We have posted updates of the following topics:
Bladder & urothelial tract > Other nonneoplastic > Malakoplakiaby Mustafa Goksel, M.D.
Topic summary: Chronic inflammatory disorder that affects many organs, most commonly occurs in urinary bladder. Histiocytic infiltrate with characteristic cytoplasmic basophilic inclusions. More common in immunocompromised patients, patients with diabetes mellitus, renal transplantation recipients; 4 times higher in women. Polypoid mass with intact mucosa; patients usually present with urinary symptoms and urinary tract infection (72% due to E. coli). Thought to be a defect in macrophage phagolysosomal response to bacterial infection, resulting in accumulation of macrophages with calcified inclusions composed of undigested bacteria and products. Treatment: antibiotics or surgical excision.
Breast > Congenital anomalies > Amastia / aplasia / hypoplasia / athelia
by Reena Tomar, M.B.B.S., M.D.
Topic summary: Amastia: complete absence of breast and nipple – areola complex (NAC); aplasia / hypoplasia: failure of breast growth despite presence of mammary gland; athelia: congenital absence of nipple – areola complex. All congenital breast anomalies are rare, athelia being the rarest. Congenital anomalies can be unilateral or bilateral (unilateral amastia is associated with Poland syndrome). Amastia can be part of other syndromes, such as AREDYLD syndrome. Athelia can be congenital or acquired. Ultrasound is the preferred method for diagnosis as compared to mammography. Treatment: 3 step breast reconstruction surgery in amastia; nipple – areola reconstruction in bilateral athelia; breast reconstruction for aplasia using free TRAM flap.
Breast > Other nonneoplastic > Microcalcifications
by Agnes Ikpoto Udoh, M.D., M.B.A., Jing He, M.D.
Topic summary: Small deposits of calcium that measure < 0.5 mm in breast tissue and are visible on mammographic imaging. Asymptomatic and too small to be palpated. 2 main types based on biochemical composition; Type I: calcium oxalate (CO), Type II: calcium phosphate / hydroxyapatite (HA). Found throughout the breast tissue, most commonly within the mammary ducts and the surrounding fibroglandular tissue. Microcalcifications are associated with both favorable prognostic factors (i.e., small size and hormone receptor positivity) and unfavorable factors (i.e., high grade), depending on the associated diagnosis. Most causes of breast calcification are benign and do not require treatment; biopsy is indicated for BI-RADS 4 lesions or more.
CNS nontumor > Dementia > Alzheimer disease
by Bartholomew White, M.D., Meaghan Morris, M.D., Ph.D.
Topic summary: Alzheimer disease is clinically characterized by a progressive dementia and neuropathologically characterized by amyloid plaques and neurofibrillary tangles (NFT). Patients typically present with a history of progressive short term memory disturbances for ~1 – 3 years, which can be clinically characterized as mild cognitive impairment; this is followed by progressive cognitive or behavioral impairment. Shorter survival in clinically diagnosed Alzheimer disease is associated with older age, male sex, increasing comorbidities and medications, lower cognitive function at diagnosis or suspected mixed dementia. NMDA receptor antagonists (i.e., memantine) are used to slow the cognitive decline by blocking neuronal excitotoxicity.
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Contributed by: Mustafa Goksel, M.D.
Diagnosis: Malakoplakia
Epithelioid eosinophilic histiocytes with scattered intracytoplasmic basophilic lamellated inclusions (Michaelis-Gutmann bodies).
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