Histopathology Of Surgical Specimen Research Articles

Cardiac Magnetic Resonance Detection of Myocardial Scarring in Hypertrophic Cardiomyopathy: Correlation With Histopathology and Prevalence of Ventricular Tachycardia

In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT). Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in HCM patients. CMR measures wall thickness and detects scar. Sixty symptomatic HCM patients (62% men; mean age 51 +/- 14 years), with preserved ejection fraction (mean 64 +/- 5%) and no angiographic coronary disease underwent CMR (cine and delayed post-contrast) using a Siemens 1.5 T scanner, followed by septal myectomy. Maximal basal septal thickness was recorded on cine CMR. Scar was determined (percentage of total myocardium) on delayed post-contrast CMR images and quantified as none, mild (0% to 25%), moderate (26% to 50%), or severe (>50%). VT was assessed using Holter monitoring. Degree of SICAD was determined (normal, mild, moderate, and severe) on histopathology of surgical specimen. SICAD and scar were seen in 45 (75%) and 38 (63%) patients, respectively. In 15 patients without SICAD, 12 (80%) had no scar; 23 (70%) patients with mild SICAD had mild scar on CMR. On multivariate analysis, degree of SICAD was independently associated with scar on CMR (Wald chi-square statistic: 6.8, p < 0.01). Patients with basal septal scar on CMR had higher VT frequency compared with those without (27% vs. 5%, p = 0.03). A strong association exists between degree of SICAD and myocardial scarring seen on CMR.

Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions

The purpose of the present study was to evaluate whether 2-fluoro[fluorine-18]-2-deoxy-D: -glucose (F-18 FDG) positron emission tomography (PET) could differentiate malignant and benign bone lesions and whether obtaining delayed F-18 FDG PET images could improve the accuracy of the technique. In a prospective study, 67 patients with bone lesions detected by computed tomography (CT) or magnetic resonance imaging were included. Whole body PET/CT imaging was performed at 1 h (early) after the F-18 FDG injection and delayed imaging at 2 h post injection was performed only in the abnormal region. Semiquantitative analysis was performed using maximum standardized uptake value (SUV(max)), obtained from early and delayed images (SUV(maxE) and SUV(maxD), respectively). The retention index (RI) was calculated according to the equation: RI = (SUV(maxD) - SUV(maxE)) x 100/SUV(maxE.) Histopathology of surgical specimens and follow-up data were used as reference criteria. The SUV(maxE) and RI were compared between benign and malignant lesions. The final diagnoses revealed 53 malignant bone lesions in 37 patients and 45 benign lesions in 30 patients. There were statistically significant differences in the SUV(maxE) between the malignant and benign lesions (P = 0.03). The mean SUV(maxE) was 6.8 +/- 4.7 for malignant lesions and 4.5 +/- 3.3 for benign lesions. However, a considerable overlap in the SUV(maxE) was observed between some benign and malignant tumors. With a cutoff value of 2.5 for the SUV(maxE), the sensitivity, specificity, and accuracy were 96.0%, 44.0%, and 72.4%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 67.1% and 90.9%, respectively. There were significant differences in the RI between the malignant and benign lesions (P = 0.004). But there was overlap between the two groups. The mean RI was 7 +/- 11 for the benign lesions and 18 +/- 11 for the malignant lesions. When an RI of 10 was used as the cutoff point, the sensitivity, specificity, and accuracy were 90.6%, 76.0%, and 83.7.0%, respectively. The PPV and NPV were 81.4% and 87.1%, respectively. The results of this study indicate that dual-time point F-18 FDG PET may provide more help in the differentiation of malignant tumors from benign ones.

Intraductal US in the assessment of tumor involvement to the orifice of the cystic duct by malignant biliary obstruction

Tumor involvement to the orifice of the cystic duct (OCD) is a risk factor for cholecystitis after metallic stent (MS) placement. ERCP and intraductal US (IDUS) were used to assess tumor involvement to the OCD. A prospective consecutive study. The University of Tokyo Hospital, Japan. Between January 2003 and May 2007, 34 patients with resectable malignant biliary obstruction underwent an ERCP and an IDUS before preoperative biliary drainage. ERCP and IDUS findings were confirmed via a histopathologic analysis of surgical specimens. An ERCP showed that the cystic duct was opacified in 22 of 34 patients (64.7%). Eight patients were diagnosed with OCD tumor involvement. In the remaining 12 patients, tumor involvement was impossible to evaluate via an ERCP. An IDUS identified tumor involvement to the OCD in all 34 patients. Tumor involvement to the OCD was diagnosed in 12 patients, including 4 patients with previously negative results during an ERCP. Tumor involvement was confirmed by histopathology of surgical specimens. The sensitivity and specificity of detection were 66.7% (8/12) and 63.6% (14/22), respectively, via ERCP, and 100% (12/12) and 100% (22/22), respectively, via IDUS. The small sample size. IDUS, in addition to ERCP, provides an accurate evaluation of tumor involvement to the OCD in patients with malignant biliary obstruction.

Clinical investigation of amelanotic malignant melanoma in the oral region

Purpose Amelanotic oral malignant melanoma (AOMM) is a rare tumor that is difficult to diagnose. We studied the clinical and pathologic features of nine cases of this tumor to define diagnostic criteria and estimate prognoses for 2 different types of AOMM. Patients and methods Nine patients with 2 different types of primary AOMM were examined between 1970 and 2002. The histopathology of surgical specimens was studied, uncertain diagnoses were supported by immunohistochemical reactions, and electron microscopy and prognoses were reviewed retrospectively. Results AOMM without radial growth phase may be particularly difficult to diagnose correctly without immunohistochemical assistance. Tumors consisted of a mixture of polygonal and spindle cells in different ratios in tumors with and without radial growth phase. The life span ranged from 3 months to 6 years 3 months, and all 9 patients died of the tumor. In 7 of the 9 cases, distant metastases were found. Conclusions AOMM without radial growth phase may be misdiagnosed as epulis or squamous cell carcinoma. Questionable lesions, particularly maxillary and palatal lesions, must be biopsied for histopathologic and possibly immunohistochemical examinations followed by rapid treatment. The prognosis of AOMM was poor.

Serial MRI in Rasmussen’s Encephalitis

The course of Rasmussen’s encephalitis (RE) was studied by a correlation of serial MRI and histopathology of surgical specimens in 10 patients (7 children, 1 adolescent, 2 young adults) followed at the University of Bonn, Germany, and University of Vienna, Austria.

Clinical value of [18-F]] fluorodeoxyglucose positron emission tomography imaging in soft tissue sarcomas.

To evaluate positron emission tomography (PET) using 2-fluoro-2-deoxy-D-glucose (FDG) for clinical application in soft tissue sarcomas. FDG PET is a promising noninvasive method for the preoperative assessment of soft tissue sarcomas and may complement radiologic tomography. Data from 50 consecutive patients with 59 masses, either suspicious for primary or locally recurrent soft tissue sarcoma, were prospectively gathered. The semiquantitative FDG uptake (standardized uptake values [SUVs]) was calculated in tumor and normal tissue (muscle). Histopathology of surgical specimens and follow-up data were used as control criteria. In primary soft tissue sarcomas, PET displayed a sensitivity of 91% and a specificity of 88%. Local recurrence was detected with a sensitivity of 88% and a specificity of 92%. All intermediate-grade and high-grade soft tissue sarcomas (primary and locally recurrent) were visualized with a precise differentiation from muscle. Fifty percent of the low-grade sarcomas showed an FDG uptake equivalent to muscle (false-negative results in one primary and three recurrent soft tissue sarcomas). Benign soft tissue tumors (e.g., lipoma, leiomyoma, ganglion) did not accumulate FDG. Inflammation resulted in an increased FDG uptake. The semiquantitative FDG uptake (SUVs) correlated with tumor grade but not with size and histologic type. High-grade and intermediate-grade soft tissue sarcomas are amenable to PET imaging, whereas low-grade lesions may not be depicted. SUVs for FDG correlate with tumor grade in soft tissue sarcomas. Benign soft tissue tumors are differentiated from higher-grade soft tissue sarcomas. These data show that FDG-PET can complement preoperative radiologic assessment for soft tissue sarcomas and that FDG-PET is a powerful diagnostic tool for detecting high-grade and intermediate-grade local recurrence.