RESUMEN
In most cases, the histopathologic and cytologic distinction between Graves' disease and papillary thyroid carcinoma is relatively easy, but on occasion Graves' disease may simulate a thyroid papillary carcinoma. For example, papillary fronds with fibrovascular cores may be present in both Graves' disease and papillary carcinoma. p27kip1 (p27) is a cyclin-dependent kinase inhibitory protein that has been shown to be an independent prognostic factor in a variety of human tumors. Our previous studies of p27 expression in hyperplastic and neoplastic endocrine lesions showed that the level of p27 was quite different in these two conditions. To determine if this distinction could also be made between Graves' disease and papillary carcinoma, we analyzed expression of p27 and other cell cycle proteins in a series of cases of Graves' disease with papillary hyperplasia and a series of papillary thyroid carcinomas. Formalin-fixed paraffin-embedded tissues from 61 randomly selected patients with thyroid disease, including 29 cases of Graves' disease with papillary architectural features and 32 cases of papillary carcinoma, were analyzed for expression of p27, Ki-67, and DNA topoisomerase II alpha (topo II alpha) by immunostaining. The distribution of immunoreactivity was analyzed by quantifying the percentage of positive nuclei that was expressed as the labeling index (LI) plus or minus the standard error of the mean. The papillary hyperplasia of Graves' disease had a p27 LI of 68.2 +/- 3.1 (range, 24 to 88), whereas papillary carcinomas had a LI of 25.6 +/- 2.5 (range, 12 to 70) (P < .0001). No significant differences in Ki-67 or topo II alpha expression were identified between papillary hyperplasia in Graves' disease and papillary carcinoma. These results indicate that p27 protein expression is significantly higher in papillary hyperplasia of Graves' disease compared to papillary carcinoma, which may be diagnostically useful in difficult cases.
Asunto(s)
Carcinoma Papilar/patología , Proteínas de Ciclo Celular , Quinasas Ciclina-Dependientes/antagonistas & inhibidores , ADN-Topoisomerasas de Tipo II , Enfermedad de Graves/patología , Proteínas Asociadas a Microtúbulos/metabolismo , Neoplasias de la Tiroides/patología , Proteínas Supresoras de Tumor , Adulto , Antígenos de Neoplasias , Carcinoma Papilar/metabolismo , Núcleo Celular/metabolismo , Núcleo Celular/patología , Inhibidor p27 de las Quinasas Dependientes de la Ciclina , ADN-Topoisomerasas de Tipo II/metabolismo , Proteínas de Unión al ADN , Diagnóstico Diferencial , Femenino , Enfermedad de Graves/metabolismo , Humanos , Hiperplasia/metabolismo , Hiperplasia/patología , Técnicas para Inmunoenzimas , Isoenzimas/metabolismo , Antígeno Ki-67/metabolismo , Masculino , Persona de Mediana Edad , Neoplasias de la Tiroides/metabolismoRESUMEN
We describe the histopathologic features of 6 cases of gastrointestinal basidiobolomycosis examined at 4 Phoenix, AZ, area hospitals during the last 4 years. Resected stomach and intestinal specimens were characterized by marked mural thickening with fibrosis, prominent tissue eosinophil infiltration and palisading granulomatous inflammation around pale fungal hyphae. In 2 cases, there was colonic perforation. Basidiobolus ranarum hyphae (associated with spore-like spherules in 4 cases) were identified within tissue sections; the irregularly branched, thin-walled, occasionally septated hyphae were typically surrounded by a thick eosinophilic cuff (Splendore-Hoeppli phenomenon). Although the histologic features of B ranarum are well described in the skin and subcutaneous tissue, gastrointestinal involvement has presented considerable diagnostic difficulty. Before the occurrence of this cluster of cases, intra-abdominal B ranarum infection has been reported only rarely.
Asunto(s)
Entomophthorales/patogenicidad , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/patología , Cigomicosis/patología , Adulto , Colon Sigmoide/microbiología , Colon Sigmoide/patología , Brotes de Enfermedades , Entomophthorales/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agrupamiento Espacio-Temporal , Cigomicosis/microbiologíaRESUMEN
A 14-year-old girl experienced sudden onset of weakness progressing rapidly to paralysis. She died 7 days later from a massive pulmonary thromboembolus. Autopsy revealed extensive infarction of the spinal cord with a fibrocartilaginous embolus of the corresponding segment of the anterior spinal artery.