Careful Histopathological Examination Research Articles

RESPONSE: re: evaluating gastric cancer misclassification: a potential explanation for the rise in cardia cancer incidence

Increased incidence of adenocarcinoma of the gastric cardia has been reported over the last few decades from several areas of North America and Europe (1–2). A mortality study from the Swedish Cancer Registry, however, suggested that the observed upward trends can be, partly or largely, accounted for by changed accuracy of registration within gastric subsites (3). We considered, therefore, trends in incidence rates for various gastric subsites in the Cancer Registry of the Swiss Canton of Vaud (covering approximately 600 000 inhabitants in 1990 from the French-speaking part of Switzerland) over the period from 1976 through 1997. In this area, uniform criteria of classification have been adopted, and traditional attention has been focused on careful endoscopic and histopathologic examination of gastric lesions (4–6). Table 1 gives average age-adjusted (on the world standard population) incidence rates for various subsites of gastric cancer during three separate calendar periods. In both sexes, no appreciable change in incidence of adenocarcinoma of the gastric cardia was observed (3.1 cases per 100 000 males, and 0.5 cases per 100 000 females from 1976 through 1979 versus 3.2 and 0.1, respectively, from 1995 through 1997), while appreciable downward trends were observed for distal and other or unspecified gastric cancer sites. These data, from a carefully surveyed European population, therefore do not support the existence of a systematic and major rise in incidence of cardiac adenocarcinomas (3,7), confirming that—in proportional terms—the cancers of the gastric cardia have become

Tumors of the pilosebaceous unit.

Appendage tumors of the pilosebaceous apparatus are relatively rare, and their clinical aspect is usually nonspecific. In most cases pilosebaceous tumors are benign; however, malignant neoplasias (e.g. trichilemmal carcinoma, malignant pilomatricoma) have been described. In the present review we propose the classification of pilosebaceous tumors by degree and by direction of differentiation and by histological configuration. Three different histological patterns have to be distinguished: tumors with central dilated hair follicle, tumors consisting of epithelial islands and keratotic cysts in the corium and neoplasias with predominantly mesenchymal components surrounding epithelial formations. Careful histopathological examination of pilar appendage tumors will help to classify the wide range of clinically and histologically different tumors and to establish the exact diagnosis.

Inverted Papilloma of the Nose and Paranasal Sinuses in Children

Inverted papillomas are rare nasal and sinus neoplasms in children. The disturbing biological characteristics of these tumors seen in adults, including malignant degeneration and the high frequency of recurrence, have been similarly observed in the pediatric population. Therefore, inverted papilloma in children mandates similar treatment to that proven effective in adults, including wide excision and careful histopathological examination of any tissue excised. Radiation therapy should be reserved for those tumors associated with carcinoma. Since recurrences can occur after long periods of time, life-long follow-up is warranted.

The role of the pathologist in diagnosis and surgical decision making in hyperparathyroidism

Hyperparathyroidism has been diagnosed with increasing frequency in recent decades. The concomitant awareness that the disease may be the cause of a concealed morbidity and even an increased mortality has resulted in more liberal indications for surgery. Many patients currently undergo surgery on the grounds of only mild hypercalcemia and in the absence of any apparent clinical symptoms. This policy of early surgical treatment has emphasized the importance of a histopathological parathyroid diagnosis, since many of these patients exhibit chief cell hyperplasia and minimal glandular enlargement. Light microscopic examination of frozen sections stained with hematoxylin-eosin and with stains for demonstration of cytoplasmic fat in the parathyroid chief cells, and appropriate weight estimates of the parathyroid glands, constitute the conventional, intra-operative basis for the diagnosis. The use of specific antiparathyroid antibodies is an important new tool in the histopathological parathyroid examination, mainly because of the ability to demonstrate the cause of increased parathyroid hormone release from the pathological parathyroid tissue. A careful histopathological examination in combination with gross inspection of the parathyroid glands by an experienced eye should contribute to adequate surgical treatment and minimize errors in operative management in patients with hyperparathyroidism.

Invasive Aspergillus Infections Complicating Coronary Artery Bypass Grafting

Endovascular infection with Aspergillus species results in unacceptably high mortality of greater than 80% in most series. Failure to recognize the infection early during its clinical course contributes to its formidable lethality. Blood cultures almost never reveal organisms, as in our Cases 1 and 2. When considering a patient with fever, changing murmur, major systemic emboli, or splenomegaly, and with blood cultures negative for organisms months or even years after cardiac surgery, therefore, the physician should maintain a high index of suspicion for fungal endocarditis. The best opportunity to establish the diagnosis antemortem rests in careful histopathologic and microbiologic examination of infected emboli and vegetations. Most authors agree that a combined approach employing early valve replacement and aggressive antifungal chemotherapy with amphotericin B and perhaps flucytosine or rifampin represents the best option for treatment of endovascular Aspergillus infections.

Histologic changes induced by intraperitoneal chemotherapy with 5-fluorouracil and mitomycin c in patients with peritoneal carcinomatosis from cystadenocarcinoma of the colon or appendix

Intraperitoneal chemotherapy with mitomycin C and 5-fluorouracil has been used to rescue patients from peritoneal carcinomatosis after perforated cystadenocarcinoma of the large bowel or appendix. A staging celiotomy was used to asses the results of therapy. In nine patients tumor was recovered from the abdominal cavity and was subjected to careful histopathologic examination. The posttreatment appearance of the tumor was compared with that before treatment. Also, tumor deposits harvested from these same patients, but from anatomic sites not directly exposed to chemotherapy were examined. The most striking findings observed in treated patients were as follows: (1) the marked reduction in the number of foci of atypical neoplastic epithelium lining the mucin globules, and (2) atrophy and degeneration of the atypical neoplastic epithelium. All treated patients showed these effects but they were not in all sampled tumor specimens, suggesting nonuniform drug distribution in the abdominal cavity and limited penetration of chemotherapy into tumor. The authors conclude that intraperitoneal chemotherapy produces marked histologic changes in mucinous tumors when there is direct contact between tumor and intracavitary drugs.

Biliary Atresia

Biliary atresia is a pathologic entity in which there is obliteration of some portion of the extrahepatic bile ducts. In the past, occlusion of the proximal ducts (at the liver hilus) was referred to as "noncorrectable" (Fig 1). If only the distal duct is occluded (and the proximal duct is patent), the lesion was referred to as "correctable." The distinction is academic because current treatment and prognosis are identical. The disease is panductular, ie, both extrahepatic and intrahepatic ducts are involved. Early in the disease, however, occlusion is complete only in the extrahepatic system. Without intervention, intrahepatic biliary obstruction and, subsequently, cirrhosis supervene. In the past, except for a few cases of the correctable variant, surgical procedures were unsuccessful until Morio Kasai performed a hepatic portoenterostomy, which was first reported in English in 1968. Bile flow was effectively reestablished in both correctable and noncorrectable forms of biliary atresia. The operation was only successful when done before the patient was 4 months of age. Subsequent confirmation of Kasai's results were reported throughout the world. ETIOLOGY/PATHOLOGY Biliary atresia was originally thought to be a congenital malformation. Careful histopathologic examination of excised surgical specimens indicate that this is not the case; instead, the disease is a dynamic, progressive panductular sclerotic process that may continue in the intrahepatic ducts even after surgical relief of biliary obstruction.

Paget’s Disease in an Epidermal Cyst

A case of Paget's disease involving both the epidermis of the nipple and an adjacent epidermal cyst is reported. Immunohistochemistry showed similarity between the infiltrating cells in both sites and those of the underlying mammary adenocarcinoma. Epidermal cysts may be involved in a variety of disease processes which affect the epidermis in general and, unless they are subjected to careful histopathological examination, these diseases may be overlooked.

Histomorphology of Idiopathic and Symptomatic Popliteal Cysts

Thirty popliteal cysts, classified on the basis of clinical arthrographic findings as 12 idiopathic and 18 symptomatic lesions, were examined by light and scanning microscopy. The histopathology varied considerably and did not allow a valid distinction between the two types of cysts. Nevertheless, careful histopathologic examination of surgically removed popliteal cysts is advisable for exclusion of malignancy and for consideration of the presenting symptom as part of an inflammatory arthritic disorder.

転移性甲状せんしゅに関する考察

A 63-year-old woman visited our hospital with complaints of swelling and pain in the right thigh. A specimen was taken from the tumor of the right femur, and through histological examination, the tumor was found to be a metastatic tumor of the thyroid gland. Radioiodine treatment (NaI 131) was applied after total thyroidectomy and bilateral modified neck dissection. Clinically, this thyroid tumor is apparently malignant because of its osseous metastasis. However, both thyroid tumors and metastatic right femoral tumor appeared to be follicular “adenomas” according to the standard pathologic criteria and no definite evidence of malignancy was found in spite of careful histopathological examination. We diagnosed this case as the so-called metastasizing goiter and classified this lesion as a subtype of well-differentiated follicular adenocarcinoma. To clarify the entity of this lesion, we need close, long-term observation and adequate standard criteria for identifying well-differentiated follicular adenocarcinoma to differentiate it from follicular adenoma.

An unusual case of globulomaxillary cyst

A case of globulomaxillary cyst with adjacent dental anomalies is presented. Some of the reported cases are reviewed and discussed. Enucleation of the cyst (if possible, with retention of the vitality of the teeth) is the treatment of choice. Careful histopathologic examination of the lining epithelium is recommended.