Tumoral calcinosis of the cervical spine in a dialysis patient. Case report and review of the literature

The authors present a case of tumoral calcinosis (TC) in a patient with chronic renal insufficiency. The clinical course, imaging features and microscopic findings are detailed. A 60-year-old woman with a 4-year history of hemodialysis presented with a painful mass in the right posterior cervical triangle. The neuroimaging revealed polycystic mass bulging from the C3–C5 facet joints and lamina on the right. The majority of cystic mass was excised and microscopic features of the specimen were consistent with TC. Tumoral calcinosis is a rare disease characterized by calcium salt deposits in periarticular soft tissue, which enlarge to form tumor-like cystic masses containing chalky calcareous material. TC is typically seen around large joints but rarely in the spine. Review of past publications provided six cases of TC involving the spine in dialyzed patients

The content of serotonin cells in duodenal biopsies of autistic patients

AbstractIntroductionAutistic spectrum disorders (ASD) don’t have the same etiology. Platelet hyperserotonemia remain the most common neurochemical abnormality in these patients. The main producer and storage of peripheral serotonin are enteric enterochromaffin cells – serotonin cells. Platelet hyperserotonemia may result from disorders in the synthesis and/or release of enteric serotonin. An increased number of people with ASD have gastrointestinal disorders. Some of them have a serotonergic background.AimThe aim was to assess the serotonin cells in the duodenal mucosa of patients with ASD.Material and methodsStudy group: 30 children with ASD, including 73% with duodenitis chronica. Control group (patients without ASD): 45 patients, 56% with duodenitis chronica. Immunohistochemical assessment of the number of serotonin cells was performed.’ResultsChildren with ASD and duodenitis have fewer serotonin cells than autistic children with a normal picture of the duodenum. Children with ASD and chronic duodenitis have fewer serotonin cells than patients from the control group. Patients from the control group, suffering from chronic duodenitis have an increased number of serotonin cells in relation to children without inflammatory lesions in the duodenum.ConclusionsThe serotonergic profiles of the GI tract of autistic patients and their peers without autistic symptoms are different. In the course of chronic duodenitis in patients with ASD the number of serotonin cells falls while in persons without autistic features it increases significantly. Chronic duodenitis contributes to an increase in the number of serotonin cells in persons without autistic features while decreasing it in patients with ASD

Compression Anastomosis Clips Versus a Hand-Sewn Technique for Intestinal Anastomosis in Pigs

Background. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000–000)

Analysis of adrenocortical tumours morphology as regards their structure and potential malignancy

Wstęp: Następstwem rozpoznania raka kory nadnercza (ACC, adrenocortical carcinoma) jest włączenie leczenia farmakologicznego, długotrwałe monitorowanie chorego oraz ewentualna decyzja o reoperacji. Celem pracy jest analiza morfologii pierwotnych guzów kory nadnerczy pod względem ich złośliwości na podstawie punktowej skali zaproponowanej przez Weissa. Materiał i metody: Poddano analizie 110 guzów kory nadnerczy u 107 chorych (M - 27,1%, K - 72,9%; w wieku 32-77 lat, średnia 55,2 &#177; 9,7). Zespół Conna rozpoznano u 16 chorych (14,9%), zespół Cushinga - u 12 (11,2%), a wirylizację - u 3 (2,8%). U 76 chorych (71,0%) w badaniach biochemicznych nie wykazano nadczynności hormonalnej guza. Wyniki: W rutynowym badaniu histopatologicznym u 6 chorych (5,4%) rozpoznano ACC, u 92 (83,6%) - gruczolaka kory nadnercza (ACA, adrenocortical adenoma), a u 12 (10,9%) - rozrost kory nadnercza. Atypię jądrową III lub IV stopnia stwierdzono w 8 guzach (7,3%), odsetek mitoz powyżej 5/50 HPF (high power field) - w 6 (5,4%), atypowe mitozy - w 5 (4,5%), odsetek komórek o jasnej cytoplazmie poniżej 25% - w 10 (9,1%), rozlany charakter zmiany - w 8 (7,3%), ogniska martwicy - w 16 (14,5%), naciekanie żył - w 4 (3,6%), naciekanie zatok - w 7 (6,3%), naciekanie torebki - w 5 (4,5%). W guzach ACC stwierdzono 4-9 opisywanych cech złośliwości, zaś w ACA - 0-3 cechy. W analizie statystycznej wykazano znamienną korelację między liczbą punktów w skali Weissa a największą wielkością guza w badaniach obrazowych (p < 0,05). Wnioski: Struktura i układ komórek w obrębie łagodnych guzów kory nadnerczy są heterogenne. Analiza morfologii guzów kory nadnercza w skali Weissa może stanowić podstawę do rozpoznania ich złośliwości.Introduction: A consequence of diagnosis of adrenocortical carcinoma (ACC) is introduction of pharmacological therapy, precise monitoring of the patients and in some cases re-operation. The aim of the study is to analyse morphology of adrenocortical tumours as regards their malignancy by use of criteria proposed by Weiss. Material and methods: 110 adrenocortical tumours in 107 patients were analysed (M 27.1%, F 72.9%; age 32 to 77 years, mean 55.2 &plusmn; 9.7). Conn syndrome was diagnosed in 16 patients (14.9%), Cushing syndrome in 12 (11.2%), and virilisation in 3 (2.8%). In 76 patients (71.0%) biochemical tests did not reveal hormonal hyperactivity of the tumour. Results: In routine histopatological examination ACC was diagnosed in 6 tumours (5.4%), adrenocortical adenoma (ACA) in 92 (83.6%) and adrenocortical hyperplasia in 12 (10.9%). Nuclear grade III or IV was observed in 8 tumours (7.3%), mitotic rate > 5/50 high power fields in 6 (5.4%), atypical mitoses in 5 (4.5%), clear cells constituting < 25% of the tumour in 10 (9.1%), diffuse architecture in 8 (7.3%), necrosis in 16 (14.5%), veins infiltration in 4 (3.6%), sinusoids infiltration in 7 (6.3%), and tumour capsule infiltration in 5 (4.5%). Among ACC tumours 4-9 features of malignancy were present, among ACA - 0-3 features. Statistical analysis revealed correlation between number of criteria proposed by Weiss and maximal tumour size (p < 0.05). Conclusion: The structure and cell arrangement in adrenocortical adenoma are heterogeneous. Application of criteria proposed by Weiss in histopathological examination of adrenocortical tumours can be useful in differentiating adrenocortical adenoma from carcinoma

Analysis of morphology of adrenal pheochromocytoma as regards their potential malignancy

Wstęp: Guzy chromochłonne nadnerczy rozpoznawane są najczęściej w trakcie diagnostyki chorych z nadciśnieniem tętniczym oraz u chorych z rakiem rdzeniastym tarczycy i podejrzeniem zespołów MEN II. Celem niniejszej pracy jest analiza morfologii guzów chromochłonnych nadnerczy w oparciu o Pheochromo-cytoma of the Adrenal Gland Scaled Score (PASS) celem określenia ich potencjalnej złośliwości. Materiał i metoda: Analizie poddano 40 guzów. Średni wiek chorych w chwili zabiegu wynosił 45,2 &plusmn;13,4 lat. Guza chromochłonnego rozpoznano przed operacją u 87,5% chorych. U 12,5% chorych kwalifikacja do adrenalektomii została podjęta na podstawie wielkości guza (wymiary od 70 do 102 mm). U 20,0% chorych rozpoznano zespoły MEN II.Wyniki: W rutynowych badaniach histopatologicznych u 39 przedstawionych pacjentów rozpoznano łagodnego guza chromochłonnego. W 1 przypadku rozpoznano jego postać złośliwą na podstawie przerzutów do węzłów chłonnych (ryc. 1.). Sumując punkty PASS &#8805;4 wystąpił w 9 z 40 guzów co stanowiło 22,5%. Spośród 35 chorych, u których od zabiegu upłynęło ponad 12 miesięcy, 2 chorych zmarło: 1 chory ze złośliwym guzem chromochłonnym zmarł 5 miesięcy po operacji i 1 chora z zespołem MEN IIA zmarła z powodu rozsiewu nowotworowego raka rdzeniastego tarczycy. U pozostałych 7 chorych u których PASS &#8805; 4 punkty w okresie od 13-90 miesięcy obserwacji nie stwierdzono wznowy lub przerzutu nowotworu. U 1 spośród chorych z PASS < 4 usunięto chirurgicznie wznowę miejscową 82 miesiące po pierwszej operacji.Wnioski: Analiza guzów chromochłonnych w skali PASS ma charakter jedynie orientacyjny i nie pozwala na jednoznaczne histologiczne rozpoznanie łagodnych i złośliwych guzów chromochłonnych. Jedynym pewnym kryterium złośliwości guza chromochłonnego pozostają przerzuty.Background: Adrenal pheochromocytoma are diagnosed the most often in patients with arterial hypertension or with thyroid medullar cancer and suspicion of MEN II syndromes. The aim of the study is to analyse the morphology of pheochromocytomas on the basis of Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) in order to estimate their potential malignancy. Material and methods: Forty tumours were subjected to analysis. Mean patients age was 45.2 &#177;13.4 years. The diagnosis of pheochromocytoma was establish before surgery in 87.5%. 12.5% of patients were referred to surgery on the basis of tumour diameter (range 70 to 102 mm). In 20.0% of patients MEN II syndromes were diagnosed. Results: In pathological examination benign pheochromo-cytoma was diagnosed in 39 presented patients. In 1 cases malignant form of pheochromocytoma was diagnosed on the basis of lymph nodes metastases. Number of points in PASS was &#8805; 4 in 9 of 40 tumours (22.5%). Among 35 patients operated on more than 12 months ago 2 patients died: 1 patient with malignant pheochromocytoma (PASS = 8 points) and 1 patient with MEN IIA syndrome (due to disseminated thyroid medullar cancer). In remaining 7 observed patients with PASS &#8805; 4 points neither recurrence nor metastases were diagnosed within the period of observation (13-90 months). In 1 out of patients with PAS

The TRAF2 and TRAF6 expression in myomas and myometrium of women in reproduction and perimenopausal age.

Uterine myomas represent one of the most common female diseases. Uterine myomas or fibromas are benign, hormone-responding tumours of, respectively, smooth muscles and fibroblasts and their aetiology induces a significant interest. In myomas the presence of aromatase was detected and, in addition, oestrogen was found to be synthesized in myoma cells. The studies were performed on myoma patients of generative age and those in peri-menopausal age. Expression of TRAF2 and TRAF6 proteins was examined using immunohistochemistry and Western blot approach in small and large uterine myomas isolated from women of various age. In addition, the evaluation was conducted at the periphery of every myoma. We indicated that the level of both tested proteins in myomas is higher than in control. TRAF2 level in myometrium was lower than in myomas but higher than in control. In the case of TRAF6 those changes were ambiguous. Age didn't have influence the level of expression in both tested TRAF in studied structures

Analysis of pathogenetic factors of persistent hypertension in patients with pheochromocytoma who underwent unilateral adrenalectomy

Wstęp W przypadku nadciśnienia tętniczego wywołanego guzem chromochłonnym metodą z wyboru jest leczenie chirurgiczne. Celem niniejszej pracy jest analiza czynników uczestniczących w patogenezie utrzymujących się podwyższonych wartości ciśnienia tętniczego u chorych poddanych jednostronnej adrenalektomii z powodu guza chromochłonnego. Materiał i metody W analizowanej grupie 25 chorych średnia wartość najwyższego ciśnienia skurczowego (SBP) przed operacją wynosiła 232,6 &plusmn; 38,5 mm Hg, a rozkurczowego (DBP) 133,3 &plusmn; 22,2 mm Hg. U 40% chorych nadciśnienie tętnicze miało charakter stały, u 60% - napadowy. Średni największy wymiar guza w badaniach obrazowych wynosił 58,1 &plusmn; 19,6 mm. Czas obserwacji po adrenalektomii wynosił średnio 48,0 &plusmn; 28,4 miesiąca. Wyniki Spadek wartości najwyższego SBP po operacji był znamienny i wynosił średnio &#8211;85,9 &plusmn; 36,9 mm Hg, a DBP &#8211;44,1 &plusmn; 22,8 mm Hg. Wykazano dodatnią zależność pomiędzy obniżeniem się SBP i DBP po zabiegu i największym wymiarem guza. Przygodna wartość SBP mierzona u chorych po operacji wynosiła średnio 124,6 &plusmn; 18,3 mm Hg, a DBP 79,0 &plusmn; 9,2 mm Hg. U 56% chorych wartości przygodnego ciśnienia tętniczego wynosiły poniżej 140/90 mm Hg, co nie powodowało konieczności przyjmowania leków przeciwnadciśnieniowych. W grupie chorych wymagających farmakoterapii stwierdzono znamiennie dłuższy czas występowania nadciśnienia tętniczego przed adrenalektomią (średnio 76,3 &plusmn; 63,5 miesiąca wobec 30,5 &plusmn; 44,1 miesiąca) oraz starszy wiek w chwili operacji (średnio 46,4 &plusmn; 10,2 roku wobec 38,3 &plusmn; 9,8 roku). Wnioski Adrenalektomia u chorych z nadciśnieniem tętniczym i guzem chromochłonnym nadnercza prowadzi do trwałej poprawy najwyższych wartości SBP i DBP. Dłuższy czas trwania nadciśnienia przed operacją i starszy wiek chorych w chwili zabiegu przyczyniają się do uzyskania gorszych wyników adrenalektomii i konieczności stosowania farmakoterapii w celu utrzymania prawidłowych wartości ciśnienia tętniczego w okresie pooperacyjnym.Background Surgery is a method of choice in the treatment of patients with pheochromocytoma. The aim of the study was to analyse factors which participate in pathogenesis of persistent hypertension in patients who underwent unilateral adrenalectomy due to pheochromocytoma. Material and methods In the analysed group of 25 patients mean value of maximal systolic blood pressure (SBP) before surgery was 232.6 &plusmn; 38.5 mm Hg, and diastolic (DBP) 133.3 &plusmn; 22.2 mm Hg. In 40% of patients arterial hypertension was permanent, and in 60% &#8212; paroxysmal. Mean maximal tumour size in diagnostic imaging was 58.1 &plusmn; 19.6 mm. Mean time of observation after adrenalectomy was 48.0 &plusmn; 28.4 months. Results A significant decrease of maximal SBP and DBP after surgery was achieved (&#8211;85.9 &plusmn; 36.9 and &#8211;44.1 &plusmn; 22.8 mm Hg respectively). A positive correlation between decrease of SBP and DBP after surgery and maximal tumour size was revealed. Accidental value of SBP measured in patients after surgery was 124.6 &plusmn; 18.3 mm Hg, and DBP &#8212; 79.0 &plusmn; 9.2 mm Hg. In 56% of patients accidental blood pressure values were lower than 140/90 mm Hg without any antihipertensive drugs. In patients who required pharmacological therapy significant longer duration of arterial hypertension before adrenalectomy (mean 76.3 &plusmn; 63.5 vs. 30.5 &plusmn; 44.1 months) and older age of patients at the time of surgery (mean 46.4 &plusmn; 10.2 vs. 38.3 &plusmn; 9.8 years) were observed. Conclusions In patients with arterial hypertension due to pheochromocytoma adrenalectomy leads to a permanent improvement of maximal values of systolic and diastolic blood pressure. Longer duration of arterial hypertension before surgery and older age of patients ignificantly contribute to worse results of adrenalectomy and necessity of antihipertensive therapy in order to keep blood pressure values in the normal range

Ocena przydatności badań obrazowych (RTG, TK, MR) w diagnostyce mięsaka Ewinga u dzieci : doświadczenia własne

Background: Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma. Material/Methods: Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data. Results: The most common site of tumor was: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue.All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI examinations showed: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children. Conclusions: X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well