Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe ... more Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe und Lymphknoten das klinische Erscheinungsbild einer lymphoproliferativen Erkrankung vortäuschen. Ein 54-jähriger Mann mit einem anamnestisch bekannten follikulären Lymphom zeigte progredient vergrößerte abdominelle Lymphknoten sowie Infiltrate im Bereich der parenchymatösen Organe. Um ein Lymphomrezidiv oder eine infektiöse Ursache auszuschließen, wurden CT-gesteuerte Biopsien entnommen, die allesamt den Befund einer eosinophilen, nekrotisierenden, granulomatösen Vaskulitis ergaben, vereinbar mit einem atypischen Churg-Strauss-Syndrom. Unter einer Therapie mit Cyclophosphamid und Prednison war die klinische Symptomatik innerhalb weniger Tage deutlich rückläufig, was sich im weiteren Verlauf auch in der Bildgebung bestätigte. Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders. A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe ... more Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe und Lymphknoten das klinische Erscheinungsbild einer lymphoproliferativen Erkrankung vortäuschen. Ein 54-jähriger Mann mit einem anamnestisch bekannten follikulären Lymphom zeigte progredient vergrößerte abdominelle Lymphknoten sowie Infiltrate im Bereich der parenchymatösen Organe. Um ein Lymphomrezidiv oder eine infektiöse Ursache auszuschließen, wurden CT-gesteuerte Biopsien entnommen, die allesamt den Befund einer eosinophilen, nekrotisierenden, granulomatösen Vaskulitis ergaben, vereinbar mit einem atypischen Churg-Strauss-Syndrom. Unter einer Therapie mit Cyclophosphamid und Prednison war die klinische Symptomatik innerhalb weniger Tage deutlich rückläufig, was sich im weiteren Verlauf auch in der Bildgebung bestätigte. Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders. A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
Renal carcinomas harboring the TFE-3 translocation are rare and occur predominately in children a... more Renal carcinomas harboring the TFE-3 translocation are rare and occur predominately in children and adolescents. Here, we report a case of infantile renal carcinoma with TFE3 translocation and show that the cell cycle is deregulated in this type of carcinoma. It is characterized by nuclear accumulation of cyclin D1 and D3 in combination with high levels of cyclin-dependent kinase inhibitor p21Cip1/Waf1 but without accumulation of p53, p16INK4a, or mdm2. The combined overexpression of p21, cyclin D1, and cyclin D3 was found exclusively in this type but not in other, more common types of renal carcinoma/oncocytoma (n=27). These results further underscore that renal carcinomas with Xp11. 2 translocations/TFE3-gene fusion represent a special type of renal neoplasm showing deregulation of specific cell cycle components. The analysis of further cases has to prove whether the derangement of the cell cycle is uniform and correlates with the specific type of molecular genetic derangement.
ABSTRACT Objectives Catheter-guided optical coherence tomography (OCT) is a new means of intralum... more ABSTRACT Objectives Catheter-guided optical coherence tomography (OCT) is a new means of intraluminal microstructural imaging, with a spatial resolution of 10–20 μm. We compared the distinction of tissue layers of several porcine ureters ex vivo using OCT and endoluminal ultrasound (ELUS). Materials and methods Fresh porcine ureters and kidneys were obtained from the municipal slaughterhouse. They were cannulated with a 7 Fr-catheter sheath, flushed with normal saline solution, and marked on the outside with a surgical suture. Images were obtained between marked positions from within the ureter lumen by means of OCT (M1, LightLab Imaging, Inc., Westford, MA, USA) and ELUS at 40 MHz. Distinction of the urothelium, lamina propria, inner and outer muscle layer was rated as (1) possible or (0) impossible by two independent observers (O1, O2). Rates of distinction were compared between OCT and ELUS image quadrants by means of a chi-square test. Results From 224 OCT image quadrants and 144 ELUS image quadrants, OCT was found to be superior to ELUS in distinguishing any wall layers (respective chi-square, p-value: O1, 68.1051, p<0.001; O2, 66.1630, p<0.001), urothelium and lamina propria (O1, 200.0750, p<0.001; O2, 240.0024, p<0.001), and lamina propria and muscle layer (O1, 38.8411, p<0.001; O2, 24.7536, p<0.001). The findings were inconclusive for inner and outer muscle layers (O1, 260.3004, p<0.001; O2, 0.4992, p>0.25). Conclusion Using OCT it was possible to distinguish between the different wall layers of porcine ureter ex vivo significantly better than with ELUS. The feasibility of OCT in vivo and in the presence of pathological wall thickening of the ureter remains to be demonstrated.
Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-lik... more Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (κ) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.
Intraluminal optical coherence tomography (OCT) applies coherent light to provide cross-sectional... more Intraluminal optical coherence tomography (OCT) applies coherent light to provide cross-sectional images with a spatial resolution of 10–25 μm. We compared OCT and matching whole-mount histology microscopy sections of porcine upper ureters ex vivo for visualization and delineation of different tissue layers of the ureteral wall. Porcine ureters (six specimens, 24 quadrants) were flushed with normal saline solution prior to insertion of the OCT catheter (diameter, 0.014 inch, OCT wavelength, 1,300±20 nm). Cross-sectional OCT images were obtained in marked locations before specimens were fixed in 4% formalin, cut at marked locations, whole-mounted, and stained with hematoxilin and eosin. Visualization and delineation of different tissue layers of the ureteral wall by OCT was compared with matching histology by two independent observers (O1,O2). OCT distinguished tissue layers of the ureteral wall in all quadrants. In OCT images, O1/O2 delineated urothelium and lamina propria in 23/24 quadrants, lamina propria and muscle layer in 19/16 quadrants, inner and outer muscle layer in 13/0 quadrants, and urothelial cell layers in 13/2 quadrants, respectively. Intraluminal OCT provides histology-like images of the ureter in porcine specimens ex vivo and reliably distinguishes between urothelium and deeper tissue layers of the ureteral wall.
Fragestellung Ziel der Studie war die Evaluierung der Mehrzeilendetektorcomputertomographie (MDCT... more Fragestellung Ziel der Studie war die Evaluierung der Mehrzeilendetektorcomputertomographie (MDCT) zur Darstellung atherosklerotischer Gefäßwandveränderungen der Koronararterien. Methodik Zunächst wurden in einer Ex-vivo-Studie 17 menschliche Leichenherzen im Vergleich zum histopathologischen Präparat untersucht. Dabei wurden für verschiedene Plaquetypen bildmorphologische Kriterien im CT evaluiert. Anschließend wurden 94 koronare MDCT-Angiogramme (MDCTA) von Patienten mit Verdacht auf eine koronare Herzkrankheit retrospektiv hinsichtlich der diagnostischen Aussagekraft sowie der Verteilung und Anzahl der in der Ex-vivo-Studie beschriebenen Plaquetypen ausgewertet. Zusätzlich wurde eine Volumetrie der verkalkten und nichtkalzifizierten Plaqueareale durchgeführt. Ergebnisse In der Ex-vivo-Studie zeigte die MDCT eine hohe Sensitivität sowohl für kalzifizierte als auch für nichtkalzifizierte Plaques. Im Vergleich zur Histopathologie konnten charakteristische Bildmerkmale der MDCT für fetthaltige, fibröse und kalzifizierte Plaquekomponenten ermittelt werden. In der In-vivo-Studie wurden mit der kontrastverstärkten MDCT-Koronarangiographie bei 38% der Patienten nichtverkalkte Plaques nachgewiesen. Bei 5 Patienten mit unauffälligem Kalziumscreening konnte erst durch die Durchführung der MDCTA eine Atherosklerose nachgewiesen werden. Schlussfolgerungen Die MDCT ist in der Lage, sowohl ex vivo als auch in vivo verschiedene Plaquetypen zu differenzieren. Die kontrastverstärkte MDCT-Angiographie der Koronararterien erlaubt im Gegensatz zum traditionellen Kalziumscreening die Detektion nichtkalzifizierter Gefäßwandveränderungen. Eine Volumetrie nichtverkalkter Plaqueanteile ist in vivo möglich. Purpose The purpose of this study was the evaluation of multidetector-row computed tomography (MDCT) for the assessment of atherosclerotic coronary artery vessel wall changes. Methods In an ex vivo study, 17 human hearts were scanned with MDCT and results were compared to histopathology. Morphologic imaging criteria of MDCT for various plaque-types were developed. In a following in vivo study, 94 coronary MDCT angiograms (MDCTA) of patients with suspected coronary artery disease (CAD) were reviewed retrospectively, assessing the diagnostic value of the coronary MDCTA, and determining the number and correlations of the various plaques types as described in the ex vivo study. Additionally, volumetry of calcified and noncalcified plaque components was performed. Results In the ex vivo study, MDCT showed a high sensitivity for calcified and non-calcified plaques. Comparing the results with histopathology, characteristic image criteria could be determined for lipid-rich, fibrous and calcified plaque components. Reviewing the contrastenhanced in-vivo MDCT coronary angiographies, presence of noncalcified plaques was proven in 38% of the patients. In 5 patients with a calcium score of 0, presence of coronary atherosclerosis was proven in the contrastenhanced scan. Conclusions MDCT is able to differentiate various plaque components in an ex vivo setting as well as invivo. Contrastenhanced MDCT of the coronary arteries allows for the detection of noncalcified plaques. In vivo volumetry of noncalcified plaques is feasible.
Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe ... more Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe und Lymphknoten das klinische Erscheinungsbild einer lymphoproliferativen Erkrankung vortäuschen. Ein 54-jähriger Mann mit einem anamnestisch bekannten follikulären Lymphom zeigte progredient vergrößerte abdominelle Lymphknoten sowie Infiltrate im Bereich der parenchymatösen Organe. Um ein Lymphomrezidiv oder eine infektiöse Ursache auszuschließen, wurden CT-gesteuerte Biopsien entnommen, die allesamt den Befund einer eosinophilen, nekrotisierenden, granulomatösen Vaskulitis ergaben, vereinbar mit einem atypischen Churg-Strauss-Syndrom. Unter einer Therapie mit Cyclophosphamid und Prednison war die klinische Symptomatik innerhalb weniger Tage deutlich rückläufig, was sich im weiteren Verlauf auch in der Bildgebung bestätigte. Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders. A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe ... more Atypische Formen des Churg-Strauss-Syndroms können durch Infiltration der parenchymatösen Organe und Lymphknoten das klinische Erscheinungsbild einer lymphoproliferativen Erkrankung vortäuschen. Ein 54-jähriger Mann mit einem anamnestisch bekannten follikulären Lymphom zeigte progredient vergrößerte abdominelle Lymphknoten sowie Infiltrate im Bereich der parenchymatösen Organe. Um ein Lymphomrezidiv oder eine infektiöse Ursache auszuschließen, wurden CT-gesteuerte Biopsien entnommen, die allesamt den Befund einer eosinophilen, nekrotisierenden, granulomatösen Vaskulitis ergaben, vereinbar mit einem atypischen Churg-Strauss-Syndrom. Unter einer Therapie mit Cyclophosphamid und Prednison war die klinische Symptomatik innerhalb weniger Tage deutlich rückläufig, was sich im weiteren Verlauf auch in der Bildgebung bestätigte. Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders. A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
Renal carcinomas harboring the TFE-3 translocation are rare and occur predominately in children a... more Renal carcinomas harboring the TFE-3 translocation are rare and occur predominately in children and adolescents. Here, we report a case of infantile renal carcinoma with TFE3 translocation and show that the cell cycle is deregulated in this type of carcinoma. It is characterized by nuclear accumulation of cyclin D1 and D3 in combination with high levels of cyclin-dependent kinase inhibitor p21Cip1/Waf1 but without accumulation of p53, p16INK4a, or mdm2. The combined overexpression of p21, cyclin D1, and cyclin D3 was found exclusively in this type but not in other, more common types of renal carcinoma/oncocytoma (n=27). These results further underscore that renal carcinomas with Xp11. 2 translocations/TFE3-gene fusion represent a special type of renal neoplasm showing deregulation of specific cell cycle components. The analysis of further cases has to prove whether the derangement of the cell cycle is uniform and correlates with the specific type of molecular genetic derangement.
ABSTRACT Objectives Catheter-guided optical coherence tomography (OCT) is a new means of intralum... more ABSTRACT Objectives Catheter-guided optical coherence tomography (OCT) is a new means of intraluminal microstructural imaging, with a spatial resolution of 10–20 μm. We compared the distinction of tissue layers of several porcine ureters ex vivo using OCT and endoluminal ultrasound (ELUS). Materials and methods Fresh porcine ureters and kidneys were obtained from the municipal slaughterhouse. They were cannulated with a 7 Fr-catheter sheath, flushed with normal saline solution, and marked on the outside with a surgical suture. Images were obtained between marked positions from within the ureter lumen by means of OCT (M1, LightLab Imaging, Inc., Westford, MA, USA) and ELUS at 40 MHz. Distinction of the urothelium, lamina propria, inner and outer muscle layer was rated as (1) possible or (0) impossible by two independent observers (O1, O2). Rates of distinction were compared between OCT and ELUS image quadrants by means of a chi-square test. Results From 224 OCT image quadrants and 144 ELUS image quadrants, OCT was found to be superior to ELUS in distinguishing any wall layers (respective chi-square, p-value: O1, 68.1051, p<0.001; O2, 66.1630, p<0.001), urothelium and lamina propria (O1, 200.0750, p<0.001; O2, 240.0024, p<0.001), and lamina propria and muscle layer (O1, 38.8411, p<0.001; O2, 24.7536, p<0.001). The findings were inconclusive for inner and outer muscle layers (O1, 260.3004, p<0.001; O2, 0.4992, p>0.25). Conclusion Using OCT it was possible to distinguish between the different wall layers of porcine ureter ex vivo significantly better than with ELUS. The feasibility of OCT in vivo and in the presence of pathological wall thickening of the ureter remains to be demonstrated.
Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-lik... more Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (κ) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.
Intraluminal optical coherence tomography (OCT) applies coherent light to provide cross-sectional... more Intraluminal optical coherence tomography (OCT) applies coherent light to provide cross-sectional images with a spatial resolution of 10–25 μm. We compared OCT and matching whole-mount histology microscopy sections of porcine upper ureters ex vivo for visualization and delineation of different tissue layers of the ureteral wall. Porcine ureters (six specimens, 24 quadrants) were flushed with normal saline solution prior to insertion of the OCT catheter (diameter, 0.014 inch, OCT wavelength, 1,300±20 nm). Cross-sectional OCT images were obtained in marked locations before specimens were fixed in 4% formalin, cut at marked locations, whole-mounted, and stained with hematoxilin and eosin. Visualization and delineation of different tissue layers of the ureteral wall by OCT was compared with matching histology by two independent observers (O1,O2). OCT distinguished tissue layers of the ureteral wall in all quadrants. In OCT images, O1/O2 delineated urothelium and lamina propria in 23/24 quadrants, lamina propria and muscle layer in 19/16 quadrants, inner and outer muscle layer in 13/0 quadrants, and urothelial cell layers in 13/2 quadrants, respectively. Intraluminal OCT provides histology-like images of the ureter in porcine specimens ex vivo and reliably distinguishes between urothelium and deeper tissue layers of the ureteral wall.
Fragestellung Ziel der Studie war die Evaluierung der Mehrzeilendetektorcomputertomographie (MDCT... more Fragestellung Ziel der Studie war die Evaluierung der Mehrzeilendetektorcomputertomographie (MDCT) zur Darstellung atherosklerotischer Gefäßwandveränderungen der Koronararterien. Methodik Zunächst wurden in einer Ex-vivo-Studie 17 menschliche Leichenherzen im Vergleich zum histopathologischen Präparat untersucht. Dabei wurden für verschiedene Plaquetypen bildmorphologische Kriterien im CT evaluiert. Anschließend wurden 94 koronare MDCT-Angiogramme (MDCTA) von Patienten mit Verdacht auf eine koronare Herzkrankheit retrospektiv hinsichtlich der diagnostischen Aussagekraft sowie der Verteilung und Anzahl der in der Ex-vivo-Studie beschriebenen Plaquetypen ausgewertet. Zusätzlich wurde eine Volumetrie der verkalkten und nichtkalzifizierten Plaqueareale durchgeführt. Ergebnisse In der Ex-vivo-Studie zeigte die MDCT eine hohe Sensitivität sowohl für kalzifizierte als auch für nichtkalzifizierte Plaques. Im Vergleich zur Histopathologie konnten charakteristische Bildmerkmale der MDCT für fetthaltige, fibröse und kalzifizierte Plaquekomponenten ermittelt werden. In der In-vivo-Studie wurden mit der kontrastverstärkten MDCT-Koronarangiographie bei 38% der Patienten nichtverkalkte Plaques nachgewiesen. Bei 5 Patienten mit unauffälligem Kalziumscreening konnte erst durch die Durchführung der MDCTA eine Atherosklerose nachgewiesen werden. Schlussfolgerungen Die MDCT ist in der Lage, sowohl ex vivo als auch in vivo verschiedene Plaquetypen zu differenzieren. Die kontrastverstärkte MDCT-Angiographie der Koronararterien erlaubt im Gegensatz zum traditionellen Kalziumscreening die Detektion nichtkalzifizierter Gefäßwandveränderungen. Eine Volumetrie nichtverkalkter Plaqueanteile ist in vivo möglich. Purpose The purpose of this study was the evaluation of multidetector-row computed tomography (MDCT) for the assessment of atherosclerotic coronary artery vessel wall changes. Methods In an ex vivo study, 17 human hearts were scanned with MDCT and results were compared to histopathology. Morphologic imaging criteria of MDCT for various plaque-types were developed. In a following in vivo study, 94 coronary MDCT angiograms (MDCTA) of patients with suspected coronary artery disease (CAD) were reviewed retrospectively, assessing the diagnostic value of the coronary MDCTA, and determining the number and correlations of the various plaques types as described in the ex vivo study. Additionally, volumetry of calcified and noncalcified plaque components was performed. Results In the ex vivo study, MDCT showed a high sensitivity for calcified and non-calcified plaques. Comparing the results with histopathology, characteristic image criteria could be determined for lipid-rich, fibrous and calcified plaque components. Reviewing the contrastenhanced in-vivo MDCT coronary angiographies, presence of noncalcified plaques was proven in 38% of the patients. In 5 patients with a calcium score of 0, presence of coronary atherosclerosis was proven in the contrastenhanced scan. Conclusions MDCT is able to differentiate various plaque components in an ex vivo setting as well as invivo. Contrastenhanced MDCT of the coronary arteries allows for the detection of noncalcified plaques. In vivo volumetry of noncalcified plaques is feasible.
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