Résumé
Hepatic neoplasms can be the primary indication for hepatic transplantation. The tumors can also be incidentally identified in explanted livers. We explored the clinicopathologic features of hepatic neoplasms identified in explanted livers. All explanted livers resected between 2001 and 2006 were evaluated for the presence of neoplasms and their clinicopathologic features were examined. In 98 liver transplants, 15 neoplasms [15.3%] were identified. Patient ages ranged from 5 to 63 years [median, 56 years]. The primary etiology of hepatic disease was hepatitis C virus in 12 cases, hepatitis B virus in 1 case, cryptigenic cirrhosis in 1 case and congenital hepatic fibrosis in 1 case. Serum alpha-fetoprotein was significantly elevated [>400 U/L] in only 2 cases. CA19-9 was not elevated in any of the cases. The tumors included hepatocellular carcinoma [HCC] in 13 cases, 1 case of choloangiocarcinoma and 1 case of combined HCC and hepatoblastoma. The tumors in size from 0.5 to 5 cm [median 1.4 cm] and were multifocal in 5 of the cases [33%]. Tissue alpha-fetoprotein expression was only seen in the cases associated with elevated serum levels. In our institution hepatic neoplasms are seen in more than 15% explanted livers. They can be incidentally indentified, are frequently not associated with elevated serum levels of alpha-fetoprotein and CA19-9, are commonly multifocal but small, and are associated with good prgonosis. Elevated serum alpha-fetoprotein, albeit specific, is not a very sensitive marker in the detection of hepatic neoplasms
Résumé
Introduction and Objective: correction of the penile deformity caused by Peyronie's disease by a variety of grafts varies in success. Long-term follow up shows a significant number of graft scaring with shortening, ED and recurrence of curvature. Autologous tunica albuginea probably provides the best grafting material with theoretically better integration and less reaction with the underlying cavernous tissue. We set out to study the effect of this graft on the hemodynamics of erection and histopathological outcome
Methods: under GA, 6 male sexually active Baboons weighing 15.1 +/- 1.3 kg, underwent cavernous pressure [CP] measurement, before and after intracavernous injection of 15 mg papavering HCl. Cavernosometry [CM] and caversopgraphy were then carried out. Through a perineal incision, we harvested a 3.5 by 1cm tunica albuginea from the right penile crus. These dimensions constitute the penile length and circumference of the penis. Implantation of the graft was carried out in the left lateral side of the penile shaft. After 6 months, the animals were evaluated for- the hemodynamics of erection and histopathology of the graft site
Results: all animals resumed sexual activity in the second postoperative months. At 6 months, surgery did not produce significant changes to the hemodynamics of erection. Cavernous pressure response to papaverine did not differ significantly before grafting [49.7k8.9 mmHg] and 6 months after surgery [5 7.7 +/- 1 7.7 mmHg, p = 0.43]. Cavemosometry pressure did not show significant changes before [1 15.5 +/- 119.7 mmHg] and 6 months after surgery [38.9 +/- 15.9 mmHg, p=0.41. Caver nosography however showed that 4 animals developed venous leakage, which was identity Bed at the graft site in one. Three animals developed a mild curvature at the site of the graft. Naked eye examination could determine-the graft site only by the four comer nylon sutures. Microscopic examination showed integration of the graft with no underlying fibrosis
Conclusions: a relatively large free tunica graft is associated with venous leakage at 6 months. Although statistically insignificant differences are found hemodynamically and no interference developed with sexual activity, follow up for 1 y and the use of smaller graft might produce better results
Résumé
The pathogenesis of Hodgkin's disease [HD] has been linked to Epstein-Barr virus [EBV]. Some histologic subtypes show a high level of viral expression. These include mixed cellularity [MCHD] and nodular sclerosis [NSHD] subtypes. Grade II NSHD is a more aggressive variant of HD. Lymphocyte predominant [LPHD] is a B cell lymphoproliferative disorder that has not been associated with EBV expression. Infiltrating lymphocytes in HD are predominantly T-lymphocytes, with a minor component of B lymphocytes. In the current study, EBV expression was tested in cases of HD in relation to histologic subtypes. An attempt was made at correlating EBV expression with T and B lymphocyte distribution in lymph nodes involved by HD. Formalin-fixed paraffin-embedded tissue from 62 cases of HD were tested for EBV mRNA expression, using the EBER-1 probe and in situ hybridization. T and B lymphocyte distribution and their ratios were evaluated using antibodies to T and B lymphocytes [UCHL-1 [CD45 R0| and CD 20, respectively], and the immunoperoxidase technique. The cases were seen in 38 male and 24 female patients, with an age range of 3 to 72 years [median 25 years]. There were 30 cases of grade I and 15 cases of grade II NSHD, 9 cases of MCHD and 8 cases of LPHD. EBV mRNA expression was seen in 29 cases [46%]. This expression was seen in 8 cases of grade 1 NSHD [26%], 13 cases of grade II NSHD [86%] and 8 cases of MCHD [88%]. None of the cases of LPHD showed viral expression. T to B lymphocyte ratios in EBV-positive cases ranged from 1/6 to 8/1, and ranged from 2/1 to 20/1 in EBV-negative cases [P=0.06]. Nine of the 29 positive cases [31%] showed equal T/B lymphocyte ratios [n=4], or predominance of B lymphocytes [n=5]. None of the EBV-negative cases showed predominance of B lymphocytes. Our study confirms previously reported findings of the prevalence of EBV expression in MCHD and NSHD. Our findings also suggest that EBV expression may be more commonly seen in aggressive forms of HD. Decreased numbers of T-lymphocytes in these aggressive subtypes may suggest that a process of more profound T-lymphocyte depletion is occurring in these cases, leading to uncontrolled EBV replication and more aggressive disease