Childhood Henoch-Schnlein Purpura Nephritis and IgA Nephropathy: One Disease Entity?——A Clinico-pathologically Comparative Study

Summary： In order to characterize their relationship through clinicopathological comparison between IgA nephropathy and Henoch-Schoenlein purpura nephritis （HSPN）, 31 children with IgA nephrop- athy aged between 3 to 15 years and 120 children with HSPN aged between 4 to 15 years were compared with each other in clinical manifestation, blood biochemistry, serum immunology and followup study. Renal pathological findings under light microscope, immunofluorescence and electronic microscope were analyzed and also compared between 31 children with IgA nephropathy and 32 biopsied children with HSPN. The results showed that the onset age was over 12 years in 25.8 % children with IgA nephropathy, but only 10 % in HSPN （P〈0.05）. The clinical patterns of IgA nephropathy and HSPN were similar, but extra-renal manifestations were more often in HSPN, all of them had skin purpura, 59 % had gastrointestinal symptoms and 47 % suffered from arthralgia, compared with only abdominal pain in 3.2 % children with IgA nephropathy. The renal pathological investigation showed global sclerosis in 35.5 % of IgA nephropathy and 3.1% of HSPN, mesangial sclerosis in 41.9 % of IgA nephropathy and 6.3 % of HSPN, but endothelial proliferation in 65.6 % of HSPN and 29 % of IgA nephropathy （all P〈0.01）. Thin basement membrane nephropathy was only found in 6. 5 % children with IgA nephropathy, no in HSPN. The electronic dense deposits in HSPN were sparse, lodse and wildly spread in glomerular mesangium, subendothelial area and even intra basement membrane, but it was dense, lumpy and mostly limited in mesangium and paramesangium in IgA nephropathy. Predominant IgA deposits were found in 81.2% of HSPN, and overwhelming IgG deposits in 12.5 % of HSPN with relatively weak IgA deposits, moreover 6.3 % of HSPN showed linear IgG deposits in glomerular capillary. Totally 71. 9 G of HSPN had IgG deposits in glomeruli and only 19.4% of IgA nephropathy showed glomerular IgG deposits （P〈0. 01）. No IgG deposit was observed in 81. 6 % of IgA nephropathy, among them most showed IgA and IgM and/or C3 deposits, moreover overwhelming IgG deposits and linear IgG deposits couldn＇t be found in IgA nephropathy. Mean 20 months follow-up showed complete remission in 72.5% of HSPN, but only 19.4% in IgA nephropathy after 34 months follow-up. Moreover, 64.5 % of IgA nephropathy had consistent hematuria and proteinuria and 16. 1% had active nephritides （P〈0.05）. It was concluded that significant clinico-pathological difference was found between HSPN and IgA nephropathy, which didn＇t support the one disease entity hypothesis. HSPN and IgA nephropathy are probably two diseases with similar immune abnormalities.

Prognostic Clinico-Pathological Features of 99 Cases Advanced Non-Small Cell Lung Cancer—Egyptian National Cancer Institute

Background: Worldwide, lung cancer is the most commonly diagnosed cancer and causes more deaths than any other cancer. In Egypt;it accounts for 7% of male cancer & 3% in females. It is considered to be 3rd most common cancer in Egyptian males & 6th most common of both sexes. Materials and Methods: A total of 99 advanced non-small cell lung cancer patients who underwent first line platinum containing chemotherapy in our institute were included in this study. All clinical and pathological data were collected from patient’s files retrospectively between 2012-2014. Results: All 99 cases were diagnosed at late stage IIIB-IV (59 cases were IIIB).The median age was 54 years (range: 30 - 70) with 53% of cases are ≥ 54 years. 71% were males with male: female ratio of 2.4:1. All male patients were chronic smokers. The most frequent symptom was coughing (68%). Most of the patients had primary lung cancer in the right lung (77%). The most common histological subtype was squamous cell carcinoma (35.4%) with 54 cases present with PS-I, the remain was PS-II. All cases received platinum containing chemotherapy. The majority of cases experienced a progressive disease 60.6%. The median progression free survival (PFS) was 6 months & median overall survival (OS) was 18 months. We found that PS, disease stage, pathological subtypes and response to treatment statistically affect both median OS & PFS. Age affects only OS. Conclusions: Our analysis suggests that some of clinico-pathological factors & response to first line platinum containing regimens affect both OS & PFS of advanced NSCLC. This may be beneficial as prognostic markers and further studies were needed to aid in identification and treatment of these patients.

Clinico-Pathological Study of Invasive Fungal Sinusitis in Ibadan, Nigeria: A Case Series

Background: Invasive fungal sinusitis is one of the less common forms of fungal infection more commonly described in North Africa and Asia. It affects healthy and immunologically competent individuals typically complicating chronic rhinosinusitis. Surgical debridement and adjuvant antifungal treatment are the mainstay of management of this condition. Objective: To describe the clinical presentation, pathological features and management of patients with invasive fungal sinusitis managed at a tertiary health facility, southwestern Nigeria. Method: Medical records of all patients with invasive fungal sinusitis managed between January 2009 and December 2018 were retrospectively reviewed. Results: Six patients with invasive fungal sinusitis were managed during the study period. All patients were immunocompetent and the mean age at presentation was 30.7 years ± 7.2 years. The average duration of symptoms prior to presentation was 18.5 months (Interquartile range, 67.5 months), and all six patients had orbital involvement and intracranial extension of the mass at presentation. They all had surgical debridement, and the specimens were sent for histological examination. Mycological studies carried out on two specimens isolated Aspergillus fumigatusas the fungal agent and all patients were started on post-operative oral antifungal chemotherapy. Five patients completed their chemotherapy and fared well with no recurrence while one patient had irregular and incomplete antifungal treatment, and developed recurrent infection before abandoning further treatment. Conclusion: Chronic invasive fungal sinusitis is an uncommon infection and fairly difficult to manage. However, timely diagnosis and combined surgical and medical treatment can give good outcomes in the patients.

Clinico-Pathological Characterization of Hereditary, Familial and Sporadic Prostate Cancer

Aim: To characterize familial prostate cancer including hereditary prostate cancer and assess the disease-free survival following radical prostatectomy. Methods: A self-administered written questionnaire was forwarded to 709 prostatectomized patients from the Aarhus Prostate Cancer Study containing questions about cases of prostate cancer (PC), age at diagnosis, vital status, and age at death for all first-degree relatives. Patients were then divided into groups according to their family history: hereditary prostate cancer (HPC), familial prostate cancer (FPC), and sporadic prostate cancer (SPC) groups. The information from a subset of both FPC (n = 17) and SPC (n = 17) groups were validated in the Danish Cancer Register and the Civil Registration System. Between groups, we described the association of age, prostatespecific antigen (PSA), postoperative Gleason score and T Stage. A Kaplan-Meier curve demonstrated postoperative disease-free survival in each group. Results: The response rate was 81% (574/709). About 21% of the patients were categorized in the FPC group, of which 7% were identified as having HPC. The median follow-up time was 63 months for HPC, 65 months for FPC and 88 months for SPC. Overall, there was no significant difference between groups in clinical features and disease-free survival except that patients with HPC were significantly associated with younger age than sporadic cases (p = 0.02). The proportion of self-reported PC diagnoses confirmed in the cancer register was 27.8%. The index persons with SPC reported no PC in first-degree relatives and none was found the cancer register. Conclusion: Overall, we found no difference in clinical characteristics and survival, following radical prostatectomy except that patients with HPC were younger at diagnosis. These results are in line with previously reported data.

A clinico-pathological and cytological study of oral candidiasis

Candidiasis of the oral mucosa arises chiefly as a re- sult of infection with Candida albicans. Many clinico- pathological analyses of macroscopic findings have been described, although the clinical findings of oral candidiasis vary considerably and the conditions are complex. The present study analyzes the distribution, clinical, cytological and histological diagnoses of oral candidiasis, associated complex diseases and the di-agnostic value of cytology. The ratio of Candida in-fection was 28.9% among 1551 study participants. Females were infected significantly more often than men (p < 0.01) and the affected age range was 60 - 79 years (61.0%, p < 0.01). The predominantly affected areas were the tongue (48.3%, p < 0.01) and gingiva (20.0%, p < 0.01), and occurrence at multiple loci was seen in 43 (9.6%) patients. The typical clinical find- ings of oral candidiasis were ulcerative/erythematous lesions (33.2%, p < 0.01) and pseudomembranous candidiasis (31.6%, p < 0.01). A histopathological dia- gnosis of candidiasis based on biopsy specimens from 26 lesions in patients with Candida infection indicated by cytology was confirmed from cultures. The break- down of a cytological to a definite diagnosis was 6 positive (SCC 4, verrucous carcinoma 1, moderate to severe dysplasia 1), 6 suspected positive (mild dyspla- sia, 2;moderate to severe dysplasia, 2;papilloma, 1 and SCC, 1) and 14 negative (epulis, 3;papilloma, 3;granulation tissue, 2;fibrosis, 2 and others, 4). Exfo-liative cytology can easily judge the presence of Can-dida species, although experience is necessary for the presumptive diagnosis of an oral mucosal disease. The application of exfoliative cytology using the Pe- riodic acid-Schiff reaction is helpful for the earlier detection of oral candidiasis with various macrosco- pic findings.

Bone Marrow Angiogenesis in Patients Presenting with Differential Chinese Medicine Syndrome:Correlation with the Clinico-pathological Features of Aplastic Anemia

Objective： To explore differences in bone marrow angiogenesis seen in aplastic anemia （AA） patients presenting with differential Chinese medicine （CM） syndrome, and to correlate these differences with clinical pathology. Methods： Thirty-five patients were enrolled, including 18 with ＂yang deficiency syndrome＂ and 17 with ＂yin deficiency syndrome.＂ Bone marrow biopsies and serum were collected. Microvessel density （MVD） and positive expression of vascular endothelial-derived growth factor （VEGF） were detected by immunohistochemisty. Hypoxia inducible factor -α （HIF-α ）, and VEGF expression were assayed by enzyme-linked immunoabsorbent assay （ELISA）, serum lactate dehydrogenase （LDH） was tested by enzyme method and liquid chip technology was used to detected the expression of interleukin （IL）-2, IL-4, IL-6, IL-10, interferon （IFN）-＇y and tumor necrosis factor （TNF）-α. Results： Counts for leukocytes, absolute neutrophils and platelets in ＂yin deficiency syndrome＂ were lower than those found in ＂yang deficiency syndrome＂ （P〈0.05）. MVD and VEGF expression, and the positive rate of CD34 and VEGF in bone marrow were lower in hA, especially in ＂yin deficiency syndrome＂ （P〈0.01 or P〈0.05）. ＂Yin deficiency syndrome＂ displayed decreased VEGF and LDH expression, and enhanced expression of HIF-α as compared to ＂yang deficiency syndrome＂ （P〈0.05）. Levels of IL-4 and IL-6 were higher in AA （P〈0.01）, but IL-10 was decreased （P〈0.05）. High TNF-c~ expression was seen in ＂yang deficiency syndrome＂ and IFN- γ expression was decreased in ＂yin deficiency syndrome＂ as compared with normals （P〈0.01 and P〈0.05, respectively）. Conclusion： AA patients have lower MVD than normals, especially in ＂yin deficiency syndrome.＂ MVD might differentially correlate to disease severity, and could be dependent on bone marrow or serum VEGF expression and LDH. Additionally, IL-2, IL-10, IL-4 and IFN- γ were negatively associated while IL-6 and TNF- α were positively associated with MVD.

Clinical significance of breast cancer susceptibility gene 1 expression in resected non-small cell lung cancer:A meta-analysis

BACKGROUND The clinical significance of breast cancer susceptibility gene 1(BRCA1)in nonsmall cell lung cancer(NSCLC)patients undergoing surgery remains unclear up to now.AIM To explore the relation of BRCA1 expression with clinicopathological characteristics and survival in patients with resected NSCLC.METHODS EMBASE,PubMed,Web of Science,and The Cochrane Library databases were searched to identify the relevant articles.To assess the correlation between the expression of BRCA1 and clinicopathological characteristics and prognosis of patients with resected NSCLC patients,the combined relative risks or hazard ratios(HRs)with their corresponding 95%confidence intervals[CIs]were estimated.RESULTS Totally,11 articles involving 1041 patients were included in the meta-analysis.The results indicated that the expression of BRCA1 was significantly correlated with prognosis of resected NSCLC.Positive BRCA1 expression signified a shorter overall survival(HR=1.60,95%CI:1.25-2.05;P<0.001)and disease-free survival(HR=1.78,95%CI:1.42-2.23;P<0.001).However,no significant association of BRCA1 expression with any clinicopathological parameters was observed.CONCLUSION BRCA1 expression indicates a poor prognosis in resected NSCLC patients.BRCA1 might serve as an independent biomarker to predict clinical outcomes and help to customize optimal adjuvant chemotherapy for NSCLC patients who had received surgical therapy.