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BACKGROUND:Growing evidence supports the notion that the onset of tumorigenesis could occur through cancer stem cells (CSCs). These tumour cells show low proliferative rates, high self-renewal capacity, propensity to differentiate into active proliferating tumour cells & resistance to chemoradiotherapy thus, possibly causing local recurrences & metastasis formation. CD44 has been used as a marker to isolate CSCs from colorectal carcinoma (CRC).AIM:To investigate the immunohistochemical expression of cancer stem cells marker (CD44) in CRC and correlate its expression with the clinicopathological aspects, TNM staging and modified Dukes’ classification.MATERIALS AND METHODS:Tumour biopsies from colectomy specimens of 60 patients with CRC were stained with hematoxylin-eosin for histological evaluation then immunostained with monoclonal antibodies against CD44 which was detected in term of negative or positive expression.RESULTS:CD44 was demonstrated in 58.3% (35/60) of cases and showed statistically significant correlation with tumour site and histological type (p-value < 0.05). However, CD44 showed statistically insignificant inverse correlation with tumour invasiveness (T), lymph node status (N), grade, TNM stage grouping and modified Dukes’ classification, while it was directly correlated with distant metastasis (M) (p-value > 0.05). Chi-square /Fisher exact test proportion independence and the p-value are set significant at 0.05 level.CONCLUSION:the CD44 rate of expression is higher in the colon than rectum and in adenocarcinoma than mucinous and undifferentiated carcinoma. CD44 showed statistically insignificant relation with T, N, M, grade, TNM stage grouping and modified Dukes’ classification.

Background and objectives Accurate recognition of urinary bladder muscularis propria (MP) invasion by urothelial carcinoma is crucial as it is the critical crossroad between conservative and aggressive management for the patient. It is now widely known that an inconsistent layer of muscularis mucosae (MM) muscle exists in the lamina propria, which can mimic the MP muscle, particularly when hyperplastic, making staging extremely challenging in some limited, unoriented, or highly cauterized specimens.Smoothelin is a novel smooth muscle-specific contractile protein expressed only by fully differentiated smooth muscle cells, and not by proliferative or noncontractile smooth muscle cells and myofibroblasts. Materials and methodsWe performed immunohistochemical staining in the bladder for smoothelin to evaluate its expression in MM and MP muscle in 60 cystectomy specimens and by comparing the staining pattern with desmin.Results In contrast to desmin, which equitably stained both types of muscle fibers, smoothelin showed striking differential immunoreactivity between MM and MP muscle.Smoothelin was expressed in different intensities and showed different immunoreactivity between MM and MP muscles. The MM showed absent (44/60, 73%) or weak staining (15/60, 25%), only one showed moderately positive staining (1/60, 1.6%), and none showed strong staining (0/60, 0%). In contrast to the MM, the MP predominantly showed strong staining (36/60, 60%) and moderate staining (24/60, 40%), with none showing weak or negative staining (0/60, 0%). There was always a significant and striking disparity in the staining intensity between the MM and the MP in every section (in cases where smoothelin was weak in the MM, it was always stronger in the MP).Conclusion The relatively distinct immunohistochemical staining pattern of smoothelin between MP and MM (including its hyperplastic forms) makes it a robust and attractive marker to be incorporated into the contemporary diagnostic armamentarium for the sometimes difficult area of staging bladder urothelial carcinoma. It also confirmed the use of desmin to differentiate between smooth muscle cells (whether MM or MP) and proliferating myofibroblasts.

Fine needle aspiration (FNA) biopsy has been documented as a reliable, cost-effective test, diagnosing different thyroid lesions. However, its sensitivity declines much in some settings. This study aimed to investigate the value of computerized morphometry and DNA ploidy in differential diagnosis of different thyroid epithelial follicular lesions diagnosed on FNA smears. In this study, 68 cases of thyroid FNA were cytologically examined, and classified according to their postthyroidectomy histopathologic diagnosis as follow: 10 cases of nodular goiter, 14 cases of adenomas, 10 cases of follicular carcinoma, 20 cases of papillary carcinoma, 10 cases of anaplastic carcinoma, and 4 cases of poorly differentiated carcinoma. Using Leica Qwin 500 image analysis system, nuclear area as a morphologic variable, and the DNA ploidy, DNA index, and proliferation indices were measured for each case. Sensitivity of FNA in the studied cases was optimum (100%) in papillary carcinomas and anaplastic carcinomas. However, the sensitivity declined sharply in discriminating nodular goiter and follicular adenoma from well-differentiated follicular carcinoma, thus, most of these cases were diagnosed as follicular lesions. A significant difference in mean values of nuclear area was found between benign and malignant lesions, with no statistical differences within the benign group. Aneuploidy was significantly associated with malignancy. Therefore, image analysis may become an important ancillary test in the initial evaluation of patients with thyroid epithelial lesions.

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