DOI: 10.3897/jbcr.e174917

Authors: Boyana Anatolieva, Ivan Ivanov, Dimitar Gospodinov

Abstract: Basal cell carcinoma is the most common malignant tumour in humans. In cases with indistinct morphology on H&E-stained slides, immunohistochemistry may help distinguish basal cell carcinoma from other similar-appearing lesions. Our study aimed to investigate the expression of a marker panel comprising EZH2, Bcl-2, and Ber-EP4 in morphologically diagnosed, CK20-verified cutaneous basal cell carcinomas.Materials and methods: A cross-sectional study of 50 histologically confirmed cases of basal cell carcinoma was conducted. Immunohistochemical staining was performed using the following markers: EZH2, Bcl-2, Ber-EP4, and CK20. Due to the lack of a standardised method for evaluating markers, we adopted and modified the staining index (SI), which semi-quantitatively combines staining intensity and the percentage of positive cells. The results were systematised and interpreted using IBM SPSS.Results: All 50 examined tumours tested negative for CK20 (100%), thereby excluding mimics. All 50 tumours stained positive for EZH2 and Bcl-2 (100%), and only one stained negative for Ber-EP4 (98% positive). We found no association between histological type and EZH2 (p = 0.376), Bcl-2 (p = 0.376), and Ber-EP4 (p = 0.318), respectively, or their co-expression (p = 0.258). High co-expression of two of the three markers was observed in 33 of the 50 examined cases (66%), and a low co-expression in 4 cases (8%).Conclusion: The marker panel demonstrates co-expression of the three markers in the context of negative CK20 in over 90% of the cases. In challenging cases, it is important to consider clinical, morphological, and immunohistochemical features together.

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DOI: 10.3897/jbcr.e126709

Authors: Hristo S. Milev, Vasil Nanev, Desislava Dimitrova, Strahil Strashilov, Angel Yordanov, Miroslava Mihailova-Strashilova, Silvia Naneva, Simoneta Ivanova, Milena Karcheva, Ivan Ivanov

Abstract: There are no specific recommendations for evaluating the Ki-67 index in heterogeneous breast carcinomas. This study aimed to evaluate the applicability of currently accepted recommendations for Ki-67 evaluation in breast cancer in the context of intratumor heterogeneity. Twelve cases of heterogeneous breast carcinomas obtained from 110 patients were retrospectively studied. Ki-67 staining was performed according to protocols provided by the reagent manufacturer. Results for Ki-67 of the separate components in each tumor were obtained, described, and analyzed statistically using a paired t-test. Values of p < 0.05 were considered as statistically significant. SPSS software was used for statistical analysis. Results from the comparison of the Ki-67 index evaluation in each heterogeneous component of the studied tumors demonstrated no statistically significant difference of mean values t = 0.4802, p = 0.6405. The anticipation of an average Ki-67 score in the evaluated cases would have changed the molecular subtype from Luminal B to Luminal A (due to the Ki-67 index below 14%) in two of the cases. Heterogeneous tumors had a different Ki-67 index in their separate components. Our observations suggest that Ki-67 in heterogeneous breast carcinoma is evaluated and reported separately for the distinguishable tumor components.

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DOI: 10.3897/jbcr.e126655

Authors: Krasimir T. Petrov, Ivan Ivanov, Tatyana Betova, Reni Tsvetkova, Radoslav Trifonov, Savelina Popovska

Abstract: In this paper we summarize the results of a retrospective investigation of tumor budding in endoscopic preoperative biopsies in patients with colorectal adenocarcinoma (CRC). The aim of this study was to assess the peritumoral budding evaluation interpretability, based on endoscopic colorectal biopsies in left and right sided colorectal carcinoma and some of the factors that influence it. A group of 100 patients, with preoperative endoscopic biopsies was selected and the tumor buds were counted on H&E stained slides, according to contemporary clinical recommendations. In the studied patient group, budding was identified in a total of 13 patients (13% of the studied cases). The primary localization of the tumor in the left or right colon was not associated with the reporting of budding in endoscopic biopsies of colorectal carcinoma. No budding was observed in highly differentiated tumors, and the presence of budding was reported less frequently in poorly differentiated tumors compared to moderately differentiated ones. Budding was accessible for evaluation in nearly 1/10 of the small biopsies from CRC. Artifacts from the sample management as well as factors related to the tumor characteristics predetermined the possibility for evaluation of tumor budding on small biopsies.

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