Retrospective Pathological Study Research Articles

Spectrum of concomitant brain vascular lesions in pediatric diffuse gliomas

Cerebrovascular disease represents a threatening factor for brain cancer survivors. However, a comprehensive evaluation of small vessel disease related to gliomas has not yet been performed. This study aims to characterize concomitant vascular lesions in pediatric diffuse gliomas and identify their association with the molecular subgroup of tumors. We performed a retrospective pathological study of biopsy samples of 77 pediatric patients with diffuse gliomas, treated in Belarusian Research Center for Pediatric Oncology, Hematology and Immunology. Eight molecular subgroups were identified by immunohistochemical and cytogenetic studies (H3K27mut, ALT, IDH1mut, BRAFmut-PXA, FGFR1, BRAFmut/FGFR2, RTK, MYB). In each group microvessel density/area (MVD/MVA), tumor vessels co-option and signs of small vessels disease (SVD) were determined. The levels of microvascularization significantly differed between the molecular subgroups of diffuse gliomas, indicating the presence of intrinsic pro-angiogenic activity there. The highest values of MVD/MVA, as well as rate of hemorrhagic necrosis, were found in the BRAFmut/FGFR2, RTK groups. SVD was common in the adjacent tissues of gliomas and occurred in 32.5 % of cases. High grade SVD was associated with the BRAFmut/FGFR2 and IDH1mut subgroups. BRAFmut/FGFR2 tumors were more aggressive and caused cortical microinfarctions in 84,6 % and leukoaraiosis in 87.5 % of cases. IDH1mut tumors were mainly linked with cortical microinfarctions (60 % of cases). The results of the study suggest that concomitant small vascular lesions are common in adjacent tumor tissue and can significantly influence the overall rate of cerebrovascular disease in convalescents with diffuse gliomas.

Intracholecystic papillary-tubular neoplasm of gallbladder: A 5-year retrospective pathological study.

Intracholecystic papillary-tubular neoplasm (ICPN) is a relatively new entity which includes neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm. This study is done to evaluate the pathological features of ICPN and to find out the factors associated with invasion. This is a 5-year retrospective study in a referral pathology center. A total of 19 cases of ICPN are found. The cases are analyzed for age and sex distribution, clinical suspicion, stages, histological architecture, differentiation, and grade of dysplasia. Descriptive statistics and test of significance by Chi-square and t-test are used in the study. ICPN comprises 23.5% of all gallbladder neoplasms. Two-thirds of the cases were suspected radiologically. Age range is 26-65 years with mean age of 50 years. They are 2.8 times more common in female. Approximately one-third of the cases show invasion. The most common histological pattern is papillary, followed by papillary-tubular and finally by tubular pattern. Pyloric and biliary are the most common differentiation pattern followed by oncocytic and intestinal pattern. About three-fourths of the cases are associated with high-grade dysplasia mostly diffuse high-grade dysplasia. We have found the younger age of presentation, less proportion of invasive tumors, fewer tumors with biliary phenotypes, and fewer tumors with high-grade dysplasia as compared to previous studies. Factors significantly associated with invasion are grade and extent of dysplasia particularly diffuse high-grade dysplasia.

Ethylene glycol toxicity: a retrospective pathological study in cats.

Ethylene glycol (EG) is a well known toxic compound, the assumption of which can be fatal to pet animals as well as to humans. Limited information is available on the pathological features of EG poisoning in pet animals, with special emphasis on cats. Twenty-five cats with histologically confirmed EG intoxication were retrospectively investigated, in order to define more precisely the gross pathological findings and improve the diagnostic process. Furthermore, a brief comparison with the lesions reported in EG-poisoned human patients and dogs was also made.

A histopathological study of 23 cases of benign epithelial polyps of intestine

Background: Intestinal polyps of the colon and rectum consist of hyperplastic polyps, adenomas and mixed polyps. The aim is to study the benign intestinal polyps histopathologically and classify them into specific groups, frequency of each subgroup and their sex and age incidence. Here aim is also to find their premalignant potential. Methods: It is a retrospective pathological study of 23 cases of intestinal polyps which included 16 resected intestinal specimens and 7 polypectomies. Haematoxylin and eosin stained paraffin sections were studied microscopically and categorised under WHO classification with special note to their malignant potential. Results: The present study was done with 23 cases of benign polyps of the intestine during the period 2011-2013. Juvenile polyps constituted 52% of polyps followed by equal incidence of villous, tubular and tubulovillous adenomas - each 8.6%. Hyperplastic polyps, pseudopolyps (Crohns disease), inflammatory fibroid polyp and ectopic pancreas were the least common group with equal incidence (4.3%). In the age group 0-9 years (47.8%) the juvenile polyps were seen. The oldest patient was 73 years. The male to female ratio was 16:7. Tubular and tubulovillous adenomas showed malignant change with age incidence 52 and 73 years respectively. Rectum was the most common site of polyps (39%). In each case of PeutzJeghers syndrome and Familial adenomatous polyposis, polyps were multiple. Conclusion: Juvenile polyps the most common type, found commonly in rectum and in the age group of 0-9 years.Familial Adenomatous Polyposis and PeutzJeghers polyps are not uncommon since they were diagnosed in this study of small number of cases.The incidence of malignancy in polyps is 9%. Malignant potential is seen in tubular and tubulovillous polyps.Ectopic pancreas can present as a polyp.

Foxp3 Staining in BK Virus Allograft Nephropathy and Comparison With Acute Cellular Rejection

Background Foxp3 +CD4 +CD25 + regulatory T cells are involved in maintaining immunologic self-tolerance. These cells have been investigated in acute cellular rejection (ACR) of renal allografts. In this retrospective pathological study, we evaluated Foxp3 + immunostaining in BK virus nephropathy (BKVN). In some circumstances, BKVN may be difficult to distinguish histologically from ACR. Methods Sequential sections were made of 30 allograft core biopsies and stained for hematorylin and eosin (H&E), C4d, cytomegalovirus (all negative), SV40, CD3, CD20, and Foxp3. Twelve biopsies were from diagnosed BKVN cases, 12 were from diagnosed ACR cases, and six showed neither BKVN nor ACR (controls). The 100× field of maximum cellular inflammation was located and marked on the H&E stain. The same area on the CD3, CD20, and Foxp3 slides was marked. Staining lymphocytes were counted under 400× magnification. Degree of BKVN was assessed according to the Drachenberg scale; degree of ACR was assessed by the Banff criteria. Results The range of Foxp3 + staining (cells/mm 2) was much larger in BKVN (0–270) compared to ACR (0–35). The mean difference did not reach statistical significance owing to a large degree of overlap between the two groups. In BKVN, the Foxp3 + infiltrate correlated with the degree of CD3 + infiltrate ( P = .012), and median Foxp3 + infiltrate increased with Drachenberg grade of BKVN. CD3 + cell levels were not significantly different in BKVN versus ACR. Conclusions BKVN cases with high levels of Foxp3 + graft infiltrates may be manifesting an immune response different from that of ACR. Positive Foxp3 correlation with Drachenberg grade suggests a down-regulatory response.

A Retrospective Study of Neurological Disease in 118 Rabbits

A retrospective pathological study of 118 rabbits presenting with neurological disease was conducted. Diagnoses were categorized on the basis of aetiopathogenesis as inflammatory, vascular, traumatic, metabolic-toxic, neoplastic, degenerative or idiopathic. Central nervous system (CNS) lesions were present in 85 (72.0%) of the rabbits and in most of these cases (70.3%) a causative agent was identified. The majority of animals (n=78, 66.1%) had disease of an inflammatory nature and 71 of these 78 rabbits had one of two zoonotic infectious diseases: encephalitozoonosis (n=69, 58.5%) and herpes simplex virus (HSV) encephalitis (n=2). Infections with zoonotic potential are therefore a major cause of CNS disease in the rabbit.

Fallopian tube malignancies: A retrospective clinical pathological study of 17 cases

SummaryThe aim of this study is to present a retrospective clinical pathological study of 17 cases of tubal malignancies. The 17 cases were diagnosed and treated in our department between July 1985 and July 2005. Clinical information and pathological data were obtained by review of hospital records. Carcinomas were staged according to the FIGO criteria; assignment of stage was made on the operative data and the pathological findings. Four patients had Stage I tumour (23.5%), six had Stage II (35.4%), five patients had Stage III (29.4%) and two had Stage IV (11.7%). The histological type of all our specimens was primary papillary adenocarcinoma of the fallopian tube. Initially, all patients were subjected to surgery. Primary fallopian tube cancer (PFTC) is a rare gynaecological malignancy, similar to ovarian cancer, but with poorer prognosis. The PFTC should be considered in the differential diagnosis of any pelvic mass. The treatment was surgical followed by adjuvant chemotherapy.

Causes of death in a post‐mortem series of ALS patients

Death represents the main hallmark of amyotrophic lateral sclerosis (ALS). Despite its importance in clinical care and phase III trials, many uncertainties remain on the cause of death due to the lack of post-mortem verifications. To provide a more robust approach to these causes, we performed a retrospective pathological study on a large cohort of patients. 100 ALS patients referred for a deterioration of their clinical condition and who died in the ALS clinic of Salpétrière had a complete macroscopic and microscopic post-mortem analysis. The clinical causes of death reported on medical records were compared to the results of autopsy. The concordance between clinical and pathological conclusions was insufficient (20%) to consider clinical assessment as a reliable marker of causes of death. At autopsy, broncho-pneumonia and pneumonia were the main causes of death. Heart failure, representing 10% of deaths, was two times more frequent in bulbar than in spinal ALS. Pulmonary embolism representing 6% of death was exclusively found in spinal onset patients and is related to lower limbs disability. An effort has to be made for a better understanding of the causes of deterioration of ALS patients. A more proactive attitude to treat respiratory infections could have a significant impact on survival.

Intramyocardial arterial narrowing in dogs with subaortic stenosis.

Earlier studies have described intramyocardial arterial narrowing based on hyperplasia and hypertrophy of the vessel wall in dogs with subaortic stenosis (SAS). In theory, such changes might increase the risk of sudden death, as they seem to do in heart disease in other species. This retrospective pathological study describes and quantifies intramyocardial arterial narrowing in 44 dogs with naturally occurring SAS and in eight control dogs. The majority of the dogs with SAS died suddenly (n=27); nine had died or been euthanased with signs of heart failure and eight were euthanased without clinical signs. Dogs with SAS had significantly narrower intramyocardial arteries (P<0.001) and more myocardial fibrosis (P<0.001) than control dogs. Male dogs and those with more severe hypertrophy had more vessel narrowing (P=0.02 and P=0.02, respectively), whereas dogs with dilated hearts had slightly less pronounced arterial thickening (P=0.01). Arterial narrowing was not related to age, but fibrosis increased with age (P=0.047). Dogs that died suddenly did not have a greater number of arterial changes than other dogs with SAS. This study suggests that most dogs with SAS have intramyocardial arterial narrowing and that the risk of dying suddenly is not significantly related to the overall degree of vessel obliteration.

Anterior temporal white matter lesions in myotonic dystrophy with intellectual impairment: an MRI and neuropathological study.

We studied 12 patients with myotonic dystrophy using MRI and the Mini-mental state examination (MMSE), to see it specific MRI findings were associated with intellectual impairment. We also compared them with the neuropathological findings in an autopsy case of MD with intellectual impairment. Mild intellectual impairment was found in 8 of the 12 patients. On T2-weighted and proton density-weighted images, high-intensity areas were seen in cerebral white matter in 10 of the 12 patients. In seven of these, anterior temporal white-matter lesions (ATWML) were found; all seven had mild intellectual impairment (MMSE 22-26), whereas none of the four patients with normal mentation had ATWML. In only one of the eight patients with intellectual impairment were white-matter lesions not found. Pathological findings were severe loss and disordered arrangement of myelin sheaths and axons in addition to heterotopic neurons within anterior temporal white matter. Bilateral ATWML might be a factor for intellectual impairment in MD. The retrospective pathological study raised the possibility that the ATWML are compatible with focal dysplasia of white matter.

The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands.

We undertook a retrospective pathological study of 118 skin resection specimens from 101 patients with hidradenitis suppurativa. Follicular occlusion was identified in all the specimens, regardless of disease duration (1 month to 18 years), but was not noted in the axillary and inguinal skin of controls. We therefore regard follicular occlusion as an early and important feature in the pathogenesis of the disease. The presence of apoeccrine glands in axillary skin provided an in vivo model to directly observe the effects of follicular occlusion on follicle inflammation and apocrine gland destruction. In the majority of cases, active folliculitis was associated with apocrinitis and apocrine destruction, whereas apoeccrine glands, which drain directly on to the epidermal surface, appeared intact and non-inflamed. These observations provide direct evidence in an in vivo model that follicular occlusion by keratinous material, with subsequent active folliculitis and secondary destruction of the skin adnexae and subcutis, occur as an integral step in the pathogenesis of hidradenitis suppurativa.

Hypocarbia as a pathogenic factor in pontosubicular necrosis

In neonates pontosubicular necrosis (PSN) is one of the patterns of acute brain injury, the sites of maximum damage being the basis pontis and the subiculum of the hippocampus. A retrospective clinical and pathological study was performed on 16 preterm and 2 term neonates with PSN and compared with 16 age-matched controls. The results indicated that hypocarbia of less than 20 mmHg was one of the important factors in the pathogenesis of PSN.

SURGICAL SIGNIFICANCE OF TOTAL IMAGE DIAGNOSIS FOR PANCREATIC CANCER

Ultrasonography (US), computed tomography (CT) and selective angiography (SAG) were performed in 72 cases of pancreatic cancer from 1978 to 1984. The stage was determined by the overall findings of US, CT and SAG in accordance with The General Rules for Surgical and Pathological Studies on Cancer of the Pancreas, and subsequently compared with surgical stage. Retrospective pathological study was performed in 22 resectable cases. Each type of examination was found to have its own advantages and disadvantages. US and SAG were able to detect tumors less than 2 cm in size, whereas CT was useful in revealing the entire aspect of the lesion. In these examinations classification of S-factor grade (less than S2) was difficult to determine whether or not there was invasion. The operative method was decided based on the overall findings of US, CT and SAG, and significant defferences were recognized depending on the parameter. The degree of vascular and sorrounding organ involvement was found to be limited importance if within the range of the standared en block resection procedure. It was also recognized that, even in cases of simultaneous invasion to the common hepatic artery and splenic artery or invasion to the portal vein of 3 cm or less, it was possible to perform an extended operation with the Appleby procedure or reconstruction of the potal vein.

Early Histological Changes in Acute Necrotizing Hemorrhagic Pancreatitis: A Retrospective Pathological Study of 20 Total Pancreatectomy Specimens

Settled lesions of acute necrotizing hemorrhagic pancreatitis have been commonly reported. Early alterations remained unknown. In a retrospective pathological study of 20 total pancreatectomy specimens, early changes have been evidenced in "grossly unmodified" areas of pancreas: acinar cells homogenization, ductal dilatation with epithelial degeneration, diffuse interstitial edema and fibroblastic reaction, necrotic angeitis . These alterations were identical to the changes described in experimental studies.