Abundant Multinucleated Giant Cells Research Articles

Unveiling the Uncommon: Gastrointestinal Basidiobolomycosis of the Colon and its Distinctive Splendore-Hoeppli Phenomenon

Background Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. Case Presentation A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining. Discussion Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis. Conclusion Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection.

CENTRAL ODONTOGENIC FIBROMA IN ASSOCIATION WITH BROWN TUMOR OF HYPERPARATHYROIDISM IN A PATIENT WITH NF1 AND RENAL FAILURE

<h3>Objective</h3> Neurofibromatosis type 1 is an autosomal dominant disorder caused by mutations in the NF1 gene at chromosomal location 17q11.2. We present a patient with bone abnormalities and a myriad of lesions secondary to his redeveloping renal failure and NF1. <h3>Clinical Presentation</h3> A 21-year-old male renal transplant recipient with NF1 presented with painless masses and large, irregular radiolucent lesions in the maxilla and mandible. The bone was generally "moth-eaten" with a sparse trabeculation pattern. <h3>Intervention and Diagnosis</h3> Histologic examination of an incisional biopsy of the left mandibular lesion revealed two types of tissue with distinct histologic features. Approximately 3/4ths of the specimen was made up of variably cellular dense fibrous connective tissue interspersed with numerous inactive islands and cords of odontogenic epithelium. The remaining specimen consisted of abundant multinucleated giant cells embedded within a highly cellular stroma containing extravasated erythrocytes and hemosiderin. Throughout the specimen, seams of lace-like osteoid and irregular trabeculae of woven bone were noted. The lesion was diagnosed as a central odontogenic fibroma (COdF) in association with a central giant cell lesion, most consistent with brown tumor of hyperparathyroidism. The bone changes were interpreted to be highly suggestive of renal osteodystrophy. <h3>Conclusion</h3> Around 30 cases of hybrid central giant cell granuloma-like lesion in association with central odontogenic fibroma have been reported. This, to the best of our knowledge, is the first reported case of brown tumor in association with COdF. It has been proposed that a primary COdF induces a reactive giant cell response, however, this is unlikely here, given that the primary tumor was probably a ‘brown tumor'. Our case illustrates the point that the giant cell component may be the initiating entity in these hybrid lesions.

Combined lesion of central giant cell granuloma and ossifying fibroma: A case report of a rare event in oral cavity.

Introduction and importanceGiant cell granulomas (GCG) and ossifying fibroma (OF) of the jaw are benign reactive lesions. GCG characterized by the presence of abundant multinucleated giant cells in a cellular stroma. On the other hand, the characteristic feature of OF is benign connective tissue replaces the normal bone. Combination of these two lesions, GCG with OF, in the jaw is extremely rare.Case presentationA 35-year-old woman presented with complains of right jaw swelling with no history of previous disease or lesion and no family history of such lesions. By physical examination, a painful swelling in the right jaw was observed. A computed tomography scan of the facial bone showed a large, expansible, lytic lesion with narrow zone of transition and internal septations, involving the right side of the maxilla and floor of the right maxillary sinus. Histopathologic examination revealed a lesion with combined features of OF and GCG.Clinical discussionGCG and OF are two of the most frequent oral lesions. Presence of both tumors in one patient as a combined lesion is highly unusual, with only a few reported cases in the literature. On clinical and radiologic examination, diagnosing such a combined lesion is not possible, however, such lesions can be easily diagnosed by microscopic examination, indicating the importance of pathologic examination.ConclusionOccurrence of combined OF and GCG is a rare event. Proper histopathologic evaluation can contribute to accurate diagnosis and better management of such lesions. Confirmative diagnosis of such lesions by radiology alone is not possible.

Histopathological analysis of soft tissue changes in gingival biopsied specimen from patients with underlying corona virus disease associated mucormycosis (CAM).

Background Corona Virus Disease-2019 (COVID-19) is perhaps the disastrous medical emergencies that has ever hit globally with multiple strains. Amongst various sequelae, mucormycosis may be considered as the most debilitating one. Post COVID-19 mucormycosis is formally regarded as corona virus disease associated mucormycosis (CAM). The aim of the current paper is to present twelve cases of CAM with unique clinical presentation with a detailed histopathological correlation of the gingival biopsied material.Material and Methods Twelve cases of CAM were included in the study who presented initially with non-purulent swelling of the gingiva. The clinic-demographic data pertaining to age, gender, location, laterality and presence of co-morbidities was collected along with histopathological examination of biopsied specimen.Results The patients ranged from 31-65 years (mean age 47.33 years). There was a male predominance. Clearly, maxillary right gingiva was mostly affected and all cases presented with non purulent, non tender swelling of the gingiva. The incisional biopsy from the gingiva consistently showed pseudoepitheliomatous hyperplasia of the surface epithelium along with vacuolar degeneration, extensive stromal edema, massive mixed inflammatory reaction, congested blood vessels, hemorrhage and abundant multinucleated giant cells. Potassium hydroxide (10% KOH) mount served no additional diagnostic advantage. After two initial biopsies any suspected case of CAM with these features was treated with appropriate antifungal therapy and conservative excision.Conclusions Gingival swelling with aforementioned histopathological features resembling post COVID-19 histological alterations could be alarming early signs of CAM and are candidate of prompt antifungal therapy rather than repeat biopsy for confirmation. Key words:CAM, COVID-19, giant cells, gingiva, mucormycosis.

A rare coexistence of central giant cell granuloma and parathyroid adenoma: Case report

Central giant cell granuloma is a reparative bony lesion characterised by abundant multinucleated giant cells within a sea of spindle shaped mesenchymal stromal cells. Giant cells are scattered throughout the fibrovascular connective tissue stroma containing hemorrhage. Its coexistence with parathyroid adenoma is very rare. Brown tumour is a close differential in this scenario. Herein we present the case of a central giant cell granuloma of maxilla and parathyroid adenoma diagnosed almost during the same time in a 58 years old male.

SIV Infection Impairs the Central Nervous System in Chinese Rhesus Macaques.

The central nervous system (CNS) impairment is a consequence seen in SIV infection of rhesus macaques of Indian-origin, which is more common in infected macaques with rapid disease progression than in those with conventional disease progression. Here, we investigated the CNS damages in SIVmac239-infected Chinese rhesus macaques. We demonstrated that SIV infection of Chinese macaques could cause neuropathological impairments, which was evidenced by appearance of SIV-RNA positive cells, the infiltration of activated macrophages and abundant multinucleated giant cells (MNGCs) in the different regions of the brains. The animals with high viremia and short survival time (average of 16weeks, rapid progression, RP) had severer neuropathological changes than those with conventional progression (CP). As compared with the RP animals, CP macaques had lower viremia and much longer survival time (average of 154weeks). These findings indicate that SIVmac239 infection of Chinese rhesus macaque can be used as a suitable animal model and alternative resource for nueroAIDS research.

Targeting receptor-activator of nuclear kappaB ligand in aneurysmal bone cysts: verification of target and therapeutic response

Aneurysmal bone cyst (ABC) is a benign tumor of bone presenting as a cystic, expansile lesion in both the axial and appendicular skeleton. Axial lesions demand special consideration, because treatment-related morbidity can be devastating. In similar lesions, such as giant cell tumor of bone (GCTB), the receptor-activator of nuclear kappaB ligand (RANKL)-receptor-activator of nuclear kappaB (RANK) signaling axis is essential to tumor progression. Although ABC and GCTB are distinct entities, they both contain abundant multinucleated giant cells and are osteolytic characteristically. We hypothesize that ABCs express both RANKL and RANK similarly in a cell-type specific manner, and that targeted RANKL therapy will mitigate ABC tumor progression. Cellular expression of RANKL and RANK was determined in freshly harvested ABC samples using laser confocal microscopy. A consistent cell-type-specific pattern was observed: fibroblastlike stromal cells expressed RANKL strongly whereas monocyte/macrophage precursor and multinucleated giant cells expressed RANK. Relative RANKL expression was determined by quantitative real-time polymerase chain reaction in ABC and GCTB tissue samples; no difference in relative expression was observed (P > 0.05). In addition, we review the case of a 5-year-old boy with a large, aggressive sacral ABC. After 3 months of targeted RANKL inhibition with denosumab, magnetic resonance imaging demonstrated tumor shrinkage, bone reconstitution, and healing of a pathologic fracture. Ambulation, and bowel and bladder function were restored at 6 months. Denosumab treatment was well tolerated. Post hoc analysis demonstrated strong RANKL expression in the pretreatment tumor sample. These findings demonstrate that RANKL-RANK signal activation is essential to ABC tumor progression. RANKL-targeted therapy may be an effective alternative to surgery in select ABC presentations.

Varicella zoster virus in the temporal artery of a patient with giant cell arteritis

We recently detected varicella zoster virus (VZV) in the temporal arteries (TA) of 5/24 patients with clinically suspect giant cell arteritis (GCA) whose TAs were GCA-negative pathologically; in those GCA-negative, VZV+TAs, virus antigen predominated in the arterial adventitia, but without medial necrosis and multinucleated giant cells [1]. During our continuing search for VZV antigen in GCA-negative TAs, in the TA of one subject, we found abundant VZV antigen, as well as VZV DNA, in multiple regions (skip areas) of the TA spanning 350μm, as well as in skeletal muscle adjacent to the infected TA. Additional pathological analysis of sections adjacent to those containing viral antigen revealed inflammation involving the arterial media and abundant multinucleated giant cells characteristic of GCA. Detection of VZV in areas of the TA with pathological features of GCA warrants further correlative pathological-virological analysis of VZV in GCA.

Immunophenotype of Dental Implant-Associated Peripheral Giant Cell Reparative Granuloma in a Representative Case Report

We report the case of a 74-year-old white male patient who had worn an overdenture for the previous 6 years, retained by 4 screwed implants and a bar, who presented with an exophytic multilobed lesion of 2.5 × 2.0 cm on the anterior aspect of 1 implant neck, which was surrounded by pink-reddish tissue. All of the soft tissue around the implant was removed until the periosteum was reached. Histologic examination of the lamina propria revealed a cellular proliferation with imprecise boundaries, dense stromal component composed of spindle- to round-shaped mononucleated cells (fibroblasts and monocytes/macrophages), abundant multinucleated giant cells surrounding microscopic hemorrhagic foci, and deposits of hemosiderin; the diagnosis was peripheral giant-cell reparative granuloma (PGCG). Giant cells share the immunohistochemical expression of monocyte/macrophage markers (CD68, calprotectin [Mc387]) and osteoclastic cell markers (tartrate-resistant acid phosphatase, cathepsin K, and microphthalmia-associated transcription factor). After 6 months of follow-up, no bone resorption or recurrence of implant loss was observed. There have been only 12 case reports on dental implant-associated PGCG. Research results to date indicate that there may be little difference in immunophenotype among the giant cells of PGCG, central giant cell reparative granuloma, and peri-implant osteolysis. In conclusion, the immunohistochemical study confirms an osteoclast like giant cells phenotype differentiation in PGCG.

Cherubism: Report of a case

Cherubism is an uncommon fibro-osseous disorder of the jaw that presents with varying degrees of involvement and tendency towards spontaneous remission. Children are normal at birth and the expanding jaw is noticed within the first year of life becoming progressively larger until the beginning of adolescence. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. Here, we describe a case of cherubism in a 4-year-old child with swelling on both sides of mandible with clinic radiographic features and suggestions for therapy.

A 55-year-old Man with Painless Joint Swelling

A 55-year-old man presented with swelling of left knee for the past one month. He also complained of episodes of joint locking. There was no history of pain, fever or trauma. Physical examination revealed localized increase in temperature of the skin, a large joint effusion, and decreased range of motion. His total leukocyte count was normal; ESR was raised to 48 mm in the first hour. Antero-posterior and lateral radiograph of the knee revealed large joint effusion with no bony abnormality. Subsequent magnetic resonance imaging (MRI) performed revealed joint effusion with lobulated enhancing synovial masses around the knee joint. The masses appeared low signal on T1 weighted (Fig. 1), T2-weighted and Proton density image (Fig. 2a). Blooming effect with marked loss of signal was seen on GRE-DESS image (Fig. 3). FNAC and joint aspiration was hemorrhagic. Synovial biopsy was performed and revealed villi and nodule with extensive hemosiderin deposition and abundant multinucleated giant cells. Figure 1 Sagittal T1-weighted MRI shows lobulated low signal synovial masses in knee joint and popliteal bursa with erosion of tibial condyle. Figures 2a and 2b Sagittal and axial proton density (PD) weighted MRI shows joint effusion with lobulated and frond-like heterogeneous hypointense lesion within the joint and bursa. Figure 3 Shows marked loss of signal with Blooming effect on GRE-DESS image. Questions What are the differential diagnoses and diagnosis? What is the management for this case and the role of MRI in it?' Answers The differential diagnoses of hypointense synovial masses on T2 weighted MRI are; pigmented villonodular synovitis (PVNS), synovial osteochondromatosis, hemophilic arthropathy, and amyloid deposition. The diagnosis was PVNS made by characteristic MRI and histopathological features. Complete synovectomy is the most common treatment; however, it is often not possible in large joints because of the complexity of the joint structure. Recurrence rates are high. Other treatment options include radiation therapy, pharmaceutical modulation of the disease, or a combination of these approaches. MRI has a very important role by demonstrating the characteristic finding and allows for the preoperative non-invasive diagnosis.

Ectopic bone formation by 3D porous calcium phosphate-Ti6Al4V hybrids produced by perfusion electrodeposition

Successful clinical repair of non-healing skeletal defects requires the use of bone substitutes with robust bone inductivity and excellent biomechanical stability. Thus, three-dimensionally functionalised porous calcium phosphate-Ti6Al4V (CaP–Ti) hybrids were produced by perfusion electrodeposition, and the in vitro and in vivo biological performances were evaluated using human periosteum derived cells (hPDCs). By applying various current densities at the optimised deposition conditions, CaP coatings with sub-micrometer to nano-scale porous crystalline structures and different ion dissolution kinetics were deposited on the porous Ti6Al4V scaffolds. These distinctive physicochemical properties caused a significant impact on in vitro proliferation, osteogenic differentiation, and matrix mineralisation of hPDCs. This includes a potential role of hPDCs in mediating osteoclastogenesis for the resorption of CaP coatings, as indicated by a significant down-regulation of osteoprotegerin (OPG) gene expression and by the histological observation of abundant multi-nucleated giant cells near to the coatings. By subcutaneous implantation, the produced hybrids induced ectopic bone formation, which was highly dependent on the physicochemical properties of the CaP coating (including the Ca2+ dissolution kinetics and coating surface topography), in a cell density-dependent manner. This study provided further insight on stem cell-CaP biomaterial interactions, and the feasibility to produced bone reparative units that are predictively osteoinductive in vivo by perfusion electrodeposition technology.

Tail Root Osteosarcoma in a Chipmunk(Tamias sibiricus)

An 8-year-old chipmunk (Tamias sibiricus) showed a mass on the tail root. Histologically, the excised mass showed proliferation of spindle-to-polyhedral cells and abundant multinucleated giant cells, with the production of neoplastic osteoid. Immunohistochemically, neoplastic cells were positive for vimentin and weakly positive for osteocalcin. Osteoid was also positive for osteocalcin. This tumor was diagnosed as a giant cell-type osteosarcoma. This is the first case report of osteosarcoma in a chipmunk.

Elastosis perforans serpiginosa en una enferma afecta de pseudoxantoma elástico

A 34-year-old female previously diagnosed of pseudoxanthoma elasticum developed an annular plaque with serpiginous borders of 42 by 30 mm in diameter on the inner left arm. A similar lesion later appeared on the inner right arm. Histopathological examination of a papule showed short, fragmented, granular, basophilic and calcified elastic fibers in the mid-reticular dermis. The epidermis showed hyperplasia surrounding degenerated and normal elastic fibers. Transepidermal elimination channels of these elastic fibers were also observed. These findings were consistent with the diagnosis of elastosis perforans serpiginosa. Abundant multinucleated giant cells were observed surrounding the area of epidermal hyperplasia and in the reticular dermis. The patient was treated with tazarotene, and the plaques disappeared in 9 months.

Cherubism: A Clinical, Radiographic, and Histopathologic Comparison of 7 Cases

Cherubism is an uncommon fibro-osseous disorder of the jaws that presents with varying degrees of involvement and a tendency toward spontaneous remission. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. We attempted to study the relationships among the degree of cherubism, the radiographic extent of the jaw lesions, the histopathologic findings, and the clinical course of 7 patients. In 7 patients diagnosed with cherubism, we evaluated the degree of fibrosis and perivascular cuffing, the presence of focal hemosiderin deposits, and giant multinucleated cell density (absent, few, moderate, or severe). Clinical course and progression were also assessed using a 4-point scale (improvement, no changes, modest progression, and marked progression). The patients were followed up for an average of 8.5 years. Two patients exhibited clinical and radiographic improvement, while 3 showed no changes, and 2 progressed despite surgical treatment in 1 of them. The course of cherubism in 1 of our patients may represent evidence of an association between the presence of abundant multinucleated giant cells, an increased extent of the lesions, and a more aggressive behavior of the disease.