Frequent Histological Finding Research Articles

Neuropathology of human sympathetic autonomic ganglia.

The neuropathologic alterations which underlie autonomic nervous system dysfunction in aging and in a variety of diseases have been systematically examined in the sympathetic ganglia of a series of 347 autopsied adults and in a review of previously published studies. Markedly swollen terminal axons containing neurofilamentous aggregates were found immediately adjacent to the neuronal cell bodies of prevertebral sympathetic ganglia in aging, in diabetes, and, to a lesser extent, in alcoholism. Dystrophic axons appeared to involve subpopulations of intraganglionic nerve fibers, chiefly those containing neuropeptide Y (NPY), and were more frequent in males than females. Neither aging nor diabetes resulted in significant numbers of actively degenerating neurons or a substantial decrease in neuronal density. Parenchymal aggregates of lymphocytes in the ganglionic neuropil and perivascular regions represented a frequent histologic finding in both prevertebral and paravertebral ganglia; however, they were not selectively increased in frequency or intensity in diabetic subjects or in any other disease entity. Many dilated clear "vacuoles," apparently located within the neuronal cell bodies of paravertebral and prevertebral ganglia according to light microscopy, were subsequently shown by electron microscopy to represent vacuolated or fluid-filled neurites, most likely terminal axons or synapses. Vacuolated neurites were more frequent in, although not confined to, diabetic patients. Similar pathologic findings have been reported in studies of sympathetic ganglia in various human diseases. The frequency of some pathologic lesions in control populations as a function of age or gender necessitates the careful selection of a relatively large, appropriately matched, control population for comparison with presumed disease-induced ganglionic neuropathology, and emphasizes the importance of quantitative comparisons.

Lung, ileum and heart are predilection sites for AApoAII amyloid deposition in CD-1 Swiss mice used for toxicity studies. Pulmonary amyloid indicates AApoAII

Amyloid deposits represent frequent histological findings in SPF strains of mice mainly used for toxicological studies. Usually, these are deposits of reactive amyloid (AA-amyloid) derived from the acute phase protein serum amyloid A (SAA). The SAA is an apoprotein of high density lipoprotein (apoSAA). Senescence-accelerated amyloid (ASsam) occurs in a special strain of mice. This type of amyloid is derived from apolipoprotein-AII and, therefore, is called AApoAII. Recently, C57B1/Ka control mice not treated for long duration with immunosuppressive agents, were found to have developed AApoAII-amyloidosis with a predilection for the deposits in the ileum (HogenEsch et al. 1993). In the present study, SPF CD-1 Swiss outbred mice, used for chronic toxicity experiments, were investigated. Amyloidosis was diagnosed by haematoxylin and eosin staining. The tissue localization of amyloid was recorded and confirmed by Congo red staining. The chemical type of amyloid was investigated by peroxidase antiperoxidase (PAP)-immunostaining using anti-murine AA and anti-murine AApoAII antibodies. Those animals which died during the study and the mice killed at end of the experiment, aged 18 months, from treated as well as non-treated control groups, showed AApoAII-amyloid deposits with similar prevalence. The AApoAII amyloid had organ predilection for gut, heart and lung tissue. A group of animals was euthanazed intercurrently at a young age, since they suffered from spontaneous dermatitis associated with Staphylococcus aureus infection. Sixty-eight percent had reactive amyloid deposits found primarily in spleen, liver, kidney and gut. From these findings and literature data on various other mouse strains, it is concluded that in mice used for toxicity studies, AA and AApoAII types of amyloidosis may be expected. The deposition patterns of these types of amyloid are slightly different. AA-amyloid has a predilection for spleen, liver, gut and kidney, and is often associated with inflammatory lesions of the skin, whereas masses of amyloid in lung, heart and ileum suggest AApoAII. Pulmonary amyloid appears to represent the most reliable deposition criterion for discriminating between both types of amyloidosis.

Chronic alcoholic myopathy: diagnostic clues and relationship with other ethanol-related diseases

We report the clinical, laboratory, functional and histological features of 100 male alcoholic patients of whom 44 had chronic alcoholic myopathy (CAM). We evaluated the use of non-invasive tests in detecting CAM, and examined its relationship with other ethanol-related diseases such as cirrhosis and cardiomyopathy. Of the CAM patients, 24 (55%) presented clinical symptoms of myopathy, whereas proximal muscle atrophy was observed in 15 patients (35%). Thirty-seven (80%) had significantly decreased muscle strength by myometric measurement and 27 (60%) had abnormally increased serum muscle enzymes. In most of these patients, the myopathy was classified as mild. The most frequent histological findings were myocytolysis, fibre size variability and type II fibre atrophy. As there was a good correlation between clinical symptoms, decreased muscle strength on myometry and histological evidence of CAM, muscle biopsy may be avoidable in some of these patients. Cardiomyopathy and liver cirrhosis were more frequent in patients with CAM, and should be checked for in chronic alcoholics with skeletal myopathy.

Histological changes associated with an artificial anterior cruciate ligament.

To investigate the histopathological features of the synovial lining of the knee following implantation of an artificial cruciate ligament. Eighty two patients underwent anterior cruciate ligament reconstruction for chronic, symptomatic instability of the knee. The cruciate ligament was reconstructed with a scaffold type prosthetic ligament. All patients underwent arthroscopy at the time of cruciate reconstruction and also as a "second look" procedure at a mean 26.5 months later, at which time synovial biopsy specimens were obtained in all cases. The most frequent histological finding was granulomatous synovitis in 48% (39/82) of patients. Particulate polyester debris produced a greater response than carbon fibres. In 24% (20/82), nonspecific inflammation was present and in 28% (23/82) the synovium was considered normal. When the prosthetic ligament was fully covered by soft tissue in-growth, a granulomatous reaction was present in 42% (24/57), irrespective of whether the ligament was partially or totally uncovered. Stabilisation of the joint did not prevent subsequent deterioration in the articular cartilage; other factors such as increasing patient age, interval between injury and reconstruction and altered knee kinematics after reconstruction are probably important. Granulomatous synovitis was not associated with progressive chondral changes. Although present in 48% of cases, granulomatous synovitis was not shown to have adverse effects on either chondral surface or the prosthetic material of the ligament. Rupture of the implant is caused by mechanical factors and granulomatous synovitis is not responsible for implant failure.

Implications of extracapsular nodal metastases for treatment and prognosis of breast cancer.

Extracapsular extension of nodal metastases from cancer of the breast is a frequent histologic finding, but its significance for prognosis and treatment is unclear. One hundred forty-three patients with breast cancer who had metastases to axillary lymph nodes were identified and divided into two groups: those with entirely intracapsular metastases (ICM), and those with extracapsular metastases (ECM). ECM was found in 58.7% of patients. A direct correlation was found between ECM and both the number of metastases and their size. Overall survival was significantly lower in patients with ECM, but an influence on survival independent of node count could be demonstrated only in patients with one to three involved nodes. ECM did not influence the pattern (i.e., locoregional versus distant) of recurrence and was not associated with increased recurrence in the axilla. Radiation therapy reduced locoregional failures in both ICM and ECM groups, but it did not improve survival. It is concluded that ECM has limited influence on prognosis independent of the number of positive nodes and is not an indication for radiation therapy of the axilla after a complete axillary dissection.

Cobalt-Alloy Metal Debris in Periarticular Tissues From Total Hip Revision Arthroplasties

To investigate the hypothesis that an association exists between the presence of metallic particulate or ionic debris released from the components of a total hip replacement and the histologic reaction in the surrounding tissues, cobalt, chromium, nickel, and molybdenum levels were measured in periarticular tissue from 22 individuals who had revision surgery. Total tissue content of the four elements (averaged per case) ranged from 2.7 to 250 micrograms of metal per gr of dried tissue (mean, 39 micrograms/gr); however, within each case, the tissue-metal content varied more widely. The highest total tissue-metal contents occurred in cases revised for infection. Fibrosis, histiocytic reaction, hemorrhage, and necrosis were the most frequent histologic findings. Polyethylene and cement particles each appeared in approximately half of all sections, while microscopic metal particles were seen only in tissues from the infected hips. Tissue-metal content did not correlate with the histologic findings, with any of the demographic variables, nor with duration of implantation. Ratios of the individual constituent elements generally reflected the cobalt-chromium alloy composition, suggesting that metal debris was present predominantly as wear particles. Only for tissues with very low metal contents did departures of these ratios indicate the presence of ionic corrosion products. The extremely low metal contents measured in many cement-bone interfacial tissues and the few metal particles found histologically suggest that metal particles may have been less important in inflammatory reaction and loosening than cement or polyethylene particles.(ABSTRACT TRUNCATED AT 250 WORDS)

Goblet cell hyperplasia in large intrapulmonary airways after intratracheal injection of cathepsin B into hamsters.

Goblet cell hyperplasia (GCH) is a frequent histologic finding in the airways of smokers. Experimental observations suggest that the process may be caused by increased proteinase activity in the airways. To investigate the possible role of cathepsin B in the development of GCH, male Syrian golden hamsters were given three intratracheal injections of bovine spleen cathepsin B or buffer (pH 5.5) at 2-day intervals. Six weeks later, we found by review of PAS-hematoxylin-stained 1-micron sections of plastic-embedded lung tissue that large intrapulmonary airways of animals given cathepsin B contained a significantly greater number of secretory cells per millimeter of airway (64.8 +/- 7.3 versus 47.5 +/- 10.3 for control animals, p less than 0.005) in association with a significant increase in the number of total cells per millimeter of airway, from 149 +/- 14 for control animals to 164 +/- 11 for cathepsin-B-treated animals (p less than 0.025). No change was observed in the number of ciliated cells (93.9 +/- 8.1/mm for control animals versus 94.8 +/- 10.3/mm for cathepsin-B-treated animals) or other cells (3.0 +/- 2.2/mm for control versus 4.3 +/- 4.1/mm for cathepsin B), indicating that selective expansion of the secretory cell population occurred. In contrast, in the main bronchi of animals given cathepsin B, no significant alterations were found in the number or percentage of secretory cells. The findings reveal that cathepsin B induces secretory cell hyperplasia in hamsters and suggest the possibility that cysteine proteinases may contribute to GCH in smokers.

Leukemia and Liver Disease in Childhood: Clinical and Histological Evaluation

Seventy-two consecutive patients with acute lymphocytic leukemia (ALL) who had undergone liver biopsy within 3 months of completing chemotherapy were studied to evaluate histological features after 2 to 3 years of chemotherapy and to correlate liver disease to the treatment schedule, the number of transfused blood units, and the identified etiology. Fibrosis due to antiblastic drugs was the most frequent histological finding. Histological liver disease was not related either to the chemotherapy schedule or the number of transfused blood units. HBV with or without delta virus and HCV infections were related to a more severe histological liver disease. In about 40% patients with chronic liver disease, no etiology was demonstrated. Immunohistochemistry revealed HBcAg in the liver of 3 HBsAg-negative patients. In conclusion, liver biopsy could be useful in patients with persistent abnormal liver function tests after the completion of chemotherapy and in patients with markers for hepatotropic virus infection.

Intestinal Spirochaetosis: Light and Electron Microscopic Study

24 cases of colon spirochaetosis have been studied by light and electron microscopy. This condition, although rarely diagnosed because of the absence of special clinical symptoms, seems to be a rather frequent histologic finding with marked variation in its geographical incidence. In our material the incidence of spirochaetosis was 16.5%, almost double than in Great Britain.

Postoperative sonographic follow-up of brain tumors in childhood

Postoperative neurosonography was performed in 69 babies and children after osteoclastic neurosurgery for primary cerebral tumors. Astrocytoma of the posterior fossa (26 cases) and medulloblastoma (25 cases) were frequent histological findings. Early postoperative bed-side examinations revealed reliably complications such as cerebral hemorrhage, edema or hygroma. Postoperative baseline studies were performed and reliability of sonographic criteria for tumor recurrence, such as high echogenicity and dense echotexture, were established. Regressive tissue changes under the usual postoperative cerebral radiation therapy and chemotherapy included transient increase in perifocal edema followed by tumor shrinking and cystic lesions or calcifications. Shunt dynamics were controlled by morphometrical studies of ventricular size. Long-time follow-up examinations were performed in most cases and covered periods of up to 4 years. Sensitivity of neurosonography for tumor recurrence was superior to non-contrast computed tomography; there were no false positive findings as proven by CT and magnetic resonance.

Synovial amyloidosis in patients undergoing long-term hemodialysis.

Synovial amyloid deposits were found in 18 patients with end-stage renal failure due to various nonamyloid nephropathies, who had been treated with long-term, periodic hemodialysis (mean 116 months). All patients had carpal tunnel syndrome, which was bilateral in 14 of them; 4 patients also had finger flexor tenosynovitis. In 2 patients, destructive arthropathies required surgical replacement of the hip. Amyloid deposits were demonstrated by light microscopy in the synovium of the finger flexor tendon and/or transverse carpal ligament of all patients who had surgery for carpal tunnel syndrome, and in the synovium and capsula of the 2 surgically removed hips. Transmission electron microscopy of synovial samples from 6 patients demonstrated the characteristic fibrillar ultrastructure of amyloid deposits, the biochemical nature of which is still unknown. In addition, 9 patients had cystic radiolucencies of bone, which were interpreted as having resulted from local amyloid deposits, involving carpal bones, humeral heads, femoral heads, acetabula, or tibial plateaus. Our results show that amyloidosis is a frequent histologic finding in dialysis patients receiving surgical management of carpal tunnel syndrome, and that it can also be associated with cystic radiolucencies of bones and with destructive arthropathies.

Primary sclerosing cholangitis.

Primary sclerosing cholangitis was diagnosed in 6 patients (4 men and 2 women), with ages ranging from 33 to 71 years. Four of them had ulcerative colitis, with an evolution from 8 to 21 years, the other two had Crohn's disease with 2 and 3 years of evolution. 66% of the patients had pain in the right upper quadrant; 50% complained of itching, 33% presented with fever, jaundice, weight loss and hepatomegaly and 16% had splenomegaly. 50% of these patients were diagnosed as having Sjörgren's syndrome. Alkaline phosphatase and gamma GT were elevated in 100% of the cases; SGOT and SGPT were slightly elevated in all cases; bilirubin was elevated only in 50% of the cases. Cholelithiasis was found in 2 patients with Crohn's disease and 1 patient with ulcerative colitis. All were subjected to laparoscopy. 2 of them were diagnosed as having persistent chronic hepatitis and the remaining patient had hepatic fibrosis. ERCP revealed alterations in the intrahepatic ducts and there was stenosis of the end of the common bile duct in one of them. The most frequent histological findings were periportal reactions with lymphocytes, plasma cells of macrophages, and periductal fibrosis with obliteration of the canaliculae.

Hepatic pathology in porphyria cutanea tarda.

We examined clinical and laboratory data and the liver pathology of 48 patients in whom porphyria cutanea tarda was related to alcohol ingestion, estrogen use and pregnancy, or was idiopathic. Biochemical test results, when abnormal, tended to be mild in most cases, with less than two-fold elevations of serum aminotransferases and alkaline phosphatase and mild hyperbilirubinemia. Fatty change, liver cell and Kupffer cell hemosiderosis and glycogenation of hepatocyte nuclei were frequent histologic findings in the 58 liver specimens studied. Alcoholic hepatitis, chronic hepatitis and cirrhosis were uncommon. Granuloma-like lobular aggregates consisting of iron- and ceroid-laden Kupffer cells, chronic inflammatory cells and fat droplets ("lobular lesions of porphyria cutanea tarda") were found in nearly two-thirds of specimens and appeared to be the most characteristic form of parenchymal damage in this form of porphyria. These lesions may be associated with pericentral fibrosis in alcoholic as well as estrogen-treated patients and may remit following therapeutic phlebotomy.

Hypertension in Nigerian children.

A retrospective review of 138 cases of hypertension in Nigerian children attending the University College Hospital, Ibadan, during a 9-year period was undertaken. The main findings were (a) that hypertension occurs more commonly in children aged 5 to 10 years and is seen in both sexes; (b) that nephrotic syndrome is the most frequent clinical condition associated with hypertension in these children; (c) that glomerulonephritis is the most frequent histological finding at biopsy or necropsy; (d) that unlike the experience in Europe and America, pyelonephritis is not a major cause of hypertension in Nigerian children; (e) that the course of hypertension in the majority of the children is rapidly progressive and prognosis is poor.