Soft Tissue Biopsies Research Articles

A case of Erdheim–Chester disease initially mistaken for Ormond's disease

A 54-year-old man presented with fever, abdominal pain, anemia, elevated C-reactive protein level and decreased renal function. Idiopathic retroperitoneal fibrosis (Ormond's disease) had been diagnosed in the past, leading to surgical ureterolysis. Re-evaluation of the CT scans and histological biopsy samples revealed unusual sclerosis of the long bones and diffuse infiltrates of foamy histiocytes in the bone marrow and the retroperitoneum. Physical examination, laboratory tests including hemoglobin concentration, erythrocyte sedimentation rate, C-reactive protein level, beta2-microglobulin level, creatinine level, CT of the chest and abdomen, bone scintigraphy, bone marrow and soft tissue biopsies and immunohistochemistry. Erdheim-Chester disease with retroperitoneal fibrosis and bone sclerosis. Treatment with glucocorticoids failed. The patient's symptoms improved significantly after initiation of interferon-alpha therapy.

Tuberculous osteomyelitis of the midfoot in the absence of a pulmonary lesion: A case report

A 57-year-old Somalian woman presented to the podiatry clinic in 2001, 9 years after immigrating to the United States, with a complaint of right foot pain overlying the Lisfranc joint after a twisting injury. Radiographs and CT scans showed no signs of fracture. One year later, the patient presented with painful, swollen soft tissues mass overlying the previous injury area. MRI revealed heterogeneous masses with underlying bony erosions. Soft tissue biopsy revealed a granulomatous lesion, suspect for Mycobacterium. A subsequent bone biopsy produced an acid-fast bacillus by DNA-RNA probe consistent with Mycobacterium species. The patient had a positive Mantoux test, but a negative chest X-ray, displaying no constitutive symptoms of fatigue or weight loss associated with most cases of tuberculosis. She was treated with anti-tuberculin medications for 9 months and conservative management of the bony lesions with a complete resolution of symptoms.

Immunhistochemische Untersuchung des Kollagen-Typ-I-Gehalts der Gingiva bei Dysostosis cleidocranialis

Patients with cleidocranial dysplasia (CCD) present a thickend and fibrotic gingiva. To the best of our knowledge it was analysed for the first time, whether this is correlated with an increased rate of collagen I in oral mucosa. 27 soft tissue biopsies of six CCD-patients and 17 tissue samples of 12 healthy persons were labled with a monoclonal antibody against collagen I and the bound antibodies were detected with alkaline phosphatase-anti-alkaline phophatase-kit. The histological slices were analysed by a digital image recognition software under a fully automated microscope and the rate of collagen I was converted into amounts of grey tones. The amount of grey tones reached from 11.909 to 15.319 in the CCD-group, and from 2752 to 12.556 in the control group. The U-Test of Mann, Whitney and Wilcoxon for two independent samples generated a rank sum of 91,50 for CCD-patients, and of 79,50 for the control group. The Z-value was 3,246, the p-value 0,005. "Fisher's exact test" identified a p-value of 0,0003. The rate of collagen I in the oral mucosa seems to be increased significantly in CCD. This could explain the typical thick and fibrotic consistency of the gingiva and could be one reason for the delayed or missing dentition.

Accuracy of Assessment of Positive Cell Markers in Tissues Prepared With Immunohistochemistry and In Situ Hybridization Techniques

The aim of the current study was to evaluate differences in the expression of phenotype and cytokine markers of lymphocytes in tissues prepared by either immunohistochemistry (IHC) or In Situ hybridization (ISH) techniques. Soft-tissue biopsies from inflamed gingival tissues were collected from 11 sites in 9 subjects with generalized or localized forms of severe periodontitis or periimplantitis, that is, inflammatory destructive disease in the tissues surrounding teeth and dental implants. The biopsies were snap frozen in liquid nitrogen and stored in −70°C. Fivemicrometer sections were cut in a cryostat and every second section was prepared for either IHC or ISH techniques. Monoclonal antibodies or biotin-labeled sense and antisense probes for CD3, CD4, CD8, CD19, interleukin-6, and interleukin- 10 were used. The histological quantitative assessments were performed using a Leitz DM-RBE microscope (Leica, Wetzlar, Germany) equipped with a Leica Q-500 MC® Image system. For the identification of positive cell markers, an interference contrast setting at a magnification of ×400 was applied. A point counting procedure was used to determine the percentage of positive cell markers within the immunochromatographic technology (ICT). A lattice comprising 400 light points was superimposed over the tissue area. Cross points that indicated positive cell markers in the compartment to be examined were counted and related to the total counts for the entire tissue area (%). To estimate the error of measurements for each of the two techniques, double assessments were performed with a two months interval. It was demonstrated that assessments of cell proportions using IHC were associated with larger variations and error of measurements than using ISH techniques. The IHC method resulted in general larger densities of phenotype markers and smaller fractions of cells positive for cytokine markers than ISH. It is suggested that the accuracy of the ISH technique is superior to that of IHC when used on comparable tissue samples (The J Histotechnol 30:167, 2007).Submitted December 14, 2006; accepted with revisions July 17, 2007

A 6-month retrospective audit of soft tissue biopsies carried out under local anaesthesia in a District General Hospital

A 6-month retrospective audit of soft tissue biopsies carried out under local anaesthesia in a District General Hospital

Apical soft tissue biopsies predict biochemical failure in radical perineal prostatectomy patients with apical cancer involvement

The aim of the study was to prospectively assess the role of apical soft tissue biopsies in radical perineal prostatectomy (RPP) patients with documented apical prostate cancer (PCA) involvement. Between June 1998 and May 1999, 77 consecutive men with localized PCA and documented invasion of the prostatic apex underwent RPP by a single surgeon. Soft tissue biopsies were systematically obtained from the prostatic fossa overlying the apex at the time of surgery. Time to biochemical failure was calculated using the Kaplan-Meier method. The rates of positive apical margins and positive apical soft tissue biopsies were 23.4% (18/77) and 15.6% (12/77). The sensitivity, specificity and positive predictive value of positive apical margins for residual apical disease as determined by apical soft tissue biopsy were 41.7, 80, and 28%, respectively. The overall biochemical failure rate was 28.6% (22/77) with a median follow-up of 51 months (range 3-73 months). The 36-month biochemical recurrence-free survival rate was 55.9+/-14.9% for patients with positive apical biopsies and 78.7+/-5.3% for those with negative biopsies (P=0.023). In conclusion, positive apical soft tissue biopsy is an independent predictor of biochemical failure in patients with apical PCA who undergo RPP. Positive apical surgical margins poorly predict residual apical disease that is frequently identifiable by apical soft tissue biopsy. Apical soft tissue biopsies should therefore be obtained in patients with known extensive apical cancer involvement at the time of RPP.

Sonographically Guided Percutaneous Needle Biopsy of Soft Tissue Masses With Histopathologic Correlation

The purpose of this study was to evaluate the accuracy of sonographically guided percutaneous core biopsy of soft tissue masses. We retrospectively reviewed the medical records of patients who underwent sonographically guided biopsy of soft tissue masses at our institution during a 50-month period. Core biopsy histopathologic results were compared with surgical or clinical follow-up. One hundred eighty-three patients, 76 male and 107 female, with a mean age of 48.5 years were included in the study. Thirteen patients had more than 1 biopsy, and the total number of biopsies performed was 196. Five patients were lost to follow-up. Biopsy results were diagnostically accurate in 174 (91%) cases. Thirteen biopsies were inconclusive. No complications occurred. The overall sensitivity, specificity, positive predictive value, and accuracy in separating malignant from benign lesions were 97%, 99%, 99%, and 98%, respectively. Sonographically guided core needle biopsy is an accurate and safe means to obtain tissue samples for the histopathologic diagnosis of soft tissue masses. It obviates the need for open biopsy and should be performed routinely for treatment planning.

Paget's Disease of the Spine and Secondary Osteosarcoma

This is a case of a 72-year-old male with a known history of Paget's disease with worsening back pain. Images from computed tomographic (CT) myelography performed 4 years prior to recent presentation demonstrate the characteristic appearance of Paget's disease of the spine with diffuse coarsened, thickened trabeculae and enlargement of the bone resulting in central canal stenosis (see Fig. 1). Selected images of the T12 vertebral body also demonstrate the characteristic appearance of Paget's disease to a slightly lesser degree than the more inferior L1 vertebral body (see Fig. 2). Fig 1 Axial CT image of the L1 vertebral body obtained postmyelography and viewed with bone windows obtained 4 years prior to recent presentation demonstrates the characteristic appearance of Paget's disease with thickened, coarsened trabeculae and ... Fig 2 Axial postmyelogram CT of the T12 vertebral body obtained 4 years prior to presentation demonstrates mild Pagetic involvement. Four years later, the patient presents with worsening back pain. High-resolution CT scanning of the spine demonstrates, at the T12 level, lytic destruction of the left margin of the vertebral body and pedicle with associated soft tissue involvement (see Fig. 3). Nuclear medicine bone scan demonstrates multifocal involvement of Paget's disease with characteristic increased radiotracer uptake and enlargement of the bones, as noted in the left femur, right hemipelvis, and spine (see Fig. 4). Fig 3 (a) Axial CT image of the T12 vertebral body at recent presentation at approximately the same level as in Fig. 2 (at the level of the celiac axis) demonstrates marked lytic destruction of the left margin of the vertebral body extending into the ... Fig 4 Nuclear medicine bone scan demonstrates characteristic Pagetic appearance with multifocal areas of increased radionuclide uptake and enlargement of the bone including the left femur, right hemipelvis, and spine. CT-guided biopsy of the T12 vertebral body was performed, given the change in morphology of the vertebral body. An 11-gauge Osteo-Site (Cook Inc., Bloomington, IN, USA) device was inserted coaxially over an 18-gauge discogram needle to obtain two core biopsies of bone and soft tissue (see Fig. 5). A diagnosis of osteosarcoma was made. Fig 5 Images from CT-guided biopsy of the T12 vertebral body demonstrate accurate needle placement into the abnormal Pagetic bone.

1119: Interventional musculoskeletal ultrasound

The learning objective is to be familiar with the indications and technical aspects of musculoskeletal procedures that can be performed under ultrasound-guidance. Ultrasound (US) is used to investigate a number of musculoskeletal pathologies. Because of its real-time capabilities, US is also useful to guide numerous musculoskeletal procedures. The purpose of this presentation is to describe a number of US-guided musculoskeletal procedures. Technical considerations will be reviewed. Procedures such as aspiration and drainage of cysts and hematomas and abscesses arthrocenthesis, infiltrations of bursae, tendons sheath and fascia, biopsy of soft tissues, synovium, bone and treatment of shoulder calcified tendinitis will be described.

Histopathological features of chronic granulomatous disease (CGD) in childhood

To describe the spectrum of histopathological features encountered in children with chronic granulomatous disease (CGD) at a specialist centre. The histopathological findings of 88 surgical pathology requests from a range of organ systems including upper and lower gastrointestinal tract biopsy series, liver, bladder, bone, lung, skin, soft tissue, bone marrow and lymph node biopsy specimens, in 32 patients aged 4 months to 18 years (median 7 years) with CGD were reviewed. In most tissues the features were those of active chronic inflammation, with or without abscess or granuloma formation, often associated with fungal infection. In some tissues, more characteristic findings were identified, including the presence of pigmented macrophages, especially in hepatic sinusoids and colonic mucosa, where active chronic eosinophil predominant colitis was also observed. Chronic granulomatous disease may present to histopathologists in a wide range of tissue specimens most often demonstrating features of active chronic inflammation with or without granuloma formation. The presence of numerous pigmented macrophages in association with such inflammation should raise suspicion of the diagnosis. In addition, diffuse granulomatous inflammation of the lung and hepatic abscess formation should be regarded as suggestive of the diagnosis.

Inflammatory lesions in the gingiva following resective/non‐resective periodontal therapy

Findings from previous experiments have revealed that inflammatory cell infiltrates may remain in the gingiva following clinically successful non-surgical periodontal therapy. To investigate the presence of inflammatory lesions in the gingiva following a periodontal treatment procedure that included either soft-tissue resection [gingivectomy (GV)] or non-resective open-flap debridement (OFD). Fifteen patients with advanced generalized chronic periodontitis were recruited. Following oral hygiene instruction and supragingival debridement, one tooth site in each quadrant (non-molar, probing pocket depth>5 mm, bleeding on probing(+) and >50% bone loss) was selected and a soft-tissue biopsy was obtained and prepared for immunohistochemical analysis. Using a split-mouth design, two quadrants were randomly selected for periodontal therapy including GV, while the two remaining quadrants were exposed to non-resective OFD procedure. Six months after completion of surgical treatment, a new set of biopsies was obtained from GV and OFD sites. The inflammatory lesions residing in the gingival biopsies obtained prior to surgical therapy were 1.33-1.41 mm(2) large and contained similar proportions of CD19(+)- (B-cells, 15%), CD3(+)- (T-cells, 7%) and elastase(+)- (polymorphonuclear cells, 2%) cells in the two treatment groups. The corresponding lesions identified in the soft-tissue specimens obtained after 6 months of healing were twice as large at OFD as at GV sites (0.19 versus 0.08 mm(2), p=0.002). The densities of CD19(+)- and elastase(+)-cells in these lesions were significantly greater at OFD than at GV sites. The findings of the present study indicate that surgical therapy including soft-tissue resection results in regenerated gingival units that contain smaller lesions with lower densities of immunocompetent cells when compared with the lesions remaining in sites treated by non-resective means.

Musculoskeletal ultrasound

Over the last few years a sonographic revolution has occurred in rheumatology. Ultrasonography has been shown to be capable of substantially changing the traditional approach to most clinical problems in daily rheumatological practice because of its ability to allow a quick, safe and inexpensive access to otherwise undetectable anatomical information on the early targets of most rheumatic diseases. Ultrasonography completes the physical examination in a rapid and accurate manner and allows the detection of a wide spectrum of pathological findings involving different anatomical structures in the musculoskeletal system. Guidance for intervention (joint aspiration, synovial or soft tissue biopsy, joint or tendon sheath injection) is a major application of ultrasonography. Sonographic guidance is particularly useful when fluid collections are very small or when the inflammatory process is adjacent to anatomical structures that could be seriously damaged by the injection.

Multicenter clinical experience with large core soft tissue biopsy without vacuum assistance

The increasing interest in accurate pretreatment diagnosis of solid tumours by morphology, immunohistochemistry, genetics and molecular biology requires clinicians to obtain undamaged large core biopsies. Simultaneously, medical imaging and surgery give priority to minimal tissue injury, affordable technology and optimal patient compliance. A new large core soft tissue biopsy device has been developed to meet the above criteria. After intensive preclinical testing, 30 patients gave informed consent and 26 underwent the new diagnostic biopsy procedure. The sample was studied by morphology, immunohistochemistry and, where indicated, by molecular biology. Successful diagnosis was considered when in line with clinical follow-up and, as for all malignant lesions, when confirmed by open biopsy or surgery. No difficulties in the technique were encountered in 25 patients. In one patient the procedure was prematurely stopped because of anxiety. In all other 25 procedures a complete diagnosis was reached with regard to morphology, immunohistochemistry and molecular biology. A number of radiologists suggested some automation of the technique. This new large core soft tissue biopsy system performs well in the clinical context without injury to the breast parenchyma or artefacts in the harvested tissue specimen. The system meets almost all of the proposed technical and financial requirements. Automation is underway.

Histopathological observations of human periimplantitis lesions.

The aim of the present study was to analyze some characteristics of advanced and progressive periimplantitis lesions in man. Soft tissue biopsies were obtained from 12 implants in six patients. The implants had been in function between 4 and 21 years and were, with one exception, located in the maxilla. The radiographic examination performed prior to biopsy revealed that all sites exhibited advanced bone loss. Further, clinical signs of severe inflammation, such as suppuration, swelling and/or fistula formation were detected in the majority of sites and seven of the 12 implants were found to be mobile at biopsy. Each biopsy was following fixation embedded in epoxy resin and sections were prepared for histometric and morphometric analysis. It was demonstrated (i). that all soft tissue units harbored large inflammatory cell infiltrates (ICT) that extended to a position apical of a pocket epithelium and (ii). that about 60% of the lesions were occupied by inflammatory cells, among which plasma cells dominated. Numerous amounts of PMN cells occurred not only in the pocket epithelium and adjacent connective tissue areas, but were also present in peri-vascular compartments in more central areas of the ICT.

Role of intraoperative biopsies during radical retropubic prostatectomy

Objectives To determine the value of intraoperative biopsy during radical retropubic prostatectomy. Methods Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon. A 2 to 3-mm circumferential biopsy was routinely obtained from the apical and bladder neck soft-tissue margin and submitted for frozen section examination. In selective cases suspicious for capsular incision, a biopsy was sent from what was believed to be the contiguous neurovascular bundle/lateral pedicle. Results Prostate cancer was observed in 4.5%, 0.8%, and 1.6% of the intraoperative biopsies sent from the apical, bladder neck, and neurovascular bundle/lateral pedicle soft-tissue margins, respectively. Patient age, Gleason score, perineural invasion on diagnostic prostate biopsy, and clinical stage were not associated with prostate cancer at the apical soft-tissue margin. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the surgical specimen to predict cancer in the apical soft-tissue margin was 57.7%, 98.2%, 62%, 97.7%, and 96%, respectively. Intraoperative biopsy of the apical soft-tissue margin reduced the positive margin rate by 3.8%. Conclusions The yield of intraoperative biopsy of the bladder neck and neurovascular bundle/lateral pedicle is too low to justify it in routine practice. Biopsy of the apical soft tissue should be routinely performed to reduce the positive surgical margin rate.

Intraosseous Sarcoidosis of the Jaws Mimicking Aggressive Periodontitis: A Case Report and Literature Review

Sarcoidosis is a relatively common systemic granulomatous disease of unknown etiology. The skeletal system is affected in up to 39% of patients, but intraosseous sarcoidosis affecting the maxilla and mandible is rare. Only 20 cases have been reported previously in the English literature. This paper presents a case of generalized intraosseous sarcoidosis of the jaw bones that mimicked rapidly progressive periodontitis. A 46-year-old male patient presented with loose teeth for assessment of implants. He had been gradually losing his teeth since 1999. His past medical history was significant, with sarcoidosis diagnosed in 1998. A panoramic radiograph showed a bilateral cotton-wool appearance of the mandible. A soft tissue and bone biopsy was performed and sent for histological examination. Microscopic examination of hematoxylin and eosin-stained sections revealed non-caseating granulomatous inflammation consistent with skeletal sarcoidosis. Intraosseous sarcoidosis of the jaw bones is rare and presents commonly as progressive and rapid alveolar bone loss similar to periodontitis. Therefore, it is important for periodontists to be knowledgeable and able to diagnose this condition, as rapid alveolar bone loss may be the first sign of sarcoidosis.

Vortex disaggregation for flow cytometry allows direct histologic correlation: a novel approach for small biopsies and inaspirable bone marrows.

Many approaches to obtaining single cells from tissue for flow cytometric immunophenotyping are used; however, these methods result in tissue that is too disrupted for subsequent histologic examination. We introduce a new technique for cell dissociation of hematopoietic malignancies that preserves tissue for histology. This is especially important with small specimens for which this type of correlation is critical. Fresh tissue from lymph node, gastrointestinal (GI) tract, skin, and other soft tissue biopsies, in addition to cores of inaspirable bone marrows, were briefly vortexed until the RPMI cell culture medium became cloudy. Larger specimens such as lymph nodes were sectioned before disaggregating, whereas smaller ones were vortexed in toto. Resultant flow cytometric analyses were compared with the histology and, in some cases, the immunohistochemistry (IHC) to determine whether the data were concordant. Cell suspensions of 104 specimens-composed of 48 lymph nodes, 19 bone marrow cores (BMCs), 11 GI biopsies, 11 skin/soft tissue biopsies, and 15 miscellaneous specimens-were prepared via vortex disaggregation. Flow cytometric analysis of 96 specimens (92.3%) showed adequacy of material and diagnostic correlation with the histology and IHC. Of the eight cases (7.7%) that were discordant, seven were attributable to significant specimen fibrosis or necrosis. With respect to tissue type, this method produced diagnostic cell suspensions for most lymph nodes (95.8%), GI biopsies (90.9%), and BMCs (89.5%); however, it was less useful for skin/soft tissue samples (81.8%). Disaggregation of tissue for flow cytometric analysis by vortexing appears to provide adequate and representative cellular material. This technique is ideal for inaspirable bone marrows and small biopsies where tissue preservation for histology is paramount.

MRI-guided musculoskeletal biopsy

MRI-guided musculoskeletal biopsy has been mentioned to be a minimally invasive method to obtain specimens for diagnostic purposes in bone tumors. To evaluate the viability, to assess the accuracy, and to record possible complications of this method, clinical data of 19 MRI-guided biopsies were analyzed. Interventions were performed on 18 patients (1-78 years) as an outpatient procedure: 15 skeletal and 4 soft tissue biopsies were taken from the pelvis, upper limb,or lower limb. We used T1-weighted gradient echoes (GE) for locating the puncture site and T2-weighted turbo spin echoes (TSE) for visualization of needle position. In 14 of 18 MRI-guided biopsies, a definite histological diagnosis was obtained. According to the pathologist, the inadequate size of the specimen was the main reason for missing the diagnoses in four cases.Long intervention time and inappropriate biopsy tools proved to be the main disadvantages of MRI-guided biopsy, but technical improvement might solve these technical problems in future.A postbiopsy hematoma was the only complication observed. Once technically improved, MRI-guided biopsy could be a precise alternative routine method for musculoskeletal biopsies in future.

Immunohistochemical characteristics of inflammatory lesions at implants.

The aim of the present investigation was to study some immunohistochemical features of peri-implant mucositis and peri-implantitis lesions. Two groups of subjects (Groups A and B) were included. Group A consisted of 10 partially edentulous subjects (eight females and two males; 45-72 years of age) who had been restored with implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden). The implants had been in function between 2 and 5 years. In each subject, one implant site demonstrating signs of peri-implant mucositis, i.e. soft tissue inflammation but no bone loss, was selected. The site was anaesthetized and a soft tissue biopsy was collected. In Group B, six subjects were included. They had been restored with implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) between 5 and 11 years prior to the current study. In each individual >or= 1 implant site exhibited signs of peri-implantitis and was selected for biopsy. All sites of peri-implantitis had (i) a history of continuous marginal bone loss (assessed in radiographs), (ii) clinical symptoms of soft tissue inflammation (bleeding on probing and suppuration) but (iii) no implant mobility. From each selected peri-implantitis site a 4 x 4 mm large soft tissue biopsy was obtained. All specimens were snap frozen and prepared for immunohistochemical analysis regarding the proportions of cells positive for the CD3, CD4, CD8, CD19 and elastase markers. Peri-implantitis lesions were considerably larger and contained significantly greater proportions of B cells (CD19+) and elastase-positive cells than mucositis lesions. Peri-implantitis sites, in contrast to sites with mucositis, consistently displayed elastase-positive cells in the central portions of the infiltrate. It is suggested that peri-implantitis lesions exhibit properties that are different from mucositis lesions.

High 2-Deoxy-2-[ 18F]Fluoro-D-Glucose Accumulation in a Case of Retroperitoneal Fibrosis Following Resection of Carcinoid Tumor

Positron emission tomography (PET) using 2-deoxy-2-[ 18F]fluoro-D-glucose (FDG) has been shown to be a highly sensitive diagnostic tool to stage, restage, and monitor the progress of various neoplasms. A number of physiological and non-neoplastic conditions, however, also may be associated with focal accumulation of FDG and can cause false-positive results. This work reports a 52-year-old man who had marked FDG accumulation in carcinoid tumor of the distal ileum. The tumor was resected. A follow-up FDG-PET scan one and a half years later revealed intense FDG accumulation in the abdominal periaortic region, suggesting recurrent malignancy. Computerized tomography (CT) of the abdomen showed soft tissue mass surrounding the aorta. Fine-needle aspiration biopsy of the periaortic soft tissue confirmed benign retroperitoneal fibrosis. This case shows that retroperitoneal fibrosis can cause intense FDG accumulation giving false impression of malignancy. In interpretation of whole-body FDG-PET, various physiological and benign causes of FDG accumulation must be considered in order to avoid pitfalls. The authors have reviewed the literature and discussed association of carcinoid tumor and retroperitoneal fibrosis. (Mol Imag Biol 2002;4:363–368)