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Low-grade
Terms modified by Low-grade Selected AbstractsCONCURRENT GASTRIC AND COLONIC LOW-GRADE MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMATA IN A PATIENT WITHOUT HELICOBACTER PYLORI INFECTIONDIGESTIVE ENDOSCOPY, Issue 1 2003HIROYUKI OKADA Mucosa-associated lymphoid tissue (MALT) lymphomata observed simultaneously in the stomach and colon are rare. We report concurrent gastric and colonic low-grade MALT lymphomata that originated from the same clone in a 58-year-old Japanese man without Helicobacter pylori infection. Endoscopy showed multiple erosive lesions in the gastric body and antrum, and a single flat elevation with an irregular margin in the sigmoid colon. Histopathological findings of both lesions suggested low-grade MALT lymphoma. Lymphoepithelial lesions were evident in the gastric lesions, but not in the colonic lesion. Southern blot analysis of lymphoma cells revealed the same immunoglobulin heavy-chain rearrangement pattern. The chromosomal translocation t(11;18)(q21;q21) was also observed. After six courses of cyclophosphamide, doxorubicin, vincristine and predonisolone, the gastric lesions disappeared endoscopically, while the colonic lesion persisted. A sigmoidectomy was consequently performed. The chromosomal translocation may be related to the pathogenesis of the present MALT lymphoma case without H. pylori infection. It is interesting that the gastric and colonic lesions differed in response to treatment and in their endoscopic and histologic features, despite having the same origin. [source] The significance of endocervical cells and metaplastic squamous cells in liquid-based cervical cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2009Kai M. Leung M.B.B.S. Abstract We conducted a retrospective study to investigate whether the presence or absence of endocervical cells (EC) and metaplastic squamous cells (MSC) was associated with the detection of squamous intraepithelial lesions in liquid-based cervical cytology. 90,376 cases of liquid-based cervical cytology smears received in 2006 were included in the study. Low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) were classified according to the Bethesda system (2001). The rates of detecting LSIL and HSIL in smears with and without EC and/or MSC were determined. There were 1,540 LSIL and 396 HSIL. The ratio of HSIL/NILM (no intraepithelial lesion or malignancy) was 0.0022 in smears without EC or MSC, 0.0040 in smears with EC only, 0.0044 in smears with MSC only, and 0.0056 in smears with both EC and MSC present. Compared with smears without EC or MSC, this ratio was significantly higher (P < 0.05) when either EC or MSC was present. Compared with smears with EC only, the ratio was also significantly higher when both EC and MSC were present (P < 0.05). On the other hand, the presence or absence of EC had no effect on the detection rate of LSIL (0.0191 for both groups), while the presence of MSC was actually associated with lower detection rate of LSIL (0.0153, P < 0.05). The presence of endocervical and metaplastic cells was associated with higher detection rates of HSIL. MSC was associated with lower detection or LSIL. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Terminology of the BSCC, European Community and the Bethesda system: the boundary between low-grade and high-grade cytologyCYTOPATHOLOGY, Issue 1 2009A. Herbert No abstract is available for this article. [source] P-25 DOES THE PRESENCE OF KOILOCYTES IN A BNA SMEAR AFFECT CLINICAL OUTCOMES?CYTOPATHOLOGY, Issue 2006L. Alexander Introduction:, There is ongoing debate about the terminology used in the classification of dyskaryosis, including whether BNA smears should be classified according to whether koilocytes are present or not. We explored the effect of koilocytosis in the management experiences and clinical outcomes of women with a single BNA smear. Methods:, This study includes 410 women aged 20,59 years, resident in Tayside who had an ,baseline' BNA smear between 31/10/1999 and 31/10/2002 who were eligible for the TOMBOLA trial but who did not participate. Recommended follow-up for these women was a repeat smear in six months. Up to three-years follow-up data was collected on subsequent cytological smears, colposcopy examinations and any related histology. The baseline smear was re-read for the presence or absence of koilocytes. Women were classified according to their clinical outcomes during their three years. Results:, 47% (192/410) of women were classified as having koilocytosis at baseline. The mean age was lower among these women (25 years) compared to those without koilocytosis (35 years). 55% (105/192) of women with koilocytosis at baseline had one or more negative smears and no further abnormal smears, compared to 63% (137/218) of those without koilocytosis, the difference was not statistically significant. 28% (53/192) of women with koilocytosis at baseline were referred to colposcopy after subsequent low-grade or high-grade smears compared to 19% (42/218) of those without koilocytosis; the difference was statistically significant. 14% (27/192) of women with koilocytosis at baseline were diagnosed with CIN2/3 or worse during follow-up compared to 10% (21/218) of women without koilocytosis; the difference was not statistically significant. Discussion:, Our results suggest that the presence or absence of koilocytosis has little impact on the clinical outcomes of women with a BNA smear. [source] Borderline nuclear change; can a subgroup be identified which is suspicious of high-grade cervical intraepithelial neoplasia, i.e. CIN 2 or worse?CYTOPATHOLOGY, Issue 5 2002J. M. Edwards Borderline nuclear change; can a subgroup be identified which is suspicious of high-grade cervical intraepithelial neoplasia, i.e. CIN 2 or worse? Only 10% of first borderline smears are associated with a histological high-grade (HG) abnormality, i.e. CIN 2,3, invasive malignancy or glandular neoplasia on subsequent investigation. The advantages of highlighting this subgroup are obvious but is this possible? From 1996 and 1997, 242 borderline smears with histological follow-up were examined by two independent experienced observers (observer 1 and 2) without prior knowledge of further investigation results. For each smear a profile of nuclear details was produced, also noting the type of cell mainly affected by the process; then the observers were asked to assess the degree of worry of HG disease for each smear i.e. whether the smear fell into group 1 borderline changes indicative of low-grade (normal, inflammatory, CIN1/HPV) disease (BL/LG) or group 2 difficult borderline smear, HG disease (CIN 2,3, invasive neoplasia or glandular neoplasia) cannot be excluded (BL/HG). Observer 1 selected a group of BL/HG with a PPV for HG disease of 38%, with observer 2 having a PPV of 50%; this compared with the overall laboratory HG disease PPV for borderline smears of 14%. Both observers found the most useful criterion to be the increase in nuclear:cytoplasmic ratio. Our results show that it is possible to separate a small group of borderline smears which should be classified as ,borderline/high grade lesion difficult to exclude' (BL/HG). Both observers had some success in arriving at this classification although their method of selecting out this group was quite different. [source] ,-Methylacyl-CoA racemase (AMACR) in fine-needle aspiration specimens of prostate lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 11 2009Gordana Kai, M.D. Abstract The elevated expression of P504S gene and its product ,-methylacyl-CoA racemase (AMACR) can serve as a molecular marker for prostate cancer. The goal of this study is to investigate P504S/AMACR expression in fine-needle aspiration smears and correlate it with cytological diagnosis. Immunocytochemistry was performed in 35 patients with morphological diagnosis of prostate carcinoma (n = 16), atypia (n = 15), and benign hyperplasia (n = 4). Among 16 malignant cases there were two low-grade, eight intermediate, and six high-grade prostate carcinomas. Cytoplasmic positivity is analyzed qualitatively as predominantly diffuse or focal and quantitatively as <5%, 5,50%, and >50% of cells. Benign cases showed no P504S/AMACR expression. Positive staining was recorded in 75% of malignant cases, but in the majority of them it was weak and focal or diffuse and in a small amount of cells. The most intensive staining was seen in low-grade carcinomas and some atypical cases. This observation indicates a correlation between P504S/AMACR expression and differentiation of cells. P504S/AMACR staining might be of great value in cytodiagnosis of prostate lesions as well as an example of the characterization of cells at the molecular level using fresh tissue obtained by fine-needle aspiration. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Comparison of p16INK4A and Hybrid Capture® 2 human papillomavirus testing as adjunctive tests in liquid-based gynecologic SurePathÔ preparationsDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2008Aziza Nassar M.D., F.I.A.C. Abstract p16INK4a, cyclin-dependent kinase inhibitor, is functionally inactivated in many tumors, including cervical cancer. We compared p16INK4A immunocytochemical staining and Hybrid Capture® 2 (HCII) on SurePathÔ specimens using tissue biopsies (as the gold standard). Their utility in a spectrum of atypical and preneoplastic lesions, and their ability to accurately identify underlying lesions of CIN II or greater was assessed using biopsy follow-up data. One-hundred and seventeen residual SurePathÔ samples were collected: 43 atypical squamous cells of undetermined significance (ASCUS), 47 low-grade (LGSIL), and 27 high-grade (HGSIL) squamous intraepithelial lesions. Two slides were prepared from each sample; one stained with the SurePathÔ autocyte stain and one immunostained using the CINtecÔ p16INK4a Cytology Kit (Dakocytomation). High-risk HPV testing was performed using the HCII DNA test (Digene, Gaithersburg, MD). Available tissue biopsy follow-up data was retrieved. p16INK4a was positive in 32.6% (14/43) ASCUS, 46.8% (22/47) LGSIL, and 48.1% (13/27) HGSIL specimens. HCII DNA test was positive in 41.9% (18/43) ASCUS, 78.7% (37/47) LGSIL, and 96.3% (26/27) HGSIL samples. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of p16INK4a and HCII were: 58.7% and 89.8%, 58.6% and 34.6%, 69.2% and 72.1%, 47.2% and 64.3%, respectively. In patients with cervical biopsies, the PPV of HCII (92.3%) results for a biopsy with CINII/III was significantly higher than the PPV of p16INK4a (52%) (P = 0.001). Using liquid-based cytology specimens, HCII is a more sensitive test than p16INK4a for detection of abnormal cytology. HCII has a higher PPV than p16INK4a for identifying CIN II/III. Diagn. Cytopathol. 2008;36:142,148. © 2008 Wiley-Liss, Inc. [source] Cytology of pancreatic acinar cell carcinomaDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2006Edward B. Stelow M.D. Abstract Acinar cell carcinoma (ACC) of the pancreas is extremely uncommon and its cytologic features have rarely been described. We describe the cytologic features of cases we have seen, review the literature regarding its cytologic features and discuss the pitfalls that may be encountered and the use of immunohistochemistry for its diagnosis. We searched our databases for all cases of histologically confirmed pancreatic ACC which had undergone prior fine needle aspiration (FNA) of the primary pancreatic lesion. The clinical histories, radiographic and sonographic findings, cytologic features, original cytologic diagnoses, and final histologic diagnoses were reviewed. Four cases of pancreatic ACC were found that had undergone FNA prior to histologic confirmation of the diagnoses. They were from 2 men and 2 women aged 50,75 yr. All masses were in the head of the pancreas, 2 had apparent peri-pancreatic adenopathy and 1 had an apparent liver metastasis. On review, all 4 had had diagnostic material on cytology samples. Original cytologic diagnoses included "acinar cell carcinoma," "pancreatic endocrine tumor," "favor neuroendocrine tumor, low-grade" and "non-diagnostic specimen." The cytologic features included small to moderate-sized loose groups with numerous single cells, prominent acinar formation, little anisonucleosis and prominent nucleoli. The cytologic features showed significant overlap with those of pancreatic endocrine tumors. Diagn. Cytopathol. 2006; 34:367,372. © 2006 Wiley-Liss, Inc. [source] Tumor budding as a useful prognostic marker in esophageal squamous cell carcinomaDISEASES OF THE ESOPHAGUS, Issue 4 2004M. S. Roh SUMMARY, We examined the prognostic significance of tumor budding in patients with esophageal squamous cell carcinoma, particularly in comparison to other routine pathological findings. Fifty-six cases who underwent an esophagectomy were reviewed. We defined tumor budding as an isolated single cancer cell or a cluster composed of fewer than five cancer cells and divided these into two grades; low-grade (< 5 budding foci) and high-grade (, 5 budding foci) within a microscopic field of ×200. There were 22 (39.3%) and 34 (60.7%) cases with low- and high-grade budding, respectively. There were significant differences in the patients with low- and high-grade budding in relation to tumor size, pT stage, lymphovascular invasion, perineural invasion, circumferential resection margin involvement, and AJCC stage (P < 0.05). The 3-year survival rates of the patients with low- and high-grade budding were 72.3% and 30.7%, respectively (P = 0.04). We propose that tumor budding may be a pathological marker suggesting high malignancy potential and decreased postoperative survival in patients with esophageal squamous cell carcinoma. [source] Ceramide levels are inversely associated with malignant progression of human glial tumorsGLIA, Issue 2 2002Laura Riboni Abstract Ceramide represents an important sphingoid mediator involved in the signaling pathways that control cell proliferation, differentiation, and death. To determine whether ceramide levels correlate with the malignant progression of human astrocytomas, we investigated these levels in surgical specimens of glial tumors of low-grade and high-grade malignancy. Tumor samples obtained from 52 patients who underwent therapeutic removal of primary brain tumors were used. The tumors were classified according to standard morphologic criteria and were grouped into tumors of low-grade and high-grade malignancy. Sections of normal brain tissue adjacent to the tumor were also analyzed in 11 of the 52 patients. After extraction and partial purification, ceramide was measured by quantitative derivatization to ceramide-1-phosphate using diacylglycerol kinase and [,- 32P]ATP. Ceramide levels were significantly lower in the combined high-grade tumors compared with low-grade tumors and in both tumor groups compared with peritumoral tissue. The results indicate an inverse correlation between the amount of ceramide and tumor malignancy as assessed by both the histological grading and ganglioside pattern. Moreover, overall survival analysis of 38 patients indicates that ceramide levels are significantly associated with patient survival. The present findings indicate that ceramide is inversely associated with malignant progression of human astrocytomas and poor prognosis. The downregulation of ceramide levels in human astrocytomas emerges as a novel alteration that may contribute to glial neoplastic transformation. The low ceramide levels in high-grade tumors may provide an advantage for their rapid growth and apoptotic resistant features. This study appears to support the rationale for the potential benefits of a ceramide-based chemotherapy. GLIA 39:105,113, 2002. © 2002 Wiley-Liss, Inc. [source] Biopsy Strategies for Endoscopic Surveillance of Pre-malignant Gastric LesionsHELICOBACTER, Issue 4 2010Annemarie C. De Vries Abstract Background:, Endoscopic surveillance of pre-malignant gastric lesions may add to gastric cancer prevention. However, the appropriate biopsy regimen for optimal detection of the most advanced lesions remains to be determined. Therefore, we evaluated the yield of endoscopic surveillance by standardized and targeted biopsy protocols. Materials and Methods:, In a prospective, multi-center study, patients with intestinal metaplasia (IM) or dysplasia (DYS) underwent a surveillance gastroscopy. Both targeted biopsies from macroscopic lesions and 12 non-targeted biopsies according to a standardized protocol (antrum, angulus, corpus, cardia) were obtained. Appropriate biopsy locations and the yield of targeted versus non-targeted biopsies were evaluated. Results:, In total, 112 patients with IM (n = 101), or low-grade (n = 5) and high-grade DYS (n = 6) were included. Diagnosis at surveillance endoscopy was atrophic gastritis (AG) in one, IM in 77, low-grade DYS in two, high-grade DYS in three, and gastric cancer in one patient. The angulus (40%), antrum (35%) and lesser curvature of the corpus (33%) showed the highest prevalence of pre-malignant conditions. Non-targeted biopsies from the lesser curvature had a significantly higher yield as compared to the greater curvature of the corpus in diagnosing AG and IM (p = .05 and p = .03). Patients with extensive intragastric IM, which was also present at the cardia were at high risk of a concurrent diagnosis of dysplasia or gastric cancer. High-grade DYS was detected in targeted biopsies only. Conclusions:, At surveillance endoscopies, both targeted and non-targeted biopsies are required for an appropriate diagnosis of (pre-)malignant gastric lesions. Non-targeted biopsies should be obtained in particular from the antrum, angulus and lesser curvature of the corpus. [source] The diagnosis of dysplasia and malignancy in Barrett's oesophagusHISTOPATHOLOGY, Issue 2 2000REVIEW Barrett's metaplasia is associated with an increased risk for adenocarcinoma. Adenocarcinoma develops through a multistep process characterized by defects in genes and morphological abnormalities. The early morphological changes of the process are called ,dysplasia'. Dysplasia is defined as an unequivocal neoplastic (premalignant) transformation confined within the basement membrane. For most Western pathologists malignancy is defined as invasion and characterized by a breach through the basement membrane. Japanese pathologists rely on cytological atypia and complex branching of crypts. Cytological and architectural abnormalities allow identification of dysplasia on routinely stained sections. A distinction is made between low- and high-grade dysplasia. The differential diagnosis between low-grade dysplasia and reactive changes can be difficult. Therefore a second opinion is strongly recommended, not only for high-grade dysplasia but also for low-grade. Immunohistochemistry for p53 and flow cytometry for detection of aneuploidy can support the diagnosis. Identification of dysplasia and malignancy depends on the number of biopsy samples examined. The minimum number of biopsies required has not yet been determined and depends partly on the length of the metaplastic segment. It has been proposed to sample with four quadrant biopsies at 20-mm intervals. New endoscopic techniques can increase the diagnostic yield. Endoscopically visible lesions increase the risk of finding malignancy. The time sequence for the progression of dysplasia is not known but progression from low- to high-grade and cancer has been shown to occur over a period of years although it may not be inevitable. [source] Prostate cancer and PSA among statin users in the Finnish prostate cancer screening trialINTERNATIONAL JOURNAL OF CANCER, Issue 7 2010Teemu J. Murtola Abstract Decreased risk of advanced prostate cancer has been reported among men using statins. However, the evidence on overall prostate cancer risk is conflicting. We compared the relative risk between current users and non-users of statins or other cholesterol-lowering medications in a population undergoing systematical prostate cancer screening. The study cohort comprised of 23,320 men participating in the screening arm of the Finnish prostate cancer screening trial during 1996,2004. Information on medication use was obtained from a comprehensive national prescription database. Cox proportional hazards regression was used to calculate multivariable adjusted hazard ratios (HRs) for prostate cancer. Serum prostate-specific antigen (PSA) level was compared between current users and non-users of cholesterol-lowering drugs. Compared with medication non-users, the overall prostate cancer incidence was decreased among statin users [HR 0.75, 95% confidence interval (CI) 0.63,0.89]. The inverse association was dose-dependent with cumulative amount of statin use, and strongest for low-grade and early stage tumors. The incidence was nonsignificantly lower also among users of other types of cholesterol-lowering drugs (HR 0.62, 95% CI 0.28,1.38), but without dose-dependence. Age-adjusted median serum PSA tended to be lower among users of cholesterol-lowering drugs, but the relative risk decrease among statin users was not related to decreased PSA. Overall incidence of prostate cancer was lowered among statin users when bias due to differential PSA testing between medication users and non-users was eliminated by systematical prostate cancer screening. Cholesterol-lowering with statins seems beneficial for prostate cancer prevention. [source] Role of ureteroscopic biopsy in the management of upper urinary tract malignancyINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2003KOJI SHIRAISHI Abstract Background:, The aim of the study presented here was to examine the accuracy of ureteroscopic biopsy in the diagnosis of upper urinary tract transitional cell carcinoma (TCC) and whether nephron-sparing management (holmium YAG laser, transurethral resection or partial ureterectomy) is possible or not based on pathological diagnosis. Methods:, Forty consecutive patients underwent ureteroscopic biopsy with the use of 3-Fr cold cup forceps. Pathological diagnosis of the biopsy sample and grade or stage of surgically resected tumors were compared. In patients with grade 1 or 2 TCC diagnosed by ureteroscopic biopsy, the disease-free and survival rates determined whether nephron-sparing management was performed or not. Results:, There were no major complications associated with ureteroscopic biopsy. The pathological grading of the biopsy specimen was almost the same as that of the surgically resected specimen. Eighty five percent of grade 2 or 3 TCC showed muscle invasive disease. There were no significant differences in the disease-free and survival rates between the nephroureterectomy and the nephron-sparing management groups, except for grade 3 or pT3 tumors. Conclusion:, Ureteroscopic biopsy is safe and accurate if sufficient tissue sample is obtained. Ureteroscopic biopsy should be performed in patients who require nephron-sparing management. Nephroureterectomy can be avoided if the tumor is confirmed as low-grade. [source] Parentage of low-grade metasediments in the Sanbagawa belt, eastern Shikoku, Southwest Japan, and its geotectonic implicationsISLAND ARC, Issue 3 2010Kazuo KiminamiArticle first published online: 19 AUG 2010 Abstract This study examines the geology of low-grade (chlorite zone) metamorphic rocks in the Sanbagawa belt and of a Jurassic accretionary complex in the Northern Chichibu belt, eastern Shikoku, Japan. The bulk chemistries of metasandstones and metapelites in the Sanbagawa belt of eastern Shikoku are examined in order to determine their parentage. The Sanbagawa belt can be divided into northern and southern parts based on lithology and geologic structure. Geochemical data indicate that metasediments in the northern and southern parts are the metamorphic equivalents of the KS-II (Coniacian,Campanian) and KS-I (late Albian,early Coniacian) units of the Shimanto belt, respectively. The depositional ages of the parent sediments of low-grade metamorphic rocks found in the Sanbagawa belt and the Jurassic Northern Chichibu belt, indicate a north-younging polarity. In contrast, sedimentological evidence indicates younging to the south. These observations suggest that a tectonic event has resulted in a change from a northerly to southerly dip direction for schistosity and bedding in the Sanbagawa and Northern Chichibu belts of eastern Shikoku. The younging polarity observed in the Sanbagawa and Northern Chichibu belts, together with previously reported data on vitrinite reflectance and geological structure, indicate that the Northern Chichibu belt was part of the overburden formerly lying on top of the Sanbagawa low-grade metamorphic rocks. [source] Bioleaching of copper and other metals from low-grade oxidized mining ores by Aspergillus nigerJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 5 2003Catherine N Mulligan Abstract A study was initiated to determine the feasibility of using the fungus Aspergillus niger for bioleaching metals from oxide low-grade ore. Large quantities of the metals are embodied in the low-grade ores and mining residues that can be recovered. Presently available techniques (pyrometallurgical and hydrometallurgical) are expensive or may have a negative impact on the environment. An oxidized mining ore containing mainly copper (7245 mg kg,1 residue) was studied. In this study, the fungus A niger produced a variety of organic acids. Addition of small quantities of sulfuric acid enhanced the organic acids, efficiency. Various agricultural wastes were evaluated as substrates and a maximum solubilization of 68% for copper for a medium containing potato peels was achieved. In conclusion, leaching of copper from a mining ore is technically feasible using A niger. Further research must be performed to increase the rate of copper removal. Copyright © 2003 Society of Chemical Industry [source] Doppler sonography in the diagnosis of urinary tract obstruction by stoneJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2004Nevbahar Akçar MD Abstract Purpose This study was conducted to evaluate the accuracy of Doppler sonography in renal colic due to obstruction and to assess whether the resistance index (RI) and interrenal RI difference (,RI) are time-dependent parameters. Subjects and Methods Obstructed and unobstructed contralateral kidneys in 28 patients with renal colic and normal kidneys in 27 control subjects were prospectively evaluated with Doppler sonography. Mean RI, mean ,RI, and duration of pain were evaluated. Statistical analysis was done using paired and independent t-tests. Results Mean RIs of the control-group, obstructed, and contralateral kidneys were 0.60, 0.71, and 0.61, respectively; mean ,RI values of the obstructed and control-group kidneys were 0.10 and 0.03, respectively. Differences in mean RI between obstructed and contralateral or control-group kidneys were statistically significant (p < 0.001). There was a statistically significant difference in ,RI between patients and controls (p < 0.001). The difference between the RI values of kidneys with low-grade (0.70) and high-grade obstructions (0.72) was not statistically significant. The difference between the ,RI values of kidneys with low-grade (0.08) and high-grade obstructions (0.13) was statistically significant (p < 0.05). Differences in the mean RI and mean ,RI values between 3 groups of patients categorized according to the duration of pain were not statistically significant. Conclusions Along with gray-scale sonography and intravenous urography, Doppler sonography can be used in the evaluation of renal obstruction. RI and ,RI are not time-dependent parameters. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:286,293, 2004 [source] Outcome of self-expandable metallic stents in low-grade versus advanced hilar obstructionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2008Rungsun Rerknimitr Abstract Background:, Self-expandable metallic stents (SEMS) are known to provide a longer patency time than plastic stents for malignant biliary obstructions including hilar obstruction. However, studies that focus on the efficacy of SEMS in low-grade and advanced hilar obstructions are still scanty. Methods:, Ninety four patients with malignant hilar obstructions were enrolled (six were later excluded). Patients were divided into two groups according to their Bismuth levels. Group A were patients with Bismuth I (n = 53). Group B were patients with Bismuth II, III and IV (n = 35). Technical success, complications, jaundice resolution, stent patency time, and patients' survival were analyzed. Results:, Our intention-to-treat analysis showed that group A had a significant lower rate of post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis than group B; 16.1% versus 44.7%, (P < 0.01). Four patients from group B still had persistent jaundice. Our per protocol analysis demonstrated that median stent patency time in groups A and B were not statistically different (74 vs 60 days). Median survival time in groups A and B were also not statistically different (90 vs 75 days). In both groups, those without liver metastasis had significantly better patency and survival time than those with liver metastasis (P = 0.010 and 0.027, respectively). Conclusions:, In patients with hilar obstruction, liver metastasis is one of the main factors that determine survival of the patient. Patency times of SEMS in both low-grade and advanced obstructions are comparable. However, in the advanced group, there is a significant risk of post-ERCP cholangitis. [source] Blood oxygenation level-dependent MRI of cerebral gliomas during breath holdingJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2004Yuan-Yu Hsu MD Abstract Purpose To assess the cerebrovascular responses to short breath holding of cerebral gliomas using blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). Materials and Methods Six patients with a low-grade glioma and one patient with a high-grade glioma were studied using T2*-weighted echo planar imaging (EPI) during repeated periods of 15-second or 20-second breath-holding. Tumor vascularity was evaluated using dynamic susceptibility contrast perfusion MRI. Results Increases in BOLD signal intensity during repeated breath-holding were consistently identified in patients' normal appearing gray matter, comparable with those in healthy adults. Absence of significant BOLD signal enhancement was noted both in low-grade and high-grade gliomas, which is either due to overwhelming hypoxia in a tumor, inadequacy or absence of hypercapnia-induced vasodilatation of tumor vessels, or both. Breath-hold regulated decreases in BOLD signals occurred only in the high-grade glioma, which is most likely due to the hypercapnia-induced steal effect that redistributes blood flow from tumor regions with unresponsive neovasculature to surrounding normal tissue. Conclusion BOLD MRI during short breath holding can disclose differential cerebrovascular response between normal tissue and cerebral glioma. J. Magn. Reson. Imaging 2004;19:160,167. © 2004 Wiley-Liss, Inc. [source] Post-radiotherapy contrast enhancement changes in fast dynamic MRI of cervical carcinomaJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2001Erik A. Boss MD Abstract This pilot study determines fast dynamic gadolinium enhanced MRI contrast enhancement parameters (onset of enhancement and time to peak enhancement) before and after radiotherapy in 10 cervical carcinoma patients. Before radiotherapy, onset of enhancement and time to peak enhancement were early, with a median of 4.5 and 5.2 seconds, respectively. High-grade tumors showed early enhancement, compared with low-grade. After radiotherapy, contrast enhancement patterns differed. In survivors, onset of enhancement after radiotherapy was later than before radiotherapy. In non-survivors, onset of enhancement after radiotherapy was still early. The median difference in onset of enhancement before and after radiotherapy in survivors and non-survivors was an increase of 3.2 and a decrease of 1.1 seconds, respectively. Early onset of enhancement after radiotherapy was a better predictor for survival than a high-signal intensity zone on post radiotherapy unenhanced T1/T2-weighted MRI. It is concluded that enhancement parameters from fast dynamic Gd-enhanced MR images can provide additional functional information with regard to tumor vascularization, and may have prognostic significance. It complements clinical examination and unenhanced MRI in determining the effectiveness of radiotherapy treatment in cervical carcinoma. Future studies will focus on the clinical utility and improvements of the estimation of contrast-enhanced parameters with this new technique. J. Magn. Reson. Imaging 2001;13:600,606. © 2001 Wiley-Liss, Inc. [source] Regional variation in exhumation and strain rate of the high-pressure Sambagawa metamorphic rocks in central Shikoku, south-west JapanJOURNAL OF METAMORPHIC GEOLOGY, Issue 7 2002K. Yagi Abstract Regional variation in the P,T path of the Sambagawa metamorphic rocks, central Shikoku, Japan has been inferred from compositional zoning of metamorphic amphibole. Rocks constituting the northern part (Saruta River area) exhibit a hairpin type P,T path, where winchite/actinolite grew at the prograde stage, the peak metamorphism was recorded by the growth of barroisite to hornblende and sodic amphibole to winchite/actinolite grew at the retrograde stage. In the southern part (Asemi River area), rocks exhibit a clockwise type P,T path, where barroisite to hornblende core is rimmed by winchite to actinolite. The difference in P,T path could suggest a faster exhumation rate (i.e. more rapid decompression) in the southern than in the northern part. On the other hand, physical conditions of deformation during the exhumation stage have been independently inferred from microstructures in deformed quartz. Recrystallized quartz grains in rocks from the low-grade (chlorite and garnet) zones are much more stretched in the southern part (aspect ratio , 4.0) than in the northern part (aspect ratio< 4.0), indicating a higher strain rate in the former than in the latter. These facts may indicate that the exhumation and strain rates are correlated (i.e. the exhumation rate increases with increasing the strain rate). The difference in the exhumation rate inferred from amphibole zoning between the northern and southern parts could be explained by an extensional model involving normal faulting, where the lower plate can be exhumed faster than the upper plate due to the displacement along the fault. Furthermore, the model may explain the positive correlation between the exhumation and strain rates, because the lower plate tended to support more stress than the upper plate. [source] Modulation of endothelial cell inflammatory integrins and stress markers with rh-factor VIIa in patients with advanced chronic hepatitis CJOURNAL OF VIRAL HEPATITIS, Issue 4 2003D. H. Van Thiel Summary. Individuals with chronic hepatitis C (CHC) progress to cirrhosis and hepatic cancer. Individuals with advanced CHC are coagulopathic and can manifest fibrinolysis. The coagulopathy is a consequence of hepatocytic dysfunction. The fibrinolysis represents a response to local endothelial cell injury, and is of a low-grade. Based upon this hypothesis, the effect of the infusion of recombinant human factor VIIa (rh-FVIIa) on endothelial cell inflammatory integrins and measures of endothelial stress were determined in 17 individuals with advanced CHC. Immediately prior to the infusion of rh-FVIIa, the plasma levels of tissue factor (TF), Thrombomodulin (TM), human soluble ICAM-1 (hs-ICAM-1), human soluble VCAM-1 (hs-VCAM-1), human soluble L-Selectin (hs-L-Selectin), the prothrombin time and the activated partial thromboplastin time were determined. The same parameters were assayed at 5, 10, 30, 120, 240 and 360 min after infusion. TF and TM levels were very high at baseline consistent with a vascular endothelial stress response. Similarly hs-ICAM-1, hs-VCAM-1 as well as L-Selectin levels were increased. Thirty minutes after the infusion, a marked reduction in ICAM-1 and VCAM-1 and to a lesser degree L-Selectin levels was observed. This reduction persisted for 360 min. No change in measures of fibrinolysis [plasminogen activator inhibitor-1 (PAI-1), total tissue factor pathway inhibitor (t-TFPI), activated tissue factor pathway inhibitor (TFPIa), d-dimers (DD), FSP and fibrinogen levels] occurred. In addition, no change in plasma Annexin-V was observed. Based upon these data it can be concluded that: (1) rh-FVIIa corrects the coagulopathy seen in advanced CHC; (2) reduces endothelial cell injury and/or stress as evidenced by the TF, TM, hs-ICAM-1 and hs-VCAM-1 levels in plasma; (3) these changes in coagulation occurred without inducing a propagated vascular thrombosis. [source] Pleomorphic xanthoastrocytoma with anaplastic features presenting without GFAP immunoreactivity: Implications for differential diagnosisNEUROPATHOLOGY, Issue 3 2005Ellen Gelpi Pleomorphic xanthoastrocytoma (PXA) is an uncommon, usually low-grade, astrocytic tumor. Characteristic histological features include tumor cell pleomorphism and lipidization of tumor cells. Albeit prognosis in PXA is generally good, cases with histological signs of anaplasia have been observed. In these cases, the differential diagnosis needs to exclude other malignancies, for example, glioblastoma or malignant fibrous histiocytoma. Immunocytochemical detection of GFAP may support exclusion of non-glial neoplasms resembling PXA. However, GFAP expression in PXA may be faint or focal, although complete lack of GFAP has not been described. A 43-year-old woman was operated on for a left occipital parasagital tumor attached to the dura. Histopathology showed a pleomorphic tumor with moderate mitotic activity and necrosis, lack of GFAP immunoreactivity and ultrastructural detection of premelanosome-like structures. These features led to the tentative diagnosis of amelanotic melanoma, and the patient was irradiated. Three years later she had local tumor recurrence and underwent another operation. The recurrent tumor showed similar plain histology as the first specimen. In contrast, anti-GFAP immunoreactivity was now detectable in pleomorphic tumor cells. Anti-GFAP staining of the first biopsy was repeated using monoclonal and polyclonal antibodies in combination with prolonged tissue pretreatment. Focal GFAP staining of tumor cells was now achieved. We conclude that non-standard GFAP staining protocols may enhance sensitivity and thus lead to detection of a low level of GFAP expression in tumor specimens, in which PXA is considered in the differential diagnosis. This may avoid misleading diagnostic considerations that impact on postoperative patient management. [source] Genetic pathways to glioblastomasNEUROPATHOLOGY, Issue 1 2005Hiroko Ohgaki Glioblastomas, the most frequent and malignant human brain tumors, may develop de novo (primary glioblastoma) or by progression from low-grade or anaplastic astrocytoma (secondary glioblastoma). These glioblastoma subtypes constitute distinct disease entities that affect patients of different ages and develop through different genetic pathways. Our recent population-based study in the Canton of Zürich, Switzerland, shows that primary glioblastomas develop in older patients (mean age, 62 years) and typically show LOH on chromosome 10q (69%) and other genetic alterations (EGFR amplification, TP53 mutations, p16INK4a deletion, and PTEN mutations) at frequencies of 24,34%. Secondary glioblastomas develop in younger patients (mean, 45 years) and frequently show TP53 mutations (65%) and LOH 10q (63%). Common to both primary and secondary glioblastoma is LOH on 10q, distal to the PTEN locus; a putative suppressor gene at 10q25-qter may be responsible for the glioblastoma phenotype. Of the TP53 point mutations in secondary glioblastomas, 57% were located in hotspot codons 248 and 273, while in primary glioblastomas, mutations were more widely distributed. Furthermore, G:C,A:T mutations at CpG sites were more frequent in secondary than in primary glioblastomas (56% vs 30%). These data suggest that the TP53 mutations in these glioblastoma subtypes arise through different mechanisms. There is evidence that G:C,A:T transition mutations at CpG sites in the TP53 gene are significantly more frequent in low-grade astrocytomas with promoter methylation of the O6 -methylguanine-DNA methyltransferase (MGMT) gene than in those without methylation. This suggests that, in addition to deamination of 5-methylcytosine (the best known mechanism of formation of, G:C,A:T, transitions, at, CpG, sites),, involvement of alkylating agents that produce O6 -methylguanine or related adducts recognized by MGMT cannot be excluded in the pathway leading to secondary glioblastomas. [source] Correlation of thrombospondin-1 and transforming growth factor-, expression with malignancy of gliomaNEUROPATHOLOGY, Issue 3 2000Tomoyuki Kawataki The expression of thrombospondin-1 (TSP-1) and its role in gliomas have not been well examined. In the present study TSP-1 expression in a panel of malignant glioma cell lines and the expression of TSP-1 and transforming growth factor (TGF-,) proteins in low-grade and malignant glioma tissues were investigated. Reverse transcription-polymerase chain reaction analysis showed that nine of nine malignant glioma cell lines expressed TSP-1 mRNA, and seven of nine glioma lines expressed TSP-2 mRNA. Production and secretion of TSP-1 were examined in the T98G glioblastoma cell line by western blot analysis. Total TSP-1 protein content in the supernatant was 10 times higher than that in the cell lysate. Secretion of TSP-1 was examined in these glioma cell lines by western blot analysis. All glioma lines secreted significant levels of TSP-1. Bioassay showed that all tumor lines had the capacity to activate latent TGF-,. Localization of TSP-1, TGF-,1, -,2, and -,3 was examined immunohistochemically in surgically resected glioma tissues, including 11 glioblastomas, six anaplastic astrocytomas, and eight astrocytomas. Most glioblastomas expressed high levels of both TSP-1 and TGF-,. Anaplastic astrocytomas expressed moderate levels of TSP-1 and TGF-,. Most malignant gliomas expressed various levels of TGF-,1, -,2, and -,3. The expression of both proteins, however, was weak in low-grade gliomas. Normal brain tissues around the tumors were negatively or very weakly positively stained for TSP-1 and TGF-,. These results indicate that most malignant glioma cells express TSP-1 in vitro and in vivo, and the expression of TSP-1 and TGF-,in vivo correlates with the histologic malignancy of glioma. Overexpression of both TSP-1 and TGF-, may increase the biologic malignancy of malignant gliomas, through generating the active form of TGF-, in tumor tissues. [source] Histologically low-grade dedifferentiated liposarcoma of the retroperitoneumPATHOLOGY INTERNATIONAL, Issue 5 2001Masaharu Fukunaga A low-grade dedifferentiated liposarcoma in the retroperitoneum of a 52-year-old woman is described. The excised specimens contained six nodules of lipoma-like well-differentiated liposarcoma and a nodule of dedifferentiated liposarcoma. The latter was composed predominantly of loosely arranged, benign-appearing spindle cells and fat cells. A small number of cells with irregularly shaped nuclei were scattered. There were no mitotic figures. The fat cells showed slight variation of size and shape, and a few multivacuolated lipoblasts were found. The spindle cell areas occupied approximately 60% of the tumor. The stroma was somewhat fibrous and myxoid and no dense collagenous matrix was found. The stroma vascularity was not prominent. Immunohistochemically, the spindle cells were positive for vimentin but negative for S-100 protein, desmin, muscle actin, and , -smooth muscle actin. Follow up for 5 months showed no evidence of recurrence or metastasis. The tumor, in which the benign-appearing spindle cell component was predominant, was considered to be a low-grade dedifferentiated liposarcoma. Close and long-term follow up is required. In retroperitoneal lipoma-like well-differentiated liposarcomas, spindle cell components like the present tumor, which represent dedifferentiation, should not be overlooked. [source] Response of myasthenia gravis to rituximab in a patient with non-Hodgkin lymphomaAMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2004Ajeet Gajra Abstract Myasthenia gravis is a B-cell-mediated autoimmune neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The underlying defect is an autoantibody-mediated attack on the acetylcholine receptors (AchRs) at the neuromuscular junction. Rituximab is a genetically engineered chimeric murine/human monoclonal antibody indicated for treatment of patients with low-grade or follicular, CD20-positive, B-cell non-Hodgkin lymphoma. Based on its potential for elimination of auto-reactive B-cell clones, rituximab may have a role in the management of some autoimmune disorders. We report a patient with B-cell, follicular non-Hodgkin lymphoma and a long-standing history of myasthenia gravis and the favorable impact of rituximab on both disorders. Am. J. Hematol. 77:196,197, 2004. © 2004 Wiley-Liss, Inc. [source] Management and Outcome of Patients With Mucoepidermoid Carcinoma of Major Salivary Gland Origin: A Single Institution's 30-Year Experience,THE LARYNGOSCOPE, Issue 2 2008Katri Aro MD Abstract Background: Mucoepidermoid carcinoma (MEC) is one of the most frequent epithelial malignancies of the salivary glands. Prediction of clinical outcome of MEC is challenging. Material and Methods: We retrospectively reviewed 52 cases of MEC of major salivary gland origin diagnosed at the Department of Otolaryngology,Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland, during a 30-year period of 1976 to 2005. Criteria used for diagnosis were those of World Health Organization classifications valid at each time point, and criteria for grading were those recommended by Armed Forces Institute of Pathology fascicle (1996). Since 1993, the degree of cell proliferation was used at our institution as an adjunct tool when grading MEC. The majority of cases occurred in the parotid gland (n = 47, 90%) followed by the submandibular gland (n = 5, 10%). Results: We had 39% high-grade (HG), 14% intermediate-grade (IMG), and 44% low-grade (LG) MECs. T categories were T1, n = 18; T2, n = 16; T3, n = 9; T4, n = 9. Forty-nine (94%) patients were treated with curative intent. These patients underwent surgery, and 24 (49%) patients received postoperative radiotherapy. Follow-up time varied from 6 months to 9 years. Forty-five percent of HG-MEC patients and 67% of IMG-MEC patients developed locoregional failures or distant metastases during a 3-year follow-up as opposed to none of the LG-MEC patients. Of MEC patients with N0 neck, two HG-MEC patients and one IMG-MEC (8%) patient developed regional recurrence during follow-up. Conclusions: Patient outcome in the different grades of MEC suggests a need for overview of the treatment protocol, especially with regard to LG-MEC and IMG-MEC. The apparently unusual occurrence of locoregional failures and metastases in LG-MEC suggests a restrictive approach in surgical management. However, the frequent occurrence of such failures in IMG-MEC warrants an aggressive approach with these tumors. [source] Expanding the Criteria of Organ Procurement from Donors with Prostate Cancer: The Application of the New Italian GuidelinesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2010A. D'Errico-Grigioni Prostate cancer (CaP) represents the most prevalent malignancy in men more than 60-year-old, posing a problem in organ procurement from elderly subjects. However, most of the currently diagnosed CaP are low-grade and intraprostatic, with low metastatic risk, and there is recent evidence that most patients are overdiagnosed. The Italian National guidelines about organ acceptance from neoplastic donors changed in March 2005, extending the pool of potential candidates with CaP and introducing the function of a second opinion expert. Between 2001 and February 2005, 40 candidate donors with total PSA,10 and/or positive digital rectal examination underwent histopathological analysis of the prostate: 15 (37.5%) donors harboured CaP, and 25 (62%) were judged at ,standard risk'. After the introduction of the new guidelines in 2005, the second opinion expert judged at ,standard risk' 48 of 65 donors, while 17 of 65 needed histopathological analysis. Four (6.2%) donors harboured CaP, and 61 (94%) where judged at ,standard risk', with a significant increase of donated and actually transplanted organs. The application of the new guidelines and the introduction of a second opinion expert allowed a significant extension of the ,standard risk' category also to CaP patients, decreasing the histopathological examinations and expanding the donor pool. [source] Early Low-Grade Proteinuria: Causes, Short-Term Evolution and Long-Term Consequences in Renal TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2005Jean-Michel Halimi Proteinuria 1 year after transplantation is associated with poor renal outcome. It is unclear whether low-grade (<1 g/24 h) proteinuria earlier after transplantation and its short-term change affect long-term graft survival. The effects of proteinuria and its change on long-term graft survival were retrospectively assessed in 484 renal transplant recipients. One- and 3-month proteinuria correlated with donor age, donor cardiovascular death, prolonged cold and warm ischemia times and acute rejection. One- and 3-month proteinuria (per 0.1 g/24 h, hazard ratio (HR): 1.07 and 1.15, p < 0.0001),especially low-grade proteinuria (HR: 1.20 and 1.26, p < 0.0001),were powerful, independent predictors of graft loss. Its short-term reduction correlated with arterial pressure (AP) (the lower the 3-month diastolic and 12-month systolic AP, the lower the risk of increasing proteinuria during 1,3 months and 3,12 months periods, respectively: Odds ratio (OR) per 10 MmHg: 0.78, p = 0.01 and 0.85, respectively, p = 0.02), and was associated with decreased long-term graft loss (per 0.1 g/24 h: HR: 0.88 and 0.98, respectively, p < 0.0001), independently of initial proteinuria. Early low-grade proteinuria due to pre-transplant renal lesions, ischemia-reperfusion and immunologic injuries is a potent predictor of graft loss. Short-term reduction in proteinuria is associated with improved long-term graft survival. [source] | ||||||||||||||||||||||||||||||||||||||||