Evaluation of use of the optional unit QA-810V for the determination of five-part leukocyte differentials

The newly developed QA-810V is an optional unit for the determination of five-part white blood cell differentials. It can be used together with the same manufacturer's haematology analyser which has been used in relatively small-sized laboratories. The present study evaluates the basic performance of the QA-810V and the MEK-8118 haematology analyser using routinely obtained blood specimens treated with ethylenedioaminetetraacetic acid-2K. In this evaluation, reproducibility was good and little carryover was found. Accurate measurements were possible for up to 24h of storage. Storage at 4 °C yielded more stable measurements of complete blood counts and five-part differentials than storage at room temperature. A good correlation between findings with the MEK-8118 haematology analyser and those with the SE-9000 haematology analyser was found for complete blood counts. The leukocyte differential obtained with the QA-810V correlated well with eye counts, with r > 0.9 for percentages of neutrophils, lymphocytes and eosinophils. Scattergrams obtained with the QA-810V reflected the presence of abnormal cells. The performance of the QA-810V was excellent and it can improve the quality of testing in clinical laboratories

A Case Report of Atypical Spindle Cell Lipomatous Tumor of the Tongue

Herein, we report a case of atypical spindle cell lipomatous tumor (ASCLT) on both sides of the tongue in a 74-year-old male patient. The patient was referred to our department for treatment of the masses in the tongue. Several elastic soft indolent masses were detected during the first examination. The masses were well defined, and their consistency was similar to that of adipose tissues. No signs of induration were observed in the surrounding tissues. The patient was not aware of the masses, which were only detected during his visit at the dental clinic that referred him to our institution. Thus, the onset of the masses remains unknown. ASCLT was identified via histopathological examination. Then, tumor excision was performed under general anesthesia. Thirteen months after surgery, the condition of the patient was good, and signs of local recurrence or postoperative metastasis were not observed

Automated bone marrow analysis using the CD4000 automated haematology analyser

At present, bone marrow analysis is performed microscopically, but is time consuming and labour intensive. No automated methods have been successfully applied to classification of bone marrows cells because automated blood cell analysers have been incapable of identifying erythroblasts. The present study was designed to evaluate automated analysis of bone marrow aspirates with the CELL-DYN 4000 (CD4000) haematology analyser, which enables automated determination of erythroblast counts in both the normal mode (haemolytic time; 11.5s) and the resistant RBC mode (34.0s). The percentages of subpopulations including lymphocytes, neutrophils and erythroblasts were obtained with the CD4000, and as a reference, differential counts by microscopic observation of May–Grünwald–Giesa-stained films of bone marrow aspirates were performed (n=98). Significant correlations (P < 0.01) between the results obtained with the two methods were observed for total nucleated cell count and lymphocytes, neutrophils, erythroblasts and myeloid/erythroid (M/E) ratio. However, there were biases in the average percentages of erythroblasts, lymphocytes and M/E ratio obtained using the normal mode with the CD4000 toward values lower than those obtained with the microscopic method. Using the RBC resistant mode with the CD4000, the average percentages of erythroblasts, lymphocytes and M/E ratio approximated those obtained with the microscopic method. In conclusion, the CD4000 in resistant RBC mode is more useful for analysis of bone marrow aspirates than is the normal mode, because the former better approximates the M/E ratio than the latter

Characterization of histopathology and gene-expression profiles of synovitis in early rheumatoid arthritis using targeted biopsy specimens

The disease category of early rheumatoid arthritis (RA) has been limited with respect to clinical criteria. Pathological manifestations of synovitis in patients whose disease is clinically classified as early RA seem to be heterogeneous, with regular variations. To clarify the relation between the molecular and histopathological features of the synovitis, we analyzed gene-expression profiles in the synovial lining tissues to correlate them with histopathological features. Synovial tissues were obtained from knee joints of 12 patients with early RA by targeted biopsy under arthroscopy. Surgical specimens of long-standing RA (from four patients) were examined as positive controls. Each histopathological parameter characteristic of rheumatoid synovitis in synovial tissues was scored under light microscopy. Total RNAs from synovial lining tissues were obtained from the specimens selected by laser capture microdissection and the mRNAs were amplified by bacteriophage T7 RNA polymerase. Their cDNAs were analyzed in a cDNA microarray with 23,040 cDNAs, and the levels of gene expression in multilayered lining tissues, compared with those of normal-like lining tissues in specimens from the same person, were determined to estimate gene-expression profiles characteristic of the synovial proliferative lesions in each case. Based on cluster analysis of all cases, gene-expression profiles in the lesions in early RA fell into two groups. The groups had different expression levels of genes critical for proliferative inflammation, including those encoding cytokines, adhesion molecules, and extracellular matrices. One group resembled synovitis in long-standing RA and had high scores for some histopathological features – involving accumulations of lymphocytes and plasma cells – but not for other features. Possible differences in the histopathogenesis and prognosis of synovitis between the two groups are discussed in relation to the candidate genes and histopathology

A 6-Year Controlled Gastric Adenocarcinoma Metastasized to the Lung, Cervical Spine and Mandible in a Japanese Male: A Patient Report

Gastric adenocarcinoma metastasized to the lung, cervical vertebrae and mandible 6 years after gastrectomy in a 70-year-old man. When the man visited our clinic, he complained of pain in the left mandible with paralysis in the left lower lip and diffuse swelling with a fluctuation inside the left ramus of the mandible. Medium contrast computed tomography (CT) presented bone loss that looked like a wormhole at the left angle of the mandible. Magnetic resonance imaging (MRI) revealed abscess or osteomyelitis at the site. He showed no response despite treatment with antibiotics, and we suspected a neoplastic lesion. With a mandibular ramus specimen obtained by biopsy and examined histopathologically, adenocarcinoma of the salivary gland was strongly suspected. MRI presented a neoplastic lesion in his cervical vertebrae, and by biopsy he was diagnosed with adenocarcinoma. Thereafter, chest CT presented multiple pulmonary metastases. Considering the patient’s history of gastrectomy due to gastric adenocarcinoma, the stomach, cervical vertebrae or mandible were examined pathologically and immunohistochemically by biopsy: all specimens showed a moderately differentiated type of tubular adenocarcinoma, and the results for cytokeratin-related tumor markers were the same. We finally diagnosed him as having metastases from gastric adenocarcinoma to the lung, cervical vertebrae and mandible. Because the metastases had spread to multiple organs, the mandibular lesion was not treated, and terminal care in another facility was unavoidably selected. In making a differential diagnosis of multiple metastases, pathological and immunohistochemical examinations of metastatic lesions by biopsy were very useful based on the diagnostic imagings by CT and MRI

An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue

Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential