RESUMO
The objectives of this study were to determine the frequency with which deeper levels reveal a lesion in polyp biopsies where no polyp was found on initial sections and to identify features that predict such occult (histologically unapparent) lesions. All initially negative biopsy specimens were accumulated over an 18-month period. Following standard sections, three to ten levels were cut, 50 µm apart. The presence of any lesion, the level at which it was found, the location, number and size of fragments, number of levels obtained, presence of any lymphoid aggregate, endoscopic size and appearance, and bowel preparation quality were recorded. There were 214 specimens, mean patient age 61.4 years (range 27-86 years). Deeper levels revealed a lesion in 52/214 (24.3 %) cases; 76.9 % were tubular adenomas (TA), 21.2 % were hyperplastic polyps, and one was a leiomyoma. All TAs were negative for high-grade dysplasia and malignancy. The mean level at which TAs were found was 1.85 (range 1-9). Male sex (p = 0.021) and right-sided location (p = 0.0075) were statistically significant predictors of an occult TA. As the presence of an adenoma affects screening, pathologists should consider "pursuing" polyps when initial sections reveal no lesion, after ascertaining the incidence of occult lesions in their own practice.
RESUMO
Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine malignancy, which usually presents as an asymptomatic, rapidly growing, firm nodule on sun-damaged skin. We present a 93-year-old female who presented with a "cutaneous horn" on the face. On excision, histologic examination revealed a combined squamous cell carcinoma in situ with underlying MCC. Merkel cell polyomavirus immunohistochemistry was negative in this lesion. This case report highlights the significant association between MCC and squamous cell carcinoma and the uncommon clinical presentation of this combined tumor in the form of a cutaneous horn.
RESUMO
BACKGROUND: The role of lipoprotein(a) [Lp(a)] as a predictor of cardiovascular disease (CVD) in patients with heterozygous familial hypercholesterolemia (HFH) is unclear. We sought to examine the utility of this lipoprotein as a predictor of CVD outcomes in the HFH population at our lipid clinic. METHODS: This was a retrospective analysis of clinical and laboratory data from a large multiethnic cohort of HFH patients at a single, large lipid clinic in Vancouver, Canada. Three hundred and eighty-eight patients were diagnosed with possible, probable, or definite HFH by strict clinical diagnostic criteria. Multivariate Cox regression analysis was used to study the relationship between several established CVD risk factors, Lp(a), and the age of first hard CVD event. RESULTS: An Lp(a) concentration of 800 units/L (560 mg/L) or higher was a significant independent risk factor for CVD outcomes [hazard ratio (HR) = 2.59; 95% confidence interval (CI), 1.53-4.39; P < 0.001]. Other significant risk factors were male sex [HR = 3.19 (1.79-5.69); P < 0.001] and ratio of total to HDL-cholesterol [1.18 (1.07-1.30); P = 0.001]. A previous history of smoking or hypertension each produced HRs consistent with increased CVD risk [HR = 1.55 (0.92-2.61) and 1.57 (0.90-2.74), respectively], but neither reached statistical significance (both P = 0.10). LDL-cholesterol was not an independent predictor of CVD risk [HR = 0.85 (0.0.71-1.01); P = 0.07], nor was survival affected by the subcategory of HFH diagnosis (i.e., possible vs probable vs definite HFH). CONCLUSION: Lp(a) is an independent predictor of CVD risk in a multiethnic HFH population.
