Non-neoplastic Disorders Research Articles

Cryopreservation of testicular tissue in pre-pubertal and adolescent boys at risk for infertility: A low risk procedure

Cryopreservation of testicular tissue (TT) has become an increasingly attractive option for fertility preservation (FP), particularly for pre-pubertal boys at risk for gonadotoxicity from cancer therapy. At our institution, all at-risk families undergo counseling regarding infertility risk and available FP strategies, including this vulnerable patient population. As the technology required to use the acquired tissue is, as yet, unproven, it is paramount to document minimal morbidity and complications from this procedure. Herein, we report these outcomes for all pre-pubertal patients who have undergone TT biopsies for FP. We retrospectively reviewed consecutive patients who underwent unilateral open TT biopsies between January 2014 and December 2016. Patient diagnosis, age, concomitant procedures, anesthetic type, complications, procedure times, planned therapy, and bleeding were evaluated. Of a total of 34 patients, mean age at biopsy was 6.9±4.4years. Diagnoses included: leukemia/lymphoma (n=12), solid tumors (n=15) and non-neoplastic disorders (hemophagocytic lymphohistiocytosis, aplastic anemia; n=7). Twenty-two patients (64.7%) were scheduled for stem cell transplantation. Eleven (32.4%) patients had not received any chemotherapy prior to TT biopsy, while all others had exposure preceding the biopsy. Biopsies were performed in conjunction with other procedures (central line placement, bone marrow biopsy, lumbar puncture, lymph node biopsy) in 29 cases (85.3%), with stand-alone procedures performed in the remainder (n=5). In stand-alone cases, mean anesthetic time was 22±8.7min. Overall, two (5.9%) patients had complications after biopsy: 1) ipsilateral epididymo-orchitis (resolved with antibiotics) and 2) ipsilateral torsedappendix testis (managed conservatively) (Table). In this series, pre-pubertal TT biopsy for cryopreservation was safely performed, and was most often coordinated concomitantly with other medically necessary procedures. The safety profile reported herein supports performing this procedure while technological advances fulfill the requirements to make it a viable option for future fertility.

The RCPA Quality Assurance Program in Dermatopathology: A Retrospective Review.

To review the Royal College of Pathologists of Australasia (RCPA) Quality Assurance Program Dermatopathology module from 2005 to 2016 to assess diagnostic performance, changes over time, and areas of diagnostic difficulty. The computerized records of the RCPA Dermatopathology subspecialist module were reviewed. Cases were categorized into groups including nonneoplastic disorders, neoplasms, and cases with multiple diagnoses. The performance of participants over time in each of these categories and in more specific areas (including melanocytic and adnexal neoplasms) was assessed. Cases which showed high rates of discordant responses were specifically reviewed. One hundred sixteen cases circulated over 10 years were evaluated. The overall concordance rate was 77%, with a major discordance rate of 7%. There was a slightly higher concordance rate for neoplasms compared with nonneoplastic lesions (80% vs. 74%). Specific areas associated with lower concordance rates included classification of adnexal tumors and identification of multiple pathologies. A spindle cell nevus of Reed yielded a 40% discordance rate, with most misclassifications indicating melanoma. The RCPA quality assurance program module has circulated a wide range of common and uncommon cases to participants over the 12 years studied, highlighting a low but important rate of major discordant responses. Melanocytic lesions, hematolymphoid infiltrates, adnexal tumors, and identification of multiple pathologies are identified as areas worthy of particular attention in quality improvement activities.

The pathological evaluation of nonneoplastic kidney disorder in tumor nephrectomy specimens.

Renal cell carcinoma (RCC) comprises 2%-3% of all visceral and 80%-85% of all adult kidney malignancies. Nephrectomy is the treatment of choice for renal tumors. The accurate pathological evaluation of nonneoplastic renal parenchyma in nephrectomy specimens is important for subsequent management. Eighty-two patients with RCC who underwent surgery at Imam Khomeini Hospital, Urmia, Iran, from April 2006 to February 2015 were studied. Paraffin blocks of the hospital archives were stained by hematoxylin and eosin (H and E) and periodic acid-Schiff staining. Microscopic examination was performed on nontumoral portions that were in the farthest possible distance from the tumor. Out of total 82 cases, 24 (29.3%) had normal renal parenchyma and 58 (70.7%) had pathological changes in renal parenchyma. The most frequent pathological findings were vascular sclerosis with parenchymal scarring and pyelonephritis. Other findings include focal and diffuse mesangial hypercellularity, eight; focal segmental glome-rulonephritis, five; membranoproliferative glomerulonephritis, three; and membranous glome-rulonephritis, two. Parenchymal scarring and vascular change included 36% of clear cell type, 41% of papillary type, and 53.8% of chromophobe type. Although there is not any statistical relation between the gender of patients and pathological findings, there was an obvious correlation between age and pathological findings. Before the age of 55 years, vascular sclerosis with parenchymal scarring and glomerular diseases and then chronic pyelonephritis are more prevalent.Evaluation of pathological changes in nonneo-plastic renal parenchyma is an essential step in recognizing patients at risk of accelerated functional failure of the single remaining kidney, particularly in patients with a background of chronic vascular injury associated with diabetes or hypertension.

Chapter 8 - The neuropathology of the adult cerebellum

This chapter summarizes the neuropathologic features of nonneoplastic disorders of the adult cerebellum. Gait ataxia and extremity dysmetria are clinical manifestations of diseases that interrupt the complex cerebellar circuitry between the neurons of the cerebellar cortex, the cerebellar nuclei (especially the dentate nuclei), and the inferior olivary nuclei. The cerebellum is a prominent target of several sporadic and hereditary neurodegenerative diseases, including multiple system atrophy, spinocerebellar ataxia, and Friedreich ataxia. Purkinje cells display selective vulnerability to hypoxia but a surprising resistance to hypoglycemia. A classic toxin that damages the cerebellar cortex is methylmercury, but the most common injurious agent to Purkinje cells is ethanol. Many drugs cause ataxia, but doubts continue about phenytoin. Ischemic lesions of the cerebellum due to arterial thrombosis or embolism cause a spectrum of symptoms and signs, depending on the territory involved. Large hemorrhages have an unfavorable prognosis because they displace critical brainstem structures or penetrate into the fourth ventricle. Fungal infections and toxoplasmosis of the cerebellum, and cerebellar progressive multifocal leukoencephalopathy, have become rarer because of improved control of the acquired immunodeficiency syndrome. Ataxia is a prominent feature of prion disease. Adult-onset Niemann-Pick type C1 disease and Kufs disease may have a predominantly ataxic clinical phenotype. The adult cerebellum is also vulnerable to several leukodystrophies. A rare but widely recognized complication of cancer is paraneoplastic cerebellar degeneration.

Computed tomography and magnetic resonance imaging of peripelvic and periureteric pathologies.

Peripelvic and periureteric areas are frequently overlooked in the imaging evaluations of the urinary system on computed tomography and magnetic resonance imaging. Several neoplastic and non-neoplastic disorders and diseases including lipomatosis, angiomyolipoma and angiolipomatous proliferation, vascular lesions, lymphangiomatosis, Rosai-Dorfman disease, Erdheim-Chester disease, extramedullary hematopoiesis, IgG4-related disease, lymphoma, mesenchymal tumors, trauma, and Antopol-Goldman lesion may involve these areas. Differentiation of these benign or malignant pathologies among themselves and from primary renal pathologies is of utmost importance to expedite the triage of patients for correct treatment approach. In this article, we aim to increase the awareness of the imaging specialists to the typical and atypical imaging features of the entities affecting these areas.

Intravascular Papillary Endothelial Hyperplasia of the oral cavity – uncommon or undiagnosed?

Background: Oral Intravascular Papillary Endothelial Hyperplasia (IPEH) also known as Masson's pseudoangiosarcoma or vegetant intravascular haemangioendothelioma is a benign, non-neoplastic disorder of vascular origin caused by abnormal proliferation of endothelial cells. It commonly presents as a cutaneous lesion, however, only a few cases of oral manifestations have been reported to date.

Total Femoral Replacement in Non-Neoplastic Disorders

Total Femoral Replacement in Non-Neoplastic Disorders

Short- and long-term efficacy of focused ultrasound therapy for non-neoplastic epithelial disorders of the vulva.

To investigate the short- and long-term efficacy and influential factors of focused ultrasound for the treatment of non-neoplastic epithelial disorders of the vulva (NNEDV). A retrospective observational study. A gynaecologic department in a single centre in China. Patients with NNEDV were included in this study: 85 patients were diagnosed with lichen simplex chronicus (LSC), 44 patients with vulva lichen sclerosus (VLS), and seven patients with lichen planus (LP). A total of 136 eligible patients with NNEDV were treated with focused ultrasound. After the treatment, based on changes in the degree of symptom severity and local skin signs (lesion size, skin colour and elasticity) before and after treatment, the treatment effectiveness for each patient was assessed. We further analysed the relations among pathologic type, age, course and curative rate. Statistical analysis was performed using the Chi-square (McNemar) test. Improvement in the symptoms and physical signs and the predictive factors. Symptom relief was observed in all patients. The appearance and colour of the vulva returned to normal after the ultrasound treatment. Complete remission (CR) occurred in 68 of 136 (50%) patients (41 patients with LSC and 12 patients with VLS). The response rate was 93.38% (127/136). Seven patients who had a poor response to the first session of treatment were treated again with ultrasound therapy and a good response was observed. No severe complications were observed. There was no significant difference in treatment results among the different pathological types (P>0.05). However, the course of the disease and the age of the patients were related to the treatment results (P<0.05). NNEDV can be treated with focused ultrasound effectively and safely. The course of the disease and the age of the patients may be predictive factors. Patients with non-neoplastic epithelial disorders of the vulva can be safely and effectively treated with focused ultrasound. No significant difference in treatment results was observed between the different types of non-neoplastic epithelial disorders of the vulva.

Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons.

Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.

Does morphology matter in 2017? An approach to morphologic clues in non-neoplastic blood and bone marrow disorders.

Numerous non-neoplastic and neoplastic conditions manifest with distinctive features in blood. Although automated complete blood count (CBC) data are essential, CBC information alone is insufficient for diagnosis. Consequently, morphologic review of blood smears is still relevant in the era of sophisticated automated analyzer systems. Pathologist interpretation of the peripheral blood smear, in conjunction with CBC and clinical information, can provide rapid diagnostic information and guide cost-effective targeted laboratory testing. Pathologist review of blood smears can be used to diagnose cases in which the clinical findings are misleading or nonspecific. Here, we discuss a selection of cases in which the pathologist examination of the blood smear can aid in rapid and accurate diagnosis and guide appropriate treatment. Exemplary non-neoplastic disorders with distinctive morphologic blood features of RBC, neutrophils, monocytes, and lymphocytes will be highlighted. The differential diagnostic considerations in blood smears with RBC destruction will be presented, expanding beyond microangiopathic hemolytic anemia. Lymphocyte morphologic assessment guides differential diagnosis including the identification of rare germline disorders. In each case presented, the integration of morphologic features guided additional testing with confirmation of the diagnosis. Peripheral blood smear review is timely and cost effective, even in an era of sophisticated automated laboratory testing.

English

INTRODUCTION: Swellings of the parotid gland are of special interest to a surgeon’s keen eye. These lesions are not only involved in diseases isolated to the parotid but can also present as a part of a generalized systemic disorder, medical or surgical. For a surgeon the interests lie in the probable origin of the swelling, its involvement of the facial nerve, the variability in behavior, regarding the operability criteria and its post-operative complications. A comprehensive knowledge of the anatomy of the parotid and the prediction of the swelling behaviour can help not only in the diagnosis but also in ensuring an apt management of the lesion and the patient. AIM OF THE STUDY: This cohort study was conducted to analyse the following in our institution: 1. The incidence of various of parotid swellings. 2. To discuss accuracy of FNAC in comparison to the histo-pathological reports. 3. The various surgical modalities of treatment of parotid swellings applied. 4. To discuss the post-operative complications. 5. To compare findings of the above study with world statistics. MATERIALS AND METHODS: The cohort study which included 45 patients was conducted at Kilpauk medical college hospital and Government Royapettah Hospital from September 2010 to October 2012. Data was collected from the patients after obtaining an informed consent. The demographic details of the patients and history of their swelling was taken. The patients were examined and basic investigations performed. Details regarding the FNAC report, surgical and non-surgical management were noted. Post-operative complications were documented. The final histopathological report was analysed and compared with the FNAC report. Inclusion criteria were patients with parotid swellings neoplastic and nonneoplastic and those above 12years of age. Exclusion criteria were patients with parotid lesions due to systemic or metabolic illness and those with age less than 12 years. CONCLUSION: The analysis of the data of the study conducted at our institution provided us with the following results: 1. Parotid lesions comprised of the most common salivary gland lesions in our hospital. 2. Amongst the various lesions it was noted that benign tumours were the most common and the least common were non-neoplastic disorders. 3. The sex incidence showed a similar distribution among both males and females with the ratio being 1:1.25. 4. The mean age of presentation was 49 yearsand it was seen that the 4th and 7th decades where the predominant age group for occurrence in case of benign and malignant tumours respectively. 5. The lesions which were predominant in the non-neoplastic, benign and malignant tumours groups where abscess, pleomorphic adenoma and mucoepidermoid carcinomas respectively. These were found to be consistent with the comparison made with world statistics. 6. FNAC correlated in a total of 39 out of 45 cases, i.e.86.67% of the cases. The sensitivity and specificity for detection of benign tumors was found to be 93.75% and 100% respectively. In the case of malignant tumours the sensitivity and specificity was found to be 87.5% and 100% respectively. 7. Patients presenting with facial nerve palsy was seen more amid the malignant tumors. 8. Most commonly performed surgery was superficial parotidectomy. Completion parotidectomy was performed in 2 cases and both were malignant tumors with recurrence. 9. Facial nerve palsy and seroma formation were the commonest complication noted post-operatively. 10. Radiotherapy was the most common non-surgical modality used and administered more commonly post-operatively.

Current insights into the aetiology, pathobiology, and management of local disease recurrence in squamous cell carcinoma of the vulva.

A review that discusses the key prognostic factors that influence local recurrence in vulval cancer.

Submandibular salivary gland tumors: Clinical course and outcome of a 20-year multicenter study.

The purpose of this retrospective chart review study was to review the nature and clinical course of benign and malignant submandibular gland tumors at 2 major university-affiliated tertiary medical centers. All patients who underwent submandibular salivary gland excision between 1990 and 2010 were included. Clinical and disease-related data were collected from the medical charts. One hundred ninety-three patients were identified, of whom 108 (56%) had non-neoplastic disorders (sialolithiasis and sialadenitis). The remaining 85 patients (44%) had a submandibular salivary gland tumor. The most common benign neoplasm was pleomorphic adenoma (53 patients). Twenty tumors (24%) were malignant: adenoid cystic carcinoma in 11 patients, mucoepidermoid carcinoma in 6 patients, and adenocarcinoma in 3 patients. Recurrence was noted in 7 patients with submandibular gland malignancy and in 2 patients with pleomorphic adenoma. The 5-year disease-free survival rate was 63%. Tumors of the submandibular gland are infrequently malignant. Recurrent submandibular salivary gland pleomorphic adenoma is rare compared with recurrences in the parotid gland.

Vulvar Cancer in China: Epidemiological Features and Risk Analysis

Objective: Describe for the first time the clinical, epidemiological features of vulvar cancer in southwest China. Identify risk factors and provide reference for the prevention of vulvar cancer. Method: We retrospectively analyzed 885 patients admitted to the West China Second University Hospital for vulvar diseases between 2006 and 2016. Vulvar cancer patients with previously diagnosed vulvar nonneoplastic epithelial disorders (n=132) were analyzed and compared to those without prior history of vulvar nonneoplastic epithelial disorders (n=219). Comparisons were also made among cancer patients and non-cancer patients with vulvar nonneoplastic epithelial disorders (n=288) and vulvar squamous intraepithelial lesions (n=246). The risk factors leading to vulvar cancer for the patients with vulvar nonneoplastic epithelial disorder were analyzed by univariate analysis. Furthermore, differences of the epidemiological features of vulvar nonneoplastic epithelial disorders, vulvar squamous intraepithelial lesion and vulvar cancer were identified. Results: According to the univariate analysis, age, first coital age, educational level, smoking, history of vaginal atrophy, HPV infection, lesion sites of the upper vulva and histo-pathological changes are strongly positively correlated with vulvar cancer. By comparing the features of vulvar cancer with those of the vulvar nonneoplastic epithelial disorder and vulvar squamous intraepithelial lesion, we found that on average patients with vulvar cancer had the highest age (ranged from 50 to 59), the lowest first coital age and the highest number of pregnancies and births. The incidences of vulvar nonneoplastic epithelial disorder and vulvar cancer were 1/1000 and 2.5/100,000 respectively with an increasing trend during last 10 years. Conclusion: Age, first coital age, educational level, smoking, atrophic vagina history, HPV infection, lesion sites of the upper vulva and histo-pathological changes are the risk factors that lead to vulvar cancer. Vulvar nonneoplastic epithelial disorder, vulvar squamous intraepithelial lesion and vulvar cancer each has distinct epidemiological features. Prompt surgical intervention and subsequent treatments are the key to a better outcome of vulvar cancer.

Histopathological spectrum of ophthalmic lesions in Chhattisgarh: study from a tertiary care centre

Background: Ophthalmic pathology is a subspecialty of cellular pathology which deals with the diagnosis and characterization of eye diseases. Ophthalmic pathologists study tissues excised by ophthalmologists through evisceration and enucleation and other small biopsies from various ophthalmic surgeries. Ophthalmic lesions include a wide spectrum of lesions ranging from benign, premalignant to malignant lesions. The diagnosis of these lesions is based on the clinical as well as histopathological features. Methods: The present study was an observational prospective study conducted on a 62 ophthalmic biopsies received in Histopathology laboratory, Department of Pathology, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, India, between March 2016 and October 2016. Institutional ethics committee of Pt. J.N.M. Medical College, Raipur, India has approved this study. Informed written consent was collected from the patients or their relatives. Results: Out of 62 cases of ophthalmic biopsies, 38 (61.29%) were non-neoplastic and 24 (38.71%) were neoplastic lesions. Among non-neoplastic lesions, inflammatory lesions of lacrimal sac were more common 16 (42%) followed by conjuctival lesions 10 (26.3%). Among the neoplastic lesions, retinoblastoma was the most common malignancy 11 (45.83%). Conclusions: The most common ocular malignancy was retinoblastoma; among non-neoplastic disorder, chronic dacryoadenitis followed by benign lesions of conjunctiva. Some ocular masses composed of rhino sporangium involving conjunctiva, lid or lacrimal sac.

Correlation study on affect balance and hardiness personality in patients with non-neoplastic epithelial disorders of the vulva

Objective To explore the correlation relation of affect balance and hardiness personality in patients with non-neoplastic epithelial disorders of the vulva (NNEDV), and provide scientific basis for health education and psychological support of NNEDV patients. Methods Psychological evaluation tests were performed among 250 NNEDV patients by using the affect balance scale and hardiness personality scale. Results The affect balance score of patients was (6.52±1.09); while the hardiness personality score was (47.36±7.02). The patient′s affect balance was positively correlated with the hardiness personality (r=0.337, P<0.05). Conclusions The score of affect balance of patients with NNEDV is lower than the general average level, as well as hardiness personality. The affect balance has a significant positive correlation with hardiness. In order to give patients with NNEDV a better psychological support, nurses should focus on health education of patients with NNEDV targeted at psychological characteristics, and provide psychological support for patients. Key words: Non-neoplastic epithelial disorders of the vulva; Affect balance; Hardiness personality; Psychological support

Validation of Whole Genome SNP Array As the Primary Genetic Test in Myelodysplastic Syndrome, to Replace Chromosome and FISH Copy Number Analysis, in a UK Diagnostic Genetic Laboratory

▪Metaphase cytogenetic (MC) analysis in patients with myelodysplastic syndrome (MDS) remains the only essential recommended genetic test in Europe(Malcovati et al, Blood 2013). The chromosome abnormalities identified provide evidence of clonality and information regarding disease characterisation, risk stratification, treatment strategies and disease monitoring. With the exception of the 3q/MECOM gene rearrangement, observed in 1% MDS, the common, recurrent chromosome abnormalities and all specified abnormalities in the revised International Prognostic Scoring System (IPSS-R) for MDS are copy number changes (deletion, duplication, amplification) (Greenberg et al, Blood 2012). However, the identification of gene mutations is increasingly becoming important to confirm a diagnosis of MDS in problematic cases, refine risk (particularly in those with lower risk IPSS-R scores) and improve patient management (Bejar et al, JCO 2011;Haferlach et al, Leukemia 2014). Currently there is insufficient prognostic evidence to use gene mutation analysis as the sole genetic test, but SNP array technology may be seen as a stepping stone towards providing some gene mutation information as it detects copy number variation (CNV) at single gene, and sometimes intragenic, resolution and copy neutral loss of heterozygosity (CN-LOH), regions which are known to harbor bi-allelic gene mutations. CN-LOH is common in hematological neoplasia, including MDS.We undertook a prospective validation study using the Affymetrix Cytoscan® HD SNP array, with more than 2.6 million copy number markers, to compare SNP array with MC in patient samples at presentation with confirmed or highly suspected MDS. Subsequent monitoring by SNP array was performed in those patients where samples were received routinely for MC. Expectations were that SNP array analysis would be at least comparable to MC, by detecting all copy number changes detected by chromosome analysis; increase the diagnostic yield of MDS, due to the detection of both sub microscopic CNV and chromosome cryptic CN-LOH; and increase the number of prognostically relevant genetic abnormalities identified.Samples from 358 patients at disease presentation were received for MC at the West Midlands Regional Genetics Laboratory, UK and were used in this study. Of the 358 patients, 207 had a diagnosis of MDS confirmed and 29 had a diagnosis of MDS/MPN confirmed. The remaining 122 cases were classified as follows: 26 other hematological neoplasia (including MPN, AML, CLL and MM), 51 reactive, 32 non-neoplastic disorders and 13 non-diagnostic.In the 236 confirmed MDS or MDS/MPN cases, marrow was available in 219 and peripheral blood (PB) only in 17. PB samples were abnormal by SNP array in 11/17 (65%). Of the 219 marrows, 146/219 (67%) had comparable SNP array and MC results. A normal karyotype or failed MC result was observed in 130 samples, of these 35 (27%) had an abnormal SNP array. Cases were abnormal by both SNP array and MC in 84 (38%) samples, of these additional abnormalities were detected by SNP array in 30 (36%), including gene mutations with prognostic significance, such as KMT2A-itd, TP53 deletion and RUNX1 deletion. A normal SNP array was observed in 5 (2%) samples with abnormal MC due to balanced rearrangements (SNP array will not detect balanced rearrangements) and low level (1-3%) abnormal clones. In marrow samples, the diagnostic yield by MC alone was 91/219 (42%) and by SNP array analysis alone 119/219 (54%). Therefore, SNP array increased the diagnostic yield of MDS and MDS/MPN by 12% and identified further abnormalities in an additional 30/219 (14%) samples.In conclusion, this validation study demonstrates that SNP array may be offered as an alternative test to MC in patients with a confirmed or highly suspected diagnosis of MDS. Patients with features suggesting 3q/MECOM involvement should have FISH for MECOM rearrangements. DisclosuresGriffiths:Affymetrix: Research Funding.

Pseudotumoral brain lesions: MRI review.

Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and/or perilesional oedema, evoke a neoplastic origin. However, a multitude of non-neoplastic disorders can simulate cerebral neoplasia. In this review, we will discuss the MRI characteristics of non-neoplastic disorders that can mimic cerebral neoplasia. Distinguishing MRI characteristics are discussed for each of these non-neoplastic disorders.

Correlation between high-resolution computed tomography of the chest and pulmonary functions in idiopathic pulmonary fibrosis

The idiopathic interstitial pneumonias are a heterogeneous group of non-neoplastic disorders resulting from damage to the lung parenchyma by varying patterns of inflammation and fibrosis. High-resolution computed tomography (HRCT) has become an integral part of the diagnosis and evaluation of the patient with idiopathic interstitial pneumonias. The aim of this work was to correlate between HRCT findings and pulmonary functions in patients with idiopathic pulmonary fibrosis (IPF). Thirty patients with features consistent with IPF as diagnosed by means of HRCT were included. The severity of IPF was scored using ‘Kasr Al Ainy HRCT scoring of IPF’ in which the lung was divided into six zones, three on each side, with a specific score given for each zone according to the extent of fibrosis. Transthorathic echocardiography was performed for all patients with the estimation of pulmonary artery systolic pressure (PASP). The mean lower lung zone score according to the HRCT score for severity of IPF was 7.93±2.67, which is consistent with typical basal distribution of IPF. A negative correlation was noted between total HRCT score with forced vital capacity, partial pressure of oxygen, and 6 min walk test. There was a positive correlation between PASP detected using echocardiography and pulmonary artery size measured using HRCT (P=0.022). There is a positive correlation between PASP detected using echocardiography and pulmonary artery size measured using HRCT. There is a negative correlation between PASP using echo and partial pressure of oxygen in arterial blood gases and also between total lung zone HRCT score and pulmonary functions.

Matrix Metalloproteinases in Non-Neoplastic Disorders

The matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases belonging to the metzincin superfamily. There are at least 23 members of MMPs ever reported in human, and they and their substrates are widely expressed in many tissues. Recent growing evidence has established that MMP not only can degrade a variety of components of extracellular matrix, but also can cleave and activate various non-matrix proteins, including cytokines, chemokines and growth factors, contributing to both physiological and pathological processes. In normal conditions, MMP expression and activity are tightly regulated via interactions between their activators and inhibitors. Imbalance among these factors, however, results in dysregulated MMP activity, which causes tissue destruction and functional alteration or local inflammation, leading to the development of diverse diseases, such as cardiovascular disease, arthritis, neurodegenerative disease, as well as cancer. This article focuses on the accumulated evidence supporting a wide range of roles of MMPs in various non-neoplastic diseases and provides an outlook on the therapeutic potential of inhibiting MMP action.