Résumé
Background: most of renal neoplasms are of epithelial origin and they are malignant. Renal cell carcinoma [RCC] accounts for approximately 2% of all cancers. The disease resulted in more than 100,000 yearly deaths worldwide. Histologic diagnosis of renal neoplasms is usually straight forward by routine light microscopy. However, immunohistochemistry may be essential in several contexts, including differentiating renal from nonrenal neoplasms, differentiating subtypes of primary renal epithelial neoplasms and diagnosing rare types of renal neoplasms or metastatic RCC in biopsy specimens
Aim of the work: multiple therapeutic options tailored to an individual patient are now being offered. In view of these developments, availability of a robust and dependable panel of immunohistochemical stains becomes even more important because pathologists are frequently asked to render diagnosis on limited material
Material and methods: in this study a total number of 50 cases of some types of renal cell tumors were immunohistochemically stained for Napsin A, CD 82 and Cyclin D1
Results: these cases included 18 cases of ccRCC [36%], 16 cases of PRCC [32%], 8 cases of ChRCC [16%] and 8 cases of oncocytoma [16%]
Conclusion: we concluded that napsin A may be useful in differentiating between ccRCC and PRCC [particularly type 1 which showed more vacuolated or clear cytoplasm]. CD82 may be useful in differentiating between ChRCC, which was CD82 positive and oncocytoma, which was CD82 negative. Cyclin D1 had no significant value in the differentiation of different types of renal epithelial tumors
Recommendation: we recommended the usage of Napsin A in differentiating between ccRCC and PRCC and CD82 in differentiation between ChRCC and oncocytoma. More studies are needed to evaluate napsin A in differentiating between ChRCC and oncocytoma
Résumé
The aim of this study is to determine the level of circulating soluble interleuktn-2Ralpha in the sera of patient with systemic lupus erythematosus [SLE] and to correlate the level of expression of these receptors with SLE disease activity. The study included fifty five SLE patients and twenty healthy volunteers as controls. The following investigations were done: Serum anti-nuclear antibodies [ANA], anti-double stranded deoxynucleic acid [ds-DNA], serum complement components [C3,C4], ESR, compete blood count, serum creatinine, creatinine clearance, 24 hour urine proteins, urinalysis and serum soluble interleukin-2Ra level. Renal biopsy was performed and examined with light microscopy for patients with lupus nephritis. The results were analyzed in relation to the clinical activity scores [systemic lupus activity measures [SLAM]]. The study showed that levels of soluble interleukin-2Ralpha [sIL-2Ralpha] were significantly higher in the total group of SLE patients compared to controls. Dividing our patients into two groups according to the presence or absence of Lupus nephritis [LN], 35 patients were found to have laboratory and pathologic evidence of LN. Serum sIL-2Ralpha levels were significantly higher in patients with nephritis than those without nephritis. There were strong positive correlation between sIL-2Ralpha levels and SLAM score, histological activity index, ESR and 24hr urine proteins, on the other arm strong inverse correlation with C3 and packed cell volume was observed. It can be concluded that serum sIL-2Ralpha is a reliable marker of disease activity in patients with SLE and could be used as an indicator of early renal involvement with the possibility of using it for follow up
Résumé
Abdominal paracentesis is an old medical procedure for treatment of tense ascites. Paracentesis induced circulatory dysfunction [PICD] is a complication that can be prevented with the administration of intravenous albumin. The aim of this work is to assess the effects of a single large volume paracentesis [LVP] on portal venous hemodynamics and cardiopulmonary functions in cirrhotic patients with tense ascites. Also, to compare between dextran-70 and albumin as a replacement therapy. Thirty adult patients from either sex with cirrhosis and intractable ascites were randomly allocated into one of three groups subjected to LVP, group I: include 10 patients received human albumin infusion 20%, group II: include 10 patients received dextran -70 infusions and group III: include 10 patients with no replacement therapy. Patients had undergone blood urea blood urea nitrogen [BUN], liver function tests. serum electrolytes [Na+ and K+], ascetic fluid analysis, arterial blood gases [ABG], duplex ultra-sonographic examination of the portal [PV] and splenic veins [SV] with calculation of their velocity and congestive index [CI], standard pulmonary functions tests and echocardiographic estimation of right and Left atrial areas and cardiac output [COP]. Effective arterial blood volume was assessed by measuring plasma renin activity [PRA] and aldosterone concentrations [PAC]. All measurements were done at baseline, 48 hours [hrs.] and on the six day after LVP. All patients reported improvement of their clinical manifestation. Urine output increased in all groups with significant difference between group I and groups II and III at 48 hrs and between group I and III at 6th day. Heart rate slightly increased 48 hrs and then decreased on the 6th day with no significant difference between studied groups while the mean arterial blood pressure slightly decreased in dl groups with only significant difference between pre-tape and 48 hrs and 6th day results in-group III. The mean right and left AA and COP significantly increased in the all groups Right AA was lower in-group III at 48 hrs compared to other two groups. There was significant difference between pre-tape and 48 hrs results of left AA in-group III. At 48 hrs left AA was significantly lower in group III compared to other two groups and in group II compared to group I. On the 6th day, left AA was significantly lower in group III compared to other two groups. The mean FEVI and FVC increased in all groups, while the mean FEVI/FVC showed no significant change. The mean PaO2 increased significantly in all groups. Oxygen saturation increased significantly in all groups at 48 hrs then decreased on the 6th day but still above pre-tape results with significant difference between 48 hrs and 6th day values. PaCO2 decreased significantly in all groups. There was a significant increase in mean PV and SV velocity 48 hrs after LVP with non-significant reduction of their congestion index. BUN significantly increased in group III compared to groups I and II. Serum sodium markedly decreased in group III compared to groups I and II with significant difference between pre-tape, 48 hrs and 6th day results of group III. PRA and PAC non significantly increased in all groups before LVP, in group I, PRA showed no significant changes after LVP, while PAC initially increased after LVP then significantly decreased on the 6th day. In-group II, PRA and PAC significantly increased after LVP with significant difference between pre-tape, 48 hrs and 6th day results of PAC. In-group III there was significant increase in PRA and PAC. As regard PRA, there was significant difference between groups I and II and group III, also between group III and group II at 48 hrs while on the 6th day there was significant difference between groups I and II and group III. As regard, PAC there was significant difference between group I and groups II and III on the 6th day. There was non-significant increased incidence of hyponatremia, hyperkalemia and incidence of PICD in group III. So, we can conclude that LVP with concomitant infusion with appropriate plasma volume expander is quite safe, palliative, and cost effective in patients with advanced cirrhosis and has a fewer complications in comparison to conventional diuretic therapy. LVP has an immediate beneficial effect on arteria blood oxygenation, cardiac functions, provides rapid improvement of lung volumes and improve portal venous dynamics. The low cost, the good tolerance and the safety of the plasma expander, dextran justify its therapeutic usage as useful alternative to human albumin in the management of intractable ascites especially small volume [<5 liter]. Also therapeutic paracentesis without replacement is effective as with albumin or dextran infusion on the outcome of cardiopulmonary functions and portal venous dynamics