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PubMed1989

[Clinico-immunological parallels in patients with focal scleroderma].

Combined immunological examination of patients with focal scleroderma included studies of the humoral and cellular immunity parameters. The findings evidence that mainly immunological disorders underlie the pathogenesis of this disease, whose various combinations form this of that immunopathological pattern. An immunological classification of focal scleroderma is suggested. Clinical and immunological parallels in patients with different immunological variants of focal scleroderma are analyzed. The results permit a conclusion on the two basic mechanisms in the pathogenesis of focal scleroderma: (1) immunodeficiency involving the effector B component and (2) an isolated hyperfunction of natural killer cells.

Adolescent↗
PubMed1995

[Current anatomopathological aspects of differentiated thyroid cancers of follicular (vesicular) origin: value and necessity of a common language].

This article reviews the pathology and classification of differentiated thyroid carcinomas. Diagnostic criteria are reviewed. Follicular and papillary carcinomas and their variants are described. New entities are detailed. Atypical adenomas and difficult follicular diseases are discussed. The need for a consensual terminology is assessed.

Adenoma↗
PubMed1998

Large granular lymphocytosis.

BACKGROUND AND OBJECTIVES: An increased number of granular lymphocytes (GL) has been reported in various clinical conditions and is currently interpreted as a reactive process to an underlying antigen stimulation. In recent years, a disease characterized by a definite increase in granular lymphocytes has been identified and recognized as lymphoproliferative disease of GL (LDGL). The aim of this study is to review the clinical, biological and pathogenetic mechanisms leading to this disorder. DESIGN AND METHODS: Criteria for the diagnosis, immunologic and molecular evaluation, clinical features and new therapeutic approaches are reviewed. RESULTS: More than 500 patients have been adequately reported in the literature. Immunologic classification of this disease distinguishes a CD3+ form which is more common, and a CD3- variant; this latter accounting for nearly 15% of LDGL cases. CD3+ LDGL is symptomatic in approximately 50% of cases, neutropenia, infections and anemia being the most frequent findings. Clonality of the T-cell receptor is usually documented in these patients. Cytokines such as IL-2, IL-12 and IL-15 have been claimed to play a role in this disorder. Symptomatic patients may benefit from combination therapy with low dose methotrexate and steroids. CD3- LDGL are usually associated with viral infection of GL: in particular, Epstein Barr and human T lymphotropic virus I/II have been claimed to play a role. Neutropenia is usually less pronounced than in CD3+ LDGL patients. Clonality has rarely been demonstrated; however, when present, it correlates with an aggressive clinical course. Spontaneous regression of lymphocytosis has been reported in both CD3+ and CD3- patients. INTERPRETATION AND CONCLUSIONS: Lymphoproliferative disease of granular lymphocytes is a well recognized disorder which encompasses a large spectrum of conditions, ranging from mild asymptomatic lymphocytosis to aggressive, usually fatal, disorders. Diagnosis of this disease is related to the demonstration that a discrete subset of GL is chronically expanded. Therapy should be delayed in asymptomatic patients; however, when needed, the combination of methotrexate or cytoxan and steroids represents the best approach.

Humans↗
PubMed1981

Acute nonlymphocytic leukemia showing abnormal nuclear lobulation.

An ultrastructural study of four cases of acute nonlymphocytic leukemia with abnormal nuclear lobulation was done. These cases were classified as M3 (Case 1), M3 variant (Cases 2 and 3), and M5, differentiated type (Case 4), on the basis of light microscopy according to the FAB classification. Ultrastructural observation of the leukemic cells of Cases 2 and 3 showed large bundles of fibrils in addition to abnormalities in the endoplasmic reticulum and granules, as had been reported in cases of acute promyelocytic leukemia. Large bundles of fibrils and abnormal nuclear lobulation also seemed to be characteristic of the M3 variant. However, the relationship between these structures was not identified. The exact nature of nuclear lobulation is not known, but seems to be related to some kind of intrinsic force and may be a presentation of the premature occurrence of lobulation intrinsic to the granulocyte or monocyte nucleus.

Adolescent↗
PubMed1989

Hepatic vein thrombosis (Budd-Chiari syndrome) in the microgranular variant of acute promyelocytic leukemia.

The microgranular form of acute promyelocytic leukemia (APL) was described in the late 1970s and adopted by the French, American, and British classification system in the early 1980s. Morphologically, this form shows distinct differences from the classic form of APL, but clinically it shares many of the same traits. Among these is the predilection for coagulopathies, including disseminated intravascular coagulation (DIC). This DIC has been associated with one previously reported case of fatal hepatic vein thrombosis (Budd-Chiari syndrome), in association with an untreated case of APL. The authors present a case of the microgranular variant of acute promyelocytic leukemia (FAB-M3V), with autopsy and electron microscopic evidence in support. It is important to recognize this variant form of APL and its association with hepatic vein thrombosis, because any successful attempt at therapy must be instituted early in the course of the disease.

Adult↗
PubMed1999

Subtypes of chromophobe cell renal carcinoma: an ultrastructural and histochemical study of 13 cases.

The Mainz classification of renal epithelial neoplasms has become accepted as a reproducible morphologic and cytogenetic classification of epithelial tumors of the kidney. Chromophobe cell renal carcinoma (CCRC) is a distinct type of renal epithelial neoplasm, first described by Thoenes et al. in 1985. Both a typical type of CCRC, composed of cells with pale reticular cytoplasm, and an eosinophilic variant (EVCCRC) have been identified. Both variants have been reported to show cytoplasmic staining with the Hale's colloidal iron method. Cytogenetic analysis has tended to confirm the Mainz classification. CCRC has been shown to have consistent chromosomal abnormalities that are not shared by other renal tumors. Ultrastructurally, CCRC is typically characterized by a cytoplasm containing scant numbers of mitochondria, which have tubulovesicular christae, and by the presence of innumerable 150-300-microm microvesicles scattered between the mitochondria. Erlandson et al. recently described two subtypes of EVCCRC. One subtype has sparse microvesicles and abundant mitochondria that have tubulovesicular christae, whereas the second type (described as an oncocytic EVCCRC) has no microvesicles and abundant mitochondria containing pseudovesicular or lamellar christae. This was believed to be more akin to the ultrastructural appearances of a renal oncocytoma. The authors believe that the phenotype of the EVCCRC shows a range of appearances at both the light microscopic and the ultrastructural levels, from features similar to the typical type CCRC through to a neoplasm that is phenotypically similar to renal oncocytoma. A series of 13 cases of CCRC from the files of the Massachusetts General Hospital for which ultrastructural examination was available is described. These cases include six cases of typical type CCRC and seven cases of EVCCRC. The authors confirm the findings of Erlandson et al. of two subtypes of EVCCRC and designate them as type 1 EVCCRC (with some microvesicles and mitochondria with tubulovesicular christae) and type 2 EVCCRC (with no identifiable microvesicles and mitochondria with pseudovesicular or lamellar christae).

Adult↗
PubMed1998

CD57 (Leu-7) expression is helpful in diagnosis of the follicular variant of papillary thyroid carcinoma.

CD57 (HNK-1) is a oligosaccharide antigen that is expressed by cells of several lineages. It is present on multipotential neuroepithelial cells during embryogenesis, and tumours of epithelial, neuroectodermal and nerve sheath origin also express CD57. Its role in the diagnosis of thyroid tumours is controversial. We have studied CD57 expression by immunohistochemistry to determine its utility in the classification of thyroid follicular lesions. Study material included 114 normal thyroid sections, 77 benign thyroid lesions (29 colloid nodules, 22 follicular adenomas, 20 cases of Hashimoto's thyroiditis and 6 of Grave's disease) and 83 thyroid carcinomas, including 31 follicular variants of papillary carcinoma. We observed CD57 positivity in 95% of thyroid carcinomas, 27% of follicular adenomas and 10% of colloid nodules. It was not expressed in the normal thyroid. CD57 expression in thyroid carcinomas was significantly different from that in normal and benign thyroid lesions (P < 0.0001). The follicular variant of papillary thyroid carcinoma also showed significantly higher CD57 expression than colloid nodules (P < 0.0009) or follicular adenomas (P < 0.0009). No significant difference was seen between colloid nodules and follicular adenomas. We conclude that CD57 immunohistochemistry is valuable in the classification of thyroid follicular lesions into benign and malignant groups and is also helpful in the diagnosis of the follicular variant of papillary thyroid carcinoma.

Adenoma↗
PubMed2004

[Anatomic variations of the spermatic vein and endovascular treatment of left varicoceles: a pediatric series].

OBJECTIVE: To report on the high incidence of anatomical variants of the origin and course of the internal spermatic vein (ISV) discovered at the time of percutaneous embolization of left varicoceles in a pediatric population. METHODS: We reviewed retrospectively the 65 cases of left varicocele treated by percutaneous embolization (grade II and III) in our institution between 1990 and 2000. The course of the left renal vein (LRV), the origin of the ISV, and the number of ISVs and their pathway were recorded in all cases, according to the Bähren classification. RESULTS: In 37/65 (57%), the ISV was single and arose from a normal LRV (type I). The following variants were encountered: type V--circumaortic LRV 9/65 (14%); type IVb--intrarenal origin of ISV 8/65 (12%); type II--multiple ISV 5/65 (8%); and pelvic collaterals 6/65 (9%). CONCLUSION: Venous anatomical variants are frequently encountered (43%) at the time of left varicocele embolization in children. Such variants often impose some adjustments to the technique of embolization and, at times, hamper the procedure.

Adolescent↗
PubMed1976

Spinal retroflexion in craniorhachischisis: its classification and limitations.

Spinal retroflexion has been studied in five stillborn human fetuses having craniorhachischisis. The findings show that retroflexion in this variant of anencephaly can be classified into severe, moderate and mild forms. The three grades can be differentiated from one another by the direction of the face, shape of the mentothoracic junction, extension of hairline on back, radiographic abnormalities of the spine, and the diaphragmatic defects. It is discussed that, though the anencephalies with severe or moderate degree of cervical retroflexion resemble iniencephaly in their features of spinal retroflexion, those having mild retroflexion are contrasted and should not be categorised with iniencephaly. It is suggested that for precision the term "spinal retroflexion" should be used after duly prefixing it by an appropriate word (severe, moderate or mild) indicating the degree of retroflexion observed.

Abnormalities, Multiple↗
PubMed1981

[Detection and analysis of clinico-pathogenetic variants of the labile stage of hypertension using mathematical methods of image recognition].

The method of cluster analysis was used for automatic classification of patients with the labile stage of hypertensive disease according to 15 parameters reflecting the condition of hemodynamics and its regulation. Two groups differing in the principal factors of high arterial pressure maintenance were distinguished. Clinical and physiological analysis of the distinguished groups was conducted on the basis of the furosemide test.

Adult↗
PubMed2002

[Neoplastic intraepithelial lesions of pancreatic ducts: new entities].

Intraductal neoplastic lesions of the pancreas have been the focus of recent efforts aiming to better characterize several entities. Beside reactive papillary hyperplastic lesion of pancreatic ducts whose limits and significance are unclear, two different entities, intraductal papillary mucinous neoplasm (IPMN) with its variant intraductal oncocytic papillary neoplasm, and pancreatic intraepithelial neoplasia (PanIN), the precursors of pancreatic adenocarcinoma have been recognized. Each has been carefully described at the microscopic level with classification into several grades of dysplasia. IPMNs are intraductal, papillary, often diffuse and mucus hypersecreting neoplastic lesions. Mucin accumulation gives to the lesion a cystic pattern. Treatment is surgical resection of the whole lesion. Intraductal oncocytic papillary neoplasm is a rare variant of IPMN. The prognosis of IPMN is globally favorable, but these tumors display the risk of malignant transformation into a mucinous or a tubular pancreatic adenocarcinoma. Although IPMN can induce symptoms, PanIN are silent and always discovered at the vicinity of an invasive adenocarcinoma. The usefulness and the reproducibility of the classification of PanIN remain to be determined. PanIN classification might resume the different successive steps of molecular genetic or epigenetic events associated with the development of a pancreatic carcinoma.

Adenocarcinoma, Mucinous↗
PubMed2005

Mechanisms of disease: focal segmental glomerulosclerosis.

Focal segmental glomerulosclerosis (FSGS), a subtype of "idiopathic nephrotic syndrome", is not a single disease, but a lesion that initially affects the glomerulus followed by the tubulointerstitium and renal vessels. The term 'FSGS' does not accurately encompass the various pathologic features of the glomerulus, which are not always focal, segmental or sclerotic. Particular variants of FSGS, such as collapsing glomerulopathy and the glomerular tip lesion, exemplify the nosologic uncertainty inherent in the classification of glomerular lesions. Pathologic variation notwithstanding, all pathologic processes that affect the podocyte lead to one of the histologic subtypes of FSGS. This specialized cell type has essential roles in maintaining the integrity of glomerular architecture, resisting endocapillary hydraulic pressure and hindering egress of proteins into the urinary space. Once initiated, podocyte lesions and ensuing fibrosis are usually irreversible, at least in human forms of FSGS. Remarkable progress has been made in unraveling the mechanisms of podocyte dysregulation that accompany the cellular variants of FSGS and in identifying genetic mutations affecting proteins of the slit diaphragm. Hopefully, this progress will drastically improve treatments for what is one of the most difficult therapeutic challenges to confront the nephrologist.

Animals↗
PubMed2000

Burkitt's lymphoma: historical background and recent insights into classification and pathogenesis.

In this paper, the authors evaluate the historical evolution of the definition of Burkitt's lymphoma (BL) and of its clinicoepidemiological (endemic, sporadic, and acquired immunodeficiency syndrome-associated BL) and morphological variants. On the basis of the morphological, immunologic, genetic, and clinical characteristics of these tumors, the authors also emphasize the importance of precise disease definitions for biological and epidemiological studies. These principles were used in accordance with the Revised European-American classification of lymphoid neoplasms (REAL), which proposed that disease entities should be defined by a constellation of pathobiological and clinical features.

Burkitt Lymphoma↗
PubMedDate not supplied

[Vertebrogenic lumbosacral radiculitis unrelated to disk herniation].

A classification of changes in the inferior lumbar portion of the spine that cause radicular pain and symptoms not amenable to concervative therapy is given. In most cases the said changes can be educed through a clinico-roentgenological investigation. Anatomical data bear proof to the presence of structural variants in which, in case of an intercurrent osteochondrosis without hernia of the disc, the compression of the root becomes quite probable. The classification lists changes that should be looked for when no hernia of the disc could be detected and lays emphasis on the multiplicity of causes accounting for the emergence of vertebrogenic radiculitis.

Exostoses↗
PubMed1993

The new WHO classification of brain tumours.

The new edition of the World Health Organization (WHO) book on 'Histological Typing of Tumours of the Central Nervous System' reflects the progress in brain tumour classification which has been achieved since publication of the first edition in 1979. Several new tumour entities have been added, including the pleomorphic xanthoastrocytoma, central neurocytoma, the infantile desmoplastic astrocytoma/ganglioglioma, and the dysembryoplastic neuroepithelial tumour. The list of histological variants has also been expanded. In line with recent morphological and molecular data on glioma progression, the glioblastoma is now grouped together with astrocytic tumours. The classification of childhood tumours has been largely retained, the diagnosis primitive neuroectodermal tumour (PNET) only being recommended as a generic term for cerebellar medulloblastomas and neoplasms that are histologically indistinguishable from medulloblastoma but located in the CNS at sites other than the cerebellum. The WHO grading scheme was revised and adapted to new entities but its use, as before, remains optional.

Brain Neoplasms↗
PubMed1984

Two physically and serologically distinct lipopolysaccharide profiles in strains of Bordetella pertussis and their phenotype variants.

The lipopolysaccharide (LPS) from nine strains representing 18 phenotype variants of Bordetella pertussis could be grouped into one of two distinct profiles by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining. One group, representing the wild-type LPS profile of B. pertussis, consisted of two silver-staining bands: a dominant brown-amber a band and a faster-migrating, minor, black-staining b band. The second group, representing a variant LPS profile, consisted of a single black-staining band of similar mobility to the b band in the wild-type profile. By electrophoretic transfer (Western) blot analysis, mouse antiserum raised against whole cells of Tohama I (prototype wild-type LPS strain) recognized only the a band from all strains/phenotypes possessing the wild-type LPS profile. In contrast, mouse antiserum raised against whole cells of 134 (prototype variant LPS strain) recognized all b bands, regardless of strain/phenotype, and could be shown to cross-react weakly with the a band from Tohama I. These results and results from cohemagglutination and immunodiffusion analyses support the classification of B. pertussis into one of two physiologically and serologically distinct LPS phenotypes: Lps AB for the wild-type profile and Lps B for the variant profile. The relationship of LPS type and phenotypic, or "phase," variation is discussed.

Animals↗
PubMed2003

Estrogen receptor classification for hepatocellular carcinoma: comparison with clinical staging systems.

PURPOSE: Several scoring systems to evaluate patients with hepatocellular carcinoma (HCC) exist. A good scoring system should provide information on prognosis and guide therapeutic decisions. The presence of variant liver estrogen receptor (ER) transcripts in the tumor has been shown to be the strongest negative predictor of survival in HCC. The aim of this study was to compare the predictive value of the commonly applied clinical scoring systems for survival of patients with HCC with that of the evaluation of ER in patients with HCC (molecular scoring system). MATERIALS AND METHODS: HCC was staged according to the Okuda classification, Barcelona Clinic Liver Cancer classification, Italian classification system (CLIP), French classification, and ER status in 96 patients. Analysis of survival was performed according to the Kaplan-Maier test and was made for each classification system and ER. A comparison between classifications was made by univariate and multivariate analysis. RESULTS: Among the clinical classification systems, only the CLIP was able to identify patient populations with good, intermediate, and poor prognosis. On multivariate analysis, ER classification was shown to be the best predictive classification for survival of patients with HCC (P <.0001). This difference was the result of a better allocation of patients with ominous prognosis (variant ER) having nevertheless good clinical score. CONCLUSION: The evaluation of the presence of wild-type or variant ER transcripts in the tumor is the best predictor of survival in patients with HCC. Its accuracy in discriminating patients with good or unfavorable prognosis is significantly greater than that of the commonly used scoring systems for the staging of HCC.

Adult↗