Evaluation of large airway specimens obtained by transbronchial lung cryobiopsy in diffuse parenchymal lung diseases

Background

The difference in diagnostic yield between surgical lung biopsy and transbronchial lung cryobiopsy (TBLC) in diffuse parenchymal lung diseases (DPLD) has been reported to be due to differences in the rate of interpathologist agreement, specimen size, and specimen adequacy. In TBLC, the specimens containing large airway components are generally believed as inadequate specimens for histological evaluation, but the detailed characteristics of TBLC specimens including the large airway and the impact on histological diagnostic rates of DPLD have not been investigated.

Methods

We retrospectively reviewed the specimen characteristics of patients with DPLD who underwent TBLC.

Results

Between February 2018 and January 2020, 74 patients and 177 specimens were included. There were 85 (48.0%) large airway specimens (LAS) that contained bronchial gland or bronchial cartilage. The ideal specimen ratio was significantly lower in the LAS-positive group than that in the LAS-negative group (5.8% vs. 45.6%), and the proportion of bronchioles, alveoli, and perilobular area were similarly lower in the LAS-positive group. The presence of traction bronchiectasis and diaphragm overlap sign on high-resolution computed tomography (HRCT) were also significantly higher in the LAS-positive group than those in the LAS-negative group. We observed a statistically significant trend in histological diagnostic yield (40.7% in LAS positive group; 60.8% in LAS positive and negative group; 91.6% in LAS negative group) (Cochran-Armitage trend test).

Conclusion

LAS is a specimen often collected in TBLC and contains a low percentage of bronchioles, alveoli, and perilobular area. Since the histological diagnostic yield tends to be higher in cases that do not contain LAS, it may be important to determine the biopsy site that reduces the frequency of LAS collection by referring to the HRCT findings in TBLC.

Autoimmune pulmonary alveolar proteinosis developed during immunosuppressive treatment in polymyositis with interstitial lung disease: a case report

Background

Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant proteins within the alveolar spaces. Autoimmune PAP (APAP) caused by elevated levels of GM-CSF autoantibodies (GM-Ab) is very rarely associated with systemic autoimmune disease. Here we report a case of APAP manifested during immunosuppressive treatment for polymyositis with interstitial lung disease.

Case presentation

A 52-year-old woman treated at our hospital because of polymyositis with interstitial pneumonia had maintained remission by immunosuppressive treatment for 15 years. She had progressive dyspnea subsequently over several months with her chest CT showing ground-glass opacities (GGO) in bilateral geographic distribution. Her bronchoalveolar lavage fluid with cloudy appearance revealed medium-sized foamy macrophages and PAS-positive amorphous eosinophilic materials by cytological examination. We diagnosed her as APAP due to an increased serum GM-CSF autoantibody level. Attenuating immunosuppression failed to lead GGO improvement, but whole lung lavage (WLL) was effective in her condition.

Conclusions

PAP should be considered as one of the differential diseases when the newly interstitial shadow was observed during immunosuppressive treatment. WLL should be regarded as the treatment option for APAP concurred in connective tissue disease (CTD).

Expression of cyclin-dependent kinase inhibitors in taste buds of mouse and hamster

Taste buds are specialized epithelial cell clusters in the oral squamous cell epithelium. Although taste buds have been reported to renew rapidly, the mechanism of cell cycle control in these specialized structures remains unresolved. To clarify the cell cycle status and role of cyclin-dependent kinase inhibitors (CDKI) for cell cycle control in the taste buds, we analyzed cell proliferation activity using bromodeoxyuridine (BrdU) and Ki-67 immunostainings and the expression of the Cip/Kip family of CDKI (p21Cip1, p27Kip1, and p57Kip2) in the circumvallate papillae of mouse and hamster. BrdU-positive cells were detected in the basal layer of the oral epithelium. In the taste buds, Ki-67-positive cells were seen in the basal area, with only a very few positive cells in the taste buds. Both p21Cip1 and p27Kip1 positive cells were seen in the suprabasal layer of the non-gustatory oral epithelium. In the taste buds, stronger p27Kip1 staining was detected than in the non-gustatory epithelium. Western blotting analysis revealed that p27Kip1 was abundant in the mucosal tissues from circumvallate papillae. Thus, our study suggests that the taste bud cells except for basal cells are post-mitotic cells and that the cell cycle arrest associated with taste bud cell differentiation could be regulated predominantly by p27Kip1.

Benign and malignant oncocytoma of the salivary glands with an immunohistochemical evaluation of Ki-67

We present two cases of benign oncocytoma derived from the parotid gland and minor salivary gland and one case of malignant oncocytoma from the parotid gland. The proliferative activity of the tumor cells was evaluated immunohistochemically for Ki-67. The average frequency of Ki-67-positive cells was 3.3% in the benign oncocytomas and 6.5% in the malignant oncocytoma. The higher frequency of Ki-67-positive cells in the malignant oncocytoma might reflect active cell proliferation. Ki-67 immunostaining may be useful in distinguishing a benign oncocytoma from a malignant oncocytoma.

Comparison between hockey stick and reversed hockey stick incision: gently curved single linear neck incisions for oral cancer

Hockey stick incision (HSI) and reversed-HSI are known to be useful incisions for lymph node dissections of the neck. Both are gently curved single linear incisions without three-point suture line junctions, but are different at the base of the skin flap. The HSI allows the elevation of a superiorly-based single cervical skin flap and the reversed-HSI allows for an inferiorly-based flap. We compared the viability of the skin flaps, exposure of the operation field and cosmetic results to evaluate the characteristics of each incision. HSI appeared to be the suitable incision for radical neck dissection due to adequate exposure of the operation field while rendering excellent cosmetic results. Reversed-HSI was applied in combination with block resection of parts of the oral cavity because it provided much better exposure of the operation field than HSI, while still achieving acceptable cosmetic results. Using this technique, a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to poor blood supply.

Differential diagnosis of cervical lymphadenopathy with intranodal color Doppler flow signals in patients with oral squamous cell carcinoma

OBJECTIVE

The purpose of this study was to differentiate reactively enlarged cervical nodes from metastatic nodes by means of color Doppler flow imaging in patients with oral squamous cell carcinoma.

STUDY DESIGN

Enlarged lymph nodes with long-axis diameters greater than 10 mm in 30 patients were classified into 4 groups according to color Doppler flow imaging findings. After the patients underwent neck dissection, the findings were correlated with the pathologic features.

RESULTS

Color Doppler flow imaging detected 58 enlarged nodes with long-axis diameters greater than 10 mm. Thirty-five lymph nodes showed no color flow signals; of these, 32 (91%) were metastatic and 3 were reactive. Of the 12 lymph nodes with central color flow signals, 11 (92%) were reactively enlarged and 1 was metastatic.

CONCLUSIONS

The presence of central signals on color Doppler flow imaging appeared to be a significant parameter associated with reactively enlarged benign nodes in patients with oral squamous cell carcinoma.

A carrier for clinical use of recombinant human BMP-2: dehydrothermally cross-linked composite of fibrillar and denatured atelocollagen sponge

The clinical applicability of a dehydrothermally cross-linked composite of fibrillar and denatured atelocollagen sponge (DCFD-AS), as a carrier of recombinant human bone morphogenetic protein-2 (rhBMP-2) was evaluated in the rat subcutaneous pouch. After four weeks, DCFD-AS with rhBMP-2 formed compact bone, without undergoing significant changes in shape and size, by means of intramembranous ossification. The ultimate size, shape and location of induced new bone was accurately controlled by the carrier. Low antigenicity of soluble atelocollagen, cross-linking without chemicals, the combination of gelatin with fibrillar collagen, and the spongy structure probably all contributed to new bone formation through intramembranous ossification without inducing an inflammatory response. Atelocollagen sponge is easily sterilized, can be stored at room temperature, and can act as a rhBMP-2 carrier without the need for complex procedures.

Expression of heat shock proteins in squamous cell carcinoma of the tongue: an immunohistochemical study

Twenty-four specimens of squamous cell carcinoma of the tongue were immunostained for heat shock proteins (HSPs) to reveal differences in stainability among normal epithelium, dysplasia and carcinoma and to clarify the prognostic significance of HSPs in comparison with survival period, clinical stage, lymph node metastasis, histological grade, and p53 immunostaining. Normal epithelium was positively stained in the suprabasal layer for HSP60 and HSP70, but was negative for HSP27 and HSP90. Dysplastic lesions were positive for HSP27, HSP70 and HSP90, but stained variously for HSP60. In squamous cell carcinoma, the cytoplasm of suprabasal tumor cells was often positive for HSP27 and HSP90 (18/24, 17/24, respectively). Although HSP immunohistochemistry has revealed changes in HSP expression during tumorigenesis of squamous epithelium of the tongue, there was no correlation between HSP staining and survival period, stage, lymph node metastasis, histological grade or p53 immunostaining.

A newly developed collagen/silicone bilayer membrane as a mucosal substitute: a preliminary report

A new bilayer membrane proved effective as a mucosal substitute. The membrane is composed of an outer layer of silicone and an inner layer of dehydrothermally cross linked composites of fibrillar and denatured collagen sponge. The membrane was placed on oral mucosal defects of five patients after operations for cancer. Ten to 14 days after application the outer silicone sheet was removed, leaving only the inner collagen sponge layer into which cellular tufts of fibroblasts and capillaries had infiltrated. The infiltrated collagen matrix became a new connective tissue that epithelialised rapidly by migration of peripheral epithelium 4-5 weeks after application. In all cases the postoperative course was unremarkable and the repair was effective.

[Proposal on new formulas for renal depth in the technetium-99m-mercaptoacetyltriglycine (MAG3) scintigraphy]

Recently, camera-based techniques to measure effective renal plasma flow (ERPF) have become more popular than single plasma sample techniques because camera-based measurements avoid the necessity of delayed plasma samples and in vitro techniques. The measurements of ERPF are used to estimate the clearance of technetium-99m-mercaptoacetyltriglycine (MAG3). However, camera-based techniques are dependent on an accurate estimate of renal depth to correct for soft-tissue attenuation. Then, new formulas for renal depth correction of technetium-99m-MAG3 clearance in place of Tønnesen's, M. Ito's, K. Itoh's, and Taylor's methods were tried to establish in this paper.

PATIENTS AND METHODS

Eleven hundred and seventy patients without any renal disease were objected. The data from measurement of renal depth using X-ray CT in supine position were analyzed statistically.

RESULTS

The depths of right kidney (Dr) and left kidney (Dl) were 7.33 +/- 1.27 and 7.07 +/- 1.27 cm. The correlation coefficients between Dr and height (H) body weight (W), body surface area (BSA: W0.425 x H0.725 x 0.007184 m2), age, and abdominal thickness (Ta) were 0.275, 0.709, 0.615, 0.087, and 0.743. The correlation coefficients between Dl and H, W, BSA, age, and Ta were 0.269, 0.732, 0.629, 0.029, and 0.812. Ta had best correlation with both Dr and Dl. The calculation formulas for Dr and Dl using Ta were as follows: Dr = 0.32 x Ta + 0.87 cm, and Dl = 0.36 x Ta - 0.08 cm. On the other hand, the multiplex calculation formulas of Dr or Dl with H, W, and Ta were as follows: Dr = 0.18Ta + 8.54 x (W/H) + 0.75 (r = 0.768), and Dl = 0.26Ta + 5.90 x (W/H)-0.16 (r = 0.823).

CONCLUSION

The new regression equations provide superior estimates of renal depth compared to conventional equations. Application of these new formulas into camera-based protocols to determine renal clearances may lead to more accurate measurements of ERPF using technetium-99m-MAG3 scintigraphy.

Detection of molecular gas in the quasar BR1202 - 0725 at redshift z = 4.69

Although great efforts have been made to locate molecular gas--the material out of which stars form--in the early Universe, there have been only two firm detections at high redshift. Both are gravitationally lensed objects at redshift z approximately = 2.5 (refs 9-14). Here we report the detection of CO emission from the radio-quiet quasar BR1202 - 0725, which is at redshift z = 4.69. From the observed CO luminosity, we estimate that almost 10(11) solar masses of molecular hydrogen are associated with the quasar; this is comparable to the stellar mass of a present-day luminous galaxy. Our results suggest that BR1202 - 0725 is a massive galaxy, in which the gas is largely concentrated in the central region, and that is currently undergoing a large burst of star formation.

Modulation of the incidence of hamster pulmonary endocrine cell hyperplasia by unilateral collapse of the lung

We evaluated the effects of the unilateral collapse of the left lung on the formation of pulmonary endocrine cell hyperplasia (PECH) induced by 4-nitroquinoline 1-oxide (4NQO) in Syrian golden hamsters. Ten hamsters were injected subcutaneously with 20 mg/kg body weight of 4NQO, once a week for 4 weeks and treated with injection of silicone rubber into the left thorax at the 8th experimental week. Another 30 animals were divided into three groups: treated with 4NQO only, left lung collapse only, and vehicle only. All animals were sacrificed at the 30th week. The lung tissues were embedded in paraffin; 50 serial sections were made from the tissues of each animal and were studied histologically and immunohistochemically. PECH showed a positive immunostain for calcitonin and/or serotonin. In the uncollapsed right lungs of the animals treated with both 4NQO and unilateral collapse, the mean incidence of PECH was 12.2 x 10(-2)/mm3 lung volume; the incidences of PECH in the animals treated with 4NQO only, collapse only, and vehicle only were 4.1, 3.8, and 1.4 x 10(-2)/mm3, respectively. In the collapsed left lungs, PECH did not form, regardless of 4NQO treatment. This study demonstrates that unilateral collapse of the lung modulates the incidence of PECH induced by 4NQO in hamsters.

Utilization of therapeutic embolization in haemorrhage caused by carcinoma of the tongue

Selective transcatheter arterial embolization, using Gelfoam, was performed in 2 patients with bleeding from tongue arteries due to carcinoma. Though the patients were in poor general condition, being in the terminal stage of cancer, there were no complications and the bleeding was successfully controlled. This method was effective in controlling haemorrhage from the tongue due to carcinoma of the tongue.