AIM: To study the endocytoscopic visualization of squamous cell islands within Barrett's epithelium. METHODS: Endocytoscopy (ECS) has been studied in the surveillance of Barrett's esophagus, with controversial...AIM: To study the endocytoscopic visualization of squamous cell islands within Barrett's epithelium. METHODS: Endocytoscopy (ECS) has been studied in the surveillance of Barrett's esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for the staining of Barrett's mucosa. Integrated type endocytoscopes (GIF-Q260 EC, Olympus Corp, Tokyo, Japan) have been recently developed, with the incorporation of a high-power magnifying endocytoscope into a standard endoscope together with narrow-band imaging (NBI). Moreover, double staining with a mixture of 0.05% crystal violet and 0.1% of methylene blue (CM) during ECS enables higher quality images comparable to conventional hematoxylin eosin histopathological images.RESULTS: In vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett's epithelium in a patient with long-segment Barrett's esophagus is reported. Conventional white light endoscopy showed typical long-segment Barrett's esophagus, with small squamous cell islands within normal Barrett's mucosa, which were better visualized by NBI endoscopy. ECS after double CM staining showed regular Barrett's esophagus, while higher magnification (×480) revealed the orifices of glandular structures better. Furthermore, typical squamous cell papillary protrusion, classified as endocytoscopic atypia classification (ECA) 2 according to ECA, was identified within regular glandular Barrett's mucosa. Histological examination of biopsies taken from the same area showed squamous epithelium within glandular Barrett's mucosa, corresponding well to endocytoscopic findings. CONCLUSION: To our knowledge, this is the first report of in vivo visualization of esophageal papillary squamous cell islands surrounded by glandular Barrett's epithelium.展开更多
AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and p...AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the fi rst group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangio-pancreatography (ERCP) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCPs and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010. RESULTS: No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs 8% in the second group, P = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the fi rst group (acute cholangitis, 60% vs 24% in the second group, P = 0.01; previous biliary operation, 76% vs 24% in the second group, P = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (P = 0.407). Two patients (8%) with atypia in the fi rst group were p53-positive. CONCLUSION: ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied.展开更多
Early diagnosis of breast cancer,the most common disease among women around the world,increases the chance of treatment and is highly important.Nuclear atypia grading in histopathological images plays an important rol...Early diagnosis of breast cancer,the most common disease among women around the world,increases the chance of treatment and is highly important.Nuclear atypia grading in histopathological images plays an important role in the final diagnosis and grading ofbreast cancer.Grading images by pathologists is a time consuming and subjective task.Therefore,the existence of a computer-aided system for nuclear atypia grading is very useful and necessary;In this stud%two automatic systems for grading nuclear atypia in breast cancer histopathological images based on deep learning methods are proposed.A patch-based approach is introduced due to the large size of the histopathological images and restriction of the training data.In the proposed system I,the most important patches in the image are detected first and then a three-hidden-layer convolutional neural network(CNN)is designed and trained for feature extraction and to classify the patches individually.The proposed system II is based on a combination of the CNN for feature extraction and a two-layer Long short-term memoty(LSTM)network for classification.The LSTM network is utilised to consider all patches of an image simultaneously for image grading.The simulation results show the efficiency of the proposed systems for automatic nuclear atypia grading and outperform the current related studies in the literature.展开更多
BACKGROUND Mammary-type myofibroblastoma(MTMF)is a rare benign extramammary soft tissue tumor with myofibroblastic differentiation.Although 160 cases of MTMF have been reported in the literature since 2001,no cases of...BACKGROUND Mammary-type myofibroblastoma(MTMF)is a rare benign extramammary soft tissue tumor with myofibroblastic differentiation.Although 160 cases of MTMF have been reported in the literature since 2001,no cases of infarction or atypical mitosis have been reported so far.Herein,we report an unusual case of MTMF in the pelvic cavity,which mimicked some malignant features,including infarction,atypical mitosis,infiltrative growth,and prominent cytologic atypia,making it difficult to ascertain whether the tumor was benign.CASE SUMMARY A 49-year-old man complained of pain and discomfort in the right buttock for more than 4 mo and did not receive any treatment.Nuclear magnetic resonance imaging(MRI)showed a 13-cm-sized mass in his right pelvic cavity.Histologically significant differences were atypical mitosis figures and multiple necrotic foci in the tumor.In addition,smooth muscle and skeletal muscle were invaded within and at the edge of the tumor.These morphologic features are often reminiscent of malignant tumors and therefore pose a diagnostic challenge to pathologists.The tumor cells were strongly positive for both cluster of differentiation 34 and desmin,and the loss of retinoblastoma 1 shown by immunohistochemical and fluorescence in situ hybridization results confirmed the pathological diagnosis of MTMF.Currently,the patient is alive and in good condition without tumor recurrence or metastasis after 2.5 years of follow-up by telephone and MRI.CONCLUSION The two pseudo-malignant characteristics of infarction and atypical mitosis broaden the morphological lineage of MTMF,a rare mesenchymal tumor.展开更多
BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature ...BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed.CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule,with mild cells in morphology,visible cilia,and bilayer structures in focal areas.Immunohistochemical staining for P63 and cytokeratin(CK)5/6 revealed the lack of a continuous bilayer structure in most areas,and no mutations were found in epidermal growth factor receptor,anaplastic lymphoma kinase,ROS1,Kirsten rat sarcoma,PIK3CA,BRAF,human epidermal growth factor receptor-2(HER2),RET,and neuroblastoma RAS genes.Case 2 was a 58-year-old female patient who presented with a solid nodule,in which most cells were observed to be medium sized,the nuclear chromatin was pale and homogeneous,local cells had atypia,and cilia were found locally.Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure.The same nine genes as above were analyzed,and HER2 gene mutation was identified.CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium.Furthermore,whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated.Moreover,clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed.Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.展开更多
Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical duc...Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.展开更多
Breast cancer(BC)is the most widely recognized cancer in women worldwide.By 2018,627,000 women had died of breast cancer(World Health Organization Report 2018).To diagnose BC,the evaluation of tumours is achieved by a...Breast cancer(BC)is the most widely recognized cancer in women worldwide.By 2018,627,000 women had died of breast cancer(World Health Organization Report 2018).To diagnose BC,the evaluation of tumours is achieved by analysis of histological specimens.At present,the Nottingham Bloom Richardson framework is the least expensive approach used to grade BC aggressiveness.Pathologists contemplate three elements,1.mitotic count,2.gland formation,and 3.nuclear atypia,which is a laborious process that witness’s variations in expert’s opinions.Recently,some algorithms have been proposed for the detection of mitotic cells,but nuclear atypia in breast cancer histopathology has not received much consideration.Nuclear atypia analysis is performed not only to grade BC but also to provide critical information in the discrimination of normal breast,non-invasive breast(usual ductal hyperplasia,atypical ductal hyperplasia)and pre-invasive breast(ductal carcinoma in situ)and invasive breast lesions.We proposed a deep-stacked multi-layer autoencoder ensemble with a softmax layer for the feature extraction and classification process.The classification results show the value of the multilayer autoencoder model in the evaluation of nuclear polymorphisms.The proposed method has indicated promising results,making them more fit in breast cancer grading.展开更多
文摘AIM: To study the endocytoscopic visualization of squamous cell islands within Barrett's epithelium. METHODS: Endocytoscopy (ECS) has been studied in the surveillance of Barrett's esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for the staining of Barrett's mucosa. Integrated type endocytoscopes (GIF-Q260 EC, Olympus Corp, Tokyo, Japan) have been recently developed, with the incorporation of a high-power magnifying endocytoscope into a standard endoscope together with narrow-band imaging (NBI). Moreover, double staining with a mixture of 0.05% crystal violet and 0.1% of methylene blue (CM) during ECS enables higher quality images comparable to conventional hematoxylin eosin histopathological images.RESULTS: In vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett's epithelium in a patient with long-segment Barrett's esophagus is reported. Conventional white light endoscopy showed typical long-segment Barrett's esophagus, with small squamous cell islands within normal Barrett's mucosa, which were better visualized by NBI endoscopy. ECS after double CM staining showed regular Barrett's esophagus, while higher magnification (×480) revealed the orifices of glandular structures better. Furthermore, typical squamous cell papillary protrusion, classified as endocytoscopic atypia classification (ECA) 2 according to ECA, was identified within regular glandular Barrett's mucosa. Histological examination of biopsies taken from the same area showed squamous epithelium within glandular Barrett's mucosa, corresponding well to endocytoscopic findings. CONCLUSION: To our knowledge, this is the first report of in vivo visualization of esophageal papillary squamous cell islands surrounded by glandular Barrett's epithelium.
基金Supported by GC Medical Hellas who offered us free cytology brushes
文摘AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the fi rst group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangio-pancreatography (ERCP) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCPs and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010. RESULTS: No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs 8% in the second group, P = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the fi rst group (acute cholangitis, 60% vs 24% in the second group, P = 0.01; previous biliary operation, 76% vs 24% in the second group, P = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (P = 0.407). Two patients (8%) with atypia in the fi rst group were p53-positive. CONCLUSION: ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied.
文摘Early diagnosis of breast cancer,the most common disease among women around the world,increases the chance of treatment and is highly important.Nuclear atypia grading in histopathological images plays an important role in the final diagnosis and grading ofbreast cancer.Grading images by pathologists is a time consuming and subjective task.Therefore,the existence of a computer-aided system for nuclear atypia grading is very useful and necessary;In this stud%two automatic systems for grading nuclear atypia in breast cancer histopathological images based on deep learning methods are proposed.A patch-based approach is introduced due to the large size of the histopathological images and restriction of the training data.In the proposed system I,the most important patches in the image are detected first and then a three-hidden-layer convolutional neural network(CNN)is designed and trained for feature extraction and to classify the patches individually.The proposed system II is based on a combination of the CNN for feature extraction and a two-layer Long short-term memoty(LSTM)network for classification.The LSTM network is utilised to consider all patches of an image simultaneously for image grading.The simulation results show the efficiency of the proposed systems for automatic nuclear atypia grading and outperform the current related studies in the literature.
文摘BACKGROUND Mammary-type myofibroblastoma(MTMF)is a rare benign extramammary soft tissue tumor with myofibroblastic differentiation.Although 160 cases of MTMF have been reported in the literature since 2001,no cases of infarction or atypical mitosis have been reported so far.Herein,we report an unusual case of MTMF in the pelvic cavity,which mimicked some malignant features,including infarction,atypical mitosis,infiltrative growth,and prominent cytologic atypia,making it difficult to ascertain whether the tumor was benign.CASE SUMMARY A 49-year-old man complained of pain and discomfort in the right buttock for more than 4 mo and did not receive any treatment.Nuclear magnetic resonance imaging(MRI)showed a 13-cm-sized mass in his right pelvic cavity.Histologically significant differences were atypical mitosis figures and multiple necrotic foci in the tumor.In addition,smooth muscle and skeletal muscle were invaded within and at the edge of the tumor.These morphologic features are often reminiscent of malignant tumors and therefore pose a diagnostic challenge to pathologists.The tumor cells were strongly positive for both cluster of differentiation 34 and desmin,and the loss of retinoblastoma 1 shown by immunohistochemical and fluorescence in situ hybridization results confirmed the pathological diagnosis of MTMF.Currently,the patient is alive and in good condition without tumor recurrence or metastasis after 2.5 years of follow-up by telephone and MRI.CONCLUSION The two pseudo-malignant characteristics of infarction and atypical mitosis broaden the morphological lineage of MTMF,a rare mesenchymal tumor.
文摘BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed.CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule,with mild cells in morphology,visible cilia,and bilayer structures in focal areas.Immunohistochemical staining for P63 and cytokeratin(CK)5/6 revealed the lack of a continuous bilayer structure in most areas,and no mutations were found in epidermal growth factor receptor,anaplastic lymphoma kinase,ROS1,Kirsten rat sarcoma,PIK3CA,BRAF,human epidermal growth factor receptor-2(HER2),RET,and neuroblastoma RAS genes.Case 2 was a 58-year-old female patient who presented with a solid nodule,in which most cells were observed to be medium sized,the nuclear chromatin was pale and homogeneous,local cells had atypia,and cilia were found locally.Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure.The same nine genes as above were analyzed,and HER2 gene mutation was identified.CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium.Furthermore,whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated.Moreover,clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed.Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.
文摘Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.
基金This work was supported by Taif University(in Taif,Saudi Arabia)through the Researchers Supporting Project Number(TURSP-2020/150).
文摘Breast cancer(BC)is the most widely recognized cancer in women worldwide.By 2018,627,000 women had died of breast cancer(World Health Organization Report 2018).To diagnose BC,the evaluation of tumours is achieved by analysis of histological specimens.At present,the Nottingham Bloom Richardson framework is the least expensive approach used to grade BC aggressiveness.Pathologists contemplate three elements,1.mitotic count,2.gland formation,and 3.nuclear atypia,which is a laborious process that witness’s variations in expert’s opinions.Recently,some algorithms have been proposed for the detection of mitotic cells,but nuclear atypia in breast cancer histopathology has not received much consideration.Nuclear atypia analysis is performed not only to grade BC but also to provide critical information in the discrimination of normal breast,non-invasive breast(usual ductal hyperplasia,atypical ductal hyperplasia)and pre-invasive breast(ductal carcinoma in situ)and invasive breast lesions.We proposed a deep-stacked multi-layer autoencoder ensemble with a softmax layer for the feature extraction and classification process.The classification results show the value of the multilayer autoencoder model in the evaluation of nuclear polymorphisms.The proposed method has indicated promising results,making them more fit in breast cancer grading.
