Isolated diffuse hemangiomatosis of the spleen with Kasabach-Merritt-like syndrome

AIMS: Diffuse haemangiomatosis of the spleen is a rare benign vascular condition occurring as a manifestation of systemic angiomatosis or, less commonly, confined to the spleen. It is sometimes accompanied by severe disturbance of blood coagulation. The goal of this study was to characterize an additional case of isolated diffuse haemangiomatosis of the spleen and to determine the histogenesis of this lesion which remains obscure. METHODS AND RESULTS: We describe a case of isolated diffuse haemangiomatosis of the spleen in which histological and immunohistological findings suggested the possibility of a malformative tumour-like lesion. The pathological cavernous vessels were distributed randomly through the red pulp, without continuity with sinuses. The endothelial cells expressed vimentin, factor VIII related antigen and CD34, but not CD8. Some cells lining the sinus lumen expressed CD68, lysozyme and myeloperoxidase. In addition, trabecular veins presented with intimal thickening. These results allow making a diagnosis between diffuse haemangiomatosis and other tumours/tumour-like lesions of the spleen, especially littoral cell angioma, splenoma and peliosis. CONCLUSION: If diffuse haemangiomatosis is usually classified as a benign proliferation of endothelial cells, we suggest that diffuse haemangiomatosis, when confined to the spleen, could be a tumour-like vascular lesion. In this hypothesis, the aetiology may be hamartomatous or malformative as is suspected in arterio-venous haemangioma of the lower extremities. The histogenesis is still questionable and no definitive proof in favour of one or the other hypothesis has been reported.     

Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer

Summary In 5 cases of invasive ductal and lobular carcinoma of the breast multiple epithelioid and giant cell containing granulomas were detected, localized mainly in circumferential regions, but also in the center of the carcinomas. These granulomas were interpreted as sarcoid-like stromal reactions, occurring as sarcoid-like lesions in uni- and bilateral primaries, in a recurrent tumour, and also in axillary lymph nodes. Histopathologically, these granulomas were not quite uniform, some of them corresponding to typical sarcoidosis, others showing marked proliferations of epithelioid or giant cells or containing fibrinoid exudate or necroses. The granulomas were surrounded by dense infiltrates of mononuclear cells. Tuberculosis and mycosis was excluded. There were no hints of generalized sarcoidosis. Pathogenetically, these are reactions in the tumour stroma of varying intensity, and are not caused by necroses of the tumour tissue nor by microbial infections. Such tumour-associated sarcoid-like stroma reactions are interpreted as a T-cell mediated immune response to an antigen expression of the carcinoma acting as the local trigger; in 2 cases they were connected with sarcoid-like lesions of the axillary lymph nodes. Their occurrence in bilateral carcinoma of the breast points to an immunological disposition for this special kind of host-versus-tumour response. The intensity of these changes in a recurrent tumour reflects an immunological hypersensitivity reaction.The pathogenetic and differential diagnostic aspects of epithelioid granulomas of the female breast in chronic granulomatous mastitis, panniculitis, foreign body reaction, rare infections, and in therapeutically induced sarcoidosis are described and discussed.Dedicated to Prof. Dr. K. Lennert, Kiel, in Honour of his 65th Birthday     

Selective kainic acid lesions in cultured explants of rat hippocampus

Summary The influence of the excitotoxin kainic acid (KA) on cultivated explants of rat hippocampus was investigated. Addition of 3 M KA to the culture medium over 24–48 h induced a destruction of the pyramidal cells in the CA3 region, whereas the CA1 pyramidal cells and the granule cells were left undamaged. Higher concentrations (10–100 M) of KA destroyed also the latter cell groups. The selectivity of the KA lesion at 3 M was further indicated by the fact that the acetylcholinesterase-positive neurons in the hippocampus were not destroyed through KA administration and that the stereoisomer dihydrokainic acid was ineffective in inducing lesions. Application of tetrodotoxin did not protect the CA3 pyramidal cells from KA lesion, whereas -glutamylaminomethylsulphonic acid (GAMS) only offered a very small, statistically not significant, protection. Baclofen protected the cultures slightly from KA lesions but not when added together with GAMS. Possible mechanisms responsible for the KA lesions in these cultures are discussed.Supported in part by a grant from the Swiss National Foundation for Scientific Research (No. 3.528.-0.83)     

Occurrence of leukoplakia and some other oral white lesions among 20 333 adult Swedish people

Among 20,333 people aged 15 yr or above, the prevalences of oral white lesions were calculated based on a partly new classification. The total prevalences were: cheek and lip biting 5.1%, smoker's palate 1.1%, frictional white lesion 5.5%, snuff dipper's lesion 8.0%, preleukoplakia 6.4% and leukoplakia 3.6%. If all these lesions were pooled, the prevalence was 24.8% and if only the entities cheek and lip biting and smoker's palate were excluded it became 20.1%. If weak "preleukoplakic" lesions were excluded from the latter figure the prevalence for marked whitish lesions was 13.8%. Etiologic and clinical subgroups of leukoplakia showed the following prevalences: using the etiologic subgroups, idiopathic leukoplakia 0.7% and tobacco-associated leukoplakia 2.9%; using the clinical subgroups, homogeneous leukoplakia 3.5% and non-homogeneous leukoplakia 0.3%. The intraoral location pattern of leukoplakias was preponderant in the commissural and buccal areas. However, the idiopathic leukoplakias showed a somewhat more even distribution and thus a more similar distribution to that of oral cancer.     

肝脏局灶性小占位的磁共振信号强度比与病灶性质的相关性

目的 计算肝细胞癌、肝转移瘤、肝脏海绵状血管瘤和肝囊肿的病灶／肝脏磁共振信号强度比（SIR）,并评价其与病灶性质的关系。方法 随机选择经确诊的肝细胞癌、肝转移瘤、肝海绵状血管瘤和肝囊肿病例共92例（148个病灶）行前瞻性磁共振成像（0．5T）研究。计算4种病灶的SIR,并进行统计学分析。结果 在T1W图像上,肝海绵状血管瘤与恶性肿瘤的SIR值间差异无显著性（t=1.799,P=0.075);质子加权像上,良恶性肿瘤的SIR之间无统计学意义（t=0.691,P=0.491);T2WI上,良性病变的SIR显著高于恶性肿瘤（P＜0．01）,且4种病变的SIR值与回波时间（TE）之间均存在线性正向相关关系。结论 在T2WI个测得的SIR可用于区分肝脏占位性病灶的性质。     

P~(53)andc-myc蛋白在食管癌及癌前病变中的表达意义

目的　探讨P53 及c -myc蛋白在食管癌及癌前病变中的表达及意义。方法　应用免疫组化SP法检测P53 及c -myc在 6 0例食管癌及 33例非典型增生中的表达。 结果　P53 及c -myc蛋白分别在食管癌与非典型增生I～II级中表达有显著差异 (P <0 .0 5 ) ;在食管癌与非典型增生III级表达中无显著差异 (P >0 .0 5 )。结论　P53 及c -myc蛋白异常表达 ,可为食管癌和癌前病变界限的划分提供参考依据。     

早期食管癌的病理形态观察及组织发生学探讨

目的探讨早期食管癌的组织发生学.方法对109例早期食管癌及癌周病变进行病理观察.结果其中20例的一点癌(黄豆大小),3例双原发癌,1例小细胞癌.癌周伴有不同程度的鳞状上皮异形增生和不典型增生.结论早期食管具有多样性生长的特点.提示临床医生在胃镜检查应注意多点取材,以防漏诊;以及正确确定手术范围,防止手术残留.     

成人特发性局灶节段性肾小球硬化病248例临床病理分析

目的 重新评价肾活检标本中特发性局灶节段性肾小球硬化病（FSGS）的发生率、主要临床及病理特点。方法 收集1994年7月～2000年7月间248例特发性FSGS的患者,观察肾组织的光镜、 荧光及电镜的特点,根据肾小球病变将特发性FSGS分为3种亚型。结果 248例成人特发性局灶节段肾小球硬化占同期肾活检的12.4%,占成年人原发性肾小球疾病的19.0%,以18～30岁为发病高峰年龄（约占44.4%）。临床表现为不同程度的蛋白尿,以肾病综合征为表现者143例（占57.7%)。FSGS的3种病理亚型中,经典型FSGS仍占绝大多数（91.5%),尖端型为4.4%,塌陷型为4.1%,肾活检时,约1/3以上为肾功能不全（约占35.1%）。13例尿毒症中76.9%病理亚型为塌陷型。结论 局灶节段性肾小球硬化病约占原发性肾小球病1/5,FSGS患者肾活检时,除表现为蛋白尿、肾病综合征外,肾功能不全也较常见。塌陷型FSGS常表现为进行性的不可逆的肾功能衰竭,其预后差。     

64例狼疮性肾炎大剂量环磷酰胺冲击治疗的研究

目的　观察大剂量环磷酰胺冲击治疗狼疮性肾炎的疗效。方法　对 6 4例狼疮肾炎 ( L N ,其尿红细胞 >10个 /高倍视野 ,2 4小时尿蛋白 >1g,血肌酐 >133μmol/ L )进行大剂量环磷酰胺 ( CTX)冲击治疗 (每月 1次 ,共 6次 ,其后每 3月 1次 ,共 6次 )。结果　 49例 L N患者达到肾脏损害缓解 ( 2 4小时尿蛋白 <1g;血肌酐 <133μmol/ L ;尿沉渣内红细胞 <10个 /高倍视野 ;尿管型消失 )。达到肾脏病变缓解所需冲击次数平均为 3.6次 ( 1～8次 )。每次用 CTX剂量均数 1.1g( 0 .6～ 1.6 g)。副作用有闭经 (发生率 33% ) ;带状疱疹 (发生率 13% ) ;出血性膀胱炎 1例。结论　此治疗方案治疗 L N有效 ,安全 ,副作用小     

Eden-Hybinette Procedure for Revision Surgery in Recurrent Anterior Shoulder Instability in Epilepsy

AimsThe purpose of this study was to analyze the clinical outcomes after Eden-Hybinette procedure for revision surgery in recurrent anterior shoulder instability in patients with epilepsy.Materials and MethodsWe retrospectively evaluated eight such patients between 2015 and 2018. Four patients had failed Latarjet/Bristow procedure and two had failed arthroscopic Bankart procedure, while two had history of both the procedures. After medical control of epilepsy, Eden-Hybinette procedure was performed in all patients. WOSI score and Rowe shoulder score was recorded preoperatively and in subsequent post-operative follow-up. A paired t test was used to analyze and compare preoperative and postoperative outcomes and was considered significant if p value was < 0.05.ResultsThe average follow-up was 30 months (range 24–48 months). There was no recurrence of shoulder instability. The mean WOSI score before surgery was 77.3 (range 70–83), which improved to 24.2 (range 19–30) at 24-month follow-up. The mean Rowe score before surgery was 11.3 (range 5–15), which improved to 81.8(range 65–90) at 24-month follow-up. The improvement in WOSI and Rowe score was found to be statistically significant [p value < 0.05]ConclusionsWe conclude that Eden-Hybinette is a useful revision procedure to manage recurrent anterior shoulder dislocation in patients with epilepsy. Optimum medical control of seizure is also an important factor in preventing recurrent shoulder instability