Kim Suvarna

Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology

With the advent of molecular subclassification of diseases, much consideration should be given to the proper processing of cardiovascular surgical pathology specimens to maximize patient care. Such specimens include endomyocardial biopsies, cardiac myectomy specimens, cardiac apical core segments, resected cardiac valves, pericardial biopsies, resected segments of aorta, cardiac tumors, vascular stents, vascular grafts, cardiac devices, resected veins, arterial biopsies including temporal artery biopsies and hearts removed during cardiac transplantation. In this report, the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology present consensus guidelines for the gross description, sectioning, processing, and staining of these specimens. This report is presented to aid pathologists, pathology assistants, and clinicians in maximizing the diagnostic utility of cardiovascular surgical pathology specimens for enhanced patient care.

Desensitization of β2-adrenoceptor-mediated responses by short-acting β2-adrenoceptor agonists in human lung mast cells

The principal aim of the present study was to determine whether long‐term treatment of human lung mast cells (HLMC) with the clinically‐relevant β2‐adrenoceptor agonists, salbutamol and terbutaline, leads to desensitization of β2‐adrenoceptor‐mediated responses in these cells. The non‐selective β‐adrenoceptor agonist, isoprenaline, and the selective β2‐adrenoceptor agonists, salbutamol and terbutaline, inhibited the IgE‐mediated release of histamine from HLMC. Salbutamol (pD2; 7.7±0.3) and terbutaline (pD2; 7.3±0.2) were roughly equipotent as inhibitors of histamine release although both agonists were less potent than isoprenaline (pD2; 8.6±0.2). Isoprenaline (10−5 M), salbutamol (10−5 M) and terbutaline (10−5 M) enhanced total cell cAMP levels in HLMC over basal by 361±90, 150±38 and 165±35%, respectively. Long‐term exposure (24 h) of HLMC to either salbutamol (10−7 M) or terbutaline (10−7 M) led to a subsequent reduction in the effectiveness of salbutamol and terbutaline (both 10−9–10−4 M) to inhibit histamine release. However, salbutamol was significantly (P<0.05) more effective than terbutaline at promoting the functional desensitization. Radioligand binding studies, using iodinated cyanopindolol, were performed to determine β2‐adrenoceptor density in cell membranes after pretreatment (24 h) of cells with either salbutamol (10−6 M) or terbutaline (10−6 M). Both agonists reduced β2‐adrenoceptor density in membranes to about the same extent (∼25% reduction) but these changes in receptor density were not statistically significant (P>0.05). These data indicate that long‐term exposure of mast cells to salbutamol causes greater levels of desensitization to β2‐adrenoceptor‐mediated responses in HLMC than terbutaline. These findings may have wider clinical significance in the context of asthma treatment as compromised mast cell inhibition could result following long‐term exposure of mast cells to short‐acting bronchodilators.

Fatal necrotizing fasciitis caused by Haemophilus influenzae serotype f.

We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated with broad-spectrum antibiotics, limb amputation and tissue debridement. The causative organism was identified by PCR as Haemophilus influenzae serotype f, which is a highly unusual cause of necrotizing fasciitis.

Atrial and placental melanoma metastasis: a case report and literature review.

Malignant melanoma can metastasize to virtually any organ of the body. The aggressiveness is determined by the primary site, depth of dermal invasion, presence or absence of ulceration, lymphovascular infiltration and regional lymph node involvement. We report a case of a pregnant woman with a previous history of stage 3 melanoma who presented with cardiac metastasis and placental melanoma infiltration. A review of literature on cardiac and placental involvement of melanoma is also provided.

A case report of a rare adnexal tumour: aggressive digital papillary adenocarcinoma

We report the case of a 78-year-old Caucasian gentleman who presented with a painful swelling in the nail bed of the right middle finger. Following amputation of the right middle phalanx histopathology confirmed aggressive digital papillary adenocarcinoma (ADPA). Further surgical treatment was offered but declined. Approximately 17 months later, the patient was found to have pulmonary metastasis. ADPA is a rare neoplasm of the eccrine sweat glands, which commonly presents as a slow-growing mass between the nail bed and distal interphalangeal joint. The disease is classically aggressive with a 14% chance of metastatic spread. The chance of recurrence is 50% with no or sub-optimal treatment, which reduces to 5% following removal with adequate resection margins. This case shows a prolonged period of disease-free survival, but highlights the need for thorough and aggressive management in cases of ADPA as well as frequent and long-term follow-up.