Association between diabetes and causes of dementia: Evidence from a clinicopathological study / Associação entre diabetes e causas de demência: evidência de um estudo clínico-patológico

ABSTRACT.Background: Diabetes mellitus is a risk factor for dementia, especially for vascular dementia (VaD), but there is no consensus on diabetes as a risk factor for Alzheimer's disease (AD) and other causes of dementia. Objective: To explore the association between diabetes and the neuropathological etiology of dementia in a large autopsy study. Methods: Data were collected from the participants of the Brain Bank of the Brazilian Aging Brain Study Group between 2004 and 2015. Diagnosis of diabetes was reported by the deceased's next-of-kin. Clinical dementia was established when CDR ≥ 1 and IQCODE > 3.41. Dementia etiology was determined by neuropathological examination using immunohistochemistry. The association of diabetes with odds of dementia was investigated using multivariate logistic regression. Results: We included 1,037 subjects and diabetes was present in 279 participants (27%). The prevalence of dementia diagnosis was similar in diabetics (29%) and non-diabetics (27%). We found no association between diabetes and dementia (OR = 1.22; 95%CI = 0.81-1.82; p = 0.34) on the multivariate analysis. AD was the main cause of dementia in both groups, while VaD was the second-most-frequent cause in diabetics. Other mixed dementia was the second-most-common cause of dementia and more frequent among non-diabetics (p = 0.03). Conclusion: Diabetes was not associated with dementia in this large clinicopathological study.

RESUMO. Introdução: Diabetes mellitus é um fator de risco para a demência, especialmente para a demência vascular (DV), mas ainda não há consenso sobre diabetes como fator de risco para a doença de Alzheimer (DA) e outras causas de demência. Objetivo: Verificar a associação entre diabetes e demência e sua etiologia neuropatológica em um grande estudo de autópsia. Métodos: Os dados foram coletados do Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento Cerebral da FMUSP entre 2004 e 2015. O diagnóstico de diabetes foi relatado por pelos parentes do falecido. A demência clínica foi estabelecida quando CDR ≥ 1 e IQCODE > 3,41. A etiologia da demência foi determinada pelo exame neuropatológico com imuno-histoquímica. A associação de diabetes com probabilidades de demência foi investigada usando regressão logística multivariada. Resultados: Foram incluídos 1.037 sujeitos, diabetes esteve presente em 279 participantes (27%). A frequência de diagnóstico de demência foi semelhante entre diabéticos (29%) e não diabéticos (27%). Não encontramos associação entre diabetes e demência (OR = 1,22; IC 95% = 0,81-1,82; p = 0,34) na análise multivariada. DA foi a principal causa de demência em ambos os grupos, DV foi a segunda causa em diabéticos. A frequência de outra demência mista foi a segunda causa de demência e mais frequente entre os não diabéticos (p = 0,03). Conclusão: A diabetes não foi associada à demência neste grande estudo clínico-patológico.

A Clinicopathologic Study of the Collagen Types of Connective Tissue Nevus / 대한피부과학회지

BACKGROUND: The collagen type of connective tissue nevus is a hamartoma in which the amount of collagen is increased. It is divided into two groups:the inherited form that contains familial cutaneous collagenoma and shagreen patches in tuberous sclerosis, and the acquired form that contains eruptive collagenoma and isolated collagenoma. OBJECTIVE: The purpose of this study is to investigate the clinical and histopathological features of the collagen type of connective tissue nevus, along with considering the associated systemic or genetic disorders. METHODS: We retrospectively reviewed the medical records and biopsy specimens of 17 patients. RESULTS: We compiled the clinical data and histopathologic feature of 17 patients with the collagen type of connective tissue nevus. The ratio of males to females was 1:1.125 and the mean age of onset was 12.2 years for the patients with eruptive collagenoma and 43.7 years for the patients with isolated collagenoma. Eruptive collagenoma was disseminated on the trunk and arms, but 1 case of eruptive collagenoma was localized on the left thigh. Isolated collagenoma developed as a solitarily lesion on the various sites. The lesions of eruptive collagenoma were less than 1 cm, but the size of the isolated collgenoma varied from 0.5 to 4 cm. Three cases of eruptive collagenoma presented with white-color lesions, but the rest of the eruptive collagenoma and isolated collagenoma showed flesh-colored lesions. No case was combined with congenital or systemic disease. Histopathologically, there were increased thickened collagen bundles that were randomly arranged in the dermis. The elastic fibers were decreased and fragmented. CONCLUSION: The collagen type of connective tissue nevus is benign and rare, and its clinical and histopathologic characteristics are similar with those of other dermal tumors or reactive disorders. Exact knowledge about the collagen type of connective tissue nevus is needed to differentiate connective tissue nevus from several other disorders that have similar characters and to disclose the association with other diseases.

A Clinicopathologic Study of 15 Cases of Angiolymphoid Hyperplasia with Eosinophilia / 대한피부과학회지

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon distinctive vascular lesion characterized by proliferation of endothelial cells. Because of its rarity, the clinical and pathological aspects of ALHE have not been fully studied in Korea. OBJECTIVE: The purpose of our investigation was to describe the clinical and pathological characteristics of ALHE. METHODS: We reviewed the medical records, clinical photographs and histological slides of 15 patients who were diagnosed as ALHE at Severance hospital. RESULTS: Of the 15 patients, 60% were men and 40% women. The average onset age of men was 53.7 years, women 33.2 years. Overall average onset age was 45.5 years. The scalp was the most frequently involved site in ALHE. Pruritus was the most common symptom. Two of four patients demonstrated peripheral blood eosinophilia and one patient showed elevation of serum IgE. The essential microscopic features of the fifteen lesions of ALHE were epithelioid proliferation of endothelial cells and perivascular inflammatory infiltration with eosinophils and lymphocytes. Four patients underwent surgery as their sole treatment modality and there were no recurrences. Other treatment modalities were topical steroid, intralesional injection of triamcinolone, systemic steroid, and 5% imiquimod cream. CONCLUSION: The clinical and pathological features of patients in this survey differ from previous studies in the age of onset, gender distribution, and anatomical distribution. Men were more affected (60%) than woman (40%), and the average age of onset was 45.5 years. The scalp and extremities were the most frequently involved sites. Surgery was the treatment of choice in ALHE. However, the clinical findings of ALHE need to be further evaluated in larger groups of patients.

The Clinicopathologic Study of Foreign Body Granuloma Induced by Injection of Filler / 대한피부과학회지

BACKGROUND: With the popularization of soft tissue augmentation with dermal fillers, filler-related complications such as foreign body granuloma (FBG) are increasing. However, there has been no comprehensive study performed on FBG induced by dermal fillers in Korea to date. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic findings of FBG induced by injection of filler. METHODS: Eighteen biopsy-proven cases of FBG due to injection of filler were reviewed and analyzed by their clinicopathological findings. In addition, the severity of granulomatous inflammation was graded by the classification proposed by Duranti. RESULTS: Two patients were injected with silicone, one with collagen and fifteen with unknown materials; they were treated by unlicensed practioners. The interval time between the injection and the presence of FBG ranged from 2 months to 30 years (mean: 2 years). Most of the lesions presented as skin-colored or erythematous subcutaneous nodules. In one patient, concomitant infection was discovered and the cultured organisms were coagulase negative staphylococcus and Mycobacteria chelonae. The histopathologic findings showed variable infiltrations of inflammatory cells, predominantly lymphohistiocytes and in fifteen patients (83.3%) multinuclear giant cells were also seen. In ten patients (55.6%), marked foreign body granulomatous inflammation of Duranti grade II were observed. In ten cases (55.6%), 'Swiss cheese appearance' representing granuloma due to lipoid materials such as silicone and paraffin were observed. CONCLUSION: This study shows various clinical presentations and histopathologic findings of FBGs incurred by filler injections, although most of the injected materials were not identified. Further investigations on different injectable products are necessary to identify the nature of the injected filler.

A Clinicopathologic Study of Lymphangioma / 대한피부과학회지

BACKGROUND: Lymphangioma is an uncommon, benign hamartomatous malformation that consists of dilated lymphatic channels lined by normal, single-cell lymphatic endothelia. The diagnosis of lymphangioma is usually made on the basis of clinical and histopathological characteristics. The lymphangiomas are divided into lymphangioma circumscriptum, cavernous lymphangioma, cystic higroma, acquired progressive lymphangioma and lymphangiectasis. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of lymphangioma, especially focusing on the pathologic classification. METHODS: We retrospectively reviewed the medical records and 52 biopsy specimens of 51 patients who had been diagnosed with lymphangioma between January 1991 to September 2005 in 8 Hospitals under the charge of the Catholic Medical Center. RESULTS: We compiled clinical data and histologic information on the 52 cases of 51 patients of lymphangioma as follows: The mean age at development was 16.5 years, and 56.9% of the patients were under 10 years old. Lymphangioma developed predominantly in females, at a sex ratio of 1:1.55. The disease duration exceeded 10 years in 45.1% of patients. Most patients were asymptomatic, but 13.7%, 9.8% and 2.0% of patients complained of tenderness, pruritus and pain, respectively. The lesion was usually solitary. Lymphangioma occurred on the trunk, extremities, head and neck, and genitalia in 43.6%, 30.9%, 20.0% and 5.5% of 52 cases respectively. The legs, back, abdomen and lip were also found to be commonly involved. Histopathologically, lymphangiomas were divided into lymphangioma circumscriptum, cavernous lymphangioma, cystic higroma, acquired progressive lymphangioma and lymphangiectasis in 69.2%, 17.3%, 1.9%, 5.8% and 5.8% of the 52 cases respectively. CONCLUSION: Lymphangioma is un uncommon, benign hamartomatous malformation of lymphatic endothelial cells and occurs in several forms that differ in clinical and histological characteristics and prognosis. Therefore it is important to make a diagnosis on the basis of clinical and histopathologic findings and to understand the characteristics of the subtypes of lymphangioma.

A Clinicopathologic Study of Bowen's Disease / 대한피부과학회지

BACKGROUND: Bowen's disease, also known as squamous intraepidermal carcinoma, is a pre-malignant skin tumor with a potential to progress to an invasive carcinoma. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological characteristics of Bowen's disease. METHODS: A total of 45 patients with Bowen's disease were enrolled in this study. The hospital charts and histopathological slides from 1994 to 2005 were reviewed retrospectively at Seoul Veterans Hospital. RESULTS: There were thirty-seven cases (82%) of single lesions and eight cases (18%) of multiple lesions. Thirty cases (81%) of solitary Bowen's disease were located in non sun-exposed areas. These included the trunk, extremities and genital area in decreasing order. Seven cases (19%) of solitary Bowen's disease occurred on sun- exposed areas including the face and the dorsum of the hand in decreasing order. Analysis of the clinical character of Bowen's disease was performed and results were as follows: the most common type was patch (20 cases; 44%), plaque (14 cases; 31%) and pigmented lesions (12 cases: 27%). Analysis of the histopathological character of Bowen's disease was performed and results were as follows: the most common type was irregular (18 cases; 46%), psoriasiform (11 cases; 28%) and verrucous, atrophic type in decreasing order. Of 18 cases where surgical removal was performed, there were 2 case (11%) of recurrence. Of 16 cases where cryotherapy treatment was administered, there were 3 cases of recurrence. And of 4 cases where CO2 laser therapy was used, there was 1 case (25%) of recurrence, in 2 cases where multiple or large-sized lesions were observed, clinical recovery processes were monitored after applying isotretinoin and 5-FU combined therapy, as well as surgical removal and cryotherapy combined therapy. CONCLUSION: In Bowen's disease among Koreans, there were many distinctive clinical and histopathological features compared to those of non-Korean cases.

A Clinicopathological Study of Kaposi's Varicelliform Eruption / 대한피부과학회지

BACKGROUND: Kaposi's varicelliform eruption (KVE) is a viral infection with disseminated skin involvement, superimposed on a pre-existing dermatosis. A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions, along with severe systemic illness, leads to clinical diagnosis. However, there is no data on the clinicopathologic study of KVE in Koreans. OBJECTIVE: The purpose of this study was to identify clinicopathologic features of KVE. METHOD: We reviewed the medical records and biopsy slides of 21 patients who had previously been diagnosed as having KVE at the National Medical Center between 1990 and 2004. RESULTS: The study results are summarized as follows: 1. The most common pre-existing disease was atopic dermatitis, followed by seborrheic dermatitis and Darier's disease. 2.Men were more commonly affected than women, and the mean age at diagnosis of eczema herpeticum was 30.8 years. 3.Face involvement was seen in 4 patients, and systemic involvement in 6 patients. 4. Histopathologically, common findings included ballooning degeneration (76.1%), reticular degeneration (47.6%), multinucleated giant cell (57.1%), and inclusion body (28.6%), and leukocytoclastic vasculitis (47.6%). CONCLUSION: KVE is a secondary viral infection that can affect patients who suffer from a primary dermatologic condition. In many instances, the history and clinical findings may be sufficient for diagnosis of KVE. However, the clinicopathologic features can help also diagnose KVE and pre-existing dermatosis.

A clinicopathologic study on ameloblastoma

A Clinicopathologic Study of Bowen's Disease / 대한피부과학회지

BACKGROUND: Bowen's disease is a form of intraepidermal (in situ) squamous cell carcinoma in histopathology, the representative premalignancy of the cutaneous squamous cell carcinoma and is usually persistent and progressive, with a small potential for invasive malignancy by 3-5%. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological characteristics of Bowen's disease. METHODS: A total of 45 patients with Bowen's disease were enrolled in this study. The hospital charts and histopathological slides were reviewed at Chungnam university hospital from 1983 to 2002. RESULTS: The male and female ratio was 1: 1.14. The mean age at diagnosis was 63 years. Twenty-two cases (58%) of solitary bowen's disease were located in non sun exposed area. Trunck, extremities, genital area followed in decreased order. Sixteen cases (42%) of solitary bowen's diseases occurred on the sun-exposed area. Face, dorsum of hand followed in decreased order. Thirty-three cases(73%) of single lesions and seven cases(27%) of multiple lesion. Analysis of clinical character of the Bowen's disease was performed and results were as follows: the most common type were patch(20 cases; 44%) and plaque (18 cases; 40%). And nodule, ulcer and papule type in decreased order. Analysis of histopathological character of the Bowen's disease was performed and results were as follows: the most common type were psoriasiform(15 cases; 41%) and irregular (12 cases; 32%). And verrucous, atrophic and combined type in decreased order. CONCLUSION: In Bowen's disease among Koreans, there were many distinctive clinical and histopathological features compared to those of non-Korean cases. In Korean cases, Bowen's diseases were located on sun exposed area only 42%, pigmented lesions were 20% and sex ratio 1: 1.14(male: female).

Clinicopathologic Study of The Acute Cutaneous Graft-Versus-Host Disease after Bone Marrow Transplantation in Hematologic Disorders / 대한피부과학회지

BACKGROUND: Graft-versus-host disease(GVHD) refers to the spectrum of organ dysfunction that occurs when immunocompetent leukocytes attack specific tissue in a relatively immunocompromised host. The most common clinical setting for GVHD is after bone marrow transplantation(BMT). Acute GVHD occurs in about 40% to 50% of HLA-matched allogeneic transplants and skin is the most commonly involved. Despite intense interest in the GVHD, little is known regarding the histopathologic change in cutaneous graft-versus-host reaction(GVHR). OBJECTIVE: We investigated the clinical and histological features of acute cutaneous GVHR in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the clinical manifestations and histological characteristics of acute cutaneous GVHR in 70 patients from January 1, 1998 through December 31, 1999. RESULTS: The most common cutaneous involvement sites are the chest(48.6%) and other frequent site are the face(21.4%), palm(20.0%), and extremities(10.0%). The clinical grades of 70 patients of acute cutaneous GVHR were 31 patients(44%) for grade 1, 25 patients (36%) for grade 2, 14 patients(20%) for grade 3, and 0 patient(0%) for grade 4. Clinically, acute cutaneous GVHR mainly presented as pruritic erythematous maculopapules or patches. Histopathologic grades of 70 patients of acute cutaneous GVHR were 25 patients(36%) for grade 1, 38 patients(54%) for grade 2, 7 patients(10%) for grade 3 and 0 (0%)patinet for grade 4. Histologically, the most common epidermal change in acute cutaneous GVHR is vacuolar degeneration (95.6%). Other epidermal findings are epidermal dyskeratotic cell(76.5%), hyperkeratosis(61.8%), spongiosis(61.8%), exocytosis(61.8%), atrophy(52.9%), and parakeratosis(13.2%), acanthosis(11.8%) and subepidermal cleft(10.0%) are rarely seen. In addition, dermal changes include perivascular lymphohistiocytic infiltration(94.1%), telangiectasia(57.4%), pigmentary incontinence(44.1%), endothelial swelling(33.8%), band-like infiltration(30.8%), neutrophilic infitraion (20.6%), periappendageal infiltration(14.7%) and extravasation of erythrocytes(13.2%).

Clinicopathological Study of 12 Cases of Erythromelanosis Follicularis Faciei et Colli / 대한피부과학회지

BACKGROUND: Erythromelanosis follicularis faciei et colli(EFFC) is an infrequently diagnosed disorder. This condition consists of the clincal triad of well-demarcated erythema, hyperpigmentation, and follicular plugging on the face and neck. The etiology of EFFC remains obscure, and therapy for EFFC is only moderately successful. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of erythromelanosis follicularis faciei et colli and suggest the new treatment method of erythema by 585nm flashlamp-pumped dye laser. METHODS: We evaluated 12 patients of erythromelanosis follicularis faciei et colli. Among them, we made a trial of 585nm flashlamp-pumped dye laser in erythema of EFFC on 11 cases. RESULTS: The results were as follows; 1. The mean age of onset and that of the first visits made by patients was 12.1 and 18.9 years, respectively, and there was a male predominance. 2. Histologic features revealed hyperpigmentation in basal layer, perivascular and periadnexal lymphocytic infiltration, and vessel dilatation in upper dermis in all specimens. Follicular plugging(62.5%), hyperkeratosis without parakeratosis(55.6%), enlarged hair follicle containing lamellar body(25.0%), and sebaceous gland hypertrophy(22.2%) were also observed. 3. Electron microscopic studies showed abnormal melanosomes, such as a stippled appearance of the periphery of a melanosome and a large number in the cytoplasm of basal cells. 4. 585nm flashlamp-pumped dye laser treatment with fluences that ranged from 6.5-7.5J/cm2 was given on 1 time. In 2 cases, results were achieved in fair improvement of erythema. Hyperpigmentation occurred in 2 cases(2/11) . CONCLUSION: Characteristically, EFFC affects adolescent males predominantly. The histologic features, although nondiagnostic, correlate with the clinical features. We suggest the new treatment modality, 585nm flashlamp-pumped dye laser, for the treatment of erythema in EFFC. EFFC, which can cause significant cosmetic problems to patients, maybe much more common than recognized. However, it is not well known, may be because the small number of cases have been reported in the literature. It can be helpful to understand the pathogenesis and improve treatment modalities when it will be recognized by more physicians and patients.

Clinicopathologic Study on 51 Cases of Prurigo Nodularis / 대한피부과학회지

BACKGROUND: Prurigo nodularis(PN) is a rare recalcitrant pruritic disease. Its pathophysiology is still debatable and a matter of speculation. And, there has been no large case study in Korea. OBJECTIVE: We tried to evaluate the epidemiologic aspects in Korea, and the clinicopathologic correlates of PN. METHODS: 51 patients were included in this study. The patients were divided into atopic and nonatopic groups. All the available clinical and laboratory data including total serum IgE were collected and analyzed. 48 slides were stained in hematoxylin-eosin. For immunophenotyping of cellular infiltrate and identification of neural tissue, 10 cases of them were stained immunohistochemically. They were examined under light microscope. RESULTS: The male to female ratio was 2.4:1. The age was varied from 3 to 64 years, averaging 36.6 years. The age of onset was varied from 2 to 64 years with two peaks in second and fifth decades. The site of predilection were the extremities (96%) and less commonly the trunk (49%). The underlying diseases were present in 23.5% of total patients. The atopic group has relatively younger age and higher total serum IgE level than non-atopic group. There was no significant difference in the recorded pathologic and immunohistopatholgic characteristics between two groups except the deep inflammatory infiltrate and dyskeratosis. There was prominent neural hyperplasia associated with vascular proliferation and inflammatory cellular infiltrate. CONCLUSIONS: There were some epidemiologic differences from western patients. There were about twice as more male patients. Age of onset had some predilections. Atopic and non-atopic groups were different in clinical and some pathologic variables. The former was younger, had higher total serum IgE, and histopathologically, showed more pronounced neural hyperplasia.

A Clinicopathological Study of the Multiple Trichoepitheliomas / 대한피부과학회지

BACKGROUND: The diagnostic dilemma in differentiation between multiple and solitary trichoepitheliomas from basal cell carcinoma(BCC) is well documented. Some authors reported that up to 35% of trichoepitheliomas were misdiagnosed initially as BCC, especially the keratinizing variant. OBJECTIVE: The purpose of this study was to review the clinicopathological characteristics of the multiple trichoepitheliomas and to suggest specific findings and useful special staining methods for differentiating from BCC. METHODS: We reviewed 14 cases of multiple trichoepitheliomas from a clinicopathological aspect. We performed H&E, periodic acid Schiff, Giemsa, Fite, and alcian blue staining using the formalin-fixed paraffin-embedded samples of multiple trichoepitheliomas. RESULTS: The average age at onset was 24.7 and 78.6% of the cases showed autosomal dominant inheritance patterns. The sites of frequent involvement were the nasolabial folds and nose, and the average size of the lesions was 4.3 x 4.3 mm. The most important histopathological finding in differentiation was papillary mesenchymal tissue, and this was well observed with the Giemsa stain. Several other findings were also useful in differentiation, such as stellate structures in cystic walls, parakeratosis and eosinophilic necrotic bodies in the cystic walls, primitive hair follicles, epidermal connections, and mast cell infiltration. CONCLUSION: Several staining methods, such as the Giemsa, periodic acid Schiff, Fite, and alcian blue stains, were useful in differentiating the trichoepitheliomas from BCCs.

Thymoma: A clinicopathologic analysis of 66 cases

A total of 66 cases of thymoma(57 surgically resected cases and 9 incisional biopsy cases) were reviewed with an attempt to correlate pathomorphologic features and clinical presentations. Criteria of benign or invasive thymoma were primarily determined by operative clinical and pathologic findings. Of them, 21 cases were invasive thymomas. The mean age of patients at the time of surgery was 47 years and it occurred largely in the sixth decade. Myasthenia gravis was accompanied in 29 cases(43%). One patient died during folow-up period, and five of the remainder suffered from recurrence. Microscopically, mixed type was the most common one(33 cases), being followed by predominantly epithelial type(17 cases) and predominantly lymphocytic type(16 cases). Thirty four cases of thymomas were cortical type, 29 mixed type, and the remaining 3 medullary type. None of the histologic type were significantly correlated with tumor invasiveness, Myasthenia gravis was more frequently associated with mixed and cortical type, respectively.

A clinicopathological study on renal biopsies in children

No abstract available.