Background: Soft tissue sarcomas (STS) are relatively rare tumors, representing less than 1% of adult malignancies based on report from American Cancer Society. The crude incidence rate in Iraq for soft tissue sarcomas was 219/ 100,000 populations during 2014 with a male: female ratio of 1.2:1, and the highest age peak falling between 30-34 years .The histological subtype and microscopic criteria are two parameters that influence the tumor grade which is the best predictor for aggressiveness. Objectives: A retrospective evaluation of soft tissue sarcomas, using immunohistochemical (IHC) study of Myosin, Desmin, Smooth muscle Actin (SMA) and Vimentin, aiming to review the primary diagnosis and whether IHC assessment in soft tissue sarcoma is mandatory to reach a final interpretation. Patients and methods: A total of 50 cases of soft tissue sarcomas were reviewed retrospectively from case archives of histopathology department/ Central Public Health Laboratory and Ghazi Al Hariri Hospital for Specialized Surgeries for the period (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Hematoxylin and Eosin (H&E) stain and IHC staining of unstained sections from formalin-fixed, paraffin-embedded tissue were performed using SMA, Vimentin, Desmin and Myosin. The staining intensity was assessed based on the percentage of positive cell expression of the four IHC monoclonal antibodies. Results: The staining interpretation of the four monoclonal antibodies were confirmatory for the original diagnosis in 40% of cases, while 60% of the final diagnoses were re-evaluated and a different interpretation was given supported by the IHC findings for Desmin, Myosin, SMA and vimentin, under the clinical and radiological context. Conclusions: The co-expression of SMA and Desmin helped in the diagnosis of leiomyosarcoma (LMS). Myosin expression was helpful in the diagnosis of rhabdomyosarcoma (RMS) and alveolar soft part sarcoma (ASPS). SMA and Vimentin were not specific for the diagnosis of malignant fibrous histiocytoma (MFH). By applying IHC markers, 60% of soft tissue sarcomas were found to be different from the preliminary diagnosis while 40% of cases were supportive of the original H&E diagnosis.
Background: Many thymoma classifications have been followed and have been updated by newer or alternative schemes. Many classifications were based on the morphology and histogenesis of normal thymus as the backbone, while other classifications have followed a more simplified scheme, whereby thymomas were grouped based on biological behavior. The WHO classification is currently the advocated one, which is based on “organotypical” features (i.e. histological characteristics mimicking those observed in the normal thymus) including cytoarchitecture (encapsulation and a “lobular architecture”) and the cellular composition, mostly the nuclear morphology is generally appreciated. Objectives: This study aims to re-classify thymomas by establishing certain morphometric parameters to evaluate the epithelial cells nuclei. An appraisal of thymoma classification as cortical/ lymphocytic/ type B1 and B2 or medullary/ spindle cells/ type A will be attempted as objective re-evaluation of thymoma. Patients: This study is a retrospective evaluation of 50 cases of thymoma, 20 cases of thymic hyperplasia and 10 cases of normal thymus (control group). Using a 5 µm formalin-fixed paraffin embeded tissue sections, stained with hematoxylin-eosin stain, these cases were previously classified histologically into lymphocytic (6 cases), lymphoepithelial (mixed) (28 cases) and epithelial (16 cases), including 2 cases of spindle cell thymoma. Methods: Computer-assisted morphometry was performed for 80 cases. This involves digitization of the histopathological features and application of morphometric analysis through software. The morphometric parameters used are nuclear area, maximum nuclear diameter and Form factor of epithelial cells nuclei. Ten normal thymus glands from the archived cases were also evaluated as a control groups. Results: The results showed that epithelial thymomas possess significantly different nuclear areas from that of a normal thymus, the maximum nuclear diameter (D-Max) follows the same pattern and adds no further outcomes. The numerical morphometric analysis showed no significant differences between lymphocytic predominant thymoma and those classified as cortical thymoma (Type B2). Thus it does not support such a re-classification. Form factor is an indication of pleomorphism, but it should be cautiously used when spindle cells are present since it may give a false indication of pleomorphism. Conclusion: Computer-Assisted morphometric analysis provides an objective, reproducible and comparable results for thymoma histological classification. Keywords: Thymoma, Histological classification, Grading, Morphometry, Computer-assistedmorphometry.
Background: Multidisciplinary team meetings (MDTs) are designed to optimize patient outcomes. It appears intuitive that MDTs are essential to clinical decision - making and patient management; however, it is unclear whether that belief is supported by evidence. With regard to cancer patients, studies demonstrated that treatment plans made by interacting health care professionals are more effective than those made by individual practitioners. Objectives: To assess the impact of multidisciplinary teams (MDTs) on clinical decision - making and patient outcomes. Methods: We follow a descriptive questionnaire survey study design and created a (10) sections surveymonkey that was distributed via email to (150) experts in surgical oncology, general surgery, oncology, radiation oncology, pathologists, and administrative staff. Fourty (40) completed responses were collected to ensure a statistical basis on which to draw sound conclusions. The remaining 110 staff have submitted incomplete answers. Answers were discussed in a separate MDT meeting with most of the participants.The survey was followed by an interpretation of the respondents’ results and comparison with literatures. Results: 75% of the participants chose” Agree and strongly agree”, supporting the hypothesis that MDT meetings ensure an effective and up-to- date management guidelines. This means that the risk of not discussing a cancer patient cannot be neglected any longer. So the hypothesis statement (H0) is rejected and the alternative statement (Ha) is accepted. Conclusions: The majority of participants saw the value in the MDT process and expressed support for its implementation locally and nationally; however, feedback about the most appropriate format is yet to be established. The clinicians identified the need for agreed standards in MDT performance
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