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PubMed2001

The clinical significance of antenatal pathological Doppler findings in the fetal middle cerebral artery in cases with peripheral reduced diastolic doppler flow but no absence of end-diastolic flow in the umbilical artery or fetal aorta.

PURPOSE: The effects of antepartum pathological Doppler findings in the fetal middle cerebral artery in cases with simultaneously peripheral reduced diastolic Doppler flow on perinatal outcome and the odds ratio of perinatal risks were studied. METHODS: 214 patients were examined by color Doppler ultrasound in relationship to complications in gestation and labor and fetal outcome. One thousand and seventy Doppler flow measurements of the middle cerebral artery, the umbilical artery and the fetal aorta between 28 and 40 weeks of gestation were performed. Sensitivity and odds ratio of synchronous cerebral pathological and peripheral pathological Doppler blood flow with regard to the prediction of intrauterine growth retardation, rate of cesarean section, preterm delivery and newborn depression was calculated. In all Doppler measurements there were no cases with absence of end-diastolic flow. RESULTS: Preterm delivery rate and intrauterine growth retardation rate were significantly higher in cases of synchronous cerebral pathological and peripheral pathological Doppler blood flow as in cases of isolated reduced peripheral blood flow (p<0.001; odds ratio 13.2 and 16.6). CONCLUSION: Pregnancies with no absence of end-diastolic flow in the fetal aorta or umbilical artery, but with reduced diastolic flow in these vessels and simultaneous pathological Doppler findings in the fetal middle cerebral artery are high risk pregnancies, above all in respect to intrauterine growth retardation, preterm delivery and newborn depression. Surveillance of pregnant women should be performed in a perinatal centre.

Aorta↗
PubMed2001

[Pathology of intractable epilepsy with regard to surgical treatment].

There have recently been a number of new pathological findings of specimens from epileptic foci that have increasingly been highlighted as opportunities for surgical treatment. These findings include a wide range from hippocampal sclerosis-related lesions of temporal lobe epilepsy to newly established malformative lesions. As to the former, special interest has been paid to additional knowledge regarding the pathology inside and outside the medial temporal regions, such as the significance of 1) accumulation of corpora amylacea in hippocampal sclerotic lesions, 2) dispersion of the granular layer of the dentate gyrus, 3) various pathologic features in the lateral temporal lobe, and 4) dual pathology in extratemporal areas. As increasing opportunities for surgical treatment of intractable epilepsy, new categories of malformative lesions are being established, including focal cortical dysplasia and microdysgenesis, the latter of which can be diagnosed only by pathological examination after surgery. In the field of surgical pathology of epilepsy patients, further clues to clarify the pathomechanism of epilepsy remain to be discovered.

Brain↗
PubMed2001

Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4.

PURPOSE: We evaluated differences in clinical and pathological outcomes between Gleason 3 + 4 and 4 + 3 prostate cancer. MATERIALS AND METHODS: The radical prostatectomy whole mounted specimens from 263 men with pathological Gleason 7 tumors were identified. Gleason 3 + 4 and 4 + 3 tumors were compared in regard to pathological variables and outcome. Significance of clinical and pathological data on progression-free survival was analyzed. RESULTS: Of the tumors 34% had a primary Gleason grade of 4, and were more likely than those with primary grade 3 to have seminal vesicle involvement (34% versus 18%, p = 0.006), a higher pathological stage (pT3 55% versus 42%, N+ 13% versus 3%, 0.001), extraprostatic extension (58% versus 38%, 0.001) and higher median preoperative prostate specific antigen (PSA) (13.5 versus 9.0 ng./ml., respectively <0.001). Mean followup plus or minus standard deviation was 6.8 +/- 1.9 years. The overall 10-year crude, cancer specific and progression-free survival rates were 83%, 99% and 58%, respectively. Primary Gleason grade was significantly associated with progression-free (risk ratio 1.6, 95% confidence interval 1.08 to 2.5, p = 0.02) but not crude and cancer-specific survival. Univariately, primary Gleason grade 4 was associated with progression-free survival, as were percent Gleason 4, seminal vesicle invasion, lymph node involvement, pT stage, margin status, DNA ploidy, preoperative PSA, cancer volume and extent of extraprostatic extension. Multivariately, only preoperative PSA (p <0.001), seminal vesicle invasion (<0.001) and DNA ploidy (0.002) were associated with progression-free survival. Primary Gleason grade and percent Gleason 4 were not identified as independently associated with progression-free survival. CONCLUSIONS: In patients with Gleason 7 score prostate cancer primary Gleason grade 3 and 4 cancers are different in pathological parameters and prognosis. However, primary Gleason grade does not provide any additional information than other known prognostic factors, such as preoperative PSA, seminal vesicle invasion and DNA ploidy.

Adenocarcinoma↗
PubMed2001

[The clinical value of surgical-pathological staging for endometrial carcinoma].

OBJECTIVE: To explore the practical value of surgical-pathological staging for endometrial carcinoma. METHODS: Ninety-six patients with endometrial carcinoma accepted primary surgical treatment from January 1995 to December 1999 were analyzed retrospectively in our hospital. The clinical and surgical pathologic staging of these patients were compared. RESULTS: The total differences between clinical and surgical-pathologic staging were 44 cases (45.8%), in stage I 24.0%, stage II 76.9%, in stage III 2 of 5 cases. The metastasis rate of pelvic lymph nodes was 10.3%, in stage I 1 of 16 cases, stage II 14.7%. Fourteen patients (14.6%) with extrauterine pelvic metastasis were found, of which 2 of 19 cases in stage I b, 23.1% in stage II. 9.4% with ovarian metastasis, in stage I a 9.7%, stage II 10.3%. 7.9% with positive peritoneal cytology, in stage I 4.0%, stage II 10.3%. 5.2% with omentum metastasis. 2.1% with appendix metastasis. Clinical stages, depth of myometrial invasions, pathological grades and histological types were related to the extent of pelvic and abdominal cavity by univariate analysis (P < 0.01, 0.05). The first three factors were significantly correlated to dissemination by multivariate (P < 0.05). CONCLUSIONS: The surgical-pathological staging is more accurate than the clinical staging, especial in stage II clinical stage depth of myoinvasion, patho-histological grades were closely related to the dissemination in pelvic-abdominal cavity. The surgical-pathological staging is able to assess prognosis objectively and guide therapy for endometrial carcinoma.

Abdominal Neoplasms↗
PubMed1999

[A comparative study between clinical response and pathologic changes to preoperative chemotherapy in non-small cell lung cancer].

OBJECTIVE: To study the clinical response to preoperative chemotherapy in relation to pathologic changes in non-small cell lung cancer (NSCLC). METHODS: Forty-six stage I-IIIa NSCLC patients were given 1-2 courses of preoperative chemotherapy with mitomycin C (MMC) 6 mg.M-2 on day 1, vindesine (VDS) 2.5-3 mg.M-2 on day 1, day 8 and/or day 15, and cisplatin (DDP) 90 mg.M-2 on day 1 (MVP regimen). 'The treatment was recycled every 28 days. Clinical response was assessed according to WHO criteria. Pathologic changes of the resected tumor were categorized to 3 grades. Grade I: No tumor under gross and microscopic observation. Grade II: Grossly no tumor present but residual tumor cells under microscopic observation. Grade III: Tumor reduced in size with clear margins; marked tumor cells degeneration and necrosis accompanied with fibrosis. Grade IV: Active proliferation of tumor cells with invasion. Grade I-II was considered to be chemotherapeutically effective. RESULTS: (1) The clinical response rate was higher in patients who had received 2 courses than those received 1 course of treatment. More patients treated with 2 courses had their pathologic changes in Grade I-II than those treated with 1 course of chemotherapy but the response rate was not fully consistent with pathologic grading. (2) Pathologic grading significantly correlated with the extent of tumor involvement but not with the lymph node status. (3) Efficacy of chemotherapy should be evaluated jointly by the clinical response and grading of pathologic changes. (4) Chemotherapy with MVP regimen did not elicit severe toxic side effect. Nor did it lead to operative morbidity, operative mortality and a delay in postoperative recovery. CONCLUSION: Preoperative chemotherapy with MVP regimen is effective in the treatment of NSCLC in stage I-IIIa.

Adult↗
PubMed2001

Pathology of ductal carcinoma in situ of the breast: a heterogeneous entity in need of greater understanding.

Breast cancer is the commonest malignancy among Singapore women. Ductal carcinoma in situ (DCIS) is the putative precursor of the majority of invasive breast cancers, and its incidence has increased dramatically with mammographic screening. It is a heterogeneous disease--radiologically, pathologically and biologically. While the diagnosis of breast cancer in its pre-invasive phase, DCIS, allows the likelihood of cure with effective therapy, issues that surround its pathological heterogeneity are often not fully understood nor recognised. In this paper, the pathology and natural history of breast DCIS are reviewed; with emphasis on pathological classification schemes that attempt to predict recurrent disease or progression to invasive cancer. The potential role of biological markers is also evaluated. Atypical ductal hyperplasia, a lesion that is often difficult to distinguish from low grade DCIS; the significance and definition of microinvasion; and the value of fine needle aspiration cytology in DCIS are discussed. In addition, pathologic-radiologic correlations of local screen-detected cases of breast DCIS are presented. Awareness of the pathological parameters that impact on the biological behaviour of breast DCIS will enable appropriate management strategies; avoiding overtreatment in biologically indolent disease, while optimising adequate therapy for aggressive lesions.

Biomarkers, Tumor↗
PubMed2001

[Effects of hepatitis G virus coinfection on hepatic pathological changes of patients with chronic hepatitis B: a long-term comparative study].

OBJECTIVE: To observe the long-term effect of hepatitis G virus (HGV) coinfection on hepatic pathological changes of patients with chronic hepatitis B (CHB) and explore the pathogenicity of HGV. METHODS: Menghini method liver biopsy was performed on 45 patients with CHB twice with an interval of 5 years on a voluntary basis. The liver tissue of 21 cases was HGV nonstructural region 5 (HGV NS5) antigen positive by peroxidase anti-peroxidase (PAP) immunohistochemical staining assay (HGV coinfection group) in these two tests, and 24 cases were negative (HGV noncoinfection group). There was no significant difference in age, sex, course of disease, amount of serum HBV-DNA by competitive quantitative polymerase chain reaction assay and severity of hepatic pathological leisions between these two groups (P < 0.05) and they were treated with the same scheme and without sustained curative effeect. The hepatic pathological changes of the two groups after 5 years were compared and analysed retrospectively. RESULTS: There was no significant difference in basic hepatic pathological change, severity of inflammatory activity grade and fibrosis stage in these two groups. The numbers of cases of inflammatory activity grade G1, G2, G3, and G4 were 3, 7, 7, and 4 in HGV coinfection group, and 5, 8, 7, and 4 in HGV noncoinfection group in the beginning of observation; and were 3, 5, 7, and 6 in HGV coinfection group, and 4, 6, 8, and 6 in HGV noncoinfection group after 5 years. The numbers of cases in fibrosis stages S1, S2, S3, and S4 were 4, 7, 7, and 3 in HGV coinfection group, and 6, 8, 6, and 4 HGV noncoinfection group in the beginning of observation; and were 3, 6, 5, 7 in HGV coinfection group, and 4, 7, 5, and 8 in HGV noncoinfection group after 5 years (P > 0.05). CONCLUSION: HGV coinfection does not lead to the activation of hepatic pathological changes and does not speed up the progression of fibrosis in patients with CHB. HGV coinfection does not play an obvious role in long-term hepatic pathological changes of patients with CHB. HGV has at most a mild hepatic pathogenicity.

Adult↗
PubMed2003

[Problems of the preoperative prediction of the pathological stage in prostate cancer].

The pathological stage of the tumor is the most influential prognostic factor for progression after radical prostatectomy. However, as many as 50% of men undergoing radical prostatectomy are found to have extraprostatic disease in the pathological specimen. Accurate identification of the risks of disease extension and of disease recurrence prior to radical prostatectomy would thus be useful in counseling men presenting with clinically localized prostate cancer. Nomograms may help patients and physicians make more informed treatment decisions based on the probability of pathological stage. Partin and co-workers popularized the use of a pretreatment nomogram based on PSA (prostate specific antigen), clinical stage (TNM stage) and biopsy Gleason score to predict the pathological stage of localized prostate cancer. However, it may not be directly applicable to Japanese males, and the interpretation and comparison of data sets should be done with caution and careful consideration. Although attempts have been made to establish a nomogram for Japanese patients, been tried, it is still based on the data for a small number of patients. More data from a greater number of patients and validation analysis are essential. Recently, artificial neural networks (ANN) have been shown to be effective in predicting pathologic stage in men with clinically localized prostate cancer. The use of ANNs is a relatively new concept and the data is based on Western people; thus, the data analysis for Japanese patients is necessary. The present paper mainly outlines the usefulness and problems for the preoperative prediction of the pathological stage in prostate cancer by nomograms and artificial neural networks.

Biomarkers, Tumor↗
PubMed1999

[Transformation of effusion and formation of granulation tissue in the pathologic process of otitis media with effusion].

OBJECTIVE: To explore the transformation of stagnant effusion (SE) and the pathologic behavior leading to granulation tissue (GT) formation in the pathologic process of otitis media with effusion (OME). METHOD: The temporoal bone slides from 306 ears with OME at the Otopathology Laboratory of the University of Minnesota USA were studied histopathologically under light microscopy. RESULT: The observations revealed a pathologic process in which the type and the condition of stagnant effusion in the middle ear cleft was variable in the dynamics of OME progression from an early pathologic stage to an advanced pathologic stage. The granulation tissue was primarily formed by two types of fibroblast proliferation in subepithelial space. The absorption and the orgnization of SE and the formation of granulation tissue maybe occur simultaneously in same areas and a same pathologic process. CONCLUSION: The granulation tissue can only form in the areas where effusion has stagnated and has been absorpted. It is very important that effusion of the otitis media should be removed completly before the formation of granulation tissue.

Granulation Tissue↗
PubMed2003

[Depression and associated organic pathologies, a still under-estimated comorbidity. Results of the DIALOGUE study].

INTRODUCTION: The field of comorbidity between organic pathologies and mood disorders remains insufficiently explored, whereas such comorbidities predict a more unfavorable outcome of both mood disorders and organic pathologies themselves. OBJECTIVE: The purpose of the Depression and organic diseases study (DIALOGUE) was to obtain in France a set of quantitative data on the prevalence of comorbidities between major depressive episodes (MDE) and associated chronic organic pathologies (ACOP), as well as on the diagnostic and therapeutic difficulties encountered in the management of such comorbidities in daily medical practice. METHODS: General practitioners (GP) and private or hospital psychiatrists were invited to collect several socio-demographic, clinical and therapeutic data on five consecutive patients corresponding to the inclusion criteria. Four groups of patients were set up: 2 082 patients followed up in primary care by their GP for a chronic somatic pathology (GPS group), as well as 2 017, 1 335 and 522 patients respectively followed up in primary care (PPD group), private (GPD group) or hospital psychiatry (HPD group) for a depression not already treated, or requiring modification of its pharmacological treatment (GPD, PPD and HPD group). RESULTS: Among the patients of the GPS group, 41% presented with an associated MDE and, among the depressed patients of the three other groups, respectively 47, 55 and 63% presented with an ACOP. MDE were rather old (more than six months of duration) and severe. However, only 20% of the MDE in the GPS group had a treatment in progress, while in 74% of these same cases the onset of MDE was retrospectively dated more than 2 months before the day of the inclusion in the study. The ACOP, whose functional impact was judged as more severe (cancer, HIV, neurological diseases, renal insufficiency, osteo-articular diseases, insulino-dependent diabetes and coronary heart disease) were more often considered as responsible for the concomitant MDE and more often followed up in psychiatric settings than the other pathologies. Among the overlap signs between the ACOP and the MDE, fatigue was cited first and embarrassed psychiatrists more than GPs, contrary to sleep disorders. In spite of the diagnostic difficulties related to the comorbidity and recognized by all the physicians, GPs seldom asked for the opinion of a psychiatrist (5%) and appealed less often than psychiatrists to the cognitive and affective signs specific of the depression (low self-esteem, anhedonia). CONCLUSION: The unrecognized frequency in the association between depression and organic pathologies pleads for closer cooperation between GPs and psychiatrists, as for continuous training not only of the GPs, but also the psychiatrists, in order to limit the observational biases and the therapeutic hesitations induced by these comorbidities.

Adult↗
PubMed2003

[A clinical and pathological study on primary oral mucosal malignant melanoma].

OBJECTIVE: The aim of this study was to investigate the association between clinical and pathological characteristics of primary oral mucosal malignant melanoma and the prognosis of this disease. METHODS: Clinical and pathological characters of 73 cases primary oral mucosal malignant melanoma were investigated. The association between risk factors, such as black macule, lymph node metastases, invasive depth, clinic stages, pathologic types, and prognosis was analyzed using Kaplan-Meier survival analysis and Log rank test. RESULTS: The age of the patients ranged from 24 to 80 years (Median age, 50). Among the patients, 43 were males and 30 were females. The most common locations of the tumor were palate and gingiva. The clinic stages of these patients were as the following: Stage I (46/73), Stage II (24/73), Stage III (3/73). The most common pathological type was nodular (44/73), followed by lentiginose malignant melanoma (15/73) and superficial spreading (1/73). According to the configuration of tumor cells, the most common type was the mixed cell type (37/73), followed by the epitheloid cell type (27/73) and the spindle cell type (9/73). Among the 73 patients, 43 were followed up, the 3-year and 5-year survival rates were 19.86% and 11.91% respectively. Black macule, lymph node metastases, invasive depth, clinic stages, pathologic types and therapeutic methods were significantly associated with the prognosis (P < 0.05). CONCLUSION: The prognosis of the primary oral mucosal malignant melanoma is associated with black macule, lymph node metastases, invasive depth, clinic stages, pathologic types, and therapeutic methods.

Adult↗
PubMed2003

[The application of needle video-assisted thoracoscopic biopsy in pathologic diagnosis and staging for advanced lung cancer].

OBJECTIVE: To study the clinical application of needle video-assisted thoracoscopic biopsy in the pathologic diagnosis and staging for advanced lung cancer. METHODS: Ninety-four patients were diagnosed as having advanced lung cancer staged IIIa-IV by chest X-ray, computed tomography and magnetic resonance imaging, for which a pathologic diagnosis was not made by sputum and pleural effusion cytology or bronchoscopic examination. Needle video-assisted thoracoscopic biopsy was performed for primary lesions, mediastinal lymph nodes, metastatic lesions in the lungs and the chest wall. RESULTS: Pathologic samples were obtained in 89 of the 94 patients by needle video-assisted thoracoscopic surgery. The successful rate was 95%. After operation, the pathologic diagnosis was confirmed to be lung cancer in all the 89 patients. Adenocarcinoma was found in 47 patients, squamous carcinoma in 23, adenosquamous carcinoma in 12, and small cell lung cancer in 7. Compared to the clinical diagnosis before operation, the pathologic diagnosis post-operation was changed in 15 patients. Pneumothorax and mild haemoptysis occurred in 4 patients and 2 of the cases respectively. All the patients were followed for 8 - 18 months with computed tomography and physical examination. No implantation metastasis was found. CONCLUSION: Needle video-assisted thoracoscopic biopsy is an effective diagnostic measure for patients with advanced lung cancer for which pathologic diagnosis, typing and staging are not determined by routine examinations.

Adult↗
PubMed2003

The histo-pathology of human giardiasis.

In giardiasis symptomatic group (I) the prevalence of diarrhoea was 5/7 (71.43%), 13/13 (100%) in Grade 0, I, II, III and IV pathology respectively which is statistically insignificant in comparison to each other (P > 0.05). The prevalence of abdominal pain is 71.43%, 73.33%, 95%, 91.67% and 100% in Grade 0, I, II, I & IV pathology respectively which is statistically insignificant to each other (P > 0.05). The prevalence of flatulence is 42.86%, 40%, 80%, 83.33% and 100% in Grade 0, I, II, III & IV pathology respectively, was statistically significant in comparison to each other (P < or = 0.05) So, the prevalence of flatulence is more frequent in patients with marked pathological changes in the duodenum. The prevalence of anorexia was 14.29%, 53.33%, 65%, 50% & 100% in Grade 0, I, II, III & IV pathology respectively, statistically significant in comparison to each other (P < or = 0.05). The prevalence of vomiting was 0%, 13.33%, 15%, 16.67 & 85.71% in Grade 0, I, II, III and IV pathology respectively, significant increased in Grade IV and absent in Grade 0 (P < or = 0.001).

Abdominal Pain↗
PubMed1992

[Thyroid pathology in the aged].

Following a review of the literature on this topic, the authors examine all patients with thyroid pathologies who were admitted to the 1st Institute of Surgical Pathology of the University of Pavia between 1-1-1974 and 31-12-1990. Only patients aged over 65 were included in the study and were subdivided into two groups, namely those aged between 65-74 (3rd age) and those over 75 (4th age). Particular attention was focused on the type of pathology (benign or malignant), other pathologies associated to the basic pathology, the type of operation performed and, in the case of malignant diseases, the histological type of tumour and any metastasis. The results of this series were then compared to those reported elsewhere. The Authors conclude that thyroid pathologies in geriatric patients are very important since, given that at this age the gland is becoming atrophic, the onset of disease often occurs before the age of 65 and symptoms in these patients are imprecise. In view of the good results obtained, it is always worth operating in order to give the patient a reasonable life expectancy, especially in those cases with collateral disorders (compression) caused by the thyroid mass.

Adenocarcinoma↗
PubMed2004

[The diagnostic value and morphologic manifestation of high resolution computerized tomography in coal miner's pneumoconiosis with pleural pathological changes].

OBJECTIVE: To analyse CT and high resolution computerized tomography (HRCT) diagnostic value and morphologic manifestation in coal miner's pneumoconiosis with pleural pathological changes. METHODS: One hundred and thirty-one cases of coal miner patients with pneumoconiosis (0(+) type: 14 cases, type I: 46 cases, type II: 58 cases, type III: 13 cases) and 20 normal people as control group were first examined by routine CT scan at 4 fixed slices, followed by HRCT examination at the region of interest (ROI). Meanwhile, all of them had high-kV chest radiography. RESULTS: According to the national standard of the People's Republic of China in the diagnosis of coal miner's pneumoconiosis with pleural plaque, 68 cases of pleural disease making up 51.91% (68/131) were found (type I accounted for 17.65%, type II 63.24%, type III 19.12%). The morphologic manifestation of pleural pathology by HRCT could be classified into four types: (1) nodular type: 73.38%, (2) flat type: 18.71%, (3) irregular type: 7.91%, (4) mixed type. The pleural pathological changes were found in thoracic wall pleura (65.02%), surface of mediastinum (22.16%), and pericardium (12.80%), but not found in the top of lung and costo-phrenic angles. The thickness of pleura was often about 5 approximately 10 mm (88.17%). CONCLUSION: Pleural pathological changes were not seldom seen in coal miner's pneumoconiosis. HRCT is a reliable examination method aiding routine CT to show pleural pathological changes, thus it has a great diagnostic and practical value. It is necessary to make a further comparison study between pathology and imagology.

Adult↗
PubMed2004

Specific isotype immune response in the diagnosis of human schistosomiasis pathology?

Since the few indirect markers available for assessing the development and the stage of intestinal schistosomiasis morbidity are weakly specific, endoscopy is still the only method able to detect severe forms of pathology. Therefore, we evaluated the isotype antibody response to the current schistosome antigen preparation (soluble egg antigens [SEA]) in 142 Senegalese patients infected with Schistosoma mansoni. They were stratified into three different stages of pathology according to ultrasonographic, endoscopic, and clinical parameters (stage 1 = no detectable pathology; stage 2 = moderate morbidity; stage 3 = severe forms of pathology). Only median specific IgG4, IgE, and IgA responses changed according to the stage of pathology. The IgA level was significantly higher in stages 2 and 3 compared with stage 1, and the IgE level was higher in stage 3 compared with stage 1. A high specific IgG4 level was observed only in stage 3 and was significantly different compared with stage 2. We show an association between the variability of the specific response to SEA and the degree of morbidity, and demonstrate that IgA and IgG4 responses could be combined markers to easily discriminate the different stages of pathology due to infection with S. mansoni.

Adolescent↗
PubMed2004

[Needle biopsy of spondyloarthropathy: pathological features and clinical significance].

OBJECTIVE: To study the pathological features of sacroiliitis, aiming at improving the early diagnosis of ankylosing spondylitis (AS). METHODS: CT guided needle biopsy of sacroiliac joint (SIJ) was performed in 96 cases of spondyloarthropathy (SpA) patients with 3 autopsy materials of non-SpA sacroiliac joints serving as control. Pathological features were studied by two independent observers. Clinical data were collected and analyzed. RESULTS: No pathological change was noticed in the control group. Among the 96 cases of SpA, pathological changes were found in 76 cases, including bone marrow inflammation, pannus formation, subchondral bony plate destruction, cartilage degeneration/erosion, synovitis, and enthesitis. The aforementioned first 4 findings were present in 45 cases of grade 0/I CT sacroiliitis. In the synovial specimens obtained, synovitis was seen in some cases of grade I and all of >/= grade II CT sacroiliitis,while no inflammatory change was noticed in all cases of grade 0 CT sacroiliitis. Frequency rate of cartilage erosion and ossification in grade 0/I CT sacroiliitis was the lowest in comparison with the other groups. Moreover, in cases of grade 0/I CT sacroiliitis, cartilage erosion only present at the bony plate side, while the joint cavity side was not affected. The inflammatory index was significantly lower in cases of grade IV CT sacroiliitis than that in the other groups. Enthesitis only presented in some cases of >/= grade II CT sacroiliitis. Among the 65 undifferentiated spondyloarthropathy patients, 45 were diagnosed as AS after SIJ pathological examination. The mean disease duration of these 45 cases was significantly shorter than that in cases of >/= grade II CT sacroiliitis. CONCLUSIONS: Inflammatory changes of SIJ did exist in cases of the < grade II CT sacroiliitis. Sacroiliitis probably initiated with bone marrow inflammation, followed by pannus formation, subchondral bony plate destruction, and cartilage degeneration/erosion, eventually leading to fibrosis, ossification and joint fusion. Synovitis and enthesitis were not the very early changes of sacroiliitis. Pathological examination was beneficial to the early diagnosis and differential diagnosis of ankylosing spondylitis.

Adolescent↗
PubMedDate not supplied

Efficacy of transarterial chemoembolization prior to liver transplantation for hepatocellular carcinoma as found in pathology.

BACKGROUND/AIMS: To analyze the efficacy of chemoembolization prior to liver transplantation in liver explants. METHODOLOGY: We reviewed pathological findings in the explanted livers of 21 patients with histologically proven hepatocellular carcinoma and liver cirrhosis who underwent transarterial chemoembolization (TACE) prior to liver transplantation. Nine patients had solitary nodules with a median diameter of 4 cm (range 1.5-7 cm), 7 patients had 2 or 3 tumors with a median total diameter of 5.9 cm (range 3-9 cm) and 5 patients had a multifocal tumor prior to TACE. Pathological up-staging of the clinical tumor classification was documented as "tumor-progression." Concurrence of clinical and pathological findings was documented as "steady disease". "Tumor regression" described those cases in which the pathological classification downgraded the clinical findings. RESULTS: There was no treatment-related morbidity in these patients' group. Tumor regression was proved in 11/21 patients (52.4%) whereas steady disease was observed in 7/21 patients (33.4%). In 5 patients (23.8%) no vital tumor was found by pathological examination. Tumor regression was observed only in one of the five patients having a multifocal tumor prior to TACE. Tumor progression was observed in 3/21 patients (14.3%). CONCLUSIONS: Our data show that TACE provides acceptable local tumor control as bridging treatment before liver transplantation. Although the majority of our patients (15/21, 71.4%) had 2 or more tumor lesions at the beginning of treatment, tumor progression was observed in only a minority (14.3%) of patients. However, multifocal tumors could not be successfully under-staged through this treatment and, furthermore, vital tumor was always observed in pathology; the usefulness of TACE in multifocal disease has to be re-estimated.

Carcinoma, Hepatocellular↗