IgG4-related sialodacryoadenitis and chronic rhinosinusitis: a clinicopathologic analysis of 13 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics of IgG4-related sialodacryoadenitis and chronic rhinosinusitis (CRS).</p><p><b>METHODS</b>A total of 13 patients (patient group) were evaluated clinically and biopsy specimens from the lacrimal/salivary glands (n=12) and nasal mucosa (n=8) were reviewed and immunohistochemistry was performed to assess IgG-and IgG4-positive cells. Similarly, nine patients with IgG4-related sialodacryoadenitis without CRS and 10 patients with common CRS were included as controls.</p><p><b>RESULTS</b>There were 8 male patients and 5 female patients. The age of patients ranged from 32 to 71 years (mean 50.2 years). The patient group had higher serum IgG4 concentration than that of the control group (P<0.05). Lymphoplasmacytic infiltration, lymphoid follicle formation and sclerosis were prominent in lacrimal/salivary glands in both groups; however the magnitude of IgG4-positive plasmacytic infiltration in the patient group was significantly higher than that of the control group (P<0.05). Similarly, evaluation of nasal mucosa revealed greater lymphocytic and plasmacytic infiltration, and lymphoid follicle formation, together with significantly higher amount of IgG4-positive plasma cell infiltration in the patient group compared to the common CRS group (P<0.05).</p><p><b>CONCLUSIONS</b>IgG4-related disease (IgG4-RD) simultaneously involving lacrimal/salivary glands and nasal cavity/paranasal sinuses is rare and characterized by a combination of IgG4-positive plasma cell infiltration involving lacrimal/salivary glands and nasal mucosa along with an increased serum level of IgG4. As a systemic disease, early and accurate diagnosis is therefore of great importance, and unnecessary surgery should be avoided.</p>

Urinary exfoliated cytology:a clinical pathological study of 735 cases / 临床与实验病理学杂志

Purpose To explore the pathological feature of urinary exfoliated cell examination and influence factors by retrospectively comparing the coincidence of diagnosis between urinary exfoliated cell examination and histopathologic results of cystoscopic biopsy. Methods 735 patients underwent both urinary exfoliated cell examination and histopathologic biopsy of cystoscope evaluation from No-vember 2010 to July 2014 in Peking University Shougang Hospital were enrolled in this study. The urinary exfoliated cells were treated with Pap staining, while the histopathologic biopsy were dealt with HE staining. All cases were divided into three groups according to the diagnosis of urinary exfoliated cell examination:negative group ( no cancer or atypical cell detected) , suspicious group ( atypical cell detected) and positive group ( cancer cell detected) . These above diagnoses were confirmed with the histopathologic biopsy. ROC curve analysis, Cochran-Armitage trend test and logistic regression analysis were performed to evaluate the sensitivity and the specificity of urinary exfoliated cell examination as well as the relationship between diagnoses with age and sex. Results The age range of 735 patients (551 male and 184 female) was 28 ~91 years and the median age was 69 years. There were 187 patients in the positive group, including 184 malignant and 3 false-positive cases. The suspicious group, including 186 cases, consisted of 67 malignant, 119 benign reactive changes. Of all 362 cases in the negative group, malignant tumor was detected in 90 cases. For histologic diagnosis, the AUC of ROC(95%CI)was 0. 800 (0. 767~0. 834), displaying significant difference as compared to the histological pathological diagnostic results(P<0. 001). As the cyto-histologic diagnostic level elevated from negative, suspicious to positive, the results of Co-chran-Armitage trend test showed significant differences(Z=15. 83, P<0. 001). If standardized with the histopathologic biopsy re-sults, the AUC (area under curve) of urinary exfoliated cell examination was 0. 800 (0. 767~0. 834) in ROC curve analysis was sig-nificantly larger (P<0. 001). Furthermore, we also found in Logistic regression that the incidence of cancer was 1. 04 (1. 03~1. 05) times higher if aged one year older ( P<0. 001 ) , while there was no significant relationship between the incidence and the sex ( P=0. 655). Conclusions The coincidence rate of urinary exfoliated cell examination increases with the malignant degree. A positive cor-relation is detected between age and the incidence of malignant tumor. Detailed clinical material can markedly improve the sensitivity and accuracy of cyto-histologic diagnosis.

High aldehyde dehydrogenase 1A1 (ALDH1A1) expression correlated with risk of lymph node metastasis in papillary thyroid carcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between ALDH1A1 expression and lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>One hundred and fifty-three paraffin-embedded specimens of PTC treated in the Beijing Tongren Hospital of Capital Medical University were selected from January 2006 to December 2013. The expression of ALDH1A1 was detected in both tumor tissues and adjacent non-tumor tissues by immunohistochemistry and several clinicopathological parameters (size, bilaterality, multifocality, tumor border and extrathyroidal extensions) were assessed by HE staining. The correlation of ALDH1A1 expression with LNM was analyzed.</p><p><b>RESULTS</b>In 153 cases of PTC, there were 82 cases with LNM, 126 cases with high ALDH1A1 expression in tumor tissues, and 112 cases with high ALDH1A1 expression in adjacent non-tumor tissues. On univariate analysis, patient age < 45 years, tumor size of 10 mm or more, invasive tumor border, and high ALDH1A1 expression in tumor tissues predicted LNM in PTC (P < 0.05), whereas gender, bilaterality, multifocality, extra-thyroidal extensions and high ALDH1A1 expression in adjacent non-tumor border did not (P > 0.05). On multivariate analysis, invasive tumor border, high ALDH1A1 expression in tumor tissues were found to be independent predictive factors for LNM in PTC (P < 0.05). After a follow-up of 42 months (median time), four patients developed locoregional recurrences, but no distance recurrence or disease related death were seen in 82 patients of follow up. The estimated 5-year locoregional recurrence was 4.88%. Of these four logcoregional recurrences, three involved lymph nodes and one involved the remaining thyroid. The ALDH1A1 expression in tumor tissues was high in all of recurrence cases.</p><p><b>CONCLUSION</b>High ALDH1A1 expression in tumor tissues is correlated with lymph node metastasis in PTC and may be used as an independent predictive factor of LNM, and may improve treatment and follow-up strategies for PTC.</p>

Middle ear adenoma: clinical and pathologic analysis / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinical and pathologic features of middle ear adenoma (MEA).</p><p><b>METHODS</b>Eight cases of MEA were collected from Beijing Tongren Hospital, Capital Medical University between 2004 and 2014, and immunohistochemical staining was performed.</p><p><b>RESULTS</b>The patients included five women and three men (mean age, 37.5 years; median 37 years; range, 21-51 years). All patients had unilateral lesions. Five MEA occurred on the left side, and three on the right. In seven patients the MEA was primary, and they presented with hearing loss (6 cases), tinnitus (5 cases), sense of ear blockage (3 cases), otalgia (1 case) and facial nerve paralysis (1 case). The remaining patient had recurrent MEA, and presented with otorrhea, aural fullness and tinnitus. Histologically, the tumor cells were arranged in a variety of patterns, including solid sheets, nests, glands, ribbons or trabeculae. Glandular structures were prominent in one case only. Immunohistochemically, the tumor cells were diffusely positive for keratin (8/8) and vimentin (8/8), and focally positive for CK 7(8/8) and CK5/6(8/8). CK7 and CK5/6 were predominantly positive in tumor cells with glandular growth pattern; CK7 was positive in the luminal cells while CK5/6 was positive in the abluminal cells. Both were also expressed focally in scattered tumor cells with non-glandular pattern. The tumor cells were also diffusely positive for synaptophysin(8/8), diffusely but weakly positive for NSE (5/8), and were diffusely or focally positive for chromogranin A (4/8). Both S-100 protein and calponin were negative in all cases. The proliferation rate was low, about 1%-2%. Six cases were followed up for one year and three months to ten years and six months, with an average follow-up period of four years and two months. Two patients developed recurrence, but there were no regional or distant metastases.</p><p><b>CONCLUSIONS</b>Diagnosis of MEA requires pathologic confirmation since the clinical symptoms are non-specific. MEA can show a variety of histologic patterns, and should be distinguished from other space-occupying lesions at this site. Immunohistochemical staining has greatly contributed to the diagnosis and differential diagnosis of MEA. The prognosis of this tumor is good. Patients with MEA require long-term follow-up for recurrences.</p>