Presence Of Spindle-shaped Cells Research Articles

Cytomorphological criteria for separation of pulmonary adenocarcinomas from squamous cell carcinomas: A statistical learning approach.

Current therapy requires separation of non-small cell carcinomas into adenocarcinomas (AC) and squamous cell carcinomas (SCC). A meta-analysis has shown a pooled diagnostic sensitivity of 63% and specificity of 95% for the diagnosis of AC. While a number of cytomorphological features have been proposed for separation of AC from SCC, we are unaware of a statistically based analysis of cytomorphological features useful for separation of these two carcinomas. We performed logistic regression analysis of cytological features useful in classifying SCC and AC. Sixty-one Papanicolaou-stained fine needle aspiration specimens (29 AC/32 SCC) were reviewed by two board-certified cytopathologists for nine features (eccentric nucleoli, vesicular chromatin, prominent nucleoli, vacuolated cytoplasm, 3-dimensional cell balls, dark non-transparent chromatin, central nucleoli, single malignant cells and spindle-shaped cells). All cytological specimens had surgical biopsy results. Inter-rater agreement was assessed by Cohen's κ. Association between features and AC was determined using hierarchical logistic regression model where feature scores were nested within reviewers. A model to classify cases as SCC or AC was developed and verified by k-fold verification (k=5). Classification performance was assessed using the area under the receiver operating characteristic curve. Observed rater agreement for scored features ranged from 49% to 82%. Kappa scores were clustered in three groups. Raters demonstrated good agreement for prominent nucleoli, vesicular chromatin and eccentric nuclei. Fair agreement was seen for 3-dimensional cell balls, dark non-transparent chromatin, and presence of spindle-shaped cells. Association of features with adenocarcinoma showed four statistically significant associations (P<0.001) with adenocarcinoma. These features were prominent nucleoli, vesicular chromatin, eccentric nuclei and three-dimensional cell balls. Spindle-shaped cells and dark non-transparent chromatin were negatively associated with adenocarcinoma. Logistic regression analysis demonstrated six features helpful in separation of AC from SCC. Prominent nucleoli, vesicular chromatin, cell balls and eccentric nucleoli were positively associated with AC and demonstrated a P value of 0.001 or less. The presence of dark, non-transparent chromatin and spindle-shaped cells favoured the diagnosis of SCC.

Clinicopathologic Correlation of Lens Epithelial Metaplasia and Late Intraocular Lens Dislocation After Repair of Retinal Detachment

In-the-bag intraocular lens dislocation is an uncommon but serious complication of cataract surgery in patients with previous repair of retinal detachment. The causative mechanism is currently unknown. We report histologic findings from a retrospective case series from 1993 to 2010 and suggest a possible mechanism to explain this association. Clinical characteristics of 8 patients presenting with in-the-bag intraocular lens dislocation after repair of retinal detachment were evaluated. Explanted capsular bags from 3 of these patients were compared with pathologic changes of crystalline lenses associated with retinal detachment. Histologic examination of the explanted capsular bags revealed a paucicellular membrane that covered the concertina-like folded surface of the lens capsule. The lens capsule was devoid of epithelial cell nuclei and showed excessive thickening with the presence of spindle-shaped cells, such as fibroblasts. Collagen fibers were noted in the extracellular matrix. Previous studies of crystalline lens pathologic findings associated with retinal detachment have shown changes in the epithelium with migration and subsequent metaplasia of epithelial cells, resulting in excessive thickening of the anterior capsule with a layer of fibrous tissue. In this retrospective series, similar histologic findings were seen, suggesting that zonular dehiscence and lens dislocation may result from progressive capsular contraction secondary to retinal detachment-induced lens epithelial metaplasia.

Impurity of stem cell graft by murine embryonic fibroblasts - implications for cell-based therapy of the central nervous system.

Stem cells have been demonstrated to possess a therapeutic potential in experimental models of various central nervous system disorders, including stroke. The types of implanted cells appear to play a crucial role. Previously, groups of the stem cell network NRW implemented a feeder-based cell line within the scope of their projects, examining the implantation of stem cells after ischemic stroke and traumatic brain injury. Retrospective evaluation indicated the presence of spindle-shaped cells in several grafts implanted in injured animals, which indicated potential contamination by co-cultured feeder cells (murine embryonic fibroblasts – MEFs). Because feeder-based cell lines have been previously exposed to a justified criticism with regard to contamination by animal glycans, we aimed to evaluate the effects of stem cell/MEF co-transplantation. MEFs accounted for 5.3 ± 2.8% of all cells in the primary FACS-evaluated co-culture. Depending on the culture conditions and subsequent purification procedure, the MEF-fraction ranged from 0.9 to 9.9% of the cell suspensions in vitro. MEF survival and related formation of extracellular substances in vivo were observed after implantation into the uninjured rat brain. Impurity of the stem cell graft by MEFs interferes with translational strategies, which represents a threat to the potential recipient and may affect the graft microenvironment. The implications of these findings are critically discussed.

Original article Angiocentric glioma: a rare intractable epilepsy-related tumour in children

Angiocentric glioma is a low-grade tumour that occurs in children and young adults with a long-standing epilepsy. The typical histopathological features of this tumour is the presence of spindle-shaped cells, radially oriented around the cortical blood vessels. We present two teenage cases of the angiocentric variant of glioma: 1) a 15-year-old girl with a chronic and intractable partial epilepsy with cystic tumour located in the right temporal lobe and 2) a 14-year-old boy with intractable seizures and an extensive cortical lesion in the left parieto-occipital area. In both cases, the total tumours excision was performed. The histopathological findings revealed a characteristic angiocentric pattern that was composed of elongated cells arranging in pseudorosette-like structures around blood vessels. Moreover, schwannoma-like areas and subpial neoplastic infiltration with palisading of tumour cells at the brain surface were seen. The neoplastic cells displayed immunoreactivity for GFAP, S-100 protein and vimentin. A slight "dot-like" EMA staining, suggesting ependymal differentiation, was detected. The clinical and pathological picture allowed to establish the diagnosis of angiocentric gliomas. The patients were discharged home in a good condition and without seizures. During the 4-year follow-up, the tumour recurrence and seizures were not observed. The appropriate diagnosis of this peculiar type of usually low-grade glial tumour is important for adequate and successful treatment. The differential diagnosis requires the exclusion of other tumours with an angiocentric pattern, i.e. ependymoma, astroblastoma, which are associated with more aggressive biology.

The transcription factor Snail expressed in cutaneous squamous cell carcinoma induces epithelial–mesenchymal transition and down-regulates COX-2

Cutaneous spindle cell squamous cell carcinoma (SCC) is a rare, but highly malignant variant of SCC. The presence of spindle-shaped cells with a sarcomatous appearance, which are derived from squamous cells, suggests that these cells are produced as a result of epithelial–mesenchymal transition (EMT). EMT is a complex process in which epithelial cells lose their polarity and cell–cell contacts, while also acquiring increased motility and invasiveness. Snail regulates EMT by binding to proximal E-boxes in the promoter region of E-cadherin and repressing its transcription. When examining the expression of EMT markers and Snail in spindle cell SCCs, we found that cyclooxygenase-2 (COX-2) expression was down-regulated. Since it has been shown that COX-2 is constitutively overexpressed in a variety of malignancies, including colon, gastric, and lung carcinomas, the down-regulation of COX-2 expression was unexpected. The presence of E-box-like sequences in the promoter region of COX-2 prompted us to perform a more detailed analysis. We introduced a Snail expression vector into keratinocyte-derived cell lines (HaKaT, HSC5, and A431 cells), and isolated stable transfectants. We determined that COX-2 expression was down-regulated in cells expressing Snail. Consistent with these observations, reporter assays revealed that COX-2 promoter activity was repressed upon Snail overexpression. Thus Snail down-regulates COX-2 in these cells.

Rare case of composite embryonal rhabdomyosarcoma and leiomyosarcoma of the tongue of an adult

The differential diagnosis of embryonal rhabdomyosarcoma (RMS), pleomorphic sarcoma, and leiomyosarcoma remains a challenge because of their overlapping histological presentations, with serious implications on the choice of treatment. We report a rare case of a tumor confined to the tongue in a 22-year-old woman. Clinical, histological, and immunohistochemical data confirmed the diagnosis of a composite tumor of embryonal RMS and leiomyosarcoma based on the presence of spindle-shaped cells within a myxoid background of spherical cells and immunoreactivity to muscle-specific markers (desmin, smooth-muscle actin, muscle-specific actin, myoglobin, and vimentin), RMS-specific myogenin, and leiomyosarcoma-specific h-caldesmon. The lack of immunoreactivity to S-100 and cytokeratin antibodies suggested the absence of melanoma and pleomorphic sarcoma, respectively. Presurgical treatment with a single round of broad-spectrum MAID (mesna, pirarubicin, ifosfamide, and dacarbazine) adjuvant therapy for the advanced soft tissue sarcoma allowed the growth of the tumor from 45mm×38mm×25mm to 45mm×40mm×40mm. Thereafter, subtotal glossectomy was performed. Based on the strong immunoreactivity of the tumor to myogenin, the patient received RMS-specific VAC (vincristine, actinomycin D, and cyclophosphamide) chemotherapy over 6 months. However, metastases to the lungs led to the patient's death. This case highlights the danger of “overdiagnosing” a patient, and the need to select a broad-spectrum adjuvant whenever a diagnosis of composite sarcoma is suspected.

Solitary fibrous tumor of the nasal cavity and paranasal sinuses

The solitary fibrous tumor (SFT), also known as benign fibrous mesothelioma or submesothelial fibroma is one of the different types of existing mesothelial tumors. It was originally described in the pleura by Klemper and Rabin in 1931 1 an dwa slate rreferre dt oa sa SF To fth epleur aand peritoneum with no actual mesothelial differentiation. Although the majority of these tumors are originated in the pleura, a number of extrapleural sites with no relationship to mucosal surfaces have been reported; these include the liver, parapharyngeal space, sublingual gland, tongue, vulva ,paroti dgland ,thyroid ,an dlarynx. 2 Th eSF To fthe nasal cavity and paranasal sinuses is extremely rare, with only 22 cases reported in the world literature so far. A 32-year-old man, originally from Mexico City with a family history of type 2 diabetes mellitus and hypertension presented to us with a 2-month history of bilateral nose obstruction, predominantly on the right side, greenish rhinorrhea, general malaise, and fever, all of which partially resolved after numerous medications previously given to him. Physical examination and endoscopy revealed a smooth-textured, grayish mass that completely obstructed the right nasal cavity and pushed the nasal septum toward the left side. Computed tomography showed a large mass that occupyied the entire right nasal cavity and part of the left cavity with remodeling and erosion of the nasal septum and right lateral nasal wall. The mass completely occupied the right ethmoidal sinus and part of the right sphenoidal an dmaxillar ysinuse s(Fi g1) .Administratio no fintravenous contrast revealed heterogeneous hyperdensity of the lesion. Examination of a biopsy specimen reported a benign tumor compatible with Schwannoma and functional endoscopic sinus surgery was performed. During surgery, the nasal mass was found to be originating from the right lateral nasal wall, with great vascularity and intense bleeding when manipulated with microdebrider. Approximately 60% of the mass was resected and was later sent for histopathologic analysis. A benign tumor was observed microscopically, with the presence of spindle-shaped cells with long nuclei and a moderate amount of eosinofilic cytoplasm; some areas showed interstitial dense collagen deposits while some other sabundan thyalinizatio n(Fig s2 an d3) .Fe wscattered dilated blood vessels and horseshoe-shaped vessels were seen, but there was no evidence of atypical cellularity, necrosis, hemorrhage, or an increase in the number of mitosis. Immunohistochemical staining was positive for vimentin ,CD3 4(Fi g4) ,an dCD9 9an dnegativ efo rS-10 0protein, actin and desmin, thus helping us establish a diagnosis for SFT.

Diagnostic pitfalls of echography in a case of hepatic cavernous hemangioma

An ecographic study of the liver in a 55-year-old female, with a history of mastectomy for a breast ductal cancer, showed multiple focal lesions. On computer tomography, we interpreted these lesions as metastatic disease. 99m Tc-labeled RBC showed non-homogeneous flow distribution in the right lobe of the liver. Fine needle aspiration biopsy under ecographic guidance showed no metastatic disease, and suggested a vascular lesion. The presence of spindle-shaped cells, reactive for CD 34 and for factor VIII, enabled definitive diagnosis of angiomatous lesion. Cytological confirmation of each hepatic mass is a mandatory prerequisite for any therapy.