Abstract
The spectrum of placental pathology in human immunodeficiency virus (HIV) is vast. Features observed are not only limited to the effects of the virus itself but may include that of ...coinfections such as tuberculosis and syphilis. The presence of other comorbidities and changes as a result of antiretroviral therapy may further confound the histologic findings. There is a paucity of unbiased information of the effects of maternal HIV on the placenta and how these changes relate to birth outcomes. Antiretroviral therapy, now in widespread use, has altered the course of maternal HIV disease and it is unknown whether this has altered the pathophysiology of HIV on the placenta. HIV-associated placental findings that have been most well described include acute chorioamnionitis, low placental weight, and maternal vascular malperfusion, with a tendency towards lower rates of chronic villitis.
The reported prevalence of tuberculous bronchial stenosis in children is unknown and rarely reported in English‐speaking literature. In adult patients with pulmonary tuberculosis, it varies from 40% ...in an autopsied series in the preantibiotic era to 10% in patients who have undergone routine bronchofibroscopy in modern times. We describe our experience of four cases of confirmed bronchial stenosis due to MTB collected between January 2000 and June 2021 in this case series descriptive study. The diagnosis of bronchial stenosis due to TB was made on flexible bronchoscopy. A TB diagnosis was made if MTB was cultured from respiratory secretions, when Ziehl‐Neelsen smear or GeneXpert MTB/RIF test was positive, or if a chest radiograph revealed radiographic features typical of MTB. Bronchial stenosis due to TB is rare even if airway compression is frequently seen. Although an early diagnosis of bronchial stenosis due to TB is difficult on chest X‐rays, all children in this series demonstrated parenchymal changes distal to the stenosis ranging from hyperinflation and lobar collaps to bronchiectasis. If bronchial stenosis resulting from TB disease is diagnosed early, balloon dilatation as described in this report, may be an effective and safe intervention, preventing long‐term complications such as irreversible lung destruction, that may require pneumonectomy.
Small round blue cell tumors (SRBCTs) are a heterogeneous group of malignant neoplasms that can be challenging to distinguish on fine‐needle aspiration (FNA) cytology. Ancillary tests as well as ...clinico‐radiological correlation are often required to make an accurate diagnosis. FNA is a low‐cost, low‐infrastructure test, making it a coveted diagnostic tool, especially in low‐resource settings. Olfactory neuroblastoma (ONB) is a rare SRBCT encountered in both pediatric and adult patients. Awareness of the cytomorphologic and immunocytochemical features of ONB is important in the workup of a SRBCT. This case report describes the primary diagnosis of metastatic ONB on FNA cytology.
Fine‐needle aspiration biopsy (FNAB) is a useful technique in the evaluation of central lung tumors which is commonly encountered in clinical cytology practice. Some of these tumors may show ...endobronchial, polypoid growth which is readily apparent to the endoscopist. Pulmonary salivary gland‐type tumors and carcinoid tumors are overall uncommon in the lung, but these tumors tend to occur centrally and show endobronchial involvement. The prognosis of these tumors is generally better than that of small cell or non‐small cell carcinomas of the lung and more conservative surgical resection is often indicated. The identification of salient cytological features and a high index of suspicion when considering the differential diagnosis of a central lung tumor is essential to accurate diagnosis. This review focuses on cytological clues as well as ancillary techniques that may be useful to the practicing cytopathologist.
Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The ...aim of this study was to investigate these relationships.
Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13.
In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) were not present. The prevalence rate of funisitis was also increased. In IPTB, multiple features of MVM - accelerated villous maturation, distal villous hypoplasia, decidual arteriopathy, increased syncytial knots, increased perivillous fibrin, and prominent extravillous trophoblast were increased, as were features of fetal vascular malperfusion (FVM) - umbilical cord vessel thrombosis, avascular villi, and fetal vascular thrombosis. Increased syncytial knots were found in 26% of preterm stillbirths and in 29% of preterm infant demises as compared to 81% of IPTB infants alive at one year.
SPTB and IPTB differ. The detected “abnormal” accelerated villous maturation pattern in SPTB and preterm demises, suggests an inability of the placenta to adapt and may be a trigger for SPTB. Funisitis was the only inflammatory response significant for SPTB. MVM and FVM are implicated in IPTB, but not an inflammatory process.
•Abnormally accelerated villous maturation was observed in spontaneous preterm birth.•Possible inability to adapt to injury was identified in preterm demises.•Funisitis, a fetal inflammatory response, significant in spontaneous preterm birth.•Maternal and fetal vascular malperfusion associated with iatrogenic preterm birth.
Background
Various patterns of colonic mucosal irregularity have been recorded on contrast enema, each with individually very low sensitivity, but high specificity.
Objective
To assess the accuracy ...of the radiologic features of Hirschsprung disease utilising a unifying stratification of any form of colonic mucosal irregularity on contrast enema.
Materials and methods
We conducted a retrospective study of children with suspected Hirschsprung disease managed at a tertiary South African hospital from January 2009 through April 2015. Three observers independently reviewed abdominal radiographs and contrast enemas. The enema analysis included a unifying category of any form of colonic mucosal irregularity. Radiologic features were compared with rectal biopsy results. We used descriptive statistics and the Fisher exact test to compare the radiologic features of children with and without Hirschsprung disease.
Results
Ninety-two children with median age of 37 days (range 3 days to 11 years) were included; 50 had biopsy-proven Hirschsprung disease. On enema, any mucosal irregularity, a transition zone and recto-sigmoid ratio inversion were associated with Hirschsprung disease (all
P
<0.01). Mucosal irregularity showed 96% sensitivity (95% confidence interval CI 86.3–99.5) and 71.4% specificity (CI 55.4–84.3); a transition zone showed 86% sensitivity (CI 73.3–94.2) and 90.5% specificity (CI 77.4–97.3); and recto-sigmoid ratio inversion showed 78% sensitivity (CI 64.0–88.5) and 83.3% specificity (CI 68.3–93.0).
Conclusion
Colonic mucosal irregularity on contrast enema has high sensitivity and moderate specificity for Hirschsprung disease.
Background
Peripheral lymphadenopathy occurs often in children; fine needle aspiration biopsy (FNAB) is a commonly performed diagnostic procedure. We describe FNAB use and outcome for peripheral ...lymphadenopathy in children in a routine clinical setting.
Methods
A retrospective study done at Tygerberg Hospital, Cape Town of children (<13 years) who had an FNAB for lymphadenopathy from July 2012 to June 2014. Demographic, clinical, treatment and follow-up data were retrieved from patient folders; FNAB and special investigation results were obtained from the laboratory database.
Results
Of the 173 children, the median age was 37 (interquartile range 13–75) months; 20 (11.5%) were HIV positive. Most FNABs were done in the neck (131; 76%) and axillary areas (34; 20%). FNAB provided a result in 165 (95%) cases; in 8 (5%) children FNAB was insufficient for diagnosis. Mycobacterial aetiology was diagnosed in 84 (49%); 49 (58%) were culture-confirmed (37 Mycobacterium tuberculosis, 10 Mycobacterium bovis BCG, 1 both and 1 non-tuberculous mycobacterium). Reactive lymphadenopathy was diagnosed in 56 (32%), neoplastic disease in 6 (3.5%) and other pathology in 19 (11%) cases. Additional special investigations changed FNAB diagnosis or led to an additional diagnosis in 8 (5%) children. Overall, 70/84 (83%) with mycobacterial aetiology and all neoplastic disease cases received the correct treatment. Follow-up appointments were arranged in 144 (83%) patients.
Conclusions
In a high tuberculosis burden area, a single FNAB provided a diagnosis in most cases in a routine referral setting; FNAB remains a safe and useful investigation. Follow-up of children to initiate appropriate treatment could improve.
LAY SUMMARY
Large swollen lymph nodes, especially in the neck, are a common finding in children. Fine needle aspiration biopsy (FNAB) is a commonly used diagnostic procedure and we looked at how well this procedure works in everyday hospital practice. We identified all children <13 years of age over a 2-year period (2012–2014) who had an FNAB done at Tygerberg Hospital, Cape Town, South Africa, and looked how well this procedure performed and what the doctors did with these children. We found 173 children who had an FNAB done. They were generally young children of around 3 years old. With a single FNAB, we could make a diagnosis in 95% of these children. About half of the children had tuberculosis or complications of a BCG vaccine (both caused by mycobacteria), only 4% had a malignancy of some kind, about a third had reactive lymph nodes (usually other mainly local infectious causes) and the rest had other pathology like abscesses. All malignancies and >80% of the mycobacterial pathology cases were correctly managed; the latter could definitely improve.
Accurate and rapid diagnosis of extrapulmonary nodal tuberculosis in children is of paramount importance. This retrospective study performed at Tygerberg Hospital using data from the laboratory ...records between January 1, 2004 and June 30, 2014 demonstrates how since the introduction laboratory-run FNAB service; fine needle aspiration biopsy has become an acceptable and routine diagnostic procedure for triage of pediatric lymphadenopathy.
