The histological assessment of liver fibrosis in grafts from extended criteria donors predicts the outcome after liver transplantation: A retrospective study

BackgroundThe use of extended criteria donors (ECD) in liver transplantation is increasing due to the organ shortage. Histological evaluation of the liver graft in the context of procurement is an important tool for extending the donor pool without affecting the quality of the transplanted organs. Macrovesicular steatosis is widely accepted as predictor of early allograft dysfunction (EAD), while other features, such as portal fibrosis, are poorly studied.AimTo identify morphological features, other than macrovesicular steatosis, that may affect recipients’ outcome.MethodsBetween 2014 and 2016, 132 donors with extended criteria underwent pre-transplant liver biopsy during procurement. Histological variables of the graft, donors’/recipients’ clinical data, EAD and patient/graft survival were registered.ResultsThe recipients who received a graft with histological-proven portal fibrosis had a significant lower patient and graft survival in comparison to patients without fibrosis (P = 0.044 and P = 0.039, respectively). Donors’ dyslipidemia was significantly associated with the occurrence of EAD (P = 0.021). When dyslipidemia was combined with histological liver fibrosis a 54.5% incidence of EAD was observed (P = 0.012).ConclusionsThe histological assessment of liver fibrosis in pre-transplant biopsy of ECD grafts, together with donor’s clinical data, provides important information on recipients’ outcome.     

Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT lymphoma) in Ulcerative Colitis

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurring in inflammatory bowel diseases, including ulcerative colitis (UC) and Crohn''s disease, has been reported, although it is extremely rare. An 18-year-old man with a two-years history of UC underwent colon endoscopy, and was found to have active total UC ranging from anus to cecum. Six biopsies were obtained. The microscopic examinations showed severe infiltrations of atypical small lymphocytes. They showed hyperchromatic nuclei and increased nucleocytoplasmic ratio and scattered immunoblastic cells. Centrocyte-like atypical lymphocytes, monocytoid cells, and plasma cells were seen in some places. Vague germinal centers were present, and apparent lymphoepithelial lesions were seen. No crypt abscesses were seen, and there were few neutrophils. No apparent other findings of UC were seen. Immunohistochemically, the atypical lymphocytes were positive for vimentin, CD45, CD20, CD79α, CD138, κ-chain, λ-chain, and p53 and Ki-67 antigen (labeling index = 63%). They were also positive for CD45RO, CD3, and CD15, but these positive cells were very scant compared with CD20 and CD79α. They were negative for CD10, CD30, CD56, cytokeratin (CK) AE1/3, CK CAM5.2, CK34BE12, CK5, CK6, CK7, CK8, CK14, CK18, CK19, CK20, EMA, chromogranin, synaptophysin, NSE, S100 protein, CEA, CA19-9, p63, and HMB45. Without clinical information, the appearances are those of MALT lymphoma. However, with clinical information, making the diagnosis of MALT lymphoma was hesitated. It is only mentioned herein that atypical lymphocytic infiltrations indistinguishable from MALT lymphoma occurred in an 18-year-old male patient with a two-year history of UC.     

Cerebral Baylisascaris larva migrans in a cynomolgus macaque (Macaca fascicularis)

An incidental, asymptomatic, focal inflammatory lesion was detected in brain cerebrum of an approximately 6-year-old, female cynomolgus macaque from a chronic toxicology study. No gross lesions were noted at necropsy. Microscopically, the lesion contained a cross-section of larvae approximately 70–80 μm in diameter, a centrally located intestine flanked on either side by large triangular excretory columns, and prominent single lateral cuticular alae. Mixed inflammatory cells of eosinophils, macrophages, and lymphocytes admixed with abundant connective tissue stroma and necrosis surrounded the larvae. Histochemical stains for trichrome revealed significant amount of fibrous connective tissue. The morphology of the larvae was compatible with Baylisascaris spp. Based on the microscopic and histochemical examination, a diagnosis of neural Baylisascaris spp. larva migrans was made.     

ALT小于2倍正常上限的HBeAg阴性慢性HBV感染者肝脏病理改变及相关因素分析

目的探讨ALT小于2倍正常值上限(upper limits of normal,ULN)的HBeAg阴性慢性HBV感染者中与肝脏病理学改变相关的临床指标。方法将60例ALT2×ULN的HBeAg阴性慢性HBV感染者按照不同肝脏炎症程度及纤维化程度分组,对比各组患者性别比例、年龄、血清ALT、HBV DNA定量、脾脏厚度、门静脉内径、肝脏瞬时弹性探测仪(FibroScan)测定肝硬度值(liver stiffness measurement,LSM)的变化情况。结果 60例患者肝脏炎症改变在G1~G3级,纤维化程度在S0~S2期,其中≥G2、达S2者分别为49例(81.7%)、19例(31.7%)。60例患者中,随着肝脏炎症及纤维化程度的加重,男性患者比例、年龄、脾脏厚度、门静脉内径、LSM值均明显增加,差异均有统计学意义(P均0.05);血清ALT水平、HBV DNA定量随肝脏炎症程度的加重亦明显增加,差异均有统计学意义(P均0.05),但以上两指标随肝脏纤维化程度的加重无明显变化。结论对于ALT2×ULN的HBeAg阴性慢性HBV感染者,仍然有相当部分患者的肝脏病变在G2或/和S2以上,对于这部分人群,尤其是男性患者,密切随访年龄、血清ALT、HBV DNA、脾脏厚度、门静脉内径、LSM值的变化对于协助了解肝脏病理变化有一定的提示作用。     

Neuropathies douloureuses et atteinte des petites fibres

It is customary to consider that a purely sensory and painful neuropathy accompanied by normal electroneuromyographic examination may be or must be a small fiber neuropathy. This leads to perform specific tests, such as measuring the intra-epidermal nerve fiber density on skin biopsy or neurophysiological tests, such as evoked potentials to noxious stimuli (laser) or quantification of thermal sensory thresholds. However, these tests are only sensitive to the loss of small fibers (A-delta and C), which does not reflect the mechanisms responsible for peripheral neuropathic pain. Selective loss of small sensory fibers inherently generates a sensory deficit that does not necessarily present a painful character. Also, assigning the cause of a painful neuropathy to a small fiber neuropathy has no pathophysiological sense, although there are indirect links between these two conditions. In fact, it is not possible to explain univocally peripheral neuropathic pain, which reflects complex and diverse mechanisms, involving different types of nerve fibers. In this context, the clinical and laboratory approach must be improved to better understand the underlying mechanisms. It is imperative to interpret the data provided by laboratory tests and to correlate these data to the clinical signs and symptoms presented by the patients. Thus, one must go beyond many a priori and misinterpretations that unfortunately exist in this area at present and are not based on any solid pathophysiological basis.     

Esophageal combined carcinomas: Immunohoistochemical and molecular genetic studies

Primary esophageal combined carcinoma is very rare. The authors herein report 2 cases. Case 1 was a combined squamous cell carcinoma and small cell carcinoma, and case 2 was a combined squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Case 1 was a 67-year-old man with complaints of dysphagia. Endoscopic examination revealed an ulcerated tumor in the middle esophagus, and 6 biopsies were obtained. All 6 biopsies revealed a mixture of squamous cell carcinoma and small cell carcinoma. Both elements were positive for cytokeratin, epithelial membrane antigen, and p53 protein, and had high Ki-67 labeling. The small cell carcinoma element was positive for synaptophysin, CD56, KIT, and platelet-derived growth factor-α (PDGFRA), while the squamous cell carcinoma element was not. Genetically, no mutations of KIT and PDGFRA were recognized. The patient died of systemic carcinomatosis 15 mo after presentation. Case 2 was a 74-year-old man presenting with dysplasia. Endoscopy revealed a polypoid tumor in the distal esophagus. Seven biopsies were taken, and 6 showed a mixture of squamous cell carcinoma, small cell carcinoma, and adenocarcinoma. The 3 elements were positive for cytokeratins, epithelial membrane antigen, and p53 protein, and had high Ki-67 labeling. The adenocarcinoma element was positive for mucins. The small cell carcinoma element was positive for CD56, synaptophysin, KIT, and PDGFRA, but the other elements were not. Mutations of KIT and PDGFRA were not recognized. The patient died of systemic carcinomatosis 7 mo after presentation. These combined carcinomas may arise from enterochromaffin cells or totipotential stem cell in the esophagus or transdifferentiation of one element to another. A review of the literature was performed.     

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

Introduction

Magnetic resonance images (MRI) fluid sign and intravertebral vacuum phenomenon of the plain radiograph are considered as the characteristic radiological findings for vertebral osteonecrosis after spinal fractures. We aim to study the association between the radiological and histopathologic findings of vertebral osteonecrosis through the use of an open retrieval of specimens.

Materials and methods

Twenty consecutive patients (54–84 years, mean 73 years) of unstable vertebral compression fractures treated with anterior corpectomy and fusion were included. All the images and pathologies were correlated, especially the histopathologic changes to the fluid sign and vacuum phenomenon.

Results

MRI fluid signs and the histopathologic findings of vertebral osteonecrosis were significantly correlated and both were noted in the first 5 months after injury. The power of the fluid sign in diagnosing vertebral osteonecrosis was better than that of the intravertebral vacuum phenomenon (diagnostic odds ratio 65 vs. 2, sensitivity 86 vs. 50 %, specificity 100 vs. 67 %).

Conclusion

MRI fluid sign is more predictable to diagnose vertebral osteonecrosis in operative case, especially within the initial 5 months after injury.     

Glioblastoma Metastasis to Parotid Gland and Neck Lymph Nodes: Fine-Needle Aspiration Cytology with Histopathologic Correlation

Glioblastoma (GBM) is one of the most highly aggressive neoplasms of the central nervous system. Extra-cranial metastases in GBM are rare. Here we present the case of a 26-year-old man with extra-cranial metastasis of a frontal lobe GBM to the parotid gland, cervical lymph nodes, and bones, with initial diagnosis made by fine needle aspiration cytology (FNAC) of the parotid gland. FNAC is a reliable technique in the study of primary and secondary parotid gland neoplasms, allowing a presumptive diagnosis in difficult cases. We correlate the cytologic, histopathologic, and immunohistochemical findings in this case and discuss previous literature reports.     

Crohn's disease: A retrospective analysis between computed tomography enterography,colonoscopy, and histopathology

IntroductionTo investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers.MethodsHospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens’ kappa analyses were performed.ResultsThe CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86).ConclusionCTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.