RESUMEN
Amyloid consists of insoluble beta-fibrillar proteins with stable structures. The Congo red staining method for histologically detecting amyloid is unsuitable for quantitatively assessing amyloid fibers. Scanning acoustic microscopy (SAM) detects the attenuation of sound (AOS) through sections. This study aimed to clarify whether AOS values reflected the amount of amyloid fibril degradation in tissues. Formalin-fixed paraffin-embedded unstained sections of various types of amyloidosis were digested with different endopeptidases. The AOS images after digestion were observed over time via SAM. The corresponding Congo red-stained images were followed to identify the amyloid. The amyloid and nonamyloid portions were statistically examined over time to determine the changes in the AOS values. Most of the amyloid areas showed significantly different AOS values from nonamyloid portions before digestion and significantly decreased after digestion; these findings corresponded with the disappearance and waning of the Congo red staining in the light microscopic images. Some nonamyloid areas with high AOS masked the reduction in AOS in the amyloid areas. The method used in this study may help detect the amyloid quantity and determine the appropriate treatment method for removing amyloid deposits from tissues.
Asunto(s)
Amiloide , Rojo Congo , Amiloide/metabolismo , Péptido Hidrolasas , Microscopía Acústica/métodos , Proteínas Amiloidogénicas/química , Coloración y Etiquetado , EndopeptidasasRESUMEN
Lung tissue stiffness is altered with aging. Quantitatively evaluating lung function is difficult using a light microscope (LM) alone. Scanning acoustic microscope (SAM) calculates the speed-of-sound (SOS) using sections to obtain histological images by plotting SOS values on the screen. As SOS is positively correlated with stiffness, SAM has a superior characteristic of simultaneously evaluating tissue stiffness and structure. SOS images of healthy bronchioles, arterioles, and alveoli were compared among young, middle-aged, and old lung sections. Formalin-fixed, paraffin-embedded (FFPE) sections consistently exhibited relatively higher SOS values than fresh-frozen sections, indicating that FFPE became stiffer but retained the relative stiffness reflecting fresh samples. All lung components exhibited gradually declining SOS values with aging and were associated with structural alterations such as loss of smooth muscles, collagen, and elastic fibers. Moreover, reaction to collagenase digestion resulted in decreased SOS values. SOS values of all components were significantly reduced in young and middle-aged groups, whereas no significant reduction was observed in the old group. Protease damage in the absence of regeneration or loss of elastic components was present in old lungs, which exbited dilated bronchioles and alveoli. Aging lungs gradually lose stiffness with decreasing structural components without exposure to specific insults such as inflammation.
Asunto(s)
Adenocarcinoma del Pulmón/patología , Envejecimiento , Colagenasas/metabolismo , Neoplasias Pulmonares/patología , Pulmón/patología , Microscopía Acústica/métodos , Manejo de Especímenes/métodos , Adenocarcinoma del Pulmón/clasificación , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colágeno/metabolismo , Tejido Elástico , Femenino , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Sonido , Adulto JovenRESUMEN
Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is newly suggested and characterized by HPV-related tumors. HMSC has a relatively good prognosis. No cases of brain invasion have been reported to date. We encountered a case of brain invasion by HMSC, in which we assessed the effectiveness of radiotherapy in comparison with biopsy and autopsy. A 69-year-old man was referred to a hospital three months after intracerebral hemorrhage (ICH). Contrast magnetic resonance imaging revealed a tumor in the ethmoid sinus involving the brain. We performed transnasal biopsy and intensity-modulated radiotherapy for sinonasal and intracranial lesions. Despite radiotherapy, the patient died on day 41 after radiation. Biopsy specimens displayed mixed findings of epithelial and mesenchymal components. The tumor was immunoreactive for p16, and the RNA in situ hybridization for HPV was positive. Finally, we diagnosed the patient as having HMSC. Autopsy of the sinonasal tissue revealed a reduction in the number of tumor cells. There was a marked reduction in the number of tumor cells in the sinonasal tissue compared to that in the invaded brain tissue. The effectiveness of radiotherapy could depend on the histopathological components and location of the lesion, even in the same patient.
Asunto(s)
Alphapapillomavirus , Carcinoma , Infecciones por Papillomavirus , Neoplasias de los Senos Paranasales , Anciano , Encéfalo , Humanos , Masculino , Papillomaviridae , Neoplasias de los Senos Paranasales/radioterapiaRESUMEN
Cells incur structural and functional damage from external stimuli. Under scanning acoustic microscopy (SAM), speed of sound (SOS), attenuation, and thickness values are plotted to visualize cellular stiffness, viscosity, and size. The obtained digital data are then compared using statistical analysis. In the present study, we aimed to investigate the alterations in the mechanical and structural characteristics of cancer cells in response to anticancer drugs, acidic fluids, and microwave burdens using SAM. We found that active untreated cells showed increased thickness and reduced SOS and attenuation, whereas dying treated cells displayed reduced thickness and increased SOS. Tannic and acetic acid treatments and microwave irradiation all increased SOS and attenuation and reduced thickness, which meant that these treatments made cells thinner, stiffer, and more viscous. Furthermore, the different anticancer drugs interacted with cancer cells to induce characteristic changes in SAM values. These structural and mechanical alterations induced in cells were difficult to observe under light microscopy. However, under SAM, cancer cell activity and function corresponded consistently with changes in SAM values. Cellular damage parameters were statistically compared between the different treatments, and time-dependent cellular changes were established. SAM observation can therefore reliably evaluate cancer cell damage and recovery after chemotherapy and physical therapy. These results may help evaluate the therapeutic efficacy of various treatments.
RESUMEN
BACKGROUND: Tuberous sclerosis complex (TSC) is a rare inherited disease with non-cancerous tumor growths in the skin, brain, kidneys, heart, and lungs. The co-occurrence of neuroendocrine neoplasm (NEN) with TSC is even rarer. There have been few reports on the relationship between TSC and neuroendocrine tumors (NETs), and fewer on the relationship between TSC and neuroendocrine carcinoma (NEC), a subtype of NEN. This is the first reported case of NEC occurring at the esophagogastric junction in a patient with TSC. CASE SUMMARY: A 46-year-old woman visiting our hospital for the treatment of TSC was admitted to the emergency department with tarry stools and dizziness. Computed tomography scans revealed thickness of the gastric cardia, multiple metastatic lesions of the liver, and enlarged lymph nodes near the lesser curvature of the stomach. Esophagogastroduodenoscopy revealed a type 3 tumor located from the esophagogastric junction to the fundus, and the pathological diagnosis by biopsy was NEC. The patient was treated with seven courses of cisplatin + irinotecan, followed by eight courses of ramucirumab + nab-paclitaxel, one course of nivolumab, and two courses of S-1 + oxaliplatin. Twenty-three months after the first treatment, the patient died because of disease progression and deterioration of the general condition. CONCLUSION: This case of NEC occurring in a patient with TSC indicates a difference in the occurrence of NETs and NECs.
Asunto(s)
Carcinoma Neuroendocrino , Neoplasias Gástricas , Esclerosis Tuberosa , Carcinoma Neuroendocrino/diagnóstico por imagen , Carcinoma Neuroendocrino/tratamiento farmacológico , Unión Esofagogástrica/diagnóstico por imagen , Femenino , Humanos , Recién Nacido , Irinotecán , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/tratamiento farmacológico , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/diagnóstico por imagenRESUMEN
OBJECTIVES: Aging causes stiffness and decreased function of the renal artery (RA). Histological study with light microscopy can reveal microscopic structural remodeling but no functional changes. The present study aimed to clarify the association between structural and functional aging of the RA through the use of scanning acoustic microscopy. METHODS: Formalin-fixed, paraffin-embedded cross-sections of renal arteries from 64 autopsy cases were examined. Speed-of-sound (SOS) values of three layers, which correspond to the stiffness, were compared among different age groups. SOS of the tunica media was examined in terms of blood pressure (BP) and SOS of the ascending aorta. Vulnerability to proteases was assessed by SOS reduction after collagenase treatment. RESULTS: The tunica intima presented inward hypertrophy with luminal narrowing, and the tunica media showed outward hypertrophic remodeling with aging. SOS of the tunica media and internal and external elastic laminae showed a reverse correlation with age. SOS of the tunica media was negatively correlated with BP and strongly associated with that of the aorta. The tunica media of young RAs were more sensitive to collagenase compared with the old ones. CONCLUSIONS: Scanning acoustic microscopy is useful for observing the aging process of the RA. This technique simultaneously shows structural and mechanical information from each portion of the RA. In the process of aging, the RA loses contractile function and elasticity as a result of protease digestion. The tunica media and the internal and external elastic laminae exhibit reduced stiffness, but the tunica intima stiffens with atherosclerosis. As a consequence, the RA's outer shape changes from round to oval with inward and outward hypertrophy. This indicates that the inner resistant intima supports the mechanical weakness of the tunica media to compensate for an increase in BP with aging.
Asunto(s)
Envejecimiento/fisiología , Arteria Renal/fisiopatología , Túnica Íntima/patología , Túnica Media/patología , Adulto , Anciano de 80 o más Años , Autopsia , Presión Sanguínea , Femenino , Humanos , Masculino , Microscopía Acústica , Túnica Íntima/diagnóstico por imagen , Túnica Íntima/fisiopatología , Túnica Media/diagnóstico por imagen , Túnica Media/fisiopatologíaRESUMEN
OBJECTIVE: To evaluate proteins related to tumor immune response and treatment outcome from radiotherapy for uterine cervical cancer patients. METHODS: We performed a retrospective immunohistochemical staining of 81 patients with uterine cervical cancer who underwent definitive radiotherapy. We examined the expression of programmed death ligand 1, human leukocyte antigen class I, tumor-infiltrating CD8+, and forkhead box P3+ (FoxP3+) T cells in tumor tissues. RESULTS: In biopsy specimen, patients with a higher number of CD8+ T cells and FoxP3+ T cells had a better disease-specific survival than patients with a lower number of CD8+ T cells and FoxP3+ cells (P = 0.018 and P = 0.009). Multivariate analysis showed that equivalent dose in 2 Gy fractions (EQD2) of the minimum dose to 90% of the high-risk clinical target volume, FoxP3+ T cells and expression of human leukocyte antigen class I were significant prognostic factors. When the EQD2 is 70 Gy or more, a higher local control rate is obtained regardless of the number of CD8- or FoxP3-positive cells. When EQD2 is <70 Gy, the number of CD8-positive cells has a significant impact on treatment outcome: the recurrence rate (local recurrence rate + distant metastasis rate) was 46.2% in the group with a CD8 value of 230 or higher, whereas the recurrence rate was 75.7% in the group with a CD8 value of less than 230. CONCLUSION: The combination of CD8 or FoxP3 with EQD2 can be potentially useful to predict the treatment results of radiotherapy for cervical cancer, leading to individualized optimal selection of treatment for cervical cancer.
Asunto(s)
Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Linfocitos T CD8-positivos/inmunología , Supervivencia sin Enfermedad , Femenino , Factores de Transcripción Forkhead/metabolismo , Humanos , Linfocitos Infiltrantes de Tumor/inmunología , Linfocitos Infiltrantes de Tumor/metabolismo , Linfocitos Infiltrantes de Tumor/patología , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patologíaRESUMEN
Combining external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT) is important for definitive treatment of cervical cancer. In cervical cancer patients receiving radiotherapy, we evaluated treatment outcomes in relation to dose-volume histogram parameters, including the computed tomography (CT)-based high-risk clinical target volume (HR-CTV) for ICBT. Between 2010 and 2015, 89 consecutive cervical cancer patients were mostly treated with 40 Gy of EBRT in 20 fractions and 18 Gy of ICBT prescribed to point A in 3 fractions. CT scans were obtained during ICBT. The HR-CTV D90 was calculated and the total doses of ICBT and EBRT were converted to the equivalent dose in 2 Gy fractions (EQD2). When the patients were divided into four groups according to EQD2 of the HR-CTV D90, the 3-year local recurrence-free survival rates were 95.2, 78.4, 52.7 and 42.9% for patients receiving >80 , 70-80 , 60-70 and <60 Gy, respectively. There was a significant negative correlation between EQD2 of the HR-CTV D90 and the HR-CTV volume at first ICBT (r = -0.713). Local recurrence was more frequent when the HR-CTV volume was ≥22 cc and EQD2 of the HR-CTV D90 was <70 Gy. Multivariate analysis showed that EQD2 of the HR-CTV D90 and concurrent chemotherapy (≥4 cycles) were significant determinants of overall survival. HR-CTV D90 was an important prognostic indicator for local recurrence. HR-CTV D90 >70 Gy is required for the better local control, especially in patients with a larger HR-CTV (≥22 cc at initial ICBT).
Asunto(s)
Braquiterapia , Dosificación Radioterapéutica , Neoplasias del Cuello Uterino/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The present study aims to identify specific staining methods for acoustic histology. We compared attenuation-of-sound (AOS) images from scanning acoustic microscopy (SAM) with light microscopy (LM) images. Ethanol-fixed tissue or cytology samples and formalin-fixed surgical or autopsy specimens were examined. Nuclei, collagen, elastic fibers and polysaccharides and various antigens, including cell surface, cytoplasmic, nuclear and stromal substances, were observed. Samples with various fixation methods were used. Hematoxylin staining had significantly higher AOS values in accordance with staining duration. Specific staining for collagen, elastic fibers and polysaccharides increased the AOS values of the specific substance. Using diaminobenzidine tetrahydrochloride in NiCl2 solution as a substrate for horseradish peroxidase increased the AOS values to those suitable for acoustic immunostaining. Collagenase digestion after collagen staining decreased AOS values, reflecting collagen density and distribution. Staining with specific dyes or acoustic immunostaining enabled the histologic localization of specific substances by SAM, similar to LM.
Asunto(s)
Anticuerpos/ultraestructura , Colágeno/ultraestructura , Colorantes , Tejido Elástico/ultraestructura , Microscopía Acústica/métodos , Polisacáridos/ultraestructura , Cadáver , Humanos , Inmunohistoquímica , Estudios RetrospectivosRESUMEN
Scanning acoustic microscopy reveals information on histology and speed of sound (SOS) through tissues. Slower SOS corresponds to lower stiffness. The aim of the present study was to investigate whether SOS values reflect the degree of degeneration with aging or dissection and whether enzymatic digestion susceptibility is distinct. The SOSs of media other than the atheromatous areas of normal and surgical dissections were measured and compared using medial degeneration grade (MDG) scores. To evaluate the damage rate, SOS was assessed after collagenase digestion. SOS scores negatively correlated with aging and MDG scores. Dissected aortas had higher SOS and MDG scores without age correlation. Collagenase digestion was present in all aortas, but older aortas were more injured than younger aortas. Dissected aortas were more vulnerable to collagenase. Older and dissected aortas expressed specific extracellular matrix components to compensate for mechanical weakness. The present method can evaluate mechanical weakness corresponding to histology to investigate the cause of rupture.
Asunto(s)
Envejecimiento , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Colagenasas/metabolismo , Microscopía Acústica/métodos , Disección Aórtica/fisiopatología , Aorta Torácica/metabolismo , Aneurisma de la Aorta/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , SonidoRESUMEN
PURPOSE: Preoperative treatment is recommended for borderline resectable pancreatic ductal adenocarcinoma. However, the standard treatment has not yet been determined. We conducted a multicenter phase 2 study to investigate the efficacy of neoadjuvant treatment of sequential chemoradiation followed by chemotherapy. METHODS AND MATERIALS: All enrolled patients were treated by preoperative chemoradiation (a total dose of 50.4 Gy in 28 fractions and orally administered S-1 at 80 mg/m2 on the day of irradiation) followed by chemotherapy (administration of gemcitabine at 1000 mg/m2/dose on days 1, 8, and 15 in 3 cycles of 4 weeks) and attempted curative resection. The primary outcome was an R0 resection rate among patients who completed preoperative treatment and pancreatectomy. The threshold of the R0 resection rate was defined as 74% based on a previous study of up-front surgery. RESULTS: Forty-five patients were included. Twenty-one patients could not undergo pancreatectomy because of progressive diseases (n = 14), adverse events (n = 5), or consent withdrawal (n = 2), and 4 patients underwent additional resection after dropping out. The resection rates were 53.3% and 62.2% in the per-protocol set (PPS) and full analysis set (FAS) populations, respectively. The R0 resection rates were 95.8% (95% confidence interval, 78.9%-99.9%) and 96.4% (81.7%-99.9%) in the PPS and FAS populations, respectively. The median overall survival and progression-free survival of all the included patients were 17.3 and 10.5 months, respectively. The median survival time of the patients with pancreatectomy was significantly longer than that of the patients without pancreatectomy in the PPS (27.9 vs 12.3 months; P = .001) and FAS populations (32.2 vs 11.8 months; P < .001). CONCLUSIONS: This study revealed that a long duration of preoperative treatment of sequential chemoradiation followed by systemic chemotherapy provides a high rate of R0 resection and sufficient survival time in patients undergoing pancreatectomy.
Asunto(s)
Adenocarcinoma/terapia , Antimetabolitos Antineoplásicos/administración & dosificación , Quimioradioterapia/métodos , Desoxicitidina/análogos & derivados , Terapia Neoadyuvante , Ácido Oxónico/administración & dosificación , Neoplasias Pancreáticas/terapia , Tegafur/administración & dosificación , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Carcinoma Ductal Pancreático/diagnóstico por imagen , Carcinoma Ductal Pancreático/patología , Carcinoma Ductal Pancreático/terapia , Desoxicitidina/administración & dosificación , Fraccionamiento de la Dosis de Radiación , Esquema de Medicación , Combinación de Medicamentos , Femenino , Humanos , Masculino , Recurrencia Local de Neoplasia , Pancreatectomía/efectos adversos , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Complicaciones Posoperatorias , Criterios de Evaluación de Respuesta en Tumores Sólidos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , GemcitabinaRESUMEN
Scanning acoustic microscopy (SAM) can assess tissue stiffness by calculating the speed of sound (SOS) through tissues. SOS increases as tissue stiffness increases. Sensitivity to protease digestion depends on protein type, concentration, and modification. We analyzed the SOS images of formalin-fixed paraffin-embedded skin sections from elderly, young, diabetic, and nondiabetic subjects, as well as chronic and acute wounds. SAM provided high-resolution histology similar to LM and revealed characteristic SOS alteration following pepsin treatment. SOS values of dermis samples from elderly subjects (especially females) were lower than those of younger adults, which was indicative of age-related dermal softening and loosening. SOS values of elderly females were lower than those of younger females and elderly males. Dermal SOS showed a positive correlation with epidermal thickness. SOS values of epidermis of elderly subjects were higher than those of younger adults and showed a rapid decline 0.5h after protease digestion. Reticular dermis of diabetic patients exhibited greater pepsin resistance than that of nondiabetic patients. Chronic wounds exhibited greater SOS values and pepsin resistance than acute wounds. SOS variation with aging, diabetes mellitus, and wound fibrosis reflected histological and mechanical changes associated with senescence and disease duration. Epidermal thickness reflects age-related changes in dermal stiffness.
RESUMEN
Wound compression and fixation are important to reduce scarring. Numerous postoperative treatments have been developed to reduce scar formation; however, a simple and effective device that improves the appearance and histochemical properties of incisional scars is needed. Therefore, the authors have devised a novel method, negative-pressure fixation, that applies negative pressure inside polyurethane foam covered with film. In the present study, negative-pressure fixation was applied to incisional wounds resulting from the insertion of a tissue expander in patients undergoing two-stage breast reconstruction. The authors aimed to evaluate the effects of negative-pressure fixation on scar appearance and histochemical properties in comparison to those for film dressing without negative pressure. A prospective, open-label, randomized, single-center study was performed. A half-side test was conducted on the incisional scar resulting from tissue expander insertion during breast reconstruction after mastectomy in 13 female patients. The dressings on both sides of the scar were replaced once per week until the tissue expander was adequately inflated. The outcomes were assessed 6 months later. Scars were photographed before the second operation and were evaluated using a visual analogue scale. All scars were removed and resutured during the final operation, allowing a histochemical analysis. The mean visual analogue scale score for the negative-pressure fixation side was significantly lower compared with that for the film dressing side (p = 0.0025). In addition, the scar on the negative-pressure fixation side was significantly narrower (p = 0.0015). Thus, negative-pressure fixation is a simple and effective device for improving the appearance and histochemical properties of incisional scars.
Asunto(s)
Cicatriz/prevención & control , Mamoplastia , Terapia de Presión Negativa para Heridas , Apósitos Oclusivos , Complicaciones Posoperatorias/prevención & control , Herida Quirúrgica/terapia , Expansión de Tejido , Adolescente , Adulto , Anciano , Cicatriz/etiología , Femenino , Humanos , Mamoplastia/métodos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The oncological effectiveness of preoperative radiotherapy for locally advanced colon cancer is unclear. We report a case of pathological complete response in a patient with locally advanced ascending colon cancer after preoperative radiotherapy following failure of chemotherapy. CASE PRESENTATION: A 65-year-old Japanese woman presented with malaise and hematochezia. A computed tomography (CT) revealed a tumor in the ascending colon which seemed to infiltrate the adjacent structures. She was diagnosed with locally advanced ascending colon cancer stages T4b, N2a, M0, and IIIC. We selected modified FOLFOX6 with panitumumab as neoadjuvant chemotherapy. However, we discontinued the chemotherapy after the 8th cycle because of disease progression and severe adverse effects. The patient then underwent radiotherapy of 60 Gy in 30 fractions, resulting in significant tumor size reduction. One month after the radiotherapy, we performed a right hemicolectomy with multivisceral resection without complications. Histopathologically, we found no residual cancer cells in the resected specimen. The patient remains alive and has not required additional therapies for 24 months, as there are no signs of recurrence. CONCLUSIONS: The present case suggests that preoperative radiotherapy might be an effective treatment options for locally advanced colon cancer.
RESUMEN
Adenocarcinoma arising from the duodenum is relatively rare. Diagnosis of this disease at an early stage is difficult because its symptoms are usually nonspecific. We herein present a case in which duodenal adenocarcinoma was successfully found by transabdominal ultrasonography. Under ultrasonography, the tumor was located in the proximal duodenum apart from the papilla of Vater, and the serosa was intact. Other diagnostic modalities showed no evidence of adjacent organ invasion or distant metastasis. Therefore, pancreatoduodenectomy was performed and the postoperative course was uneventful. The ultrasonographic findings corresponded well with the pathological diagnosis. The following three procedures were essential in this case: systematic scanning of the digestive tract to determine the location of the lesion, graded compression ultrasound to remove air bubbles from the region of interest, and precise observation of the intestinal walls using proper transducers. The precise and skillful performance of transabdominal ultrasonography using a suitable device can help to diagnose duodenal adenocarcinoma, a rare malignancy.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Neoplasias Duodenales/diagnóstico por imagen , Duodeno/diagnóstico por imagen , Ultrasonografía , Adenocarcinoma/cirugía , Neoplasias Duodenales/cirugía , Duodeno/patología , Duodeno/cirugía , Femenino , Humanos , Persona de Mediana Edad , Pancreaticoduodenectomía , Tomografía Computarizada por Rayos XRESUMEN
The aim of this study was to reveal the pathogenesis of aortic stenosis (AS) and regurgitation (AR) by comparing differences in mechanical and biochemical alterations. We applied scanning acoustic microscopy (SAM) to measure the speed of sound (SOS) through valves to estimate the elasticity and monitor sensitivity to protease treatment, as the SOS is correlated with the stiffness of materials, which is reduced after digestion by proteases. The fibrosa of both the AS and AR groups were stiffer than the fibrosa of the normal group. The AR group displayed significantly stiffer fibrosa than the AS group, with the exception of calcified areas. The AS group showed significantly decreased SOS values following protease digestion, whereas the AR showed little reduction. The AS group presented type III collagen in the fibrosa and the ventricularis. In the AR group, both type I collagen and type III collagen coexisted in the fibrosa and the ventricularis. Upon immunostaining for advanced glycation end-products, the AS group showed sparse, weak staining, whereas the AR group presented a strong, band-like positive reaction in the fibrosa. In conclusion, tissue remodelling associated with damage and repair is associated with AS pathogenesis, whereas static chemical alterations with slow collagen turnover induce AR.
Asunto(s)
Insuficiencia de la Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/fisiopatología , Válvula Aórtica/patología , Válvula Aórtica/fisiopatología , Anciano , Anciano de 80 o más Años , Envejecimiento/patología , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Colágeno/metabolismo , Colágeno/ultraestructura , Módulo de Elasticidad , Femenino , Humanos , Masculino , Microscopía Acústica , Valores de ReferenciaRESUMEN
Scanning acoustic microscopy (SAM) discriminates lesions in sections by assessing the speed of sound (SOS) or attenuation of sound (AOS) through tissues within a few minutes without staining; however, its clinical use in cytological diagnosis is unknown. We applied a thin layer preparation method to observe benign and malignant effusions using SAM. Although SAM is inferior in detecting nuclear features than light microscopy, it can differentiate malignant from benign cells using the higher SOS and AOS values and large irregular cell clusters that are typical features of carcinomas. Moreover, each single malignant cell exhibits characteristic cytoplasmic features such as a large size, irregular borders and secretory or cytoskeletal content. By adjusting the observation range, malignant cells are differentiated from benign cells easily using SAM. Subtle changes in the functional and structural heterogeneity of tumour cells were pursuable with a different digital data of SAM. SAM can be a useful tool for screening malignant cells in effusions before light microscopic observation. Higher AOS values in malignant cells compared with those of benign cells support the feasibility of a novel sonodynamic therapy for malignant effusions.
Asunto(s)
Líquidos Corporales/citología , Microscopía Acústica/métodos , Neoplasias/patología , Humanos , Neoplasias/diagnósticoRESUMEN
A scanning acoustic microscope (SAM) calculates the speed of sound (SOS) through tissues and plots the data on the screen to form images. Hard tissues result in greater SOS; based on these differences in tissue properties regarding SOS, SAM can provide data on tissue elasticity. The present study evaluated whether tissue modifications, such as formalin fixation, periodic acid-Schiff (PAS) reactions and protein degradation, changed the acoustic properties of the tissues and whether SAM could be a useful tool for following chemical changes in sections. The fixation process was observable by the increased SOS. During the PAS reaction, the glycosylation of tissues was characterized by an increased SOS. Mucous or glycogen distribution was visualized and was found to be statistically comparable among lesions and states. Protease digestion by pepsin led to a decreased SOS. Tissue sensitivity to proteases varied due to the stage, cause and duration of inflammation or ageing. Changes in acoustic properties were more sensitive than those in optical histology. SAM facilitates the visualisation of the time course or distribution of chemical modifications in tissue sections, thus aiding their comparison among tissues. SAM may be an effective tool for studying changes such as protein cross-linkage, tissue repair and ageing.