Histological Patterns and Mammographic Presentation of Invasive Lobular Carcinoma Show No Obvious Associations.

Invasive lobular carcinoma of the breast has different mammographic appearances, including spiculated or lobulated masses, architectural distortion, increased breast density, and the possibility of also being occult. Histologically, the morphology is also variable, as several patterns have been described beside the classical one, including the solid, the alveolar, the trabecular, the one with tubular elements, and others. Of 146 ILC cases, 141 were reviewed for mammographic appearance and 136 for histological patterns by two radiologist and two pathologists, respectively; 132 common cases were analyzed for possible associations between mammographic presentation and the histological patterns. Interobserver agreement on the presence or absence of a given mammographic morphology ranged from 45% (increased density) to 95% (occult lesion); the most common radiomorphology was that of a spiculated mass. Interobserver agreement on the presence or absence of a given histological pattern ranged between 79% (solid) and 99% (classical) but was worse when semi-quantification was also included. The mammography-pathology correlation was less than optimal. Multifocality was more commonly detected by histology. The identification of a mammographic mass lesion often coincided with a mass-like lesion on the histological slides and vice versa, but nearly half of the mammographically occult lesions were felt to have masses on histological slides assessed grossly. Histological patterns showed no obvious associations with one or the other mammographic appearance.

Galectin-8 Immunohistochemical Profile in Pancreatic Ductal Adenocarcinoma: Emerging Evidence for Its Prognostic Role.

Pancreatic ductal adenocarcinoma (PDAC) represents the most frequent pancreatic malignancy, with stromal and epithelial heterogeneity reflected in outcome variability. Therefore, a molecular classification is promoted based on the validation of new diagnostic and prognostic markers. Galectin-8 (Gal8) has been pointed out as a prognostic factor for survival in several types of tumors. Due to limited existing data on PDAC, our study aimed to evaluate the Gal8 profile in PDAC alongside its prognostic status. A total of 87 cases of PDAC were immunohistochemically investigated, and Gal8 immunoexpression was qualitatively and semi-quantitatively assessed and correlated with classical clinicopathological parameters and survival. Gal8 immunoexpression was identified to be mostly nuclear and cytoplasmic, followed by exclusively cytoplasmic and exclusively nuclear. A statistical analysis between Gal8 profiles defined by negative, low, or high scores and clinicopathological characteristics showed significant differences in tumor size, pN stage, and lympho-vascular invasion. Although a Cox regression analysis did not support the prognostic status of Gal8, and we did not confirm its relationship with OS, our results show that exclusively nuclear labeling was associated with an increased mean OS compared with cytoplasmic and nuclear labeling (29.37 vs. 17.93 months). To the best of our knowledge, this is the first study to report a detailed pattern of Gal8 immunostaining in PDAC and to correlate this pattern with clinicopathological characteristics and survival. Our results show that Gal8 immunoexpression is associated with a more aggressive phenotype, thus opening perspectives for larger studies to validate Gal8 as a prognostic factor.

Granulomatous Secondary Syphilis: A Case Report with a Brief Overview of the Diagnostic Role of Immunohistochemistry.

The diagnosis of syphilis can be challenging for dermatologists and dermatopathologists. In particular, secondary syphilis can have different clinical and histopathological presentations. A granulomatous tissue response is an unusual finding in secondary syphilis. We report the case of a 77-year-old man who presented with a 4-week history of non-pruritic generalised macules, papules, nodules and plaques. Histopathologically, there was a dense perivascular and periadnexal lympho-histiocytic dermal infiltrate with non-palisading and non-caseifying epithelioid granulomas and abundant plasma cells. The diagnosis of syphilis was confirmed by serology and immunohistochemical detection of Treponema pallidum in the biopsy specimen. A brief overview of the diagnostic role of immunohistochemistry is also provided, with particular emphasis on reported cases of granulomatous secondary syphilis.

Typical histological pattern of seminoma and its immunoreactivity: A diagnostic challenge.

A 20-year-old man presented in the Department of Urology, with the complaint of left-sided lower abdominal lump for past 9 months. The patient denied of having any constitutional symptoms including weight loss.

Trends in incidence and histological pattern of thyroid cancer in Ho Chi Minh City, Vietnam (1996-2015): a population-based study.

BACKGROUND: The burden and trend of thyroid cancer in Vietnam have not been well documented. This study aimed to investigate the trends in incidence and histological pattern of thyroid cancer in Ho Chi Minh City from 1996 to 2015. METHODS: A population-based study retrieved data from the Ho Chi Minh City Cancer Registry during 1996-2015. Trends in the incidence of thyroid cancer were investigated based on age, gender, and histology for each 5-year period. Annual percentage change (APC) in incidence rates was estimated using Joinpoint regression analysis. RESULTS: In the study period, there were 5953 thyroid cancer cases (men-to-women ratio 1:4.5) newly diagnosed in Ho Chi Minh City with the mean age of 42.9 years (±14.9 years). The age-standardized incidence rate of thyroid cancer increased from 2.4 per 100,000 during 1996-2000 (95% confidence interval [95% CI]: 2.2-2.6) to 7.5 per 100,000 during 2011-2015 (95% CI: 7.3-7.9), corresponded to an overall APC of 8.7 (95% CI 7.6-9.9). The APC in men and women was 6.2 (95% CI: 4.2-8.2) and 9.2 (95% CI: 8.0-10.4), respectively. The incidence rate in the < 45 years age group was the highest diagnosed overall and increased significantly in both men (APC 11.0) and women (APC 10.1). Both genders shared similar distribution of subtype incidences, with papillary thyroid cancer constituted the most diagnosed (73.3% in men and 85.2% in women). The papillary thyroid cancer observed a markedly increase overall (APC of 10.7 (95% CI 9.3-12.0)). CONCLUSIONS: There were appreciable increases in the age-standardized incidence rate of thyroid cancer in both genders, mainly contributed by the papillary subtype. The age of patients at diagnosis decreased gradually. The widespread utilization of advanced diagnostic techniques and healthcare accessibility improvement might play a potential role in these trends. Further investigations are needed to comprehend the risk factors and trends fully.

Telomerase reverse transcriptase (TERT) promoter mutation correlated with intratumoral heterogeneity in hepatocellular carcinoma.

Telomerase reverse transcriptase (TERT) promoter mutations are frequently observed in hepatocellular carcinoma (HCC); however, the impact of TERT promoter mutations (TPMs) on clinical features and morphological patterns in HCC remains unresolved. Using DNA extracted from 97 HCCs, correlations between TPM status and both the clinical features of HCC and the immunohistochemically-based subgroups were evaluated. Morphological tumor patterns were semi-quantitatively analyzed using hematoxylin and eosin-stained slides of the whole tumor cross-sectional area. The percentages of tumor area occupied by early, well, moderate and poor histological patterns were calculated as a homogeneity index. TPMs were observed in 53 of 97 (55%) HCCs and were significantly associated with older age (P = 0.018) and HCV-related background (P = 0.048). The biliary/stem cell marker-positive subgroup was less likely to have TPMs (29%) compared to the Wnt/ß-catenin signaling marker-positive subgroup (60%). In contrast to TPM-negative HCCs, TPM-positive HCCs clearly exhibited intratumoral morphological heterogeneity (0.800 ± 0.117 vs 0.927 ± 0.096, P < 0.0001), characterized by two or more heterogeneous histological patterns (P < 0.0001) and had more well or early differentiated histological patterns (P = 0.024). Our findings showed that intratumoral heterogeneity was strongly related to TPM-positive HCCs, which established novel roles of TPMs, and may improve our understanding particularly about HCC development and diagnosis.

Problems in the reproducibility of classification of small lung adenocarcinoma: an international interobserver study.

AIMS: The 2015 WHO classification for lung adenocarcinoma (ACA) provides criteria for adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (INV), but differentiating these entities can be difficult. As our understanding of prognostic significance increases, inconsistent classification is problematic. This study assesses agreement within an international panel of lung pathologists and identifies factors contributing to inconsistent classification. METHODS AND RESULTS: Sixty slides of small lung ACAs were reviewed digitally by six lung pathologists in three rounds, with consensus conferences and examination of elastic stains in round 3. The panel independently reviewed each case to assess final diagnosis, invasive component size and predominant pattern. The kappa value for AIS and MIA versus INV decreased from 0.44 (round 1) to 0.30 and 0.34 (rounds 2 and 3). Interobserver agreement for invasion (AIS versus other) decreased from 0.34 (round 1) to 0.29 and 0.29 (rounds 2 and 3). The range of the measured invasive component in a single case was up to 19.2 mm among observers. Agreement was excellent in tumours with high-grade cytology and fair with low-grade cytology. CONCLUSIONS: Interobserver agreement in small lung ACAs was fair to moderate, and improved minimally with elastic stains. Poor agreement is primarily attributable to subjectivity in pattern recognition, but high-grade cytology increases agreement. More reliable methods to differentiate histological patterns may be necessary, including refinement of the definitions as well as recognition of other features (such as high-grade cytology) as a formal part of routine assessment.

Pathological Characterization of Lymphoma with Pulmonary Involvement in Cats.

Studies evaluating histological patterns of lung infiltration by lymphoma in cats are lacking. We evaluated retrospectively the histological patterns of 125 necropsy cases of feline lymphoma collected over a 12-year period. Of the 125 cases, 16 showed lung infiltration (12.8%). Nine cats were female, seven cats were male and all were of mixed breed. Gross lesions observed in the lungs consisted of masses (25%) and nodules (18.7%); however, the majority of cases (56.2%) did not show any gross abnormality. Peribronchial-vascular infiltration (93.7%) was the most frequent pattern, followed by pleural (56.2%), interstitial (50%), nodular (37.5%) and alveolar (12.5%) patterns, but 75% of the cases had more than one pulmonary infiltration pattern. There were 14 (87.5%) B-cell and two (12.5%) T-cell lymphomas. Six cats (37.5%) were positive for feline leukaemia virus and three cats (18.7%) were positive for feline immunodeficiency virus. Diffuse large B-cell lymphoma was the most frequent type, accounting for 56% of all cases.

Nectin1 expression is frequently decreased in gastric cancers.

Gastric cancer (GC) is rich in many different histological types, but how the histological pattern is defined remains to be proved. The relation between GC histological types and the expression of nectin1, which is one of the cell adhesion molecules that composes adherens junction, has not been reported. According to a publicly available database of 406 GC patients, the median overall survival of Nectin1 high expression patients was 55.4 months and that of low expression patients was 25.6 months (P = 0.0246). Using surgically or endoscopically resected GC samples, nectin1 expression was analyzed by immunohistochemistry. Nectin1 expressed at adherens junction in all the normal epithelial cells. However, nectin1 expressed not at adherens junction but at apical membrane in epithelial cells in intestinal metaplasia. The expression pattern of nectin1 in intestinal type GC resembled to intestinal metaplasia. In order to analyze the difference in nectin1 expression between GC histological types, a total of 116 intestinal type GC and 33 diffuse type GC. The expression of necitin1 in diffuse type GC (3.0%) was remarkably decreased compared to that in intestinal type GC (65.5%) (P < 0.0001). In conclusion, this is the first report showing an association between nectin1 expression and histological subtypes of GC.

Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters.

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

Histological fibrosis may predict the failure of core decompression in the treatment of osteonecrosis of the femoral head.

PURPOSE: Osteonecrosis of femoral head (ONFH) is histopathologically characterized by necrotic areas associated with reactive fibrosis, trabecular bone remodeling and thickening zones. Our double goal was to evaluate if: 1) main ONFH risk factors were related to specific histological specimen patterns 2) different histological patterns were related to the final outcome after a core decompression (CD) procedure. METHODS: This observational longitudinal cohort study respected the STROBE statement. We described a series of 41 ONFH (Ficat stage I and II) treated by CD. Specimens from core biopsies were scored according to the extension of necrosis, fibrosis, trabecular bone remodeling and thickening, and were correlated (multivariate analysis) to clinical, biological and radiological factors (age, delay between symptoms onset and surgery, alcohol, steroids, smoking, related disease, cholesterol, triglycerides, x-ray and MRI findings). Prospectively, differences in survivorship among different histological patterns were assessed (log-rank test on Kaplan-Meier curves). Minimum follow-up was 3 years. RESULTS: Risk factors did not correlate with the histological pattern. The CD survival rate was progressively decreased at 36 months after surgery, thereafter, remained relatively constant (59% at 1 year, 46% at 2 years, 37% at 3 and 5 years). A survival sub-analysis showed a higher CD survivorship in patients with lower extension of fibrosis on core biopsies than patients with high fibrosis levels (log rank p = 0.019). CONCLUSIONS: The extension of fibrosis on specimens from biopsies in ONFH is a predictor of the outcome of the CD, therefore it may be considered a prognostic variable. However, it did not correlate with any risk factor. Different ONFH risk factors background did not correlate with specific histological patterns.

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding.

BACKGROUND: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding. AIMS & OBJECTIVES: The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and histopathological pattern of the hysteroscopic directed biopsy. RESULTS: Sixty patients presenting with postmenopausal bleeding in outpatient department, after applying both inclusion and exclusion criteria, were enrolled in the present study. Majority (38.33 %) of patients had atrophic endometrium or normal endometrium. Endometrium was hyperplastic in 18 (30 %) patients, polyp in 6 (10 %) patients, and growth in 7 (11.67 %) patients. On histopathology, majority of patients (38.33 %) had atrophic endometrium. Endometrial hyperplasia was detected in 14 (23.33 %) out of which 11 had simple hyperplasia while 3 had atypical hyperplasia. Endometrial cancer was detected in 8 (13.33 %) patients. Out of 8 cases of endometrial malignancy, one case was confirmed as endometrial adenocarcinoma on histopathology. CONCLUSION: Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions. Histo-pathological evaluation is mandatory for ruling out malignancy in selected cases of PMB through hysteroscopy.

Estudio microscópico de dermatopatías en equinos de la sabana de Bogotá, Colombia / Microscopic Study of Skin Diseases in Horses from the Bogotá Savanna, Colombia / Estudo microscópico de dermatopatias em equinos da savana de Bogotá, na Colômbia

Los caballos ocupan el tercer lugar en presentación de enfermedad dermatológica luego de los perros y los gatos; sin embargo, es escasa la información que se dispone sobre los aspectos demográficos de las enfermedades dermatológicas en esta especie en Colombia. El objetivo del presente trabajo fue hacer un estudio preliminar para conocer las enfermedades dermatológicas que afectan a los equinos en la sabana de Bogotá, mediante biopsia, raspado de piel y tricograma, con el fin de acercarse al diagnóstico y así establecer medidas terapéuticas y profilácticas que beneficien la salud animal y la productividad en explotaciones comerciales. Se recibieron 39 biopsias de piel, 39 raspados cutáneos y 37 muestras de cortezas pilosas de equinos con algún tipo de dermatopatía, las cuales fueron procesadas en el Laboratorio de Histopatología de la Universidad de La Salle. Las lesiones inflamatorias se clasificaron teniendo en cuenta los patrones histológicos de enfermedad inflamatoria de la piel y los tumores, según la clasificación de la Organización Mundial de la Salud (OMS). Las dermatitis alérgicas fueron las patologías más frecuentes (46%) y las neoplasias se observaron en el 13% de los casos; en el 10% de los raspados cutáneos se observaron esporas de hongos en posición ectotrix. En uno de los tricogramas se identificaron ácaros del género Psoroptes spp. Este es el primer reporte de diagnóstico microscópico de enfermedades dermatológicas en equinos en el país con el fin de contribuir al conocimiento demográfico de las dermatopatías en la sabana de Bogotá.

Horses hold third place in number of cases of skin disease after cats and dogs; however, there is little information about the demographic aspects of dermatological diseases in this species in Colombia. The purpose of this work was to carry out a preliminary study in order to determine the dermatological diseases that affect horses in the Bogotá Savanna, through biopsy, skin scraping and trichogram, in order to approach the diagnosis and thus to establish therapeutic and prophylactic measures that benefit the animal's health and productivity in commercial farms. Thirty-nine skin biopsies, thirty-nine cutaneous scraping and thirty-seven samples of hairy peel from horses with some kind of skin disease were received, all of which were processed by the Histopathology Laboratory from La Salle University. The inflammatory injuries were sorted taking into account the histological patterns of inflammatory skin disease and tumors, according to the classification by the World Health Organization (WHO). Allergic dermatitis was the most common pathology (46%) and neoplasia was observed in 13% of the cases; fungal spores in ectothrix position were found in 10% of the cutaneous scrapes. Mites of the type Psoroptes spp were identified in one of the trichograms. This is the first report of microscopic diagnosis of skin diseases of horses in the country with the goal of contributing with the demographic knowledge of skin diseases in the Bogotá Savanna.

Os cavalos ocupam o terceiro lugar em apresentação de doença dermatológica depois dos cachorros e dos gatos; contudo, é escassa a informação que se dispõe sobre os aspectos demográficos das doenças dermatológicas nesta espécie na Colômbia. O objetivo do presente trabalho foi fazer um estudo preliminar para conhecer as doenças dermatológicas que afetam os equinos na savana de Bogotá, mediante biopsia, raspagem de pele e tricograma, com a finalidade de aproximar-se ao diagnóstico e assim estabelecer medidas terapêuticas e profilácticas que beneficiem a saúde animal e a produtividade em explorações comerciais. Foram recebidas 39 biopsias de pele, 39 raspagens cutâneas e 37 amostras de crostas pilosas de equinos com algum tipo de dermatopatia, as quais foram processadas no Laboratório de Histopatologia da Universidade de La Salle. As lesões inflamatórias se classificaram levando em conta os padrões histológicos de doenças inflamatórias de pele e os tumores, segundo a classificação da Organização Mundial de a saúde (OMS). As dermatites alérgicas foram as patologias mais frequentes (46%) e as neoplasias se observaram em 13% dos casos; em 10% das raspagens cutâneas se observaram esporas de fungos em posição ectotrix. Em um dos tricogramas se identificaram ácaros do gênero Psoroptes spp. Este é o primeiro relatório de diagnóstico microscópico de doenças em equinos no país com a finalidade de contribuir ao conhecimento demográfico das dermatopatias na savana de Bogotá.

Diaphyseal osteosarcoma with varying histomorphologic patterns.

Osteosarcoma is the most common primary malignant tumor of the skeleton involving predominantly metaphysis of the long bones. Diaphyseal osteosarcoma is a rare form, which accounts for approximately 10% of all cases of osteosarcomas. Osteosarcoma contains a family of lesions with considerable diversity in histologic features and grade. We present a case of a 29-year-old male with diaphyseal osteosarcoma of the left tibia, who presented with pain and swelling over middle one-third of the left leg. The biopsy of the lesion revealed varied histomorphologic features in a small tissue studied. This prompted us to report the various histologic patterns of osteosarcoma.

Padrão histológico de biópsias renais em rins nativos / Histological pattern of renal biopsies in native kidneys

JUSTIFICATIVA E OBJETIVOS: A biópsia renal constitui o padrão-ouro para diagnóstico, prognóstico e tratamento da maioria das doenças renais, especialmente das glomerulopatias. O objetivo deste estudo foi revisar as biópsias renais percutâneas realizadas na investigação de doenças renais. MÉTODO: Estudo retrospectivo de prontuários de 174 pacientes submetidos à biópsia renal percutânea no período compreendido entre 1988 e 2010. Foram coletados os seguintes dados: idade, sexo, apresentação clínica, padrão histológico e complicações.Os dados foram armazenados no banco de dados do Microsoft Excel. As variáveis contínuas foram expressas em média e desvio-padrão e as frequências relativas foram calculadas. RESULTADOS: A idade média dos pacientes foi de 33,7 ± 16,7 anose 51,4% eram do sexo masculino. Glomerulonefrites (GN) foram diagnosticadas em 60,9% do total. Doença de lesão mínima (DLM)foi a GN primária mais comum em adultos (17,9%), seguida por GN proliferativa (17%), GN membranosa e GN segmentar e focal cada uma com (14,2 %). Nefrite lúpica foi a GN secundária mais comum (12,6% do total de biópsias). A principal apresentação clínica foi a proteinúria. Complicações foram observadas em 10,3% das biópsias realizadas, hematúria em 15 (8,6%) e hematoma perirrenal em três (1,7%) pacientes, sendo um complicado com abscesso perirrenal. CONCLUSÃO: O padrão histológico mais comum foi o de glomerulonefrites. Doença de lesão mínima foi a glomerular primária mais frequente. Nefrite lúpica foi a doença glomerular secundária mais frequente. Proteinúria foi a principal indicação para biópsia renal. A biópsia renal percutânea é uma técnica segura no presente estudo.

BACKGROUND AND OBJECTIVES: The kidney biopsy constitutes the gold-standard procedure to diagnosis, prognosisand treatment of the most kidney diseases, specially the glomerulophaties.The objective of this study is to review renal biopsies performed for investigation of kidney disease. METHOD: This is a retrospective study of records of 174 patients submitted to percutaneous biopsies between 1988 and 2010. There was reviewed the following medical records: age, gender, clinical presentation, histological pattern and complications. The data were stored in the Microsoft Excel database. Continuous variables were expressed as mean and standard deviationand the relative frequencies were calculated. RESULTS: Mean age of these patients was 33.7 ± 16.7 years and 51.4% of them were male. Glomerulonephritis (GN) comprised 60.9% of the total. The most common primary GN in adults was minimal change disease (17.9%), followed by proliferative GN (17%), membranous GN and segmental and focal GN, each one with 14.2%. The most common secondary GN was lupus nephritis, with 12.6% of total biopsies. The main clinical presentation was proteinuria. Complications were observed in 10.3% of biopsies performed hematuria in 15 (8.6%) and perirrenal hematomain three (1.7%) patients, being one complicated with per perirrenal abscess. CONCLUSION: The most common histological pattern was GN. Minimal change disease was the most frequent primary glomerular disease. Lupus nephritis was the most frequent secondary glomerular disease. Proteinuria was the main indication for renalbiopsy. Percutaneous renal biopsy is a safe technique in study.

Serum Levels of VEGF in IgA Nephropathy / 대한신장학회잡지

BACKGROUND: Vascular endothelial growth factor (VEGF) is a potent enhancer of microvascular permeability and a selective endothelial cell growth factor. In human kidney, VEGF is expressed mainly in glomerular visceral epithelial cells. We investigated the relationship between serum levels of VEGF and factors reflecting the severity of disease including histological patterns in order to elucidate the relevance of VEGF in the pathogenesis of IgA nephropathy. METHODS: Serum VEGF was studied using a sandwich ELISA from 21 patients with IgA nephropathy. Histological patterns are classified to 5 grades by WHO classification and frequencies of crescent and glomerular sclerosis, degree of interstitial fibrosis were recorded. Serum concentrations of creatinine, albumin, IgA, amounts of 24 hour urine protein excretion, and creatinine clearances are also evaluated. RESULTS: Serum VEGF levels were significantly correlated with histological grade(r=0.471, p < 0.05), frequency of cellular crescent(r=0.485, p < 0.05), degree of interstitial fibrosis(r=0.562, p < 0.01), and 24 hour urine protein excretion(r=0.439, p < 0.05), and inversely with serum albumin concentration(r=-0.594, p < 0.01). Studies in 17 patients without crescent formation revealed that only serum albumin concentration showed significant correlation with serum VEGF level. CONCLUSION: Serum VEGF concentration is mainly correlated with cellular crescent formation reflecting activity of the disease rather than chronic structural changes such as glomerular sclerosis or interstitial fibrosis. Elevated serum VEGF concentration seems to be due to the release of relatively large amounts of stored VEGF from damaged visceral epithelial cells. Serum VEGF concentration may be a useful marker to evaluate the degree of acute renal injury, especially cellular crescent formation.