Retrospective liver histomorphological analysis in dogs in instances of clinical suspicion of congenital portosystemic shunt

AbstractIntroduction: The clinical symptoms of portosystemic shunts (PSSs) and hepatic microvascular dysplasia (HMD) – portal vein hypoplasia (PVH) in dogs are similar. PSSs are abnormal vascular connections between the portal vein system and systemic veins. HMD is a very rare developmental vascular anomaly, recognisable during histopathological examination. The study aim was to assess the prevalence of HMD–PVH and hepatocellular and vascular pathologies in the liver. Material and Methods: Liver biopsies from 140 dogs (of different breeds and both sexes) arousing clinical suspicion of PSS were examined histopathologically. Results: An initial PSS diagnosis was confirmed in 125 dogs (89.29%). HMD–PVH was found in 12.32% of dogs, as an isolated disease in 9.29%, especially in Yorkshire terriers, and with extrahepatic PSS in 6.67%. Histopathological analysis of muscles around sublobular veins showed that HMD cases presented hypertrophy or hypertrophy with fibrosis. In 2.17% of all dogs with liver vascular developmental disorders calcification was visible around vessels (without correlation by degenerative changes in those vessels), suggesting prior onset of deep metabolic disorders. Clinical suspicion of PSS was also formed upon quite different pathological processes in young dogs. Conclusion: Histopathological findings diagnosed the type of vascular anomalies (PSS or HMD–PVH) or other pathological changes conclusively, therefore detailed hepatic histopathology is an indispensable component of the clinical diagnostic process.

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Hyaluronic acid and TGF-β1 in dogs with hepatobiliary diseases

Acta Veterinaria Brno ◽

10.2754/avb201887030231 ◽

2018 ◽

Vol 87 (3) ◽

pp. 231-240 ◽

Cited By ~ 2

Author(s):

Václav Ceplecha ◽

Kristína Řeháková ◽

Corinne Lendon ◽

Pavel Proks ◽

Miša Škorič ◽

...

Keyword(s):

Hyaluronic Acid ◽

Liver Fibrosis ◽

Transforming Growth Factor Beta ◽

Transforming Growth Factor ◽

Histopathological Examination ◽

Vascular Anomaly ◽

Non Invasive ◽

Portosystemic Shunts ◽

Advanced Liver Fibrosis ◽

Tgf Β1

The aim of the study was to assess serum hyaluronic acid (HA) and transforming growth factor beta 1 (TGF-β1) concentrations: 1) to differentiate hepatic fibrosis from other forms of liver disease, and 2) for the non-invasive staging of canine liver fibrosis. We also evaluated the association between serum HA concentration and the size of the shunt vessel as an indirect marker of decreased liver clearance in patients with single congenital vascular anomaly. Forty-one healthy client-owned dogs and forty dogs diagnosed with hepatobiliary disease were enrolled in the prospective study. Patients were divided into 4 subgroups: 1) congenital portosystemic shunts (CPSS); 2) parenchymal diseases (a. mild and moderate fibrosis, b. advanced fibrosis and cirrhosis); 3) hepatic neoplasia; 4) biliary tract disorders based on thorough clinical, ultrasound and histopathological examination. Serum HA and TGF-β1 concentrations were measured using ELISA. The HA concentration was significantly increased in patients with advanced liver fibrosis/cirrhosis (P < 0.001) and CPSS (P < 0.001) compared to healthy dogs. Using a cut-off HA concentration of 135.94 ng/ml, the sensitivity and specificity for diagnosis for advanced liver fibrosis/cirrhosis was 100% (95% CI, 50.6–100) and 90.8% (95% CI, 81.6–95.7), respectively. The TGF-β1 levels did not significantly differ among groups (P = 0.180). Negligible correlation was found between serum HA concentration and the size of portosystemic shunt vessel (rs = 0.07; P = 0.831). These findings suggest that serum HA concentration is a potential non-invasive biomarker for advanced liver fibrosis and/or cirrhosis in dogs. The utility of measuring serum concentration of TGF-β1 for diagnosing canine liver fibrosis was not supported.

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Mixed adenoneuroendocrine carcinoma (MANEC) as a rare case of the rectum

Progress in Health Sciences ◽

10.5604/01.3001.0014.6653 ◽

2020 ◽

Vol 10 (2) ◽

pp. 87-90

Author(s):

A. Romańczyk ◽

W. Ustymowicz ◽

K. Ustymowicz ◽

J. Zińczuk ◽

A. Pryczynicz

Keyword(s):

Chromogranin A ◽

Clinical Symptoms ◽

Histopathological Examination ◽

Neuroendocrine Differentiation ◽

Large Cell ◽

Rectal Neoplasm ◽

Diagnostic Process ◽

Mixed Adenoneuroendocrine Carcinoma ◽

Good General Condition ◽

Process Classification

Introduction: Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor consist of two components, adenocarcinoma and neuroendocrine differentiation. Every each have to represents at least 30% of the tumor. Diagnosis is based on cytology, architecture and immunostaining. Specific neuroendocrine markers for MANEC are chromogranin A and synaptophysin. Purpose: In this paper, we aimed to present a case of MANEC arising from rectum. Case presentation: 67-years-old man was admitted to the hospital due to abdominal pain, obstruction and blood in the stool. From the colonoscopy simple, the histopathological examination exposed microfoci of adenocarcinoma. Small pelvis MRI disclosed clinically known circular, solid infiltrate in the middle and upper part of the rectum. Local advancement in MRI was T4b N2 EMVI + CRM +. Patient underwent the neoadjuvant radiochemo-therapy. The control MRI revealed tumor reduction. Local advancement in MRI was yT3d yN0 EMVI + CRM + RG3. The histopathological examination of the surgical material revealed MANEC tissue consisting of Adenocarcinoma G2 (60%) and Large cell neuroendocrinal carcinoma (40%) pT3 pN0 pMx. Immunohistochemical staining revealed a positive expression of chromogranin A, synaptophysin and Ki67 - 80% in the neuro-endocrine component. Lymphonodulitis reactiva 19/19. Seminal vesicles without neoplastic infiltration. The patient was discharged in good general condition, with a recommendation of a follow-up visit at a surgical clinic. Conclusions: MANEC is rare as a rectal neoplasm. Has no specific clinical symptoms. The most important in the diagnostic process is histopatho-logical analysis. Updating the knowledge about MANEC by new reports may optimize the diagnostic process, classification and treatment of this cancer.

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Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination

Medicinski pregled ◽

10.2298/mpns1208277m ◽

2012 ◽

Vol 65 (7-8) ◽

pp. 277-280 ◽

Cited By ~ 6

Author(s):

Sinisa Mirkovic ◽

Ana Tadic ◽

Tatjana Djurdjevic-Mirkovic ◽

Aleksandra Levakov

Keyword(s):

Clinical Symptoms ◽

Histopathological Examination ◽

Definitive Diagnosis ◽

Histopathological Analysis ◽

Histopathological Diagnosis ◽

Periapical Lesions ◽

Significant Difference ◽

Clinical Diagnoses ◽

Staining Protocol ◽

Hematoxylin And Eosin

Introduction. The preliminary diagnosis of chronic periapical lesions is made on the basis of clinical symptoms and radiographs, which is a reliable diagnostic tool, but it has only a subsidiary role since histopathological verification is essential for the definitive diagnosis. This study was aimed at diagnosing removed chronic periapical lesions and classifying them by size as well as at comparing the clinical diagnoses with histipathological results. Material and Methods. The study included 34 patients diagnosed with chronic periapical process by applying clinical examination and radiography. The removed chronic periapical lesions were processed according to classical histological technique and analyzed by hematoxylin and eosin staining protocol. Results. According to histopathological analysis 53% of chronic periapical lesions were periapical granulomas and 47% were radicular cysts. The size of the lesions ranged from < 9 mm (70% of lesions), 9 to 20 mm (18% of lesions) and > 20 mm (12% of lesions).The histopathological examination revealed that clinical diagnosis was wrong in 26% of cases. Conclusion. A statistically significant difference between clinical and histopathological diagnosis has been found. The histopathological findings strongly suggest the necessity of complete curettage of lesions sizing > 20 mm in order to prevent recurrences.

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Hamartoma: a rare developmental disorder

Medycyna Weterynaryjna ◽

10.21521/mw.5683 ◽

2017 ◽

Vol 73 (4) ◽

pp. 202-207 ◽

Cited By ~ 2

Author(s):

Bartłomiej J. Bartyzel ◽

Andrzej Max ◽

Joanna Gruszczyńska ◽

Małgorzata Sobczak-Filipiak ◽

Tomasz Męcik-Kronenberg ◽

...

Keyword(s):

Developmental Disorders ◽

Developmental Disorder ◽

Clinical Symptoms ◽

Histopathological Examination ◽

Suppressor Gene ◽

Domestic Animals ◽

Congenital Defects ◽

Benign Tumors ◽

Body Parts ◽

Preneoplastic Lesions

Hamartoma is a developmental disorder of various body parts and organs. It is characterized by a non-neoplastic growth of tissue with an uneven distribution and proportion of individual cells. Lesions progress for several years, but usually do not give clinical symptoms, and do not undergo malignant transformation. They occur alone or coexist with other defects, sometimes forming a characteristic clinical picture of a syndrome of congenital defects. Mutations in genes, such as PTEN, GLI3, SDH B/D, PIK3CA and ACT1, cause a dysfunction of the tumor suppressor gene and result in an increased neoplastic transformation. Hamartoma is a lesion between developmental disorders and benign tumors, which occurs frequently in humans, but is very rare in domestic animals. In a histopathological examination, however, it is diagnosed relatively often. In the veterinary literature, both hamartoma and choristoma are attributed mostly to errors in embryogenesis and are not considered as preneoplastic lesions.

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Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

CVIR Endovascular ◽

10.1186/s42155-019-0096-7 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Osman Ahmed ◽

Abhijit L. Salaskar ◽

Steven Zangan ◽

Anjana Pillai ◽

Talia Baker

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Splenic Vein ◽

Portosystemic Shunt ◽

Refractory Ascites ◽

Hepatic Veins ◽

Sonographic Guidance ◽

Portosystemic Shunts ◽

Intrahepatic Portosystemic Shunt ◽

End To End

Abstract Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

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The Increasing Impact of Translational Research in the Molecular Diagnostics of Neuromuscular Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms22084274 ◽

2021 ◽

Vol 22 (8) ◽

pp. 4274

Author(s):

Dèlia Yubero ◽

Daniel Natera-de Benito ◽

Jordi Pijuan ◽

Judith Armstrong ◽

Loreto Martorell ◽

...

Keyword(s):

Molecular Diagnosis ◽

Clinical Symptoms ◽

Neuromuscular Diseases ◽

Genomic Analysis ◽

Molecular Diagnostic ◽

Diagnostic Process ◽

Targeted Analysis ◽

Whole Exome ◽

Referral Hospitals ◽

Uncertain Significance

The diagnosis of neuromuscular diseases (NMDs) has been progressively evolving from the grouping of clinical symptoms and signs towards the molecular definition. Optimal clinical, biochemical, electrophysiological, electrophysiological, and histopathological characterization is very helpful to achieve molecular diagnosis, which is essential for establishing prognosis, treatment and genetic counselling. Currently, the genetic approach includes both the gene-targeted analysis in specific clinically recognizable diseases, as well as genomic analysis based on next-generation sequencing, analyzing either the clinical exome/genome or the whole exome or genome. However, as of today, there are still many patients in whom the causative genetic variant cannot be definitely established and variants of uncertain significance are often found. In this review, we address these drawbacks by incorporating two additional biological omics approaches into the molecular diagnostic process of NMDs. First, functional genomics by introducing experimental cell and molecular biology to analyze and validate the variant for its biological effect in an in-house translational diagnostic program, and second, incorporating a multi-omics approach including RNA-seq, metabolomics, and proteomics in the molecular diagnosis of neuromuscular disease. Both translational diagnostics programs and omics are being implemented as part of the diagnostic process in academic centers and referral hospitals and, therefore, an increase in the proportion of neuromuscular patients with a molecular diagnosis is expected. This improvement in the process and diagnostic performance of patients will allow solving aspects of their health problems in a precise way and will allow them and their families to take a step forward in their lives.

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Placental mesenchymal dysplasia- A case report

IP Journal of Diagnostic Pathology and Oncology ◽

10.18231/j.jdpo.2021.054 ◽

2021 ◽

Vol 6 (3) ◽

pp. 249-252

Author(s):

Zeba Nisar ◽

Mahendra A Patil ◽

Vaishali J Pol ◽

Jaydeep N Pol

Keyword(s):

Case Report ◽

Histopathological Examination ◽

Clinical Suspicion ◽

Termination Of Pregnancy ◽

Rare Disorder ◽

Molar Pregnancy ◽

Female Fetus ◽

Beta Hcg ◽

Antenatal Visits ◽

Placental Mesenchymal Dysplasia

Placental mesenchymal dysplasia is a rare disorder mainly characterized by enlarged placenta. Patients on antenatal visits present with normal or slightly raised Beta-HCG, raised Alfa-fetoprotein and cystic structures on USG resembling a molar pregnancy. It has to be differentiated from molar pregnancies to avoid unnecessary termination of pregnancy. This condition is associated with IUGR or IUFD. Mostly the fetus are females. Due to lack of awareness of this condition it remains underreported. Here we present a case report of 20 years old female 37 week pregnant with IUGR with clinical suspicion of molar pregnancy gave birth to alive female fetus and on histopathological examination of placenta was diagnosed with PMD.

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Clinical Trial of Efficacy and Toxicity of Disoproxil Tenofovir Fumarate and Emtricitabine for Mild to Moderate SARS-CoV-2 Infections

10.1101/2021.09.28.21264242 ◽

2021 ◽

Author(s):

Aldo A M Lima ◽

Erico A G Arruda ◽

Roberto J Pires-Neto ◽

Melissa S Medeiros ◽

J Quirino-Filho ◽

...

Keyword(s):

Clinical Trial ◽

Vitamin C ◽

Respiratory Infection ◽

Clinical Symptoms ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Suspicion ◽

Pharmacological Intervention ◽

Controlled Clinical Trial ◽

Double Blind

This study aimed to evaluate the efficacy and toxicity of tenofovir (TDF) and TDF combined with emtricitabine (TDF/FTC) in patients with mild to moderate COVID-19 infections. We conducted a randomized, double-blind, placebo-controlled clinical trial in patients with clinical suspicion of mild to moderate respiratory infection caused by SARS-CoV-2 who were treated at an outpatient clinic. Patients were randomly recruited to take 10 days of TDF (300 mg/day), TDF (300 mg/day) combined with FTC (200 mg/day) or placebo Vitamin C (500 mg/day). The primary parameter was the score of symptoms and predictive signs of COVID-19, assessed on the seventh day of patient follow-up. From a total of 309 patients with clinical suspicion of SARS-CoV-2, 227 met the inclusion criteria and were randomly distributed into the following groups: (a) 75 (one did not initiate treatment) in the TDF group; (b) 74 in the TDF combined with FTC group; and (c) 77 in the Vitamin C group (placebo). Of the 226 patients, 139 (62%) were positive for SARS-CoV-2. Fever (37.8oC), ageusia or dysgeusia, anosmia or dysosmia, and two or more clinical symptoms or signs were significantly associated with SARS-CoV-2 infection. There was no significant change in clinical score based on clinical symptoms and signs between treatment groups. Patients with mild to moderate infection by SARS-CoV-2 had higher concentrations of G-CSF, IL-1β, IL-6 and TNF-α compared to patients without infection. Patients with mild to moderate respiratory infection, with fever (37.8oC), loss of smell, loss of taste and two or more symptoms, have a better prediction for the diagnosis of COVID-19. Patients with SARS-CoV-2 showed higher and more persistent proinflammatory cytokines profile compared to patients not infected with SARS-CoV-2. Pharmacological intervention with TDF or TDF combined with FTC did not change the clinical signs and symptoms score in mild to moderate respiratory infection in patients with SARS-CoV-2 compared to the Vitamin C group (placebo).

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Ovarian tumors: Incidence, histological type of lesions and treatment in pediatric age group

Postępy Higieny i Medycyny Doświadczalnej ◽

10.5604/01.3001.0014.8603 ◽

2021 ◽

Vol 75 ◽

pp. 292-296

Author(s):

Patrycja Sosnowska-Sienkiewicz ◽

Piotr Nogal ◽

Dawid Gawron ◽

Korneliusz Wójcik ◽

Danuta Januszkiewicz-Lewandowska ◽

...

Keyword(s):

Clinical Symptoms ◽

Malignant Tumors ◽

Histopathological Examination ◽

Tumor Staging ◽

Benign Lesion ◽

Mature Teratoma ◽

Malignant Lesion ◽

Ovarian Tumors ◽

Histological Type ◽

Tumor Type

Background: The aim of this study was to evaluate the incidence and histological type of lesions affecting the ovaries and to analyze employed methods of invasive treatment. Materials&Methods: Medical records of patients who were treated surgically for ovarian tumors in the years 2015 -2019 were reviewed. The study group was comprised of 31 female patients. Results: During 5 years time, there were 31 girls in the age from 3 months to 17 years hospitalized in the department. The mean age was 11 years. Histopathological examination was performed in all of these cases. 12 patients were diagnosed with malignant lesion, 19 with benign lesion. The most commonly diagnosed malignant tumors were a dysgerminoma and a mixed germ cell tumor. In the group of benign lesions, the most frequent tumor type was mature teratoma. The first occurring symptom was abdominal pain. Some of the lesions were diagnosed accidentally during ultrasonography. The diagnostics was expanded depending on the size of the tumor, staging and clinical condition of the patient. All the patients were treated surgically, 16 of them underwent laparoscopic surgery. Torsion of the ovary or oviduct was observed in 3 cases. Chemotherapy was introduced in 8 cases as complementary treatment. Conclusions: The most commonly diagnosed tumor was mature teratoma. Ultrasonography is the most frequent method of the ovaries’ examination. Ovarian lesions are characterized by non-specific clinical symptoms, which is associated with prevalent incidental detection during ultrasonography.

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Doughnut bother! Histopathological examination of anastomotic doughnuts following colorectal anastomosis does not change patient management

Surgical and Experimental Pathology ◽

10.1186/s42047-019-0054-7 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Steven Dixon ◽

Hannah Barrow ◽

Jane Hughes

Keyword(s):

Patient Management ◽

Residual Disease ◽

Histopathological Examination ◽

Colorectal Anastomosis ◽

Complete Response ◽

Patient Treatment ◽

Histopathological Analysis ◽

Retrospective Case ◽

Female Ratio ◽

Stapling Device

Abstract Introduction The use of a circular stapling device to create an anastomosis following colonic or rectal resection is common practice in the United Kingdom. Histopathological analysis of the anastomotic doughnuts produced takes time and resources, but does it ever change patient management? The aim of this study was to review the examination of doughnuts and whether patient treatment was altered by the findings. Method A retrospective case note review of all cases involving anastomotic doughnuts in a single trust between December 2010 and January 2018, was performed. Results There were 435 cases identified, male to female ratio was 2.0:1, age range 20–86 years and a median age of 66 years. 376 Doughnut samples were received by the pathology department (86.4%) and 354 were examined (81.4%). The disease processes involved were adenocarcinoma (n = 352, 80.9%), diverticular disease (n = 47, 10.8%), no residual disease/complete response (n = 22, 5.1%), adenoma (n = 7, 1.6%), mucinous (n = 5, 1.1%), Crohn’s disease (n = 1, 0.2%) and neuroendocrine (n = 1, 0.2%). Benign adenomatous change was identified in 4 cases (0.9%). No doughnuts examined contained dysplastic or malignant changes. Conclusion The histological examination of anastomotic doughnuts is extremely unlikely to identify malignant change and subsequently does not change patient management. Pathology departments could save time and resources by not routinely examining doughnuts.

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