Histomorphological spectrum and immunohistochemical characterization of hemangioblastomas: An entity of unclear histogenesis.

Introduction: Hemangioblastomas (HBs) are rare WHO grade I neoplasms of uncertain histogenesis. Most are sporadic and association with von Hippel-Lindau disease (VHL) is uncommon. Materials and Methods: Histomorphological and immunohistochemical evaluation of 24 cases of HBs was done. Results: Age range was 15-68 yrs (median: 30 yrs) with male:Female of 1.2:1 (M-13; F-11). Cerebellum was commonest location (n = 20), one each was seen in brain stem, cervical spinal cord, fourth ventricle and frontal lobe, respectively. VHL association was noted in 5 cases. Four cases were recurrent in nature of which 3 were in association with vHL. Histologically, reticular variant was the predominant subtype (n = 15), 5 were of cellular variant and 4 were mixed. Nuclear pleomorphism, nuclear cytoplasmic inclusions, cytoplasmic vacuolation were noted in the stromal cells in varying proportions. Immunohistochemical evaluation was successful in only 11 cases and of which 8 showed stromal cell positivity for alpha-inhibin. CD56 (NCAM), Nestin and synaptophysin positivity was seen in 6, 7 and 4 cases, respectively. Nestin positivity was noted in stromal cells only and no reactivity with the endothelial cells seen. S-100 protein and NSE positivity was seen in 8 and 10 cases, respectively. Glial fi brillary acidic protein (GFAP) showed two distinct patterns of immunoreactivity — scattered stromal cell positivity (n:5) and pattern of reactive astrogliosis positivity (n:10). CD44 positivity was noted in 5 cases. VEGF and EGFR positivity was seen in 5 cases each. None of the cases showed positivity for epithelial membrane antigen and no stromal cells in any of the cases showed positivity for CD34 and CD31. Conclusion: HBs can occur in throughout the neuroaxis. Cerebellum is the commonest site of occurrence for HBs and uncommonly can occur in the supratentorial compartment and spinal cord. Its association with vHL is uncommon and no histological or immunohistochemical correlation was identifi ed with the same.

Origem das artérias dos nós sinoatrial e atrioventricular em população do sul da Índia: um estudo angiográfico / Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study / Origen de las arterias de los nódulos sinusal y atrioventricular en población del Sur de la India: un estudio angiográfico

Fundamento: Estudar o suprimento arterial do sistema condutor e sua correlação com a dominância das artérias coronárias em população do sul da Índia. Objetivo: Determinar angiograficamente as origens da artéria do nó sinoatrial (AnSA) e artéria do nó atrioventricular (AnAV) em indianos.Métodos: O estudo incluiu 300 pacientes consecutivos (114 do sexo feminino e 186 do sexo masculino; idade média, 55 anos), habitantes da região costeira ao sul da Índia, submetidos a cineangiocoronariografia devido a sintomas como dor no peito, angina pectoris ou teste ergométrico positivo. As angiografias incluíram ambas as artérias coronárias (direita e esquerda) em posição oblíqua anterior direita e esquerda. A origem da AnSA e AnAV a partir das artérias coronárias foi observada e correlacionada à dominância arterial. Resultados: O nó SA (sinoatrial) recebeu suprimento pela artéria coronária direita (ACD) em 53% dos casos, pelo ramo circunflexo (Cx) da artéria coronária esquerda (ACE) em 42,66% dos casos, e em 4,33% dos casos esse nó foi irrigado por ambas as artérias coronárias. O nó AV (atrioventricular) também recebeu suprimento sanguíneo com mais frequência da ACD (72,33% dos casos) do que do ramo Cx da ACE (27,66%). Surpreendentemente, em nenhum caso este nó recebeu suprimento de ambas as artérias coronárias. Conclusão: Os resultados do presente estudo podem auxiliar os cirurgiões cardíacos, sobretudo em cirurgias relacionadas a valvopatias, devido à franca proximidade entre os ramos nodais e o complexo valvar.

Background: To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. Objective: To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. Methods: The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance.Results: The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. Conclusion: The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Fundamento: Estudiar el suministro arterial del sistema conductor y su correlación con la dominancia de las arterias coronarias en población del Sur de la India. Objetivo: Determinar angiográficamente los orígenes de la arteria del nódulo sinusal (AnSA) y la arteria del nódulo atrioventricular (AnAV) en indios. Métodos: El estudio incluyó 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 años), habitantes de la región costera al Sur de la India, sometidos a cineangiocoronariografía debido a síntomas como dolor en el pecho, angina pectoris o test ergométrico positivo. Las angiografías incluyeron ambas arterias coronarias (derecha e izquierda) en posición oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observó y se correlacionó con la dominancia arterial. Resultados: El nódulo SA (sinusal) recibió suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nódulo fue irrigado por ambas arterias coronarias. El nódulo AV (atrioventricular) también recibió suministro sanguíneo con más frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningún caso este nódulo recibió suministro de ambas arterias coronarias.Conclusión: Los resultados del presente estudio pueden auxiliar a los cirujanos cardíacos, sobre todo en cirugías relacionadas a valvulopatías, debido a la franca proximidad entre las ramas nodales y el complejo valvular.

The Subclavius Posticus Muscle: its Phylogenetic Retention and Clinical Relevance / Músculo Subclavio Posticus: Presencia Filogenética y Relevancia Clínica

During routine dissection practice a supernumerary muscle was found on the right side infraclavicular region of a male cadaver. This muscle was arising from the superior surface of the first rib and its coastal cartilage and inserted to a thick ligament that extended from the medial end of the suprascapular notch to the capsule of the acromioclavicular joint. This accessory muscle slip was innervated by a branch from the nerve to subclavius. According to its location and innervation the aberrant muscle was considered to be the subclavius posticus. The anatomic relationships of the muscle make it clinically significant.

Durante una disección de rutina, un músculo supernumerario fue encontrado en el lado derecho de la región infraclavicular de una cadáver de sexo masculino. Este músculo se originaba de la superficie superior de la primera costilla y cartílago costal y se insertaba en un grueso ligamento que se extendía desde la parte medial de la incisura supraescapular a la cápsula de la articulación acromioclavicular. Este músculo estaba inervado por un ramo del nervio subclavio. De acuerdo a su localización e inervación el músculo aberrante fue considerado como el músculo subclavio posticus. Las relaciones anatómicas del músculo tienen significancia clínica.

Anatomical organization of aortic arch variations in the India: embryological basis and review

Objectives: To determine the percentage and type of aortic arch variations in Indian subjects and their clinical surgical importance and embryological basis. Patients and methods: In our investigation, branching patterns of the aortic arch were studied in 62 formalinfixed cadavers of booth sexes of Indian origin, aged 45-79. The dissections were carried out in formalin preserved after exposing the thoracic and cervical region during routine dissection of undergraduate students of Indiam origin in Kasturba Medical College, Mangalore. Results: The usual three-branched aortic arch was found in 56 cadavers (91,4 percent); variations were found in six cadavers (9,6 percent); 4,8 percent presented common origin of the carotid arteries; 1,6 percent had biinnominate sequence, and the same specimen had left coronary artery arising from arch of aorta directly; 1,6 percent presented right subclavian artery arising directy from the aorta; 1,6 percent had left vertebral artery a branch of aortic arch...