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Primary central nervous system plasmablastic
lymphoma presenting in human immunodeficiency
virus-negative but Epstein-Barr virus-positive
patient: A case report
We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL)primarily occured in the central nervous system and diagnosed by surgical resection. Thispatient appeared headache and Magnetic resonance imaging (MRI) showed multiple lesionsin the right cerebral hemisphere including the right frontal-parietal lobe and right basalganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy inJanuary 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. Thepatient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. Chinaon March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then felldown and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms ofangulus oris numbness and the right upper limb powerless ten days ago.MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontalparietallobe, the meninges are closely related, there was extensive peritumoural edema notedwith pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shiftof the midline to the right side.Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferationof plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cellswere large with round or oval nuclei and showed coarse chromatin and smaller or unapparentnucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were oftenpresented. Immunohistochemistry staining and gene rearrangement together with othersupportive investigation confirmed the diagnosis of primary central nervous systemplasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP(rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Othersupportive treatment was provided for symptomatic epilepsy. The patient regained musclestrength in both upper limbs and right lower limb and the symptomatic epilepsy wascontrolled after two weeks. Then the patient was discharged. Follow-up data shows thepatient to be alive eleven months after discharge.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1649317674697046
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Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature
Angioimmunoblastic T-cell lymphoma (AITL) is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases), accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes (CIC). Polyarteritis nodosa (PAN) is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a male patient with AITL who had a renal infarction secondary to PAN, mimicking a neoplastic lesion.A 40-year-old man underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, a diagnosis of AITL was performed. The patient was successfully treated with a cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of AITL, a whole body CT-scan showed a lesion in the lower pole of the left kidney. A renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between PAN and AITL has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessel walls injury. A careful evaluation is needed in the management of AITL patients with signs of renal failure in order to avoid delay of treatment and organ damage.Key words: renal infarction, polyarteritis nodosa, T-cell lymphoma
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Sporadic Hemangioblastoma of the Kidney: a rare
renal tumor
Hemangioblastoma is a benign and morphologically distinctive tumor that can occursporadically or in association with von Hippel-Lindau disease in approximately 25 % of thecases, and which involves the central nervous system in the majority of the cases. Rareoccurrences of hemangioblastoma in peripheral nerves and extraneural tissues have beenreported. This report describes one case of sporadic renal hemangioblastoma happened in a16-year-old Chinese female patient, presenting with hematuria, and low back pain.Histologically, the tumors were circumscribed, and composed of sheets of large polygonalcells traversed by arborizing thin-walled blood vessels. The diagnosis of hemangioblastomawas confirmed by negative immunostaining for cytokeratin, and positive staining for alpha-inhibin, S100 and neuron-specific enolase (NSE). This benign neoplasm which can bemistaken for various malignancies such as renal cell carcinoma, epithelioidhemangiopericytoma and epithelioid angiomyolipoma, deserves wider recognition for itsoccurrence as a primary renal tumor.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/5445834246942699
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Introduction of virtual microscopy in routine
surgical pathology - a hypothesis and personal view
from Europe
The technology of whole image acquisition from histological glass slides (Virtual slides,(VS)) and its associated software such as image storage, viewers, and virtual microscopy(VM), has matured in the recent years. There is an ongoing discussion whether to introduceVM into routine diagnostic surgical pathology (tissue-based diagnosis) or not, and if these areto be introduced how best to do this. The discussion also centres around how to substantiallydefine the mandatory standards and working conditions related to introducing VM. Thisarticle briefly describes some hypotheses alongside our perspective and that of several of ourEuropean colleagues who have experienced VS and VM either in research or routine praxis.After consideration of the different opinions and published data the following statements canbe derived: 1. Experiences from static and remote telepathology as well as from daily routinediagnoses, confirm that VM is a diagnostic tool that can be handled with the same diagnosticaccuracy as conventional microscopy; at least no statistically significant differences (p >0.05) exist. 2. VM possesses several practical advantages in comparison to conventionalmicroscopy; such as digital image storage and retrieval and contemporary display of multipleimages (acquired from different stains, and/or different cases). 3. VM enables fast andefficient feedback between the pathologist and the laboratory in terms of ordered additionalstains, automated access to the latest research for references, and fast consultation withoutstanding telepathology experts. 4. Industry has already invested "big money" into thistechnology which certainly will be of influence in its future development. The mainconstraints against VM include the questionable reimbursement of the initial investment, themissing direct and short term financial benefit, and the loss of potential biological identitybetween the patient and the examined tissue. This article tries to analyze and evaluate thefactors that influence the implementation of VM into routine tissue-based diagnosis, forexample in combination with predictive diagnosis. It focuses on describing the advantages ofmodern and innovative electronically based communication technology.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1245603103708547
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Epididymis rhabdomyoma: A case report and
literature review
Genital rhabdomyoma is very rare tumor that usually occurs in the vulvar of young women.Epididymis rhabdomyoma in a young man is extremely uncommon and has rarely beenreported. Here, we report a case of epididymis rhabdomyoma of a 17-year-old man andreview the literatures.Virtual slideThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1177628224692794
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Is there a link between diabetic glomerular injury and
crescent formation? A case report and literature review
Glomerular crescents are most commonly associated with rapidly progressive crescenticglomerulonephritis; however, they also develop in response to a wide range of primary andsecondary glomerular injuries. Since various kind of glomerulopathies occasionally overlaydiabetic glomerular injuries, the presence of crescents in renal biopsy specimens of diabeticsmay have stimulated a search for etiologies other than diabetes. In this report, we describe anunusual case of diabetic glomerulosclerosis with peculiar extracapillary proliferation.Although such a relationship has so far been ignored in most of the literature, the etiologicallinkage between diabetic glomerulosclerosis and the development of crescents may not beexceptional. We have reviewed the previous literature and herein discuss the pathologicalimplications of the development of crescents in patients with diabetic glomerulosclerosis.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/3950457896920255
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Serum peptidome patterns of breast cancer based on
magnetic bead separation and mass spectrometry
analysis
Background:
Breast cancer is one of the most common cancers in the world, and the identification ofbiomarkers for the early detection of breast cancer is a relevant target. The present study aimsto determine serum peptidome patterns for screening of breast cancer.
Methods:
The present work focused on the serum proteomic analysis of 36 healthy volunteers and 37breast cancer patients using a ClinProt Kit combined with mass spectrometry (MS). Thisapproach allows the determination of peptidome patterns that are able to differentiate thestudied populations. An independent group of sera (36 healthy volunteers and 37 breastcancer patients) was used to verify the diagnostic capabilities of the peptidome patternsblindly. An immunoassay method was used to determine the serum mucin 1 (CA15-3) ofvalidation group samples.
Results:
Support Vector Machine (SVM) Algorithm was used to construct the peptidome patterns forthe identification of breast cancer from the healthy volunteers. Three of the identified peaksat m/z 698, 720 and 1866 were used to construct the peptidome patterns with 91.78%accuracy. Furthermore, the peptidome patterns could differentiate the validation groupachieving a sensitivity of 91.89% (34/37) and a specitivity of 91.67% (33/36) (> CA 15-3,P < 0.05).
Conclusions:
These results suggest that the ClinProt Kit combined with MS shows great potentiality for thediagnosis of breast cancer.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1501556838687844
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Expression features of SOX9 associate with tumor
progression and poor prognosis of hepatocellular
carcinoma
Background:
SOX9 as a member of the SOX (SRY [sex determining region Y] box) gene superfamily hasbeen previously demonstrated to be a proto-oncogene in a variety of malignancies. However,the clinical significance of SOX9 expression in hepatocellular carcinoma (HCC) remainsunclear. The aim of this study was to investigate the expression of SOX9 in HCC anddetermine its correlation with tumor progression and prognosis.
Methods:
One-hundred and thirty HCC patients who had undergone curative liver resection wereselected and immunohistochemistry, Western blotting, and quantitative real time polymerasechain reaction (Q-PCR) were performed to analyze SOX9 expression in the respectivetumors.
Results:
Immunohistochemistry, Western blotting, and Q-PCR consistently confirmed SOX9overexpression in HCC tissues compared with their adjacent nonneoplastic tissues (P < 0.01).Additionally, immunostaining showed more SOX9 positive cells in the higher tumor stage(T3 ~ 4) and tumor grade (G3) than in the lower tumor stage (T1 ~ 2, P = 0.03) and tumorgrade (G1 ~ 2, P = 0.01), respectively. Moreover, HCC patients with high SOX9 expressionwere significantly associated with lower 5-year overall survival (P < 0.01) and lower 5-yeardisease-free survival (P < 0.01), respectively. The Cox proportional hazards model furthershowed that SOX9 over-expression was an independent poor prognostic factor for both 5-year disease-free survival (hazards ratio [HR] = 2.621, 95% confidence interval [CI] = 1.548-5.829, P = 0.01) and 5-year overall survival (HR = 3.825, CI = 1.638-7.612, P = 0.003) inHCC.
Conclusion:
Our data suggest for the first time that the overexpression of SOX9 protein in HCC tissues isof predictive value on tumor progression and poor prognosis.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/9029740396926377
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A rare case of malignant triton tumor in the
cerebellopontine angle
Malignant triton tumor (MTT) is defined as malignant peripheral nerve sheath tumor withrhabdomyoblastic differentiation. Intracranial MTT is extremely rare, and only four cases havebeen reported in the literature. Here, we report a case of MTT occurring in the cerebellopontineangle, and describe its histopathological characteristics, immunohistochemical features, andprognosis.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1336227313684480
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Quantitative comparison of immunohistochemical
staining measured by digital image analysis versus
pathologist visual scoring
Immunohistochemical (IHC) assays performed on formalin-fixed paraffin-embedded (FFPE)tissue sections traditionally have been semi-quantified by pathologist visual scoring ofstaining. IHC is useful for validating biomarkers discovered through genomics methods aslarge clinical repositories of FFPE specimens support the construction of tissue microarrays(TMAs) for high throughput studies. Due to the ubiquitous availability of IHC techniques inclinical laboratories, validated IHC biomarkers may be translated readily into clinical use.However, the method of pathologist semi-quantification is costly, inherently subjective, andproduces ordinal rather than continuous variable data. Computer-aided analysis of digitizedwhole slide images may overcome these limitations. Using TMAs representing 215 ovarianserous carcinoma specimens stained for S100A1, we assessed the degree to which dataobtained using computer-aided methods correlated with data obtained by pathologist visualscoring. To evaluate computer-aided image classification, IHC staining within pathologistannotated and software-classified areas of carcinoma were compared for each case. Twometrics for IHC staining were used: the percentage of carcinoma with S100A1 staining(%Pos), and the product of the staining intensity (optical density [OD] of staining) multipliedby the percentage of carcinoma with S100A1 staining (OD*%Pos). A comparison of the IHCstaining data obtained from manual annotations and software-derived annotations showedstrong agreement, indicating that software efficiently classifies carcinomatous areas withinIHC slide images. Comparisons of IHC intensity data derived using pixel analysis softwareversus pathologist visual scoring demonstrated high Spearman correlations of 0.88 for %Pos(p < 0.0001) and 0.90 for OD*%Pos (p < 0.0001). This study demonstrated that computeraidedmethods to classify image areas of interest (e.g., carcinomatous areas of tissuespecimens) and quantify IHC staining intensity within those areas can produce highly similardata to visual evaluation by a pathologist.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1649068103671302
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