Relevant Histological Findings Research Articles

Acute and chronic mammary periprosthetic histological changes of the muscle

Augmentation mammoplasty with subpectoral prosthesis implantation is a frequent performed procedure in plastic surgery for reconstructive and aesthetic purposes. Although prosthesis implantation in a pocket under the major pectoralis muscle has been related to volumetric and functional alterations, there is not much information about the associated short- and long-term histological changes. Therefore, the aim of our study was to describe the acute and chronic histological muscle alterations associated with subpectoral prosthesis implantation. We collected samples from patients with breast tissue expander (<6 months after implantation) and prosthesis (>1 year after implantation) and from patients without implantation as a control group. The samples were processed for assessing their histological, histochemical and immunohistochemical properties. In the control group, no relevant histological findings were identified. Additionally, in the patients with expander, we observed mild augmentation of the internalised nuclei, normal morphology, significant muscle atrophy and fibrosis, whereas in the patients with prosthesis considerable augmentation of internalised nuclei, significant muscle atrophy, fibrosis and alteration of normal muscle morphology were observed. Prosthesis implantation induces histological changes in the periprosthetic striated muscle. Chronic fibrosis and inflammation play key roles in this process, which should be characterised in more detail from the histological and molecular biological perspective.

Topline/Final Diagnostic Inclusion of Relevant Histologic Findings in Surgical Pathology Reporting of Carcinoma in Prostate Biopsies.

As the list of histologic parameters to include in surgical pathology reports of prostate cancer biopsies grows, some pathologists include this information in the microscopic description or summary sections of the report, whereas others include it in the "topline" or final diagnosis section. This prompted us to develop a multi-institutional survey to assess reporting trends among genitourinary (GU) pathologists. A survey instrument was shared among 110 GU pathologists via surveymonkey.com. Anonymized respondent data was analyzed. Eighty-four (76%) participants completed the survey across four continents. Most participants report tumor volume quantitation (88%), number of cores involved (89%), and both Gleason grade and Grade group (93%) in their topline; 71% include percent of pattern 4, with another 16% including it depending on cancer grade; 58% include the presence of cribriform growth pattern 4, with another 11% including it depending on cancer grade. When present, most include extraprostatic extension (90%), prostatic intraductal carcinoma (77%), and perineural invasion (77%). Inclusion of atypical intraductal proliferation (AIP) in the topline diagnosis was cancer grade-dependent, with 74% including AIP in Grade group 1, 61% in Grade group 2, 45% in Grade group 3, 30% in Grade group 4, and 26% in Grade group 5 cancers. Certain histologic features such as Gleason grade and tumor volume/cores involved are frequently included in the topline diagnosis, whereas the incorporation of other findings are more variably included. Prostate biopsy reporting remains a dynamic process with stylistic similarities and differences existing among GU pathologists.

Relevant dose of the environmental contaminant, tributyltin, promotes histomorphological changes in the thyroid gland of male rats

Organotin compounds, such as tributyltin (TBT), are common environmental contaminants and suspected endocrine-disrupting chemicals. Tributyltin is found in antifouling paints, widely used in ships and other vessels. The present study evaluated whether a 15-day treatment with TBT at a dose of 100 ng/kg/day could induce histomorphological changes in the thyroid gland of rats. TBT promoted relevant alterations in the thyroid architecture, being the most relevant histological findings the presence of increased number of small-size follicles in the treated group. In qualitative analyses, colloid vacuolization, papillary budging structures, cystic degeneration and chronic thyroiditis, were observed. Moreover, histomorphometric analysis showed statistically significant changes in the follicular architecture of TBT-treated rats, mainly a decrease in the follicle area (colloid) and an increased epithelial height that resulted in an increased epithelial height/colloid ratio. Augmented collagen deposition was also seen in the thyroids of treated groups. In immunohistochemical (IHC) analyses, the localization of NIS protein was described and a significant increased proliferation index (evaluated by Ki67 positive cells) in the treated group was reported. As an indirect measurement of oxidative stress, mitochondrial protein SDHA was also analyzed by IHC analysis. Although the cytoplasmic expression of SDHA was observed in both groups, the staining intensity score was higher in TBT-treated group. Our results suggest that besides causing histomorphological changes, environmental relevant dose of TBT treatment can also induce oxidative alterations.

Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits.

To evaluate the feasibility, safety, and biocompatibility of intravitreal injection of human mesenchymal stem cells (MSCs) in immunocompetent pigmented rabbits. Thirty-two pigmented rabbits (24 females, 8 males; Chinchilla-New Zealand White) were divided into 8 groups of 4 animals. Commercially prepared human MSCs were injected (0.05ml) into the post-lens vitreous of the right eyes. Groups 1 and 4 received isotonic medium (Ringer lactate-based), groups 2, 5, 7, and 8 received a low dose of 15 × 106 cells/ml. Groups 3 and 6 received a high dose of 30 × 106 cells/ml. Clinical signs were evaluated and scored before MSCs injection and weekly for 2 or 6 weeks. Animals were sacrificed at 2 or 6 weeks after injection. Eyes, liver, spleen, and gonads were assessed by histology and by fluorescent in situ hybridization to evaluate survival and extraocular migration of MSCs. There were no relevant clinical findings between control and MSC-injected rabbit eyes at any time point. There were also no relevant histological findings between control and MSC-injected rabbits related to ocular, liver, spleen, or gonad tissues modifications. MSCs survived intravitreally for at least 2 weeks after injection. Extraocular migration of MSCs was not detected. MSCs are safe and well-tolerated when administered intravitreally at a dose of 15 × 106 cells/ml in pigmented rabbits. These findings enable future research to explore the intravitreal use of commercially prepared allogenic human MSCs in clinical trials of retinal diseases.

Do We Need Surveillance Urethro-Cystoscopy in Patients with Neurogenic Lower Urinary Tract Dysfunction?

PurposeTo examine the value of surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction (NLUTD) in regard to the conflicting literature as it is generally agreed that patients with NLUTD are at increased risk for bladder cancer.Materials and MethodsIn a cross-sectional study, a consecutive series of 129 patients (50 females, 79 males, mean age 51, range 18–88) suffering from NLUTD for at least 5 years was prospectively investigated using urethro-cystoscopy and bladder washing cytology at a single university spinal cord injury (SCI) center.ResultsDue to suspicious urethro-cystoscopy and/or bladder washing cytology findings, 13 (10%) of 129 patients underwent transurethral resection of the bladder lesion and/or random bladder biopsies. Overall, 9 relevant histological findings were found in 5% (7/129) of our patients: bladder melanosis (n = 1), nephrogenic adenoma (n = 3), keratinizing squamous metaplasia (n = 1), intestinal metaplasia (n = 3), and muscle-invasive adenocarcinoma of the bladder (n = 1).ConclusionsUsing surveillance urethro-cystoscopy, we found relevant histological findings in 5% of our patients suffering from NLUTD for at least 5 years. Thus, surveillance urethro-cystoscopy might be warranted, although the ideal starting point and frequency remain to be determined in further prospective studies.

Is routine pathological examination necessary in appendectomy for acute appendicitis?

Dear editor, Appendectomy is still one of the most common emergency abdominal operations and is generally performed for a suspected diagnosis of acute appendicitis. Although routine pathological analysis has shown a low incidence of detecting clinically significant unsuspected diseases, cancer of the appendix is an uncommon disease that is rarely suspected before surgery. Appendiceal neoplasm are reported in less than 2% of appendectomies and are typically associated to an acute appendicitis symptomatology and discovered only during operation or later during pathological examination. In fact, the majority of surgeons send all the surgical specimens for pathological examination. It is also true that recent evidences suggest that many pathological analyses could be omitted for certain routine samples, and these kinds of examination are expensive and need time to be performed. Economic questioning of routine diagnostic procedures, especially pathological evaluation, is becoming increasing popular, aiming for a more responsible and evidence-based use of these procedures. A lower cost for a diagnostic test may be obtained by limiting its demand with a lower number of unnecessary specimens sent. In 1996, the US College of American Pathologist Surgical Pathology Committee recommended the selection of surgical resection specimens for examination, preferably with the creation of an institutional practice policy with two lists: one with specimens exempt from routine submission to the pathology and another with specimens for gross examination only. On the other side, the common behavior responds to a social need, originated from the “defensive medicine” that surgeons have to consider in every performed action involving patients. We retrospectively evaluated 1,219 consecutive patients with more than 18 years treated with appendectomy between 1986 and 2006. All the patients had a preoperative diagnosis of acute appendicitis. None of the patients had a preoperative diagnosis of appendiceal neoplasm. In all the patients, resected specimens were sent to pathologist for examination. In 17 patients (1.39%), appendix neoplasms were identified. Seven patients were found to have a mucocele or a cistoadenoma or the mixed form. In four patients, a mucinous adenocarcinoma was found with one case of pseudomyxoma peritonei. Other four patients were found to have carcinoid tumors and two patients had lymphoma. Crohn’s disease was identified in four more patients. Carcinoids presented at an earlier mean age than the others. In all the patients, there was a suspicious macroscopic appearance. Even if relevant histological findings after appendectomy are uncommon and the discovery of an unsuspected diagnosis in front of a macroscopically normal specimen is extremely rare, the histopathological analysis could not always be omitted, especially in those cases with a suspicious macroscopic appearance. Int J Colorectal Dis (2009) 24:1243 DOI 10.1007/s00384-009-0711-5

Milzruptur

Though rare, splenic rupture is the most common indication for splenectomy. In the vast majority of cases ruptures are clearly related to trauma (traumatic ruptures); in other cases there is a pre-existing disease affecting the spleen (pathologic ruptures); and in a minority of patients no obvious reason can be identified (spontaneous ruptures). In approximately 10% of cases an iatrogenic cause, in the broadest sense (including side effects of drugs), and relevant histological findings (approximately half of which will be unexpected) can be anticipated. Knowledge of pathophysiological aspects of splenic rupture and assessment of simple macroscopic findings such as splenic dimensions and weight, and information on macroscopically visible lesions are of key diagnostic importance, as is accurate microscopic examination with targeted histological pattern analysis, supplemented as appropriate by histo- and immunohistochemical studies on adequately prepared material.

Papillomas and carcinomas of the choroid plexus: histological and immunohistochemical studies and comparison with normal fetal choroid plexus.

Choroid plexus tumors are rare. Results on immunohistochemical features are scanty and controversial even regarding normal plexus. Thirteen cases of choroid plexus tumors and five samples of normal fetal choroid plexus were submitted to immunohistochemical study using a panel of epithelial, neuronal and stromal markers. Relevant histological findings were presence of clear cells in 3/5 papillomas (PP) and 7/8 carcinomas (CA) and all 5 fetal plexuses; rhabdoid cells, desmoplasia and vascular proliferation were found respectively in 3, 4 and 5 cases out of 6 poorly differentiated CA and were absent in PP and well differentiated CA. Pancytokeratin AE1/AE3 was strongly positive in all 13 cases, even in the undifferentiated component of poorly differentiated CA, where reactivity was focal in 3 and diffuse in 3 cases. Low molecular weight cytokeratin (35betaH11) was not expressed in any of the 8 CA, but was present in all 5 PP. In 4 of 6 poorly differentiated CA there was reactivity for smooth muscle actin (1A4) in 10 to 30% of the cells. This was true also for one case lacking rhabdoid cells. Laminin was undetectable in all 6 cases of poorly differentiated CA but was present in 4 PP and 2 well differentiated CA. All 5 fetal plexuses expressed GFAP.

Nontraumatic spine disorders: part II

In this article we present several conditions that present as nontraumatic but urgent issues needing prompt and accurate imaging evaluation in the acute setting. We also present several conditions that frequently present a diagnostic challenge to the practicing radiologist: cauda equina syndrome, benign versus malignant vertebral collapse, atlantoaxial rotatory fixation, and idiopathic vertebral osteonecrosis (Kummell's disease). Familiarity with the disease processes, relevant histologic findings, the resultant imaging anatomy, and the strengths and weaknesses of various imaging tests available will allow the practicing radiologist the opportunity to image patients with these suspected conditions efficiently and effectively.

Cardiac Lithomyxoma

Among 102 consecutive cardiac myxomas, 10 (10%) showed heavy calcification both on gross inspection and on x-ray examination. Mineralization was partial in 6 patients (mean age 56.8 years) and massive stone-like in 4 (mean age 70 years); relevant histologic findings in patients with partial calcification were Gamma-Gandy bodies in 5, cartilaginous and bone metaplasia in 2, and aspecific calcium deposits in 1. All were incidental findings either at autopsy or during clinical investigation.