Assessment of malignant skeletal disease: initial experience with 18F-fluoride PET/CT and comparison between 18F-fluoride PET and 18F-fluoride PET/CT.
Einat Even‐SapirUr MetserGideon FlusserLimor ZurielYehuda KollenderHedva LermanGennady LievshitzIlan G. RonEyal Mishani
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18F-fluoride PET/CT was performed on 44 oncologic patients to evaluate its diagnostic accuracy in assessing malignant osseous involvement and in differentiating malignant from benign bone lesions.(18)F-fluoride PET and (18)F-fluoride PET/CT were interpreted separately. Lesions showing increased (18)F-fluoride uptake were categorized as malignant, benign, or inconclusive. The final diagnosis of lesions was based on histopathology, correlation with contemporaneous diagnostic CT or MRI, or clinical follow-up of at least 6 mo (mean, 10 +/- 3 mo).Increased (18)F-fluoride uptake was detected at 212 sites, including 111 malignant lesions, 89 benign lesions, and 12 lesions for which the final diagnosis could not be determined. In a lesion-based analysis, the sensitivity of PET alone in differentiating benign from malignant bone lesions was 72% when inconclusive lesions were considered false negative and 90% when inconclusive lesions were considered true positive. On PET/CT, 94 of 111 (85%) metastases presented as sites of increased uptake with corresponding lytic or sclerotic changes, and 16 of the 17 remaining metastases showed normal-appearing bone on CT, for an overall sensitivity of 99% for tumor detection. For only 1 metastasis was PET/CT misleading, suggesting the false diagnosis of a benign lesion. The specificity of PET/CT was significantly higher than that of PET alone (97% vs. 72%, P < 0.001). PET/CT identified benign abnormalities at the location exactly corresponding to the scintigraphic increased uptake for 85 of 89 (96%) benign lesions. In a patient-based analysis, the sensitivity of PET and PET/CT was 88% and 100%, respectively (P < 0.05) and the specificity was 56% and 88%, respectively (not statistically significant). Among the 12 patients referred for (18)F-fluoride assessment because of bone pain despite negative findings on (99m)Tc-methylene diphosphonate bone scintigraphy, (18)F-fluoride PET/CT suggested malignant bone involvement in all 4 patients with proven skeletal metastases, a potential benign cause in 4 of 7 patients who had no evidence of metastatic disease, and a soft-tissue tumor mass invading a sacral foramen in 1 patient.The results indicate that (18)F-fluoride PET/CT is both sensitive and specific for the detection of lytic and sclerotic malignant lesions. It accurately differentiated malignant from benign bone lesions and possibly assisted in identifying a potential cause for bone pain in oncologic patients. For most lesions, the anatomic data provided by the low-dose CT of the PET/CT study obviates the performance of full-dose diagnostic CT for correlation purposes.Keywords:
PET-CT
Histopathology
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Background Magnetic resonance imaging (MRI) can provide in vivo assessment of tissue damage, allowing evaluation of multiple sclerosis (MS) lesion evolution over time – a perspective not obtainable with postmortem histopathology. Relapsing–remitting experimental autoimmune encephalomyelitis (EAE) is an experimental model of MS that can be induced in the common marmoset, a small new world primate, and that causes perivenular white matter (WM) lesions similar to those observed in MS. Methods Brain lesion development and evolution were studied in vivo and postmortem in four marmosets with EAE through serial T2- and T2*-weighted scans at 7-tesla. Supratentorial WM lesions were identified and characterized. Results Of 97 lesions observed, 86 (88%) were clearly perivenular, and 62 (72%) developed around veins that were visible even prior to EAE induction. The perivenular configuration was confirmed by postmortem histopathology. Most affected veins, and their related perivascular Virchow-Robin spaces, passed into the subarachnoid space rather than the ventricles. Conclusion As in human MS, the intimate association between small veins and EAE lesions in the marmoset can be studied with serial in vivo MRI. This further strengthens the usefulness of this model for understanding the process of perivenular lesion development and accompanying tissue destruction in MS.
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Subarachnoid space
Neuropathology
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To investigate whether three stereotactic core needle biopsies (S-CNB) in non-palpable breast lesion are enough for accurate preoperative diagnosis.Between September 1994 and December 2000, 523 patients with mammographically detected breast lesions and who proceeded to surgery were preoperatively stereotactically biopsied with an automated 14-gauge biopsy device. Three samples were taken from each lesion irrespective of whether the lesion presented as "microcalcifications only", "microcalcifications and a mass", or a "mass, architectural distorsion, or stellate lesion without microcalcifications". The histopathology was divided into three subgroups: diagnostic, atypia (ranging from atypical cells to probably cancer), and non-diagnostic material.Post-surgical histopathology diagnosed 454 (87%) malignant tumors and 69 (13%) benign lesions. Three S-CNB correctly diagnosed the malignant tumors in 84% in the subgroup "microcalcifications only". In the category "microcalcifications and a mass", the diagnostic accuracy was 97% and in the subgroup "mass, architectural distorsion, or stellate lesion without microcalcifications" 3 S-CNB resulted in 93% correct diagnostic material. In 19 of the 454 patients (4%) 1, 2 or all 3 preoperative S-CNB showed atypia. In 20 patients (4%), all 3 S-CNB were non-diagnostic. Thirteen of these 20 patients had "microcalcifications only" and 7 had a mass without microcalcifications.Three S-CNB were enough for correct diagnosis in "masses, architectural distorsions, or stellate lesions without microcalcifications" and in "microcalcifications and a mass", but were not sufficient in "microcalcifications only".
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Objective To study the histopathological basis of MRI-detectable lesion in the EAE model of rhesus monkey.Methods Firstly,the model of rhesus EAE can b e established.Then serial MR imagin g was performed.The MRI,clinical an d pathology were compared and correlated for evaluation in the CNS over disease process.Result Nine animals all attacked .The conventional MRI absents speciality in revealing pathologic structure.Gd-DTPA enhancement helped to distinguish active plaques fr om inactive plaques.It can be as located reference sign where should be occur demyelination.MT imaging i mprove the rate of finding out little lesions.Histopathologic exam-ination in relative area revealed perivascular flammatory cuffing and d emyelination and axons injure .Conclusions serial MR studies are an important method to clinical and his topathologic analysis for the evalu ation of CNS lesion in the EAE.
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Encephalomyelitis
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This study aimed to observe the characteristic histopathological lesion of internal organ of broiler chicken infected by Leucocytozoon caulleryi.
Material and Method: This study conducted in several locations in two island of Indonesia which recorded as endemic area. Clinical symptom was observed to determine the suspected animal. Subsequently, blood smear was conducted to confirm the parasetiemia stage and observed the gross lesion of whole body related to pathological symptom of leucocytozoonosis. Every internal organ which was suspected affected, performed for histopathological preparation and examined under light microscope. The data analysis presented descriptively.
Results: Clinical symptom was observed from the sample population. Blood smear result confirmed that suspected chicken was due to the parasitemia of leucocytozoonosis. Most pathological finding showed petechiae spread in muscle tissue. Spleen, liver, lung and heart microscopic lesion showed megalozchizont. Several inflammation findings were showed in infected organ and alteration tissue order was shown in spleen.
Conclusion: Leucocytozoon caulleryi could impact the histological aspect and affect the several organs specifically with high vascularization.
Keywords: Chicken; Histopathology; Leucocytozoon caulleryi
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Aberrant crypt foci (ACF) are putative preneoplastic lesions that might represent the earliest morphological lesion visible under light microscope in colonic carcinogenesis.ACF has many changes in histopathology,molecular genetics,biochemistry and immunohistochemistry which is widely regarded as precancerous lesion.ACE has great significance in clinic and antitumor drug screening.
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Purpose: To describe an unusual limbal lesion clinically resembling pterygium in a young patient with neurofibromatosis type 1. Methods: Clinical case report with a review of the literature. Results: The lesion was excised, and histopathology was performed. Histopathology disclosed conjunctival mucosa with expansion of the substantia propria by dense and loose collagenous tissue, small nerves, and thin-walled blood vessels. No skin or skin appendages were seen, although a small amount of mature adipose was present. Focally, spindle cells with wavy nuclei were seen scattered within the collagenous areas and were positive on S100 immunohistochemistry. Mast cells were readily identifiable. There was no evidence of actinic elastosis, dysplasia, or malignancy. These histopathological features most resemble heterotopia with some features of neurofibroma. Conclusions: We report an unusual limbal lesion in a patient with neurofibromatosis type 1. Histopathological features resemble a heterotopia with some neurofibroma features. We suggest that all lesions excised from patients with neurofibromatosis, no matter how characteristic in appearance, be sent for histopathological confirmation of diagnosis.
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To evaluate the success of ultrasound in post-excision specimen visualization, and negative predictive value of ultrasound for estimation of tumor-free margins using histopathology as the gold standard.Cross-sectional analytical study.The Aga Khan University Hospital, Karachi, Pakistan, from May 2010 till January 2013.Sonography of all breast nodules was done before and after exicision by two female radiologists with at least five years clinical experience. All surgeries were performed by the same referring breast surgeons. All nodules were non-palpable and had histopathology as well as specimen sonography performed at AKUH. Subjects were excluded, if histopathology was not available, post-procedure sonogram not done or done in another hospital and nodules that were not seen on ultrasound. After needle localization in 47 patients using ultrasound and in 7 patients using mammogram was done, sonogram was conducted in all 54 lesions. These were then assessed by ultrasound for detection of lesion and tumor-free margins in malignant lesion. Post-excision ultrasound was performed for the evaluation of lesion whether visualized or absent with localizing needle in situ, lesion dimensions, depth measurement between the superior margin of the lesion and its edge.All 54 lesions were present on post-exicison scan, out of which 28 were documented as malignant and 26 as benign. Ultrasound declared all specimens as tumor-free. On histopathology, two lesions were documented as having tumor-positive margins and were proven to be invasive lobular carcinoma. Therefore, the negative predictive value of the specimen sonography for margin detection was 26/28 (92.8%).Ultrasound of the excised breast tumor specimen is a simple and reliable technique for confirmation of the tumor-free margins in non-palpable breast lesions.
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We report a case of cat-scratch disease. The histological findings of the primary cutaneous lesion were characterized by the presence of necrotic areas surrounded by epithelioid cells in a palisade arrangement and an infiltrate composed of lymphoid cells, plasma cells and giant cells foreign body type.
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