Anatomopathological Diagnosis Research Articles

Partial hydatidiform mole diagnosis in a cat: a case report

A case of a stillborn Norwegian Forest kitten characterised in the course of anatomopathological and genetic examination is reported. The hydatidiform mole was diagnosed by delayed development, low birth weight of the kitten and abnormal placental development. Anatomopathological diagnosis was confirmed in genetic tests based on the amplification of highly heterozygous microsatellite sequences located on the X (FCA311) and autosomal chromosomes (FCA506, FCA532 and FCA178), as well as the sex-specific Sry and amelogenin (Amel) genes. The presence of two microsatellite alleles of paternal origin and one allele of maternal origin was observed in all analysed tissues (kidney, liver, brain, heart and spleen) of the stillborn kitten. The kitten's sex was diagnosed by the presence of the paternal Sry gene, and maternal and paternal products of Amel, as well as one maternal and one paternal X chromosome FCA311 microsatellite allele. The results thus confirmed that the haploid egg was fertilised by two sperm, yielding a triploid karyotype. In summary, the successful application of genetic markers in postnatal diagnosis of this condition in the cat confirms considerable usefulness of these techniques, especially in cases where cytogenetic diagnosis is insufficient or impossible.

LYMPHOME GASTRIQUE DU MALT

It is the most frequent location of the primary digestive tract lymphoma , originally from the lymphoid tissue of the digestive tract or MALT. We distinguishe two types: the marginal zone lymphoma of malt and diffuse large B cell lymphoma .The clinical symptoms are not specific and the diagnosis depend on the biopsy results. The disease staging is systematic looking for remote associated nodal or visceral involvement. The role of the Helicobacter pylori recently implied in the genesis of these malignant lymphomas reopened all the debates including the therapeutic. The discovery in the latter years of anatomopathological, immunohistochemical and molecular diagnosis tools and also new efficient therapeutic strategies contributed to improve the prognosis. The treatment is based on the helicobacter pylori eradication. The marginal zone lymphoma treatment is consensual and well codified, chemotherapy and /or radiotherapy can be proposed if no improvement. For the diffuse large B cell lymphoma the chemotherapy is the standard treatment associated or not with surgery or radiotherapy. The addition of the CD 20 antibody can improve the results.

Tumoraciones mesenquimales de músculo liso uterino de potencial incierto: revisión anatomopatológica y pronóstica de un caso clínico

Uterine smooth-muscle tumours with unusual growth patterns represent an histologically heterogeneous and uncommon group of uterine smooth-muscle tumours that cannot be diagnosed as either benign or malignant.We report the case of a 27year-old woman who consulted for a 6-month history of bladder fullness sensation, abdominal distension and polaquiuria. Transvaginal ultrasound showed a 9cm intramural mass at the uterine fundus that was surgically excised. The anatomopathological diagnosis of uterine smooth-muscle tumour with growth pattern, epithelioid variant, was reported. ConclusionsThe diagnosis of uterine smooth-muscle tumours may create great challenges for the pathologist who classifies these tumours by their histological features. The immunohistochemical staining may be helpful to establish their behaviour and prognosis. The clinical management remains a dilema and surgical treatment of choice has not been well defined, due to their uncertain clinical behaviour. Most of these tumours have a benign clinical course but these patients should receive long-term follow-up.

Clinical case of Botryomycome fulminant at the Center of Diagnostic and Treatment of Tuberculosis of Baleng (West - Cameroon)

Botryomycome also called pyogenic granuloma, is an inflammatory tumor of the skin and mucous membranes often caused by superinfection of minor traumatism. Its uniqueness lies in its granulomatous organization in which each granulation contains bacteria and the predominance of many newly formed blood vessels, with the lights on variables ratings and a turgid endothelium responsible for the ulcero-hemorragic appearance. This delicate condition poses a real problem of treatment which included: an appropriate antibiotherapy, surgical removal or electrocoagulation which, until today is more difficult in countries with limited income. An octagenarian came to our hospital with a large mass on the left foot. This mass had the appearance of a malignant tumor. However, the anatomopathologic diagnosis showed that it was a pyogenic granuloma. The importance of the mass, its location on the sole of the foot, imposed the functional impairment of this member. Electrocoagulation is not available in our hospital and the surgical excision proposed was refused by the patient. The patient was treated with the antibiotics Ceftriaxone and Gentalline at indicated doses for 15 days. After the failure of that antibiotherapy treatment, as a last resort, the patient was treated for a month with another combination of antibiotics (free of cost) made of dapsone and rifampicin. This new combination gave very good results. This example shows dapsone and rifampicin can be use as a new weapon for the management of pyogenic granuloma in countries with limited incomes.

False positive results using calcitonin as a screening method for medullary thyroid carcinoma

The role of serum calcitonin as part of the evaluation of thyroid nodules has been widely discussed in literature. However there still is no consensus of measurement of calcitonin in the initial evaluation of a patient with thyroid nodule. Problems concerning cost-benefit, lab methods, false positive and low prevalence of medullary thyroid carcinoma (MTC) are factors that limit this approach. We have illustrated two cases where serum calcitonin was used in the evaluation of thyroid nodule and rates proved to be high. A stimulation test was performed, using calcium as secretagogue, and calcitonin hyper-stimulation was confirmed, but anatomopathologic examination did not evidence medullar neoplasia. Anatomopathologic diagnosis detected Hashimoto thyroiditis in one case and adenomatous goiter plus an occult papillary thyroid carcinoma in the other one. Recommendation for routine use of serum calcitonin in the initial diagnostic evaluation of a thyroid nodule, followed by a confirming stimulation test if basal serum calcitonin is showed to be high, is the most currently recommended approach, but questions concerning cost-benefit and possibility of diagnosis error make the validity of this recommendation discussible.

Cementoblastoma: A case report in deciduous tooth

The benign cementoblastoma is an odontogenic tumor originated from neoplastic cementoblasts, a rare lesion mainly associated to impacted and deciduous teeth. It affects mostly young people with an average age of 20years old, and its preferred location is in the posterior region of the mandible; the lesion will present itself fused both radiologically and microscopically to a root of an erupted permanent tooth, and the anatomopathological diagnosis is obtained through the analysis of the piece sent together with the involved dental element. The present study presents a case of cementoblastoma in the mandible involving the second deciduous molar tooth and preventing the eruption of the premolar tooth in a girl aged 11years old. This report discusses relevant aspects concerning clinical, radiographic, and histopathological characteristics and treatments.

MMP‐8 polymorphism is genetic marker to tendinopathy primary posterior tibial tendon

Posterior tibial tendon is particularly vulnerable and is responsible for much morbidity in sportspersons. Some patients have a predisposition without a clinically recognized cause, suggesting that individual characteristics, inclusive genetic inheritance, play an important role in tendinopathy. Matrix metalloproteinase (MMP)-8 is a proteinase capable of degrading a large amount of extracellular proteins, and influence degradation and remodeling of collagen. To determine whether the -799 polymorphism in the promoter of MMP-8 gene is associated with tendinopathy in posterior tibial tendon, 50 patients undergoing surgical procedures and anatomopathological diagnosis of degenerative lesions of the posterior tibial tendon and 100 control patients with posterior tibial tendon integrity and without signs of degeneration in magnetic resonance imaging were evaluated for the -799 MMP-8 polymorphism. There was a significant difference in the presence of the different alleles (P = 0.001) and genotype (P = 0.003) between the control group and the test group for the MMP-8 gene. The polymorphism at position -799 of the gene for MMP-8 is associated with tendinopathy primary posterior tibial tendon in the population studied. The results suggest that individuals with the T allele are at greater risk of developing tendinopathy.

Upper gastrointestinal bleeding due to gastric and duodenal Kaposi's sarcoma

A 30-year-old homosexual male was recently diagnosed with HIV infection (category A2). He was been admitted into the hospital because of anal pain and diarrhea of 8 months. He presented purplish cutaneous lesions, laterocervical adenopathies and a palpable anal mass. The rest of physical exploration did not reveal any other significant alteration. The amount of CD4 was 350 cells/mL and the viral load of 10,000 copies/mL. Fecal cultures were negative. A colonoscopy was performed and detected an ulcerated rectal mass that was biopsied (Fig. 1). He presented an episode of hematemesis so it was performed an upper endoscopy which demonstrated the presence of lesions suggestive of Kaposi’s in the stomach (Fig. 2) and duodenum (Fig. 3). The definitive anatomopathologic diagnosis of the cutaneous anal lesion, gastric biopsy and adenopathies was Kaposi’s sarcoma. The patient began antiretroviral treatment and chemotherapy with liposomal doxorubicin and radiotherapy. Upper gastrointestinal bleeding due to gastric and duodenal kaposi’s sarcoma

Pseudotumor fibroso do cordão espermático: relato de uma lesão infrequente

Os pseudotumores fibrosos sao lesoes incomuns que ocorrem geralmente em resposta a cirurgia, trauma, infeccao ou inflamacao. Relatamos um caso de paciente com 25 anos de idade que apresentou massa escrotal indolor. Realizou-se orquiectomia radical. O diagnostico anatomopatologico foi de pseudotumor fibroso do cordao espermatico.

Bovine Viral Diarrhea (BVD) in a European Bison (Bison Bonasus) - Anatomopathological Findings and Diagnosis

Bovine Viral Diarrhea (BVD) in a European Bison (Bison Bonasus) - Anatomopathological Findings and Diagnosis

Early diagnosis and treatment of renal cell carcinoma of native kidney in kidney transplantation.

The frecuency of malignancies in renal transplant (RT) patients is increasing. Renal cell carcinoma (RCC) of native kidneys is one of the most frequent and its outcome can be more aggressive than in general population. To evaluate the incidence and prognosis of RCC in renal transplant patients followed in our transplantation unit. Between January 1997 and December 2009, 683 patients underwent kidney transplant at our hospital. Ultrasonography of the native kidneys was annually performed in all renal transplant patients. When suspect solid masses were found at ultrasonography, patients underwent computed tomography. If the suspicion was confirmed, nephrectomy was performed. 14 radical nephrectomies were performed in 12 patients due to suspect CCR. In 11 nephrectomies (corresponding to 9 patients), anatomopathologic diagnosis was CCR (incidence 1.5%). Histologic stage was T1N0M0 in all cases. In the other 3 RT, the diagnosis was complicated renal cyst. Those patients without carcinoma had polycystic kidney disease. The time on dialysis before CCR diagnosis was 36.7 ± 24.3 months and the interval between RT and diagnosis was 39 ± 25.8 months. After a mean follow-up of 58.6 ± 38.6 months, the outcome of all cases has been excellent, without tumor recurrence. Annual renal ultrasonography plays a key role in the early diagnosis of CRR. The early treatment of this pathology is associated with an excellent prognosis in RT patients.

Abstract P6-02-03: The Use of Charcoal Suspension Labeling as an Adjunct in the Detection of Non-Palpable Breast Lesions

Abstract Introduction and Objectives: Inert charcoal suspension is used as a tissue marker, which provides innumerous advantages over other labeling methods and techniques, such as dyes and metallic needles. In addition, the use of charcoal does not present problems with regards to its diffusion, labeling the trajectory from the lesion to the skin, being easily identified by both the surgeon and pathologist. The occurrence of morphological alterations due to the use of charcoal is very rare. In contrast, there are still doubts and questions concerning the interference of charcoal labeling with regards to the anatomopathological diagnosis accuracy. The main objectives in this study are to analyze the efficiency of labeling impalpable breast lesions with inert charcoal suspension; to evaluate the morphological alterations associated with its use and to determine whether the use of charcoal labeling hampers with the diagnostic interpretation of the pathologist. Materials and Methods: The study evaluated a total of 135 cases of impalpable breast lesions, previously labeled with charcoal suspension. Histological H/E stained slides containing charcoal pigments were analyzed using optical microscopy, by which both quantitative and qualitative evaluations with regards to inflammatory response and interference in diagnosis were performed. Lymphocyte, giant cells and neutrophils were evaluated and quantified. Moreover, the distribution of the charcoal suspension present in the lesions was evaluated. Results: As to the quantitative and qualitative evaluation of the inflammatory response caused by the use of charcoal labeling, it was observed that granulomas were present in all samples, regardless of the quantity of injected charcoal. Lymphocytic inflammatory response was absent in 5.19% of the samples only, were 82.22% demonstrated discrete intensity and 12.59% was moderate. With regards to acute inflammatory response, 42.96% showed total absence of neutrophilic exudate, were as 42.22% demonstrated discrete and 11.11% moderate, and only 3.7% of cases were intense. Conclusion: This study corroborates the utility and easiness of the charcoal method as a means of efficient labeling of impalpable breast lesions. In addition, this technique is easy to use, has a low cost, high efficiency and does not interfere with the histological analysis. Moreover, it is comfortable for the patient and is of great help in finding and localizing the lesions to both the surgeon and pathologist. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-02-03.

Pulmonary artery sarcoma: a rare cause of dyspnoea

A 72-year-old woman with no significant medical history presented to the emergency room for severe dyspnoea. The initial clinical diagnosis was acute pulmonary embolism. Heparin infusion was initiated while awaiting a computed tomographic scan but the patient's condition deteriorated dramatically and stat echocardiogram showed tamponade. Post-evacuation echo showed a dilated right ventricle with pulmonary hypertension and obstruction of the right pulmonary artery by a homogeneous mass attached to the pulmonary artery, suggesting a tumour rather than a thrombus. Computed tomographic scan confirmed the presence of an obstructive mass with almost no perfusion of the right lung. The patient was referred to cardiac surgery and the mass was removed, with anatomo-pathological diagnosis of a typical pulmonary artery sarcoma. Unfortunately, the patient died a few days after surgery. Primary pulmonary artery sarcoma is a rare tumour that arises in the central pulmonary arteries. Clinical presentation is often attributed to other causes of pulmonary hypertension, like pulmonary embolism. Magnetic resonance imaging could help to distinguish a soft tissue mass from a thrombus but definitive diagnosis is almost always made at surgery or autopsy since patients usually present in acute and unstable situations. Prognosis is poor, from several months to a few years, and depends on how early the diagnosis is made, the presence of recurrence or metastasis after surgical resection, and the use of adjuvant therapy like radiation and chemotherapy.

Placenta increta causing hemoperitoneum in the 26th week of pregnancy: a case report

IntroductionPlacenta increta is a serious complication of pregnancy. We describe a case leading to uterine rupture associated with massive intra-abdominal hemorrhage.Case presentationA 34-year-old Caucasian Albanian woman, gravida 2, para 1, was admitted to the emergency department of our hospital for acute abdominal pain associated with profound secondary anemia. An anatomopathological diagnosis of placenta increta destruens was made. An urgent hysterectomy was performed after resuscitation procedures, applied due to the severe anemia and the abdominal drama accompanying the case. Intra-operatively, a uterus-saving procedure was found to be impossible, and hysterectomy remained the only surgical option. The uterine structures were sent for further microscopic evaluation. On histological examination, deep trophoblastic infiltration of the uterine wall was observed, justifying the surgeon's decision. Our patient received blood transfusions and antibiotics. Her sutures were removed on the eighth postoperative day and she was discharged the following day in a stable condition.ConclusionThis case, describing a patient with uterine rupture and massive hemorrhage, illustrates a serious and potentially fatal complication of placenta previa. In such cases, surgery is essential, and hysterectomy may be the only viable option.

Minor surgery activity in primary care.

ObjectiveThe aim of this study was to describe the activity in our Outpatient Minor Surgery unit during its first five-year period.DesignRetrospective descriptive study.MethodsIt was carried out in two centres of a Basic Health Area with a catchment area of 73,000 inhabitants.ParticipantsPatients who underwent surgery from January 2002 to December 2007 were included in the research.Main outcome measuresInformation on the sociodemographic data of the patients, characteristics of the lesions, risk factors, treatment and its complications was gathered.ResultsA total of 2317 surgical procedures was performed on 1520 patients. The mean was 46 years old and 52% were men. The concordance between clinical and anatomopathological diagnosis was 81%. There were complications in 5% of them. The main pathologies were: epidermoid cysts (22%), nevus (20%) and fibromas (18%). They were mainly located in the back (24%), superior extremities (14%) and head (11%). In 73% mepivicaine was used as anaesthetic. The most current techniques used were: incision (36%), curettage (33%) and fusiform excision (28%). Less than 1% had malignant lesions, 50% of which were not diagnosed clinically. The mean waiting time was 30 days. Ninety-two percent had the informed consent.ConclusionsMinor surgery in primary care is feasible and has a good clinicopathological concordance and minimum complications, but some malignant lesions are overlooked in the diagnosis based exclusively on clinical criteria.

Caracterización clínico-patológica de la dermatitis vesicular subepidérmica en el hospital Hermanos Ameijeiras, 2004–2008

Background The subepidermical vesicular dermatitis (SVD) is a morphological pattern of reaction due to inflammatory skin diseases, characterized by the separation of dermoepidermical junction, by immune nature or not. Patients and methods We made an observational, descriptive and retrospective study of skin biopsys prescribed by Pathological Anatomy Service of "Hermanos Ameijeiras" hospital, that informed the morphological pattern of SVD. The research was directed in the period of January 1st, 2004 to March 31st, 2008, and it involved the Dermatology and Pathological Anatomy Service of that center. The objectives were to know the frequency of this pattern in relation to the skin biopsys that were taken, to identify the diseases into the pattern and their frequency of presentation, as well as to stablish the correspondence between the clinical diagnosis and anatomopathological diagnosis. The study universe was conformed by the totality of skin biopsys by inclusion in parafine, those were received in the center in that period, they were 6620, and the sample was 50 biopsys. We applied the statistic method of Kappa coefficient to measure the relation between interest variables. Results We detected a low frequency presentation of morphological pattern of SVD, it was 0.8%. We found many diseases into this pattern, the most representative was pemphigoids group, it constituted a 24% of the total. It had a good clinical-anatomopathological correspondence in 68% of the cases. Comment A good clinical-anatomopathological correspondence in these diseases is indispensable to reach an accurate and appropriate final diagnosis.

Histopathologic characterization of lesios in rheumatic valvulopathy

Cardiac valvulopathies may be caused by acquired or congenital diseases and result in valvular stenosis and/or insufficiency. For a correct diagnostic evaluation of cardianc valves, and in particular of rheumatic valvulopathy, pathologists should know the patient's clinical history, the degree of insufficiency and/or stenosis and echographiacal data. Histopathologic features of rheumatic valvulopathy include precocious, tardy and terminal lesions. Rheumatic valvulopathy may produce mitral insufficiency. Mitral valve incompetence has been calssified into three types by echography (Carpentier, 1980). 56 cases of valvular samples have been examinated at our institution from January 2004 to January 2008. Any case was processed according to diagnostic/opeartive protocol we prepared carefully: gross examination, photographic documentation, sampling, standard stains and histochemical special stains. On the basis of the operative diagnostic protocol, histopathologic diagnosis of rheumatic valvulopathy was effected in three cases. Special methods of histochemistry, in addition to hematoxylin and eosin, are fundamental for the differential diagnosis of valvulopathies. Histopathologic diagnosis of rheumatic valvulopathy is complex and requests several histomorphologic data: our operative diagnostic protocol is extremely useful to reach an anatomo-pathologic diagnosis of surgical sample, which constitutes an essential element to confirm preoperative clinical-echographic diagnosis.

Detection of Mycobacterium avium in pet birds

The present study is a report on the presence of Mycobacterium avium in four birds of the psittaciform order kept as pets. Anatomopathological diagnosis showed lesions suggestive of the agent and presence of alcohol-acid resistant bacilli (AARB) shown by the Ziehl-Neelsen staining. The identification of Mycobacterium avium was performed by means of PRA (PCR Restriction Analysis). DNA was directly extracted from tissue of the lesions and blocked in paraffin. The role of this agent in pet bird infection is discussed, as well as its zoonotic potential.

Análises histopatológica e morfométrica no diagnóstico da "nova" displasia broncopulmonar e comparação clinicopatológica com a forma clássica da doença

INTRODUÇÃO: A displasia broncopulmonar (DBP) continua sendo a principal complicação nos recém-nascidos (RN) prematuros. Com o uso de surfactante exógeno e da prevenção de doenças respiratórias no período neonatal a incidência de DBP clássica vem diminuindo, porém uma nova forma de DBP tem surgido, mais branda e associada aos desenvolvimentos pulmonar alveolar e vascular incompletos. Do ponto de vista anatomopatológico a DBP clássica é caracterizada por processos de lesão e reparação, e os achados da "nova" DBP são de hipoplasia alveolar com nenhuma fibrose. OBJETIVOS: Demonstrar as alterações histopatológicas e morfométricas em pulmões de prematuros que foram a óbito, com quadro clínico compatível com "nova" DBP, comparando-as com um grupo controle (sem DBP) e com a forma clássica da doença, além de correlacionar os três grupos com o tempo de uso de oxigênio entre outros fatores de risco da DBP. MATERIAL E MÉTODOS: A população foi composta por 59 amostras de pulmões de prematuros com idade gestacional (IG) menor que 34 semanas e submetidos à oxigenioterapia. Fatores de risco para DBP foram coletados por meio da revisão de prontuários. Amostras pulmonares foram separadas em dois grupos, o com DBP clássica e o sem DBP clássica. O segundo grupo foi então submetido à análise morfométrica para contagem do número de alvéolos, medidas as áreas e os perímetros dos alvéolos. Após esta análise a população estudada ficou dividida em grupo com DBP clássica; com "nova" DBP (casos com mais de sete dias de oxigenioterapia); e grupo controle ou sem DBP clássica ou "nova" (casos com menos de sete dias de oxigenioterapia). RESULTADOS: o primeiro grupo apresentava inflamação e fibrose septal evidentes. Já os segundo e terceiro grupos apresentavam alterações histopatológicas mínimas, sendo então necessária a análise morfométrica para separá-los. O grupo com "nova" DBP apresentou número de alvéolos, sua área e perímetro diminuídos (p < 0,005) quando comparados ao grupo controle. Não houve diferença estatisticamente significativa entre os três grupos com relação aos fatores de risco para desenvolvimento de DBP. CONCLUSÃO: As formas de DBP clássica e "nova" são de etiologia multifatorial, porém distintas entre si. Para diagnóstico anatomopatológico da "nova" DBP pode ser necessária a análise morfométrica. As alterações histopatológias e morfométricas deste estudo antecederam a necessidade de oxigenioterapia por mais de 28 dias. Portanto, instituir terapêutica para DBP antes do 28º dia de vida em RN prematuro em oxigenioterapia estaria justificado pelos nossos achados histopatológicos e morfométricos.

Carcinoma mucoepidermoide da traqueia mimetizando asma brônquica

In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.