Application of the current diagnostic algorithm for early mycosis fungoides to a single center cohort: Identification of challenges and suggestions for modification.

BACKGROUND: Diagnosing early-stage mycosis fungoides (MF) remains a significant challenge. The International Society for Cutaneous Lymphomas (ISCL) proposed an algorithm for diagnosing early MF incorporating clinical and histopathologic characteristics, as well as immunohistochemistry and molecular studies. Here we aim to examine the diagnostic utility of the ISCL algorithm. METHODS: In this single-center retrospective review, the ISCL algorithm was applied to 28 patients diagnosed with early-stage MF. Immunohistochemistry and molecular studies were not performed for all patients, so a subgroup analysis was conducted including 18 patients in whom both studies had been performed. We calculated the diagnostic sensitivity of the algorithm. Subsequently, we examined how modifying the algorithm's histopathologic criterion from epidermotropism without spongiosis to epidermotropism influenced its sensitivity. RESULTS: Forty-three percent (12/28) of the cohort and 50% (9/18) of the subgroup met the algorithm's diagnostic threshold. When the algorithm was modified, 71% of the cohort and 89% of the subgroup met the algorithm's threshold. CONCLUSION: While the ISCL algorithm is useful in diagnosing early-stage MF, its sensitivity remains suboptimal. Further refinement of the algorithm to capture spongiotic subtypes of MF may improve its diagnostic value.

Results of native and transplant kidney biopsies of children in a single center over a 15 years period.

Renal biopsy is an important diagnostic procedure in pediatric nephrology. This study retrospectively investigates the indications, results and complications in a single tertiary children's hospital in Turkey. We evaluated the native and transplant kidney biopsies in Gazi University Pediatric Nephrology Department between 2001 and 2015. A total of 196 biopsies (144 natives and 52 transplants) were included into the study. The mean age of the patients was respectively 10.8 ± 3.5, 13.9 ± 1.5 years. The main indication for a biopsy was non-nephrotic proteinuria with or without hematuria (n= 35), followed by steroid-resistance nephrotic syndrome (SRNS) (n = 34) and Henoch-Schönlein purpura (HSP)-related proteinuria (n = 20) for native kidneys. We found that focal segmental glomerulosclerosis (FSGS) (11.7%) was the most common histopathologic diagnosis for native kidneys, but acute cellular rejection (7.6%) was the most common histopathologic diagnosis for transplant kidneys. The complication rate in our study was founded 6.6% totally. Different complication rates were found in other studies; however, we think that this difference comes from the inspecting methodology of the complications. Hence, we wanted to share our own experience in the context of other studies in the literature.

Diagnostic pitfalls in pathological diagnosis of infectious disease: patients with syphilitic lymphadenitis often present with inconspicuous history of infection.

Retrospective study was applied to 16 cases of syphilitic lymphadenitis to elucidate the pathological diagnostic features. The typical morphology of syphilitic lymphadenitis includes: (i) well preserved or partially destroyed lymph node structure; (ii) reactive hyperplasia of lymph follicles with broadened germinal centers in the cortex and medulla of the lymph node; (iii) thickened fibrotic lymph node capsules with infiltration of plasma cells; and (iv) phlebitis and endarteritis in varying degree. Additional morphology includes: (i) focal histiocytes with ingested debris; (ii) noncaseating granuloma with epithelioid histiocytes and disperse giant cells; and (iii) hyperplastic centroblast and occasionally isolated mononuclear Reed-Sternberg cell-like giant cells. Treponema pallidum was identified in 15 of the 16 cases by immunohistochemical staining. The histopathological diagnosis of syphilitic lymphadenitis poses difficulty in differentiation from other infectious or neoplastic lymphadenopathies. The newly established Treponema pallidum antibody is sensitive to identification of Treponema pallidum in formalin fixed paraffin embedded tissue.

Prior knowledge of the clinical picture does not introduce bias in the histopathologic diagnosis of melanocytic skin lesions.

A common debate among dermatopathologists is that prior knowledge of the clinical picture of melanocytic skin neoplasms may introduce a potential bias in the histopathologic examination. Histologic slides from 99 melanocytic skin neoplasms were circulated among 10 clinical dermatologists, all of them formally trained and board-certified dermatopathologists: 5 dermatopathologists had clinical images available after a 'blind' examination (Group 1); the other 5 had clinical images available before microscopic examination (Group 2). Data from the two groups were compared regarding 'consensus' (a diagnosis in agreement by ≥4 dermatopathologists/group), chance-corrected interobserver agreement (Fleiss' k) and level of diagnostic confidence (LDC: a 1-5 arbitrary scale indicating 'increasing reliability' of any given diagnosis). Compared with Group 1 dermatopathologists, Group 2 achieved a lower number of consensus (84 vs. 90) but a higher k value (0.74 vs. 0.69) and a greater mean LDC value (4.57 vs. 4.32). The same consensus was achieved by the two groups in 81/99 cases. Spitzoid neoplasms were most frequently controversial for both groups. The histopathologic interpretation of melanocytic neoplasms seems to be not biased by the knowledge of the clinical picture before histopathologic examination.

The First Case of Human Hepatic Fasciolosis Presented as Hepatic Pseudotumor Histopathologically Diagnosed in Romania-A Case Report.

Human hepatic fasciolosis has been reported in 81 countries, some of which are endemic areas. In Europe, case reports from humans were published in Portugal, Spain, France, and Italy. Regarding Romania, we do not have any data on the prevalence of this parasitosis, with the exception of two cases of twins that were born in Romania and diagnosed in the last 37 years in Italy after joining their mother that lived there. We report the case of a patient diagnosed in Romania with chronic fasciolosis, presented as a hepatic pseudotumor that was diagnosed during the histopathological examination of the hepatic lesion. The patient received oral treatment with triclabendazole, two doses of 10 milligrams (mg) per kilogram (kg) of body weight, given 12 h apart, with no side effects during or after the treatment. The evolution of the patient was favorable. In conclusion, even in areas free of human fasciolosis, the presence of an anemic syndrome especially in children, abdominal pain in the upper quadrants, associated or not with other digestive manifestations, even more so associated with eosinophilia in the acute phase, should be carefully evaluated for ruling out a parasitosis such as fasciolosis even in countries where this diagnosis seems unlikely.

Incipient Melanonychia: Benign Finding or Occult Malignancy? A Case Report of Subungual Melanoma.

Subungual melanomas are rare neoplasms that tend to debut as longitudinal melanonychia. They are primarily found in patients over 60 years of age and are usually diagnosed late, representing a diagnostic challenge. We present a case report of a 59-year-old female Hispanic patient who initially presented with melanonychia and was eventually diagnosed with subungual melanoma in situ. She was surgically treated and, after three months, remained healthy. Relevant risk factors, clinical and onychoscopic findings, diagnostic criteria, and treatment options are also discussed. Since many benign entities present similarly, high clinical suspicion is critical for diagnosing this entity.

The Diagnostic Dilemma of an Odontogenic Jaw Lesion in a Pediatric Patient: A Case Report.

This paper presents a case report of a 10-year-old child patient reported with the chief complaint of a painless, hard swelling in the lower right back region of the jaw. The clinical and radiographic examination, including intraoral periapical radiograph (IOPA) and cone-beam CT (CBCT), was performed. Conservative treatment was planned based on the clinical and radiological diagnosis of the cyst. But the histological examination revealed unicystic ameloblastoma (UA). This clinical case of UA, which was misdiagnosed as a combination of a radicular cyst and a dentigerous cyst, is being presented to highlight the importance of histopathologic investigation of all tissue specimens retrieved after surgery, particularly when the clinical and radiological findings are insignificant.

Primary Dermal Melanoma: A Rare Clinicopathological Variant Mimicking Metastatic Melanoma.

Primary dermal melanoma (PDM) is a rare distinct variant of cutaneous melanoma, predominantly occurring on the extremities of young or middle-aged adults. In comparison to conventional melanoma, PDM is characterized by unexpectedly prolonged survival and long-term survival. Thus, correct identification of this variant is crucial to avoid potential misdiagnosis and establish correct treatment and follow-up. In addition, no consensus and specific guidelines exist on the management of this peculiar subtype of cutaneous melanoma.

Radiologic-Histopathologic Correlation of Adult Spinal Tumors: A Retrospective Study.

AIM: Preoperatively performed magnetic resonance images (MRIs) are essential before treating spinal tumors surgically. This study aims to investigate the compatibility of MRI preliminary diagnosis and proven histopathologic diagnosis of consecutively operated 96 spinal tumors. MATERIAL AND METHODS: Medical records were retrospectively reviewed for all spinal tumors operated at our institute during a period of 6 years. One hundred and ten spinal tumors were detected. Fourteen tumors were excluded because they were not met our study criteria. RESULTS: Ninety-six cases of spinal tumors were detected in 46 female and 50 male patients. The mean age was 49.3 ± 22.7 years. The most common symptom was radicular pain (88.6%). Histopathologic diagnoses were metastasis (n = 26), meningioma (n = 16), schwannoma (n = 15), ependymoma (n = 9), astrocytoma (n = 6), chronic nonspecific granulomatous infection (n = 4), lymphoma (n = 3), lipoma (n = 3), epidural tuberculosis abscess (Pott's disease) (n = 3), and other pathologies in 11 cases. Cervical spine was the less spinal region affected with metastases (P < 0.05). Thoracic spine was the most affected spinal region from meningioma (P < 0.05). Preoperatively, preliminary diagnosis on MRIs was proven with histopathologic examinations in 22 metastasis, 14 meningioma, 11 schwannoma, and all epidermoid cyst and lipoma cases. Despite the fact that MRI cannot diagnose all cases of spinal tumors, MRIs had a high accurate rate to diagnose the most common spinal neoplasms (69.8%). CONCLUSIONS: Metastases rarely occurred in cervical spine, whereas meningiomas were most likely to occur in thoracic spine. MRIs can help diagnose metastases and spinal benign lesions, whereas they failed to distinguish astrocytomas and lymphomas. Further prospective studies with large size are needed to support our results.

Pathomorphological features of calcinosis circumscripta in a dog.

A 19-month-old male German shepherd dog was presented with a hindlimb footpad mass. The mass was excised and histopathology was performed. Grossly, the cut section of the mass had multiple well-circumscribed nodules with a chalky appearance. Histopathologically, basophilic-stained calcium deposits of various sizes were distributed from dermis to subcutis, surrounded by epithelioid cells, multinucleated giant cells, and reactive fibroblasts. Myxoid metaplasia, calcium deposits in hair follicles, and psammoma-like bodies were also found. These histopathologic observations will greatly help to understand the pathogenesis of calcinosis circumscripta.

Geriatric oral lesions: A multicentric study.

AIM: To carry out an oral biopsy survey in geriatric patients from the participating institutions. METHODS: The biopsy records of the participating institutions were reviewed for oral lesions from patients aged 65 years and older diagnosed from 2003 to 2012. Demographic data and the site of the lesions were collected. Histopathological diagnoses were categorized into two categories: non-neoplastic lesions (reactive/inflammatory lesion, cyst, allergic/immunologic disorders, potentially malignant disorders, infection and others) and neoplastic lesions (benign and malignant tumors). Data were analyzed by appropriate statistics using stata11. RESULTS: Of the 76,045 accessioned cases, 11,346 cases (14.92%) were in geriatric patients. The mean age of the patients was 72.98 ± 6.25 years. A total of 5010 cases (44.16%) were diagnosed in males, whereas 6336 cases (55.84%) were diagnosed in females. The male-to-female ratio was 0.79:1. Non-neoplastic lesions outnumbered the neoplastic counterpart. The five most prevalent oral lesions in the geriatric population in the present study in descending order of frequency were squamous cell carcinoma, focal fibrous hyperplasia (irritation fibroma), radicular cyst, osteomyelitis and epithelial dysplasia, respectively. The site of predilection was labial/buccal mucosa, followed by gingiva, mandibular bone, tongue and maxillary bone, respectively. CONCLUSIONS: The geriatric oral lesions from the present study showed a similar trend with studies based on histopathological data, but different from the studies based on clinical data. This study also shed more light on potentially malignant disorders, as well as benign and malignant tumors.

Suction Filter in Endoscopic Endonasal Surgery: A Technical Note.

BACKGROUND: The collection of the greatest possible amount of pathologic tissue is of paramount importance in neurosurgery to achieve the most accurate histopathologic diagnosis, to perform all of the necessary biomolecular tests on the pathologic specimen, and to collect biological material for basic or translational science studies. This problem is particularly relevant in pituitary surgery because of the possible small size and soft consistency of tumors, which make them suitable for removal through suction, reducing the amount of available pathologic tissue. To solve this issue, we adopted a filter connected to the suction tube, which allows the surgeon to collect all of the tissue aspirated during surgery. METHODS: Our experience of 1734 endoscopic endonasal procedures, performed adopting this device since 1998 to December 2015, has been revised to assess its advantages and limitations. RESULTS: This system is easy-to-use, does not impair the surgical maneuvers, and does not add any relevant cost to the surgery. The tissue collected through the filter proved useful for diagnostic histologic and biomolecular analyses and for research purposes, without any relevant artifacts as a result of this method of collection. CONCLUSIONS: The use of a filter has allowed us to obtain the greatest amount possible of pathologic tissue at each surgery. This surgical material has revealed to be helpful both for diagnostic and basic science purposes. The use of the filter has proven to be of particular importance for microadenomas, soft tumors, and supradiaphragmatic or skull base lesions with heterogeneous features, improving the accuracy of histopathologic diagnosis.

Role of galactography in the early diagnosis of breast cancer.

BACKGROUND: The purpose of this study was to evaluate the usefulness of galactography (GL) in the early diagnosis of breast cancer in patients with pathologic nipple discharge (PND). PATIENTS AND METHODS: We retrospectively studied all galactograms obtained in 117 women with PND, who subsequently had a biopsy. The findings detected in the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System (GICS): GICS 2, benign; GICS 3, probably benign; GICS 4, suspicious for malignancy; and GICS 5, highly suspicious for malignancy. RESULTS: The galactograms were classified into GICS 2 (29 cases; 24.7%), GICS 3 (42 cases; 35.8%), GICS 4 (30 cases; 25.6%), and GICS 5 (16 cases; 13.6%). A good correlation was observed between histological diagnosis and GICS categories (p < 0.05). All cases diagnosed with carcinoma (n = 18) were classified in GICS categories 4-5: ductal carcinoma in situ in 14 cases (11.9%) and invasive carcinoma in 4 cases (3.4%). CONCLUSION: GL is a useful procedure in the early diagnosis of breast cancer in patients with PND.

Pathomorphological features of calcinosis circumscripta in a dog / 한국실험동물학회지

A 19-month-old male German shepherd dog was presented with a hindlimb footpad mass. The mass was excised and histopathology was performed. Grossly, the cut section of the mass had multiple well-circumscribed nodules with a chalky appearance. Histopathologically, basophilic-stained calcium deposits of various sizes were distributed from dermis to subcutis, surrounded by epithelioid cells, multinucleated giant cells, and reactive fibroblasts. Myxoid metaplasia, calcium deposits in hair follicles, and psammoma-like bodies were also found. These histopathologic observations will greatly help to understand the pathogenesis of calcinosis circumscripta.

Candidiasis bucal en pacientes con diabetes mellitus / Oral Candidiasis in patients with diabetes mellitus

Se realizó un estudio descriptivo y transversal de 75 pacientes con diabetes mellitus, quienes presentaron candidiasis bucal, tratados en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde marzo de 2013 hasta igual mes de 2015, a fin de evaluar los resultados del diagnóstico clínico e histopatológico de la citada afección. Las muestras para biopsias se fijaron y procesaron con la técnica clásica de inclusión en parafina; se colorearon con una tinción especial de ácido peryódico de Schiff, lo cual confirmó la existencia de cambios celulares. Predominaron el sexo masculino, el grupo etario de 60 años y más; la ausencia de manifestaciones clínicas, el paladar duro y la comisura labial como los sitios de mayor prevalencia y la candidiasis eritematosa como la forma clínica más común. La presencia de hifas patógenas y células levaduriformes fueron los hallazgos histopatológicos más sobresalientes.

A descriptive and cross-sectional study of 75 patients with diabetes mellitus who presented oral candidiasis, treated in the stomatological service of the Specialties Polyclinic of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out, from March, 2013 to the same month in 2015, in order to evaluate the results of the clinical and histopathologic diagnosis of the mentioned affection. The samples for biopsies were fixed and processed with the classic technique of inclusion in paraffin; they were colored with a special stain of Schiff periodic acid, which confirmed the existence of cellular changes. There was a prevalence of male sex, the 60 years and over age group; the absence of clinical symptoms, the hard palate and the corner of the mouth as the sites of greater prevalence and the erythematous candidiasis as the most common clinical form. The presence of pathogen hyphae and yeast-like cells were the most outstanding histopathologic findings.

Consistency rates of clinical and histopathologic diagnoses of oral soft tissue exophytic lesions.

BACKGROUND AND AIMS: Histpathologic diagnosis of exophytic lesions is occasionally influenced by clinical and radiograph-ic diagnosis and even the surgeon's observation during biopsy. The aim of this study was to evaluate the cases with failure in clinical diagnosis. MATERIALS AND METHODS: A total of 73 patients with peripheral exophytic lesions were evaluated in Zahedan Faculty of Den-tistry in 2006. Specialists gave their differential diagnoses based on the criteria of oral medicine texts. Then a biopsy was taken and the histopathologic diagnosis was determined. Finally, consistency rates of clinical and histopathologic diagnoses were de-termined. Statistical analysis was carried out with SPSS software using Chi-Square and Fisher's exact tests. RESULTS: In the present study 73 subjects with oral soft tissue (peripheral) exophytic lesions were orally examined and biopsies were taken. Forty-four subjects (60.35%) were females and 29 (39.7%) were males. A total of 81.7% (62 subjects) of clinical diagnoses were consistent with histopathologic reports. In 18.3% (11 subjects) of the cases clinical diagnoses were not con-firmed by histopathologic reports. CONCLUSION: In order to reach a diagnostic agreement, conformity of clinical and histopathologic diagnoses is necessary.

Proporción de concordancia entre los diagnósticos clínico e histopatológico bucofaciales durante 20 años / Proportion of agreement between the clinical and the histopathologic diagnosis during 20 years

Se realizó un estudio para determinar la proporción de concordancia entre los diagnósticos clínico e histopatológico de las biopsias estudiadas en el departamento de Patología Bucal de la Facultad de Odontología de la Universidad Autónoma de Nuevo León. Se recopilaron los diagnósticos histopatológicos de 2 183 biopsias a partir del libro de registro de los años 1989 a 2008. Se asignaron códigos a las distintas variables estudiadas y se procesaron con Epi Info para obtener las frecuencias y porcentajes. El estudio presentó una concordancia del 54,1 por ciento, ligera discordancia del 13,8 por ciento, no concordancia de 7,9 por ciento y sin diagnóstico clínico un 24,2 por ciento. Las lesiones en glándulas salivales presentaron la mayor concordancia con un 66,8 por ciento y para tejido óseo los quistes no odontogénicos ocuparon el primer lugar de concordancia con el 80,0 por ciento. Se encontró una concordancia aceptable, superior a otros estudios similares. Existe la posiblidad de mejorar el nivel científico mediante la actualización continua de los clínicos(AU)

To determine the proportion of agreement between the clinical and histopathologic diagnoses of study biopsies in the Oral Pathology Department. From the registry book from years 1989 to 2008 the histopathologic diagnoses of 2 183 biopsies were collected codifying the different study variables and were processed using Epi Info to obtain the frequencies end percentages. This study presents a 7.9 percent of agreement, a slight agreement of 13.8 percent, no-agreement of 7.9 percent and without clinical diagnosis of 24.2 percent. The salivary glands lesions showed the high agreement for the 66.8 percent and for the bone tissue the non-odontogenic cysts occupied the first place of agreement for the 80.0 percent. There was an acceptable agreement higher than other similar studies. There is the possibility to improve these features by means of a continuous updating of the clinical diagnoses(AU)

Histopathologic features of ulcerative colitis and Crohn's disease / 中华消化内镜杂志

Objective To retrospectively study histopathologic features of ulcerous colitis (UC) and Crohn's disease (CD) by endoscopic biopsy. Methods Data of age, gender and intestinal involvement of 106 cases of CD and 180 cases of UC confirmed by pathology were reviewed. Mucosal architecture, chronic inflammation, acute inflammation and epithelial features were evaluated based on histopathological criteria.These features were compared between the two groups. Results Compared with CD cases, UC showed significantly higher percentage of architectural disorders ( P ＜ 0. 05 ), lower percentage of discontinuous chronic inflammation ( P ＜ 0. 05 ) and higher incidence of cryptitis, crypt abscesses and polymorph cells in lamina propria (P ＜0. 05 ), and higher rate of epithelium damage, flattened and less mucous cell as well. Granuloma, pseudo pylorus glands metaplasia and narrow ulcer only occurred in CD cases. Lesions of 90% (162/180) cases of UC were limited to colon, while those of 28% (30/106) of CD cases to ileocecum, and those of 56% (59/106) CD cases involved different parts of gastrointestinal tract. Conclusion Diagnosis of CD and UC needs comprehensive analysis. Diagnostic evidence for CD includes focal involvement of ileocecum, the multifocal involvement in gastrointestinal tract, granuloma, discontinuous inflammation, pyloric gland metaplasia, while that for UC includes mucosal damage limited to colon, continuous chronic inflammation, architectural disorders, or epithelial damage.