教学课程资源库 更多>>

关键词： Epilepsy   Schizophrenia   Psychosis   Interictal psychosis   Psychopathology   Nonclinical individual  

摘要： Objective: There is a historical debate whether psychopathology of epilepsy psychosis is unique to epilepsy or common to other psychoses. However, a large comprehensive studies on this issue are scarce. To clarify the characteristics of interictal psychosis (IIP), we evaluated psychopathology quantitatively. Methods: This study included 150 patients with IIP (epilepsy+/psychosis+), 187 patients with schizophrenia (SC: epilepsy-/psychosis+), 182 patients with epilepsy (EP: epilepsy+/psychosis-), and 172 non clinical individuals (NC: epilepsy-/psychosis-). The IIP group comprised 127 chronic and 23 brief psychoses. Age, sex, and years of education, onset and duration of psychosis, and onset and duration of epilepsy were matched among the groups. The psychopathology was evaluated using the 16-item Brief Psychiatric Rating Scale (BPRS), which comprises three symptom factors namely negative symptoms (NS), positive symptoms (PS), and anxiety-depressive symptoms (ADS). Results: For overall 16-BPRS and NS factor scores, there were significant interactions between epilepsy related (epilepsy+/-) and psychosis-general (psychosis+/-) effects. The EP exhibited higher scores than did the NC, whereas the IIP exhibited lower scores than did the SC. For PS and ADS factor scores, the IIP and SC exhibited a significant psychosis-general effect. Chronic IIP was associated with more serious psychopathologies than was brief IIP. However, limited with chronic IIP, there was a significant interaction between epilepsy-related and psychosis-general effects on the overall 16-BPRS and NS factor scores. Conclusion: These findings demonstrate the first large quantitative evidence on the unique psychopathology of IIP which has been only narratively described. The psychopathology is associated with the interaction between epilepsy-related and psychosis-general effects. (c) 2021 Published by Elsevier Inc.

关键词： clinical staging   digital rectal exam   national cancer database   pathologic features   prostate cancer   radical prostatectomy  

摘要： Background Accurate staging at the time of prostate cancer diagnosis is fundamental to risk stratification and management counseling. Digital rectal exam (DRE) is foundational in clinical staging of prostate cancer, even with a known limited interexaminer agreement and poor sensitivity for detecting extraprostatic disease. We sought to evaluate the prognostic value of DRE for the presence of advanced pathologic features (APFs) following radical prostatectomy (RP). Methods All patients undergoing RP as primary treatment for clinically localized prostate cancer in the National Cancer Database between 2008 and 2014 were identified. Patients with additional malignancies, prior treatment with radiation or systemic therapy, incongruent clinical staging and DRE findings or without fully evaluable clinical staging were excluded. The primary outcome was the presence of postsurgical APFs, defined as positive surgical margins, nodal disease, or pathologic stage T3 or greater. Multivariable logistic regression analysis was performed to account for prostate-specific antigen (PSA), biopsy grade group, percent of positive biopsy cores, and clinical stage. Results In total, 91,525 patients consisting of 69,182 cT1, 20,641 cT2, and 1702 cT3-T4 were included. The average age was 61.1 +/- 7.0 years, and the average PSA was 8.6 +/- 10.3 ng/ml. On multivariable analysis, cT3 and T4 were associated with the presence of APFs (odds ratio [OR] 11.12, p < .01 and 5.28, p = .04), however, cT2 was only slightly associated with the presence of APFs when compared with cT1 (OR 1.15, p < .01). Furthermore, cT2 was associated with more node-positive disease (OR 1.63, p < .01), positive margins (OR 1.06, p < .01), and more than or equal to pT3 disease (OR 1.22, p < .01). Conclusions Overall, advanced clinical stage as assessed by DRE was independently associated with an increasing risk of APFs. For individual APFs, the greatest effect is noticed between clinical stage and nodal positivity and less s

摘要： Adolescence is an important developmental window, characterized by critical changes in brain development (eg cortical thinning), and also by the peak time of onset for many mental health disorders. 1 Understanding the neurodevelopmental roots of psychopathology has been a major focus in our field. Researchers have been charged with providing the foundational knowledge needed to guide the design of effective, neurobiologically based prevention and early intervention efforts. 2 Although we have made some gains, we still have far to go. The questions that need to be answered require large-scale, longitudinal studies examining brain development beginning early in life, prior to the onset of mental health disorders, with repeated, multi-level assessments to understand the intertwining cascade of alterations in brain, behavior, and experience over time.

摘要： Background Facial papules (FPs) are considered to be created by the inflammatory process, which involves facial vellus hairs, in frontal fibrosing alopecia. Aim To demonstrate the histopathological features of FPs and the composition of the inflammatory infiltrate. Methods In total, 18 patients with FPs were enrolled in the study after histopathological confirmation of lichen planopilaris. Histopathological evaluation of the specimens was performed by two dermatopathologists. The samples were immunostained with CD4, CD8 and CD123 monoclonal antibodies, and the percentage and proportion of cells stained with these markers were investigated. Results A follicular lichenoid reaction and perifollicular fibrosis were present in all cases. Vellus hairs were detected in 83.3% of biopsy specimens (15 cases), all of which were involved by the inflammation. The majority of the follicles (72%) revealed follicular plugs. Reduction and destruction of elastic fibres were visible in the perifollicular (adventitial) and the papillary dermis (100% and 78% of specimens, respectively). Prominent sebaceous glands and dilated ducts were detected in 78% and 72% of samples, respectively. CD4-positive T cells formed 67.72% and CD8-positive T cells 32.28% of the infiltrate, and the mean CD4/CD8 ratio was 2.48. In 13 (72.2%) biopsy specimens Perifollicular inflammation, fibrosis and elastic-fibre destruction were constant histopathological features of FPs;furthermore, prominent sebaceous glands were present in the majority of samples. We also observed a CD4-positive predominance in the infiltrate.

关键词： cutaneous squamous cell carcinoma   histopathologic upgrading   Mohs micrographic surgery  

摘要： Background: Initial biopsies of cutaneous squamous cell carcinomas (cSCCs) may not reveal aggressive histologic features, which would otherwise inform appropriate surgical management and patient education. Objective: To assess the incidence of, and risk factors for, histopathologic upgrading of cSCC during Mohs micrographic surgery (MMS). Methods: This was a retrospective cohort study of invasive cSCCs treated with MMS between 2017 and 2019 at 1 academic institution. An "upgrade"was defined as a lesser degree of differentiation (poor or moderate) and/or bony or perineural invasion identified during MMS that was not reported in histopathologic evaluation of the initial biopsy. Results: Of the 1558 tumors studied, 115 (7.4%) were upgraded during MMS. In multivariate logistic regression analysis, male sex, prior field treatment, location on the ear/lip, rapid growth of cSCC, and tumor diameter >= 2 cm were significant predictors of tumor upgrading. Upgraded tumors were more likely to require >= 3 MMS stages to clear, complicated closure (flap or graft), or outside (referral) repairs. Limitations: Single-center study, retrospective, and inter-rater variability. Conclusions: A significant proportion of cSCCs is histopathologically upgraded with more aggressive features during MMS. Routinely documented patient and tumor characteristics can predict tumor upgrading and assist clinicians in directing the management of potentially high-risk cSCC patients.

关键词： macule   patch   primary cutaneous B-cell lymphoma   follicle center-cell lymphoma   marginal-zone lymphoma  

摘要： Importance: Primary cutaneous B-cell lymphoma (PCBCL) classically presents with papules, plaques, nodules/ tumors. Previous reports of PCBCL manifesting with macular lesions are scarce, and focused on primary cutaneous follicle-center cell lymphoma (PCFCL), with limited data on its clinicopathological correlation. Objective: To report our experience with PCBCL presenting with erythematous macules. Design: Retrospective cohort. Setting: Two tertiary cutaneous-lymphoma outpatient clinics. Participants: Fourteen patients with low-grade PCBCL manifesting with erythematous patches, diagnosed and managed between January 2000 and December 2019. Intervention: Clinical data were collected from the medical files. Biopsy specimens of the macules, and if present of the typical nodular/tumoral lesions, were reviewed. Main outcome measures: Characterizing the macular lesions of low-grade PCBCL. Results: There were 14 patients, aged 16–67 years, 8 had PCFCL and 6 had primary cutaneous marginal zone lymphoma (PCMZL). All had erythematous macules, measuring 1–15 cm, which mimicked: figurate erythema, interstitial granuloma annulare, livedo reticularis, vascular tumors, and in 7 patients showed also follicular accentuation, thus simulated early-stage folliculotropic mycosis fungoides. In 3 patients macules were the presenting lesions, in 2 as the sole manifestation, whereas in 12 patients typical PCBCL lesions were observed during the disease course. On histopathology, the macular lesions showed in all superficial and deep perivascular infiltrates and in all but 1 also periadnexal lymphoid infiltrates. Microdules were observed in 11 biopsy specimens, in only 4 of them nodular infiltrates were also observed B-cells comprised the majority of the lymphocytes in only 4 patients, while in the remaining 10, B and T-cells were either equally distributed or T-cells outnumbered B. Polymerase-based analysis of a patch showed immunoglobulin heavy chain monoclonality in 7 of 11 cases tested. Con

关键词： Neoadjuvant chemotherapy   Targeted axillary dissection   Breast cancer   Axillary lymph node dissection, axillary ultrasound  

摘要： Highlights•Pathologic features are crucial predictive factors for ypN0 in breast cancer patients after neoadjuvant chemotherapy (NACT) •Multiple sonographically abnormal nodes have been shown to be associated with increased nodal burden •Despite so, the initial number of sonographically abnormal nodes was not predictive of ypN0 •In patients for NACT, with many abnormal nodes on initial ultrasound, they should be given a trial of axillary preservation

关键词： active duodenitis   Brunner glands   Crohn disease   duodenum   erosion   focal activity   granuloma  

摘要： Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active "lobulitis" and "ductitis" is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

关键词： Locally advanced breast cancer   MRI   Response patterns   Exemestane   Letrozole   Tumor cellularity  

摘要： Purpose To correlate MRI morphological response patterns with histopathological tumor regression grading system based on tumor cellularity in locally advanced breast cancer (LABC)-treated neoadjuvant with third-generation aromatase inhibitors. Methods Fifty postmenopausal patients with ER-positive/HER-2-negative LABC treated with neoadjuvant letrozole and exemestane given sequentially in an intra-patient cross-over regimen for at least 4 months with MRI response monitoring at baseline as well as after at least 2 and 4 months on treatment. The MRI morphological response pattern was classified into 6 categories: 0/complete imaging response;I/concentric shrinkage;II/fragmentation;III/diffuse;IV/stable;and V/progressive. Histopathological tumor regression was assessed based on the recommendations from The Royal College of Pathologists regarding tumor cellularity. Results Following 2 and 4 months with therapy, the most common MRI pattern was pattern II (24/50 and 21/50, respectively). After 4 months on therapy, the most common histopathological tumor regression grade was grade 3 (21/50). After 4 months an increasing correlation is observed between MRI patterns and histopathology. The overall correlation, between the largest tumor diameter obtained from MRI and histopathology, was moderate and positive (r = 0.50, P-value = 2e-04). Among them, the correlation was highest in type IV (r = 0.53). Conclusion The type II MRI pattern "fragmentation" was more frequent in the histopathological responder group;and types I and IV in the non-responder group. Type II pattern showed the best endocrine responsiveness and a relatively moderate correlation between sizes obtained from MRI and histology, whereas type IV pattern indicated endocrine resistance but the strongest correlation between MRI and histology.