Absence Of Necrosis Research Articles

EPID-28PROGNOSTIC AND PREDICTIVE BIOMARKERS IN RECURRENT WHO GRADE 3 GLIOMA PATIENTS TREATED WITH BEVACIZUMAB AND IRINOTECAN

BACKGROUND: Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A) has shown activity in the treatment of recurrent malignant glioma. Predictive markers and prognostic models are required in order to individualize treatment for grade 3 glioma patients. The primary endpoint of this study was to identify predictive biomarkers associated with response to bevacizumab therapy. The secondary endpoint was to identify prognostic factors associated with progression-free survival (PFS) and overall survival (OS). METHODS: A total of 62 consecutive, recurrent grade 3 glioma patients were administered bevacizumab and irinotecan between December 2005 and November 2014 according to a previously published clinical protocol. A wide range of clinical, histopathological and molecular factors were screened for significant correlation (p < 0.05) with response and survival endpoints using logistic and Cox regression, respectively. Potentially predictive biomarkers were subjected to multivariate analysis. The landmark method was employed for analysis of survival by response. RESULTS: Twenty-two of 57 evaluable patients (38.6 %) demonstrated a response at the time of their best response MRI (RANO criteria). Responders had significantly prolonged OS (p = 0.007) and trended toward longer PFS (p = 0.067) as compared to non-responders (OS: 12.4 vs 4.3 months, PFS: 5.6 vs 3.2 months). A favorable WHO performance status (PS) and absence of necrosis were significantly more common in responders than non-responders. Multivariate analysis also identified a poor PS as the only prognostic factor for PFS, while an unfavorable PS and immunohistochemical p53 accumulation were prognostic of reduced OS. CONCLUSIONS: A poor baseline PS and the presence of necrosis were negatively associated with response to bevacizumab. An unfavorable PS and p53 positivity are prognostic of worse outcome in this patient population.

Uterine sarcomas.

Uterine sarcomas.

Integrated FDG PET/MR Imaging for the Assessment of Myocardial Salvage in Reperfused Acute Myocardial Infarction.

To compare the size of the area with reduced myocardial fluorodeoxygluose (FDG) uptake with the endocardial surface area (ESA) method as a marker for the area at risk in patients with reperfused acute myocardial infarction. The study was approved by the local institutional review board. All patients gave written informed consent prior to their examination. Twenty-five patients (mean age ± standard deviation, 54 years ± 14) underwent prospective cardiac positron emission tomography/magnetic resonance imaging after acute coronary occlusion and interventional reperfusion. On late gadolinium contrast enhancement images, the size of infarction and the area at risk, as determined with ESA, were assessed and compared with the area of reduced FDG uptake. Statistical analysis comprised paired t tests and Mann-Whitney U tests, as well as Pearson r and Spearman ρ for correlations. In patients with infarcted myocardium and reduced FDG uptake (n = 18), a good correlation between the area of reduced FDG uptake and the area at risk according to ESA was observed (r = .70, P = .001). The area of reduced FDG uptake (31% ± 11 of left ventricular myocardial mass) was larger than the size of the infarct (10% ± 10, P < .0001) and the area at risk according to ESA (17% ± 13, P < .0001). In six patients, no late contrast enhancement was seen, whereas all patients had an area of reduced FDG uptake (29% ± 8) in the perfusion territory of the culprit artery. In patients with reperfused acute myocardial infarction, the area of reduced FDG uptake correlates with the area at risk as determined with the ESA method and is localized in the perfusion territory of the culprit artery in the absence of necrosis, although the area of reduced FDG uptake largely overestimates the size of the infarct and the ESA-based area at risk.

Molecular mechanisms behind progressing chronic inflammatory dilated cardiomyopathy.

BackgroundInflammatory dilated cardiomyopathy (iDCM) is a common debilitating disease with poor prognosis that often leads to heart failure and may require heart transplantation. The aim of this study was to evaluate sera and biopsy samples from chronic iDCM patients, and to investigate molecular mechanism associated with left ventricular remodeling and disease progression in order to improve therapeutic intervention.MethodsPatients were divided into inflammatory and non-inflammatory DCM groups according to the immunohistochemical expression of inflammatory infiltrates markers: T-lymphocytes (CD3), active-memory T lymphocyte (CD45Ro) and macrophages (CD68). The inflammation, apoptosis, necrosis and fibrosis were investigated by ELISA, chemiluminescent, immunohistochemical and histological assays.ResultsThe pro-inflammatory cytokine IL-6 was significantly elevated in iDCM sera (3.3 vs. 10.98 μg/ml; P < 0.05). Sera levels of caspase-9, −8 and −3 had increased 6.24-, 3.1- and 3.62-fold, (P < 0.05) and only slightly (1.3-, 1.22- and 1.03-fold) in biopsies. Significant release of Hsp60 in sera (0.0419 vs. 0.36 ng/mg protein; P < 0.05) suggested a mechanistic involvement of mitochondria in cardiomyocyte apoptosis. The significant MMP9/TIMP1 upregulation in biopsies (0.1931 - 0.476, P < 0.05) and correlation with apoptosis markers show its involvement in initiation of cell death and ECM degradation. A slight activation of the extrinsic apoptotic pathway and the release of hsTnT might support the progression of chronic iDCM.ConclusionsData of this study show that significant increase of IL-6, MMP9/TIMP1 and caspases-9, −8, −3 in sera corresponds to molecular mechanisms dominating in chronic iDCM myocardium. The initial apoptotic pathway was more activated by the intramyocardial inflammation and might be associated with extrinsic apoptotic pathway through the pro-apoptotic Bax. The activated intrinsic form of myocardial apoptosis, absence of necrosis and decreased fibrosis are most typical characteristics of chronic iDCM. Clinical use of anti-inflammatory drugs together with specific anti-apoptotic treatment might improve the efficiency of therapies against chronic iDCM before heart failure occurs.

Anterior Gradient 2 is a Poor Outcome Indicator in Luminal Breast Cancer.

Recent data have shown anterior gradient 2 (AGR2) to be a novel oncogene overexpressed in luminal breast cancers. However, many studies only focused on its relationship with treatment resistance, and the clinical relevance of AGR2 has not been widely evaluated. AGR2 expression in a cohort of breast cancer was correlated with the clinicopathologic features, biomarker expression, and patient survival. AGR2 expression correlated with lower grade (p = 0.002) and absence of necrosis (p = 0.001) and was most highly expressed in luminal cancers (p < 0.001). Correspondingly, AGR2 correlated positively with estrogen receptor, progesterone receptor, and androgen receptor (p < 0.001) and negatively with epidermal growth factor receptor (p =0.002) and CK5/6 (p < 0.001). AGR2 was an independent unfavorable disease-free survival prognostic factor in patients with hormone therapy (hazard ratio 2.537, p = 0.023). Interestingly, it was also an independent adverse disease-free survival prognostic factor in node-positive luminal cancers (hazard ratio 3.381, p = 0.016). AGR2 expression was higher in nodal metastasis than the corresponding primary tumors in luminal cancers (p= 0 .023). The prognostic impact of AGR2 expression could be related to treatment outcome in estrogen receptor-positive breast cancers and/or its metastasis-promoting effects. It could be an important tumor biomarker and negative prognostic factor potentially exploitable in clinical practice.

Comparison of 3.0 T magnetic resonance imaging and X-ray mammography in the measurement of ductal carcinoma in situ: A comparison with histopathology

PurposeTo determine if MRI data obtained at 3.0T can more accurately report the size of DCIS as compared to radiographic mammography, as a whole cohort and when subdivided by lesion characteristics. MethodsThirty-nine participants underwent X-ray mammography and MRI prior to breast surgery for DCIS. Longest diameter (LD) measurements were recorded for each imaging modality and compared to histopathological LD via a logarithmic transformed Bland–Altman agreement plot methodology resulting in dimensionless mean difference and 95% limits of agreement (LoA). ResultsData from 39 patients with a median age of 55 years (range 38–78 years) underwent analysis. Mastectomy was undertaken in 21 cases, while breast conserving surgery was performed in 18 subjects. Histopathological analysis revealed one low grade, nine intermediate grade, and 21 high grade lesions. The mean±standard deviation LD measurements for histopathology, X-ray mammography and MRI were 50.6±34.2mm, 30.7±23.1mm and 49.6±26.8mm respectively. Bland–Altman agreement plot analysis for the whole cohort revealed not only a smaller logarithmic mean difference between MRI and histopathology (0.086), but also narrower 95% LoA (−0.941 to 1.113) compared with X-ray mammography and histopathology (mean difference −0.658, 95% LoA −3.503 to 2.187). When the level of agreement was assessed between clinically relevant subgroups additional significant differences were noted based on grade, hormonal receptor status, invasion, necrosis, mircocalcifications and growth pattern. ConclusionMRI provides a more accurate estimation of DCIS size than X-ray mammography. MRI's superior ability was not only noted in general, but also for clinical relevant subdivisions such as grade and the presence or absence of necrosis.

Hepatoprotective and in vivo antioxidant activity of Olax subscorpioidea Oliv. (Olacaceae) and Distemonathus benthamianus Baill. (Caesalpiniaceae).

Background:Liver diseases are on rise and remain a serious health problem. Olax subscorpioidea and Distemonanthus benthamianus are two plants used in Ivorian traditional medicine in the treatment of many diseases including jaundice and hepatitis.Objective:The present study was carried out to assess the hepatoprotective and in vivo antioxidant potentials of the hydro-ethanolic leaf extracts of these plants in carbon tetrachloride (CCl4)-induced hepatotoxicity in rats.Materials and Methods:The plant extracts at doses of 25 and 100 mg/kg bw, and silymarin (25 mg/kg bw) were intraperitoneally (i.p.) injected once daily for 7 days to different groups of rats. Hepatotoxicity was induced on the 7th day in all the group animals except control. Rats were sacrificed on the 8th day and blood was collected. Serum biochemical parameters and antioxidant activity were measured using standard procedures. Histopathological examinations of liver rats were also performed.Results and Discussion:Hepatotoxicity induced with CCl4 was well manifested by significant increase in serum activities of GOT, GPT, ALP and GGT, and enhancement of total bilirubin and TBARS levels. On the other hand, the level of total protein, albumin, α1-globulin significantly decreased, and DPPH-free radical scavenging activity and TAP were lowered. Pretreatment with plant extracts and silymarin prevent the toxic effects of CCl4 by decreasing serum enzyme activities, total bilirubin and TBARS levels and improving serum TAP and DPPH-free radical scavenging potential. Histopathological observations showed almost normal hepatic cells with a mild degree of inflammation, lesser fatty infiltration and absence of necrosis among the rats treated at 100 mg/kg of extracts of both the plants.Conclusion:The results suggest that the hydro-ethanolic leaf extracts of O. subscorpioidea and D. benthamianus possesses hepatoprotective and in vivo antioxidant activity.

Utility of Heart-type Fatty Acid Binding Protein as a New Biochemical Marker for the Early Diagnosis of Acute Coronary Syndrome.

Acute coronary syndrome (ACS) refers to a constellation of clinical symptoms caused by acute myocardial ischemia. Cardiovascular diseases (CVDs) are major and growing contributors to mortality and disability in India. Especially patients with non-ACS-related troponin elevations have an adverse outcome and require careful patient management. So, we look forward for another marker Heart-type Fatty Acid Binding Protein (H-FABP) that reliably detects myocardial ischemia in the absence of necrosis and would be useful for initial identification and for differentiating patients with chest pain of aetiology other than coronary ischemia. The study was done on 88 subjects of whom 34 subjects were with ischemic chest pain, 29 were with non-ischemic chest pain and 25 were normal subjects. Receiver operating characteristic (ROC) curve analysis was done which showed that area under the curve (AUC) for H-FABP was 0.885(0.79-0.94) and that of high-sensitive Troponin T (hs-TnT) in initial six hours was 0.805(0.70-0.88). The specificity of H-FABP was higher compare to hs-TnT while sensitivity was comparable during 0-6 h of presentation of chest pain. H-FABP can be used as an additional marker to hs-TnT in diagnosis of myocardial infarction (MI) and for exclusion of non-AMI (acute myocardial infarction) patients.

Hepatoprotective properties of the leaf extract of Citrullus lanatus (Thunb.) on carbon tetrachloride induced liver damage in rats

The effects of the leaf extract of Citrullus lanatus (Thunb.) on carbon tetrachloride (CCl4) induced liver damage in rats were investigated. Five groups of six male rats were used for this study. Groups A and B served as the control groups and were respectively administered with distilled water and CCl4 in olive oil while groups C, D and E were administered respectively with 500, 1,000 and 1,500 mg/kg body weight of the ethanolic leaf extract of C. lanatus for 7 days. Animals were subsequently anaesthetized, blood samples were collected for alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total bilirubin, total protein and albumin assays; liver organ was isolated and processed for histopathological studies. The results showed significant increase (p < 0.05) in the serum levels of ALT and AST both in the plasma and liver homogenate in the group treated with CCl4 while in the extract treated group, there was a decrease in the levels of the aminotransferases. Histopathological studies showed severe portal congestion and necrosis of hepatocytes in the group treated with CCl4 while the groups administered with the extract showed a moderate venous congestion with absence of necrosis. These results obtained highlight the ability of the leaf extract of C. lanatus to ameliorate and reverse damage of the liver tissues of albino rats caused by CCl4 toxicant.

Gastric schwannoma: CT findings and clinicopathologic correlation.

The purpose of this study was to evaluate the computed tomography (CT) imaging characteristics of gastric schwannoma. Eight cases of gastric schwannomas confirmed by surgery and pathology were retrospectively analyzed by CT. We reviewed the CT findings of gastric schwannomas for the following characteristics: tumor location, size, contour, margin, growth pattern, enhancement pattern, the presence or absence of necrosis, and perigastric lymph nodes. The tumors were located in the lesser curvature of gastric body (n = 5) and greater curvature of the gastric antrum (n = 3) with a median size of 4.8 cm (range 1.7-11.4 cm). Gastric schwannomas appeared as submucosal tumors with CT features of ovoid (7/8 patients), well-defined (8/8) and exophytic (4/8) or mixed (3/8) growth patterns. On dynamic CT examination, the tumors displayed homogeneous enhancement in seven cases and heterogeneous enhancement in one case. Solid parts of eight tumors demonstrated mild enhancement during the arterial phase and strengthened progressive enhancement during the venous and delayed phases. Two cases had perigastric lymph nodes. Gastric schwannomas typically manifested as ovoid, well-defined, exophytic, or mixed growth pattern masses on CT. Homogeneous progressive enhancement on dynamic CT is a characteristic finding of gastric schwannoma.

Behavior of European pear cultivars to floral bud necrosis in southern Brazil

The pear crop offers an expansive market opportunity in southern Brazil, because of suitable climatic conditions and available infrastructure. However, there are still some barriers that prevent satisfactory economic production. Floral bud necrosis (FBN) is one of the main problems afflicting pear orchards in southern Brazil. FBN is characterized by the occurrence of necrosis in the flower primordia of floral buds decreasing the crop yield potential. The objective of this work was to evaluate the behavior of European pear cultivars (Clapp's Favourite, Conference, Packham's Triumph, Rocha, Abate Fetel, Santa Maria, Decana and William's) grafted on quince rootstocks (Adams, EMA and EMC) to FBN susceptibility in two different phenological stages (vegetative dormancy and green tip) and two different edaphoclimatic regions (Fraiburgo/SC and Urupema/SC) of southern Brazil during the 2009/2010 and 2010/2011 growing seasons. Twenty floral buds at both phenological stages of vegetative dormancy and green tip were collected in 10 randomized plants per plot in each region. The floral buds were assessed by microscope following the symptomatic scale of: 1. Floral buds with absence of necrosis; 2. Floral buds with partial necrosis and, 3. Floral buds with total necrosis. The combinations Conference/Adams and Packham's Triumph/EMA and the combination Abate Fetel/Adams showed the highest severity of floral bud necrosis in both phenological stages evaluated in the region of Fraiburgo/SC and Urupema/SC, respectively. The Clapp's Favourite/EMA and Conference/EMC combinations significantly showed the lowest severity of FBN in both the phenological stages of vegetative dormancy and green tip in both regions of Fraiburgo/SC and Urupema/SC, in the edaphoclimatic conditions of southern Brazil during the 2009/2010 and 2010/2011 growing seasons.

PROGNOSTIC MARKER ANALYSIS IN PEDIATRIC POSTERIOR FOSSA EPENDYMOMAS

BACKGROUND: NELL2 expression has been shown to identify patients with posterior fossa ependymomas (PFEp) that exhibit prolonged survivals. We analyzed expression NELL2; KI-67; Tenascin C; CD34; VEGF; and CA IX as well as vascular density against post-operative survival (Progression Free and Overall Survival; PFS, OS) in 31 patients under the age of 22 years. METHODS: PFEp from patients aged 22 years or less were studied. HE KI-67; Tenascin C; CD34; VEGF; and CA IX status. RESULTS: 3 WHO Grade I, 19 Grade II and 9 Grade III PFEp were studied. Median follow-up time was 9.0 years; median survival was 6.1 years. NELL2 status correlated with PFS (Log Rank P-Value: 0.0220) and exhibited a strong trend towards prolonged OS (Log rank p = 0.0555). Peri-necrotic CAIX localization correlated with PFS (Log rank = 0.0041) and OS (Log rank p = 0.0010) All patients with a CA IX ≤ 5% total area localization were alive at last follow-up. Perinecrotic CAIX staining was also associated with CD34 density (p = .0057) though not with VEGF expression score. MIB-1 labeling index (LI) correlated with OS (p = 0.0185) and PFS (p = 0.0049). MIB-1 LI and perinecrotic CA IX individually correlated with PFS. The effect of perinecrotic CA IX remained when grade was added to a Cox model predicting PFS. There was a significant difference in the distributions of perinecrotic CA IX as stratified by NELL2 expression (Wilcoxon p = 0.0225) with NELL2 negative tumors exhibiting much stronger CA IX expression. CONCLUSIONS: Immunodetection of NELL2 expression was confirmed as a predictive biomarker for PFS in these tumors. This effect is related to the absence of necrosis, low vascular proliferation, low MIB-1 proliferation index, and the absence of CA IX expression. SECONDARY CATEGORY: Pediatrics.

Invasive lobular carcinoma co-existing with benign phylloides tumor

Phylloides tumor constitutes less than 1% of all breast tumors and 2 - 3% of fibroepithelial breast tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Here we report a case of a 60 years- old female who presented with left breast lump. Fine needle aspiration cytology was done which suggested epithelial hyperplasia with fibrocystic changes. Biopsy was performed which showed predominance of stromal hypercellularity with proliferation of spindle cells (no atypia, mitosis and stromal overgrowth were noticed). However, a focus showed proliferation of discohesive tumor cells arranged singly and in single file. A diagnosis of benign phylloides tumor with foci of invasive lobular carcinoma was made. The diagnosis was confirmed with IHC which showed intense 80%positivity for estrogen and progesterone receptor and spindle cells showing positivity for bcl-2. In situ lobular carcinoma component was not observed. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10321 Journal of Pathology of Nepal (2014) Vol. 4, 597-599

Ischemic Memory Imaging in Nonhuman Primates with Echocardiographic Molecular Imaging of Selectin Expression

Selectins are adhesion molecules that are expressed by the vascular endothelium upon activation and may be an imaging target for detecting myocardial ischemia long after resolution. The aim of this study was to test the hypothesis that molecular imaging of selectins with myocardial contrast echocardiographic (MCE) molecular imaging could be used to detect recent brief ischemia in closed-chest nonhuman primates. Myocardial ischemia was produced in anesthetized adult rhesus macaques (n = 6) by percutaneous balloon catheter occlusion of the left anterior descending or circumflex coronary artery for 5 to 10 min. Three separate macaques served as nonischemic controls. MCE perfusion imaging was performed during coronary occlusion to measure risk area and at 100 to 110 min to exclude infarction. MCE molecular imaging was performed at 30 and 90 min after reperfusion using a lipid microbubble bearing dimeric recombinant human P-selectin glycoprotein ligand-1 (MB-YSPSL). Collection of blood for safety data, electrocardiography, and echocardiography were performed at baseline and before and 10 min after each MB-YSPSL injection. Vital signs, oxygen saturation, electrocardiographic results, ventricular systolic function, pulmonary vascular resistance, and serum safety markers were unchanged by intravenous injection of MB-YSPSL. On echocardiography, left ventricular dysfunction in the risk area had resolved by 30 min, and there was no evidence of infarction on MCE perfusion imaging. On selectin-targeted MCE molecular imaging, signal enhancement was greater (P < .05) in the risk area than remote territory at 30 min (25 ± 11 vs 11 ± 4 IU) and 90 min (13 ± 3 vs 3 ± 2 IU) after ischemia. There was no enhancement (<1 IU) in control nonischemic subjects. In primates, MCE molecular imaging of selectins using MB-YSPSL, a recombinant ligand appropriate for humans, is both safe and effective for imaging recent myocardial ischemia. This technique may be useful for detecting recent ischemia in patients with chest pain even in the absence of necrosis.

Oncocytic adrenocortical neoplasm arising from adrenal rest in the broad ligament of the uterus.

Oncocytic adrenocortical neoplasm is characterized by abundant eosinophilic cytoplasm containing mitochondria, occasional nuclear atypia and diffuse growth pattern. Oncocytic adrenocortical neoplasm arising in adrenal rest is, however, extremely rare. We report a case of oncocytic adrenocortical neoplasm arising in adrenal rest of the broad ligament with associated marked lipomatous metaplasia. A well circumscribed tumor was accidentally detected in the pelvic cavity of a 29 year old Japanese woman, adjacent to the broad ligament of the uterus. The tumor was composed of large eosinophilic cells associated with diffuse growth pattern and abundant mature adipose tissue admixed with foci of clear cells. Both steroidgenic factor 1 (SF-1) and alpha-inhibin were immunohistochemically positive in tumor cells. Abundant mitochondria detected by immunohistochemical and electron microscopic examination confirmed the diagnosis of oncocytic adrenocortical neoplasm. The absence of necrosis, capsular and vascular invasion as well as the low mitotic index indicated the benign potential of this tumor. The tumor cells were also positive for dehydroepiandrosteron-sulfotransferase (DHEA-ST), 17β-hydroxysteroid dehydrogenase type 5 (17β-HSD5), 3β-hydroxysteroid dehydrogenase (3β-HSD) and steroid 17α-hydroxylase (P450-c17), suggesting a possible production of testosterone of this tumor. This is the first reported case of oncocytic adrenocortical adenoma arising in adrenal rest of the broad ligament.

Unicystic variant of low grade mucoepidermoid carcinoma: A rare case report

The most common malignant neoplasm of salivary gland origin is mucoepidermoid carcinoma (MEC), and it comprises of about 5-10% of all salivary gland neoplasm. It is mostly seen in major salivary glands (54%) and two third of them occurs in the parotid gland, and 46% is seen in minor salivary glands. Histo-morphological complexity of MEC has a constellation of varying amount of epidermoid cells, goblet cells, intermediate cells and mucocytes. It is graded histopathologically based on the relative proportion of cell type, cystic spaces, degree of tumor invasion, anaplasia, mitotic rates and presence or absence of necrosis into low-grade, Intermediate grade and high-grade. In the literature, several variants of MEC such as conventional, clear cell, warthin-like, sclerosing and unicystic variant have been reported. The aim of the current case report is to present a low-grade variant of unicystic MEC which is rare, but a distinctive tumor affecting the salivary gland. Till date, to the best of our knowledge only one case has been reported.

Differentiation of Gastric True Leiomyoma From Gastric Stromal Tumor Based on Biphasic Contrast-Enhanced Computed Tomographic Findings

The objective of this study was to identify the computed tomographic criteria that differentiate gastric true leiomyoma from gastric stromal tumor. Computed tomographic images of gastric true leiomyoma (n = 11) and gastric stromal tumor (n=30) were reviewed. The location, contour, growth pattern, enhancement pattern, necrosis, and ulceration were analyzed. Long diameter (LD), short diameter (SD), LD/SD ratio, and enhancement degree were measured and calculated. The Fisher exact test, grouped t test, rank sum test, and receiver operating characteristic curve were analyzed. Sensitivity and specificity were also calculated. Cardial location, round/ovoid contour, intraluminal growth, homogeneous enhancement, absence of necrosis, less than 3.35 cm in LD and less than 2.3 cm in SD, enhancement degree of less than 12.5 Hounsfield units in the arterial phase versus less than 31.5 Hounsfield units in the portal venous phase were found to be significant variables for differentiating gastric true leiomyoma from gastric stromal tumor (P < 0.05). These 9 computed tomographic criteria are helpful to differentiate gastric true leiomyoma from gastric stromal tumor.

Cystic renal oncocytoma and tubulocystic renal cell carcinoma: morphologic and immunohistochemical comparative study

Renal oncocytoma (RO) may present with a tubulo-cystic growth pattern in 3–7% of cases. In such cases its morphology may significantly overlap with tubulocystic renal cell carcinoma (TCRCC). We compared the morphological and immunohistochemical characteristics of these tumors aiming to clarify the differential diagnostic criteria and facilitating their discrimination. Twenty-four cystic RO (CRO) and 17 TCRCC were selected and analyzed for architectural pattern, stromal features, cytological criteria, necrosis, nuclear grade and mitotic activity. Immunohistochemical panel including various cytokeratins, vimentin, CD10, AMACR, antimitochondrial antigen (MIA), EMA and Ki-67. The islands of tumor cells, myxoid stroma, lower nuclear grade, absence of necrosis and mitotic figures were strongly suggestive of diagnosis of CRO while the absence of islands of tumor cells, fibrotic stroma, higher nuclear grade and presence of necrosis and mitoses were strongly suggestive of TCRCC. Immunohistochemical analysis of vimentin, CK7, CD10, AMACR and Ki-67 may discriminate between CRO and TCRCC. Islands of tumor cells and type of stroma may be major morphologic criteria for differentiating between CRO and TCRCC. In difficult cases, or cases when limited specimen availability precludes the assessment of morphologic criteria, immunohistochemical markers such as vimentin, CK7, CD10, AMACR and CK7 could lead to correct diagnosis.

Correlation between PARP-1 immunoreactivity and cytomorphological features of parthanatos, a specific cellular death in breast cancer cells

In parthanatos, a PARP-1 (poly (ADP-ribose) polymerase 1)-mediated cell death, dissipation of mitochondrial membrane potential, large-scale DNA fragmentation and chromatin condensation were observed. In contrast to apoptosis, it does not cause apoptotic bodies formation. Although PARP-1-mediated cell death presents loss of membrane integrity similar to necrosis, it does not induce cell swelling. The purpose of the study was to correlate the immunohistochemical parameters of PARP-1 reactivity and the selected cytomorphological features of parthanatos: the lack of apoptotic bodies and the absence of necrosis in breast cancer (BC) specimens. Immunohistochemistry for PARP-1 was performed on 83 BC specimens. Correlations between parameters of PARP-1 expression and sub-cellular localisation and the presence of apoptotic bodies and necrosis were evaluated. High expression of PARP-1 (immunoreactive score ≥6) was associated with the lack of apoptotic bodies (P=0.013) and with the absence of necrosis (P=0.002). The presence of apoptotic bodies was correlated with re-distribution of PARP-1 from the nucleus to cytoplasm in BC cells (P=0.029). Additionally, a tendency was observed between necrosis and loss of nuclear PARP-1 expression (P=0.049). Our study suggests that PARP-1 may play a crucial role in induction and regulation of specific type of cellular death called parthanatos.

Portosplenomesenteric Venous Thrombosis in Patients With Acute Pancreatitis Is Associated With Pancreatic Necrosis and Usually Has a Benign Course

Although there are some data on prevalence of portosplenomesenteric venous thrombosis (PSMVT) in patients with acute pancreatitis (AP), the progression of PSMVT in patients who have and have not received anticoagulants has not been studied systematically. We evaluated the prevalence and natural history of PSMVT in a well-defined cohort of individuals with AP. In a retrospective study, we analyzed data from the University of Pittsburgh Medical Center on 162 patients with a sentinel attack of AP from 2003-2010. Data were collected on patient demographics, clinical presentation, etiology, clinical course, and outcomes. One hundred twenty-two patients underwent contrast-enhanced computed tomography; the scans were reviewed to identify thromboses and/or narrowing of splanchnic veins (splenic, superior mesenteric, and portal). PSMVT was detected in 22 patients overall (14%; 18% among patients who underwent contrast-enhanced computed tomography). Median time to detection of PSMVT was 17 days (interquartile range, 11-40 days). PSMVT formed most frequently in the splenic vein (19 of 22, 86%), followed by portal (8 of 22, 36%) and superior mesenteric (6/22, 27%) veins. Development of PSMVT was associated with presence (21 of 22, 95%), location, and extent of pancreatic necrosis. Fifty-three percent of patients (21 of 40) with necrosis developed PSMVT. Anticoagulants were administered infrequently (6 of 22, 27%) and always for indications unrelated to PSMVT. Most patients with PSMVT developed collateral veins (19 of 22, 86%), and 27% (6 of 22) were found to have varices during endoscopic evaluation, but clot resolution was infrequent (2 of 22, 9%). No patient developed complications directly related to PSMVT. PSMVT develops in about half of patients with necrotizing AP and is rare in the absence of necrosis. Despite infrequent administration of anticoagulants, complications directly related to PSMVT are rare.