V popisovanom prípade autori dokumentujú makroskopický a mikroskopický pitevný nález chronickej disekujúcej aneuryzmy vzostupnej časti aorty a aortálneho oblúka s izolovanými trhlinami v stene aorty bez jej prasknutia u 71-ročnej ženy s minimálnou klinickou symtomatológiou. Aneuryzmatické rozšírenie priesvitu aorty bolo podmienené nielen vyklenutím cievnej steny na základe prítomnosti organizovaného intramurálneho trombu, ale aj v dôsledku prítomnosti plošného defektu intimy a medie aorty so zachovaním celistvosti obvodu fibroticky zmenenou adventíciou. Histologicky bola v torakálnej aorte zistená cystická degenerácia medie s minimálnymi prejavmi aterosklerózy.
We present macroscopic and microscopic findings in a case of chronic dissecting aneurysm of ascending aorta and aortic arch associated with isolated tears of aortic wall without its rupture in a 71-year-old female presenting with minimal clinical symptomatology. Aneurysmal dilation of the aorta was caused not only by the bridging of the vascular wall based on the presence of an organizing intramural thrombus in the false lumen between the separated layers, but also by a wide flat defect in the aortic intima and media with the preservation of the aortic wall integrity due to fibrotical alteration of tunica adventicia. Histologic examination of the thoracic aorta detected cystic medial degeneration with mild atherosclerosis.
Pulmonary small cell carcinoma (SCLC) is usually diagnosed in small biopsy or cytological specimens based on cytomorphology; however in ambiguous cases diagnosis requires additional support by immunohistochemistry. While TP53 and RB1 alterations with secondary overexpression of p16 are mainstay events in SCLC pathogenesis, diagnostic value of p16-positivity in the diagnosis of SCLC has not yet been fully investigated. We examined the expression of p16, CD56, synaptophysin (SYP), chromogranin A and thyroid transcription factor-1 (TTF1) in a series of pulmonary and extrapulmonary small cell carcinomas, pulmonary carcinoids and non-small cell lung carcinomas, and compared diagnostic performance of these markers in the diagnosis of SCLC. P16 was positive in 95 of 101 SCLCs, and displayed highest diagnostic sensitivity of ~94%. Composite biomarkers CD56+p16+TTF1 and CD56+p16+SYP were both able to detect correctly all SCLC cases. Importantly, three (~3%) SCLC cases completely negative for all conventional markers displayed diffuse positivity for p16. CD56 and p16 demonstrated highest concordance between paired small biopsy and cytology specimens. 50% of squamous cell carcinomas, ~41% of adenocarcinoma/NSCLC-favour adenocarcinoma cases, and ~93% of extrapulmonary small cell carcinomas also showed p16-positivity. Combination of CD56, p16 and TTF1 produced diagnostic classifier that outperformed best single marker CD56 in differential diagnosis between SCLC and NSCLC. In conclusion, in the appropriate morphological context p16 represents a useful supplementary marker for diagnosis of SCLC, even in cases where only cytological material is available.
- MeSH
- biopsie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- geny p16 fyziologie MeSH
- imunohistochemie metody MeSH
- karcinoid diagnóza patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- malobuněčný karcinom diagnóza patologie MeSH
- nádorové biomarkery metabolismus MeSH
- nádory plic patologie MeSH
- nemalobuněčný karcinom plic patologie MeSH
- plíce patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spinocelulární karcinom diagnóza patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
