Light Microscopic Appearance Research Articles

Retrospective immunohistochemical investigation of suspected non-visceral leiomyosarcoma in dogs.

Visceral leiomyosarcoma is well described in dogs, but information about non-visceral locations and prevalence is lacking. The diagnosis of leiomyosarcoma is challenging without a gold standard, and often includes the use of immunohistochemical (IHC) stains. We used defined histopathologic patterns, histochemical staining, and IHC staining for smooth muscle actin (SMA), desmin, and laminin to characterize suspected non-visceral leiomyosarcoma in dogs at a single academic institution. In a retrospective search, we identified 24 dogs with a definitive or suspected histologic diagnosis of leiomyosarcoma in a non-visceral location. Histopathology results and clinical details were obtained. Biopsy sections were reviewed by a single pathologist using standardized histologic criteria, including light microscopic appearance, immunohistochemistry (more than two-thirds of neoplastic cells labeled with SMA and desmin or laminin), and histochemical staining (minimal-to-mild matrix deposition by Masson trichrome). Of the 24 cases of possible non-visceral leiomyosarcomas, 4 were consistent with a definitive diagnosis of non-visceral leiomyosarcoma (3) or leiomyoma (1) based on the established criteria. Only the leiomyoma had more than two-thirds of neoplastic cells label with all 3 markers; all 3 leiomyosarcomas had more than two-thirds of neoplastic cells label with SMA and laminin. Our data highlight the uncommon nature of non-visceral leiomyosarcoma and the importance of IHC for their diagnosis. A definitive diagnosis could not be made based on SMA alone, and desmin was not useful in this cohort. Further studies are needed to clarify the histopathologic, IHC, and clinical features of canine non-visceral SMA-positive mesenchymal tumors.

Potential Protective Effect of Vitamin C on Qunalphos-Induced Cardiac Toxicity: Histological and Tissue Biomarker Assay.

Insecticides and toxicants abound in nature, posing a health risk to humans. Concurrent exposure to many environmental contaminants has been demonstrated to harm myocardial performance and reduce cardiac oxidative stress. The purpose of this research was to study the protective effect of vitamin C (Vit C) on quinalphos (QP)-induced cardiac tissue damage in rats. Eighteen albino male rats were randomly categorised into three groups (n = 6). Control, QP group: rats received distilled water. QP insecticide treatment: an oral administration of QP incorporated in drinking water. QP + Vit C group: rats received QP and Vit C. All the experiments were conducted for ten days. Decline of cardiac antioxidant biomarkers catalase (CAT) and reduced glutathione (GPx) along with increased proinflammatory markers tumour necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) indicated oxidative and inflammatory damage to the heart following administration of QP when compared to control rats. The light microscopic and ultrastructure appearance of QP-treated cardiomyocytes exhibited cardiac damage. Administration of Vit C showed decreased oxidative and inflammatory biomarkers, confirmed with histological and electron microscopic examination. In conclusion, Vit C protected the heart from QP-induced cardiac damage due to decreased inflammation and oxidative stress.

Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia A successfully managed with rituximab \u2013 case report and review of the literature

BackgroundHepatitis C virus (HCV) and human immunodeficiency virus (HIV) cause a wide range of glomerular pathologies. In people with haemophilia, transfusion-associated infections with these viruses are common and definitive pathological diagnosis in this population is complicated by the difficulty of safely obtaining a renal biopsy. Membranous nephropathy (MN) is a common cause of adult onset nephrotic syndrome occurring in both primary and secondary forms. Primary MN is associated with podocyte autoantibodies, predominantly against phospholipase A2 receptor (PLA2R). Secondary disease is often associated with viral infection; however, infrequently with HIV or HCV. Distinguishing these entities from each other and other viral glomerular disease is vital as treatment strategies are disparate.Case presentationWe present the case of a 48-year-old man with moderate haemophilia A and well-controlled transfusion-associated HCV and HIV coinfection who presented with sudden onset nephrotic range proteinuria. Renal biopsy demonstrated grade two membranous nephropathy with associated negative serum PLA2R testing. Light and electron microscopic appearances were indeterminant of a primary or secondary cause. Given his extremely stable co-morbidities, treatment with rituximab and subsequent angiotensin receptor blockade was initiated for suspected primary MN and the patient had sustained resolution in proteinuria over the following 18 months. Subsequent testing demonstrated PLA2R positive glomerular immunohistochemistry despite multiple negative serum results.ConclusionsPursuing histological diagnosis is important in complex cases of MN as the treatment strategies between primary and secondary vary significantly. Serum PLA2R testing alone may be insufficient in the presence of multiple potential causes of secondary MN.

Scanning electron microscopy as a confirmatory tool for morphological identification of Dirofilaria (Nochtiella) repens

Background: Dirofilaria repens (Railliet & Henry, 1911) is a filarial nematode that mainly affects canids. It can also infect humans accidentally, causing subcutaneous or conjunctival lesions, especially in the Old-World, including Egypt. Scanning electron microscopy (SEM) is very useful in diagnosis and identification of different parasites including D. repens. Objective: The current work aimed use SEM as a confirmatory tool for morphological identification of D. repens. Material and Methods: Morphological diagnosis of the excised nematodes was performed by studying their naked eye and light microscopic appearance. This was then confirmed using scanning electron microscopy (SEM). Results: Three worms were identified; one excised from maxillofacial subcutaneous lesion and two were excised from the bulbar conjunctival lesion. All worms were females. Scanning electron microscopic examination showed external cuticular longitudinal ridges and circular striations on the whole worm length surface especially in the mid-body region, which are characteristic for D. repens. The anterior end of the worms was wider than the posterior end that possessed a dimple-like anal orifice. The anterior end of the subconjunctival worms was spoon-like, and wider than that of the subcutaneous worm. The dimple-like anal orifice of the subconjunctival worm was more retracted than that of the subcutaneous worm. Conclusion: Two new human cases of dirofilariasis have been diagnosed in Egypt. SEM was used as a confirmatory tool for their diagnosis.

Hairy Projections on Non Hairy Cells- A Case Report

Adult T-Cell Leukaemia/Lymphoma (ATLL) is a mature T-cell neoplasm. It is caused by human retrovirus Human T-cell Lymphotropic Virus Type 1(HTLV-1). The neoplastic cells after monoclonal integration begin to express T-cell associated antigens namely CD2, CD3 and CD5. These leukaemic cells are highly pleomorphic in light microscopic appearance and also they have a highly variable clinical presentation ranging from acute to lymphomatous to chronic to smouldering. There is a chance of missed or miss diagnosis due to their morphological and clinical heterogeneity and specialised test like immunophenotyping or flow cytometry is essential for exact categorisation. Authors hereby, report a case of 45-year-old female patient suffering from ATLL whose peripheral smear showed leukaemic cells with unusual hairy projections resembling hairy cell leukaemia posing diagnostic dilemma.

Exploratory single blind study on polarising and light microscopic appearance of crystals of commonly prescribed drug

Background: It is not unusual for the pathologist to encounter various drug crystals in urine sediment which are morphologically different from the ones in his cognitive domain. Paucity of literature on crystals of all the drugs, makes it difficult to identify them. This study aims at exploring the microscopic appearance of crystals of common drugs. Material and Methods: Forty common drugs administered orally were included for the study. These drugs were mixed with distilled water on a slide, coverslipped and observed by two pathologists who were blinded. Of which one was a telepathologist who reported on images sent. Results: Crystals varied in their appearance and birefringence, few resembled architecture of known structures in urine sediment. Acetaminophen with hexagonal architecture resembled cysteine, broad colourless rectangular ceftriaxone crystals mimicked waxy cast. No definite answer was available for few, These data along with the light and polarising microscopic features are discussed in detail. Conclusion: Crystals of unusual appearance should alarm the pathologist to think of a drug and alert the physician in case of drugs causing renal damage.

Histology, histochemistry and ultrastructure of the nasopharyngeal tonsil of the buffalo (Bubalus bubalis).

The light microscopic appearance and ultrastructure of the nasopharyngeal tonsil (tonsilla pharyngea), collected from 12 adult buffaloes of local mixed breed, were explored for the distribution of different types of epithelia, lymphoid tissue and high endothelial venules. The tonsillar mucosa was lined by pseudostratified columnar ciliated epithelium having goblet cells. The respiratory epithelium associated with the underlying lymphoid tissue formed the lymphoepithelium. The epithelium was further modified into follicle-associated epithelium (FAE) characterized by reduced epithelial height, presence of a few dome-shaped cuboidal cells equivalent of the M-cells and absence of goblet and ciliated cells. The lymphoid tissue was distributed in the form of isolated lymphoid cells, diffuse lymphoid tissue and lymphoid follicles, mainly distributed within the propria-submucosa along with the sero-mucous glandular tissue. The goblet cells of the respiratory epithelium and the acinar cells contained different mucopolysaccharides. Scanning electron microscopy of the surface mucosa demonstrated a dense mat of cilia, island-like arrangement of microvillus cells, M-cells and a few brush-like cells. The transmission electron microscopy revealed the different cell organelles of the respiratory epithelium and the FAE. Lymphocyte migration via the high endothelial venules in the propria-submucosa was also observed.

Amyloid and hyaline globules in undifferentiated nasopharyngeal carcinoma

We characterize the clinicopathological features of two patients (one 38 year old woman and one 42 year old man, both of Chinese ethnicity) with Epstein Barr Virus positive non-keratinizing nasopharyngeal carcinoma from an endemic region with prominent presence of amyloid and one case with both amyloid and abundant intracytoplasmic hyaline globules. The amyloid material was positive for Congo red and showed apple green birefringence when examined under polarized light. The amyloid was immunoreactive for cytokeratins and was located both intra- and extracellularly. Frequently the amyloid had a light microscopical spherical appearance and displayed peripheral radiating fibrils from a central homogenous core. One of the patients had a unique presentation of nasopharyngeal carcinoma with perceived hemoptysis and coughing up two pieces of tumor tissue. In reality, the nasopharyngeal tumor was polypoid and the two fragments were pinched of from the main tumor mass.

Abstract IA01: The origins of ovarian cancer.

Abstract Ovarian cancer is a generic term that can be used for any malignant ovarian tumor. The majority of ovarian cancers are carcinomas, i.e., malignancies with epithelial differentiation. Ovarian carcinomas represent a heterogeneous group of tumors that can be divided into five major types based largely on their light microscopic appearance. Notably, the origins of these different tumor types (high-grade serous carcinoma, low-grade serous carcinoma, endometrioid carcinoma, clear cell carcinoma, and mucinous carcinoma) remain incompletely understood. Indeed, many ovarian cancers may not actually originate in the ovaries, but instead involve the ovaries secondarily. Even those that develop in the ovaries may arise from cell types, for example endometrial- or fallopian tube-type epithelium, that are not considered intrinsic to normal ovaries. Potential origins and putative precursors of the five major types of ovarian carcinoma will be reviewed and experimental data from mouse models supporting a role for the ovarian surface epithelium and/or fallopian tube epithelium will be presented. A more complete understanding of the origin(s) of each type of ovarian carcinoma is needed to inform the development of effective ovarian cancer prevention, early detection and treatment strategies. Citation Format: Kathleen R. Cho. The origins of ovarian cancer. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr IA01.

Atypical Lymphocytes and Cellular Cannibalism: A Phenomenon, First of its Kind to be Discovered in Chronic Periapical Lesions.

Lymphocytes are often termed to be isomorphic, having a monotonous light microscopic appearance. Morphological aspects of lymphocytes in tissue sections thereby are not routinely taken notice of as their morphology seems to vary only in case of lymphoid malignancies, hematological malignancies apart from certain viral infections. Atypical lymphocytes are the lymphocytes with unusual shape, size or overall structure. These are more commonly known as reactive lymphocytes. The unusual histomorphological feature of these cells include larger size than normal lymphocytes; in some cells the size exceeds even 30 microns. The large size is the result of antigenic stimulation of the cell. Alongwith these, the other rare feature which is recently coming under light is "Cellular Cannibalism" which is defined as a large cell enclosing a slightly smaller one within its cytoplasm. Previously, this feature was noted only in cases of malignant tumors. The objectives of this study were to determine the proportion of atypical lymphocytes in chronic periapical granulomas and cysts; to determine the proportionate cellular cannibalism in these periapical lesions. This was a descriptive, observational study conducted in the Department of Oral Medicine and Radiology and Oral Pathology and Microbiology. Haematoxylin and eosin stained 30 slides of chronic periapical granulomas and 20 slides of cysts reported in the year 2014-15 and the clinical proformas of the patients were retrieved from the files of the Department of Oral Medicine and Radiology and Oral Pathology and Microbiology. These slides were evaluated by 3 experts from the specialization of Oral Pathology and Microbiology to determine the presence of atypical lymphocytes and cellular cannibalism under high power magnification (400X). Out of the 30 slides of chronic periapical granulomas, about 12 slides (40%) revealed presence of atypical lymphocytes. In case of slides of chronic periapical cysts, however, only 4 out of the 20 slides (20%) examined histopathologically showed presence of atypical lymphocytes. An interesting feature of cellular cannibalism was noted in tissues with atypical cells. Cannibalistic cells were present in 12 out of the 30 slides of chronic periapical granulomas (40%). None of the cysts, however, revealed cannibalistic cells (0%). In the present study, we have quoted our observations on the unique cellular composition that was seen in histopathological sections of chronic periapical lesions. As also it was noted that those cases in which atypical cells & cellular cannibalism was evident the lesion clinically showed size more than 5cm. The question arises that whether presence of atypical cells from the tissue sections in these lesions denotes an aggressive clinical behavior and should be given a due consideration in deciding the treatment protocols for such cases to provide an optimum patient care.

Structural differences in epiphyseal and physeal hypertrophic chondrocytes.

We have observed that epiphyseal and physeal hypertrophic chondrocytes in BALB/c mice show considerable differences of light microscopic and ultrastructural appearance, even when the cells are at the same stage of differentiation. In addition, cell structure maintenance improved with tissue preparation controlled for osmolarity and for membrane stabilization using 0.5% ruthenium hexammine trichloride (RHT) for both light microscopy (LM) and electron microscopy (EM) or 0.5% lanthanum nitrate for LM. Physeal hypertrophic chondrocytes showed a gradual increase in size closer to the metaphysis and a change in shape as cells elongated along the long axis. The nucleus remained central, with uniformly dispersed chromatin, and the rough endoplasmic reticulum (RER) was randomly dispersed throughout cytoplasm with little to no presence against the cell membrane. Even the lowermost cells showed thin elongated or dilated cisternae of RER and intact cell membranes. Epiphyseal chondrocytes remained circular to oval with no elongation. Nucleus and RER were positioned as a complete transcellular central nucleocytoplasmic column or as an incomplete bud with RER of the column/bud always continuous with RER peripherally against the intact cell membrane. RER was densely packed with parallel cisternae with adjacent cytoplasm empty of organelles but often filled with circular deposits of moderately electron-dense material consistent with fat. Optimal technique for LM involved fixation using glutaraldehyde (GA) 1.3%, paraformaldehyde (PFA) 1% and RHT 0.5% (mOsm 606) embedded in JB-4 plastic and stained with 0.5% toluidine blue. Optimal technique for EM used fixation with GA 1.3%, PFA 1%, RHT 0.5% and cacodylate buffer 0.03 M (mOsm 511) and post-fixation including 1% osmium tetroxide. These observations lead to the possibility that the same basic cell, the hypertrophic chondrocyte, has differing functional mechanisms at different regions of the developing bone.

Gene-gene and gene-environment interactions in apolipoprotein L1 gene-associated nephropathy.

Molecular genetics have revolutionized the understanding of susceptibility to the broad spectrum of kidney diseases with light microscopic appearance of FSGS, particularly in populations with recent African ancestry. These disorders include idiopathic FSGS, HIV-associated nephropathy, severe lupus nephritis, sickle cell nephropathy, and the primary kidney disorder focal global glomerulosclerosis, which had historically been ascribed to systemic hypertension. FSGS was once thought to include a multitude of unrelated disorders with similar histologic appearance. However, variation in the apolipoprotein L1 gene locus is now known to account for the vast majority of such cases in African Americans as well as nearly all the excess risk for FSGS and related forms of progressive nondiabetic nephropathy in populations with recent African ancestry, relative to European ancestry. Inheriting two coding apolipoprotein L1 gene nephropathy risk variants is necessary for susceptibility to CKD; however, these variants alone are insufficient to produce disease. This work reviews the evidence supporting second hits or modifying factors that affect risk for apolipoprotein L1 gene-associated nephropathy and produce the protean manifestations of this common and complex syndrome. Targeting modifiable second factors will lead to preventive therapies for slowing progression of nondiabetic nephropathy in many patients possessing two apolipoprotein L1 gene risk variants. This model of genetic risk coupled with modifiable second hits will serve as a paradigm applicable to patients with CKD of various etiologies as well as a host of other complex disorders.

Ultrastructural features of neuroblastic tumours in relation to morphological, and molecular findings; a retrospective review study

BackgroundNeuroblastoma is the most common solid tumour of infancy and is responsible for 15% of childhood cancer deaths. Presence of amplified MYCN in neuroblastoma is associated with poor prognosis and rapid tumour progression. The aim of this study was to examine and compare the ultrastructural features of high-risk MYCN amplified neuroblastomas, with lower-risk non-MYCN amplified tumours.MethodsThis was a retrospective study evaluating archival diagnostic tissue samples, in which Fluorescence in-situ hybridisation (FISH) had been used at diagnosis to establish MYCN status. 22 (11 MYCN amplified tumours and 11 non-MYCN amplified) tumours of similar light microscopic appearance (poorly differentiated neuroblastoma) were then selected for ultrastructural examination.ResultsThere is a relationship between ultrastructural features in neuroblastoma and MYCN status, although with marked overlap between groups. MYCN amplified tumours generally exhibited a ‘less differentiated’ ultrastructural phenotype, with significantly smaller neurotubules (NT) in the cell body (p < 0.002). Non-MYCN amplified tumours show increased features of neuronal differentiation, with fewer neurosecretory granules (NSG) and NT in the cytoplasm.ConclusionsMYCN amplification is associated with a less differentiated ultrastructural phenotype, and lack of MYCN amplification with relative ultrastructural neuronal differentiation.

Pseudohyperplastic Adenocarcinoma of the Prostate

A 60-year-old man underwent radical prostatectomy after a needle biopsy diagnosis of adenocarcinoma of the prostate with Gleason score 3 þ 3 1⁄4 6 in 4 of 12 cores. Sections of radical prostatectomy tissue showed areas with a somewhat nodular growth of complex glands resembling benign prostatic hyperplasia (fig. 1). This proliferation represents an uncommon variant of usual acinar adenocarcinoma of the prostate known as pseudohyperplastic adenocarcinoma, so called because the light microscopic appearance can simulate that of epithelial hyperplasia in the prostate. This variant, along with other deceptively benign appearing variants (atrophic and foamy gland adenocarcinomas), constitutes a large percentage of needle biopsy cases misdiagnosed as benign. There are no known clinical, radiological or gross features specific for pseudohyperplastic prostatic adenocarcinoma. Microscopically, pseudohyperplastic adenocarcinoma shows papillary infolding (fig. 2), luminal undulations and branching, and cystic dilatation. Pseudohyperplastic prostatic adenocarcinoma in the whole gland may be localized

Ancillary Diagnostic Techniques in the Evaluation of Adult Epithelial Renal Neoplasms

The role played currently by the different ancillary diagnostic techniques in the diagnosis of adult epithelial renal tumors continues to be debated. It has also become clear that in some instances light microscopic appearance alone cannot be used to classify these neoplasms into specific categories with the degree of precision required for therapeutic purposes. Renal cell carcinoma (RCC) subtypes may share common histologic characteristics but exhibit different biological behavior and response to therapy which clearly indicates the crucial role that advanced pathologic speciation plays in the current assessment of these neoplasms. Although immunohistochemistry is widely used for the purpose of categorizing renal tumors because of its widespread availability, the immunoprofiles of the various types of renal neoplasms overlap significantly, making definitive diagnostic determinations difficult and challenging at times. This manuscript will address how ancillary diagnostic techniques can be incorporated into the routine evaluation of neoplastic renal masses to improve classification. Both cytology and surgical specimens will be addressed, as fine needle aspiration (FNA) is being used with preference in many cases in the diagnosis of renal masses. Surgical and cytopathologists must intelligently select the ancillary diagnostic technique/s that will provide the information needed to solve the differential diagnosis under consideration in a given case. However, in some cases >1 of these techniques should be used to make an accurate diagnosis with the aim of arriving at an unequivocal diagnosis. The identification of specific signaling pathways that are defective in certain types of renal neoplasms has made possible the design of target-specific therapies that are directed towards the aberrant pathways associated with the defective proteins found in these tumors. This makes the exact classification of these neoplasms and the detection of these aberrant proteins targeted for treatment an absolute requirement for the application of these molecular-based therapeutic interventions. The role that the pathologic assessment plays in the classification of renal tumors becomes more important than ever to take advantage of this and similar new molecular-oriented therapies.

Interactions of Actinomyces-Like Organisms with Host Cells: Light Microscopic Examination

Objective: To determine the interactions of Actinomyces-like organisms (ALOs) with host cells, including vaginal epithelial cells, polymorphonuclear leukocytes (PMNLs) and erythrocytes, using Pap smear microscopy and based on their light microscopic appearances. Study Design: Cervicovaginal samples obtained from 200 patients were examined by both Pap smear microscopy and anaerobic culturing. Since the results obtained by these methods were not concordant for diagnosis of genital Actinomyces, the results of Pap smear microscopy were used as a reference, and the smears with ALOs were carefully screened with regard to interactions of ALOs with host cells. Results: ALOs were detected as attached to vaginal epithelial cells, PMNLs and erythrocytes via their filament-like structures. At some attachment sites, the epithelial cell membrane and filaments of ALOs were almost fused with each other. A group of PMNLs surrounded the ALOs. However, ALOs were observed to form colonies to evade phagocytosis by PMNLs. At the connection points between erythrocytes and ALOs, the findings of interest were the changes in the shapes of the erythrocytes and filament-like structures of the ALOs on the erythrocyte membrane. Conclusions: The adhesiveness of ALOs can be observed in routine Papanicolaou-stained cervicovaginal smears at light microscopic level.

Light microscope observations on the epididymis of paca (Agouti paca).

The features of paca epididymis, based on its appearance in light microscope, is described in this paper. The cellular population of the epithelial lining comprises principal cells, basal cells, apical cells, narrows cells, and hallo cells. The epididymis is divided in five distinct and continuous regions, Zone I, or initial segment, and zone II, are both localized into the head. Zone III comprises the distal head and all the body. Zones IV and V are restricted to the tail, in the proximal and distal cauda epididymis respectively. Each zone can be readily distinguished on the basis of morphological characteristics. The height of epididymal epithelium is greater in zone I. There is a progressive increase in the diameter of the tubular lumen through the different areas, with the maximum in the zone V. The presence of a high epithelium, and the virtual absence of sperm in zone I suggest fast transit of spermatozoa in this region. Zone V comprises the distal tail, has smaller epithelial lining, greater luminal diameter, shorter stereocilia than the other zones, and contains spermatozoa packed inside the lumen, that characterizes this zone as a place of sperm storage. The findings are compared with other reports in rodents and other domestic animals, to contribute to the understanding of epididymal morphophysiology.

Renal cell carcinoma with areas mimicking renal angiomyoadenomatous tumor/clear cell papillary renal cell carcinoma

We present a cohort of 8 renal carcinomas that displayed a variable (5%-95% extent) light microscopic appearance of renal angiomyoadenomatous tumor/clear cell papillary renal cell carcinoma (RAT/CCPRCC) without fulfilling the criteria for these tumors. All but 1 case predominantly (75%-95% extent) showed histopathologic features of conventional clear cell renal cell carcinoma. In 5 of 7 cases with mostly conventional clear renal cell carcinoma (CRCC) morphology, a diagnosis of CRCC was supported by the molecular genetic findings (presence of von Hippel-Lindau tumor suppressor [VHL] mutation and/or VHL promoter methylation and/or loss of heterozygosity [LOH] for 3p). Of the other 2 cases with predominantly characteristic CRCC morphology, 1 tumor did not reveal any VHL mutation, VHL promoter methylation, or LOH for 3p, and both chromosomes 7 and 17 were disomic, whereas the other tumor displayed polysomy for chromosomes 7 and 17 and no VHL mutation, VHL promoter methylation, or LOH for 3p. One tumor was composed primarily (95%) of distinctly RAT/CCPRCC-like morphology, and this tumor harbored a VHL mutation and displayed polysomy for chromosomes 7 and 17. Of the 5 cases with both histomorphologic features and molecular genetic findings of CRCC, we detected significant immunoreactivity for α-methylacyl-CoA racemase in 2 cases and strong diffuse immunopositivity for cytokeratin 7 in 3 cases. Despite the combination of positivity for α-methylacyl-CoA racemase and cytokeratin 7 in 2 cases, there was nothing to suggest of the possibility of a conventional papillary renal cell carcinoma with a predominance of clear cells.

Clinicopathologic study on complications of orthotopic liver transplantation in 54 patients with chronic hepatitis B viral infection.

To study the complication incidence of 54 patients with chronic HBV infection following orthotopic liver transplantation (OLT) and risk factors associated with HBV recurrence and hepatocellular carcinoma (HCC) recurrence or metastasis post-OLT. The light-microscopic appearance of hepatic allograft biopsies in 54 patients with chronic HBV infection following OLT was examined. The related clinical data were analyzed. The incidence and occurrence time of post-OLT complications were studied. Furthermore, the relationship between hepatitis B virus recurrence and acute rejection and the relationship among HCC recurrence/metastasis, acute rejection, tumor diameter, and portal vein invasion were particularly studied. Frequent complications of patients with chronic HBV infection following OLT were acute rejection [38 (70.4%); occurrence time: 5-365 days], chronic rejection [1 (1.9%); occurrence time: 10.7months], bile duct complications [24 (44.4%);occurrence time: 7-940days], HBV recurrence [7 (13.0%); occurrence time: 1-540days], HCV infection [3 (5.6%); occurrence time: 60days, 60days, 33months], CMV infection [8 (14.8%); occurrence time: 67-90days], and HCC recurrence or metastasis [17 (31.5%); occurrence time: 2-41months]. At the end of 1year post-OLT, 95% of patients with post-hepatitis B cirrhosis were alive. At the end of 3years post-OLT, 85% of patients with post-hepatitis B cirrhosis were alive. However, at the end of 1year post-OLT, 67.6% of patients with post-hepatitis B HCC were alive. At the end of 3years post-OLT, 50% of patients with post-hepatitis B HCC were alive. The number of acute rejection episodes in patients with recurrent HBV infection and in those without recurrent HBV infection was 0.86±1.46 times/patient and 1.07±0.90 times/patient, respectively (p>0.05); the number of moderate acute rejection episodes (RAI score ≥4) in patients with recurrent HBV infection and in those without recurrent HBV infection was 0.29±0.49 times/patient and 0.50±0.63 times/patient (p>0.05). Incidence of patients with ≥3 episodes of acute rejection in patient with recurrent HBV infection and in those without recurrent HBV infection was 14.3 and 10.6% (p>0.05). Furthermore, the number of acute rejection episodes in patients with HCC recurrence or metastasis and in those without HCC recurrence or metastasis was 1.12±0.93 times/patient and 1.06±1.39 times/patient, respectively (p>0.05). The number of moderate acute rejection episodes (RAI score ≥4) in patients with HCC recurrence or metastasis and in those without HCC recurrence or metastasis was 0.65±0.79 times/patient and 0.65±1.06 times/patient, respectively (p>0.05). Incidence of patients with ≥3 episodes of acute rejection in patients with HCC recurrence or metastasis and in those without HCC recurrence or metastasis was 5.9 and 17.6%, respectively (p>0.05). The tumor diameter in patients with HCC recurrence or metastasis was 6.72±3.40 cm; however, that in patients without HCC recurrence or metastasis was 3.55±2.17 cm (p=0.0047). The incidence of portal vein invasion in patients with HCC recurrence or metastasis and in those without HCC recurrence or metastasis was 68.75 and 33.3%, respectively (p=0.006). There was no significant difference between HBV recurrence and acute rejection post-liver transplantation in patients with chronic HBV infection. There was no significant difference between HCC recurrence and acute rejection. The tumor diameter in patients with HCC recurrence or metastasis was significantly greater than that in patients with no HCC recurrence or metastasis. Portal vein invasion was significantly more frequent in patients with HCC recurrence or metastasis than in those with no HCC recurrence or metastasis.

Integrated haemato-oncology diagnostics: a case-based presentation

The analysis of haematological malignancies utilises a range of cellular and genetic techniques of increasing sophistication and sensitivity. The results of all test parameters must be viewed together to facilitate an accurate and timely diagnosis, give prognostic indices (phenotypic or genetic), and be useful for monitoring treatment and/or disease progression. This approach requires the capability to perform a wide repertoire of diagnostic investigations and have the ability to interpret the data. This integrated approach to haemato-oncology diagnostics has proven advantages for clinicians and their patients. Morphological assessment of the blood, bone marrow and other diagnostic material (e.g., body fluids, tissue biopsies) remains the cornerstone for the diagnosis of the majority of haematological malignancies. Expertise in the light microscopic appearances of haematological malignancies therefore is essential. For some malignancies the morphology may be diagnostic and supplementary investigations are confirmatory. For others, the morphological appearances together, with the clinical information, gives a rapid ‘working diagnosis' and will determine the ancillary tests required to reach a definitive diagnosis and disease classification. This presentation will illustrate these concepts utilising clinical cases.