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Background Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a glomerular disease defined by non-organized glomerular deposits of heavy and light chain-restricted immunoglobulin and is rarely reported in children. Methods We characterized a series of nine pediatric patients from two academic centers with biopsy-proven PGNMID and additionally describe two patients with monotypic IgG in the setting of IgM deposition. Results Each patient presented with hematuria and/or proteinuria; however, only five had elevated serum creatinine. Prodromal or concurrent infection was identified in six patients, low C3 in five, and alternate complement pathway gene variants in two. No monoclonal serum proteins were identified in five tested patients. Seven patients had monotypic deposits composed of IgG3-[lambda], two showed IgG3-[kappa], and one each IgG1 and IgG3 with lambda dominance in the setting of IgM deposition. The glomerular pattern was predominantly mesangial proliferative or membranoproliferative glomerulonephritis (MPGN). Treatment and outcomes were variable; four patients have recent PGNMID diagnoses and therefore minimal follow up, one had relatively stable kidney function for over a decade, and six experienced kidney failure, with four receiving transplants. Recurrent deposits of the same isotype were identified in five of six transplanted kidneys, corresponding to three of four transplanted patients. One of these patients developed PGNMID recurrences in three separate kidney allografts over a 20-year disease course. Conclusions Our study emphasizes the need for upfront IgG subclass investigation in pediatric mesangial or MPGN with IgG deposition and monotypic or biased light-chain staining. Furthermore, this pediatric experience suggests expanded pathogenic considerations in PGNMID., Author(s): Paul Miller [sup.1] , Andrew Y. Xiao [sup.1] [sup.2] , Vanderlene L. Kung [sup.3] , Richard K. Sibley [sup.1] , John P. Higgins [sup.1] , Neeraja Kambham [sup.1] , [...]

* Context.--Accurate HER2 testing in breast cancer is crucial for appropriate precision therapy. HER2 testing is most commonly accomplished by a combination of immunohistochemistry and in situ hybridization techniques, as gene amplification is closely tied to protein overexpression. During the last 5+ years, brightfield dual in situ hybridization (DISH) has replaced fluorescence methods (fluorescence in situ hybridization [FISH]) in some laboratories. Objective.--To analyze routine HER2 DISH performance in the field. Design.--We reviewed our experience with HER2 DISH performed at outside laboratories and referred for patient care. Results.--Of 273 identified retrospective DISH results, 55 had repeated FISH testing at our institution; 7 (13%) were discordant. Additional cases had technical flaws hampering appropriate scoring. In 23 cases (42%), HER2 DISH was performed without immunohistochemistry. Slide review of a prospective cohort of 42 consecutive DISH cases revealed 14 (33%) with technical or interpretative limitations potentially jeopardizing results. Commonly identified problems include lack of or weak signals in most tumor cells, and silver precipitate or red signals outside of nuclei, resulting in false-negative or false-positive interpretations, respectively. Further, 44% (24 of 55) of DISH reports lacked complete data, specifically average HER2 signals/cell. Conclusions.--While HER2 DISH can be an efficient and effective alternative to FISH, we illustrate pitfalls and reinforce that careful attention to slide quality and technical parameters are critically important. HER2 DISH cotesting with immunohistochemistry could help minimize false-negative or false-positive HER2 results. doi: 10.5858/arpa.2019-0510-OA, The human epidermal growth factor receptor 2 (HER2) is encoded by the ERBB2 gene on chromosome 17. (1) Sentinel studies in the 1980s demonstrated that overexpression of this tyrosine kinase [...]

Keratin 8 and 18 (K8/K18) mutations are found in patients with cryptogenic cirrhosis, but the role of keratin mutations in noncryptogenic cirrhosis and the incidence of keratin mutations in the general population are, not known. We screened for KS/K18 mutations in genomic DNA isolated from 314 liver explants of patients who primarily had noncryptogenic cirrhosis, and from 349 blood bank volunteers. Seven unique K8/K18 mutations were found in 11 independent patients with biliary atresia, hepatitis B/C, alcohol, primary biliary cirrhosis, and fulminant hepatitis. Seven of the 11 patients had mutations previously described in patients with cryptogenic cirrhosis: K8 Tyr-53 [right arrow] His, K8 Gly-61 [right arrow] Cys, and K18 His-127 [right arrow] Leu. The four remaining patients had mutations at one K8 and three other K18 new sites. Of the 349 blood bank control samples, only one contained the Tyr-53 [right arrow] His and one the Gly-61 [right arrow] Cys K8 mutations (P < 0.004 when comparing cirrhosis versus control groups). Two additional mutations were found in both the liver disease and blood bank groups and, hence, likely represent polymorphisms. Livers with keratin mutations had cytoplasmic filamentous deposits that were less frequent in livers without the mutations (P = 0.03). Therefore, K8/K18 are likely susceptibility genes for developing cryptogenic and noncryptogenic forms of liver disease.

Gastric carcinoma (stomach cancer) is the second most common cancer worldwide: although its incidence is declining in the US and western Europe, it is still very common in Latin America and Asia. Infection with Helicobacter pylori, formerly called Campylobacter pylori, is associated with gastric carcinoma. Studies have indicated that H. pylori is particularly related with the intestinal type of adenocarcinoma; the other is the diffuse type. The availability of a blood test for H. pylori makes it possible to diagnose the infection noninvasively. This test was used in a case-control study at a large health maintenance organization to determine the risks for gastric carcinoma. Blood samples collected in the 1960s from 186 patients who developed gastric carcinoma (cases) were analyzed for H. pylori antibodies. Blood samples from the same number of patients without the disease (controls) were also analyzed. Controls were matched with regard to sex, race, age at serum donation, date of donation, and site where the donation occurred. Analysis of tissue biopsy specimens from most of the cases was also carried out. Results showed that infection with H. pylori was a risk factor for gastric adenocarcinoma, both the intestinal and diffuse types. Eighty-four percent of 109 patients with this disease were infected with H. pylori, compared with 61 percent of the controls, yielding a threefold-elevated risk for those who were infected. H. pylori infection was a particularly important risk factor for gastric adenocarcinoma in women (18-fold elevated risk compared with controls) and blacks (9-fold elevation). Peptic ulcer disease was negatively associated with stomach cancer. Smoking and blood group did not appear to be factors in developing the disease. however, a history of stomach surgery was a risk factor for stomach cancer. Although it is possible that vulnerability to H. pylori and cancer are caused by a third factor, this is unlikely. The physiological reasons for this are enumerated. H. pylori infection can not be considered the sole explanation for stomach cancer, since it is very common. A reasonable estimate of its role in gastric carcinoma is that it causes 60 percent of the disease worldwide. (Consumer Summary produced by Reliance Medical Information, Inc.)