Journal of Pathology and Translational Medicine

Original Articles

Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy: Myung-Jin Cha, Jeong-Wook Seo, Seil Oh, Eun-Ah Park, Sang-Han Lee, Moon Young Kim, Jae-Young Park; J Pathol Transl Med. 2020;54(5):396-410. Published online July 29, 2020; DOI: https://doi.org/10.4132/jptm.2020.06.10

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Background
The definitive pathologic diagnosis of cardiac sarcoidosis requires observation of a granuloma in the myocardial tissue. It is common, however, to receive a “negative” report for a clinically probable case. We would like to advise pathologists and clinicians on how to interpret “negative” biopsies.
Methods
Our study samples were 27 endomyocardial biopsies from 25 patients, three cardiac transplantation and an autopsied heart with suspected cardiac sarcoidosis. Pathologic, radiologic, and clinical features were compared.
Results
The presence of micro-granulomas or increased histiocytic infiltration was always (6/6 or 100%) associated with fatty infiltration and confluent fibrosis, and they showed radiological features of sarcoidosis. Three of five cases (60%) with fatty change and confluent fibrosis were probable for cardiac sarcoidosis on radiology. When either confluent fibrosis or fatty change was present, one-third (3/9) were radiologically probable for cardiac sarcoidosis. We interpreted cases with micro-granuloma as positive for cardiac sarcoidosis (five of 25, 20%). Cases with both confluent fibrosis and fatty change were interpreted as probable for cardiac sarcoidosis (seven of 25, 28%). Another 13 cases, including eight cases with either confluent fibrosis or fatty change, were interpreted as low probability based on endomyocardial biopsy.
Conclusions
The presence of micro-granuloma could be an evidence for positive diagnosis of cardiac sarcoidosis. Presence of both confluent fibrosis and fatty change is necessary for probable cardiac sarcoidosis in the absence of granuloma. Either of confluent fibrosis or fatty change may be an indirect pathological evidence but they are interpreted as nonspecific findings.

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Advances in cellular and tissue-based imaging techniques for sarcoid granulomas
Junwoo Kim, Girish Dwivedi, Berin A. Boughton, Ankur Sharma, Silvia Lee
American Journal of Physiology-Cell Physiology.2024; 326(1): C10. CrossRef
Lipomatous Metaplasia Is Associated With Ventricular Tachycardia Recurrence Following Ablation in Patients With Nonischemic Cardiomyopathy
Lingyu Xu, Mirmilad Khoshknab, Juwann Moss, Ronald D. Berger, Jonathan Chrispin, David Callans, Francis E. Marchlinski, Stefan L. Zimmerman, Yuchi Han, Natalia Trayanova, Benoit Desjardins, Saman Nazarian
JACC: Clinical Electrophysiology.2024; 10(6): 1135. CrossRef
Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis
Jukka Lehtonen, Valtteri Uusitalo, Pauli Pöyhönen, Mikko I Mäyränpää, Markku Kupari
European Heart Journal.2023; 44(17): 1495. CrossRef
Cardiac sarcoidosis: a comprehensive review of risk factors, pathogenesis, diagnosis, clinical manifestations, and treatment strategies
Hussain Haider Shah, Syeda Alishah Zehra, Aliza Shahrukh, Radeyah Waseem, Tooba Hussain, Muhammad Sheheryar Hussain, Fareeha Batool, Muhammad Jaffer
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis
Shu Kato, Yasuhiro Sakai, Asako Okabe, Yoshiaki Kawashima, Kazuhiko Kuwahara, Kazuya Shiogama, Masato Abe, Hiroyasu Ito, Shin’ichiro Morimoto
Journal of Clinical Medicine.2022; 11(1): 251. CrossRef
Cardiac sarcoidosis: A multimodal approach to reach the diagnosis
Nicolas Piriou, Patrick Bruneval
International Journal of Cardiology.2021; 323: 264. CrossRef
Value of 3D mapping‐guided endomyocardial biopsy in cardiac sarcoidosis
Danielle M. Haanschoten, Ahmet Adiyaman, Nils A. ‘t Hart, Piet L. Jager, Arif Elvan
European Journal of Clinical Investigation.2021;[Epub] CrossRef
Cardiac Sarcoidosis: A Clinical Overview
Ana Carolina Alba, Shyla Gupta, Lakshmi Kugathasan, Andrew Ha, Alejandro Ochoa, Meyer Balter, Alvaro Sosa Liprandi, Maria Inés Sosa Liprandi
Current Problems in Cardiology.2021; 46(10): 100936. CrossRef

An Immunohistochemical and Polarizing Microscopic Study of the Tumor Microenvironment in Varying Grades of Oral Squamous Cell Carcinoma: Aeman Khalid, Safia Siddiqui, Bharadwaj Bordoloi, Nafis Faizi, Fahad Samadi, Noora Saeed; J Pathol Transl Med. 2018;52(5):314-322. Published online July 27, 2018; DOI: https://doi.org/10.4132/jptm.2018.07.17

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Abstract PDF

Background
Invasion of epithelial cells into the connective tissue brings about massive morphological and architectural changes in the underlying stroma. Myofibroblasts reorganize the stroma to facilitate the movement of tumor cells leading to metastasis. The aim of this study was to determine the number and pattern of distribution of myofibroblasts and the qualitative and quantitative change that they cause in the collagen present in the stroma in various grades of oral squamous cell carcinoma (OSCC).
Methods
The study was divided into two groups with group I (test group, 65 cases) consisting of 29 cases of well-differentiated squamous cell carcinoma, 25 moderately differentiated SCC, and 11 poorly differentiated SCC, and group II (control group) consisting of 11 cases of normal mucosa. Sections from each sample were stained with anti–α-smooth muscle actin (α-SMA) antibodies, hematoxylin and eosin, and Picrosirius red. Several additional sections from each grade of OSCC were stained with Masson’s trichrome to observe the changes in collagen. For the statistical analysis, Fisher’s exact test, Tukey’s post hoc honest significant difference test, ANOVA, and the chi-square test were used, and p < .05 was considered statistically significant.
Results
As the tumor stage progressed, an increase in the intensity α-SMA expression was seen, and the network pattern dominated in more dedifferentiated carcinomas. The collagen fibers became thin, loosely packed, and haphazardly aligned with progressing cancer. Additionally, the mean area fraction decreased, and the fibers attained a greenish yellow hue and a weak birefringence when observed using polarizing light microscopy.
Conclusions
Myofibroblasts bring about numerous changes in collagen. As cancer progresses, there isincrease in pathological collagen,which enhances the movement of cells within the stroma.

Citations

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Multifractal Alterations in Oral Sub-Epithelial Connective Tissue During Progression of Pre-Cancer and Cancer
Debaleena Nawn, Sawon Pratiher, Subhankar Chattoraj, Debjani Chakraborty, Mousumi Pal, Ranjan Rashmi Paul, Srimonti Dutta, Jyotirmoy Chatterjee
IEEE Journal of Biomedical and Health Informatics.2021; 25(1): 152. CrossRef

Endobronchial Smooth Muscle Tumors: A Series of Five Cases Highlighting Pitfalls in Diagnosis: Tripti Nakra, Aanchal Kakkar, Shipra Agarwal, Karan Madan, Suresh C Sharma, Deepali Jain; J Pathol Transl Med. 2018;52(4):219-225. Published online July 11, 2018; DOI: https://doi.org/10.4132/jptm.2018.05.16

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Abstract PDF

Background
Primary endobronchial smooth muscle tumors (SMTs), which are extremely rare, include endobronchial leiomyomas and leiomyosarcomas. Clinically, SMTs present with signs and symptoms of bronchial obstruction, and lack specific radiological findings. Thus, histopathological examination is required for accurate diagnosis as well as for tumor grading. We examined the histomorphological and immunohistochemical features of endobronchial SMTs and highlighted pitfalls in diagnosis, particularly when using small biopsies.
Methods
Cases of primary endobronchial SMTs diagnosed at our Institute over the last 6 years (2012–2017) were retrieved from the departmental archives. Histopathological features and immunohistochemistry performed for establishing the diagnosis were reviewed.
Results
Five cases of SMTs occurring in endobronchial locations were identified. These included three cases of leiomyoma, and two cases of leiomyosarcoma. The age distribution of patients ranged from 13 to 65 years. Leiomyomas showed more consistent staining with smooth muscle markers (smooth muscle actin, desmin, and smooth muscle myosin heavy chain), while tumors of higher grade showed variable, focal staining, leading to erroneous diagnosis, especially on small biopsies.
Conclusions
The diagnosis of endobronchial SMTs relies on histopathological examination, for both confirmation of smooth muscle lineage and determination of the malignant potential of the lesion. Appropriate immunohistochemical panels including more than one marker of smooth muscle differentiation are extremely valuable for differential diagnosis from morphological mimics, which is necessary for instituting appropriate management.

Citations

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Case report: Successful bronchoscopic interventional treatment of endobronchial leiomyomas
Yinfeng Wang, Yixiang Zhang, Ruirui Tong
Open Life Sciences.2024;[Epub] CrossRef
Pediatric endobronchial tumors with a mimicker: A case series
Kulwiwat Promsawasdi, Teerasak Phewplung
Pediatric Pulmonology.2024; 59(10): 2669. CrossRef
Smooth Muscle Conditions of the Chest
Matthew R. McCann, Lucas R. Massoth, Carlos A. Rojas, Yin P. Hung, John P. Lichtenberger, Gerald F. Abbott, Justin T. Stowell
Journal of Thoracic Imaging.2021; 36(5): 263. CrossRef
A Well-Defined Endobronchial Tumor in a 26-Year-Old Man
Christina Triantafyllidou, Petros Effraimidis, Mirjam Schimanke, Simone Ignatova, Anders Ringman, Susann Skoog, Farkas Vánky, Miklós Boros, Karin Cederquist
Chest.2021; 159(5): e313. CrossRef
Primary Pulmonary Leiomyoma
Mohammad Abu-Hishmeh, Gowthami Kobbari, Fouzia Shakil, Oleg Epelbaum
Journal of Bronchology & Interventional Pulmonology.2020; 27(4): e54. CrossRef

Placental Lesions in Meconium Aspiration Syndrome: Binnari Kim, Soo-young Oh, Jung-Sun Kim; J Pathol Transl Med. 2017;51(5):488-498. Published online August 9, 2017; DOI: https://doi.org/10.4132/jptm.2017.07.20

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Abstract PDF

Background
Meconium aspiration syndrome (MAS) is defined by respiratory distress requiring supplemental oxygen in a meconium-stained neonate. MAS is clinically subclassified as mild, moderate, and severe according to the oxygen requirement. The aims of this study were to compare the histological findings in the placentas of MAS neonates with those of meconium-stained but non-MAS neonates and to analyze the correlation between the severity of MAS and the grade of its histological parameters. Methods: We collected 160 singleton term placentas from neonates with meconium staining at birth from a tertiary medical center, Seoul, Republic of Korea. We reviewed hematoxylin and eosin sections of tissue samples (full-thickness placental disc, chorioamniotic membranes, and umbilical cord). Results: Funisitis was present more frequently in MAS than in non-MAS (p < .01), of which the stage was correlated with the severity of MAS (p < .001). The histological findings consistent with maternal underperfusion and chronic deciduitis were more frequent in MAS than in non-MAS (p < .05). There was a correlation between the degree of chorionic vascular muscle necrosis and the severity of MAS (p < .05). Conclusions: Our results suggest that fetal inflammatory response evidenced by funisitis occurs prenatally in MAS and that the stage of funisitis and of chorionic vascular muscle necrosis may be a predictive marker of the severity of MAS.

Citations

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Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis
Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf
Archives of Gynecology and Obstetrics.2024;[Epub] CrossRef
Machine learning‐based placental clusters and their associations with adverse pregnancy outcomes
Julie M. Petersen, Samantha E. Parker, Kimberly A. Dukes, Jennifer A. Hutcheon, Katherine A. Ahrens, Martha M. Werler
Paediatric and Perinatal Epidemiology.2023; 37(4): 350. CrossRef
The risk of meconium aspiration syndrome (MAS) increases with gestational age at term
Clara Ward, Aaron B. Caughey
The Journal of Maternal-Fetal & Neonatal Medicine.2022; 35(1): 155. CrossRef
Protective placental inflammatory and oxidative stress responses are attenuated in the context of twin pregnancy and chorioamnionitis in assisted reproduction
Hayley R. Price, Nick Pang, Hugh Kim, Michael W. H. Coughtrie, Abby C. Collier
Journal of Assisted Reproduction and Genetics.2022; 39(1): 227. CrossRef
Correlation between Pregnancy Outcome and Placental Pathology in COVID-19 Pregnant Women
Sara A. Al-Rawaf, Enas T. Mousa, Noora M. Kareem, Atif Amin Baig
Infectious Diseases in Obstetrics and Gynecology.2022; 2022: 1. CrossRef
Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women
Nadia M. Ikumi, Thokozile R. Malaba, Komala Pillay, Marta C. Cohen, Hlengiwe P. Madlala, Mushi Matjila, Dilly Anumba, Landon Myer, Marie-Louise Newell, Clive M. Gray
AIDS.2021; 35(5): 717. CrossRef
Meconium Aspiration Syndrome: A Narrative Review
Chiara Monfredini, Francesco Cavallin, Paolo Ernesto Villani, Giuseppe Paterlini, Benedetta Allais, Daniele Trevisanuto
Children.2021; 8(3): 230. CrossRef
Isolated acute funisitis in the absence of acute chorioamnionitis: What does it mean?
Tracy B. Grossman, Debra S. Heller, Rebecca N. Baergen
Placenta.2019; 75: 42. CrossRef
Influence of foetal inflammation on the development of meconium aspiration syndrome in term neonates with meconium-stained amniotic fluid
Kyoko Yokoi, Osuke Iwata, Satoru Kobayashi, Kanji Muramatsu, Haruo Goto
PeerJ.2019; 7: e7049. CrossRef

Case Study

Benign Triton Tumor: A Rare Entity in Head and Neck Region: Krishnappa Amita, S. Vijay Shankar, Kuchangi C. Nischal, Haleuoor B. Basavaraj; Korean J Pathol. 2013;47(1):74-76. Published online February 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.1.74

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Abstract PDF

Benign triton tumors (BTT) are very rare lesions composed of mature skeletal muscle and neural tissue. We report a case of a 14-year-old boy who presented with asymptomatic swelling of the chin over an 18-month duration which increased gradually to involve the left side of the lower lip. Clinically, a diagnosis of neurofibroma was made. Excisional biopsy confirmed the diagnosis of a BTT. Having an affinity for large nerve trunks like the brachial and sciatic, these tumors rarely occur in the head and neck region. When they do, they may involve the large central cranial nerve trunk and present as intracranial masses or involve the smaller peripheral nerve twigs and present as asymptomatic skin nodules, of which only four cases involving peripheral nerves are reported in the English literature. Here, we report the fifth documented case of a BTT involving the mental branch of the trigeminal nerve. A brief review of the literature is also provided.

Citations

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Update on MR Imaging of Soft Tissue Tumors of Head and Neck
Justin D. Rodriguez, A. Morgan Selleck, Ahmed Abdel Khalek Abdel Razek, Benjamin Y. Huang
Magnetic Resonance Imaging Clinics of North America.2022; 30(1): 151. CrossRef
Pediatric benign triton tumor of trigeminal nerve: a case report and literature review
Sophia Peng, Mandana Behbahani, Shelly Sharma, Stacy Speck, Nitin R. Wadhwani, Jeff C. Rastatter, Tord D. Alden
Child's Nervous System.2022; 38(11): 2055. CrossRef
Rhabdomyomatous mesenchymal hamartoma presenting as a chin nodule in a 15‐year‐old male
Lisa M. Marinelli, Wendi E. Wohltmann, Kevin D. Myers, Geoffrey T. Sasaki
Journal of Cutaneous Pathology.2021; 48(2): 322. CrossRef
Pediatric Benign Tumors With a Skeletal Muscle Component: Myogenin Expression, Diagnostic Pitfalls, and New Molecular Insights
Lara Berklite, John Ozolek, Larry Wang, Luisa Santoro, Vittoria Donofrio, Alessandra Stracuzzi, Ivy John, Rita Alaggio
Pediatric and Developmental Pathology.2021; 24(3): 213. CrossRef
Incidental Hamartoma in an elderly patient: a case report
Tae-Sung Joo, Hyejee Kim, In-Ki Park, Jae-Ho Shin
BMC Ophthalmology.2020;[Epub] CrossRef
Peripheral Nerve Sheath Tumors of Head and Neck: Imaging-Based Review of World Health Organization Classification
Ahmed Abdel Khalek Abdel Razek, Omneya A. Gamaleldin, Nermeen A. Elsebaie
Journal of Computer Assisted Tomography.2020; 44(6): 928. CrossRef
Benign peripheral nerve tumors
Zinon T. Kokkalis, Nikolaos A. Stavropoulos, Andreas F. Mavrogenis, Andreas Panagopoulos, Panayotis N. Soucacos
Injury.2019; 50: S77. CrossRef
Tumor de tritón benigno: reporte de un caso en órbita
Tatiana Urrea Victoria, Luis Alberto Ruíz Robles, Ana María Vanegas Monroy, Humberto Quintana Muñoz
Universitas Médica.2017;[Epub] CrossRef
Benign Triton Tumor: Multidisciplinary Approach to Diagnosis and Treatment
Raj Thakrar, Caroline D. Robson, Sara O. Vargas, John G. Meara, Reza Rahbar, Edward R. Smith
Pediatric and Developmental Pathology.2014; 17(5): 400. CrossRef
Ectomesenchymoma with Embryonal Rhabdomyosarcoma and Ganglioneuroma, Arising in Association with Benign Triton Tumor of the Tongue
Katherine A. VandenHeuvel, David F. Carpentieri, Jie Chen, Kar-Ming Fung, David M. Parham
Pediatric and Developmental Pathology.2014; 17(3): 226. CrossRef
Adulthood Benign Triton Tumor Developed in the Orbit
Dong Hyeon Bae, Choong Hyun Kim, Jin Hwan Cheong, Jae Min Kim
Journal of Korean Neurosurgical Society.2014; 56(2): 146. CrossRef

Case Reports

Exuberant Smooth Muscle Cells in Fibroadenoma of the Breast: A Case Report.: Ga Eon Kim, Young Kim, Eun Hui Jeong, Jo Heon Kim, Min Ho Park, Ji Shin Lee; Korean J Pathol. 2010;44(4):431-434.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.4.431

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Abstract PDF

Smooth muscle cell metaplasia is an extremely rare form of stromal differentiation in fibroadenomas. We describe a case of fibroadenoma with exuberant smooth muscle cells in a 72-year-old woman. The mass was located in the upper central portion of the left breast. It was well circumscribed and its greatest dimension was 3 cm. Histologically, the glandular elements resembled the appearance of fibroadenoma, but the stromal elements were composed of spindle cell bundles with abundant eosinophilic cytoplasm and elongated cigar-shaped nuclei. Neither mitotic activity nor cellular atypia was seen. The stromal cells were immunohistochemically positive for smooth muscle actin, calponin, desmin, and estrogen receptor-beta, but negative for CD34, S-100 protein, p63, CD10, estrogen receptor-alpha, progesterone receptor and cytokeratin. These results proved that the stromal cells showed features of smooth muscle cells.

Citations

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Unusual Myoid Differentiation in a Canine Benign Mixed Mammary Tumour
Barbara Brunetti, Luisa Vera Muscatello, Louis J. DeTolla, Giancarlo Avallone, Isabel Pires
Case Reports in Veterinary Medicine.2021; 2021: 1. CrossRef

Smooth Muscle Hyperplasia of the Epididymis: Report of A Case and Review of the Literature.: Hyun Soo Kim, Ji Youn Sung, Gou Young Kim, Sung Jig Lim, Hyun Cheol Kim, Hyung Lae Lee; Korean J Pathol. 2009;43(2):177-181.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.177

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Abstract PDF

A 66-year-old man underwent surgery to remove an incidentally discovered non-tender intrascrotal mass. Ultrasonography revealed an irregular-margined, heterogeneous mass-like lesion in the epididymal tail. The mass was relatively well circumscribed but unencapsulated, irregular and firm; it consisted of expansile, increased smooth muscle fascicles originating from the epididymal muscular coat. Its cellular growth pattern lacked the cohesive, well-circumscribed proliferation pattern typical of a leiomyoma. A diagnosis of smooth muscle hyperplasia of the epididymis was made. Although ultrasonography is the imaging modality of choice for evaluating suspected intrascrotal masses, there are times when it cannot reliably identify the character of the masses and distinguish malignant from benign lesions. Ill-defined, solid extratesticular masses, that are ultrasonographically ambiguous, should be excised and confirmed histopathologically and smooth muscle hyperplasia of the epididymis should be included in the differential diagnosis of solid extratesticular masses.

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Smooth muscle hyperplasia of the testicular adnexa: a clinicopathologic study of 12 cases
Fatimah Alruwaii, David J. Grignon, Muhammad T. Idrees
Human Pathology.2020; 99: 27. CrossRef
Hiperplasia muscular paratesticular (epididimaria) pseudotumoral. Descripción de 2 casos
Inmaculada Ruiz Molina, Vicente Cívico Amat, Beatriz Santiago Agredano
Medicina Clínica.2019; 152(5): e25. CrossRef
Pseudotumoral paratesticular (epididymal) muscle hyperplasia. Two case reports
InmaculadaRuiz Ruiz Molina, Vicente Cívico Amat, Beatriz Santiago Agredano
Medicina Clínica (English Edition).2019; 152(5): e25. CrossRef
Smooth muscle hyperplasia of the epididymis
O Blach, AM Pollock, D Douglas
Journal of Surgical Case Reports.2011; 2011(10): 10. CrossRef

Original Article

The Expression of Transforming Growth Factor-beta1 and alpha-Smooth Muscle Actin is Increased in the Human Myxomatous Valve.: Jeong Hwan Park, Ho Joong Youn, Jung Sook Yoon, Chul Soo Park, Soo Sung Oh, Woo Baek Chung, Jong Won Chung, Yun Seok Choi, Dong Hyun Lee, Yong Seog Oh, Wook Sung Chung, Soon Jo Hong, Youn Soo Lee, Sung Bo Sim, Sun Hee Lee; Korean J Pathol. 2009;43(2):152-156.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.152

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Abstract PDF

BACKGROUND
In vitro experimental studies have reported that transforming growth factor-beta1 (TGF-beta1) stimulates the production of alpha-smooth muscle actin (alpha-SMA) in porcine valves. However, the relation between TGF-beta1 and alpha-SMA in myxomatous valves has not been elucidated.
METHODS
We classified 27 subjects into two groups: 1) myxomatous group (M:F=11:12, mean age=55+/-15 years) and 2) rheumatic group (M:F=3:1, mean age=41+/-17 years) according to preoperative echocardiographic and postoperative histologic findings. Twenty-seven valve specimens from the patients who underwent valve replacement were obtained. Tissue samples were analyzed by immunohistochemistry for TGF-beta1 and alpha-SMA. The positively stained areas were measured using an image analysis program (Image Pro-Plus 4.5), and then the TGF-beta1 volume fraction (TGF-VF) and alpha-SMA volume fraction (alpha-SMA-VF) were calculated.
RESULTS
TGF-VF in myxomatous valves was higher than in rheumatic valves (2,759+/-2,294 vs 864+/-276, p=0.04). alpha-SMA-VF in myxomatous valves was higher than in rheumatic valves (4,122+/-2,275 vs 2,421+/-844, p=0.002). There was a significant correlation between TGF-beta1 and alpha-SMA in myxomatous valves (r=0.38, p=0.04). There was no significant correlation between TGF-beta1 and alpha-SMA in rheumatic valves (r=-0.50, p=0.67).
CONCLUSIONS
TGF-beta1 and alpha-SMA may be related to the pathogenesis of myxomatous valves. The activation of TGF-beta1 might increase the expression of alpha-SMA in human myxomatous valves.

Citations

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Apoptosis and abundance of Bcl-2 family and transforming growth factor β1 signaling proteins in canine myxomatous mitral valves
Sirilak Surachetpong, Treenate Jiranantasak, Anudep Rungsipipat, E. Christopher Orton
Journal of Veterinary Cardiology.2013; 15(3): 171. CrossRef
Pathology, protein expression and signaling in myxomatous mitral valve degeneration: Comparison of dogs and humans
Heike Aupperle, Sirilak Disatian
Journal of Veterinary Cardiology.2012; 14(1): 59. CrossRef

Case Report

Ovarian Sertoli-Leydig Cell Tumors with Heterologous Gastrointestinal Type Epithelium or with Striated Skeletal Muscle: report of two cases.: Ki Ouk Min, Eun Joo Seo, Young Shin Kim, Kyo Young Lee, Sang In Shim; Korean J Pathol. 1996;30(1):50-56.

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Abstract PDF: Sertoli-Leydig cell tumors of the ovary are rare, accounting for no more than 0.5% of all ovarian neoplasms. These tumors occur predominantly in women 10 to 30 years of age. Heterologous elements are found in over 20% of the moderately and poorly differentiated Sertoli- Leydig cell tumors. The most common element is gastrointestinal mucin-secreting epithelium, found in approximately 20% of all cases. Approximately 4% of Sertoli-Leydig cell tumors contain immature skeletal muscle and/or cartilaginous elements. The origin of these neoplasms is regarded as neometaplasia of the mesodermal neoplastic element. While the degree of differentiation of Sertoli-Leydig cell tumors is probably of greater importance in determining prognosis than the presence of heterologous components, recent evidence does point to an unfavorable effect on clinical outcome when heterologous mesenchymal components such as cartilage and striated muscle are present. We experienced two cases of ovarian heterologous Sertoli-Leydig cell tumors with gastrointestinal type epithelium and striated skeletal muscle in 20 and 21 year-old females, respectively. One case involved a patient who had complained of amenorrhea for 3 years while the other case involved a patient who had complained of left lower abdominal tenderness and amenorrhea for one and one half years. It was determined by ultrasonography of the pelvis that the two patients suffered from right and left ovarian masses. Both patients underwent adnexectomy. These tumors were large with partly solid and partly cystic areas. Based on light microscopic examination one case was classified as an intermediate Sertoli-Leydig cell tumor with heterologous gastrointestinal type epithelium, while the other case was classified as a poorly differentiated Sertoli-Leydig cell tumor with heterologous striated skeletal muscle.

Original Articles

Expression of CD44 Splice Variants(v4/5 and v6), alpha-Smooth Muscle Actin, and nm23 Proteins in IB-IIB Uterine Cervical Cancer.: Hee Kyung Chang, Man Ha Huh, Dong Hee Kim, Un Dong Park; Korean J Pathol. 1997;31(6):546-556.

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Abstract PDF: We examined the expressions of CD44 splice variants (v4/5, v6), alpha-smooth muscle actin, nm23 to evaluate their roles as prognostic factors in 70 cases of uterine cervical carcinoma (stage IB to IIB) who were surgically treated from January 1989 to June 1990 with a clinical follow-up of a minimum of 5 years. The expression was examined by an immunohistochemical method using archival formalin fixed paraffin embedded tissue. In the 70 cases, 61 cases were squamous cell carcinoma and 9 cases were adenocarcinoma. CD44v4/5, CD44v6, alpha-smooth muscle actin, and nm23 were detected in 41.4%, 70%, 100%, and 74.3% of tumor samples, respectively. CD44 splice variants and nm23 showed membrane and cytoplasmic staining of tumor cells, respectively. The expression of alpha-smooth muscle actin showed cytoplasmic staining confined to stromal cells and was classified into three grades by the extent in stromal cells: with less than 10% of stromal cells; 32.9%, 10-50% of stromal cells; 40.0%, more than 50%; 27.1%. These expressions were not correlated with histologic types, lymph node involvement, recurrence, and grades of tumor infiltrating lymphocyte (TIL). But CD44v4/5 had significantly inverse correlation with TIL (p=0.049). The expression of CD44v4/5 was significantly correlated with that of CD44v6 (p=0.05), and that of alpha-smooth muscle actin was inversely correlated with that of nm23 (p=0.049). In conclusion, in FIGO IB-IIB uterine cervical carcinoma CD44 variants, nm23, and SMA show high prevalence, however, with little prognostic significance assessed by recurrence and lymph node metastasis.

Expression of Alpha Smooth Muscle Actin and Lysozyme in Various Glomerular Diseases.: Sun Hee Sung, Woon Sup Han; Korean J Pathol. 1998;32(1):51-57.

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Abstract PDF: The cells of glomerular mesangium is composed mostly of intrinsic contractile mesangial cells and a few macrophages. Injury to the mesangium is central to many glomerular diseases. This study was aimed to evaluate and compare the expressions of alpha-smooth muscle actin (ASMA) and lysozyme in the mesangium of various human glomerular diseases and also of according to the severity of their progressions. We performed immunohistochemical and transmission electromicroscopic examinations in 51 cases of renal biopsy including 5 normal kidneys. The results were as follows; (1) ASMA staining was negligible in normal glomeruli. (2) Increased ASMA staining was observed in the mesangium of glomeruli from all specimens of primary glomerular disease, regardless of their diagnosis. (3) The staining intensity of ASMA in mesangium was mild in minimal change disease and membranous glomerulonephritis, and strong in focal segmental glomerulosclerosis (FSGS), diffuse mesangial hypercellularity, membranoproliferative glomerulonephritis (MPGN), and IgA nephropathy (IgAN). (4) The staining intensity of ASMA have no correlation with mesangial immune deposits. (5) The staining intensity of ASMA in mesangium was inversely correlated with the disease progression in FSGS and IgAN. (6) Glomeruli showing global or segmental sclerosis invariably lacked ASMA. (7) Compared with ASMA, the mesangial cells with lysozyme expression were very rare, even though it was in proportion to ASMA staining. Interstitial ASMA expression was confined to fibrotic area in various glomerular diseases. In conclusion, the expression of ASMA and lysozyme in mesangium are increased in a variety of glomerular diseases, regardless of disease entity. Their intensity was in proportion to the mesangial cell proliferation. In progressive glomerulonephritis, such as IgAN and FSGS, the increased expression of ASMA was prominent in the early lesion, and decreased with the progression of the glomerular sclerosis.

Expression of Glomerular-Smooth Muscle Actin and Vimentin in Idiopathic Membranous Nephropathy as Prognostic Indicators.: Min Jin Lee, Ok Kyung Kim; Korean J Pathol. 2001;35(1):26-34.

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Abstract PDF: BACKGROUND
The natural history of idiopathic membranous nephropathy (IMN) is heterogeneous with some patients showing spontaneous remission while others show a progressive course leading to end-stage renal failure. We tried to assess quantitatively alpha-smooth muscle actin (alpha-SMA) and vimentin expression as markers to predict the outcome of membranous nephropathy.
METHODS
This study included 24 patients with biopsy proven IMN. We measured the volume of the positive area for alpha-SMA and vimentin within the glomeruli and compared the results with 5 patients in the normal control group. We evaluated glomerular alpha-SMA and vimentin expression in correlation with BUN and serum creatinine level at the time of diagnosis and after treatment.
RESULTS
Glomerular alpha-SMA and vimentin in IMN were higher than in the control group. Glomerular alpha-SMA was significantly higher in progressive IMN than in non-progressive IMN. The glomerular alpha-SMA was sifnificantly correlated with BUN and serum creatinine at last follow-up (p<0.05), but there was no statistically significant correlation at diagnosis. The glomerular vimentin was not different between progressive and non-progressive groups.
CONCLUSION
These data suggest that the expression of glomerular alpha-SMA may be a useful prognostic indicator and may be able to differentiate between patients with membranous nephropathy who respond well to treatment and those who continue to progress.

Expressions and Diagnostic Usefulness of MIB-1 and p53 in Uterine Smooth Muscle Tumors.: Mi Jin Kim, Yong Jin Kim, Seung Ho LeeSeungHo; Korean J Pathol. 2001;35(6):524-530.

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Abstract: BACKGROUND
Controversy still remains concerning the criteria for the categorization of uterine smooth muscle tumors by conventional histologic examination. Various ancillary techniques have been used to improve diagnostic accuracy.
METHODS
Immunohistochemical study of MIB-1 and p53 was performed on 10 usual leiomyomas (UL), 13 cellular leiomyomas (CL), 5 bizarre leiomyomas (BL), 2 cases of intravenous leiomyomatosis (IL), 5 smooth muscle tumors of uncertain malignant potential (STUMP) and 8 leiomyosarcomas (LMS), to investigate the diagnostic value of MIB-1 and p53 in uterine smooth muscle tumors.
RESULTS
The MIB-1 labelling index was low in ULs and their variants (mean 5.67+/-5.53), but it was increased in STUMPs (17.67+/-6.51) and markedly increased in LMSs (35.71+/-11.35). In ULs and their variants, no immunostaining for p53 was noted except in one case of BL, while 2 (40%) of 5 STUMPs and 3 (38%) of 8 LMSs showed positive reactions for p53. There were significant differences among leiomyoma, STUMP and LMS in the MIB-1 labelling index and p53 expression.
CONCLUSIONS
These results suggest that both abnormal expressions of p53 and a high MIB-1 labelling index are frequently associated with leiomyosarcoma. Our data also indicate that the classification system of Kempson and Hendrickson is well correlated with the MIB-1 labelling index.

Case Reports

Type 2 Fiber Predominance in Patients with Muscle Cramp and Exertional Myalgia: A Report of Three Cases.: Na Rae Kim, Sung Hye Park, Lim Suh Yeon, Byung Joon Kim; Korean J Pathol. 2003;37(1):58-61.

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Abstract PDF: Type 2 fiber predominance or a decrease of the type 1/type 2 ratio was rarely reported as the only abnormal pathologic finding in patients suffering from muscle cramp and myalgia. Here, we describe the clinicopathologic findings of three cases of type 2 fiber predominance, presented with muscle cramp and myalgia in otherwise healthy patients. All of them were young men (18, 19 and 22 years). Light microscopic and neurologic examinations, and laboratory data showed mere nonspecific findings that were not concordant with their subjective symptoms. However, enzyme histochemistry performed on muscle biopsy revealed an increased fraction of type 2 fibers; 73%, 80%, and 75%, in each case. The pathogenesis of this entity remains unclear, but the recognition of this unusual clinicopathologic entity is important for both pathologists and neurologists so they can avoid misdiagnoses or unnecessarily tiresome studies. We emphasize that type 2 fiber predominance should be included in the underlying causes of unexplained muscle cramps and exertional myalgia, especially among young adults, although it remains unclear whether the fiber type predominance is a separate entity or a part of other underlying neurologic or systemic disorders.

Fibrovascular Polyp of the Hypopharynx: A Case Report.: Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Bum Jo Jung, Joong Wook Shin, See Young Park, Kyung Ja Cho, Je G Chi; Korean J Pathol. 2008;42(4):226-228.

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Abstract PDF: We report here on a case of fibrovascular polyp arising in the hypopharynx of a 62-year-old man. Laryngomicroscopic surgery with laser ablation was performed to excise the mass. Histopathologically, the surface of the polyp was covered with mature squamous epithelium. The polyp showed a characteristic lobular proliferation of mature adipose tissue that was separated by myxoid or collagenous connective tissue. Some scattered skeletal muscle bundles were seen in the central portions of the polyp and these bundles were surrounded by a concentric proliferation of the spindle cells; this was reminiscent of Pacinian corpuscles. Regarding their location and the intermingled pattern of proliferating tissues, it is more plausible that the skeletal muscle is a hamartomatous component rather than entrapped, preexisting tissue.

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