Spectrum Of Pathologic Findings Research Articles

A kaleidoscopic view of male urethral pathologies on 64-slice multidetector computed tomographic urethrography: A novel technique.

Pathologies of the male urethra are mostly obstructive in nature and require imaging to delineate the lesion type, site, extent and associated abnormality of the urinary bladder. Contrast urethrography (CU) is the gold standard investigation for urethral assessment but has many limitations. Cross-sectional imaging is infrequently used for the evaluation of the urethra but has been gaining importance recently. Multidetector computed tomographic urethrography (MDCTU) has the capability of evaluating the entire length of a male urethra in a single setting and overcomes many technical and patient limitations of CU. Being a novel technique, most radiologists are not familiar with MDCTU and the imaging spectrum of various urethral and bladder pathologies. This pictorial review attempts to present the imaging appearance of the normal male urethra and spectrum of pathological findings, with highlights on its advantages over the CU technique.

Facial Papules in Birt-Hogg-Dubé Syndrome: A Growing Spectrum of Pathologic Findings

Birt-Hogg-Dubé syndrome is rare genodermatosis caused by a mutation in the folliculin gene. It is characterized by pulmonary cysts, renal tumors, and a variety of skin manifestations including trichodiscomas, fibrofolliculomas, less commonly reported angiofibromas, and perifollicular fibromas. These cutaneous lesions have overlapping histopathologic features. Here we report a case of a man presenting with facial papules and nonspecific histology found to have Birt-Hogg-Dubé syndrome and a novel mutation in the folliculin gene. Our aim is to raise awareness of the spectrum of associated cutaneous and pathologic findings in Birt-Hogg-Dubé syndrome, which are not all included in the diagnostic criteria.

Pediatric Musculoskeletal Ultrasound: Practical Imaging Approach.

The purpose of this article is to review some of the common indications for pediatric musculoskeletal ultrasound examination, with emphasis given to imaging technique, normal anatomy, and the spectrum of pathologic findings seen in the pediatric population. Ultrasound is an essential first-line tool in pediatric musculoskeletal imaging. It aids in determining which patients may benefit from further imaging, including radiography, CT, and MRI.

The spectrum of histomorphological findings related to joint endoprosthetics

Approximately 230,000 total hip and 170,000 knee joint endoprostheses are implanted in Germany annually of which approximately 10% (i.e. 40,000 interventions per year) are cases of revision surgery. These interventions involve removal of a previously implanted prosthesis which has resulted in complaints and replacement with a new prosthesis. There are manifold reasons for revision surgery, the most common indication being so-called endoprosthesis loosening, which is subdivided into septic and aseptic loosening. Histomorphological studies revealed that periprosthetic tissue from endoprosthesis loosening can be classified into four types (I) wear-particle induced type, (II) infectious type, (III) combined type and (IV) fibrous type. Types I and IV represent aseptic loosening and types II and III septic loosening. Recently, the topic of implant allergy has emerged. The detection of cellular, mostly perivascular lymphocytic infiltrates is discussed as being a sign of an allergic tissue reaction. It has most frequently been observed in type I periprosthetic membranes with a dense load of metal wear, which occurs with metal-on-metal bearings. Apart from endoprosthesis loosening, arthrofibrosis is another complication of joint endoprosthetics and can cause pain and impaired function. Histopathologically, arthrofibrosis can be evaluated by a three-tiered grading system. Furthermore, bone pathologies, such as ossification, osteopenia or osteomyelitis can occur as complications of joint endoprosthetics. This review gives an overview of the whole spectrum of pathological findings in joint endoprosthetics and offers a comprehensive and standardized classification system for routine histopathological diagnostics.

Right ventricular cardiovascular magnetic resonance imaging: normal anatomy and spectrum of pathological findings

BackgroundThe right ventricle (RV) has been defined as the “forgotten chamber”, as its role in cardiac physiopathology has long been underestimated. Nevertheless, the RV is involved in a wide range of pathological conditions and its altered function may significantly affect the patient’s clinical status.MethodsA selection of the most common cardiovascular magnetic resonance (CMR) features in a spectrum of pathological conditions is illustrated. Although its complex morphology, thin myocardium and trabeculated apex, RV can be accurately imaged by CMR, revealing its involvement in ischaemic and non-ischaemic heart disease. CMR has emerged as the pre-eminent modality in monitoring ventricular performance in congenital heart disease, pulmonary hypertension and cardiomyopathies. Arrhythmogenic right ventricular cardiomyopathy is a difficult diagnosis and the recently revised task force criteria confirmed a crucial role of CMR to increase diagnostic accuracy, by combining detection of RV dilation, regional wall motion and structural abnormalities. Moreover, a multiparametric approach of CMR is often necessary for delineation and characterisation of cardiac masses.ConclusionCMR, combining assessment of morphology, structure and function, has definitively emerged as the reference technique to evaluate a large variety of RV diseases.Teaching Points• CMR offers unique advantages for imaging of many RV congenital, ischaemic and non-ischaemic diseases.• Because of high reproducibility, CMR has a crucial role in decision-making for chronic RV pathology.• The use of CMR increases detection of RV disease as infarction or arrhythmogenic cardiomyopathy.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-013-0222-3) contains supplementary material, which is available to authorized users.

Abstract LB-507: A color coded fluorescent transgenic mouse model of spontaneous pancreatic cancer for imaging spectrally distinct cancer cells and stroma

Abstract Conditional fluorescent (mTmG) indicator mice constitutively express a conditional tdTomato transgene (mTmG) that converts to the expression of EGFP following exposure to Cre recombinase. PdxCre+, mTmG+ mice express bright, membrane-targeted, green fluorescent protein (mG) specifically in the pancreatic epithelial parenchyma. Non-epithelial pancreatic tissues and non-pancreatic tissues ubiquitously express membrane-targeted tdTomato (mT), providing a red fluorescent backlight in imaging studies. In the present report, we have applied the strengths of the PdxCre+, mTmG+ dual color system to the study of spontaneous tumor development in a triple transgenic PdxCre, LSL-KrasG12D/+, LSL-Trp53R172H/+ mouse model of human pancreatic ductal adenocarcinoma (PDAC). We generated mice that follow the well-described progression of pre-neoplastic changes in the pancreas, and ultimately develop fluorescent pancreatic tumors, recapitulating the sequence of events that occur in human PDAC in an imagable mouse model system. To establish this model, we intercrossed four lines of transgenic mice [PdxCre (C), LSL-KrasG12D/+(K), LSLTrp53R172H/+(P), and mTmG (mTmG)] and generated small cohorts of quadruple transgenics (CKPmTmG) and littermate controls. Like PdxCre+, mTmG+ dual transgenic mice, CKPmTmG mice demonstrated green fluorescent pancreata and red fluorescent non-pancreatic tissues. As in the non-fluorescent PdxCre, LSL-KrasG12D/+, LSL-Trp53R172H/+ (CKP) parental line, CKPmTmG mice developed pancreatic dysmorphia and dysplasia within the first several weeks of life. These changes were accompanied by development of pancreatic tumors and were associated with early mortality not seen in littermate controls. Ex vivo imaging of CKPmTmG mice at necropsy demonstrated a spectrum of pathologic findings, including cystic and solid pancreatic tumor masses surfaced by distorted and distended green fluorescent pancreatic ducts and duct-like structures. The non-epithelial pancreatic tissues provided a red fluorescent background. Histologic findings included ductal dilatation, ductal atypia with features of pancreatic intraepithelial neoplasia (PanIN) as previously described in CKP mice, atrophy of pancreatic acini, and duct-centered desmoplasia entrapping the occasional isolated pancreatic islet. This dual color, quadruple transgenic mouse model enables us to apply fluorescence imaging technology to the study of tumor microenvironment in mice genetically engineered to develop pancreatic cancer spontaneously. Based on preliminary studies, this mouse model promises to be a valuable tool with which to address many intriguing questions and timely controversies regarding the pathogenesis of human pancreatic cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-507. doi:1538-7445.AM2012-LB-507

Gastrointestinal: Large antro‐duodenal ulcers following hepatic selective internal radiotherapy

A 85-year-old man presented with progressive epigastric pain and small-volume melaena 2 months after hepatic Yttrium-90 microsphere selective internal radiotherapy (SIRT) (SIR spheres, SIRTex Medical, Australia) for recurrent hepatocellular carcinoma. Pretreatment coil embolisation of the gastroduodenal and a larger branch of the superior mesenteric artery had been performed, and scintigraphic assessment of splanchnic shunting was unremarkable. Upper GI endoscopy revealed diffuse gastritis sparing the proximal aspects of the lesser curvature and a large antroduodenal ulcer. Sites of minor oozing not amenable to endoscopic therapy were noted. After discontinuation of anticoagulation and intravenous administration of proton pump inhibitors (PPI), bleeding ceased and symptoms improved. The second-look endoscopy using a high-definition videoscope 3 days later showed improvement of the gastritis, but ulcer morphology and size remained essentially unchanged (Fig. 1A+B). Histopathological evaluation of ulcer margin and gastric antrum biopsies confirmed aberrant microsphere deposition (Fig. 2). The patient was continued on double-dose PPI and symptomatic therapy, and slight endoscopic improvement was documented after 4 weeks (Fig. 1C). High-definition endoscopy (Olympus GIF-H180) providing a detailed view of the proximal ulcer (a, gastric antrum) and the distal, deeper ulcer margins (b, distal duodenal bulb). Note the raised nodular proximal edges. Repeat high-definition endoscopy 4 weeks later revealing a minor reduction in ulcer extensions with consolidated margins (c). Ulcer margin specimen with multiple purple psammoma-like spheroid foreign bodies with peripheral halos representing resin SIRT microsphere deposition (H&E, normal particle size 20–40 µm). SIRT is an emergent locoregional treatment option for irresectable primary or metastatic hepatic cancers by selective application of radioactive 90Y resin or glass microspheres into tumor feeding contributaries of the hepatic artery. Though several studies have demonstrated its overall safety, injury due to off-target microsphere distribution, potentially owing to vascular variants, collateral circulation and alterations in mesenteric flow dynamics, remains a matter of concern despite strict adherence to established procedural protocols. The relative embolic potential of resin microsphere delivery may, by reversal of hepatopetal blood flow, relate to a greater risk of aberrant particle deposition over glass microspheres. There is a spectrum of pathological findings in SIRT-related radiation injury, however, demonstration of spheroid particles on biopsies is instrumental in clarifying the etiology of mucosal damage following SIRT. Given its increasing popularity as a potent oncologic treatment option, clinicians and endoscopists should be aware of these complications to allow for early diagnosis and appropriate management. Contributed by

Neuroimaging of Tuberous Sclerosis: Spectrum of Pathologic Findings and Frontiers in Imaging

The purpose of this article is to present neuroimaging findings in tuberous sclerosis complex, including recently developed imaging techniques that have demonstrated clinical benefit to this patient population. Neuroimaging advances have improved the diagnosis of tuberous sclerosis complex and the treatment of children with this condition. Superimposition of functional information from PET onto MRI allows accurate and noninvasive identification of epileptogenic tubers, improving surgical cure rates. Magnetic source imaging can also be used to localize epileptiform activity arising from tubers.

Distribution of pathologic findings in individuals with nephrotic proteinuria according to serum albumin

Previous studies of the nephrotic syndrome have not carefully examined the relationship between serum albumin and the distribution of pathologic diagnoses found at the time of biopsy. The spectrum of pathologic findings in individuals with nephrotic proteinuria and a normal serum albumin has not been determined. Knowledge regarding the spectrum of findings in nephrotic proteinuria according to serum albumin levels may help nephrologists in the clinical decision making of when to perform a renal biopsy and in determining proper management of these patients. Pathologic reports of native kidney biopsies performed for idiopathic proteinuria >3 g/24 h were reviewed. Clinical characteristics and biopsy findings were compared for individuals with serum albumin <30 g/L (Group I), 30 to <35 g/L (Group II) and >/=35 g/L (Group III). There were 57 patients in Group I, 20 in Group II and 35 in Group III. The proportion of individuals with focal and segmental glomerulosclerosis (FSGS) increased according to group: 26% in Group I, 45% in Group II and 74% in Group III. Of 35 patients in Group III, 34 had FSGS or advanced nephrosclerosis from another cause. Seven of 17 Group III patients with follow-up required dialysis after a mean interval of 6 years. Few of these patients received immunosuppressive therapy. As serum albumin increases in the nephrotic syndrome, the proportion of patients with FSGS increases. Patients with nephrotic proteinuria and a serum albumin >35 g/L suffer from FSGS, nephrosclerosis and have poor renal survival. When evaluating nephrotic patients, nephrologists should use this knowledge about the spectrum of disease in the clinical decision making of when to perform a biopsy and in providing the patient more precise information regarding risks, benefits and alternatives of the kidney biopsy procedure.

The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ--The Price of Screening Mammography

Wouldn’t it be easier if we lived in a binary world? Everything would be either black or white, yes or no, 1 or 0. And biopsy results would be either normal or cancer. Unfortunately, in the world of cancer, our efforts to detect the disease early have made this a fantasy. We are increasingly faced with the reality of a big gray zone — a broad spectrum of pathologic fi ndings between normal tissue and invasive cancer. And our nosology refl ects the associated ambiguity — dysplasia, intraepithelial neoplasia, hyperplasia with atypia, and even abnormalities of “unknown signifi cance.” The unifying theme for these fi ndings is that they may progress to invasive cancer. Or they may not. Despite the presence of the word “carcinoma,” ductal carcinoma in situ (DCIS) is the poster child for this problem (a senior pathologist involved in developing classifi cation systems confi ded to one of us that he regretted the use of the term carcinoma in DCIS). No one believes that DCIS always progresses to invasive cancer, and no one believes it never does. Although no one is sure what the probability of progression is, studies of DCIS that were missed at biopsy ( 1 , 2 ) and the autopsy reservoir ( 3 ) suggest that the lifetime risk of progression must be considerably less than 50%. There is an added complexity: DCIS is associated with not just one risk but two. In addition to the specifi c risk that the lesion might progress to invasive cancer, DCIS confers a general risk. It is a marker for an increased chance of developing invasive cancer elsewhere in the ipsi- or contralateral breast. Again, although no one is sure what this probability is, a recent prospective study of a cohort of patients with DCIS who were treated largely by excision alone suggested that the 5-year risk of subsequent invasive breast cancer elsewhere is less than 10% ( 4 ). In short, there is a sea of uncertainty surrounding DCIS. Some lesions will progress to cancer, others will not. Some women with DCIS will develop cancer elsewhere in their breasts, whereas others will not. And we’re not sure what the chances are. It isn’t surprising that among women with DCIS the uncertainty of being in this gray zone leads to anxiety. In this issue of the Journal, Partridge et al. ( 5 ) report that many women with DCIS are anxious — even months after the diagnosis. The authors also report that anxiety is associated with exaggerated risk perceptions — many women with DCIS estimate their risk of developing invasive cancer 5 years following treatment to be greater than 50%. Although it’s tempting to hope that better educating women (and their doctors) about the actual risks of DCIS would reduce anxiety, it’s entirely possible that our measures of risk perception and anxiety are simply markers for the same underlying construct — how women feel about being in the gray zone. They are told that they don’t have cancer, but they are not normal; instead, they are at higher risk for developing cancer. Because DCIS is an asymptomatic and nearly always nonpalpable lesion, the majority of women exposed to this sea of uncertainty got there the same way — via screening mammography. Thus, the associated anxiety must be considered to be a harm of mammographic screening. But anxiety is certainly not the only harm. The fundamental paradox of early cancer detection is that, while some may be helped, others get a diagnosis they’d be better off without. The central harm of screening is overdiagnosis — the detection of abnormalities that meet the pathologic defi nition of cancer but will never progress to cause symptoms. Although this concept may seem implausible to clinicians, basic scientists have begun to uncover biologic mechanisms that halt the progression of cancer ( 6 – 8 ). Overdiagnosis has now been associated with early detection

HISTOPATHOLOGICAL FEATURES OF TESTICULAR REGRESSION SYNDROME: RELATION TO PATIENT AGE AND IMPLICATIONS FOR MANAGEMENT

Testicular regression syndrome (TRS) represents a congenital condition in which no normal testicular tissue can be identified following exploration for a clinically impalpable testis. A spectrum of pathological findings may be present but there is little literature systematically examining these features. We searched a pediatric histopathology database to identify cases of TRS, and the histopathological findings were reviewed and pooled with those of all previously published smaller series. A total of 117 cases were identified during the period (1989–2004), median age 2 (range birth–12) years. In 52 (44%) a nodule was identified macroscopically, median maximum diameter 0.5 (range 0.1–2.0) cm. Microscopic hemosiderin-laden macrophages were present in 85 (73%), dystrophic calcification in 52 (44%), residual testicular tubules in 12 (10%), vas deferens in 71 (61%), and epididymal tissue in 39 (33%). The prevalence of hemosiderin laden macrophages and dystrophic calcification were significantly greater in cases ≤3 years (84% versus 64% and 55% versus 32%, respectively). But there was no significant difference in the frequency of other findings between the younger and older age groups; in particular, the presence of residual testicular tubules was similar (7% versus 13%, respectively). Furthermore, there was no significant correlation between identification of a macroscopically distinct nodule and presence of residual tubular structures, tubules being identified in 6 of the 65 cases in which no clearly identifiable nodule was seen macroscopically. The presence of hemosiderin-laden macrophages and foci of dystrophic calcification showed a positive association. TRS is associated with specific histopathological features, the findings being consistent with changes secondary to intrauterine testicular torsion. Residual testicular tubules are found in 10% of cases regardless of the presence or absence of a macroscopically identifiable nodule.

The association of bloody nipple discharge with breast pathology

It is believed that bloody spontaneous nipple discharge (SND) portends a greater chance of malignancy than nonbloody discharge, and that cytologic evaluation of SND assists in treatment planning. Our aims were to assess (1) the pathology of women with/without SND who require diagnostic breast surgery, (2) whether bloody SND is associated with a different spectrum of pathologic findings than nonbloody, and (3) whether SND cytology is influenced by pathologic findings. One hundred seventy-five women who underwent breast operation were enrolled. Cytologic evaluation was performed on Papanicolaou-stained cytospin preparations of SND. Papilloma and hyperplasia (both without atypia) were more frequent in breasts with than without SND; breast cancer was more common in breasts without SND (P <.001 for all). All cases of breast cancer with SND, but only 33% without, contained a papilloma or papillary features. Seventy-five percent of cancers presenting with SND were nonbloody. Papilloma was the most common diagnosis in breasts with bloody SND and was more common (P=.017) than in breasts without, whereas hyperplasia was the most common diagnosis in breasts with nonbloody SND and was more common (P=.031) than in breasts with bloody SND. SND cytology was not significantly influenced by pathology. Breast cancer can present as unilateral nonbloody SND, indicating the importance of surgical intervention. Papilloma was more common in women with SND than without and most often presented as bloody SND.

Mesenchymal hamartoma of the liver in the adult: Association with distinct clinical features and histological changes

Mesenchymal hamartoma of the liver (MHL) is an uncommon mass lesion composed of architecturally abnormal bile ducts in an uncommitted myxoid stroma. Most MHL are diagnosed in childhood. More than 50% of cases are seen in the first year of life, although a few cases have been previously reported in adults. The spectrum of pathological findings in the cases presenting in adults, including differences in comparison with MHL in children, has not been fully characterized. In this report, we describe 3 cases of MHL in patients 46, 63, and 66 years of age. Each of the patients was a woman who had a solid or multicystic hepatic mass ranging from 5 to 24 cm in maximum dimension. In contrast to the childhood cases, the stromal component was fibrotic with areas of dense hyalinization and only focal myxoid areas. In 1 case, the mesenchymal component was the predominant feature of the lesion, with only occasional ductal elements identified with thorough tissue sampling. Immunohistochemical analysis with a panel of antibodies showed that, as in normal bile ducts, the ductal structures within the lesion were immunoreactive for cytokeratin 7 and negative for cytokeratin 20. The stroma was composed of a prominent population of fibroblasts and myofibroblasts that were positive for smooth muscle actin and vimentin. Analysis of the current findings, together with the previous case reports, shows that in contrast to MHL in children, this lesion in adults is found more commonly in women who present with abdominal pain. Recognition of the clinicopathologic differences between adult and pediatric cases will facilitate accurate diagnosis of this uncommon lesion. HUM PATHOL 33:893-898. Copyright 2002, Elsevier Science (USA). All rights reserved.

The spectrum of pathologic findings in resections for complicated pancreatitis: Can histology help predict persistent pain?

The spectrum of pathologic findings in resections for complicated pancreatitis: Can histology help predict persistent pain?