RESUMO
BACKGROUND: Precise histological diagnosis is important for the successful management of intraductal papillary mucinous neoplasms (IPMNs). OBJECT: The object of this study was to determine whether cell block cytology is useful for preoperative cytomorphological grading and typing of IPMNs. METHODS: The subjects were 23 patients with IPMN from whom pancreatic juice was collected via a pancreatic catheter and who subsequently underwent pancreatic resection. RESULTS: In 20 of the 23 cases, the quantity of cells collected for cell block cytology was sufficient to enable typing and grading of the IPMN. The rates of consistency between the results of typing and grading by cell block cytology and histological examination of the surgical specimen were 95% and 80%, respectively. Typing of the 10 main-duct/mixed-duct-type IPMNs by cell block cytology yielded 5 gastric types, 3 intestinal types, 1 oncocytic type, and 1 pancreatobiliary type, and the typing was consistent with the surgical diagnosis in all 10 cases. The results of typing of the branch-duct-type IPMNs by cell block cytology were identical to the results of histological typing in the surgical specimens in every case but one. However, the specificity of cell block cytology for grading IPMNs was 55.6%. CONCLUSIONS: The cell block cytological findings were fairly consistent with the histopathological features of the surgical specimens, thereby indicating that cell block cytology may be useful for preoperative and typing of IPMNs, but only play a supplementary role in grading IPMNs.
Assuntos
Adenocarcinoma Mucinoso/patologia , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/patologia , Gradação de Tumores/métodos , Neoplasias Pancreáticas/patologia , Adenocarcinoma Mucinoso/classificação , Adulto , Idoso , Carcinoma Ductal Pancreático/classificação , Carcinoma Papilar/classificação , Citodiagnóstico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/metabolismo , Suco Pancreático/citologia , Suco Pancreático/metabolismo , Neoplasias Pancreáticas/classificação , Cuidados Pré-Operatórios , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The presence of hippocampal sclerosis (HS) on MRI has a great impact on the clinical evaluation and counselling of patients with temporal lobe epilepsy (TLE) and is considered as a key criterion for the decision to recommend epilepsy surgery. However, neuropathological studies describe evidence of HS in up to 10% of non-epileptic individuals, questioning the impact of this MRI finding in patients with TLE. We evaluated the prevalence of HS on MRI in the general population. METHODS: 100 healthy subjects and 10 patients with TLE due to HS were investigated in a prospective study using a specific protocol for the detection of hippocampal pathology (coronal FLAIR, coronal T2 TSE and a T1 weighted 3D SPGR sequence). RESULTS: HS was detected in none of the healthy subjects (95% confidence interval=0-3.6%), but in all patients. Inter-rater agreement was perfect for presence of HS. Thirty-three subjects had an unilaterally enlarged temporal horn as an isolated secondary criterion for HS and inter-rater agreement was slight for this point. Incidental pathological findings were detected in two patients (2%): one had a low grade astrocytoma (1%), one an aneurysm of the posterior communicating artery (1%). CONCLUSIONS: HS was not diagnosed in healthy subjects, supporting its impact on the evaluation of patients with temporal lobe epilepsy. An unilateral enlarged temporal horn that occurred in one third of the healthy subjects should not be considered as a pathologic finding or even as a marker for HS.
Assuntos
Epilepsia do Lobo Temporal/diagnóstico , Hipocampo/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Epilepsia do Lobo Temporal/patologia , Feminino , Lateralidade Funcional , Humanos , Masculino , Prevalência , Estudos Prospectivos , EscleroseAssuntos
Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/patologia , Dissecção Aórtica/complicações , Fístula Esofágica/patologia , Fístula Vascular/patologia , Idoso , Dissecção Aórtica/patologia , Aneurisma da Aorta Torácica/patologia , Doenças da Aorta/etiologia , Fístula Esofágica/etiologia , Esofagoscopia , Evolução Fatal , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Humanos , Choque/etiologia , Tomografia Computadorizada por Raios X , Úlcera/etiologia , Úlcera/patologia , Fístula Vascular/etiologiaAssuntos
Angioedema/patologia , Enteropatias/patologia , Intestino Delgado/patologia , Adulto , Angioedema/diagnóstico por imagem , Angioedema/etiologia , Angioedema/terapia , Feminino , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/etiologia , Enteropatias/terapia , Mucosa Intestinal/patologia , Intestino Delgado/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
Exostoses like-3 (EXTL3) is a putative tumour suppressor gene but its involvement in colorectal cancer (CRC) is unclear. We have investigated the role of methylation of the EXTL3 promoter as a mechanism for EXTL3 regulation and tested the hypothesis that loss of EXTL3 expression is associated with mucinous differentiation and alteration of glycoprotein expression in CRC cells. The methylation status of the EXTL3 gene promoter was analysed by methylation-specific PCR following bisulphite modification in CRC cell lines and microdissected primary CRC tissues and their corresponding adjacent normal colorectal mucosa. EXTL3 promoter methylation was detected in seven of 11 mucinous CRCs (63.6%) but in none of 26 non-mucinous CRCs examined. EXTL3 promoter methylation was also detected in the normal colonic mucosa of three patients with mucinous CRC but not in the normal colonic mucosa of any patients with non-mucinous CRC. The presence of EXTL3 methylation was significantly associated with the partial loss of HS expression in mucinous CRC lesions. The mucinous CRC cell lines, Colo201 and Colo205, showed EXTL3 promoter methylation and loss of EXTL3 mRNA expression. However 5-aza-2'-deoxycytidine treatment demethylated the EXTL3 gene promoter and restored its mRNA expression. Furthermore, the basal expression of HS in CRC cells was abolished by treatment with EXTL3-siRNA. We conclude that EXTL3 promoter methylation and its related loss of EXTL3 expression are involved in the loss of HS expression in mucinous CRCs.
Assuntos
Adenocarcinoma Mucinoso/genética , Neoplasias Colorretais/genética , Metilação de DNA , Regulação Neoplásica da Expressão Gênica/genética , Heparitina Sulfato/genética , N-Acetilglucosaminiltransferases/genética , Proteínas Supressoras de Tumor/genética , Adenocarcinoma Mucinoso/patologia , Idoso , Biomarcadores Tumorais/genética , Neoplasias Colorretais/patologia , Regulação para Baixo , Feminino , Heparitina Sulfato/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , N-Acetilglucosaminiltransferases/metabolismo , Reação em Cadeia da Polimerase , Regiões Promotoras Genéticas , Proteínas Supressoras de Tumor/metabolismoAssuntos
Colite/diagnóstico , Colo/patologia , Idoso , Calcinose/complicações , Colite/complicações , Doenças do Colo/complicações , Fibrose , Humanos , MasculinoAssuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Metotrexato/efeitos adversos , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/imunologia , Feminino , Humanos , Contagem de Linfócitos , Linfócitos/imunologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-IdadeRESUMO
A 63-year-old man was diagnosed as having grade IV mitral regurgitation (MR). Intraoperative examination revealed perforation (13x7 mm) of the anterior mitral leaflet (AML) and prolapse of the posterior mitral leaflet (PML). The prolapsing part of the PML was resected as a rectangle and the AML perforation was covered with this resected PML patch. A Carpentier-Edwards rigid ring (30 mm) was used to secure the mitral valve annulus after suturing the PML. The patient had an uneventful course after surgery and postoperative echocardiography showed no regurgitation.
Assuntos
Endocardite Bacteriana/complicações , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/etiologia , Transplante Autólogo , Resultado do TratamentoRESUMO
PURPOSE: Thiazolidinedione derivatives (TZDs) are known to be ligands of peroxisome proliferator-activated receptor gamma (PPARgamma). In this study, we investigated the effect of a TZD, troglitazone, on inflammation and fibrogenesis in the pancreas of an experimental model of chronic pancreatitis. MATERIAL AND METHODS: Male WBN/Kob rats with spontaneous chronic pancreatitis were fed rat chow containing 0.2% troglitazone from 1 to 4 months of age. Immunohistochemical studies of rat pancreas were carried out with monoclonal mouse antibody against human alpha-smooth muscle actin (alpha-SMA) or rabbit polyclonal antibody against collagen type I, collagen type III, or fibronectin. Cytokine production was measured by enzyme-linked immunosorbent assay. The inhibitory action of troglitazone on nuclear factor-kappaB (NF-kappaB) binding activity in activated macrophages was also investigated. RESULTS: Long-term administration of troglitazone reduced inflammatory cell infiltration and fibrosis in the pancreas of WBN/Kob rats, and expression of alpha-SMA, procollagen I, III, and fibronectin was significantly reduced by troglitazone. The increase in TNF-alpha production by activated macrophages was significantly decreased by troglitazone. Peritoneal macrophages isolated from WBN/Kob rats produced a large amount of TNF-alpha, whereas those from troglitazone-treated WBN/Kob rats produced only a marginal amount of TNF-alpha. Lipopolysaccharide-induced NF-kappaB binding activity in peritoneal macrophages was also significantly reduced by troglitazone. CONCLUSIONS: Troglitazone prevented the progression of chronic pancreatitis via inhibition of ECM synthesis and proinflammatory cytokine production mediated by the inhibition of NF-kappaB activity.
Assuntos
Antineoplásicos/uso terapêutico , Cromanos/uso terapêutico , NF-kappa B/metabolismo , PPAR gama/metabolismo , Pancreatite/prevenção & controle , Tiazolidinedionas/uso terapêutico , Fator de Necrose Tumoral alfa/metabolismo , Actinas/metabolismo , Animais , Doença Crônica , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Fibronectinas/metabolismo , Ligantes , Lipopolissacarídeos/farmacologia , Macrófagos Peritoneais/citologia , Macrófagos Peritoneais/metabolismo , Masculino , NF-kappa B/antagonistas & inibidores , Pancreatite/metabolismo , Pancreatite/patologia , Ratos , Ratos Endogâmicos , Ratos Wistar , TroglitazonaRESUMO
Left ventricular myxoma is particulary rare. Our case is a 77-year-old female. Transesophageal echocardiography showed a giant tumor in the left atrium. An urgent operation was performed. A giant mass was excised en bloc via a transinteratrial septal approach. Histopathologically it was myxoma. As a transthoracic echocardiography at 1-year postoperation showed a tumor in the left ventricle. A mass was excised en bloc via a vertical approach. Histopathologically it was diagnosed again as myxoma. We looked at the earliest transesophageal echocardiogram again, and found the small tumor on the same area under the posterior mitral leaflet. At the diagnose of cardiac tumor, possibility of multiple formation should be always considered.
Assuntos
Ecocardiografia Transesofagiana , Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Idoso , Ecocardiografia , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Ventrículos do Coração , Humanos , Mixoma/diagnóstico por imagemRESUMO
AIM: To examine the expression of p65, one of nuclear factor-kappa B (NF-kappa B), in the conjunctival epithelium of the C57Bl6 mouse and a patient with epidemic keratoconjunctivitis (EKC). METHODS: Normal and epithelial scraped cornea obtained 6 hours after the injury were processed for paraffin section. Samples of a normal and an EKC conjunctival epithelium were obtained using impression cytology. Both samples were analysed by immunocytochemistry using anti-p65 antibody. RESULTS: Immunocytochemistry with the anti-NF-kappa B p65 antibody revealed that p65 was localised in the cytoplasm of the conjunctival epithelium in the C57Bl6 mouse without the treatment. Six hours after the scraping of the cornea, p65 protein was expressed in the nuclei of the conjunctival epithelium. p65 was localised in the cytoplasm of the conjunctival epithelium in the human normal eye. p65 protein was expressed in the nuclei of the conjunctival epithelial cells in the EKC patient. CONCLUSION: These findings suggest that NF-kappa B was activated in the conjunctiva in the epithelial scraping of the mouse cornea and in human EKC.
Assuntos
Túnica Conjuntiva/química , Córnea/química , Epitélio Corneano/química , Ceratoconjuntivite/metabolismo , NF-kappa B/análise , Animais , Núcleo Celular/química , Túnica Conjuntiva/lesões , Lesões da Córnea , Citoplasma/química , Células Epiteliais/química , Humanos , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos C57BL , Fator de Transcrição RelAAssuntos
Artéria Carótida Interna , Estenose das Carótidas/diagnóstico , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Oftalmoplegia/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Idoso , Artéria Carótida Interna/patologia , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Transtornos da Visão/etiologiaRESUMO
Gross and histopathological features of auricular chondritis in young Crj:CD(SD)IGS rats were examined. Although the rats were identified with metallic ear tags on the right pinnae, auricular chondritis was also observed on the contralateral (left) ear in some animals. Histopathologically, the lesions were characterized by granulomatous inflammation with destruction of the normal cartilaginous plate, formation of new cartilaginous nodules and osseous metaplasia. Proliferative cell nuclear antigen (PCNA) positive cells were present predominantly in chondrocytes found in the centre of the newly-formed cartilaginous nodules. The results suggest that the newly-formed cartilaginous nodules were due to interstitial proliferation of chondrocytes.
Assuntos
Doenças das Cartilagens/veterinária , Otopatias/veterinária , Inflamação/veterinária , Doenças dos Roedores , Animais , Doenças das Cartilagens/epidemiologia , Doenças das Cartilagens/patologia , Divisão Celular , Condrócitos/química , Condrócitos/patologia , Otopatias/epidemiologia , Otopatias/patologia , Feminino , Granuloma/patologia , Granuloma/veterinária , Inflamação/epidemiologia , Inflamação/patologia , Masculino , Antígeno Nuclear de Célula em Proliferação/análise , Ratos , Ratos Sprague-Dawley , Doenças dos Roedores/epidemiologia , Doenças dos Roedores/patologiaRESUMO
We report a rare case of cervical cord compression caused by intraspinal pannus formation at C6 in a patient with long-term rheumatoid arthritis. No atlantoaxial abnormalities were seen. The imaging findings are presented and the pathology discussed.
Assuntos
Artrite Reumatoide/complicações , Inflamação/etiologia , Compressão da Medula Espinal/etiologia , Vértebras Cervicais , Feminino , Humanos , Inflamação/cirurgia , Laminectomia/métodos , Pessoa de Meia-Idade , Compressão da Medula Espinal/cirurgiaRESUMO
We report a case of extreme, largely unilateral dilatation of Virchow-Robin spaces. Fluid-attenuated inversion-recovery images revealed high-signal foci adjacent to the dilated spaces, possibly due to chronic ischaemia.
Assuntos
Encefalopatias/diagnóstico , Imageamento por Ressonância Magnética , Idoso , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/patologia , Dilatação Patológica , Feminino , Humanos , Isquemia/patologiaRESUMO
Dysfunction of the median nerve is quite common and mostly observed related to carpal tunnel and pronator syndromes. We report a rare case of median nerve compression caused by a leiomyoma in the distal forearm. Spiral CT with MPR (multiplanar reconstruction) clearly located the lesion preoperatively.
Assuntos
Antebraço/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Neuropatia Mediana/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada Espiral , Diagnóstico Diferencial , Antebraço/cirurgia , Humanos , Leiomioma/cirurgia , Masculino , Neuropatia Mediana/cirurgia , Microcirurgia , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Exame Neurológico , Neoplasias de Tecidos Moles/cirurgia , Nervo Sural/transplanteRESUMO
BACKGROUND: Intravenous myocardial contrast echocardiography with harmonic power Doppler imaging is a novel technique for assessing myocardial perfusion. AIMS: The aim of this study was to quantitatively assess myocardial perfusion by harmonic power Doppler imaging in patients with a previous myocardial infarction and compare myocardial contrast echocardiography results with myocardial viability evaluated by thallium-201 single-photon emission computed tomography ((201)Tl-SPECT) and the results of Doppler flow measurement of coronary flow velocity reserve. METHODS: Twenty-three patients with anterior myocardial infarction who were scheduled for adenosine stress (201)Tl-SPECT underwent myocardial contrast echocardiography with harmonic power Doppler imaging. Harmonic power Doppler imaging was performed at rest and during adenosine infusion (0.15 mg/kg/min) using an intravenous infusion of Levovist. The peak colour pixel intensity ratios of the risk area to the control area were used for quantitative analysis of myocardial perfusion by harmonic power Doppler imaging. Coronary blood flow velocity was measured using Doppler-tipped guidewire in the distal portion of left anterior descending artery and coronary flow velocity reserve was calculated. RESULTS: In patients with myocardial viability assessed by (201)Tl-SPECT, pixel intensity ratios both at rest and during hyperaemia were significantly higher compared with those in patients without myocardial viability (at rest: 0.62 +/- 0.28 vs 0.37 +/- 0.17, P=0.038, during hyperaemia 0.72 +/- 0.19 vs 0.40 +/- 0.18, P=0.003). Coronary flow velocity reserve was significantly different between two groups (2.35 +/- 0.43 vs 1.49 +/- 0.53, P <0.01). CONCLUSIONS: Quantitative assessment of microvascular integrity by harmonic power Doppler imaging corresponds to the evaluation of the microcirculation by coronary flow velocity reserve.
Assuntos
Ecocardiografia Doppler , Infarto do Miocárdio/diagnóstico por imagem , Adenosina , Idoso , Velocidade do Fluxo Sanguíneo , Meios de Contraste , Angiografia Coronária , Circulação Coronária , Teste de Esforço , Feminino , Humanos , Injeções Intravenosas , Modelos Lineares , Masculino , Microcirculação , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Polissacarídeos , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
This report reviews the lateralising and localising signs of epileptic seizures in respect to the differential diagnosis of epilepsy. The lateralising value of epileptic signs and symptoms can frequently be derived from the neuroanatomy. Focal clonic, focal tonic, and versive seizures as well as ictal unilateral dystonia are associated with a seizure onset zone in the contralateral hemisphere. Postictal nose wiping is performed with the hand ipsilateral to the epileptogenic zone. Similarly, unilateral blinking points to an ipsilateral seizure onset. Automatisms with preserved consciousness, ictal speech, and vomiting correlate to an epileptogenic zone in the non-dominant hemisphere, while postictal dysphasia is produced by seizures arising from the dominant hemisphere. Lateralising and localising signs and symptoms of epileptic seizures are of great help in the differential diagnosis of epilepsy from the first diagnosis of epileptic events to presurgical video-EEG monitoring.
Assuntos
Encéfalo/patologia , Dominância Cerebral , Epilepsia/diagnóstico , Comportamento Estereotipado , Encéfalo/fisiopatologia , Diagnóstico Diferencial , Epilepsia/patologia , Epilepsia/fisiopatologia , Epilepsia do Lobo Temporal/diagnóstico , Lateralidade Funcional , Humanos , Imageamento por Ressonância Magnética , Exame Neurológico/métodosRESUMO
We describe two cases in which echocardiographic image enhancement with an intravenous contrast agent using harmonic power Doppler (HPD) imaging established the diagnosis of abnormal structures in the left ventricle (LV).
Assuntos
Ecocardiografia Doppler , Idoso , Meios de Contraste , Ecocardiografia Doppler/métodos , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Trombose/complicações , Trombose/diagnóstico , Trombose/diagnóstico por imagemRESUMO
We report the first case to our knowledge of chronic pancreatitis associated with mitochondrial encephalopathy with the A8344G mitochondrial DNA (mtDNA) mutation. This 10-year-old-girl had suffered from recurrent abdominal pain with elevated serum amylase and lipase since the age of 6, and easy fatigability, tremor and astatic seizures since the age of 8. A biopsy of quadriceps muscle revealed ragged-red-fibers and cytochrome c oxidase deficiency. Analysis of mtDNA in peripheral blood identified an A8344G mutation in the mitochondrial tRNA(Lys) gene. Taken together with physical signs of myoclonic seizures and cerebellar dysfunction, we diagnosed her as myoclonic epilepsy with ragged-red fibers associated with chronic pancreatitis. Although no association between mitochondrial disease and pancreatitis has yet been established, this case suggests it is necessary to consider the participation of mitochondrial abnormality in the pathogenesis of recurrent pancreatitis.