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Colorectal carcinoma (CRC) is one of the most common cancers in the world. Preoperative radiation with concurrent chemotherapy and subsequent surgery is the standard treatment for locally advanced rectal cancer. However, the tumor response to preoperative chemoradiotherapy (pCRT) varies significantly. CSCs have been found in many human malignant tumors including rectal cancer. Several markers for CSCs have been proposed in CRC, OCT-4 and CD133 have been the most frequently researched. This study was targeted to evaluate the immunohistochemical expression of stem cell markers OCT-4 & CD133 in rectosigmoid adenocarcinomas and correlate their expressions with the grade, stage, and response of the tumor to CRT. The present study comprised 30 specimens of rectosigmoid adenocarcinoma. The primary antibodies used were: OCT-4 antibody, clone PA5-27438, and CD133 antibody, clone144305. Positive OCT-4 expression was observed in 12/30 cases. A significant relationship was found between OCT-4 expression and tumor stage and sex of the patients. No statistically significant relation was found between OCT-4 expression and age of the patients, tumor grade, lymph node stage, pathological response to CRT, OS, or the expression of CD133. 20/30 cases were positively stained for CD133, no significant correlation between CD133 expression and any of the clinicopathological parameters. OCT-4 was expressed in 40% and CD133 in 66% of rectosigmoid cancers studied, so they might be involved in the development of CRC. New therapeutic perspectives based on the selective targeting of the specific population of cells expressing one of those CSCs. OCT-4 expression might be a bad prognostic indicator in rectosigmoid cancer.

Objective: HER-2/neu status in gastric carcinomas (GCs) has not been studied before in the Egyptian population. Materials and Methods: Seventy-three GCs were evaluated for the expression of HER-2/neu and Ki-67 using immunohistochemistry (IHC). Fluorescence in situ Hybridization (FISH) was done for HER2/neu IHC score 2+ cases. Results: Out of the 73 gastric carcinomas, 23 (31.5%) were score 0, 17 (23.3%) were score 1+, 23 (31.5%) were score 2+, and 10 (13.7%) were score 3+. FISH analysis revealed that the HER-2/neu gene was amplified in 11 out of the 23 cases (47.8%) scored 2+ by IHC. Therefore, the overall HER-2/neu positivity rate was 28.8% and it was significantly associated with higher T-stage and lymphovascular invasion (LVI). The Ki-67 expression rate ranged between 10% and 100%, with 84.9% of the cases (n = 62) featuring high Ki-67 scores. High Ki-67 score was significantly associated with male sex, tumor grade, and number of positive nodes. HER-2/neu protein expression correlated significantly with Ki-67 score. Twenty tumors showed combined HER-2/neu positivity and high Ki-67 score and were significantly associated with higher T-stage and occurrence of LVI, implying a more aggressive behavior. Conclusions: The rate of HER-2/neu positive GCs in our series simulates universal rates, thereby mandating routine evaluation of HER-2/neu status in all GCs submitted to our laboratory to benefit from trastuzumab therapy. Further studies on a larger number of GCs are required to prove that the concurrent HER-2/neu positivity and high Ki-67 score are markers of worse prognosis.

In Egypt colorectal carcinoma (CRC) is the most common type of malignancy of the digestive system. Selectively inhibiting neoangiogenesis by targeting tumor-associated blood vessels is an important therapeutic strategy. Prostate specific membrane antigen (PSMA) is expressed in the tumor-associated neovasculature of most solid cancers making it an interesting therapeutic target. We thought to study the expression of PSMA in a series of CRCs in order to test for its possible use as a target for antiangiogenic cancer therapy in Egyptian patients. One hundred CRC cases were retrieved. Representative sections from each tumor were subjected to immunohistochemistry using PSMA antibodies and CD31 antibodies as reference marker. Accordingly vascular endothelial cell immunoreactivity was semiquantitatively scored. PSMA immunostaining was positive in the neovasculature of 75% of tumors. A statistically significant relation was found between PSMA immunostaining and distant metastasis as well as vascular invasion. The present findings strengthen the evidence on the potential usefulness of PSMA as a therapeutic vascular target. This study is the first to demonstrate a positive relation between PSMA expression in CRC and distant metastasis as well vascular invasion, suggesting that PSMA may play a significant role in vascular invasion and subsequent metastasis.

Fine-needle aspiration cytology (FNAC) of breast masses has been replaced by ultrasound-guided core-needle biopsy (USG-CNB) in many countries. However, in Egypt, breast FNAC continues to play the major role in diagnosing breast masses. In this prospective study, we evaluated the efficacy of USG-FNACs performed at a breast cancer screening center by comparing the FNAC results with the corresponding definitive histological examination outcome. We also investigated the role that CNB can play as a complementary diagnostic tool for FNAC in selected cases. A total of 229 consecutive nonpalpable breast masses were included in this study. Each FNAC was placed into one of four categories: 3.5% nondiagnostic, 13.5% benign, 12.3% atypical/suspicious (indeterminate), and 70.7% malignant. The overall diagnostic accuracy was 98.9%, with a specificity and sensitivity of 99.3 and 96.7%, respectively. The overall positive predictive values and negative predictive values were 99.3 and 96.7%, respectively. Only 37 masses (16%) were converted to CNB, with the indeterminate cytology being the most common cause (54%) for this conversion. Two cases demonstrating the superior benefit of FNAC over CNB are illustrated. Although we started the study by reserving CNB as a first choice to assess microcalcifications without architectural distortion, we ended the study by deciding to perform combined FNAC and CNB for this type of lesions. In conclusion, aiming to maximize the preoperative diagnosis of cancer, it would be cost efficient and time saving to use FNAC as a first-line investigation to benefit from the wealth of cytological information yielded, followed by CNB in selected cases. Diagn. Cytopathol. 2010;38:880–889. © 2010 Wiley-Liss, Inc.

Background: The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. Osteopontin (OPN) is a pleiotropic integrin-binding protein with many functions. We assessed pleural effusion and serum concentrations of OPN and C-reactive protein (CRP) in patients with different types of pleural effusions. Methods: The current study comprised three groups: 20 patients with transudative effusion, 30 patients with malignant effusion and 30 patients with tuberculous effusion. OPN was analysed using a commercially available enzyme-linked immunosorbent assay kit. Results: OPN effusion values were significantly higher in exudates (both malignant and tuberculous effusion cases) compared with transudative effusion. Also when compared separately, patients with tuberculous effusion and those with malignant effusion had a significantly higher fluid and OPN effusion/serum ratio than those with transudative effusion. Patients with tuberculous effusion had a significantly higher serum CRP effusion and effusion/serum ratio of CRP than those with malignant or transudative effusion. Conclusion: OPN is significantly increased in exudative effusion compared with transudative ones. However, serum OPN and effusion/serum OPN ratio were not significantly different in patients with malignant from those with tuberculous effusions. The lack of difference in serum OPN and effusion/serum OPN ratio between patients with malignant and those with tuberculous effusion may be attributed to the heterogeneity of the malignant effusion group. Receiver-operating characteristic (ROC) curve analysis has shown that effusion/serum CRP ratio outperformed effusion/serum OPN ratio as a diagnostic marker for tuberculous pleural effusion.

Background:Data from Egyptian studies provide widely varying estimates on the prevalence of preinvasive cervical lesions. The aim of this study was to estimate the rate of cervical intraepithelial neoplasia (CIN) in Egyptian women living in Alexandria to clarify the need for implementing a national organized screening program and a vaccination program in our community.Materials and Methods:The study was conducted over a 6 years period and covered the different socioeconomic levels to have a representative sample for women living in Alexandria. All women included did not have any cervical disorder related complaints. Conventional Pap smears were obtained and diagnosed using the Bethesda system. Women with abnormal Pap smears were managed according to the 2006 consensus guidelines within the available facilities. Persistent abnormal cytological results were referred for colposcopic biopsy. Histological results were grouped into: Reactive changes, CIN 1, CIN 2/CIN 3 and adenocarcinomain-situ(AIS).Results:Out of the 6173 smears included in the study 6072 (98.36%) were normal and only 101 (1.63%) were abnormal. After colposcopic biopsies, 0.08% had CIN 1, 0.03% had CIN 2, 3 and 0.01% had AIS.Conclusion:We concluded that cervical cancer screening programs, although life-saving for a number of women, are not a sufficiently high priority in our community. Money for national health screening programs should preferably be directed more towards recruiting women for breast cancer screening, since breast cancer accounts for about 33% of all female cancers in Egypt ranking number one, while cervical cancer ranks number 13.