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Mixed epithelial and stromal tumour of kidney
S68
PATHOLOGY 2013 ABSTRACT SUPPLEMENT
divergent differentiation are rare, therefore the clinical significance and prognosis is uncertain.
THE UTILITY OF S100P IN EUS FNAS OF PANCREATIC TUMOURS – CAN IT HELP IN DISTINGUISHING BENIGN FROM MALIGNANT LESIONS Alexandra Du Guesclin, Cameron Skehan, Amanda Naismith, Piero Nelva, Beena Kumar Monash Medical Centre Clayton, Southern Health, Vic, Australia Pancreatic ductal adenocarcinoma is the most common malignant neoplasm of the pancreas. Endoscopic ultrasound fine needle aspiration (EUS FNA) is a rapid, safe, cost-effective way to establish an accurate diagnosis of pancreatic cancer. Due to overlapping cytological features between neoplastic and reactive ductal epithelium, a high rate of false positivity/negativity involved in this test, we have explored the utility of tumour markers as an adjunct to conventional procedures. S100P is a protein in the S100 family of calcium binding proteins. S100P expression has been found to increase during the progression from pancreatic intraepithelial neoplasia to invasive adenocarcinoma, but is absent in benign and reactive pancreatic epithelial cells. The diagnostic value of S100P on FNA biopsy specimens of the pancreas was evaluated. There were 300 cases of pancreatic FNAs in the department, of which 50 cases where cell blocks contained adequate material were utilised for this pilot study. Mixes of benign, suspicious and malignant cases were included. Unstained sections from the cell block were stained with S100P. The slides have been analysed based on intensity and percentage of staining. Nuclear or nuclear/cytoplasmic staining was regarded as positive. Cytoplasmic without nuclear staining was regarded as negative. The sensitivity and specificity were calculated.
Pathology (2013), 45(S1)
Conclusion: In this case, the history of overdose was relatively specific. Acute and chronic toxicity are reported in the literature and concurrent consumption of alcohol is associated with increased toxicity. The autopsy findings in this case were relatively typical, and histology was valuable for diagnosis.
PROLIFERATIVE GLOMERULONEPHRITIS WITH MONOCLONAL IGG DEPOSITS ON A BACKGROUND OF CHRONIC LITHIUM NEPHROTOXICITY – A CASE REPORT Leo Francis1, Victoria Francis1, Sree Venuthurupalli2 1Department of Anatomical Pathology, Royal Brisbane & Women’s
Hospital, Brisbane, and 2Department of Medicine, Toowoomba Hospital, Toowoomba, Qld, Australia Aims: To document a previously unreported association of chronic lithium nephrotoxicity and proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID). Methods: A 70-year-old female with a long-term history of lithium treatment for bipolar disorder presented with the nephrotic syndrome. A renal biopsy was performed. Results: A chronic tubulo-interstitial nephritis with microcysts was present, typical of lithium toxicity. The glomeruli showed a membranoproliferative glomerulonephritis with mesangial and granular capillary loop reactivity for C3, IgG and kappa (but not lambda) light chain. Electron microscopy confirmed mesangial and subendothelial deposits which lacked microtubular and fibrillary features. Cryoglobulins were not detected. Discussion: Lithium treatment can cause the nephrotic syndrome, but usually due to minimal change nephropathy or focal segmental glomerulosclerosis. An association with PGNMID has not been described in the literature, and is probably coincidental.
The results are currently under evaluation.
COLCHICINE TOXICITY CAUSING DEATH Francis1,
Milne2
Nathan Queensland, and 2Queensland Health Forensic and Scientific Services, Forensic Pathology, Qld, Australia Victoria
1Pathology
Introduction: Colchicine is a naturally-occurring alkaloid most commonly used for pain relief in gout. Fatal toxicity can occur with therapeutic doses (7 mg). Significant overdose leads to multiorgan failure and is almost universally fatal. A case study of deliberate colchicine overdose is presented. Results: The patient was a 51-year old male with a history of gout and alcohol abuse but no known history of psychiatric illness or suicide attempts. He was admitted to hospital complaining of abdominal pain, nausea, vomiting and diarrhoea. He admitted to ingesting 230 colchicine tablets (115 g) and a bottle of whiskey approximately 14 hours previously. Treatment was initiated but approximately 27 hours post-ingestion, he died. Autopsy findings included coronary atherosclerosis, changes consistent with chronic alcohol abuse in the liver and changes consistent with colchicine toxicity throughout the gastrointestinal tract. Toxicological analysis of admission bloods showed a colchicine level of 0.10 mg/kg with no alcohol detected.
MIXED EPITHELIAL AND STROMAL TUMOUR OF KIDNEY Laurence A. Galea1, Kiran Manya2, Shomik Sengupta2, Alison Skene1 1Department of Anatomical Pathology, Austin Pathology, Austin Health, Heidelberg, and 2Department of Urology, Austin Health, Heidelberg, Vic, Australia Benign mixed epithelial and stromal tumour of the kidney (MESTK) is a recently described rare neoplasm. It shows a predilection for perimenopausal women. About 50 cases have been described in the English literature. The pathogenesis of MESTK is uncertain with deranged hormonal environment, including unopposed oestrogen implicated in the induction of periductal foetal mesenchymal cell proliferation. A translocation involving t(1;19)(p22;p13.1) was identified in one case. Recent evidence supports the theory of a single cell of origin with the capacity for epithelial and stromal differentiation. Though most MESTK are benign, a few cases with aggressive behaviour and malignant transformation have been reported. We describe another two cases of MESTK occurring in two female patients. The mode of presentation, operative procedures and pathology is described.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2013 ABSTRACT SUPPLEMENT
divergent differentiation are rare, therefore the clinical significance and prognosis is uncertain.
THE UTILITY OF S100P IN EUS FNAS OF PANCREATIC TUMOURS – CAN IT HELP IN DISTINGUISHING BENIGN FROM MALIGNANT LESIONS Alexandra Du Guesclin, Cameron Skehan, Amanda Naismith, Piero Nelva, Beena Kumar Monash Medical Centre Clayton, Southern Health, Vic, Australia Pancreatic ductal adenocarcinoma is the most common malignant neoplasm of the pancreas. Endoscopic ultrasound fine needle aspiration (EUS FNA) is a rapid, safe, cost-effective way to establish an accurate diagnosis of pancreatic cancer. Due to overlapping cytological features between neoplastic and reactive ductal epithelium, a high rate of false positivity/negativity involved in this test, we have explored the utility of tumour markers as an adjunct to conventional procedures. S100P is a protein in the S100 family of calcium binding proteins. S100P expression has been found to increase during the progression from pancreatic intraepithelial neoplasia to invasive adenocarcinoma, but is absent in benign and reactive pancreatic epithelial cells. The diagnostic value of S100P on FNA biopsy specimens of the pancreas was evaluated. There were 300 cases of pancreatic FNAs in the department, of which 50 cases where cell blocks contained adequate material were utilised for this pilot study. Mixes of benign, suspicious and malignant cases were included. Unstained sections from the cell block were stained with S100P. The slides have been analysed based on intensity and percentage of staining. Nuclear or nuclear/cytoplasmic staining was regarded as positive. Cytoplasmic without nuclear staining was regarded as negative. The sensitivity and specificity were calculated.
Pathology (2013), 45(S1)
Conclusion: In this case, the history of overdose was relatively specific. Acute and chronic toxicity are reported in the literature and concurrent consumption of alcohol is associated with increased toxicity. The autopsy findings in this case were relatively typical, and histology was valuable for diagnosis.
PROLIFERATIVE GLOMERULONEPHRITIS WITH MONOCLONAL IGG DEPOSITS ON A BACKGROUND OF CHRONIC LITHIUM NEPHROTOXICITY – A CASE REPORT Leo Francis1, Victoria Francis1, Sree Venuthurupalli2 1Department of Anatomical Pathology, Royal Brisbane & Women’s
Hospital, Brisbane, and 2Department of Medicine, Toowoomba Hospital, Toowoomba, Qld, Australia Aims: To document a previously unreported association of chronic lithium nephrotoxicity and proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID). Methods: A 70-year-old female with a long-term history of lithium treatment for bipolar disorder presented with the nephrotic syndrome. A renal biopsy was performed. Results: A chronic tubulo-interstitial nephritis with microcysts was present, typical of lithium toxicity. The glomeruli showed a membranoproliferative glomerulonephritis with mesangial and granular capillary loop reactivity for C3, IgG and kappa (but not lambda) light chain. Electron microscopy confirmed mesangial and subendothelial deposits which lacked microtubular and fibrillary features. Cryoglobulins were not detected. Discussion: Lithium treatment can cause the nephrotic syndrome, but usually due to minimal change nephropathy or focal segmental glomerulosclerosis. An association with PGNMID has not been described in the literature, and is probably coincidental.
The results are currently under evaluation.
COLCHICINE TOXICITY CAUSING DEATH Francis1,
Milne2
Nathan Queensland, and 2Queensland Health Forensic and Scientific Services, Forensic Pathology, Qld, Australia Victoria
1Pathology
Introduction: Colchicine is a naturally-occurring alkaloid most commonly used for pain relief in gout. Fatal toxicity can occur with therapeutic doses (7 mg). Significant overdose leads to multiorgan failure and is almost universally fatal. A case study of deliberate colchicine overdose is presented. Results: The patient was a 51-year old male with a history of gout and alcohol abuse but no known history of psychiatric illness or suicide attempts. He was admitted to hospital complaining of abdominal pain, nausea, vomiting and diarrhoea. He admitted to ingesting 230 colchicine tablets (115 g) and a bottle of whiskey approximately 14 hours previously. Treatment was initiated but approximately 27 hours post-ingestion, he died. Autopsy findings included coronary atherosclerosis, changes consistent with chronic alcohol abuse in the liver and changes consistent with colchicine toxicity throughout the gastrointestinal tract. Toxicological analysis of admission bloods showed a colchicine level of 0.10 mg/kg with no alcohol detected.
MIXED EPITHELIAL AND STROMAL TUMOUR OF KIDNEY Laurence A. Galea1, Kiran Manya2, Shomik Sengupta2, Alison Skene1 1Department of Anatomical Pathology, Austin Pathology, Austin Health, Heidelberg, and 2Department of Urology, Austin Health, Heidelberg, Vic, Australia Benign mixed epithelial and stromal tumour of the kidney (MESTK) is a recently described rare neoplasm. It shows a predilection for perimenopausal women. About 50 cases have been described in the English literature. The pathogenesis of MESTK is uncertain with deranged hormonal environment, including unopposed oestrogen implicated in the induction of periductal foetal mesenchymal cell proliferation. A translocation involving t(1;19)(p22;p13.1) was identified in one case. Recent evidence supports the theory of a single cell of origin with the capacity for epithelial and stromal differentiation. Though most MESTK are benign, a few cases with aggressive behaviour and malignant transformation have been reported. We describe another two cases of MESTK occurring in two female patients. The mode of presentation, operative procedures and pathology is described.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.