Journal of Clinical Pathology current issue

Similar immunogenetics of Barrett's oesophagus and cervical neoplasia: is HPV the common denominator?

Rajendra, S, Robertson, I K — Mon, 21 Dec 2009 10:05:05 PST

Fusion genes in epithelial neoplasia

Zhang, H, Oliveira, A M — Mon, 21 Dec 2009 10:05:06 PST

Recurrent chromosomal rearrangements with the formation of fusion genes have been traditionally associated with haematological and mesenchymal neoplasms. This view has cultivated the erroneous impression that the oncogenic mechanisms present in these tumours are fundamentally different from those found in epithelial neoplasms. In spite of the fact that, as a group, most epithelial tumours apparently show a higher degree of chromosomal instability, a careful and critical analysis of relatively older findings and several more recent discoveries has shown that some common mechanistic denominators occur in all forms of neoplasms independent of their line of differentiation. The aim of this review is to briefly review and discuss the occurrence, mechanisms and biological relevance of chromosomal rearrangements and fusion genes in epithelial neoplasia, with a special emphasis in thyroid, head and neck, kidney, breast, prostate and lung neoplasms.

Heart transplant biopsies: interpretation and significance

Nair, V, Butany, J — Mon, 21 Dec 2009 10:05:06 PST

The endomyocardial biopsy(EMB) is a valuable tool that is inadequately utilised, except in monitoring orthotopic, homograft, heart grafts. Performed on a regular, programmed schedule, or on an emergent basis when needed, the EMB is the gold standard for monitoring graft function ( with regard to cellular rejection), often before clinical symptoms develop. This paper addresses these points and discusses handling of tissues and some studies for possible antibody mediated rejection when the lack of morphologic features of cellular rejection does not fit with the patients clinical presentation, days or months after the surgical procedure. In the hands of a skilled operator the EMB procedure is relatively painless and free of signicicant complications.

HLA and kidney transplantation

Clark, B, Unsworth, D J — Mon, 21 Dec 2009 10:05:06 PST

This article focuses on the immunogenetics, immunology, rejection and immunosuppression in kidney transplantation. HLA matching still affects outcome data, and HLA matching improves graft survival. Graft sources and related outcomes are discussed.

Our approach to a renal transplant biopsy

John, R, Herzenberg, A M — Mon, 21 Dec 2009 10:05:06 PST

Kidney transplantation has become increasingly common in major health centres, making renal allograft evaluation through biopsy a common procedure. Early allograft dysfunction occurs in 30–50% of all transplants, while chronic graft failure is almost uniform at a rate of 2–4% a year. Allograft biopsy remains the gold standard for the diagnosis of graft dysfunction. Rejection, albeit the most important, is only one of many causes of allograft dysfunction. The widely accepted Banff classification has set criteria for the diagnosis of acute and chronic rejection. The major differential diagnoses are acute ischaemic injury, calcineurin inhibitor toxicity (acute and chronic), infections, including pyelonephritis and polyomavirus nephropathy, chronic obstruction/reflux, hypertension, and recurrent and de novo disease. In this review, there is an outline of the Banff criteria and their implications, the various causes of graft dysfunction, and a discussion on morphological guidelines towards the various diagnoses.

Approach to a lung transplant biopsy

Hwang, D M, Yousem, S A — Mon, 21 Dec 2009 10:05:06 PST

With increasing numbers of lung transplants being performed worldwide, lung transplant allograft biopsies are becoming increasingly common. The evaluation of lung transplant biopsies typically focuses on the assessment of allograft rejection and infection, but other entities may also be seen in biopsy material. Presented here is an approach to lung transplant biopsies, in which there is an overview major diagnostic entities that may be encountered and discussion of findings that may present interpretive challenges.

Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation

Adeyi, O, Fischer, S E, Guindi, M — Mon, 21 Dec 2009 10:05:06 PST

The spectrum of diseases encountered in post-transplant liver pathology biopsies is broad. In this review, these have been divided as belonging to one of three categories: (1) new-onset/de novo post-transplant abnormalities (early and late), (2) rejection, and (3) recurrence of original disease. The clinical and pathological features of the entities making up each category, with the relevant differential diagnosis and overlaps between and within these groups, are discussed and illustrated. Recurrent or de novo neoplasms make up a fourth category not included in this review. Early new-onset conditions are mostly related to surgical complications, donor factors and ischaemia to the graft. These include reperfusion/preservation injury, lipopeliosis, small-for-size-syndrome, biliary sludge syndrome and hepatic artery thrombosis. The various forms of rejection (cellular, chronic, antibody-mediated, and late atypical rejection) are detailed. Most chronic liver diseases can and do recur in the graft. They may display features that overlap with de novo conditions (eg, primary sclerosing cholangitis versus chronic rejection). As with most cases of allograft biopsy interpretation, accurate diagnosis rests with careful correlation of histological features with clinical, imaging and laboratory findings, and often comparison with previous sequential and follow-up biopsies. Late-onset new diseases include biliary strictures, idiopathic chronic hepatitis and de novo autoimmune hepatitis, among others. This review provides a practical approach to the interpretation of these challenging biopsies. Selected difficult scenarios or conundrums are identified and discussed in the relevant sections.

Immunophenotypic distinction between pigmented villonodular synovitis and haemosiderotic synovitis

Mahendra, G, Kliskey, K, Athanasou, N A — Mon, 21 Dec 2009 10:05:06 PST

Aim:

Haemosiderotic synovitis (HS) is caused by excessive bleeding into a joint. It occurs secondary to a variety of conditions and needs to be distinguished from pigmented villonodular synovitis (PVNS) for the purposes of treatment. The histopathological distinction between these conditions, particularly in biopsy specimens, can be problematic.

Methods:

Immunophenotypic findings in 20 cases of PVNS and 20 cases of HS were analysed using monoclonal antibodies against proliferation (Ki-67), apoptosis (bcl2), macrophage (CD14, CD68, HLA-DR) and osteoclast (CD51) antigens.

Results:

Macrophages in PVNS and HS expressed CD14 and HLA-DR. The giant cells in PVNS, but not those in HS, expressed CD51 and were negative for CD14 and HLA-DR, indicating that these cells had an osteoclast phenotype. Considerably more CD51-expressing mononuclear cells were noted in PVNS compared with HS. The Ki-67 proliferation index was higher in PVNS than in HS.

Conclusions:

The findings indicate that there are immunophenotypic differences in giant cells between PVNS and HS, and that expression of CD51 and a high Ki-67 index effectively distinguishes between these two conditions.

Correlation of autoantibodies and CD5+ B cells in ocular adnexal marginal zone B cell lymphomas

Kubota, T, Moritani, S, Yoshino, T, Nagai, H, Terasaki, H — Mon, 21 Dec 2009 10:05:06 PST

Aim:

To determine the clinicopathological properties of ocular adnexal marginal zone B cell lymphomas (MZBLs) with CD5+ B cells.

Methods:

This study determined the clinicopathological properties of MZBL samples from 97 patients with ocular adnexal MZBLs and searched for hallmarks of systemic autoimmunity in these patients.

Results:

Two elderly female patients were found to have ocular adnexal MZBLs with CD5+ B cells; flow cytometry analysis suggested that one of these MZBLs had CD5+ B cell clonal proliferation. The levels of anti-single stranded (SS)-DNA and anti-SS-A/Ro antibodies in these two patients were significantly higher than those in controls that were matched for age, gender and disease (2/2 versus 0/14; p = 0.008) and controls without MZBL (2/2 versus 0/30; p = 0.002). The genes from the immunoglobulin heavy-chain variable region for one of the patients showed a V3-21 segment. In addition, another patient with ocular adnexal reactive lymphoid hyperplasia with CD5+ B cells also had anti-SS-DNA antibodies.

Conclusion:

Patients with ocular adnexal MZBLs with CD5+ B cells may have a background of systemic conditions with CD5+ B-cell-related autoantibodies.

Detection of mutations in the gyrA gene in fluoroquinolone resistance Salmonella enterica serotypes typhi and paratyphi A isolated from the Infectious Diseases Hospital, Kuwait

Dimitrov, T, Dashti, A A, Albaksami, O, Jadaon, M M — Mon, 21 Dec 2009 10:05:06 PST

Background:

Enteric fever due to Salmonella enterica is a major health problem, and fluoroquinolones such as ciprofloxacin are mostly the antibiotic of choice for treatment. Resistance to ciprofloxacin has been noticed to increase due to the emergence of new mutations in the bacterial DNA.

Aims:

To explore the fluoroquinolone resistance and molecular characterisation of reduced quinolone susceptibility in S typhi and S paratyphi A in Kuwait.

Methods:

136 clinical isolates of S typhi and 40 of S paratyphi A were collected over five years. The antimicrobial susceptibility was studied by various methods. DNA sequencing of gyrA, gyrB, parC and parE genes was performed in 31 isolates.

Results:

There was a substantial difference in MIC range between the two serotypes, with the most common MIC for S typhi being 0.25 mg/l and for S paratyphi A being 1 mg/l. The proportion of nalidixic acid resistant strains increased gradually over the years. These strains had a significantly higher range of MIC of ciprofloxacin (0.023 mg/l to 1.0 mg/l) compared to the nalidixic acid sensitive strains (0.0016 mg/l to 0.125 mg/l). DNA sequencing of gyrA gene showed the presence of three different point mutations: Ser83->Phe in 17 strains, Ser83->Leu in 3 strains and Asp87->Asn in 6 strains. No mutations in the other genes were found.

Conclusions:

It is very important to keep searching for new mutations and continuously monitor drug resistance in different parts of the world in order to efficiently manage cases with enteric fever.

Female-type fibrocystic disease with papillary hyperplasia in a male breast

Robertson, K E, Kazmi, S A, Jordan, L B — Mon, 21 Dec 2009 10:05:06 PST

Fibrocystic disease is a common benign finding in the female breast and often presents as a palpable mass. It is much less commonly found in the male breast. A case is reported of a young man with female-type fibrocystic disease associated with papillary hyperplasia in the right breast.

Brucellosis in the UK: a risk to laboratory workers? Recommendations for prevention and management of laboratory exposure

Reddy, S, Manuel, R, Sheridan, E, Sadler, G, Patel, S, Riley, P — Mon, 21 Dec 2009 10:05:06 PST

Brucella spp is an uncommon class 3 pathogen isolated in laboratories serving non-endemic areas. This is a report of four recent cases of brucellosis diagnosed at five different London laboratories, and it highlights the need to maintain a high index of suspicion for brucellosis in patients with a history of travel to and/or consumption of unpasteurised foods from endemic areas. A protocol for risk categorisation is proposed, and there is a description of the strategy adopted for serological follow-up of exposed staff and use of postexposure prophylaxis.

Retraction

Mon, 21 Dec 2009 10:05:06 PST

Snippets in haematology

McCloskey, S., McMullin, M. F. — Mon, 21 Dec 2009 10:05:06 PST