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Aims: Disruption of apoptotic cell death has been implicated in tumour aggressiveness in colonic carcinogenesis. The Fas–Fas ligand (FasL) system is involved in the execution of apoptosis induced by the immune system. c-FLIP protein constitutes an inhibitor of Fas and other (TRAIL) death receptor-mediated apoptosis. The aim of this study was to investigate the simultaneous expression of Fas, FasL and c-FLIP in relation to standard clinicopathological parameters and patients' outcome in colorectal cancer. Methods and results: Levels of Fas, FasL and c-FLIP protein expression were quantified immunohistochemically in paraffin-embedded tissues from 90 patients. Immunopositivity was detected for Fas, FasL and c-FLIP in 71%, 35.5% and 68.8% of cases, respectively. Concurrent expression of Fas/FasL was seen in 28 samples (31%), of which 24 (85.7%) also displayed c-FLIP positivity ( P = 0.04). c-FLIP overexpression (> 10%) tended to prevail marginally in higher stage tumours ( P = 0.09). Additionally, FasL and c-FLIP adversely affected survival on both univariate ( P = 0.001 and P = 0.0024, respectively) and multivariate analysis [hazard ratio (HR) 3.491, P = 0.005 and HR 2.960, P = 0.036, respectively]. Conclusions: The frequent expression and coexpression of Fas, FasL and c-FLIP in colorectal carcinoma implicates c-FLIP as an inhibitor of the Fas–FasL-induced death pathway in these tumours. Moreover, c-FLIP conveys independent prognostic information in the presence of classical prognosticators . [ABSTRACT FROM AUTHOR]

This paper reports the case of a 45-year-old female with histologically documented, multiple cutaneous metastases in the palmar and plantar surface of the fingers and toes originating from a breast adenocarcinoma after treatment with a docetaxel and pegylated liposomal doxorubicin regimen. The rarity of such a metastatic pattern from breast cancer and the eventual association with the chemotherapy administered are thoroughly discussed. [ABSTRACT FROM AUTHOR]

To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories. [ABSTRACT FROM AUTHOR]

Aims: To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision. Methods: A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SIN specimens were evaluated further. Results: Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SINs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines. Conclusions: Pathological examination of SINs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases > 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance. [ABSTRACT FROM AUTHOR]

Estrogen receptors, progesterone receptors, and cathepsin D were determined in 10 patients with giant-cell bone tumor. Progesterone receptors were expressed in 5 of 10 patients tested, whereas low levels of estrogen receptors were found in 1 patient. Cathepsin D levels were elevated in 5 of 5 samples studied. High values of progesterone receptors correlated with low tumor grade. Cathepsin D levels correlated negatively with tumor grade but positively with local tumor expansion. Giant-cell bone tumor expressing progesterone receptors may manifest benign behavior. Cathepsin D may be involved in tumor expansion, possibly through its effect on bone resorption. [ABSTRACT FROM AUTHOR]

A detailed analysis of the consistency with which pathologists from 12 different European countries diagnose and classify breast disease was undertaken as part of the quality assurance programme of the European Breast Screening Pilot Network funded by the Europe against Cancer Programme. Altogether 107 cases were examined by 23 pathologists in 4 rounds. Kappa (κ) statistics for major diagnostic categories were: benign (not otherwise specified) 0.74, atypical ductal hyperplasia (ADH) 0.27, ductal carcinoma in situ (DCIS) 0.87 and invasive carcinoma 0.94. ADH was the majority diagnosis in only 2 cases but was diagnosed by at least 2 participants in another 14, in 9 of which the majority diagnosis was benign (explaining the relatively low κ for this category), DCIS in 4 (all low nuclear grade) and invasive carcinoma (a solitary 1-mm focus) in 1. The histological features of these cases were extremely variable; although one feature that nearly all shared was the presence of cells with small, uniform, hyperchromatic nuclei and a high nucleo-cytoplasmic ratio. The majority diagnosis was DCIS in 33 cases; κ for classifying by nuclear grade was 0.38 using three categories and 0.46 when only two (high and other) were used. When ADH was included with low nuclear grade DCIS there was only a slight improvement in κ. Size measurement of DCIS was less consistent than that of invasive carcinoma.The majority diagnosis was invasive carcinoma in 57 cases, the size of the majority being 100% in 49. The remainder were either special subtypes (adenoid cystic, tubular, colloid, secretory, ductal/medullary) or possible microinvasive carcinomas. Subtyping was most consistent for mucinous (κ, 0.92) and least consistent for medullary carcinomas (κ, 0.56). Consistency of grading using the Nottingham method was moderate (κ=0.53) and consistency of diagnosing vascular invasion, fair (κ=0.38). There was no tendency for consistency to improve from one round to the next, suggesting that further improvements are unlikely without changes in guidelines or methodology. [ABSTRACT FROM AUTHOR]

In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifteen years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadenomas with areas of phyllodes tumor were rejected from the analysis because they were classified as fibroadenomas. Based on the criteria proposed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). The median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those with malignant. The median size of benign tumors was 3 cm, 9.5 cm for borderline, and 7.25 cm for malignant. Out of 55 patients with benign PTs, 37 underwent wide local excision and the remaining 18, with small tumors, underwent enucleation. In this group of patients, there was no recurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 months and 2 years later due to a locally recurrent PT (the last one proven histologically in the permanent biopsy of the recurrence to be malignant). Twelve patients with malignant PT underwent mastectomy, either during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide local excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal breast tissue surrounding the tumor. One patient with 8 cm diameter malignant PT, who underwent mastectomy, passed away sixteen months later from widely spread metastases. Applying the criteria of Azzopardi and Salvadori, each case of PT can be managed successfully avoiding unnecessary mastectomies. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in vulvar intraepithelial neoplasia (VIN) Greek patients. The study uses high frequency electrosurgical unit with at least 80 watts (W) output for LEEP procedure and performs statistical analysis using the SPSS-13 for Windows. Results show that LEEP may represent a valuable excisional method for VIN treatment that is affordable and requires short period training.

The article presents a case study of a 36-year-old woman who underwent excision of the right Bartholin's gland which proved to be adenoid cystic carcinoma (ACC), one of the rarest neoplasms of the genital tract in women. Before surgery, she was treated with antibiotics due to the swelling at the Bartholin's gland but showed no improvement. The patient underwent hemivulvectomy and lymph node dissection without radiotherapy and was cured from the disease eight years after.

Objective To describe the clinical, histological, immunohistochemical and behavioural patterns of the metastases of renal cell carcinoma to the skin. Patients and methods In a retrospective review of 132 cases of renal cell carcinoma submitted for examination to the Anticancer Institute 'St Savas' nine patients with metastatic disease to the skin were discovered. Clinical data and follow-up information were collected and correlated to tumour behaviour and patient survival. Immunohistochemical studies with epithelial membrane antigen (EMA), vimentin, keratin and carcino-embryonic antigen (CEA) were performed. Results In six of the nine patients the skin metastasis was the first evidence of a tumour. Histology of the skin nodule led to identification of the primary site. Histological proof of the renal origin of the tumour was obtained using the above immunohistochemical studies. All patients died from their disease within 3 years of presenting with the skin metastases. Conclusion Metastases to the skin from a renal cell carcinoma as first evidence of the disease may not be as rare as the literature describes. Definite proof of the origin of the tumour requires specialized immunohistochemical techniques. [ABSTRACT FROM AUTHOR]

Discusses the incidence of breast cancer in Greece, using histology reports of women with invasive breast cancer over a period of 35 years, from January 1961 to December 1995. Age of patient; Diameter of tumor; Number of lymph nodes found in the specimen; Number of lymph nodes with metastases.