Fibrillary-immunotactoid glomerulonephritis: report of two cases

Fibrillary-immunotactoid glomerulonephritis: report of two cases

PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION 63 POLYOMA BK VIRUS PATHOLOGY IN RENAL ALLOGRAFTS morphological similarities with other common hepatic m...

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PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION

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POLYOMA BK VIRUS PATHOLOGY IN RENAL ALLOGRAFTS

morphological similarities with other common hepatic mass lesions such as cholangiocarcinoma and metastatic tumours. Thyroid transcription factor-1 (TTF-1) is selectively expressed in thyroid and lung tissues, with primary epithelial carcinomas from these organs showing strong nuclear immunopositivity. Recently cytoplasmic TTF-1 positivity has been reported in hepatocytes. We aimed to investigate whether TTF-1 expression may be useful in differentiating HCC from common hepatic mass lesions in diagnostic liver biopsies. Methods: Archived formalin-fixed, paraffin-embedded liver biopsies of confirmed HCC, cholangiocarcinoma and metastatic carcinoma were examined for TTF-1 immunohistochemical expression. Results: TTF-1 positivity (cytoplasmic, coarse granular) was detected in 19/25 (76%) HCC, 0/12 (0%) cholangiocarcinoma and 1/25 (4%) metastatic carcinoma (positive predictive value 95%; negative predictive value86%). TTF-1 was expressed in five (100%) nuclear grade 1, 11 (79%) grade 2, and three (50%) grade 3 HCC. Discussion: Our study suggests that TTF-1 expression has diagnostic utility in differentiating HCC from other tumours involving the liver. In communities where both HCC and cholangiocarcinoma are common, there is justification for including TTF-1 in the immunohistochemical evaluation of liver tumour biopsies.

Jiao Yang, Lai-Meng Looi, Phaik-Leng Cheah Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

THE HISTOLOGICAL FEATURES OF INTESTINAL SPIROCHAETOSIS IN A SERIES OF 113 PATIENTS

Department of Neuropathology, University of Sydney, NSW, were reviewed. Patients with positive serology for anti-Jo-1 antibody were included. Biopsies were examined by frozen sections stained with H&E, acid phosphatase, SDH, combined COX/SDH, ATPases at pH 9.4/4.3, and PAS; and also by paraffin sections stained with H&E. Immunohistochemistry for MHC class 1 antigen was performed. Results: Five cases of anti-Jo-1 associated myopathy were identified (median age 47 years, 60% female). Progressive weakness (2), lung disease (4), arthralgia (3) and rash (1) were the presenting symptoms. All muscle biopsies showed a striking perifascicular distribution of regenerating and necrotic myofibres, highlighted by MHC-1 immunostaining. Other changes included atrophic myofibres (all cases), chronic inflammation (4), focal rimmed vacuoles (1), as well as mild mitochondrial abnormalities (2). Conclusions: Muscle biopsies in anti-Jo-1 syndrome show a necrotising myopathy with a striking perifascicular accentuation. MHC-1 immunostaining is helpful. Recognition of these features is important, as this syndrome has a strong association with interstitial lung disease, and requires long-term immunosuppressants.

Aim: With the advent of more potent and effective immunosuppression in the transplant setting, the role of polyoma BK virus (BKV) in renal graft outcome has gained increasing importance. Nevertheless, its prevalence and contribution to allograft damage and rejection remains unclear. We studied renal allograft biopsies received over a 5-year period for prevalence of BKV infection and possible relationship to graft pathology. Methods: Archived formalin-fixed, paraffin-embedded renal allograft biopsies of 108 patients (age range 1675 years; mean 39 years) were examined for immunohistochemically detectable BKV and graft pathology. BKV-positive biopsies were further elucidated by electron microscopy and immunoelectron microscopy. Results: BKV was detected in renal tubular nuclei of 10 biopsies from eight patients (age range 1753 years; mean 35 years), a prevalence (7.4%) at the high end of other reported studies. Tubulointerstitial rejection (Banff 1a and above) was detected in six (75%) BKV-positive patients compared to 46% of those without detectable BKV (p0.030). One infected patient lost her graft. Discussion: This study supports a deleterious effect of BKV on renal allografts. Because BKV is difficult to detect morphologically, a high index of suspicion and specific immunohistochemistry are required when examining renal allograft biopsies.

DIAGNOSTIC UTILITY OF THYROID TRANSCRIPTION FACTOR-1 IN THE DIFFERENTIAL DIAGNOSIS OF HEPATOCELLULAR CARCINOMA, CHOLANGIOCARCINOMA AND METASTATIC CARCINOMA Neethu Gopinath, Lai-Meng Looi Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Aim: Hepatocellular carcinoma (HCC) is a common, highly fatal malignancy in Asia. Its biopsy diagnosis can be difficult because of

H Mahajan1, N J Carr2, K L Tan3, R Sharma1 1 ICPMR, Anatomical Pathology, Westmead Hospital, Westmead; 2 Graduate School of Medicine, University of Wollongong, Wollongong; 3 Anatomical Pathology, Concord Repatriation General Hospital, Concord, New South Wales, Australia Aim: To determine the presenting symptoms and histological changes in a large series of intestinal biopsies showing spirochaetosis. Methods: A multicentre retrospective review of cases diagnosed as spirochaetosis was performed. Results: A total of 113 cases were retrieved from the archives, comprising 97 colorectal specimens and 16 appendices. In only 25 cases was the presenting symptom recorded as diarrhoea. Of the colorectal specimens 87 (90%) showed no mucosal abnormality (apart from the spirochaetes); 10 showed mucosal inflammation, but six of them had a diagnosis of another inflammatory disease process accounting for the inflammatory changes. Five appendices showed acute appendicitis; the other 11 were unremarkable. Conclusion: Spirochaetosis in an unselected general population is unlikely to be of pathological significance.

FIBRILLARY-IMMUNOTACTOID GLOMERULONEPHRITIS: REPORT OF TWO CASES Hema Mahajan, Anita Achan, Ross Boadle, Thomas Ng. ICPMR, Department of Anatomical Pathology, Westmead Hospital, Westmead, New South Wales, Australia Fibrillary-immunotactoid glomerulonephritis is a relatively newly identified form of immune-mediated glomerular disease found only in 0.61% of native renal biopsies. Most patients rapidly progress to renal failure. A Congo red stain for amyloid is negative. The

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diagnosis is established by electron microscopy based on arbitrary ultrastructural criteria regarding fibril size and/or organisation. We describe two cases of fibrillary-immunotactoid glomerulonephritis and discuss the controversies and recent development on the nomenclature of fibrillary glomerulopathy.

VASOACTIVE INTESTINAL PEPTIDE AND CATECHOLAMINE SECRETING COMPOSITE PHAEOCHROMOCYTOMA A CASE STUDY AND LITERATURE REVIEW



H Mahajan1, D Lee2, G A McBride1, P Chin2, W H Watt2 1 Department of Pathology; 2 Department of Urology, The Wollongong Hospital, Wollongong, New South Wales, Australia We describe a 49-year-old female who presented with watery diarrhoea, palpitations, intense anxiety and headaches. Her blood pressure was 135/85 mmHg and there was no history of hypertension. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a 6 cm right adrenal tumour. Endocrine profile showed increased plasma metanephrine, normetanephrine and vasoactive intestinal peptide (VIP). Laparoscopic adrenalectomy was performed with complete resolutions of symptoms as well as biochemical abnormalities. Histopathology confirmed a ‘composite phaeochromocytoma’ with the non-phaeochromocytoma component as ganglioneuroma. Composite phaeochromocytoma is the coexistence of a phaeochromocytoma with another tumour type of the same embryonic origin in a single adrenal tumour. Its incidence is estimated to be 3%. The occurrence of a functional VIP and catecholamine co-secreting tumour is even more obscure. To date there are only five cases of clinically significant VIP secreting composite tumours reported in the literature. Secretion of functionally active VIP not only can confound the clinical presentation but can also lead to suboptimal perioperative management that may produce adverse outcomes. We present a case report followed by a literature review of this rare entity.

CHARACTERISTICS OF WOMEN WITH ABNORMAL CERVICAL CYTOLOGY Gamze Mocan Kuzey1, Mehmet Coskun Salman2, Melih Velipasaoglu2, Kunter Yuce2 1 Department of Pathology; 2 Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey Aim: To review the characteristics of women with abnormal cervical cytology. Methods: Women who had abnormal cervical cytology on Papanicolaou (Pap) test obtained at Hacettepe University Hospital in 2007 constituted the study group. Cytological and pathological diagnoses, human papillomavirus (HPV) status, and follow-up procedures were investigated. Results: Among 10 713 women with smear tests, 190 (1.8%) with cytological abnormalities constituted the study group. Mean age was 43.9 years. 17.2% were asymptomatic, while infections and menstrual abnormalities were the most common symptoms. 76.8% of abnormalities were detected by liquid-based cytology (LBC). Squamous cell abnormalities were detected in 87.4%. Most common diagnoses were atypical cells of undetermined significance (ASC-US; 40.0%) and low grade squamous intraepithelial lesion (LSIL; 27.9%). High grade changes were detected in 10.0%. 11.6% had squamous cell carcinoma (SCC) or adenocarcinoma. Of 61

patients with HPV-DNA test, 27.9% were oncogenic. 51.7% underwent pathological diagnosis. Intraepithelial lesions were detected in 17.9% and invasive lesions were detected in 10.0%. 83.1% had normal cytology during follow-up. Conclusions: Although organised cytological screening programs have reduced incidence and prevalence of cervical cancer, it still represents a considerable burden in developing countries due to some problems in screening.13 LBC overcame some of these problems.4 Especially, annual gynaecological examination should be encouraged in such countries to reduce the incidence of invasive cancer. References: 1 Austin RM. College of American Pathologists Conference XXX on quality and liability issues with the Papanicolaou smear: introduction. Arch Pathol Lab Med 1997; 121: 2278. 2 Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999; 80: 82741. 3 Hutchinson ML, Berger BM, Farber FL. Clinical and cost implications of new technologies for cervical cancer screening: the impact of test sensitivity. Am J Manag Care 2000; 6: 76680. 4 Stein SR. Thinprep versus the conventional Papanicolaou test: A review of specimen adequacy, sensitivity and cost-effectiveness. Primary Care Update Ob/Gyns 2003; 10: 3103.

PILOT STUDY: FREQUENCY AND CHARACTERISATION OF HUMAN PAPILLOMAVIRUS GENOTYPES IN GYNECOLOGIC CYTOLOGY MATERIAL Gaye Guler Tezel, Gamze Mocan Kuzey, Gulnur Guler, Sevgen Onder, Pinar Firat Hacettepe University School of Medicine, Department of Pathology, Ankara, Turkey Aim: To evaluate the presence of human papillomavirus (HPV) and its genotypes in the liquid-based cytology samples from women attending routine cervical screening. Methods: Samples obtained from 128 women (87 with cytological abnormalities, 41 with normal cytology) were included in the study. The samples were tested by a commercial polymerase chain reaction (PCR)-array hybridisation assay. Frequent types and the correlation between the types and cytological diagnosis were evaluated. Results: HPV was observed in 70/128 cases. Single HPV type was detected in 28 cases, while multiple types in 42. The most frequent types were 16, 53 and 31. High risk types were observed in 61 cases including all malignant and five high grade squamous intraepithelial lesion (HSIL) cases. Low risk types were not seen in any malignant or HSIL cases. In 29 low grade squamous intraepithelial lesion (LSIL) cases, 23 had high risk. Of 42 atypical cells of undetermined significance (ASC-US) cases, 25 had high risk. Of controls, 38 were negative for HPV. Conclusions: HPV infection is a major risk factor for invasive cervical carcinoma. HPV 16 and 18 are responsible for 70% of the cases. HPV 16 was the most frequent HPV type in our series, followed by HPV 53. Determination of HPV profile in Turkey will provide valuable data for both epidemiological studies and vaccination strategies.

TLR2 EXPRESSION IN ORAL CANCER, DYSPLASTIC AND HYPERPLASTIC LESIONS L K Ng, H M Hussaini, A M Rich, G J Seymour Faculty of Dentistry, University of Otago, New Zealand