Expression of p53, D2-40 and alpha-smooth muscle actin in different histological subtypes of facial basal cell carcinoma

Vol. 55 No. 2 Suppl., 2014
This supplement was not sponsored by Outside Organizations.


Razvan Mercut, Marius Eugen Ciurea, Claudiu Margaritescu, Sanda Mihaela Popescu, Monica Mihaela Craitoiu, Ovidiu Simion Cotoi, Doina Carina Voinescu

Although, generally BCC growths slowly and is minimally invasive, tumors developed in the head and neck region behave more aggressively with deep tissue invasion, recurrence and even local or distant metastases, causing significant morbidity or mortality. Recently, numerous studies have been conducted in order to identify new prognostic markers of BCC aggressiveness, but the results are not consistent. Thus, we were interested here in the immunohistochemical investigation of p53, D2-40 and alpha-SMA expression in the aggressive forms (eight infiltrative-morpheaform, six micronodular and six metatypical cases) versus superficial facial BCCs (five cases). As results, we first noticed that p53, D2-40 and alpha-SMA expression varied between different types of investigated BCCs. The highest reactivity was observed in metatypical subtype for the D2-40. p53 was mainly expressed in the micronodular BCC subtype and on overall, the tumor reactivity to this marker correlated directly with the reactivity for the other two used biomarkers. The infiltrative-morpheaform facial BCCs were peculiar more reactive to alpha-SMA. For all three investigated markers, regardless the histological subtype, the tumor reactivity was higher at the advancing edge, and in addition, at this level we noticed a D2-40 and alpha-SMA stromal reactivity for some cases of the more aggressive BCC subtype (peculiar in metatypical subtype). Thus, we concluded that in order to identify the most aggressive forms of facial BCCs it is useful to investigate these three markers, and this is even more important as they can all constitute therapeutic targets.

Corresponding author: Claudiu Margaritescu, Associate Professor, MD, PhD; e-mail:

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Iancu Emil Plesea, Luminita Chiutu, Silviu Iulian Bordu, Ion Georgescu, Eugen Florin Georgescu, Diana Ciobanu, Nicolae-Dragos Margaritescu, Violeta Comanescu, Raducu Nemes

Aim: The authors present their experience in addressing the gastrointestinal stromal tumors (GIST). Materials and Methods: 15 GISTs operated in the last five years (2008-2013) were analyzed. Results: The preoperative diagnosis was difficult: established by clinical examination and CT in two cases; imagistic accidental discovery in four cases and revealed by evolving complications in nine cases (gastrointestinal bleeding in four cases and bowel obstruction in five cases). CT may be useful in the preliminary estimation of the tumor extent. Tumor location was: stomach four, duodenum one, small bowel seven, and colon three. Pathological examination set the main criteria for assessing the risk of recurrence and indication for adjuvant therapy: the tumor size, the histological type (spindle cell nine, epithelioid four, and mixed two) and the mitosis rate, while the immunohistochemistry examination established the correct diagnosis (positivity for CD117 and CD34) and criteria of aggressiveness (positivity for Ki67). All cases were operated, the surgical procedure being chosen according to the tumor location and stage. Adjuvant therapy with Imatinib 400 mg/day was performed in the 12 cases with high risk of recurrence. The therapeutic outcome was: a postoperative morbidity rate of 13.3%, four patients cured, one local recurrence under Imatinib therapy, a mortality rate of 6.6% and 10 patients in different phases of adjuvant therapy. Conclusions: GIST has been imposed over the last decade as the main type of non-epithelial tumor of the digestive tract. The preoperative imagistic investigations can be very useful for setting the surgical strategy. The improvement of the mitotic index and/or Ki67 labeling index (LI) determination could render more accurate the scales for prognostic assessment. The two steps algorithm - surgery + adjuvant therapy - still remains the only option to make this dangerous condition a curable one.

Corresponding author: Luminita Chiutu, Associate Professor, MD, PhD; e-mail:

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