Basic and applied pathology最新文献

Background and aim: Recently, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has been introduced in the diagnosis of pancreatic lesions, adjacent lymph nodes, and organs. To investigate the usefulness of liquid-based cytology (LBC) in EUS-FNA, we compare the efficacy of the conventional smear (CS) and LBC in EUS-FNA specimens. Methods: Forty-three paired LBC and CS slides were obtained using a split sample protocol. The specimen adequacy and diagnostic values were compared. Results: The adequate cases for diagnosis were 36 (83.7%) in CS and 22 (51.2%) in LBC. Inadequate samples were mostly obtained from lymph nodes: 6 cases in CS and 17 in LBC. The sensitivity, specificity, and accuracy of CS and LBC were as follows: 90.5%, 95.5%, and 93.0% in CS, respectively, and 57.1%, 100%, and 79.1% in LBC. The false-negative and false-positive rates were 4.7% and 2.3% in CS, respectively, and 20.9% and 0% in LBC. The overall agreement of CS and LBC for the diagnosis of malignancy was high (κ= 0.616). Conclusions: CS is a more effective and adequate preparation method for use in EUS-FNA-based diagnosis. Considering the split sample protocol of this study, LBC is a comparable diagnostic tool to CS in the evaluation of EUS-FNA specimens.

Background and aims: The origin, niche, and function of human hepatic stem/progenitor cells (HHSPCs) have been longstanding areas of debate. We designed this study to elucidate the distribution of potential HHSPCs during the various stages of regeneration by the expression of known HHSPC markers. Methods: Immunostainings for c-kit, cytokeratin (CK)19, and CD133 were performed in cases of massive hepatic necrosis (MHN) in various regenerating stages. Results: We identified c-kit-positive cells as single cells primarily in the stroma of portal tracts but rarely in the sinusoids. There were no differences in the numbers or distribution of c-kit positive cells according to MHN regeneration stage. The number of CK19-positive cells mostly in a ductular arrangement significantly increased along the interface, and single cells or small clusters of CK19-positive cells were occasionally observed in the sinusoid in cases of MHN. CD133-positive cells were located in ductular structures along the interface in cases of MHN, while no CD133-positive cells were observed in the normal liver. Conclusion: The c-kit- or CD133-positive cells appear first at the limiting plate and are then organized into ductular structures or moved to the sinusoid as single cells or clusters during hepatic regeneration.

Pneumothorax is a common and serious complications related to acupuncture needling. Although there have been several clinical cases of pneumothorax induced by acupuncture, autopsy reports on cases of sudden death with the typical gross pathological findings are rare. In the two cases presented here, the deceased suffered dyspnea and chest discomfort after the completion of acupuncture treatments and were found dead within a few hours. Acupuncture pathways from the skin to the lungs, resulting in total bilateral lung collapse were found upon autopsy in these cases. When a sudden death occurs in association with acupuncture the possibility of pneumothorax should be considered and there should be meticulous efforts to find evidence during forensic autopsy.

Background and aims: Colorectal carcinoma is among the most frequently observed malignancies in Pakistan. The HER 2/neu protein is intimately involved in tumorigenesis and its receptor has been demonstrated as a therapeutic target in several carcinomas. This study was designed to assess the clinico-pathological pattern and the HER 2/neu immunohistochemical score with respect to the histological grades of colorectal carcinoma in our population. Methods: Tissue biopsies from 100 patients, with detailed documentation of their clinical account, were subjected to immunohistochemistry utilizing monoclonal anti-HER 2/neu antibody. Positive expression was assigned a score from 0–3+. Results: A distinct positive HER 2/neu scoring pattern was observed in n= 42 cases of non-mucinous, mucinous and signet ring cell adenocarcinomas, all with a specific histological grade. An inverse correlation (P= 0.001) was observed between the two parameters. Conclusion: Colorectal carcinoma is a growing malignancy, even in the younger population and HER 2/neu protein is credibly expressed in colonic cancer cells in our patients especially where the histological grade is low or moderate. Therefore, it may be applied as a reasonably reliable immunohistochemical marker and a target for a new adjuvant monoclonal antibody-based immunotherapy.

We report here the case a 30-year-old parous, phenotypically normal, reproductive woman. She presented with mature teratoma of the ovary, which contained well formed, grossly visible prostatic gland with a central urothelium-lined duct resembling a urethra. Mature teratomas are characterized by the presence of tissues derived from the embryonic layers of ectoderm, mesoderm, or endodermal lineage. However, prostatic tissue is a very unusual component of teratomas. The rare existence of prostatic tissue in a mature teratoma can be explored through three feasible pathogenetic theories. These origins include teratomatous monodermal differentiation, developmental abnormality, or metaplasia. The coexistence of rare prostatic tissue with a rare central urethral duct in a mature teratoma makes this case a particularly intriguing one. To our knowledge, this is only the second case of ovarian mature teratoma containing a urethral duct in prostatic tissue in the literature.

Early gastric cancer is defined as gastric cancer confined to the mucosa or submucosa. For the majority of early gastric cancers without nodal involvement, endoscopic mucosal removal (EMR) is safer and more cost-effective than are other treatment methods. Here we report a rare case of differentiated mucosal carcinoma with extensive lymphovascular invasion and lymph node metastasis. Endoscopy showed a 5.5 cm non-ulcerated slightly elevated and depressed lesion without indication of submucosal involvement. Although the tumor met the extended criteria for EMR, D2 gastrectomy was performed. The resected specimen showed a 5.5 cm intramucosal carcinoma with extensive lymphovascular invasion of the submucosa, and metastasis to two perigastric nodes, indicating that metastasis can occur in patients with non-ulcerated differentiated mucosal tumors. Although these tumors are extremely rare, the risks and limitations of EMR should be fully considered in choosing an optimal surgical procedure.

Background and aim: Cyclooxygenase-2 (COX-2) plays an important role in colorectal cancer development and is frequently up-regulated in colorectal cancer. The purpose of this study was to investigate COX-2 overexpression in colorectal adenocarcinoma and to evaluate the correlation with the clinicopathological parameters and p53 expression, as well as its effect on patient survival. Methods: We evaluated the expression of COX-2 and p53 on the tissue microarray of 414 colorectal adenocarcinomas by immunohistochemistry. Data was analyzed by Fisher's exact test, χ²-test, one-way ANOVA, Cox regression hazards model and log-rank test with Kaplan–Meier curves. Results: The cytoplasmic COX-2 overexpression was detected in 56.3% of colorectal adenocarcinoma samples. COX-2 overexpression was correlated with favorable clinicopathologic factors in lymph node metastasis (P= 0.002), American Joint Committee on Cancer and Dukes’ stage (P= 0.008 and P= 0.017, respectively), and lymphatic invasion (P= 0.001). Other characteristics associated with COX-2 overexpression were colonic site of tumor (P= 0.008) and poor differentiation (P= 0.017). There was no correlation between COX-2 overexpression and p53 expression (P= 0.485). In univariate survival analysis, patients with COX-2 overexpression revealed better overall survival and disease-free survival (P= 0.021 and P= 0.017, respectively, log-rank test). In multivariate survival analysis with the Cox proportional hazards model, COX-2 overexpression was an independent prognostic factor of overall survival and disease-free survival (P= 0.029 and P= 0.039, respectively). Conclusions: COX-2 overexpression was significantly associated with favorable clinicopathologic phenotype and an indicator of better survival in our cohort of colorectal cancer patients.

Acantholytic variant of squamous cell carcinoma (AVSCC) of the breast typically has pseudoglandular or pseudoangiosarcomatous histopathologic features due to marked dyscohesiveness of tumor cells which have dense squamoid cytoplasm. Tumor cells show immunoexpression for cytokeratin AE1/AE3, high molecular weight cytokeratin and p63, thus pertaining squamous characteristics. We present a typical case of AVSCC of the breast with preoperative metastasis to a sentinel lymph node and one-time recurrence. The tumor was predominantly composed of acantholytic component with minor contribution of patternless spindle cell component. Multifocal intraductal carcinomas were found within the tumor. Although some reports had mentioned about other breast cancers focally showing these characteristic features in usual invasive ductal carcinomas or metaplastic carcinomas, only nine cases have been collected as this recently defined entity since 1986. It is suggested that this tumor would be more aggressive than usual invasive ductal carcinomas based on the original report of three cases. However, additional cases of AVSCC often did not show dismal prognostic outcome. We present a typical case of AVSCC of the breast without critical progression of the disease for 38 months.