Piriformis syndrome--an attempt to understand its pathology.

OBJECTIVE: Gross anatomy of the hip rotators and histology of the sciatic nerves in adult cadavers were studied, aiming to the identification of possible pathologic changes related to the piriformis syndrome (PS). MATERIAL: 50 cadavers were dissected; in 17 cases with macroscopical findings the sciatic nerves were harvested (34 sciatic nerves; 17 cadavers). History of low back or leg pain was not available. METHOD: Site anatomy and additional findings at the harvesting sites were recorded, such as anatomical variations, adhesions, hematomas etc. All nerves were additionally microscopically analyzed. In cases with findings at the dissection, the contralateral unaffected nerves served as controls. All the dissected nerves were conserved in 10% formalin solution, embedded in paraffin, stained with Hematoxylin and Eosin (H&E) and immunolabeled with antibodies against Neurofilament (NF). RESULTS: Both the H&E staining as well as the performed immunohistochemistry showed, to a variable degree, significant alterations in the structure of the affected nerves compared to the controls. CONCLUSIONS: These findings both in the local anatomy and sciatic nerve correspond to lesions that are expected in PS. Nevertheless, since this was a cadaveric study, unassociated to a certain pain patient's history, results should be considered and interpreted as an indication of a sciatic nerve injury in PS.

In situ expression of E-selectin and intercellular adhesion molecule-1 in chronic inflammatory diseases of the gastrointestinal tract.

AIM: The study of cell adhesion molecules contributes to our understanding of the inflammatory mechanisms which include the endothelial activation of newly formed or pre-existing vessels, the increase of inflammatory cells' adhesive capability and their migration into perivascular tissues. The aim of the present study was to investigate the local presence and the extent of expression of E-selectin and intercellular adhesion molecule-1 (ICAM-1) in the mucosa of patients with chronic gastritis, chronic inflammatory bowel disease, and controls, as well as to identify possible correlations between in situ expression of the above adhesion molecules and degree of inflammatory activity or therapeutic response. DESIGN: In cryostat tissue sections we examined the immunohistochemical expression and localization of E-selectin and the intercellular adhesion molecule-1 (ICAM-1). Our specimens consisted of 27 cases of chronic gastritis, 42 cases of ulcerative colitis, and 15 cases of Crohn's disease. RESULTS: E-selectin was expressed in capillary endothelia as well as on neutrophils, located either in the lamina propria or in the glandular epithelia or lumina. This marker's expression was associated with the active phase of ulcerative colitis (p<0.0005) and possibly of chronic gastritis (p=0.06). ICAM-1 immunolabelling was localized in endothelia and chronic inflammatory components which had passed through the vascular walls. This marker's immunoreactivity was generally increased in all our specimens compared to normal mucosa and generally tended to correlate with chronic phases of the inflammatory process (p<0.10). CONCLUSIONS: E-selectin regulates the accumulation of neutrophils in the early stages of the inflammatory process and is thus associated at least with the active phase of ulcerative colitis. Whether any post-therapy alteration of E-selectin immunopositivity seems to indicate a good response to drug therapy is well worth investigating in ulcerative colitis patients. ICAM-1 immunoreactivity in lymphoplasmacytic infiltrates might serve as a marker of chronic immune stimulation, which is potentially responsible for the persistence of the inflammatory disorders.

Middle ear adenomatous tumor with a predominant neuroendocrine component.

A primary adenomatous tumor of the middle ear was examined by light microscopy, ultrastructural and immunohistochemical techniques. In support of its extensive neuroendocrine differentiation, was the diffuse detection of neuron-specific enolase (NSE) and positive immunoreaction with antibodies to chromogranin and synaptophysin. The great majority of tumor cells contained neurosecretory granules and intraluminal mucin production could be focally detected. These characteristics confirm the diagnosis of a middle ear adenomatous tumor (MEAT) of a biphasic nature and with a prominent neuroendocrine component.

A solitary cutaneous tumor with distinct areas of verruca and seborrheic keratosis-like lesion.

A single, exophytic, cutaneous tumor on the thigh of a 52-year-old man was examined by light microscopy, in situ hybridization and immunohistochemistry. It demonstrated distinct areas of verruca and of seborrheic keratosis-like morphology simultaneously. Focally, architectural abnormalities were noted in some deeper parts of the tumor, but there was no morphological evidence of malignancy. The patient has remained disease-free for two and a half years after surgery. Biotinylated full genomicDNA probes of HPV confirmed the presence of types 6/11 exclusively in the verrucous portion of the neoplasm. In the verrucous component p53 protein was overexpressed and, additionally, increased Ki-67 immunopositive signals were detected, being localized below the HPV-DNA-expressing spinous cells.

Morphological-histochemical study of intestinal carcinoids and K-ras mutation analysis in appendiceal carcinoids.

Intestinal carcinoids are potentially malignant neoplasms. Their histogenesis and pathogenesis are currently uncertain. The morphological and histochemical characteristics of twenty intestinal carcinoids are studied. The primary sites of three mucin-producing tumors were examined by electron microscope. Furthermore 11 appendiceal carcinoids were analysed by the polymerase chain reaction (PCR) for the detection of ras and p53 point mutations. Microscopically all carcinoids were of mixed type. Focal mucin production was evident in three carcinoids that metastasised to regional lymph nodes. HID-Alcian blue staining proved that mucin in both primary and secondary foci did not belong to the sulphated group. The secretory granules and mucin droplets found in a single neoplastic cell suggest that carcinoids of the small intestine and some of the appendix arise from the endoderm. Neither ras nor p53 mutations were detected. It seems that ras oncogenes are probably not involved in the pathogenesis of appendiceal carcinoids.

Membranous glomerulonephritis: a morphometric study.

Archival material from 45 renal biopsies with a diagnosis of idiopathic membranous glomerulonephritis (MGN) were studied by computer-aided image analysis in order to evaluate the prognostic significance of glomerular and interstitial morphometry in MGN. The control group consisted of thirty seven normal renal biopsy specimens. The surface area, the perimeter, the major axis length and the shape factor of renal glomeruli as well as the percentage of the interstitial fibrosis were measured. All the morphometric parameters related to the size of glomeruli had significantly higher values in the patient group (p = 0.000 for all the parameters). However, no significant difference of the glomerular size between different stages of MGN was observed. In contrast, the percentage of interstitial fibrosis increased as the MGN stage rose (median values: 10.3% in stage 1, 14.2% in stage II, 26.9% in stage III, 28.9% in stage IV and 34.2% in stage V, Kruskal-Wallis ANOVA H = 37.645, p = 0.000). In the multivariate analysis the percentage of interstitial fibrosis was the only independent prognostic factor (p = 0.013). Our findings suggest that, in membraneous glomerulonephritis, the interstitial fibrosis increases as the MGN stage progresses, while the size of renal glomeruli has increased at a very early stage of the disease. This fact may indicate that interstitial fibrosis, not glomerular lesions, is mainly responsible for the reduction of renal function.

Lipoid proteinosis of the oral mucosa: case report and review of the literature.

We describe a 37-year-old woman who presented with progressive mouth dryness. Physical examination revealed long-standing plaques on the face and upper limbs, papular lesions of the oral cavity and tongue firmness. A lower lip biopsy was performed. Light microscopy demonstrated accumulation of PAS-positive material around blood vessels, capillaries and salivary gland canaliculi as well as focally massive hyaline deposits in the submucosa. Immunohistochemistry revealed widespread presence of type IV collagen in the hyaline material and around thickened blood vessels. Laminin immunoreactivity was particularly strong at thickened basement membranes. The above findings were compatible with lipoid proteinosis, which is likely to involve primary perturbation of collagen metabolism and production of glycoproteins.

Primary myxoid chondrosarcoma of the thyroid gland.

We describe a case of primary myxoid chondrosarcoma of the thyroid gland that occurred in a 68-year-old man. To our knowledge, this is the first case of such a tumor reported in the english literature under this name.

Neuroendocrine differentiation in follicle-cell thyroid carcinoma: correlation to prognostic factors in papillary carcinoma.

The presence of NE-differentiation in the follicle-cell thyroid carcinoma has been investigated by immunohistochemical detection of chromogranin A in the neoplastic cells. It has been found that NE-differentiation was present in a significant percentage in the papillary Ca alone (46.60%) whereas all Huerthle-cell neoplasms and the large majority of follicular and undifferentiated carcinomas showed non reactivity for Chromogranin A. Moreover, we have correlated the presence of NE-differentiation to well known prognostic factors in papillary Ca. We found a statistically significant correlation between the neuroendocrine differentiation and some unfavourable factors such as old age of the patient, size of the tumor, invasion of thyroid capsule and lymphnode involvement. We suggested that NE-differentiation could be considered as an index of poor prognosis.

Primary retroperitoneal mucinous cystadenoma. A rare case with two cysts and review of the literature.

BACKGROUND: Primary retroperitoneal mucinous cystadenoma is a rare neoplasm, with benign biological behavior. Delay in diagnosis and treatment of this tumor may be fatal for the patient, because of complications, such as rupture, infection and malignant transformation. CASE PRESENTATION: We present a 23-year-old woman, who was admitted to the hospital because of a palpable abdominal mass and discomfort since 4 months. Computed Tomography and Magnetic Resonance Imaging scans were performed and showed two retroperitoneal cystic masses, which were excised by laparoscopy. Histological and immunohistochemical examination revealed that the inner surfaces of the cysts were lined by epithelium with features of mesothelial cells, in addition to ovarian mucinous cystadenoma. This is the 29(th) case and the second reported case with two contemporary cysts. CONCLUSION: The origin of retroperitoneal mucinous cystadenomas is still unclear. Pathological and immunohistochemical findings proved that these tumors resemble ovarian mucinous cystadenomas but are unattached to the ovary and can arise at any location in the retroperitoneum. Surgical excision of the aforementioned tumors is the treatment of choice. Hippokratia 2014; 18 (3): 278-281.

[Loss of beta 2 microglobulin from the surface of "dysplastic" and malignant epithelial cells of the uterine cervix]. / Verlust von beta 2-Mikroglobulin aus der Oberfläche "dysplastischer" und maligner Epithelzellen der Cervix uteri.

We studied 75 cervical biopsies (39 cases with CIN I-III and 36 with invasive squamous carcinoma differentiated to various degrees) immunohistochemically to determine the beta 2-m content of the epithelial cells. In cells having CIN we found a clear decrease in beta 2-m with a statistically significant correlation to the degrees of severity of the lesion. All of the invasive carcinomas showed a complete absence of beta 2-m. This finding should be evaluated within the framework of an immunological dedifferentiation, and it supports the views regarding the neoplastic nature of cervical dysplasia. The demonstration of beta 2-m in atypical epithelial cells of the cervix is a possible indication for the intraepithelial localisation of the lesion.

Computerized morphometric study on fine needle aspirates of cellular follicular lesions of the thyroid.

OBJECTIVE: To investigate the value of computerized nuclear morphometry in the differential diagnosis of cellular follicular lesions of the thyroid cytologically diagnosed on fine needle aspiration (FNA) smears. STUDY DESIGN: Sixty cases of FNA thyroid smears were cytologically diagnosed and classified as follows: 30 cases of follicular carcinoma, 20 cases of cellular hyperplastic nodules and 10 cases of follicular adenoma. Using an image analysis system, two morphometric variables, nuclear area and major axis length of the nucleus, were measured for each case. RESULTS: For both nuclear morphometric variables, statistical differences were found between carcinomas and hyperplastic nodules as well as between carcinomas and adenomas. No statistical differences were found between the nuclear variables in either hyperplastic nodules or adenomas. CONCLUSION: The results confirm the aim of our study, to establish nuclear morphometry by computerized image analysis as an additional tool in the differential diagnosis of thyroid follicular lesions cytologically diagnosed on FNA smears.

Effect of dietary protein restriction on the development of renal failure after subtotal nephrectomy in rats.

We have examined the effect of a low protein diet on the development of glomerular sclerosis and progressive renal failure after subtotal nephrectomies in rats. Two groups of male Sprague-Dawley rats were studied after five-sixths nephrectomy; group 1 were maintained on a normal diet (13.5 g day-1 kg-1 body weight) and group 2 were fed with a low protein diet (6 g day-1 kg-1 body weight). Rats maintained on a low protein diet survived for longer, and had significantly less glomerular sclerosis and significantly greater glomerular filtration rates when the experiment ended after 7 months. We conclude that dietary protein influences favourably the development of glomerular scarring and renal failure after subtotal nephrectomy in rats.

Unilateral ureteric ligation in diabetic rats: a pathologic and morphometric study.

We studied the combined effect of unilateral ureteral ligation on the morphology and pathology of the contralateral kidney in normal and streptozotocin induced diabetic rats. In the diabetic group that underwent ligation of the right ureter the weight and volume of the left kidney was far greater, the tissue specific gravity far lower, while the percentage of affected glomeruli was significantly greater compared with control rats and those undergoing only ureteric ligation.

Histological diagnosis of cutaneous "warty" carcinoma on a pre-existing HPV lesion.

A middle-aged man with an 8-year history of a fungating tumour mass on his thigh was histologically diagnosed as having an invasive "warty" carcinoma at the location of a pre-existing human papillomavirus (HPV) lesion. The tumour surface had a verruciform appearance with papillae containing fibrovascular cores. Many of the malignant cells displayed changes consistent with koilocytotic atypia. We noticed a greater degree of nuclear atypia in comparison with a verrucous carcinoma. Focally, some neoplastic cells demonstrated features of basaloid differentiation. Under in situ hybridization conditions, only HPV16 DNA, which is commonly associated with genital neoplasia, was detected selectively in rather superficial areas, corresponding to morphological evidence of HPV infection (i.e. koilocytotic atypia). It is worth noting that cutaneous location of such a warty carcinoma is very rare.

Spontaneous interbody fusion after controlled injuries to the spine: an experimental study in rabbits.

To evaluate the rationale of spontaneous spine fusion after a spinal injury, the authors conducted an experimental study that consisted of three types of controlled injuries to a rabbit spine model. The first was injury to the intervertebral disk (type I injury). The second was injury of the intervertebral disk along with injury to one of the adjacent vertebral end plates (type II). In type III injury, both the opposing end plates were injured along with the intervertebral disk. In 38 rabbits, a total of 82 injuries of these three types were inflicted. Twenty-six injuries were of type I (n = 22 rabbits), 26 were type II (n = 24 rabbits), and 30 were type III (n = 26 rabbits). Spontaneous fusion occurred only in type III injuries. From the 30 type III injuries, fusion occurred in 20 (66.6%). For an autofusion to occur, both epiphyseal plates may be injured. In the clinical situation, this observation suggests that a radiographically obscure lesion of both neighboring vertebrae may proceed to autofusion of that spinal segment observed later.

Congenital epulis: an ultrastructural and immunohistochemical case study.

We report a case of an otherwise healthy, two days old, female with a a mass derived from the mandible. Light microscopy findings were compatible with the diagnosis of congenital epulis. The lesion showed negative staining for S-100 protein, which is a characteristic finding in cases of epulis and distinguishes it from granular cell tumor. The characteristic electron microscopy findings, as well as other features of epulis in relation to the theories for its possible origin are also reviewed

Localization of the glucocorticoid receptor in rat brain mitochondria.

The distribution of glucocorticoid receptor in subcellular fractions of brain cortex and hippocampus, two regions rich in glucocorticoid receptor, has revealed its presence in nuclei, cytosol, mitochondria, synaptosomes, and synaptosomal mitochondria. The identification of glucocorticoid receptor has been accomplished both by Western blotting using antibodies recognizing the carboxy and the amino terminus of the glucocorticoid receptor and by immunogold electron microscopy using the same anti-glucocorticoid receptor antibodies. Antibody-glucocorticoid receptor interaction is abolished by preincubation of each antibody with its competing peptide. In addition to the intact 95-kDa glucocorticoid receptor in all fractions, lower molecular weight glucocorticoid receptor fragments have been also detected by Western blotting. The presence of glucocorticoid receptor in brain mitochondria supports the concept of a direct action of glucocorticoids on mitochondrial gene transcription, parallel to the established primary actions of the hormones on nuclear gene transcription, as a mechanism of coordinate regulation of respiratory enzyme biosynthesis by steroid hormones.

Epidermolysis bullosa acquisita: treatment with intravenous immunoglobulins.

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune bullous disorder that is often difficult to treat. Few cases have been reported and therapy consists mainly of combinations of systemic steroids, immunosuppressants and, recently, administration of intravenous human immunoglobulin (IVIg). We describe a case of EBA in which our therapeutic choices were limited due to the patient's poor general condition, including extensive infection of the lesions and a history of pulmonary tuberculosis. The patient was treated with IVIg at a dose of 400 mg/kg per day for 5 consecutive days every 4 weeks. The treatment was well tolerated and the results were satisfactory. It seems that IVIg, due to its possible immunomodulatory mode of action, can be an efficacious therapeutic agent in this rare autoimmune disease.

Findings of computerized nuclear morphometry of papillary thyroid carcinoma in correlation with the age of the patients.

The aim of this study was to evaluate the usefulness of nuclear morphometry in the pathology of papillary thyroid carcinoma by computer-aided image analysis and the statistical comparison of nuclear morphometric parameters with the age of patients. Seventy cases of papillary thyroid carcinoma diagnosed by fine needle aspiration (FNA) biopsies were classified into two groups according to the patients' age (group I: <45 years and group II: >45 years). The following six nuclear morphometric parameters were measured in a large number of randomly selected nuclei of each case: area, perimeter, major axis length, elongation, roundness, and compactness. The statistical analysis was performed by using special algorithms, and the results of the two groups were compared for each of the parameters measured using the t-test. Area, perimeter, and major axis length of papillary thyroid carcinoma nuclei demonstrate a statistically significant correlation with the age of patients, whereas elongation, roundness, and compactness did not show any correlation. Nuclear morphometry in association with the follow-up of patients could be suggested as an important prognostic index for papillary thyroid carcinoma.