Sabato 27 ottobre 2012 - Pacini Editore

330
Fig. 2. Histological features of the lesion. a: oval-shaped tireocytes
with irregular nuclei and nuclear grooves and pseudoinclu sions (H&E,
20x magnification). B: tumor cells strongly stained for tireoglobulin.
(tireoglobulin, 10x magnification).
Chromogranin and Calcitonin. Thus, a diagnosis of a Hyalinizing
Trabecular Tumor (HTT) was posed.
Conclusions. Due to the uncerainty of its nature, the diagnostic
challenges, and the mimicry of other types of thyroid tumors,
UrInArIO
Detection of motile cilia in renal allograft biopsy:
report of three cases with grade ii acute rejection
and calcineurin inhibitor nephrotoxicity
M.R. Ambrosio, B.J. Rocca, A. Barone, M. Brogi, M. de Santi * ,
M.T. del Vecchio *
Department of Human Pathology and Oncology, Pathological Anatomy
Section, University of Siena, Italy; * Both Authors have equally contributed
to the abstract
Background. Cilia are hair-like organelles expressed ubiquitously.
They can be divided into two types: motilia cilia that arise
from ductal structures epithelial cells and non motilia or primary
cilia, arising from almost every cell type known. Motilia cilia are
present in invertebrate and lower vertebrate kidney in which they
are specialized for fluid propulsion or, perhaps, glomerular filtration.
Conversely, primary cilia are present in adult human kidney
and reabsorb ions and other molecules according to fluid balance
requirements. Here, we report three interesting cases in which
motilia cilia, arising from proximal tubular cells, were unexpectedly
observed in a renal allograft biopsy of patients with grade II
acute antibody mediated rejection (AMBR), calcineurin inhibitory
nephrotoxicity and acute tubular necrosis (ATN). Motilia cilia
are not usually found in human fetal and adult kidneys, and their
association with specific diseases is still unclear. One potential
explanation is that motilia cilia arise from proximal tubular cells
as a reversion to a more primitive or less differentiated state.
Materials and methods. Three male patients of 56-, 59- and 72
year-old respectively underwent cadaveric renal transplantation for
an end-stage renal disease secondary to unknown disease in two
cases and to IgA nephropathy in one case. The immunosuppression
regimen comprised mycophenolate mofetil, tacrolimus and prednisolone.
Two months after surgery, the patients underwent renal biopsy
examination. Allograft biopsies were taken on clinical indications
due to acute dysfunction using percutaneous renal needle biopsy
guided by ultrasound (G18). Slides were prepared according to standard
techniques and stained with haematoxylin and eosin, periodic
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Venerdì, 26 ottobre 2012
Sala Brunelleschi – ore 17,00-18,30
HTT represents a challenging entity and the exact relationship
between HTT and other malignant lesions needs further investigations.
references
1 Carney JA, Ryan J, Goellner JR. Hyalinizing trabecular adenoma of
the thyroid gland. Am J Surg Pathol 1987;11:583-91.
2 De Lellis RA, Lloyd RV, Heitz PU, editors. WHO Classification of
tumours. Pathology & genetics of tumours of endocrine organs. Lyon:
IARC Press 2004.
3 Nosè V, Volante M, Papotti M. Hyalinizing trabecular tumor of the
thyroid: an update. Endocr Pathol 2008;19:1-8.
4 Zhu H, Qi JP, Wang YW, et al. Hyalinizing trabecular tumor and
papillary carcinoma of the thyroid. Chin Med J 2010;123:2832–5.
5 LaGuette J, Matias-Guiu X, Rosai J. Thyroid paraganglioma: a clinicopathologic
and immunohistochemical study of three cases.
6 Evenson A, Mowschenson P, Wang H, et al. Hyalinizing trabecular
adenoma – an uncommon thyroid tumor frequently misdiagnosed as
papillary or medullary thyroid carcinoma. Am J Surg 2007;193:707–12.
7 Zhu H, Qi JP, Wang YW, et al. Hyalinizing trabecular tumor and
papillary carcinoma of the thyroid. Chin Med J 2010;123: 2832-5.
acid-Schiff (PAS) and Masson’s trichromatic for light examination.
Immunohistochemical stains were performed on 3 µm- thick sections
of each block employing the Ultravision Detection System anti-
Polyvalent HRP (Lab Vision, Fremont, CA, U.S.a.; Bio-Optica). For
ultrastructural examination, specimens of the fresh tissue are minced
into approximately 1-mm pieces and immediately fixed in 2.5%
cacodylate-buffered glutaraldehyde pH 7.3 for 3-4 hours at 4 C°. The
specimen are washed overnight in the same buffer, fixed in buffered
1% osmium tetroxide for 2 hours, washed, dehydrated trough a
graded series of ethanol, cleared in propylene-oxide and embedded in
Epoxy resin (Araldite). Semithin sections 1 µm thick, cut with glass
knives on an LKB V Ultratome and stained with toluidine blue, are
examined with the light microscope for general evaluation of tissue
morphology. Ultrathin sections from selected areas are cut with a
diamond knife using the same ultra microtome, retrieved onto copper
grids, double-stained with uranly acetate and lead citrate and examined
at 100 kV with a Philips 208 S transmission electron microscope.
Results. Histology: renal biopsy met Banff criteria of adequacy;
for allograft pathology and score we used Banff 07 classification.
Peritubular capillaritis and C4d deposition in peritubular and
glomerular capillaries were observed. Proximal tubules showed
luminal dilatation with some intraluminal epithelial necrotic
cells, and flattening and loss of brush border of epithelial cells;
scattered proximal tubules were filled by uniformly sized small
vacuoles (isometric vacuolization). Scattered T (CD3) and B cells
(CD20+) were present in a edematous interstitium.
Ultrastructural pathology: glomerular ultrastructural examination
showed endothelial cell swelling associated with loss of fenestrae;
capillary lumina were dilated and contained neutrophils,
lymphocytes and macrophages. Proximal tubular cells showed
isometric vacuolization, intraluminal detachment of epithelial
cells, shortening and partial loss of brush border. The presence of
multipla cilia with a 9+2 microtubular arrangement arising from
one proximal tubular cells was unexpectedly observed.
Discussion. The detection of motile cilia has been reported in tubular
cells that often showed morphological alterations correlated to
atrophy, loss of brush border, vacuolization and thickening of basal
membrane, loss of microvilli and sparse scattered mitochondria.
This kind of correlation is observed also in neoplastic and non neo-