Abstract
Background
Small renal mass (SRM) biopsy remains under-utilized due to stigma. Meanwhile, the alarmingly high benign findings in resected kidney masses highlight the need for improved ...preoperative diagnosis and patient selection.
Methods
The purpose of this study is to review the success rate of SRM biopsy and to evaluate its impact on patient management. A total of 168 percutaneous image-guided core needle biopsies (CNBs) of SRMs were retrieved at a tertiary academic center between 2015 and 2019. Subsequent treatment choices, side effects and outcomes were retrospectively reviewed.
Results
The diagnostic rate of CNB was 86.9%. Benign neoplasms accounted for a significant portion (14.3%) of SRM. Renal cell carcinomas (RCCs) were the most common diagnoses (69.6%) as expected. In biopsy-resection correlation, the positive predictive value of CNB was 100%. Tumor typing and subtyping by CNB were highly accurate, 100% and 98.3% respectively. Nuclear grading for clear cell RCC was accurate in 83.8% cases. The CNB results had significant impact on treatment. Most patients with RCCs underwent either resection (54.1%) or ablation (33.9%), in contrast to observation in benign neoplasms (90.5%). Most importantly, the benign resection rate (3.2%) in this series was much lower than the national average.
Conclusion
CNB provided accurate diagnoses for the majority of SRMs and revealed benign diagnoses in a subset of clinically suspicious lesions. Employment of CNB in suspicious SRM may help avoid overtreatment for benign lesions.
Myelolipoma is an uncommon benign neoplasm composed of mature adipose tissue and hematopoietic elements. Myelolipoma occurs most frequently in the adrenal gland but occasionally can be seen in ...extra-adrenal locations such as lung, liver, retroperitoneum, mediastinum, and kidney. We report a case of extra-adrenal myelolipoma presented as a localized asymptomatic mass in the renal sinus of left native kidney of a 60-year-old woman. The patient was being investigated for end-stage renal disease status post renal transplant. Histologic examination of the lesion showed classic features for myelolipoma. Our case illustrates the awareness of this entity in unusual location and the appropriate use of diagnostic modalities to prevent unnecessary surgical interventions particularly in patients with major co-morbidity in the future.
Lipoleiomyomas are uncommon uterine lesions containing adipose and smooth muscle tissue. They have a variable presentation and are usually found incidentally on imaging or post-hysterectomy tissue ...analysis. Given their low prevalence, there is a dearth of literature describing imaging characteristics for uterine lipoleiomyomas. In this image-rich case series, we summarize an example of an initial presentation as well as present ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) findings for 36 patients.
We present the detailed clinical course of a representative patient evaluated for uterine lipoleiomyoma and describe imaging findings seen in another 35 patients. This includes ultrasound findings from 16 patients, CT findings from 25 patients, and MRI findings from 5 patients. Among the 36 total patients, symptoms at the time of diagnosis were variable but often included abdominal or pelvic pain; however, most patients were asymptomatic, and the lipoleiomyomas were incidentally discovered on imaging.
Uterine lipoleiomyomas are rare and benign tumors with variable presentations. Ultrasound, CT, and MRI findings can assist in diagnosis. Findings on ultrasound typically include well-circumscribed hyperechoic and septated lesions with minimal to no internal blood flow. CT shows fat-containing either homogeneous or heterogeneous circumscribed lesions depending on their ratio of fat and smooth muscle tissue. Lastly, on MRI, uterine lipoleiomyomas commonly appear heterogenous with loss of signal on fat-suppressed sequences. These imaging findings are highly specific for lipoleiomyomas, and familiarity with these findings may reduce unnecessary and potentially invasive procedures.
Oxidative stress and chronic inflammation play critical roles in the pathogenesis of ulcerative colitis (UC) and inflammatory bowel diseases (IBD). A previous study has demonstrated that dimethyl ...fumarate (DMF) protects mice from dextran sulfate sodium (DSS)-induced colitis via its potential antioxidant capacity, and by inhibiting the activation of the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome. This study aims to clarify the nuclear factor erythroid 2-related factor 2/antioxidant responsive element (Nrf2/ARE) pathway pharmacological activation and anti-inflammatory effect by DMF, through focusing on other crucial antioxidant enzymes and inflammatory mediator, including glutamate-cysteine ligase catalytic subunit (GCLC), glutathione peroxidase (GPX) and cyclooxygenase-2 (COX-2), in a DSS-induced colitis mouse model. The oral administration of DMF attenuated the shortening of colons and alleviated colonic inflammation. Furthermore, the expression of key antioxidant enzymes, including GCLC and GPX, in the colonic tissue were significantly increased by DMF administration. In addition, protein expression of the inflammatory mediator, COX-2, was reduced by DMF administration. Our results suggest that DMF alleviates DSS-induced colonic inflammatory damage, likely via up-regulating GCLC and GPX and down-regulating COX-2 protein expression in colonic tissue.
Abstract
Introduction
Hypophysitis is a rare chronic inflammation of the pituitary gland corresponding currently to six histopathological subtypes. Among them, IgG4-related hypophysitis was recently ...added in this classification. The aim of this case report is to present a case of IgG4-related hypophysitis that mimics a pituitary tumor clinically and radiologically.
Case Presentation
Herein we report a 51-year-old Caucasian woman with history of multiple sclerosis who presented with clinical evidence of hypopituitarism and two-week history of diplopia. MRI showed 1.6 x 1.2 x 1.7 cm pituitary mass with stalk deviation. Patient underwent trans-sphenoidal resection of pituitary mass. Microscopic examination showed pituitary tissue with marked lymphoplasmacytic infiltration and fibrosis. CD138, IgG4, kappa, and lambda immunostains confirmed marked increase in polyclonal plasma cells with 35 to 40 IgG4-positive plasma cells per high power field. These findings were consistent with diagnosis of IgG4-related hypophysitis. The patient’s symptoms significantly improved after hydrocortisone therapy.
Discussion
Hypophysitis is a chronic inflammation of the pituitary gland, currently categorized into six histopathological subtypes: lymphocytic, granulomatous, xanthomatous, necrotizing, mixed, and IgG4-related. IgG4-related sclerosing disease involving the central nervous system is very rare, and the pituitary gland is the most commonly reported site. IgG4-related hypophysitis was first diagnosed on clinical grounds in 2004 and then by pathology in 2007. In 2011, Leporati et al proposed three criteria for diagnosis of IgG4-related hypophysitis. Fulfillment of any of three criteria is sufficient for the diagnosis to be made: (1) histopathological biopsy of pituitary that shows mononuclear cells infiltration with more than 10 IgG4-positive cells per high power field, (2) pituitary MRI that reveals typical lesions for hypophysitis and a tissue biopsy from another organ showing IgG4 lesion, (3) a third criterion composed of three components, typical hypophysitis lesions from MRI imaging, an increase in serum IgG4 levels (>140 mg/dL), and prompt clinical response to steroids.
Background. Serous borderline tumor represents a group of noninvasive tumor of the ovary bridging between benign serous cystadenoma and serous carcinoma. They are commonly seen in younger women and ...usually have an excellent outcome but seldom show local recurrence (J. F. Leake et al. 1991). Metastasis to the lymph nodes has rarely been reported (M. D. Chamberlin et al., 2001; M. B. Verbruggen et al., 2006). Moreover, the brain is exceptionally a rare metastatic site for ovarian tumor. There is one case of an advanced staged SBT with micropapillary pattern metastasis to the brain recently and by far it is the most distant metastasis reported (M. D. Martin et al., 2017). However, to the best of our knowledge, no report has been documented for a recurrent stage 1 typical SBT metastasizing to the brain.
Training in patient safety, quality, and management is a key component of Graduate Medical Education (GME) training in all specialties. However, residency programs, especially Pathology programs, ...often find it challenging to create strong learning opportunities in these areas.
Focused quality assurance (QA) projects are one approach to teach and engage trainees in these key areas. Residents have been historically involved in different QA projects in our department but mainly in small secondary roles. Leading a large QA project that can enhance residents’ management skills and improve clinical operations in our laboratory was the main objective of our project.
A new process for laboratory self-inspection led by residents was implemented that simulates the exact process of a formal outside College of American Pathologists (CAP) inspection. We aim to prove that resident-led QA activities not only have profound educational benefit but can also result in significant performance and operational improvement.
For this paper, we focus on the Histology laboratory since the ramifications from the self-inspection process during a three year period were profound leading to change in management, workflow changes, and notable improvement in staff morale.
The self-inspection process exposed the residents to operational issues and corrective actions that provided them the opportunity to take a more active role in laboratory management and helped prepare them for post-graduation challenges. It also helped the department identify and rectify many operational issues, confirmed by the enumeration of CAP deficiencies and significant improvement of staff morale.
Progressive deterioration of kidney function in chronic kidney disease (CKD) is mediated by hypertension, oxidative stress, inflammation, and fibrosis. Renin-angiotensin blockade is commonly used to ...retard CKD progression. In addition, vasoactive peptides have been shown to reduce blood pressure and exert antioxidant, anti-inflammatory and anti-fibrotic effects. We hypothesized that administration of LCZ696 (sacubitril/valsartan) is more effective than valsartan alone in slowing progression of CKD. Male Sprague Dawley rats underwent sham surgery or 5/6 nephrectomy and after two weeks the CKD animals were randomized to no treatment, valsartan (30 mg/kg), or LCZ696 (60 mg/kg) daily by gavage. Serum, urine and kidney tissue analyses were performed after 8 weeks. The untreated CKD rats exhibited hypertension, proteinuria, tubular and glomerular damage, upregulation of pro-inflammatory, pro-oxidant and pro-fibrotic pathways; reduction in nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) and its key target products. LCZ696 administration improved renal function and histology and attenuated most of the molecular markers of oxidative stress, inflammation and fibrosis. Furthermore, LCZ696 was more effective than valsartan therapy alone in delaying the progression of kidney disease. Future clinical trials are needed to determine the safety and efficacy of this agent in treatment of patients with CKD.
•Solid pseudopapillary neoplasms are positive for LEF1 and negative for INSM1.•Well differentiated pancreatic neuroendocrine tumors are positive for INSM1 and negative for LEF1.•A limited ...immunohistochemical panel comprising of INSM1 and LEF1 can accurately distinguish between them.
Solid pseudopapillary neoplasm (SPN) and well differentiated pancreatic neuroendocrine tumor (PNET) can show significant cytomorphological overlap. In this study, we evaluated the role of INSM1 and LEF1 immunohistochemical stains in distinguishing between these two tumors. 22 SPN and 25 PNET surgically resected cases were stained for both INSM1 and LEF1. All the 22 cases of SPN showed strong and diffuse nuclear staining for LEF1 (in >95 % of tumor cells), while all 25 PNET were negative for LEF1. All 25 PNET cases were positive for INSM1 (moderate to strong intensity nuclear staining in >50 % of the tumor cells), while all 22 cases of SPN were negative for INSM1. The results of our study show that a limited panel comprising of INSM1 and LEF1 immunostains accurately distinguishes between SPN and PNET.
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