Postinflammatory scarring of cardiac valves of rheumatic and nonrheumatic etiology

Abstract In rheumatic heart disease, cardiac valves often display only a nonspecific postinflammatory scarring, without specific features, such as the rheumatic granuloma. Fifty-five native valves excised from 47 patients, exhibiting postinflammatory scarring, were studied. Patients were subdivided into three groups according to their case histories: patients with both streptococcal infection and rheumatic fever (group I), with streptococdal infection without noncardiac major manifestations of rheumatic fever (group II), and without either of these features (group III). Pathological examination alone was unable to differentiate among the three groups, all the valves showing the same general pathological features. Differences in terms of sex, age, and valvular involvement were detected among group III and the others, whereas patients belonging to the first two groups did not differ significantly. These results suggest that diagnostic criteria for rheumatic fever are too restrictive and that a postinflammatory valvular scarring of nonrheumatic etiology does exist

PAPILLARY-CYSTIC TUMOUR OF THE PANCREAS. CASE REPORT.

ACTA CHIR SCAN

Colorectal adenosquamous carcinoma: Peculiar morphologic features and distinct immunoprofiles in squamous and glandular components

Colorectal adenosquamous carcinoma (ASC) is exceedingly rare, comprising less than 0.1% of all colorectal malignancies, and is characterized by the admixture of glandular and squamous components. Due to its rarity, immunohistochemical and biological profiles have not been well investigated. The clinico-pathologic features of 29 cases of primary colorectal adenosquamous carcinomas, including four synchronous metastases, as well as the immunohistochemical expression of keratin 20, CDX2, keratin 34βE12, keratin 5/6, p63, p40, β-Catenin, Cyclin D1 and mismatch repair protein (MMR) expression in both squamous and glandular components are described. All ASCs showed aggressive clinico-pathologic features; all cases showed at least one aggressive pathologic characteristic (poorly differentiated, vascular invasion, infiltrative growth pattern) and 69% of cases were either stage III or IV. The squamous component was keratin 34βE12 positive in all cases and keratin 5/6 positive in 27 cases, while only 7 cases showed p63 and/or p40 expression. β-Catenin and Cyclin D1 showed different expression, with nuclear staining of Cyclin D1 in the squamous component of all cases (both primary and metastatic lesions) and nuclear staining of β-Catenin predominantly in the glandular component. All but one case showed proficient MMR profile. Sixteen patients (64%) died of their disease with median survival of 10 months. ASC show aggressive clinical outcome and aggressive pathologic characteristics. A peculiar keratin 34βE12 positive profile in the squamous component is seen differing from squamous cell carcinoma and non-intestinal ASC. The staining patterns for β-Catenin and Cyclin D1 between components, supports a possible divergent clonal evolution of the neoplasm