Detection of the membrane attack complex as a diagnostic tool in dermatomyositis

BACKGROUND

Currently there is no reliable diagnostic marker to distinguish between the subgroups of idiopathic inflammatory myopathies (IIMs), i.e. dermatomyositis (DM), polymyositis (PM) and inclusion body myositis (IBM). Membrane attack complex (MAC) has been shown to be involved in the pathogenesis of dermatomyositis but its role as a diagnostic marker has not been evaluated.

AIM

To assess the diagnostic utility of MAC deposition in distinguishing dermatomyositis from other neuromuscular disorders.

MATERIAL AND METHODS

Immunohistochemical detection of MAC deposition on endomysial microvessels was carried out on 127 muscle biopsies comprising of 21 cases of dermatomyositis, 42 other IIMs and 64 non-IIM neuromuscular diseases.

RESULTS

MAC deposition showed a high sensitivity (80.9%) and specificity (85%) to differentiate DM from other IIMs. Its specificity was higher (98.4%) in discriminating DM from non-IIM muscular diseases and IIM from non-IIMs.

CONCLUSION

MAC deposition can serve as a reliable marker to distinguish DM from other IIMs (i.e. PM and IBM) as well as from non-IIM diseases. It can also serve as a useful adjunct in diagnosis of IIMs when there is diagnostic dilemma with their morphologic similarities. These results provide further credence to the long-standing view that MAC-mediated capillary destruction is involved in the immunopathogenesis of DM.

Determination of oxidative status and apoptosis in peripheral blood of dogs with sarcoptic mange

The aim of the present study was to determine the erythrocytic oxidant/antioxidant balance and apoptosis of peripheral blood leukocytes of dogs with natural Sarcoptes scabiei var. canis mite infestation. A total of twenty four clinically Sarcoptes-infested dogs were examined and used to execute the study. While another twenty four healthy dogs free of any ecto-parasite were used as controls. Peripheral blood samples were obtained from each infested only once on the day of dermatological examinations. Determination of oxidant/antioxidant balance was conceded by estimating the levels of lipid peroxides and antioxidants in erythrocytes. While, apoptosis of peripheral blood leukocytes was determined by estimating externalization of phosphatidylserine (PS) at the cell surface as well as by detection of depolarization mitochondrial membrane potential (ΔΨm) by flow cytometry. Sarcoptes-infested dogs had revealed significantly higher (P≤0.001) contents of erythrocytic lipid peroxides in comparison with the healthy controls. Whereas the level of reduced glutathione was found to be significantly lower (P≤0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The activity of glutathione peroxidase was found to be significantly lower (P≤0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The activity of glutathione-S-transferase was also found to be significantly lower (P≤0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The dogs with sarcoptic mange had revealed significantly lower (P≤0.001) activity of superoxide dismutase in coparision with the healthy dogs. The dogs with sarcoptic mange had also revealed significantly lower (P≤0.001) activity of catalase in coparision with the healthy dogs. The percentage of apoptotic leukocytes was found to be significantly higher (P≤0.001) in Sarcoptes-infested dogs as compared to the healthy controls. Sarcoptes-infested dogs had also exhibited significantly (P≤0.001) higher percentage of leukocytes with depolarized mitochondrial membrane potential in comparison with the healthy controls. It is concluded that significant alteration in oxidant/antioxidant balance and increased rate of apoptosis in peripheral leukocytes may be implicated in the pathogenesis of clinical Sarcoptes mite infestation in dogs.

Successful surgical excision of a nondysraphic holodorsal intramedullary lipoma in a 14-month-old child

INTRODUCTION

Nondysraphic intramedullary lipomas of the spinal cord are rare lesions. They are most commonly seen in the second or third decade of life. Their occurrence in the pediatric age group is even rarer.

CASE REPORT

The authors describe a 14-month-old child who presented with delayed motor milestones involving the bilateral lower limbs. The child was unable to sit or stand. MRI revealed a dorsally located intramedullary lipoma extending from C7 to D12. The child underwent C7-L1 laminotomy and gross total excision of the lipoma. Postoperatively, the child improved neurologically and attained normal power in the bilateral lower limbs.

DISCUSSION

Very few cases of extensive intramedullary lipomas involving the dorsal cord have previously been reported. Only two cases of pediatric extensive dorsal lipomas have been mentioned to date. The authors describe successful surgical excision of a holodorsal intramedullary lipoma in a 14-month-old child. To the best of the authors' knowledge, this is the first case being reported of a holodorsal intramedullary lipoma in the youngest patient.

Familial progressive hypermelanosis in Indian monozygotic twins

Familial hyperpigmentation, or melanosis universalis hereditaria, is a rare hyperpigmentary disorder with onset in infancy. Here, we describe monozygotic twins with similar pattern of progressive hyperpigmentation with onset in early neonatal period without any family history. Histopathological examination showed increased melanin throughout the epidermis. Although hereditary defects may influence melanogenesis resulting in a pigmentary anomaly, the pathogenesis of hyperpigmentation in this case remains unclear.

TP53 polymorphisms in gliomas from Indian patients: Study of codon 72 genotype, rs1642785, rs1800370 and 16 base pair insertion in intron-3

Several single nucleotide polymorphisms of the TP53 gene have been reported, amongst which polymorphism in codon 72 (rs1042522) has received significant attention and shown to be associated with disease susceptibility in different cancer types. However, there are variable reports on this polymorphism in gliomas from worldwide with inconsistent results. In addition, the implications of other polymorphic loci are not much explored in gliomas. Hence, in the present study the TP53 sequence was analyzed for all polymorphism and mutations in a total of 84 gliomas of different types and grades from patients of Indian origin. The complete sequence of all coding exons (2 to 11) and introns 2, 3, 5 and 8 of TP53 gene were studied while for introns 1, 4, 6, 7, 9 and 10, only exon flanking regions could be studied. The polymorphic loci were compared with control population. In addition to the well known codon 72 polymorphism (rs1042522), three other polymorphisms rs1642785, rs1800370 and a 16 base pair insertion in intron-3 were found. At codon 72, our study showed higher Arg/Arg genotype in gliomas compared to normal population (38% versus 13%). The Arg allele frequency in glioma patients was comparatively higher than controls (0.55 versus 0.45; P=0.037). The Arg allele frequency was also high in adult glioblastomas compared to paediatric counterparts (0.55 versus 0.36). However, there was no significant association of TP53 mutations with any genotype of codon 72. At rs1642785, the G allele frequency was significantly higher in gliomas than in control population (0.55 versus 0.36, P=0.005). The genotype at a 16 base pair insertion in intron-3 was almost similar in case and control. However, the polymorphism at rs1800370 was exclusive to gliomas. This is the first report of TP53 gene polymorphism in glioma patients from India. Our study also delineates the frequency of four polymorphisms in gliomas for the first time. The codon 72 variant (rs1042522) and rs1642785 polymorphisms possibly poses risk to glioma development in Indian population. However, the functional significance of these polymorphism needs further elucidation.

MGMT gene promoter methylation in pediatric glioblastomas

PURPOSE

Relatively few studies have been performed on molecular properties of pediatric glioblastoma multiforme (GBM). Methylation of DNA repair gene O(6)-methylguanine-DNA methyltransferase (MGMT) promoter region has been associated with favorable prognosis and prolonged survival in adult GBM patients treated with temozolomide (TMZ). We explored the frequency of MGMT gene promoter methylation in pediatric glioblastomas and compared it with the known molecular alterations in p53.

METHODS

Twenty pediatric GBM cases were selected. MGMT promoter methylation was assessed by methylation specific PCR. p53 expression was determined by immunohistochemistry.

RESULTS

MGMT gene promoter methylation was observed in 50% of pediatric glioblastomas. p53 protein expression was detected in 60% of cases. Seventy percent of cases with methylated MGMT promoter were p53 immunopositive.

CONCLUSIONS

The frequency of MGMT gene promoter methylation in pediatric GBMs was similar to adult GBM patients. The pediatric GBMs should also be investigated for MGMT promoter methylation to identify a subset of patients likely to benefit from TMZ therapy. p53 protein overexpression was more common in pediatric primary GBMs. To the best of our knowledge this is only the second study on MGMT gene promoter methylation status in pediatric GBMs.

Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer

OBJECTIVE

In the management of epithelial ovarian cancer (EOC), the identification of peritoneal deposits is the most important prognostic factor. We conducted a prospective study to evaluate the role of multidetector CT (MDCT) in identifying peritoneal deposits pre-operatively.

METHODS

38 previously untreated patients (median age 50 years; range 26-70 years) were evaluated with contrast-enhanced MDCT of the abdomen and pelvis. All CT scans were performed on a four-slice MDCT scanner with thin-slice image acquisition. Multiplanar coronal, sagittal or oblique images were constructed and all images were reviewed by at least two radiologists. The extent of disease was determined and mapped for all areas of the abdomen and pelvis. CT scans were reviewed and compared with surgical findings. Peritoneal deposits and thickening were separately noted for each of the nine segments of the abdomen and pelvis (i.e. bilateral hypochondria, bilateral lumbar, bilateral iliac fossa, epigastrium, umbilical region and hypogastrium) and were mainly used to determine the accuracy of MDCT in the depiction of peritoneal carcinomatosis.

RESULTS

Sensitivity, specificity, positive and negative predictive values and accuracy of CT in the detection of peritoneal deposits were similar to those reported in the literature. The most common anatomical sites to have peritoneal deposits were the pouch of Douglas (18 cases) and the right subdiaphragmatic region (18 cases).

CONCLUSION

Despite the improved scanning technology, image reconstruction and viewing ability of MDCT, its overall accuracy for the detection of peritoneal deposits is not significantly improved when compared with conventional CT; however, MDCT is useful in the assessment of disease at specific locations in the abdomen and pelvis.

Determination of Working Length of Root Canal

BACKGROUND

This study was undertaken to determine the working length of root canal by microprocessor controlled impedance quotient apex locator and conventional radiographic method.

METHODS

Patients whose teeth were to be extracted were selected for this study. A total of 100 teeth in the same or different patients were identified. Biomechanical preparation of the canal was done for smooth negotiation of the entire canal. The electrode of the Root ZX™ was attached to the selected file and the length adjusted till the beep of the Root ZX™ indicated the apical foramen. The electrode was removed but the file was stabilized with the help of soft gutta percha. An intraoral periapical (IOPA) radiograph was taken using basic guidelines. The tooth was then extracted under local anaesthesia along with the file in the tooth. A window was cut on one surface of the root apex approximately 4mm from the apex to expose the root canal. The file tip was identified. The distance of the file tip from the apex was measured under 3X magnification and the reading recorded. Similarly the distance from the file tip to the radiographic apex was measured on the radiograph under magnification and the reading recorded. All the readings were tabulated. The actual distances measured between the extracted tooth, the electronic apex locator and on the radiograph were compared using a paired 't' test to determine the accuracy of each method in relation to the minor diameter.

RESULT

It was observed that the radiographic method had a significant variation from the electronic method when compared to the actual measurement on the extracted tooth.

CONCLUSION

The electronic method is a more accurate method as compared to radiographic method for determination of working length of the root canal.

A rare case of intracranial solitary fibrous tumor of meninges: case report

The authors report a case of intracranial tumor in a 60 year female, previously asymptomatic presenting with altered sensorium following a road traffic accident. Imaging showed a small left frontotemporal contusion along with a large right frontoparietal extra axial mass lesion suggestive of a meningioma. Patient improved significantly after craniotomy and tumour decompression. Histopathology with immunohistochemical analysis however revealed the presence of a solitary fibrous tumor of meninges. The case is reported in view of its rarity, atypical presentation and need to distinguish from meningiomas which they can mimic radiologically.

Paraganglioma of cauda equina: report of seven cases

The authors report seven uncommon cases of paraganglioma of the cauda equina region with reference to their clinical, radiological, and pathological findings. The common presenting symptoms in all the patients were low backache with radiation to both thighs, sensory and motor deficits in four patients, and urinary retention in three patients. One patient presented with ataxia and superficial sidrosis of the brain. Magnetic resonance imaging (MRI) revealed well-circumscribed lesions that were isointense on T1- and T2-weighted images with flow voids. All the tumors were well circumscribed and could be excised completely; however, one recurred. Histological examination revealed a classic "zellballen" pattern in four tumors. Two mimicked ependymoma but were confirmed as paraganglioma by immunohistochemistry. MIB-1 LI was low in all the tumors. Thus, there were no identifying clinical or radiological features that helped in differentiating paraganglioma from other common tumors, such as ependymoma or neurinoma, in this region, and preoperative diagnosis was not possible in any of the cases. Morphologic features and immunohistochemical analysis proved to be the mainstay of arriving at a correct diagnosis. This report highlights the significance of important morphologic features and immunohistochemistry in the diagnosis of paraganglioma at this unusual site.

Epitheloid hemangioendothelioma of urinary bladder

Epitheloid hemangioendothelioma is an uncommon vascular neoplasm and has an unpredictable clinical behavior. It is characterized by round or spindle-shaped endothelial cells with cytoplasmic vacuolation. Most often, epitheloid hemangioendothelioma arise from the soft tissues of the upper and lower extremities and it has borderline malignant potential. We describe the first reported case of epitheloid hemangioendothelioma in the urinary bladder, which was treated by transurethral resection. The diagnosis was confirmed by immunohistochemistry.

Congenital myopathies--a comprehensive update of recent advancements

The congenital myopathies are relatively newly discovered compared with other categories of muscle diseases. Current research continues to clarify and classify the congenital myopathies. These pose a diagnostic problem and cannot be diagnosed by routine hematoxylin and eosin stain. A lot of special techniques are required to diagnose them correctly and it's various subtypes. The disease specific structural changes seen in the muscle are detected by enzyme histochemistry, immunohistochemistry and electron microscopy. Through this review we provide an up-to-date analysis of congenital myopathies including clinical and pathologic aspects.

Spinal teratomas: a clinico-pathological study of 27 patients

BACKGROUND

Spinal cord teratomas are uncommon tumours. The diagnosis is rarely suspected before surgery and final diagnosis is invariably made at histopathological examination.

METHODS

We retrospectively analysed our neuropathology records for the last 20 years and all patients diagnosed as spinal teratomas were retrieved. The clinical and radiological features were noted. Slides were reviewed and the diagnosis was confirmed.

FINDINGS

During a period of 20 years, we found 27 examples of spinal teratomas. There was a wide age range and 37.3% presented in adulthood. Male predominance was observed both in children as well as adults. The dorso-lumbar location was common in children as well as in adults but an intramedullary location, in association with a myelomeningocele and split cord malformation, was more common in children. Twenty one patients had associated features of spinal dysraphism. Of the six who were not associated with this, five were adult patients. Radiologically mixed solid and cystic morphology, fat signal and areas of calcification were seen in one third of patients. All tumours except one showed benign (mature) components. Interestingly, two lesions contained mature renal tissue: one exhibited pulmonary differentiation and one had Wilm's tumour as a component of the teratoma. In five patients the initial sections showed epidermis with skin adenexal structures and a diagnosis of dermoid cyst was suspected but serial sectioning revealed other teratomatous components. All patients were treated with surgical excision.

CONCLUSION

Although there are no specific features on imaging, mixed solid and cystic morphology, fat signal and areas of calcification are helpful in the pre-operative diagnosis. Most of these lesions are diagnosed on histopathological examination after surgery and therefore thorough sampling and serial sectioning are mandatory to identify all components of the teratoma in order to avoid misdiagnosis.

Correlation of diagnostic yield of stereotactic brain biopsy with number of biopsy bits and site of the lesion

Our objective was to examine the reliability of histological diagnosis achieved vis a vis the number of biopsy bits obtained along a single trajectory of the stereotactic needle. A retrospective analysis of stereotactic biopsies performed in a single tertiary care neurosciences center, during a period of 11 years, between 1995 to 2005 was done. The overall diagnostic accuracy achieved on histopathology was correlated with the number of bits obtained by stereotactic biopsy. A total of 86 cases were analyzed, which consisted of 58 males and 28 females. Age ranged from 6 to 75 years, with a mean age of 36.1 years. Twenty percent of the patients were in the pediatric age group and 15% were > or =60 years of age. Most common sites biopsied were thalamus/basal ganglia (55.8%), followed by eloquent areas and other sites. A definitive histological diagnosis was established in 70 cases (diagnostic yield, 81.3%), which encompassed 65 neoplastic and 5 nonneoplastic lesions. Astrocytic lesions, the most common, include 10 pilocytic astrocytomas (PA), 29 diffuse astrocytomas (DA), 11 anaplastic astrocytomas (AA), and 7 glioblastoma multiforme (GBM). In 16 cases no definite histological diagnosis could be offered. The number of biopsies ranged between 1 and 6 bits (mean, 2; median, 1). The majority (68.7%) of the biopsies were 1 or 2-bits. The diagnostic accuracy increased from 76.5% for single biopsies to 84% and 88.2% for 2 and 3 bits, respectively, and 100% for biopsies with 5 to 6 bits. Overall, a trend of higher diagnostic yield was seen in cases with more biopsies when compared with single bit biopsies. Thus, this small series confirms that stereotactic procedures involving multiple bits are associated with a high diagnostic yield.

Anaplastic meningioma in an adolescent: a report of a rare case and brief review of literature

OBJECTIVE

Anaplastic meningioma is an uncommon neoplasm in childhood and adolescence. Due to the rarity, treatment options for anaplastic meningioma in this age group are not clearly outlined.

CASE

A 15-year-old boy presented with a left forehead swelling with a history of a left frontal tumor. Radiological investigations revealed a dura-based tumor with a large extracranial and a smaller intracranial component. Craniotomy with near-total excision of the tumor was performed. Histopathological examination of the tumor showed features of an anaplastic meningioma. The patient is currently receiving radiotherapy and chemotherapy. However, he has developed scalp swellings while on radiotherapy.

CONCLUSION

Anaplastic meningioma is extremely rare in children. Extensive sampling is required to recognize the meningothelial nature of the tumor and immunohistochemistry helps in making an accurate diagnosis in such cases. Therapeutic interventions in such cases need to be closely monitored due to the aggressive behavior of this tumor.

Lumbosacral Wilms' tumor as a component of immature teratoma associated with spinal dysraphism--a rare case and short literature review

Occurrence of extrarenal Wilms' tumor, in the lumbosacral region, as such or as a component of immature teratoma is an extremely uncommon condition and this diagnosis is almost always postsurgical. We report a case of immature teratoma in the lumbosacral region which was composed of mature teratomatous components and Wilms' tumor as an immature component. This 20-day-old male child presented with a swelling over the lower back at birth. Imaging of the spine revealed spina bifida and tethered cord. Excision of soft tissue swelling and detethering of the cord was performed. This case represents the fourth reported case of lumbosacral Wilms' tumor as a component of immature teratoma associated with spinal dysraphism. We discuss possible mechanisms and clinical characteristics of extrarenal Wilms' tumor and present a short review of the literature.

Pediatric glioblastomas: a histopathological and molecular genetic study

Glioblastoma multiforme (GBM) occurs rarely in children. Relatively few studies have been performed on molecular properties of pediatric GBMs. Our objective in this study was to evaluate the genetic alterations in pediatric GBM (age < or = 18 years) with special reference to p53, p16, and p27 protein expression, alterations of the epidermal growth factor receptor (EGFR), and deletion of the phosphate and tensin homolog gene (PTEN). Thirty cases of childhood GBMs reported between January 2002 and June 2007 were selected, and slides stained with hematoxylin and eosin were reviewed. Immunohistochemical staining was performed for EGFR, p53, p16, and p27, and tumor proliferation was assessed by calculating the MIB-1 labeling index (LI). Fluorescence in situ hybridization analysis was performed to evaluate for EGFR amplification and PTEN deletion. Histopathological features and MIB-1 LI were similar to adult GBMs. p53 protein expression was observed in 63%. Although EGFR protein overexpression was noted in 23% of cases, corresponding amplification of the EGFR gene was rare (5.5%). Deletion of the PTEN gene was also equally rare (5.5%). One case showed polysomy (chromosomal gains) of chromosomes 7 and 10. Loss of p16 and p27 immunoexpression was observed in 68% and 54% of cases, respectively. In pediatric de novo/primary GBMs, deletion of PTEN and EGFR amplification are rare, while p53 alterations are more frequent compared to primary adult GBMs. Frequency of loss of p16 and p27 immunoexpression is similar to their adult counterparts. This suggests that pediatric malignant gliomas are distinctly different from adult GBMs, highlighting the need for identification of molecular targets that may be adopted for future novel therapeutic strategies.

Tubular aggregate myopathy: a rare form of myopathy

Tubular aggregate myopathy (TAM) is a rare form of myopathy with an autosomal dominant or recessive pattern. Four rare cases of TAM are described. All patients presented with muscle aches and pains, sometimes cramps. Muscle biopsies were snap frozen and processed for routine, special, enzyme, and immunohistochemistry. Tissue was also processed for electron microscopy. Muscle biopsy revealed similar changes characterized by subsarcolemmal accumulation of granular material that stained red with modified Gomori trichrome stain, intense blue with nicotinamide adenine dinucleotide-tetrazolium reductase, but was non-reactive to succinyl dehydrogenase and cytochrome oxidase stains. Ultrastructural examination showed aggregates of hexagonal tubules in the subsarcolemmal region, which are pathognomonic of this entity. This report highlights the importance of histochemistry and electron microscopy for accurate diagnosis; otherwise TAM can be misdiagnosed on clinical grounds as a metabolic or mitochondrial myopathy.