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Characterization of adrenal cortical proliferations requires integration of dynamic endocrine tests with imaging and histopathological characteristics. While pathologists are more frequently exposed to adrenalectomy specimens from patients with presumed adrenal cortical neoplasms, pre-operative biopsy specimens from non-functional adrenal lesions have also expanded the clinical tasks of pathologists. Confirmation of the adrenal cortical origin and distinction of benign cortical proliferations from adrenal cortical carcinomas are well-defined clinical responsibilities of pathologists. However, application of immunohistochemical and/or molecular biomarkers in adrenal cortical neoplasia and careful correlation of morphological features with laboratory findings and disease pathogenesis have evolved the impact of pathologist's role in the multidisciplinary team of endocrine disorders. This review provides an overview of what surgical pathologists need to know about the clinical, morphological, immunohistochemical and molecular features of various forms of adrenal cortical neoplasms (ACNs) in order to advance the clinical care.

Alpha-inhibin expression has been reported in pheochromocytomas and paragangliomas (PPGLs). We analyzed alpha-inhibin immunohistochemistry in 77 PPGLs (37 pheochromocytomas [PCCs] and 40 paragangliomas) and correlated the results with catecholamine profile, tumor size, Ki-67 labeling index, succinate dehydrogenase B subunit and carbonic anhydrase IX (CAIX) staining, and genetic pathogenesis. PPGLs were classified as pseudohypoxic cluster 1 disease with documented VHL mutation or SDHx mutation or biochemical phenotype, whereas NF1-driven and RET-driven PPGLs and those with a mature secretory (adrenergic or mixed adrenergic and noradrenergic) phenotype were classified as cluster 2 disease. The Cancer Genome Atlas data on INHA expression in PPGLs was examined. Alpha-inhibin was positive in 43 PPGLs (56%). Ki-67 labeling indices were 8.07% and 4.43% in inhibin-positive and inhibin-negative PPGLs, respectively (P

A 63 year-old postmenopausal woman presented to her family physician with a tender palpable mass in the right lower quadrant in November 2019. She noticed that this pain was reproducible with pressure on the right hip. Her medical history was significant for hypothyroidism, tubular adenomas, and

The classification of adenohypophysial neoplasms as "pituitary neuroendocrine tumors" (PitNETs) was proposed in 2017 to reflect their characteristics as epithelial neuroendocrine neoplasms with a spectrum of clinical behaviors ranging from small indolent lesions to large, locally invasive, unresectable tumors. Tumor growth and hormone hypersecretion cause significant morbidity and mortality in a subset of patients. The proposal was endorsed by a WHO working group that sought to provide a unified approach to neuroendocrine neoplasia in all body sites. We review the features that are characteristic of neuroendocrine cells, the epidemiology and prognosis of these tumors, as well as further refinements in terms used for other pituitary tumors to ensure consistency with the WHO framework. The intense study of PitNETs has provided information about the importance of cellular differentiation in tumor prognosis as a model for neuroendocrine tumors in different locations.

Although growth hormone (GH)–producing pituitary neuroendocrine tumors are by far the most common neoplastic cause of acromegaly and gigantism, other neoplastic causes exist, including hypothalamic tumors, which secrete eutopic GH-releasing hormone (GHRH) as well as a number of other tumor types throughout the body, which may secrete GHRH or GH in an ectopic fashion. This chapter is devoted to these less common but equally important entities and focuses on their clinical, radiological, biochemical, and pathological characteristics, in addition to diagnostic challenges that may be encountered when dealing with these interesting neoplasms.

Pituitary neuroendocrine tumors (PitNETs) : nomenclature evolution, not clinical revolution

Adrenocortical tumors range from primary bilateral micronodular or macronodular forms of adrenocortical disease to conventional adrenocortical adenomas and carcinomas. Accurate classification of these neoplasms is critical given the varied pathogenesis, clinical behavior, and outcome of these different lesions. Confirmation of adrenocortical origin, diagnosing malignancy, providing relevant prognostic information in adrenocortical carcinoma, and correlation of laboratory results with clinicopathologic findings are among the important responsibilities of pathologists who evaluate these lesions. This article focuses on a practical approach to the evaluation of adrenocortical tumors with an emphasis on clinical and imaging findings, morphologic characteristics, and multifactorial diagnostic schemes and algorithms.

Ischemia–reperfusion (IR) injury usually occurs during liver transplantation. Aquaporins (AQPs) are transmembrane channels that facilitate water permeability through cell membranes and are essential for the regulation of water homeostasis. Changes in the AQPs expression have been correlated with several inflammatory diseases. Less is known about AQPs expression in hepatic ischemia reperfusion injury. To clarify the roles of AQPs in IR injury, in this current study we examined the gene expression patterns of AQP1, 8 and 9 in the liver after IR injury. Male balb/c mice were exposed to partial (70%) hepatic ischemia for 65 min and then randomized into five groups of reperfusion [0 h (A), 8 h (B), 1 day (C), 3 days (D), and 7 days (E)]. A surgical group was also selected as the sham group. Serum and liver tissue samples were collected for evaluation of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and liver histopathology. Real time PCR was performed to evaluate the AQPs expression. I/R injury resulted in a significant increase in ALT and AST (p

Hepatic encephalopathy (HE) is a potentially reversible spectral neuropsychiatric state that complicates liver disease and negatively affects the prognosis. This study evaluated the effect of Curcuma longa in acute HE in rat and determined the behavioral, biochemical, and histological changes. Forty male Sprague Dawley rats were randomly divided into the control and three experimental groups. Thioacetamide (TAA, 300 mg/kg) was administered intraperitoneally to induce acute HE. Curcumin was administered orally at doses of 200, 300, and 400 mg/kg. The animals’ behavior, levels of ammonia, alkaline phosohatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST) enzymes were evaluated. The livers were evaluated histologically too. TAA could successfully induce inflammation and necrosis in hepatic tissue. Regarding the behavioral score, an increase in the dose of curcumin was correlated with a significant decrease in behavioral score. Ammonia, ALP, ALT, and AST levels were significantly lower among curcumin-receiving groups when compared with the control group, which was dose dependent. Histologically, curcumin was shown to reduce inflammation and necrosis in hepatic tissue, which was dose dependent too. Our findings revealed that curcumin could successfully prevent acute HE, which may happen due to a reduction in release of free radicals in the liver.

The objective of the present study was to determine the magnetic resonance imaging (MRI) and gross pathological findings of articular cartilage in osteoarthritis experimentally induced in rabbit as an animal model. Ten adult Dutch male rabbits were randomly divided into two equal groups. In group one, in the left knee (stifle), the cranial (anterior) cruciate ligament (CCL) was sectioned [transected group (TG)], and in the second group, only arthrotomy was performed through the same approach, but the CCL was left intact [arthrotomy group (AG)]. In both groups, the right knees were considered as controls. Thirty days after operation, MRI was performed under general anesthesia, and then the animals were sacrificed for gross pathological study. MRI was performed by a 1.5-T scanner with a wrist coil to evaluate the coronal and sagittal gradient echo T2-weighted proton density and T1- and T2-weighted sequences. A magnification loupe was used to inspect the menisci, femoral and tibial cartilages, and synovium. The results revealed that the measured mean articular cartilage thickness by MRI was less in TG in comparison to AG and control groups (p < 0.05), whereas the difference between AG and control was not significant. Statistical analysis of the results revealed that the measured mean articular cartilage thickness by MRI was less in TG than those of AG and control groups, whereas the difference between AG and control was not significant. There were no significant differences in meniscal degeneration, joint effusion, and MRI overall grades between AG and the control groups. The difference was significant between TG with AG and the controls in relation to MRI findings. The gross examination revealed that there were no gross abnormalities in AG but there were also significant differences between the TG and AG, and between TG and the controls. Changes were localized primarily to the distal aspect of the medial femoral condylar cartilage. It was concluded that the MRI findings in early osteoarthritis process consisted of articular cartilage loss and meniscal degeneration. The quantitative alterations in articular cartilage thickness measured by MRI can be a noninvasive way to predict osteoarthritis. The MRI findings were also well correlated with the results of pathological study.

Introduction Extramedullary hematopoiesis (EMH) commonly occurs in the spleen, liver and lymph nodes. Rare cases of EMH in the adrenal gland have been reported. Case Presentation We report the case of a 33-year-old man from the South of Iran suffering from major β-thalassemia, who underwent open left adrenalectomy and the histopathology revealed EMH. Conclusions In patients in which a history of hematologic disorders exists, careful imaging and hormonal assay should be done to certify a diagnosis of EMH. However, the surgical management becomes inevitable in certain cases.

This is a rare case of metastatic follicular carcinoma of thyroid in a patient with no history of thyroid problem. A frontal bone mass was examined microscopically and showed the pattern of metastatic follicular carcinoma. Thyroid ultrasonography then revealed a nodule in left lobe. Total thyroidectomy was done for the patient and microscopic examination confirmed the diagnosis.

Background Circumpatellar electrocauterization to destroy pain receptors during total knee arthroplasty without patellar resurfacing is commonly used to decrease postoperative knee pain. We aimed to evaluate the effect of denervation with electrocauterization on patellar cartilage. Methods Twenty rabbits were randomly assigned to two equally sized case and control groups. The rabbits in the case group underwent surgery via the anterior midline skin incision and medial parapatellar arthrotomy, followed by denervation electrocauterization at a depth of 1 mm and a distance of 3 mm from the outer border of the patella. In the control group, surgery was identical to that performed in the case group, but without patellar denervation. Twelve weeks after surgery, all rabbits were sacrificed. Range of motion, macroscopic evaluation of cartilage using modified Outerbridge scoring, and histopathological assessment using a modified histologic scoring system for cartilage were evaluated. Results Three rabbits died during the study. Nine cases and eight animals from the control group were included in the final evaluation. All rabbits had passive full range of motion. Mean Outerbridge score was 2.0 in the case group and 0.37 in the control group (p = 0.002). There were statistically significant differences in cellularity (p = 0.016), loss of matrix (p = 0.004), and clustering of chondrocytes (p = 0.008) between the two groups. Microscopic variables as a whole were statistically significant (p = 0.001). Conclusions Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. Level of evidence level II.

Plasma cell tumors are characterized by a monoclonal proliferation of immunoglobulin-secreting plasma cells. Dural infiltration of plasma cells without involvement of the parenchyma, leptomeninges or skull is a rare event. We present a 34-year-old man presenting with hallucination and amnesia. Magnetic resonance imaging revealed a left fronto-temporal mass with a dural tail mimicking meningioma. The mass was excised and histopathological examination revealed sheet of mature plasma cells. The cells were immunoreactive for kappa light chain, MUM1, CD38, and negative for epithelial membrane antigen. There was no recurrence after postoperative radiotherapy. Intracranial involvement from plasmacytoma should be considered in a case of solitary dural mass.

Papillary serous cystadenocarcinoma of the ovary is a common tumor but occurrence of ovarian type papillary serous cystadenocarcinoma in the testis is very rare. Herein we report such a case in a 49-year-old man presenting with testicular swelling. In this tumor, mesothelioma of tunica vaginalis should be excluded by immunohistochemistry. The best treatment is radial orchiectomy and it is very resistant to chemoradiation. Our case was well after orchiectomy and now after a year he is doing well and completely symptom free.

Purpose: To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model. Methods: 12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches. Results: 10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H2O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H2O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium. Conclusions: The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects.

Background: The full-thickness articular cartilage defects of knee have a poor healing capacity that may progress to osteoarthritis and need a knee replacement. This study determines the healing effect of bioglue in fullthickness articular cartilage defect of femoral condyle in rabbit. Methods: Forty-eight male rabbits were randomly divided into four equal groups. In group A, 4 mm articular cartilage defects were created in the right and left medial femoral condyles. Then a graft from xiphoid cartilage was transferred into the defect together with a designed bioglue and the knees were closed. In group B, an articular cartilage defect was created identical to group A, but the defect size was 6 mm. In group C, 4 and 6 mm articular cartilage defects were created in the right and left medial femoral condyles respectively. The graft was transferred into the defect and the knees were stitched. In group D, articular cartilage defects were created similar to group C, just filled with bioglue and closed. The rabbits were euthanized and subgroups were defined as A1, B1, C1 and D1 after 30 days and A2, B2, C2 and D2 after 60 days. The cartilages were macroscopically and histologically investigated for any changes. Results: Microscopic and macroscopic investigations showed that bioglue had a significant healing effect in the femoral condyle.