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Polyoma BK virus pathology in renal allografts
PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION
63
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 value 86%). 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 (p 0.030). 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
63
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 value 86%). 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 (p 0.030). 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