Applied pathology最新文献

Transplant glomerulopathy is the most common glomerular lesion noted in long-standing renal allografts and isografts. Morphologic examination of 328 specimens taken from 177 patients because of decreasing function revealed transplant glomerulopathy in 55, rejection glomerulonephritis in 39, de novo glomerulonephritis in 20, and recurrent glomerulonephritis in 9 patients. The most important microscopic finding is a finely lamellar thickening of the glomerular basement membrane. Endothelial swelling and mesangial proliferation are minor. Immunofluorescence is weekly positive and electron-dense deposits are missing. There is, however, subendothelial electron-lucent thickening of the lamina rara interna comparable to the lesions seen in thrombotic microangiopathy. Transplant glomerulopathy can be superimposed on other glomerular transplant lesions and is typically associated with chronic rejection; in fact it can been considered to be the glomerular equivalent of chronic vascular rejection.

Three new cases of benign lipomatous lesions of the uterus are described, with particular attention to the possible relation between symptomatology and the presence of mast cells in the neoformation. The literature is reviewed, a brief history is presented of important stages in the study of these forms, and a new histogenetic theory proposed based on a different concept from those accepted to date.

22 renal biopsies of 22 patients with 6-month-old transplants have been examined at the light- and electron-microscopic level to demonstrate the toxic effects induced by ciclosporin A (CS). These patients presented stable renal function and were exempt from acute rejection symptoms or nephrotoxicity. Interstitial fibrosis, tubular atrophy and interstitial lymphocytic infiltration were the lesions most often observed by light microscopy. In a single case an arteriolar lesion suggestive of arteriolopathy due to Cs was seen. Ultrastructural observations of renal tubular cells showed a tendency of rough and smooth endoplasmic reticulum to microdilate and microvacuolize. In 4 out of 22 cases there were mitochondrial alterations with giant mitochondria. In only 1 case, clusters of cilia were seen. Clinical histological correlations show that interstitial fibrosis is directly proportional to CS blood level. CS higher blood levels suggest a higher risk of nephrotoxicity.

Allograft glomerulonephritis (GN) is a noteworthy alternative in the differential diagnosis of renal graft dysfunction. The true frequency of allograft GN is unknown; a rough estimate is 5-15%. The highest rates of recurrence (100-20%) have been reported, in decreasing order of frequency, in mesangiocapillary GN (MCGN) type 2, IgA nephropathy, MCGN type 1, and focal segmental glomerulosclerosis (FSGS). In addition, in about 2% of allografts membranous GN (MGN) occurs as a de novo lesion. Electron microscopy has proved valuable in detecting early or mild MGN, MCGN type 2 and FSGS, and in differentiating between MCGN type 1 and allograft (rejection) glomerulopathy. Even with the aid of electron microscopy, however, the demarcation between MCGN type 1 and allograft glomerulopathy may prove impossible. The finding of prominent mesangial deposits (in an otherwise normal allograft), is highly suggestive of recurrent IgA nephropathy.

Papillomavirus common internal capsid antigen (PV-Ag) was demonstrated using an immunoperoxidase technique in 74 out of 239 (31.0%) cases of cervical condylomata diagnosed histologically. All the positive cases but 2 (72/74) had nuclear changes compatible with dysplasia or cervical intraepithelial neoplasia (CIN). Immunocytochemically determined PV-Ag positivity was found in 54 out of 92 CIN I (58.7%), in 14 out of 32 CIN II (43.8%) and in 4 out of 18 CIN III (22.2%). The extent of koilocytosis in the epithelium had a direct correlation with the PV-Ag positivity: when koilocytosis extended to more than two thirds of the epithelium thickness, 24/41 cases (63.4%) were positive; when between one third and two thirds, 32/105 cases (30.5%) were positive; when present in less than one third 16/93 cases (17.2%) were positive. The positivity was 41.8% under 30 years of age and 20.5% over 30. Out of 16 positive cases followed with multiple biopsies for 6-20 months, 9 remained positive without change in CIN degree and 7 became negative, with CIN regression in 4 cases and progression to CIN III with disappearance of koilocytosis in 3 cases. More specific methods than histocytopathology alone are needed for epidemiologic and follow-up studies, especially in the cases in which the disappearance of antigenic and morphological expression of PV infection is not followed by dysplasia regression.

Nineteen New Zealand white rabbits received one (n = 5), two (n = 5), or three (n = 9) injections of 60 mg methylprednisolone and were sacrificed 10, 20, 30, and 60 days following the last treatment. They were compared to 15 controls for histological examination of femoral and humeral epiphyses and femoral condyles. Treated animals had a significant rise in serum triglycerides (p less than 0.01) 10 days following treatment. 15 treated animals and 6 controls had grade I lesions of bone marrow (p less than 0.05). Lesions of grades II and III were only observed in 5 treated animals. The severity of histological lesions were not correlated with steroid doses. Tetracycline fixation was suppressed in treated rabbits.

Computer processing of microscopic imagery of cervical lesions can provide novel quantitative diagnostic information. Interpretation of this information, from the level of the image itself to that of diagnostic truth, calls for the use of appropriate data structures. The resolution of the problems of diagnostic consensus and truth may be furthered by the use of these techniques in conjunction with diagnostic expert systems. The impact of our expanded ability to differentiate and to extract diagnostic and prognostic information will lead to changes in the way we practice clinical pathology. Technologic advances have now made it possible to perform quantitative measurements in a very rapid fashion as a practical part of routine clinical pathology activity.

The changes of trabecular bone in primary hyperparathyroidism were studied in 391 iliac crest bone biopsies. In 60 unselected cases a histomorphometric analysis was performed. The classical osteoitis fibrosa is very rare in our material (4%). Only 49% of the cases developed specific endosteal fibrosis, 46% had increased remodelling surfaces and in 1% it was not possible to detect any difference in comparison to age-related controls. For diagnostic purposes the investigation is not helpful in nearly 50%.