence of VPI in T1 ≤3cm patients detected by single and dual block elastic stain was 6.3% (235/3730) and 12.0% (273/2278), respectively (P＜0.001). Therefore, 5.7% T1 patients (stage IA) are additionally upstaged to T2a (stage IB) by dual block elastic stain. But the incidence of VPI in pT2a patients had no significant difference between single-block group and dual-block group (16.8% vs 17.1%, P=0.916). The lymphovascular invasion, lymph node metastasis, poor differentiated carcinomas and the presence of STAS status could be well significant predictors of VPI (P＜0.001). Area under the ROC curve of adenocarcinoma morphology was 0.263 for lepidic pattern, 0.544 for acinar and papillary pattern, and 0.720 for micropapillary and solid pattern in predicting invasion of pleura.Conclusion: Our results indicated that using dual-block elastic stain identify more VPI positive T1 NSCLC patients who are upstaged to T2a and could benefit from optimal management after post-operation. The application of dual-block elastic stain is an efficient and practical method to detect VPI, especially for patients with high-risk prognostic factors.

Expression levels of cathepsin L and cystatin C in a hyperglycemic environment were associated with aortic aneurysm development in a mouse model

Objectives Diabetes mellitus (DM) attenuates the development of aortic aneurysms (AA). This study investigated the expression of cathepsin L and cystatin C in a hyperglycemic environment, and the influence of these proteins on AA development. Methods Mice were divided into AA and DM+AA groups ( n=30 per group). DM was induced by injection of streptozotocin; AA was induced by injection of angiotensin II. Doppler examination was used to measure aortic diameter, and Weigert’s elastic stain was used to detect elastin degradation. Cathepsin L and cystatin C in aortic tissue were examined by western blotting, immunohistochemistry, and polymerase chain reaction. Results Aortic diameter in the DM+AA group was less than that in the AA group, and elastin fragmentation grade of the aortic wall was reduced in the DM+AA group. More cathepsin L-positive cells were observed in the AA group than in the DM+AA group; conversely, more cystatin C-positive cells were observed in the DM+AA group than in the AA group. Both protein and mRNA levels of cathepsin L and cystatin C showed similar trends to those observed in immunohistochemistry. Conclusions Expression levels of cathepsin L and cystatin C in a hyperglycemic environment were associated with AA development in a mouse model.

Reappraisal of Serosal Invasion in Patients With T3 Colorectal Cancer by Elastic Stain: Clinicopathologic Study of 139 Surgical Cases With Special Reference to Peritoneal Elastic Lamina Invasion

Context Peritoneal elastic lamina invasion (PELI) has been reported to be an important adverse prognostic factor in pT3 colorectal cancer (CRC). However, the data supporting this contention are limited. Objective To clarify the associations between PELI of pT3 CRC and prognostic significance, 139 consecutive surgical cases of pT3 CRC were examined. Design One hundred thirty-nine consecutive in-house surgical cases of pT3 CRC between 1993 and 2011 were examined. Thirty consecutive surgical cases of pT4a CRC resected during the same period were examined for comparison. Case selections were restricted to pT3 CRCs with the sections containing the deepest adenocarcinoma invasion partially or entirely covered with the peritoneum. Elastic staining was performed on one section containing the deepest tumor invasion partially or entirely covered with the peritoneum. The associations between the presence of PELI and clinicopathologic factors including prognosis of the patients were examined. Results Peritoneal elastic lamina invasion was identified in 23.0% (32 of 139) of the pT3 CRCs. PELI was associated with primary site (P = .006), lymph node metastasis (P < .001), lymphovascular invasion (P < .001), recurrence (P = .007), and patient's age (P = .002). The proportions of patients with a 4-year recurrence-free period in those with negative PELI, positive PELI, and pT4a tumor were 90.3%, 66.7%, and 28.9%, respectively (P < .001). Conclusions Elastic staining is useful to evaluate the serosal invasion of CRC. Positive PELI is a significant predictive factor for lymph node metastasis and recurrence-free survival in patients with pT3 CRC. This indicates that pT3 tumors with PELI should be treated like pT4a tumors.

The Meso-Piezo-Capacitive Effect

In mesoscopic scales, we design a single potential heterojunctionalong the direction of growth (001)，Firstly,we analyzes the conditions of the structure as a capacitor, and then through the schrodinger equation and poisson equation introduced the relation between capacitance and the width of the barrier,at last we investigate,theoretically the effect of the capacitance changes by the elastic stain due to a certain stess on the structure which along the direction of growth. We call it meso-piezo-capicitive effect.