RESUMEN
A 6-year-old boy presented to ER with acute pain in right iliac fossa without any history of lower urinary tract symptoms, haematuria and urinary catheterization. Ultrasound showed loculated cystic area in pelvis with non-visualized appendix. A CT scan abdomen and pelvis revealed loculated, multi-septated cystic lesion in right hemipelvis thought to be a collection from possible appendicular inflammation / perforation. The laboratory findings revealed raised CRP and normal urine routine examination and culture. Exploratory laparotomy revealed cystic urinary bladder growth involving dome with normal appendix, partial cystectomy was done. Histopathology confirmed polypoid cystitis with no evidence of malignancy. This is a very rare presentation of polypoidal cystitis, not previously reported in literature.
Asunto(s)
Cistitis , Neoplasias de la Vejiga Urinaria , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/etiología , Niño , Cistectomía , Humanos , Hallazgos Incidentales , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Renal cell carcinoma (RCC), accounts for 2-3% of all new cancers diagnosed. Most renal tumours have characteristic histological features, which help in their sub classification. However, some cases do show overlapping morphology which pose a diagnostic challenge for the pathologists. Tumour ancillary studies such as immunohistochemistry (IHC) may play a significant role in segregation of these tumours. This study was undertaken to determine the role of IHC in diagnosing these tumours. METHODS: December 2015. It was carried out in histopathology laboratory of Shifa International Hospital, Islamabad. A total of fifty-five (n=55) nephrectomy specimens having RCC subtypes were included. A specific morphological diagnosis was rendered in each case on H&E.. A panel of six immunohistochemical markers CK7, CD10, CD117, CA IX, AMACR and Vimentin was then applied in each case and a final diagnosis considering both morphology and IHC was given. Statistical analysis was done using SPSS version 20.0. Mean and SD were calculated for quantitative variables where as frequencies and percentages were calculated for qualitative variables. RESULTS: Out of a total of 55 cases, 36 (65.55%) were males whereas 19 (34.5%) were females. The mean age of patients was 54.04±14.40 years. Clear cell RCC comprised 70.9% (n=39), Papillary RCC 14.5% (n=8), Chromophobe RCC 10.9% (n=6) and clear cell papillary RCC 3.6% (n=2) of cases on morphology. After application of IHC stains in all cases, 83.6% (n=46) of cases were found to have correct diagnosis on H& E. However, 16.4% (n=9) of cases could not be correctly diagnosed on morphology alone and it was in these cases that IHC played a major role in reaching a final diagnosis. CONCLUSIONS: Although most RCC subtypes display a characteristic morphology on H&E, in a significant proportion of the cases there are considerable overlapping morphological features. Our study shows that a correct diagnosis cannot be made on H & E alone in a notable number of cases. Therefore, IHC should be applied in all cases to reach a final diagnosis, which has both prognostic and therapeutic implications.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/metabolismo , Neoplasias Renales/diagnóstico , Neoplasias Renales/metabolismo , Adulto , Anciano , Antígenos de Neoplasias/metabolismo , Anhidrasa Carbónica IX/metabolismo , Carcinoma de Células Renales/patología , Estudios Transversales , Femenino , Humanos , Inmunohistoquímica , Queratina-7/metabolismo , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Neprilisina/metabolismo , Pronóstico , Estudios Prospectivos , Proteínas Proto-Oncogénicas c-kit/metabolismo , Racemasas y Epimerasas/metabolismo , Vimentina/metabolismoRESUMEN
BACKGROUND: Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. METHODS: 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. RESULTS: No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly. CONCLUSION: Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery.
Asunto(s)
Bocio Nodular/cirugía , Tiroidectomía , Adulto , Femenino , Humanos , Masculino , Tiroidectomía/métodosRESUMEN
OBJECTIVE: To observe and document the clinical features, mode of presentation, histopathological and immunohistochemical features of Kikuchi's disease. DESIGN: An observational and descriptive study. PLACE AND DURATION OF STUDY: Histopathology department, Armed Forces Institute of Pathology, Rawalpindi from January, 1997 to December, 2001. SUBJECTS AND METHODS Thirty-one cases of Kikuchi's disease of lymph node were diagnosed during the study period. Hematoxylin and Eosin stained slides were examined and histological features including extent of architectural effacement, zonation, extent of necrosis, and cellular composition were recorded. Special stains and immunohistochemistry was done. RESULTS: Kikuchi's disease was diagnosed in 31 cases (1.9%) out of 5762 lymph node biopsies received. There were 10 male and 21 female patients. Ten patients were aged between 21 and 25 years (33%). Eight (25.8%) patients were from pediatric age group. Thirty patients (96.4%) presented with cervical lymphadenopathy. Thirteen (41.9%) lymph nodes showed fragmentation, while 8 (25.8%) revealed perinodal spill. Seventeen cases (54.7%) showed more than 50% necrosis. Zonation was seen in 13 (41.9%) cases. Immunohistochemistry showed majority of cells to be histiocytes and T-lymphocytes. Eight cases were followed-up, all of which showed regression of symptoms over 4-8 months. CONCLUSION: Kikuchi's disease is an uncommon cause of cervical lymphadenopathy in young females. Necrotic areas, karyorrhexis, zonation, absence of neutrophils and predominance of histiocytes with many plasmacytoid monocytes are features that aid in diagnosis. Immunohistochemistry can be used to differentiate it from malignant lymphoma. It is important for clinicians and pathologists to be aware of this entity as it is a benign disorder with a self-limiting course.