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com

Keeling‘s Fetal and

Neonatal Pathology
T. Yee Khong, Roger D. G. Malcomson (Eds.)

This fifth edition of a successful book provides an overview of fetal and perinatal pathology, concentrating
on common problems, especially where the anatomical pathology findings guide the direction of further
investigations.

A new feature of this edition is an emphasis on the molecular aspects of pathology in the perinatal setting.
There are four new chapters, including one on the genetic and epigenetic basis of development and disease,
and over 300 new illustrations. The format of the book remains the same as previous editions with the first half
covering general areas in perinatal pathology. The second half is based on organ systems and covers specific
pathological entities, now including discussion of the relevant molecular pathology. There is extensive cross-
referencing between chapters.

5th ed. 2015. XVII, 882 p. 717 illus., 611 illus. in color. Hardcover
ISBN 978-3-319-19206-2
€ 259,00 | £233.50

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S114
PS-06-007
Spitzoid neoplasms: Clinical and histopathological features in corre-
lation with ALK immunoreactivity
P.-I. Stinga*, R. Andrei, C. Popp, S. Dutulescu, A. Cioroianu, O.
Barbuceanu, M. Cioplea, S. Zurac
* *
Clinical Colentina Hospital, Pathology, Bucharest, Romania
Objective: Spitzoid melanocytic tumours are a clinical, histopath-
ological and molecular heterogenous group of skin tumours.
Translocation of the anaplastic lymphoma kinase(ALK) have been
found in spitzoid neoplasms leading to kinase fusion proteins that
can be detected immunohistochemically.
Method: Here we described the clinical and histopathological features of
33 Spitz tumours(19 Spitz nevi(SN), 11 atypical Spitz tumours(AST) and
3 spitzoid melanomas(SM)) and correlate them with the immunoreactiv-
ity for ALK.
Results: We found ALK positivity in 54 % of ATS, in 32 % of SN
and in 0 % of SM included in the study. The majority of ALK
positive tumours were diagnosed in females(71,57 %), aged between
8 and 55 years, and were located in trunk region(45,54 %); 27,
62 % of the ALK positive tumours were identified in paediatric
patients. Plexiform tumours displayed ALK positivity. There was a
tendency toward ALK-positive tumours being hypo-/amelanotic. A
halo reactions was observed in 27,27 % of the spitzoid tumours with
ALK immunoreactivity.
Conclusion: Morphologic appearance of the lesion is linked to the
ALK expression and thus to molecular changes. There was no
relation between ALK positivity and malignancy, but the results
aren’t statistically significant(too few cases of SM). In our study,
there was a tendency towards developping ALK-positive spitzoid
tumours in female patients.
PS-06-008
Ex-vivo dermoscopy as an aid in dermatopathology practice: A pilot
study
G. Nikolic*, M. Bosic, R. Stefanovic, V. Mijajlovic, D. Brasanac
* *
University of Belgrade, Institute of Pathology, Serbia
Objective: The purpose of the study was to evaluate if ex-vivo
dermoscopy could be useful in gross examination of skin biopsies.
Method: On gross examination 143 ex-vivo skin lesions were
evaluated by senior dermatopathologist, fellow, one senior and
two junior residents, as well as by dermoscopy (by the same
senior resident). The concordance of macroscopic/dermoscopic
and histopathological diagnoses was examined using kappa
statistics.
Results: Dermoscopy showed almost perfect agreement with
histopathology in diagnosing tumours of epidermal origin
(p˂0.001). Substantial concordance was found in overall cases,
as well as in benign and malignant tumours, in situ/dysplastic
lesions, and tumours of melanocytic origin (p˂0.001). This level
of agreement was only met by senior dermatopathologist in gross
examination of overall cases, malignant tumours and those of
epidermal origin (p˂0.001). Training in dermatopathology im-
proved gross assessment by fellow and senior resident compared
to junior residents, but with only moderate concordance in overall
cases, benign, malignant and tumours of epidermal origin
(p˂0.001). No more than fair level of agreement in diagnosing
in situ/dysplastic lesions was met, also by senior pathologist
(p = 0.043).
Conclusion: Ex-vivo dermoscopy is superior in gross assesment of
skin biopsies, and it could be useful tool especially in examina-
tion of melanocytic tumours and in situ/dysplastic lesions.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-06-009
A case of congenital dermatofibrosarcoma protuberans confirmed
by florescence in situ hybridisation
E. Sunnetcioglu*, G. Narli, S. Ozturk Sari, I. Yilmaz, H. K. Turkoz, D.
Tuncel, N. Buyukbabani
Istanbul Faculty of Medicine, Pathology, Turkey
Objective: Dermatofibrosarcoma protuberans (DFSP) is a locally ag-
gressive mesenchymal tumour of the skin that rarely affects children.
Congenital cases are extremely uncommon. We present a case of
congenital DFSP with florescence in situ hybridization (FISH)
findings.
Method: FISH analysis using dual-color dual fusion probe for type 1
collagen alpha 1 - platelet-derived growth factor beta (COL1A1-
PDGFB) fusion gene was performed.
Results: Incisional biopsies of an irregular red plaque and satellite
lesions on the left hip of an 8-month-old female existing since birth
were evaluated. The clinical diagnosis was tufted hemangioma. An
infiltration of spindle cells extending from the papillary dermis to the
subcutaneous fat tissue in a honeycomb pattern was observed. CD34
was positive and factor XIIIa, S100 protein and smooth muscle actin
were negative. COL1A1-PDGFB fusion gene generated by
t(17;22)(q22;q13) was demonstrated by FISH analysis.
Conclusion: Recognition of congenital DFSP in clinical practice may
be problematic due to its resemblance to vascular lesions. A skin
biopsy is required for the diagnosis. Histopathologic differential di-
agnosis includes various spindle cell tumours. Infiltration of the fat
tissue in a honeycomb pattern is a peculiar finding and CD34
immunopositivity is supportive. However, detection of the specific
fusion gene by molecular methods is essential for the definitive di-
agnosis.
PS-06-010
Large-cell transformation of mycosis fungoides: Report of 11 cases
U. Soyluer*, B. Yaman, N. Ozsan, T. Akalin, B. Gerceker Turk, I. Ertam,
G. Ozturk, M. Hekimgil
Ege University, Dept. of Pathology, Izmir, Turkey
Objective: Mycosis fungoides (MF) is the most common type of cutane-
ous T-cell lymphoma.A minority group of mycosis fungoides(MF) pa-
tients undergo a process of large-cell transformation(LCT), which often is
characterized by an aggressive behavior. The aim of this study is to dis-
cuss the clinical, histological and immunophenotypical features and prog-
nostic value of LCT.
Method: Eleven cases with LCT in MF diagnosed between 2000 and
2017 were studied.
Results: Patch, plaque and/or tumoural lesions were observed in the
study group, including 9 males and 2 females, with median age of trans-
formation 60.2 years-old and median time of transformation 9 years
(range, 4–30 years). All skin biopsies revealed a superficial/deep dermal
infiltration of atypical lymphocytes composed of >25 % large neoplastic
cells. Epidermotropism was absent in two cases and very few in one,
meanwhile folliculotropism was observed in five patients.
Immunphenotypically CD30 was strongly positive on large neoplastic
cells in four cases, weak in five, whereas two were negative. Four patients
had nodal involvement. All received chemotherapy, radiotherapy and/or
total body electron beam therapy. One CD30-negative case died after
1 year of LCT diagnosis.
Conclusion: Patient’s early stage MF history is important in terms of
differential diagnosis. Older age, advanced initial disease, short transfor-
mation period and CD30 negativity were detected as worse prognostic
factors, but larger series are required to validate the prognostic signifi-
cance of these features.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-06-011
Endocrine mucin-producing sweat gland carcinoma of the eyelid-
case report and review the literature
S. Lérias*, M. Rito, R. Fonseca, J. Rosa
*
IPO Lisboa, Anatomia Patológica, Lisbon, Portugal
Objective: Endocrine mucin-producing sweat gland carcinoma
(EMPSGC), is a rare adnexal tumour of the skin, which is believed to
be a precursor of primary cutaneous mucinous carcinoma (PCMC)
Method: Report a case and review the literature.
Results: A 84-year-old female presented with a 6 x 4 mm lower
eyelid’s papule. It was a well-circumscribed dermal tumour, show-
ing a lobular architecture with solid and cribriform patterns. The
tumour cells were monomorphic. Mucin production was detected
by PAS/AB. Estrogen and progesterone receptors were positive,
the tumour cells were strongly and focally positive for
synaptophysin and chromogranin. A rim of myoepithelial cells
was evident around some tumour nodules corresponding to an in
situ component. In the 56 cases reported in the literature
EMPSSGC occurs more frequently in females’ eyelid and presents
as a solitary slow-growing skin-coloured plaque.
Conclusion: This report describes a rare eyelid’s tumour. The clinical
impression often suggests a benign condition namely epidermal cyst,
chalazion, hidrocystoma and syringoma. Its recognition is important as
it may represent a precursor of PCMC which has a more aggressive
behaviour. Given its putative clinical potential the complete excision is
advisable.
PS-06-012
Correlation between clinical and pathological response after neo-
adjuvant electrochemotherapy in vulvar squamous cell carcinoma:
A preliminary study
C. Ricci*, A. De leo, D. Santini, B. Corti, A. M. Perrone, P. De Iaco, A.
Galuppi, A. G. Morganti
* *
Università di Bologna, Anatomia Patologica, Italy
Objective: Electrochemotherapy (ECT) is a potential treatment for
solid tumours. In this study, we focused on pathological findings
after neo-adjuvant ECT used for a local control of the disease in
Vulvar Squamous Cell Carcinoma (V-SCC), analyzing the
pathological regression and his correlation with the clinical
response.
Method: We enrolled nine patients with histological diagnosis of
primary V-SCC and eligible for surgery and ECT. Patients were
reviewed after ECT and clinical response to therapy was evaluated
using RECIST criteria. Surgery and pathological exams were sub-
sequently performed with the evaluation of pathological
regression.
Results: Clinical response, evaluated by RECIST criteria and path-
ological regression, evaluated quantifying the percentage of neo-
plastic volume replaced by inflammatory infiltrate and fibrosis,
didn’t show a linear correlation: 1 CR (with complete pathologi-
cal regression), 6 PR (3 with mild pathological regression, 2 with
moderate regression and one with heterogeneous regression, rang-
ing from mild to moderate) and 2SD (one with mild regression
and one with heterogeneous regression, ranging from mild to
moderate).
Conclusion: This data demonstrate that ECT could be an efficacious
therapeutic tool in the neo-adjuvant treatment of the V-SCC but although
limited to a small series, shows that there isn’t an exact correlation be-
tween clinical and pathological response, suggesting that could be useful
integrate both assessments to obtain a more accurate “treatment response
staging” to ECT.
S115
PS-06-013
Jadassohn nevus - association with other tumours as problem of
patient’s management
P.-B. Harsan*, M.-C. Dinca, A.-M. Vrancianu, C. Dumitru, R. Andrei, C.
G. Popp, S. Zurac
*
Colentina University Clinical Hospital, Dept. of Pathology, Bucharest,
Romania
Objective: Jadassohn nevus (JN) represent a complex congenital
hamartoma sometimes associated with various benign cutaneous lesions
(seborrheic keratosis, basaloid hamartomas, verruca vulgaris,
nevocellular nevi, adnexal tumours), intermediate malignancies
(keratoachantoma, proliferating trichilemal cyst) or malignant (basal or
squamous cell carcinoma, adnexal carcinomas, melanoma,
leiomyosarcoma) or with oculocerebrocranial/orthopedic developmental
abnormalities (sebaceous/epidermal nevi syndrome).
Method: We retrospectively reviewed 59 cases of JN diagnosed in the
last 14 years in our department.
Results: Sixteen cases presented associated lesions, 4 of them being
associated with multiple lesions. We identified 9 cases with associated
single or multiple benign lesions (7 tricoblastomas, 4 siringomas 1
sebaceoma, 2 seborrheic keratosis and one basal cell hamartoma), one
case associated with a low grad tumour (keratoacanthoma) and 6 associ-
ated with malignant lesions (4 basal cell carcinoma and two squamous
cell carcinoma). None of the patients had skeletal, cerebral or ocular
anomalies.
Conclusion: Identification of neoplasms associated to JN is very impor-
tant considering the frequency of co-occurring malignancies in JN.
Considering that most of the JN are located in the head and neck, this
association can raise problems of surgical management
PS-06-014
A rare neoplasm of conjunctiva: Inverted follicular keratosis
N. Bakoglu*, I. Saygin, S. Hizarci
Karadeniz Technical University, Pathology, Trabzon, Turkey
Objective: Inverted follicular keratozis is a uncommon solitary benign
tumour and it is a variant of seborrhoeic keratosis. It occurs most com-
monly on the face, although on conjunctiva is infrequent.
Method: The surgical specimens were formalin-fixed and paraffin em-
bedded. The section were stained with routinary H&E.
Results: We report 60 year old man patient who had conjunctival mass in
the right eye. A complete excision of the lesion was performed.The his-
topathological analysis showed an inverted, cup shaped lesion composed
of proliferations of basaloid cells and observed squamous eddies and
follicular changes.
Conclusion: Viral warts, seborrhoeic keratozis and actinic keratozis
should be kept in mind in differantional diagnosis. The benign lesion of
inverted follicular keratozis could be distinguished from squamous cell
carcinoma. Histopathologically squamous eddy formation and lack of
epithelial dysplasia were significant of inverted follicular keratozis.
İnverted follicular keratozis is a unusual occurring lesion found on the
conjunctiva and should be included in the list of differential diagnoses of
conjunctival masses.
PS-06-015
Urticarial Vasculitis - a study of 8 cases
G. Ayaz*, S. Ozekinci, A. Bugra, K. Cure Kiziltac, Z. B. Erdem
*
Okmeydani Research Hospital, Pathology, Istanbul, Turkey
Objective: Urticarial vasculitis (UV) is a rare clinico-pathologic
entity that is characterized histologically by leukocytoclasis, fi-
brinoid necrosis around small vessels and clinically by
S118
Results: A wide excision of a lower limb tumour measuring 10 cm in its
highest diameter was performed. The gross specimen measured
10 × 4 × 4 cm, and the lesion within the specimen was semitranslucent,
gelatin-like, and with foci of hemorrhage and cyctic transformation.
Histologic examination showed a multicyctic lesion with a prominent
myxoid matrix. A small number of irregular, spindle-shaped, or stellate
cells, with hyperchromatic nuclei were noted. According to the modified
FNCLCC grading system, the tumour in this cases scored 4 (tumour
differentiation; score 2, mitotic count; score 1, tumour necrosis; score
1), that is, grade 2.
Conclusion: We presented a rare case of a large tumour with clinical and
histop ath ological features of low-grad e MFS in the leg .
Immunohistochemistry is not of a great help for the diagnosis and only
the histological examination is the clue for the final diagnosis.
PS-06-028
Pilomatricoma: Analysis of 24 paediatric cases
A. Kilitci*, M. Tad
*
Ahi Evran University Hospital, Dept. of Pathology, Kirsehir, Turkey
Objective: Pilomatricoma(calcifying epithelioma of Malherbe) is a com-
mon skin neoplasm in the paediatric population that is often
misdiagnosed as other skin conditions or tumours.The objective of the
present retrospective study was to review the clinical and histopatholog-
ical presentation of this neoplasm in children.
Method: The records were searched for all cases of pilomatricoma be-
tween 2011 and 2015 at pathology department,and reviewed to determine
sex,age,location,size of the tumour,pathological features and recurrence
rate.All patients underwent surgical excision.
Results: A total of 24 lesions in 24 patients were identified.The median
age was 13 years.Of the 24 patients diagnosed with
pilomatricoma,14(58.3 %) were female.In all cases,the initial presentation
was an asymptomatic,slow growing,superficial hard mass with bluish
discolouration.The most common sites of occurrence were the upper
limbs(45.8 %),face(20.8 %) and preauricular region(12.5 %).The size of
the surgical specimens collected ranged from 0.4 to 2.5 cm.The diagnosis
was confirmed by histopathological examination.Ghost cells and basaloid
cells were described in most of the cases.There were no recurrences in this
series.
Conclusion: This entity should be considered with other benign or ma-
lignant conditions in the clinical differential diagnosis of solitary firm skin
nodules,especially those on the face,neck and upper limbs.The diagnosis
can generally be made by clinically.The treatment of choice is surgical
excision,and the recurrence rate is very low.
PS-06-029
Immune response in squamous cell carcinoama (SCC): Tumoural
microenvironmental study
O. Pop*, M. Bembea, C. Pusta, A. Pascalau
*
University of Oradea, Dept. of Pathology, Romania
Objective: The classical theory said that an intact immune response is
important to preventing and inhibiting tumour development. There are
only few studies related with the immune system pattern in the skin
cancer. Most of all have been done in the skin malignant melanoma.
The aim of our study was to identify and analyze the immune response
profile in the squamous cell carcinoma microenvironment.
Method: The study is a retrospective-type and are 35 cases included in it
from 2016, random choose from the file of Marghita Hospital Pathology
Department. Two skill pathologist review the cases diagnosed with squa-
mous cell carcinoma, previously stain with hematoxilin eosin. All the
cases are labeled with CD3 and CD20 by immunohistochemistry tech-
nique. (Bechmark XT, Ventana Medical Systems Inc.,USA)
Virchows Arch (2017) 471 (Suppl 1):S1–S352
Results: The average values of T and B lymphocyte populations from the
intratumoural areas are 434 respectively 127, the T/B ratio is 3.42. In the
peritumoural areas, the average values for lymphocytes T and B are 778
respectively 337, 2.3 is T/B ration.
Conclusion: According with our data the cellular immune response is
more important in the intratumoural areas, but overall the higher number
of T cell are seen in peritumoural areas (peritumoural T cell/intratumoural
T cell = 1.79)
PS-06-030
Basal cell carcinoma of external auditory canal: A rare complication
of long-lasting systemic lupus erythematosus
M. Farcas*, C. Popp, L. Zamfir, M. Cioplea, F. Staniceanu, S. Zurac
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Malignant tumours of external auditory canal (EAC) are very
rare, with an estimated annual incidence of 1-6/1.000.000. The most
common type is squamous cell carcinoma, followed by adenoid cystic
carcinoma, basal cell carcinoma (BCC) and melanoma. Exposure to cy-
totoxic and immunosuppresive agents as treatment in systemic lupus
erythematosus (SLE) combined with immune system defects increases
overall malignancy susceptibility.
Method: We present the case of a 56-year-old man with long personal
history of SLE (24 years) associated with Sjogren syndrome, and coagu-
lation abnormalities. At presentation he had two reddish ulcerative and
asymptomatic plaques, each in every EAC and multiple painful purplish
nodules in fingers in evolution of 1 year.
Results: A fungating mass located in the left ear’s EAC, measuring 2,2 cm,
was found. A biopsy of the tumour mass was performed revealing a BCC,
therefore the patient underwent a surgical removal of external ear with the
external segment of EAC harboring the tumour. Final histopathological
diagnosis was nodular and infiltrative BCC, pT2Nx, completely removed.
Conclusion: Patients with SLE have a higher incidence of developing
non-melanoma skin cancer with a significant risk after 20 years of dis-
ease. Therefore, SLE patients should be carefully monitorized for skin
malignancies in order to avoid mutilating surgery of head and neck.
PS-06-031
Compound melanocytic nevus with lymphatic embolus of nevus cell.
A rare finding
N. Koufopoulos * , K. Kapatou, C. Goudeli, F. Antoniadou, M.
Theodorakopoulou, L. Khaldi
*
Saint Savvas Cancer Hospital, Pathology, Athens, Greece
Objective: We present a case of compound melanocytic nevus with a
lymphatic vessel embolus composed of nevus cell aggregate.
Method: A 40-year old female with no previous history presented with a
pigmented nodule on the lower back. The clinical diagnosis of
melanocytic nevus was made. Grossly, the resected specimen consisted
of elliptical skin with a slightly raised brown nodule measuring 0.5 cm in
maximum diameter and 0.1 cm in height.
Results: On microscopic examination a compound melanocytic nevus
was identified. The junctional component consisted almost exclusively
of melanocytic nests with very few scattered single cells. The
intraepidermal component consisted mainly of nests of Type A and
Type B cells without atypia or mitotic activity. A number of the nests
both junctional and intraepidermal contained melanin pigment. In the
upper dermis an aggregate of nevus cells was found within a lymphatic
vessel lined by a single layer of endothelial cells. In the deeper sections
performed for immunohistochemistry both nevus cell aggregate and ves-
sel disappeared.
Conclusion: The diagnosis of compound nevus with lymphatic nevus
cell aggregate was made. Intralymphatic nevus cell aggregates are an
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-08-011
Paediatric marginal zone lymphoma of the parotid gland - a rare
pathological entity
F. Porcescu*, A. Neicu, F. Vasilescu, G. Becheanu, S. Enache, V. Enache,
M. Dobre, C. G. Vasile, I. A. Ostahi
*
Victor Babes, Pathology, Bucharest, Romania
Objective: Marginal zone lymphoma in the paediatric population is a
very rare reported entity with an obvious male predominance (ratio
20:1) in children and prevalent involvement of cervical lymph nodes.
In this report, we describe a particular case of this condition in a
12 years old female patient with marginal zone lymphoma of the
parotid gland.
M e t h o d : T h e p a t i e n t u n d e r w e n t p a r o t i d g l a n d b i o p s y.
Histopathological, mmunohistochemical and molecular assessments
of the biopsy specimen were performed in order to establish the
diagnosis.
Results: Histopathological examination revealed periductal lymphoid in-
filtrate associated with lymphoepithelial lesions and presence of germinal
centers with marginal zone expansion. The monocytoid neoplastic lym-
phocytes were positive for CD20 and negative for CD3.
Immunohistochemistry showed evidence of light chain restriction, with
a kappa/lambda ratio of 5:1. Hemi-nested polymerase chain reaction,
testing for immunoglobulin heavy-chain rearrangements, detected a clon-
al population at the level of FR2-JH region of the immunoglobulin heavy
chains.
Conclusion: The histopathological, immunophenotypic and molecular
findings are consistent with the diagnosis of paediatric marginal zone
lymphoma of the parotid gland. Recognition of this entity can prove
challenging as it might be difficult to distinguish between a paediatric
marginal zone lymphoma and an atypical marginal zone hyperplasia with
monotypic Ig expression.
PS-08-012
CD5 and CD30 expression in de novo diffuse large B cell lymphomas:
A retrospective study
A. I. Cioroianu*, C. Popp, L. Nichita, M. Cioplea, P.-I. Stinga, M. Busca,
M. Ciubotaru, S. A. Zurac
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Rare phenotypic aspects such as CD5-positive(CD5+),
CD30-positive(CD5+) or“double expressor” diffuse large B-cell lympho-
mas( DLBCL) were found to have clinical and therapeutic implications.
The aim of our study is to determine the aberrant expression of CD5 and
CD30 in these lymphomas.
Method: We evaluate retrospectively 57 DLBCL (37 lymph nodes and
20 extranodal cases) diagnosed between 2013 and 2016. The specimens
were obtained from 33 women(57.9 %) and 24 men(42.1 %), aged 23–82
years (mean age 59.54), untreated patients with no previous history of
lymphoma.
Results: We found that 7(12.3 %) DBCL were CD5 + ( >0 % cutoff),
with a male predominance (1,3:1), 5 of them were classified as non-
germinal center B-cell subtype(non-GCB) and all of them expressed
bcl2 too; 19(33.3 %) were CD30+ using >0 % cutoff threshold and
9(15.8 %) with >20 % cutoff; the expression of bcl2 was higher in the
group with 0–19 % CD30+ cells; 4(7 %) cases expressed both CD5
and CD30; most of CD5+ and/or CD30+ cases showed centroblastic
monomorphic features.
Conclusion: Although the expression of CD5 and CD30 in DLBCL
was noted in a minority of these patients, and their biology is
incompletly understood, these markers should be performed in ev-
ery case of DLBCL because they may influence the course of the
disease.
S137
PS-08-013
ERG1: Marker of lymph node sinus histiocytosis?
A. Handra-Luca*
*
APHP Université Paris Nord GHU, GHU Avicenne, Dept. of Pathology,
Bobigny, France
Objective: We aimed to analyse the expression patterns of ERG1 in
gallbladder neck lymph node sinus histiocytosis. The ERG1 antibody,
detecting the protein coded by the V-ETS avian erythroblastosis virus
E26 oncogene homolog, is used in the current practice for the immuno-
histochemical diagnosis of vascular and prostatic tumours.
Method: ERG1 protein was assessed by immunohistochemistry on gall-
bladder neck lymph nodes (identified on classical cholecystectomy spec-
imens) with sinus histiocytosis.
Results: Nuclear ERG1 was expressed in intrasinus monocytes, in sinus
histiocytosis lesions, of all studied lymph nodes (2 cases of drepancytosis
and of lymph node lipopneumatosis each and, 1 case of C-hepatitis virus
cirrhosis and of lymph node anthracosis each). As expected, lymph node
endothelial cells (sinus or vascular) expressed ERG1. ERG1 expression
lacked in extra-sinusoid macrophages of lymph node lipopneumatosis
foci and of anthracosis.
Conclusion: The results of this study suggest a specific intrasinusoid
expression of ERG1 in monocyte/histiocyte-type cells of lymph node
sinus histiocytosis lesions besides the expression in endothelial cells.
PS-08-014
Epidemiological trends of follicular lymphoma in Poland
A. Szumera-Cieckiewicz*, U. Wojciechowska, M. Prochorec-Sobieszek,
J. Didkowska, G. Rymkiewicz, E. Paszkiewicz-Kozik, M. Kotarska, K.
Sokol, J. Walewski
*
Maria Sklodowska-Curie Memorial Cancer Center and Institute of
Oncology, Warsaw, Poland
Objective: In Western countries follicular lymphoma(FL) is one of the
largest group of lymphocytic malignancies (20–40 % of all non-Hodgkin
lymphomas). Contrary the low frequency of FL is observed in Eastern
Europe. The aim of the study is to determine the incidence and epidemi-
ological trends of FL in Poland.
Method: Data from the Polish National Cancer Registry for the years 2000–
2014 are analyzed. The basic statistical indicators are applied: absolute num-
bers, percentages, crude rates(CR) and age-standardized rates(ASR).
Results: 3928 cases of FL with overall incidence CR0.68 and ASR0.46
are identified. The median age of onset is 61 and male to female ratio
0.86. The structure of morphological types of FL: NOS, grade 1, 2 or 3 are
72.58 , 4.81 , 12.88 , 9.73 % respectively. Among all collected mature B-
cell lymphomas FL is placed next to BLL/CLL(CR 3.6), plasma cell
neoplasm(CR 3.4), and diffuse B-cell lymphoma(CR 2.1).
Conclusion: Despite of increasing tendency of FL in Poland it comprises
only 6.27 % of mature B-cell lymphomas. The etiology and pathogenesis of
FL is not entirely understood but according to population-based case-control
studies some environmental risk factors might have powerful impact on FL
development. The differences of morphologic grouping between countries
may result of variable diagnostic and registration criteria as well.
PS-08-015
One patient with two lymphomas: Report of three cases of simulta-
neous lymphomas
A. Abuomar*, S. Alonso, R. Duran, M. Blanes, T. Lopez, V. Castaño
*
Hospital General Universitario, Dept. of Pathology, Alicante, Spain
Objective: Two simultaneous lymphomas in one patient are very rare.
Most of the cases reported in the literature report simultaneous lympho-
mas in the gastrointestinal tract. We report the first two cases to our
S172
50 years (range, 18–80 years), with no gender predilection. The differen-
tial diagnosis of conjunctival myxoma includes amelanotic melanoma,
fibrous histocytoma, lymphangioma, amelanotic nevus, lymphoma,
myxoid neurofibroma, spindle cell lymphoma or rhabdomyosarcoma.
Conjunctival myxoma can be misdiagnosed as a conjunctival cyst.
Conjunctival myxomas can occur in association with the Carney
Complex, which is an autosomal dominant syndrome associated with
benign tumours, spotty mucocutaneous pigmentation, and endocrine
overactivity.
PS-11-011
Orbital cystic schwannoma arising from optic nerve
Z. Bayramoglu*, E. Ayik, C. I. Bassorgun, G. O. Elpek
*
Akdeniz University, School of Medicine, Pathology, Antalya, Turkey
Objective: Most of the primary tumours of optic nerve are meningiomas
and gliomas. Schwannomas arising from optic nerve are extremely rare
lesions and only a few case has been reported until today. These lesions
are slow-growing, well-circumscribed, solid/cystic masses. Here we re-
ported a rare lesion schwannoma located in optic nerve with a cystic
morphology.
Method: case report
Results: A 57-year-old female patient presented with a left ocular pain
and progressive left proptosis. The patient was otherwise healthy. Orbital
magnetic resonance imaging revealed an intraconal heterogeneous mass
of 25 mm × 18 mm, radiographically consistent with a cavernous hem-
angioma. Surgical resection was performed and according to histopatho-
logical and immunohistochemical examination the final diagnosis was
determined as “Orbital Schwannoma with Cystic Morphology”.
Conclusion: Peripheral nerve tumours comprises 2 % of all orbital tu-
mours and schwannomas are the most common types. Schwannomas are
benign tumours arising from Schwann cells and most commonly involve
trigeminal nerve root in intracranial location. Even if it is rare,
schwannomas arising from optic nerve can be seen and cystic morphol-
ogy of these tumours should not mislead the diagnosis.
PS-11-012
Keratoplasty in patients with Acanthamoeba keratitis: A study of
three cases
L. Alfaro*, C. Peris-Martinez, M. Roca-Estelles
*
Valencia, Spain
Objective: Corneal infections by amoebas present difficulties for clinical
diagnosis and may be confused with other keratitis of the herpetic, fungal
or bacterial type. We reviewed the clinical features and evolution in three
patients with amoebic keratitis who required corneal transplantation after
failure of medical treatment.
Method: The studied samples were three specimens of penetrating kera-
toplasty. Patients were two women aged 22 and 28 years and a 40- year-
old male. One patient underwent a small corneal biopsy 1 week before
transplantation, which was negative for amoebae. Samples were proc-
essed in a conventional manner and in addition to H/E sections
Trichrome, PAS and Gram techniques were performed.
Results: The three patients revealed corneal cysts and trophozoites of
Acanthamoeba. The epithelium was detached in all three although only
two presented significant ulceration. One of the patients who had devel-
oped a crystalline keratopathy had superficial stromal band deposits
interpreted by accumulation of the drugs used in their treatment.
Conclusion: The difficulty of reaching a clinical diagnosis of certain-
ty is reflected in the negativity of cultures in all three patients al-
though all had a history of contact lens use. For this reason they
had received combined antibacterial and ant-amoebic treatment and
one of them antifungal.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-11-013
New diagnostic approaches to uveal melanoma: EGFR, TGFb and
MMP9 expression correlate with histological type and invasiveness
N. Danilova*, S. Davidova, P. Malkov
*
Lomonosov Moscow State University, Dept. of Pathology, Russia
Objective: The purpose of the present study was to investigate the relationship
between MMP9 expression and scleral invasion of uveal melanoma (UM). We
also examined the effect of growth factors (TGFb and EGF), oncosuppressor
protein (p16) on the histological types and mitotic activity of tumour.
Method: Tumour specimens were obtained from 42 primary UM imme-
diately after enucleation.
Results: Hyperexpression of MMP9 and EGFR were correlated with a high
proportion of spindle cells in UM (Kruskal-Wallis test p < 0,05 for each).
Moreover, we have demonstrated the association between the level of EGFR,
TGFb and MMP9 expression to the initial stage of tumour invasion (Spearman’s
test p < 0,05). Moreover, there was a correlation between TGFb hyper-
expression and mitotic activity (Spearman’s test p = 0,059). Furthermore, a
low level of p16 expression in UM was proportional hyperexpression of TGFb.
Conclusion: EGFR and MMP9 are known to be used as targets for anti-
cancer therapy. The results of our study are suggesting to develop newer
approaches of UM treatment on the early stages of invasion in order to keep
an affected eye as an organ. Thereupon, it was concluded about the key-role
of abnormalities in TGFb-pathway that cause the down-regulation of p16-
gene, where the latter may lead to increased mitotic rate.
Tuesday, 5 September 2017, 09:30–10:30, Hall 3
PS-12 Cardiovascular Pathology
PS-12-001
Skeletal muscle biopsy in the diagnostic algorithm of rare cardiomy-
opathies - a retrospective study
M.-C. Dinca*, D.-A. Costache, P.-B. Harsan, C. G. Socoliuc, E. Gramada,
E. Manole, A. Bastian
*
Colentina University Clinical Hospital, Dept. of Pathology, Bucharest,
Romania
Objective: To highlight the usefulness of performing skeletal muscle
biopsies in the work-up of cardiomyopathies with skeletal muscle in-
volvement. Cardiac abnormalities are common during the evolution of
many neuromuscular diseases, manifesting as dilated or hypertrophic
cardiomyopathies, arrhythmias or conduction disturbances. While in
most cases the onset is late, the cardiac symptoms may dominate the
clinical picture or even precede the myopathic signs.
Method: We retrospectively reviewed 463 consecutive muscle biopsies
performed and analyzed in a 3 years period (2014–2016), using the
Colentina Clinical Hospital Pathology Department database.
Results: The skeletal muscle tissue was obtained using open biopsy un-
der local anesthesia; muscle cryosections served for histological,
histoenzimological, immunohistochemical stains and complementary
techniques of western blotting and electron microscopy. We diagnosed
two cases of desmin-related myofibrillar myopathies, one later proved to
be caused by a newly identified form of mutation in desmin, the other
carrying an additional mutation in alpha-B crystalline gene, two cases of
acid maltase deficiency with cardiac involvement, one case of Danon
disease, a multi-minicore myopathy with cardiomyopathy and one gam-
ma sarcoglycanopathy with severe cardiac signs.
Conclusion: The morphological aspects enabled us to establish the diag-
nosis with major impact on clinical management and directed further
confirmatory genetic testing.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-13-014
A new challenging pattern of gastrointestinal stromal tumour - in-
sights from a case report
D. Vinha Pereira*, P. Chaves
*
IPO Lisboa, Serviço de Anatomia Patológica, Lisbon, Portugal
Objective: Gastrointestinal stromal tumours (GISTs) are well known to
have many different morphological patterns and this is even more prom-
inent in post Imatinib treatment relapses. Some patterns could be chal-
lenging, as this case demonstrates.
Method: We report the case of a patient submitted to peritoneal implants
resection and hepatic metastasectomy, after polar gastrectomy and
Imatinib treatment for a gastric GIST and a partial nephrectomy for a
kidney tumour.
Results: We received multiple peritoneal nodules and a liver metastasis
from a 49 years-old man diagnosed with gastric GIST 5 years before. He
completed 3 years of Imatinib, till he was submitted to a kidney tumour
surgery. All nodules were morphologically similar (mixed pattern GIST
with degenerative changes, positive for CD117 and DOG1), except 1,
composed by epithelioid clear cells, negative for CD117, DOG1,
citokeratines and PAX8. PCR analysis of this lesion allowed the detection
of the same c-KIT gene mutation observed in the “classical nodules”.
Conclusion: As far as we know, this is the first time that an after Imatinib
epithelioid clear cell GIST pattern is described. This case is an example of
a new diagnostic challenge to consider on the recognition of morpholog-
ical patterns after therapy.
PS-13-015
Mismatch repair proteins and epithelial mesenchymal transition in
colorectal cancer
I. Drike*, I. Strumfa, A. Vanags, J. Gardovskis
*
Riga Stradin’s University & P. Stradins Clinical University Hospital,
Garkalne, Latvia
Objective: Mismatch repair (MMR) deficiency is present in ≈ 15 % of
colorectal carcinoma (CRC) cases, including Lynch syndrome(LS)-relat-
ed cancers (Whitehall et al.,2011; Berginc et al.,2009). In turn, a relation-
ship between epithelial-mesenchymal transition (EMT) and LS has been
demonstrated (Gu et al.,2014). Our aim was to investigate EMT-MMR
protein association in consecutive CRCs.
Method: By immunohistochemistry, expression of MSH2, MSH6,
PMS2, MLH1, CD44, E-cadherin was detected. Expression intensity EI
was measured in a 0–3 scale (0, no expression; 1-weak, 2-moderate, 3-
strong). The final score was expressed as a sum of EIs by extent (%).
Results: Evaluating retrospectively 124 consecutive CRCs, loss of MSH2,
MSH6, PMS2, and MLH1 was found in 1;0;11 and 4 cases, respectively.
The MMR protein expression was reclassified as low versus high using the
median as cut-off: MSH2 1.39; MSH6 1.9; PMS2 1.8; MLH1 1.43. The
overall expression of E-cadherin was 1.81[95 % confidence interval: 1.74–
1.89], of CD44: 1.29[1.16–1.41]. T test showed statistically significant
difference in E-cadherin level by MSH2 (low 1.72[1.61–1.82]; high
1.91[1.81–2.01]; p = 0.01) or PMS2 (low 1.71[1.60–1.82]; high
1.95[1.85–2.05]; p < 0.01). CD44 showed significant difference by
PMS2 (low 1.43[1.24–1.62]; high 1.17[1.00–1.34]; p = 0.04).
Conclusion: In the study, significant, complex associations are shown
between EMT and expression level of MMR proteins in consecutive CRC.
PS-13-016
Pathohistological changes of gastric mucosa in wistar rats after acute
exposure to orally administrated acrylamide
J. Ilic Sabo*, M. Djolai, T. Lakic, M. Panjkovic, J. Amidzic, A. Fejsa
Levakov
*
Clinical Center of Vojvodina, Histology and Embryology, Novi Sad, Serbia
S179
Objective: In 2002, acrylamide is discovered as toxic byproduct in foods
rich in starch, which are prepared at high temperatures.
Method: Ours research was carried out 6 groups of 5 experimental animals
(Wistar rats). Two control groups orally implicated distilled water. Two
experimental groups orally administrated acrylamide in a daily dose of
25 mg/kg, and two dose of 50 mg/kg. Three groups were sacrificed after
24 h and three after 72 h; On histological gastric tissue material is applied
qualitative and semi-quantitative histological analysis and stereological
measurements of individual compartments of the stomach mucosis.
Results: In the stomach mucosis of Wistar rats is seen direct slight dam-
age of the surface epithelium, accompanying mild inflammatory reaction,
degranulation of mast cells and slight thinning of lamina muscularis mu-
cosae. After toxic effect on epithelium starts reconstruction of the epithe-
lium, which is confirmed by the presence of immature form of
mucoproductive cells. Examined inflammatory, degenerative and regen-
erative parameters show a positive correlation with respect to dose and/or
a time of exposition to acrylamide.
Conclusion: Understanding the effects of acrylamide on gastric mucosa
lead to adequate prevention in diet habits and treatment in gastric diseases.
PS-13-017
Histopathologic variations in gastrointestinal neuroendocrine
tumours
L. A.-Maria Zamfir*, A. Pavel, M. Farcas, L. Nichita, G. Micu, E.
Gramada, C. Popp
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Gastrointestinal neuroendocrine tumours (GI-NETs) are rela-
tively rare entities, a genetically diverse group of malignancies that lacks
universally accepted standards for assessing biologic behavior.
Method: We conducted a retrospective study including 27 consecutive
cases of GI-NETs. Multiple histologic and demographic features were re-
corded and correlated with Ki67 index.
Results: Mean age at diagnosis was 63.5 years (31–84) and M/F ratio was
4/5. Thirteen cases (48.15 %) had gastric origin, eight (29.63 %) involved
the small intestine and six (22.22 %) originated in the colon. The average
mitotic index was 7 mitosis/10 HPF (0.45 mm) (ranging from 1 to 22
mitoses). The average Ki67 index was 27 % (ranging from 66 % in
colonic NETs to 18 % in gastric NETs). Ki67 expression had extremely
significant association with tumour histological grade (r = 0.89,
p = <0.0001) and mitotic rate (r = 0.79, p = <0.0001). Also, the histolog-
ical grade was found to be correlated with the location of the tumour,
colonic lesions being mostly high grade (r = 0.39, p = 0.036). There was
no correlation between age and mitotic rate or histological grade.
Conclusion: Ki67 index correlates well with tumour grade and mitotic
index, thus being helpful in routine histopathology practice. Location
correlates with histological grade of GI-NET, colonic lesions being pre-
dominantly high grade.
PS-13-018
Confocal laser-scanning microscopy and conventional light micros-
copy targeting morphological changes in colorectal lesions
A. S. Postolache*, I. Dumitru, S. A. Varban, M. Sajin, G. Stanciu, S.
Stanciu, R. Hristu
*
Emergency University Hospital, Dept. of Pathology, Bucharest,
Romania
Objective: Histological examination of gastro-intestinal lesions is
based on conventional hematoxylin-eosin light microscopic images
of thin-slice specimens. A study of a non invasive method that
may yield immediate microscopic images of untreated tissue was
carried out: laser-scanning confocal microscopy has the ability to
serially produce thin optical sections through thick specimens.
S180
Method: The study materials consisted of fresh human colon tissue that
includes lesions as hyperplastic polyps and adenomas in addition to normal
mucosa and adenocarcinomas. The confocal method offers virtual histolog-
ical images of the lesions that were correlated to the corresponding histo-
logical sections in order to provide a morphologic parallel and to highlight
the advantages and disadvantages between those two methods.
Results: The nuclei were not visualized in normal mucosa or hyperplastic
polyps. In adenomas with high-grade dysplasia and adenocarcinomas,
nuclei were more often visible than in adenomas with low-grade
dysplasia.
Conclusion: Our findings show the utility of confocal microscopy as a
promising technique that accurately visualizes histology in fresh, un-
stained tissues, enhancing early detection of gastro-intestinal pathologies,
including premalignant lesions.
PS-13-019
Why should pathologist always report glandular atrophy in
helicobacter pylori gastritis?
B. Roxana-Zoia*, G.-V. Micu, C.-G. Popp, T. Voiosu, S.-A. Zurac
*
Colentina Hospital, Dept. of Pathology, Bucharest, Romania
Objective: Gastric dysplasia is the last step in Helicobacter pylori (HP)
induced carcinogenesis, after glandular atrophy (GA) and intestinal meta-
plasia (IM). This study evaluates the significance of GA and IM for
patients’ outcome.
Method: We designed a case-control study including endoscopic gastric
biopsies from 72 patients with similar demographic data (two groups: 36
patients with gastritis and dysplasia and 36 patients with gastritis without
dysplasia).
Results: HP infection rate was higher in patients with dysplasia (91 % vs
52 %; p = 0.073). GA and GA-IM association were more frequent in dys-
plasia group (p = 0.034, respectively p = 0.038). No significant correlation
between IM and dysplasia were found. In patients with dysplasia, minimal
GA was associated with a higher density of HP (33.33 % vs. 5.55 %),
whereas severe GA was linked to low density HP (2.77 % vs. 30.00 %).
Conclusion: There is a strong connection between HP status and subse-
quent premalignant changes. GA is the most significant indicator of evo-
lution towards intraepithelial and invasive malignancy, so it is mandatory
to be always evaluated and reported, in order to conceive a special man-
agement plan for patients with persistent atrophy after HP gastritis.
PS-13-020
Usability of p53 for demonstrating synchronicity in multiple colorec-
tal adenocarcinomas
A. Pavel*, G. Micu, M. C. Nitu, L. Tutuianu, F. Staniceanu, C. Popp
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Some patients with colorectal cancer have more than one
distinct site of carcinoma. Multiple tumours can be synchronous car-
cinomas or one primitive tumour and its metastasis. The aim of our
study is to establish the usability of p53 staining pattern to discrim-
inate these cases.
Method: We retrospectively evaluated 22 consecutive cases of tumours
to investigate the method used to establish their synchronous character.
Most patients had two lesions, but we also had patients with more tu-
mours. Data regarding demography, histologic subtypes, presence of ad-
enomas, immunophenotype and p53 status were evaluated.
Results: The most frequent association is between adenocarcinomas
(82 %). Other are between adenocarcinoma and mucinous carcinoma
(9 %). and adenocarcinoma and neuroendocrine carcinoma (9 %). In only
4 % of the cases, identification of morphologic dissimilar patterns at least
one of which being an unusual subtype was used for the diagnosis. We
established the diagnosis of primary synchronous tumours in 18 % of cases
Virchows Arch (2017) 471 (Suppl 1):S1–S352
using the presence of adjacent precursor lesions (adenomatous) in both
tumoural locations. For all the other cases (82 %) differences in p53 status
are helpful for final diagnosis.
Conclusion: Although important for staging and treatment, identifying of
synchronous colonic carcinomas, is usually difficult, requiring immuno-
histochemical criteria.
PS-13-021
The importance of immunohistochemistry in the diagnosis of GISTs
M. Bercea*, A. Dema, S. Taban, M. Cornianu, S. Olariu, S. Milos
*
Emergency County Hospital, Pathology, Timisoara, Romania
Objective: A few decades ago, gastrointestinal stromal tumours
(GISTs) were diagnosed as tumours of smooth muscle or neural
tumours of the gastrointestinal tract, such as leiomyoma,
leiomyosarcoma or schwannoma. The aim of this study was to
evaluate how the evolution of immunohistochemistry helped us
improve our diagnosis of GISTs.
Method: A retrospective study was performed on two different periods of
time (both 5 years long ): 1996–2000 and 2012–2017, in order to identify
patients with GISTs. We analyzed the morphological characteristics and
the immunohistochemical profile of these tumours.
Results: In the first group of patients (1996–2000) we have identified 8
potential cases of GISTs diagnosed back then as: schwannomas,
leiomyoblastomas, leiomyosarcoma, neurofibroma and
ganglioneuroblastoma. On the other hand, in the second group, we have
identified 33 patients with GIST. All of them were CD117 positive and 20
of them, CD34 positive.
Conclusion: It is possible that the incidence of GISTs has increased in the
past two decades too, but it is clear that immunohistochemistry, in our
case the c-kit, is crucial for the precise diagnosis of GISTs.
PS-13-022
Pancreatic metastasis from clear cell renal carcinoma: Report of 3
cases
R. C. Oliveira*, R. Almeida, P. Rodrigues, J. Fraga, B. Fernandes, H.
Moreira, M. A. Cipriano
*
Centro Hospitalar e Universitário de Coimbra, Dept. de Anatomia
Patológica, Portugal
Objective: Clear cell renal carcinoma (ccRCC) has a high metastatic
capacity, with 30 % synchronous and up to 50 % metachronous presen-
tation; pancreatic metastasis are rare (1.6–11 %), usually occurring sev-
eral years after nephrectomy. Diagnosis may not be straightforward, es-
pecially in the absence of clinical background.
Method: Three male patients, between 57 and 70-years-old, pre-
sented with pancreatic nodules, two in the head and one in the
tail, well-defined and hypervascular. One patient with head lesion
had a total of 9 nodules. Two patients had previous nephrectomy
6 years before for ccRCC.
Results: All nodules had solid and alveolar pattern, composed by clear cells
with wide cytoplasm, small nuclei and rare mitotic figures, without lymph
node metastasis. Immunohistochemistry: positivity for CD10 and vimentin;
negativity for synaptophysin and chromogranin A. Investigation discovered
that the patient without background had been subjected to nephrectomy
6 years before for ccRCC. The final diagnosis of ccRCC pancreatic metas-
tasis was made. The patient with 9 nodules had brain metastasis 6 months
after surgery and was lost to follow-up. Remaining patients are alive without
tumour relapse.
Conclusion: Pancreatic metastases are commonly the only location for
ccRCC. Pathological differential diagnosis can be extensive, but conjugation
of morphology, immunhistochemistry and clinical background provide the
answer.
S182
PS-13-028
Ulcerative colitis: Arguments in favour of a composite, histologic,
endoscopical and clinical, score for dynamic evaluation of patients
O. S. Barbuceanu*, C. Popp, L. Nichita, A. Bastian, S. A. Iacob, C.
Neacsu, C. Socoliuc, S. Zurac
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Since ulcerative colitis (UC) is a longstanding disease with
variable and unforeseeable evolution, there is more and more important
the need for a reliable score for dynamic evaluation of patients. Clinical
and endoscopical scores fail to evaluate histologic remission, frequently
minimizing the risks for relapse and unfavorable evolution, while histo-
logic scores are not well correlated with clinical evolution and with life
quality reported by patients.
Method: We prospectively evaluated 45 patients with UC that underwent
yearly complete clinical, endoscopical and histologic evaluation. Various
histologic and immunohistochemical features were correlated with pa-
tients outcome in order to identify the most significant candidates for a
composite score.
Results: Geboes histologic score correlated well with Mayo clini-
cal and endoscopical score endoscopic (t test two-tailed 0.0006),
but failed to correlate with patients evolution. Persistence of eo-
sinophils and basal plasmacytosis, in inactive lesions, is signifi-
cantly correlated with relapse risk. Architectural distortion is cor-
related with p53 and p21 overexpression and with risk of
dysplasia.
Conclusion: Some histologic and immunohistochemical parameters,
easy to evaluate, can be included in UC scores in order to improve their
prognosis value.
PS-13-029
SPEM in gastrectomy specimens of patients with gastric adenocarci-
noma: Correlation with clinicopathologic variables
H. Sahin*, M. Ozgur Gunay, C. Ataizi Celikel
*
Marmara University, Dept. of Pathology, Istanbul, Turkey
Objective: SPEM (spasmolytic polypeptide-expressing metaplasia)
is a metaplastic mucous cell lineage with phenotypic characteris-
tics of antral gland cells within oxyntic mucosa. SPEM has been
found to be retalted with gastric adenocarcinoma (GCa) as strong-
ly as intestinal metaplasia (IM). Also, in some mouse models of
GCa, SPEM increased the risk of GCa, dramatically.
Method: Partial/total gastrectomy specimens of patients with GCa
between 2015 and 2016, in Marmara University Department of
Pathology, were included in the study. Characteristics of patients,
tumour and non-neoplastic gastric mucosa were noted from pa-
thology reports.
Results: Our study included 189 patients with a mean age of 63.8.
Frequencies of SPEM, IM, Paneth metaplasia(PCM), and H.
Pylori(HP) were 14 , 50 , 52 , and 39 %, respectively. Mean
age was higher in SPEM(+) cases (67.4) than SPEM (-) ones
(63.2) (p > 0.05). SPEM was more frequent in HP(+)
(p < 0.05), multifocal atrophy (p < 0.05), İM (p < 0.05), PCM
(p < 0.1). All SPEM(+) cases had IM, except one. localisation of
the tumour had no effect on the presence of SPEM. Results of the
logit model showed a statistically significant relationship between
PCM, HP and SPEM (both p < 0.1). Controlling for all other
factors, probability of observing SPEM increased from 11 to
21 % in HP (+) cases, as compared to HP(-) ones.
Conclusion: Our study indicated that SPEM may represent a pre-
cursor for development of intestinal metaplasia, and it is closely
associated with HP. But our data is limited to support SPEM, as
the precursor lesion for GCa.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
PS-13-030
Statistical analysis of small bowel lesions presenting as tumours
I. A. Ostahi*, M. E. Dumbrava, E. Simona, E. Valentin, F. Andrei, F.
Vasilescu, C. Vasile, G. Becheanu
*
Victor Babes Pathology Inst., Histopathology and IHC, Bucharest,
Romania
Objective: Although the small bowel represents 75 % of the length and
90 % of the surface area of the gastrointestinal tract, small intestine neo-
plasms are 40–60 times less common than colonic ones.
Method: We made a retrospective analysis of small bowel tumours reg-
istered at Victor Babes National Institute of Pathology between 2007 and
2017 and at Fundeni Clinical Institute between 2011 and 2016.
Results: We identified 63 cases that matched the criteria, out of which 27
(42.86 %) were female patients and 36 (57.14 %) were male patients. The
ages ranged between 1 and 80 years old, with an average age of 51 years-
old. The most frequent lesion was gastric heterotopia (fundic glands), found
at 31 % (20/63) of the patients. Gastrointestinal stromal tumours were the
second most frequent lesions, representing 22 % (14/63) of cases, while
adenocarcinomas represented 9.5 % (6/63) cases, like lymphoid nodular
hyperplasia. The 5th most frequent finding was Brunner gland hyperplasia,
found in 8 % (5/63) of cases, out of which 3 were associated with gastric
heterotopia. 3 cases of non-Hodgkin malignant lymphoma and 3 of ade-
nomatous polyps were identified. There were 2 cases with NETG1, 1
lymphatic ectasia, 1 leiomysarcoma, 1 hyperplastic polyp and only 1 case
of undifferentiated malignant tumour.
Conclusion: Small intestine growths may be neoplastic or non-neoplastic
lesions and may be equally discovered in small intestine biopsies or
excision specimens.
PS-13-031
Short-term histopathological response to anti-tumour necrosis factor
alpha therapy in patients with ulcerative colitis
D.-A. Costache*, A.-M. Vrancianu, M.-C. Dinca, B.-R. Mateescu, C.-G.
Popp, M.-D. Cioplea
*
Colentina University Clinic Hospital, Pathology Dept., Bucharest,
Romania
Objective: Predicting short-term efficacy of anti-tumour necrosis factor
alpha (anti-TNFα) treatment by analysing the histopathological aspects
of colon biopsy in patients with chronic active ulcerative colitis (UC).
Method: Colonoscopy was performed on patients with active UC diag-
nosed in Colentina University Clinical Hospital between 2012 and 2014
and biopsies were obtained from the most affected area of the colon or
rectum, for histological evaluation, according to the method described by
Geboes, before beginning the anti-TNFα treatment and after 6 to
12 months of therapy.
Results: The study included 13 patients, 9 males with ages between 31 and
63 and 4 females with ages between 19 and 42 years old. A clear improve-
ment in the histological score was observed after the treatment. The average
Geboes score had a significant decrease (p = 0.03) from 5 at baseline, to 4 at
the final of the study. The grade of crypt destruction decreased form an
average of 1.46 to 0.84 (p = 0.04). The grade of erosion/ulceration was
reduced after therapy (p = 0.01) and the number of epithelial apoptotic
bodies diminished (p = 0.05).
Conclusion: The results provide evidence that the administration of anti-
TNFα therapy rapidly reduces epithelial lesions and remodelling, response
that is more significant on short-term than dissolution of inflammation.
PS-13-032
Rare osseous metaplasia in left colonic adenocarcinoma: Case report
G. Halcu*, W. Luminita, P. Ileana, L. Gabriela, B. Traean
*
Spitalul Clinic Coltea, Anatomie Patologica, Romania, Romania
Virchows Arch (2017) 471 (Suppl 1):S1–S352
Results: Of 49 cases, 19 (38.8 %) had intertubular growth, 26 (53.1 %)
had rete invasion and 6 (12.2 %) had HSTI. On statistical analysis,
intertubular growth was related to only ITGCN (p = 0.019) among the
clinicopathological parameters. Rete invasion was correlated to
lymphovascular invasion (p = 0.14). HSTI was significantly associated
with tunica albuginea invasion and lymphovascular invasion (p = 0.003,
p = 0.007, respectively).
Conclusion: Our data support that, intertubular growth pattern is not an
uncommon finding in pure seminomas. The presence of intertubular
growth wasn’t found to be associated with clinicopathological parameters
other than ITGCN. But further studies with large series are required to
evaluate the significance of intertubular growth. The close correlation
between HSTI and some predictive parameters, such as tunica albuginea
invasion and lymphovascular invasion, demonstrate that the HSTI may
be a possible predictor in pure seminomas.
PS-25-004
Recurrence variability in transitional cell carcinoma of the bladder
A.-D. Michire-Stefana*, M. D. Cioplea, C. G. Popp, V. Mitroi, C. G.
Socoliuc, L. Zamfir, L. Tutuianu, L. Nichita
*
Clinical Hospital Colentina, Pathology, Bucharest, Romania
Objective: Transitional cell carcinoma is a malignant tumour arising
from the urothelial epithelium and may involve the lower and upper
urinary tract, with proclivity for multifocality and frequent recurrence.
Method: We conducted a retrospective analysis in 71 patients with re-
current urothelial carcinoma of the bladder who underwent transurethral
bladder biopsy during a period of 4 years (2012–2016).
Results: The mean age at first diagnosis was 67.4 years, with low-grade
tumours in 32 cases (45.07 %) and high-grade in 39 cases (54.93 %).
Regarding the initial tumour staging, 12 cases were found to be Ta (non-
invasive), 43 cases T1 and 16 cases T2. Tumour recurrence was noted
within 12 months of follow-up in 44 patients (61.97 %), between 12 and
24 months in 19 (26.76 %) and between 24 and 60 in 8 (11.27 %), with a
mean value of 12 months, particularly 13.6 months for high-grade tu-
mours and 10.8 months for low-grade carcinomas. Tumour grading pro-
gression was observed in 13 of 31 (40 %) of low-grade carcinoma
exhibiting high-grade secondary tumour. We also found that 15 patients
(12 %) had more than one recurrence.
Conclusion: These data support the progressive nature, either in grading
or staging, of bladder cancer, urging a more frequent clinical follow-up.
PS-25-005
Case series of micropapillary variant of urothelial carcinoma: Tiny
yet mighty
A. Sali*, S. Menon, G. Bakshi, G. Prakash, A. Joshi, V. Murthy, U.
Mahantshetty, S. Desai
*
Tata Memorial Hospital, Dept. of Pathology, Mumbai, India
Objective: To report a series of micropapillary urothelial carcinoma
(MPUC) diagnosed at our tertiary cancer care centre.
Method: Histopathological slides of the 22 patients diagnosed with
MPUC between the years 2007–2016 were reviewed. The clinical details
and follow up was recorded from the electronic medical records.
Results: All 22 patients were male with median age of 62 years (range 38
to 86 years).Transurethral resection of bladder tissue (TURBT) was per-
formed in all but one case that underwent upfront cystoprostatectomy.
Cystoprostatectomy following TURBT was done in 4 cases.
Characteristic morphology with retraction spaces around invasive nests
of multiple papillae was seen in all cases. The stage at presentation was
pT2 (11cases), pT1 (10cases) and pTa (Single case). Lymphovascular em-
boli were seen in six cases and nodal metastasis was observed in seven
cases. Most patients were treated with non-surgical treatment in the form of
S265
neoadjuvant chemotherapy (9cases), adjuvant chemotherapy (Single case),
radiotherapy (2cases) and chemoradiotherapy (3cases). Follow up was
available in 16/22 cases with median follow up of 11 months (Ranging
2–113 months). Nine patients (56 %) died of the disease within 2–
24 months of diagnosis.
Conclusion: MPUC is a unique variant of UC with definite male pre-
dominance and very dismal prognosis. Most patients require multimodal
treatment strategies.
PS-25-006
The expression of cyclin D1 in patients with renal cell carcinoma
D. Latic*, J. Jevtic
*
Clinical Center of Montenegro, Center for Pathology and Forensic
Medicine, Belgrade, Serbia
Objective: The key role of cyclin D1 is regulation of cell cycle through
the Rb tumour-suppressor protein. 75 % cases of renal cell carcinoma
have higher expression of cyclin D1 from normal renal tissue.
Method: This retrospective study included 74 patients with renal
cell carcinoma, who underwent surgery in Clinic of Urology in
Belgrade. All cases were patohistologically verified in Insitute of
Pathology. Immunohistochemical staining procedure for cyclin D1
was done. Real-time PCR method was used for detection of
CCND gene expression.
Results: Median value for cyclin D1 immunohistochemical expression
was 40 % in clear cell histological type. CCND gene duplication was
found in 83,3 % of patients with clear cell renal cell carcinoma. These
were statistically significant results.
Conclusion: Gene amplification correlated to immunohistochemical ex-
pression can lead us to the key point of cancer development. It can be
useful to analyze transcriptional regulation of cyclin D1 expression to
find out is that important in prevention and treatment of renal cell carci-
noma.
PS-25-007
Multifocal synchronous bilateral Leydig cell-like testicular tumours
in a young patient with clinical suspicion of adrenogenital syndrome
and of Ollier disease: Just a coincidence? A case study with review of
the literature
J. Lobo*, S. Carvalho, C. Meireles, Â. Rodrigues, R. Henrique
*
IPO Porto, Dept. of Pathology, Portugal
Objective: The main differential diagnosis of testicular Leydig cell
tumours(LCT) is with testicular tumours of the adrenogenital
syndrome(TTAGS). Sex cord-stromal tumours(SCST) are associated
with Ollier disease(OD), a rare condition caused by mutations in
IDH1/2. We present a case of multifocal synchronous bilateral Leydig
cell-like testicular tumours that suggested a diagnosis of TTAGS in a
patient with clinical suspicion of Ollier disease.
Method: A 33-year-old male with history of bone fragility/deformities
and pathological fractures presented with bilateral testicular nodules.
Physical examination revealed hypospadias and tumour markers were
negative. Ultrasound-guided testicular biopsy of the largest
nodule(1.3 cm) was attained.
Results: Histological examination of this hilar brownish nodule showed a
proliferation of cells with granular, eosinophilic cytoplasm containing
abundant lipofuscin, and a fibrous stroma with adipocyte foci and lym-
phocytic infiltrate. The lesion was positive for alpha-inhibin, calretinin,
CD99, synaptophysin and CD56, and negative for androgen-receptors. In
accordance with clinical/analytical data, a diagnosis of TTAGS was sug-
gested. Bone/cartilage disease in early age and the association with SCST
raised the concern for Ollier disease, and IDH1/2 mutation screening is
ongoing.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
and rich fine vascular network, without necrosis/mitosis/vascular inva-
sion. Immunohistochemical profile: chromogranin A-diffusely prostive;
synaptophysin-zonally positive; PGP9.5-focally positive; AE1-AE3/
GATA 3/HMB45/Melan A-negative.
Conclusion: Histopathological and immunohistochemical aspects
correlated with imagistic data was characteristic for single primary
bladder paraganglioma in a relatively-young patient, with no as-
sociated symptoms, stage pT2a. The patient was disease-free
8 months after resection. Primary bladder paraganglioma accounts
for less than 0.05 % of bladder tumours. The literature shows
increasing numbers of paraganglioma case reports/studies in the
last 2 years, but further molecular and genetic studies are needed
to assess risk factors, prognosis and individualised treatment.
PS-25-021
Incidental prostate cancer in TUR-P specimens: Cost/effectiveness in
three tissue sampling methods
L. Tutuianu*, M. Cioplea, C. Popp, V. Mitroi, A.-D. Michire Stefana, O.
Sandu, S. Zurac, L. Nichita
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: To determine the cost/effectiveness of detecting incidental
prostate cancer using three different tissue sampling methods for TUR-
P specimens.
Method: We examined retrospectively all TUR-P specimens submitted
in our department during 3 years: from 2012 to 2013 the specimens were
entirely processed regardless of their weight (method A); from 2013 to
2014 the specimens were sampled randomly in five cassettes or less
(method B); from 2016 to 2017, five cassettes were sampled for 12 grams
of tissue and one additional cassette for each extra 5 grams of tissue
(method C).
Results: Prostate cancer was identified in 1 of 30 (3.4 %) cases evaluated
by method A, in 26 of 162 (16 %) samples evaluated by method B and in
34 of 227 (15 %) samples evaluated by method C. The median number of
cassettes required per case was 10 for method A, 4.9 for method B and 7.8
for method C, with the median cost per case: 100€/case-method A, 49
€/case-method B and 78€/case-method C.
Conclusion: The cost/effectiveness ratio is most favorable for method B,
having the lowest cost per case and the highest percentage in detecting
prostate cancer.
PS-25-022
CDK8/CDK19 inhibition as therapeutic target of metastatic prostate
cancer
A. Offermann*, F. Becker, N. Klümper, W. Vogel, J. Brägelmann, S.
Perner
*
University Hospital UKSH, Institute of Pathology, Lübeck, Germany
Objective: Previously, we found the Mediator subunits and kinases
CDK8 and CDK19 to be highly expressed in advanced PCa and to be
involved in migration and invasion. Aim of this study was to identify
downstream targets of CDK8/CDK19 and to explore if their inhibition
has the potential to reduce PCa aggressiveness.
Method: Immunohistochemical staining for CDK8, CDK19 and
pSTAT1(Ser727), and fluorescence-in-situ-hybridization for
CDK8/CDK19 were performed on a well characterized PCa cohort.
PCa cells were treated with different CDK8/CDK19 small molecule in-
hibitors or siRNA followed by MTT, wound healing, and immunocyto-
chemistry (ICC) and Western-Blot for epithelial/mesenchymal markers.
Levels of pSTAT1(Ser727) in response to CDK8/CDK19 inhibition were
measured by Western-blot and ICC.
Results: CDK8 and CDK19 were higher expressed in PCa compared to
benigns, and increased in about 20 % of metastases. CDK8/CDK19
S269
correlated significantly with nuclear pSTAT1(Ser727). We observed
CDK8 or CDK19 gene amplification in 15 % of tumours.
CDK8/CDK19 inhibition resulted in decreased migration, while prolifer-
ation was not affected. Mesenchymal markers and nuclear
pSTAT1(Ser727) were reduced in response to CDK8/CDK19 inhibition.
Small molecule inhibitors led to comparable effects as specific CDK8 and
CDK19 knockdown
Conclusion: CDK8/CDK19 overexpression in PCa is based on gene
amplification at least in a subset of tumours. CDK8/CDK19 inhibition
leads to reduced migratory potential and mesenchymal phenotype. We
identified the CDK8 phospho-substrate STAT1 as downstream signaling
of CDK8/CDK19 in PCa. Collectively, this study give evidence that
CDK8/CDK19 inhibition by recently published small molecule inhibitors
might be a potential therapeutic option for PCa patients.
PS-25-023
Ectopic adrenal tissue in kidney: A case report
Z. Türkmen Usta*, M. E. Ercin, I. Saygin, E. Cakir
*
Karadeniz Technical University, Dept. of Pathology, Trabzon, Turkey
Objective: Ectopic adrenal tissue in mid pole of kidney is extremely rare.
Site of its appearance is closely related to the migration of primordial
adrenal cells in the course of organogenesis. We present a patient diag-
nosed as ectopic adrenal tissue in kidney.
Method: The surgical specimens were formalin-fixed and paraffin em-
bedded. The section were stained with routinary H&E.
Immunohistochemistry was performed.
Results: A 75-year-old man suffering from urinary stone. The abdominal
computed tomography showed that 21x20mm dimension cortical cyst in
mid pole of left kidney. He has no abnormal blood pressure, Cushing
Syndrome’s signs, electrolite or hormonal imbalance. Left partial ne-
phrectomy and excision of cyst wall in mid pole of left kidney was
performed by urologist due to suspicuous for malignancy.
Histopathological and immunhistochemical results were compatible ec-
topic adrenal tissue in mid pole of kidney.
Conclusion: Awareness for ectopic adrenal tissue in mid pole of kidney
and differentiating from neoplastic lesions such as clear cell renal cell
carcinoma and clear cell malignant melanoma are the main goal on it.
PS-25-025
Pitfalls in the diagnosis of prostate cancer in the era of immunohis-
tochemistry: A retrospective review of 1394 cases
L. Beltran*, A. Ahmad, G. Fisher, H. Moller, P. Scardino, D. Berney
*
Barts Health NHS Trust, Dept. of Cellular Pathology, London, United
Kingdom
Objective: There are few studies on the rate of over diagnosis of prostate
cancer (PC). A previous study by our group from 1990 to 1996 showed an
error rate of 7.5 % but with no immunohistochemistry (IHC) performed.
We wished to examine a more contemporaneous series when IHC was
readily available, being more relevant to current clinical practice.
Method: Core biopsies and TURPs from clinically localized PC diag-
nosed and managed conservatively in the United Kingdom, mostly be-
tween 2000 and 2003 were reviewed by two uropathologists. All incom-
plete cases where excluded and reasons for potential misdiagnosis were
examined. IHC was performed centrally if needed.
Results: 1080 sets of biopsies and 314 TURPs were reviewed: 19 biop-
sies (1.75 %) and 7 TURPs (2.22 %) were reclassified as benign. 4
biopsies (0.37 %) were reclassified as suspicious but not diagnostic of
PC. The total error rate was 2.15 %. IHC was centrally performed in 4
cases and originally on 7. The most common error on biopsies and
TURPs was the overcall of areas of adenosis, followed by partial atrophy
and PIN.
Virchows Arch (2017) 471 (Suppl 1):S1–S352
excised, being surrounded by apparently normal skin. Microscopically,
we identified a subepidermal proliferation, with lobular arrangement,
consisting of highly pleomorphic epihelioid cells, with brisk mitotic ac-
tivity, many of the mitotic figures being atypical. Sparse sebaceous dif-
ferentiation was noticed as multivesicular and vacuolated clear cytoplasm
and also scuamous metaplasia as dyskeratotic cells and small keratin
pearls. Areas of necrosis with “comedo” pattern centered the large tumour
lobules. Immunohistochemical study revealed strong, diffuse positivity
for cytokeratins. CEA was negative.
Conclusion: The histopathological aspects and the immunoreactivity
were compatible with the diagnosis of poorly differentiated sebaceous
carcinoma. Further investigations were recommended for excluding
Muir-Torre Syndrome.
E-PS-05-004
Invasive squamous cell carcinoma developed on actinic keratosis, is
there a progressive line of carcinogenesis?
R. Soana*, A. Ienea, C. Popp, L. Nichita, S. Dutulescu, B. Niculae, C.
Socoliuc, S. A. Zurac
*
Colentina University Hospital, Pathology, Brasov, Romania
Objective: To verify if evolution towards invasive squamous cell carci-
noma (iSCC) in actinic keratosis (AK) is linear – KIN1 to KIN 2 to KIN3
to iSCC
Method: We retrospectively 55 consecutive cases of iSCC developed on
AK, correlating the degree of dysplasia with the presence of invasive
lesions and tumour grading
Results: Just 20 cases of iSCC had associated KIN3 while 35 cases had
KIN2 and KIN1. Most iSCC were well differentiated (30 cases), 19 of
them being developed on KIN1 and 2, while we had only 2 cases of G3
iSCC, both developed on KIN3.
Conclusion: Most cases of iSCC are developed on low- and
intermediate-grade lesions of KIN, sustaining the hypothesis that progres-
sion towards invasive malignancy is not linear. Probably, the first step is
field cancerization, numerous cell acquiring mutations leading to KIN.
Continuous UV trauma is affecting one cell from the already mutated
ones, regardless of grade of dysplasia already obtained, and this addition-
al DNA-lesion triggers the invasive behavior. It is probable that G3 iSCC
are more prone to develop on high grade KIN.
E-PS-05-005
Rhabdomyoblastatic transdifferentiation in metastatic melanoma
A. Dumitru*, T.-A. Georgescu, M. Costache, M. Sajin
*
University Emergency Hospital, Dept. of Pathology, Bucharest,
Romania
Objective: Metastatic melanoma with rhabdomyoblastic differentiation
is an extremely rare condition with poor prognosis
Method: A 57-year-old woman was admitted at the Emergency
University Hospital in Bucharest due to abdominal pain and upper gas-
trointestinal bleeding. An CT scan with IV contrast suggested a tumour
with considerable enhancement, located in the endopelvic portion of the
ileum. At this point, the patient underwent a surgical intervention with
removal of the tumour mass. The patient deceased 4 days after the oper-
ation due to cardiovascular comorbidities.
Results: On gross examination, the tumour resembled a GIST that was
well circumscribed, the cut surface was tan-gray with areas of infarction,
hemorrhage and necrosis. Microscopic examination was surprising and
revealed two main types of cells: some suggestive for melanoma and
others with rhabdoid features. At this point, searching through patient’s
medical history revealed that she had multiple records of metastatic mel-
anoma. Immunohistochemical tests showed intense positivity for
melanocytic markers and rhabdoid markers. CD 117 and DOG 1 were
S311
negative, excluding a GIST. Interestingly, Ki-67 expression was lower in
rabdhoid cells, as well as HMB-45 expression. The final histopathologi-
cal diagnosis was intestinal metastatic melanoma with rhabdomyoblastic
transdifferentiation
Conclusion: Although rhabdoid features in melanoma have been de-
scribed and are not uncommon in metastatic disease, true
rhabdomyoblastic transdifferentiaton is extremely rare and can be a real
challenge even for an experienced pathologist
E-PS-05-007
Pilomatrical carcinoma in the thigh: A case report and review of
literature
D. Radi*, M. Abd-Elazeem
*
Faculty of Medicine Tanta, Dept. of Pathology, Egypt
Objective: A 51-year-old male patient presented to the outpatient
clinic with a history of slowly growing subcutaneous mass in the
middle inner aspect of left thigh for 8 months, recently the mass
rapidly enlarged.
Method: Microscopic examination of the resected mass showed
poorly circumscribed nodular lesion in the deep dermis composed
of irregular nests of large pleomorphic basaloid cells undergoing
abrupt trichilemmal type keratinization enclosing structurless eo-
sinophilic cells (shadow or ghost cells), focal calcification, and
exuberant foreign body reaction with multinucleated giant cells
were seen. Focal areas showed infiltrating sheets of tumour cells,
with numerous mitoses including atypical forms. Areas of transi-
tion into atypical squamous epithelial cells and abundant necrosis
were also seen.There was no infiltration of deep resection margin.
Results: The presence of infiltrative nests, pleomorphism, atypical mito-
ses, and abundant necrosis were leading to a diagnosis of pilomatrical
carcinoma, despite the lack of vascular invasion or perineural involve-
ment. A second opinion was taken by two expert dermatopathologists to
confirm the diagnosis.The patient was followed up and he did not show
any evidence of local recurrence or metastasis for 15 months after the
surgery without adjuvant chemotherapy or radiotherapy
Conclusion: The pilomatrical carcinoma is an extremely rare malignant
tumour of skin appendages. The diagnosis is often not straight forward
and missed due to shared features with its more common benign coun-
terpart. In patients with recurrence or fast growth of pilomatricoma, the
diagnosis of carcinoma should be considered. Wide excision with 1–2 cm
safety margin is the treatment of choice with regular follow-up to detect
recurrence.
E-PS-05-008
CD3+ and CD8+ T-cells in invasive and in situ squamous cell carci-
noma (SCC) of the skin and actinic keratosis
A. Stravodimou*, V. Tzelepi, H. Papadaki, A. Mouzaki, S. Georgiou, M.
Melachrinou, E. Kourea
*
University of Patras, Dept. of Pathology, School of Medicine, Greece
Objective: T-lymphocytes (CD3+) participate in tumour surveil-
lance and their subpopulations either facilitate (regulatory T-
cells) or impede (CD8+ T-lymphocytes) tumour growth. The study
aimed to examine CD3+ and CD8+ T-lymphocytes in invasive
squamous cell carcinoma (SCC) of the skin and adjacent in situ
squamous cell carcinoma (ISSCC), actinic keratosis (AK) and
normal skin (NS).
Method: Paraffin tissue sections from 124 cases of INSCC, with
adjacent ISSCC, AK or normal skin (NS), present in 51, 122 and
122 cases, respectively, were immunostained for CD3 and CD8.
The lymphoid infiltrates were evaluated using the Klintrup-
Makinen grading scheme. Statistical analysis was performed using
Virchows Arch (2017) 471 (Suppl 1):S1–S352
histopathological demonstration of gastric mucosa in rectum, with
oxyntic mucosa as the most common histological type. Also,
Helicobacter pylori and neuroendocrine cells have been identified in rec-
tal HGM. Malignant degeneration of anorectal lesions has not been re-
ported. The most accepted hypothesis for HGM is explained by the
pluripotentiality of stem cells lining the primitive intestinal canal.
Although the treatment of choice is resection, usually with optimal re-
sults, this patient has relapsed three times.
Conclusion: HGM are infrequent lesions, being even more unlikely those
located in rectum. The histopathological diagnosis is accesible.
E-PS-08-003
Retroperitoneal ciliated foregut cyst: A rare malformation
A. Kilitci*, H. Umudum, O. Memis
*
Ahi Evran University Hospital, Dept. of Pathology, Kirsehir, Turkey
Objective: Foregut cyst (FC) is an uncommon, benign, solitary
cyst consisting of four layers; ciliated pseudostratified columnar
epithelium, subepithelial connective tissue, a smooth muscle layer,
and an outer fibrous capsule. FCs are classified as bronchogenic,
enterogastric or undifferentiated. Friedreich first described the le-
sion in 1857 and predicted its congenital origin. We present a FC
that arised in the retroperitoneum and was difficult to separate
from other retroperitoneal cystic mass lesions.
Method: A 27-year-old female presented with flank pain. Abdominal CT
revealed a cystic lesion, measuring approximately 7.8 cm in diameter,
located near the posterior stomach, superior pole of left kidney and pan-
creas. Total cystectomy was performed.
Results: Macroscopic examination revealed a 7.8x6 cm unilocular cyst
enclosed by a thin capsule, which contained viscous, yellowish fluid. There
was no solid component in the lesion. The surgeon confirmed no continuity
of the cyst into the surrounding organs. Microscopy demonstrated the cyst to
consist of four layers. In focal areas, seromucous glands were seen in the wall.
There was no evidence of malignancy. By this findings, this case was diag-
nosed as retroperitoneal ciliated foregut cyst.
Conclusion: FC located in the abdomen or retroperitoneum is extremely
rare and few cases have been described in English literature.
Intraabdominal and retroperitoneal locations have been explained by the
presence of pleuroperitoneal canals in the early embryonic stage. FC
should be considered in the differential diagnosis of retroperitoneal cystic
masses includes lymphangiomas, cystic pancreatic tumours, pseudocysts,
and hematomas.
E-PS-08-004
Gastrointestinal stromal tumours - histologic staging and prognostic
implications
M. Farcas*, A. Pavel, M. Nitu, C. Popp
*
Colentina Clinical Hospital, Pathology, Bucharest, Romania
Objective: Gastrointestinal stromal tumours (GISTs) are mesenchimal
tumours derived from interstitial Cajal cells, arising most commonly in
stomach (60 %), jejunum and ileum (30 %), and colorectum (5 %). The
majority of them are asymptomatic and are diagnosed in patients older
than 50 years.
Method: We conducted a retrospective descriptive study of 10 consecu-
tive cases of GIST diagnosed in our department.
Results: There was an equal number of men and women, with a median
age of 50 years (range 27–72 years). The main localization was the stom-
ach (40 %), followed by small intestine (30 %), colon (20 %) and anal
canal (10 %). Tumours with colonic localisation were the most advanced
(T3 and T4 stadialization) and had a higher progression risk. Mitotic
index had a median value of 2, the highest index being found in gastric
tumours. None of the patients had nodal invasion.
S317
Conclusion: The behavior of GISTs ranges from benign to malignant
and, in adult patients, it is predicted by anatomic site, tumour size, and
mitotic activity. Altough, according to Miettinen and Lasota, colonic
tumours have a good prognosis for a given diameter and mitotic index,
these GISTs are usually asymptomatic and are diagnosed in advanced
stages.
E-PS-08-005
Morphological and immunohistochemical aspects of premalignant
lesions in colonic polyposis. Case reports with short literature review
A. Maiorean*, M. Aschie, I. Poinareanu, A. Mitroi, G. Cozaru, M. Enciu,
G.-I. Baltatescu, O. Cojocaru, D. Aschie, A. A. Nicolau, A. Chisoi
*
Emergency County Hospital, Clinical Pathology Service, Constanta,
Romania
Objective: Colonic polyps, either non-neoplastic or neoplastic, are
clinicopathological entities of great consequence, because of the
subsequent malignancy risk they pose. Thus, the prevention of
colorectal cancer, in predisposed patients, is based on the detec-
tion and the accurate diagnosis of colonic polyposis, for both
solitary, sporadic polypoid lesions and colorectal polyposis
syndromes.
Method: In this paper we present a number of colorectal polyps with
different morphological and immunohistochemical aspects. The cases
were diagnosed in the Clinical Pathology Service of Constanta’s
Emergency County Hospital.
Results: Colorectal adenoma is currently considered a premalignant le-
sion, whose incidence evolves parallel with that of colorectal adenocar-
cinoma. A degree of epithelial dysplasia is always involved in adenomas,
making them susceptible to infiltrative and invasive malignant epithelial
proliferation, which is why, in certain cases, additional immunohisto-
chemical testing is recommended to establish the correct diagnosis and
to choose the appropriate therapeutic management according to the his-
topathological appearance.
Conclusion: The diagnosis of colorectal premalignant lesions permits
choosing the optimal therapeutic management and the proper follow-up
for the diagnosed patients, such that colorectal cancer may be prevented.
E-PS-08-006
Osseous metaplasia in an inflammatory caecal polyp: Case report
M. Mansy*, J. Gupta
*
Maidstone Hospital, Cellular Pathology, United Kingdom
Objective: Introduction: Osseous metaplasia has been described in
various types of tissues, including neoplastic and non-neoplastic
conditions. However, it is an exceedingly rare finding in colonic
and rectal polyps, with only twenty-two cases reported to date in
the English literature1, 2. We report a case of osseous metaplasia
in an inflammatory caecal polyp.
Method: Case report: A 70 year-old male underwent a surveillance co-
lonoscopy and was found to have a caecal polyp which has been excised.
Macroscopically, the tan-brown coloured polyp measured 10 mm in di-
ameter, was bisected and submitted for microscopic examination.
Histopathologic examination revealed polypoid large bowel mucosa
showing a surface cap of ulceration and granulation tissue. There were
underlying irregular and dilated colonic crypts within the inflamed stro-
ma. In addition, there was bone formation within the core of the polyp
with the spicules of bone separated by loose myxoid stroma [Figure 1].
No dysplasia or malignancy was present. The appearances were
interpreted as those of an inflammatory ulcerated polyp with osseous
metaplasia.
Results: Conclusion: Occurrence of osseous metaplasia in colonic polyps
is quite rare. The exact pathogenesis is still unknown. Theories included