Analytical and Quantitative Cytopathology and Histopathology最新文献

Objective: To investigate the potential of a computerized system for the discrimination of benign from malignant endometrial nuclei and lesions.

Study design: A total of 228 histologically confirmed liquid-based cytological smears were collected: 117 within normal limits cases, 66 malignant cases, 37 hyperplasias without atypia, and 8 cases of hyperplasia with atypia. From each case we extracted nuclear morphometric features from about 100 nuclei using a custom image analysis system. Initially we performed feature selection, and subsequently we applied a logistic regression model that classified each nucleus as benign or malignant. Based on the results of the nucleus classification process, we constructed an algorithm to discriminate endometrium cases as benign or malignant.

Results: The proposed system had an overall accuracy for the classification of endometrial nuclei equal to 83.02%, specificity of 85.09%, and sensitivity of 77.01%. For the case classification the overall accuracy was 92.98%, specificity was 92.86%, and sensitivity was 93.24%.

Conclusion: The proposed computerized system can be applied for the classification of endometrial nuclei and lesions as it outperformed the standard cytological diagnosis. This study highlights interesting diagnostic features of endometrial nuclear morphology, and the proposed method can be a useful tool in the everyday practice of the cytological laboratory.

Objective: To evaluate the value of differential cytology of bronchoalveolar lavage (BAL) in common interstitial lung diseases (ILDs) and its relation with high-resolution computed tomography (HRCT) fibrosis.

Study design: A retrospective analysis of BAL from 91 patients. The total and percentage of cells were collected and analyzed according to published guidelines.

Results: The main diagnoses were connective tissue diseases (n = 24), hypersensitivity pneumonitis (HP) (n = 15), sarcoidosis (n = 12), idiopathic pulmonary fibrosis (IPF) (n = 14), smoking-related interstitial lung diseases (sr-ILDs) (n = 8), aspiration (n = 8), and others (n = 10). The lymphocyte percentages differed among diagnoses (F = 2.85, p = 0.008). A greater number of lymphocytes were found in sarcoidosis (Md = 20%, IQR = 12-45%), HP (Md = 29%, IQR = 13-55%), and organizing pneumonia (Md = 28, IQR = 9-50%). No patient with IPF presented with > 25% lymphocytes in BAL. In 6/15 (40%) of the HP cases, the percentage of lymphocytes was < 25%. A total of 56 participants (62%) displayed HRCT findings that were indicative of fibrosis. In those cases the percentage of lymphocytes was 10.1 (IQR = 6.1-18.0) as compared with 20.2% (IQR = 9.7-37.5) of those 35 cases without fibrosis (p = 0.007). In patients with fibrosis in HRCT, the percentage of neutrophils was 11.3 (IQR = 4.1-21.4) as compared with 3.8 (IQR = 1.4-3.8) in those without fibrosis (p = 0.009).

Conclusion: Several patterns in differential cytology are observed in common ILDs. The presence of fibrosis has an impact on these findings.

Background: Amyloid goiter is a rare cause of thyroid enlargement which can be confused clinically as well as cytologically with both colloid goiter and neoplastic process of thyroid.

Case: A 30-year-old man, diagnosed with chronic kidney disease 5 months previously and currently on dialysis and awaiting renal transplant, was referred by clinicians for fine needle aspiration cytology (FNAC) for thyroid swelling. FNAC showed dense amorphous clumps of extracellular material which appeared magenta colored on Giemsa and eosinophilic on Papanicolaou stain. Congo red staining and polarization showed characteristic apple green birefringence, thus confirming the material as amyloid, and the diagnosis of amyloid goiter was made.

Conclusion: Amyloid on FNAC smears can be easily mistaken for colloid, and correct interpretation can avoid a false diagnosis of colloid goiter. A search should be made to look for any features suggestive of medullary carcinoma of the thyroid as amyloid is more often associated with it.

Objective: To explore spatial and volume relations of the calcitonine gene-related peptide (CGRP)-positive and tyrosine hydroxylase (TH)-positive nerve fibers in the wall of cortical blood vessels.

Study design: Kidney specimens from 10 rats were processed for confocal microscopy. Nerve fibers were stained with anti-CGRP and anti-TH antibodies and image stacks were collected. Three-dimensional reconstruction and quantification of labeled fibers were performed to reveal their distribution and spatial relations.

Results: CGRP- and TH-immunoreactive nerve fibers were distributed throughout the kidney cortex. TH-positive fibers were dominant in the small periglomerular arteries (up to 4.6-fold). Examined nerves were finely intertwined in the wall of small blood vessels of the kidney and ran in the same nerve bundle but without co-localization. Extensive, web-like branching and varicosities of the TH nerves were observed. Sensory fibers prevailed in the wall of the larger arteries "embedded" into tubules near the medullary rays, and their endings can be verified in the muscularis layer of the interlobular arteries.

Conclusion: Characteristics of the investigated fibers emphasize their role in the regulation of kidney blood vessel diameter and their influence on hypertension onset.

Background: Anaplastic spermatocytic seminoma is a rare variant of the conventional spermatocytic seminoma, with only 6 cases reported up to now. The anaplastic variant contains only the medium-sized cell type, hallmarked by large-sized nucleoli, whereas the small lymphocyte-like and giant cells typical of the conventional spermatocytic seminoma are lacking.

Case: We report herein an unusual case of a 40-year-old man with an anaplastic spermatocytic seminoma which metastasized first to the retroperitoneal lymph nodes and, something never before reported, subsequently to the lung and other organs. The immunophenotype with c-kit and SALL4 positive and PLAP, as well OCT 3/4 negative tumor cells were identical to those of conventional spermatocytic seminoma. Cytogenetically the tumor cells showed a gain of chromosome 9, typical for spermatocytic seminoma, but simultaneously also the short arm 12p were overexpressed--an overexpression crucial to the aggressive behavior of seminomas and other nonseminomatous tumors but never before encountered in spermatocytic seminoma.

Conclusion: The current opinion is that seminoma and nonseminomatous germ cell tumors develop from a common primitive progenitor cell, whereas spermatocytic seminomas develop from differentiated spermatogonia. The herein presented cytogenetic hybrid tumor shows that a crossover between the two different histogenetic "tracks" is possible.

Objective: To detect RET (REarranged during Transfection) protein by immunohistochemistry (IHC) in gastric cancer.

Study design: A total of 210 samples were employed, of which 197 specimens were from 91 surgical pieces of gastric adenocarcinoma, comprising 91 tumoral, 91 nontumoral, and 15 intramucosal dysplastic samples. Another 13 gastric mucosae were from cancer-free patients. Two RET antibodies (clones Ret01 and 3F8) were used separately for IHC.

Results: Of the nontumoral samples from gastric cancers, 28 were positive (31%) with either antibody Ret01 or 3F8. The positive stains were often located in deep pyloric glands and associated with chronic inflammation patterns (p = 0.045). RET positivity correlated with phosphorylated epidermal growth factor receptor, which had been previously tested (p = 0.021). In tumoral samples RET was positive in 7 cases with antibody Ret01 (8%) and 9 cases with 3F8 (10%). In 15 intramucosal dysplastic samples RET was detected in 6 cases with antibody Ret01 and 8 cases with 3F8. There was an accordance between the IHC using antibodies Ret01 and 3F8 in tumoral, nontumoral, and intramucosal dysplastic samples (p = 0.500, 1.000, and 0.500). The 13 samples from cancer-free patients were always negative.

Conclusion: Activation of RET proto-oncogene may be one of the molecular pathogeneses in gastric inflammatory and tumoral diseases.

Objective: To present a computerized system for recognition of Fuhrman grade of cells in clear-cell renal cell carcinoma on the basis of microscopic images of the neoplasm cells in application of hematoxylin and eosin staining.

Study design: The applied methods use combined gradient and mathematical morphology to obtain nuclei and classifiers in the form of support vector machine to estimate their Fuhrman grade. The starting point is a microscopic kidney image, which is subject to the advanced methods of preprocessing, leading finally to estimation of Fuhrman grade of cells and the whole analyzed image.

Results: The results of the numerical experiments have shown that the proposed nuclei descriptors based on different principles of generation are well connected with the Fuhrman grade. These descriptors have been used as the diagnostic features forming the inputs to the classifier, which performs the final recognition of the cells. The average discrepancy rate between the score of our system and the human expert results, estimated on the basis of over 3,000 nuclei, is below 10%.

Conclusion: The obtained results have shown that the system is able to recognize 4 Fuhrman grades of the cells with high statistical accuracy and agreement with different expert scores. This result gives a good perspective to apply the system for supporting and accelerating the research of kidney cancer.

Prostate pathology is a daily occurrence in urological and general medical consultations. Besides hyperplasia and neoplastic pathology, other processes, such as infectious ones, are also documented. Their etiology is diverse and varied. Within the infectious prostatic processes, fungi can also be a specific cause of prostatitis. Fungal prostatitis often appears in patients with impaired immunity and can also be rarely found in healthy patients. It can result from a disseminated infection, but it can also be localized. Fungal prostatitis is a nonspecific and harmless process. Diagnosis is commonly made by fine needle aspiration cytology or by biopsy. A number of fungi can be involved. Although there are not many reported cases, they are becoming more frequent, in particular in patients with some degree of immunodeficiency or those who live in areas where specific fungi are endemic or in visitors of those areas. We present a comprehensive review of the various forms of fungal prostatitis, and we describe the morphological characteristics of the fungi more frequently reported as causes of fungal prostatitis. We also report our own experience, aiming to alert physicians, urologists and pathologists of these particular infections.

Objective: To describe, by computerized morphometry, the degree and the type of steatosis in liver transplants that developed primary nonfunction and to compare the results with the quantification by pathologist.

Study design: Twelve patients who developed primary nonfunction after liver transplantation were matched with 23 transplanted patients with a regular postoperative clinical course. Morphology of the liver biopsy included many stereological parameters; all cases were evaluated by an operator blinded to the diagnosis and to the clinical history. The assessment of steatosis by morphometry was compared with the pathologist's evaluation. Moreover, to assess the reproducibility of the morphometric model, another operator applied the morphometric model in a blinded fashion to a randomly selected sample of cases.

Results: The percentage of hepatocytes with microsteatosis and the ratio of macro/microsteatosis were higher in primary nonfunction. The pathologist's evaluation of steatosis showed a marked overestimation when compared to morphometry. Lastly, the comparison between the results of 2 blinded operators of morphometric analysis showed a high reproducibility with a low interobserver variability.

Conclusion: Our quantitative estimation of the degree and the quality of steatosis avoids interobserver interpretations. Moreover, our analysis shows that the quantification of steatosis in liver transplantation by the current assessment must be reviewed in order to reevaluate the real impact of steatosis.

Objective: To study the value of urinary survivin as a diagnostic marker for diagnosis of bladder cancer as compared to urine cytology.

Study design: This study was carried out on 40 patients presenting with bladder cancer and 20 patients presenting with benign urological disorders.

Results: For bladder cancer diagnosis, urine cytology has lower sensitivity, accuracy, and negative predictive values as compared to survivin, while it has higher specificity and positive predictive value than survivin. On the other hand, the sensitivity, specificity, and the accuracy of combined survivin and urine cytology were 100%, 95% and 97%, respectively. Positive urine cytology and survivin were significantly higher in cases showing advanced stage and high grade as compared to cases presented with superficial stage and low grade.

Conclusion: Urinary survivin appears to be a reliable, noninvasive diagnostic test to identify patients with bladder cancer. The sensitivity of survivin test was superior to that of urine cytology in the diagnosis of bladder cancer, especially in cases presenting with superficial stage or low grade. Combined evaluation of both survivin and urine cytology gave better sensitivity, specificity, and accuracy for bladder cancer diagnosis.