Gross Pathological Examination Research Articles

Predicting the coagulation volume induced by microwave ablation of hepatocellular carcinoma: the role of deposited energy, ex-vivo bovine liver charts and central hyperdense area on post-treatment CT

Purpose To study the correlation between the overall coagulation zone (A) attained in percutaneous microwave ablation (MWA) of hepatocellular carcinomas (HCC) and: (1) the hyperdense zone (C) visible in the central part of zone A on post-treatment unenhanced CT scans; (2) the deposited energy; (3) the coagulation zones observed on ex-vivo bovine liver. Materials and methods The post-procedural computed tomography (CT) scans of HCCs treated with a single energy deployment through the same 2450 MHz MWA system were retrospectively analyzed, retrieving the dimensions of A and C zones and the deposited energy (E). Ex-vivo bovine liver MWA with the same system were performed and analyzed to determine the same quantities by gross-pathologic examination and CT imaging. Results A total of 101 HCC treatments were analyzed. The average coagulation volumes increased linearly with deposited energy (1.11 cc/kJ, R 2 = 0.90, 4.2 kJ ≤ E ≤ 48 kJ), similarly to ex-vivo findings (1.38 cc/kJ, R 2 =0.97, 7.2 kJ ≤ E ≤ 144 kJ). The long axis (L) and short axis (D) of zones A and C held a fairly constant ratio both in-vivo (LC/LA=0.43 ± 0.13; DC/DA=0.42 ± 0.10) and ex-vivo (LC/LA = 0.49 ± 0.07; DC/DA = 0.28 ± 0.06). Conclusions The average dimensions of the ablation zone induced by the considered system on HCC increase linearly with the deposited energy and are fairly well predicted by the corresponding ex-vivo dimensions. The ratio between each linear dimension of A and C zones was found to be roughly constant over a large deposited energy span, both ex-vivo and in-vivo.

Morphological MRI of knee cartilage: repeatability and reproducibility of damage evaluation and correlation with gross pathology examination.

To assess the performance of a morphological evaluation, based on a clinically relevant magnetic resonance imaging (MRI) protocol, in scoring the severity of knee cartilage damage. Specifically, to evaluate the reproducibility, repeatability, and agreement of MRI evaluation with the gross pathology examination (GPE) of the tissue. MRI of the knee was performed the day before surgery in 23 patients undergoing total knee arthroplasty. Osteochondral tissue resections were collected and chondral defects were scored by GPE according to a semi-quantitative scale. MR images were independently scored by four radiologists, who assessed the severity of chondral damage according to equivalent criteria. Inter- and intra-rater agreements of MRI evaluations were assessed. Correlation, precision, and accuracy metrics between MRI and GPE scores were calculated. Moderate to substantial inter-rater agreement in scoring cartilage damage by MRI was found among radiologists. Intra-rater agreement was higher than 96%. A significant positive monotonic correlation between GPE and MRI scores was observed for all radiologists, although higher correlation values were obtained by radiologists with expertise in musculoskeletal radiology and/or longer experience. The accuracy of MRI scores displayed a spatial pattern, characterized by lesion overestimation in the lateral condyle and underestimation in the medial condyle with respect to GPE. Evaluation of knee cartilage morphology by MRI is a reproducible and repeatable technique, which positively correlates with GPE. Clinical expertise in musculoskeletal radiology positively impacts the evaluation reliability. These findings may help to address limitations in MRI evaluation of knee chondral lesions, thus improving MRI assessment of knee cartilage. • MRI evaluation of knee cartilage shows moderate to strong correlation with gross pathology examination. • MRI evaluation overestimates cartilage damage in the lateral condyle and underestimates it in the medial condyle. • Education and experience of the radiologist play a role in MRI evaluation of knee chondral lesions.

Protective effect of an angiotensin-converting-enzyme inhibitor on neurogenic pulmonary edema in rabbits

Neurogenic pulmonary edema (NPE ) was indicative of poor prognosis in the epidemic of enterovirus 71 infections. The pathogenesis of NPE remains poorly understood. The objectives of this experimental study were to explore whether RAS is activated during NPE in rabbit models induced by fibrin and the effects of an angiotensin converting enzyme inhibitor (enalaprilat) on NPE. NPE models were induced by intracisternal injection of fibrinogen and thrombin. According to random number table method, 18 healthy adult New Zealand rabbits were assigned to three groups (with 6 in each) : normal control group (Con group), NPE group and enalaprilat treated (Ena) group. After establishment of NPE models, rabbits in Ena group were given intravenous enalaprilat 0.5 mg/kg. Expression of ACE,ACE2,AT1R mRNA of the lung tissue were evaluated by real-time polymerise chain reaction; and Ang II of the lung tissue was determined by enzyme linked immunosorbent assay ( ELISA ). Meanwhile, histopathological lung injury scores were evaluated. ACE mRNA expression level in NPE group ( 17.2 ± 3.3) appeared an increasing trend in contrast to Con group ( 12.6 ± 5.2 ) and Ena group ( 11.5 ± 2.4, both P > 0.05 ). Compared with Con group (81 ± 22 ), ACE2 mRNA expression levels of NPE group ( 52 ± 6 ) and Ena group ( 45 ± 13 ) both decreased ( both P < 0.05 ) . ACE mRNA/ACE2 mRNA expression levels of NPE group ( 0.33 ± 0.06 ) and Ena group ( 0.26 ± 0.04 ) were higher than those of Con group ( 0.16 ± 0.05, both P < 0.05 ), as well as the ratio of Ena group decreased compared with untreated NPE group ( 0.26 ± 0.04 vs. 0.33 ± 0.06, P < 0.05 ) . There were no statistically significant differences in expression of AT1 mRNA of the lung tissue among three groups, but Ena group ( 4.8 ± 1.1) in contrast to NPE group ( 6.7 ± 1.3) has no significant difference (P > 0.05). Lung AngII level of NPE group [(540 ± 147) pg/ml] was significantly higher than that of Con group [(253 ± 37 ) pg/ml] and Ena group [(309 ± 35 ) pg/ml, both P < 0.05 ]. Gross pathologic examination showed that pink foamy edema fluid appeared in the tracheal tubes in NPE group, but spontaneously appeared in neither Con group nor Ena group; and the level of pulmonary subpleural bleeding in Con group, 12 graded 0; in NPE group, 2 graded II, 10 graded III; in Ena group, 2 graded, 8 grade II, 2 grade III. The histopathologic lung injury scores in Ena group was decreased in contrast to NPE group (1.36 ± 0.26 vs.2.32 ± 0.49, P < 0.05) and mainly for the improvement of alveolar overdistension and interstitial edema. The present study showed that when NPE occurs, a high lung AngII concentration was associated with an imbalance between ACE mRNA to ACE2 mRNA expression level. Activated local RAS in lung tissue resulted in lung injury. Enalaprilat treatment may attenuate lung injury by interventing local RAS in lung tissue with decreased ratio of ACE mRNA to ACE2 mRNA and lung AngII concentration. The result will be significant for the angiotensin converting enzyme inhibitor used in the theatment of NPE.

Primary renal synovial sarcoma：a case report and literature review

Objective To improve the diagnosis and therapy of primary renal synovial sarcoma . Methods A single case of primary renal synovial sarcoma was reported .A 54-year-old female presented with left flank pain for six days .Enhanced CT scan revealed a nearly-circular mass with the diameter of 2.0 cm in the superior portion of the left kidney .It showed low and high density with punctate calcification .There were low and high density in left kidney around .A possible diagnosis of left renal tumor with rupturing was given prior to exploratory operation .During the operation , a large hematoma was found on the lateral peri-re-nal fascia, which adjoined with other organs .The hematoma was opened and the 1 000 ml dated clot and blood were removed .The tissue inside the hematoma showed fish meat like .The fast pathologic examination showed sarcomatoid tissue , then the case underwent radical left nephrectomy . Results Gross pathologic examination showed a ashen and fish-liked tumor of 3.0 cm×2.5 cm×1.5 cm with multiple sites of necrosis and hemorrhage .The histopathological examination revealed the tumor cells were spindle shaped .The tumor cells organized as bundle with indistinct border line and larger quantity of mitotic phase , which were positive for BCL-2, vimentin, EMA, CD79a and SMA, but negative for CD34, CK and CD10.A diagnosis of renal syn-ovial sarcoma was then determined .Targeted therapy with sunitinib （ 37.5 mg po qd ） was carried out postopreratively .There was no recurrence and metastasis during the six months following up . Conclusions Primary renal synovial sarcoma is an extremely rare entity .It is very difficult to diagnose through clinical symptoms and imaging .The accurate diagnosis is based on pathology or genetic and molecular tests .Radical nephrectomy and adjuvant therapy are the preferred strategy for the treatment .The prognosis is poor .Targeted therapy with sunitinib may be effective . Key words: Kidney neoplasms; Synovial sarcoma; Sunitinib; Diagnosis; Treatment

Comparison of two gastrostomic methods of natural orifice translumenal endoscopic surgery： an experimental study

Objective To compare the operation process, complications and access healing between PEG（percutaneous endoscopic gastostomy）-like approach and needle knife incision in natural orifice translumenal endoscopic surgery （NOTES）. Methods Sixteen dogs were randomly divied into 4 groups （4 dogs per group）, and two1.5 cm in diametre gastostomies （2 cm apart） were performed by PEG-like approach and needle knife incision respectively in each dog＇s anterior wall of stomach. Each gastrostomy was closed by 3 endoclips after the peritoneal exploration. Time consumption for each gastrotomy and complications were recorded. Leakage pressure was measured for the first group （0 day）. The healing of each gastostomy and the peritoneal cavity complications, as well as leakage pressures, were examined for 3 other groups on the 3rd day, 7th day and 14th day after necropsy. Results All experimental animals successfully underwent gastrostomies by PEG-like approach and needle knife incision. Although the time consumption for PEG-like approach was longer than that of needle knife incision （8.4 ± 2. 2 min vs. 5.3 ± 1.5 min, P 〈 0. 05）, the bleeding rate during operation was signifcantly lower （6. 2% vs. 37. 5% , P 〈0. 01）. The average leakage pressures for PEG-like approach and needle knife incision on 0 day, 3rd day and 7th day were 12. 3 ± 2. 3 mmHg vs. 11.4 ± 2. 6 mmHg （P 〉 0. 05）, 32. 4 ± 6.7 mmHg vs. 23.7 ± 7. 7 mmHg （P 〈 0. 05） and 76. 8 ± 9. 6 mmHg vs. 52. 4 ± 8. 8 mmHg （P 〈 0. 05）, respectively. In 14d group, the average leakage pressures for two approaches were both beyond 160 mmHg wihout leakage of the stomach. Gross pathological examination revealed that gastrostomies by PEG-like approach had a better healing than that of needle knife incision at the same time point. No peritoneal bleeding, adjacent organ injury or infection were found during necropy in any survived animals. Conclusion Compared with the needle knife incision, PEG-like approach shows the obvious advantages of greater security and more rapid healing in gastrostomy process in spite of the prolonged time consumption. Key words: Endoscopic surgical procedures; Natural orifice translumenal endoscopic surgery; Percutaneous endoscopic gastostomy; Methods