When one follows a systematic approach to make a diagnosis of pathologic of pathologic lesions, it is relatively easy to render a cancer diagnosis in almost all cases in routine daily practice. The first step is to recognize whether or not the specimen contains a lesion and then to determine whether the lesion is neoplastic or nonneoplastic. Since neoplasm is clonal proliferation, neoplastic conditions are usually composed of a single cell type, whereas nonneoplastic conditions consist of multiple different cell types. After a neoplastic condition has been documented, the next step is to decide whether the neoplasm is of an epithelial origin or mesenchymal origin. The main differences between epithelial tumors and mesenchymal tumors include : 1) the tumor cells in epithelial tumors are oval, round to polygonal, while those in mesenchymal tumors are in general spindleshaped : 2) epithelial tumors generally form tumor cell nests, while mesenchymal tumors arrange diffusely without forming tumor cell nests : 3) in epithelial tumors, desmoplastic stroma is wellformed in between tumor cell nests, while in mesenchymal tumors there is no desmoplastic stroma ; and lastly, 4) feeding vessels open in the stroma in epithelial tumors, while they open between tumor cells in mesenchymal tumors. After this one should decide whether the tumor is benign or malignant. The differences between benign and malignant tumors include : 1) differentiation ; 2) growth rate ; 3) growth pattern ; and 4) metastasis. The benign tumor is ell differentiated, grows slowly, shows an expansile growth lattem with encapsulation, and does not metastasize. On the other hand, the malignant tumor is in general poorly differentiated, grows rapidly with frequent mitoses, shows an invasive growth pat-tern without capsular formation, and frequently metastasizes. In general malignant tumors show a high cellularity, tumor necrosis, and nuclear alterations, which include nuclear enlargement with a high nudear/cytoplasmic ratio, hyperchromatism, pleomorphism, prominent nucleolus, and frequent mitoses. The final step is to classify the type of tumor based on the cellular differentiation and gross and microscopic growth patterns based on the light microscopic exarhination of H & E stained slides. For the correct identification of the tumor, immunostaining, electron microscopic evaluation, and molecular diagnostic tools may be required. After establishment of a diagnosis of malignancy, one should think about the prognostic factors. The two wellknown prognostic (factors (category I) applicable in almost all tumors include stage and grade. Therefore, information about the stage and grade should also be included in the pathology report.
Diagnosis ; Hand ; Mitosis ; Necrosis ; Neoplasm Metastasis ; Pathology ; Pathology, Molecular

A case of primary malignant melanoma of the larynx is reported. The patient, a 41-year-old Korean man, presented with dyspnea and blood tinged sputum. Physical examination showed blackish necrotic mass involving right side of the larynx. The mass proved to be malignant melanoma containing many melanin pigments. A description of the lesion and a review of literature are given.
Adult ; Aged ; Female ; Human ; Laryngeal Neoplasms/pathology* ; Larynx/pathology* ; Male ; Melanoma/pathology* ; Middle Age ; Necrosis

Spontaneous total necrosis of hepatocellular carcinoma is extremely rare, with only 15 cases reported to date in the English literature, and the involved mechanism remains unresolved. This paper describes a case of spontaneous necrosis of hepatocellular carcinoma in a 70-year-old man with chronic hepatitis. The patient suffered epigastric pain on admission and computed tomography revealed a 4 cm mass with low density in the left lobe of the liver. Fine needle aspiration biopsy revealed a few scattered, naked and irregular nuclei exhibiting nuclear hyperchromasia in the dirty necrotic background, a finding highly suggestive of malignancy. The lobectomized liver revealed a 3.5 cm, well encapsulated, round, and nearly totally necrotic mass. On microscopic examination, the tumor was found to be composed of thick trabeculae of necrotic tumor cells, supporting the diagnosis of hepatocellular carcinoma. After surgery and throughout 13 months of follow up the patient has recovered well.
Aged ; Carcinoma, Hepatocellular/*pathology ; Case Report ; Human ; Liver Neoplasms/*pathology ; Male ; Necrosis ; Thrombosis/*pathology

OBJECTIVETo investigate the histopathological changes in the liver and other organs after impact injury.

METHODSThe rabbits were impacted with a BIM-IV biological impacting machine at the xiphoid process. The severity of liver injury was graded and scored through gross anatomy. At the same time, the pathological changes in the liver, heart, and lung were observed by light and electron microscopes.

RESULTSLight microscopy showed that the pathological changes in the liver were: 1) loss of normal structure, hemorrhage and distortion of hepatic lobules; 2) cloudy swelling, degeneration, vacuolation and necrosis of liver cells; 3) infiltration of neutrophils. The lungs were injured and there were liver cell emboli in the small pulmonary arteries. Electron microscopy showed that the ultrastructure of the liver cells was severely damaged and the cells had significant features of necrosis.

CONCLUSIONSThe major pathomorphological changes in the liver after impact injury are hemorrhage and necrosis. They may be complicated by exfoliation of liver cells to hepatic sinusoids. These cells circulate with the blood to form emboli in the pulmonary blood vessels.

Animals ; Female ; Hemorrhage ; pathology ; Liver ; injuries ; pathology ; Male ; Myocardium ; pathology ; Necrosis ; Rabbits

Adolescent ; Blood Vessels ; pathology ; Female ; Femur Head ; blood supply ; pathology ; Femur Head Necrosis ; pathology ; Humans ; Male

OBJECTIVE: To summarize the research progress on the role of macrophage-mediated osteoimmune in osteonecrosis of the femoral head (ONFH) and its mechanisms. METHODS: Recent studies on the role and mechanism of macrophage-mediated osteoimmune in ONFH at home and abroad were extensively reviewed. The classification and function of macrophages were summarized, the osteoimmune regulation of macrophages on chronic inflammation in ONFH was summarized, and the pathophysiological mechanism of osteonecrosis was expounded from the perspective of osteoimmune, which provided new ideas for the treatment of ONFH. RESULTS: Macrophages are important immune cells involved in inflammatory response, which can differentiate into classically activated type (M1) and alternatively activated type (M2), and play specific functions to participate in and regulate the physiological and pathological processes of the body. Studies have shown that bone immune imbalance mediated by macrophages can cause local chronic inflammation and lead to the occurrence and development of ONFH. Therefore, regulating macrophage polarization is a potential ONFH treatment strategy. In chronic inflammatory microenvironment, inhibiting macrophage polarization to M1 can promote local inflammatory dissipation and effectively delay the progression of ONFH; regulating macrophage polarization to M2 can build a local osteoimmune microenvironment conducive to bone repair, which is helpful to necrotic tissue regeneration and repair to a certain extent. CONCLUSION At present, it has been confirmed that macrophage-mediated chronic inflammatory immune microenvironment is an important mechanism for the occurrence and development of ONFH. It is necessary to study the subtypes of immune cells in ONFH, the interaction between immune cells and macrophages, and the interaction between various immune cells and macrophages, which is beneficial to the development of potential therapeutic methods for ONFH.
Humans ; Femur Head/pathology* ; Osteonecrosis/therapy* ; Macrophages/pathology* ; Inflammation ; Femur Head Necrosis/pathology*

We evaluated CT findings of bronchial carcinoid and accuracy of preoperative pathological diagnosis according to two subtypes. The subjects were 10 cases (typical;5, atypical;5), confirmed by surgery and tissue pathology. Sputum cytology (n=10), percutaneous aspiration (n=1) and bronchoscopic biopsy (n=8) were performed, preoperatively. The CT findings were analysed according to two subtypes. Typical carcinoid shows central location in all, and bronchial lumens just proximal to tumor were widened in two, whereas atypical carcinoid presented as peripheral leison in two. Among central atypical carcinoid, two cases showed flat meniscus appearance of lumen. Remaining one showed diffuse wall thickening. Intratumoral low density by necrosis was noted in one. Both subtypes show contrast enhancement. For preoperative diagnosis, sputum cytology & percutaneous aspiration were not conclusive at all. As for bronchoscopic biopsy, only 3 cases were accurately diagnosed as typical carcinoid. Typical carcinoid presented as endobronchial mass in all, whereas atypical carcinoid presented in various appearance. In all atypical & some typical carcinoid were misdiagnosed as primary lung cancer, preoperatively. However, in typical carcinoid, conservative surgery was possible. In conclusion, if there is discrepancy between CT findings & preoperative pathological diagnosis, full understanding of CT findings of bronchial carcinoid is imperative to choose appropriate surgical modality.
Biopsy ; Carcinoid Tumor* ; Diagnosis* ; Lung Neoplasms ; Necrosis ; Pathology ; Sputum

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon but potentially catastrophic pathology. Multiple classification schemes have been proposed for this occurrence. Although no consensus has emerged regarding which classification should be used, Li's classification scheme is more precise and complete compared to other classification systems and can be used to guide the treatment of SISMAD. Initial conservative treatment is promising, with favorable early and long-term outcomes for most patients; endovascular treatment is recommended for patients with persistent/recurrent symptoms after conservative treatment; surgical treatment should be performed without delay for patients with arterial rupture, intestinal necrosis, or failed endovascular treatment.
Classification* ; Consensus ; Humans ; Mesenteric Artery, Superior* ; Necrosis ; Pathology ; Rupture

The Chinese investigators separated bullet wounds into three zones in the beginning of 1980s: a primary wound tract, a contusion zone adjacent to prinary wound tract, and a concussion zone neighboring the contusion zone. Basing on the research results by MRI scan and pathological observation, the author and his coworkers recently proposed that the gunshot wounds should be divided into four consecutive zones: a primary wound tract, a zone of coagulative necrosis, a zone of muscle disruption, and a zone of muscle distortion. A zone of coagulative necrosis plus a zone of muscle disruption equals to a contusion zone, they are separately named because the former is irreversibly devitalized and the latter still has the ability to recover. The sectionalized method shows the range of debridement and provide reference for the conservative treatment or thoroughly debridement. However, the mechanism of each zone need to be further studied.
Debridement ; Humans ; Necrosis ; Wounds, Gunshot ; pathology ; surgery ; therapy

Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a disease characterized by exuberant endothelial proliferation within the lumen of medium-sized veins. In 1923, Masson regarded this disease as a neoplasm inducing endothelial proliferation, however, now it is considered to be a reactive vascular proliferation following traumatic vascular stasis. The lesion has a propensity to occur in the head, neck, fingers, and trunk. Occurrence within the abdominal cavity is known to be very rare, and especially in the liver, there has been no reported case up to date. The authors have experienced intravascular papillary endothelial hyperplasia of the liver in a 69-yr-old woman, and report the case with a review of the literature.
Aged ; Angiography ; Endothelium, Vascular/pathology ; Female ; Hemangioendothelioma/*pathology/surgery ; Human ; Liver/*blood supply/*pathology ; Necrosis ; Vascular Neoplasms/*pathology/surgery