Acid-responsive aggregated SERS nanoparticles for improved tumor diagnose

Surface enhanced Raman scattering (SERS) technology has attracted increasing attention in histopathologic examination for tumor diagnose due to its high resolution and photo-stability. However, the diagnostic accuracy is inadequate due...

Clinicopathologic Appearance of Advanced Ketoacidosis With Basal Vacuolation in Renal Tubules

Context.— Basal vacuolization (BV) in renal tubules is a histopathologic hallmark of advanced ketoacidosis that enables us to retrospectively diagnose these cases. Objective.— To clarify the pathologic background and serologic findings of ketoacidosis with BV, and to reveal the pathologic findings by each pathologic background. Design.— We examined 664 serial autopsy cases. A systemic histopathologic examination and measurement of serum β-hydroxybutyrate concentration were performed for the cases with BV. The extent of steatosis and fibrosis in the organs and the degree of coronary artery stenosis were semiquantitatively investigated. Immunohistochemistry for adipophilin was also performed to analyze its usefulness for the pathologic diagnosis. Results.— Basal vacuolization was found in 16 cases, all of which showed a pathologic serum β-hydroxybutyrate concentration. The main background of ketoacidosis was considered as alcohol abuse in 6 cases, diabetes in 5, malnutrition in 3, and hypothermia and infection in 1 case each. Severe hepatic fibrosis was observed only in the alcohol-abuser group. Moreover, cardiac steatosis was more severe in patients with possible alcohol abuse than in those with other causes. Immunohistochemistry for adipophilin showed immunoreactivity consistent with BV in 13 of 16 cases. There was no correlation between β-hydroxybutyrate concentration and either the postmortem or storage interval. Conclusions.— Basal vacuolization may be a useful finding for detecting ketoacidosis cases in a postmortem investigation. Serum β-hydroxybutyrate was a stable and reliable compound for the definitive diagnosis of ketoacidosis in such cases. The present study showed that pathologic changes in some organs may vary by each pathologic background of ketoacidosis with BV.

The Squamous Vaginal Papillomatosis in Prepubertal Female Twins: A Case Report

This is the first case describing vaginal papillomatosis with a fibroepithelial polyp of the vulva in a prepubertal girl and vaginal papillomatosis in her twin sister. Parents contacted pediatric urologist regarding their eight-year-old daughter (twin A), who had a growth next to the external urethral meatus. The girl was referred to a pediatric surgeon. The exophytic 3 cm long structure with necrosis on top was found. After obtaining informed consent from girl parents, pediatric surgeon removed the exophytic structure and perform cystoscopy and vaginoscopy for possible changes in the bladder and vagina. Cystoscopy findings were normal. On vaginoscopy, numerous macroscopic papillomatous structures were identified on the cervix and vaginal walls. Vaginal biopsies were performed on the areas affected by papillomatosis. Histopathologic examination showed a fibroepithelial polyp with a central fibrovascular core covered by squamous epithelium and vaginal squamous papillomatosis. The decision was made to perform vaginoscopy on her twin sister (twin B), too. On vaginoscopy, solitary small vaginal papillomas were also found. In this case manifestation of vaginal papillomatosis in twins might have been influenced by inheritance and the same bacterial and viral environment.

An autopsy case of unexpected death due to Addison’s disease caused by adrenal tuberculosis

Background Adrenal tuberculosis is difficult to diagnose due to non-specific symptom. Unexpected death due to adrenal insufficiency after trauma surgery is rare. Case presentation A 45-year-old man, who was admitted to hospital because of trauma to the right hand, died unexpectedly on the 13th day after replantation of amputated fingers. He was diagnosed with brain edema and diluted hyponatremia. Autopsy and histopathologic examination revealed severe brain edema combined with cerebellar tonsillar hernia, extensive destruction of adrenal gland caused by bilateral adrenal tuberculosis and right lung invasive pulmonary tuberculosis. Conclusions Trauma and pulmonary tuberculosis complicated with adrenal tuberculosis induced the adrenal crisis, which eventually lead to severe cerebral edema and hernia, and finally death from respiratory and circulatory failure. This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to diluted hyponatremia after trauma surgery.

Patterns and Utility of Calprotectin in Patients with Microscopic Colitis

Context Calprotectin is a cytoplasmic-protein that is released upon neutrophilic activation. Measuring fecal-calprotectin (FC) is used for monitoring inflammatory bowel disease activity and distinguishing it from irritable bowel syndrome. However, its utility in other types of colitis has not been well-investigated. Design Cases of collagenous-colitis (CC) and lymphocytic-colitis (LC) between 2015 and 2020 were retrieved from our institution surgical pathology database. Endoscopy and histopathologic examination findings were reviewed to confirm the diagnosis. 15 CC and 13 LC cases were included as FC was done at the time of initial diagnosis (before therapy). 62 cases of normal endoscopy and histopathologic examination were selected as a control group. One-way analysis of the variance (ANOVA) and receiver operating curve (ROC) analysis of FC were performed. Results Abnormally elevated FC (> 50 ug/g) was identified in 77% and 64% of CC and LC cases, respectively. Only 1.6% of control cases had mildly elevated FC of 54 ug/g. The mean FC of CC and LC groups (246 and 214, respectively) were significantly higher than the control group (22.4); p= <0.05. LC and CC groups had no statistically significant difference in the mean FC (p = 0.8). The area under the curve was 0.93 with ROC analysis. At the suggested cut-off of 50 ug/g, the sensitivity was 78.6%, specificity was 98.4% with a likelihood ratio of 48.7. Conclusions Fecal calprotectin can be elevated in patients with lymphocytic or collagenous colitis, however with no statistically significant difference between the two types. Therefore, it has the potential to be used as a marker for screening, diagnosis, and monitoring response to therapy in patients with microscopic colitis.

Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study of Fifty Cases

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder.

Prenatal diagnosis of feta noncompaction cardiomyopathy with de novo CALM2 mutation

We report what apprears to be the first case of fetal noncompaction cardiomyopathy in both ventricles accompanied by a mutation in the calmodulin gene (CALM2): A 25-year-old woman was referred to our hospital at 25+1 weeks of gestation for evaluation of fetal defects. A postnatal echocardiography showed biventricular noncompaction cardiomyopathy. After terminated the pregnancy, fetal noncompaction cardiomyopathy was comfirmed by autopsy and histopathologic examination. And the whole-exome sequencing of genomic DNA demonstrated a de novo heterozygous mutation (c.389A>G;p.D130G) in CALM2, whereas the parents were normal. In this case report, we highlight the gene mutation in noncompaction cardiomyopathy.

Nodular fasciitis on the arm

A 20-year old female with no trauma history presented to our department of dermatology with a 6-month history of a painful tumor of the arm. Physical examination revealed a 5-cm hard-elastic and friable tumor, which were movable and unattached to the underlying tissues. Surgical excision of the tumor was performed. Histopathologic examination concluded to nodular fasciits. Nodular fasciitis is a benign pseudosarcomatous tumour composed of a vascular and fibroblastic proliferation. Surgical excision is the gold standard treatment and recurrence is rare.

Primary bladder amyloidosis mimicking bladder cancer complicated by bladder rupture: A case report

Primary bladder amyloidosis is a rare pathological finding. The clinical importance of this finding is that it may clinically mimic bladder cancer. The only accurate diagnostic method available till now is the histopathologic examination of tissue samples usually obtained through transurethral resection.