Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
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Intrathyroidal epithelial thymoma (ITET)/carcinoma showing thymus-like differentiation (CASTLE), a rare thyroid neoplasm, was recently shown to be immunoreactive for CD5, providing immunophenotypic evidence of previously postulated thymic differentiation. To assess whether ectopic malignant neoplasms with thymic differentiation display other markers associated with thymic carcinoma, we studied five cases of ITET/CASTLE, two cases of cervical thymic carcinoma, and one case of cervical thymoma for bcl-2 and mcl-1 immunoreactivity. ⋯ Similarly, all of the five cases of ITET/CASTLE, both cervical thymic carcinomas, but not the cervical thymoma, were immunoreactive for mcl-1, as were 9 (90%) of 10 thymic carcinomas, in contrast to 6 (33%) of 18 benign and invasive thymomas. We conclude that dual immunoreactivity for bcl-2 and mcl-1 is a feature of malignant neoplasms with thymic differentiation in general, both within the thymus and at ectopic sites.
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Idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) and cryptogenic organizing pneumonia (COP) are synonyms for an inflammatory interstitial process characterized by young fibromyxoid connective tissue within airways and air spaces. This clinicopathologic condition is associated with an excellent response to steroidal therapy in more than 80% of patients. In this study, we examined matched groups of 10 patients with steroid-responsive idiopathic BOOP/COP and 9 patients with idiopathic BOOP/COP who fared poorly despite therapy. ⋯ Steroid-nonresponsive cases of BOOP/COP may have a propensity to cause irreversible injury to the lung, a feature not seen in cases with a good outcome. Another explanation may be that such cases represent a BOOP/COP-like reaction pattern in patients with an associated fibrosing interstitial pneumonia, especially usual interstitial pneumonia. The differential diagnosis of BOOP/COP with organizing diffuse alveolar damage, eosinophilic pneumonia, and other chronic interstitial pneumonias is discussed.
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Low-grade mucosa-associated lymphoid tissue (MALT) lymphomas of the salivary gland are usually indolent diseases with a protracted clinical course. Recurrent multifocal disease has been shown to represent identical clones in some cases, and intraclonal variation resulting from continuing somatic hypermutation has been described, but emergence of novel, major clones upon recurrent disease has not been documented. We analyzed three consecutive biopsy specimens of parotid lymphoid infiltrates of a young woman with Sjögren's disease. ⋯ Primers specific to the clone seen in the first two lesions failed to amplify products from the third lesion, but primers specific to the third clone showed similar products in the second clone in a small quantity, indicating that this clone persisted and expanded. Our results suggest that different B-cell clones might dominate during the course of low-grade MALT lymphoma of the salivary gland. This implies that in some cases, these processes can represent oligoclonal B-cell proliferations.
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A total of 125 transplant procedures involving the lung have been performed at Loyola University of Chicago in 120 patients. There were 67 single (40 right, 27 left), 44 bilateral single, 2 double lung, and 12 heart-lungs (HL) transplant procedures. This paper summarizes the pathologic findings in 565 transbronchial, 102 endobronchial, 20 open lung, and 92 endomyocardial biopsies and compares them with the recommendations in the published literature. ⋯ In the 12 patients with heart-lung transplants, a total of 92 endomyocardial, 35 transbronchial, and 1 endobronchial biopsies were obtained. Acute rejection was seen only in 2 endomyocardial biopsies, whereas the transbronchial biopsy showed acute mild or moderate rejection in 10, chronic rejection in 1, and cytomegalovirus infection in six biopsies. We conclude that: (a) all biopsies with alveolated lung parenchyma can be evaluated for rejection and infection yielding clinically significant diagnoses; (b) sections from three levels stained by H&E are essential for evaluation; (c) routine Gomori's methenamine silver, elastic van Gieson, and trichrome stains are not required for transbronchial biopsy, however, routine Gomori's methenamine stain is recommended for all anastomotic site biopsies; (d) routine immunoperoxidase for cytomegalovirus is extremely helpful; (e) Grade B rejection should be further graded; and (f) endomyocardial biopsy played no significant role in the management of heart-lung recipients.
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We present five cases of leprosy in five human immunodeficiency virus-positive individuals. The patients were five men between the ages of 18 and 45 years. ⋯ In one patient, there was bilateral "claw hands." Histologically, two cases were categorized as lepromatous leprosy, two as borderline tuberculoid, and one as borderline lepromatous. Follow-up information obtained in the five patients showed one patient had died, and the remaining four patients were alive and receiving antileprosy treatment.