Mirror syndrome associated with fetal cardiac anomaly: A case report.

A rare mirror syndrome (Ballantyne syndrome) was seen in a woman who carried a hydropic fetus caused by fetal atrio-ventricular septal defect (AVSD). Diagnosis was made with confidence after ruling out cardiogenic pulmonary edema and preeclampsia. Placental pathology demonstrated multifocal villous edema and accelerated maturation of trophoblasts which may support the earlier reports about potential etiologic roles of the placenta to trigger the disease.

Interobserver reproducibility in determining p16 overexpression in cervical lesions : use of a combined scoring method.

OBJECTIVES: To evaluate interobserver reproducibility of a combined scoring method for immunohistochemical interpretation of p16 overexpression in cervical lesions. MATERIALS AND METHODS: p16 immunostaining was performed in cervical samples from 183 patients, including 69 normal, 42 low grade squamous intraepithelial lesions(LSIL), 36 high grade SIL (HSIL), and 36 squamous cell carcinomas(SCCAs). Each case was evaluated by a combined scoring method based on the percentage of positive cells (score 0-3), the intensity of staining (score 0-3), and the distribution pattern (score 0-2). Immunoexpression for p16 was considered as positive when the combined score was 4-8 and negative with a score of 0-3. Ten pathologists with varied experience in interpretating p16 immunostains evaluated each slide independently. RESULTS: All normal cervical squamous epithelia (69/69) were uniformly negative for p16. All HSILs (36/36), all SCCAs (100/100), and all but one of the LSILs (40/41, 97.6%) showed positive expression. In 172 of 183 cases (93.9%), p16 interpretation was concordant with all pathologists. Eleven cases with discordant results included 10 LSILs and 1 normal mucosa sample. Percentage of agreement of each pathologist pair ranged from 96.7-100% (mean 98.1%) with mean kappa value of 0.96 (range 0.93-1.000). CONCLUSION: The proposed combined scoring method shows good reproducibility among the participating pathologists and good correlation with the histologic diagnosis. This method may be a useful guide in the interpretation of p16 expression in cervical epithelial lesions.

Sentinel lymph node for breast cancer: Pathologic aspects, handling and evaluation of specimen.

Sentinel lymph node(SLN) biopsy is a safe and accurate staging procedure for breast cancer in patients without clinical evidence of axillary lymph node metastasis. The studies in various conditions including multifoci of breast cancer, intraductal carcinoma with microinvasion, post-neoadjuvant therapy, and predictors of positive sentinel and non-sentinel lymph nodes are reviewed. Particular attention is paid to the roles of cytology, frozen section, multiple level study in frozen section and standard paraffin section, and immunohistochemistry in evaluating the SLN. A guide-line for optimal handling, processing, and evaluation of the fresh specimen from intraoperative consultation and the standard fixed specimen is presented.

Pathology and etiology of 110 consecutively removed aortic valves.

OBJECTIVES: To study the pathology and determine the etiology and prevalence of aortic valve disease from surgically removed aortic valve specimens. MATERIAL AND METHOD: All the native surgically excised aortic valves (AV) received from June 1997 to March 1999 (22 months) were studied macroscopically including cuspal measurements and microscopically. By preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of predominant aortic stenosis (AS), aortic stenosis with regurgitation (AS-AR) and predominant aortic regurgitation (AR). The patients' medical records were reviewed and the clinical information was extracted. The etiology was determined according to the macroscopic, microscopic and clinical findings. RESULTS: Among 110 AV (76 isolated AV and 34 with concomitant mitral valves from patients aged 15-96 years, mean age 47.54 years; male:female = 1.39:1) there were 25 AS (22.73%), 34 AS-AR (30.91%) and 51 AR (46.36%) cases. Eighty-four (76.36%) were tricuspid, 16 (14.54%) were bicuspid and 10 were undetermined. Cuspal measurements of each disease were provided and compared. All AS specimens were related to moderate to severe calcification and causes included postinflammatory disease (14 cases, 56%; age range 38-67 years, mean age 53.29 years, male:female = 0.56:1), degenerative calcific change (11 cases, 44%, age range 56-76 years, male:female = 1.2:1; mean age 69 years of 5 tricuspid AV and 60.83 years of 6 bicuspid AV). In AS-AR, 29 cases (85.29%; mean age 47.10 years; male:female = 1.23:1) were attributable to postinflammatory disease and 5 cases (mean age 70.20 years; male:female = 1.5:1) to degenerative calcific change. In pure AR, there were 21 cases (age range 15-65 years, mean age 29.76 years) of postinflammatory disease, 14 cases of infective endocarditis (IE) and postIE (age range 20-63 years, mean age 42.21 years; all 10 IE cases contained gram positive cocci), 1 case (age 55 years) of bicuspid calcific change, 8 cases of AV with dilated valve ring, 5 cases of miscellaneous causes and 2 cases of indeterminate etiology. Aschoff bodies were found in 3 AR cases. Four of 18 postinflammatory AS-AR and 4 of 14 postinflammatory disease AR cases had past history of rheumatic fever. One postinflammatory AS also had infective endocarditis from gram positive cocci without clinical sign. Severe degenerative calcific change had a higher incidence of underlying diabetes (3 of 15 cases, 20%), hypertension (8 of 14 cases, 57.14%) and dyslipoproteinemia (9 of 13 cases, 69.23%) in comparison with 3.37% (3/89) for diabetes, 9.09% (8/88) for hypertension and 30.99% (22/71) for dyslipoproteinemia in other AV diseases in combination. CONCLUSION: The three common causes of severe AV functional disorders were postinflammatory disease (58.18%), degenerative calcific change (15.45%) and IE-postIE (12.72%). Underlying diseases of severe degenerative calcific change included hypertension, dyslipoproteinemia and diabetes. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details are important in evaluating the etiology of valvular diseases especially in severely calcified specimens.

Angiogenesis in stage IIIB squamous cell carcinoma of uterine cervix: reproducibility of measurement and preliminary outcome as a prognostic factor.

This study was performed to determine the reliability and replicability of IMD analysis using the Factor VIII immunohistochemical method. The following purpose was determining the relationship between IMD and clinical outcome in individual cervical cancer patient treated with radical radiotherapy. Twenty nine patients with stage IIIB cervical cancer were enrolled. Phase one was performed by using two pieces of tissue biopsy from different locations in the tumor from each patient. The IMD value was counted by the two pathologists after counterstaining by Factor VIII immunohistochemical method. No interobserver disagreement between the two pathologists was found (correlation coefficient = 0.92, 95% CI 0.82-0.96 for the first piece of tissue and 0.85, 95% CI 0.67-0.93 for the second piece). There was no variability in the IMD between the 2 pieces of tissue specimens from different locations of the tumor Phase two followed to evaluate the relationship between IMD and clinical outcome in individual cervical cancer patients. Because of the small sample size, different patients' characteristics, different treatment protocol and short term follow up, there is no statistically significant conclusion.

Primary peripheral primitive neuroectodermal tumor of the ovary with an epithelial cyst : A case report and review of literature.

Peripheral primitive neuroectodermal tumor (pPNET) has some histologic resemblance to a classic central primitive neuroectodermal tumor (cPNET), however it is distinctively different from cPNET by its CD99 immunoreactivity, characteristic chromosomal translocation, t(11;22)(q24:q12) and EWS/FLI-1 chimeric mRNA. Peripheral PNETs have a predilection for soft tissues rather than for viscera. Only 15 cases of primary ovarian PNET have been reported, and only one case was proven to be pPNET. Ovarian PNET is an aggressive tumor. We report a case of a 40-year-old Thai woman with a Stage IIIb right ovarian PNET is an aggressive tumor. Despite debulking operation and vigorous adjuvant chemotherapy, the patient died of disease 6 months later. Grossly, the tumor was solid and cystic. Microscopically, the former displayed unique features mimicking cPNET, but the pPNET phenotype was validated by CD99 staining. The solid portion also contained mucin-producing gland-like structures, previously described as ependymal diffentiation. In the cystic portion, the histology demonstrated epithelial linning tissue resembling cystadenoma of borderline malignancy of the ovary. It is generally accepted that both cPNET and pPNETs can have polyphenotypic differentiation. PNETs can be originated from either totipotential germ cells, neural crest remnant or mullerian-derived cells.

Pseudotrisomy 13 syndrome : A case report.

We report on a male baby with microcephaly, holoprosencephaly of alobar type with sigle ventricle, cyclopia, proboscis, poorly developed testes, and clenched hands without polydactyly, suggestive of trisomy 13 syndrome. However, the cytogenetic study disclosed 46,XY. The case presented here very well represents pseudotrisomy 13 syndrome and signifies the value of cytogenetic study and genetic counseling.

Effect of Oral Cilostazol on the Patency of Microvascular Anastomoses in Rats.

In order to evaluate the effect of cilostazol on patency of microvascular anastomoses, a double blind control study was performed on microanastomoses of the femoral artery in rats. Thirty female Spraque- Dawley rats were divided into two groups according to a blind protocol. One group (group A) was given cilostazol orally (10 mg/ kg) 2 hours before the operation and for 7 days post-operatively. The other group (group B) received normal saline solution orally in the same amounts and at the same times as group A. The femoral artery anastomoses were performed under standard microvascular conditions. Seven days post-operatively, the patency of the arterial anatomoses was evaluated by Acland\\\'s test and histological study. The patency rate by Acland\\\'s test was 73% in group A, and 53% in group B. There was no significant difference between the patency rates of these two groups (p = 0.082). The area of the patency of the lumen by histological study was 61.67% in group A and 48% in group B. There was no significant difference between the groups in relation to patency of the microanastomoses (p = 0.381). There were no complications observed in this study.

Hemorrhagic invasive ductal carcinoma with immunohistological expression of b-subunit HCG: A case report.

A hemorrhagic breast mass was excised from a 27-year-old female. Microscopically, the tumor showed typical areas of invasive ductal carcinoma with intraductal component admixed with some trophoblast-like tumor giant cells in the hemorrhagic area. These cells exhibited β-subunit HCG by immunohistochemistry. The modified radical mastectomy was done after exclusion of the coexisting choriocarcinoma in breast cancer. Postoperatively, the HCG serum level was within normal limit and the gynecological check up showed no positive findings. The modified radical mastectomy specimen revealed that the residual tumor showed the same findings as seen in the previously excised mass.

Value of liver biopsy findings in AIDS patients.

From the year 1997 to 2000, 146 liver biopsies were performed in 140 AIDS patients, admited to Bamrasnaradura hospital with prolonged fever (73.6%), hepatomegaly (71.4%) and abnormal liver function test (69.3%) being the principle indications. The findings of liver biopsies included TB (18), MAC (14), Cryptococcosis (10), Histoplasmosis (6), Penicillosis (4), CMV (2) and 7 granulomas in which no organism was identified. Opportunistic infections were found in 61 of 146 biopsies (41.8%). Neoplasm was seen in 22 biopsies (15.1%); the most common neoplasm was hepatocellular carcinoma, found in 16 biopsies (11%). Other findings included chronic active hepatitis (3), cirrhosis (3) and alcoholic hepatitis (1). The liver biopsy is a helpful diagnostic tool in AIDS patients with prolonged fever, hepatomegaly or abnormal liver function tests.

Pathology and etiology of 154 mitral valve abnormalities surgically removed in Siriraj Hospital.

Objectives: To study the pathology, determine the etiology and prevalence of mitral valve disease from surgically removed mitral valve specimens. Materials and Methods: All the native surgically excised mitral valves (MV) received during June 1997 to March 1999 (22 months) were studied macroscopically and microscopically. By preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of predominant mitral stenosis (MS), mitral stenosis with regurgitation (MS-MR) and predominant mitral regurgitation (MR). The patients' medical records were reviewed and the clinical information was extracted. The etiology was determined according to the macroscopic, microscopic and clinical findings. Results: Among 154 MV (120 isolated MV and 34 with concomitant aortic valves from patients aged 7-79 years, mean age 43.98 years) there were 68 MS (44.16%), 30 MS-MR (19.48%) and 56 MR (36.36%) cases. All MS cases (age range 10 - 65 years, mean age 45.37 years, male : female = 1:1.51), all MS-MR cases (age range 20 - 66 years, mean age 40.03 years; male : female = 1:1.31) and 20 of 56 MR cases (35.71% of MR cases, 12.98% of total cases, age range 8 - 63 years, mean age 31.21 years, male : female = 1.22 : 1) were attributable to post-inflammatory disease. Prominent calcification occurred in 76.47% of MS, 70% of MS - MR and 25% of post-inflammatory disease MR cases. Moderate to marked neovascularization was found in 34.32% of MS, 56.66% of MS-MR and 65% of MR cases. Aschoff bodies were found in 1 MS and 4 MR cases. Eight of 39 MS (20.51%), 4 of 16 MS-MR (25%) and 6 of 13 (46.15%) post-inflammatory disease MR cases had past history of rheumatic fever. Other causes of pure MR included floppy valves (18 cases, 32.14% of MR cases, age range 40 - 79 years, mean age 61.72 years, male : female = 3.5 : 1;15 cases with chordal rupture), infective endocarditis (IE) [7 cases including one with post-inflammatory disease MS and one post-IE (age range 20 - 50 years, mean age 34.12 years, male : female = 6 : 1) with gram positive cocci in all IE], papillary muscle necrosis (1 case), ruptured necrotic papillary muscle (1 case), miscellaneous and indeterminate cause (4 cases). In comparison with post-inflammatory MR, posterior leaflet in floppy MR had longer basal-free edge length (mean basal-free edge length of floppy valve = 16.65 mm. p <.0001)and more frequent chordal rupture. Among MS and MS-MR post-inflammatory valves, 90.81% were completely excised whereas partial specimens were received in 40% of post-inflammatory MR, 61% of floppy valves and 50% of miscellaneous cases. Conclusion: Post-inflammatory disease (presumably rheumatic fever associated) of MV is still a main valvular heart disease in Thai patients undergoing valvular operation as it accounted for 75.97% of all MV specimens. In pure MR, the three most common causes were post-inflammatory disease, floppy valve and infective endocarditis. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details are important in the evaluation of the etiology of valvular disease especially in partial specimens.

The efficacy of wall-typed suction and polyurethane foam in vacuum assisted wound dressing system.

Vacuum assisted wound dressing was introduced as one of the methods for wound management in problematic wounds. This system which was expensive included a controllable vacuum suction unit and polyurethane foam. In this study we evaluated the efficacy of a controllable wall-typed suction that was available in the patient ward to be used with various types of polyurethane foam in the market. One type of the polyurethane foam that had suitable pore size and good porosity was selected and used in 4 patients with sacral pressure ulcers and 1 patient with both sacral and trochanteric pressure ulcers. These patients were not candidates for surgery and their ulcers were not improved by conventional dressing. The vacuum dressing system was applied to the ulcers for 2 months. The sizes of the ulcers were reduced statistically (p=0.042) without complication. In conclusion, the controllable wall-typed suction and polyurethane foam could be used effectively for wound dressing in problematic wound and ulcer.

Dedifferentiated leiomyosarcoma of the retroperitoneum, report of a case with immunohistochemical and ultrastructural study.

Dedifferentiated leiomyosarcoma is referred to well-differentiated leiomyosarcoma with presence of pleomorphic malignant fibrous histiocytome - like portion. A case of this tumour of the retoperitoneum was reported in a 75-year-old Thai woman who complained of 2 months of right sided abdominal pain. The 8 cm well-circumscribed mass adherent to the aorta and right ureter was found. Removal of the tumour with cauterization of the remaning fibrous tissue was performed. The patient died 3 months later with recurrence of the tumour and metastasis. Pathological examination revealed well-differentiated leiomosarcoma with abrupt change into malignant fibrous histiocytoma – like tumour. The pleomorphic multinucleated giant cells had immunoreactivities for vimentin, alpha-1-antitrypsin and alpha-1-antichymotrypsin. Very few cells stained with smooth muscle actin. Ultrastructural features were those of undifferentiated cells with rare poorly developed microfilaments with dense aggregate-like area. The findings were similar to one dedifferentiated leiomyosarcoma of the intestinal tract reported by Fakuda et al. The immunohistochemical and ultrastructural study of the dedifferentiated portion reflected malignant fibrous histiocytoma-like features (myofibroblastic) or differentiation toward smooth muscle.

Surgical treatment of phyllodes tumour of the breast in Siriraj Hospital.

The authors studied retrospectively the surgical treatment of phyllodes tumour of the breast patients between 1989-1994 in the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University. 24 patients were found. Their ages ranged from 18-60 years (mean 40 years). 17 patients were single and 7 patients were married. The pathological diagnoses of the growths were 15 benigns, 6 borderline malignants and 3 malignants. The size clinically were 1.5 to 30 cm (mean 10.7 cm.) and pathologically were 2 to 48 cm. (mean 10.98 cm.). 7 patients (29.17%) suffered recurrence of the growths. The time that the breast masses were detected before coming to the hospital ranged from 1 to 36 months (mean 7 months). The follow-up period ranged from 4 to 71 months (mean 17 months). The latest surgical procedures were 12 excisions, 7 simple mastectomies 2 subcutaneous mastectomies, 2 modified radical mastectomies, and 1 extended radical mastectomy.