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Sometimes the distinction between gastric adenocarcinomas and breast carcinomas can be challenging. Hepatocyte nuclear factor 4‐alpha (HNF4A) has been suggested as a potential marker in these cases. The aim of the present work was to evaluate the role of the combined use of HNF4A and GATA3 as immunohistochemical markers in distinction between primary and metastatic breast and gastric carcinomas. This retrospective study was conducted on (81) cases divided into four groups of cohorts: primary BC (cohort I, n = 25), primary GC (cohort II, n = 23), and metastases derived from both types of tumors designated as metastasis derived from BC (cohort III‐A, n = 17) and metastasis derived from GC (cohort III‐B, n = 16). We performed immunohistochemistry analysis of HNF4A and GATA3 in all (81) cases. HNF4A expression was seen in 22 of 23 primary gastric adenocarcinomas and was absent in all 25 primary breast carcinomas (sensitivity 95.7%, specificity 100%). HNF4A was seen in 15 of 16 metastatic gastric adenocarcinomas and was absent in all 17 metastatic breast carcinomas (sensitivity 93.8%, specificity 100%). GATA3 showed 92 and 88% sensitivity, and 95.7 and 100% specificity for primary breast carcinomas and metastatic breast carcinomas, respectively. Our data confirmed the potential utility of HNF4A as a diagnostic marker and can be used as an adjunct to GATA3 as an immunohistochemical panel to differentiate between breast and gastric carcinomas.

Background: Chronic rhinosinusitis (CRS) is a common inflammatory disorder whose underlying etiopathogenesis has not yet been completely understood and appears to be multifactorial. Microbial biofilms and bony osteitis are gaining an increased concern as they are considered to be among the possible factors that contribute to the overall local inflammatory load in chronic rhinosinusitis (CRS). This study investigated the impact of mucosal biofilm and bony osteitis on the pathophysiology and severity of chronic rhinosinusitis with nasal polyps (CRSwNP). Results: Forty-five CRSwNP patients performing functional endoscopic sinus surgery (FESS) and 10 control patients were involved in this cross-sectional study. Mucosal and bony specimens from ethmoid sinus were obtained for both light and scanning electron (SEM) microscopic examination. The histopathologic bony grade was positive in 40/45 of CRSwNP patients versus 6/10 of the control patients (P = 0.300); histopathologic mucosal grade was 44/45 versus 4/10 (P < 0.001), and tissue eosinophilia was 45/45 versus 6/10 (P < 0.001); biofilm was positive in 37/45 versus 4/10 (P = 0.012). The mean of the sinonasal outcome treatment score (SNOT)-22 is 39.8 versus 50.5 (P = 0.067); Lund-Mackay score (LMS) is 19.6 versus 3.1 (P < 0.0001). Conclusion: (1) Mucosal biofilms and osteitis were detected in patients undergoing FESS for CRSwNP and also in controls without CRS. This suggests that mucosal biofilms and osteitis may not alone be the etiology of CRS without other cofactors. The pathogenesis of biofilms could be related to host factors. (2) The high odds ratio and wide confidence interval in our study suggest that there is a statistically significant association between biofilm formation and CRSwNP. (3) The high grade of mucosal inflammation and tissue eosinophilia suggests the inflammatory load added by osteitis and bacterial biofilm (BBF).

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