Abstract ES9-1: Local therapy of the primary tumor in de novo Stage IV breast cancer

Background: Distant metastases are present in 6% or more of newly diagnosed breast cancer patients, worldwide. In this context, locoregional therapy for the intact primary tumor has been hypothesized to improve overall survival and local control, based on multiple retrospective studies, but clinical trials have reported conflicting results. Methods: All four completed trials included women presenting with metastatic breast cancer and an intact primary tumor. The trial design mandated initial systemic therapy prior to randomization in two trials (EA2108 and Tata Memorial) with subsequent randomization to locoregional therapy (LRT) or not, if there was no progression. In two other trials (MF 07-01 and POSYTIVE) randomization occurred upfront. LRT consisted of surgery and radiotherapy per standards applied to patients with non-metastatic disease, with minor differences between trials. The primary endpoint was two or three year overall survival in all four trials, with locoregional control and quality of life as secondary endpoints. Progression-free survival was also examined. The randomized sample size ranged from 93 to 350 across the trials (the POSYTIVE trial did not reach full accrual). Tumor characteristics were balanced between arms, except MF 07-01, which favored the LRT arm. Prospectively measured quality of life (QoL) outcomes have been reported for POSYTIVE and EA2108, assessed using standard instruments. Results. The design, accrual, and main results of the four completed trials, and one still in follow-up (Shien, JCOG 1017) are shown in the Table. Median follow-up duration at the time of reporting ranges from 23 to 53 months in these trials. The overall survival in three of four trials shows no advantage with the use of LRT. MF 07-01 is an outlier, with improved 5-year OS in the LRT arm. Of note, survival rates vary across the trials, depending on the resource environment; in the Tata (India) trial this was 20 months at 2 years, and in EA2108 (USA and Canada) it was 53.1 months (95% CI: 47.9,-) in the systemic therapy arm and 54.9 months (95% CI: 46.7,-) in the locoregional therapy arm. Locoregional progression rates were significantly lower in those randomized to primary site LRT, with locoregional progression occurring in less than 20% of patients treated with LRT with systemic therapy. However, in the systemic therapy alone arms, a minority of patients (under 20%) required palliative LRT, demonstrating the efficacy of contemporary systemic therapy in avoiding symptomatic locoregional progression. Despite the improved local control however, quality of life measures were largely similar between arms in the two trials where prospective, preplanned evaluation of these parameters has been reported (POSYTIVE and EA2108). Conclusions: The preponderance of current evidence does not support use of early locoregional therapy for the primary site as a means to improve survival in patients presenting with metastatic breast cancer. However, LRT was associated with improved locoregional disease control, albeit with no overall impact on quality of life. Questions remain regarding the survival value of primary site LRT in the oligometastatic setting, since this aspect has not been prospectively examined in any existing trial.

Phase III trials testing primary site local therapy in de novo Stage IV breast cancersystemic therapy firstAccrual period.Randomized NOverall survival HR (95% CI)Locoregional progression-free survivalBadwe (India)Yes2005-123501.04 (0.84, 1.34)0.16 (0.10, 0.26)Khan (USA & Canada)Yes2011-152561.11 (0.82, 1.52)0.35 (0.21, 0.57)Shien (JapanYes2011-16407Not reportedNot reportedSoran (Turkey)No2008-122740.66 (0.49, 0.88)1% vs. 11%Fitzal (Austria)No2010-19930.69 (0.36, 1.33)8.9% vs. 17.8%

Citation Format: S Khan. Local therapy of the primary tumor in de novo Stage IV breast cancer. [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES9-1.

Enrichment of the hydrogenotrophic methanogens for, in-situ biogas up-gradation by recirculation of gases and supply of hydrogen in methanogenic reactor

During in situ biogas up-gradation by supplying hydrogen from an external source and enrichment of hydrogenotrophic methanogens, high pressure of H₂ negatively affects hydrolytic and fermentative activities. To overcome this problem, the present study aimed to enrich the hydrogenotrophic methanogens by optimization of various parameters associated with gas recirculation along-with hydrogen supply from the external source. Due to recirculation of gases and supplied hydrogen, methane generation was two-fold higher in the optimal condition than in conventional anaerobic digestion, with the highest methane content of 99%. Additionally, the hydrogenotrophic methanogens were enriched, with a decrease in acetoclastic methanogens and an increase in Bathyarchaeia population, which utilizes H₂ and CO₂ to produce acetate and lactate as end products. The study concludes that recirculation increases methane production by converting H₂ and CO₂ into methane and enhances the degradation of organic matter left over undigested in the hydrolytic reactor.

Positivity, diagnosis and treatment follow-up of cutaneous leishmaniasis in war-affected areas of Bajaur, Pakistan

This study was conducted to explore the frequency of positivity of cutaneous leishmaniasis (CL) in the tribal district Bajaur located near the Pak-Afghan border. The present study was conducted at the Leishmaniasis Center of Headquarter Hospital Khar District Bajaur, Pakistan. In total, 646 patients were recruited and included in the study after ethical approval and consent from the patients. CL was confirmed by taking blood samples from the sides of the lesion and observing them under a microscope using Giemsa staining. Information about demographic factors was collected from the study participants with a questionnaire and analyzed by SPSS. It was found that 73.8% of suspected patients were positive and 26.2% were negative for CL. There were 51.9% male and 48.1% female patients. The most frequently affected site was the face (42.6%), and most of the patients (85.8%) had only one lesion. The positivity of CL was higher among those under age 15 years. The area of most positivity, with 45.2% of the cases, was Tehsil Mamund. Most of the patients (46.6%) lived in stone houses, with 98.6% of patients having domestic animals in their houses. Approximately 198 patients were treated with intramuscular and intralesional injections of meglumine antimoniate, and their weekly follow-up revealed that 48% of patients recovered, while the remaining patients left the course of treatment at different stages of therapy. The positivity of CL is high in this area and is confirmed by the detection of Leishmania amastigotes in the blood collected from their lesions. Socioeconomic factors are the main underlying causes of the rapid spread of this disease and meglumine antimoniate is an effective drug.

Comparative genomics and evolutionary analysis of plant CNGCs

Comparative genomics and computational biology offer powerful research tools for studying evolutionary mechanisms of organisms, and the identification and characterization of conserved/distant genes and gene families. The plant CNGC gene family encodes evolutionary conserved ion channel proteins involved in important signaling pathways and biological functions. The fundamental ideas and standard procedures for genome-wide identification and evolutionary analysis of plant cyclic nucleotide-gated ion channels employing various software, tools, and online servers have been discussed. In particular, this developed method focused on practical procedures involving the comparative analysis of paralogs and orthologs of CNGC genes in different plant species at different levels including phylogenetic analysis, nomenclature and classification, gene structure, molecular protein evolution, and duplication events as mechanisms of gene family expansion and synteny.

Measurement of Prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) Production in Proton-Proton Collisions at sqrt[s]=13 TeV

The p_{T}-differential production cross sections of prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) charmed hadrons are measured at midrapidity (|y|<0.5) in pp collisions at sqrt[s]=13  TeV. This is the first measurement of Σ_{c}^{0,++} production in hadronic collisions. Assuming the same production yield for the three Σ_{c}^{0,+,++} isospin states, the baryon-to-meson cross section ratios Σ_{c}^{0,+,++}/D^{0} and Λ_{c}^{+}/D^{0} are calculated in the transverse momentum (p_{T}) intervals 2<p_{T}<12 and 1<p_{T}<24  GeV/c. Values significantly larger than in e^{+}e^{-} collisions are observed, indicating for the first time that baryon enhancement in hadronic collisions also extends to the Σ_{c}. The feed-down contribution to Λ_{c}^{+} production from Σ_{c}^{0,+,++} is also reported and is found to be larger than in e^{+}e^{-} collisions. The data are compared with predictions from event generators and other phenomenological models, providing a sensitive test of the different charm-hadronization mechanisms implemented in the models.

Comparison of Effect of Yoga versus Aerobic Exercise on Waist Circumference, Waist-Hip Ratio and Body Mass Index in Overweight and Obese Adult Individuals

Background Obesity is becoming serious global public health issue due to sedentary lifestyle and bad eating habits. Dietary and lifestyle practices are directly related to obesity, which can cause serious health problems like cardiac ailments, diabetes, and hypertension etc. Vast varieties of options are available for weight reduction including physical exercises, various diet plans and also the pharmacological agents. Physical activity improves the fitness of the individual and helps in reducing the ill effects of the obesity. Objective To compare the effects of Yoga and Aerobic Exercise on weight circumference, waisthip ratio (WHR) and body mass index (BMI) in overweight and obese individuals. Method An experimental study was started with purposive sampling. Sixty overweight and obese individuals from the community were divided equally into two groups, one group was given supervised yoga asana and the other group was given supervised aerobic exercise for 6 weeks. Waist circumference, waist hip ratio and body mass index were taken pre and post intervention. Result Statistically significant difference was seen in pre and post intervention value of waist circumference, waist hip ratio and body mass index in both the groups with the p value < 0.05. However there was no statistical significant difference noted in waist hip ratio in individuals performing aerobic exercises as p value was > 0.05. Conclusion Both the interventions showed significant reduction in waist circumference, waist hip ratio and body mass index, while better results were noted in the individuals performing yoga asanas.

Degradation of lignin by Bacillus altitudinis SL7 isolated from pulp and paper mill effluent

Lignin is a major by-product of pulp and paper industries, and is resistant to depolymerization due to its heterogeneous structure. Degradation of lignin can be achieved by the use of potential lignin-degrading bacteria. The current study was designed to evaluate the degradation efficiency of newly isolated Bacillus altitudinis SL7 from pulp and paper mill effluent. The degradation efficiency of B. altitudinis SL7 was determined by color reduction, lignin content, and ligninolytic activity from degradation medium supplemented with alkali lignin (3 g/L). B. altitudinis SL7 reduced color and lignin content by 26 and 44%, respectively, on the 5th day of incubation, as evident from the maximum laccase activity. Optimum degradation was observed at 40 °C and pH 8.0. FT-IR spectroscopy and GC-MS analysis confirmed lignin degradation by emergence of the new peaks and identification of low-molecular-weight compounds in treated samples. The identified compounds such as vanillin, 2-methyoxyhenol, 3-methyl phenol, oxalic acid and ferulic acid suggested the degradation of coniferyl and sinapyl groups of lignin. Degradation efficiency of B. altitudinis SL7 towards high lignin concentration under alkaline pH indicated the potential application of this isolate in biological treatment of the lignin-containing effluents.

Measurement of the Cross Sections of Ξ_{c}^{0} and Ξ_{c}^{+} Baryons and of the Branching-Fraction Ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+}) in pp Collisions at sqrt[s]=13 TeV

The p_{T}-differential cross sections of prompt charm-strange baryons Ξ_{c}^{0} and Ξ_{c}^{+} were measured at midrapidity (|y|<0.5) in proton-proton (pp) collisions at a center-of-mass energy sqrt[s]=13  TeV with the ALICE detector at the LHC. The Ξ_{c}^{0} baryon was reconstructed via both the semileptonic decay (Ξ^{-}e^{+}ν_{e}) and the hadronic decay (Ξ^{-}π^{+}) channels. The Ξ_{c}^{+} baryon was reconstructed via the hadronic decay (Ξ^{-}π^{+}π^{+}) channel. The branching-fraction ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+})=1.38±0.14(stat)±0.22(syst) was measured with a total uncertainty reduced by a factor of about 3 with respect to the current world average reported by the Particle Data Group. The transverse momentum (p_{T}) dependence of the Ξ_{c}^{0}- and Ξ_{c}^{+}-baryon production relative to the D^{0} meson and to the Σ_{c}^{0,+,++}- and Λ_{c}^{+}-baryon production are reported. The baryon-to-meson ratio increases toward low p_{T} up to a value of approximately 0.3. The measurements are compared with various models that take different hadronization mechanisms into consideration. The results provide stringent constraints to these theoretical calculations and additional evidence that different processes are involved in charm hadronization in electron-positron (e^{+}e^{-}) and hadronic collisions.

Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas

Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

BrCNGC gene family in field mustard: genome-wide identification, characterization, comparative synteny, evolution and expression profiling

CNGCs are ligand-gated calcium signaling channels, which participate in important biological processes in eukaryotes. However, the CNGC gene family is not well-investigated in Brassica rapa L. (i.e., field mustard) that is economically important and evolutionary model crop. In this study, we systematically identified 29 member genes in BrCNGC gene family, and studied their physico-chemical properties. The BrCNGC family was classified into four major and two sub phylogenetic groups. These genes were randomly localized on nine chromosomes, and dispersed into three sub-genomes of B. rapa L. Both whole-genome triplication and gene duplication (i.e., segmental/tandem) events participated in the expansion of the BrCNGC family. Using in-silico bioinformatics approaches, we determined the gene structures, conserved motif compositions, protein interaction networks, and revealed that most BrCNGCs can be regulated by phosphorylation and microRNAs of diverse functionality. The differential expression patterns of BrCNGC genes in different plant tissues, and in response to different biotic, abiotic and hormonal stress types, suggest their strong role in plant growth, development and stress tolerance. Notably, BrCNGC-9, 27, 18 and 11 exhibited highest responses in terms of fold-changes against club-root pathogen Plasmodiophora brassicae, Pseudomonas syringae pv. maculicola, methyl-jasmonate, and trace elements. These results provide foundation for the selection of candidate BrCNGC genes for future breeding of field mustard.

Cloning, biochemical characterization and molecular docking of novel thermostable β-glucosidase BglA9 from Anoxybacillus ayderensis A9 and its application in de-glycosylation of Polydatin

This study reports a novel BglA9 gene of 1345 bp encoding β-glucosidase from Anoxybacillus ayderensis A9, which was amplified and expressed in E. coli BL21 (DE3): pLysS cells, purified with Ni-NTA column having molecular weight of 52.6 kDa and was used in the bioconversion of polydatin to resveratrol. The kinetic parameters values using pNPG as substrate were K_m (0.28 mM), V_max (43.8 μmol/min/mg), k_cat (38.43 s^-1) and k_cat/K_m (135.5 s^-1 mM^-1). The BglA9 was active in a broad pH range and had an activity half-life around 24 h at 50 °C. The de-glycosylation efficiency of BglA9 for polydatin was determined by estimating the amount of glucose released after enzymatic reaction by a dinitrosalicylic acid (DNS) assay. The kinetic parameters of BglA9 for polydatin were 5.5 mM, 20.84 μmol/min/mg, 18.28 s^-1and 3.27 s^-1 mM^-1 for K_m, V_max, k_cat, and k_cat/K_m values, respectively. The K_i value for glucose was determined to be 1.7 M. The residues Gln19, His120, Glu355, Glu409, Glu178, Asn222 may play a crucial role in the deglycosylation as revealed by the 3D structure of enzyme docked with polydatin.

Exercise as an Emerging Factor Effecting Cardiovascular Health (An Experimental Approach)

This resaerch study was basically carried out for the purpose to assess the effect of moderate intensity exercise on cardiovascular health. Ten (10) participants were voluntarily selected and thus they were randomly divided into two (02) groups i.e. (Experimental Group (EG)=05+ Control Group (CG)=05.A self-made eight weeks’ self-made moderate intensity exercise protocol was applied on all the subjects. Pre and post test data were collected through Harvard Step Test. A written informed consent was taken from each subject before participation in the study. All participants were informed about the benefits and risk factors of the study. After fulfilling all the ethical protocols, eight weeks self-made moderate intensity exercise protocol was applied on all the subjects. Pre and post test data were collected through Harvard Step Test. The collected data were tabulated and analyzed by using various statistical tools. On the basis of analysis the researcher arrived at conclusion that exercise has a significant effect on cardiovascular health.

Chemical profile and antiperiodontal potential of Thymus linearis Benth. Essential oil using ADMET prediction, In silico and in vitro tools

Periodontitis is an important health concern that is associated with long term complications. Development of resistance to antibiotics limits the treatment options in periodontitis. We investigated Thymus linearis essential oil for treatment of periodontitis. The essential oil was collected using hydrodistillation and characterized using GC-MS. The constituents were further analyzed for druglikeness, ADMET properties and molecular docking using transcription regulators 2UV0 and 3QP5. The GC-MS results revealed that carvacrol was a major constituent (76.26%) followed by caryophyllene oxide (6.83%) and L-borneol (6.08%). The in vitro antimicrobial studies showed significant inhibition against Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa (MIC range 0.024 –0.312μg/mL). The essential oil showed a good inhibition of bacterial biofilm produced by S. aureus (72%) and S. epidermidis (70%). Finally, the antiquorum sensing property (30 mm zone of inhibition) was recorded with violacein inhibition (58%). Based on in silico and in vitro findings, it was concluded that T. linearis essential oil can be used for the treatment of periodontal infections.

Length-weight relationship: eight species of Cyprinidae from river Panjkora, Khyber Pakhtunkhwa, Pakistan

Seven hundred and twenty four fish specimens were captured from March to September 2016. The materials used in the current study were cast nets, hand nets. Eight cyprinid fish species were studied for their length-weight relationships. Parameter b in the LWR was 3.03, 3.06, 3.02, 2.29, 2.82, 3.43, 2.73 and 2.47 for Schizothorax plagiostomus, Schizothorax esocinus, Racoma labiata, Tor putitora, Barilius vagra, Garra gotyla, Puntius ticto and Arassius auratus respectively. Current study is the first attempt on the LWRs of cyprinid species, provide a baseline approach for conservation and /management of local fish fauna of economic importance.

Thyroid lobectomy for low-risk thyroid cancers

BACKGROUND

The 2016 American Thyroid Association (ATA) guidelines proposed thyroid lobectomy for low-risk differentiated thyroid cancer (DTC); however, this approach is yet to be widely adopted. The aim of the study was to review our practice over three years following the publication of these guidelines identifying patients who underwent lobectomy-only for low-risk DTC in two regional units in the same multidisciplinary team (MDT).

METHOD

A retrospective review of patients who were operated between January 2016 and December 2018 was carried out.

RESULTS

In total, 288 patients undergoing thyroid surgery were included. The preoperative distribution of cytology was: Thy 1 or 2 in 46, THY3a in 57, THY3f in 154, THY4 in 18 and THY5 in 13 patients. Median size of nodules was 26mm (range 1-70mm). DTC was diagnosed in 95 patients (33%). Overall, 39% (n = 37) of patients underwent completion thyroidectomy according to ATA recommendations on size or adverse histological features. The only variable associated with likelihood of completion was tumour size (p < 0.05, OR 1.14). Ten patients were discharged following surgery with no further follow-up as they had T1a/b well-differentiated DTC with no high-risk histological features.

CONCLUSION

Lobectomy-only appears to be the current surgical practice in two-thirds of patients presenting to our regional units with differentiated thyroid carcinoma. In the context of the current drive to reduce the extent of treatment for low-risk thyroid cancer, there is a need for a more homogeneous approach to these patients and for protocols for long-term follow-up after lobectomy-only.

Λ_{c}^{+} Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV at the LHC

The prompt production of the charm baryon Λ_{c}^{+} and the Λ_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. These new measurements show a clear decrease of the Λ_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12  GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/π and Λ/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies.

Porto-Sinusoidal Vascular Disease and Focal Nodular Hyperplasia-like Nodules in a Patient with Neurofibromatosis and Non-Cirrhotic Portal Hypertension

Introduction/Objective

Non-cirrhotic portal hypertension (NCPH) is uncommon. The underlying pathophysiology appears to lie at the level of intrahepatic portal veins and sinusoids, hence the term “porto-sinusoidal vascular disease” (PSVD). We report a rare case of PSVD with focal nodular hyperplasia (FNH)-like nodules in a patient with neurofibromatosis type 2 (NF2).

Methods/Case Report

A 57-year-old male with NF2 and type 2 diabetes, presented with a large variceal bleed requiring blood transfusion and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Imaging showed a nodular liver, presumed to be cirrhosis due to non-alcoholic liver disease. Liver biopsy was not done. Thereafter, he had several episodes of hepatic encephalopathy and TIPS was downsized to prevent recurrences. The patient required liver transplantation for intractable portal hypertension and severe hepatic encephalopathy; his liver synthetic function was near normal and MELD was 11. Portal vein was patent. The explanted liver was micronodular, soft and weighed 946 grams. Unencapsulated nodules, a few mm to 1 cm in size, were present. Microscopically, there was diffuse nodularity in the absence of bridging fibrosis. Thin, incomplete curvilinear fibrous septa were present. There were aberrant veins, hypervascular portal tracts, herniated portal veins and rare occluded portal veins. Trichrome and reticulin stains confirmed architectural abnormalities including nodularity, lack of bridging fibrosis and approximation of portal tracts. Immunohistochemistry for glutamine synthetase accentuated architectural distortion and revealed nodules with FNH-like geographic areas of staining.

Results (if a Case Study enter NA)

NA

Conclusion

This is a rare case of NCPH due to PSVD in a patient with NF2. Microscopy suggested incomplete septal cirrhosis (ISC), a pattern associated with both PSVD and regression of fibrosis in a cirrhotic liver. Isolated portal hypertension without loss of synthetic function favors primary PSVD over regression of fibrosis. FNH-like nodules are consistent with regenerative changes caused by localized abnormalities of blood flow.