Thin-walled Blood Vessels Research Articles

Pediatric vascular tumors of liver:a clinicopathological study of 22 cases

Objective: To investigate the clinicopathological features of hepatic vascular tumors in children. Methods The clinical characteristics, histology and immunohistochemical staining results were summarized and analyzed in 22 cases of hepatic vascular tumors in children at Guangzhou Women and Children's Medical Center from September 2007 to November 2020. Results: The 22 patients aged from 1.0 month to 2.5 years (mean age 9 months). There were 10 males and 12 females. Five cases were found in premature and had low birth weight infants; three cases were discovered in the antenatal period; one patient also had cutanous hemangioma; six patients had associated anemia; Kasabach-Merritt phenomenon was not seen in any patient. CT examination showed 17 tumors were solitary and five were multifocal lesions. Macroscopically, the tumors size ranged from was 0.6 cm to 11.0 cm; the cut surface was solid, gray red and brown in color, and in six cases there were hemorrhage and necrosis in the central area. Microscopically,15 cases of solitary congenital hepatic hemangiomas showed characteristic necrosis in the central area, with loose fibrous tissues at periphery. Proliferation of capillaries, residual bile ducts between the vascular lumens, and dilated thrombosed vascular channels were seen, and contained extramedullary hematopoietic foci and calcification. Five cases of multiple hepatic infantile hemangiomas showed capillaries of different sizes composing of plump endothelium and pericytes and were arranged in lobular or diffuse patterns. Two cases of cavernous hemangioma (venous malformation) consisted of dilated thin-walled blood vessels with branch-like pattern lined with flat endothelial cells. Immunohistochemically, all 22 case expressed vascular endothelial markers CD31 and CD34, but D2-40 was negative. Glut1 was positive in five cases of multiple hepatic infantile hemangiomas, and the other cases were negative. Conclusion: Hepatic vascular tumors in children are rare, and their classification is different from that of adults. It is of great significance to make clear pathologic diagnosis.

Malignant pleural mesothelioma showing rare morphology indistinguishable from myxofibrosarcoma concomitant with EGFR-mutated lung adenocarcinoma: A case report.

Introduction and importancePrimary tumors of the pleura are rare, with malignant mesothelioma being the most common of these neoplasms. Pathological diagnosis of sarcomatoid mesothelioma can be more challenging than that of epithelioid malignant mesothelioma because of its similarities with true sarcomas and restricted or inconsistent expression of mesothelial markers in immunohistochemistry analysis.Presentation of caseHere, we present an unusual case of malignant pleural mesothelioma concomitant with lung adenocarcinoma in a 72-year-old Japanese man, a smoker with no family history of cancer and asbestos exposure. Malignant pleural mesothelioma is composed of epithelial and spindle-shaped cells. Spindle-shaped cells with scant eosinophilic cytoplasm and hyperchromatic nuclei proliferated in abundant myxoid stroma containing thin-walled blood vessels, mimicking myxofibrosarcoma. The loss of BAP1 (BRCA1-associated protein 1) expression, as assessed by immunohistochemistry, and homozygous deletions of CDKN2A, detected using fluorescence in situ hybridization (FISH), were observed in both components. Targeted sequencing revealed that lung adenocarcinoma harbored EGFR mutations, whereas no mutations were detected in either component of biphasic mesothelioma.DiscussionAlthough alcian blue-stained mucins were detected in biphasic mesothelioma subsets, the clinicopathological significance of myxoid stroma in biphasic and sarcomatoid mesothelioma remains largely unknown.ConclusionOur case presented a unique morphology mimicking myxofibrosarcoma in a sarcomatoid component of biphasic mesothelioma; therefore, it raises a question on the clinicopathological significance of myxoid stroma in sarcomatous areas of biphasic and sarcomatoid mesothelioma.

Influence of portal hypertension on the state of the hemomicrocirculatory level of rat skin: morphological study

The effect of portal hypertension on the condition of the hemomicrocirculatory tract of the skin male white nonlinear rats was studied. Hypertension was simulated by applying a ligature to the portal vein according to the conventional method. After 30, 60 and 90 days, skin biopsies were taken from the anterior abdominal wall for optical microscopy examination, which was subjected to routine histological processing. In animals of the control group, which underwent sham surgery, the skin remained unchanged. In rats of the experimental group after 30 days in the basal layer of the epidermis there were cells with signs of degenerative changes. The basement membrane of the epidermis had small areas with thinning and thickening, which in both cases were accompanied by the formation of small and massive leukocyte infiltrates. Its edema was noted, which extended to the papillary and reticular layer of the dermis. Elastic fibers were unchanged. Only 50% of the microvessels looked intact, 20% microvessels were narrowed, and 30% had signs of stagnant hyperemia due to dilatation. After 60 days the epidermis was thinned, in the basal layer the cells with picnotized and displaced to the periphery nucleus were detected. In all studied layers of epidermis, besides reticular layer, expansion of arterioles, venules and capillary loops was observed. After 90 days the epidermis was represented by 3-6 layers of cells, its general refinement was observed due to the reduction of the thickness of the spinous and granular layers with simultaneous thickening of the horny layer. In the papillary layer of the dermis, the number of thin-walled blood vessels was increased. The average diameter of the arterioles of the hypodermis decreased relative to the values on the 60th day. The mean diameter of the arterioles of the subdermal network on the border of the papillary and reticular layers and capillary loops under the basal membrane was reduced what can be a sign of sclerotic changes in the microvessels. The venules diameter remained increased. In arterioles and venules, stasis of the microvessels, edema of their walls, microaneurysm, and venous sacculation were detected. Thus, we believe that the changes in the microvessels of the skin, which are observed in portal hypertension, are the result of hemodynamic disturbances in the tissue, which is a complex chain of hemomicrocirculatory flow to the direct action of hypertension in the portal vein and is a secondary response to systemic vascular damage.

Adult-onset eccrineangiomatous hamartoma treated with excision and skin grafting: a case report

<p>Eccrine angiomatous hamartoma is a rare benign tumour like malformation characterized by intradermal proliferation of eccrine and vascular components. It usually arises before puberty but can occur at any age. It typically presents as a solitary or multiple reddish or brownish plaque or nodule that progressively enlarges in size. Symptoms such as pain and hyperhidrosis may be associated. Lesions are commonly located over distal extremities. We report a case of a 45-year-old lady who presented with a gradually enlarging solitary reddish plaque over the left retro-auricular region of the scalp since the last 12 years and associated with occasional pain. Histopathology revealed pproliferation of eccrine sweat glands and thin-walled blood vessels in the dermis. Additional ultrasound and MRI contrast studies were done to assess the vascular component and involvement of underlying structures. The patient was treated successfully with complete excision of the lesion followed by split thickness skin grafting.</p><p><strong> </strong></p>

Is immunohistochemistry always the panacea to morphologic mimics? Two, distinct soft tissue tumors exhibiting alveolar pattern and TFE3 immunoreactivity

Alveolar soft part sarcoma (ASPS) and certain perivascular epithelioid cell neoplasms (PEComas) exhibit overlapping histopathological features, including immunohistochemical expression of TFE3, as well as TFE3 gene rearrangement. PEComas with an epithelioid morphology are known to exhibit variable immunoexpression of muscle markers. At the same time, aberrant immunoreactivity of HMB45 immunostain, which is invariably, used to substantiate a diagnosis of a PEComa, has been reported in various other tumors. Herein, we discuss two rare cases of soft tissue tumors with overlapping morphological and immunohistochemical features. Case1: A 34-year-old male underwent a biopsy for a recurrent, right-sided nasal polyp. Biopsy showed polygonal tumor cells, containing prominent nucleoli, arranged in a "nesting-type"/alveolar growth pattern. Immunohistochemically, tumor cells displayed TFE3 positivity and an aberrant positivity for HMB45. Special stain (PAS-diastase) highlighted intracytoplasmic granules and crystals. Diagnosis of ASPS was offered. Furthermore, the tumor cells displayed TFE3 gene rearrangement. Case 2: A 29-year-old female underwent an aural polypectomy. Microscopic examination revealed a tumor with a "nesting-type"/alveolar arrangement of tumor cells with vacuolated cytoplasm, arranged around thin-walled blood vessels. Immunohistochemically, tumor cells were diffusely positive for HMB45 and TFE3 and focally for SMA. A diagnosis of a PEComa was offered. This report constitutes the first documentation of aberrant HMB45 immunoreactivity in case of ASPS, and one of the first reported cases of a PEComa in the ear. It emphasizes the value of integrating clinicopathological features with immunohistochemical and molecular results in differentiating two rare, but distinct soft tissue tumors with overlapping features. An exact diagnosis of both these tumor entities has therapeutic implications.

The "bumpy" adolescent nose: Acne associated angiofibroma-like nasal papules.

Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin-walled blood vessels, typical of angiofibromas. We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.

A RARE CASE OF SPORADIC SUPRATENTORIAL HEMANGIOBLASTOMA

We report the rare case of 65-year-old male patient with supratentorial hemangioblastoma and gigantic cyst of the left hemisphere of the brain without von Hippel-Lindau disease. Hemangioblastoma is a rare benign tumor classified as grade I by the WHO of the central nervous system of uncertain histogenesis. This neoplasm’s stroma consists of dense networks of thin-walled blood vessels of various calibers. About 140 cases of supratentorial localization of this type of tumor are presented in the world literature. We have given a fairly complete clinical, neuroradiological and histological picture that allows one to differentiate hemangioblastoma from other histological structures. Promising modalities in the treatment of patients with this pathology when it is impossible to perform total tumor resection are considered.

Cranial Intraosseous Angiolipoma: Case Report and Literature Review

Angiolipomas are slow-growing, soft tissue tumors consisting of mature adipocytes and thin-walled blood vessels. While most Angiolipomas are subcutaneous lesions in the trunk and upper extremities, intraosseous angiolipomas are rare at cranial site. We present the case of a 61-year-old female with an enlarging lesion in the left frontoparietal skull following minor head trauma. Radiography confirmed an expansile, enhancing, spiculated bony lesion in the left frontoparietal calvarium with extension outside the cortex into the soft tissues. She underwent a craniectomy for complete resection of the calvarial mass, which was histologically composed of mature adipocytes and disorganized blood vessels highlighted by an immunophenotype positive for S100 and CD34, respectively, consistent with a cranial intraosseous angiolipoma. The review of the literature that reported five cases of cranial intraosseous angiolipoma with our case representing the sixth case is discussed.

Relationship between the blood-vessel coupling characteristics and the propagation of pulse waves

Pulse waves cannot be understood simply as pressure waves (longitudinal waves) propagating in compressible blood fluid, nor as radially expanding-contracting displacement waves (transverse waves) propagating along solid blood vessels, but rather as complex waves with fluid-solid coupling and longitudinal wave-transverse wave coupling beyond ordinary imagination. Starting from a new approach to analyze the coupling constitutive relation, a series model is proposed, providing more information for traditional Chinese medicine (TCM) pulse diagnosis in terms of the “position, rate, shape and potential”. It is shown that the equivalent volumetric compression modulus Ks and the corresponding pulse wave propagation velocity cs of the coupling pulse wave system, mainly depend on two dimensionless parameters: the ratio of the blood modulus to the vessel modulus, Kb(p)/E(p) and the ratio of the diameter to the thickness, D(p)/h0, of thin-walled blood vessels, which may vary from person to person and from different pulse locations for the same person. The influences of them on the cs are quantitatively analyzed, showing that for human body the magnitude of Kb/E is in the order of 103 so that the magnitude of cs is in the order of 100–101 m/s to adapt to the human physio-biochemical reactions. By clinical invasive measurements, it is confirmed that the pulse volume transverse wave and the pulse pressure longitudinal wave are coupled and propagate at the same speed, and it is shown that the pulse wave is actually a “biological wave” with oxygenation and biochemical reactions on the wave front. Furthermore, the relations of the “pulse pressure amplification” with the nonlinear constitutive relation and with the load enhanced reflection at the bifurcation of blood vessels, as well as the Lewis’s hypothesis about the formation of dicrotic wave are discussed.

52. FGFR3-TACC3: Case report and review of a potentially targetable diagnostic marker in high grade gliomas

Background: FGFR3-TACC3 fusion has been identified in IDH wild-type WHO grade III and IV astrocytomas, with an incidence of 2–3% in most case series and a range of 1–8%. These tumours have characteristic histopathological features and a poor prognosis. The aberrant CD34 immunohistochemical staining and glial and neuronal marker co-expression may lead to a misdiagnosis of a glioneuronal tumour with a better prognosis. An immunohistochemistry antibody to FGFR3 is commercially available which may serve as a more cost-effective screening test for identification of possible FGFR3-TACC3 cases. These tumours may also be amenable to treatment by FGFR tyrosine kinase inhibitors, or through inhibition of oxidative phosphorylation as a down-stream functional target of FGFR3-TACC3 fusion. Aims: A report highlighting common pitfalls in the diagnosis of high grade astrocytoma with FGFR3-TACC3 gene fusion. Methods: A single case study and review of the supporting literature. Results and conclusions: A 64-year-old male with a four month history of focal sensory abnormalities had a solitary 24 mm, intra-axial, contrast-enhancing left parietal lobe brain lesion on MRI. A stereotactic craniotomy and tumour resection was performed. Histopathology showed a malignant heterogeneous tumour. The cellular morphology included gemistocytic features, larger pleomorphic cells and numerous mitotic figures. Additional findings were psammomatous calcifications and thin-walled branching blood vessels with perivascular lymphoid cuffing. Many of the lesional cells co-expressed neuronal and glial protein markers on immunohistochemistry and there was also patchy aberrant CD34 staining. IDH1, IDH2 and BRAF genes were wild-type on molecular pathology testing. There was no loss of chromosome 1p or 19q or EGFR amplification by cytogenetic analysis. The Illumina TP170 next-generation sequencing assay identified a FGFR3-TACC3 gene fusion, a TERT promoter mutation (C250T) and a gain of FGFR3. The diagnosis of anaplastic astrocytoma, WHO grade III, IDH wild-type with FGFR3-TACC3 fusion, TERT promoter mutation and FGFR3 gain was made.

622 Economic Burden of Bleeding Gastrointestinal Angioectasias

INTRODUCTION: Angioectasias are dilated, thin-walled blood vessels resulting from degenerative changes in capillary vascular structure. They can occur anywhere within the gastrointestinal tract and are the most common source of small intestinal bleeding in patients over age 50. Small bowel angioectasias have the highest re-bleeding rates when compared to other sources. It is assumed that angioectasias complicated by bleeding result in consumption of a large volume of medical resources but this consumption has not yet be quantified in the medical literature. METHODS: A retrospective cross-sectional study was performed using Medicare data base analysis of ICD-10-DM codes for patients diagnosed with anemia and/or gastrointestinal hemorrhage during 2016 and 2017. A Crosswalk analysis of ICD-10-DM codes pertaining to primary gastrointestinal bleeding and primary anemia from angioectasias converted these codes into corresponding DRG (inpatient) and CPT (outpatient) codes. These codes of interest were followed throughout 2016 and 2017 in order to determine the cost of medical care for symptomatic angioectasias. RESULTS: In 2016, 38,250 Medicare services were provided in the management of angioectasias at a total cost of roughly $240 million. Hospitalizations accounted for 48% of total service volume but 95% of total costs at an average expense of $12,391 per inpatient stay. Outpatient services accounted for 52% of all services provided but only 5% of total annual costs in this analysis. Average costs for individual outpatient services were broken down into categories of therapeutic endoscopy ($922), diagnostic endoscopy ($805), injections ($522), blood transfusions ($261), and outpatient clinic visits ($261). Therapeutic endoscopy was the most expensive outpatient service category, accounting for 64% of all outpatient costs. A separate analysis of 2017 Medicare data validated our findings from the previous year with a steady total cost and only slightly (5%) increase in volume of individual services. CONCLUSION: Angioectasias are a common source of gastrointestinal bleeding and are associated with high recurrence rates as well as substantial morbidity. This study confirms that a large volume of medical resources are consumed in that management of bleeding angioectasias. In recognition of these findings, additional research is justified to improve upon our understanding and management of this disease process.

Astrogliosis inhibition attenuates hydrocephalus by increasing cerebrospinal fluid reabsorption through the glymphatic system after germinal matrix hemorrhage

Germinal matrix hemorrhage (GMH) results from the rupture of the immature thin-walled blood vessels and consequent bleeding into the subependymal germinal matrix and possible lateral ventricles. The purpose of this study is to investigate how astrogliosis impacts the glymphatic-meningeal lymphatic system in cerebrospinal fluid (CSF) reabsorption after GMH and how the anti-scarring agent olomoucine attenuates post-hemorrhagic hydrocephalus. GMH was induced by stereotaxic collagenase infusion into P7 Sprague-Dawley rats of both sexes. Western blot and immunofluorescence were used to assess astrogliosis and how astrogliosis affects glymphatic function by measuring Aquaporin-4 expression. Intracisternal injection of fluorescence tracer was used to measure CSF diffusion throughout the brain, its dispersion in the paravascular area and CSF drainage into the deep cervical lymph nodes at 28 days after GMH. Both short-term and long-term behavioral tests were used to assess the neurological outcomes. Nissl staining was used to assess the morphological changes at 28 days after hemorrhage. GMH elicited astrogliotic scarring and reduced the exchange between CSF and interstitial fluid, as well as CSF reabsorption through the meningeal lymphatic vessels. This might be associated with redistribution of Aquaporin-4. Olomoucine ameliorated scar tissue formation and attenuated post-hemorrhagic hydrocephalus. These findings of this study suggested that the glymphatic system might play a role in CSF reabsorption in neonates following GMH. Scar tissue formation impairs this CSF clearance route, and therefore astrogliosis inhibition might be a potential therapeutic strategy for neonatal post-hemorrhagic hydrocephalus.

Superficial Myofibroblastoma in the Vulva Mimicking Aggressive Angiomyxoma: A Case Report and Review of the Literature

Background: Superficial myofibroblastoma (SMF) is a very rare benign mesenchymal tumor in the female lower genital tract. Only 46 cases have been reported in the English language literature, among which only 7 cases arose in the vulva. Sometimes SMF histologically mimics aggressive angiomyxoma (AA) in which massive myxoid change in stroma is characteristic. We herein report a case of vulvar SMF with prominent myxoid stroma and review the literature with the emphasis on the differential diagnosis of SMF and AA. Case presentation: a 37-year-old woman presented with a painless mass in the vulva. Magnetic resonance imaging (MRI) showed a well-circumscribed 7 cm mass in the subcutis of the vulva. The tumor was resected. Histopathologically, the tumor was characterized by sparsely populated spindle-shaped cells in the fibromyxoid stroma. Thin-walled blood vessels were detected. Mitoses or pleomorphism was not found. Tumor cells were positive for vimentin, ER, PgR, and desmin. Some cells were positive for alpha-SMA and CD34. All cells were negative for S100 protein. Conclusions: because SMF and AA show different clinical prognoses, distinguishing SMF from AA is important. However, SMF may share many common histological features with AA: superficial localization (above fascia), sharp borderline from adjacent tissue, expansive growth pattern; a specific vascular pattern will lead to an accurate diagnosis of SMF. Familiarization with the histological characteristics of the two entities will help to make a prognostic prediction.

Giant cavernous hemangioma of the eleventh rib

BackgroundCavernous hemangioma of the rib is extremely rare benign vascular tumor. It is difficult to diagnose in time because both invasive and noninvasive examinations usually fail to distinguish it from other tumors of the rib and other bones.Case presentationWe described an asymptomatic 44-year-old woman with cavernous hemangioma of the rib that was incidentally discovered in the bathing. The tumor was completely resected by minithoracotomy through posterolateral incision. The pathological tissue was diagnosed as a cavernous hemangioma composed of thin-walled blood vessels and red blood cells.ConclusionsWe reported this case of giant cavernous hemangioma of the rib for its extremely rare occurrence. The preoperative diagnosis is a challenge both clinically and radiologically, and difficult to distinguish this tumor from other tumors of the rib or long bones.

SUPERFICIAL ANGIOMYXOMA IN 3 YEARS OLD CHILD MIMICKING LEFT BREAST TISSUE: A CASE REPORT

Angiomyxoma is a soft tissue tumor characterized by the presence of prominent myxoid matrix and numerous thin-walled blood vessels. It is usually located in trunk, head, neck, extremities and genitalia. Total excision of the tumor is the treatment method. Local recurrence is possible but metastases are not seen. We herein report the clinical, radiological and pathological findings of a rare case of angiomyxoma which is placed in the left breast parenchyma of a 3 years old female. The tumor developed rapidly in last six months and it had been seen like a grown up breast tissue.

Angiofibroma of soft tissue: a clinicopathologic analysis of 24 cases

Objective: To investigate the clinicopathologic and genetic features, pathologic diagnosis and differential diagnosis of angiofibroma of soft tissue(AFST). Methods: The clinicopathologic characteristics of 24 cases diagnosed at Fudan University Shanghai Cancer Center from 2011 to 2017 were analyzed; immunohistochemical staining and interphase fluorescence in situ hybridization (FISH) were performed, and the literatures were also reviewed. Results: There were 15 male and 9 female (male∶female=1.7∶1.0) patients with age of onset ranging from 8 to 68 years (mean, 45 years). Fourteen cases occurred in extremities, including upper limbs (n=3) and lower limbs (n=11); seven cases were in the trunk, and 1 case each was in the temporal region, retroperitoneum and liver, respectively. Clinically, the tumors usually presented as a slowly growing painless mass. Tumor sizes ranged from 0.8 to 14 cm (mean 4.6 cm). Microscopically, most lesions were well-circumscribed, with fibrous capsules. Few cases infiltrated the surrounding fibrofatty tissue focally. The tumors were mainly composed of sparse short spindle cells and numerous small, branching, thin-walled blood vessels distributed in amyxoid, fibromyxoid or collagenous matrix, often accompanied by medium-sized, round or irregular and ecstatic vessels at the tumor periphery.By immunohistochemistry, all tested cases expressed vimentin (5/5), and showed variable positivity for EMA (2/4), ER (1/2), PR (2/3), α-SMA (1/18)and desmin (1/10). Ki-67 proliferation index were all less than 5%. CD34, CD31 and ERG staining clearly outlined the contours of blood vessels in the stroma. Four cases were tested for NCOA2 gene rearrangement by FISH, of which three were positive. Follow-up data was available in 17 patients (range, 3 to 69 months; mean, 30 months) were all free of disease. Conclusions: Soft tissue angiofibroma is a benign fibroblastic neoplasm characterized by a prominent and complex vasculature set in a myxoid-to-collagenous stroma, and cytogenetically a distinctive NCOA2 gene rearrangement. Caution should be exercised for the possibility of potentially misinterpretation of AFST as vascular tumors and other myxoid soft tissue tumors.

Clinicopathologic features of gastric plexiform fibromyxoma

Objective: To analyse the clinicopathologic features of gastric plexiform fibromyxoma (PF) including diagnosis, differential diagnosis, immunohistochemistry and molecular pathology. Methods: Eight cases of PF were collected from June 2006 to June 2017 at the Second Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Zhengzhou University. The clinicopathologic findings of eight cases of PF were retrospectively analyzed, and immunohistochemistry (EnVision method) and molecular detection of glioma-associated oncogene homologue 1 (GLI1) gene translocation were performed. All cases were histologically reviewed with immunohistochemical staining for smooth muscle actin (SMA), CD10, CD117, DOG1, CD34, ER, PR, ALK and S-100. Fluorescence in situ hybridization (FISH) was used to detect the GLI1 gene translocation, and mutation of CKIT exons 9, 11, 13 and 17; and PDGFRA exons 12, 14 and 18 were identified by Sanger sequencing in four cases. Relevant literature was reviewed. Results: The study included four men and four women, age ranged from 26 to 72 years (mean 51 years). Histologically, the tumors were rich in small thin-walled blood vessels and myxoid matrix, and exhibited multiple nodular growth pattern in the gastric wall. The tumor cells were bland, spindled or oval. Immunohistochemically, all cases strongly expressed vimentin and SMA, and some expressed CD10 (4/8), desmin (3/8), H-caldesmon (5/8) and PR (5/8), but were negative for CD34, S-100, ER, ALK, CD117 and DOG1. The GLI1 gene translocation detection was performed in eight cases by FISH with three positive cases and five negative cases. Mutation analyses for exons 9, 11, 13, and 17 of CKIT genes and exons 12, 14, and 18 of the PDGFRA genes were performed and the tumors all of four tested cases were wild-type. Seven patients were followed up (ranged from 24 to 95 months, mean 50 months) after diagnosis and none of the patients had recurrence or metastasis. Conclusions: PF is a rare novel mesenchymal tumor of the stomach. Its distinct clinicopathologic features and immunohistochemical positivity for SMA, CD10 and PR can help differentiating this entity from other gastrointestinal mesenchymal tumors. FISH detection of GLI1 gene translocation offers an additional molecular diagnostic marker for the diagnosis.

Study of the Ultrastructure of the placenta in gestational Diabetes Mellitus

The placenta is the organ situated between the mother and fetus. It plays critical roles during pregnancy and is essential for fetal growth and development. The placental functions are determined by the ultrastructure of the placental barrier which is an exchange surface area between the fetus and mother. Gestational diabetes mellitus (GDM) comprises unfit conditions for embryonic and feto-placental development and may result in placental abnormalities. This study was made to detect the ultrastructural changes of the placenta in women with gestational diabetes. The placentas of 10 control and 10 women with GDM were studied. Whole thickness placental samples were taken and prepared for light and transmission electron microscopy study. Light microscopic study of the control placenta showed numerous densely packed microvilli, thin walled blood vessels and narrow intervillous spaces. The placentas of GDM showed reduced number of microvilli, wide intervillous spaces, thick walled vessels, edematous spaces and areas of fibrosis and perivillous fibrinoid degeneration. Electron microscopic study of the placentas of control women showed terminal villi with a thick layer of syncytiotrophoblast (Sy) with a lot of cylindrical microvilli and a thin layer of cytotrophoblast (Cy). There were some endoplasmic reticulum cisternae beside few mitochondria. The underling villus core was harboring fetal capillaries lined with flat endothelial cells and thin basement membrane. In GDM placenta, there was hypertrophy of Cy with atrophy of the Sy with multiple vacuoles and areas for glycogen storage. The microvilli were scarce and the villous core showed congested capillaries, edematous spaces, glycogen storage areas and fibrosis. All the changes in placentas of GDM are suggested to be attributed to the associated hypoxia and oxidative stress due to the associated decreased uteroplacental flow that was aggravated by the thick placental barrier.

Ultrastructure of the placenta in gestational diabetes mellitus

Objectives: The placenta plays critical roles during pregnancy and is essential for fetal growth and development. Its functions are determined by the ultrastructure of the placental barrier that is an important feature to maintain the exchange surface area between the fetus and the mother. Gestational diabetes mellitus (GDM) comprises unfit conditions for embryonic and feto-placental development, and may result in placental abnormalities. The aim of this study was to detect the ultrastructural changes of the placenta in women with GDM. Methods: The placentas of 10 women with GDM without pregestational diabetics, hypertension and chronic diseases and 10 controls were studied. Six control women were delivered vaginally and the remaining cases by caesarian section at a gestational age of 36 to 39 weeks. Placental samples were measured for their thickness and prepared for light and transmission electron microscopy study. Results: Light microscopic study of the control placentas showed numerous densely packed microvilli with syncytial knots and thin-walled blood vessels and wide intervillous spaces. The placentas of GDM cases showed reduced number of microvilli with syncytial knots, thick-walled vessels, edematous spaces, areas of fibrosis and perivillous fibrinoid degeneration. Electron microscopic study of the placentas of the control women showed terminal villi with a thick layer of syncytiotrophoblasts (Sy) with a lot of regular cylindrical microvilli and a thin layer of cytotrophoblasts (Cy). There were some endoplasmic reticulum cisternae besides few mitochondria. The underlying villus core was harboring fetal capillaries lined with flat endothelial cells and thin basement membrane. There was no fibrosis or edema. In the placenta of GDM women, there was hypertrophy of Cy with atrophy of Sy with multiple vacuoles and areas for glycogen storage. The subtrophoblastic membrane was thick and the microvilli were scarce. The villous core showed congested capillaries, stromal macrophages, edematous spaces, glycogen storage areas and fibrosis. Conclusion: All the changes in placentas of gestational diabetes were attributed to associated hypoxia and oxidative stress due to decreased uteroplacental flow that was aggravated by the thick placental barrier and the presence of edema, fibrosis and glycogen storage areas that increased the distance of transfer between the fetus and mother.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Diagnosis of Intrapancreatic Accessory Spleen

Introduction: Accessory spleen (AS) is a rare congenital anomaly in which there is failure of fusion between a portion of the developing splenic tissue and the main body of the spleen. The majority of cases occur at the splenic hilum, while the second most common site is the tail of the pancreas. Intrapancreatic accessory neoplasm (IPAS) cytopathology findings include heterogeneous small lymphocytes along with traversing small vessels. Immunohistochemical staining for CD8 is a useful tool that specifically highlights the endothelial cells of the splenic sinus. Here report an additional case of IPAS diagnosed by endoscopic ultrasound (EUS) guided fine needle aspiration (FNA). Case presentation: A 20 year old Caucasian female presented as a referral to the gastroenterology department for an EUS evaluation after she had an elevated liver function test postpartum. An magnetic resonance cholangiopancreatography (MRCP) revealed an obstruction in the common bile duct and a small solid mass at the tail of the pancreas measuring 11 mm in size. She underwent an Endoscopic Retrograde Cholangiopancreatography (ERCP) with common bile duct stone removal. Endoscopic ultrasound (EUS) with FNA was performed and revealed a single hypoechoic oval welldemarcated 11.4 mm x 8.9 mm pancreatic solid mass at the tail of the pancreas. Cytopathology revealed a benign intrapancreatic accessory spleen. Cell block sections displayed branching thin walled blood vessels surrounded by lymphoid cells that shows positive immunoreactivity for CD8. Immunohistochemical stains were positive leukocyte lymphoid antigen. Conclusion: IPAS is a benign congenital anomaly that may mimic a pancreatic neoplasm. FNA can be performed for diagnosis. The use of a combination of common cytomorphologic features, immunohistochemical stains and radiologic findings will enable an accurate diagnosis and prevent unnecessary surgical procedures.