Αρχειοθήκη ιστολογίου

Σάββατο 26 Αυγούστου 2017

Flavoprotein fluorescence imaging-based electrode implantation for subfield-targeted chronic recording in the mouse auditory cortex

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Publication date: Available online 26 August 2017
Source:Journal of Neuroscience Methods
Author(s): Jun Nishikawa, Yuto Ohtaka, Yuishi Tachibana, Yasutaka Yanagawa, Hisayuki Osanai, Takeaki Haga, Takashi Tateno
BackgroundChronic neural recording in freely moving animals is important for understanding neural activities of cortical neurons associated with various behavioral contexts. In small animals such as mice, it has been difficult to implant recording electrodes into exact locations according to stereotactic coordinates, skull geometry, or the shape of blood vessels. The main reason for this difficulty is large individual differences in the exact location of the targeted brain area.New methodsWe propose a new electrode implantation procedure that is combined with transcranial flavoprotein fluorescence imaging. We demonstrate the effectiveness of this method in the auditory cortex (AC) of mice.Results: Prior to electrode implantation, we executed transcranial flavoprotein fluorescence imaging in anesthetized mice and identified the exact location of AC subfields through the skull in each animal. Next, we surgically implanted a microdrive with a tungsten electrode into exactly the identified location. Finally, we recorded neural activity in freely moving conditions and evaluated the success rate of recording auditory responses.Comparison with existing method(s)These procedures dramatically improved the success rate of recording auditory responses from 21.1% without imaging to 100.0% with imaging. We also identified large individual differences in positional relationships between sound-driven response areas and the squamosal suture or blood vessels.ConclusionsCombining chronic electrophysiology with transcranial flavoprotein fluorescence imaging before implantation enables the realization of reliable subfield-targeted neural recording from freely moving small animals.



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Molecular Characterization of a Series of Solitary Fibrous Tumors, including Immunohistochemical expression of STAT6 and NATB2-STAT6 Fusion Transcripts, using Reverse Transcriptase(RT)–Polymerase Chain Reaction(PCR) Technique: An Indian Experience

Publication date: Available online 26 August 2017
Source:Pathology - Research and Practice
Author(s): Bharat Rekhi, Omshree Shetty, Parul Tripathi, Prachi Bapat, Mukta Ramadwar, Jyoti Bajpai, Ajay Puri
A solitary fibrous tumor (SFT) is characterized by a diverse clinicopathologic spectrum. Recent studies have unraveled STAT6 as a useful diagnostic immunohistochemical (IHC) marker for a SFT and NAB2-STAT6 as its specific gene fusion transcript.Thirty-three SFTs were tested for STAT6 immunostaining by polymer detection technique. STAT6 immunoexpression was further graded, based on intensity (mild, moderate and strong) and percentage of immunopositive tumor cells, ranging from 1–25%(1+); 26–50%(2+); 51–75%(3+) and in more than 75%(4+) tumor nuclei.These cases along with 17 other tumors were tested for 8 variants of NAB2-STAT6, using qualitative endpoint reverse-transcriptase (RT)-PCR technique. RNA extraction was performed using Recover All Total nucleic acid extraction kit. The selected cases were screened for all the 8 fusion variants, using 8 primer pairs for NAB2 and STAT6 genes.Thirty-three SFTs occurred in 18 men and 15 women (M: F=1.2:1), with age varying from 13–74 years(average=49.6); across various body sites. Immunohistochemically, most SFTs (30/33) (90.9%) displayed moderate to strong immunostaining for STAT6, including 3+ and 4+ immunostaining patterns in 27/33 (81.8%) tumors. By RT-PCR, 30/33(90.9%) cases of SFT were positive for NAB2-STAT6 fusions, including NAB2ex4/STAT6ex2 (7cases), NAB2ex7/STAT6ex2 (7cases), NAB2ex6/STAT6ex3 (6cases), NAB2ex6/SAT6ex16 (4cases), NAB2ex3/STAT6ex19 (4cases), NAB2ex6/STAT6ex17 (single case), NAB2ex4/STAT6ex4 (single case) and NAB2ex6/STAT6ex18 (none). NAB2-STAT6 fusions were not observed in 9 cases of synovial sarcoma, 4 of Ewing sarcoma, 2 of MPNST and 2 cases of dedifferentiated liposarcomas (100% specificity). On comparing with clinical outcomes, more cases (7/11)(63.6%) of classic SFT were associated with favorable outcomes, while more cases(5/8)(62%) of atypical and malignant SFTs were associated with aggressive outcomes.This study reinforces high sensitivity and specificity of NAB2-STAT6 fusion and its correlation with strong and diffuse IHC expression of STAT6 in a SFT, irrespective of its occurrence in various body sites and its histopathologic types. NAB2ex4-STAT6ex2 and NAB2ex7-STAT6ex2 fusions were relatively more frequently observed in our patients. Atypical and malignant SFTs, together, were more frequently associated with relatively aggressive clinical outcomes.



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Intensity-modulated radiotherapy in head and neck cancer — an update for oral and maxillofacial surgeons

Intensity-modulated radiation therapy (IMRT), a relatively new method of delivering radiotherapy, can precisely target a point within a specific tumour and reduce the dose to nearby anatomical structures. This is particularly important in the head and neck where radiotherapy can easily and irreparably damage the salivary glands, spinal cord, and eyes, and where, with increasingly better outcomes and survival, late complications of conventional radiotherapy (including osteoradionecrosis of the cervical spine) can be difficult to manage.

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Diagnostic dilemma between medication-related osteonecrosis and oral squamous cell carcinoma in a mandibular lytic lesion

Osteolytic lesions of the mandible are common, and there are two important differential diagnoses that must be considered: medication-related osteonecrosis of the jaws (MRONJ) and squamous cell carcinoma (SCC). In patients with a history of taking antiresorptive medication as well as risk factors for neoplasia it can be difficult to differentiate between the two. We describe two cases in both of which a mandibular osteolytic lesion was inadequately identified as either MRONJ or SCC because of confusing clinical and histopathological features.

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Congenital Absence of the Palmaris Longus Muscle: A Meta-Analysis Comparing Cadaveric and Function Studies

The aim of our paper was to provide comprehensive data on the prevalence of absence of palmaris longus muscle (PLM) and its anatomical characteristics, and conduct two separate meta-analyses comparing cadaveric and functional studies while identifying variation among different ethnic groups. An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included prevalence of absence of palmaris longus muscle among subjects, ethnicity, laterality, side and gender.

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Diagnostic dilemma between medication-related osteonecrosis and oral squamous cell carcinoma in a mandibular lytic lesion

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Publication date: Available online 26 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Tocaciu, O. Breik, B. Lim, C. Angel, N. Rutherford
Osteolytic lesions of the mandible are common, and there are two important differential diagnoses that must be considered: medication-related osteonecrosis of the jaws (MRONJ) and squamous cell carcinoma (SCC). In patients with a history of taking antiresorptive medication as well as risk factors for neoplasia it can be difficult to differentiate between the two. We describe two cases in both of which a mandibular osteolytic lesion was inadequately identified as either MRONJ or SCC because of confusing clinical and histopathological features. We also reviewed relevant publications to identify similar cases. Here we discuss our clinical dilemma when faced with two different conditions that present with similar clinical and histopathological features.



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Intensity-modulated radiotherapy in head and neck cancer — an update for oral and maxillofacial surgeons

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Publication date: Available online 26 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P.A. Brennan, K.L. Bradley, M. Brands
Intensity-modulated radiation therapy (IMRT), a relatively new method of delivering radiotherapy, can precisely target a point within a specific tumour and reduce the dose to nearby anatomical structures. This is particularly important in the head and neck where radiotherapy can easily and irreparably damage the salivary glands, spinal cord, and eyes, and where, with increasingly better outcomes and survival, late complications of conventional radiotherapy (including osteoradionecrosis of the cervical spine) can be difficult to manage. IMRT has the potential advantage of reducing side effects including xerostomia and myelopathy of the cervical spinal cord. Several clinical trials have recently been published, and in this update we give an overview of IMRT for oral and maxillofacial surgeons, and discuss what the future may hold for radiotherapy.



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Quelle est la place des fils tenseurs pour rajeunir le visage

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Publication date: Available online 25 August 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): B. Cornette de Saint Cyr, L. Benouaiche
Le traitement de la ptose ou du relâchement cutané au niveau du visage évolue progressivement depuis une solution purement chirurgicale vers des traitements médicaux moins invasifs, mésothérapie, lasers ou fils tenseurs. Ce choix varie à la fois selon l'indication posée par le praticien, mais aussi selon la demande des patients qui s'oriente aujourd'hui de plus en plus vers des solutions thérapeutiques sans cicatrice, sans éviction sociale. Nous proposons de présenter les fils disponibles, leur technique de pose, et les résultats obtenus après avoir rappelé l'historique et la technologie de ces fils. Nous discuterons les critères d'évaluation des bonnes et mauvaises indications pour ce traitement, la méthode choisie ainsi que le type et le nombre de fil choisis selon ces critères. Nous proposerons une stratégie de traitement par les fils tenseurs intégrant les autres solutions thérapeutiques synergiques proposées en médecine esthétique.The last decades has seen new priorities in treatment of a flabby, ageing face towards minimally invasive aesthetic surgery, to be accompanied and followed by the requirements to perform such interventions with the maximally reduced health hazards, with inconsiderable injury, without cuts and, respectively, to be followed by no resulting scars, as well as a short postoperative period. We propose a new reviewing presentation of the tensor threads. After having explained the technology of the threads, we will discuss the good patient indication, the criteria which determine the choice of the threads and methods for each type of patient. There are many techniques, which we will present. Then, we will discuss the results, unsatisfactory outcomes obtained and complications encountered, as well as how to improve the cosmetic outcomes to be obtained. To conclude, we will propose a strategy for the long-term treatment of the neck and the face, preventing surgical management of the aging process.



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Multicenter evaluation of quality of life and patient satisfaction after breast reconstruction, a long-term retrospective study

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Publication date: Available online 25 August 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): T. Ménez, A. Michot, S. Tamburino, R. Weigert, V. Pinsolle
IntroductionBreast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients' satisfaction.MethodsWomen who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction.ResultsA total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction.ConclusionThe authors identified factors of higher patients' satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities.



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Lifting cervicofacial en ambulatoire

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Publication date: Available online 25 August 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): F. Soulhiard
But de l'étudeDémontrer que la chirurgie du lifting cervicofacial est particulièrement adaptée à l'hospitalisation ambulatoire.Patients et méthodesDe 2010 à 2016 inclus : 246 patients ont été opérés d'un lifting cervicofacial en ambulatoire.RésultatsAucune complication majeure n'est survenue dans cette série. Parmi les patients, 98 % ont exprimé leur satisfaction et accepteraient à nouveau cette intervention en ambulatoire.ConclusionLes lifting cervicofaciaux peuvent être réalisés en ambulatoire en toute sécurité. Le taux de satisfaction mesuré montre une très forte adhésion des patientes à la prise en charge ambulatoire.ObjectiveThe proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory.MethodsBetween 2010 and 2016, 246 patients were operated for a facelift in ambulatory.ResultsNo major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory.ConclusionThe facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care.



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Management of High-Velocity Injuries of the Head and Neck

Publication date: Available online 25 August 2017
Source:Facial Plastic Surgery Clinics of North America
Author(s): Jacob S. Majors, Joseph Brennan, G. Richard Holt

Teaser

Trauma centers must prepare to manage high-velocity injuries resulting from a mass casualty incidents as global terrorism becomes a greater concern and an increasing risk. The most recent conflicts in Iraq and Afghanistan have significantly improved understanding of battlefield trauma and how to appropriately address these injures. This article applies combat surgery experience to civilian situations, outlines the physiology and kinetics of high-velocity injuries, and reviews applicable triage and management strategies.


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Publication date: Available online 26 August 2017 Source:Journal of Oral and Maxillofacial Surgery ...

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Publication date: Available online 26 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Satvinder Singh Bakshi




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Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Publication date: Available online 26 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Writing Group, A.R. Naylor, J.-B. Ricco, G.J. de Borst, S. Debus, J. de Haro, A. Halliday, G. Hamilton, J. Kakisis, S. Kakkos, S. Lepidi, H.S. Markus, D.J. McCabe, J. Roy, H. Sillesen, J.C. van den Berg, F. Vermassen, ESVS Guidelines Committee, P. Kolh, N. Chakfe, R.J. Hinchliffe, I. Koncar, J.S. Lindholt, M. Vega de Ceniga, F. Verzini, ESVS Guideline Reviewers, J. Archie, S. Bellmunt, A. Chaudhuri, M. Koelemay, A.-K. Lindahl, F. Padberg, M. Venermo




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European Society for Vascular Surgery Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease

Publication date: Available online 26 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): H.-H. Eckstein




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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Publication date: Available online 26 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Authors/Task Force Members, Victor Aboyans, Jean-Baptiste Ricco, Marie-Louise E.L. Bartelink, Martin Björck, Marianne Brodmann, Tina Cohnert, Jean-Philippe Collet, Martin Czerny, Marco De Carlo, Sebastian Debus, Christine Espinola-Klein, Thomas Kahan, Serge Kownator, Lucia Mazzolai, A. Ross Naylor, Marco Roffi, Joachim Röther, Muriel Sprynger, Michal Tendera, Gunnar Tepe, Maarit Venermo, Charalambos Vlachopoulos, Ileana Desormais, Document Reviewers, Petr Widimsky, Philippe Kolh, Stefan Agewall, Héctor Bueno, Antonio Coca, Gert J. De Borst, Victoria Delgado, Florian Dick, Cetin Erol, Marc Ferrini, Stavros Kakkos, Hugo A. Katus, Juhani Knuuti, Jes Lindholt, Heinrich Mattle, Piotr Pieniazek, Massimo Francesco Piepoli, Dierk Scheinert, Horst Sievert, Iain Simpson, Jakub Sulzenko, Juan Tamargo, Lale Tokgozoglu, Adam Torbicki, Nikolaos Tsakountakis, José Tuñón, Melina Vega de Ceniga, Stephan Windecker, Jose Luis Zamorano




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Pediatric soft tissue tumor of the upper arm with LMNA-NTRK1 fusion

Publication date: Available online 26 August 2017
Source:Human Pathology
Author(s): Shinji Kohsaka, Tsuyoshi Saito, Keisuke Akaike, Yoshiyuki Suehara, Takuo Hayashi, Tatsuya Takagi, Kazuo Kaneko, Toshihide Ueno, Shinya Kojima, Ken-ichi Kohashi, Hiroyuki Mano, Yoshinao Oda, Takashi Yao
A 6-year-old girl was admitted to our hospital due to the presence of a slow-growing tumor in her right elbow. Biopsy specimens showed a round- to spindle-cell neoplasm with uncertain malignant potential, leading to the decision of surgical resection. Histologically, the resected tumor was encapsulated by fibrous tissue, but focally invaded the surrounding skeletal muscles. The tumor was composed of ganglion-cell-like short spindle cells with lymphocytic infiltration in the collagenous background. Tumor cells with large bizarre nuclei were occasionally observed, and multinucleated giant cells were scattered at the periphery. Hemangiopericytoma-like patterns and adipose tissue elements were not evident, and mitotic figures were rarely observed (<1 per 10 high-power fields). Immunohistochemically, the tumor cells were positive for S-100 and CD34 and focally positive for EMA and AE1/AE3. RNA sequencing and subsequent RT-PCR revealed alternative splicing forms of LMNA-NTRK1 fusion (Ex2-Ex10 and Ex2-Ex15).



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Association of PD-L1 expression and PD-L1 gene polymorphism with poor prognosis in lung adenocarcinoma and squamous cell carcinoma

Publication date: Available online 26 August 2017
Source:Human Pathology
Author(s): Min-Kyung Yeo, Song-Yi Choi, In-Ock Seong, Kwang-Sun Suh, Jin Man Kim, Kyung-Hee Kim
Programmed cell death 1 receptor (PD-1)/programmed death-1 ligand-1 (PD-L1) interaction has been linked to tumor immune evasion. PD-L1 expression has been indicated in identifying non-small cell lung carcinoma (NSCLC) patients for treatment with anti-PD-1 or anti-PD-L1 therapy. The goal of this study was to evaluate the clinicopathologic values of PD-L1 expression and single nucleotide polymorphisms (SNPs) in the PD-L1 gene in lung adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). The 147 NSCLC tissues consisted of 84 samples of ADC and 63 samples of SqCC. All tissue microarray paraffin blocks were used for PD-L1 immunohistochemical assays with 22C3, SP263 and SP142 clones. Three SNPs in the PD-L1 gene, rs4143815, rs822336, and rs822337, were genotyped using SNP pyrosequencing. The PD-L1 expression was significantly higher in SqCC than in ADC. Among ADCs, PD-L1 expression was significantly higher in papillary and solid types than in lepidic and acinar types. Statistical associations of the PD-L1 expression with a shorter disease-free survival outcome and lymph node metastasis in the ADCs were found but no associations in SqCCs. Among the three SNPs, the rs4143815 genotype CC was statistically associated with positive a 22C3 PD-L1 labelling in NSCLCs. The rs4143815 genotype GG instead showed a trend of shorter survival outcomes but did not reach statistical significance in the ADCs. Our results showed a significantly higher prevalence of positive PD-L1 expression in lung SqCC than in ADC. However, the PD-L1 expression and rs4143815 genotype GG might be useful for the prediction of poor prognosis in lung ADC cases.



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Aldehyde dehydrogenase 1 (ALDH1A1) expression by immunohistochemistry is associated with chemo-refractoriness in patients with high-grade ovarian serous carcinoma

Publication date: Available online 26 August 2017
Source:Human Pathology
Author(s): Madhuchhanda Roy, Joseph Connor, Ahmed Al-Niaimi, Stephen L Rose, Aparna Mahajan
Aldehyde dehydrogenase-1A1 (ALDH1A1), CD133, CD44, and CD24 have been reported as cancer stem cell markers in ovarian cancers. The goal of our study was to assess the prognostic significance of these markers in patients with advanced serous ovarian cancer. Formalin-fixed, paraffin-embedded tissues from 347 ovarian cancer were used to construct a microarray. Immunohistochemical studies for ALDH1A1, CD133, CD44, and CD24 were performed and scored semiquantitatively by two pathologists based on intensity and percent of positive immunoreactive cells. Immunohistochemistry was compared to clinical parameters and survival. Of the 347 cases, early stage disease, nonserous tumors, cases with incomplete therapy, and cores with no tumor were excluded. Immunohistochemistry was interpretable in 124 of the 136 stage III and IV ovarian serous carcinoma. ALDH1A1, CD24, and CD44 were variably detected in both tumor and stromal cells, and immunoreactivity in tumor was stronger than in stromal cells. CD133 immunoreactivity was not quantified due to nonspecific staining in tumor and stroma. Statistical analyses using χ2 and Student's t test revealed that ALDH1A1-positive (n=53) carcinoma were 3 times more likely to demonstrate platinum refractoriness than ALDH1A1-negative (n=71) tumors (17% vs 6%, respectively; P=.04); however, neither progression-free or overall survival was influenced by ALDH1A1 status in this cohort. The expression of CD44 and CD24 had no clinicopathological associations in the present study. Our study supports that ALDH1A1 expression is associated with poor response to platinum-based therapy in patients with high-grade ovarian serous carcinoma. Further study of this relationship is needed to understand how this could impact clinical care.



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J chain and myocyte enhancer factor 2B are useful in differentiating classical Hodgkin lymphoma from nodular lymphocyte predominant Hodgkin lymphoma and primary mediastinal large B-cell lymphoma

Publication date: Available online 26 August 2017
Source:Human Pathology
Author(s): Erika M. Moore, Steven H. Swerdlow, Sarah E. Gibson
Although most classical Hodgkin lymphomas (CHL) are easily distinguished from nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and primary mediastinal large B-cell lymphoma (PMBL), cases with significant CD20 expression cause diagnostic confusion. Although the absence of OCT-2 and BOB.1 are useful in these circumstances, a variable proportion of CHL are positive for these antigens. We investigated the utility of J chain and MEF2B in the diagnosis of CHL, NLPHL, PMBL, T-cell/histiocyte-rich large B-cell lymphoma (TCRLBL), and B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and CHL (BCLU, DLBCL/CHL) compared to OCT-2 and BOB.1. J chain and MEF2B highlighted lymphocyte predominant (LP) cells in 20/20 (100%) NLPHL and were negative in 43/43 (100%) CHL. 14/15 (93%) PMBL and 4/4 (100%) TCRLBL were MEF2B-positive, while 67% of PMBL and 50% of TCRLBL were J chain-positive. 3/3 BCLU, DLBCL/CHL were negative for J chain and MEF2B. J chain and MEF2B were 100% sensitive and specific for NLPHL versus CHL. MEF2B was 100% sensitive and 98% specific for PMBL versus CHL. Whereas loss of OCT-2 and/or BOB.1 expression had a sensitivity of only 86% and specificity of 100% for CHL versus NLPHL, PMBL, and TCRLBL, lack of both J chain and MEF2B expression was 100% sensitive and 97% specific. J chain and MEF2B are highly sensitive and specific markers of NLPHL versus CHL, are particularly useful in highlighting LP cells, and, with rare exception, are of greater utility than OCT-2 and BOB.1 in differentiating CHL from NLPHL and other large B-cell lymphomas.



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THYMOMA: A clinicopathological correlation of 1470 cases

Publication date: Available online 26 August 2017
Source:Human Pathology
Author(s): Annikka Weissferdt, Neda Kalhor, Justin A. Bishop, Se Jin Jang, Jae Ro, Fredrik Petersson, Bingcheng Wu, Gerald Langman, Hollie Bancroft, Yalan Bi, Yunxiao Meng, Filomena Medeiros, Hans Brunnstrom, Dominic Spagnolo, Siaw Ming Chai, Andrew Laycock, Paul E. Wakely, Goran Elmberger, Fernando A. Soares, Antonio H. Campos, Derya Gumurdulu, Isabel Alvarado-Cabrero, Domenico Coppola, Arlene M. Correa, David Rice, Reza J. Mehran, Boris Sepesi, Garrett Walsh, Larry Kaiser, Cesar A. Moran
We present 1470 surgical resections for thymoma identified in the pathology files of 14 institutions from 11 countries with the purpose to determine and correlate a simplified histological classification of thymoma and pathological staging with clinical outcome. The study population was comprised of 720 men and 750 women between the ages of 12 and 86years (average: 54.8years). Clinically 137 patients (17%) had a history of myasthenia gravis, 31 patients (3.8%) of other autoimmune disease, and 55 (6.8%) patients of another neoplastic process. Surgical resection was performed in all patients. Histologically, 1284 (87.13%) cases were thymomas (World Health Organization [WHO] types A, B1, and B2, and mixed histologies), and 186 (12.7%) were atypical thymomas (WHO type B3). Of the entire group, 630 (42.9%) were encapsulated thymomas and 840 (57.9%) were invasive thymomas in different stages. Follow-up information was obtained in 1339 (91%) patients, who subsequently were analyzed by univariate and multivariate statistical analysis. Follow-up ranging from 1 to 384months was obtained (mean: 69.2months) showing tumor recurrence in 136 patients (10.1%), while 227 died- 64 (28.2%) due to tumor and 163 (71.8%) due to other causes. Statistical analysis shows that separation of these tumors into- thymoma and atypical thymoma- is statistically significant (P=.001), while tumor staging into categories of encapsulated, minimally invasive, and invasion into adjacent organs offers a meaningful clinical assessment with a p=value of 0.038. Our findings suggest that our simplified histological schema and pathological staging system are excellent predictors of clinical outcome.



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