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ABSTRACT: In view of divergent outcomes of surgery for rectal cancer despite standard protocols, the aim of this study was to provide a basis for improving lymph node assessment by defining the number, shape, and distribution of all lymphatic structures in the mesorectum.
Cadavers from 6 males and 6 females who died from causes other than colorectal or neoplastic pathologies were studied. Rectum and mesorectum were excised en bloc. The adipose tissue was separated from the rectum and divided into 9 sections before fixing the specimen in paraffin, cutting into smaller portions, and staining with hematoxylin and eosin. Slides were analyzed with an optical microscope, and identified lymph nodes were counted in each section.
The mean age of the deceased was 52.7 (range, 26-65) years. No evidence of previous history of neoplastic pathology or any type of premortal colorectal inflammatory process was found. A total of 412 lymph nodes were identified, with a mean of 34.3 (SD, 2.1; range, 31-37) lymph nodes per cadaver. The mean number of lymph nodes differed significantly across levels of the mesorectum, with 22.2 lymph nodes in the upper, 9.8 in the middle, and 2.3 in the lower sections; 266 (64.6%) of all lymph nodes were located in the upper third of the mesorectum. Distribution density was higher in the proximal posterior sections, with 197 lymph nodes (47.8%) in the upper 2 thirds of the posterior mesorectum. Node diameter was less than 5 mm in 330 (80%) of 412 nodes.
Our study confirmed that more than 30 lymph node units normally exist in the mesorectal area. In view of previous studies demonstrating advantages of increasing the number of lymph nodes evaluated, staging of rectal cancer might be improved by counting more than 12 lymph nodes per specimen.
Diseases of the Colon & Rectum 12/2010; 53(12):1640-4. · 3.13 Impact Factor
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ABSTRACT: The aim of this review is to underline the reasons why a post-mortem examination has to be performed in all cases of juvenile sudden death. Sudden death in children and young adults can be caused by potentially heritable cardiovascular disorders and fatal outcome is often the first symptom in apparently healthy subjects. In these cases, a careful autopsy, performed according to a standardized protocol, becomes the sole diagnostic tool to guide clinical and molecular genetic family screening and to adopt the proper therapeutic and preventive strategies. Thus, a post-mortem examination is a fundamental part of a multidisciplinary approach to the issue of juvenile sudden death.
Giornale italiano di cardiologia (2006) 05/2009; 10(4):209-15.
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ABSTRACT: A novel 4949-base pair mitochondrial DNA (mtDNA) deletion was detected in various tissues in a postmortem study of a patient with Kearns-Sayre syndrome (KSS). Deleted mtDNA levels were higher in skeletal muscle and brain and lower in kidney, working myocardium, and endocrine tissues (thyroid, parathyroids, pancreas, and adrenal glands). The distribution of the deletion in skeletal muscle and conducting myocardium was analyzed by means of laser capture microdissection (LCM). In skeletal muscle, the abundance of deleted mtDNA was slightly higher in cytochrome c oxidase (COX)-negative fibers (70%) than in COX-positive fibers (64%), whereas in the conducting myocardium it was lower in the atrioventricular node (9%) than in the sinus node and bundle of His (30% and 32%, respectively). In this study, LCM proved to be a reliable technique for a more accurate assessment of genotype/phenotype correlation when investigating mtDNA-related disorders.
Human Pathlogy 11/2003; 34(10):1058-61. · 2.88 Impact Factor
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ABSTRACT: An infant with normal facies and none of the extracardiac anomalies usually associated with Williams syndrome presented at birth with an echocardiographic pattern of supravalvular pulmonary stenosis and displastic pulmonary valve. A clinical reappraisal was planned at 3 months of age, but the girl died suddenly at home at 2 months of age. At autopsy, both ventricles were hypertrophic, and the valves showed mild dysplasia. The walls of the great arteries were thick, with a "washed leather" consistency, but there was no gross evidence of discrete stenosis. The histologic mosaic appearance of the media of the great arteries, due to elastosis and extreme disarray of the elastic lamellae, prompted a postmortem diagnosis of supravalvar aortic stenosis and suggested a diagnosis of Williams syndrome, which was subsequently confirmed by fluorescence in situ hybridization. Pediatricians and pathologists should be alerted that Williams syndrome in the newborn may present as an isolated supravalvular pulmonary stenosis, whereas supravalvular aortic stenosis becomes clinically significant only a few months later.
Archives of pathology & laboratory medicine 10/2003; 127(9):e367-70. · 2.58 Impact Factor
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International Journal of Cardiology 05/2003; 88(2-3):301-4. · 7.08 Impact Factor
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ABSTRACT: It has been demonstrated that clitoral and vaginal tissues express nitric oxide synthase isoforms in a way that parallels that of the penile corpus cavernosum. Considering the role of the vagina in the female sexual response and the anatomic connection between the clitoris and the anterosuperior vaginal wall, our aim was to study the distribution of type 5 phosphodiesterase (PDE5) in the anterosuperior wall of the human vagina.
Immunohistochemistry was performed on the vaginal tissue of 14 women obtained at autopsy and on exfoliated cells of the vaginal epithelium obtained from 5 healthy female donors. Specific antibodies against PDE5 were tested on both paraffin sections and cytologic smears. Immunoblotting experiments were performed in parallel with the same antibodies.
The histologic analysis of human cadaveric vaginal tissue revealed that PDE5 immunoreactivity was mostly localized in the smooth muscle of vessels, forming a pseudocavernous tissue in the vaginal wall and endothelium. The Skene periurethral glands and vaginal epithelium were also positive for the antibody. The latter finding was confirmed using exfoliated cells of the vaginal epithelium harvested in vivo.
The presence and tissue distribution of PDE5 in the human vagina suggest that the integrated system of nitric oxide synthase-PDE5 may play a physiologic role not only in the male sexual response but also in female sexual arousal.
Urology 08/2002; 60(1):191-5. · 2.43 Impact Factor
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ABSTRACT: A persistent left superior vena cava (PLSVC) is a relatively frequent systemic venous anomaly associated with congenital heart defects. This anomaly has been explained with the persistence of the left superior cardinal vein. PLSVC usually drains into the right atrium, via coronary sinus, but it joins the left atrium in approximately 8% of the cases either directly in the setting of atrial isomerism, or via an unroofed coronary sinus, or through a coronary sinus type atrial septal defect.
We describe a case of an adult patient with atria in the situs solitus, PLSVC draining into the left atrium, atresia of coronary sinus without atrial septal defect, and with additional cardiac anomalies (ventricular septal defect and discrete subaortic stenosis).
A possible embryological explanation to this case rises from a right partial isomerism of the superior cardinal veins, which gives reason for both the coexistence of the PLSVC draining into the left atrium and the absence of coronary sinus, atrial septal defect, or coronary sinus ostium.
Cardiovascular Pathology 11(3):149-52. · 2.07 Impact Factor
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ABSTRACT: Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital systemic angiodysplasia with multiple vascular malformations in the skin, gastrointestinal tract and, less often, in other internal organs and the brain.
A 36-year-old man with past history of BRBNS was admitted to our hospital for progressive dyspnea and fatigue. Primary pulmonary hypertension (PPH) was diagnosed. He then developed acute abdominal pain and dyspnea, dying in a few hours due to sudden cardiac arrest. Postmortem examination demonstrated angiomatous lesions located in the skin, small bowel, heart, lungs, liver and thyroid. The lesions were slightly raised, soft and compressible and microscopically consisted of dilated vascular channels lined by a flattened endothelium. The vascular wall was formed by several layers of smooth muscle cells, intermixed with abundant aggregates of elastic lamellae and thin collagen fibers. Luminal thrombi were a frequent finding. In the small bowel, we identified the presence of an abnormally large artery directly opening into a thin-walled venous channel. The most striking finding in the lungs was the presence of thrombi of varying age in the lumen of segmental and elastic arteries, as well as muscular arteries and arterioles. Severe medial hypertrophy of muscular arteries and muscolarization of arterioles were also present. Intimal proliferative lesions and plexiform lesions were never observed.
The pulmonary findings are consistent with recurrent thromboembolic events from shunts in the visceral lesions. To our knowledge, this is the first report of BRBNS with visceral arterovenous (AV) fistulae complicated by thromboembolic pulmonary hypertension (PH).
Cardiovascular Pathology 13(6):317-22. · 2.07 Impact Factor
