[Show abstract][Hide abstract] ABSTRACT: We present the clinicopathologic features of 3 cases of leiomyomatosis peritonealis disseminata (LPD). The patients were 33, 34, and 41 years old at the time of diagnoses. The 3 women had undergone laparoscopic removal of multiple uterine leiomyomas between 1 and 6 years before the diagnoses of LPD. Laparoscopic uterine leiomyomectomies were performed on 3 occasions in patient 1, and once in patients 2 and 3 by the time a diagnosis of LPD was made. In patients 2 and 3, one of the multiple uterine leiomyomas had been qualified as mitotically active. Patients 1 and 2 received hormonal treatment before LPD was diagnosed. Malignancy was clinically and/or pathologically suspected in all the 3 cases. Patients 1 and 2 were managed conservatively. Patient 3 underwent radical hysterectomy with bilateral adnexectomy and omentectomy. Patients 1 and 2 belong to a rare subset of LPD that have fewer tumor nodules larger (5 to 10 cm) than typically seen. Patient 3 was classic in that she exhibited innumerable nodules measuring between a few millimeters and 1.5 cm, intraoperatively mimicking peritoneal carcinomatosis. Histopathologically, patients 1 and 2 were diagnosed as pure LPD, whereas patient 3 was diagnosed as LPD associated with endometriosis (adenomyosis type). Patients 1 and 3 had incipient foci of leiomyomatous changes in the blood vessel walls, at the site of the LPD tumors, supporting the hypothesis that these are de novo lesions arising locally and not migrated or disseminated from the previously excised or concurrent uterine smooth muscle tumors, usually seen in this context. Conceivably, laparoscopic leiomyomectomy with morcellation may play a role in the pathogenesis of this rare condition, at least in hormonally susceptible patients. Alternatively, LPD may derive from metaplastic submesothelial cells, a condition analogous to gliomatosis peritonei.
[Show abstract][Hide abstract] ABSTRACT: We previously described the development of non-proteinuric diabetic nephropathy (NPDN) in the Cohen Diabetic rat (CDs), a model that simulates type 2 diabetes in humans. We currently applied the positional cloning strategy to investigate the mechanisms underlying NPDN. We crossbred between CDs and SBN/y, a non-diabetic healthy rat strain. We generated F1 and F2 progenies and fed them diabetogenic diet that elicits diabetes and NPDN in CDs but not in SBN/y. We determined metabolic and renal phenotypes. Over 5 months, 75% of F2 developed a gradually intensifying diabetic phenotype. In parallel, GFR declined in 25% of F2. Unexpectedly, 75% of F2 developed significant proteinuria. We scanned the F2 genome with microsatellite markers and used linkage analysis to identify QTLs. We detected diabetes-related QTLs on RNO4, confirming a previously identified QTL, and on RNO13, a novel QTL. We also detected two novel QTLs for the decline in GFR on RNO4 and RNO13, and another novel QTL for proteinuria on RNO13. The metabolic and renal-related QTLs overlapped. We conclude that the mechanisms underlying NPDN are related to genes that map to RNO4 and 13, suggesting a common genetic background for the development of diabetes and the renal disease. Our findings further suggest that proteinuria is inhibited in diabetic CDs, thus accounting for the non-proteinuric phenotype, but "unmasked" in diabetic F2, which genome has been modified. Identifying the nature of the factor inhibiting the expression of proteinuria in CDs may provide a clue to treatment and prevention of proteinuria in diabetes.
[Show abstract][Hide abstract] ABSTRACT: We present a case and review of the literature of well-differentiated sigmoid adenocarcinoma with numerous metastases into pericolic lymph nodes. All positive lymph nodes were small. The authors concluded that there is no clear correlation between nodal size and the likelihood of metastasis in the lymph node, and the status of small lymph nodes must receive special attention by clinicians and pathologists.
[Show abstract][Hide abstract] ABSTRACT: Purposes: We retrospectively assessed our experience with the W-shaped orthotopic ileal pouch, which was constructed with non-absorbable titanium staples. For these purpose, we discuss the results of bladder capacity, urinary continence and early and long-term postoperative complications. Materials and Methods: We included in the study 17 patients who underwent radical cystoprostatectomy followed by construction of an orthotopic W-shaped ileal pouch between October 2000 and November 2009. A 65-70 cm segment of ileum was isolated and prearranged into a W-configuration, leaving two 10 cm intact segments on both sides of the ileal fragment. In our technique we entirely anatomized all adjacent limbs in order to create a sphere-shaped pouch. The ureters were directly anastomized to both intact segments of the ileal division. All our patients underwent pouchscopy 6 months after operation and annually. Results: Mean operative time for neobladder reconstruction and ureteral anastomoses was 87 ± 7.67 minutes. In one patient a leak from the ileo-ileal anastomosis was confirmed on the 3rd day after operation. In 2 cases unilateral stricture of the ureteral-neobladder anastomosis was documented. Staple lines were mostly covered with ileal mucosa after 6 months. The mean functional bladder capacity was 340 ± 27.6 mL and 375 ± 43.4 mL at 6 and 12 months, respectively. First-year daytime and nighttime continence was good and acceptable in 90% and 78% of patients, while it increased to 95% during the 2nd year. Conclusions: The long term follow-up shows that non-absorbable titanium staples can be safely used for creation of an orthotopic ileal neobladder. However, these data should be further validated in a larger series of patients.
International braz j urol: official journal of the Brazilian Society of Urology 04/2013; 39(2):167-172. DOI:10.1590/S1677-5538.IBJU.2013.02.03 · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lymphangioleiomyomatosis (LAM) is a systemic, progressive, and fatal condition affecting almost exclusively women in their reproductive years. LAM most often occurs as a sporadic disease, but also occurs in women with tuberous sclerosis complex (TSC) (syndromic LAM). There are no pathologic differences between sporadic and syndromic LAM. Sporadic LAM is a rare disease with prevalence of approximately 1 to 2 cases per million women in the United States and among populations of white descent, and is even rarer among Asian and African individuals. Syndromic LAM affects 4% to 5% of women with TSC. Sporadic LAM is often found also in association with renal angiomyolipoma, the most common sign of TSC, but LAM associated with angiomyolipoma does not define TSC. Although LAM is not diagnostic for TSC either in isolation or in association with angiomyolipoma, still it is considered by some researchers as an incomplete expression (forme fruste) of TSC. LAM may involve the lungs and the axial lymphatics and lymph nodes of the thorax and retroperitoneum. In sporadic LAM, thoracic, intraabdominal, and cervical lymph nodes can be involved with or without lung involvement. The diagnosis of LAM is often delayed. A case of LAM in a young lady, which was complicated with pleural and peritoneal chylous effusions, is presented. The diagnosis was first made on a retroperitoneal lymph node biopsy. The patient had a prolonged prior history of respiratory problems owing to lung involvement, and eventually died 2 years after diagnosis. Focus on the clinicopathologic diagnosis of TSC is also made.
[Show abstract][Hide abstract] ABSTRACT: We present a case with sudden onset of throat pain, dysphagia and hoarseness. On endoscopic examination, supraglottic swelling and a brown covering of the mucous membranes were seen. The diagnosis of haemochromatosis was made on laryngeal biopsy. The patient admitted to long-term iron treatment for anaemia. Haemochromatosis can affect many different organs. If the larynx is involved, the airway may be endangered.
The Netherlands Journal of Medicine 06/2009; 67(6):234-6. · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we tried to design a scheme for performing transrectal ultrasonographic (TRUS)-biopsies that would be accurate and include the optimal number of cores.
We included in this study 600 consecutive patients with suspicious findings on a per-rectum examination and/or an elevated prostate-specific antigen (PSA) (>4 ng/mL) level. Patients were followed for 7 to 10 years. In all patients, we took from 8 to 16 biopsy samples, according to the prostate volume, from the lateral aspects. In the second session, the biopsy samples were taken medially; in the third session, we included the transitional zone, while in consecutive sessions, we increased the number of cores from all areas.
Only 573 of the patients remained in follow-up. TRUS-biopsy detected prostate cancer (PCa) in 257 patients (44.85% overall detection rate). The detection rate in the first and second sessions was 32.98% and 14.94%, respectively, reaching 13.2% and 2.17%, in the third and fourth sessions, respectively. Prostate volumes were significantly smaller (52.9 +/- 22.4 cc vs 58.9 +/- 23.8 cc, P < 0.002) and the PSA/adenoma/prostate volumes ratio (ad-pro) ratio was higher (18.3 +/- 9 vs 13.96, P < 0/001) in the patients with PCa. Patients with PCa underwent fewer biopsy procedures and biopsy sessions than patients without a diagnosis of PCa (14.9 +/- 8.9 vs 20.4 +/- 12, P < 0.001;1.3 +/- 0.6 vs 1.7 +/- 0.9, P < 0.001). Biopsy samples obtained from the base were positive for cancer only in larger prostates with a mean volume of 54.3 +/- 15.3 cc. Numbers of biopsy procedures and PSA/ad-pro ratio were the strongest predictive factors for PCa detection (P < 0.001).
In patients with a prostate volume >or=53 cc and PSA/ad-pro ratio >or=18, the optimal biopsy cores should be >or=15. Using this scheme, the discontinuation of biopsy procedures might be considered after three consecutive sessions.
Journal of endourology / Endourological Society 06/2009; 23(6):1007-13. DOI:10.1089/end.2008.0260 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The plasmacytoid variant of urothelial carcinoma is rare, of which less than 40 cases have been reported in the English language literature. Herein we report the largest series to date of 17 cases of urothelial carcinoma with plasmacytoid features and report the associated clinicopathologic findings. The architectural pattern of the tumor varied from cells arranged in cords and single cells (35%), small nests (17%), solid sheetlike growth (29%), and diffuse discohesive patternless architecture (23%). The plasmacytoid component varied from 15% to 100% of the specimen analyzed; in 12 cases the plasmacytoid component composed greater than 50% of the tumor. The individual tumor cells had striking morphologic overlap with plasma cells with an eccentrically placed nucleus and abundant amphophilic to eosinophilic cytoplasm. The nuclei were of low to intermediate nuclear grade with minimal nuclear pleomorphism. Thirteen of 17 cases (76%) were associated with conventional high-grade invasive urothelial carcinoma and 9 cases showed very focal intracytoplasmic vacuoles mimicking signet ring cells. One case also showed sarcomatoid dedifferentiation. The tumor cells were positive for cytokeratin 7 (94%) and cytokeratin 20 (31%); CD138 was positive in 94% of cases. All cases were invasive -- 7 into at least the lamina propria, 7 into at least the muscularis propria, and 3 into perivesical fat. Follow-up information was available in 16 cases (range: 2 wk to 43 mo; mean 10 mo; median 5.5 mo). Eleven patients died of disease and 5 patients were alive with disease. Plasmacytoid variant of urothelial carcinoma is an aggressive subtype associated with poor prognosis. In limited samples, it may be misdiagnosed as chronic cystitis or plasmacytoma, a pitfall further compounded by CD138 expression. Distinction from metastatic carcinoma from other primary sites such as stomach and breast is critical due to differing therapeutic implications.
The American journal of surgical pathology 12/2008; 33(3):417-24. DOI:10.1097/PAS.0b013e318186c45e · 4.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the interobserver reproducibility and prognostic value of the FIGO grading system with the histological parameters employed in the various recently proposed binary grading systems of endometrial cancer.
Seventy two consecutive stage I endometrioid endometrial carcinomas from hysterectomy specimens were independently graded by two pathologists. Clinical data and outcome were obtained from the patients' records. The following histological parameters were evaluated: FIGO grade (dichotomized to grades 1 and 2 vs. grade 3), nuclear atypia, presence of more than 50% solid growth, diffusely infiltrative rather than expansive growth pattern, presence of tumor cell necrosis, and mitotic count. Interobserver agreement was measured by the kappa (k) statistics. Kaplan-Meier survival analysis, log-rank tests and Cox proportional hazard regression were used to evaluate the equality of survival distributions and to model the overall effects of the various predictor variables on survival.
The interobserver reproducibility was as follows: FIGO grade, k=0.65; nuclear atypia, k=0.63; solid growth, k=0.51; infiltrative growth pattern, k=0.38; tumor necrosis, k=0.52; and mitotic index, k=0.44. In the comparison of the Kaplan-Meier curves, the following parameters were associated with a significantly poorer survival: FIGO grade 3, p=0.02; presence of more than 50% solid growth, p=0.01; and a high mitotic index, p=0.01. The other binary histological parameters were not significantly predictive of survival.
The proposed novel binary grading parameters are not advantageous in terms of interobserver reproducibility and prognostic significance over dichotomization to FIGO grades 1 and 2 vs. grade 3. A simple binary grade based solely on presence of more than 50% solid growth has a comparable reproducibility and prognostic value.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 10/2008; 35(3):247-51. DOI:10.1016/j.ejso.2008.07.010 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although different diseases, tuberous sclerosis complex and autosomal dominant polycystic kidney disease have been seen in association, the molecular basis of this being the proximity of tuberous sclerosis complex 2 and polycystic kidney disease 1 genes on the same chromosome (16p13.3). Therefore, the classic autosomal dominant polycystic kidney disease renal phenotype may occur in the context of tuberous sclerosis complex disease as a result of large deletions involving both the polycystic kidney disease 1 and tuberous sclerosis complex 2 genes. This is known as the tuberous sclerosis complex 2/autosomal dominant polycystic kidney disease 1 contiguous gene syndrome. The criteria for this condition are fulfilled when renal lesions typical for classic autosomal dominant polycystic kidney disease phenotype are associated with tuberous sclerosis complex phenotype. We present a new case of the sporadic form of this genetic disorder. The diagnosis of tuberous sclerosis complex in this patient was established on the presence of major and minor features, and the diagnosis of ADPKD was based on the presence of numerous large roundish renal cysts lined by a nondescript tubular epithelium. Sporadic cases of autosomal dominant polycystic kidney disease and tuberous sclerosis complex do occur. Molecular analysis was not performed because the patient's parents refused permission.
International Journal of Surgical Pathology 08/2008; 16(4):375-85. DOI:10.1177/1066896908319578 · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Elevated PSA value in the presence of an indwelling catheter is still an enigma. The aims of this prospective study were: to investigate the reliability of elevated PSA levels in patients with normal DRE and indwelling catheter after AUR; to assess the impact of preoperative TRUS-biopsy in detecting prostate cancer in such circumstances; to estimate the crucial duration of follow-up period.
63 patients were included in the study. PSA was assessed 5 days after catheter insertion. All patients failed to void without catheter and have been scheduled for surgery. TRUS-biopsy was performed before operation. All patients underwent surgery at least two weeks after prostate biopsies. Postoperative follow-up visits continued for at least 7 years. Biopsies were taken when indicated by persistently elevated PSA or an abnormal DRE.
Mean PSA before catheter insertion differed significantly from PSA obtained on the 5(th) day after AUR (p = 0.001). Mean prostate volume calculated on TRUS was 80.5 +/- 28 ml. Mean duration of indwelling catheter placement was 37.8 +/- 7.97 days. Mean delay in operative treatment as a result of preoperative evaluation was 23.548 +/- 2.487 days. Carcinoma was detected in 13 patients, while clinically insignificant cancer was present in 31% (4 patients). It must be also emphasized that 38% of patients with carcinoma were >70 year-old. Preoperative TRUS-biopsy and postoperative pathologic exam diagnosed carcinoma in 5 patients (2 and 3 respectively). During 42 months of 7-year follow-up cancer was revealed in 8 patients. Mean PSA value in the follow-up period was significantly elevated in patients with carcinoma: 5.99 +/- 3.34 v/s 2.34 +/- 1.68 ng/ml (p = 0.007) and was the strongest predictor for cancer detection (p = 0.001).
The detection rate of clinically significant cancer on preoperative biopsies postoperative pathologic exam in patients with AUR and indwelling catheter is low. These patients could be safely operated on without any delay. However, in order to detect clinically important cancer in the peripheral zone a postoperative monitoring period of should be recommended: starting 6 months after operation and continuing subsequently for at least 4 years. Postoperative PSA level is the strongest predictor of cancer detection and could be usefully employed in these patients. AUR and in the patients with large prostate cause elevated PSA. Cancer detection rate on preoperative biopsies is low in these patients. Long postoperative monitoring period should be strongly recommended.
Journal of Endourology 11/2007; 21(10):1203-6. DOI:10.1089/end.2007.9907 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the suitability and safety of a novel suture-less hermetic docking head (HDH) device for aortic anastomosis, and to test it in vitro, on cadavers, and in animals.
Uncontrolled prospective studies.
HDH device with commercial vascular grafts.
Two experimental series were conducted in vitro to test the hermetic seal of the anastomosis and the fixation of the device. Another series was performed in 6 cadavers with atherosclerotic aortas. Two in vivo trials tested the HDH device when implanted in ten and five pigs, respectively, with follow-up of 22 weeks. Pathological, histological and radiographic studies of the aorta were performed.
The in vitro and cadaveric studies demonstrated the resilience of the device under physiological and extreme conditions (up to 1200mmHg pulsatile flow on the bench and up to 270mmHg in cadaveric studies). These studies also established the safety and ease of application of the device in both normal and atherosclerotic aortas. Insertion was easy and rapid. There was no indication of leakage, narrowing or stenosis at the anastomotic sites. The implants' position was maintained without distal or proximal migration. Reliable fixation was observed despite significant increase (up to 112%) in the weight of the animals. Histologically, normal tissue reaction of the lamina was observed.
The suture-less HDH device's behavior in vitro and in vivo suggests that this implant is useful for aortic anastomosis, and its use is faster and simpler than common suturing techniques.
European Journal of Vascular and Endovascular Surgery 08/2007; 34(1):79-86. DOI:10.1016/j.ejvs.2007.02.004 · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the metabolic and genetic basis of diabetes in the Cohen Diabetic rat, a model of diet-induced diabetes, as a means to identify the molecular mechanisms involved. By altering individual components in the diabetogenic diet, we established that the dietary susceptibility that leads to the development of diabetes in this model is directly related to the high casein and low copper content in chow. The development of diabetes is accompanied by depletion of the acini from the exocrine pancreas and replacement with fat cells, while the appearance of the islets of Langerhans remains intact. With reversion back from diabetogenic to regular diet, the diabetic phenotype disappears but the histological changes in the exocrine pancreas prevail. Using positional cloning, we detected a major quantitative trait locus (QTL) on rat chromosome 4 with a chromosomal span of 4.9 cM, and two additional loci on chromosomes 7 and X. A screen for genes within that QTL in the rat and in the syntenic regions in mouse and man revealed only 23 candidate genes. Notable among these genes is Ica1, which has been causally associated with diabetes and bovine casein. We conclude that the development of diabetes in our model is dependent upon high casein and low copper in diet, that it is accompanied by histomorphological changes in the exocrine but not endocrine pancreas, that it is reversible, and that it is associated with a major QTL on chromosome 4 in which we detected Ica1, a high priority candidate gene.
[Show abstract][Hide abstract] ABSTRACT: Appendiceal anomalies are extremely rare malformations. The authors present a type of appendiceal triplication not previously described in an adult patient with review of the literature. Microscopic examination of postappendectomy specimen revealed acute perforative appendicitis associated with formation of three separate appendiceal lumina.
[Show abstract][Hide abstract] ABSTRACT: Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. A 30-year-old woman presented with a 1-year history of a palpable, asymptomatic right breast mass without axillary lymphadenopathy and family history of breast carcinoma. Malignant phyllodes tumor was diagnosed. The authors present not previously described histological appearance of this tumor where an epithelial component was identical to that of a tubular adenoma of the breast, with the review of the literature. This is in addition to very rare liposarcomatous stromal differentiation in the malignant phyllodes tumor.
International journal of medical sciences 02/2006; 3(4):130-4. · 1.55 Impact Factor