Alopesilerin histopatolojik tanısında vertikal ve transvers kesitlerin tanısal değerlerinin karşılaştırılması

Bu araştırmada klinik olarak sikatrisyel ve sikatrisyel olmayan alopesilerin transvers ve vertikal kesitlerdeki histopatolojik bulgularının tanımlanması ve her iki metodun tanısal değerinin karşılaştırılması amaçlanmıştır. Bu ileriye dönük (prospektif) çalışmaya, Ekim 2006- Ekim 2007 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı Polikliniği’ne saç dökülmesi yakınmasıyla başvuran 53 hasta alındı. Ayrıntılı klinik öykü ve dermatolojik muayene sonrasında tüm hastalara klinik ön tanı/tanılar konuldu. Her hastadaki alopesik alandan 2 adet 4 mm’lik punch biyopsi alındı. Örneklerin birinden transvers kesitler hazırlandı. Diğer biyopsi ise vertikal kesitler ve direkt immünofloresan inceleme için kullanıldı. Klinik ön tanı ve/veya tanılar, transvers ve vertikal kesitlerden elde edilen histopatolojik bulgular ve direkt immünofloresan incelemenin sonucu birlikte değerlendirilerek her hasta için dermatolog tarafından en olası alopesi tipi belirlendi. Daha sonra ise aynı patolog tarafından tek başına transvers ve tek başına vertikal kesitler incelendi ve bu kesitlerin tek başına incelenmesi ile konulan tanıların en olası tanıyla uyumu karşılaştırıldı. Epidermis, dermoepidermal bileşke ve dermisteki bulgular sadece vertikal kesitlerde izlenirken, kıl folliküllerine ait nicel verilerin transvers kesitlerde daha doğru olarak değerlendirildiği saptandı. Sikatrisyel olmayan alopesilerin histopatolojik tanısında transvers kesitlerin vertikal kesitlerden daha üstün olabileceği sonucuna varıldı (p=0.05). Sikatrisyel alopesi nedenleri arasında yer alan liken pilanopilarisli hastalarda ise vertikal kesitlerin transvers kesitlere göre daha değerli olduğu görüldü (p=0.04). Diğer sikatrisyel alopesilerde ise her iki yöntemin tanı koyma başarısı arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Sonuç olarak; alopesi alt tiplerinin histopatolojik tanısı için, klinik olarak sikatrisyel olmayan alopesi düşünülen hastalarda tek biyopsi alınması durumunda bu biyopsiler transvers kesitler için kullanılmalıdır. Liken planopilaris ile uyumlu klinik bulguları olan hastalarda vertikal kesitlerin incelenmesi yeterlidir. Klinik olarak liken planopilaris dışındaki sikatrisyel alopesi tipleri düşünülen hastalarda ise hem transvers hem vertikal kesitler yapılabilir. In this study, we aimed to define the histopathological findings of cicatricial and noncicatricial alopecias in transverse and vertical sections of punch biopsy specimens, and compare the diagnostic value of both methods. The study included 53 patients with the complain of hair loss who were admitted to Department of Dermatology Outpatient Clinic, Başkent University Faculty of Medicine, Ankara, Turkey between October 2006 and October 2007. All the patients were given a clinical diagnosis or prediagnosis after the detailed clinical history and dermatological examination. In each patient, two 4 mm punch biopsies were obtained from the alopecic lesions. While one of the biopsy specimen was sectioned transversely, the other was used for vertical sections and direct immunofluorescence examination. The findings of clinical diagnosis or prediagnosis, the histopathological findings of both transverse and vertical sections and direct immunofluorescence examination were evaluated together, and the most probable diagnosis for each patient was made by the dermatologist. The same pathologist evaluated the transverse sections and the vertical sections separately and the diagnosis reached with either method was compared with the most probable diagnosis. The histopathologic findings in the epidermis, dermoepidermal junction and dermis were only observed in vertical sections, whereas the quantitative data of the hair follicles were evaluated more accurately in transverse sections. Transverse sections were thought to be superior to vertical sections for the histopathological diagnosis of noncicatricial alopecias(p=0.05). In contrast, vertical sections were appeared to be superior to transverse sections in patients with lichen planopilaris, a form of cicatricial alopecia (p=0.04). No statistical difference were found between the diagnostic values of both methods in other types of cicatricial alopecias (p>0.05). In conclusion, for the histopathological diagnosis of subtypes of alopecia, in cases which a single biopsy is obtained, transverse sections should be preferred in clinically noncicatricial alopecias. In patients whose clinical findings are consistent with lichen planopilaris vertical sections should be evaluated, whereas either transverse or vertical sections can be performed in clinically cicatricial alopecias other than lichen planopilaris

The relationship between glomerular IgG staining and poor prognostic findings in patients with IgA nephropathy: the data from TSN-GOLD working group

Background Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis. Methods A total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated. Results 81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = - 0.084, r = - 0.102, r = - 0.006, r = 0.062, r = 0.014, r = - 0.044, r = - 0.061, r = - 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05). Conclusion Glomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors

Trends of primary glomerular disease in Turkey: TSN-GOLD registry report

Background Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. Methods Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013-2017, and 2017-current. Results A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (x 2 = 198, p 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (x 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. Conclusions In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing

Trends of primary glomerular disease in Turkey from 2009 to 2017: A regional registry report from TSN-Gold working group

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