A case report of renal calyceal diverticulum with hypertension in children and review of literature

Background Renal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment. Case presentation Physical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up. Conclusion There exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.

Evaluation of PGP 9.5, NGFR, TGFβ1, FGFR1, MMP-2, AT2R2, SHH, and TUNEL in Primary Obstructive Megaureter Tissue

Primary obstructive megaureter (POM) morphogenesis is not fully known. The aim of the study was to evaluate the appearance of different factors that might take part in the pathogenesis of POM. Megaureter tissues of 14 children were stained with hematoxylin and eosin as well as with immunohistochemistry for protein gene product 9.5, nerve growth factor receptor, transforming growth factor beta 1 (TGFβ1), fibroblast growth factor receptor 1 (FGFR1), matrix metalloproteinase 2 (MMP-2), angiotensin 2 receptor type 2, and sonic hedgehog (SHH) protein. Apoptosis was detected by terminal dUTP nick-end labeling reaction. POM tissues revealed transitional epithelium with scattered vacuolization, submucosa with inflammatory cells, and focally vacuolized and chaotically organized muscle layers. Apoptosis, appearance of MMP-2, FGFR1, and SHH prevailed, but TGFβ1 positive cell number was lower in patients. Correlation between MMP-2 in epithelium and endothelium, FGFR1 and MMP-2 in epithelium, and TGFβ1 in epithelium and connective tissue in patients was detected. POM morphopathogenesis involves an apoptotic cell death of epithelium and smooth muscle as well as tissue degradation in epithelium and connective tissue of the ureter wall. The decrease of tissue growth through diminished TGFβ1 expression and stimulation of FGFR1 and MMP-2 suggests a disbalance of tissue remodelation in the megaureter wall:

Histological Origin and Clinicopathological Analysis of Primary Ovarian Neuroendocrine Neoplasms

Purpose To investigate the histological origin and clinical and pathological features of primary ovarian neuroendocrine neoplasms. Methods We retrospectively analyzed nine cases of ovarian neuroendocrine neoplasms diagnosed at our hospital from January 2009 to January 2021. Results The mean age of the nine patients was 44.9 ± 15.2 years (range, 28–68 years). Six cases manifested ovarian carcinoid cancer, and the pathological types were insular and trabecular carcinoid; microscopic observation showed that the carcinoid components were limited and that stromal reaction was slight. Four cases showed teratomas, with the carcinoid components not displaying adjacent mucinous glands; and the other cases exhibited carcinoid cancer as the only tumor component, without adjacent or migratory epithelial components. The six patients were followed up for 76.6 ± 41.2 (6–123) months after resection, without disease. Two cases manifested adenocarcinoma admixed with neuroendocrine carcinoma, and the intermigration of neuroendocrine carcinoma and adenocarcinoma components could be observed; and one case was an isolated small cell neuroendocrine carcinoma with no epithelial proximity or migration observed. Adenocarcinoma admixed with neuroendocrine carcinoma and small-cell neuroendocrine carcinoma exhibited an obviously promoted interstitial reaction and damaging infiltration: these three patients underwent radical surgery supplemented by postoperative radiotherapy and chemotherapy, and follow-up lasted 34.6 ± 24.2 (7–52) months; two patients died and one showed recurrence. Conclusions Ovarian neuroendocrine neoplasms may reflect multiple tissue origins, carcinoid and simple neuroendocrine neoplasms with no adjacent, transitional epithelium, and may originate from original/transformed neuroendocrine cells or stem cells of the ovarian stroma. In addition, the adenocarcinoma admixed with neuroendocrine carcinoma may originate from dedifferentiated epithelium. The prognosis with carcinoid cancer is favorable, while the prognosis for neuroendocrine carcinoma is poor.

Solid Cell Nests Hyperplasia (Ultimobranchial Body Remnants) of the Thyroid: A Pitfall

Introduction/Objective Solid cell nests (SCN) are small epithelial cell nests interspersed within thyroid parenchyma, resembling squamous/transitional epithelium. SCNs, which are ultimobranchial remnants, are popularly considered pluripotent stem-cells responsible for developing follicular and C-cells. While SCNs are not an uncommon incidental findings in thyroid, solid cell nest hyperplasia is rare. SCNs are often mistaken for benign entities such as C-cell hyperplasia (CCH) or malignant lesions such as papillary thyroid carcinoma (PTC), metastatic squamous cell carcinoma, or medullary thyroid microcarcinoma (MTC). Methods/Case Report To reiterate this diagnostic dilemma, we present a case of a 57-year-old male with a six-year history of Hashimoto thyroiditis and multiple bilateral thyroid nodules. Ultrasonography revealed two nodules, one in each lobe, measuring 2.0x1.9x1.8cm(right) and 1.6x1.5x1.5cm(left). Both were solid, hypoechoic nodules with smooth margins and no echogenic foci. Fine-needle aspiration of right nodule was suspicious for follicular neoplasm, Hürthle- cell type, and the left nodule was atypia of unknown significance. Right-hemithyroidectomy specimen revealed follicular adenoma and oncocytic adenomatous nodules in a background of florid lymphocytic thyroiditis (Hashimoto). In two blocks, small solid nests of cells were identified, largest focus measuring 0.5 cm. The cells were polygonal to epithelioid with moderate amphophilic cytoplasm. Nuclei were centrally located, irregular to oval with occasional grooves. While nests had a squamoid appearance, they did not have intercellular bridges. Although nuclear grooves and evenly dispersed chromatin and chromocenters were noted, they lacked optical clearing or intra-nuclear inclusions characteristic for PTC. Thus, excluding these two possibilities, primary diagnostic considerations were SCN versus CCH. Immunohistochemical analysis showed cells positive for P63 and CK5/6 and negative for PAX-8, TTF-1, thyroglobulin, CEA, and calcitonin. Results (if a Case Study enter NA) NA Conclusion If wrongly diagnosed as CCH, patients may be placed in a high-risk category for possible development of MTC. It is, thus, necessary to be aware of SCN, which can occasionally become hyperplastic, to prevent misdiagnosis.

Experimental study on the proliferating activity and differentiation of renal stem cells in superinvasive opisthorchiasis

AIM: This study aimed to identify the replication potential of the kidneys in different forms of opisthorchiasis in laboratory animals. MATERIALS AND METHODS: An experiment was conducted on 60 Syrian male hamsters. The first group was set as the control (n = 10), the second group (n = 25) was infected with metacercariae (Opisthorchis felineus), and the third group (n = 25) was a model of a superinvasive form of opisthorchiasis infection with 50 O. felineus larvae and repeated infection with 50 metacercariae in 14 and 25 days. The hamsters were withdrawn from the experiment on days 7, 15, and 30 via an overdose of narcosis and decapitation. The kidneys were isolated and histologically examined through histochemical and immunohistochemical staining methods. Microscopy was conducted, and results were statistically analyzed. RESULTS: The quantitative characteristics, proliferation tendencies, and differentiation of regional stem cells were identified. In the cortical and medullary substance of the kidneys, CD117, Oct4, and CD34 markers were expressed, and CD31-positive stem cells further differentiated to progenitor cells. Epithelial structures developed in the form of tubules. In the glomeruli, vasculogenesis occurred, and the number of vascular loops increased. CONCLUSION: O. felineus secretome initiated the activation of stem cells in the renal tubules and pericytes of a microcirculatory network. The transitional epithelium of the renal pelvis and the initial parts of the ureter proliferated. Under the action of the secretome of parasites, stem cells proliferated directly in glomerular loops.

The Role p53 Protein Expression in Urothelial Neoplasm

The urinary bladder had a line with transitional epithelium. Urothelial neoplasms are the majority among the bladder neoplasms. Urothelial neoplasms were more common in males than in females. Urothelial neoplasms usually occur in the elderly age group. The majority of the tumor size was more significant than 3 cm, and papillary type is majorly found among the tumors. The present study aimed to identify the grade and staging of the p53 in urothelial neoplasms. The bladder carcinoma (54) cases from Department of Pathology, Sree Balaji Medical College and hospital (during September 2015 to September 2017) were analysed. The median age for bladder carcinoma in the present study was 66 years. The clinical parameter studied was the size of the lesion based on the cytoscopic or radiological findings (31- 33). Based on tumor size, lesions were classified into two groups, less than equal to 3cm and greater than 3cm, which was found to be 42% and 58%, respectively This study concludes that p53 is useful in differentiating benign and malignant neoplasms in morphologically difficult cases. Immunohistochemistry for p53 is useful adjunct to histomorphology.

A new heterotropic vascularized model of total urinary bladder transplantation in a rat model

This study developed a new procedure of urinary bladder transplantation on a rat model (n = 40). Heterotopic urinary bladder transplantation (n = 10) in the right groin vessels was performed. Direct urinary bladder examination, microangiography, histological analysis, and India ink injection were performed to evaluate the proposed method's functionality. Observation time was four weeks. One week after the procedure, the graft survival rate was 80%, two urinary bladders were lost due to anastomosis failure. The rest of the grafts survived two weeks without any complications. Lack of transitional epithelium or smooth muscle layer loss and lack of inflammatory process development were observed. This study was performed in order to obtain the necessary knowledge about urinary bladder transplantation. The proposed technique offers a new approach to the existing orthotropic models.

Epithelial expression of Gata4 and Sox2 regulates specification of the squamous–columnar junction via MAPK/ERK signaling in mice

The squamous–columnar junction (SCJ) is a boundary consisting of precisely positioned transitional epithelium between the squamous and columnar epithelium. Transitional epithelium is a hotspot for precancerous lesions, and is therefore clinically important; however, the origins and physiological properties of transitional epithelium have not been fully elucidated. Here, by using mouse genetics, lineage tracing, and organoid culture, we examine the development of the SCJ in the mouse stomach, and thus define the unique features of transitional epithelium. We find that two transcription factors, encoded by Sox2 and Gata4, specify primitive transitional epithelium into squamous and columnar epithelium. The proximal–distal segregation of Sox2 and Gata4 expression establishes the boundary of the unspecified transitional epithelium between committed squamous and columnar epithelium. Mechanistically, Gata4-mediated expression of the morphogen Fgf10 in the distal stomach and Sox2-mediated Fgfr2 expression in the proximal stomach induce the intermediate regional activation of MAPK/ERK, which prevents the differentiation of transitional epithelial cells within the SCJ boundary. Our results have implications for tissue regeneration and tumorigenesis, which are related to the SCJ.

STUDY OF ANTI-INFLAMMATORY EFFECT OF CONCENTRATED JUICE AND GRANULES FROM VACCINIUM OXYCOCCOS FRUITS ON THE MODEL OF BACTERIAL CYSTITIS IN RATS

The fruits of marsh cranberries due to the content of phenolic compounds, in particular proanthocyanidins, are effective in the prevention and treatment of cystitis [1]. The aim of the research was to study the anti-inflammatory properties of condensed juice of Vaccinium oxycoccos fruits and granules “Cranberry” in a model of acute bacterial cystitis in rats. Materials and methods. The anti-inflammatory properties of condensed juice from Vaccinium oxycoccos fruits and granules “Cranberry” were studied in a model of acute bacterial cystitis in rats, which was caused by three daily transurethral injection into the bladder of 0.3 ml of E. coli strain at a concentration of 106 CFU/ml. “Canefron® H” was used as a reference drug. Tissues were studied histologically by assessing the structure of the bladder wall and the condition of blood vessels. Results. Infection of animals with E. coli resulted in a significant increase in the desquamation of the transitional epithelium, edematous changes and narrowing of blood vessels in the tissues of the bladder wall. During treatment with the drug “Canefron® N” there was a decrease in cell infiltration and desquamation of cells, dilation of blood vessels. When animals used condensed juice from Vaccinium oxycoccos fruits and granules “Cranberry” in the histological picture of the walls of the bladder there was a decrease in desquamation, edema and cellular infiltration, the lumen of blood vessels was approaching normal. Conclusions. The use of condensed juice from Vaccinium oxycoccos fruits and granules “Cranberry” was accompanied by a positive effect on the tissues of the walls and blood vessels of the bladder of rats (there was a decrease in desquamation of the superficial layers of the transitional epithelium and normalization of the histological picture of vascular entanglement, that was not inferior to the comparison drug “Canefron® N”.

Nephrogenic Adenoma of the Urinary Bladder after Kidney Transplantation: Long-Term Follow-Up

Nephrogenic adenoma is a rare lesion that consists of epithelial cells arranged in tubular form, resembling tubules in the renal medulla, and is found usually in the urinary bladder although it can occur anywhere in the transitional epithelium of the lower urinary tract. The first case of nephrogenic adenoma of the urinary bladder was reported before the first kidney transplantation, and the lesion has been reported in patients with and without renal transplantation. The origin of cells in nephrogenic adenoma is debated and has been postulated to arise from cells of embryonic origin or from metaplasia secondary to chronic irritation or from implantation of allograft cells in patients with kidney transplantation. The long-term outcome and potential to convert into malignancy are not established, and therefore, there are no recommendations on how to follow up these patients. We present a case of a patient who was found to have nephrogenic adenoma of the urinary bladder during his second kidney transplantation from a cadaveric donor. He had undergone living donor kidney transplantation previously which subsequently failed. The patient did not manifest any symptoms of nephrogenic adenoma. During a follow-up period of 5 years, he has not manifested any symptoms related to nephrogenic metaplasia. Histopathological examination 5 years after the second transplantation did not show any malignant change. It can be concluded that nephrogenic adenoma is likely to behave in benign fashion post kidney transplantation.