Bladder Cancer Sample Handling and Reporting: Pathologist's Point of View

The aim of this narrative review is to provide adequate information on handling and reporting of the bladder cancer samples to improve the closely collaboration between pathologists and urologists. The main (but not exclusive) research tool used was PubMed and 87 references were selected and quoted in the text. We have considered handling of biopsies, transurethral resection (TUR), and cystectomy specimens to summarize the different methods of sampling and the related issues. Moreover, we considered and discussed the main prognostic factors, such as histological tumor type, grade, and stage of bladder cancer, that should be described in the pathological report. In addition, critical issues encountered in the interpretation of histological samples were discussed.

Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival

Purpose Insertion of a nutritional jejunostomy in conjunction with esophagectomy is performed with the intention to decrease the risk for postoperative malnutrition and improve recovery without adding significant catheter-related complications. However, previous research has shown no clear benefit and there is currently no consensus of practice. Methods All patients treated with esophagectomy due to cancer during the period 2006–2017 reported in the Swedish National Register for Esophageal and Gastric Cancer were included in this register-based cohort study from a national database. Patients were stratified into two groups: esophagectomy alone and esophagectomy with jejunostomy. Results A total of 847 patients (45.27%) had no jejunostomy inserted while 1024 patients (54.73%) were treated with jejunostomy. The groups were comparable, but some differences were seen in histological tumor type and tumor stage between the groups. No significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate were seen. There was no evidence of increased risk for significant jejunostomy-related complications. Patients in the jejunostomy group with anastomotic leaks had a statistically significant lower risk for severe morbidity defined as Clavien-Dindo score ≥ IIIb (adjusted odds ratio 0.19, 95% CI: 0.04–0.94, P = 0.041) compared to patients with anastomotic leaks and no jejunostomy. Conclusion A nutritional jejunostomy is a safe method for early postoperative enteral nutrition which might decrease the risk for severe outcomes in patients with anastomotic leaks. Nutritional jejunostomy should be considered for patients undergoing curative intended surgery for esophageal and gastro-esophageal junction cancer.

Expression of Apoptotic Protease Activating Factor-1 in adenoid cystic carcinoma of the salivary glands and its clinicopathological relevance

Background/Aim. Apoptotic Protease Activating Factor-1 (Apaf-1) is a key molecule in the intrinsic or mitochondrial pathway of apoptosis. Some pathological conditions such as cancer, stroke, and neurodegenerative diseases, are the result of disregulation in the intrinsic apoptosis pathway. The aim of this study was to analyse the immunohistochemical expression of Apaf-1 in ACC tumor cells of the salivary glands and its correlation with clinicopathological parameters (gender, age, localization, histological type and overall survival). Methods. Formalin-fixed, paraffin-embedded tissues from 50 human ACC of the salivary glands, male and female, average age 58 years, were used for our present study. We used the technique of tissue microarray (TMA blocks). Sections from the TMA mould, 5?m thick, were stained with the streptavidin-biotin immunohistochemical technique using primary antibodies specific for Apaf-1 (Leica Biosystems, Newcastle, UK). Stained tissue sections were analyzed by the light microscope (Olympus type BH-2). Based on the data collected, the database was created in SPSS software v. 22.0 (SPSS Inc., Chicago, ILL, USA), which was used for a further statistical analysis. The statistical data analysis included methods of descriptive and analytical (inferential) statistics. Results. The results of the immunohistochemical analysis of Apaf-1 expression in the samples of patients with ACC of the salivary glands were compared with the clinicopathological parameters of these patients. The immunohistochemical expression of Apaf-1 showed no statistical significance with regard to the patients gender (p=0.552), age (p=0.106), histological tumor type (p=0.654) and localization of ACC in the salivary glands (p=0.486). There was no statistically significant correlation observed between overall survival of ACC patients and Apaf-1 expression in tumor cells (p=0.340,Long-Rank test). Conclusion. With regard to ACC, Apaf-1 expression is not in correlation with clinicopathological parameters (gender, age, localization, histological tumor type, outcome of the disease, and overall survival). Therefore, we believe Apaf-1 cannot be regarded as an independent prognostic factor.

Novel diagnostic and therapeutic approaches to the treatment of ovarian cancer

Introduction. Ovarian cancer is an intra-abdominal, chemosensitive, chronic disease and according to current protocols, it is primarily treated with surgery followed by adjuvant chemotherapy. In Serbia, 820 cases of ovarian cancer are newly diagnosed annually. The aim of the study is to present the results of surgical treatment in 304 patients with ovarian cancer, treated during a 15-year period (2003 - 2017) at the Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Material and Methods. Before the operation, clinical, gynecological, ultrasonography examination and analysis of cancer antigen 125 blood concentrations were performed in all patients. Based on basic diagnostics, additional pelvic, abdominal and thoracic computed tomography or magnetic resonance imaging studies, together with colonoscopy if needed, were performed. The selection of the type and extent of surgical procedure was based on intraoperative assessment of the stage of disease, intraoperative histopathological confirmation of ovarian cancer, wish for fertility preservation and general patient?s condition. Exclusion criteria were histopathologically confirmed benign or borderline ovarian tumors, i. e. absence of cancer in the final microscopic specimen. Results. The patients? age ranged from 19 - 88 years, with a median of 53.4 years. According to the International Federation of Gynecology and Obstetrics staging, most patients had stage III - 98 (33.1%) and epithelial ovarian cancer - 240 (84.2%). The most common surgical procedures were hysterectomy with bilateral adnexectomy and omentectomy, whereas cytological analysis was performed in 138 (45.4%) treated patients. Complications were recorded in 13 (4.3%) operated patients with inflammation and wound seroma being the most common (4 patients - 1.3% of cases). Conclusion. Ovarian cancer treatment is planned individually, depending on the stage of the disease, histological tumor type, patient?s general condition, wish for fertility-sparing treatment and technical capacity of the institution where the treatment is performed.

Comparison of the Subgross Distribution of the Lesions in Invasive Ductal and Lobular Carcinomas of the Breast: A Large-Format Histology Study

To compare the lesion distribution and the extent of the disease in ductal and lobular carcinomas of the breast, we studied 586 ductal and 133 lobular consecutive cancers. All cases were documented on large-format histology slides. The invasive component of ductal carcinomas was unifocal in 63.3% (371/586), multifocal in 35.5% (208/586), and diffuse in 1.2% (7/586) of the cases. The corresponding figures in the lobular group were 27.8% (37/133), 45.9% (61/586), and 26.3% (35/133), respectively. When the distribution of the in situ and invasive component in the same tumors was combined to give an aggregate pattern, the ductal carcinomas were unifocal in 41.6% (244/586), multifocal in 31.6% (185/586), and diffuse in 26.8% (157/586) of the cases. The corresponding figures in the lobular category were 15.0% (20/133), 54.2% (72/133), and 30.8% (41/133), respectively. Ductal cancers were extensive in 45.7% (268/586), lobular in 65.4% (87/133) of the cases. All these differences were statistically highly significant (). While the histological tumor type itself (ductal versus lobular) did not influence the lymph node status, multifocal and diffuse distribution of the lesions were associated with significantly increased risk of lymph node metastases in both ductal and lobular cancers.