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PubMed1990

Encapsulated hepatocellular carcinoma: radiologic findings and pathologic correlation.

The encapsulated form of hepatocellular carcinoma (HCC) is a pathologic subtype that has been found to occur with variable frequency in typical HCC in Japanese radiological, surgical, and autopsy series. It is well-differentiated tumor that tends to grow slowly and noninvasively, and has a better prognosis than other gross forms of HCC. Among the 73 cases of typical HCC in patients of non-Asian extraction in our files, 11 could be positively identified as encapsulated based on strict pathological criteria. The purpose of this study was to review the radiographic appearance of these encapsulated tumors. Radiographically, the tumors demonstrated a hyperdense rim in 5 of 9 cases with postinfusion computed tomography scans, an anechoic halo in 4 of 6 cases with ultrasonograms, and an avascular rim on the capillary phase in 5 of the 8 cases with angiograms. Encapsulated HCC can be found in non-Asian patients, and the radiographic and pathologic findings are similar to the descriptions in the Japanese series.

Adult↗

PubMed2005

Non-uniformity in the regional pattern of Lewy pathology in brains of dementia with Lewy bodies.

We examined the regional pattern of Lewy pathology in brains of dementia with Lewy bodies (DLB) to clarify whether Lewy pathology uniformly progresses or not. Thirty-five autopsied DLB cases were examined using alpha-synuclein-immunohistochemistry, and the regional degree of Lewy pathology in the brainstem, diencephalon and cerebral cortex was quantitatively evaluated. Consequently, we found that the regional pattern of Lewy pathology differed according to the pathological subtype, and was divided into three types: type 1 showed a brainstem-predominant pattern, type 2 was almost equal for the brainstem and cerebral cortex, and type 3 showed a cerebral cortex-predominant pattern. The limbic type/pure and common forms were mainly composed of type 1, whereas the neocortical type/common and Alzheimer's disease (AD) forms were mainly composed of type 3. These findings suggest the possibility that Lewy pathology of the limbic type/pure and common forms mainly progresses from the brainstem to the cerebrum, whereas that of the neocortical type/common and AD forms mainly progresses from the cerebrum to the brainstem. Cases with type 1 Lewy pathology mainly developed parkinsonism, whereas those with type 3 Lewy pathology mainly developed dementia. This corresponded to most of the limbic type/ pure and common forms which developed parkinsonism, whereas most of the neocortical type/common and AD forms developed dementia. Type 1 cases may thus be clinically diagnosed as having Parkinson's disease (PD) with dementia. These findings suggest that PD has clinico-pathological continuity with DLB, and that the regional pattern of Lewy pathology is not uniform.

Aged↗

PubMed2003

Ventricular free wall rupture following acute myocardial infarction.

SUMMARY: Ventricular free wall rupture remains a dreaded complication of acute myocardial infarction. A dramatic fatal presentation is not universal and if recognized early, especially in its sub-acute form, a therapeutic intervention may be lifesaving. Changing trends in its natural history and the previously described pathological subtypes have emerged since the advent of thrombolysis. Although frequently unpredictable, certain clinical, echocardiographic and electrocardiographic signs should suggest the diagnosis. Moreover, knowledge of predisposing risk factors and a high index of suspicion are helpful in early recognition of this complication. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. In this review, we sought to highlight established and debatable aspects of this pathology to hopefully enhance prompt diagnosis and treatment by all clinicians caring for patients suffering acute myocardial infarction.

Aneurysm, False↗

PubMed2004

Focal cortical dysplasias: surgical outcome in 67 patients in relation to histological subtypes and dual pathology.

The purpose of this study was to assess whether the histological subtype of focal cortical dysplasia and dual pathology affect surgical outcome in patients with medically intractable epilepsy due to focal cortical dysplasia (FCD). We retrospectively analysed the outcome of 67 patients from 2 to 66 years of age at follow-up periods of 6 to 48 months after epilepsy surgery. Histological subtypes were classified according to Palmini and included a few cases with mild histological abnormalities corresponding to the definition of mild malformations of cortical development. The seizure outcome was classified according to Engel and evaluated at the last follow-up visit as well as at follow-up periods of 12 and 24 months after surgery. The outcome in patients with FCD and additional hippocampal pathology (dual pathology) was analysed separately. Distribution of histological subtypes differed in temporal and extratemporal localization, with a significantly higher extratemporal prevalence of FCD type 2. There was a tendency towards better postsurgical outcome related to the last follow-up visit in patients with more subtle abnormalities classified as mild malformations of cortical development (mMCD) (63% Engel Ia), FCD type 1a (67% Engel Ia) and FCD type 1b (55% Engel Ia) compared with patients with FCD type 2a (43% Engel Ia) and FCD type 2b (Taylor type) (50% Engel Ia). Considering the outcome at follow-up periods over 12 and 24 months, complete seizure-freedom was achieved significantly more often in patients with FCD type 1 and mMCD than with FCD type 2, and seizure reduction by less than 75% (Engel IV) occurred in more patients with FCD type 2a compared with the other subgroups. This tendency was seen in the whole patient group and in the extratemporal subgroup. Patients with dual pathology almost always had temporal lobe epilepsy; the outcome in this patient group was generally favourable (66% complete seizure-freedom at the last follow-up visit). The outcome remained almost constant with longer periods of follow-up. We conclude that patients with FCD type 1 and mMCD had a better outcome compared with those with more severe forms of cortical dysplasia. A higher incidence of FCD type 1 in temporal localization did not allow the effects of histological subtype and localization to be separated. A subanalysis of extratemporal FCDs, however, revealed a similar tendency for a better outcome with FCD type 1, suggesting that the histological subtype itself seems to be at least a relevant cofactor influencing postsurgical outcome.

Adolescent↗

PubMed2005

Central nervous system tumours in children: epidemiology and risk factors.

In children, a variety of distinct tumour types arise in the central nervous system (CNS) but they are frequently considered by epidemiologists as a single entity. CNS tumours are the second most common childhood malignancy and occur more frequently in developed countries than developing nations. Approximately 50% of paediatric CNS tumours are gliomas, with astrocytomas of the piloctyic type predominating. Distributions of subtypes by age show that primitive neuroectodermal tumours (PNET) and ependymomas mainly occur in children less than 10 years. There is an ongoing debate with regard to the apparent increases in incidence over recent decades, which, it has been suggested, are accounted for by improved diagnostic technologies implemented in the mid 1980s. CNS tumours differ between children and adults with respect to the proportion of all cancers (20% in children, less than 2% in adults), their cellular origins, classification scheme, the proportions of pathological subtypes, and anatomic site. The causes of childhood CNS tumours are largely unknown; and although an estimated 5% or more may be explained by genetic predisposition, investigations of environmental aetiology have not been fruitful. Whilst high dose ionising radiation is an established risk factor for this group of tumours, reported associations with dietary N-nitroso compounds have not been consistent. Exposure to ELF EMF, at any level, has not been associated with childhood CNS tumours, but the current evidence base is inadequate for complete evaluation. The rarity of childhood CNS tumours necessitates careful attention being paid to the design of future aetiological studies.

Bias↗

PubMed1999

Diffusion tensor imaging of lesions and normal-appearing white matter in multiple sclerosis.

OBJECTIVE: To determine whether diffusion tensor imaging (DTI) can detect structural changes in normal-appearing white matter, and to distinguish between plaques of different pathologic severity, in patients with MS. BACKGROUND: Conventional MRI detects lesions sensitively in MS but has limited pathologic specificity. The diffusion of water molecules in brain tissue, most fully expressed mathematically by a tensor quantity, reflects its intrinsic microstructure. It is now possible to estimate the diffusion tensor noninvasively in the human brain using MR DTI. This method is unique in providing precise and rotationally invariant measurements of the amount and directional bias (anisotropy) of diffusion in white matter tracts relating to tissue integrity and orientation. METHODS: DTI was performed in six patients with MS and in six age-matched control subjects. Diffusion was characterized in normal-appearing white matter in both groups, and in lesions of different pathologic subtypes (inflammatory, noninflammatory, T1 hypointense, and T1 isointense). RESULTS: DTI identified significantly altered water diffusion properties in the normal-appearing white matter of patients compared with control subjects (p < 0.001), and distinguished between lesion types. The highest diffusion was seen in destructive (T1 hypointense) lesions, whereas the greatest change in anisotropy was found in inflammatory (gadolinium-enhancing) lesions. CONCLUSIONS: DTI detects diffuse abnormalities in the normal-appearing white matter of MS patients, and the findings in lesions appear to relate to pathologic severity. Its use in serial studies and in larger clinical cohorts may increase our understanding of pathogenetic mechanisms of reversible and persistent disability.

Adult↗

PubMed1988

[Prognosis of primary pulmonary hypertension and its determinants].

Most patients with primary pulmonary hypertension (PPH) die within two to four years of the onsets of their symptoms. However, several reports have described patients with PPH who have lived more than 10 years including a case with regression. We studied prognoses and the various determinants in 21 patients (7 men and 14 women; 18 deceased and three living) with PPH to elucidate its pathophysiology. Age at the onset of the disease varied from 12 to 73 years, with a mean of 29 years. All causes of death were of right heart failure, except for two cases of non-cardiac deaths. The prognoses were as follows: less than one year, two cases; 1-2 years, seven (one living); 2-3 years, five; 3-4 years, two; 4-5 years, one; more than six years, four (two living), with a mean of three years and five months. Pulmonary artery pressure decreased 10 years later (mean pressure, from 54 to 41 mmHg) in one patient, who lived for 13 years, followed by a non-cardiac death. Various clinical and pathological factors, including age at the onset of disease, sex, relationship to pregnancy, immunological abnormalities (4, positive; 17, negative), patent foramen ovale (five, patent; 16, not patent), PaO2, hemodynamic parameters, treatments, pathological subtypes (10, plexogenic pulmonary arteriopathy; two, pulmonary micro-thromboembolism; one, pulmonary veno-occlusive disease) numbers of plexiform lesion/cm2 were examined for prognostic correlations. None of the above factors were found to correlate significantly with prognoses. The only significant correlation was between the cardiac index (r = 0.981, p less than 0.001, n = 6), and total pulmonary resistance (r = -0.894, p less than 0.02, n = 6) in patients with pregnancy-related PPH. There was variability in the state of progression, namely, from rapid progression to regression. Clinically as well as pathologically, PPH may consist of several subgroups. However, whether it is due to differences in etiology or reactions of the disease is not clear. The pregnancy-related cases may comprise a homogenous subgroup within PPH.

Adolescent↗

PubMed2000

Autocrine motility factor receptor expression associates with tumor progression in thymoma.

We assessed the autocrine motility factor receptor (AMFR/gp78) expression in thymoma. AMFR/gp78 antigen was identified in tumor cells in 16 out of 51 (31.4%) thymomas. The AMFR/gp78 expression was closely associated with the stage (I/II vs. III/IV, p<0.0001), pathological subtypes (epithelial vs. other types, p=0.0214), and enhanced expression of alpha-smooth-muscle actin within stroma (p<0. 0001). The outcome of the patients with AMFR/gp78 expression was significantly worse than for those without it (p<0.01). All initial tumors with recurrence expressed AMFR/gp78. The AMFR/gp78 appears to be involved in tumor progression in thymoma.

Actins↗

PubMed2000

[Combination chemotherapy of uterine sarcomas].

OBJECTIVE: To study the results of combination chemotherapy of uterine sarcoma after operation and recurrent tumor. METHODS: One hundred seventy-four cases of three major pathological subtypes of uterine sarcomas were treated in the Cancer Hospital from 1960 to 1996. Clinical data were analyzed of 51 cases of uterine sarcomas treated with postoperative adjuvant chemotherapy and 38 cases with recurrent tumors received 98 courses of chemotherapy. They were divided into 4 groups according to the adjuvant chemotherapy regimen: single drug, VAC, VAD, and other regimens. Chemotherapy regimens for recurrent tumors were VAD, PA/PAC, and other combination regimens including etoposide, ifosfamide, cisplatin, adriamycin. RESULTS: The 5-year survival rate of stage I-II uterine sarcoma patients was 54.9% receiving adjuvant chemotherapy. It was 72.7% in VAD group which was significantly higher than that in other regimen groups. The survival rate was related to the number of chemotherapy course. The chemo-sensitivity of various pathological types of recurrent uterine sarcomas was not different. CONCLUSION: The 5-year survival rate does not improve in patients with stage I-II uterine sarcomas given postoperative chemotherapy. VAD is among the best regimens and at least 3 courses should be performed. The results of new treatment regimens such as EPA, IA, etc., must await further clinical observation.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Oral Kaposi's sarcoma: a 10-year retrospective histopathologic study.

Microscopic diagnosis of early Kaposi's sarcoma continues to be a challenge to the pathologist, as does the identification of bacillary angiomatosis (BA) which may have a similar appearance. 120 oral Kaposi's sarcoma (KS) biopsies submitted to the UCSF oral pathology service from 1981-1991 were reviewed in order to describe the clinical-pathologic spectrum of these lesions and to search for unrecognized cases of BA. Also, histopathologic features of oral KS were compared to 30 oral pyogenic granulomas, and immunohistochemical stains for endothelium-associated CD34 antigen were done. The diagnosis of KS was confirmed in all biopsies and no cases of BA were found. Histologically, the KS specimens exhibited numerous features that separated them from pyogenic granulomas, and could themselves be divided into two clinical-pathologic subtypes: small, well-delineated macular lesions (31), which were characterized by inconspicuous patches of spindle cells containing ill-defined vascular spaces; and larger, infiltrative nodular lesions (89), which were characterized by spindle cells lining vascular slits and bizarre-shaped vessels. Extravasated RBCs were evident in almost all KS lesions; hemosiderin deposits and hyaline globules were seen in half of each of the small and large lesions. Nuclear atypia was minimal and mitotic activity was slight. Lymphocytes in small lesions added to the difficulty of microscopic interpretation of these incipient lesions. CD34 was expressed on all spindle cells lining vascular spaces in larger lesions and on spindle cells of small, subtle lesions. We conclude that within the spectrum of lesions that are diagnosed as oral KS, two clinical-pathologic types can be identified: macular small spindle-cell lesions and nodular infiltrative vascular lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

[Clinico-morphologic reconsideration of anaplastic lymphoma. Retrospective study of 60 patients with aggressive clinical course and multiple recurrences].

PURPOSE: To identify anaplastic large cell lymphoma Ki-1+ (ALCL-Ki-1+) among a group of patients with aggressive Hodgkin's disease (HD) and to know the biological behaviour of the neoplasia (ALCL-Ki-1+). PATIENTS AND METHODS: Biopsies and clinical data of sixty patients with previous morphological diagnosis of HD lymphocytic depletion (LD), syncytial variant of nodular esclerosis (NE-II) and other subtypes of HD with aggressive clinical features were reviewed. A morphological, immunohistochemical (IHQ), proliferative and flow cytometric (FCM) studies were performed in lymph node biopsies. RESULTS: Morphological study and IHQ identify three groups: 15 patients (25%) lymphocytic predominance (LP) HD, 36 (60%) ALCL-Ki-1+ and 9 (15%) of non-Hodgkin's lymphoma (NHL) and unclassifiable cases. Nine cases of LP show anaplastic and variable immunophenotype being the rest of B-cell nature. 75% of LP patients showed long survival and frequent second neoplasias (47%). ALCL-Ki-1+ group had good initial response to therapy (84%) and multiple relapses, 67% showed CD15 positive marker (the so-called ALCL-HD related). CONCLUSIONS: A retrospective study of a selected group of patients previously diagnosed of aggressive HD showed different pathological subtypes: LP, LP with anaplastic areas, ALCL-Ki-1+ Hr (Hodgkin's related) and ALCL-Ki-1+ (classical type), all of them were CD30+, which could represent different stages of the same neoplasia.

Adolescent↗

PubMed2004

[The expression of matrix metalloproteinase-2 and -9 in cervical cancer and a study of their relationship].

OBJECTIVE: To detect the expressions of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in cervical cancer and their correlation with clinicopathologic features. METHODS: With the use of specific monoclonal antibody to human MMP-2 and MMP-9, the formalin-fixed and paraffin-embedded specimens of 62 invasive carcinomas of cervix uteri, 5 carcinomas in situ, 10 normal cervical epithelia and 10 lymph node metastases were detected by immunohistochemical method. RESULTS: MMP-2 and MMP-9 protein expressions in tumor and peritumoral stromal cells were enhanced in invasive carcinoma, compared to those in carcinoma in situ and controls (P < 0.05). There was a low correlation between MMP-2 and MMP-9 (r = 0.34, P < 0.01); the expression level of MMP-9 was higher than MMP-2. The protein expressions of MMP-2 and MMP-9 did not correlate with tumor stage, histological grade or pathological subtype. MMP-9 was correlated with lymph node metastasis and lymphovascular space invasion. CONCLUSION: The over-expression of matrix metalloproteinase-2 and -9 was correlated with invasive behaviour of cervical cancer, MMP-9 was significantly correlated with the lymph node metastasis, it might become a useful prognostic indicator for early cervical cancer.

Adult↗

PubMed1994

Histopathologic spectrum of AIDS-associated lesions in Maharaj Nakorn Chiang Mai Hospital.

The histopathological alterations in various organs and the presence of AIDS-associated lesions were studied in 86 biopsy and 29 necropsy specimens of AIDS patients. The most common cancer seen in this study were malignant lymphomas (4% of cases) with development of extensive extranodal lymphomatous involvement from the outset. Although a preponderance of high grade B-cell pathologic subtypes is found in AIDS-associated lymphoma, we also report the first case of T-lymphoblastic lymphoma with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorly organized granulomas and extensive necrosis with numerous bacilli. Penicilliosis (20% of cases) appeared to be the most common cutaneous lesion with multiple organ involvement. The involved organs showed a partially anergic tissue reaction characterized by poorly formed granulomas with diffuse infiltrate of fungi-laden macrophages and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the predominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major pathologic feature in this group was diffuse alveolar damage stage II to III with heavy loads of organism and extensive lymphoplasmacytic infiltration.

AIDS-Related Opportunistic Infections↗

PubMed2005

Molecular pathological subclassification of mucinous adenocarcinoma of the colorectum.

The purpose of the present report was to examine the possibility of molecular pathological subtyping of mucinous adenocarcinomas (MAC) of the colorectum. Thirty-five formalin-fixed and paraffin-embedded MAC specimens of the colorectum were analyzed. Genetic alterations of p53 gene and microsatellite instability (MSI) as well as immunohistochemical analysis of mucin subtypes (human gastric mucin (HGM), anti-mucin monoclonal antibody recognizing gastric gland mucous cells-1, MUC2, CD10) and expression levels of human mutL homolog 1 (hMLH1), p53 and Ki-67 were performed. According to MSI and p53 status, these tumors were subclassified into three groups: mutator-type tumors with a high frequency of MSI (20%), suppressor/p53-type tumors with p53 mutation, p53 overexpression or loss of heterozygosity of D17S250 (an adjacent locus to p53; 40%) and the unclassified tumors (40%). The suppressor/p53-type tumors had a significant association with distal colon location (P = 0.019), venous invasion (P = 0.002), extent of lymph node metastasis (P = 0.007) and higher tumor stage (P = 0.018). In contrast, mutator-type tumors had frequent expression of HGM (P = 0.005) and prominent lymphocytic infiltration at the advancing front of the tumor (P = 0.005). These results indicate that MAC of the colorectum could be subclassified according to molecular pathological background, reflecting distinct clinicopathological and phenotypic characteristics.

Adaptor Proteins, Signal Transducing↗

PubMed2005

Spinal meningioma: relationship between histological subtypes and surgical outcome?

Intraspinal meningiomas are slow growing benign tumors that produce indolent neurological deficits, which are often reversible following operation. It is unclear, if there is a correlation between postoperative neurological restoration and histopathological parameters. The aim of the present work was to seek for existence of such parameters. Retrospectively, we reviewed the charts of 33 patients with spinal meningiomas who were operated on from January 1980 through December 1995. Histological classification was performed according to WHO criteria. Laminoplasty or hemilaminoplasty was performed in 29 patients (88%) and suboccipital craniotomy with cervical laminoplasty in 4 patients (12%). Mean age of the 30 women (91%) and the 3 men (9%) was 63+/-20 years (range 22-88). Spinal meningiomas were of high-cervical location in 9 (27%) and of low-cervico-thoracic location in 24 (73%) patients. Tumor position was laterally in 19 (58%), posteriorly in 8 (24%) and anteriorly in 6 (18%) patients. Histological classification was psammomatous in 22 (66%), fibroblastic in 7 (22%) and meningothelial in 4 (11%) patients. Following tumor resection, neurological deficits resolved in 26 of 33 patients (79%) and worsened in 7 of 33 patients (21%) all of the latter had meningiomas of the psammomatous type. Resection of psammomatous meningiomas of the spine is associated with a less favorable neurological outcome postoperatively than resection of spinal meningiomas of other pathological subtypes. Posterior or lateral tumor position in the spinal canal, location below C4, age less than 60 years, and duration of preoperative symptoms seem to be correlated with a good outcome.

Adult↗

PubMed2001

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome-related lymphoma.

Bone marrow involvement is reported in approximately 25% of patients with newly diagnosed acquired immunodeficiency syndrome-related lymphoma (ARL). Studied were 291 patients with ARL, diagnosed and treated at one medical center between 1984 and 1998. Clinical, immunologic, and pathologic characteristics of patients with bone marrow involvement were compared with those of patients without marrow involvement. Bone marrow involvement was present in 55 patients (19%). Small noncleaved lymphoma was diagnosed in 38% of the entire group and was the most common pathologic subtype in patients with bone marrow involvement (55% versus 34%; P =.008). Analysis of complete blood counts revealed a median hemoglobin level of 10.6 g/dL in both marrow-positive and marrow-negative groups. In contrast, a platelet count lower than 100 000/microL was more common in patients with bone marrow involvement (27% versus 11%; P =.02). Patients with marrow involvement were more likely to have leptomeningeal (cerebrospinal fluid [CSF]) lymphoma than patients whose marrows were uninvolved (24% versus 7%; P <.001) and were also more likely to have high lactate dehydrogenase (LDH) (P =.002), bone involvement (P <.001), and/or systemic B symptoms including fever, night sweats, and/or weight loss (P =.05). Median survival did not differ between marrow-positive and marrow-negative groups. On multivariate analysis, factors associated with decreased survival of marrow-positive patients included greater than 50% involvement (P =.002), systemic B symptoms (P =.008), and high-grade histologic type (P =.035). Marrow involvement in ARL correlates with small noncleaved pathology, thrombocytopenia lower than 100 000 mm(3), high LDH, and lymphomatous involvement of the CSF. Survival is statistically shorter in patients with greater than 50% marrow involvement, high-grade pathology, and/or systemic B symptoms.

Adult↗

PubMed2002

Primary colorectal lymphoma: spectrum of imaging findings with pathologic correlation.

Primary colorectal lymphoma is a very uncommon disease; therefore, it has received little attention in the radiology literature. Moreover, imaging features of newly described pathologic subtypes have not been reported such as low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue and peripheral T-cell lymphoma that involves colorectal area. We retrospectively reviewed double-contrast barium enema and CT scans in the patients with primary colorectal lymphoma. In this article the radiologic appearances of primary colorectal lymphoma are categorized into focal lesion and diffuse lesion. Focal lesion includes polypoid mass, circumferential infiltration with smooth mucosal surface, circumferential infiltration with extensive ulceration, cavitary mass, mucosal nodularity, and mucosal fold thickening. Diffuse lesion includes diffuse ulcerative lesion and diffuse nodular lesion. Peripheral T-cell lymphomas that involve the colon manifested as either a diffuse or focal segmental lesion and showed extensive mucosal ulceration. These findings are similar to those of Crohn's disease or tuberculous colitis and are different from those of previously reported colorectal lymphoma. Low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue manifest as multiple mucosal nodularity. The imaging features of primary colorectal lymphoma are quite variable and overlap with other colonic pathology; however, it is important for radiologists to know the imaging features of primary colorectal lymphoma with their pathologic correlation.

Barium Sulfate↗

PubMed2005

Typical medullary breast carcinomas have a basal/myoepithelial phenotype.

Medullary breast cancer (MBC) is a rare, diagnostically difficult, pathological subtype. Despite being high grade, it has a good prognosis. MBC patients have an excess of BRCA1 germ-line mutation and reliable identification of MBC could help to identify patients at risk of carrying germline BRCA1 mutations or in whom chemotherapy could be avoided. The aim of this study was therefore to improve diagnosis by establishing an MBC protein expression profile using immunohistochemistry (IHC) on tissue-microarrays (TMA). Using a series of 779 breast carcinomas ('EC' set), diagnosed initially as MBC, a double-reading session was carried out by several pathologists on all of the histological material to establish the diagnosis as firmly as possible using a 'medullary score'. Only MBCs with high scores, i.e. typical MBC (TMBC) (n=44) and non-TMBC grade III with no or low scores (n=160), were included in the IHC study. To validate the results obtained on this first set, a control series of TMBC (n=17) and non-MBC grade III cases (n=140) ('IPC' set) was studied. The expression of 18 proteins was studied in the 61 TMBCs and 300 grade III cases from the two sets. The global intra-observer concordance of the first reading for the diagnosis of TMBC was 94%, with almost perfect kappa (kappa) of 0.815. TMBC was characterized by a high degree of basal/myoepithelial differentiation. In multivariate analysis with logistic regression, TMBC was defined by the association of P-cadherin (R=2.29), MIB1 > 50 (R=3.80), ERBB2 negativity (R=2.24) and p53 positivity (RR=1.45).

Breast Neoplasms↗