Tiberiu Augustin GEORGESCU, Monica CIRSTOIU, Mariana COSTACHE, Anca LAZAROIU, Adrian DUMITRU and Maria SAJIN

ABSTRACT

Introduction: Endometrial hyperplasia represents a diversified set of disorders which has challenged pathologists for decades. Due to its high likelihood of progression to carcinoma, endometrial intraepithelial neoplasia (EIN) demands prompt and specialized intervention.

Materials and methods: This 15-month (September 2014 – November 2015) retrospective analysis involved 258 cases of female patients with atypical and non-atypical endometrial hyperplasia investigated and treated at the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate the histopathological, immunohistochemical and therapeutical aspects of premalignant endometrial lesions as well as their concurrence with endometrial carcinoma.

Results: Our findings indicate that 23% of the women preoperatively diagnosed with atypical hyperplasia were found with endometrial carcinoma on the hysterectomy specimen. Surprisingly, we identified two cases of atypical hyperplasia with focal p53 expression. Mutation of p53 is a late genetic event seen in endometrial carcinoma which does not usually occur in EIN. Interestingly, these cases did not present endometrial carcinoma on the hysterectomy specimen.

Conclusions: All female patients diagnosed with EIN have an increased risk of developing endometrial carcinoma, as there are no histologic subdivisions or grades of atypical hyperplasia to further stratify risk for malignancy. Therefore, we emphasize the importance of accurate detection of premalignant endometrial lesions and exclusion of a coexisting endometrial carcinoma as mandatory prerequisites for proper medical management.

Keywords: non-atypical endometrial hyperplasia, atypical endometrial hyperplasia, EIN, endometrial carcinoma

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Oana Maria PATRASCU, Mariana COSTACHE, Adrian Vasile DUMITRU, Corina Nicoleta MEHOTIN, Maria SAJIN and Anca Mihaela LAZAROIU

ABSTRACT

Background: From the first recognition of dysplastic nevi as a pathology per se, many debates have been raised and many histological and immunohistological studies have been conducted in order to establish the true significance of these lesions. Therefore, the aim of this study was to establish if there is a correlation between HMB-45, Melan A and Bcl-2 expression and the grade of dysplasia, as well as between the marker’s staining patterns.

Material and Methods: Ten dysplastic nevi from six female patients were selected and their histological features (size, dysplasia), as well as the immunohistological staining patterns, were studied (HMB-45, Melan A, Bcl-2). The Pearson correlation coefficient and regression was calculated with Windows Excel Data Analysis.

Results: We demonstrated that there was a notable correlation between the dysplasia and the size of the lesions (r(8)= 0.62 with p-value= 0.052), and also between Melan A and Bcl-2 (a r(6)= 0.73, p<0.05), but we did not obtain a statistically significant correlation between other features (p>0.05).

Conclusions: We can affirm, at least in our cases, there is a correlation between the grade of dysplasia and the size of the lesion, and also, that there is a correlation between Melan A and Bcl-2 staining, explained by MITF gene. These results were only partial concordant with those in other studies, therefore a larger number of cases is recommended to be further analyzed in order to clearly draw a conclusion.

Keywords: dysplastic nevi, Bcl-2, Melan A, HMB-45, imunohistological stains

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Alina Mariana AVRAM, Olga Dana SIMIONESCU, Mariana COSTACHE and Mariana GRIGORE

ABSTRACT

Background: Despite the fact that melanoma is an easy approachable tumor for diagnosis, the incidence of this skin cancer is still increasing. Histopathological assessment of melanocytic tumors is the gold standard in melanoma diagnosis and represents a problematic aspect of dermatology and pathology. Over the past decades many efforts have been made in determining histological characteristics influencing the prognosis and survival of patients with clinically localized primary melanoma. Some of these parameters also proved to be essential for tumor staging and choosing adequate clinical management.

Objective: We present a retrospective study of 21 melanoma cases with histopathological errors or incomplete path reports, with the intention to raise awareness about the importance of an accurate diagnosis for the management of these cases and for patient prognosis.

Methods: We retrospectively reviewed data from pathology reports and discharge medical records from 21 patients diagnosed with melanoma between 2006 and 2014 and treated in other hospitals that presented in our clinic for second opinion. All slides were reviewed by an authorized dermatopathologist and the new path report was compared with the other ones, presented by the patients.

Results: The majority of the path reports were incomplete, with absent (35.7%) or wrong (35.7%) tumor thickness, making impossible to stage the tumor. Absence of histopathological diagnosis was noticed in 3 cases and a wrong diagnosis was determined in 3 patients. Other missing parameters were ulceration status, mitotic rate, microsatellitosis and surgical margins evaluation. missing or incorrect determined in half of the cases.

Conclusions: This study presents the fact that there is a lack of relevant information in the path reports of melanoma cases, making impossible to stage and treat this patients, with adverse clinical impact. We want to emphasize the importance of a standardized histopathological evaluation of melanocytic tumors, consistent with the generally accepted standards, leading to improved healthcare quality and reduced medico legal risks associated with melanoma.

Increased attention to the essential elements for the diagnosis and treatment of melanoma can improve the care of most of these patients and improve prognosis and survival rates.

Keywords: melanoma, path report, error, prognostic factor, Breslow index

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