Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) from peritoneal lesions: a prospective cohort pilot study

Background Diagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC). Aim This pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions. Methods From March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes. Results A total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2–3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed. Conclusions EUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions.

Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy

Objective Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. Study Design Retrospective study. Setting A voice and swallowing clinic at a tertiary referral hospital. Methods We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. Results For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons’ estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. Conclusion Surgeons’ reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.

The Optimal Application of Medium Potency Topical Corticosteroids in Preventing Laser-Induced Inflammatory Responses—An Animal Study

Background: During ablative fractional resurfacing (AFR) laser therapy, thermal damage to the skin is inevitable, resulting in inflammatory responses and small wounds. Corticosteroids are known for their anti-inflammatory effect. However, inappropriate application of corticosteroids carries the risk of delayed wound healing. Therefore, we aimed to find the optimal administration route, timing, and duration of medium potency corticosteroid treatment to prevent AFR laser-induced inflammatory responses and to minimize the risk of delayed wound healing. Methods: We determined the anti-inflammatory efficacy of corticosteroids by skin erythema and tissue biopsies on C57BL/6 mice. Wound healing was evaluated by crust area and epithelial gap. Finally, Masson’s trichrome stain and α-SMA immunohistochemistry stain were used to analyze scar contracture. Results: Our results demonstrated that one dose of medium-potency topical corticosteroid applied immediately after AFR laser treatment could prevent erythema effectively with minimal disruption to wound healing. Notably, when more than one dose was administered, wound healing was delayed and scar contracture was aggravated by the application of medium-potency topical corticosteroids in a dosage-dependent manner. Conclusion: Our findings suggested that single-dose medium-potency topical corticosteroids could potentially improve AFR laser-induced acute inflammatory responses in clinical applications.

Quercetin Prevents Primordial Follicle Loss via Suppression of PI3K/Akt/Foxo3a Pathway Activation in Cyclophosphamide - Treated Mouse

Background: Chemotherapy improves survival rates but often causes some adverse effects associated with ovarian damage, characterized by a decreased of primordial follicle stockpiles. Recent studies reveal that chemotherapy may stimulate the PI3K signaling pathway, who has roles in manipulating the dormancy and activation of mammalian primordial follicles, resulting in accelerated primordial follicles activation followed by the loss of ovarian reserve. As an inhibitor of PI3K pathway, whether quercetin has protective properties against chemotherapy - induced follicle loss in mice is worth to be explored.Methods: The effects of quercetin on the mouse model of cyclophosphamide-induced ovarian dysfunction were investigated. Paraffin sections of mouse ovary were stained with hematoxylin and eosin for differential follicles count and TUNEL assay for apoptosis detection. Immunohistochemistry stain with ki67 and Foxo3a were used to evaluate the activation of primordial follicles. The function of PI3K signaling pathway were assessed via the western blot of ovary.Results: Quercetin cotreatment rescued the reduction number of dormant primordial follicles induced by cyclophosphamide. Moreover, analysis of the PI3K/Akt/Foxo3a pathway demonstrated that quercetin co - administration decreased phosphorylation of proteins that stimulate follicle activation in ovary induced by cyclophosphamide. Meanwhile, Quercetin prevents cyclophosphamide - induced apoptosis in early growing follicles and early antral follicles, maintaining AMH level secreted by these follicles, preserving the quiescence of the primordial follicle pool, characterized by the intranuclear staining of Foxo3a in primordial follicle. Conclusions: Quercetin attenuates cyclophosphamide - induced follicle loss by preventing the phosphorylation of PI3K/Akt/Foxo3a pathway members and maintaining AMH level secreted by growing follicles.

Quercetin Prevents Primordial Follicle Loss via Suppression of PI3K/Akt/Foxo3a Pathway Activation in Cyclophosphamide - Treated Mouse

Background: Chemotherapy improves survival rates but often causes some adverse effects associated with ovarian damage, characterized by a decreased of primordial follicle stockpiles. Recent studies reveal that chemotherapy may stimulate the PI3K signaling pathway, who has roles in manipulating the dormancy and activation of mammalian primordial follicles, resulting in accelerated primordial follicles activation followed by the loss of ovarian reserve. As an inhibitor of PI3K pathway, whether quercetin has protective properties against chemotherapy - induced follicle loss in mice is worth to be explored.Methods：The effects of quercetin on the mouse model of cyclophosphamide-induced ovarian dysfunction were investigated. Paraffin sections of mouse ovary were stained with hematoxylin and eosin for differential follicles count and TUNEL assay for apoptosis detection. Immunohistochemistry stain with ki67 and Foxo3a were used to evaluate the activation of primordial follicles. The function of PI3K signaling pathway were assessed via the western blot of ovary.Results: Quercetin cotreatment rescued the reduction number of dormant primordial follicles induced by cyclophosphamide. Moreover, analysis of the PI3K/Akt/Foxo3a pathway demonstrated that quercetin co - administration decreased phosphorylation of proteins that stimulate follicle activation in ovary induced by cyclophosphamide. Meanwhile, Quercetin prevents cyclophosphamide - induced apoptosis in early growing follicles and early antral follicles, maintaining AMH level secreted by these follicles, preserving the quiescence of the primordial follicle pool, characterized by the intranuclear staining of Foxo3a in primordial follicle. Conclusions: Quercetin attenuates cyclophosphamide - induced follicle loss by preventing the phosphorylation of PI3K/Akt/Foxo3a pathway members and maintaining AMH level secreted by growing follicles.

Histopathological features of multiorgan percutaneous tissue core biopsy in patients with COVID-19

AimsThe global outbreak of COVID-19 has resulted in an increased mortality. However, whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs is still unclear. In this study, postmortem percutaneous biopsies of multiple organs from deceased patients were performed to understand the histopathological changes caused by COVID-19.MethodsBiopsy specimens of pulmonary, cardiac, hepatic and lymphoid tissues were obtained from three patients, who died due to COVID-19 pneumonia. H&E stain, Masson trichrome stain, immunohistochemistry stain and in-situ hybridisation were used.ResultsPulmonary damages caused by SARS-CoV-2 infection was diffuse alveolar damage (DAD). In the early phase, the histological findings were mainly those of exudative features of DAD. The later phase was characterised by organisation of DAD combined with bacterial pneumonia. No serious damage was found in the bronchiolar epithelium and submucosal glands. The hepatic tissue revealed features of ischaemic necrosis, but findings suggestive of mild lobular hepatitis were also observed. The lymphoid tissue revealed features of non-specific acute lymphadenitis. The cardiac tissue revealed changes of underlying disease. SARS-CoV-2 RNAs were not detected in hepatocytes, cholangiocytes and lymphocytes of lymph nodes.ConclusionsCOVID-19 predominantly involves the pulmonary tissue, causes DAD and aggravates the cardiovascular disease. However, other extrapulmonary tissues did not reveal any virus-specific findings, but were affected by multiple factors. The findings in this report caution the pathologists that they should not mistakenly attribute all the histological features to CoV infection. Moreover, the clinicians should pay attention to the potentially injurious and correctable causes.

Exophytic primary gastric squamous cell carcinoma and H. pylori gastritis

Primary gastric squamous cell carcinoma (SCC) is rare, and the simultaneous Helicobacter pylori infection has not been reported in the literature. Here, we presented a patient with concurrent H. pylori gastritis and primary gastric SCC. A 54-year-old Hispanic man presented with diarrhoea, chills, night sweats and weight loss of 16 lbs for the previous 6 weeks. Abdominal CT revealed large exophytic mass from the stomach infiltrating multiple organs. Biopsy was performed and histology showed squamoid features. Immunohistochemistry stain was positive for p40, CK5/6, CK7 and Helicobacter type organisms. Patient was diagnosed with primary gastric SCC and has been receiving chemotherapy. We also reviewed the diagnosis, prognosis and treatment of primary gastric SCC.

Multiple Myeloma 1 Transcription Factor Is Superior to CD138 as a Marker of Plasma Cells in Endometrium

Chronic endometritis is characterized by plasma cell (PC) infiltration of endometrial stroma. Identification of PCs can be challenging by routine hematoxylin and eosin (H&E) stain due to the low numbers of PCs or to their being obscured by other cells in the stroma. CD138 is widely used as an ancillary immunohistochemistry stain to identify PCs; however, it has a high background reaction. In this study, multiple myeloma 1 (MUM1) transcription factor is introduced as an alternative PC marker in endometrial tissues. In this study, 311 endometrial biopsies, submitted to rule out chronic endometritis, were selected. They were divided into Group I (n = 87) and Group II (n = 224). Both had MUM1 and H&E while Group I also had accompanying CD138 stains. In both groups combined, MUM1 detected plasma cells in 48% of the cases, while CD138 and H&E identified the cells in 23% and 15% of the biopsies, respectively. In addition to having a clean background, MUM1 is a more sensitive stain than CD138 for detection of PCs in endometrium.