Applied pathology最新文献

To evaluate the possible transmural differences in the structure of left ventricular myocardium in patients with ischaemic heart disease, 45 human hearts were examined with morphometric methods. There were 10 control hearts, 10 hearts with coronary atherosclerosis but without myocardial infarction, 11 hearts with acute subendocardial infarction and 14 hearts with acute transmural infarction. The following histoquantitative parameters were separately estimated for both subendocardium and subepicardium in each heart: the volume fraction of diffuse connective tissue, the mean fiber diameter and the numerical density of arterioles. Diffuse myocardial fibrosis was more severe in subendocardium in all groups, the highest values were found in hearts with acute subendocardial infarction. In all groups the numerical density of arterioles was higher in subendocardium. The numerical density of arterioles was increased in respect to the controls in both subendocardium and subepicardium in hearts with coronary atherosclerosis without evidence of myocardial infarction and in hearts with acute subendocardial infarction. The possible pathophysiological implications for ischaemic heart disease are discussed on the basis of these results. The results suggest different pathophysiological mechanisms in subendocardial and transmural myocardial infarction. They also suggest that transmural differences should be considered when the findings of endomyocardial biopsies are evaluated.

Sixty-three bronchial tumours are described. Using the criteria of necrosis, a mitotic count of 5 or greater per 10 high-power fields, well marked nuclear pleomorphism, lymphatic and vascular invasion, either singly or in combination, 38% of cases were considered atypical or well-differentiated neuroendocrine carcinoma. If an undifferentiated growth pattern was added as a further criterion, 49% of bronchial carcinoids were atypical. Oncocytic change was common (59% of cases) but only one pure oncocytic carcinoid was present in the series. Bone was seen in 25% of cases. In some cases it arose from the bronchial cartilage but in others it was seen in the centre of the tumour. The range of histological patterns seen in carcinoids is described. Rare types of bronchial carcinoids showed a papillary pattern as well as spindle cell foci. Two cell types were noted--large cells with eosinophilic cytoplasm and cells with small hyperchromatic nuclei and little cytoplasm. These cells are apoptotic as shown ultrastructurally. The differential diagnosis of these tumours is discussed. In 35 cases a clinico-pathological correlation was possible. Bronchial carcinoids are biologically unpredictable tumours. The present study indicates that nearly half the cases could be classified as atypical or well-differentiated neuroendocrine carcinoma. However, there still remained some cases where the histology was typical but subsequent lymph node metastases developed.

Fine needle aspiration cytology (FNAC) of the breast is a minimally invasive and low-cost method. In this study we reviewed our experience on a total of 1,080 cases. Sensitivity, specificity and predictive value were calculated. The causes of error were examined and we concluded that accuracy improves when aspirations are done by the cytopathologist himself and fixing and staining procedures are immediately performed in a specialized laboratory.

A peculiar case of renal oncocytoma was studied by clinical, light- and electron-microscopic examinations. The neoplasm, which was first discovered 21 years ago, at operation turned out to be very large, well-circumscribed and lacking any feature of aggressiveness. Histologically, it was composed totally of oncocytes without relevant atypia or necrosis. Ultrastructurally, a cytoplasmic filling by mitochondria with paucity of other organelles and filaments also supported the diagnosis. The authors also reviewed the literature and emphasized the diagnostic criteria of this type of tumor.

A series of 12 cases of neuroendocrine (Merkel cell) tumor of the skin, observed in the last 4 years, is reported. The mean age of the patients, 10 females and 2 males, was 62.4 years. The head, buttocks and extremities were the primary locations. The recurrence rate was 33.3% and 2 patients died of their disease. The histology is characterized by small round cells growing in solid sheets, nests or trabeculae. Ultrastructural study showed cytoplasmic membrane-bound granules of neurosecretory type and collections of perinuclear intermediate filaments as constant findings. The presence of cytoskeletal proteins was studied with monoclonal antibodies against cytokeratin and neurofilaments, as well as neuron-specific enolase reactivity, by the immunoperoxidase technique in 7 cases. Cytokeratin was demonstrated in 5 tumors and neurofilaments in 3, whereas the neuron-specific enolase was positive in all tested cases. In 4 patients a fine-needle aspiration biopsy of the primary, skin recurrences or lymph node metastasis was performed, showing the reliability of this technique in the diagnosis and staging of the disease.

Two cases of 'adult' rhabdomyoma and 2 of 'fetal' rhabdomyoma have been immunologically studied using several antisera specific of skeletal muscle fibers proteins. This paper also deals with a review of the literature on these rare benign skeletal muscle proliferations. It is concluded that 'adult' rhabdomyoma contains fetal myosin and therefore the term 'adult' does not seem immunologically appropriate any longer. In addition the tumoral cells show the same level of differentiation as seen in neonatal skeletal muscle. Therefore it seems that the definition of neonatal rhabdomyoma is more appropriate for these benign muscular proliferations. The 2 cases of fetal rhabdomyoma appear phenotypically similar to normally developing myoblasts and contain fetal myosin. Therefore it seems that the definition 'fetal' is here appropriate for what appears to be a disorganized proliferation of otherwise normal fetal skeletal muscle fibers. The differential diagnosis between these latter tumors and rhabdomyosarcomas has been discussed.

Epidemiologic studies indicate a close association between hepatocellular carcinoma (HCC) and chronic hepatitis B virus (HBV) infection. HCC, a most frequent malignancy, is far more common in the Far East and Africa than in the West and may be the first to be greatly eliminated because of prevention of HBV infection by vaccination. The conceptual integration of epidemiologic observations, morphologic studies of the human precursor stages and investigations of animal infections by hepadna viruses with biologic and genomic similarity to HBV as well as with clinical and molecular biologic studies contribute to the understanding of the hepatocarcinogensis. In the woodchuck model after laboratory infection, HCC develops regularly without external cocarcinogen in permanent surface antigen carriers. The hypothesis is presented that an episodic necroinflammation in the carrier stage may act as an endogenous cocarcinogen or promoter in that previous integration of hepadna viral DNA in the host chromosone may become disorganized, which induces the clonal development of HCC. This hypothesis may become important in the management of the carrier stage.

We have recently presented a method of assessing the amount of submucous gland, expressed as volume per unit luminal surface area in the tracheobronchial tree. We have now applied this technique in the trachea, left main bronchus, left upper lobe bronchus, lingular bronchus and three generations of the inferior lingular bronchus in 14 non-smokers and 14 smokers. The results show that there was statistically significantly more gland in the smoking group than in the non-smoking group at all but the two most distal generations, so the technique could be used to assess the effects of inhaled pollutants in groups. Overlap between the cases in the two groups meant, however, that individual profiles could not be used diagnostically. Questions about why the profile has the shape it does and why it responds to cigarette smoke as it does are considered but cannot be answered with the data at present available.

After a review of the incidence data on malignant soft-tissue tumors in Italy (Registro dei Tumori della Regione Lombardia, provincia di Varese), Europe (nine European Cancer Registries considered representative of various geographical areas) and extra-European countries (data of ten World Cancer Registries), the aim and the organization of the Italian Malignant Soft-Tissue Tumor Registry are described. The collection system is based on dedicated forms prepared for the computerization of all data. From 1.1.1985 to 31.3.1987, 207 cases of malignant and potentially malignant soft-tissue tumors entered the Registry, with exclusion of those sarcomas arising in viscera. The distribution, categorized by histologic type, sex and site, and the preliminary results on relapses and metastases are reported.

Two cases of multilobated B cell lymphoma primarily involving the renal parenchyma are reported. The rarity of the finding and the utility of immunohistochemical analysis are pointed out.