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Δευτέρα 3 Μαΐου 2021

Pediatric follicular bronchiolitis with severe atelectasis: a case report

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):526-532. eCollection 2021.

ABSTRACT

Follicular bronchiolitis is a rare pulmonary disorder characterized by the presence of multiple hyperplastic lymphoid follicles with a peribronchiolar distribution. An 11-year-old girl with total atelectasis of the right middle lobe (RML) and diffuse multiple small nodules at both lung bases presented to our hospital with frequent upper respiratory infections and pneumonia. The disease progressed during a 3-month period of macrolide therapy, and thoracoscopic biopsy with lobectomy of the atelectatic RML was performed. The histopathologic diagnosis was follicular bronchiolitis. The patient's pulmonary function improved dramatically after oral steroid treatment. It can be difficult to diagnose follicular bronchiolitis based solely on clinical, laboratory, and radiologic findings; the disorder must be confirmed histopathologically. A patient with longstanding irr eversible atelectasis and resulting recurrent respiratory infection may require lobectomy for the diagnosis and treatment of follicular bronchiolitis.

PMID:33936377 | PMC:PMC8085817

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EphA2 as a new target for breast cancer and its potential clinical application

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):484-492. eCollection 2021.

ABSTRACT

PURPOSE: The aim of this research was to study the expression of EphA2 to assess its suitability as a new breast cancer target.

METHODS: Immunohistochemistry (IHC) was used to detect EphA2 protein expression in pathology tissue samples from 250 cases of breast cancer, and the expression of EphA2 mRNA was detected by in situ hybridization (ISH). Breast cancer cells were isolated and cultured. The expression of EphA2 in the cells was detected by the indirect immunofluorescence assay (IFA), and the expression of EphA2 in breast cancer was analysed.

RESULTS: EphA2 protein and mRNA were mainly expressed in tumor cells and vascular endothelial cells. EphA2 protein was expressed in 187 cases, with a positive rate of 74.80%, whereas EphA2 mRNA was expressed in 209 cases, with a positive rate of 83.60%. EphA2 protein and mRNA expression were correlated with lymph node metastasis, clinical stage, and breast cancer histologic grade (P<0.05). In addition, the positive expression rates of EphA2 protein and EphA2 mRNA were correlated (P<0.05). EphA2 was barely expressed in normal breast cells but highly expressed in breast cancer cells.

CONCLUSION: EphA2 is highly expressed in breast cancer tissues and has the potential to be a new breast cancer target, providing a preliminary basis for the development of new targeted drugs for breast cancer and the construction of fluorescent-targeted tracers for fluorescence-guided mastoscopic breast-conserving surgery.

PMID:33936371 | PMC:PMC8085825

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Castleman's disease of the left parotid gland: a case report

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):533-537. eCollection 2021.

ABSTRACT

Castleman's disease is a very rare heterogeneous group of lymphoproliferative disorders characterized by non-neoplastic growths. It is unknown about the pathophysiology of the Castleman's disease. Previous studies demonstrated that Castleman's disease can be divided into two groups according to clinical classification, including unicentric Castleman disease (UCD) and multicentric Castleman disease (MCD). The hyaline vascular type is most common in the head and neck, and is abbreviated as UCD. In the present case, a woman complained that a mass in her parotid gland was growing and it was painless seven months ago. The computed tomography (CT) showed that the superficial lobe of the parotid gland on the left had an elliptical soft tissue density shadow, about 2.5×3.5 cm, with clear boundaries and no obvious abnormalities in the surrounding bone. The CT scan sho wed no obvious abnormalities in the shape and density of the right parotid and bilateral submandibular glands. After the operation, combined with the results of immunohistochemistry, the final diagnosis was Castleman tumor. The patient recovered smoothly, after the operation and during follow-up. The patient maintained good health without recurrence or metastasis.

PMID:33936378 | PMC:PMC8085830

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Reduced circulating exosomal miR-382 predicts unfavorable outcome in non-small cell lung cancer

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):469-474. eCollection 2021.

ABSTRACT

Circulating microRNAs (miRNAs) have been demonstrated as robust and promising biomarkers for non-small cell lung cancer (NSCLC). Our aim was to determine the significance of serum exosomal miR-382 in NSCLC. Circulating exosomes were collected from 126 patients with NSCLC and 60 normal controls before treatment and one month after surgery. The circulating exosomal miR-382 expression was measured with quantitative RT-PCR (qRT-PCR) in all the participants. Our findings demonstrated that circulating exosomal miR-382 was very reduced in NSCLC. In addition, it showed high accuracy for discriminating NSCLC patients from healthy subjects. Interestingly, serum exosomal miR-382 improved the diagnostic accuracy of carcinoembryonic antigen (CEA). Moreover, its level increased significantly one month following surgical resection. Reduced circulating exosomal miR-382 was po sitively associated with poor clinical variables. NSCLC cases with lower serum exosomal miR-382 suffered worse overall survival (OS) and serum exosomal miR-382 was independently associated with OS. Taken together, circulating exosomal miR-382 is a robust biomarker for evaluating the progression of NSCLC.

PMID:33936369 | PMC:PMC8085833

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Giant osteochondroma of ilium: a case report and literature review

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):538-544. eCollection 2021.

ABSTRACT

Osteochondroma is one of the most common benign bone tumors. It usually grows on the metaphysis of long bones and rarely develops in bones of scapula, feet, hands, and pelvis. The management of this disease is en-bloc excision of the tumor. We present a 45-year-old female subject, who complained of having found a mass on the right hip for more than 20 years which was diagnosed to be osteochondroma on X-ray, computed tomography (CT) and 3-dimensional (3-D) reconstruction. We performed en-bloc excision for the patient. Pathologic examination of surgical specimen confirmed the diagnosis of osteochondroma. The patient made a complete recovery and there has been no recurrence after one year of follow-up. Osteochondroma usually represents an osteo-cartilaginous aberrant overgrowth of normal epiphyseal growth plates. The disease has a slow onset and a long history. X -rays and CT scans are sufficient for diagnosis before surgery and the final diagnosis should based on pathology. Differential diagnosis includes chondrosarcoma or other neoplasms. When osteochondroma causes pain, compression of peripheral nerves, or continuous growth and other clinical symptoms, en-bloc excision of the tumor is needed. Better recognition and more comprehensive evaluation of these rare cases should be highlighted to avoid misdiagnosis during our clinical practice.

PMID:33936379 | PMC:PMC8085818

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Relationship between histologic changes and inflammatory markers in chronic rhinosinusitis

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Int J Clin Exp Pathol. 2021 Apr 15;14(4):501-507. eCollection 2021.

ABSTRACT

The present study aimed to elucidate the relationship between histologic changes and inflammatory markers in chronic rhinosinusitis (CRS). Inflammatory markers of CRS, including eosinophil and neutrophil counts, the eosinophil-to-lymphocyte ratio, and the neutrophil-to-lymphocyte ratio, were investigated in tissues and peripheral blood. Inflammatory markers were evaluated according to the histologic changes of stromal edema, stromal fibrosis, and basement membrane (BM) thickening. Among 92 patients with CRS who underwent pathologic examinations, stromal edema, stromal fibrosis, and BM thickening were identified in 84.8%, 25.0%, and 53.3% of patients, respectively. Stromal edema and BM thickening were observed more frequently in CRS with nasal polyps than in CRS without nasal polyps (P = 0.001 and P = 0.001, respectively). Tissue inflammatory mark ers differed according to the presence of histologic changes in tissues. In peripheral blood, however, only the eosinophil count differed according to BM thickening. Patients with two or more histologic changes had higher tissue eosinophil-to-lymphocyte ratios (P = 0.008) and eosinophil counts (P = 0.002) compared with subjects with no or one histologic change. Conversely, the tissue neutrophil-to-lymphocyte ratio and neutrophil count were higher in patients with no or one histologic change than in patients with two or more changes. Collectively, tissue inflammatory markers may be correlated with histologic changes in CRS. However, serum inflammatory markers have a limited ability to predict histologic changes in patients with CRS.

PMID:33936373 | PMC:PMC8085832

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Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas

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Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06819-0. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to assess the prognostic capacity of the nodal yield in elective neck dissections performed in patients with head and neck squamous cell carcinomas (HNSCC) without clinical or radiological evidence of regional involvement (cN0) at the time of diagnosis.

METHODS: Retrospective study including 647 patients with HNSCC treated with an elective neck dissection.

RESULTS: Patients with < 15 dissected nodes (n = 172, 26.6%) had a 5-year disease-specific survival of 64.9% (95% CI: 57.3-72.5%), while for patients with ≥ 15 dissected nodes (n = 475, 73.4%), it was of 81.9% (95% CI: 78.4-85.4%) (P = 0.0001). The nodal yield category had prognostic capacity on the disease-specific survival in patients with tumors located in the oral cavity (P = 0.001), the oropharynx (P = 0.023) and the hyp opharynx (P = 0.034), while for patients with tumors located in the larynx, no significant differences appeared (P = 0.779). Differences in regional recurrence-free survival were also observed based on the nodal yield category in patients with extra-laryngeal tumors (5-year regional recurrence-free survival of 81.0% in patients with < 15 dissected nodes vs 89.0% in patients with ≥ 15 dissected nodes; P = 0.046).

CONCLUSION: The nodal yield in elective neck dissections in patients without evidence of lymph node disease (cN0) had prognostic capacity depending on the location of the primary tumor. For tumors located in the larynx, the number of dissected nodes did not significantly influence the prognosis. For tumors located in the oral cavity, oropharynx or hypopharynx, patients with < 15 dissected nodes had a disease-specific mortality 2.9 times higher than patients with ≥ 15 dissected nodes.

PMID:33938992 | DOI:10.1007/s00405-021-06819-0

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Lasers in endoscopic middle ear surgery: where do we stand today?

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Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06807-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery.

METHODS: Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded.

RESULTS: Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with mini mal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications.

CONCLUSION: Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue.

PMID:33938993 | DOI:10.1007/s00405-021-06807-4

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Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing

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10-1055-s-0041-1727148_200140ov-1.jpg

J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1727148

Tuberculum sellae meningiomas pose significant challenges because they are surrounded by crucial neurovascular structures, such as the optic and oculomotor nerves, pituitary stalk, internal carotid artery and its branches, and the anterior cerebral arteries. Even if small, such meningiomas frequently extend to the optic canal that is considered a poor prognostic factor for vision. In this video clip, we illustrate the case of a 60-year-old female who had an approximately 3-cm tuberculum sellae meningioma with optic canal involvement. She underwent surgical resection of the tumor through a pterional approach. After extradural optic canal unroofing, detaching, devascula rizing, and debulking the tumor, careful dissection of the meningioma from the surrounding tissues was performed. Next, the tumor extensions into both of the optic canals were removed. Finally, coagulation and resection of the tumor origin on the dura of the tuberculum sellae following Simpson's grade-I resection were performed. Histopathology revealed that the tumor was a World Health Organization (WHO) grade-I meningioma. The patient had an uneventful postoperative course and her visual acuity was preserved, with no visual field defect on postoperative visual examination. In this video, the basic surgical techniques in performing extradural optic canal unroofing, preserving the arachnoid plane, and stay in collect layer, which is the essential technique for dissecting meningiomas and for preserving neurovascular structures, are demonstrated.The link to the video can be found at: https://youtu.be/vD54Iji0C4Q.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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Extended Endoscopic Endonasal Approach for a Giant Parasellar Epidermoid Cyst

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10-1055-s-0041-1727127_200083ov-1.jpg

J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1727127

Epidermoid cysts are rare lesions which typically grow slowly. For this reason, these lesions are usually discovered when they are already very large. The parasellar location is no exception to this rule and may involve the cavernous sinus or the Meckel cave.We present a 34-year-old female patient without past medical history who was admitted in our tertiary referral center for episodes of diplopia in the right lateral gaze and right trigeminal dysesthesias. Brain magnetic resonance imaging (MRI) showed a large right parasellar mass with mixed intensity signal on the T1 and T2 sequences, without contrast enhancement and a typical hypersignal intensity on diffusion-wei ghted sequences evoking an epidermoid cyst. We discuss the radiologic criteria which differentiate the lesions originating in the cavernous sinus from those of the Meckel cave (Figs. 1 and 2).Parasellar tumors may be approached through classical transcranial approaches such the epidural temporopolar or the subtemporal approach which involve a significant degree of brain retraction. The last decade witnessed the advent of extended endonasal approaches which offer an interesting alternative and avoid the manipulation of the brain. We used the endoscopic transpterygoid approach in our patient and we were able to achieve an excellent clinical and radiological result. We discuss the nuances of the technique and present the surgical steps of the procedure (Figs. 3 and 4).The endoscopic endonasal approach represents an excellent therapeutic option for parasellar lesions. A thorough knowledge of the anatomy and experience with endoscopic techniques are obvious prerequisite.The link to the v ideo can be found at: https://youtu.be/QonSvHrCwOU.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video

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10-1055-s-0041-1727125_200074ov-1.jpg

J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1727125

Tumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, w e present a brief anatomical–surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions (Figs. 1 and 2).The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table o f contents  |  Abstract  |  open access Full text

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