Assuntos
Linfoma não Hodgkin/diagnóstico , Neoplasias da Traqueia/diagnóstico , Idoso , Obstrução das Vias Respiratórias/etiologia , Biópsia por Agulha Fina , Fracionamento da Dose de Radiação , Dispneia/etiologia , Endossonografia , Esofagoscopia , Feminino , Humanos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/radioterapia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/radioterapia , Resultado do TratamentoRESUMO
BACKGROUND: Focal zones of hepatic necrosis alternating with nodular regeneration in severe, acute to subacute hepatitis can be difficult to differentiate histologically from established cirrhosis, and diagnostic errors can result in incorrect patient management. Thus, an easily applicable, well-defined histologic method for differentiating these two lesions would be useful. METHODS: We examined trichrome (TRI), reticulin (RETIC), Verhoeff's elastic (VE), and orcein (ORC) stains on 13 cases of hepatic necrosis with regenerative nodules and 10 cases of end-stage cirrhosis to evaluate their utility for this problem. RESULTS: Zones of recent necrosis in all severe hepatitis cases stained paler blue or pink, respectively, with TRI and VE than the established scar in cirrhosis or residual normal portal zones/central vein walls. With VE and ORC, elastic fibres were not seen in the necrotic zones of severe hepatitis, but were present in all cirrhotic livers. RETIC outlined the residual cell plate architecture in necrotic areas but had indistinct staining in fibrotic areas. The combination of the RETIC, TRI and ORC distinguished hepatic necrosis with regenerative nodules from nodules in the scar of established cirrhosis in 100% of the cases examined. CONCLUSION: We conclude that this trio of special stains can be helpful adjuncts for this diagnostic problem.
Assuntos
Corantes , Cirrose Hepática/diagnóstico , Fígado/patologia , Necrose Hepática Massiva/diagnóstico , Adulto , Idoso , Colágeno/análise , Diagnóstico Diferencial , Elastina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reticulina/análiseRESUMO
We report a case of a mucus-filled kidney (muconephrosis) encountered during laparoscopic nephrectomy for presumed xanthogranulomatous pyelonephritis. Conversion to open nephrectomy and en-bloc right hemicolectomy were necessary because of severe perinephric fibrosis and suspected renal-enteral fistula. Pathologic examination revealed a renal pelvic villous adenoma and diffuse intestinal metaplasia of the urothelium; no enteral communication or gastrointestinal pathologic features were found. Urothelial villous adenoma is extremely rare, and one should consider neoplastic etiologies, including appendiceal mucinous cystadenocarcinoma and mucus-secreting adenocarcinoma of the renal pelvis, in directing the appropriate management of muconephrosis.
