Expression of bcl-2 in ductular proliferation is related to periportal hepatic stellate cell activation and fibrosis progression in patients with autoimmune cholestasis.

AIM: To study bcl-2 expression in ductular proliferation cholangiocytes and hepatic stellate cell activation in liver biopsies from patients with autoimmune cholangitis and primary biliary cirrhosis. MATERIALS AND METHODS: Twenty-four primary biliary cirrhosis patients and 11 autoimmune cholangitis patients were included. Thirty-four females, average age: 52.5+/-12.6 years. We studied the presence of ductular proliferation, cholestasis, florid ductal lesion, granulomata, ductopenia and histologic stage. Patients were classified in primary biliary cirrhosis or autoimmune cholangitis according to antimitochondrial antibodies, antinuclear antibodies, smooth muscle antibody, antiGP210 and antiSP100 autoantibodies. We studied the presence of bcl-2 by monoclonal antibcl-2 antibody (clon 100, BioGenex). The presence of activated (specific antialpha-actin antibodies) and independent lobular, periportal and portal hepatic stellate cell was assessed using a semiquantitative scale. RESULTS: Interlobular ducts bcl-2 was seen in 18 (51.4%) patients. Activated periportal hepatic stellate cell correlated with Ludwig's stage (r=0.43; n=35; p=0.01). Ten out of 15 (66.6%) patients with ductular proliferation showed positive interlobular ducts bcl-2 while bcl-2 was negative in 8 out of 20 (40%) patients without ductular proliferation; p<0.05. Bcl-2 positive patients in ductular proliferation showed a more advanced Ludwig's stage (2.33+/-0.77 versus 1.26+/-1.05; p<0.05) and a higher periportal hepatic stellate cell activation index (0.83+/-0.78 versus 0.23+/-0.43; p=0.009). No relationship was found among periportal hepatic stellate cell activation and the presence of florid ductal lesion, cholestasis, granulomata or biliary erosive necrosis. Hepatic stellate cell activation was similar in patients with either autoimmune cholangitis or primary biliary cirrhosis. CONCLUSIONS: Periportal hepatic stellate cell activation seems to play a main role in fibrosis progression in patients with autoimmune cholestasis. Bcl-2 expression in ductular proliferation may promote hepatic stellate cell activation and fibrosis.

SLC11A1 promoter gene polymorphisms and fibrosis progression in chronic hepatitis C.

BACKGROUND AND AIMS: The solute carrier family 11 member 1 (SLC11A1) gene (formerly Nramp1) encodes for the protein solute carrier family 11, member 1. It affects susceptibility and clinical outcome of autoimmune and infectious diseases. We investigated the possible role of the functional polymorphism located in the promoter region of SLC11A1 and tumour necrosis factor (TNF) genes in the progression of fibrosis in chronic hepatitis C. METHODS: A total of 242 Caucasian Spanish patients with biopsy proven chronic hepatitis C and 194 healthy control subjects were genotyped for SLC11A1 and TNF promoter polymorphisms. RESULTS: No significant differences in the distribution of frequencies among patient and control groups were observed. The SCL11A1 homozygous 2/2 genotype was rarely detected among patients showing advanced fibrosis (2/82; 2.4%) but was highly represented in those with mild fibrosis (29/160; 18.1%; odds ratio (OR) 8.85 (95% confidence interval (CI) 1.9-55.2, p(c) = 0.002). In patients carrying allele 3 of SLC11A1, the presence of -238 TNF A/G was associated with advanced fibrosis (14/26 (53.8%) v 68/216 (31.4%); OR 2.53 (95% CI 1.03-6.23); p = 0.02). CONCLUSIONS: SLC11A1 gene promoter polymorphism could influence fibrosis progression in chronic hepatitis C in that the homozygous genotype 2/2 exerts a protective effect against cirrhosis development. Also, the combination of TNF -238 A/G and the presence of allele 3 is conducive to progression to pre-cirrhotic or cirrhotic stages of the disease.

Fibromatosis mamaria. Proliferación fibroblástica benigna con agresividad local / Fibromatosis of the breast. Locally aggressive benign fibroblastic proliferation

La fibromatosis mamaria es una tumoración mesenquimatosa benigna que simula clínica, radiológica y citológicamente a un carcinoma. Sólo la histología hace el diagnóstico diferencial de un carcinoma mamario. Además presenta agresividad local, con invasión local y recidiva de un 21-27 por ciento. El tratamiento es la exéresis quirúrgica amplia con márgenes libres. Se expone el caso de una paciente 30 años, sin antecedentes de interés, que presenta una tumoración de 2 cm en cuadrante inferointerno de mama izquierda no adherida a planos profundos. El estudio radiológico es sugestivo de malignidad y la citología resultó negativa para células malignas. Se realizó una tumorectomía con amplios márgenes se seguridad. El diagnóstico histológico es de fibromatosis mamaria. En la revisión anual la evolución fue favorable. (AU)

Hepatic metastases from the spindle cell variant of medullary thyroid carcinoma: report of a case with diagnosis by fine needle aspiration biopsy.

BACKGROUND: The liver is a common site of neuroendocrine tumors (NTs) metastatic from primaries in the gastrointestinal tract, pancreas, biliary system and lungs. Medullary thyroid carcinoma (MTC) is also a potential source of metastases of NTs. Their metastases to the liver are frequent and can appear several years after the primitive tumor. Although a wide variety of cytomorphologic features are normally exhibited by MTC in smears, a spindle-shaped cell pattern can predominate, complicating the correct interpretation of a metastasis. CASE: A 63-year-old man presented with multiple liver nodules two years after a total thyroidectomy for MTC. Fine needle aspiration biopsy smears of the liver revealed neoplastic cells occurring in loose groupings or lying singly, most of them with a spindle shape and elongated nucleus with the characteristic "salt and pepper" chromatin pattern of a neuroendocrine tumor. Cytoplasmic dendritic processes and intranuclear inclusions were frequently seen. The cytomorphologic features of the tumor were essentially the same as those of the primary MTC. Immunoreactivity for calcitonin confirmed the diagnosis. CONCLUSION: In fine needle aspiration biopsy of liver masses, knowledge of the spindle pattern of the NT is important in order to achieve a correct diagnosis when metastases are the first manifestation of an occult primary tumor. Among neuroendocrine tumors, MTC must be included in the differential diagnosis.

Seminal vesicle epithelium as a potential pitfall in the cytodiagnosis of presacral masses. A report of two cases.

BACKGROUND: Whenever abdominoperineal resection is performed because of a rectal adenocarcinoma, the prostate and seminal vesicles may be displaced backward to the presacral space, giving rise to a false radiologic image of a presacral tumor. Due to cytologic atypia associated with the epithelium of seminal vesicles, there is a real possibility, in fine needle aspiration biopsy (FNAB), of erroneously giving a malignant diagnosis. CASES: Two men, aged 53 and 57 years, presented with presacral masses three months and six years, respectively, after abdominoperineal resection for rectal adenocarcinoma. In both cases, FNAB smears showed some groups and single cells with large and irregular nuclei. These cells suggested a recurrence of carcinoma. The presence of cytoplasmic coarse pigment and a background with spermatozoa and blobs of inspissated secretory product were sufficient to determine that these presacral masses represented the seminal vesicles. CONCLUSION: Awareness that seminal vesicles may give rise to a radiologic impression of presacral tumor after abdominoperineal resection of the rectum will avoid unnecessary FNAB and a cytologic false positive diagnosis of colorectal adenocarcinoma.

Fine needle aspiration and touch imprint cytology of a malignant fibrous histiocytoma of the spermatic cord. Case report.

BACKGROUND: No cytologic reports on spermatic cord sarcomas have been published. CASE: A 64-year-old man presented with a slowly growing, painless, left spermatic cord enlargement. Fine needle aspiration (FNA) obtained < 1 mL of bloody fluid consisting of solitary, mark-edly anaplastic and pleomorphic tumor giant cells occasionally arranged in small fragments. Rare atypical spindle cells could be observed. Some reactive lymphocytes were observed intermingled with tumor cells. Immunohistochemistry displayed vimentin reactivity and negativity for keratins and leukocytic common antigen. The specimen removed showed a well-circumscribed, 30-mm, yellowish solid tumor. Touch imprints displayed pleomorphic tumor cells showing intense anisonucleosis; a moderate amount of clear, sometimes microvacuolated cytoplasm; and tissue fragments with a storiform pattern. Histologic examination revealed microscopic and immunohistochemical features of malignant fibrous histiocytoma (MFH) arising in soft tissues of the spermatic cord. CONCLUSION: FNA of a spermatic cord lesion may reveal a pleomorphic sarcoma. A pleomorphic appearance together with some spindle elements and compatible immunocytochemistry could help diagnose spermatic cord MFH. This is one of the few reports dealing with FNA cytology of paratesticular tumors and the first report, to the best of our knowledge, showing the cytologic characteristics of a case of spermatic cord MFH.

Pérdida del injerto en trasplante hepático. Estudio anatomoclínico de 131 injertos fracasados en la primera década (1986-1996) del programa del hospital 12 de octubre / Graft loss in liver transplantation: pathological and clinical study of 131 graft failures during the first decade (1986-1996) of the liver transplant program at Hospital 12 de Octubre

Introducción. Existen diversas complicaciones que pueden conducir a la pérdida del injerto hepático (por retrasplante o fallecimiento). Los objetivos del presente trabajo son conocer las complicaciones morfológicas que se desarrollan en estos injertos fracasados y determinar cuáles son las causas de fracaso más relevantes en esta terapéutica. Pacientes y métodos. En el Hospital 12 de Octubre (Madrid) se realizaron 494 trasplantes hepáticos entre 1986 y 1996. Su indicación más frecuente fue la cirrosis (criptogénica, alcohólica y por hepatitis C). En 61 pacientes se indicó retrasplante. En 22 se realizó un segundo retrasplante y en dos un tercer retrasplante. En 56 pacientes fallecidos (40 por ciento de los fallecimientos del programa) se realizó autopsia. Un total de 131 injertos fracasados (75 obtenidos en el retrasplante y 56 tras autopsia) fueron estudiados morfológicamente de forma protocolizada. Las causas de fracaso fueron establecidas tras la oportuna correlación anatomoclínica. Resultados. En 109 injertos las lesiones hepáticas explicaban su fracaso. El rechazo crónico (31 por ciento), las alteraciones circulatorias (31 por ciento) y el fallo primario (16 por ciento) fueron las causas hepáticas de fracaso más frecuentes. Las alteraciones circulatorias fueron infartos, necrosis isquémicas parenquimatosas zonales y/o colangitis isquémicas, no siempre asociadas a lesiones vasculares del injerto. En los injertos con fallo primario se observaron lesiones isquémicas parenquimatosas con algunas características similares a las de los injertos con alteraciones circulatorias. La causa más común de muerte fue la sepsis (46 por ciento), frecuentemente asociada a alteraciones circulatorias. La causa más frecuente de retrasplante fue el rechazo crónico (40 por ciento; 75 = 100 por ciento), seguido de las alteraciones circulatorias (27 por ciento) y del fallo primario (21 por ciento). Sin embargo, la incidencia de rechazo crónico decreció de manera muy notable en el segundo lustro de la década estudiada, cediendo su puesto a las alteraciones circulatorias como primera causa de fracaso. Conclusiones. Tras el descenso del rechazo crónico del injerto como causa de su fracaso, se requiere mejorar el control de los factores favorecedores de cualquier forma de isquemia en el injerto para continuar reduciendo el número de injertos fracasados (AU)

Fine needle aspiration cytology of a cervical lymph node lymphangioma in an adult. A case report.

BACKGROUND: Although the cytologic features of cervical cystic lesions are well established, no cytology reports on lymphangioma in adults have been published. CASE: A 60-year-old male presented with a slowly growing, upper laterocervical, painless enlargement. Fine needle aspiration (FNA) obtained 15 mL of yellowish fluid, consisting predominantly of a uniform population of small and round lymphocytes without mitosis or atypia and with some histiocytes intermingled with them. Some centrocytes and occasionally centroblasts and plasma cells could also be observed. Immunohistochemistry performed on cell block sections displayed polyclonal B lymphocytes mixed with T cells. The specimen showed a clearly circumscribed, 50-mm, cystic lesion with a multilocular appearance and abundant, yellowish liquid. Microscopic examination demonstrated cystic lymphangioma arising from the medullary portion of a lymph node. CONCLUSION: FNA cytology permits a suggested diagnosis of lymphangioma. This is one of the few reports of FNA cytology of lymphangioma and, to the best of our knowledge, this entity has not previously been found as a neck mass in an adult.