Remains your authoritative source for comprehensive coverage of those skin diseases in which histopathology plays an important role in diagnosis. This edition maintains the proven, clinicopathologic classification of cutaneous disease while incorporating a “primer” on pattern-algorithm diagnosis. More than 1,800 full-color illustrations, including photomicrographs and clinical photographs, help you visualize and make the most of the clinical diagnostic process.

Lever's Histopathology of the Skin

Objective  To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design  Systematic review and meta-analysis of cohort studies. Data sources  PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies  Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction  Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results  There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions  There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

https://www.bmj.com/content/bmj/353/bmj.i1753.full.pdf

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Prognostic factors are clinical and pathological features that give information in estimating the likely clinical outcome of an individual suffering from cancer. The author gives a short review of the most important prognostic factors in breast cancer. 376 breast cancer cases of a ten year interval in a county hospital are summarized. Traditional clinico-pathological parameters i.e. TNM and steroid receptor status are discussed. The more common karyotipic, oncogene and tumor suppressor gene alterations are outlined in the study. Methods for their detection are presented and their value in prognostication is reviewed. Emphasis was laid on steroid receptors, c-erpB-2, p53 and bcl-2 alterations. Genes responsible for heritable forms of increased breast cancer risk are briefly reviewed.

Prognostic factors in breast cancer

Earlier studies have reported the effectiveness of aspirin in preventing preeclampsia in women considered to be at moderate to high risk of developing this disorder. This current study was a meta-analysis of cohort studies examining risk factors for preeclampsia with the goal of estimating early in pregnancy (r16wk gestation) a woman’s risk of developing preeclampsia based on the presence of absence of various risk factors. Three practical estimates were generated: the absolute risk of developing preeclampsia in the presence or absence of a given risk factor; the relative risk in the presence or absence of a given risk factor, and the population attributable fraction (PAF) for preeclampsia in relation to each risk factor. On the basis of their analysis, the authors aimed to provide a list of risk factors that could be used to identify those women at high risk for developing preeclampsia. The PubMed and Embase databases were used to identify articles studying the association between preeclampsia and one or more risk factors in a previous pregnancy or in the current pregnancy. They specifically evaluated practical risk factors that were patient specific, easily remembered by the patient or found in previous medical records, and could be determined in the first trimester by the physician. Risk factors studied included: previous history of preeclampsia, placental abruption, intrauterine growth restriction (IUGR), or stillbirth; nulliparity; advanced maternal age; chronic hypertension; preexisting diabetes; high body mass index (BMI); kidney disease; lupus; antiphospholipid (aPL) antibody syndrome; multiple gestation, and assisted reproduction. The pooled preeclampsia event rate in the exposed and unexposed groups was calculated for each risk factor and pooled relative risk was calculated. Subsequently the PAF for each risk factor was calculated using the pooled relative risks. A total of 25,356,688 pregnancies from 92 studies were included in the meta-analysis. The mean pooled event rate for preeclampsia among all risk factors was 2.7% (SD=0.93%) for unexposed groups, while the mean pooled event rate for all exposed groups was 7.3% (SD= 4.6%). The highest pooled rate of preeclampsia was observed in women with aPL antibody syndrome [17.3%, 95% confidence Interval (CI), 6.8%-31.4%] while a previous history of preeclampsia had the highest pooled relative risk (8.4; 95% CI, 7.1-9.9). Chronic hypertension was the risk factor with the second highest pooled rate (16.0%; 95% CI, 12.6%-19.7%) and pooled relative risk (5.1%; 95% CI, 4.0%-6.5%) for preeclampsia. Preexisting diabetes, BMI >30, and pregnancy achieved by assisted reproduction were other risk factors with notably high pooled rates and relative risks. The presence of all but one of the risk factors evaluated (IUGR) was determined to significantly increase the risk of developing preeclampsia. Although aPL antibody syndrome was associated with the highest rate of preeclampsia it is a relatively uncommon disorder and therefore had one of the lowest PAFs for preeclampsia (0.18%; 95% CI, 0.08%-0.33%), whereas nulliparity, prepregnancy BMI >25, and prior preeclampsia were found to have the highest PAFs (32.3%; 95% CI, 27.4%-37.0%; 23.8%; 95% CI, 22.0%-25.6%; and 22.8%; 95% CI, 19.6%-26.3%, respectively). On the basis of their meta-analysis, the investigators identified multiple risk factors that could be used to identify early in pregnancy women who are at “high risk” of developing preeclampsia. They suggest this information could be used to develop a clinical prediction model that would be useful in determining those women who would benefit from aspirin prophylaxis during their pregnancies.

/pdf/clinical-risk-factors-for-preeclampsia-determined-in-early-seyf5wieqa.pdf

Clinical Risk Factors for Preeclampsia Determined in Early Pregnancy: Systematic Review and Meta-Analysis of Large Cohort Studies

Several years ago, as editor-in-chief of theAmerican Journal of Surgical Pathology, Dr Sternberg inaugurated a series of articles under the same heading as his book's title,Histology for Pathologists. These articles have now been considerably augmented and incorporated into this large, almost 1000-page, comprehensive text, whose 80 authors comprise an international cast of experts. Inevitably, the chapters vary in their quality, to an extent that reflects either inadequate editorial surveillance or adherence to a very tight deadline. I would assume that the instruction to contributors was to write on pure and applied histology, with the level of detail required by a practicing pathologist. As Dr Sternberg mentions in his preface, there are many histology books in existence, but none contains the detail and variations from normal that form a baseline for estimating the presence of disease. The papers originally published in theAmerican Journal of Surgical Pathologyare strictly

Histology for Pathologists

A 65-year-old patient with endometrial adenocarcinoma underwent hysterectomy. Pathological examination of the right ovary revealed a coexisting stromal luteoma. The possible relationship between the two neoplasms as well as the intriguing pathogenesis and controversial nomenclature of ovarian steroid cell tumors are discussed. The incidental discovery of a stromal luteoma in a total hysterectomy specimen removed for endometrial carcinoma raises interesting questions about the perceived innocuous nature of these rare lipid cell tumors.

Ovarian stromal luteoma in a patient with endometrial carcinoma.

SNNL is a rare, benign lesion which may arise from trauma, a sclerosing haemangioma or it may represent a burned out phase of various conditions like parasitic infections, or chronic infections like tuberculosis. Histopathology provides the definite diagnosis, which thus helps clinicians in allaying unnecessary anxiety of the patient and in planning proper management.We are reporting two cases here, which had solitary necrotic nodules of liver (SNNL), with emphasis on the aetiology and morphology of the lesions. SNNL was incidentally detected during cholecystectomy done in both young female patients. The lesion was solitary in one case and it was multiple in the other. The suspected aetiology in one of the cases was parasitic, whereas it was tuberculosis in the other. The clinical features in both cases were suggestive of neoplasms.

Solitary Necrotic Nodule of Liver (SNNL): A Report of Two Cases.

1. Barnes L, Eveson JW, Reichart P, Sidransky D, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press; 2005: pp. 223–224. 2. Toida M, Shimokawa K, Makita H et al. Intraoral minor salivary gland tumors: a clinicopathological study of 82 cases. Int J Oral Maxillofac Surg 2005;34:528–32. 3. Evans HL, Luna MA. Polymorphous low-grade adenocarcinoma: a study of 40 cases with long-term follow up and an evaluation of the importance of papillary areas. Am J Surg Pathol 2000;24:1319–28. 4. de Bondt BJ, Stokroos R, Casselman JW et al. Clinical impact of short tau inversion recovery MRI on staging and management in patients with cervical lymph node metastases of head and neck squamous cell carcinomas. Head Neck 2009;31:928–37. 5. Kawahara A, Harada H, Yokoyama T, Kage M. Cytomorphologic features of a polymorphous low grade adenocarcinoma of the palate. A report of 2 cases with immunocytochemistry. Acta Cytol 2003;47:1127–30. 6. Kawahara A, Harada H, Kage M, Yokoyama T, Kojiro M. Extracellular material in adenoid cystic carcinoma of the salivary glands: a comparative cytological study with other salivary myoepithelial tumors. Diagn Cytopathol 2004;31:14–8. 7. Mincione GP, Nesi G, Amorosi A. Polymorphous lowgrade adenocarcinoma of the soft palate: fine needle aspiration cytology. Cytopathology 1999;10:61–5.

Ganglioneuroma in the neck masquerading as a benign mesenchymal lesion on cytology: a morphological mimic.

Multicystic Nephroma (MCN) is an uncommon renal pathology, characterized by the presence of usually unilateral circumscribed focal lesion consisting of multiple thin walled cysts. The etiology and pathogenesis of multicystic nephroma is not clear, and it is considered as a neoplastic lesion by many authors. To the best of our knowledge it has not yet been reported from India. We report first two pediatric cases of MCN from India. Computerized Tomography (CT) scan in both the cases revealed a unilateral cystic lesion in the lower pole of kidney. Keeping in mind the age, clinical presentation and radiological appearance, a possibility of Wilm 's tumour with cystic change could not be ruled out preoperatively and both children underwent nephrectomy. Since MCN has a benign behaviour it must be differentiated from focal cystic neoplastic lesions, including Cystic Partially Differentiated Nephroblastoma (CPDN), which has a low but distinct capability for local recurrence, and from Wilm's tumour with cystic change. Segmental form of unilateral renal dysplasia also needs to be considered in the clinical and radiological differential diagnoses.

Multicystic nephroma--report of two cases.

Objective: To study a case series of genital malignancies coexisting with genital tuberculosis. Materials and Methods: A series of three cases with known genital malignancies were found to have coexisting genital tuberculosis on subsequent workup. Results: First case was a 45 years old lady who underwent staging laparotomy for ovarian cancer. On histopathology examination, there was coexisting tuberculosis with papillary serous carcinoma. Second case was 53 years old postmenopausal lady who underwent extrafascial hysterectomy along with pelvic lymph node dissection. Histopathology showed tubercular changes along with endometrial malignancy. Third patient was a 50 years old postmenopausal lady with stage IIA carcinoma of cervix. She underwent radical hysterectomy and histopathology revealed tubercular changes in pelvic lymph nodes. All patients were given antitubercular therapy for 9 months in postoperative period along with adjuvant therapy. Conclusion: Although diagnosed as an incidental finding in the case series, genital tuberculosis may present in patients with malignancies as a result of immunosupression.

Coexisting genital malignancies with tuberculosis: A case series with review of literature.

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