1/17. Fine needle aspiration cytology of mammary duct ectasia: report of a case with novel cytologic and immunocytochemical findings.BACKGROUND: Mammary duct ectasia (MDE), or periductal mastitis, is a well-defined clinical entity with a characteristic histopathologic appearance on breast biopsy specimens. However, the cytologic features of MDE have been described only recently in the cytopathology literature, and fine needle aspiration (FNA) cytologic findings are based mainly on a small number of case reports in the English-language literature. Therefore, awareness of this entity and recognition of its cytomorphologic features could aid in a more accurate diagnosis. We report the novel cytologic and immunocytochemical findings on a case of MDE that was confirmed by histologic examination on a subsequent biopsy. CASE: We report the findings of breast FNA cytology in a 50-year-old female with a mammographically and clinically suspicious lesion. Cytology displayed a paucicellular aspirate, typified by a few scattered, cohesive clusters of ductal epithelial cells with mild nuclear atypia and distinct, peripherally located myoepithelial cells. Intermingled within the ductal elements were numerous polygonal cells with abundant, finely vacuolated cytoplasm that were immunoreactive for macrophage-specific antibody, CD68. The background consisted of a variable number of foam cells and negligible amount of blood. CONCLUSION: The current case of MDE demonstrates cytomorphologic features that may pose diagnostic problems, particularly as a consequence of variable cytologic atypia this entity may present on FNA cytology. This diagnostic difficulty is compounded because of the abnormal mammographic and suspicious clinical findings that may be associated with MDE. CD68 immunoreactivity is a useful ancillary tool to verify the histiocytic, rather than epithelial and potentially neoplastic, nature of multivacuolated cells. To the best of our knowledge, there has been no prior reported case of MDE in the English-language literature studied utilizing CD68 antibody. This case report emphasizes that MDE is a heterogeneous entity with diverse cytomorphologic features. FNA cytology in conjunction with immunocytochemistry might permit accurate classification in the proper clinical setting.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/17. Spontaneous flow of bile through the human pancreatic duct in the absence of pancreatitis: nature's human experiment.One hundred years ago E. L. Opie proposed two distinct hypotheses to address the pathogenesis of gallstone-induced pancreatitis. These hypotheses appear mutually exclusive. The first predicts that impediment to the flow of pancreatic juice causes pancreatitis (the pancreatic duct obstruction hypothesis), whereas the second predicts that bile flow into the pancreatic duct behind an impacted gallstone would trigger the onset of acute pancreatitis (the common-channel hypothesis). One of the more convincing arguments against the latter hypothesis is the observation that bile, when experimentally perfused through the pancreatic duct of dogs, does not induce pancreatitis. This experimental situation had spontaneously developed in the patient we describe here: a biliopancreatic fistula had permitted the continuous flow of bile through a large portion of the pancreas, which was associated with cholangitis but had apparently never led to pancreatitis. This patient's case would suggest that in humans, just as in experimental animals, bile flow through the pancreatic duct is not necessarily involved in the onset of gallstone-induced pancreatitis and lends further support to Opie's pancreatic duct obstruction hypothesis.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
3/17. Massive multicystic dilatation of the uterine wall with myometrial venous thrombosis during pregnancy.We present a pregnancy complicated by multicystic dilatation of the uterine wall during the second trimester, leading to massive uterine distension, anemia and preterm cesarean section. The cystic changes detected by ultrasound and magnetic resonance imaging involved the whole uterine wall surrounding the entire amniotic cavity. Histopathological examination revealed the benign nature of the cystic changes, which represented dilated and thrombosed venous lacunae. Disturbed venous drainage, combined with local thrombosis, was likely to have led to the collection of a large volume of blood in the uterine wall and the subsequent multicystic change of the myometrium.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/17. True aneurysms in a saphenous vein graft placed for repair of a popliteal aneurysm: etiologic considerations.Although vein graft aneurysms have been described to be atherosclerotic in nature, it has been hypothesized that vein graft aneurysms may be a part of a systemic dilating process. In the case reported here, histopathologic examination of vein graft aneurysms demonstrates aneurysmal degeneration with no atherosclerotic changes and do support the hypothesis that vein graft aneurysms may be a manifestation of a systemic dilating process.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/17. Preoperatively undiagnosable intrahepatic bile duct dilatation contains early-stage intrahepatic cholangiocarcinoma.Intrahepatic bile duct dilatation is a clue to indicating the presence of IHCC. Moreover it is still often difficult to find IHCC at an early stage in spite of recent progress in the area of molecular biological markers and imaging modalities. We had three interesting cases in which we were suspicious of the presence of IHCC. Preoperative imaging studies of these three cases showed the dilatation and stenosis of the intrahepatic bile duct without any apparent mass. As IHCC could not be ruled out, a hepatectomy was done for the purpose of both diagnosis and treatment of the patients. Postoperative diagnoses were IHCC in one, hepatolithiasis in another and chronic cholangitis in the third patient. A histological analysis revealed that the tumor of IHCC was not infiltrating the parenchyma of the liver with neither vascular nor lymphatic invasion, which suggested that it was an initial nature of the IHCC. In the case of intrahepatic bile duct dilatation and stenosis, which makes it hard to identify IHCC, surgical resection is crucial to make a definite diagnosis and prescribe the most effective course of treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/17. Hepatic sinusoidal ectasia.Oral contraceptive-associated sinusoidal ectasia is a rare lesion of unknown pathogenesis. We describe the case of a 31-year-old woman who had used oral contraceptives for 10 years and was found to have abnormal liver function tests on "routine" examination. A single 9 x 5 x 4 cm hypervascular lesion was demonstrated radiographically. The hepatic immuno-diacetic acid and liver-spleen scans were normal. One subcapsular lesion was identified in the resected right hepatic lobe; it was characterized by focal marked dilatation of the sinusoidal spaces associated with rare hepatocyte necrosis and early intrasinusoidal fibrosis. The subcapsular location and the vascular nature of this wedge-shaped lesion suggest it may represent the telangiectatic precursor of a centrally scarred focal nodular hyperplasia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/17. Giant coronary artery aneurysm in association with systemic arterial ectasia. A case report.Since the advent of coronary angiography, coronary artery aneurysm has been diagnosed with increased frequency. The etiology of coronary artery aneurysm is atherosclerosis in 50%, followed by other causes. In a 71-year-old man with previously documented abdominal aortic aneurysm of 6 cm diameter and ectasia of both left and right middle cerebral arteries, thoracic magnetic resonance imaging (MRI) demonstrated a large hollow para-cardiac mass (maximum diameter of 7 cm) lying in the anterior-lateral part of the atrio-ventricular sulcus. Coronary arteriography confirmed the aneurysmatic nature of the proximal tract of left anterior descending (LAD) artery lesion. Screening for laboratory signs of vasculitis was negative and other vascular and systemic diseases were excluded, suggesting an atherosclerotic aetiology of the aneurysm. In the absence of current cardiac symptoms, conservative management has been chosen and the patient is still well 2 years after presentation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/17. Chronic progressive and relapsing neuromyopathy with massive dilatations of endoplasmic reticulum in muscle fibers.Large intracytoplasmic inclusions arising from the endoplasmic reticulum and nuclear envelope were found in the muscle fibers of a 32-year-old individual with a life-long, chronic and progressive sensory-motor neuropathy. The morphological features of the inclusions were similar to that occasionally reported in the striated muscles in several unrelated conditions as well as to "hyaline" or "colloid" inclusions commonly seen in motor neurons of the brain stem and spinal cord. The chemical nature of the inclusions is not known. Their occurrence in the muscle fibers is probably secondary to chronic denervation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/17. Epithelial dysplasia in Caroli's disease.We report a young patient with a solitary intrahepatic cyst without demonstrable connection with the biliary tree. The operative appearances suggested hydatid disease but histological examination of the resected cyst showed that it was the result of Caroli's disease already complicated by severe dysplasia. This case provides further evidence for the premalignant nature of Caroli's disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/17. Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.Although contrast cholangiography has a greater accuracy than sonography in determining the precise nature of extrahepatic biliary obstruction, it is not without risk. High-resolution real-time sonography is frequently adequate to evaluate the extrahepatic biliary system in multiple planes without known risk to the patient. In a one-year period the authors prospectively observed eight instances of distal biliary obstruction with abrupt termination of the common bile duct, and all were associated with malignant obstruction. There was no instance of abrupt ductal termination secondary to benign disease in this series. Malignancy should be suspected when careful sonograms along the longitudinal axis of an obstructed distal common bile duct reveal an abrupt termination.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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