Frequent Histopathological Finding Research Articles

Retrospective study evaluating the impact of genomic profiling on management of patients with metastatic breast cancer

Abstract Background Genomic profiling of metastatic breast cancer (MBC) using next-generation sequencing (NGS) has identified driver mutations however, the routine sequencing to guide treatment decisions in this setting is still unclear. Methods Retrospective study of patients with MBC presented to 4 cancer centers in Egypt, from January 1, 2013 to December 31, 2017. Patients were randomized into; group (A) patients who received chemotherapy based on genomic testing and group (B) as control group who have the same clinico-pathological features as group (A) but received non-genomic based treatment. Results 46 patients met our inclusion criteria. Of these, Invasive ductal carcinoma, grade II, luminal-A sub-type (ER, PR +ve, HER-2 -ve) were the most frequent histopathological findings in both groups. Triple negative sub-type was the second most frequent hormonal status in both groups. The most common mutation identified among patients with genotyping was PIK3CA (41.7%), while TP53 was the second most common mutation (25%). The 4 months ORR for the 2nd line was 66.7% ,33.3% in the control arm and genomic arm respectively with (P value= 0.124). For the 3rd line, the ORR was 42.3%, 16.7% in the control arm and genomic arm respectively with (P value=0.370). For the 4th line, the ORR was 23.1%, 50% in the control arm and genomic arm respectively with (P value=0.346) reflecting genomic profiling non-significance. Regarding the median PFS, it was 6, 4 and 4 months in the control group versus 2, 4 and 4 months in the genomic group for the 2nd, 3rd and 4th line respectively with (P values =0.010, 0.782 and 0.655) respectively reflecting genomic profiling non-significance. Regarding the median OS (calculated since date of diagnosis), it was about 50 months and 80 months for control and genomic group respectively with non-significant trend increase in survival in the genomic arm. (P value = 0.062). Conclusions Gene profiling did not improve the 4 months ORR, PFS and OS. Genomic profiling is not a routine practice in MBC settings and it is recommended only for cases that are resistant to the standard therapy or for which no standard therapy is available and for those enrolled in a clinical trial. Editorial acknowledgement Amr Abd-El Aziz El-Said, Ashraf Ahmed El Masry, Neamat Elsayed Elsayed Hegazy, Amr munir Amin. Legal entity responsible for the study Alexandria University. Funding Has not received any funding. Disclosure The author has declared no conflicts of interest.

866 Safety and Efficacy of the Novel Endorotor® Mucosal Resection System: First Multicenter USA Experience

INTRODUCTION: The EndoRotor® (ER) non-thermal tissue resection device (Interscope Inc., USA) is a novel mechanical endoscopic resection system developed for use in the gastrointestinal tract for removal of neoplastic or pre-neoplastic tissue. It utilizes adjustable suction and a rotary cutting blade to precisely resect mucosal and submucosal tissue. Our aim was to assess the technical feasibility, safety and efficacy of endoscopic mucosal resection (EMR) using the ER device. METHODS: This was an IRB-approved multicenter retrospective review of prospectively collected data of patients that underwent EMR with ER device from 11/2018 to 06/2019 at 4 high-volume US centers. Patient-specific data were collected including demographics and indication for EMR. Procedural and histopathological data were also obtained. RESULTS: During the study period, 35 patients underwent EMR with ER of 42 lesions. Patient characteristics described in Table 1. Most common indications for EMR were colon polyps (n = 15, 42.9%) and Barrett’s Esophagus (n = 10; 28.6%). Most (n = 25; 71.4%) patients had a prior resection attempt for the same indication using standard techniques; ER-EMR was successful in all these difficult cases. The majority (n = 32; 91.4%) had a single lesion resected; 3 patients had multiple lesions resected in same session. ER-EMR was technically feasible in all patients, with complete resection achieved in 33 (94.3%) patients (Table 2). Mean lesion size was 2.1 cm (range = 0.35–4 cm). Most frequent histopathological findings in the colon were tubular adenoma (n = 10; 45.5%) or sessile serrated adenoma (n = 5; 22.7%). Most common esophageal pathology in BE patients was high-grade dysplasia (n = 5; 50%). Intra-procedural bleeding was observed in 9 (25.7%) patients, all managed endoscopically. No ER-related perforation occurred. Post-procedural complications were reported in 7 patients (20%), including self-limited chest pain (n = 1), mild stenosis (n = 3), and delayed bleeding (n = 3). Of patients that have undergone a follow-up endoscopy (n = 13; 37.1%), no residual lesion was seen in majority (n = 10; 76.9%). CONCLUSION: The Endorotor® device is a novel, effective and safe non-thermal EMR technique that allows efficient endoscopic resection of flat and polypoid lesions, especially those with submucosal scarring. Our initial experience suggests it has a promising role in the endoscopic management of both naïve and difficult to remove luminal lesions in the foregut and in the colon.

Dermatosis autoinmunes en caninos. Estudio retrospectivo

<p>Se investigaron muestras de piel de caninos con diagnóstico de enfermedad autoinmune ingresadas entre los años 2004 y 2016 al Laboratorio de Patología Especial Veterinaria (FCV, La Plata, Argentina). Los objetivos fueron identificar casos de caninos con lesiones cutáneas y seleccionar aquéllos con diagnóstico de enfermedad autoinmune. También se propuso relacionar las dermatosis autoinmunes con la raza, edad, sexo, el tipo y la ubicación anatómica de las lesiones clínicas y, por ultimo, describir las diferentes lesiones histopatológicas que caracterizaron cada afección. Las enfermedades autoinmunes representaron el 2,07% del total de casos ingresados en el período de estudio, siendo las más frecuentes el pénfigo foliáceo y el lupus eritematoso discoide. Los caninos de raza pura fueron más afectados que los mestizos, siendo la región dorsal de la nariz la ubicación anatómica de mayor presentación (35,3%). Entre los hallazgos histopatológicos más reiterados se observaron pústulas (54,1%), áreas de separación dermoepidérmica (45,9%) y espongiosis (44,7%). Si bien el porcentaje de caninos con dermatosis autoinmunes es bajo, es importante incluirlas dentro de los diagnósticos diferenciales de las enfermedades que cursan con pústulas, pápulas, vesículas e infiltrado inflamatorio en la unión dermoepidérmica. La histopatología es una herramienta útil y relativamente accesible en nuestro medio, que permite arribar al diagnóstico de tales enfermedades.</p>

Histopathological findings in laparoscopic sleeve gastrectomy specimens.

Objective: To study the demographic data and histopathological specimen findings of patients who have undergone laparoscopic sleeve gastrectomy. Design: A retrospective descriptive study. Setting: Pathology and Laboratory Medicine Department, Al-Ahli Hospital, Doha, Qatar. Methods: Data of patients who underwent laparoscopic sleeve gastrectomy between January 1, 2009 and December 31, 2016 were retrospectively collected from the laboratory information system of Al-Ahli Hospital. Results: A total of 342 patients underwent laparoscopic sleeve gastrectomy. Among these patients, 294 (86%) were Qatari and 241 (70%) were female. The patient age ranged from 13 to 72 years, and most patients were in the 31–40-year age group. Histological examination of specimens showed that lymphocytic aggregates in the lamina propria were the most frequent histopathological finding (171, 50%), followed by no remarkable pathological finding (98, 28.6%). The other pathological findings were follicular gastritis, fundic gland polyps, and acute and chronic gastritis. Conclusion: Our findings clearly indicate the need for routinely performing histopathological examination of laparoscopic sleeve gastrectomy specimens. The study also highlights lymphocytic aggregates as the most common histopathological finding.

Karakteristike nalaza na scintigramu štitaste žlezde sa 99mTc-pertehnetatom kod pacijenata sa diferenciranim tireoidnim karcinomom

Introduction: Differentiated thyroid carcinoma (DTC) derived from follicular cells is the most frequent endocrine malignancy, which most commonly occurs in patients with thyroid nodules. Aim: The aim of this retrospective analysis is to examine the type of scintigraphic finding of the thyroid gland obtained with 99mTc-pertechnetate in patients with DTC before tireoidectomy. Material and methods: Medical documentation comprised of 95 subjects with presurgical evaluation of thyroid nodules, including 18 men (51.5 ± 8.7 years old, range 43-68) and 77 women (48 ± 12, range 14-72 years). Other tests performed during the preoperative tests are the following: ultrasound examination of the thyroid gland, thyrotropin and thyroglobulin concentration measurement. Results: During the preoperative evaluation, thyroid ultrasound was performed in 20 (21%) out of 95 subjects with DTC, while 99mTc-pertechnetate scintigraphy was performed in 75 (79%) of patients, in addition to a clinical examination. What is the distribution of scintigraphic finding? Significantly, the highest incidence of DTC was found in the multinodular goiter: 61 (64%) subjects were diagnosed with this type of DTC, while 31 (33%) carcinomas were found in abnormal, solitary "cold" nodules. The most frequent histopathological finding amongst nodules and multinodular goiter detected by scintigraphy was papillary thyroid carcinoma. Thyroid carcinoma was found in two patients with Graves' disease and in one patient with a normal scintigraphic finding. The values of thyroid hormones were normal in 71% of DTC and elevated in fewer cases (21%). The ultrasound examination showed high-risk features in only 18 subjects (19%). Conclusion: Our results have shown that DTC is the most common finding in the multinodal goiter, and that it occurs much less often within the "cold" thyroid nodules. In a small percentage of subjects, thyroid neoplasm was found in patients with hyperthyroidism. The results of the study showed that thyroid gland scintigraphy with 99mTc-pertechnetate still has a significant diagnostic role in the examination of thyroid nodules.

Spectrum of glomerular diseases in native kidneys in patients attending Nepal Medical College Teaching Hospital

Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal. We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital.Methods: This is a retrospective analysis of patients who have undergone native kidney biopsy from July 2013 to June 2014. Seventy five cases were included. We reviewed the biopsy requisition and where available admission forms for symptoms, indications and complications of the biopsy, urine analysis report and final biopsy report. Kidney biopsy was done under USG guidance or assistance. Automated biopsy gun of 16 or 18G was used. Kidney tissues were sent for light microscopy and immune fluorescence examinations. After 24 hrs of biopsy, USG-KUB and urine RME were repeated for complicationsResults: Majority of our study population (62%) was from age group of 13 to 30 years. Sixty five percent of the patients (n= 49) were admitted with a diagnosis of nephrotic syndrome. Most frequent histopathological finding was Minimal Change Disease (26.7%) followed by LN (21.3%), Membranous Nephropathy (18.6%), Focal Segmental Glomerulosclerosis (13.4%) and IgA nephropathy (9.3%). Patients with the histopathological diagnosis of LN and IgAN presented with hematuria in 81.2% and 71.4% respectively. MCD patients presented with proteinuria only. Total no. of glomeruli in the sample was 23.41±11.55.Conclusion: Nephrotic syndrome was the most common indication for the renal biopsy. MCD was the most common histological finding in our series and Lupus nephritis is not uncommon in our series.Journal of Advances in Internal Medicine Vol.5(2) 2016: 24-28

Lupus glomerulonephritis in 788 Chinese children: a multi-centre clinical and histopathological analysis based on 549 renal biopsies

Background: System lupus erythematosus (SLE) is a severe multisystem autoimmune disease.Objective: To describe the clinical and pathological features, treatment, and renal outcome in children under 18 years with lupus nephritis (LN).Methods: The study was undertaken by a questionnaire completed in 26 Grade 3A hospitals’ paediatric renal units in China. The study comprised 788 children (619 girls, 169 boys) diagnosed with SLE by the American College of Rheumatology criteria (1997) during 2005–2010. Results of renal biopsies were classified according to the guidelines of The International Association of Nephrology and the Renal Pathology Society (2003). Guidelines by the Chinese Society of Paediatric Nephrology were applied for the diagnosis and treatment (for trial implementation) in 2010 to determine inclusion. The data included the prevalence of acute kidney injury (AKI), SLE disease activity index (SLEDAI), renal histopathology and the induction of therapy mode.Results: The mean (SD) age of onset of SLE was 10.9 (2.90) years (range 1–18) and at diagnosis was 11.3 (2.9) years. The mean (SD) SLEDAI score was 13.5 (5.53). The clinical classification was as follows: about 36 (4.6%) patients had isolated haematuria, 99 (12.6%) isolated proteinuria, 60 (7.6%) isolated haematuria and proteinuria, 157 (19.9%) acute glomerulonephritis, 392 (49.7%) nephrotic syndrome, 20 (2.5%) rapidly progressive glomerulonephritis, 15 (1.9%) chronic nephritis, 2 (0.3%) tubule-interstitial damage and 7 (0.9%) subclinical LN. A total of 549 children (69.7%) underwent renal biopsy. The most frequent renal histopathological findings of LN were Class IV, followed by Class II and Class V + IV. There were no significant differences between the age groups in either renal pathological types or prognosis. In 242 (30.7%) patients, LN was complicated by AKI. Those with AKI had an older mean (SD) age at onset than the non-AKI patients [11.5 (2.8) years vs 10.7 (2.9) years, respectively, p < 0.0001] and a higher SLEDAI score [14.3 (5.8) vs 13.1 (5.4), respectively, p = 0.003]. In the induction phase, cyclophosphamide (CTX) and mycophenolate mofetil (MMF) were equally effective in the patients with the same pathological type. Follow-up records were only available for 482 (61.2%) patients, with a mean (SD) follow-up time of 21.5 (18.4) months. Six of the 35 patients who deteriorated required dialysis and seven died.Conclusion: In LN, AKI is a risk factor for poor outcome. Owing to different times of onset and remission, the pathological types of LN cannot be estimated by clinical manifestation alone, and therefore renal biopsy should be undertaken in all LN children with AKI. In the induction phase, there was no significant difference in efficacy between CTX and MMF. Follow-up of children with LN in China needs to be improved.

Evaluation the effectiveness of intravenous cyclophosphamide treatment in children with lupus nephritis

Objective: Renal involvement in systemic lupus erythematosus is an important cause of morbidity and mortality. Cyclophosphamide is widely used in the treatment of lupus nephritis. The aim of this study is to evaluate the effectiveness of intravenous cyclophosphamide treatment in children with lupus nephritis. Material and Method: In this study, 28 patients with lupus nephritis treated by intravenous pulse cyclophosphamide between the years 1999, and 2011 in Istanbul Faculty of Medicine, Department of Pediatric Nephrology were investigated retrospectively. Clinical history, presenting symptoms and findings, laboratory analysis, results of renal biopsy, treatment methods and prognosis were evaluated. Results: Proteinuria was determined in 27 (96.5%), macroscopic hematuria in 4 (14.3%), hypertension in 15 (53.5%), and renal failure in 11 patients (39.2%) as initial presentations. The most frequent extrarenal clinical findings were arthritis/arthralgia (67.9%), constitutional (64.3%) and skin findings (60.7%). The most frequent histopathological finding of lupus nephritis patients in our study group was Class 4 lupus nephritis (53.5%), followed by Class 2 (21,6%), Class 3 (10,7%) and Class 5 (3.5%) nephritis respectively. Renal remission was obtained in 21 (75%) patients throughout 62.7±49 (6-204) months of follow up period in study group. Nineteen patients (67.8%) were in remission in terms of both renal and extrarenal findings. Morbidity ratio (ESRF) was 14.2%, and mortality rate was 3.5% in our study group. ESRF and death in the study group were statistically related to increased serum creatinine levels during the initial presentation (p: 0.047). Side effects of intravenous cyclophosphamide were detected in 39.2% of the patients, while most frequent side effect was neutropenia (21.4%). Conclusion: In this study, intravenous cyclophosphamide treatment was determined as effective and reliable with minimum side effects in order to obtain renal and extrarenal remission in patients with pediatric lupus nephritis. The presence of high serum creatinine during the initial presentation was found as a poor prognostic factor.&nbsp;

A Cross-Sectional Study of the Prevalence of Gastrointestinal Symptoms and Pathology in Patients With Common Variable Immunodeficiency.

The objective of this study was to study the prevalence of gastrointestinal (GI) symptoms and histopathology in patients with common variable immunodeficiency (CVID) as well as linking the findings to GI infections and markers of systemic immune activation. In this cross-sectional study, we addressed GI symptoms in 103 patients and GI histopathological findings in 53 patients who underwent upper and lower endoscopic examination. The most frequent histopathological findings were linked to GI symptoms, B-cell phenotype, and markers of systemic immune activation (soluble (s)CD14, sCD25, and sCD163). Microarray analysis compared "celiac-like disease" in CVID to celiac disease. Screening for selected bacterial and viral infections in fecal samples and gut mucosal biopsies was performed. The main findings of this study were as follows: most common GI symptoms were bloating (34%), pain (30%), and diarrhea (26%). The most frequent histopathological findings were increased intraepithelial lymphocytes in the descending part of the duodenum, i.e., "celiac-like disease" (46% of patients), decreased numbers of plasma cells in GI tract mucosa (62%), and lymphoid hyperplasia (38%), none of which were associated with GI symptoms. Reduced plasma cells in GI mucosa were associated with B-cell phenotypic characteristics of CVID, and increased serum levels of sCD14 (P=0.025), sCD25 (P=0.01), and sCD163 (P=0.04). Microarray analyses distinguished between CVID patients with "celiac-like disease" and celiac disease. Positive tests for bacterial and viral infections were scarce both in fecal samples and gut mucosal biopsies, including PCR test for norovirus in biopsy specimens (0 positive tests). In conclusion, GI pathology is common in CVID, but does not necessarily cause symptoms. However, reduced plasma cells in GI mucosa were linked to systemic immune activation, "celiac-like disease" in CVID and true celiac disease appear to be different disease entities, as assessed by gene expression, and infections (including norovirus) are rarely a cause of the CVID enteropathy.

FV 4. U-Fiber Density Imaging identifies specific microstructural alterations in the epileptogenic zone in individual patients with cryptogenic focal epileps

Patients with cryptogenic focal epilepsy (cFE), where conventional MRI does not show any structural lesion represent the fastest growing number of epilepsy surgery candidates in most tertiary referral centers. The absence of a visible surgical target challenges presurgical evaluation and requires complementary diagnostic methods to guide further investigations, especially intracranial EEG recordings. Here we present a new diagnostic approach, based on the quantification of regional u-fiber density to identify specific microstructural abnormalities in the epileptogenic zone of patients with cFE. 55 patients with cFE and 60 healthy controls were investigated. Diffusion Tensor Imaging (DTI) data was acquired on a GE Signa HDx 3T MRI Scanner, using an acquisition scheme with 64 diffusion weighted directions, a b-value of 1000 s/mm[b] and 2.4 mm slice thickness. Whole brain tractography was performed, creating an average of 1.05 million fiber tracts per subject. From this dataset, we specifically selected u-fibers, based on length, curvature and shape criteria. Density images were created, specifying the number of u-fibers within any 1 mm[c] voxel of the brain. These u-fiber density images (UFDI) were spatially normalized to a template in MNI-space and smoothed with an 8 mm kernel. For every single patient the UDFI was statistically compared against the control population, using SPM software. Clusters of significant reductions in UFDI were determined, thresholding at a minimum size of 5 cm[c] and a p-value <0.001, correcting for multiple comparisons using the family wise error (FWE) method. Localization of UFDI reductions was compared with clinical data from the presurgical evaluation. All patients had normal conventional MRI, using a specific epilepsy protocol on a 3T scanner. In 43 patients, a conclusive hypothesis on the epileptogenic zone could be derived, based on ictal and interictal EEG, seizure semiology, FDG-PET and ictal SPECT imaging and neuropsychological assessment. Only those 43 patients were included in the final analysis. In the remaining 12, clinical data was inconclusive, preventing further analysis of their UDFI alterations. Clusters of significant UFDI reductions were found in 91% of the patients and 78% of these reductions were consistent with the clinically suspected epileptogenic zone. Twelve patients underwent intracranial EEG recording with depth electrodes, confirming seizure onset in 74% of the detected UFDI reductions. Eight patients had resective surgery and the most frequent histopathological finding was a mild architectural disturbance with blurred gray-white matter border and ectopic neurons in the white matter. Quantitative UFDI has proven sensitive and specific to detect microstructural alterations in patients with cFE, superior to other complementary diagnostic methods. Histopathology has shown mild malformations of cortical development (MCD), a well-known cause of cFE. MCD typically affect the gray-white matter border, and this is exactly where u-fibers are located, spanning between neighboring gyri, directly underneath the cortex. We hypothesize the ectopic neurons disrupt the microstructural order of subcortical white matter, thereby artificially reducing the number of u-fibers we could reconstruct in this region. UFDI has become a routine diagnostic method in our department for all patients with cFE and is now routinely used to guide implantation of intracranial electrodes.

The etiology and autopsy findings in Colchicine intoxication-related deaths

Colchicine is a drug which has a very narrow therapeutic range. This drug has been commonly used for Familial Mediterranean Fever (FMF), Behcet’s disease, gout arthritis and acute pseudo gout attacks. In this study, the investigation reports and autopsy reports written by the Council of Forensic Medicine of Ankara between the years 2010-2014 were retrospectively analyzed to find out presence in the cases related to colchicine. Six cases were identified as colchicine intoxication, while three of them used colchicine for medical purpose. In four cases, colchicine was found to have been used for suicidal purpose. Among these four cases, two used colchicine for treatment. In all of our cases, colchicine was detected in bile specimen. Alveolar pulmonary edema and petechial hemorrhage were observed in the lung in all cases. Colchicine was detected in blood in four of the cases. In two cases, the concentration was found to be in therapeutic ranges (0,012 mg/L and 0,018 mg/L), while the other two, in lethal levels (0.099 mg/L and 0,264 mg/L). The most frequent histopathological finding is alveolar pulmonary edema in colchicine intoxication autopsies. Colchicine is widely used alkaloid drugs with narrow therapeutic ranges. More than 0.8 mg / kg in the acute high dose has usually fatal effects. The deaths resulted from colchicine intoxication are mainly suicide-oriented. Similar to other suicides with medicines, they are common among women. In our cases, colchicine was used for intention of suicide in four incidents (66, 66%).

Clinical Manifestations of Respiratory Bronchiolitis as an Incidental Finding in Surgical Lung Biopsies: A Retrospective Analysis of a Large Austrian Registry

Background: While respiratory bronchiolitis (RB) is a frequent histopathological finding in smoker's lungs, RB-associated interstitial lung disease (RB-ILD) remains a rare disease. Objectives: We analyzed how the histological finding of RB was associated with clinical information in a series of 684 consecutive surgical lung biopsies. Methods: Retrospective analysis with delineation of clinical manifestations, smoking habits, pulmonary function test, and blood gas analysis in patients with RB in surgical lung biopsy. In 240 of these biopsies, RB was diagnosed, and in 146 of these cases a full clinical dataset was available. Results: The final diagnosis of these 146 patients was consistent with RB-ILD (n = 18), pulmonary Langerhans cell histiocytosis (n = 7), various ILD (n = 9), spontaneous pneumothorax (n = 43), traumatic pneumothorax (n = 5), lung cancer (n = 41), various benign lung tumors (n = 8), and chronic pulmonary effusion (n = 15). Smoking history was positive in 93% of patients, 72% revealed centrilobular emphysema in their biopsy, and 58% described dyspnea as the main symptom. Amongst these diagnoses there were significant differences in age and smoking habits, but only small distinctions in pulmonary function test and blood gas analysis. Out of the patients with RB-ILD, 17% developed lung cancer in the later course. Conclusion: RB is strongly related to smoking, emphysema, and dyspnea and frequently associated with lung cancer. RB-ILD is a rare disease that may represent a considerable risk for lung cancer. Pulmonary function testing and blood gas analysis do not differ between RB-associated diseases. The finding of RB should prompt further diagnostic workup, and in case of RB-ILD, entail regular screening for lung cancer.

Lupus nephritis in Croatian children: clinicopathologic findings and outcome.

We report clinical and histopathological features, treatment and outcome of 37 Croatian children with biopsy-proven lupus nephritis seen over a 30-year period. The mean age at lupus nephritis presentation was 12.11 ± 2.59 years (range 4.66-17.0). The most frequent histopathological finding was class IV (37.8%), followed by class III (35.1%), class V (16.2 %) and class II (10.8 %) lupus nephritis. Compared with other classes there were more boys among patients with class IV lupus nephritis, and hypertension, nephrotic syndrome and decreased estimated glomerular filtration rate at presentation were more common. The median histopathological activity and total scores were highest in class IV lupus nephritis patients. The mean follow-up was 7.14 ± 4.71 years, ranging from 1.1 years to 21.0 years. Kaplan-Meier estimate S: of patient and kidney (without renal failure) survival rate S: were 90.5% and 87 % at five years. The renal survival rate of class IV lupus nephritis patients was found significantly lower compared with other histological classes combined. Decreased estimated glomerular filtration rate at the time of diagnosis, class IV lupus nephritis versus other lupus nephritis classes, and high total histological score were the parameters significantly associated with adverse outcome. The therapy with cyclophosphamide showed as superior to the therapy with azathioprine.

Drug-resistant focal sleep related epilepsy: Results and predictors of surgical outcome

In this study we report the results of surgery in a large population of patients affected by drug-resistant focal sleep related epilepsy (SRE) and the identified prognostic factors. We conducted a retrospective analysis of a case series of 955 patients operated on for drug-resistant focal epilepsy from 1997 to 2009. Ninety-five patients with focal SRE and a follow-up of at least 2 years were identified. Presurgical, surgical and histopathological variables were analyzed. Risk of seizures recurrence was assessed by univariate and multivariate analysis. Mean age at epilepsy onset was 5.6 ± 4.9 years. MRI revealed a focal abnormality in 78.9% of cases. Sixty-two percent of patients required a Stereo-EEG investigation. The cortical resection involved the frontal lobe in 61.1% of cases, while in 38.9% an extrafrontal resection was performed. Focal cortical dysplasia (FCD) type II was the most frequent histopathological finding. Mean postoperative follow-up was 82.3 months. Seventy-three patients (76.8%) were in Engel's class I. At univariate analysis, variables associated with a favorable outcome were: absence of Stereo-EEG investigation; positive MRI; complete removal of the epileptogenic zone (EZ); presence of FCD type II and FCD type IIb. A diagnosis of FCD type I was associated with postoperative recurrence of seizures. Multivariate analysis identified the complete removal of the EZ and FCD type I as independent predictors of a favorable and unfavorable outcome respectively. SRE can frequently originate outside the frontal lobe and a favorable surgical outcome is achieved in three-fourths of cases independently from the location of the EZ.

13. A case of sebaceous adenoma in a salivary gland

Sebaceous differentiation in parotid glands is a frequent histo-pathological finding (approximately 20-40%), however sebaceous neoplasms occurring in parotid glands are very uncommon. Sebaceous adenomas are benign adnexal neoplasms and account for 0.1% of all salivary gland neoplasms. These adenomas occur most commonly in the parotid gland; however they have been reported in the submandibular, sublingual, and minor salivary glands. The literature describes a few cases diagnosed by fine needle aspirate cytology, however it remains a histological diagnosis in the majority of cases. Histologically, the neoplasm is characterised by abundant islands of sebaceous cells admixed in a fibrous stroma surrounded by cystic and duct like structures. There have been no reports of recurrence following adequate surgical excision. We present a case of sebaceous adenoma in a parotid gland, to draw attention to this differential diagnosis in the diagnosis of parotid masses.

Clinico-biochemical correlation to histological findings in alcoholic liver disease: a single centre study from eastern India.

Alcoholism is a health problem not only in developed countries but also in developing countries. Cirrhosis due to alcohol is a common cause of death among individuals abusing alcohol. A better knowledge of the spectrum of alcoholic liver diseases, its clinical, biochemical and histopathological features could result in early detection and prevention of alcoholic liver diseases before it's catastrophic and life threatening effects. A total of 200 patients with alcoholic liver diseases were studied with respect to alcohol consumption, clinical features, biochemical and histopathological changes. The clinical features, biochemical parameters, and histopathology of liver including Ishak's modified histological activity index (HAI) were correlated with the amount and duration of alcohol consumed. Majority of the patients were in the age group of 40-49 years and all the cases were males. Majority consumed alcohol of about 75-90 grams per day for a duration of 10-12 years. Anorexia and jaundice were the most common symptom and clinical finding respectively. Hyperbilirubinemia and hypoalbuminemia were the most common abnormalities observed in liver function tests. Advanced HAI stages with features of cirrhosis were most frequent histo-pathological finding noted in this study. Clinico-biochemical profile was significantly correlated with degree of alcohol ingestion as well as with liver histopathology. The wide prevalence of alcoholic liver disease including cirrhosis among Indian males was noted with significantly lower quantity and duration of alcohol ingestion. The severity of liver damage is directly proportional to the quantity and duration of alcohol consumed. Clinical features and biochemical changes may forecast the liver histopathology among the patients of alcoholic liver disease.

Gastric polyps: analysis of endoscopic and histological features in our center

the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. gastric polypoid lesions were found in 269 of the 6,307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of ≤ 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received protom pump inhibitors (PPIs). Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%).

The prenatal effects of mobile microwave radiation on mice

Objective The aim of this study was to investigate the histopathological and ultrastructural prenatal effects of mobile phone microwave radiation on mice liver. Materials and methods Pregnant mice were divided into three groups of 10 animals each. Group one (G1) was the control group with mice unexposed to mobile phone. Group two (G2) mice were exposed for half-hour every day during the gestational period with the cell phone in answering state. Group three (G3) mice were exposed during the gestational period for 1 h every day with the cell phone in answering state and for 12 h while the cell phone was in standby state. The microwave radiation produced by mobile phones operated at a microwave frequency range of 900–1800 MHz. Mice fetuses were examined and then killed with an overdose of ether. Liver biopsies were prepared for histopathological and ultrastructural examinations. Results The mean body weight and length of fetuses of G3 showed a statistically significant decrease compared with G1 (P<0.05). Congestion of the central vein and dilation of hepatic blood sinusoids were the most frequent histopathological findings. The ultrastructural results were apparent in G3 in the form of dilated rough endoplasmic reticulum, loss of mitochondrial cristae and pleomorphic mitochondria, mitochondrial swelling and fragmentation, hepatocytic vaculations, nuclear inclusions, and inflammatory cell infiltration in the periportal areas, of mainly lymphocytes. The results of this study showed a significant reduction in the average body weight and length of fetuses of G2 and G3. Conclusion The ultrastructural damage observed in the examined specimens shows the hepatocellular injuries and consequent systemic impairment of body functions.

Telocytes in human isolated atrial amyloidosis: ultrastructural remodelling

The human heart can be frequently affected by an organ-limited amyloidosis called isolated atrial amyloidosis (IAA). IAA is a frequent histopathological finding in patients with long-standing atrial fibrillation (AF). The aim of this paper was to investigate the ultrastructure of cardiomyocytes and telocytes in patients with AF and IAA. Human atrial biopsies were obtained from 37 patients undergoing cardiac surgery, 23 having AF (62%). Small fragments were harvested from the left and right atrial appendages and from the atrial sleeves of pulmonary veins and processed for electron microscopy (EM). Additional fragments were paraffin embedded for Congo-red staining. The EM examination certified that 17 patients had IAA and 82% of them had AF. EM showed that amyloid deposits, composed of characteristic 10-nm-thick filaments were strictly extra-cellular. Although, under light microscope some amyloid deposits seemed to be located within the cardiomyocyte cytoplasm, EM showed that these deposits are actually located in interstitial recesses. Moreover, EM revealed that telopodes, the long and slender processes of telocytes, usually surround the amyloid deposits limiting their spreading into the interstitium. Our results come to endorse the presumptive association of AF and IAA, and show the exclusive, extracellular localization of amyloid fibrils. The particular connection of telopodes with amyloid deposits suggests their involvement in isolated atrial amyloidosis and AF pathogenesis.

Histopathological evaluation of recurrent goiter.

The recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. An inadequate surgical removal of the thyroid gland, lack of substitution therapy and pathological stimulation of the thyroid growth can all promote the recurrence. The aim of this study was to find the connection between the histopathological findings during the first and second operation and the recurrence of goiter. The study group consisted of 29 women and 1 man. The mean time to recurrence was 15 years. The most frequent histopathological finding during the first and second operation was struma nodosa. According to our observations different histopathological findings were found in 63.4% cases after primary and secondary thyroidectomy. Some genetic investigations showed that nodules in recurrent goiters did not derive from nodules left during the first operation but from a group of cells which had high growth potential. Thus, not only the operation technique and substitution after operation are key factors of successful therapy of goiter, but also other factors which stimulate the re-growth of thyroid tissue.