Cristian Perna

Hybridization for human epidermal growth factor receptor 2 testing in gastric carcinoma: a comparison of fluorescence in-situ hybridization with a novel fully automated dual-colour silver in-situ hybridization method.

García‐García E, Gómez‐Martín C, Angulo B, Conde E, Suárez‐Gauthier A, Adrados M, Perna C, Rodríguez‐Peralto J L, Hidalgo M & López‐Ríos F 
(2011) Histopathology59, 8–17

Adaptive immune response during hepatitis C virus infection.

Hepatitis C virus (HCV) infection affects about 170 million people worldwide and it is a major cause of liver cirrhosis and hepatocellular carcinoma. HCV is a hepatotropic non-cytopathic virus able to persist in a great percentage of infected hosts due to its ability to escape from the immune control. Liver damage and disease progression during HCV infection are driven by both viral and host factors. Specifically, adaptive immune response carries out an essential task in controlling non-cytopathic viruses because of its ability to recognize infected cells and to destroy them by cytopathic mechanisms and to eliminate the virus by non-cytolytic machinery. HCV is able to impair this response by several means such as developing escape mutations in neutralizing antibodies and in T cell receptor viral epitope recognition sites and inducing HCV-specific cytotoxic T cell anergy and deletion. To impair HCV-specific T cell reactivity, HCV affects effector T cell regulation by modulating T helper and Treg response and by impairing the balance between positive and negative co-stimulatory molecules and between pro- and anti-apoptotic proteins. In this review, the role of adaptive immune response in controlling HCV infection and the HCV mechanisms to evade this response are reviewed.

Mast Cell Quantification in Normal Peritoneum and During Peritoneal Dialysis Treatment

CONTEXT Mast cells (MCs) have been implicated in fibrogenesis, angiogenesis, and immunity against bacteria. These 3 mechanisms participate in the peritoneal pathology secondary to peritoneal dialysis (PD) treatment. Despite their potential relevance to PD-related pathology, few studies have focused on MCs. OBJECTIVE To evaluate possible variations in the number of MCs during PD treatment. DESIGN A quantitative study of tissue MCs in normal and pathologic peritoneum. Parietal peritoneal biopsies were collected from 4 groups: (1) normal controls (n = 9), (2) uremic non-PD patients (n = 16), (3) uremic patients on PD (n = 26), and (4) non-renal patients with inguinal hernia (n = 20). MCs were evaluated using immunohistochemistry for the detection of tryptase. The total number of cross sections of vessels per peritoneal field was examined in 22 of the 26 peritoneal biopsies of PD patients. RESULTS PD tissue samples showed fibrosis, mesothelial cell loss, and variable hyalinizing vasculopathy. The number of MCs was similar in normal controls and non-PD uremic patients (mean +/- SE: 7.13 +/- 0.67 and 7.74 +/- 0.74 MCs/mm2, respectively). Peritoneal dialysis patients showed a reduction (4 +/- 0.38 MCs/mm2, P < .001), whereas hernia sac samples showed an increase (10.59 +/- 3.48 MCs/mm2). MC reduction showed no correlation with time on dialysis, fibrosis, number of vessels, or previous episodes of peritonitis. CONCLUSIONS The peritoneum of patients receiving PD treatment shows a reduction of MCs. Despite such a reduction, fibrosis takes place, suggesting that MCs do not play a critical role in fibrosis genesis. Mast cell loss may be a contributory factor to peritonitis episodes in PD patients.

Tissue distribution of hyalinazing vasculopathy lesions in peritoneal dialysis patients ☆: An autopsy study

Uremia is considered capable of inducing structural anomalies of the peritoneum, including hyalinizing vasculopathy (HV). To further elucidate the contribution of uremia to the severity of HV, we performed an autopsy study of peritoneal dialysis (PD) patients with severe peritoneal HV lesions. Uremia is a systemic condition and, if capable of inducing HV, it will be expected to be detected outside the peritoneum. Seven autopsy cases of PD patients showing prominent peritoneal HV lesions were selected. Histological slides from the peritoneum, abdominal organs, heart and pericardium, lungs, visceral pleura, and central nervous system were reviewed. Peritoneal lesions were intense in all patients with prominent HV, fibrosis, and a variable presence of inflammation, fibrin, and calcification. Except for focal HV lesions in the intestinal submucosa of one diabetic patient, HV lesions were limited to the peritoneal membrane. None of the other extraperitoneal tissues showed such lesions. In conclusion, extraperitoneal vessels of PD patients show no relevant HV lesions when compared to peritoneal ones. This observation suggests that PD-related factors are the main contributors to the severity of vasculopathy. Uremia may participate in the development of the lesion but it does not seem to be responsible for its severity.

Fine Needle Aspiration Cytology of Solid Papillary Carcinoma of the Breast

BACKGROUND: Solid papillary carcinoma of the breast (SPCB) is a distinctive form of papillary carcinoma that tends to occur in older women and usually has a favorable prognosis. CASES: We report the cytologic and histologic findings in four cases of SPCB. All but one of the patients were elderly women (mean age, 66 years). Three patients presented with breast masses, and one patient presented with a breast mass and nipple discharge. Cytology demonstrated moderately to highly cellular smears with irregular groups of predominantly monolayered epithelium composed of small, polygonal or cuboidal cells with eosinophilic cytoplasm and rounded, eccentrically placed nuclei. Papillalike clusters with thin, fibrovascular cores were also observed. Immunocytochemical expression of synaptophysin was present in two cases. The diagnosis of SPBC was subsequently confirmed histologically and immunohistochemically. CONCLUSION: The FNA of SPCB displays some features that may be helpful in its correct identification preoperatively.

Small bowel perforation due to cholesterol atheromatous embolism.

Cholesterol atheromatous embolism (CAE) is a multisystem disorder resulting from release of cholesterol crystals from atherosclerotic plaques (1). The gastrointestinal tract is said to be involved in 20% of cases of systemic atheroembolism. Perforation is uncommon and only three cases of bowel perforation have been reported, two involving the large bowel and one the small bowel (3-5). We report a patient with severe atherosclerotic cardiovascular disease who presented widespread CAE following aortic surgery, resulting in progressive renal failure. In addition, atheroembolism to the small bowel resulted in two clinical episodes of jejunal perforation.

Subungual Malignant Melanoma of the Hand: Unusual Clinical Presentation: Case report

A 75-year-old woman presented with a four month history of a slowly growing tumour on the distal portion of the third finger of her left hand. The lesion suggested clinically an inflammatory process or an epidermoid carcinoma. The finger was amputated through the proximal interphalangeal joint. Microscopic examination showed an acral-lentiginous melanoma, subungual type (Clark level V). No elective lymph node dissection was done, and no prophylactic chemotherapy was given. The patient remains free of disease eight months after operation. Clinicians should be aware of this rare lesion, which may mimic other benign or malignant conditions.

Fine-Needle Aspiration Cytology of Mammary Myofibroblastoma: A Report of Six Cases

Objective: To evaluate cytologic features of mammary myofibroblastoma in order to establish the possibility of precise preoperative recognition. Study Design: This was a multi-institutional study of 6 patients with myofibroblastoma (5 men and 1 woman) in which preoperatively fine-needle aspiration cytology was performed. Four cases showed classical histologic features, 1 corresponded to the cellular variant and the remaining 1 to the fibrous form. Results: Except for 1 case, smears were cellular and distributed as irregular aggregates and single cells. Most groups showed a small amount of metachromatic stroma and capillaries. Cells retained cytoplasm and showed a spindle-to-plump oval morphology with moderate pleomorphism. Nuclear pleomorphism was present and was relevant in 1 case. Intranuclear pseudoinclusions and mast cells were present in 3 cases. No epithelial clusters were seen. Due to hypercellularity and pleomorphism 1 case was considered as suspicious for malignancy. The remaining 5 were diagnosed as low-grade mesenchymal lesions, and myofibroblastoma was suggested in 3. Conclusion: Cytologic features of myofibroblastoma reflect what is seen on histology. When such findings are correlated with image studies, preoperative recognition can be possible. This is especially true for male patients in whom the tumor is relatively frequent.

Massive Thyroid Tumoral Embolism From a Breast Carcinoma Presenting as Acute Thyroiditis

We describe an unusual case of metastatic disease to the thyroid, characterized by massive intra-arterial embolization and clinical presentation as acute thyroiditis. The patient, a 37-year-old woman with a history of breast carcinoma, presented clinically with acute thyroiditis. No nodules were palpable, and fine-needle aspiration cytology of the left lobe was performed. It showed a pleomorphic carcinoma and was followed by total thyroidectomy. Histology disclosed a pleomorphic carcinoma diffusely affecting the thyroid gland. It was characterized by an extensive intra-arterial tumoral embolization. Immunohistochemistry confirmed the metastatic nature of the neoplasm. This is a very uncommon form of metastatic disease to the thyroid. The ischemia and necrosis associated with the embolic process were most probably responsible for this clinical presentation. This atypical clinical and cytologic presentation may induce confusion with a primary neoplasm, mainly anaplastic thyroid carcinoma.

Mejoría clínica y anatomopatológica de la psoriasis en pacientes con artrosis tratados con condroitín sulfato: descripción de 3 casos

Fundamento y objetivo Con la prescripcion de condroitin sulfato como tratamiento sintomatico de la artrosis de rodilla, se observo que algunos pacientes con psoriasis concomitante mejoraban notablemente de las lesiones cutaneas. Describimos los resultados clinicos y anatomopatologicos correspondientes a las placas eritematodescamativas e hiperqueratosicas de 3 pacientes con gonartrosis y psoriasis tratados con condroitin sulfato. Pacientes y metodo Tres pacientes adultos con gonartrosis bilateral y psoriasis de larga evolucion,caracterizada por grandes placas eritematosas, descamativas e hiperqueratosicas y rebeldes a diversos tratamientos, recibieron 800 mg/dia de condroitin sulfato durante 2 meses. Seobtuvieron biopsias cutaneas antes y despues del tratamiento. Resultados En los 3 pacientes se observaron, coincidiendo con una notable mejoria clinica,una disminucion del espesor de la epidermis (espesor total, espesor desde la capa basal hasta el inicio de la cornea y espesor de la capa cornea), una disminucion del numero de queratinocitos en fase de proliferacion, una disminucion del grado de actividad de la psoriasis y la sustitucion de extensas areas de paraqueratosis por una queratinizacion ortoqueratosica. Conclusiones La administracion de condroitin sulfato consiguio una notable mejoria clinica e histologica de las lesiones psoriasicas. La confirmacion de estos resultados preliminares en futuros ensayos clinicos podria suponer un importante avance en el arsenal terapeutico para los pacientes con psoriasis, dado el excelente perfil de seguridad de este farmaco.