An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy

Forensic Science, Medicine and Pathology - Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in...     

Etiology of Seizures in the Elderly

Our study covered a 5-year period, and included all patients within a well-defined area who developed seizures after age 60 years. The dominant cause of seizures was a previous stroke, accounting for 32% of all cases. Tumors accounted for 14%, and the cause of seizures remained unknown in 25%. Seizures were recurrent in greater than 80% of patients with first seizure greater than 6 months after stroke. Fifteen of 21 patients with tumors had metastatic tumors. Of the six patients with primary brain tumors, five had malignant gliomas and one had a meningioma. We conclude that epilepsy with onset after age 60 years is more often symptomatic than is epilepsy in younger patients; since seizures were the first sign of a central nervous system (CNS) disease in half of the patients with brain tumors, careful investigation is necessary to reach a correct diagnosis.     

High p‐mTOR expression is associated with recurrence and shorter disease‐free survival in atypical meningiomas

Due to their widely variable clinical behavior, the post‐surgical treatment of atypical meningiomas is controversial. Therefore, prognostic factors able to identify high‐risk cases, which may benefit from adjuvant treatments, are warranted. Mammalian target of rapamycin (mTOR) belongs to the PI3K‐AKT pathway. Its phosphorylated form (p‐mTOR Ser2448) is involved in cell growth, differentiation and tumorigenesis. The aim of this study was to evaluate p‐mTOR Ser2448 expression and its eventual correlation with clinicopathological features, recurrence, or disease‐free survival (DFS), in atypical meningiomas. p‐mTOR immunohistochemical expression was analyzed in 48 atypical meningiomas and correlated with clinicopathological parameters and with DFS. Eighty‐one percent of atypical meningiomas expressed p‐mTOR Ser2448. High immuno‐expression was significantly associated with recurrences (P = 0.01) and lower DFS (P = 0.01). The presence of brain invasion, high mitotic index plus sheeting, and Simpson grade were significant and independent prognostic variables at multivariate analysis. p‐mTOR Ser2448 is expressed in atypical meningiomas. High expression predicts development of recurrences and shorter DFS in patients affected by these tumors. Since p‐mTOR Ser2448 is a target of anti‐neoplastic drugs, evaluation of its expression may be used, not only to identify atypical meningiomas at higher risk of recurrence, but also to select those to submit to adjuvant targeted chemotherapy.     

Strong androgen receptor expression is not useful in distinguishing GATA3 + metastases

GATA binding protein 3 (GATA3) immunohistochemical expression is commonly considered to be a sensitive and specific diagnostic marker for breast and urothelial carcinomas in surgical pathology practice. However, since its expression has been also demonstrated in other tumors, GATA3 should be better used in conjunction with other immunohistochemical markers to establish tumor primitivity in metastatic setting.Interestingly, GATA3 expression seems to be significantly correlated with androgen receptor (AR) expression in breast carcinoma. In addition, strong AR expression -defined as immunohistochemical positivity in more than 60% of tumor cells- was suggested to be 100% specific for breast origin in GATA3+ metastases.The aim of this study was to verify whether strong AR expression may actually be useful to determine primivity in GATA3+ metastatic setting. Thus, we investigated AR and GATA3 immuno-expression in a cohort of metastatic tumors derived from urothelial, breast, endometrial and salivary gland carcinomas. We did not find any GATA3 or AR expression in the metastases from endometrial or salivary gland carcinomas, while GATA3 expression was seen in the majority of metastases from urothelial or breast carcinomas. In addition, strong AR expression was seen in 73% and in 47% of metastatic breast and urothelial carcinomas, respectively.On the whole, our findings confirm that GATA3 is sensitive and specific for breast and urothelial origin in metastatic setting. According to our results, strong AR expression is not useful to distinguish breast from urothelial primitivity, as previously suggested.     

Knee complaints and consequences on work status; a 10-year follow-up survey among floor layers and graphic designers

Background  

The purpose of the study was to examine if knee complaints among floor layers predict exclusion from the trade.     

The many faces of plectin and plectinopathies: pathology and mechanisms

Plectin, a giant multifunctional cytolinker protein, plays a crucial role in stabilizing and orchestrating intermediate filament networks in cells. Mutations in the human plectin gene result in multiple diseases manifesting with muscular dystrophy, skin blistering, and signs of neuropathy. The most common disease caused by plectin deficiency is epidermolysis bullosa simplex (EBS)-MD, a rare autosomal-recessive skin blistering disorder with late-onset muscular dystrophy. EBS-MD patients and plectin-deficient mice display pathologic desmin-positive protein aggregates, degenerated myofibrils, and mitochondrial abnormalities, the hallmarks of myofibrillar myopathies. In addition to EBS-MD, plectin mutations have been shown to cause EBS-MD with a myasthenic syndrome, limb-girdle muscular dystrophy type 2Q, EBS with pyloric atresia, and EBS-Ogna. This review focuses on clinical and pathological manifestations of these plectinopathies. It addresses especially plectin’s role in skeletal muscle, where a loss of muscle fiber integrity and profound changes of myofiber cytoarchitecture are observed in its absence. Furthermore, the highly complex genetic and molecular structure of plectin is discussed; a high number of differentially spliced exons give rise to a variety of different isoforms, which fulfill distinct functions in different cell types and tissues. Plectin’s abilities to act as a dynamic organizer of intermediate filament networks and to interact with a multitude of different interaction partners are the basis for its function as a scaffolding platform for proteins involved in signaling. Finally, the article addresses a series of genetically manipulated mouse lines that were generated to serve as powerful models to study functional and molecular consequences of plectin gene defects.     

Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score

Background  

Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care.