Common Histopathological Subtype Research Articles

Correlation between the dermatoscopic and histopathological features of pigmented basal cell carcinoma

Dermatoscopy has a great value in the diagnosis of pigmented basal cell carcinoma (BCC), which is a clinical variant of BCC. The precise definitions of histopathological correlates of dermatoscopic features observed in pigmented BCC have not been established yet. The present study aimed to investigate the correlation between the dermatoscopic features of pigmented BCC and their histopathological counterparts to provide clear histopathological definitions of each dermatoscopic feature. In this case series that comprised a methodological component, after the orientation of dermatoscopic features was determined by placing sutures in the lesions, the histopathological counterparts of each were examined and definitions were made accordingly. Although the most common histopathological subtype of BCC is the solid type, the most common histopathological subtype observed in the pigmented BCC lesions in the present study was the superficial multifocal type (72.5%). Blue-whitish veil was observed in 57.5% (n=23) of the lesions, a percentage higher than that reported in the literature. In addition to confirming the previously histopathologically defined dermatoscopic features of pigmented BCC, we identified three histopathologically undefined features of pigmented BCC that are spoke-wheel areas, large blue-grey ovoid nests and multiple blue-grey globules. Dermatoscopy facilitates prediction of the corresponding histopathological findings in pigmented BCC, based on specific dermatoscopic features.

Pediatric Lymphoma: A 10-year Experience at a Tertiary Care Hospital in Pakistan

Lymphoma is the third most common childhood malignancy. Less information is available on this disease and its outcome from our country. We present here a single institute experience. A retrospective study was carried out at Aga Khan University Hospital, Karachi on children (<15 y) diagnosed with lymphoma from 1998 to 2007. Sixty-eight patients were identified. Fifty-one children were diagnosed as non-Hodgkin lymphoma (NHL). Mean age of presentation was 8.4 years with male-to-female ratio of 5.8 : 1. Most common histopathologic subtype of NHL was Burkitt lymphoma (55%). Abdominal mass was the main presenting feature of Burkitt and diffuse large B cell lymphoma. T-lymphoblastic lymphoma presented mainly as mediastinal mass. Ten children died, 4 secondary to tumor lysis syndrome, 5 because of disease progression, and 1 with chemotherapy-induced toxicity. One-third of the patients left without treatment. Seventeen children were diagnosed as Hodgkin lymphoma with mixed cellularity as the commonest subtype (65%). Overall survival of children with NHL and Hodgkin lymphoma was 62% and 94%, respectively. A greater proportion of NHL, advanced stage, and profound male preponderance were observed. Improvement in survival can only be achieved with increasing awareness, identifying and tackling causes of abandonment, early referral, and better supportive care.

Childhood pancreatic tumors: a single institution experience

Purpose The rarity and histopathologic diversity of primary pancreatic neoplasms in children have made it difficult to predict prognosis and to develop optimal management protocols. Methods A 90-year (1918-2007), single institution, retrospective review of all patients with neoplastic pancreatic masses was performed. Results Eighteen patients were identified with 7 distinct histopathologic subtypes. The most common were gastroenteropancreatic neuroendocrine, solid pseudopapillary, and acinar tumors. There were 6 benign and 12 malignant tumors. Six patients had disease outside the pancreas at their initial operation. There were 7 deaths (41%), 2 related to the initial operation, 3 from disease progression, 1 from a small bowel obstruction, and 1 from necrotizing pancreatitis. Five deaths were in patients with extrapancreatic disease found at initial operation. The median duration of follow-up for the 10 survivors was 41 months. Conclusion In adults, pancreatic ductal adenocarcinoma is by far the most common histopathologic subtype, with other subtypes more common in children. Stage is an important prognostic factor. Long-term disease-free survival in childhood pancreatic malignancies is achievable with complete surgical resection, prognosis, and adjuvant treatment, depending on the histopathologic type.

Reactive Localised Inflammatory Hyperplasia Of The Oral Mucosa

To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. A retrospective, cross-sectional descriptive study. Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) cases were peripheral giant cell granuloma and three cases (0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years (mean = 30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years (mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 (72.3%) in females with an age range of 2 to 75 years (mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16 (4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean = 1.8 years). Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. The present study has shown that the prevalence of reactive localised inflammatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process.

Registry of gastric cancer treatment evaluation (REGATE): Baseline characteristics of 10,299 patients from 22 countries

4575 Background: Gastric cancer (GC) is the second most common cause of cancer death in the world. Recent advances in diagnosis and treatment provide new options in the management of this poor-prognosis disease. REGATE is an international disease registry designed to assess real-world practice patterns for patients (pts) with GC. Methods: Pts with newly diagnosed GC were enrolled. The target sample size was calculated according to the GC prevalence in participating countries. Data were collected at 2 visits occurring within a 10-month timeframe: baseline (pts and tumor characteristics, treatment plan) and after completion of initial treatment (actual therapy received). Characteristics of the patients at the time of enrollment are described. Results: From August 2004 to July 2008, 10,299 pts were enrolled by 223 investigators in 22 countries (Asia-Pacific 43%, Europe 31%, Latin-America 20%, and North Africa 6%). Characteristics are as follows. Median age 60 years (range: 18–104) with 23% of pts &lt;50 years. Male 65%, female 35%; 91% of pts were symptomatic; 8% had family history of GC; and 32% had H. pylori infection. GC was diagnosed by endoscopy in 95% of pts. Primary tumor location: antrum 39%, body 39%, proximal 17%. Histopathological type was assessed using WHO, Lauren, and/or Ming classifications in 75%, 60% and 31% of pts, respectively. The most common histopathological sub-types were diffuse (51%) and intestinal (44%) according to Lauren; signet ring cell (41%) and tubular (22%) according to WHO. Most patients (55%) had a poorly/undifferentiated tumor. AJCC stage at diagnosis: I-21%, II-20%, III-21%, IV-38%. Initial choice of planned therapy was mainly based on stage (69% of pts) and determined by either a multidisciplinary team (41%) or a surgeon alone (37%). Conclusions: REGATE is the largest prospective international disease registry that provides new insight into the characteristics of patients with newly diagnosed GC. Results including worldwide treatment patterns over time are expected after all patients have completed their initial treatment. [Table: see text]

Primary orbital endodermal sinus tumor (yolk sac tumor)

Endodermal sinus tumor, or yolk sac tumor, is the most common malignant neoplasm of germ cell origin and usually occurs in infant testes or ovaries. On rare occasions, the tumor may arise from extragonadal sites, including sacrococcygeal region, uterus, vagina, prostate, retroperitoneum, liver, mediastinum, pineal gland, and third ventricle. The orbit is an unusual location for the primary development of this neoplasm. We report the case of a girl with primary orbital endodermal sinus tumor who was managed with exenteration and chemotherapy with the result of a disease-free survival of 9 years.

Familial Non-VHL Clear Cell (Conventional) Renal Cell Carcinoma: Clinical Features, Segregation Analysis, and Mutation Analysis of FLCN

Familial renal cell carcinoma (RCC) is genetically heterogeneous. The most common histopathologic subtype of sporadic and familial RCC is clear cell (cRCC) and von Hippel-Lindau (VHL) disease is the most common cause of inherited cRCC. Familial cRCC may also be associated with chromosome 3 translocations and has recently been described in patients with Birt-Hogg-Dube (BHD) syndrome, caused by germline FLCN mutation. Fewer than 20 kindreds with familial cRCC without VHL disease or a constitutional translocation have been described. The purpose of this investigation was to define the clinical and genetic features of familial non-VHL cRCC (FcRCC) and to evaluate whether unrecognized BHD syndrome might be present in patients with apparent nonsyndromic RCC susceptibility. We analyzed the clinical features of, and undertook segregation analysis in, 60 kindreds containing two or more cases of RCC (at least one confirmed case of cRCC) and no evidence of an RCC susceptibility syndrome. We also undertook FLCN analysis to evaluate whether unrecognized BHD syndrome might be present in 69 patients with apparent nonsyndromic RCC susceptibility. FcRCC was characterized by an earlier age at onset than sporadic cases and more frequent occurrence of bilateral or multicentric tumors. Segregation analysis showed autosomal dominant inheritance with sex- and age-dependent penetrance. A germline FLCN mutation was detected in 3 of 69 (4.3%) patients with apparent nonsyndromic RCC susceptibility. We describe the clinical and genetic features of the largest series of FcRCC and recommend these patients be offered FLCN analysis, in addition to constitutional cytogenetic and VHL analysis.

Treatment of Hodgkin's Disease: A Twenty-Year Follow-up of Patients at a Center in Korea

Hodgkin's disease (HD) is a hematologic malignancy which shows common features regardless of race, but racial differences may be considered with certain clinical characteritcs. HD in Korea shows somewhat different characteristics when compared to cases in Western countries. We evaluated the clinical and histopathologic characteristics of HD, the outcomes of various chemotherapy regimens, and prognostic factors of HD in Korea. One hundred and five patients with initial histopathologic diagnosis of Hodgkin's disease were retrospectively reviewed 20 years after diagnosis at Yonsei University College of Medicine. Nodular sclerosis was the most common histopathogic subtype (41%) and mixed cellularity was nearly as common (40%). The overall complete remission rate (CR) was 87.6%. The disease-free survival (DFS) and overall survival (OS) rate were 79.2% and 84.8% at 5-years, 70% and 79.2% at 10- and 20-years. There were no significant differences in CR rate and DFS, but OS rates were significantly higher in m-BACOP and ABVD regimen. Univariate analysis revealed that age, B-symptom, ECOG scale, Ann Arbor stage, international prognostic index, and serum β2-microglobulin level were significant prognostic factors for both DFS and OS. Multivariate analysis demonstrated that age, B symptoms, and ECOG scale were significant prognostic factors for OS only. In conclusion, the survival rates of HD patients in our center were superior to those of previous reports in Korea and Western countries. Considering the higher OS rate and decreased incidence of side effects, the ABVD regimen may be recommended for the initial treatment of Hodgkin's disease.

Ultrasound features of different histopathological subtypes of borderline ovarian tumors

To describe the gray-scale sonographic and color Doppler imaging features of the most common histopathological subtypes of borderline ovarian tumors. We analyzed retrospectively the preoperative transvaginal sonographic reports of patients with a histological diagnosis of borderline ovarian tumor. All patients were scanned consecutively by two of the investigators using transabdominal and transvaginal gray-scale imaging to assess the morphology and color Doppler to obtain indices of the blood flow. Sonographic findings were compared to histopathological data. A total of 113 consecutive cases were reviewed from two referral centers for gynecological oncology. At histological examination 50 tumors (44%) were classified as being serous borderline ovarian tumors (SBOT), 61 (54%) were mucinous borderline ovarian tumors (MBOT) (42 intestinal type and 19 endocervical type), and two patients (2%) presented with borderline endometrioid tumors. SBOTs and endocervical-type MBOTs had very similar sonographic features and a smaller diameter, fewer locules (usually unilocular-solid lesions) and a higher color score than intestinal-type MBOTs. Intestinal-type MBOTs were characterized by a significantly higher percentage of lesions with > 10 locules when compared with the endocervical-type MBOTs. Intestinal-type MBOTs have different sonographic features from other common borderline ovarian tumors.

Primary nephrotic syndrome during childhood in Turkey.

Minimal change nephrotic syndrome (MCNS) is the most common cause of primary nephrotic syndrome (NS) during childhood. However, recent studies from different countries have reported an increasing incidence of focal segmental glomerulosclerosis (FSGS) in children. This is a retrospective study in which 392 Turkish children who were diagnosed with NS during the last 10 years and were followed for at least 2 years, were evaluated. Mean age of the study group was 4.6 +/- 3.4 years (range 0.9-16 years) and 232 were male and 160 were female. In total, 280 patients were diagnosed as MCNS with their initial presentations, laboratory features, and clinical course. Kidney biopsy was performed in the remaining 112 children according to current recommendations. The results showed that membranoproliferative glomerulonephritis (MPGN) was the most common histopathologic diagnosis, 38 (34%) of the 112 patients were found to have MPGN. The number diagnosed as FSGS was 26 (23%). A significant difference was found between the age groups for both MPGN and FSGS, the former being more common in children >6 years of age and the latter more frequent in children </=6 years. MCNS was found in only 19% of all biopsies performed and the total incidence of MCNS (presumptive + biopsy proven) was 76%. There was no significant difference between the incidence of different histopathological subtypes before and after 1995. Minimal change nephrotic syndrome is still the most common primary NS in childhood and MPGN is found to be the most common histopathologic subtype in the present patient population who underwent biopsy.

Seizure Outcome after Temporal Lobectomy in Temporal Lobe Cortical Dysplasia

To identify the temporal lobe cortical dysplasia (CD) histopathology classification subtype and determine the seizure outcome of patients who underwent temporal lobectomy with coincident CD. We reviewed the data of 28 patients with temporal lobe epilepsy who underwent surgery with pathologically verified CD at our institution from 1990 to 2000. The seizure outcome was assessed at a minimum of 1 year after surgery according to Engel's classification. Of 28 patients who underwent surgery, nine (32.1%) had isolated CD, and 19 (67.9%) had CD and hippocampal sclerosis (CD&HS). Twenty-six (92.9%) patients had histopathology subtype Ia (architectural abnormalities). Twenty (71.4%) patients were seizure free (Engel class I). Favorable seizure outcome (Engel class I, II) was achieved in 26 (92.9%) patients. No difference in seizure outcome was noted between patients with CD and CD&HS. The most common histopathologic subtype in patients with temporal lobe CD is type Ia (architectural abnormalities). Temporal lobectomy in temporal lobe epilepsy patients with CD can achieve favorable seizure outcome.

Histopathological spectrum of childhood nephrotic syndrome in Indian children.

Nephrotic syndrome in children is a clinical manifestation of different histopathological subtypes. There is a paucity of recent large studies dealing with the histopathological spectrum from developing countries. A prospective study was performed from January 1990 to December 2000 at our center, involving 600 children (with age of onset up to 16 years) with idiopathic nephrotic syndrome (INS). The objectives were: (1) to study the histopathological distribution of different subtypes of INS and (2) to compare the clinical and biochemical parameters at the time of diagnosis of minimal change disease (MCD) with non-MCD subtypes. For the purpose of this study we analyzed only those children with INS who underwent biopsies. The study group included 290 children in which adequate biopsy reports were available. There were 213 males and 77 females. Mean age at onset of INS was 7.9+5.1 years. Facial edema was found in 286 (98.6%), microhematuria in 120 (41.3%), gross hematuria in 7 (2.5%), and hypertension in 77(26.8%) patients. All patients of the study group were seronegative for HBsAg and HIV. Focal and segmental glomerulosclerosis (FSGS) was the most common histopathological subtype, occurring in 110 of 290 children (38%). Other subtypes included MCD in 95 children (32%), membranoproliferative glomerulonephritis (MPGN) in 44 children (15%), mesangioproliferative glomerulonephritis in 33 children (11%), membranous glomerulonephritis in 5 children (2%), and diffuse mesangial sclerosis in 3 children (1%). In children under 8 years of age, MCD was the most common entity, whereas FSGS predominated in children with age at onset greater than 8 years. The age at onset of nephrotic syndrome was significantly higher in the non-MCD group than the MCD group. The incidence of hypertension, microhematuria, and gross hematuria was significantly lower in the MCD group. MCD remains the most common histopathological subtype in Indian children with INS and onset under 8 years of age. The incidence of MPGN continues to be high. MCD can be differentiated from non-MCD subtype by younger age at onset, absence of hypertension, and absence of microscopic hematuria.

Eight-year experience of malignant lymphoma--survival and prognostic factors.

Several reports have suggested a geographic difference in the histopathologic characteristics and prognosis of malignant lymphoma around the world. We tried to evaluate the clinical and histopathologic characteristics, therapeutic outcomes, and prognostic features of malignant lymphoma, particularly in Korean patients. Three hundred and seventy-six adult patients with the initial histopathologic diagnosis of malignant lymphoma of Yonsei University College of Medicine over an 8-year period were analyzed, retrospectively, with the following results: 1) There were 47 cases of Hodgkin's disease (HD) (12.5%) and 329 of non-Hodgkin's lymphoma (NHL) (87.5%) with a 1:7 ratio. The most common histopathologic subtype of HD was mixed cellularity (44.7%), and that of NHL was intermediate grade (70.8%), especially diffuse large-cell type (44.1%), whereas follicular type was less common. In regard to the incidence of extranodal presentation, it is rare in HD (4.2%), but occurs in 49.8% of patients with NHL. 2) The complete remission (CR) rate was 91.5% in HD and 63.6% in NHL, and the 5-year and 7-year disease-free survival rates were 71.3% and 57.0% in HD; 67.0% and 49.6% in NHL. The 5-year and 8-year overall survival rates were 90.7% and 68.0% in HD; 65.2% and 60.2% in NHL. 3) By multivariate analysis, we found that age, performance status, histopathologic grade, stage, serum lactate dehydrogenase (LDH) and beta 2-microglobulin were the useful prognostic factors in predicting survival in NHL, while no definite prognostic factors were found in HD. Also, in NHL patients less than 60 years old, stage, serum LDH, and histopathologic grade were closely associated with their therapeutic outcomes. In conclusion, the characteristics of malignant lymphoma in our hospital differ from those in Western countries with respect to the clinical, histopathologic and immunophenotypic patterns, but the prognostic factors and overall therapeutic outcomes were quite comparable to those of other reports from Western countries.