Histopathological Comparison Research Articles

Comparison and Correlation of Cytology, Colposcopy and Histopathology of Premalignant Lesions of Cervix In Rural Women of Barabanki District

Comparison and Correlation of Cytology, Colposcopy and Histopathology of Premalignant Lesions of Cervix In Rural Women of Barabanki District

Comparison of Radiology and Histopathology in Thymic Epithelial Tumours

Tumours of the thymus gland have a limited evidence base due to their low incidence rate. The Masaoka-Koga staging system has been known as the strongest prognostic indicator for both survival and recurrence of thymic tumours but there is no standardised way to assess clinical staging in pre-operative images. As appropriate staging can influence patients’ need for adjuvant therapy, it is important to evaluate if current imaging can accurately predict post-operative staging. This was a retrospective study comparing the pre-operative radiological staging and post-operative pathological staging of 34 patients. This was conducted at the Golden Jubilee National Hospital between March 2013 and October 2016. A Kappa statistic was used to evaluate agreement between the assessments. 61.8% (21 out of 34) of the CT stages agreed with the pathology stages: 78.6% (11 out of 14) in stage I; 41.7% (5 out of 12) in stage II; 40% (2 out of 5) in stage III; and 100% (3 out of 3) in stage IV. There was moderate agreement between the preoperative CT assessment and the post-operative pathological staging (kappa coefficient = 0.42, p value < 0.01). With further analysis of a larger sample size it could be concluded that radiological staging of thymic tumours before surgery is quite accurate but requires standardisation and utilisation of other imaging techniques to ensure appropriate levels of care.

Placental histopathological findings in preterm/term and early/late onset small for gestation age: Are they significant?

We undertook a prospective comparison of placental histopathological findings in preterm versus term and early onset versus late onset small for gestation age (SGA) to find more information on the etiological aspects of this disorder. A total of 130 women with nonanomalous SGA were allocated into preterm (n = 60); term (n = 70); early onset (n = 9) and late onset (n = 121) groups. The blinded intergroup placental histopathology comparison was performed both qualitatively (type of lesion) and quantitatively (number of the lesion). All SGA placentae showed varying number of maternal underperfusion (MUP), fetal under perfusion, inflammatory, and others lesions. There was a slight higher percentage of placenta having MUP in preterm and early onset SGA. Perivillous fibrin deposition was peculiar for placenta of preterm SGA (P = 0.043). Both preterm and early onset SGA had a higher number of placental lesions, but there was no statistical difference either in type or number of the placental lesion in any of the examined groups.

P3.01-028 Comparison of Touch Imprint Cytology and Section Histopathology in the Diagnostic of the Small Peripheral Lung Tumors: Topic: Morphology

P3.01-028 Comparison of Touch Imprint Cytology and Section Histopathology in the Diagnostic of the Small Peripheral Lung Tumors: Topic: Morphology

Effect of the Taser X26 and Taser X2 Electric Stun Guns on Skin Tissue of Pigs in the Context of Use by the Uniformed Services

The Taser (full name: Thomas A. Swift’s Electric Rifle) is an electric stun gun, manufactured by Taser International. Its operational range varies from 4.60 metres to 10.6 metres1 thanks to wire electrodes that remain connected to the main device. The electrodes penetrate the skin and soft tissues of the person who is the target for temporary immobilisation. The high voltage generated at low intensity causes severe pain and disruption of the nervous system, resulting in temporary total paralysis. The Taser is a device of direct coercion, whose use is permissible for widespread application in cases where conservative methods of controlling dangerous situations have been exhausted. The natural question that arises is the impact and influence of the electrically active electrodes fired on the surrounding tissues. The aim of the study was a histopathological evaluation and comparison of the effects of the cartridges from the Taser X2 and Taser X26 in terms of the local reaction on a portion of the skin and subcutaneous tissue of domestic pigs fresh from a slaughterhouse. Fragments of the tissue were subjected to histological treatment and analysed using an optical microscope. There were changes in the microscopic image indicating mechanical damage to the epidermis and subcutaneous layers of the dermis due to the use of the devices researched.

Comparison of serum PCR assay and histopathology for the diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients with sinus involvement.

Background and Purpose:Invasive fungal infections cause morbidity and mortality in patients with hematologic malignancies and immunosuppression. Although these infections are commonly caused by Candida and Aspergillus species, infections caused by Mucoralean fungi are also on a growing trend. The definitive diagnosis of mucormycosis includes visualization of non-septate hyphae on pathology or growth of Mucoralean fungi culture. Polymerase chain reaction (PCR) is used to diagnose mucormycosis from paraffin blocks; however, it yields discrepant results in diagnosis of mucormycosis from blood samples. In the current study, we sought to examine the efficiency of PCR test for the diagnosis of mucormycosis and aspergillosis.Materials and Methods:Thirty-one patients with suspected fungal sinus infection were recruited from the Hematology-Oncology unit in Taleghani Hospital, Tehran, Iran. DNA was extracted and semi-nested PCR was performed.Results:PCR was reported negative for all the 31 serum samples. Our assay had a sensitivity of 1.3 ng and 12 pg for Mucoralean and Aspergillus species, respectively.Conclusion:Using serum PCR, we detected Aspergillus and Mucoralean species in patients with suspected fungal sinus infection. While this test may have utility in diagnosis directly from biopsy site, it appears unreliable for use as a noninvasive blood test.

Proceedings of the 2016 National Toxicology Program Satellite Symposium.

The 2016 annual National Toxicology Program Satellite Symposium, entitled "Pathology Potpourri" was held in San Diego, CA, at the Society of Toxicologic Pathology's (STP) 35th annual meeting. The goal of this symposium was to present and discuss challenging diagnostic pathology and/or nomenclature issues. This article presents summaries of the speakers' talks, along with select images that were used by the audience for voting and discussion. Some lesions and topics covered during the symposium included malignant glioma and histiocytic sarcoma in the rodent brain; a new statistical method designed for histopathology data evaluation; uterine stromal/glandular polyp in a rat; malignant plasma cell tumor in a mouse brain; Schwann cell proliferative lesions in rat hearts; axillary schwannoma in a cat; necrosis and granulomatous inflammation in a rat brain; adenoma/carcinoma in a rat adrenal gland; hepatocyte maturation defect and liver/spleen hematopoietic defects in an embryonic mouse; distinguishing malignant glioma, malignant mixed glioma, and malignant oligodendroglioma in the rat; comparison of mammary gland whole mounts and histopathology from mice; and discussion of the International Harmonization of Nomenclature and Diagnostic Criteria collaborations.

Histopathologic comparison of condylar hyperplasia and condylar osteochondroma by using different staining methods

The objectives of this study were to investigate the application and differential diagnostic value of safranin O staining, safranin-fast green staining, and Runt-related transcription factor 2 (Runx2) immunohistochemistry with regard to condylar hyperplasia and condylar osteochondroma. Histopathologic presence was evaluated by using hematoxylin and eosin staining, safranin O staining, safranin-fast green staining, and immunohistochemistry of Runx2 in postoperative specimens of normal condyle (control), condylar hyperplasia, and condylar osteochondroma. Safranin O staining clearly highlighted the tissue structure of the condylar cartilage, especially the hypertrophic layer. The safranin-fast green method showed a contrast in staining between cartilage and subchondral cancellous bone in the condyle specimens. Both methods were better than hematoxylin and eosin staining for morphologically distinguishing condylar hyperplasia and condylar osteochondroma. The expression of Runx2 in condylar hyperplasia was significantly greater than that in condylar osteochondroma. This study indicated that safranin O staining and safranin-fast green staining are effective staining methods to differentiate between condylar hyperplasia and condylar osteochondroma. Immunohistochemistry findings suggested that Runx2 is valuable in the differential diagnosis of these two diseases.

Histopathologic comparison of dexmedetomidine's and thiopental's cerebral protective effects on focal cerebral ischemia in rats

This study was designed to investigate whether dexmedetomidine and thiopental have cerebral protective effects after focal cerebral ischemia in rats. Thirty male Sprague Dawley rats were randomly assigned to three groups: control group (Group C, n=10), dexmedetomidine group (Group D, n=10), thiopental group (Group T, n=10). After all rats were anesthetized, they were intubated, then mechanically ventilated. A catheter was inserted into the right femoral artery for continuous mean arterial pressure, physiological parameters and blood sampling at baseline, 5min after occlusion and 20min after reperfusion. A catheter was inserted into the left femoral vein for intravenous (IV) medication administration. Right common carotid artery of each rat was isolated and clamped for 45min. At the end of the duration common carotid artery were unclamped and the brain reperfusion was achieved for 90min. Dexmedetomidine was administered for Group D IV infusion, and Group T received thiopental IV. According to histopathologic scores cerebral ischemia was documented in all rats in Group C, but no ischemia was found in three rats in Group T and in four rats in Group D. Grade 3 cerebral ischemia was documented in three rats in Group C, and in only one rat in both groups T and D. For histopathologic grades the difference between Group T and Group D was not significant (p>0.05). But the differences between Group C and Group T (p<0.05) and Group C and Group D (p<0.01) were statically significant. In conclusion, we demonstrated that dexmedetomidine and thiopental have experimental histopathologic cerebral protective effects on experimental focal cerebral ischemia in rats.

5-Aminolevulinic acid-mediated fluorescence diagnosis of colon cancer: A histopathological comparison of fluorescent and non-fluorescent tumours

Background: 5-Aminolevulinic acid (5-ALA) selectively accumulates in cancer cells and is metabolised in the mitochondria to the fluorophore protoporphyrin IX. The GLiSten trial evaluated 5-ALA as a fluorescent probe for intraoperative detection of colon cancer and lymph node metastases. Only 13 of 40 cases showed fluorescence, suggesting a fundamental difference between fluorescent and non-fluorescent cancers. The aim of this study was to investigate whether differences in fluorescence were due to tumour cellularity, in particular T cell infiltration, which may be of prognostic significance. Method: Primary tumour tissue was available from 30 patients. The density of tumour cells, vascularity and stromal compartment size were quantified using digitally scanned tissue sections stained with haematoxylin and eosin. A set of 300 random points was superimposed onto each tumour image. The structure indicated by each point was then categorised as tumour, stroma, vessel or other. The proportions of tumour and vessel points gave the tumour cell density and vessel density respectively. The relative size of the stromal compartment was given by the tumour to stroma ratio. A tissue section was also stained for the T cell marker CD3 by immunohistochemistry. Percentage staining was quantified in three high-density fields using the Nuance imaging system. Results: We were unable to detect any difference between fluorescent and non-fluorescent cancers in terms of tumour cell density (difference in means 3.7%; P = 0.452), vessel density (difference in means 0.17%; P = 0.684), tumour-stroma ratio (difference in mean ratios 0.12; P = 0.934), or T cell count (difference in means 0.92%; P = 0.726). Furthermore, comparisons of the distributions of each variable demonstrated substantial overlap between the fluorescent and non-fluorescent cohorts. Conclusion: The results suggest that tumour and microenvironment structure do not differ between cancers that fluoresce with 5-ALA and those that do not. We therefore propose that the cellular metabolism of 5-ALA is a more likely explanation for differential fluorescence.

Channa striatus cream down-regulates tumour necrosis factor (TNF)-alpha gene expression and alleviates chronic-like dermatitis in mouse model

Ethnopharmacological relevanceHaruan, Channa striatus, is a freshwater fish which has been well-known locally to accelerate wound healing during post-operative and post-partum periods. The fish extract also has potent anti-inflammatory and analgesic properties. Aim of the studyTo assess topical anti-inflammatory effect of Haruan cream on 12-0-tetradecanoylphorbol-13-acetate (TPA)-induced chronic-like dermatitis in mice. Materials and methodsMale ICR mice were randomized into six groups of five mice each: acetone (vehicle), TPA alone (negative control), three Haruan treatment groups (Haruan 1%, Haruan 5% and Haruan 10%) and hydrocortisone 1% (positive control). Briefly, both surfaces of mouse ears were applied with TPA (2.5μg/20μl acetone) for five times on alternate days and with Haruan or hydrocortisone 1% cream for the last three days. Mouse ear thickness was measured 24h after final treatment with the cream and the ears were harvested for further histological analysis and gene expression studies of TNF-α by real-time reverse transcriptase-polymerase chain reaction (RT-qPCR). ResultsTopical application of Haruan cream had reduced the mouse ear thickness 18.1–28%) with comparable effect to the positive control. In addition, histopathological comparison had shown evident reduction in various parameters of cutaneous inflammation including dermal oedema, inflammatory cells infiltration and proliferation of epidermal keratinocytes. Furthermore, TPA application had resulted in the up-regulation of TNF-α gene expression by 353-fold, which was subsequently down-regulated by the Haruan cream (34- to 112-fold). ConclusionHaruan is an effective topical anti-inflammatory agent in this mouse model of chronic-like dermatitis, thus suggesting its potential as a non-steroidal treatment option for chronic inflammatory dermatoses.

Value of Bethesda classfication combined with TIRADS in assessing the malignat risk of thyroid nodules

Objective To evaluate the diagnostic value of Bethesda system combined with thyroid imaging reporting and data system (TIRADS) in assessing the malignat risk of thyroid nodules. Methods Histopathological, cytological and ultrasound (US) data were studied retrospectively for 243 cases after surgery, including 273 thyroid nodules. All thyroid cytopathological slides and US reports were classified according to Bethesda system and TIRADS. Based on histopathological comparison, the sensitivity and specificity were determined for Bethesda category and Bethesda category combined with TIRADS. Results The sensitivity and specificity of Bethesda category were 91.0% and 90.3%, respectively. In indeterminate nodules, malignancy rate was 38.7% in Bethesda categoriesⅠ and Ⅲ, and 85.4% in Bethesda categories Ⅳ and Ⅴ. In contrast, combined with TIRADS, the sensitivity and specificity of positive results were 82.4%, 100%, and negative results were 99.5%, 83.8%, respectively. The malignancy rate of TIRADS 2/3a in Bethesda categories Ⅰ/Ⅲ, TIRADS 3b/3c/4 in Bethesda categories Ⅰ/Ⅲ, TIRADS 2/3a in Bethesda categories Ⅳ/Ⅴ, and TIRADS 3b/3c/4 in Bethesda categories Ⅳ/Ⅴwere 3.7%, 81.8%, 45.4% and 100%, respectively. Conclusions Bethesda system combined with TIRADS may be helpful to the preoperative diagnosis of thyroid nodules, which may reduce unnecessary repeat fine needle aspiration and excessive surgery. Key words: Ultrasonography; Biopsy, fine-needle; Thyroid diseases; Bethesda system; Thyroid imaging reporting and data system

Thin-section computed tomography–histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity

ObjectiveTo retrospectively compare focal interstitial fibrosis (FIF), atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) with pure ground-glass opacity (GGO) using thin-section computed tomography (CT). Materials and methodsSixty pathologically confirmed cases were reviewed including 7 cases of FIF, 17 of AAH, 23of AIS, and 13 of MIA. All nodules kept pure ground glass appearances before surgical resection and their last time of thin-section CT imaging data before operation were collected. Differences of patient demographics and CT features were compared among these four types of lesions. ResultsFIF occurred more frequently in males and smokers while the others occurred more frequently in female nonsmokers. Nodule size was significant larger in MIA (P<0.001, cut-off value=7.5mm). Nodule shape (P=0.045), margin characteristics (P<0.001), the presence of pleural indentation (P=0.032), and vascular ingress (P<0.001) were significant factors that differentiated the 4 groups. A concave margin was only demonstrated in a high proportion of FIF at 85.7% (P=0.002). There were no significant differences (all P>0.05) in age, malignant history, attenuation value, location, and presence of bubble-like lucency. ConclusionA nodule size >7.5mm increases the possibility of MIA. A concave margin could be useful for differentiation of FIF from the other malignant or pre-malignant GGO nodules. The presence of spiculation or pleural indentation may preclude the diagnosis of AAH.

Abstract 4272: Organoids and patient-derived tumor xenograft of pancreatic adenocarcinoma share morphological and genetic features with the primary tumor

Abstract Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer death, with a 5-year overall survival rate &amp;lt;7%. Several active systemic therapies are now available for PDAC. Personalizing therapy may be improved with the development of realistic tumor models from a patient's explanted tumoral tissue. Human pancreatic tumor patient-derived xenografts (PDX) implanted into immunodeficient mice and tumor organoids grown in vitro 3D culture are two promising models. However, it is uncertain if these models are histopathologically and genetically similar to the primary PDAC. Histopathological comparison of sections from PDX tumor, organoids, and primary PDAC from a 63-year-old female patient were performed on paraffin embedded tissue. H&amp;E and immunohistochemical staining for cytokeratins (CK7, CK20), p53, Claudin-4, and CEA were performed. DNA and mRNA sequencing was performed. Both PDX and organoids exhibited histopathological features remarkably consistent with the original patient tumor including the histologic grade (moderately differentiated), cytological appearance (irregular nuclear membranes, open chromatin and prominent nucleoli), mitotic activity (5 -7/10 HPF), and immunohistochemical profile. The PDX and organoids demonstrated diffuse moderate-to-strong positivity for CK7, CEA, p53, and Claudin-4 and focal weak positivity for CK20 - all similar to the primary tumor. The immunohistochemical staining pattern was consistent with mRNA sequencing of the primary tumor which showed that CEA, Claudin-4 and p53 expression were ∼960-fold, ∼27-fold and ∼3 fold higher respectively (vs. benign pancreatic tissue). DNA sequencing revealed somatic mutations in KRAS and TP53 genes seen in &amp;gt;90% and ∼70% of PDACs respectively, and a few rare somatic mutations, such as a sodium leak channel (NALCN) mutation, seen in ∼3% of PDAC. Both PDX and organoid models of PDAC maintain key histological features, immunohistochemical profile and basic gene expression pattern akin to the primary tumor. These findings suggest that PDXs and organoids have the potential to serve as reliable pathophysiological models for optimizing individual therapy for patients with PDAC. Citation Format: Isabel Romero Calvo, Ashwin Akki, Andrey Ugolkov, Mary M. Buschmann, Samantha M. Sparrow, Teresa Barry, Margaret Eber, Tongjun Gu, Shuang Qin Zhang, Hedy Kindler, William Dale, Kevin Roggin, Andrew P. Mazar, Kevin P. White, Christopher R. Weber. Organoids and patient-derived tumor xenograft of pancreatic adenocarcinoma share morphological and genetic features with the primary tumor. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4272.

Ex vivo comparison of angioscopy and histopathology for the evaluation of coronary plaque characteristics

The yellow plaque has been considered to be a vulnerable and high risk for acute coronary syndrome events but not fully evaluated. The aim of this study was to evaluate the relationship between angioscopic color grade and histological features in coronary autopsy specimens. We longitudinally sectioned 110 coronary arteries from 40 autopsy hearts with non-cardiovascular death. Harvested arteries were imaged with intravascular ultrasound to identify the focal plaque (plaque burden >50%). An angioscopic examination of each focal plaque evaluated its color intensity as follows: 0 (white), 1 (light yellow), 2 (yellow), or 3 (dark yellow). The corresponding histological assessment was classified according to a modified version of the American Heart Association classification of atherosclerosis. Two hundred six plaques were matched to the histological analysis. Of these, 82 (40%) were categorized as yellow (≥grade 1). Although, yellow plaque often includes thin-cap fibroatheroma (TCFA), the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for histological TCFA were 83, 91, 22, 99 and 91%, respectively. The false-positive coronary angioscopic diagnoses for TCFA that contributed to the low positive predictive value consisted of the following plaques: thick FA (>65μm), accumulations of large quantities of foam cells on the luminal surface, or dense calcified plates at the surface of the intima. Vulnerable coronary plaques were detected with high sensitivity and low positive predictive value from their yellow color on angioscopy. Not only fibroatheroma but also various types of plaques and their components, such as immature lipidic components and superficial calcium plates, appeared yellow on coronary angioscopy.

Histopathologic comparison of dexmedetomidine's and thiopental's cerebral protective effects on focal cerebral ischemia in rats

This study was designed to investigate whether dexmedetomidine and thiopental have cerebral protective effects after focal cerebral ischemia in rats. Thirty male Sprague Dawley rats were randomly assigned to three groups: control group (Group C, n=10), dexmedetomidine group (Group D, n=10), thiopental group (Group T, n=10). After all rats were anesthetized, they were intubated, then mechanically ventilated. A catheter was inserted into the right femoral artery for continuous mean arterial pressure, physiological parameters and blood sampling at baseline, 5min after occlusion and 20min after reperfusion. A catheter was inserted into the left femoral vein for intravenous (IV) medication administration. Right common carotid artery of each rat was isolated and clamped for 45min. At the end of the duration common carotid artery were unclamped and the brain reperfusion was achieved for 90min. Dexmedetomidine was administered for Group D IV infusion, and Group T received thiopental IV. According to histopathologic scores cerebral ischemia was documented in all rats in Group C, but no ischemia was found in three rats in Group T and in four rats in Group D. Grade 3 cerebral ischemia was documented in three rats in Group C, and in only one rat in both groups T and D. For histopathologic grades the difference between Group T and Group D was not significant (p>0.05). But the differences between Group C and Group T (p<0.05) and Group C and Group D (p<0.01) were statically significant. In conclusion, we demonstrated that dexmedetomidine and thiopental have experimental histopathologic cerebral protective effects on experimental focal cerebral ischemia in rats.

The effect of ER:YAG plus 5-fluorouracil on the outcome of punch grafting in nonsegmental vitiligo: a left–right comparative study

Introduction Histopathologically, in vitiligo lesions, functioning melanocytes are absent and the inflammatory infiltrate is usually minute and trivial. Among the surgical methods used is minigrafting, which is considered the safest and easiest by many practitioners. Best results were obtained in segmental type and in the lesions involving the face. Application of topical 5-fluorouracil (5FU) on ER : YAG-ablated skin had been previously used with success in treating vitiligo lesions even in difficult-to-treat areas such as the fingers. Aim of the study In this study, we tried to explore the effect of the prior application of 5FU on ER : YAG-ablated skin on the outcome of punch grafting in lesions that were unresponsive to phototherapy and were known to have moderate prognosis with surgery. Patients and methods The study was a prospective left–right comparative study that was carried out on 20 patients with nonsegmental vitiligo who were in need for surgery after the exclusion of facial and periungual lesions. Histopathological and immunohistochemical comparison between the two modalities were also made using the sequential biopsy technique. Results The clinical outcome was significantly better on the site pretreated with ER : YAG laser ablation and 5FU (P=0.001). Inflammatory cells in the form of dermal CD4+ and CD8+ cells were present in all operation sites showing depigmentation (32 lesions). Of them, 28 cases (87.5%) showed invasion of the lower layers of the epidermis in close proximity to the melanocytes by the CD8+ cells. Histopathological and immunohistochemical results were similar on both sides. Conclusion The prior application of 5FU on ER : YAG-ablated skin yields better clinical results that were not explained by the histopathological findings. We suggest that both mechanical and immunologic mechanisms were involved in the process of repigmentation on using this manoeuvre.

Type II focal cortical dysplasia: Ex vivo 7T magnetic resonance imaging abnormalities and histopathological comparisons.

In the present report, the correlations between ex vivo high-resolution imaging and specific histological and ultrastructural patterns in type II focal cortical dysplasia (FCD) have been studied to explain the differences in the magnetic resonance imaging (MRI) detection of dysplasia and to contribute to the presurgical imaging evaluation of this pathology. Surgical specimens from 13 patients with FCD IIa/b were submitted to 7T MRI scanning, and then analyzed histologically and ultrastructurally to compare the results with the MRI findings. Region of interest (ROI)-based measures on T2-weighted images (T2wi) were quantitatively evaluated in the lesion and in adjacent perilesional gray and white matter. Matched histological sections and 7T T2wi showed that the core of the lesion was characterized by patchy aggregates of abnormal cells and fiber disorganization related to inhomogeneity of intracortical signal intensity. The quantitative approach on T2wi can help to distinguish the lesions and perilesional areas even in a clinical MRI-negative case. The ultrastructural study showed that the strong signal hyperintensity in the white matter of FCD IIb was related to a dysmyelination process associated with severe fiber loss and abnormal cells. Less severe histopathological features were found in FCD IIa, thus reflecting their less evident MRI alterations. We suggest that white matter abnormalities in type IIb FCD are due to defects of the myelination processes and maturation, impaired by the presence of balloon cells. To reveal the presence and the border of type II cortical dysplasia on MRI, a quantitative ROI-based analysis (coefficient of variation) is also proposed.

Histological examination of vascular damage caused by stent retriever thrombectomy devices

Background and objectivesAlthough the recently marketed stent retriever thrombectomy devices have demonstrated a high recanalization rate and favorable clinical outcomes, there is a concern about the risks of intimal injuries...

Margin Reduction Based on Comparison of Histopathology With Delineations on CT, MRI, and FDG-PET in Laryngeal and Hypopharyngeal Cancer

Tumor delineation is one of the weakest links in the radiation therapy (RT) treatment chain. The margin needed to determine the clinical target volume (CTV) is also questionable. In order to improve treatment, more insight into the errors made by delineation is needed. In this study, gross tumor volume (GTV) delineations on computed tomography (CT), magnetic resonance imaging (MRI), and the automatic segmentation on 18fluorodeoxyglucose positron emission tomography (FDG-PET) of laryngeal and hypopharyngeal squamous cell carcinoma are validated on histopathology. Twenty-one patients were included with a laryngeal (n=14) or hypopharyngeal (n=7) tumor (T3/T4). Before total laryngectomy/partial pharyngectomy, CT, MRI (T1weighted and T2-weighted), and FDG-PET images were made in RT positioning mask. The GTV was delineated in consensus by 3 experienced observers on CT and MRI. FDG-PET was delineated semi-automatically using a Gaussian mixed model based threshold. Tumor has been delineated by a pathologist on whole-mount hematoxylin and eosin stained (HE) histopathologic sections (intersections of approximately 3 mm) and afterwards digitized and reconstructed to a 3 dimensional specimen. This 3D specimen was then registered to the imaging prior to laryngectomy. The GTVs were compared with the histopathologic-based tumor delineation in 3 dimensions, including the microscopic extension. The margin around the GTV needed to ensure 95% coverage of the histopathologically determined tumor surface, was 3 mm (SD 2), 4 mm (SD 2) and 4 mm (SD 2) for CT, MRI and FDG-PET, respectively. In the semi-automatic delineation of FDG-PET, for 1 case a margin of 9 mm was needed, probably due to large necrotic parts in the tumor. The part of the tumor included in the GTV (sensitivity) amounted to 86% (SD 9), 80% (SD 11) and 79% (SD 11) for CT, MRI and FDG-PET, respectively, while the overestimation of the tumor volume amounted to 87% (SD 45), 62% (SD 33) and 50% (SD38). The positive predictive value (PPV), on CT, MRI, and FDG-PET was found to be 53% (SD 14), 59% (SD 13), and 66% (SD 15), respectively. In order to cover 95% of the histopathologic tumor surface, including the HE-determined microscopic extension, the margin added to the GTVs needed to be 6-7 mm (average margin + 1.5 times SD). This margin indicates that the standard clinical target volume (CTV) margin of 10 mm could be reduced. FDG-PET has the highest PPV; therefore semi-automatic delineation of FDG-PET can be used as an initial delineation of the GTV. This delineation must be reviewed by a physician and, if necessary, modified based on additional information from high resolution CT or MRI.