[Apoptosis in renal adenocarcinoma. Expression of bcl-2 in locally confined tumors]

INTRODUCTION AND OBJECTIVE

Bcl-2 is a proto-oncogene known to be a negative regulator of apoptosis, whose expression conferring prolonged cell survival and contributing to tumorigenesis. Inconsistent results concerning bcl-2 expression and the frequency of apoptosis were noted in renal cell carcinoma. To investigate a possible role of bcl-2 protein in renal cell carcinomas, we analyzed its expression and relationship with clinical and pathological parameters, including prognostic impact.

METHODS

58 patients diagnosed of renal cell carcinoma stage pT1, pT2 and pT3a N0 M0 (TNM 1997) were treated by radical or partial nephrectomy. We analyzed clinical and pathological parameters including bcl-2 expression in paraffin-embedded tumor samples using immunohistochemical technique.

RESULTS

Bcl-2 immunopositivity was detected in 44/58 of the samples in different grades of intensity. There was no correlation of nuclear grade, tumoral size, stage or recurrency with bcl-2 immunopositivity. Bcl-2 expression was not related to prognosis if we divided all cases into subgroups according of stain intensity.

CONCLUSIONS

Bcl-2 expression was not related with any pathological parameters; size, nuclear grade and stage or prognostic.

Aspiration cytology of 147 adnexal cysts with histologic correlation

OBJECTIVE

To assess the usefulness of cytology in the diagnosis of 147 histologically established adnexal cysts.

STUDY DESIGN

Retrospective, macro-microscopic study based on fluid aspirated from 132 ovarian and 15 extraovarian cysts and projected as a cytohistologic correlation.

RESULTS

Typical macroscopic features were identified in 76% of endometriotic cysts, in 53% of mucinous neoplasms and in 67% of dermoid cysts. Cytology helped to identify 67% of nonneoplastic and 56% of neoplastic cysts. The lowest diagnostic sensitivities were observed in functional cysts and benign serous neoplasms (50%), while the highest were shown by endometriotic cysts (76%) and malignant epithelial neoplasms (71%). Inadequate samples were obtained from all types of cysts, even malignant ones (two mucinous cystadenocarcinomas). Diagnostic cytology was useless in extraovarian cysts (33% sensitivity). An adult granulosa cell tumor was erroneously diagnosed as a follicular cyst by cytologic examination.

CONCLUSION

Examination of the cyst fluids obtained by aspiration demonstrated low sensitivity, with 43% of inadequate samples obtained from all types of cysts. Malignant cystic neoplasms may be overlooked in inadequate samples. Our study also revealed that specificity in this type of analysis is high in inadequate samples, provided that the technique is carried out correctly.

Does focal destruction of the thoracic aorta wall by Staphylococcus aureus lead to the development of infected aneurysms? An experimental study

OBJECTIVE

The infrequency of infected aneurysms suggests that either infection of segments of the aortic wall is uncommon, or that infections do not always lead top infected aneurysm formation. The purpose of the study was to determine whether focal Staphylococcus aureus infection of aortic wall segments leads consistently to the development of infected aneurysms and to evaluate the segments in which infection did not lead to the infected aneurysm formation.

METHODS

Twenty pigs were inoculated with 0.1 ml of a Staphylococcus aureus inoculum in three segments of the thoracic aorta wall (study group). In another 10 pigs, 0.1 ml of saline solution was injected in three segments of the thoracic aorta wall (control group).

STUDY GROUP

histological abnormalities and bacterial culture of the inoculation sites were evaluated at 10 days (n = 5 pigs), 30 days (n = 5 pigs), and 90 days (n = 10 pigs).

CONTROL GROUP

histological abnormalities were evaluated at 10 days (n = 5 pigs) and 90 days (n = 5 pigs).

RESULTS

STUDY GROUP

infected aneurysms developed in only two animals killed at 30 days. At 90 days, destruction of the elastic tissue, scar tissue and neointima formation were found in all the aortic segments studied.

CONTROL GROUP

no significant changes were found in any of the segments evaluated.

CONCLUSION

In our experimental model, acute local infection by S. aureus caused the development of infected aortic aneurysm in only 10% of the animals. In the remaining 90%, healing of the site of infection followed resolution of the infection.

Ethanol intake, plasma catecholamine levels, and ST-segment changes without myocardial injury in rats with short-term ethanol consumption

The authors studied the effect of short-term ethanol consumption on the ST-segment and the association between ST-segment changes and the amount of daily ethanol intake and levels of plasma catecholamines. The study used 63 rats (control group n = 20, study group n = 43). The rats in the study group were exposed for 6 days to progressively larger doses of ethanol followed by 15 days of continuous exposure to ethanol. At baseline an electrocardiogram (ECG) was recorded, and on day 25 the ECG was repeated and plasma catecholamine levels were measured. The animals' hearts were removed and processed for histologic study. Repolarization abnormalities were observed in 68% of the ethanol-consuming rats. Two factors differentiated the subgroup of ethanol-consuming rats with ST-segment changes from the subgroup without ST-segment changes: amount of daily ethanol intake (0.0077 +/- 0.02 mL/g/d vs 0.0058 +/- 0.019 mL/g/d) and plasma epinephrine levels (3,881 +/- 733 pg/mL vs 1,478 +/- 406 pg/mL). No myocardial damage was detected. Our results suggest that in ethanol-consuming rats, high-volume daily ethanol intake and increased plasma catecholamines may mediate changes in the ST-segment.

Solitary rectal ulcer syndrome in a child

We describe a 6-year-old boy with solitary rectal ulcer syndrome, and the sigmoidoscopic and histopathologic findings. The evolution of the histologic features and the absence of trauma suggest that the origin of the ulceration is ischemic in nature.

Cystic adenomatoid tumor of the uterus

We describe a case of cystic adenomatoid tumor of the uterus in a 38-year-old woman. The tumor was a subserosal cystic mass with a maximum diameter of 8 cm and located at the posterior wall of the right cornual region. Histologically, the tumor was composed of multiple cavities lined by flattened cells, lying among thin septa of connective tissue. The neoplasm showed small solid areas with a more typical histologic pattern of adenomatoid tumor. Immunohistochemical techniques showed the cells to be positive for keratins. They showed desmosomes, abundant intracytoplasmic filaments, and microvilli on ultrastructural study. The histologic, immunohistochemical, and ultrastructural characteristics of the present case closely resemble those of benign cystic mesothelioma and strongly support the mesothelial origin of the adenomatoid tumor of the uterus.

Nonimmunologic hydrops fetalis: an etiopathogenetic approach through the postmortem study of 59 patients

Aiming at increasing our understanding of the various causative factors of nonimmunologic hydrops fetalis (NIHF) and their pathogenetic mechanisms, we have reviewed 59 cases of this condition from a total number of 4,175 pediatric post-mortem studies performed at the Department of Pathology of the Hospital La Paz from 1967 to 1987. We found eight cases (13.5%) without clinical, biochemical, or post-mortem findings justifying the development of hydrops fetalis, seven cases (12%) associated with certain pathologic findings that by themselves do not explain the development of hydrops and, finally, 44 cases (74.5%) in whom pathological findings may explain the development of the condition. Notwithstanding the etiological diversity of this last group, in 31 of these cases (70%), some common pathogenetic features may be recognized, basically a failure of the right ventricle of the heart in the fetus or newborn, due to a primary heart condition, to intracardiac tumors, or to obstructive phenomena at the level of the right venous drainage. In our opinion, whenever NIHF is diagnosed or suspected, causes of right cardiovascular failure should be investigated, since about 50% of all cases seem to be due to this pathogenetic mechanism.

Complete atrioventricular canal. Anatomic study and presentation of a new technique for total correction

A new surgical technique for total correction of complete common atrioventricular canal was evolved from study of 34 specimens from affected infants who had died in the first year of life. An interventricular patch was fashioned to reconstruct the interventricular septum and the atrioventricular valves. The patch had two distinct components, one superior or atrial and the other inferior or ventricular. The division was made by inserting a lateral support at different levels on either face of the patch, to which the anterior and posterior atrioventricular cusps were sutured. The interatrial defect was closed with a patch that, together with the atrial component of the interventricular patch, produced a foramen ovale type closure mechanism. The authors present the pathologic observations which served as a basis for development of the surgical technique.

[Incomplete Digeorge syndrome (author's transl)]

A newborn with multiple malformations, recurrent infections and hypocalcemic tetany is presented. The malformations included: Facial asymmetry, micrognathia, epicantus, low set nose, peculiar ears, club-feet and heart disease. The immunologic work-up disclosed a cellular immunodeficiency, but normal humoral immunity, and a diagnosis of "incomplete DiGeorge syndrome" was made. No thymus, nor parathyroid glands were found at autopsy. The disagreement between the analytical data and the pathological findings of "complete DiGeorge syndrome" are discussed. The existence of vestigial ectopic thymus not found in the dissected organs is considered the most likely hypothesis. Finally some considerations are made about a possible role of the rubeola virus on its etiology and the actual therapeutic possibilities.