Successful Endovascular Treatment of Cerebral Venous Thrombosis with a Novel, Larger Aspiration Catheter (REACT): A Case Report.

Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.

Protective effect of aqueous Curry leaf (Murraya koenigii) extract against cadmium-induced oxidative stress in rat heart.

Treatment of rats with a low dose of cadmium chloride caused a significant damage in the rat cardiac tissue indicated by the increase in the level of serum glutamate oxaloacetate transaminase and lactate dehydrogenase1 activities. Histological studies confirmed the damage due to cadmium. That cadmium-induced tissue damage was caused due to oxidative stress was evident from the changes observed in the levels of lipid peroxidation and reduced glutathione, the protein carbonyl content, and the alterations in the activities of cardiac antioxidant and pro-oxidant enzymes. Treatment of rats with cadmium also caused alterations in the activities of mitochondrial Kreb's cycle as well as respiratory chain enzymes. All these changes were ameliorated when the rats were pre-treated with an aqueous extract of Curry leaf (Murraya koenigii). The studies indicated that the aqueous extract of Curry leaf protects the rat cardiac tissue against cadmium-induced oxidative stress possibly through its antioxidant activity. As curry leaf is consumed by people as part of their diet in India and South-East Asian and some European countries as well, and, as it has no reported side-effects, the results seem to have relevance at places where humans are exposed to cadmium environmentally or occupationally.

Myoepithelial cells: any role in aspiration cytology smears of breast tumors?

AIMS AND OBJECTIVE: To study the role of myoepithelial (ME) cells in distinguishing benign, proliferative breast diseases (PBD) and frank malignant breast lesions. MATERIALS AND METHODS: In this study, histology proven 71 cases of fine needle aspiration cytology (FNAC) of palpable breast lesions were selected. There were 30 invasive carcinomas (24 infiltrating duct carcinoma and 6 infiltrating lobular carcinoma), 25 cases of benign lesion (21 fibroadenomas and 4 fibrocystic lesions) and 11 proliferative breast diseases (other than carcinoma in situ) and five cases of carcinoma in situ. The number of ME cells were estimated in respect to 1000 ductal cells. In every case at least 20 high power fields (x 40) were studied. Quantitative estimation of ME cell was correlated with the final diagnosis. Corresponding histopathology cases were also evaluated for diagnostic confirmation along with the pattern of distribution of ME cells. The ME cells were also quantitated on histopathology sections on smooth muscle actin (SMA) immunostained sections. RESULTS: The mean number of ME cells per 1000 ductal cells on cytology smears was 5.1 +/- 5.5, 30.8 +/- 25, 28.3 +/- 20.2, and 38.4 +/- 38.8 in malignant, carcinoma in situ, PBD and benign breast lesions respectively. The non parametric Mann Whitney test showed significant difference in number of the ME cells between benign and malignant groups (p < .000), PBD and malignant groups (p < .000) and carcinoma in situ and malignant group (p < .001). However, it was insignificant between benign and PBD group, and PBD and carcinoma in situ (p > .01). In SMA stained histopathology sections, ME cell in benign, PBD, carcinoma in situ and malignant cases were 741.12 +/- 248, 238 +/- 172, 121.6 +/- 115 and 15.6 +/- 25.1 respectively. Statistical analysis showed significantly different number of ME cell between benign versus PBD group, carcinoma in situ and malignant group. It was also significant between PBD versus malignant, and carcinoma in situ versus malignant (p < .001, Mann Whitney test). However number of ME cell was not significant between PBD versus carcinoma in situ. CONCLUSION: The number of ME cell in breast lesions may be helpful in distinguishing PBD versus invasive malignant tumors on FNAC smears. However it is not helpful to distinguish benign lesions versus PBD.

Perivascular epithelioid cell tumor (PEComa) of falciform ligament - an extremely rare tumor.

Primary tumor of falciform ligament is exceedingly uncommon. So far, seven cases of Perivascular Epithelioid Cell tumor (PECom), a recently described histological entity with characteristic perivascular tumor cell arrangement and expression of muscle and melanocytic marker by the cells, have been reported in literature. Here, we report a case of PEComa of falciform ligament, which presented with a huge abdominal lump. Pre-surgical CT scan of abdomen was uninformative regarding the nature and organ of origin of the tumor. On laparotomy, it was surprisingly found to arise from the falciform ligament, and this was easily removed. Histopathological diagnosis confirmed PEComa. There was no recurrence of disease after two years of follow up.

Image morphometry of acute leukemias. Comparison between lymphoid and myeloid subtypes.

OBJECTIVE: To determine if image morphometry has any role in distinguishing blasts of acute lymphoblastic leukemia (ALL-L2) from those of acute myeloid leukemia (AML-M1) and (AML-M2). STUDY DESIGN: Ten cases each of ALL-L2, AML-M1 and AML-M2 diagnosed according to the French-American-British criteria were studied. In all cases May-Grünwald-Giemsa-stained bone marrow aspiration smears were obtained. At least 100 blast cells from each case were subjected to analysis randomly with an image cytometer using Leica Quantimet 600 software (Cambridge, U.K.). The area, convex area, length, width, perimeter, convex perimeter, roundness, total optical density, average optical density and pixel grey value variance of the nuclei were measured by random selection of cells using a 40:1 objective (1 pixel = 0.446 micron). RESULTS: Mann Whitney's nonparametric test showed that there was considerable overlap of morphometric variables between the 3 subtypes. Though statistical significance was found in "roundness" between blasts of AML-M1 and ALL-L2, power analyses (sample size of 100 blasts of each subtype) did not show sufficient power for this variable. However, between blasts of ALL-L2 and AML-M2, "average optical density" and "pixel grey value variance" were statistically significant with full power using power analyses. CONCLUSION: Image morphometry may be helpful in differentiating blasts from lymphoid and myeloid leukemic subtypes.

Pathology teach and tell: neonatal hemochromatosis with massive hepatic necrosis.

Neonatal hemochromatosis (NH) is an uncommon disorder clinicopathologically defined by severe liver disease of intrauterine onset associated with extrahepatic siderosis that spares reticuloendothelial elements. NH phenotypically is a similar disorder to hereditary hemochromatosis. However, its extremely early onset of liver failure makes it notably unique. Massive liver necrosis in the newborn is a rare occurrence, but whenever present hemochromatosis should be considered in the differential diagnosis. Herein, we report a case of neonatal hemochromatosis that had massive hepatic necrosis with sparing only little parenchyma. The outcome was fatal within the first month of life.

Urine: beyond cytology for detection of malignancy.

In the present review we discuss various ancillary modalities for detection of malignancies in urine samples, with an emphasis on urothelial carcinomas. Flow cytometry, bladder tumor antigen (BTA), nuclear matrix protein (NMP), matrix metalloproteinase (MMP), human chorionic gonadotrophic (HCG), telomerase, and other techniques are discussed. DNA FCM is a relatively costly and sophisticated technique. It has a practical application in the diagnosis of bladder cancer among subjects at high risk and is of value in monitoring the course of the disease and anticipating recurrence following conservative treatment. The BTA test is a simple, rapid, and inexpensive adjunct to cystoscopy and the results of the test are equivalent or superior to those of voided urinary cytology. NMP-22 immunoassay is a useful diagnostic test for predicting recurrence of urothelial malignancy. It is also a cost-effective and sensitive screening test for detecting tumor in patients with urothelial carcinoma. Beta-HCG estimation in urine samples appears to be an efficient diagnostic marker for the assessment of distant metastasis in bladder carcinoma rather than a screening test. Other ancillary techniques such as detection of expression of cytokeratin 20 by RT-PCR, MMP-9 estimation, and fluorescent in situ hybridization and telomerase activity are rarely applied clinically in routine urinary samples and are not cost-effective.