BACKGROUND: Pre-existing non-neoplastic renal diseases or lesions may influence patient renal function after tumor removal. However, its description is often neglected or omitted in pathologic reports. To determine the incidence and clinical significance of non-neoplastic lesions, we retrospectively examined renal tissues obtained during 85 radical nephrectomies for renal cell carcinoma. METHODS: One paraffin-embedded tissue block from each case containing a sufficient amount of non-tumorous renal parenchyma was cut and processed with hematoxylin and eosin and periodic acid-Schiff methods. Non-neoplastic lesions of each histological compartment were semi-quantitatively and quantitatively evaluated. RESULTS: Among the various histologic lesions found, tubular atrophy, arterial intimal thickening, and glomerulosclerosis were the most common (94.1%, 91.8%, and 88.2%, respectively). Glomerulosclerosis correlated with estimated glomerular filtration rate at the time of surgery, as well as at 1- and 5-years post-surgery (p=.0071), but tubulointerstitial fibrosis or arterial fibrous intimal thickening did not. Post-hoc analysis revealed that glomerulosclerosis of more than 20% predicted post-operative renal function. However, its significance disappeared when gender and age were considered. CONCLUSIONS: In conclusion, non-neoplastic lesions, especially with regard to glomerulosclerosis percentage, should be described in pathology reports to provide additional information on renal function decline.
Atrophy ; Carcinoma, Renal Cell* ; Eosine Yellowish-(YS) ; Fibrosis ; Glomerular Filtration Rate ; Hematoxylin ; Humans ; Incidence ; Methods ; Nephrectomy ; Pathology ; Retrospective Studies

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.
Adolescent ; Cytoplasm ; Eosinophils ; Ependymoma ; Female ; Frozen Sections ; Giant Cells ; Humans ; Intranuclear Inclusion Bodies ; Mitosis ; Necrosis

A 55-year-old woman presented with frequent episodes of syncope due to sinus pauses. During ambulatory Holter monitoring, atrial fibrillation and first-degree atrioventricular nodal block were observed. Magnetic resonance imaging and CT scans showed a tumor-like mass from the superior vena cava to the right atrial septum. Open chest cardiac biopsy was performed. The tumor was composed of proliferating IgG4-positive plasma cells and lymphocytes with surrounding sclerosis. The patient was diagnosed with IgG4-related sclerosing disease. Because of frequent sinus pauses and syncope, a permanent pacemaker was implanted. The cardiac mass was inoperable, but it did not progress during the one-year follow-up.
Atrial Septum/*pathology ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pacemaker, Artificial ; Sclerosis/complications/diagnosis/therapy ; Syncope/etiology ; Vena Cava, Superior/*pathology

No abstract available.
Lymphoma, B-Cell, Marginal Zone* ; Orbit* ; Orbital Diseases*

BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or <10 DCs/10 high power field [HPF]). DC shedding of more than three consecutive months was significantly more prevalent in the HG as compared with their LG counterparts (p<0.0001). Urinary DCs were present for more than one year in 29.4% of the HG and 8.1% of the LG. Real-time polymerase chain reaction for PV was higher in both urine (51.4% vs. 11.1%) and plasma (9.1% vs. 0%) of the HG than the LG. The prevalence of PV nephropathy was higher in the HG than the LG (p=0.019). However, there was no significant difference in the prevalence of acute rejection. CONCLUSIONS: Shedding of > or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or <10 DCs/10 high power field [HPF]). DC shedding of more than three consecutive months was significantly more prevalent in the HG as compared with their LG counterparts (p<0.0001). Urinary DCs were present for more than one year in 29.4% of the HG and 8.1% of the LG. Real-time polymerase chain reaction for PV was higher in both urine (51.4% vs. 11.1%) and plasma (9.1% vs. 0%) of the HG than the LG. The prevalence of PV nephropathy was higher in the HG than the LG (p=0.019). However, there was no significant difference in the prevalence of acute rejection. CONCLUSIONS: Shedding of > or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

Ultrasonography-guided fine needle aspiration biopsy (US-FNA) is one of the methods used to diagnose thyroid lymphoma, but it has a relatively high false-negative rate. The authors report a case of a primary thyroid lymphoma associated with underlying lymphocytic thyroiditis that was initially misdiagnosed as lymphocytic thyroiditis based on US-FNA findings.
Biopsy ; Biopsy, Fine-Needle ; Lymphoma ; Thyroid Gland ; Thyroiditis, Autoimmune

PURPOSE: To examine the usefulness of various receptor tyrosine kinase expressions as prognostic markers and therapeutic targets in muscle invasive urothelial cancer (UC) patients. MATERIALS AND METHODS: We retrospectively analyzed the data of 98 patients with muscle invasive UC who underwent radical cystectomy between 2005 and 2010 in Yonsei Cancer Center. Using formalin fixed paraffin embedded tissues of primary tumors, immunohistochemical staining was done for human epidermal growth factor receptor 2 (HER2), fibroblast growth factor receptor 1 (FGFR1), and fibroblast growth factor receptor 3 (FGFR3). RESULTS: There were 41 (41.8%), 44 (44.9%), and 14 (14.2%) patients who have over-expressed HER2, FGFR1, and FGFR3, respectively. In univariate analysis, significantly shorter median time to recurrence (TTR) (12.9 months vs. 49.0 months; p=0.008) and overall survival (OS) (22.3 months vs. 52.7 months; p=0.006) was found in patients with FGFR1 overexpression. By contrast, there was no difference in TTR or OS according to the HER2 and FGFR3 expression status. FGFR1 remained as a significant prognostic factor for OS with hazard ratio of 2.23 (95% confidence interval: 1.27-3.90, p=0.006) in multivariate analysis. CONCLUSION: Our result showed that FGFR1 expression, but not FGFR3, is an adverse prognostic factor in muscle invasive UC patients after radical cystectomy. FGFR1 might be feasible for prognosis prediction and a potential therapeutic target after thorough validation in muscle invasive UC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma/*metabolism/*mortality/surgery ; Cystectomy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Muscles/pathology ; Neoplasm Invasiveness ; Prognosis ; Proportional Hazards Models ; Receptor, ErbB-2/metabolism ; Receptor, Fibroblast Growth Factor, Type 1/*metabolism ; Receptor, Fibroblast Growth Factor, Type 3/metabolism ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms/*metabolism/*mortality/surgery ; Urothelium/pathology

To evaluate the usefullness of SPECT thallium-201 exercise myocardial perfusion scan in coronary artery disease, polar maps processing SPECT images were compared to the exercise treadmill test and the findings of coronary angiographies in 12 normal subjects and 27 patients with the coronary artery disease. The following results were obtained : 1) Sensitivity and specificity of thallium-201 exercise myocardial perfusion scan was 96% and 83%, higher than that of exercise treadmill test(81% abd 61%). 2) In the branches of coronry artery, the sensitivity, specificity and positive predicitive values were 82%, 88%, 90% in left anterior descending artery, 33%, 88%, 57% in left circumflex artery and 69%, 81%, 90% 64% in right coronary artery. 3) The good correlation was observed between the degree of perfusion defect in polar map of thallium-201 myocardial scan in stress and 'myocardial ischemic score' predicted in coronary angiography(p<0.001). Also the degree of reversible perfusion defect had significant correlation with the durtion of exercise. 4) The pulmonary to myocardial ratio of thallium-201 uptake in coronary artery disease group higher than that of angina group. And the perfusion defect with stress and double product at maximal exercise had strongest assocition with the pulmonary to myocardial ratio of thallium-201 uptake by stepwise multiple linear regression. In conclusion, SPECT thallium-201 exercise myocardial perfusion scan is superior to the exercise treadmill test in diagnosing the coronary artery disese and is useful for predicting the sites and degree of coronary arterial stenosis. Also the pulmonary to myocardial ratio of thallium-201 uptake is thought to be good new test index in evaluating the left ventricular function of patients with coronary artery disease.
Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Exercise Test ; Humans ; Linear Models ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Function, Left

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.
Anti-Bacterial Agents ; Biopsy ; Breast ; Breast Neoplasms ; Cough ; Diagnostic Imaging ; Disease Progression ; Female ; Fever ; Glass ; Humans ; Lung ; Lung Diseases, Interstitial ; Neoplasm Metastasis ; Pneumonia ; Sputum ; Steroids