Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology

BACKGROUND/AIMS: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases. METHODS: We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical or suspicious cells on brush cytology were identified. RESULTS: Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802– 15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909; 95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR, 4.318; 95% CI, 1.512–12.262). CONCLUSIONS: Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.

Differential diagnosis in Hashimoto thyroiditis of atypical cell clusters from papillary thyroid carcinoma / 临床与实验病理学杂志

Purpose To analyze differential diagnosis between Hashimoto thyroiditis of atypical cell clusters ( ACC) and papillary thy-roid carcinoma (PTC). Methods 153 cases of Hashimoto thyroiditis (HT) were collected and divided into 3 groups:PTC group (49 cases), ACC group (32 cases), and HT as control group (72 cases). Morphology observations were done. CD56, CK19, galectin-3 and Ki-67 were detected by immunohistochemistry. Results Morphologic differences were observed among the groups. PTC showed milder positive expression of CK19 and galectin-3, and weaker positive expression of CD56 than that of ACC. Ki-67 index in ACC and PTC was lower than that of HT. Conclusions Morphological characteristics combined with CD56, CK19, Galectin-3 and Ki-67 evalu-ations could be valuable in the differential diagnosis between PTC and ACC.

Morfología atípica de Cryptococcus neoformans en tejidos autopsiados / Atypical morphology of Cryptococcus neoformans in post-mortem tissues

Cryptococcus neoformans es el agente de la Blastomicosis Europea, Torulosis o Cryptococcosis. Causa enfermedad en pacientes inmunocomprometidos. Estos hongos viven en distintos ambientes, penetran a los pulmones por inhalación y por diseminación hematógena, pueden comprometer el cerebro, meninges y otros órganos. En los tejidos invadidos y en su habitat natural se presenta con igual morfología, como levaduras gemantes globosas a ovales, de 4 a 7 u de diámetro aunque pueden verse células de 2 a 15 u, rodeadas de una gran cápsula de mucopolisacáridos que duplica o triplica el diámetro de las células. Típicamente son células simples o con un brote, en ciertas lesiones pueden encontrarse cadenas cortas de 2 a 3 células. Las levaduras están ampliamente separadas por espacios ocupados por sus cápsulas. El objetivo de este trabajo es informar la morfología atípica de un aislamiento de C. neoformans en tejidos de órganos: hígado, bazo, riñón y cerebro obtenidos por autopsia de una persona de sexo masculino de 33 años de edad. La Identificación de C. neoformans fue realizada por sus caracteres morfológicos, cultivos y fenotípicos. En hígado, bazo y riñón se observaron abundantes levaduras grmantes con gran cápsula. Algunas levaduras estaban unidas a las células madres por una base ancha, lo cual no es característica de la especie. Presentaba marcada asociación entre células formando estructuras caprichosas y muy desarrolladas con escasas formas típicas del hongo y pseudomicelios. En cerebro fue más frecuente la observación de elementos gemantes simples.

C. neoformans is the agent of the Cryptococcosis, European Blastomycosis or Torulosis. This fungus can cause disease in normal individuals and in inmunocompromised patients. Infection follows inhalation, but shows a remarkable propensity to spread hematogenously to the brain and meninges and even other organs. C. neoformans is an encapsulated budding yeasts, globular to oval in shape, 4 to 7 u in diameter not including capsules, but cells from 2 to 15 u may occur. The yeasts are surrounded by a large mucopolysaccharide capsule which duplicates or triplicates the cell diameter. Cells are typically single or with one bud, but may be found in short chains of 2 to 3 cells. The yeasts are clearly separated by spaces occupied by capsules. The aim of this work is to communicate the atypical morphology presented by a C. neoformans strain isolated from liver, spleen, kidney and brain tissue. Tissues were obtained through autopsy of a 33-year-old male patient without accurate cause of death. The identification of C. neoformans was made by its morphological, culture and phenotypical characteristics. In liver, spleen and kidney were observed budding yeast abundant with large capsule and numerous buds. The buds were linked to mather cells by a wide base, which is not characteristic of the species. Showed a strong association between cells, without letting go of the parent cell, were capricious and highly developed structures. Presented few typical forms of the fungus and pseudomycelia rudimentary. In brain was more often observed budding simple elements.

Comparison of Therapeutic Effect of ALA-PDT with Blue Light According to the Thickness of Atypical Cell Layer and the Histopathologic Subtypes in Actinic Keratosis / 대한피부과학회지

BACKGROUND: Precancerous diseases of the skin such as actinic keratosis (AK), Bowen disease (BD) and skin cancer, i.e. basal cell carcinoma (BCC), are treated successfully with photodynamic therapy (PDT). In BCC, the therapeutic effect of PDT was different according to the subtypes. However, there has been no study on the response to PDT in the thickness of atypical cell layer and the histopathologic subtype of AK. OBJECTIVE: We evaluated the responses to PDT using a topical 20% aminolevulinic acid (ALA) solution and a blue light, according to the thickness of atypical cell layer in AK. Further, we assessed the therapeutic response in the histopathologic subtypes of AK. METHODS: There were a total of 29 AK lesions from 20 patients enrolled in the study. The lesions were incubated with a topical 20% ALA solution for 2 hours and were exposed to blue light (417+/-5 nm) with 10 J/cm2. They were treated 2 times at the 4 weeks intervals. The evaluation of the response to ALA-PDT was done by the skin biopsy at the post 8 weeks period from the last treatment. The therapeutic response was assessed into 3 grades (complete remission, partial remission, no response). The relationship between the therapeutic response and the thickness of atypical cell layer was evaluated. The thickness of atypical cell layer was measured from the most superficial aspect of the Malpighian layer to the tip of rete ridge. In addition, we evaluated the therapeutic effects according to the histopathologic subtypes. RESULTS: The thickness of atypical cell layer were 0.0327+/-0.0087 mm in complete remission (CR) group, 0.1253+/-0.1128 mm in partial remission (PR) group and 0.1485+/-0.1973 mm in no response (NR) group (p=.0206). CR were achieved in 100% (4/4) of atrophic type, 43.75% (7/16) of hypertrophic type and 0% (0/9) of bowenoid type in AK. The response of ALA-PDT was the best in atrophic type (p=.032) and the lowest in bowenoid type (p=.0051) as compared with other subtypes. CONCLUSION: The responses to ALA-PDT were different in the thickness of atypical cell layer and it was statistically significant. The therapeutic effect was the best in the atrophic type of AK.

The Significance of Atypical Cell in Urinary Cytology / 대한비뇨기과학회지

PURPOSE: Atypical cells in urinary cytology are frequently observed in patients who have history of urothelial cancer A study was made to evaluate the significance of atypical cell in urinary cytology for the detection and surveillance of urothelial cancer. MATERIALS AND METHODS: We studied retrospectively 100 patients with atypical cell in urinary cytology. A bladder washing specimen was used for cytology Four groups of subjects were participated in this study. Group I - patients who showed gross hematuria, or lower urinary tract symptoms, but no history of the urothelial cancer. Group II - patients with urinary tract surgery for urothelial cancers. Group III - patients with intravesical therapy due to transitional cell carcinoma of the bladder. Group IV - patients with history of urothelial cancers, but no recurrence for l year or more. RESULTS: Mean follow up was 39 months. Cystoscopy and radiography showed urothelial cancer in 72 patients(72%) with atypical cytology. The bladder cancer was found in If of 27(63%) in group I, 26 of 26(100%) in group II, 4 of 5(80%) in group III and 13 of 14(93%) in group IV respectively. The interval from atypical cytology to the detection of urothelial cancer was 4 months. Upper tract tumors developed in 11 patients and prostatic urothelial recurrence in l patient. CONCLUSIONS: These data demonstrate the clinical importance of atypical cytology and emphasize the search for urothelial cancer. Patients with history of transitional cell carcinoma who showed atypical cells are likely to have a overt transitional cell carcinoma, and require further evaluation of intravesical and extravesical sites to detect the urothelial cancer.

A Case of Lymphomatoid Papulosis / 대한피부과학회지

We report herein a case of lymphomatoid papulosis in a 23-year-old female who had recurrent erythematous pinhead to pea sized papules and nodules on the both inner thighs and forearms for 4 years. Some lesions showed central hemorrhagic necrosis or scale formation. Individual lesions persisted for several months and showed spontaneous regression leaving pigmentation or depigmented atrophic scar. Histopathologically, there was marked cell infiltration, especially in the dermoepiderrnal junction and perivascular area. Infiltraled cells consisted of sorne ncutrophils and numerous atypical cells that had variable sized and irregular shaped nuclei. Electronmicroscopically, some atypical cells had cerebriform nuclei with marked peripheral condensation of chromatin and cytoplasm contained a few organelles, many polyribosomes and some dense bodies.

Tuberous Sclerosis

A case of the tuberous sclerosis, 14-years old boy, was observed. In his father and sister, the cerebral tubers were noted by brain computerized tomography. This disease has been reported occasionally in dermatologic and psychiatric department because of adenoma sebaceum, mental retardation and epilepsy respectively, but it has not been reported at neurosurgical department in Korea. The histopathology of the brain lesion showed atypical cell(tuberous sclerosis cell), gliosis and nonspecific calcification which confirmed the diagnosis of tuberous sclerosis.