NEWSPath

ANATOMIC PATHOLOGY

Russell Body Gastritis: An Unusual, Tumor-like Lesion of the Gastric Mucosa

Andreas Erbersdobler, Susan Petri, and Guntram Lock

The case of an 80-year-old woman who presented with epigastric symptoms is reported. Upper gastrointestinal endoscopy displayed Candida esophagitis and a localized swelling of the fundic mucosa. Histologic examination of the gastric biopsy showed a distinctive accumulation of numerous uniform plasma cells filled with so-called Russell bodies. On low-power view, the lesion resembled a neoplastic process due to the marked expansion of the lamina propria with distension of fundic glands. However, immunohistochemistry confirmed a polyclonal pattern of the plasma cells. This unusual reactive lesion of the gastric mucosa has only rarely been described and has been termed Russell body gastritis.

Archives of Pathology and Laboratory Medicine, Vol. 128, No. 8, pp. 915917

Node Retrieval in Axillary Lymph Node Dissections: Recommendations for Minimum Numbers to be Confident about Node Negative Status

Somner JE, Dixon JM, Thomas JS.

Aims: To determine the minimum number of lymph nodes needed in an axillary lymph node dissection (ALND) specimen to be confident that the axilla is free from metastases.

Methods: The Edinburgh Breast Unit selects patients with large and high-grade tumours for ALND; 609 consecutive ALNDs performed between October 1999 and December 2002 were reviewed. Full data about the underlying invasive breast cancer were available for 520 patients. Data were collected regarding number of positive nodes and total number of nodes collected, tumour size and grade, and presence of lymphovascular invasion.

Results: Axillary node metastases were seen in 64% of patients. The mean number of positive nodes found was 3.56, with a mean of 17.9 nodes collected. The highest proportion of patients with lymph node metastases were in the group with 16-20 nodes recovered/specimen (68%); specimens with >20 nodes recovered did not have a higher rate of nodal involvement. There was a significant difference between the proportion of metastasis positive specimens in those with 1-15 nodes recovered (58.5%) and those with 16 or more recovered (69.1%). A linear association test showed a direct correlation between the number of nodes collected and presence of node metastasis (p = 0.0005).

Conclusions: Although there is no minimum number of nodes that should be recovered in an ALND specimen, 16 nodes should be regarded as a target to ensure a high level of confidence that the nodes are negative. Node positivity in an ALND specimen appears to obey the law of diminishing returns.

J Clin Pathol. 2004 Aug; 57(8): 845-8.

Analysis of Survivin Expression in Subtypes of Lymphoma

[Article in Chinese]

Gu X, Lin HL.

Background and Objective: It is difficult to diagnose and classify lymphoma in clinical pathology. This study was designed to examine the expression of survivin, an important anti-apoptosis gene, in subtypes of lymphoma, and to investigate its value in classification of lymphoma.

Methods: Biopsies from 83 cases of lymphoma and 5 cases of lymph node reactive proliferation were collected from the First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to June 2003. Reverse transcription- polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed to determine the mRNA and protein expression of survivin. In addition, the survivin expression in four tumor cell lines (K562, HL60, Raji, and Jurkat cell line) were also determined by RT-PCR and immunohistochemical staining. Semi-quantity assay was used to evaluate the quantity of survivin protein and mRNA expression in subtypes of lymphoma.

Results: Protein expression of survivin was high and strong in diffuse large B-cell lymphoma (DLBL) (87.2%, 34/39), Burkitt lymphoma (BL) (100%,2/2), and lymphoblastic lymphoma (LBL) (85.7%,6/7), while their expression were lower and weaker in follicular lymphoma (FL)(22.2%), extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) (33.3%), and marginal zone lymphoma (MZL)(40.0%). There exist a significant difference between the higher expression group (DLBL, BL, and LBL) and lower one (FL, MZL, and MALT) in expression of survivin. Chi-square test, Chi(2)=24.77,P< 0.01. Furthermore, survivin protein expression level in older patients (media age: 57-year old) with DLBL was higher than that in younger patients (media age: 41-year old). Almost all of Reed-Sternberg cells (R-S cells) in Hodgkin's lymphoma (HL) showed strongly positive expression of survivin. The protein expression of survivin was positively correlated with mRNA (r=0.627 0,P< 0.01).

Conclusion: The expression level of survivin mRNA and protein shows significant difference in subtypes of lymphoma, and it might be act as a biomarker to classify the subtypes of lymphoma.

Ai Zheng, Jun 2004, 23(6): 655-61.

MICROBIOLOGY

Unrecognised Tuberculosis in HIV-infected Patients: Sputum Culture is a Useful Tool

Swaminathan S, Paramasivan CN, Kumar SR, Mohan V, Venkatesan P.

Diagnosis of tuberculosis is challenging, especially in human immunodeficiency virus (HIV) positive persons who may have atypical clinical and radiographic features. We report the isolation of Mycobacterium tuberculosis from sputum samples of 10 (4%) HIV-positive persons who were asymptomatic with normal chest radiographs and negative sputum smears for acid-fast bacilli. Six of them had strongly positive tuberculin reactions while four were severely immunosuppressed. Our observation highlights the utility of routine sputum culture in the diagnosis of tuberculosis in high-risk individuals.

Int J Tuberc Lung Dis., Jul 2004, 8(7), 896-8.

END PIECE

Digital Imaging in Pathology: Theoretical and Practical Considerations, and Applications

F,Joel, W+M,Leong, Anthony S-Y.Leong

Digital imaging is rapidly replacing photographic prints and Kodachromes for pathology reporting and conference purposes. Advanced systems linked to computers allow greater versatility and speed of turn-around as well as lower costs, allowing the incorporation of macroscopic and microscopic pictures into routine pathology reports and publications. Digital images allow transmission to remote sites via the Internet for primary diagnosis, consultation, quality assurance and educational purposes and can be stored and disseminated in CD-ROMs. Total slide digitisation is now a reality and has the potential to replace glass slides to a large extent. There are extensive applications of digital images in education and research, allowing more objective and automated quantitation of a variety of morphological and immunohistological parameters. Three-dimensional images of gross specimens can be developed and posted on websites for interactive educational programs and preliminary reports indicate that medical vision systems are a reality and can provide for automated computer generated histopathological diagnosis and quality assurance.

Pathology (Australia) Volume 36, Number 3, June 2004, 234 241


		July 2004
		ANATOMIC PATHOLOGY Russell Body Gastritis: An Unusual, Tumor-like Lesion of the Gastric Mucosa Andreas Erbersdobler, Susan Petri, and Guntram Lock The case of an 80-year-old woman who presented with epigastric symptoms is reported. Upper gastrointestinal endoscopy displayed Candida esophagitis and a localized swelling of the fundic mucosa. Histologic examination of the gastric biopsy showed a distinctive accumulation of numerous uniform plasma cells filled with so-called Russell bodies. On low-power view, the lesion resembled a neoplastic process due to the marked expansion of the lamina propria with distension of fundic glands. However, immunohistochemistry confirmed a polyclonal pattern of the plasma cells. This unusual reactive lesion of the gastric mucosa has only rarely been described and has been termed Russell body gastritis. Archives of Pathology and Laboratory Medicine, Vol. 128, No. 8, pp. 915917 Node Retrieval in Axillary Lymph Node Dissections: Recommendations for Minimum Numbers to be Confident about Node Negative Status Somner JE, Dixon JM, Thomas JS. Aims: To determine the minimum number of lymph nodes needed in an axillary lymph node dissection (ALND) specimen to be confident that the axilla is free from metastases. Methods: The Edinburgh Breast Unit selects patients with large and high-grade tumours for ALND; 609 consecutive ALNDs performed between October 1999 and December 2002 were reviewed. Full data about the underlying invasive breast cancer were available for 520 patients. Data were collected regarding number of positive nodes and total number of nodes collected, tumour size and grade, and presence of lymphovascular invasion. Results: Axillary node metastases were seen in 64% of patients. The mean number of positive nodes found was 3.56, with a mean of 17.9 nodes collected. The highest proportion of patients with lymph node metastases were in the group with 16-20 nodes recovered/specimen (68%); specimens with >20 nodes recovered did not have a higher rate of nodal involvement. There was a significant difference between the proportion of metastasis positive specimens in those with 1-15 nodes recovered (58.5%) and those with 16 or more recovered (69.1%). A linear association test showed a direct correlation between the number of nodes collected and presence of node metastasis (p = 0.0005). Conclusions: Although there is no minimum number of nodes that should be recovered in an ALND specimen, 16 nodes should be regarded as a target to ensure a high level of confidence that the nodes are negative. Node positivity in an ALND specimen appears to obey the law of diminishing returns. J Clin Pathol. 2004 Aug; 57(8): 845-8. Analysis of Survivin Expression in Subtypes of Lymphoma [Article in Chinese] Gu X, Lin HL. Background and Objective: It is difficult to diagnose and classify lymphoma in clinical pathology. This study was designed to examine the expression of survivin, an important anti-apoptosis gene, in subtypes of lymphoma, and to investigate its value in classification of lymphoma. Methods: Biopsies from 83 cases of lymphoma and 5 cases of lymph node reactive proliferation were collected from the First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to June 2003. Reverse transcription- polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed to determine the mRNA and protein expression of survivin. In addition, the survivin expression in four tumor cell lines (K562, HL60, Raji, and Jurkat cell line) were also determined by RT-PCR and immunohistochemical staining. Semi-quantity assay was used to evaluate the quantity of survivin protein and mRNA expression in subtypes of lymphoma. Results: Protein expression of survivin was high and strong in diffuse large B-cell lymphoma (DLBL) (87.2%, 34/39), Burkitt lymphoma (BL) (100%,2/2), and lymphoblastic lymphoma (LBL) (85.7%,6/7), while their expression were lower and weaker in follicular lymphoma (FL)(22.2%), extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) (33.3%), and marginal zone lymphoma (MZL)(40.0%). There exist a significant difference between the higher expression group (DLBL, BL, and LBL) and lower one (FL, MZL, and MALT) in expression of survivin. Chi-square test, Chi(2)=24.77,P< 0.01. Furthermore, survivin protein expression level in older patients (media age: 57-year old) with DLBL was higher than that in younger patients (media age: 41-year old). Almost all of Reed-Sternberg cells (R-S cells) in Hodgkin's lymphoma (HL) showed strongly positive expression of survivin. The protein expression of survivin was positively correlated with mRNA (r=0.627 0,P< 0.01). Conclusion: The expression level of survivin mRNA and protein shows significant difference in subtypes of lymphoma, and it might be act as a biomarker to classify the subtypes of lymphoma. Ai Zheng, Jun 2004, 23(6): 655-61. MICROBIOLOGY Unrecognised Tuberculosis in HIV-infected Patients: Sputum Culture is a Useful Tool Swaminathan S, Paramasivan CN, Kumar SR, Mohan V, Venkatesan P. Diagnosis of tuberculosis is challenging, especially in human immunodeficiency virus (HIV) positive persons who may have atypical clinical and radiographic features. We report the isolation of Mycobacterium tuberculosis from sputum samples of 10 (4%) HIV-positive persons who were asymptomatic with normal chest radiographs and negative sputum smears for acid-fast bacilli. Six of them had strongly positive tuberculin reactions while four were severely immunosuppressed. Our observation highlights the utility of routine sputum culture in the diagnosis of tuberculosis in high-risk individuals. Int J Tuberc Lung Dis., Jul 2004, 8(7), 896-8. END PIECE Digital Imaging in Pathology: Theoretical and Practical Considerations, and Applications F,Joel, W+M,Leong, Anthony S-Y.Leong Digital imaging is rapidly replacing photographic prints and Kodachromes for pathology reporting and conference purposes. Advanced systems linked to computers allow greater versatility and speed of turn-around as well as lower costs, allowing the incorporation of macroscopic and microscopic pictures into routine pathology reports and publications. Digital images allow transmission to remote sites via the Internet for primary diagnosis, consultation, quality assurance and educational purposes and can be stored and disseminated in CD-ROMs. Total slide digitisation is now a reality and has the potential to replace glass slides to a large extent. There are extensive applications of digital images in education and research, allowing more objective and automated quantitation of a variety of morphological and immunohistological parameters. Three-dimensional images of gross specimens can be developed and posted on websites for interactive educational programs and preliminary reports indicate that medical vision systems are a reality and can provide for automated computer generated histopathological diagnosis and quality assurance. Pathology (Australia) Volume 36, Number 3, June 2004, 234 241
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