The differential diagnosis of sellar masses may be complex. Metastatic disease constitutes 1% of all pituitary lesions and sometimes mimics the clinical-radiological presentation of pituitary adenoma. The definitive diagnosis usually relies on histology, but occasionally even histological features of pituitary metastasis may resemble those of adenomas. We present a patient initially diagnosed with pituitary adenoma, but whose clinical course finally revealed pituitary metastasis of a hepatocellular carcinoma. The existing literature on this topic is reviewed.

Background: Occult lymph node (LN) metastases are clinically relevant and confer a worse prognosis in non-small-cell lung cancer (NSCLC) patients. Current staging methods are unable to identify patients with poor outcome. Their detection requires both a more sensitive and specific technique. We aimed to assess the role of messenger RNA expression in pathologically negative LNs (pN0) of stage I NSCLC patients as markers of occult micrometastases and to correlate the results with local or distant tumor recurrence and survival.Patients and methods: Potential molecular markers were evaluated in 344 LNs and 38 tumors by quantitative real-time RT-PCR. Only CEACAM5 and PLUNC showed high expression in lung tumor tissue and null expression in RNA from benign LNs.Results: Thirteen per cent of the LNs were positive for CEACAM5 and 16% for PLUNC. Eight of 38 NSCLC patients had positive expression in pN2 nodes by CEACAM5 and/or PLUNC and disease-free survival (P = 0.028) and overall survival time was significantly worse in these patients compared with those with negative expression (P = 0.0083).Conclusions: Quantitative real-time RT-PCR of CEACAM5 and PLUNC can estimate the presence of micrometastatic cells in LNs with greater precision than current staging method used for assessing tumor recurrence risk.

9654 Background: 5-year survival for p with surgically resected stage IA-IB (NSCLC) is 70 and 38%. Recurrence of the disease is probably due to undetected systemic occult micrometastases (OM) at the time of initial diagnosis in the histopathologic analysis.The detection of OM would require a more sensitive and specific technique and would be of the greatest interest to define a high risk population and select p for postoperative adjuvant treatments. Objective: to assess the role of CEA, PLUNK and CK19 mRNA expression in pathological negative lymph nodes (LN) from resected stage I NSCLC p as markers of OM and correlate the results with relapse. Methods: paired tumour and histological negative LN (n=84) from 10 p were analyzed for the presence of CEA, CK19 and PLUNC mRNA expression using quantitative real-time PCR Q-PCR. RNA was extracted; GADPH was used as an endogenous control.Samples were also analyzed by immunohistochemistry for LN staging. Results: 10 NSCLC p;7 males;age range:47–77;5 adenoca, 3 squamous cell ca and 2 undiff tumours. CK19 and PLUNC were found to be expressed in tumour tissue of all p.CEA did not express in one of the squamous cell ca. tissues. In the 84 pathological negative LN, 23, 8% (20/84) were positive for CEA, 20%(17/84) for PLUNC,100%(84/84) for CK19 mRNA expression. Most LN positive for CEA were positive for PLUNC as well. The expression pattern were very similar for both markers in all 10 p analyzed.6/10 p showed positive lymph nodes and 4/10 were negatives.1/10 p relapsed after 11 mo of surgery and died after 18 mo. P had detectable levels of CEA and PLUNC mRNA in LN assessed by Q-PCR. The 9 p that did not relapse, 4 had no detectable LN expression levels of these markers and 5 had detectable LN expression levels (median follow-up of 12,5 mo; range 4–18 mo). Conclusions: CK19 has shown to be non specific tumoral marker since it were found to be expressed in all LN tested. But CEA and PLUNC have shown to be specific markers of OM.This fact could be of prognostic relevance and maybe a tool for select high-risk patients considered for adjuvant therapies.50 p are being assessed to corroborate this finding. Final data will be presented. No significant financial relationships to disclose.

Microvessel density (MVD) has been studied in a number of neoplasias, and apparently, there is a relationship between angiogenesis and tumor progression, response to treatment, and outcome. In pituitary adenoma, the association between MVD and vascular endothelial growth factor (VEGF) with tumor behavior has been described, but correlation with other angiogenic factors such as fetal liver kinase 1 (Flk-1) or proliferative markers is unknown. We investigated MVD, VEGF, and its receptor Flk-1 expression in 60 human pituitary adenomas: 13 growth hormone cell adenomas, 7 prolactin cell adenomas, 5 corticotroph cell adenomas, 2 thyrotroph cell adenomas, and 33 nonfunctioning adenomas (30 gonadotroph cell adenomas and 3 null cell adenomas). We performed immunohistochemistry for CD34, Ki-67, VEGF, and Flk-1. To evaluate MVD, we used 2 methods: the number of vessels per square millimeter and the Chalkley method. Immunohistochemistry results were correlated, as well as with clinicopathologic factors. Adenomas with higher MVD were thyrotroph cell adenomas (299.9 +/- 87.5), and those with lower MVD were prolactin cell adenomas (168.6 +/- 63.3; P = .45, analysis of variance). We found a trend toward higher MVD in the adenomas of older patients (P = .142), but no difference was found regarding sex, extrasellar extension, or Ki-67 (P > .05). However, extrasellar extension was nearly significant when the Chalkley method score was high (P = .056). Low expression of VEGF was seen predominantly in prolactin cell adenomas, and high in nonfunctioning adenomas, or in cases of older patients (P < or = .032). Flk-1 score correlated with VEGF (P = .006). High expression was observed in nonfunctioning adenomas, cases presenting at older ages, and with extrasellar extension (P < or = .022). Our study shows that VEGF and Flk-1 are widely expressed in pituitary adenomas, predominantly in nonfunctioning adenomas and those presenting at older ages. Moreover, Flk-1 is associated with a more aggressive phenotype, and it may have potential therapeutic interest.

838 Background: Apoptosis and proliferation deregulation plays a role in tumor pathogenesis and progression, and apparently in response to treatment. We studied whether the expression of proteins involved in these mechanisms can identify a subset of breast carcinoma (BC) patients who will respond to neoadjuvant chemotherapy (NACT). Methods: We selected 99 core needle biopsies (CNB) and the corresponding resection specimens from BC patients in NACT. Clinical response (CR) based on tumor size was classified as complete (100%), partial incomplete (>50%), minor (<50%) or progression. Tumor cellularity was assessed in CNB sections and specimens as the percentage invasive cells. Specimens were classified by a five-point grading system. Staining for Bcl2, Bad (pBad Ser136), cleaved Caspase-3, p53, Her2/neu and Ki67 was performed in CNB. All antibodies were scored based on the proportion except for pBad that was considered as negative (no/faint) or positive (moderate/strong). Results were correlated with CR, pathologic response (PR) and clinico-pathological factors. Results: Patients median age was 49 years (range 25–80). Median initial tumor size was 5.5 cm (range 1.5–12) and after treatment 3.2 cm (range 0–15) (p=0.02). 88% were of ductal type, 12% lobular and 63% grade 3. Overexpression of Bcl2 (>50%) or p53 (>20%) was observed in 51% and 41%, respectively; pBad was present in 44% tumors; activated caspase-3 (>50%) in 17% and Ki67 (>30%) in 27%. Complete CR was seen in 37% and PR and 17% (p=0.002). Tumor cellularity decreased from a median of 30% to 5% and 30% showed >90% reduction of the clinical size (p<0.000). Her2/neu was positive in tumors of older patients (p=0.02) with high Ki-67 (p=0.04) and predicted tumor reduction (p=0.03). Ki67 and p53 overexpression was seen in grade 3, with low Bcl2 (p30% (p=0.02) and as a trend with pBad (p=0.09). The grade of PR correlated with pathological size, cytological changes and lymph-node status (p<0.04), and as a trend with Bcl2 (p=0.07), Her2/neu (p=0.09) and Ki67 (p=0.11). Conclusions: In BC following NACT, Ki67 correlates with CR. The observed trend towards improved PR depending on the levels of Bcl-2, Her2/neu and Ki67 supports the idea that they may have predictive value. No significant financial relationships to disclose.